Slashdot Mirror
Stroke Victim Stranded At South Pole Base
Hugh Pickens writes "Renee-Nicole Douceur, the winter manager at the Amundsen-Scott research station at the South Pole, was sitting at her desk on August 27 when she suffered a stroke. 'I looked at the screen and was like, "Oh my God, half the screen is missing."' But both the National Science Foundation and contractor Raytheon say it would be too dangerous to send a rescue plane to the South Pole now, since Douceur's condition is not life-threatening. Douceur's niece Sydney Raines has set up a Web site that urges people to call officials at Raytheon and the National Science Foundation. However, temperatures must be higher than -50 degrees F for most planes to land at Amundsen-Scott or the fuel will turn to jelly. While that threshold has been crossed at the South Pole recently, the temperature still regularly dips to 70 degrees below zero. 'It's like no other airfield in the U.S.,' says Ronnie Smith, a former Air Force navigator who has flown there about 300 times. A pilot landing a plane there in winter, when it is dark 24 hours a day, would be flying blind 'because you can't install lights under the ice.' The most famous instance of a person being airlifted from the South Pole for medical reasons was that involving Jerri Nielsen FitzGerald, a doctor who diagnosed and treated her own breast cancer. Using only ice and a local anesthetic, she performed her own biopsy with the help of a resident welder. When she departed on October 16, 1999, it was the earliest in the Antarctic spring that a plane had taken off."
'It's like no other airfield in the U.S.'
The South pole isn't apart of the US.
McChord Air Force Base has a couple of C-17s in Christchurch *right now* involved in Operation Deep Freeze. Of course, the jets keep the engines running while cargo goes off and on, and as a point of fact, we are now actually doing NVG landings and take-offs.
If you want news from today, you have to come back tomorrow.
Not only is the condition not life threatening at the moment, the rescue wouldn't achieve much since by the time the victim could be transported out of there, any damage would've been done already. Not to mention that putting her into an unpressurized plane (if it's too cold for the C130) could be dangerous by itself.
Could you install lights *over* the ice though? Some sort of high-power laser projector on a pole or mounted on a building capable of projecting an image of the landing lights onto the snow.
When you sign up for a tour of duty to a place like that, you also sign a number of waivers and documents stating that you are aware that there is no bailing out early, and no chance of a rescue flight in winter. I'm sure it must suck to try to recover from a stroke while at the South Pole, but there is no reason to risk the life of others just to get her out - even less now that she is actually recovering.
At least actual transport is fast once it's safe to send it these days; Amundsen and his team spend 99 days going from the coast to the south pole and back, Scott and his team was on the move for about 150 days before succumbing to hunger and cold (in reality succumbing to bad planning and lack of preparation).
Everything in the world is controlled by a small, evil group to which, unfortunately, no one you know belongs.
... will be that the criteria for residing at the South Pole will be tightened to not include people at risk for common age related conditions -- ie. people over 40 or so. Granted, a stroke can occur at any age, but strokes predominantly occur in older individuals. This means that future qualified people will denied such opportunities because one person couldn't accept the concequences of risks that common sense would dictate are associated with living at such a remote outpost.
Absolutely. Anyone at any age who volunteers to spend time on the South Pole must recognize they have no access to emergency care. I sympathize with her situation, but no more lives should be put at risk to rescue her.
She had the stroke a month and a half ago. The next scheduled flight is one week away. Maybe this would have been newsworthy on September 10th, but at this point, if she's functional, she can last another week.
Honestly, how bad would she (and her family back home) feel if they send a "rescue flight" tomorrow, and it crashes on attempted landing, killing the crew? Or how bad would her family feel if it landed successfully, managed to take off again, but then the engines die halfway to the coast due to jelled fuel, killing the crew AND her?
Another non-functioning site was "uncertainty.microsoft.com."
The purpose of that site was not known.
Wait a minute. It's the THING.
It took her over and doesn't know how to operate her body, so it's claiming to have had a stroke so it can get back to the mainland to infect the rest of us...
Some people will start to exhibit altitude sickness even at 8,000 feet.
http://lkml.org/lkml/2005/8/20/95
This reminds me of Ingrid Betancourt; she was warned not to go in the rebel area because she could get kidnapped. She still went to the rebel area and got kidnapped. And we are supposed to feel sorry for her.
lucm, indeed.
First, email the people on this list and tell them the money saved denying Renee a Medevac flight will not be worth the bad press. Ask them to do the right thing.
Please no. This really isn't about saving money. If that's all it was, they'd do the flight just to head off the bad PR.
Sending a flight to the south pole in adverse conditions costs lives. Figuring a 1 in 15 chance of a crash per round trip and a flight crew of 3, that's 0.2 lives you're paying to airlift her out of there.
That's an acceptable risk for someone who will die unless they're rescued, but that's not the case: she had a stroke; the damage is done. They probably have her on blood thinners now and she's off-duty and taking it easy, which is basically all that they can do for her in a proper hospital to prevent a recurrence. Any rehab therapy she needs can be adequately done by videoconference until they can get a flight down there.
I'm sure(?) that the people at NASA are looking at this and thinking:
"What would this be like if this happened in deep space, with no possibility of rescue or even airdropped (space dropped?) supplies?"
Is there an age restriction on astronauts (to reduce the likelihood of diseases which become more prevalent with age?). Are there any policies about pushing people out of the airlock if they can't be helped (now that would be something interesting to see on wikileaks).
This looks like a bad situation for everyone involved.
How does she know if it was really a stroke? Only by symptoms??? It could be many other diseases from optic neuritis, multiple sclreosis onset... or glaucoma. Did she have a CAT or MRI scan to differentiate? Also if she had stroke and it just affected her vision she may consider herself as very lucky, without thrombolytic therapy. She was also aware that going to South Pole is not like hitchiking in the mountains, no 911 calls. Anyway I wish her well and hope she will recover.
Raines has set up a Web site that urges people to call officials at Raytheon and the National Science Foundation.
With the purpose of what? Endangering more lives? This isn't a rational plea for help, it's irrational panic.
Assorted stuff I do sometimes: Lemuria.org
You're talking about trying to mark the runway with reflected light? That is you are going to shine a laser light on the ice and the reflection off will somehow be bright enough to see at a distance?
I doubt that would work. The normal situation has lights which directly emit light.
http://lkml.org/lkml/2005/8/20/95
Paging Doctor House
-50F is about -45C.
== Jez ==
Do you miss Firefox? Try Pale Moon.
It would be easy to mod a plane to use Hydrogen. real issue is the fluids in the hydraulic systems.
Still You think someone would take up the challenge to redesign a plain for the Antarctic environment. A lot of issues to overcome but certainly not impossible.
sounds like an ideal xprize project
http://photolibrary.usap.gov/Portscripts/PortWeb.dll?query&field1=Filename&op1=matches&value=09122008_NVG_C17.JPG&catalog=Antarctica&template=USAPgovMidThumbs
Nice landing shots at night.
Id like to see a SR71 land there.
Liberty freedom are no1, not dicks in suits.
A C-17 Globemaster III aircrew from McChord Air Force Base, Washington, performed the first known after-dark landing in Antarctica using night vision goggles on September 11, 2008.
http://photolibrary.usap.gov/Portscripts/PortWeb.dll?query&field1=Filename&op1=matches&value=09122008_NVG_C17.JPG&catalog=Antarctica&template=USAPgovMidThumbs
Liberty freedom are no1, not dicks in suits.
Your giant u2 concerts have giant lasers, thats enough to light up a virtual run way.
You're only caveat is temperature, but hey, your laser can be inside a building just have it go 'out the window' as such .
Only people who want job security pretend it takes months. You could design a system in a 24hr (3day) burst design session. Ala skunk works 1958.
Those were real engineers, not engineers designing a way to guarantee that their jobs will be valid for 12 years of updates, because documentation is poor.
Hackers can build this in 8 hrs, just give them unlimited online ordering ability.
Liberty freedom are no1, not dicks in suits.
http://www.greatlandlaser.com/other-applications.html
Oh theres a patent.....
Liberty freedom are no1, not dicks in suits.
What is the very first thing you do in a first aid scenario? You see someone down you stop and assess the situation. You never proceed to help a victim unless its safe to do so or you want to earn a stupidity ..er.. I mean bravery medal.
You go in all mucho and heroic you stand a chance of increasing the number of casualties. No only does that put your stupid arse in a sling, but it also limits the amount of help that will be available for the original casualty when the smarter rescue team arrives.
Sydney Raines is now actively petitioning for something that could have a very good chance of not only getting people killed, but worse still potentially getting people killed and preventing help for the one who currently needs it.
That's a hell of a story. What a badass.
sustainable living
I know Renee personally. In fact, I submitted this story to Slashdot in late September, but it didn't get posted.
There are other factors involved. Renee is aware of the problems with an evacuation this time of year, but was more concerned about being prevented from getting a second medical opinion and being denied a medical attendant on the evacuation flight. She sought publicity upon the advice of her lawyer, who felt this was the only way to pressure the company to do the right thing - and the publicity campaign has worked. Renee is now getting a second medical opinion and will be getting a medical attendant on her evacuation flight.
Polar aviation technology has advanced considerably since 1999, and a Twin Otter can safely land at considerably lower temperatures than an LC-130. You may note that Renee did not ask for an evacuation in August or most of September - merely that a plane be put on standby for an evacuation as soon as possible in October. She didn't earn her Engineering degree or get to be Winter Site Manager by being stupid. There was also concern that the denial of her reasonable request for a second medical opinion, etc., might be retaliation related to some issues with anonymous whistleblowers which she handled.
It should also be noted that some types of stroke can get progressively worse, and that she is currently at a high altitude with low oxygen which might exacerbate the damage. I understand the skepticism, but like I say - she is not stupid.
More information here, though note that this page was established by family members, not Renee herself:
http://www.facebook.com/pages/Evacuate-Renee-Nicole-Douceur-from-Antarctica-Immediately/139354572829055
Renee is at the South Pole, at an elevation of 9300 feet - however, because the atmosphere at the poles is thinner than at the equator, air pressure at South Pole is roughly equivalent to 10,500 feet.
However, this is a good point. It is one of the reasons why Renee requested a medical attendant on her evacuation flight, as well as a second medical opinion about her condition. Both requests were at first denied, but fortunately this publicity campaign has succeeded in getting both these requests granted.
As always with news stories, some of the most relevant details were omitted.
(I wintered with Renee at McMurdo Station in 2009, and have been in contact with her regarding her current circumstances.)
Workers in Antarctica tend to be young (before they've had kids) or old (after they've had kids) or social misfits (like me!)
Workers in their 50s are common.
In any case, there were other factors involved - like being denied a second medical opinion or a medical attendant on her evacuation flight - that caused her to seek publicity. Fortunately, she is now getting both - thanks to the publicity.
Green and Red Flares for a temporary runway, heating coils around the tanks to keep temps around -10.
Simple, easy, cheap. Get to it, Raytheon. If your best couldn't think of this solution in less than 5 minutes, quit sending people there, as you are obviously NOT prepared to be responsible.
Still waiting on Serviscope_minor to wake up to fucking reality and realize that Jessica Price isn't going to fuck him.
If you're at Kerguelen, why did you even bother to post as an Anonymous Coward? Aren't there, like, only 4 of you?
Anyway, there were other factors involved. See my other posts.
As I've been saying elsewhere, there were other factors involved. Renee was being denied a second medical opinion, and denied a medical attendant on her evacuation flight. Thanks to the publicity, this has now been rectified. Naturally, the relevant facts never make the news. It ain't sexy.
I assure you that Renee is no whiner. I wintered with her at McMurdo in 2009. She's a tough lady.
There are other factors in play here, which may come out in the future.
Renee was primarily concerned about getting a second medical opinion and a medical attendant for her evacuation flight. Both of these were previously denied to her - but thanks to the publicity, both have been now been granted.
Who needs a conversion chart? At ~ -40, it's the same for both scales. Anything colder than that is "too cold to contemplate", and the actual numbers are irrelevant.
I wonder why the south pole station doesn't make more use of robotic transport such as the Tubleweed Rover, ballistic transport pods or steerable balloons to transport supplies rather than depending on people. The ISS relies on robotic "progress" supply ships at least as much as it relies on human space flights. If we can do this in space, why not on earth?
This kind of thing is what the V22 Osprey was made for. It should have the range to get to the south pole, and it should be able to land vertically, get the person on board in 30 seconds, and get the hell out of there.
I have to say, time and again, its pretty cool shit to see the breadth of people who hang out on Slashdot... Here's a story about a woman at the freaking SOUTH POLE and we have people posting who actually know her. AND someone chimes in from another one of the most isolated places on the planet. Its just cool in so many ways. (technology - the fact that anyone can read Slashdot from apparently anywhere... and then the fact that they do...) Hey, anyone on the ISS want to chime in?
And to think that I gave up the opportunity to spend a year in Antarctica as a research assistant in my youth... Don't mind "normal" cold, but that was a bit more than I was willing to submit to. In any case, these people are to be admired for their persistence in following their dream.
Sometimes, real fast is almost as good as real-time.
Whoa. That guy is the bloke *I* want around when the crap hits the fan.
You make me wonder who'd win if he battled a honey badger.
The standard treatment for stroke includes a clot-busting drug such as TPA if you can get it to the patient in the first few hours after the stroke. While this won't help her, they should keep a stockpile of it around for the next time somebody gets a stroke.
It's a bit more complicated than that - it helps some kinds of strokes and hurts others, so you need to consult a neurologist about it; I don't know if they'd also need to have CAT scan or equivalent medical hardware to help diagnosis.
Bill Stewart
New Fast-Compression-only CPR http://preview.tinyurl.com/dy575ks
That was my thought upon reading the article. Do we have 58 year old astronauts on active duty? I also think that positions such as these come with the personal risk assumption. Sending a plane out to get her would put other lives in more danger than is posed by her waiting.
One of the airplanes mentioned in the article is a DeHavilland Canada Twin-Otter. Twin-Otters are great aircraft. I am glad that they're being built again (now by Viking Air)
Hrm, Kerguelen. The land of perpetual wind. Having spent time there, do you think it would be practical to put in wind turbines and use these for useful, exportable things such as aluminum production?
You can't just strap skis on a C-130 and make it into an LC-130 - it's a different plane, structurally. For a C-130, the gear is retractable; on an LC-130, the gear is fixed and the skis go up and down around the tires, allowing it to land on snow or hard surfaces on any flight.
The differences start at the keel. They have the same exterior shape, but internally, the LC-130 and C-130 aren't identical and aren't convertible.
Twin Otters and Baslers (stretched DC-3s) have strap-on skis. For Antarctic operations, they land at Rothera Station on gravel, are towed to snow, and are equipped in the field with skis and spend the entire summer landing on snow. At the end of the summer, they do the process in reverse, occasionally passing through Pole a day or two after the last LC-130 flight in mid-February.
Apparently, according to her own words, Renee is already acclimated at about 10,000 feet. Wikipedia confirms that Amundsen-Scott station is at an altitude of 9,301 feet.
That's the GPS altitude, but the density altitude (because of the low temperature of the air) fluctuates between about 9300 feet and 14,000 feet (approx 630 millibars to just over 700 millibars), hovering in the 10K-11K range most of the time.
A winter evac has happened using a twin-otter in late April 2001 of the doctor suffering from pancreatitis. It is possible to land at night at the South Pole - Lot's of oil drums with lit jetfuel line the runway. Temperature -90F. It's doable but has to be life threatening and is a real risk to the pilots.
I think they use lithium batteries in which case there are some that can operate at very very low temperatures so fuel freezing wouldn't be a problem
It is true that the flight crew for a LC-130 is three-persons (Pilot, Co-Pilot, Navigator), but there are additional personnel for any mission to the Antarctic. A flight engineer, crew chief and loadmaster will usually be attendant on the flight. In addition to that, this flight would be an AeroMed flight, and so would have at least a flight-nurse and two medical technicians.
The only unit that *MIGHT* reach the south-pole, right now, and do a medevac, would be the 109AW from Scotia NY. With the fuel and bearings and gaskets ceasing, even that would be a crap-shoot for actually getting out of there, if you even were able to land using the ground-radar for altitude gauging in the low-light conditions. Any wind and the airfield will become a giant cloud of snow, reduced to near-zero visibility.
Unfortunately, this would be an extremely risky mission; risking 9-crew members in extreme conditions to do a medical transport in the Antarctic spring. This mission would be on-par with risking a SEAL-team to rescue a hostage that was going to be released in 3 months anyways. Sorry, no car-analogies. I would take the mission, and trust in the pilots, but I don't think the pilots can/will do this one.
The fact that we cannot reliably get to the South Pole for 5 months of the year is the very reason they have a general-surgeon and ER doctor at the pole.The patient is stabilized, and I also think that it is touching that so-many people have mobilized support for this woman, but we don't have the TECHNOLOGY in place to get down there and get-out with any amount of safety. She will have to wait 3-months for reasonable landing conditions.
The Navy has lost an aircraft in a crash at the pole, and we have lost an aircraft to a snow-crevice on the airfield. Its a dangerous environment.
And to the McChord C-17 folks. Its great that you guys fly the long-haul down to McMurdo, just to drop the stuff off for the ANG to pickup to actually get to the pole. Nothin' but love for ya, baby. :-)
Right now electric power is only practical for the smallest of planes, unfortunately.
"When information is power, privacy is freedom" - Jah-Wren Ryel
This is perhaps a stupid question because I don't know much about this area or base. But I know they just finished building an ice road - why is that not an option? http://en.wikipedia.org/wiki/McMurdo-South_Pole_highway
//m
It should also be noted that some types of stroke can get progressively worse, and that she is currently at a high altitude with low oxygen which might exacerbate the damage. ...
If you can pass a message along, tell her to rebreathe with the assistance of a plastic bag. This helps prevent hypocapnia (low blood CO2), which is induced by oxygen therapy....
All patients on oxygen should have 5% carbon dioxide added into the mix. While uncommon, this is not entirely unheard of. I found some MSDS from a British medical gasses supplier last week about their various CO2 blends: Normal air enriched to 5% CO2, Oxygen with 5% CO2, pure CO2 for use by an anesthesiologist. The bookmark is on another computer, can find if interested...
Also see the last paragraph on this page: http://www.altitude.org/sleep_at_high_altitude.php
Learn the rules so you know how to break them properly.
www.teslabox.com
True but that was at the beginning of winter and not the end. Also the patient had gall bladder attacks and life threatening pancriatitis. The current patient had a stroke and is in stable condition. Completely different situations.
The backup plane may not have even helped. Lets see, I am going to send another identical aircraft into exactly the same conditions where another aircraft had difficulties. What is to say that the seconds aircraft wouldn't have problems just like the first?
I applied for that job several years ago and was a finalist, so I know a bit about the situation down there. There is a doctor on duty down there through the winter, so she is getting medical attention. Also, the time is almost here for "regular" flights to begin in and out of there for the beginning of the scientific research season. Remember that it is almost mid-autumn here and so that means it is mid-spring down there. And, normally, flights do begin from our station in New Zealand to our outpost on McMurdo Sound. Normally, the planes land there and then go on to the South Pole. At the latest, they should be able to get her out of there by November. They only allow a person to have that job for 13 months because of the stresses involved in living in the dark and extreme cold of the Antarctic winter. When I talked to the lady that had the job while I was applying, she said it was 90 below outside and that the hazard there that is feared most and is trained for the most is that of fire. Regarding the territory issue, the United States has no territorial claims on Antarctica unlike many other countries who do have claims. We officially recognize none of them. Another interesting fact, Antarctica truly is international territory and is the only place in the world you can go without a passport. As noted, we do have two major installations down there, at the South Pole and at McMurdo Sound. The military is involved, but the stations are managed by Raytheon for the National Science Foundation, which is our organization that is responsible for the scientific research and related work that goes on down there. Raytheon is a logistical contractor to NSF for purposes of keeping the stations up and running, and providing all of the services needed by the people on site during the winter and during the research season. Normally, the first planes in down there that signal the beginning of the research season go in in late October. The last planes out are usually in February. After that, everyone down there are on their own until the following October. Now, though, we do have good contact with the folks who work down there with the internet.
Given the speculation I am seeing here about there possibly being obese or mentally unfit people working down there, I can assure you that is not the case. The Raytheon jobs at Antarctica are among the hardest to get in the world. You have to go through an extensive application and interview process and then, if they think they want to hire you, there is a major medical screening involved. The necessary health and fitness level may not be at the level required say for an astronaut, but it is pretty darn close. The fact is that otherwise healthy people do sometimes get sick, with major things happening like strokes or cancer. The doctor several years ago who had cancer really did need to get out of there so that treatment could begin. In order to get her out, they had to mobilize a whole National Guard unit, from Maine, as I recall who could get a plane into there at just the right moment, get the lady loaded on and then off they went again. Very, very hazardous conditions. I do not know what the ambient temperature was for that endeavor but it was definitely during a part of the year when 90 below (fahrenheit) is not unusual. Back to territorial issues, many countries do have scientific stations in Antarctica. And, it is suspected that well below the ice are a plethora of minerals, perhaps even hydrocarbons, as the land underneath the ice is geologically related to both Australia and S. America, both of which have major mineral deposits. There is a global treaty the governs Antarctica and for now, it is truly reserved for the conduct of science. In about 1990, there was an addendum to the treaty which prohibits any mining or mineral extractive activity down there for 50 years. It won't be that long before it should be up for renewal. The logistical matters involved with trying to mine or extract hydrocarbons down there would be truly horrendous. One more thing -- the conditions at the S. Pole are made even more treacherous than one might realize because the elevation there is over 9,000 feet -- thin air territory. That means there is almost two miles of ice on top of whatever land there is at the south pole. What snow and ice there are there has blown in over the millennia and accumulated. It is a desert like situation because there is little to no actual snowfall there, only snow that blows in from elsewhere. If you can understand what I have come to know about Antarctica, I truly wanted that job and still would jump at the opportunity to have it. It would be the closest thing to having the chance to live on another planet for 13 months.
DRSABCD - Danger, Response, Send for help, Airway, Breathing, Circulation, Defibrillation. Still stuck at "Danger".
--
no sig for you. come back one year.
Or as we're taught DRABCD because if you need an acronym to remember to do the S then something is wrong with you :)
Jeff Tracy? Is that you?
I know this is a bit late, but I will post this here in case anyone is looking through this later.
I got an email from Renee better explaining her position and her situation:
"Latest news: It appears the Kenn Borek Air Ltd DC-3 Baslers and Twin Otters are stuck in Chile, South America until the weather clears at the UK’s Rothera Base on the peninsula of Antarctica. Once the planes get there the pilots will rest and put skis on the planes then fly here (I think a 6 to 8 hour flight, maybe more). This goes to show and proves my point that Raytheon / NSF should have pre-positioned the planes ahead of time so that when a weather window opened they could come in to get me, instead of now being stuck in Chile.
"Perhaps you are unaware that there were different professional opinions between the consultant doctors at University of Texas Medical Branch and the National Science Foundation consultants regarding the need for a medical attendant and supplemental oxygen while flying from the South Pole to McMurdo Station on the coast of Antarctica then hop on a C-17 then fly to Christchurch, New Zealand for diagnostic testing to see what really happened / going on and determine if its safe for me to fly over the Pacific then across the US to John Hopkins in Baltimore, Maryland.
"When I learned of the differing professional opinions I requested to have an independent opinion from John Hopkins. After battling with the Raytheon lawyers for more than a week to allow my doctor here to sign the paperwork to have an independent opinion I finally received the independent opinion from John Hopkins yesterday. They don’t think it was a stroke and think it could be a tumor or something else. They too mention I need to get MRI right away and should have been done within a couple of weeks when I had the so-called “stroke” or whatever. But here I wait which in 3 days time will be seven weeks because a decision was made within a matter of days (I have a memo) after the surmised stroke while brain swelling was still on going that they were not going to send a special mission (undoubtedly using the pretext that weather is to dangerous for the crew). Even worse they solely relied on their subcontract doctors from Texas (which we all know goes to the lowest bidder) on what they were saying. I’m not faulting the doctors by any means but it’s Raytheon and NSF not taking the initiative to seek other opinions which meant I was the one who had to speak up and demand an independent opinion – which of course said she needs to get out in quick haste, right away – not just leave her because somehow she appears to be stable.
"For the record I’ve always said I know the risks involved in flying a rescue mission and would not want the aircrew to risk their lives just for me. However, when precedent was set in April 2001 at minus 92F in the pitch black then again in September 2003, then I ask why aren’t they pre-positioning resources ahead of time such that when a weather window opens (which it has) then come in and fly me out.
"As far as the thinking that my situation is not life-threatening I say how do they really know it’s not? No one mentions that within days of my so-called stroke while brain swelling was still going on they made a decision not to even make an attempt to come in early but instead continue with the pre-planned schedule for flying to South Pole, which is mid-October.
"Raytheon has clear policies which says and I quote: “This category [Urgent] refers to cases that must be evacuated as soon as possible to save life, limb, or eyesight or prevent permanent disability” which “by definition, movement required as soon as possible with highest support level.” The doctors here have always said even to this day that I need to be evacuated as soon as possible. John Hopkins said the same yesterday. Obviously, to save life is life-threatening but certainly though eyesight or prevent permanent disability is perhap