Roadside Rescue Triggers Rare Code Chill and ‘Miracle’ Ending

Members of the Allen Hospital ICU team, including Dr. Vishal Goyal (third from left), Dr. Karl Terwilliger (fourth from right) and Dr. Sharad Bajaj (far right).

At UnityPoint Health, we want to be there for patients every step of the way. On one particular Friday night in January, that was never more true.

Valerie Jones, the supervisor of the supply chain department at the hospital in Marshalltown, and her husband, Kirk, saw a car ahead of them veer off the road.

It marked the start to a remarkable story of UnityPoint Health patient care, collaboration that ended at Allen Hospital in Waterloo, a trauma intervention called “code chill” and an unbelievably happy ending.

But the path from Marshalltown to Waterloo is anything but a straight line, and it all began in Marshalltown, with Valerie and her husband.

“We were about 50 feet behind another car when we saw it gently slide into a snowbank,” said Valerie. “We got next to his car 10 seconds later, and I could see him slumped over. We couldn’t get in. It was locked, and I could see he was gasping for air – he was unconscious but gasping. We were all banging on the windows for two minutes as more cars stopped, and someone took his boot off and was trying to break the window.

“Out of nowhere, this wonderful man (identified later as Isaac Wildman) came by with a sledgehammer and just smacked it and broke it. My husband then climbed in from the passenger side, and I went to the other side and threw open the van door. He had all this equipment. I just threw the equipment and his seat back. He had no pulse.”

Valerie, who has worked at the hospital in Marshalltown for 36 years, was a scrub tech 18 of them and began administering CPR, while another person at the accident, Angie Eastman, helped Kirk do chest compressions.

“Honestly, I thought he died,” said Valerie. “I just put my mouth on him and gave him breaths. I didn’t care if I was going to get sick. It was like, ‘I have to give this man air, he’s gasping.’”

Within minutes, Jimmy Hicklin, Tanner Wolken, Crystal Cremeans, Nathan Overmann, Bobby Colin and Nick Heintz with UnityPoint Health – Marshalltown EMS arrived and pulled the man from the car and continued emergency treatment.

“The longer someone is unresponsive without oxygenated blood, the more unlikely we will have a positive outcome,” said Heintz, manager of the Marshalltown EMS. “CPR provides a temporary solution to ensure vital organs still get blood. By Val administering CPR immediately, it helped ensure these organs continued to get blood until paramedics were able to provide interventions such as an advanced airway, fluid resuscitation, medications and defibrillation.”

The EMS crew soon delivered the patient to the emergency department at UnityPoint Health – Marshalltown, where Dr. Blaine Westemeier believed the man would be ideal for a hypothermia protocol (also called “code chill”). After a quick phone call, the decision was made to transfer the patient to UnityPoint Health – Allen Hospital in Waterloo.

A hypothermia protocol is a special process performed on a cardiac arrest victim. A sedated patient’s body is cooled to 33 degrees Celsius (91.4 Fahrenheit) to reduce swelling, which is what happens to the brain when it doesn’t receive oxygen. The patient is then kept cool for 24 hours. After that, the body is warmed for 17 hours with hopes the patient will wake up.

However, a hypothermia protocol can only be performed in certain situations, such as when someone has coded and was resuscitated within 30 minutes. And even if those criteria are met, the chilling process must start within a four- to six-hour window – and the sooner the better.

In Waterloo an hour later, Dr. Karl Terwilliger and Dr. Sharad Bajaj received the patient, but the 59-year-old’s condition was complicated by the fact he had multiple blockages that had to be resolved.

“And that was going to take some time, and I’m thinking that we don’t have much time because we’re already at the fourhour mark,” said Dr. Terwilliger.

No matter. The cath lab team chose to start the cooling process while the patient was still having stents put in place. Then he was rushed to the ICU, where the cooling catheter started the 24-hour chilling process.

“I’ve been doing this a long time, over 20 years, but we get this (to work) once or twice a year,” said Dr. Terwilliger. “This was pretty dramatic. I really didn’t expect a good result.”

Then, the waiting game began. By Sunday, there was real hope.

“The monitor we had on his brain was giving really high numbers and usually we only see those high numbers when someone’s waking up,” said Dr. Terwilliger. “So, I had a good feeling on Sunday and, sure enough, when we turned all the sedation off, he woke up.

“It was a long weekend. I probably worked 60 out of 72 hours, but when he woke up, it made the whole thing worthwhile.”

The patient’s prognosis is amazingly good. Other than some short-term memory loss and lingering discomfort from the chest compressions, he’s looking at a full recovery after some cardiology appointments.

For Valerie, Kirk, Isaac and Angie, it was the happy ending she needed. For three days, they wondered if the man survived and, because of patient privacy laws, was unable to inquire about his status.

“It means everything to me and, wow, thank you Jesus for placing me there,” Valerie said. “And you know what I told somebody? Maybe that was my whole purpose of being born, was to save this one man. You just never know what you’re on this earth for, what you’re here to accomplish.”

“For me, it was a miracle,” said the patient, who asked to not have his name published. “If I was a minute or two later getting out of work, then they would have never seen me go off the road. It was miracle that the right people were in the right place when this happened.”

And the result underscored strong collaboration between two UnityPoint Health facilities.

“It took an amazing team effort on the part of two hospitals to coordinate this kind of care,” Dr. Terwilliger said. “I think it was a really good story how the Marshalltown team and Allen team got together and collaborated and did a really good job of saving this guy’s life. And he’s such a nice guy. That’s the thing, he’s such a nice guy.”

“There were all very good people, and I appreciate every one of them,” said the patient. “I’m very thankful for everybody who worked to save me.”