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Memorable Moments

of us like the variety, not knowing what's going to come through the door next," says Dr. H. Arnold Muller, a 1953 graduate of DMS. "For me," he adds, "part of the fun of it was the challenge of effecting rapport with somebody who didn't start the day off thinking they were going to be there and [who] doesn't know you from a hole in the ground."

Dartmouth Medicine asked Muller, Yanofsky, and several others with Dartmouth ties to share their most memorable moments in emergency medicine. The following stories are edited from either written or taped accounts.

H. Arnold Muller, M.D.
A 1953 graduate of DMS, Muller was the founding chief of emergency medicine at Penn State-Milton S. Hershey Medical Center in 1973. Later, as Pennsylvania secretary of health from 1979 to 1987, he lobbied for accreditation of trauma centers and for EMT training standards. From 1987 to 2003, he was chief of the emergency department at the Lebanon, Pa., VA Medical Center. He retired from practice in 2003 but continues to teach part-time at Penn State-Hershey. Here he describes an experience he had back in the 1970s.

My most vivid memory is not a gripping story per se, but one that illustrates how far the field has come. I clearly recall an ambulance pulling up at the ER door with the two attendants both in the front seat—and the patient all alone in the back. The driver and the other fellow both got out and brought in the patient, who was dead. Even so, one of them should have been in the back. I was startled, to say the least. It's not that they didn't care—it's just that they saw their job as simply being to drive the patient to the hospital.

This incident may sound banal to someone not in emergency medicine, but anyone now in the field would surely be shocked by it, as I was then. We've come such a long way. Today, emergency medical technicians (EMTs) and paramedics evaluate patients at the scene—be it the highway or the home—and start treatment right away. And they're in contact with the emergency department, to let the staff know what's coming in and to ask advice. They can even send ahead EKGs and other test results. It's a much better, more mature field now.

One of our crew members got so tired and dehydrated they had to give her IV fluids to keep her going.

Norman Yanofsky, M.D.
Yanofsky, the medical director of DHMC's Emergency Department (ED), was in training in the 1970s when emergency medicine was on its way to becoming a specialty. After doing his residency at Northwestern and working as an ED physician in Chicago, he came to DHMC in 1982 to head its new emergency department. Here he describes the inauguration of the Dartmouth-Hitchcock Air Response Team (DHART) on July 1, 1994.

I'll never forget the first day the helicopter was in service. We had no idea what would happen. I thought that it might be as much as two weeks

before anybody called us. We went on line at 7:00 in the morning on July 1, and within 15 minutes we got called down to Springfield, Vt. It was a scene call—an unconscious person who had been in an automobile accident.

I think we got seven calls the first day DHART was in service, and we were able to respond to six of them. In fact, one of our crew members got so tired and dehydrated—because it was a very hot July day—that they had to give her IV fluids just to keep her going.

John Hinds, B.S.
Hinds, a flight paramedic and the current operations manager for DHART, has worked in the emergency services field for 29 years—as a paramedic for 23 years and as a National Ski Patroller in New England for 29 years. He is also a member of a federal Disaster Medical Assistance Team (DMAT) based in Massachusetts and was deployed with the team to Plattsburg, N.Y., after the 1998 ice storm; to Ground Zero after 9/11; and to Bam, Iran, after an earthquake there in 2003. He is also a paramedic for a joint FBIBoston DMAT tactical medical support program.

About a year and a half ago, I was part of a DHART specialty ground transport team that had been sent to another New Hampshire hospital to pick up a nine-year-old boy from their pediatric ICU and transport him to DHMC. We had been told that he'd been sick for three days and was having difficulty breathing, and at Dartmouth, he would be able to get more intensive care.

Upon entering his room, I was immediately convinced that he needed to go by DHART air and not by ground. He was lying on his left side and was dusky in color and lethargic. His skin was pale and clammy, and he appeared tired and distant. He also had a croupy cough, and as he was gasping for air, I could see that he was using his accessory muscles—the muscles between his ribs and in his neck and shoulders—in order to breathe. That's a sure sign of trouble.

"There's no way I'm going to put that boy in the ground ambulance," I said to myself. I was afraid that he would go into cardiac arrest in short order. So I called Dr. Filiano, the chief of Dartmouth-Hitchcock's Pediatric Critical Care Section, and requested that the helicopter

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