Patient's Perspective: Lessons From Survival
By Tim Johnsen
[My article is also published in Healthcare Business Today.]
Thanks to the concussion, I don’t remember the crash landing at 0517 on April 1, 1988. Yes, April Fool’s Day—seems fitting.
The first thing I remember is David, our pilot, crying out to me and my paramedic partner telling us he was sorry. His cries weren’t what you might expect from a grown man; there was an intense pain embedded within them. I knew almost immediately that he had to be the most critically injured of the three of us. It was dark, a cold rain had just abated, and fog obscured the Midwestern hay field where we had just crashed.
As soon as I realized what had happened, I felt along the ceiling of the aircraft for the pilot’s controls where my hands had never touched before. I knew I had to shut the fuel lines down along with the aircraft power. There was no fire, but I recalled the instructions from many flight nurse safety trainings we had done. Always shut the fuel lines down. Shut the power down. And I did, without hesitation.
My partner, Len, who was the flight paramedic, was also just coming around. He was lifting a heavy portable cardiac monitor/defibrillator off his face, which had sustained extensive fractures. There was fresh blood everywhere in the aircraft, pouring from Len’s face and arms and my left ear. The lower half of my ear was aggressively torn from my head, ripped by the headset that was now around my neck (this was before flight crews wore helmets). As soon as I unbuckled my four-point restraint, I fell through the body of the aircraft onto Len and we both tumbled to the ground outside of the helicopter. His shoes were neatly sitting side by side outside on the ground. Without him in them. That part still puzzles me to this day.
Our pilot David was still in agonizing pain, crying out his apologies to us. We tried to gain access to him, but he was beneath and between the mangled steel. We couldn’t even reach him, a jarring reality for a flight crew that does their work within just a few feet of each other. As a trauma nurse, though, I was glad to hear his cries: it meant that his airway was open, he was breathing and alive.
As soon as Len and I were able to stand and start to comprehend what had happened, we remembered that we were close to a major highway, not too far outside the city in which we were based. I told Len that we needed to split up, to get to the highway, and flag down help for David. I recalled walking through tall grass that was wet and cold, but with determination and adrenaline I made it up a small hill where I started to see an occasional car driving by. I don’t recall feeling any pain.
I had been telling myself that if I could just make it to the highway I could rest and be relieved of my duties, and someone else would take over the scene. I was wrong. Several cars drove by me, and I can vividly remember the terror in their eyes. This made no sense to me at the time. “I obviously needed help. Why won’t they stop?” I wondered.
Several weeks later it occurred to me that a bloody young man coming out of the fog probably was too horrifying as a sight to stop and help. They just kept going.
I finally saw the bright lights, red and blue, flashing in the dark, foggy distance. It was the ambulance crew who had called us to the scene of a motor vehicle accident with one victim who needed us. Once the ground ambulance crew lost touch with us over the radio, they assumed we had turned around and aborted the flight due to the weather and had headed back to the hospital. They were shocked to see me waving them down in my bloodied state and nearly ran over me while pulling off the highway to stop.
I remember them tearing up, assuming both David and Len were likely dead. Because of the concussion I had received at impact, I wasn’t able to give them a clear story. I tried to communicate that they both were alive, but that we needed another ambulance crew and fire and rescue team equipped with the Jaws of Life.
The shaken crew gave me a quick report out on the patient in the back of the ambulance that our flight crew had been heading to help, something that amuses me all these years later. They put the radio in my hand and laid me down next to him on the bench next to his stretcher. His head was bloody, and he had an open lower leg fracture, an IV infusing, and a blood pressure cuff on his arm. The patient looked at me with a bewildered look, likely wondering why his EMS crew had left, ran out into the field to find the downed copter, and left me to care for him, something I clearly wasn’t capable of doing.
Vulnerability and humor
The next thing I remember was pulling into the ER ambulance bay at my hospital. Familiar faces came running out to begin care of both me and my new friend from the car wreck. I heard my brother’s voice. He was telling me to wiggle my feet and squeeze his hands. He was a nurse, too, working at another trauma hospital in the city and had been notified of the crash. His initial fear was if I wasn’t killed, that I might be paralyzed. Thankfully, I gripped his hands tightly and moved both feet to his command.
I was comforted by the warm blankets piled on me, but the glances exchanged by my nurses and physicians were far from reassuring. They were scared; I could see it in their faces. David was still trapped at the scene of the crash, and no one in the room knew how we was doing. Len was in a different ambulance being taken to another trauma center. I took in my surroundings and realized I was in our major trauma room, the area reserved for the worst of the worst cases. As a flight nurse I had cared for many trauma patients in that very room. Now, I was on the receiving end of that care.
The team removed the warm blankets, and using their trauma shears they quickly cut away my clothing, along with any shred of dignity I had left. It was a vulnerable situation, with all my co-workers staring at my almost-naked body. Yet, I couldn’t help but laugh and make the comment that I was glad I had worn clean underwear that day. I suppose you can be in the midst of trauma and hang onto your humor at the same time.
My girlfriend had arrived and was watching the chaos unfold, holding me with one hand and holding a wadded-up bundle of dressings to my left ear, fighting nausea as each new handful of 4x4s filled back up with blood. As I was awaiting a plastic surgeon to come put that bottom half of my ear back on, I kept asking her, “How is my patient doing?”, just like every well-trained Florence Nightingale-inspired nurse should do. She told me I didn’t have a patient on board the flight, that we had never made it to the scene. Because the ground crew had given me “report” on the patient and laid me next to him, my battered brain mixed up the facts and he had become, at least in my mind, “my patient.”
This conversation, courtesy of my head injury, played out repeatedly over the first 24 hours. “How is my patient doing?” I would ask over and over, as my girlfriend, my brother, and caregivers gave each other knowing looks, and answered my question yet again.
Once I was on the step-down unit after three days in the neuro-trauma ICU, I attempted physical therapy despite intense dizziness and nausea, and got a very form fitting, full-torso brace. That was my new “shirt” for the next three months.
I also had two visitors while in the step-down unit. Each day in the hospital, two men in suits would enter my room, stand there silently for about 20 minutes, and then leave. I truly couldn’t figure out who they were or what they wanted. They were never there when anyone else was around. Was I now hallucinating from the combination of my pain medications and concussion?
On the pair’s third, awkward visit, I finally got up the nerve to initiate the conversation.
“So, I hate to be rude, but I really don’t know who you are or what you want,” I stated. They looked at each other, chuckled, and said “We really should round more.” They introduced themselves as the CEO and COO of the organization. To this day, I’ve never seen two grown men be so awkward in a situation as much as they were when they were rounding on me.
All in all, my injuries from that harrowing experience included a concussion, a partially amputated ear repaired that morning by one of the meanest surgeons I can recall in my career (but hey, my ear looks great), a compression fracture in my lower spine, and spinal instability that narrowly avoided the need for Herrington Rods.
Thankfully, I had a full recovery to such an extent that I went dressed as myself to a Halloween party later that year. Fake blood, my torn flight uniform, a prosthetic ear from a Halloween store that we cut in half and covered in fake blood. Clearly, self-deprecating humor is a great coping mechanism for me.
David, the pilot of the helicopter, and Len, my paramedic partner, sustained serious injuries as well. David, the most critical of the three of us, sustained seven vertebral fractures all up and down his spine. It took about ten fire and rescue and EMS team members to cut him out of the helicopter. He spent more than a year in rehab, and still uses a cane to walk.
Len had severe facial trauma, a concussion, and a “hot belly,” meaning there was something bleeding in his abdomen. He went to surgery that day, and the source of the bleeding was found and corrected. He went on to have five facial surgeries over the coming months, spending several of those months with his jaws wired shut.
Lessons Learned
The helicopter crash was so long ago, and my career has changed course so many times, that in telling this story now, it all seems like a lifetime ago. At the time of the crash, I was a young nurse who was just approaching my fourth full year in practice. The flight program was suspended for a period of time, but I went on to fly for another five years. We completely re-vamped the flight program with far-improved safety standards and higher weather minimums.
About a year later I was appointed Chief Flight Nurse and before leaving that job, promoted again to Program Director for the entire air-medical program. Safety became the “North Star” of the program. I went back a few years ago to give a speech and tell a few stories to the very young flight crew which was surreal for everyone in the room. I’m proud to say that the program has been accident-free to this day.
That accident was such a seminal career- and life-defining moment for me. Over 35 years later, I am still applying the lessons I learned from that night, both personally and professionally.
1. Rely on your training. I had paid strict attention to every part of my flight safety training, and it turns out that I would need every bit of it. I was able to know within seconds of regaining consciousness that the fuel lines and the power had to be shut off. Never take your training for granted. It may indeed save your life one day. As boring as those annual trainings may be and no matter how many times you’ve done them, they are there for a reason.
2. Every situation, even the hard ones, can prepare you for the next thing. In hindsight, I can see now an early peek into my future leadership roles in what happened that night. I took control amidst the chaos and gave my partner direction to split up and go get help. I later became the leader of the flight program and made sure flight crew safety was paramount.
3. Be a good leader. Leaders need effective communication skills and should always be held to the highest ethical standards. Those two administrators who rounded on me couldn’t even utter a simple “hello” and made me speak first. Now, after years of caring for patients and running hospitals, I could go back and teach them a lot about purposeful rounding.
Even more alarming, I later found out that the COO had cut a dangerous deal with the flight company that was linked directly to our crash. It came out in court years later that our pilots were financially incentivized to accept the flights not accepted by the competing program due to bad weather. We should have never taken off in wet, foggy conditions. That administrator put people’s lives at stake with that decision. Now, whenever I sign a significant contract, I pause to think about what impact this new program, service, or item may mean to our teams and patients. The power of the pen is mighty indeed.
4. It’s okay to say you’re not okay. I should have never been given report on the patient from the car accident and left abandoned with him in the back of that ambulance. I don’t blame those paramedics, however. They were noticeably shaken and their instinct to go save the pilot and paramedic from the site of the crash is completely understandable.
But it wasn’t safe—for any of us. A clearer-thinking me would have objected to “assuming care of the patient.” I think this translates perfectly into healthcare’s larger burnout issues and well-being movement taking place all across America right now. There’s something either in our training or perhaps in our nature as caregivers to “just power through.” But all research now indicates far better approaches to seeking care than we had in the past. Now, it’s not only okay, but highly encouraged, to seek help when you need it, either physically or emotionally.
5. Maintain clarity in chaos, a topic I’ve written and spoken about previously. I’ve gone on to be the incident commander in far too many incidents, major traumas, violent events, tragedies, and even a global pandemic. If you’re the leader, set the right tone for the most effective and beneficial outcomes for as many as possible.
There was a lot of chaos that night and not much clarity from what I can recall. For example, a few minutes after receiving my third tetanus shot just a few hours after the crash, my brother stopped the nurse who was about to administer a fourth shot. He asked, “Is this a new series of immunizations, as opposed to the recommended one shot every five years?” In all the chaos, the order for a tetanus shot was never checked off, so whoever would pick up my chart would grab another tetanus shot and give it to me. Safe to say I’ve never had lockjaw!
Of course, I don’t blame anyone here; these nurses’ friends were coming in as trauma victims. It was a skeleton crew late at night and nerves were rattled. In hindsight, establishing an internal incident command might have made things go more smoothly.
6. Listen to your mother and wear clean underwear. Always.
7. Marry the girl who held your hand and your bloody ear. She’s a keeper.