Train Wreck

“Are you flying? We have a train vs. bicycle.”

Just minutes after 23-year-old Ervin Hunter was struck by a train while riding his bicycle on October 10, 2012, Air Care was called by Albion Community Dispatch to respond to the scene. Upon landing just after 10 am at nearby Albion fire station, flight nurses Sara Sturgeon and Jan Eichel proceeded to the waiting ambulance and made contact with the Huron Valley Ambulance paramedics and other rescuers who were providing initial treatment.

Initial Assessment

Ervin had multiple severe injuries that were actively bleeding including a large, posterior scalp avulsion, complete amputation of left foot and left forearm, and a complex left ear laceration. There was also concern over his potential internal injuries; Ervin had diminished breath sounds indicating possible chest trauma and decreased responsiveness from a traumatic brain injury. He was hemodynamically unstable with a heart rate of 147 bpm, blood pressure of 81/56 and respiratory rate of 30. An oxygen saturation reading was unobtainable due to his poor peripheral perfusion.

Emergency Interventions

Due to his altered level of consciousness and labored breathing, the decision was made immediately to place an endotracheal tube for protection of his airway. Rapid sequence induction was quickly performed (utilizing the Hypoperfusion arm of Air Care's protocol.) Interventions were made to control bleeding and Ervin was loaded into the aircraft with the help of the Albion Department of Public Safety. During the 18-minute flight to Bronson Methodist Hospital in Kalamazoo, Ervin was placed on the ventilator, received a high-flow infusion of normal saline and one unit of packed red blood cells (PRBC). Upon arrival in the Emergency Department, trauma surgeon Dr. Jon Walsh and the Tier I trauma team continued Ervin's trauma resuscitation and evaluated his injuries. By that time Ervin had lost a great deal of blood and remained tachycardic and hypotensive, placing him into an advanced classification level of hemorrhagic shock.

Blood Products + TXA = Improved Survival

Within the first few critical hours after his arrival Ervin was taken to surgery where he received additional blood products and was started on the medication, Tranexamic Acid (TXA). He received an initial bolus of the medication followed by an infusion over the next 6 hours. TXA has been shown in studies to be a safe, inexpensive, and easily administered medication that can significantly reduce the risk of fatal bleeding events in trauma patients, potentially saving thousands of lives yearly¹. (See the additional article "What is TXA?" in this issue of AirWaves.)

Ervin's road to recovery has been a slow and steady progression. After multiple surgeries and procedures he was transferred to inpatient rehabilitation six weeks after his accident where he worked hard and continued to improve. Recently he was able return home with his family and is grateful to all of those who were a part of his rescue, resuscitation, and continued care throughout his recovery. Just like Ervin, West Michigan Air Care takes pride in working hard and continuing to improve, making steady progress in patient care.

—By Sara Sturgeon and Jan Eichel, Flight Nurses


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