Global Rescue Associate Director of Medical Operations Devon Davis, MD (l), Geoffrey Corn, Missy Corn, and Global Rescue Supervisor of Medical Operations Patrick Longcore.
On safari in the Eastern Cape Karoo region of South Africa in January 2016, Global Rescue members Missy and Geoffrey Corn were having the time of their lives. It was their fourth trip to Africa and the couple was looking forward to creating memories of a lifetime. Little did they know that Missy was about to suffer a potentially life-threatening stroke on the first day of their trip, thousands of miles from home.
Global Rescue received a call from the outfitter for the Corns’ trip. The caller urgently stated that Missy was suffering from signs of a stroke -- facial drooping, left arm and leg weakness, confusion, and speech difficulty.
With time of the essence, Missy was immediately transported to the hospital via ambulance after an evaluation by a local physician.
Preparing for the worst
Global Rescue Operations personnel immediately contacted the hospital, liaising with Missy’s physician there to discuss treatment. The company deployed one of its physicians and a critical care paramedic to Port Elizabeth to Missy’s bedside to oversee her care and later evaluate her stability for a flight back to a hospital close to home.
Upon arrival at the hospital, Missy underwent radiological studies showing an ischemic stroke and large arterial clot in the right brachial artery. She was admitted to the intensive care unit for care and observation. Subsequent radiology revealed progression to a hemorrhagic stroke but no other new brain injury.
While in South Africa, Global Rescue’s medical personnel helped to obtain Missy’s medical records for Global Rescue doctors to review. Through a consultation with Johns Hopkins Medicine, with which Global Rescue has an exclusive relationship, physicians there agreed with the Global Rescue medical team’s assessment and guidance on continuing medical care.
The Global Rescue team evaluated transport options. Determining Missy’s case to be critical, the team initiated an air ambulance to conduct medical repatriation back to her home hospital.
An unexpected delay
Then, a further complication: radiological studies of Missy’s lungs showed the presence of multiple pulmonary emboli, including the main pulmonary artery. The critical nature of her condition required cancelling the air ambulance evacuation based on the possibility of it proving fatal (the jet had traveled from Europe and was refueling in Namibia at the time the mission was scrubbed). With the presence of new clotting, an anticoagulation medication was needed. Yet, due to the previous discovery of bleeding in Missy’s brain, this medication could potentially cause further bleeding and also prove fatal.
With no other option, anticoagulation was initiated and she was transferred to the ICU for close observation.
After spending the weekend in the ICU and developing no new issues with the medication, Missy was transferred to the general ward. Over the next two weeks, she worked with physical therapy and our deployed personnel as she prepared for her return to the U.S.
Based on improvement in her condition and the physician’s recommendations, Missy was finally determined to be fit to withstand the long flight home after [another week] of rehab and stabilizing care. Global Rescue medical personnel identified a comprehensive stroke center in the Denver area, the closest suitable facility to the Corns’ residence.
Missy was discharged from the hospital to the care of Global Rescue paramedics, who accompanied her from the South African hospital to the facility in Denver, Colorado.
A personal touch
Missy praised the Global Rescue paramedic who was at her bedside for weeks in South Africa.
“He knew everything that was going on medically with me and would explain it to me,” she said. “When I ended up back in the ICU, he came every day and kept track of me. He talked to my sisters and knew everything about my care and my doctor. When I didn’t know what was going on, he just handled it. Then when my husband left and I was there by myself, it was even more important to have him there.
She continued, “Anything I needed, he got it for me. He smuggled in blueberries because I was losing weight and couldn’t eat the food in the hospital. I broke out in a horrendous rash from the soap they washed me with, and he went and got me little bars of soap so I wouldn’t break out. He held my hand when I needed it.
“He was amazing, all that he did for me. If it weren’t for Global Rescue, I probably wouldn’t be here,” said Missy, emotionally.
Recovering back home
Upon arrival at the Denver hospital, Missy was transferred to the neurological unit for evaluation.
After a successful transport home accompanied by two members of Global Rescue’s transport team, Missy was able to continue her recovery. Following an evaluation in Denver, she was transferred to an inpatient rehabilitation facility in Kansas. In March, she was discharged to her home.
“I’m working therapy five days a week and I can walk without a cane now,” said Missy. “The fine motor skills in my left hand are coming back slowly. It’s not where I need to be yet, but I’m trying to get back into my daily routine.”
Missy is on track for a good recovery. In fact, she and her husband already have plans to return to South Africa in September if she is well enough. Once again, they will head out on safari.
“I tell all my friends and family that if they’re doing any travel, I recommend Global Rescue highly,” said Missy. “We purchased annual Global Rescue memberships this year and it was worth every penny.”
Lieutenant Colonel Rick Steiner is a retired US Army Special Forces commander with 19 years of military experience. For the past 10 years, Steiner has relied on Global Rescue to be his “back up team” whenever he heads out on his hunting or fishing expeditions. “I’ve been to Afghanistan, Somalia, Uganda, Cameroon, Tanzania, and British Columbia, so having a rescue organization standing behind me that has the capability to come get me anywhere I might be is not a ‘nice to have’ -- it’s an absolute necessity,” said Steiner.
Steiner’s hunts take him to very remote areas. “All of the photos here are taken in the Sangha River area of southeast Cameroon, south of Lobeke National Park,” said Steiner. “On the other side of the river is the Central African Republic. We hunted the entire region as my outfitter there, Faro Lobeke Safaris, has over 500,000 hectares in two hunting blocks.
“The entire area is triple canopy jungle with a few villages and logging camps. There are no paved roads --only logging trails maintained by the logging companies. Local fauna includes lowland gorillas, forest elephant and buffalo, bongo antelope, forest sitatunga, various duikers, leopards, a wide variety of monkeys, chimpanzees, and assorted snakes and insects. Daytime highs in May are around 100 degrees F, with 85% humidity, and it rains about every other night. The local people are baka tribesmen, also known as pygmies,” noted Steiner.
“It's a very tough place to hunt. I've taken just about every species available on two separate hunts there. You can only see 20 yards or less in the jungle, and you’re wet all the time -- sweat, rain, or a combination. But it's incredibly rewarding to hunt the place. Needless to say, there are a lot of hazards -- food, water, the gorillas, elephant, buffalo, snakes, car accidents -- so it's very important to be good at personal health management, risk management, and also to have a good medevac plan.”
This past spring, Steiner turned to Global Rescue for assistance when he was feeling feverish while traveling. “I called to get advice on dosages for medicine I was taking. What I got from Global Rescue was a level of follow up and service that approached family practice doctor level of engagement. Totally great.”
Steiner concludes: “Global Rescue is the only service provider of its type that has earned my confidence. I simply won’t go on a hunting or fishing expedition without the peace of mind that comes from having a Global Rescue membership.”
Angie Heister and her husband, Robert
Walking through the Tsitsingombe River Valley in Zimbabwe four years ago, Global Rescue member Angie Heister had no idea that her life was about to change dramatically. Angie and her husband were 10 days into their trip.
“Our guide was shooting birds to cook for us for lunch,” said Angie. “We’d already finished the dangerous game hunting and were in an area where we believed there weren’t any buffalo. We were going down a dirt road with the grass about 8 feet tall around us. With the direction of the wind and the noise we’d been making, that buffalo really should not have been there. He should have gone. Animals will usually run away when they see you but this animal didn’t. He waited for us. You never know what’s in the mind of a wild animal, but I often wonder if maybe he was injured and didn’t want to move, and we got too close and scared him. It was a loud sound, almost like a roar. I yelled ‘lion’ and took off running before I saw the animal.”
The male Cape buffalo emerged from behind a ziziphus bush and came rushing toward Angie and her husband. The bull first hit Angie’s husband, knocking him over. Angie was next.
“It was about four seconds from the time I saw the animal until it gored me. It just happened so fast,” she said. “The horn gored me, and I was thrown. What I didn’t know at the time was that it dislocated my spine. The animal had knocked my husband unconscious. The next thing I know, I’m lying on the ground. I’d heard stories about these animals and how mean they are, so I was trying to cover my head with my arms because I was expecting the animal to come back. That’s the reputation they have. It’s a miracle that the animal did not come back. He kept going.
“I realized I couldn’t move my legs but I wasn’t really processing what that meant,” Angie continued. “I didn’t realize that I was bleeding. The professional hunter came over to assess the situation. He and the guide realized I couldn’t walk, but didn’t realize how much I was bleeding. I knew was having trouble breathing, and it was all I could do to say, ‘I can’t breathe. I can’t breathe!’ We didn’t know it at the time but my ribs were broken and my lungs had collapsed.”
Angie was losing blood quickly, with a gaping wound on her left side. Their guide attempted to stanch her bleeding before bringing her to the nearest suitable landing area for a helicopter. He called Global Rescue.
A helicopter arrived within an hour and transported Angie to a facility in Victoria Falls. In the emergency room, she was stabilized and her injuries were assessed. She had no sensation in her lower extremities and had lost a life-threatening amount of blood.
Global Rescue physicians consulted with Angie’s attending physician and recommended that Angie be transported immediately to South Africa. Global Rescue performed a medical evacuation, bringing Angie via a medically equipped jet to a world-class trauma center in Johannesburg.
“Luckily it was decided that Global Rescue could take me to Johannesburg, which was a fantastic thing,” noted Angie. “It was a tier one health center -- a fantastic hospital with great medical care. Later, I did some research which confirmed it was a really great hospital. But at the time, all you know is that you’re in a country that you didn’t plan to go to, you’re in a hospital, you can’t move your legs, and you can’t feel your legs. You just don’t even have any idea what’s ahead.”
In Johannesburg, Angie was evaluated by neuro and trauma surgeons. In the meantime, Global Rescue dispatched the first of three paramedics to oversee her care. After a thorough review of Angie’s condition with specialists from Johns Hopkins medicine, the physicians determined that she required emergency surgery to fuse the vertebrae in her spine. The buffalo attack left her spinal cord severely bruised and her lower extremities would remain paralyzed for an unknown period of time.
“The trauma surgeon cleaned out the wound and tried to determine the extent of my injuries while trying to keep me alive,” said Angie. “The doctor later told me that the wound was big enough to fit his wrist and forearm through, and that he could see my bowels and the bottom of my lungs. It really is unbelievable that the horn didn’t hit an artery and I didn’t bleed to death. They said my spinal cord was dislocated and they needed to do surgery, but it would probably be two weeks before I was stable enough for that surgery. They put rods in my spine, and the doctors told me the area was very bruised and swollen.
“Global Rescue sent over their first paramedic to assess my situation,” Angie continued. “My husband was still in shock. Family had asked if they should come over but he told them no because he still didn’t know what was going on. He said several times that it was a tremendous help to have Global Rescue’s paramedic there to sit down and explain to him all the different things that were happening to me, and to say ‘we’re checking everything that they’re doing and what they’re doing is the right thing.’ You just can’t imagine the feeling when you’re that far away from home and in shock. You just can’t process what happened. Having Global Rescue there was an incredibly important thing.
“Global Rescue sent a second paramedic who took charge of gathering all of the medical tests and coordinating with the doctors there to validate that I was getting the right treatment. Before the accident, I was a health nut. I worked out four or five days a week, running and lifting weights. I was in reasonably good shape. After the accident, I had trouble even holding a fork.”
As rehab progressed, the Global Rescue team worked closely with Angie on her options for rehabilitation back in Dallas.
“Global Rescue started the conversation about where to take me when I got home,” said Angie. “I didn’t know anything about rehab centers, yet it looked like I would have to go to one. At this point, I didn’t realize that I would be paralyzed for the rest of my life, you know? My thinking was, I had the surgery and the doctor said I’ve got to give it six months. I thought I would start working on learning how to live like that, just in case. I wasn’t going to wait six months before trying anything. But it hadn’t set in mentally that this was going to be the new world.
“We were looking at rehab places in the suburbs of Dallas Metroplex. Now I laugh when I drive around and see all these little places because most of them are guaranteed to get you back on the football field really fast. They’re all geared toward a high school sports injury. I didn’t realize what a specialized rehab it is for spinal cord injury. Global Rescue had been recommending Baylor as the best one. As I look back, so much of the advice we received from Global Rescue was so critical because at the time, we just didn’t know anything.
“At the same time, Global Rescue began to discuss how we would be getting back home. There were countless logistics that Global Rescue handled that we would never have considered – what type of aircraft, ideal countries in which to refuel, and on and on. The medical oversight by Global Rescue was fantastic. The Global Rescue paramedic suggested that I do more rehab before I traveled. At the time, I thought he’d lost his mind. Now looking back, I can see that he was 100% right.
“Having the Global Rescue team look at my situation and say, ‘In this many weeks you should be so much stronger and then you should be able to do this’ – well, it was just imperative. I don’t quite have the words to explain how important it was having Global Rescue help us figure out where we were going to be in a day or a week or a few weeks, because we were just lost.
“After I was moved to the rehab unit of the Johannesburg hospital, I was learning how to transfer from the bed into my wheelchair or from the wheelchair into another seat. It’s a very hard thing to learn. A few days before we were scheduled to travel, Global Rescue’s third paramedic arrived. He was wonderful. I can’t even imagine had it been just my husband and me trying to get home. There’s no way physically we could have done it.”
Global Rescue evacuated Angie back home to Dallas.
(Part II to follow)
Global Rescue member Steven Huskey was on a hunting trip to the Canadian Rockies when suddenly things went very, very wrong.
“During a steep, snowy descent through the Canadian Rockies in pursuit of an elusive Big Horn sheep, I found myself sliding down the mountain toward a cliff. As I went over the edge, I instinctively grabbed for a sapling. It was like a made-for-TV-movie.”
With help from Global Rescue, Huskey lived to tell the tale of his ordeal.
“[As I fell,] the momentum of my weight and my pack dislocated my right shoulder, breaking the socket and tearing pretty much every tendon and ligament including my bicep. After finishing the descent with my arm duct-taped to my body and an extremely agonizing horseback ride to camp, I was able to call Global Rescue on the satellite phone,” said Huskey.
The Global Rescue operations team launched into action, making plans for a field rescue and evacuation to transport Huskey to a hospital to receive medical care. With significant snowfall forecast for the following two days, the helicopter rescue was set for the first break in the weather.
“First, they worked with my guide to ensure I was stable and gave him warning signs to monitor. Second and most impressive, they coordinated with my fiancée, the local medical personnel, the outfitter, the aircraft as well as the Royal Canadian Mounted Police and other local authorities,” said Huskey. “The snow and terrain prevented a ground rescue team from reaching my location, so as soon as the weather broke, Global Rescue had a helicopter en route. Their coordination and persistence was impressive.”
The helicopter transported Huskey to the hospital, where he was evaluated, admitted, and treated for his right shoulder dislocation. Global Rescue’s paramedics kept in contact with him throughout his ordeal to ensure he was receiving proper care until he was discharged.
Huskey’s advice: “If you are a back country adventurer, your Global Rescue membership should be at the very top of your packing list.”
Snakes are an integral part to many ecosystems and, as an outdoor enthusiast, it is only a matter of time before you encounter one in the backcountry. Venomous snakes are most prevalent in temperate and tropical climates, with April-October being peak snakebite season. There are roughly 15-20 deaths per year in North America related to venomous snakes. The risk of dying from a venomous bite increases when multiple bites are involved and when the bite occurs in the very young, old, or in persons with underlying respiratory or cardiovascular problems. In the US, venomous snakes account for only about 20% of all snakebites and out of that 20%, many do not result in envenomation. Some studies suggest that up to 20% of rattlesnake bites are deemed ‘dry’ bites, with no venom being injected. Dry biting is a sign of maturity in the snake; more experienced snakes will use a dry bite as they try to gauge the level of a perceived threat and since snakes do not have an infinite amount of venom they will try to use it sparingly.
The majority of poisonous snakes in the US are pit vipers. Rattlesnakes, copperheads, and cottonmouth (water moccasins) snakes are in this family, known as Crotalidae. Typically, pit viper victims tend to be young males, 11-19 years old, who are bitten on the hand while trying to pick up the snake. Alcohol has been shown to be a common factor in these incidents.
The best guideline for snakes is complete avoidance. The old adage that ‘it’s more afraid of you than you are of it’ is generally true, and most snakes only bite when they feel threatened. If snakes are encountered, give them a wide berth and continue on your trek.
As there are many types of snakes, venomous vs. nonvenomous, and different types of venom, hemotoxic vs. neurotoxic, opinions on treatment methodologies can be as numerous as the different snakes themselves. However, many experts tend to agree that certain folklore treatments should be avoided. These include pouring alcohol over the bite, making an incision over the bite site, cauterization, amputation, use of electric shocks, and packing the extremity in ice. Many of these so-called treatments are urban legends. The use of suction (attempting to ‘suck’ the venom out of the bite) is controversial but all experts agree that if attempting this technique you should not use your mouth to apply suction.
Field management for snakebites should focus on limiting the systemic spread of the venom and rapid evacuation of the victim to a hospital equipped to handle envenomations. During the evacuation, you should do the following:
1. Keep the patient calm and inactive. Remove jewelry and constrictive clothing.
2. Clean around the bite site and keep the wound free from dirt and debris by covering with a sterile dressing.
3. Immobilize the limb in a neutral position.
4. Avoid the use of compression bandages unless bite is from a neurotoxic snake (coral snake, cobra, krait, or other).
For those with advanced medical training, continue to monitor vital signs, ensure airway is patent, be prepared to treat victim for anaphylaxis, nausea/vomiting, and pain. The patient should be continuously monitored for the first 4-6 hours. If after 6 hours the victim does not display any adverse signs or symptoms, it is generally safe to suspect a bite without envenomation. Support hydration orally if possible, start an IV in an unaffected limb if available. Defer food ingestion during prompt evacuations; if a prolonged evacuation is presented, nourishment will become important to support strength and health. Avoid alcohol intake. Evaluate victim’s tetanus status and consider giving tetanus toxoid. Antivenin is the only proven therapy for snakebite but only when it is specific for the snake involved. DO NOT try to kill or capture the snake for identification purposes. Dead snakes, even several hours later, can reflexively bite injecting venom causing either a second bite or biting another member of the group. Embrace technology and snap a photo with your smartphone…using the zoom!
Wherever your travel takes you, Global Rescue encourages you to do a thorough area study of your destination and research the native flora and fauna that might be harmful.
Read here about a medical evacuation we conducted for a member bitten by an African cobra in Namibia.
In today’s fast-paced world, cellular phones have become a primary means of communication. The technology has advanced rapidly and now people carry sleek smartphones full of apps you did not even know you needed. Cell phones operate off of cellular towers, with your cell phone bouncing its signal to the closest tower, which then relays that signal onward. As you travel farther from urban areas or travel into terrain that is hilly or mountainous, that cellular signal disappears as you are able to connect with fewer and fewer towers. How do you communicate when you are in an area with no cellular towers or where the terrain inhibits your connection to these towers? Satellite phones.
Satellite phones, or sat phones, are mobile two-way communication devices that use satellites orbiting the Earth to receive and transmit data. Sat phones rely on line-of-sight with their satellites to establish a connection. Since they rely on line-of-sight, they work best in open areas with a clear view of the sky. Using them indoors, in vehicles, and even in a city surrounded by tall building and wires will hinder your signal. Satellite constellations are either configured as geosynchronous or low Earth orbit.
Geosynchronous satellites, also called high earth orbit or GEO, are very large satellites that maintain a high altitude (around 22,000 miles) orbit and follow the Earth as it spins. This means that they are always centered along the Equator and generally remain in a constant location in the sky. A constellation of perhaps four satellites will be able to provide coverage for nearly the whole globe. Because of their size, these satellites are able to handle large volumes of data. However, because of their height, they have significant delays in transmission, resulting in momentary pauses for the person on the other end of the line. Since sat phones rely on line-of-sight, polar coverage is hindered and it may be difficult or impossible to get a signal if you are in a canyon or a mountainous area.
Low Earth orbit, or LEO, satellites offer a significantly lower orbit, around 900 miles. They are much smaller and lighter when compared to their GEO counterparts, and there are more of them in orbit. A typical LEO constellation consists of up to 60 satellites orbiting the earth at high speeds. This means that at any one time you will have line-of-sight to at least two or three satellites, giving you more reliable coverage if you are in a polar or mountainous region. Since LEO satellites are much smaller, they are more suited to voice transmission or short text/SMS messaging.
These days almost anyone can benefit from owning a sat phone. Are you a mountain climber or trekker who routinely travels far up in the mountains in small groups? Do you fish in exotic locales, isolated beaches, far down rivers that time forgot, or clear high-mountain lakes? Does the thrill of an African safari stir something deep and primal within you? Even for those who do not typically travel abroad, our own backyards are ripe with places where there is little to no cellular coverage. Anyone who likes to be prepared should know that cellular networks will be the first to crash and/or become overloaded in an emergency or disaster situation while satellite networks will be much more reliable. No matter your pleasure or purpose, satellite phones are a reliable communication alternative.
You can expect to spend in the range of $500-$1500 on a sat phone, depending on your particular needs. Pricing structure for airtime varies with each manufacturer, but a safe estimate is around $2 per minute, plus a monthly service fee. This is significantly lower than roaming charges offered through some cellular networks. Many vendors also rent sat phones for about $75 per week plus airtime.
It is worth noting that, since Global Rescue requires two-way communication with our members, a sat phone is just one method of enabling this.
Satellite phone use is restricted, and in some cases illegal, in a number of countries. Examples include: North Korea, India, Myanmar, Cuba, Iran, Libya, Sudan, Poland, Hungary, and Angola. Please confirm coverage details with your provider prior to purchasing or renting a phone and research possible restrictions imposed by the countries you’ll be visiting.
Should you have questions or wish for further information on sat phones, please post a comment below or feel free to contact Global Rescue at 617-459-4200.
It is impossible to know exactly when or where an injury will occur. While hunting deep within the triple canopy forests of Cameroon, a Global Rescue member thought he had seen it all. Despite having been charged by a buffalo and challenged by a gorilla in the preceding days, the member was unharmed and determined to continue on with the hunt. He understood the inherent dangers of hunting in Africa and felt that he had taken the necessary precautions to deal with the native animals and insects. What he had not envisioned, though, was that the most terrifying moment of the trip would come from an object as seemingly harmless as an elastic band.
Several days into his trip, the member was struck in the eye by an elastic band that had broken under tension. Immediate pain and a flash of bright light were followed by the loss of vision in the member’s eye. Over the next few hours, his vision slowly began to return but it remained blurry. Soon after the initial injury, the member contacted Global Rescue.
Immediately upon receiving the call, Global Rescue critical-care paramedics began to gather more information from the patient. Utilizing improvised items, including the Global Rescue Membership card, as a basic reading chart, the patient was asked to read the phone number from his outstretched arm. Unable to complete the tests, the patient acknowledged sensitivity to light, and noticed that his injured right eye felt a bit firmer to the touch than his left. Having consulted ophthalmologists at Johns Hopkins and given the risk for a permanent loss of vision in the eye, Global Rescue began making plans to evacuate the member.
Deep within the forest, the hunting party began their four hour journey to the nearest airstrip. Global Rescue then secured rights to the only air provider permitted to land on the unlit grass runway. While our operations team was confirming with the patient that a plane would arrive at first light to take him out of the forest to Douala, they were also busy arranging and coordinating transportation to a hospital with a world class ophthalmology department in Belgium. Upon arrival in Douala, he boarded a flight to Belgium, where the staff at the hospital was awaiting his arrival.
The patient was soon examined by the ophthalmologist, who examined the injured eye and provided the required treatment. After consulting with the doctors at Global Rescue, the member was deemed sufficiently stable to return home for continued care in the United States.
While hunting in a remote part of Canada, one Global Rescue member never imagined that fog would be his biggest obstacle since facing a quintuple-bypass in 2004. Global Rescue received a worried call from the member’s wife stating that persistent fog was creating dangerous flying conditions and delaying his scheduled helicopter flight home. For most, this postponement would mean hunting for a few more days, but for this Global Rescue member, who had already run out of his heart medications, it had become a life threatening situation.
Global Rescue immediately assessed the situation and began coordinating with helicopter assets, the member’s Primary Care Physician, pharmacies and the outfitter. Having consulted with Johns Hopkins doctors, Global Rescue’s in-house medical team provided the member with advice to help keep his heart condition under control while he was waiting without medication. As soon as there was a window of time without fog, a helicopter was dispatched to the hunter’s location. The member along with six others in his party were extracted and transported to base camp. The helicopter pilot greeted the member with a package containing all of his medications and a potentially grave situation was averted.
After the member was safely home, he wrote to thank Global Rescue:
“Please convey my deep thanks to all who participated in this effort to help me during this episode. I and the others in my hunting party were very impressed with the thoroughness of your efforts, your commitment and, perhaps most important personally, the support and comfort that you gave to my family. I will remain a Global Rescue client and will laud your capabilities and performance at every opportunity. Thanks again.”
Denis Karnosky, October 2012