Medevac Wars

The other doc on wards with me got a call about a 50-yr-old male with bright red hematemesis and a rapidly falling hematocrit in one of the northwestern villages, so he activated the medevac to pick up the patient and bring him to the hospital.  Fifteen minutes later, he got a call from one of the northeastern villages about a 61-yr-old male on antiepileptic medication who had been in status epilepticus for 20 minutes.  The health aide did not have any ativan or diazepam in the clinic.  My colleague had to activate the medevac again--but there was only one plane, and the two villages were quite far from each other.  He & the ED doc conferred about which patient should be picked up first.  They decided the man with the GI bleed was more critical, and as they directed the medevac to head northwest first, I called some of the northeastern villages to ask if they had any ativan or diazepam that someone could transport by snow machine to the patient having nonstop seizures.  An hour later, the patient did get some diazepam delivered from a nearby village, and he was going to be next in line for the medevac, but then another call came in about a 5-yr-old girl with no known seizure disorder also in status epilepticus.  The decision was made to medevac the girl first--it turns out she had a serum sodium of 110 (!) and marked neurologic abnormalities, and she ended up being transferred to Anchorage.