From Physician to Patient

For Diane Ruschke, an emergency physician at Jordan Valley Hospital in West Jordan, UT, the 4th of July holiday in 2003 started off as an exciting weekend hiking with friends in Little Cottonwood Canyon in Utah. But halfway through the holiday, the doctor who was used to being in charge suddenly became the patient in a freak accident that left her seriously injured on the side of rugged Pfeifferhorn Mountain.

"This is a very popular hike that takes you up past an alpine lake to an area with VW-sized boulders in a really steep climb and a pretty minimal footpath," Ruschke recalls. "I was already coming down, and there were a couple of kids--probably in their teens--going up and, being inexperienced and not knowing what they were doing, they were kicking off a lot of loose rock."

Suddenly, without warning, a rock the size of a bowling ball came bouncing down the hill and landed at Ruschke's feet.

"As it landed, the rock bounced up and hit me in the upper left quadrant, richocheted off my shoulder and kept going," she says. "It didn't even knock me to the ground, but it took my breath away, and I remember thinking, 'I have to sit down; I can't breathe.' The place it happened was steep and irregular, and I had to hike down a couple more feet to some loose rock to sit down. I knew my chest hurt, but other than that, I thought I was fine. My friend saw the rock hit me and instantly dialed 9-1-1, because she was sure from the impact alone there would be something really bad wrong with me. When she reached me, I told her I thought I was fine; I just needed to sit for a few minutes. But after 5 minutes, when I tried to stand, I passed out and couldn't stay conscious. I passed out multiple times in a row, and that's when I decided I wasn't OK and told them I thought I needed a helicopter."

Actually getting a helicopter to respond should have been easier than it turned out to be. Because it was a holiday weekend, the helicopter service had already responded to multiple calls to rescue people out of the canyon, none of whom required transport to the hospital, says Ruschke.

"When we called 9-1-1 and told them I thought I was probably pretty seriously injured and needed a helicopter, they said they would send a rescue team. We made it very clear where we were and how difficult it was to get there, and we were definitely led to believe they were going to send a helicopter. Hours later the helicopter hadn't come. I was starting to get more demanding and telling them how critically I thought I was injured, so they said they would send a ground crew from below to evaluate me first. Unknown to us, because of all the previous calls with no transport, they had made the decision they would no longer dispatch the helicopter until a ground crew reached the person and made an assessment, which significantly complicated things.

"At that point, I wasn't very coherent anymore," Ruschke says, "and I told my girlfriend, 'You need to tell them I'm critically injured. I think I've ruptured my spleen, I have a belly full of blood, and I know my BP isn't over 70. I don't have palpable radial pulses anymore, and if they don't send a helicopter, I'm not going to come off this mountain.'"

The dispatcher's reply was not what they wanted to hear. "Where exactly are you?"

It became apparent, says Ruschke, they had no idea where she was, and they were trying to send a ground crew up.

"We had given them very clear instructions with respect to where we were on the mountain," she says, "but we knew it would take a really good hiker not carrying any kind of equipment at least three hours to reach us and another three to carry me out. At that point, they decided to try to long-line someone down to me, and that's what they ended up doing. I remember when the helicopter finally came around the first time, as he passed over us, I had such an intense feeling of relief that I was really going to get out of there."