Volume 2 | Issue 2

Dear Partners,
We hope that and your teams are doing well and staying safe in what is our shared new normal. It has been several months since we have provided an update on the LifeLine program and team, and we thought that now would be a great time to connect. Responding to the COVID-19 pandemic has challenged all of us to think differently and respond in new ways to the patients we serve, all the while keeping our teams healthy. While I know that all of this has been difficult for us and our teams, I think it is humbling to know the difference that our profession as healthcare providers and first responders has made for our fellow man.

In our April edition of the LifeLine Dispatch, we shared our initial response to the COVID-19 pandemic. I vividly remember leaving our 2020 LifeLine Emergency and Critical Care Conference to participate in an IU Health response team to the first patient being diagnosed in Indiana. Fast forward until today, caring with those infected with COIVD-19 has become an everyday experience, personal protective equipment (PPE) has become an integral part of our everyday uniform and we have adapted our response to provide all levels of care and modes of transport for a patient population that didn’t exist.
While 2020 has served as a tremendous challenge, I would be remiss to not share a few of our team’s accomplishments, of which I am very proud.

We have spent any available downtime working to improve ourselves and the commitment we have to you. One of our biggest areas of growth has been in the overall management of our statewide fleet of ground ambulances. In the name of safety, we have committed to increased driver training with a proactive driver quality assurance program. We have managed our fleet by transitioning to electronic maintenance logs, increasing the size of our fleet maintenance team, establishing tighter standards for preventative maintenance and aggressive vehicle replacement plans.

The LifeLine App – we continue to see counties throughout the state adopt usage of the LifeLine App for scene flight activation. We believe this solution, not only provides clear transparency to our partners, but more importantly cuts several minutes from our response time and increases accuracy. The Communications Center Update below will give you more insight into the use of the LifeLine App this year.

Healthcare finances and billing continue to be a hot topic for us and our patients. This year LifeLine is proud to be able to share one of our greatest differentiators – LifeLine does not surprise or balance bill patients. Although we just announced this, Hoosiers have been members the LifeLine family since 1979 without balance bills. This commitment not only shows our value of compassion but validates that we provide the highest quality medical transport product at the lowest out-of-pocket cost for our patients. Please see the informational flier and videos below.

Excellence in the delivery of clinical care is a cornerstone of LifeLine’s history and commitment to our patients and partners. Our quality and education team have spent much of 2020 increasing our capacity to support both clinical growth and quality assurance for LifeLine’s team members. This investment represents our continued promise to providing the highest quality medical transport to our patients. The quality and education team have also been working on the foundations of both an EMT and paramedic training program, which we hope to begin in the near future. We are deeply committed to developing the next generation of providers and elevating the EMS profession across the state.

One of my greatest concerns continues to be the physical safety of our team members and partners in both the field and hospital settings. We are thankful for the great work that you do to protect your team members and appropriately inform our team of the patient’s needs. While I think that we have all adapted to the protected measures required of our profession, I hope that you are focusing on caring for your team’s needs, both safety and emotional. We work in a profession where we are supposed to be “battle-hardened” and ready for whatever is next. I must admit, I was not prepared for the toll the pandemic has brought. Current research is equating the emotional toll of the pandemic on healthcare workers to multiple combat tours in the military. I think one of the most important counter measures we can take is to be mindful of our fellow team members and partners in care, while recognizing the selfless sacrifice they make every day they wear the uniform. So today, and every day, we want to extend a grateful and heart-felt thank you to you and your team.

As we approach a season that is traditionally spent surrounded by friends and family with a multitude of celebrations, there is no question that the rest of this year will look different for many of us. While change is hard, I hope you find comfort in knowing the intangible good that your work brings to our fellow Hoosiers. Our team wishes you peace and joy this holiday season, and we look forward to a brighter and better 2021.

Please know that we stand ready across the state, 24/7 to serve you and your patients in their time of need.

Happy Holidays,

Cory Hall
Statewide Director
Indiana University Health LifeLine
317-677-3063
chall6@iuhealth.org

The IU Health LifeLine Communications Center is constantly looking for ways to improve our partner’s experiences when requesting a transport or interacting with our partners. Several recent improvements include the transition to a cloud-based phone system, The LifeLine App for customers, a crew-based mobile app and adding additional ways to request a transport.

With the transition to Genesys Pure Cloud System, came a robust data collection program with an opportunity to track key performance indicators (KPI) and several performance improvement opportunities. With the increased call volume from LifeLine’s recent expansions, it was important to make sure staffing was appropriate at peak call times and callers were sent to the appropriate transport specialist.

Updates to the Communications Center include adjustments to staffing based on call volumes (time of day and day of week) and adding an additional swing shift to help with call volume. Also, calls are now routed to the appropriate transport specialist based how the long they are off the phone, to help distribute call volume throughout the Communications Center.

Not only has the new phone cloud system helped with metrics, staffing and customer satisfaction, it has helped LifeLine’s Communications Center technology work with other systems. Because 911 centers phone numbers are programmed into the system, when a 911 dispatch center calls LifeLine, the call is given the highest priority in the phone system. The transport specialist also receives a "whisper" from the phone system of the pending scene flight request and the phone system populates the scene flight process flow in our computer-aided dispatch (CAD) system.

Some of the new technology implemented at LifeLine’s Communication Center include text, chat and email features. For patients transferred within or to an IU Health facility, the LifeLine Communications Center receives patient and bed information electronically from the IU Health Transfer Center. Scheduled discharges from an IU Health facility are emailed to the Communications Center. From LifeLine’s website, you can immediately chat with a transport specialist.

The Communications Center implementation that has had the biggest impact for our customers is the LifeLine App. This web browser or mobile-based application eliminates the need for multiple phone calls, reduces radio traffic (for LifeLine and the requesting agencies) and significantly reduces the time it takes to request an aircraft for a scene. The app also allows fire, EMS and 911 agencies to track LifeLine in real time, providing much needed transparency.

A recent example of just how well the FV app works took place on a local major highway at the county line. Two counties were working the scene unbeknownst to the other and two helicopters were requested. The first county called a competitor, but they were unavailable. The request was transferred to LifeLine, but the coordinates given were incorrect, delaying the aircraft arrival. Several minutes later, the second county used the LifeLine App to request a helicopter, using the App map to pinpoint coordinates. The two LifeLine helicopters arrived on scene merely seconds apart, even though they were requested at two different times. By using the App, the second county dispatch center was able to provide exact coordinates to LifeLine, meanwhile providing real-time updates of the crew’s ETA.

IU Health LifeLine has ten 911 dispatch centers across the state using the App, with two additional 911 centers in progress. The LifeLine App is free to any 911 dispatch center in LifeLine’s service area. There is no additional equipment or personnel needed to use the LifeLine App. The only commitment needed from the 911 dispatch center is a one-time, free training that takes two to three hours.

One of the first 911 dispatch centers to adopt the LifeLine App was Johnson County.

“Here at Johnson County we love how easy and quick it is to use the app to request a helicopter. When we have serious accidents where we need air ambulances, the app makes getting one quicker and easier than ever because we can request the air ambulance while making other important phone calls. Not to mention, we have noticed that the app can save us not seconds, but minutes, when it comes to the time it takes to get confirmation. We have added the commonly used landing zones so we can populate that information quicker and easier as well. The app is an invaluable tool in our center!”

-Travis DeVore, RPL, Deputy Director, Johnson County Communications 911

For more information about the LifeLine App or the LifeLine Communications Center, please contact Tony Napier at 317-963-2662 or tnapier@iuhealth.org.

A Brief Discussion of the Accuracy of COVID-19 Polymerase Chain Reaction (PCR) Testing and Duration of SARS-CoV-2 Infectivity
By: Tom Lardaro, MD, MPH, Assistant Professor of Clinical Emergency Medicine, Medical Director, IU Health LifeLine

SARS-CoV-2 PCR testing is the current gold standard for identifying individuals with COVID-19. This strategy is most commonly accomplished by using either nasopharyngeal or oropharyngeal swabs to collect samples. These tests are very commonly deployed in a variety of settings and it is important for clinicians and the public to understand the accuracy of these tests. To that end, there is a significant amount of evidence available that will help us better understand and implement PCR test results used for identifying individuals with COVID-19.

First, it is important to understand that the timing of the test during the disease course appears to significantly impact test accuracy. Kucirka et al. explore this topic in great depth in a recent publication that can be found in the Annals of Internal Medicine (1). There is a large quantity of false negative PCR tests, and symptomatic individuals with signs and symptoms concerning for COVID-19 should be advised to quarantine in accordance Center for Disease Control (CDC) Guidelines irrespective of a negative test result if the index of suspicion for COVID-19 is high.

Below is a brief synopsis of the Kucirka et al study findings. While interpreting the information, bear in mind that most patients are expected to show symptoms within 5 days of contracting the virus with nearly all patients who will be symptomatic showing symptoms by day 12. Testing immediately after a high-risk exposure appears to be very low yield based on these results. For example, one day after exposure the probability of a false negative test result is 100%.

CI = Confidence Interval
* Day 5 is considered the mean day of symptom onset and greater than 95% of patients are expected to show symptoms by Day 12.
** After Day 8 the probability of a false-negative test begins to increase with each incremental day.

On a closing note, it should also be mentioned that a positive test result does not necessarily correlate with infectivity and patients who are no longer infectious may still have a positive test result. This begs the question: “How long should a person suspected of having COVID-19 quarantine to prevent transmission of the infection?” Cevik et. al explore the duration of viable virus in a November 19, 2020 publication. Their systemic review of 79 studies found no studies showing live virus beyond day 9 of illness despite prolonged shedding of SARS-CoV-2 RNA (2). Thus, a 10-day window from symptom onset seems to be a reasonable amount of time for quarantine for symptomatic individuals based on this data.

Disclaimers: much continues to be learned about COVID-19 and the above discussion is in no way meant to supersede guidance from local health departments and/or the official guidance provided by the CDC. Despite all the data above, basic preventative measures should continue to be implemented, such as mask-wearing, adequate interpersonal distancing, and the avoidance of mass gatherings whenever possible until a larger portion of the population has immunity to the virus.

Acknowledgements and References:
Dr. Ben Hunter from the IU School of Medicine Department of Emergency Medicine provided the references used and provided inspiration for the content discussed.

1) Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J. Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure. Ann Intern Med. 2020 Aug 18;173(4):262-267. doi: 10.7326/M20-1495. Epub 2020 May 13. PMID: 32422057; PMCID: PMC7240870.

2) Cevik M, Tate M, Lloyd O, Maraolo AE, Schafers J, and Ho A. SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis. Lancet Microbe. Published online November 19, 2020. DOI:https://doi.org/10.1016/S2666-5247(20)30172-5.

Fluid Resuscitation in Pediatric Sepsis
By: Gregory Faris, MD, Assistant Professor of Clinical Pediatric Emergency Medicine, Deputy Medical Director, IU Health LifeLine

While advances have been made, sepsis continues to be a significant source of morbidity and mortality among pediatric populations. Despite increased frequency of sepsis in pediatrics over the past 10 years, there have been improved mortality rates, thanks in large part to a focus on sepsis recognition and management in the acute care settings. Early management for sepsis is centered on aggressive fluid resuscitation, rapid antibiotic therapy and source control.

Aggressive fluid therapy is the lynchpin of sepsis management. While there are some exceptions to this approach based on past medical history (ie. congenital heart disease), the goal for fluid resuscitation is to infuse 60 mL/kg of isotonic fluid within the first hour of care. In order to achieve this goal, providers must first recognize septic children. Once sepsis has been identified the first step to fluid resuscitation in sepsis is placing an IV. Intravenous access can be challenging in any child but especially so in septic children. If IV access is difficult to obtain, placing an IO should be viewed as a quick alternative in order to initiate fluid resuscitation. Placing an IO in an awake child is challenging, however it may be your only option. If the child is awake then infuse the IO with lidocaine per your protocol. While this will not make the procedure pain free, it will greatly improve their comfort.

After an IV/IO has been established aggressive fluid resuscitation should begin promptly. For most patients, it is recommended to bolus in 20 ml/kg aliquots to your goal of 60 ml/kg or more if necessary. If you believe the patient is fluid overloaded or if the patient has a medical condition requiring closer monitoring, then boluses of smaller volume (5-10 mlg/kg) can be considered with more frequent reassessment between the boluses. If your intention is to treat sepsis then it is important to fluid resuscitate in the most appropriate manner, via push-pull method of fluid bolus or by using a pressure bag if you are able to monitor the volume appropriately. In general, using an IV pump for fluid resuscitation in sepsis will not infuse the volume of fluid necessary in your goal time frame. Push-pull bolus method is simple to set up by placing a three-way stopcock between the bag of isotonic fluid and the patient. The three ports of the stopcock should include the line from the bag, the line to the patient and a large syringe in the third position. Once set up the fluid is pulled from the fluid bag into the syringe, then by changing the stopcock pushed into the patient until you have reached the goal volume.

Achieving rapid fluid resuscitation is simple with this method. Infusing 60 ml/kg in the first hour of treatment is easily achieved. Aggressive IV/IO access followed by rapid fluid administration will drastically improve the outcome of your next pediatric sepsis patient.

Greg Faris, MD
Deputy Medical Director
IU Health LifeLine

Cyanotic Heart Disease in the Newborn
By: Riley Hospital for Children Neonatal Advance Practice Providers

Cyanotic heart disease is any congenital heart defect that predisposes a newborn to shunt blood across the level of the ductus arteriosus, effectively bypassing the lungs. As a result of this shunt, it can be difficult to consistently maintain oxygen saturations greater than 90% and can be the first clinical sign that prompts a healthcare facility to evaluate an infant for congenital heart disease (CHD). While the blanket term CHD is used often, it is important to differentiate if the defect is acyanotic or cyanotic. Cyanotic heart lesions routinely require prostaglandin (PgE1) infusion to maintain the patency of the ductus and ensure an outflow tract to the body and/or the lungs. Common cyanotic heart lesions include: transposition of the great vessels, tetralogy of fallot, tricuspid atresia, truncus arteriosus, TAPVR (total anomalous pulmonary venous return), hypoplastic left heart syndrome (can also be acyanotic), coarctation of the aorta, interrupted aortic arch, pulmonary atresia, or Ebstein’s anomaly.

Signs/Symptoms of Cyanotic Heart Disease

Murmur – may or may not be present but a murmur that is high-pitched, harsh, or associated with a thrill is always pathologic….many cyanotic lesions do not have murmurs
May or may not have cyanosis
Gradient between upper and lower extremity blood pressures – difference should be less than 15 mmHg
Gradient between pre ductal and post ductal oximetry or post ductal saturations greater than pre ductal
Respiratory distress
Decreased perfusion and/or pulses
Feeding difficulty
CXR: Decreased pulmonary vascularity or cardiomegaly
ABG: paO2 <100

Types of Cyanotic Heart Disease

Transposition of Great Arteries (TGA)

Transposition of the great arteries occurs when the aorta originates from the right ventricle and the pulmonary artery from the left ventricle resulting in two parallel circulations. One circulation sends deoxygenated, systemic, venous blood to the right atrium and back to the systemic circulation via the right ventricle and aorta, and the second sends oxygenated pulmonary venous blood to the left atrium and back to the lungs via the left ventricle and pulmonary artery. Post ductal oxygen saturations are typically higher, which can aid in diagnosis.

Tetralogy of Fallot (TOF)

Tetralogy of Fallot is characterized by four separate cardiac issues: a ventricular septal defect (VSD), pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. This cardiac lesion results in lower oxygen saturations due to the mixing of oxygenated and deoxygenated blood in the left ventricle via the VSD followed by preferential flow of the mixed blood from both ventricles through the aorta because of the obstruction through the pulmonary valve. This defect may be identified via chest x-ray if a typically “boot-shaped” heart is visualized.

Tricuspid Atresia

Tricuspid atresia is the result of the tricuspid valve maldevelopment resulting in a lack of communication between the right atrium and the right ventricle. As a result, the right ventricle is underdeveloped and dependent on a VSD to allow the venous blood to reach the lungs and become oxygenated. If the VSD is too small or non-existent, little or no blood can reach the lungs. A patent ductus arteriosus is essential to treat infants with tricuspid atresia.

Truncus Arteriosus

In normal cardiac development there are two main arteries that leave the heart, the pulmonary artery and the aorta. In a truncus arteriosus, there is only one common vessel leaving the heart, a trunk, which then separate to branches which feed blood to the lungs and the systemic circulation. The trunk sits over the right and left ventricle and typically the top portion of the septum is missing, creating a VSD, which allows for mixing. This defect often results in pulmonary over circulation which can lead to congestive heart failure in the first two weeks of life.

Total Anomalous Pulmonary Venous Return (TAPVR)

In a normally formed heart, the pulmonary veins return oxygen rich blood from the lungs to the left atrium. In TAPVR, the pulmonary veins drain blood into the right atrium by way of an anomalous (abnormal) connection. There are three main types of TAPVR:

Supracardiac TAPVR (pulmonary veins come together and create an abnormal vertical vein which dumps blood into the superior vena cava and then to the right atrium)
Cardiac TAPVR (pulmonary veins come together and drain through the coronary sinus into the right atrium)
Infracardiac TAPVR (pulmonary veins come together and drain down into the hepatic venous system and then enter the right atrium through the hepatic veins). The mixing that occurs explains the decreased oxygen saturations that are seen with TAPVR. Of note, if there are any obstructions within these connections, the cyanosis can reach critical levels quickly secondary to pulmonary edema and pulmonary hypertension. Children with obstructive TAPVR will be critically ill (labile blood pressures, severe cyanosis, pulmonary hypertension) and will require surgical intervention within the first few days of life.

Hypoplastic Left Heart Syndrome (HLHS)

HLHS is one of the most challenging cardiac defects to treat as it is essentially a single ventricle physiology. As the name implies, the left side of the heart is completely underdeveloped (both the mitral and aortic valves are completely closed or extremely small and, as a result, the left ventricle itself is tiny, thus, the outflow tract to the body is also small, usually only a few millimeters in diameter). Because of this maldevelopment, oxygenated blood must shunt across an ASD back to the right atrium and mix with the venous blood. This mixed blood is then pumped out via the right ventricle that is essentially doing double duty by sending blood both to the lungs via the pulmonary arteries and to the body via the PDA. The PDA is the only way that blood can get to the systemic circulation. Prostaglandin infusion, which ensures that the ductus remains patent, is the only way to safely bridge these children to surgery. Additionally, it is important to remember that supplemental oxygen should be avoided as it promotes blood flow to the lungs (by lowering the pulmonary vascular resistance) which essentially steals blood from the systemic circulation and puts further stress on the already over-worked right ventricle.

Coarctation of the Aorta

Coarctation of the aorta is a narrowing of the aorta which is the main blood vessel carrying oxygenated blood to the body. If this narrowing is very small, the left ventricle must use much higher pressures to push the blood into the systemic circulation which if not adequately treated can lead to congestive heart failure. Maintaining a PDA will allow the oxygenated blood an unobstructed tract out of the heart and relieve some of the work required of the left ventricle. Diagnosis is often made when diminished/absent lower extremity pulses are noted on examination or a gradient between upper and lower blood pressures is captured. A murmur is often auscultated on the back with this cardiac defect

Interrupted Aortic Arch

Interrupted aortic arch is a defect caused by the absence/discontinuation of the aorta (the main vessel carrying oxygenated blood to the systemic circulations). These defects are divided into three categories: 1) Type A (the interruption is just after the subclavian artery – about 30-40% of cases), Type B (the interruption occurs between the left carotid artery and the left subclavian artery – most common type, about 53% of cases), and Type C (the interruption is between the innominate artery and the left subclavian artery, least common type, only 3% of cases). This defect is almost always associated with a large VSD and is often seen with the chromosomal abnormality DiGeorge Syndrome (especially Type B). Prostaglandin infusion is required to maintain adequate blood flow to the area past the interruption. It is also important to remember that these infants have an increased risk of pulmonary over circulation secondary to shunting across the VSD.

Pulmonary Atresia

Pulmonary atresia is a defect caused by the inadequate development of the pulmonary valve which inhibits the forward flow of blood out of the right ventricle and into the pulmonary artery. Many times this defect will also be associated with a patent foramen ovale (PFO) which is a communication between the right and left atrium that is used in fetal circulation. This PFO allows oxygen depleted blood to flow from the right to left atrium completely bypassing pulmonary circulation (blood will always take the path of least resistance) which will make the infant increasingly cyanotic. However, if the ductus arteriosus remains patent and shunting can occur from the aorta back to the pulmonary artery (left to right shunt), this will allow some of the oxygen poor blood to reach the lungs and become oxygenated. Prostaglandin infusion will maintain the patency of the ductus and reduce the severity of cyanosis.

Ebstein’s Anomaly

Ebstein’s anomaly is a malformation of the tricuspid valve (the valve separating the right atrium and the right ventricle). The tricuspid valve normally has three leaflets. In Ebstein’s, two of the leaflets are displaced downward into the right ventricle and the third leaflet is elongated (and sometimes tethered) to the right atrium. This allows a constant communication between the atrium and ventricle which allows retrograde flow between the ventricle and atrium. This backward flow will cause the right atrium to enlarge and elevates the atrial pressure. The elevated pressure will prevent closure of the PFO (the fetal communication between the right and left atrium) and shunt deoxygenated blood to the left atrium, bypassing the pulmonary circulation. This heart defect can also present with supraventricular tachycardia (SVT) secondary to accessory conduction pathways. Ebstein’s anomaly is often diagnosed by a heart murmur and by a grossly enlarged heart on chest x-ray but maybe missed in the newborn if the symptoms are mild.

No Suprise Billing for LifeLine Patients

Unlike most air medical programs in Indiana, IU Health LifeLine does not surprise or balance bill transported patients.

If transported by LifeLine, your patient will not receive a bill for the remaining balance of their transport bill (post insurance claim).

Download the PDF to read more about LifeLine's billing practices.

Levels of Transport Care
Created with our partners and shared patients in mind, check out LifeLine's guide to transport medicine.

We have defined and explained each level of transport LifeLine provides, the capabilities, patient conditions and team members you will see on each transport.

You can download your own copy to print or request a printed copy to be printed and shipped for free.

A Tool for 911 Dispatch Centers - Request a Helicopter at the Touch of a Button

IU Health LifeLine is one of a few medical transport programs in the country to deliver its partners with a tool that increases transparency, decreases helicopter activation time and provide an easier and quicker way to request a medical helicopter.

During emergencies, 911 centers are busy supporting local operations. This can result in a need to reduce the number of phone calls, keeping telecommunications available for other calls and critical radio traffic. IU Health LifeLine is helping by collaborating with 911 centers to improve efficiency by allowing requests via a web browser, iPhone or android app. The LifeLine App is a unique tool, with secure logins and training to any county LifeLine serves.

Watch this video to learn more about the LifeLine App.

Interested in the LifeLine app for your county's 911 dispatch center or fire and EMS agency? Email LifeLine to schedule a demonstration and training.

Note: Your county's 911 dispatch center must be live on the application before fire and EMS agencies can use the app. Call or email to find out if your county dispatch center is using the app.

Seriously Injured Teen Meets LifeLine Crew
by: TJ Banes, IU Health Journalist

On a recent Friday around noon, Brandon Stuckwish climbed aboard a LifeLine helicopter. The last time he was inside the aircraft was around 10 p.m. on a Thursday night in July.

That wasn’t the only difference. The last time Stuckwish was a passenger critically injured in an accident in Jackson County, just northeast of Seymour, Ind. Stuckwish was reportedly driving his prized red 2006 Chevy pickup truck when he lost control. The vehicle flipped several times, landing in a soybean field. Stuckwish was thrown several feet from the vehicle. Three teen passengers were also injured.

Stuckwish’s condition was critical. His injuries included a broken leg and arm, cracked ribs, and fractured spine. He lost consciousness a number of times at the scene. He remained at Methodist Hospital for two weeks and in rehab for three more weeks.

“We were first told if he made it, he’d probably have one surgery every day for two weeks. He didn’t wake up until day six,” said his mom, Kelli Jo Stuckwish. “A lot of things went wrong that night but a lot of things went right,” said his dad, Ryan Stuckwish.

On the recent Friday when Brandon Stuckwish, visited the downtown LifeLine heliport, some of those things that went “right” became crystal clear.

First there was a warm welcome by crew who flew to Stuckwish’s aid – LifeLine nurse, Mike Boone, paramedic, Shawn McClaughry, and pilot Ivan Brentin.

The reunion with Stuckwish was a first for Boone who has worked with LifeLine for eight years. He was an intensive care nurse before joining LifeLine. “I think it’s a fulfilling job and at this level, it’s also challenging. I appreciate it and get a lot of fulfillment when you see outcomes like Brandon’s,” said Boone.

Stuckwish, who turns 18 in November, shook hands with the three men and offered, “thanks” for their lifesaving efforts. It hit home with McClaughry, a father to six children ranging in age from 13 to 24. He began his medical training in the Army and became a paramedic 20 years ago. He’s been with LifeLine for eight years. “It’s mentally and physically challenging and pushes you to want to do more,” said McClaughry. A former Marine pilot, Brentin has been with LifeLine for 15 years.

On the night of Stuckwish’s accident Brentin landed the helicopter on a nearby soccer field. He said the weather was pleasant; the flight was calm. But when the crew landed they quickly realized Stuckwish was agitated and in severe pain. During the minutes on the scene they focused on helping him relax and stabilizing him for transport to IU Health Methodist Hospital

At Methodist he was met by the trauma team including surgeon Dr. Ashley Meagher. Stuckwish became the first successful patient at IU Health to receive a treatment called REBOA, resuscitative endovascular balloon occlusion of the aorta. It is a technique using a balloon catheter that temporarily stops the bleeding.

“Without every single person involved, Brandon wouldn’t be here today. He needed attention and he needed it fast. Every time I hear a helicopter, I look up and thank God,” said his mom.

A small scar over his right eye, a back brace, and a slight limp are the only visual indicators of the accident that nearly claimed his life. But, in his mind and his heart, Stuckwish holds tight to lessons learned.

As a senior at Brownstown Central High School, he talks openly to friends about making good choices. He tells them how things can change in a split second. He also focuses on a future that is full of promise.

He’s taken courses in welding and manufacturing and enjoys doing farm work with his dad and helping with his uncle’s power washing business. After graduation he hopes to pursue a career in trades. In his spare time he loves to fish and recently enjoyed catching red snappers during a trip to Florida.

He’s still not back behind the wheel driving but when he’s ready he’d love to buy his dream vehicle – a 1985 red and white Chevy pick-up truck. In the meantime, he’s working to fix up a 1995 Dodge Cummins.

“Honestly, I’d love to have my red truck back,” said Stuckwish. “But after everything, I know that’s not possible and I’m just glad to be alive.”

Brixton Stewart was just a few weeks old when he suffered a seizure at home. His parents rushed him to their local Emergency Department but doctors struggled to stabilize Brixton. LifeLine was called in to transport Brixton to Riley Hospital for Children.

"They were like angels walking through the door," said Deanna Todd, Brixton's mom.

Brixton spent 96 days at Riley. He's now at home and doing well.

The family had a virtual reunion with the LifeLine crew that was by their side during the crisis with their son. Watch to see what Deanna had to say about the impact of the LifeLine team on their lives.

Jesse Hawkins didn't know, when he first felt chest pain, that he was experiencing a severe aortic aneurysm. His wife, Gale rushed him to a local hospital in Northern Indiana. "[The doctor] ran me back to his room... and they stopped me at the desk and told me what [the diagnosis] was and I started hysterically crying and fell to the floor," said Gale. Jesse's local care team called IU Health LifeLine to airlift him to Methodist Hospital. This week Jesse and Gale were reunited via video conference with the team who helped save his life. "It was a horrible experience with a surprisingly good outcome," said Jesse. "I'm forever grateful."

Watch the heart-warming reunion of the LifeLine 5 crew Grant, Ben and Ric with the Hawkins.

A look back at LifeLine rescue of crash victim: “A life-defining moment”
By: IU Health Senior Journalist T.J. Banes

On a recent Thursday morning in October IU Health LifeLine flight nurse Mike Collins answered his cell phone. He responded to questions about an incident that happened two years ago, reciting details as if it just happened hours earlier.

It was a rescue he will never forget.

hen Collins and his flight crew arrived at the scene near Columbus, Ind. they immediately recognized the challenges – it was dark and there were downed power lines. They landed the helicopter and jumped aboard an emergency vehicle, where they drove about two miles to the accident victim. He was laying on a backboard in a front yard.

“His oxygen was low and we couldn’t clear the blood in his airways. When we got him in the ambulance, things went from bad to worse,” recalls Collins, who has been with LifeLine for seven years and was named “Critical Care Transport Nurse of the Year.” Prior to that he was an ER nurse at IU Health Methodist Hospital. His wife, Jackie Collins is a nurse at IU Health West. Together they have three teenagers, ages 13, 15, and 16.

In the early morning hours of Sept. 19, 2018, as he worked to save the victim, he thought of his own children. “Every time I fly out, the first thing on my mind is ‘this could be my kid,’” said Collins. On this night the victim was a 24-year-old young man named Jordan Shehan. Collins recognized immediately what he considers one of the greatest rewards of his job: “I deal with the sickest of patients and often we’re their last resort. There’s an excitement and a seriousness to remember all the things you trained for and be ready to act.”

What he trained for made the difference between life and death for Shehan. Collins performed an emergency Cricothyrotomy, an incision through the skin and cricothyroid membrane to establish an airway. “Thanks to IU Health, we have had a lot of training in a cadaver lab so we were ready when we needed to be,” said Collins, who was also an instructor for the training exercises. “It was a career-defining moment. I’ve never done that once in my career and there are many people who never do them in their career,” he said.

Last October, a year after the accident, Sheehan was able to thank Collins during a LifeLine reunion. They both look back on the details of that night in near disbelief that Sheehan walked away and is healthy to this day.

“It was awesome to see Mike and to thank him personally. We hugged and we cried,” said Shehan, who stays in contact with Collins and his wife through social media. “The people who work for LifeLine do a lot to go above and beyond for every patient. I’m living proof that the job they do is amazing.”

Shehan remembers little about the accident. He left work after his shift at Applebee’s restaurant and was on his way home to Hope, Ind., 15 minutes northeast of Columbus. Police reports indicate Shehan ran off the road and struck several mailboxes and a utility pole.

Once stabilized, he was transported to IU Health Methodist Hospital where he spent 60 days in ICU. He was in a coma for 20 of those days. Among his injuries were cracked ribs, a punctured lung and fractured vertebrae in his neck. Multiple surgeries followed.

But today, thanks to Collins and other LifeLine crewmembers, Shehan is back at work – a new job with a soft drink distributor. He also said he has a new girlfriend and has moved out of his parent’s home. And he is grateful to be alive. He’s even thinking about starting a support group for others who have been transported by LifeLife.

“It’s been real eye opening. I was 24 and perfectly healthy, a high school athlete, and it was rare for me to even get a cold. In the blink of an eye everything changes,” said Shehan. “It changed how I look at life. You can’t take any moment for granted because it could be your last. I’m hoping to reach out to others who have gone through similar situations as LifeLine patients. I think there is a lot we could relate about and learn from each other.”

Every day is a learning experience for Kate Pedigo.
By: IU Health Senior Journalist T.J. Banes

Inside the downtown offices of the IU Health LifeLine heliport, is a bulletin board filled with red hearts. Each heart includes an encouraging message or note of appreciation to team members who are steadfast in their cause: Safely transporting critically ill patients.

In recent weeks, those emergency responders have affectionately filled the board with “hearts for Kate.”

A critical care nurse, Kate Pedigo has become known as the “Corona Queen.” She has transported a majority of patients who have symptoms or a diagnosis of COVID-19.

“I’m not really sure how it happened but it’s the way things have worked out. I was the one on duty when the calls came and I ended up seeing most of the patients,” said Pedigo, 35.

One of the messages from her peer reads: “Thanks Kate for being the expert for COVID-19 transports. You are valued.”

Pedigo has worked with LifeLine for just over a year. Before that she was a nurse at IU Health Bloomington and has worked in areas of labor and delivery, ER, and as a paramedic.

“The virus is so contagious and there are still so many unknowns that we’ve had to adapt quickly to protect ourselves, our patients with the diagnosis, and our patients we care for after the diagnosed patient,” said Pedigo. “The biggest thing I’ve noticed that’s so different is visiting restrictions have changed for families. I used to call a family member to tell them when we were leaving and call them again once we arrived safely at the hospital. Now we no longer have family at the bedside so we’ve lost part of that whole person care.”

LifeLine teams throughout the state quickly adopted action plans for screening and transporting patients showing symptoms of, or diagnosed with COVID-19. They also introduced additional measures to ensure the safety of team members.

And they continue learning and sharing ideas as the virus rapidly spreads. Months ago Pedigo was talking to colleagues around the country specializing in emergency medicine to get a jump on patient care. She isn’t sure how many diagnosed patients she has transported but she estimates more than a dozen. All have been taken to IU Health Methodist Hospital for additional care. Most of her patients have been between 40 to 50 years of age.

“With every COVID transport we do just as with any critically ill patient, our goal is to get the patient to the right place by initiating or maintaining the highest level of care,” said Pedigo. “We are learning with each one. We’ve never done this before and we are adapting to changes and talking as a team about what we need to do to support each other and stay safe.”

For her part, Pedigo is working with LifeLine managers to compile a list of tips she’s learned along the way. For instance, instead of one pair of gloves, she wears multiple layers and strips the gloves off as she leaves one area and moves to the next. A protective gown now covers things she normally had access to on her flight suit. So another tip she offers her team members is to have the essentials at the ready.

“I keep airway clamps and carabiners outside my flight suit now,” said Pedigo. Most of the patients she transports are on numerous medications so she uses the spring-loaded gate clamps to hold all the drip bags together for safe transport.

When she’s not on duty as a LifeLine nurse, Pedigo is at home with another essential worker – her husband Ryan is a captain with the Bloomington Police Department. He works days; she works nights. “We’ve had a lot of conversations about the direction this whole pandemic is going and ways to help control it. I’ve offered up suggestions on disinfecting the police cars and equipment,” said Pedigo. And when they’re both home, they unwind by playing outside with their dogs “Barbara,” and “Abe.”

“I’m proud of my profession,” said Pedigo. “I think everyone is coming together to get it done. Yes, everyone is stressed but we are working together as a team – not just nurses, but EMS, firefighters, police – we’re all in it together.”

IU Health LifeLine team: Protected, positioned and prepared
By: IU Health Senior Journalist T.J. Banes

They are trained to arrive at a home, hospital, or accident scene, and assess and react. Their focus is on protecting themselves and protecting the patient for ground or air transport.

And now there is a new twist to their care – it’s the rapidly growing COVID-19 virus. So how have IU Health LifeLine crewmembers prepared for the unexpected?

“I think preparation for things like this is core to our DNA,” said Cory Hall, a statewide director of emergency services. He added that team members practiced similar protection skills last year when the World Health Organization declared the Congo Ebola outbreak a world health emergency. “So in the background we’ve had methods of preparation, but did I anticipate this would affect our operation so dramatically? No,” said Hall, who has worked with IU Health LifeLine for nine years.

Since the beginning of March they logged 30 transports where a patient had either been diagnosed or presented symptoms of COVID-19. That number is increasing weekly.

The majority of preparation began the first week of March, said Shawn Remick, also a statewide manager for LifeLine. “When we recognized the need to transport the patients and make sure we had PPE (personal protective equipment) we moved quickly to a new model,” said Remick, who has been with IU Health LifeLine for six years.

Here’s a breakdown of what that model looks like:

The first line of action is dispatchers screen every patient over the phone. A sort of triage tool determines a patient’s immediate needs, in compliance with the CDC guidelines. IU Health LifeLine averages about 100 screenings a day.
Next, there are two plans of action. If a patient is not diagnosed with COVID or does not qualify as a person under investigation for the virus, then an air or ground transport is dispatched according to everyday operations. If the patient screens potentially positive, or presents a risk factor, the call is escalated to triage officers with critical care experience who offer a second review. They may ask questions such as “Have you had a chest x-ray?” or “Are you using a ventilator?”

“One of the core things we’re mindful of is various hazards that can evolve such as if the patient is on a ventilator the virus can aerosolize so we need protection from airborne contaminants,” said Hall.

In that case an additional team member is deployed as a safety officer. That emergency technician ensures other team members have the protective gear and the proper equipment for a safe transport with minimal delays. For ground transports, LifeLine has equipped an ambulance specifically for airborne isolation.

All LifeLine team members are trained in the use of personal protective equipment – such as choosing the right size and properly removing the equipment said Remick. “As this changes hour by hour there is additional training. We want to be sure we always have the most up-to-date information and we are using that as we continue our day to day operation.”

As an additional layer of assistance, Hall and Remick are rounding more frequently to the various LifeLine bases throughout the state to check in on team members.

“We have an incredible responsibility to be in a constant state of readiness to support IU Health and all Hoosiers,” said Hall. “I think the biggest drive for us it to keep our team safe. We work in a high-risk environment and I think because we are so accustomed to the risks in our work we work harder to mitigate the exposure, a heighten safety, and keep our system connected. We have an overwhelming pride and appreciation for our team. They not only do transports safely but they are giving outstanding clinical care to complex patients.”

LifeLine Crew Members Experience Hands-On Learning
By: IU Health Senior Journalist T.J. Banes
Photos by Visual Journalist, Mike Dickbernd

As she completed her nine weeks of orientation, Lauren Posas stepped outside the classroom and inside what appeared to be a LifeLine helicopter.

Managed by Metro Aviation the van simulator is set up to feel like a real helicopter – complete with visual screens depicting in-air transport sights and sounds. But the most challenging part for Posas, a critical care nurse, was the passenger – a doll-like figure representing a pediatric trauma patient. During the simulation drill, Posas was charged with aiding a severely injured patient requiring intubation.

Before joining IU Health LifeLine, Posas worked in ER at IU Health Methodist Hospital.

“I really like the challenge and opportunity to work independently. There’s a lot of new skills and knowledge that come with that,” said Posas. “I’m a hands-on learner so when you can create a high intensity situation in a safe environment it takes some of the shock away when you get into the actual situation.”

Over the course of a month about 65 simulations helped train IU Health LifeLine crewmembers. The coursework is part of ongoing training throughout the year, said Matt Ramseyer, a LifeLine nurse, paramedic, and clinical educator.

“This provides a safe learning environment and helps them see what it’s like to work in a tight space with limited resources,” said Ramseyer, who has been with LifeLine for five years. After the exercises, crewmembers review the drills in a de-briefing and talk about what went well and what could be done better said Ramseyer.

And for Posas, the simulation marked the end to her orientation. She received her flight wings, symbolizing her new role as a nurse with IU Health LifeLine.

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