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A Dignified Transfer for Patient and Son

PT escorts rehab patient on journey for fallen soldier

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Salvatore Corma Jr. sat at his father's bedside. Sal Corma Sr., known as "Big Sal," suffered from cardiovascular disease, cancer, diabetes and renal failure, which kept him in and out of the hospital every few weeks. He was currently at Magee Rehabilitation Hospital, recovering from a recent amputation and an even more recent stroke.

Little Sal, the Cormas' only son, was a military officer serving in Afghanistan. He had been granted three weeks leave to spend with his ailing father. Little Sal met the physical therapists and encouraged his father in rehab sessions. He was concerned about Sal's health, but when duty called, he returned to base.   

It was last time they'd see each other. A month later, Little Sal was killed in action.

"The minute I glimpsed the two uniforms I knew exactly what they meant," said his mother, Trudy Corma.

The family was devastated, but they also had a decision to make. The military had arranged to fly Salvatore's body home, and the family was invited to his dignified transfer--a procession of the casket from the plane--at Dover (DE) Air Force Base. The site was less than two hours away, and Big Sal was adamant about attending. But his poor health made travel nearly impossible.

Nearly, but not entirely. Magee Rehab worked with the military to coordinate safe transport to the base. It was an incredible journey, with a bittersweet ending for all.

Preparing for Departure

Alex Kobb, a senior physical therapist at Magee Rehab, had worked with Big Sal on a few occasions. One thing was immediately certain: Big Sal was proud of his boy.

"I felt like I knew his son just from talking to him--how he graduated from West Point and all the things he'd achieved," Kobb said.

When the PT learned of Little Sal's death, his heart went out to the family. He knew of Big Sal's ailments and, like the rest of the medical team, knew the man wasn't fit for discharge. But with an escort, Kobb suggested, he could be just fine. About 12 hours later, Kobb was in an ambulance on the way to the Air Force base.

The trip was by no means ordinary. Though the Cormas would be gone for less than 24 hours, the journey required a maelstrom of planning and preparation. Administrators, case managers, pharmacists, paramedics and military personnel were all involved in the effort. At the helm was Lane Brown, PhD, director of brain injury and stroke services at Magee Rehab, who navigated the clinical and legal aspects of Corma's transport. "It was immediately obvious that it was the right thing to do, to figure out a way to help [Corma] go to Dover," she said.

Once clinicians confirmed Mr. Corma was stable enough for travel with a medical escort, Dr. Brown had to figure out how to get him from point A to point B. The military could provide a limousine, but that wouldn't be sufficient in a medical emergency. Instead, Dr. Brown secured transport through JeffSTAT, an ambulance provider that sympathized with the Cormas' case and signed on for a 24-hour run. "That was probably the biggest hurdle," Dr. Brown said. "It essentially meant they took that crew out of service for as long as was going to be needed."

Between Kobb and the paramedic, there was enough medical support to permit travel, but the trip still sidestepped a few protocols. Typically, insurance regulations deem that anyone fit for travel should be discharged and treated as an outpatient. Because this was a unique case--and Mr. Corma needed intense medical supervision--the hospital bypassed insurance and offered to foot the bill.

"I'm amazed that Magee suggested the ambulance--and then said they would pay for it! That's a huge expense," Mrs. Corma said.

Then there was the base. The military had never allowed an ambulance on the tarmac before, and the dignified transfer was usually limited to family members and friends. The Cormas were rolling with a group of six, half of whom never met their son.

Fortunately, the military accommodated their special needs. Within hours, Kobb, the paramedic and ambulance driver were cleared by security, and the ambulance was welcomed at the airport. Brown said she was impressed by how helpful the military was in planning for the trip. "An Army representative stayed with the family all day long and worked with us and the base at Dover," she explained. "They were available and supportive--that was encouraging."

Into the Night

The ambulance took off around 11:30 p.m., with Mrs. Corma up front and Kobb riding in the back. On a stretcher, Big Sal lay wide awake during the 1.5-hour trip, the anticipation too high to rest.

The group was eager to go, but knew little of what to expect. Not sure what to wear, Kobb donned a suit and tie instead of his usual attire, and packed water, snacks and tissues for the ride. Mrs. Corma, on leave from her job as a nurse, carried a packet of medications to administer if the trip took longer than expected.

The troupe aimed to arrive before 2 a.m., the earliest the plane bearing Little Sal's body was expected to land. They were also prepared to wait. "The military gave us a 12-hour window, so it could be 2 that morning or 2 the following afternoon," Kobb said.

The plane was on the ground and ready for transfer by 3 a.m.

"That was a scene that will certainly stick in my head," Kobb recalled. "It was basically pitch black, completely quiet and the big C-17, the belly of it opened up and had floodlights coming down on the casket with the flag draped over it."

The casket was blessed, then passed to an honor guard and processed to a car that would carry it off the tarmac. A three-second salute was held to honor the body as it headed for the Air Force Mortuary Affairs Operations Center. The transfer only lasted about 15 minutes, but it made the hours of planning worth it.

"It was beautiful," Mrs. Corma said. "The military was so loving and compassionate--there must have been 30 or 40 military personnel there."

Amid the emotional moments, Kobb kept his focus on Big Sal. The PT set up his wheelchair and helped him transfer between stretcher, wheelchair and vehicles. "My job was to be with Sal and help in any way and make sure he was OK through the process," he explained.

A Sigh of Relief

Physically and emotionally exhausted, the group retired to a hotel, where they dozed for a few hours before making the return trip. Back at Magee Rehab, Mrs. Corma stayed in Big Sal's room until his inpatient therapy was complete; another unorthodox move, but one that didn't go unappreciated. "I cannot tell you the level of professionalism, compassion and empathy that everybody extended," Mrs. Corma said.

Aside from some fatigue, Mr. Corma suffered no setbacks to his health. In fact, the trip went alarmingly well--even by military standards. "At the end, I remember the [Army] major said to me, 'You know why something didn't go wrong? Because you had everything in place in case it did. If you didn't have it in place, I guarantee you something would have [gone wrong].'"

Big Sal has since returned home, but he's due back at Magee Rehab soon to order a prosthesis.

It was a lot of work in a little time, but the payoff was just right, according to Kobb. "In terms of all the arrangements that were made and everyone who went down there, that's the feeling you had--it was the right thing to do, and we were happy to help in any way."

Cheryl McEvoy is an assistant editor/web editor for ADVANCE.




     

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