ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, July 21, 1996 TAG: 9607190007
SECTION: EXTRA PAGE: 1 EDITION: METRO
TYPE: PROFILE
SOURCE: MARK MORRISON STAFF WRITER
The call comes in, always the same. Someone needs help. Within minutes, a pilot, a nurse and a paramedic are in the air in a helicopter from Roanoke. Sometimes their efforts end in heartache. Sometimes, in a saved life. Rarely are they ever routine.
This is one of their flights.
4:15
It was Friday afternoon, on the eve of a full moon, and the crew at Life-Guard 10 was back to playing the waiting game.
Flight nurse Patsy Stovall and paramedic Jeff McKinney were both on the telephone; Stovall to her mother-in-law, McKinney to the dispatch center at Carilion Roanoke Memorial Hospital.
Pilot Terry Lovell was headed to the kitchen for a snack, something to pass the time.
Lovell, McKinney and Stovall like this waiting game because of what it means: they aren't needed somewhere by someone who has been mangled in a car crash, or gravely hurt in some other horrible way.
At the same time, they also dislike the waiting because they love what they do. They love the action. They feed on the adrenaline of flying, of racing against the clock and saving someone's life.
Either way, waiting is a game they know well. Sometimes, it can drag on for hours, even days. Or sometimes, like on this particular Friday, only a matter of minutes.
The hot line rang.
They were needed. They had just returned from Bedford County on an earlier flight, but now Bedford County needed them again.
Near New London, 40 miles away.
The wait was over.
For a man named Clarence Callaham, it was just beginning.
Clarence Callaham had navigated this turn probably thousands of times before - a left onto U.S. 460 from Black Water Road, where he has lived for most of his life.
He was going to Wheeler's Motel just a mile down the highway, where he earns an extra $15 a week mowing the grass. He was driving a 1975 Plymouth Valiant. It was a beautiful Friday afternoon. Clear and about 75 degrees.
He felt good.
A retired bricklayer, Callaham had reason to feel good. At 72, he still had his health, a devoted wife named Matilda, six children and 16 grandchildren, most of whom lived nearby.
They all called him Papa.
At the intersection, he looked left. A tractor-trailer barreled past. He pulled forward.
Then ...
Milton Pippin Jr. tried to stop, but it happened so fast. He was headed home to Gretna from a contracting job in Roanoke. He was in the passing lane, in a Ford pickup, driving the speed limit.
He skidded - 76 feet. The sound of his screeching tires gave him a flicker of hope.
Maybe he would stop in time.
Then ...
They collided, like all cars and trucks do at high speeds, violently. The force of the impact pushed Callaham's Valiant 34 feet into the grassy median.
The next thing Callaham knew, a state trooper was there, and a nurse.
Both had been driving along the same stretch of road; the trooper on regular patrol, the nurse on her way home from work at Carilion Bedford Memorial Hospital. They arrived at the wreck within moments after it happened.
Immediately, the trooper, Lee Willis, radioed for a rescue squad, although he wasn't sure rescue would be needed. To him, it looked like this would be a fatality.
Already, a small crowd had gathered around, bystanders mostly from Owens Market across the road.
The nurse, Janet Blankenship, crawled into the passenger seat next to Callaham. Someone told her his name.
``Clarence,'' she said to him. ``Can you hear me?''
His eyes opened. He responded. These were good signs. But he was confused. He didn't know exactly where he was or what had happened. This was a bad sign, indicating to Blankenship that he might have a brain injury.
``Clarence, are you short of breath?''
He answered yes. His chest hurt, he said.
Blankenship, a critical-care nurse who also works as a volunteer with both the Bedford Life Saving Crew and Goode Rescue Squad, quickly checked his breathing with the extra stethoscope she keeps in her car.
It sounded like his left lung had collapsed.
She saw that his left leg was pinned under the wreckage of the door. She suspected a broken femur, maybe a compound fracture. She knew that he would need to be extricated from the car.
By this time, another volunteer had arrived, from the Forest Fire Department. Blankenship asked him to contact Bedford County dispatch.
She said: ``Have them call Life-Guard.''
4:17
Just after takeoff, as they ascended over Victory Stadium, Jeff McKinney radioed back to the hospital.
``RMH Control. Life-Guard.''
The voice of dispatcher June Wilkes came back.
``Life-Guard. This is RMH.''
``OK, Miss June, we're off, outbound, five souls on board, going to the Bedford area of New London. We're going to show probably about 20 minutes down to that area. ... We'll get some more information from you in just a few minutes as soon as we clear the [Roanoke] air space.''
``That's affirmative, Life-Guard.''
In route, McKinney sat in the cockpit with Terry Lovell. Patsy Stovall was in back where the patients are carried.
They wore matching blue flight suits, heavy black boots and crash helmets equipped with radio headsets to make communication possible over the noise of the twin jet engines and chopper blades.
Each of them shared the same primary concerns: safety, the weather, and, of course, time. Would they get there soon enough to make a difference?
In rescue work, the concept is called the golden hour of trauma, when a trauma patient's chances of survival and recovery are greatly increased if that patient can be transported to a hospital trauma center within one hour.
But to the crew at Life-Guard 10, safety always is the first concern.
``If we cannot land safely,'' McKinney says, ``then we're not doing that patient any good. All we're going to be is three more patients and a big ball of disaster.''
This is where the pilot has the key job. It is his responsibility alone to fly the helicopter safely. There are no co-pilots. And it is his decision to accept or reject a flight, to attempt a landing or back away, and to check the weather.
Life-Guard 10 is equipped with both color weather radar and a storm scope. Often, the pilot has to turn down flights because of bad weather. In 1995, Life-Guard missed 157 flights because of weather out of 1,104 requests.
Sometimes, it can be a tough call, particularly knowing that someone's life could hang in the balance.
``The pressure's there,'' says Lovell. ``But it's pretty much self-induced.''
On this day, it was clear. The closest rain clouds were four states away.
4:21
On their earlier flight to Bedford County, Lovell and crew had flown to a car wreck near Thaxton. So, the logistics of setting up radio communications and a landing zone - or L-Z - with rescue workers at the accident scene were fresh in their minds.
McKinney again called the hospital.
``Hey June, I've got Bedford County up on line two. I'm going to call them and I think we're going to be talking to Bedford County Unit 200 again. If that's true, then I've already got their radio frequency and everything lined up.''
``OK, so that's your radio frequency for your L-Z. It's going to be Bedford Fire. They are still extricating. It's a male, fractured femur, decreased lung sounds left side. He is awake, but disoriented. That's all they can advise. They cannot advise anything of the accident. It will be near Owens Market, New London. Owens Market, New London.''
``OK, I'm familiar with that area. Owens Market with Unit 200 on the scene.''
Meanwhile, Lovell called air traffic control at Roanoke Regional Airport, which gives Life-Guard 10 priority air space for rescue calls. He informed the tower of their destination and estimated flight time.
Throughout the flight, he scanned the sky for any approaching aircraft that might not be paying attention to them. And he monitored an array of gauges and 55 caution lights for signs of engine trouble or other mechanical failures.
In back, Stovall stretched a pair of blue rubber gloves over her hands, as the usual thoughts ran through her head.
Would this be someone from her family?
A friend?
It was possible. Stovall was raised in Bedford County in the Diamond Hill community between Moneta and Stewartsville. Another flight nurse at Life-Guard 10, Carl Cline, once picked up two of his brothers.
Would this be a child?
Stovall hoped not. Flights with children are so emotionally charged.
Would they get there safely?
In the back of her mind, it's something she always thinks about.
And would they get there in time?
Always, time. The golden hour.
She jotted down a few words on a clipboard in her lap.
``Femur.'' ``Disoriented.'' ``Absent breathing sounds.''
This could be a bad one.
The femur is the largest, longest and heaviest bone in the human body. Stovall knew that if it was broken, the chances were good for other serious injuries. The fracture could have punctured the femoral artery, which could send him quickly into shock, or cause him to bleed to death.
He was disoriented. That could mean a head trauma, swelling and pressure on the brain, a sudden loss of consciousness, possibly a coma.
Absent breathing. This was perhaps Stovall's gravest concern. If indeed his left lung had collapsed, then she knew his right lung could rapidly collapse in its wake.
Then his breathing would stop altogether.
4:22
``Roger, Bedford County. Life-Guard. We're currently outbound toward the New London area, near Owens Market. We're probably showing about 10 minutes to that location right now. Could you get hold of the Bedford Fire Department and ask them if we're going to be landing on 460 or in a field close there in the area?''
``Life-Guard 10, I copy. Your landing zone is being set up at this time directly on 460, a quarter-mile east of the wreck. Your contact will be Bedford Unit 200.''
``OK. We should pick up radio contact with them in just a few minutes.''
At the crash scene, Janet Blankenship soon was joined at Clarence Callaham's side by Scott Arney, the jail medic for the Bedford County Sheriff's Department who also works as a volunteer at the Moneta Volunteer Rescue Squad.
Arney had been at the bank in Bedford, heard the rescue call on his beeper and sped to the scene.
Like Trooper Willis, he also thought the worst when he saw Callaham's car. But he was encouraged when he found that Callaham was still conscious and talking - and when he learned Life-Guard was already on the way.
He listened to Callaham's lungs. He saw that his seat belt wasn't fastened, that his steering wheel was broken and bent, probably from the impact of Callaham's unrestrained torso slamming against it. There also was damage to the dashboard.
``Clarence, does your chest hurt?''
``Yeah.''
``How about your neck?''
``No.''
``How about your back?''
``No, just my chest.''
Callaham seemed to be fading.
By this time, both the Goode and Bedford rescue squads had arrived. Bedford also sent its crash truck that carries the Jaws of Life and other extrication equipment. Members of the Bedford crew went to work on the wreckage.
In the car, a blanket had been draped over Callaham and Arney, who was trying to start an IV line in Callaham's right arm.
Arney and Blankenship began worrying about another problem. They detected some swelling under Callaham's left arm, indicating a possible cardiac tamponade, where blood accumulates in the sack that surrounds the heart.
It can cause cardiac arrest.
Bedford Volunteer Fire Chief Donald Hale arrived. It was his job to set up a landing zone for Life-Guard, just as he had done earlier in Thaxton. In his 11 years with the Fire Department, he says it was the only time he could remember two back-to-back flights like this.
On this call, he decided against a landing on the roadway, mainly because he didn't want to tie up traffic, particularly on a Friday afternoon when he didn't know how long the extrication might take.
He spied a hayfield across the road, but it was surrounded by an electric fence and the hay was waist deep. Then he remembered an open field a quarter-mile down the road toward Lynchburg. It would be perfect.
It was relatively flat. It was free of deadly power lines, and much wider than the minimum 100-foot radius required by Life-Guard to land. Hale parked there and looked to the horizon, and waited. Every few minutes, he repeated the same call into his radio.
``Bedford Fire Unit 200. Life-Guard 10.
``Bedford Fire Unit 200. Life-Guard 10.''
4:25
``Roger 200, Life-Guard 10. Got you on copy.''
Now it was Hale's job to give McKinney directions to the landing zone.
``OK, come down 460, you'll come up on the accident scene. It'll be about a quarter mile east of the accident. We'll be landing in a field on the side of 460, on the north side of 460.''
This contradicted the previous instructions that they would be landing directly on 460.
McKinney asked for verification.
``OK, we will be landing in the field, not on 460?''
``Ten-four. There is a field. It's got corn planted in it, but it's only about 4 to 6 inches tall.''
``Copy. North side of 460. We're showing probably about six or seven minutes to your area.''
4:26
At the accident scene, traffic was creeping along the one open eastbound lane past the wreck. The small crowd had grown sizeable. A pair of television crews arrived. Some of the onlookers were members of Callaham's family who live down the same stretch of Black Water Road.
Among them were his brother, a sister, one of his sons, his daughter, a few grandchildren and his wife. They tried to console each other. They tried to pray, but mostly all they felt was a profound helplessness.
The minutes ticked on.
Around the car, there was a heightened level of tension and excitement and anticipation.
Life-Guard calls are always like this.
Jeff Johnson, captain of the Bedford Life Saving Crew, called on his radio to Life-Guard 10.
``We've got a 72-year-old male subject here. Looks like absent lung sounds on the left side, possible femur fracture. Also, possible cardiac tamponade. Vitals are stable. We just got the top off the car. We'll be getting him out shortly and I believe we do have one IV established.''
``Do you have any idea on your extrication time?'' McKinney asked.
``We should be out here in just a few minutes, I believe.''
``OK, sounds good. We should be landing in about four or five minutes.''
A possible cardiac tamponade.
McKinney and Stovall didn't like the sound of that. They knew the potential implications.
On the helicopter, there is nothing they can do for a cardiac tamponade, other than to get back to the hospital as fast as possible.
The only remedy is to insert a needle carefully into the sack around the heart and drain the blood, a delicate procedure done only at the hospital using X-ray to guard against puncturing the heart itself.
4:31
From the air, they got their first look at the wreck.
It looked no less chaotic, no less dramatic, from 2,500 feet.
Beyond the wreck, Lovell tipped the helicopter sharply over their designated landing zone, circled tightly, and surveyed the corn field below. He was glad it was daylight. Daylight landings are much easier, much less stressful, much less treacherous.
Below him, Lovell looked first for power lines or other obstacles to their landing. Then he looked on the ground for flares, yellow police tape, traffic cones or anything else that could be a potential hazard.
Loose items like these can be deadly if they get sucked into the helicopter's rotor system.
In the past 10 years, there have been 26 fatal crashes in the United States involving medical flight helicopters, according to the Association of Air Medical Services. They resulted in 77 deaths; 10 were patients.
Lovell didn't see any problems. Using both of his hands and both of his legs to work the helicopter's controls, he turned into the wind, hovered a moment, and set down. Their goal now was to be on the ground for less than 10 minutes.
Anything longer could bust the golden hour.
4:32
Lovell remained with the helicopter as Chief Hale drove McKinney and Stovall the quarter-mile down the road to the accident. When they pulled up, Callaham was being removed from the wreckage.
``Clarence, can you hear me?'' Stovall asked him.
He opened his eyes.
Good. He was still conscious.
``Where are you hurting?''
``My chest.''
Good. He could talk. That meant he was still pushing air through his lungs.
She placed the end of her stethoscope on his left side and listened.
``Clarence, you've been in a wreck,'' she explained, her voice a calming contrast to the hurried scene around them. ``We're going to fly you to Roanoke Memorial Hospital. They're going to take care of you there.''
If he had a cardiac tamponade, his heartbeat would sound muffled.
Good. It didn't.
But his blood pressure was a little high - 154 over 96. Normal is 120 over 80. Maybe it was from the excitement, or from a blow to the head. Maybe he just had high blood pressure. In this situation, there was no way to tell.
He was still disoriented.
Stovall had to assume the worst, that he had suffered a brain injury.
He could quickly deteriorate.
Meanwhile, McKinney looked over Callaham's car, the crumpled door, the deformed steering wheel, the bruised dashboard and the size of the truck that hit him. He took a mental snapshot that he would pass along to the trauma team when he returned to Roanoke.
Then he turned his attention to Callaham.
The patient was on a stretcher ready to be loaded into an ambulance for the drive back to the helicopter. While Stovall continued to monitor his breathing and his heart rate, McKinney pressed his hands into Callaham's belly.
``Does that hurt?'' he asked.
Still, Callaham's only complaint was his chest.
But Callaham's belly felt rigid to McKinney, a sign that he could be bleeding internally.
In the ambulance en route back to the helicopter, Stovall again told Callaham that they were taking him to Roanoke.
This is something the Life-Guard crew tries to repeat.
``I think it just helps relieve their anxiety a little bit,'' Stovall says. ``It helps keep them from feeling out of control.''
She works on the same principle whenever she has to do anything painful to a patient.
``Clarence,'' she said in the ambulance. ``I've got to start another IV on you now. It's going to hurt for a second.''
4:55
Callaham moaned, quietly and deeply, over and over. His breathing was faster, more labored.
``Hey, Patsy,'' McKinney said when they arrived back at the helicopter. ``Maybe we ought to go ahead and pop his chest. He's struggling awfully hard right now.''
McKinney listened to Callaham's chest again.
``Clarence, are you having trouble breathing?'' Stovall asked.
Lovell stood nearby, waiting to help load Callaham into the helicopter.
Unlike with a cardiac tamponade, if Callaham's lungs collapsed, if he stopped breathing, there were things they could do. They could snake a tube down his trachea and into his lungs. Then, they could essentially breathe for him.
They also could try reinflating his lungs by inserting a needle into his surrounding chest cavity.
Both are procedures McKinney and Stovall are trained to do.
But they decided against doing anything for the moment. Although he was struggling, Callaham's breathing was still steady. It sounded like his left lung probably was only partially collapsed. If he could just hold on.
They loaded up.
4:59
From the cockpit, Lovell checked behind him for any people who might have strayed near the tail rotor.
A spinning tail rotor can be lethal. It turns at 1,600 revolutions per minute, faster than the human eye can see, and it stands not quite six feet off the ground.
The Life-Guard crew warns ground people about this danger more than any other.
``Nobody ever lives to tell about rotor strikes,'' they like to say.
Lovell cranked the engines.
``Clear,'' he called out.
For a minute or two more, he remained on the ground, again going over the standard checklist of safety precautions. In back, McKinney leaned down to just a few inches above Callaham's face.
``Hey Clarence,'' he yelled. ``It's going to get loud in here. It's going to be hard to talk. We're going to get you to the hospital as fast as we can.''
Then, over his headset, McKinney called up to Lovell.
``Get us as much time as you can, man.''
Lovell lifted them up and pointed them in the direction of Roanoke.
On the ground, the lift-off stirred 70-mph winds. In a moment, there was only the distant echo of chopping.
And then calm.
They had been on the ground nearly 30 minutes - half the golden hour.
``We're off the scene in route to RMH,'' Lovell said on the radio. ``Six souls on board. ETA is going to be around 15 minutes and we've got an hour, 20 minutes of fuel.''
``That's affirmative. Life-Guard.''
5:03
In a small cubicle in the Roanoke Memorial emergency room, Billy Thompson waited for Lifeguard's call. He is a nurse and communications specialist whose job is to monitor and prepare for the transports coming into the emergency room.
``RMH ER. Life-Guard 10.''
``Go ahead, Jeff.''
``All right, Billy, we're inbound, 12-minute ETA to the rooftop helipad. We've got a 72-year-old male who was involved in a motor vehicle accident. He was the driver of a vehicle that was T-boned on the driver's side. Again, we're talking about a 55- or 60-mph impact. There was about two-and-a-half feet of intrusion on the driver's side ...''
McKinney continued his report, while Thompson listened on the other end. He went over Callaham's possible problems: the collapsed lung, the cardiac tamponade, his rigid abdomen, disorientation and possible femur fracture.
``Jeff, that left chest is swollen?'' Thompson verified. ``You're thinking a cardiac tamponade?''
``Yeah, we're thinking maybe he may have something going inside of his chest area there. I don't know if it might be a tamponade or not. He has complained about a significant amount of pain on that left side. He does have some swelling to that area. He was not wearing a seat belt. Unrestrained, and there was severe damage to the inside of the vehicle. The steering wheel was completely deformed.''
Thompson took the information to the attending emergency room physician, Dr. John Evett.
About 40 seconds later, he came back on the radio.
``Jeff, we're going to make this a trauma alert.''
``OK, trauma alert.''
``Jeff, what's your latest updated ETA? About seven minutes?''
``Showing six minutes to the rooftop.''
Thompson then called the hospital operator, who sent out a beeper message to the members of the trauma team scattered throughout the building. Thompson also called on the emergency room loudspeaker.
``Trauma alert. Five minutes. Trauma alert. Five minutes.''
5:10
Stovall placed her hands on Callaham's chest.
In the noisy environment of a helicopter, it isn't possible to hear a patient's breathing patterns, so the medical crew has to rely on watching and feeling.
Stovall didn't feel much rise and fall in his chest.
``You should see my hands, they're not moving,'' she said to McKinney.
McKinney also had a hand on Callaham's chest.
``Yeah, he's losing this side big time.''
He studied the oxygen mask over Callaham's mouth, watching for it to fog up and then clear again with each of Callaham's breaths. At his feet, McKinney had an intubation kit ready just in case Callaham quit breathing.
But the fogging pattern continued.
Stovall looked out the window for a landmark.
``OK, where are we?''
Below, she saw familiar terrain. Even if Callaham bottomed out now, she knew they could probably keep him breathing and alive long enough to get him into the trauma team with at least a fighting chance.
``Vinton,'' she said. ``Good.''
5:15
On the helipad, they were met by two security guards and an attendant from the emergency room. With the helicopter still running, they helped Stovall and McKinney transfer Callaham onto a gurney.
Callaham's breathing was labored but steady. He was still conscious.
From the roof, they wheeled him to a waiting elevator. They never ran, like on television. They don't like to risk sliding a patient off the gurney onto the floor.
``Clarence,'' Stovall said in the elevator. ``We're taking you down to the trauma room. There are going to be a lot of people there. There's going to be a lot going on.''
In all, there were 14 people waiting for Callaham, including four surgical residents, an attending trauma surgeon, an anesthesiologist, two nurses, a respiratory therapist, an X-ray technician, a lab person and the hospital chaplain.
The golden hour.
Stovall and McKinney stood back for a moment. They seemed to enjoy this luxury now that it was someone else's turn with Callaham. They stripped the blue rubber gloves from their hands.
The gloves were stained brown in places from dried blood.
After a few minutes, they left Callaham to the care of the trauma team.
They felt relief. Satisfaction.
In their line of work, they have one job with one goal: to deliver their patient to the trauma team alive.
Now, it was time for paper work. It was time to rejoin Lovell back at the hangar. It was almost dinner time. Maybe they would order out for food. Or finish their telephone calls from earlier. Or watch themselves on the 6 o'clock news.
Anything to pass the time.
It was Friday evening, on the eve of a full moon, and the crew at Life-Guard 10 was back again to playing the waiting game.
EPILOGUE
Clarence Callaham was lucky.
He did not have a serious head injury. He did not suffer a cardiac tamponade. He did not end up with any significant abdominal bleeding, and his femur was not broken.
He did, however, suffer a partially collapsed lung, as suspected. He also had a bruised pancreas, several broken ribs and a dislocated thumb.
But he should make a complete recovery. Andi Wright, trauma coordinator at Roanoke Memorial, said Callaham healed remarkably fast. In all, he spent 10 days in the hospital.
At his home on Black Water Road two weeks after the wreck, Callaham was stiff and sore. He had to be helped up from his chair, and his thumb was wrapped in bandages. But he was in good spirits.
At the wreck, he thought he was going to die.
He said he feels lucky now to be alive.
He sat in a converted carport, cozily crowded with comfortable chairs and family photographs, that serves as the center of activity for the Callaham clan. It is where Callaham plays his favorite card game, solitaire, and watches television.
He planned to start mowing the grass again at Wheeler's Motel when he felt a little better. He also planned to resume driving again, although his family says they won't let him. And he vowed, from now on, to always wear his seat belt.
He had never heard of Life-Guard 10 before the accident.
Nor did he recall much about his flight. What he remembered more was when Patsy Stovall visited him in his hospital room a few days later to check on his progress. Callaham is not a man of many words, and he regretted letting her go when there still was something left unsaid.
``I felt like I should have thanked her, but I didn't.''
LENGTH: Long : 551 lines ILLUSTRATION: PHOTO: 1. Paramedic Jeff McKinney relaxes in the station whileby CNBwaiting for a rescue call.
2. McKinney and flight nurse Patsy Stovall clean out the
helicopter after an earlier flight.
3. June Wilkes in dispatch sends flight calls to Life-Guard 10
from the hospital.
4. The Life-Guard 10 team takes car accident victim Clarence
Callaham from the helipad to the awaiting trauma team at Carilion
Roanoke Memorial Hospital.|
5. Paramedic McKinney (left) sits up front with the pilot, Terry
Lovell.
6. Nurse Stovall makes notes en route to the scene.
7. A crowd of onlookers, including family of the victim, gathers
at the accident site.
8. McKinney and Stovall help Bedford County rescue workers free
Callaham from the wreckage.
9. Rescuers load Callaham into the helicopter, which had landed
on the side of U.S. 460 in a field clear of trees and power lines.
10. Now in flight, McKinney and Stovall begin the IV on
Callaham.
11. Stovall holds her patient's arm.
12. The view of downtown Roanoke is reassuring when the clock is
ticking.
13. Life-Guard 10 lands on the helipad at Roanoke Memorial
Hospital.
14. Clarence Callaham at home with get-well cards two weeks after
his accident.
15. The Life-Guard 10 crew transfers care of Callaham to the
waiting Roanoke Memorial trauma team.
16. After another successful flight, Jeff McKinney and Patsy
Stovall head back to their quarters to wait for the next call to
come in. color.
ERIC BRADY Staff