Mountain Biking

Mountain Biker’s Life Saved After Passing Doctor Performs Trailside Tracheotomy –

A mountain biker in Minnesota was given life-saving surgery on the side of the trail by a passing ER surgeon, the Washington Post reports.

Todd Van Guilder was riding on the Cuyuna Lakes Trails on September 12 when he crashed and fell on his stomach and chest. When he sat up he was struggling to see and starting to have difficulty breathing. His riding buddy called 911 and before long 6 emergency service workers were on the scene.

After assessing his condition, paramedics decided he would need oxygen and a police officer volunteered to jog three-quarters of a mile back down the trail to the parking lot to grab a tank. Thankfully, on the way down, the officer passed 38-year-old Jesse Coenen, an emergency room doctor from Wisconsin, who was visiting the trails.

Coenen uses mountain biking to wind down from 13 hour shifts in the ER, but sprung into action when he heard what had happened. He and his riding friend rode down to the parking lot to fetch the oxygen and then rode it back to where Van Guilder was lying unconscious.

“I quickly realized this was a serious situation,” said Coenen, “They told me that the guy had fallen off his bike and that a helicopter had been dispatched. They were helping him to breathe, but it was necessary to make sure that his breathing was adequate.”

The first option for Coenen and the medics was to try intubating Van Guilder. Intubating is a process where a tube is passed down through the throat so they could help him breathe with a manual resuscitator. Coenen made several attempts to insert the tube but was unable to as he couldn’t see the windpipe, leaving him with just one option, a tracheotomy.

I figured he might have anywhere between 10 and 20 minutes before he died. That’s when I decided to enter the windpipe through the neck.”—Jesse Coenen

The tracheotomy is usually done under general anaesthetic and bypasses the throat to allow a tube to enter directly into the windpipe via incisions in the neck. Coenen said, “His oxygen level had started to drop, and I was getting concerned, I figured he might have anywhere between 10 and 20 minutes before he died. That’s when I decided to enter the windpipe through the neck.”

Thankfully the paramedics had a scalpel and gloves but Coenen now had to carry out the surgery on a live human for the first time. “Cutting somebody’s neck like this is a rare procedure, even for a doctor,” he said. “I’d done it before on mannequins and a pig cadaver, and I knew by heart how to do it. I’d just hoped I would never have to.” Coenen’s first incision wasn’t wide enough to insert the tube so he had to cut it again at which point the tube was inserted allowing a paramedic to manually deliver oxygen, saving Van Guilder’s life.

Even despite the surgery, Coenen said that he wasn’t sure Van Guilder would survive but soon his oxygen levels were rising and he could be transported down the trail then taken to hospital in a helicopter. Van Guilder was treated for a traumatic brain injury but escaped with no broken bones. After 10 days of being monitored by doctors, he was released from hospital with minor injuries and on a soft food diet. He told the Washington Post, “I talked to him [Coenen] on a Zoom call and told him how grateful I am that he happened to be there that day at that precise moment. I’m obviously extremely fortunate. What are the odds?”