On November 1, 1986 a corporate jet owned by Coca-Cola arrived at Elisabeth City, North Carolina carrying the CEO and Acting President of the Word Foundation and several members of the board of directors.      Shortly after they had left the airport for a meeting in town, a series of events began to unfold which drove one man to create what we know today as Corporate Angel Network or "Angel Flight".

A Coast Guard Falcon 20 was beginning its takeoff roll at Elisabeth City when it blew both front wheels causing the jet to veer off the runway and run into a fence line. The jet was headed to Memphis, TN to pickup a little girl by the name of Crystal Grant and carry her to Good Samaritans Children's Hospital in Houston TX to under-go a liver transplant. The pilots of the Coca-Cola plane watched the events and slowly began to hear the stories about the jet's mercy mission. After a few hours the CEO and his passengers returned to the airport and witnessed the scene and asked the pilots what was going on. Once the CEO had learned of the situation he asked to be taken to the Coast Guard Station so he could speak with the station commander. Once there he asked him if there was anything he could offer or do. The Commander said, in a frustrated voice, "Yeah, can you make miracles happen. We need a jet and we need one fast." The CEO just smiled and said you've got one and pointed to his company jet. 
  
 

Within two hours the Coca-Cola jet was on it's way to Memphis and the situation seemed under control. But unbeknownst to them a similar scene was playing out in San Diego where the donor organ was being prepared for transport to Houston. The aircraft lined up to take it to Houston had lost its ability to pressurize its cabin and a similar scramble was under way to find a replacement. 
  
 

Calls went out and everyone made excuses from corporate CEO's to airlines managers as to why they just couldn't help out. Once word made its way to Elisabeth City the situation was reaching its last window of opportunity for the surgeons. Time was now becoming an enemy. 
  
 

Again the CEO of Coca-Cola was called upon to help out and he jumped on the phone with his pilots now in Houston. They told him there was just no way they could go and retrieve the organ and return to Houston in time for the operation to take place.  The CEO began to think and ponder what would be speedy enough to retrieve it in time. A call was placed to the Governor of Georgia and he then placed a call to the Governor of California requesting help. 
  
 

On that day sitting on the ramp at NAS Miramar were 6 brand new F/A-18A's and 2 F/A-18B's (two-seaters) wearing the colors of the Blue Angels, as the team prepared to debut them to the world on November 6. It only took 4 phone calls to reach the base commander and 2 more to reach the commander of the "Blues." 1:55 minutes later, Navy Lt. Tony Less, in Blue Angel # 8, was gear up eastbound with his precious cargo strapped into the rear Martin Baker ejection seat -- held in place by four dress belts. 
  
 

Unbeknownst to the family or anyone in Houston, while all of this was unfolding, the local media had interviewed the little girl moments before she was placed into the prepping room for her surgery. A reporter asked her if she was scared. She responded, "No I'm not worried. My mommy told me that my Angel will watch over me". 
  
 

It was an ironic statement indeed. At that moment Blue Angel #8 was coming off an ANG tanker over Western New Mexico and making a mad dash for Houston. 
  
 

The clock was still ticking, and with each movement of the hand went further against the surgeons. With only 90 minutes to spare, Angel #8 turned final to Houston's Hobby Rwy 4L and rolled out to a stop surrounded by police cars and an ambulance to rush the organ to the hospital. 
  
 

To sum up this story, the transplant was successful and Crystal returned home to Memphis in time for Thanksgiving. The CEO of Coca-Cola lobbied the Fortune 100 companies to create Corporate Angel Network, the name inspired by the Blue Angels. To this day Blue Angel #8 wears a small silhouette of an Angel praying on the canopy rail and the name "Crystal" written underneath. 
  
 

A little over a month after the surgery the "Blues" made a planned detour to Memphis to say hi to a little girl named Crystal. And it was on that day, December 18, 1986, that Crystal met her Angel, the Angel who saved her life. 
  
 

That was fourteen years ago. Today Crystal is 24 and every year she is personally invited to attend a show near her home in Memphis as the guest of honor to the Blue Angels.

Glascow Coma Scale Infant Eye Opening Child/Adult 4 Spontaneously Spontanesously 4 3 To Speech To Speech 3 2 To Pain To Pain 2 1 No Response No Response 1 Best Verbal Response 5 Coos, Babbles Oriented 5 4 Irritable cries Confused 4 3 Cries To Pain Inapp. Words 3 2 Moans, Grunts Incomprehensible 2 1 No response No response 1 Best Motor Response 6 Spontaneous Obays Commands 6 5 Localizes pain Localizes Pain 5 4 Withdrawls f/ pain Withdrawls f/ pain 4 3 Flexion(decorticate) Flexion(decorticate)3 2 Extension(Decereb.) Extension(Decereb.) 2 1 No Response No Response 1 _____=TOTAL ->(GCS <=8?->Intubate!)<-TOTAL=______ PEDIATRIC TRAUMA SCORE +2 +1 -1 Pt. Size >20 kg 10-20 kg <10 kg Airway Normal Mantainable Not mantainable without Needs invasive invasive procedures procedures CNS Awake Obtunded Comatose Systolic >90 radial 50-90 femoral <50 mm Hg BP no pulse open None Minor Major or Wounds Penetrating Skeletal None Closed Fx Open Mult. Fx Total_________ <= 8: Critical injury: Transport to Pediatric Trauma Center

Trauma General HX - MOI - Location of trauma, pentrating vs blunt injury? Assess LOC (alert, verbal, pain, unconscious.) AIRWAY obstruction? Pulses, BP, capillary refill, severe bleeding? Disability/neuro assessment. Glasgow coma score. Expose and perform exam, Check pupils; tracheal deviation? Sub-Q air? Juglar venous distension? Assess chest: look for trauma, pneumo, check lung sounds. Evaluate adbomen, pelvis, extremities, back. Abdominal guarding, distension, rigidty, hypotension, pallor, bruising? Are there medical causes? (e.g. diabetes, CVA, MI, ect.) --Assess scene safety. Protect C-spine, Give O2, Check respiratory rate, adequacy -- vent if needed. Trauma Head HX - MOI-- estimate forces involved. Any changes in LOC? Amnesia? Was seat belt, helmet worn? Resp. rate, pattern, quality; Chest or trunk injuries? Vitals, Pupils, Neuro deficits? Posturing? Reflexes? Blood or CSF from ears, nose? Scalp, skull depression, associated facial trauma? ++--Secure airway while providing C-spine immobilization. Control bleeding with direct pressue. Do not stop bleeding from nose, ears if CSF leak is suspected. Give )2, start large bore IV (TKO unlesspatient is in shock.) Monitor vitals & neuro status. EKG, Pulse, oximetry; consider intubation and ventilation if GCS<= 8. CAUTION-- Airways suspect C-spine injury in the head injury patient. Assess and document LOC changes. Be alert for airway problems and seizures. Restlessness & or agitation can be due to hypoxia or hypoglycemia. Check chemstrip. Traumatic Cardiac Arrest --Penetrating trauma? Transport rapidly to trauma center.-- HX - If blunt trauma (MVA, crash injury) survival =< 1%; consider pronouncing patient dead in the field, espically if there are other patients who need medical care (contact OLMC). ++--Secure airway, do CPR (shock VF). O2 IVs, en route. Splint fractures en route.

Trauma - Abdominal: HX - Mechanism of injury, associated trauma, penetrating vs blunt injury? Suspect internal hemorrhage. Guarding distentsion, rigidity, hypotension, pallor, bruising? RUQ - Liver, gallbladder, duodenum, head of panceras, right kidney (posteriorly) asending colon, transverse colon. LUQ - Stomach, tail of pancreas, liver, left kidney (posteriorly), spleen, transverse colon, desending colon. LLQ - small intestine, decending colon, left ovary, fallopian tube. RLQ - appendix, cecum, right ovary, fallopian tube, small intestine. Midline - Great vessels (arota, vena cava) bladder, uterus. Back - Kidneys, spleen, on left side + - Vitals, 02, IV, treat for shock, transport. Trauma Chest: HX - MOI: estimate forces involved. Lung Disease? Resporatory distress? Pain? Use of accessory muscles? LOC, color, GCS, is pt. anxious? Tracheal shift? Symmetrical cx expansion? JVD? Lung sounds? Hemoptysis? Sub Q emphysema &/or crepitus? Life Threatening chest injuries: -Flail Segment -Open Chest Wounds -Tension pneumothorax + Secure airway, high flow O2, intubate if necessary and assist ventilations Open Chest Wound: Cover with occlusive dressing. Look for exit Wounds. Tension pneumothorax: Evaluate and decompress Impaled objects: stabilize in place. Do not delay transport if pt. is unstable. Consider IV Fluids for shock (2 large bore IVs( Monitor EKG, Vitals, Full spinal Immobilization. Caution--Consider other causes for respiratory distress

Burn Chart (only count 2 and 3 degree) Infant: Head = 18% Left Arm = 9% Right Arm = 9% Front = 18% Back = 18% Perineum = 1% Right Leg = 14% Left Leg = 14% Adult: Head = 9% Left Arm = 9% Right Arm = 9% Front = 18% Back = 18% Perineum = 1% Right Leg = 18% Left Leg = 18% Iv Fluid Resuscitation % Burn Area x Pt. Wt. in Kg = ml/hr NS --------------------------------------- 4 Give this amount over the first 8 hours Give an equal amount over the next 16 hours Example: 20% burned area, pt. weighs 70 Kg: 20x70 = 1400 = 350 ml/hr for 8 hours. Then give ----- ---- 175 ml/hr over next 16 hours. 4 4 (Calculated from time of injury) *The patient in shock needs more aggressive IV fluid replacement and should be treated according to your shock protocol. *Major burns should be treated at a burn center, including : > or = 25% body surface, hands, feet, face, or perineum; electrical burns; inhalation burns; other injuries; or severe preexisting medical problems.

Physiological: -Systolic BP less then 90 -Respiratory Distress--Rate < 10 or > 29 -Altered mental status, or Glasgow score 20 minutes using heavy tools -Death of any occupant in the patient's vehicle -Ejection of patient from an enclosed vehicle -Falls greater then 15 feet Comorbid Factors: (Any combination of high-energy transfer in comorbid factor should increase the index of suspicion for severe trauma injury.) -AGE <12 or >60 -Pregnancy -Significant preexisting medical problems -Extremes of HOT and COLD -Presence of intoxicants Index of Suspicion: -You may enter any patient into the Trauma System suspected of having experienced trauma regardless of physical findings. The reasons for system entry must be documented completely. Rapid Trauma Priority, Color, Condition, Notes: 1 Red Immediate Life Threatening 2 Yellow Urgent Can Delay up to 1 hour 3 Green Delayed Up to 3 Hours 4 Black Deceased No Care Needed Priorty one: Unconscious, disoriented, very confused, rapid respirations, weak irreguler pulse, severe uncontrolled bleeding, other signs of shock (cold, clammy skin, low blood pressure, ect.) Priorty two: Urgent, can delay Transport up to 1 hour: Conscious, oriented, with an significant fracture or other signigicant injury, but without signs of shock. Priorty three: Delayed Transport up to 3 hours, Walking wounded, CAOx3, minor injuries. Priorty four: Deceased no care needed: no pulse, no respirations (open Airway first), obvious mortal wounds (e.g. decapitation.) Notes: -Assessment of Patients should be <1 minute each. (Have someone else control bleeding during your survey.) -All unconscious patients are Priorty 1 - Immediate. -"Walking wounded" are usually GREEN - Priority 3 -All pulseless patients are BLACK - Priorty 4 Mentation/LOC Assessment: A- Alert able to answer questions V- Verbal responds to verbal stimuli P- Pain responds only to pain stimuli, protect airway U- unconscious Protect airway, consider intubation Multiple Patients: -Strategically park vehicle and stay in one place -Establish Command, and identify yourself as Command to dispatch (use calm clear voice) -Size up the scene and advise dispatch of: a. Exact location and type of incident b. Any hazerdous conditions c. The location of the command post d. The best routes of access to the scene e. Estimated number and severity of patients -Designate an EMT to perform rapid triage (see rapid triage), tag and number mulitiple patients (Immediate, Delayed, Ambulatory) -Order Resources (fire, police, ambulances, HazMat, extrication, Air Units, tow vehicles, buses, ect.) -Set up staging areas (clearly state the location of staging/assembly areas, and thing of access and egress) -Coordinate access of incoming units to the scene -Assign patients to incoming medical units -Maintain communications with On Line Medical Control (OLMC) -Keep Patient log indicating patient number, severity, treating and transporting units, medical interventions, and destination hospitals. Mass Casualty Incident: (use multiple patient guidelines above and the following ICS groups.) Medical Branch Director: -Responsible for overall medical direction/coordination -Orders additional medical resources -Serves as a resource for group supervisors Triage Group Supervisor: -Estimates number and severity of patients -Establishes tagging and extrication teams -Establishes triage areas, if necessary -Maintains rapid and orderly flow of patients to treatment areas Treatment Area Group Supervisors: -Secures treatment areas, idnetifies equipment needs -Clearly marks, Treatment Areas for Immediate, Delayed, Ambulatory -Established treatment teams when resources allow, Identifies order of patient transport Transportation Group Supervisors: -Establishes Patient Landing Zone (near treatment area) -Assigns Patients to ambulences, supervises actual loading. -Relays Unit number, severty and number of patients to Communications Group Supervisor. Communications Group Supervisor: -Communicates with Medical Resources Hospital (MRH) to identify receiving hospitals -Maintains patient log -Recieves information from Transportation Group. Radios or phones this information to MRH, and is given the destination hospital for each ambulence. Confirms destination with ambulence, and moves another unit from EMS Staging Area into Loading Zone.