With the approval of Survivors Network, co-founder Krista Haugen, HEMS Critical Care will be adding a Survivors Network “page’ that will be linked to their page.  We will highlight their “Survivor Stories” and “Resources” for thskd238145sdcose in emergency medical services. The information is not only for flight crews, but for anyone in EMS; we are all “responders” to life’s darkest moments of grief, despair, and loss. It’s not without risk to our minds, body, and spirit. You all have co-workers right now who are suffering in silence.

The “Survivor Stories” represent the universality of the human response to traumatic events while maintaining the individuality of each person’s response and subsequent journey. These are stories of struggle, courage, and resilience. We hope that by sharing our experiences, we open the door to conversation and help to further understand what it means to “survive” in the air medical and emergency medical response industries.

The ultimate goal in sharing these stories is to help prevent incidents and accidents, and to share lessons on how to “survive,” should an incident or accident happen.  In the words of survivor Michael Hester, “Don’t give up.”

There is no greater agony than bearing an untold story inside you. ―Maya Angelou

  
Survivor Story: Krista Haugen

I’d like to share a personal story and some personal perspectives —my interests are 3-fold: Safety & risk-mitigation, being proactive & ready for an accident should it occur, and finally responding to accidents appropriately. I do not profess to have all the answers, but I hope to give you food for thought and open the door to thoughtful conversation about some very complex issues.

Flight crews are a unique breed in many ways…we can handle intensely stressful situations and in fact thrive on it. We enjoy the high level of practice, the autonomy, the variety of challenges in this high-stress environment; we love flying, and we believe in the mission. When time is of the essence, we can offer a chance to those in outlying areas where before there was none. I am originally from Montana, and I currently reside in Washington state…I know the value of air medical transport in these states. This was, and still is in my mind, a great mission and an invaluable service.

 When I applied for a flight nursing position in Seattle, it was not without slight hesitation because I knew the dangers of the job. I was an ER nurse in Tacoma when Airlift 1 crashed on September 11, 1995. I attended the memorial service for Amy Riebe, Marna Fleetwood, and Lee Bothwell with some friends who were flight nurses at the time. That left an indelible impression, as this was clearly a massive loss personally and professionally for the staff at Airlift.

In spite of this knowledge, I did not ask anything about safety during my interview. I did not know what to ask; I didn’t know what a “safety” looked like. I didn’t know what I didn’t know.

When I was hired at Airlift, I would come to understand the bonds that develop within the flight crews as we stood together to care for the sickest of the sick in the most adverse of conditions. These are the bonds that support our spirits and boost our inner strength as we constantly bear witness to the suffering of others. Drawing upon years of education and experience, we give everything we have intellectually, as well as emotionally, to help strangers in their hour of greatest need. We were bonded by virtually every emotion as we faced the variety of challenges and complexities that this industry presents. It is not uncommon to hear “the people I work with are like family to me” not unlike the police department, fire department, and military who are also bonded by events that others, even your real family, may not understand.

I’d been a flight nurse for five years when we got the call on September 29, 2005. A missing helicopter, three souls on board. Adult nurse Erin Reed, peds nurse Lois Suzuki, and pilot Steve Smith. The next call…a debris field in the Puget Sound. No survivors. We were a close-knit crew…the devastation was immeasurable. We would never know what happened, as a large portion of the aircraft was never recovered.

One month later, on October 28, 2005, I was working at Airlift 3, based south of Seattle. It was anything but a “normal” day at work (if there even is such a thing) because our hearts were so heavy after losing our crew. And our minds were unsettled because of not knowing why. But…they were in the old aircraft, an Agusta Mark II.

On this day we were in a brand new Agusta Power, complete with a terrain awareness warning system, night vision goggle capability and all of the technological bells and whistles. The company had been in the process of replacing the old Mark IIs with a new fleet of Powers. I naively found that to be reassuring.

Our pagers went off for an interfacility transport. An adult male with a leaking abdominal aortic aneurysm from a small town on the southernmost coast of Washington. There is very limited medical care there. This call/flight exemplifies what air-medicine is all about. This is not the place to be with a leaking AAA.

I flipped the “ignore” switch on my heavy heart and went to work. We lifted from our base & were underway. I was focused on the flight itself, at the same time running through the physiology of a AAA in my mind. I began to notice the visibility was getting worse…a thick cloud bank lay low over the hills. “I don’t think we can get through that weather,” our pilot, Ken said, “I’m turning around.” Even though our patient seemed to be in dire straits, it wasn’t safe to continue the flight. Ken radioed the communication center to determine if the patient could be brought to a rendezvous point where the weather was better. It was determined that we could meet the patient in Olympia. We returned to base to wait.

Finally, our pagers went off to meet the patient, and we headed for Olympia. We met on the rooftop helipad & assumed care of the patient. I was relieved that he seemed remarkably stable considering his diagnosis and the fact that time hadn’t been on his side so far in his transport to Seattle, until now. I was experienced enough not to be lulled into a false sense of security by his initial presentation, but my instinct was that this would be an uneventful transport.

So I was completely stunned when, as we lifted from the rooftop helipad, I heard the engine noise suddenly decrescendo, and we immediately lost lift and then altitude. I was fully aware that we were crashing before the belly of the helicopter impacted the retaining wall of the helipad, and my first thought was “Are you… KIDDING me?” I was in absolute disbelief. As we teetered for a moment my thoughts snapped to Airlift 4…to Erin, Lois, Steve…the devastation of their loss on their families, friends, Airlift, and the EMS community as a whole.

Not that there’s ever really a good time for this sort of thing, but I thought, “This timing is really bad,” and I thought of my Airlift colleagues going through another memorial service, and my friends, and especially my family, as we had already suffered the loss of one of my sisters.

It initially felt like we were crashing in slow motion. I was in the aft-facing seat and had no idea how far we had to fall. I briefly thought, “What can I do?” but I quickly realized there was nothing…it was the most helpless feeling you can imagine. All I could do was sit and wait for an unknown eventuality and all I could think at that point was, “Please God not now.”

Suddenly the tail rotor impacted the cement building and then the main rotors. We were propelled into the most violent and loud horror you can imagine. As we were falling and ricocheting off the buildings, all I could do was try to hang on. The mechanisms of injury flashed through my mind as these massive transfers of energy were taking place. I’d been an emergency/critical care nurse for 15 years, and I knew the potential outcomes. Words like “impalement,” “blunt force trauma,” and “rapid deceleration,” bounced through my head as I was waiting for the energy to be transferred to me as the rotor blades were exploding into shrapnel as we impacted the side of the building.

I suddenly had the gut-wrenching feeling that there was a distinct possibility that we were not going to survive this…there are no words to describe what that felt like.

So when we finally impacted the ground after what seemed an eternity, I was again stunned but was cautiously ecstatic to realize that we were all alive & I didn’t have any serious physical injuries. I told Ken, our pilot, “We’re okay we’re okay” and he responded that he was shutting down the aircraft. My pediatric RN partner was getting out of her belts as I asked the patient if he was okay. He said he was. I don’t think I even gave a second thought to his AAA (which, incidentally, turned out to be diverticulitis…good thing.)

The survival training we’d had was at the forefront of my mind, and I knew how to be decisive. Though we were on dry land, it was water survival training that I found to be most helpful. When I was suspended upside down in that underwater cage, I realized how much slack there was in my belts and since kept them cinched as tightly as I could tolerate. Further, we were taught to fight the instinct to bail out of the aircraft immediately and wait until the rotor noise was completely gone. So I waited.

Because of our training, I knew how to close the fuel lines, shut off the battery, engage the rotor brake (had our pilot been incapacitated), and egress the aircraft,  Our pilot, Ken, called the Communication Center and the Post-Accident & Incident Policy, or PAIP was initiated. When the aircraft was silent, I asked Ken if I could get out. My door was jammed, so I pulled the red Velcro tab & tried to pop out the window. It wouldn’t budge (come to find out you have to pull out the weather stripping as well). So I kicked it into several pieces (which is a great use for adrenalin) and crawled out. The distal tail section of the aircraft was lying across the courtyard and what was left was smoking. A crowd of ER staff had gathered, called 911, & immediately went to work helping Ken get the patient out. When my partner got out, she immediately had a syncopal episode. It was a surreal moment when I found myself kneeled over her doing a neuro assessment next to the wreckage of our helicopter. She did come to, thankfully, and the ER staff took over from there.

THE AFTERMATH:

While I feel I was adequately prepared to deal with this particular accident itself, neither I nor my organization was adequately prepared for the aftermath. Plus we were all already maxed out by the fatal crash of Airlift 4.

I stood for a moment in the courtyard where we’d crashed and realized I felt nothing. I was completely emotionally numb & I thought that was odd considering what had just happened.  I went to the ER to be evaluated as well but found that I couldn’t sit still.

So a couple of days later, when my chief flight nurse at the time asked, “What do you need?” I had absolutely no idea.

Responses to traumatic or stressful events are individual and varied and fall on a continuum. Different people cope in different ways. So there is no “right answer,” per se as to exactly how people should be supported. But that is something that individuals and organizations need to figure out, preferably before the need arises because it is extraordinarily difficult to sort all that out in the midst of a crisis.

Surviving survival was something I knew little about. Initially, I thought I was okay. Three months later I discovered I was not. The nightmares and sleep disturbances came hand-in-hand, along with terribly distressing feelings of anxiety and a constant sense of impending doom. My unfamiliarity with these feelings produced fear, which only served to exacerbate everything else. Come to find out, there are solid scientific physiologic explanations for this, but I didn’t know that at the time.

While I was SO grateful to have survived the crash without serious physical injuries, I had NEVER experienced anything like this in my life. It was as if my spirit, or light…that thing that makes you, you…had disappeared.  Fifteen years of emergency nursing and all of the secondary trauma that brings, the recent loss of our crew and a close look at my mortality proved to be overwhelming. Being a typical flight crewmember, I was a master of the poker-face, and so the magnitude of my distress would go unnoticed, except for those who knew me well. And I did not know where to turn for help. I didn’t know anyone else who’d survived a helicopter crash before. I had heard about a guy named Jonathan, the sole survivor of a crash into the Potomac River, but at the time he just seemed so far away, and I didn’t have the wherewithal to figure out how to reach him, or if he’d even want to be reached.

I returned to work. But when I had crawled out of the wreckage of the aircraft, I was a changed person. Any naivete or innocence was completely shattered, and my trust and faith had been rocked. We eventually learned that the cause of our crash was deemed “pilot error” as Ken had accidently lifted from the helipad with one engine in idle. But the bigger questions, “Why exactly did that happen?” haunts me to this day. There was human error, but there were also system issues at play.  Our crash was fully preventable, and I was hell-bent on not allowing what had happened to our crew to happen to anyone else. I felt that, since we had all survived, this crash presented a set of lessons handed to us on a silver platter. After all, we had been in the eye of the storm. We had valuable information which we were not only willing to share; we wanted very much to share it so that our colleagues and friends would not have to experience what we had.

My primary concern post-crash was that neither the crash nor the fallout is allowed to happen to anyone again. What I needed the most was to know that lessons from preventable accidents are learned, collaborative solutions are developed and applied, and the information is shared industry-wide because we are all connected. I soon came to realize that, aside from still reeling from the loss of Erin, Lois, & Steve, my program was in the thick of a financial and PR nightmare after experiencing back-to-back crashes.  The organizational turmoil plus my personal turmoil was taking too large of a toll for me to continue flying.

So nearly a year after the crash, I decided that flying wasn’t in the cards for me anymore, and I went from being a member of a very bonded group of professionals caring for others’ injuries and illnesses to feeling alone in dealing with my own. So beyond the symptoms I was experiencing, I lost the job that I’d loved, lost my direction, lost most of my income, and as a result had to sell my home. Any one of these situations in and of itself is stressful, let alone all of them together.

Finding a nursing job back in a hospital wasn’t as easy as it may seem. There is no hospital in Western Washington that doesn’t have contact with Airlift. So if I left, how could I find a place to work where I wouldn’t constantly be reminded…? I seriously considered leaving nursing altogether.

I finally realized that help was not going to come to me so if I wanted to get my life back on track I was going to have to find it myself. I sought out counselors and psychologists who specialized in trauma; I educated myself, I talked a lot, listened a lot, and read as much as I could searching for anything that would help me find the tools to calm this overwhelming stress response. It wasn’t that I was ruminating or wallowing in this because God knows if I could have escaped this catecholamine-laden hell I would have, but it is in fact, involuntary…the body’s physiologic response to stress. And rather than attempt to ignore it and let it impact my health, relationships, and career for the rest of my life, I chose to look at it, and learn about it, and find effective methods to cope. By the grace of God and with the support of my family & friends, my spirit came back…but it took years. It has taken an immense amount of work to recover from this accident. There is a clear need for resources.

In 2006 I heard of the Alert helicopter crash in Kalispell, MT, my hometown. I called their chief flight nurse and left a message of support for their flight crew. It was the combination of having a personal attachment to Montana and realizing the Alert crew would likely experience what I had experienced post-crash that prompted me to call. I heard back from their pilot, who I’d graduated high school with, and eventually, I heard back from Megan Hamilton. We talked at length and immediately recognized the similarities in the post-crash fallout, though our accidents were quite different. She then paid it forward and contacted Teresa and Jeff after their crash in Kansas, where she’d had her nursing and EMS training. Then we met Jonathan, the sole survivor of the crash into the Potomac River, and so our group is expanding, person by person, and it is in the sharing of these human experiences that healing can be found. Together, we have since created the Survivor’s Network for Air & Surface Medical Transport.

SOLUTIONS:  “What do we live for, if it is not to make life less difficult for each other?”  George Eliot

There are a plethora of lessons that can be pulled out of each of our experiences that are not meant to be kept to ourselves.  I can accept the risk of uncontrollable catastrophe—this job clearly has inherent risks…but I can’t accept unnecessary risks and accidents that are preventable or the secondary trauma that comes from being unprepared.

Here’s what I believe worked up to this point:

Education and training build competence and confidence and helps to relieve anxiety even in this type of maximally stressful situation. I felt I was prepared to handle this situation. The things that helped us survive this were:

  • Facilitated CRM/AMRM
  • Helmets, Nomex, Steel-toed high top leather boots
  • Four-point restraints cinched tightly
  • Hands on survival training: Water, winter, dryland
  • Had we crashed in a more remote area, I had a small survival kit on my person, and there were additional survival supplies in the aircraft
  • Crash simulator experience at AMTC in Reno
  • Safety checklists—familiarity with aircraft systems, egress
  • PAIP in place—procedures, emergency contacts, etc
  • Personal and organizational preparedness for accidents

 All of this happened because the program had a proactive approach to safety. And it MADE A POSITIVE & INVALUABLE DIFFERENCE FOR US! What a shame it would be to survive the crash itself, only to die because you were unprepared for what came next.

SURVIVORS NETWORK:

We were scattered across the country, alone in our unique experiences. Now we’re networking and sharing information, and that has helped us, as well as many across the industry, immensely. Part of industry risk mitigation is breaking free of existing in our little bubbles and realizing that we are all a community. Accidents impact all of us. Certainly, each program and region have its set of unique needs, but we can certainly learn from the experiences of others. Ours was not the first time someone had lifted with one engine in idle in this aircraft. It was a known issue with this particular helicopter.

 “Safety is not proprietary.”

The Survivors Network addresses the continuum of Risk Mitigation-Accident Preparedness-Response-and Recovery.  It also serves as a venue for people to share lessons they have learned regarding safety and survival.

We identified an opportunity to create something positive from our experiences and between all of us, we found our voice, and we found a place at the table.  We know we don’t have all the answers, and so we are always looking to network, partner, and collaborate to help create a better future for this industry of invaluable professionals who do incredible work.

KISS THE WAVE:

I recently had the phenomenal experience of rafting the Colorado River through the Grand Canyon. Before we approached the big rapids, our paddle guide laid out the plan for getting through them. When she finished, she said, “You kiss the wave or the wave kisses you,” meaning, when you’re approaching the rough water, you have a plan, you work together, you lean in, dig in with your paddle, and never give up…you kiss the wave…you get through the rough water, and if someone still gets knocked into the water, you’re prepared…you throw out a lifeline and work together to get them to a safe place. Whoever is in the water can choose to grab it or not, but at least it was there. Conversely, if you’re unprepared, have no plan, aren’t working together and supporting each other, the wave kisses you…it broadsides you & either knocks individuals out or flips your entire raft in which case you’re no good to each other because everybody needs to be rescued.

Now…I’ve been swimming for a long time, and I finally made it to the shore. My raft is long gone, but here you all are in your rafts. We know there are rapids ahead—we’ve seen them, and we know what they can do. So we are calling to you now from the river’s edge, “Kiss the wave!”

Click here for Survivor Network resources, information, education, training, tools, and support. 

References:

  1. survivors-network. (2016). survivors-network. Retrieved 23 August 2016, from http://www.survivorsnetwork-airmedical.org/

 

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