‘In the Caring Hands of the Elite’: Critical Care Coordination Saves Lives on the Slopes

Stowe, VT – High above the valley floor, alone on the edge of a wooded slope on Mount Mansfield, Steve Stahl fell unconscious into the snow.

Nearby, Mike Jolly, RN, was enjoying a day of skiing with his long-time friend, Jared Supple. Both experienced emergency medicine clinicians with experience working on Mt. Mansfield ski patrol, Jolly and Supple noticed a pair of skis planted into the snow on the opposite side of the trail. A motionless figure lay nearby.

When Jolly and Supple found Stahl, he was unresponsive and barely breathing. As they worked to clear his airway, Stahl’s heart gave out — cardiac arrest: a dire condition with a survival rate of less than 10% when it occurs outside of a hospital. Jolly and Supple immediately began CPR and called their on-duty ski patrol colleagues stationed at the mountain’s peak.

“We knew we’d need every resource we could muster to bring him back and off the mountain,” said Jolly, an emergency medicine nurse at University of Vermont Health Network – Central Vermont Medical Center. “And we knew we’d need a lot of things to go just right, along with a bit of luck, to get him out of that situation alive.” 

One thing not left to luck was the well-prepared health system that would ultimately save Stahl’s life: members of the ski patrol and good Samaritans on the slope; first responders and critical care crews on the ground and in the air; and the cardiologists, intensive care nurses, physicians and others at University of Vermont Medical Center. 

Life-saving emergency care on the slopes 

Jolly estimates that it took about two minutes for his ski patrol colleagues to arrive. They brought a defibrillator (AED) along with other vital equipment to resuscitate Stahl and safely transport him down the mountain. 

Further down the mountain, Steve’s 18-year-old son, Liam, was growing anxious. He had briefly parted ways with his dad to ski a different part of the trail. After several minutes passed and Steve still hadn’t appeared, he asked a passing skier about his dad, identifying him by his red helmet. It was then that he learned of the grave situation unfolding uphill. He took off his skis and ran up the slope. 

“I couldn’t believe what was happening,” said Liam, who watched as Jolly, Supple and the ski patrollers fought to resuscitate his dad. “I had my mom on the phone the whole time, and I just kept yelling at my dad to keep fighting.”

First responders delivered a shock to Stahl’s heart with the AED, but couldn’t find a pulse, partly due to the freezing temperatures. They gave him a jolt of cardiac epinephrine via IV and loaded him into a toboggan for the descent, attaching an auto pulse device to continue chest compressions.

A race to critical cardiac care

Forty miles away at Burlington International Airport, a radio crackled to life, alerting University of Vermont Health Network’s critical care flight crew to the unfolding crisis. Initially on standby, the helicopter crew decided to take off, heading for Mt. Mansfield.

“Better to be in the air and then told we’re not needed, than being needed and unable to fly because we missed our weather window,” said Jeff Patterson, senior flight paramedic with UVM Health Network, noting that every minute impacts a patient’s odds of survival and the damage done to vital organs. “Shrinking the time to care that addresses the root cause of the problem – that’s the ultimate goal.”

Twenty minutes later, pilot Tom Streit landed the helicopter in the busy parking lot of Stowe Mountain Resort. Patterson and flight nurse Jason Hull joined Stowe Fire & Rescue and ski patrol as they stabilized Stahl, intubated him and placed him on a ventilator for the flight to UVM Medical Center. He remained unconscious and in critical condition, his heart struggling to maintain a healthy rhythm.

Beating a ‘widowmaker’

At UVM Medical Center’s catheter lab, interventional cardiologist Jan Denkmann, MD, and his team quickly diagnosed the cause of Stahl’s heart failure: a near complete blockage of his left anterior descending artery. The condition is often called a “widowmaker.” 

“Steve was a healthy guy, but sometimes plaque can develop in the artery over a long period of time,” said Dr. Denkmann. “When the plaque ruptures and opens to the bloodstream, it can cause a clot. In Steve’s case, it happened in an extraordinarily dangerous part of his heart.”  

Dr. Denkmann and his team used cardiac catheterization, a minimally invasive procedure, to remove the clot and place a stent to restore blood flow. With Stahl’s heart still struggling to pump enough blood throughout his body, Dr. Denkmann also surgically inserted a balloon heart pump to enhance blood flow. 

“His heart was still having trouble recovering and it was unclear if it could sustain itself,” said Dr. Denkmann. “The next 48 hours were going to be critical.”

Alison Stahl, Steve’s wife, arrived shortly after he was moved to the Intensive Care Unit. There she joined Liam and met Katelin Morrissette, MD, the cardiac intensive care physician overseeing his care. 

“It was an incredibly precarious time for him, and it was miraculous that he’d made it that far,” said Dr. Morrissette. “The first responders were just incredible – they made a heroic effort to get him down the mountain and stabilized – but his heart had experienced so much trauma. It wasn’t clear if it could recover.”

Uncertainty and hope

Dr. Morrisette and Dr. Denkmann agreed that Stahl’s heart was in urgent need of more support. At about 2 am, Dr. Denkmann’s team surgically implanted a second heart pump, known as an Impella. The procedure allowed Stahl’s heart to rest and recover while the Impella circulated his blood like a healthy heart would. 

“That was an emotional time, and I will never forget the care and compassion his nurses and doctors showed for Steve and for all of us,” said Alison, who spent the next two days at Steve’s side. “Nurses like Emily, Lorna and Amy. Even though he was unconscious, they spoke to him like he was there and awake. It gave us hope.”

Slowly, Stahl improved. After two days clinicians were able to remove the heart pumps, take him off the ventilator and reduce his sedation. Early one morning, he slowly opened his eyes to see Liam’s teary face looking back at him.

“Seeing Liam’s face – and then Alison’s – was the best feeling in the world,” he said from their home in Connecticut.

A miraculous recovery

After a few more days, Stahl was well enough to leave the ICU for the hospital’s cardiology unit, where he gradually regained his strength and processed what he had been through. 

“That transition can be a difficult time for people like Steve who have survived a near-death experience,” said Kramer Wahlberg, MD, the cardiologist who oversaw Stahl’s recovery. “Much of my time was spent helping him catch up and process what he’d experienced. His physical recovery was incredible – not many people go through what he did and live to see their loved ones again, and those who do often have lasting health problems.”

Stahl walked out of the hospital 10 days after his arrival, his heart function back within the range of a healthy adult. Now, two months after his cardiac arrest, he is back to many of the activities he loves. He plans to return to work soon at the modest home improvement company he started in his semi-retirement.

Reflecting on Stahl’s miraculous recovery, Patterson, the senior flight paramedic, attributes the outcome to three key factors. 

“That day, you had great clinical decision making, incredible communication and a little bit of luck,” he said. “It’s a case study in how multiple health care organizations should work together in an emergency.” 

Alison Stahl, thankful for her husband’s returning health, sees it somewhat differently.

“We will never be able to sufficiently thank the people who cared for Steve,” she said. “From start to finish, he was in the arms of angels…he was in the caring hands of the elite.”