Patient Stories 
Sgt. Thomas Keller thought he had only cracked his rib after dropping a barbell on his chest, but the situation was much graver than he thought. Fortunately, quick action by a local medevac team and a cardiothoracic surgeon kept a life-threatening injury from becoming fatal.
Thomas Keller is a correctional officer at the Rosebud Adult Correctional Facility near Mission, S.D. Working out after his shift with fellow officers, he found himself struggling after accidentally dropping a barbell loaded with 315 pounds on his chest.
“The bar slipped out of my hands and landed on my chest,” he said. “I caught the bar after it bounced off my chest and I stood up and racked it. Another officer asked if I was alright and I just told him I needed some water and I’d be fine. I walked around the weight room a little bit, and I remember it getting really dark and I went to a knee.”
A stroke of luck
Thomas’s coworkers called an ambulance, who transported him to the Indian Health Service’s Rosebud Unit Emergency Room. He had fractured his sternum and punctured his heart — a serious condition that would need specialized care. They made the call to arrange for transport to Monument Health Rapid City Hospital.
The Oglala Lakota Air Rescue service had a helicopter that had just fueled up in Winner, South Dakota, on their way home from Sioux Falls. It wasn’t a routine stop for them, so they were nearby purely by chance. The crew landed at the Rosebud Emergency Room before they had a full grasp of Thomas’s injury. Once they understood the severity of the situation, they knew they had to get Thomas in the helicopter and transport him to Monument Health as quickly as possible.
The original plan had been to fly Thomas from the Rosebud Unit Emergency Room to Monument Health by airplane. It would have resulted in another 45 minutes of transport time — which likely would have resulted in a fatal outcome for Thomas.
OLAR was founded in 2019 and is the only Native American-owned air rescue service in the country. They partner with Apollo MedFlight, who provides medical air transport in 11 states, including South Dakota. Together, they provide emergency air rescue services to the Pine Ridge Indian Reservation in southwestern South Dakota, as well as other rural tribal lands throughout the state.
“The mission of Oglala Lakota Air Rescue is to provide immediate access to life-saving care in the communities we serve,” explained CEO Wade Black. “We appreciate being recognized for our role in Thomas’s amazing story, and are proud of the focus on patient care that our teams provide day in and day out.”
Racing against the clock
When the helicopter landed on Monument Health’s helipad, the team took Thomas directly to the surgical suite for treatment. Kalyan Vunnamadala, M.D., a cardiothoracic and vascular surgeon at the Heart and Vascular Institute, had already been briefed by the Rosebud Unit Emergency Department. He understood every minute spent getting Thomas to surgery was the difference between life and death.
“I spoke with the emergency room doctor at Rosebud, who said there was fluid around Mr. Keller’s heart. My concern was that this was blood pushing on his heart,” Dr. Vunnamadala said. “We had a team waiting in the operating room, including our anesthesiologist and our perfusionist who runs the heart-lung machine. All of our OR team was waiting, and as soon as Mr. Keller came in we knew time was of the essence.”
Thomas’s injury had caused pericardial effusion — a buildup of fluid inside the lining around the heart — that results in excess pressure. Dr. Vunnamadala performed a median sternotomy, which involved opening the breastbone in order to access the heart, and then cut open the pericardium to relieve the pressure.
Perspective and gratitude
“I initially thought I had just broken a rib. I didn’t know it was that severe. But when I saw that many doctors suited up and locked in, I knew it was more serious,” Thomas said. “Once they put the gas on my nose, I remember I had a sigh of relief. It felt like my fight was done. It was in this guy’s hands now, and I felt like it was all going to be okay.”
MedEvac Foundation International selected Thomas Keller as their Patient of the Year for 2021 for his experience with Oglala Lakota Air Rescue and Monument Health. Award recipients are chosen based on their ability to demonstrate that their medical event and the decision to request medical transport improved their quality of life. Recipients typify the foundation’s ideals of giving of oneself and enhancing the lives of others.
“When he came to us, Thomas was as close to death as one can be,” Dr. Vunnamadala said. “The reason he’s alive today has a lot to do with all the medical teams involved in his care. But it also has to do with the team that saw him in the emergency room who made that phone call, and having the flight crew who brought him to us immediately. Thank God the OLAR team was close because he would not have made it even another 20 minutes. That crew gave him a fighting chance at life.”