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Couple relives horrific crash to help La Crosse area first responders improve trauma care

Amy Silverman made an emotional revelation Thursday to the two Gundersen MedLink Air rescuers who saved her life when they tended to her broken, mangled and bleeding body in a ditch nearly 13 months ago.

Silverman choked back tears as she confided her secret to Mike Ashbacher and Tony Hovey during a review of the crash on Oct. 9, 2016. She and her boyfriend, Rick Gordon, lost their left legs below their knees after a car slammed into the Harley-Davidson motorcycle they were riding on Hwy. 35 in Trempealeau County and they were thrown, like two rag dolls, into a ditch.

“Something you guys don’t know,” Silverman said, her voice shaking, “I thank God every day for taking my leg and not my life. When it’s late at night, and I realized I haven’t thanked God, I do it then.”

Touched by the emotion, flight nurse Hovey said, “This is making a positive impact,” reflecting the fact that they all are moving forward with a resolve to turn what had been a gruesome tragedy into lessons for others.

The Northbrook, Ill., high school special education teacher and mother of two agreed with that assessment during the often-difficult-to-watch presentation that flight nurse Hovey and flight paramedic Ashbacher pulled together.

They developed the presentation for a symposium Friday at Gundersen to show first responders and other trauma care specialists that all elements of a hospital system must be in sync to save lives in otherwise horrific situations.

Reliving the scenario seemed as much of a therapeutic exercise for Silverman, Gordon, Hovey and Ashbacher, as well as three of Silverman’s friends, as it would be a teaching moment at the symposium.

The four have developed strong bonds of friendship since Hovey and Ashbacher were dispatched to the scene and experienced their first encounter to the admittedly salty-tongued Silverman, who was cursing a blue streak as she writhed in pain.

Peter Thomson photos, La Crosse Tribune  

Amy Silverman flashes her typical smile — perhaps delivering one of the salty lines she is noted for — at Gundersen Health System, with two of her rescuers, flight nurse Tony Hovey and flight paramedic Mike Ashbach, enjoying her repartee.

Impact knocks off helmet

The impact of the car’s hitting the motorcycle and being throw into the air had knocked off her helmet, resulting in her suffering a traumatic brain injury.

In addition to the fact that part of Silverman’s tibia was missing and her fibula was crunched, leaving her left foot dangling by just a few shreds of muscle, her other injuries included a broken arm and other fractures, including a face so shattered that intubating her so she could breathe was a nearly impossible challenge.

Moen

Trempealeau police officer Tim Moen, having reached the scene before MedLink, had been able to apply tourniquets to stanch the bleeding. Later, he would credit the fact that Silverman’s and Gordon’s bodies had landed relatively close together had made the task easier.

Quickly assessing the situation, the MedLink crew determined that Silverman’s condition was more perilous.

Her disfigured leg was what Hovey described as a “distracting injury,” but medical workers cannot let such injuries divert their attention, he said.

“Typically, you try to straighten it,” Ashbacher said, but that only made Silverman’s bleed more, so he had to return it to its original position.

Now able to see humor in the incident — a year removed from a situation that was deadly serious at the time — Silverman laughed and squeezed Gordon’s hand when Ashbacher said, “She was hitting everybody.”

For his part, Hovey said, “I wanted to put her down a rabbit hole. I used some MMA moves …” Motioning that he basically straddled Silverman to control her, he said he literally “pounded her” with ketamine, an analgesic used to relieve pain and calm a patient, as well as lidocaine, a tissue-numbing medication.

Even though Silverman already had a tourniquet on her leg, Hovey applied another one just to be safe because he couldn’t tell whether the other one was working.

“I didn’t have time to second-guess that, so I just did it,” he said. “You err on the side of helping the patient.”

Explaining why they focused on Silverman, Ashbacher said, “Rick, we could tell you were making sense … (leaving the decision) who can we help the most?

“We didn’t have to give you any medicine to keep you from swearing,” he said, drawing laughs from Silverman and her friends in the small conference room at Gundersen — laughter that grew louder when Rick quipped, “Do you have any more of that?”

Peter Thomson, La Crosse Tribune 

Amy Silverman holds the hand of her boyfriend, Rick Gordon, during one of the more emotional moments during a presentation recalling the motorcycle crash on Oct. 9, 2016, that resulted in leg amputations for both of them.

‘You trust your partner’

Recalling Ashbacher’s approach to intubating Silverman, Hovey told the group, “He said, ‘This doesn’t look right’ because of all the maxillofacial fractures.”

Nonetheless, Ashbacher took his best shot, and it “was perfect,” Hovey said. “You’re a professional, and you trust your partner.”

Meanwhile, the pair had to use Gundersen Med Comm to communicate details to the hospital about the patients, genders, physical conditions, expected arrival times and what types of treatments had been used to that point.

(The 51-year-old Silverman continues to be amused, and flattered, by the fact that they guesstimated her age as around 35. Hovey noted that her condition didn’t make it easy, especially with no time to look for identification.)

All of that information is vital as soon as possible so that the hospital and emergency room can be prepared for what the patients need, what doctors and specialties might need to be called, whether to call in extra staff, etc.

Even though the accident scene was roughly 30 miles from Gundersen’s La Crosse campus, the MedLink chopper could cover that in 11 minutes, which left precious little time for the hospital to gear up and staff up.

As it was, just 63 minutes transpired between the time of the initial page of the crew, assessment and treatment, preparation for flight and landing in La Crosse. Total time between the page and Silverman’s arrival in a trauma treatment room was an hour and 11 minutes.

Hovey’s presentation for the trauma conference, which is expected to be delivered to many other medical meetings, includes more than 30 recordings of communications funneled through MedComm among the MedLink crew and the hospital, city of Trempealeau and Trempealeau County law enforcement and rescue personnel, Gundersen Tri-State Ambulance, social workers and Mayo Clinic in Rochester, Minn., and the helicopter dispatched from there.

Part of the messaging relayed in this case was that the helicopter would be transporting “an approximately 35-year-old woman who was conscious and combative and had been intubated.”

Peter Thomson, La Crosse Tribune 

Projected on a screen during part of a trauma care presentation, Amy Silverman gets a warm welcome from her children, Jake and Hanna, when she arrived home after months of hospitalization and rehabilitation. At left is one of Silverman's friends who accompanied her from the Chicago suburb of Northbrook this week to attend the presentation Friday. At right is Gundersen MedLink AIR flight nurse Tony Hovey. Silverman is one of eight children, and as many as 25 friends and relatives were expected to attend.

‘Combative’ description brings smiles

On Thursday, Silverman said, “That’s funny” when Hovey mentioned the erroneous age again, and she smiled at the “combative” description.

She also interrupted the presentation to say, “As chaotic as this is, and as unbelievable as it was, I feel an incredible sense of calm and peace among you guys. ... You saved my life.”

The MedLink AIR pilot, Dale Dougherty, had landed on the highway and would be tasked with transporting Silverman to La Crosse. After it became obvious that Gordon also would need the speed of a helicopter, they had to make sure that the area could accommodate two choppers.

You can’t just order up another helicopter without determining whether it can land safely at the scene, Hovey said. If emergency conditions required it, a chopper could land in a field, and Gundersen could settle up later if any crops are damaged, he said.

In this case, it was as easy as asking a deputy to move his vehicle, said Hovey, who gave major kudos to Moen, who received the first lifesaving award his department has bestowed.

Another element of critical timing is when helicopters are on the ground, Hovey said, noting that it would be dangerous if both landed or took off at the same time, or if one was landing when the other was taking off.

What’s more, having helicopters at the site with whirling blades and spinning tail rotors — depending on whether they need to land “hot” and keep running for a quick swoop to board a patient or whether they can shut down — requires more vigilance for those on the ground to protect themselves and patients as they wrestle with equipment and gurneys.

Often, the rescuers don’t know the names of those injured, Hovey said, adding, “You start calling these people souls. When you first start, it seems odd, but then you think, ‘Oh, that’s what it is.’”

Name unknown, she was ‘PSI 82’

Still an unknown entity upon arrival at Gundersen, Silverman became known “PSI 82,” until her identity could be determined.

While the flight of a medical helicopter may seem smooth and enviable to those of us peering up and squinting against the sun — conditions are much different up there, Hovey said.

“Try 110 decibels of continuous noise, with pitching and rolling,” he said, complicated with the uncertainty over whether the patient might become sick and vomit.

“Your partner makes or breaks you in the air, but you are two people with a shared goal,” he said.

One slide of the presentation shows Silverman’s fibula embedded in the car’s fender — not merely denting the fender but impaling it. And not just a little chunk, but 10.5 centimeters of fibula.

Even though Silverman had seen the slide before, she said, “How in the HELL did that happen? I’d like to see it in slow motion, just to understand how that happened.”

Of course, she doesn’t know because she can’t remember anything about the crash or much of her initial weeks out of months in the hospital and rehabilitation.

“I don’t remember anything,” Silverman said, adding, “I think that was God’s way of protecting me, that I don’t know everything I went through.

“But he remembers everything,” she said, motioning to Gordon.

“I wish I didn’t,” he said.

Since Gordon had been flown to Mayo in Rochester and Silverman to Gundersen, and their lengthy periods of recuperation, it was nearly three months before they saw each other.

The first time Ashbach and Hovey visited Silverman in the hospital, Ashbach said, “Hi, I’m Mike and this is Tony.”

Her response: “Hi, I’m Mike and this is Tony,” because she had virtually no memory at the time and was in a phase of parroting back whatever people said to her.

Another slide carries the title of “What Wasn’t Broken” and lists spirit, hope, will and faith.

That slide dovetails well with another slide, titled “Broken body but not broken spirit,” as she was being put into the ambulance and signaling the camera with two birds — one on each hand.

Peter Thomson, La Crosse Tribune  

Gundersen MedLink AIR flight nurse Tony Hovey details some of the measures he and flight paramedic Mike Ashbach used to save Amy Silverman and Rick Gordon. Hovey and Ashbach delivered the presentation during a trauma symposium at Gundersen Health System Friday.

Daughter: ‘I wanted to tell her to fight’

The presentation also includes messages that friends and relatives submitted for inclusion, parts of which include:

From her daughter, Hanna: “I wanted to tell her to fight because I wouldn’t be able to do without her. … My mom is the most amazing person I know, and I am so blessed to have her. She beat all odds and continues to amaze me.”

Another person: “I always tell Amy that Phil (Amy’s Father in heaven) said, ‘NOT TODAY.’”

Gordon: “I looked at my feet and I saw Amy. I tried to get up, but I couldn’t.” Acknowledging being more spiritual since the crash, he also wrote, “everything happens for a reason, but I don’t know the reason for this yet. … Amy and I are fortunate to have been placed in the hands of many people who had a part” in saving their lives.

Silverman, for her part, has written to Hovey’s daughter Maizie, saying, “Your dad saved my life, and he is my true hero.”

Silverman and Gordon, who had met a year before the crash and began living together just a month before, haven’t been on a motorcycle and don’t plan to again.

“We miss it, though,” said Gordon, the father of a son and a daughter.

Silverman agreed, acknowledging that it had been his lifestyle for 36 years.

On the other hand, Silverman said her late father “would have frickin’ killed us — he hated motorcycles.”

In their amputee support group of about 25 people, Silverman said, about seven or eight had lost their limbs in motorcycle accidents.

The couple — Silverman generally uses two crutches to walk and Gordon, a cane — credit the support of family and friends for their ability to persevere.

Amy Vesely, one of those friends who accompanied them to La Crosse from Chicago, said, “I never heard her complain.”

At the same time, Vesely said, there were times when she wondered whether her old friend would be back psychologically.

“I realized she was back on the day she realized she didn’t have her leg,” when Silverman pondered that only a short time before saying that was something she had to live with, Vesely said.

Peter Thomson, La Crosse Tribune 

Confessing to a bit of prostheses envy, Amy Silverman (left) says she thinks Rick Gordon's is cooler than hers.

Three bone grafts, maybe more

Silverman has had three bone graft operations — two, using her own bones and the third, from a donor — to strengthen her fibula and may have to endure more.

She was able to recover from the traumatic brain injury without surgery. The same was true with her facial fractures, with recovery aided by using just a soft diet with little chewing, and no scarring.

Asked how they could remain so upbeat, Gordon said, “We never sat down and said, ‘What do we do now?’ We realize how miraculous this is.

“Every once in a while, you get angry, but get right out of it,” he said.

“I don’t see any other option,” Silverman said. “I am grateful, and I want to live my life.”

Silverman and Gordon said they are willing to share their stories because they believe they will help others who encounter misfortune and, in helping train responders, they may help save lives.

Amid several emails Silverman and Hovey have exchanged, Silverman found this message from him especially meaningful: “I truly believe that our legacy is not what we leave behind but what we inspire others to do and continue doing after we are gone.”

Silverman’s reaction: “I love it. I love it. That’s really true.”

In their cycling days, Silverman had grown tired of enjoying scenery that Gordon was not able to because he was driving. To ensure that he would be able enjoy the trips as much as she did, she began shooting videos with her cellphone for them to watch together.

One, which she found in her cellphone during recovery and titled, “10 minutes before the crash,” actually was cut much closer.

Hovey was able to approximate the spot where she shot the video, and where the crash occurred.

It was a scant 11 seconds before a cataclysmic event imposed a monumental shift on their lives.

“I thank God every day for taking my leg and not my life. When it’s late at night, and I realized I haven’t thanked God, I do it then.” Amy Silverman

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La Crosse Boat Harbor residents scramble after order to vacate

At least nine people will need to find a new place to live and about 20 others will need to find a winter home for their boats after receiving a letter Thursday requiring them to get their houseboats out of the water.

Dennis Smalley, La Crosse Boat Harbor Neighborhood

“Now everybody is scrambling who has boats in the water, whether you’re a live-aboard or you wanted to freeze your boat in,” said Dennis Smalley, spokesman for the La Crosse Boat Harbor Neighborhood. “I don’t know if it’s shocking, but certainly it puts a lot of people in a financial hardship or time-constraint hardship.”

The marina, at 1500 Joseph Houska Drive, has been at the center of a legal predicament after the city began evicting former operator Steve Mills last year, accusing him of defaulting on the terms of his lease. A judge ruled in May that the company cannot assume a new lease for the city’s harbor, leaving the city without an agreement to operate the facility in 2018. There also are updates needed to bring the docks up to Wisconsin Department of Natural Resources standards.

The city allocated $1.8 million in October to replace the existing marina and has been moving forward with designs to remove the noncompliant Styrofoam floats and reconfigure the marina, as well as make it more handicapped accessible.

The city wants Rupel Lewandowski Holdings LLC to remove the docks and other assets by the end of November so work can begin as soon as possible, Mayor Tim Kabat said.

“The most cost-effective way is for all the docks and the vessels to be out of the water so the new marina can be installed,” Kabat said.

It’s easier and cheaper to do the work on the ice in the winter, the mayor said.

“When the spring comes and things thaw, it’s all in place, so they just connect it,” he said.

Rupel Lewandowski Holdings, owned by Chris Rupel and Rick Lewandowski, finalized its purchase of the harbor assets Monday and has expressed interest in operating the marina.

According to the removal letter received by boaters, which was signed by Lewandowski, the company does not have a lease with the city and was informed by the city this week that it needed to have its newly purchased assets off of city property by Dec. 1. The letter apologizes for the inconvenience but serves notice that all boats need to be removed immediately and that the company has begun removing the docks.

Without removing the boats and subsequently the docks, Kabat said, the city can’t guarantee the work will be done by May 1, the start of next year’s boating season. However, with the recent cold snap and windy, rainy weather, pulling the boats out isn’t going to be easy.

“It’s not like your fishing boat, where you’ve got your trailer in your garage and back it into the water, load your boat and take it home,” Smalley said. “That’s not how it works.”

Most houseboat owners don’t have their own trailers, and it’s a time-consuming process for the few companies who do such removals. Smalley estimated four to five boats could be pulled in one day under perfect conditions, but wind and rain makes it difficult. It’s also not cheap — costing $11 per foot — which can add up quickly, with some boats up to 50 feet long.

“The whole timing of it, the short notice and trying to figure out what to do has put a lot of fear and anxiety into a lot of the boaters,” Smalley said.

Once the boats are out of the water, finding a place to park them won’t be easy.

“Where is everybody going to go? They’re going to have to go somewhere,” Dick McKim said.

McKim has lived at the Isle la Plume marina since July 2008. He and his wife, Pam, sold their home and moved into their houseboat year-round after their children were out of the house.

“We’re trying to figure out what to do and what’s going on,” McKim said.

Living on the water isn’t uncommon, even in places where the river freezes. While winterizing a houseboat means keeping it in place, there are plenty of heating options to keep the inside comfortable. Both the people who live there year-round and those who simply freeze their boats in the harbor pay for a slip lease from May through October and a second lease for November through April.

“We were all kind of surprised,” said TJ Ullery, who has lived at the marina for more than three years. “I have no real succinct plan on what I’m going to do.”

Ullery, who lives with his three dogs and a pet snake, wasn’t opposed to taking his boat out of the marina or the new docks, as long as there’s a plan in place for him and his neighbors.

“You can pull my boat out. I just need somewhere to go,” Ullery said.

He hopes the city will consider a dock replacement that slows down its timeline and replaces them in parts.

“It just seems like it’s all being done way too fast and kind of backward,” Ullery said.

Part of the challenge from the city’s perspective, Mayor Kabat said, has been its longtime removal from the day-to-day operations. Mills operated the marina for nearly 40 years, holding all of the leases and agreements.

“We have no official information that there are people who live there year round,” Kabat said.

The city has no agreements with anyone to reside in the harbor year-round, he added.

McKim was amazed to hear that from the mayor Friday.

“This is my address. It’s on my driver’s license. I’ve got a mailbox outside, and I get mail here,” McKim said.

“It’s not like your fishing boat, where you’ve got your trailer in your garage and back it into the water, load your boat and take it home. That’s not how it works.” Dennis Smalley, spokesman for the La Crosse Boat Harbor Neighborhood

NATE BEIER, SPECIAL TO THE TRIBUNE 

Bangor's Drew Johnson drags Edgar's Cade Littleton along as the quarterback picks up a first down during the Cardinals' 16-8 win over defending champion Edgar in a WIAA Division 7 state quarterfinal matchup on Friday.


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La Crosse County delegation divided on tourism tax bills

With work on Wisconsin’s biennial state budget finally done, two of La Crosse County’s elected representatives in Madison have introduced legislation to pave the way for a special tax the county has promised to use to pay for road work. The county’s third representative, however, is not backing the bills.

Shilling

State Sen. Jennifer Shilling, D-La Crosse, and state Rep. Steve Doyle, D-Onalaska, both have introduced bills that would permit La Crosse County to become the first county in the state to have a half-percent premier resort area tax. State Rep. Jill Billings, D-La Crosse, is not supporting the legislation, however.

The tax, which would be collected on any taxable items or services sold at businesses designated by the state as tourism related, would raise an estimated $6.6 million per year, according to the state Revenue Department. The county intends to use money raised from the tax exclusively for improvement and maintenance of roads and bridges, spending $5 million per year to catch up on an $87 million backlog of road work. The remaining 25 percent of the tax proceeds would be split among the county’s 18 municipalities.

State law allows premier resort area taxes to be used to pay for infrastructure other than roads and bridges, including parking ramps, park improvements or a civic center, for example. The county board, however, has formally gone on record with an official resolution committing itself to spend the money only on roads and bridges.

State law allows any municipality or county that has at least 40 percent of its equalized property value in tourism-related businesses to charge the tax. Those that fall short like La Crosse County, which has only 5 percent, must seek an exception from the Legislature.

Gov. Scott Walker has indicated that he would sign La Crosse County’s bill as long as it contains a provision requiring a binding referendum before the tax can be implemented, which it does. “I think that’s very significant,” Doyle said. “I think that’s the governor saying he respects the idea of local control.”

Billings said she understands and appreciates the jam the county is in over the road funding shortfall, but said she can’t support the special sales tax approach, even though a nonbinding referendum last spring on the sales tax was approved by 55 percent of the county’s voters and just under 56 percent of the voters in the city of La Crosse.

“I have a problem with it because I’ve heard from so many people about the adverse effects on brick-and-mortar businesses, especially downtown,” Billings said. “I have to say that I understand that the county is trying to be creative. But I think the state needs to come up with solutions to this, with a reliable revenue stream. … I would like to see a funding stream that’s more directly related to users.”

A user-related funding stream could be higher gas taxes or vehicle registration fees, for example, but the Republican-controlled Legislature opted not to go for boosting these revenue sources in the recently approved biennial budget. If the budget had included those tax hikes, Walker had promised a veto.

Doyle and Shilling, who is Senate minority leader, agree with Billings that a state solution to the county’s road woes would be preferable. “I would prefer to have a statewide fix to transportation so we would have enough revenue to renovate, rehabilitate and maintain our crumbling roads and bridges,” Shilling said.

In the past week, Shilling and Doyle both noted, the bills they are sponsoring were given numbers (SB493 in the Senate, AB610 in the Assembly). They also were assigned to committees, and Doyle and Shilling must work with the chairs to get the bills scheduled for public hearings before the committees, a necessary step before they can move on to final votes in the Senate and Assembly.

In the Senate, Shilling’s bill goes to the Economic Development, Commerce and Local Government Committee. In the Assembly, the bill will go before the Ways and Means Committee, on which Doyle sits. As Doyle sees it, the assignment to his committee could be a positive sign for the legislation getting a hearing and a committee vote.

On the other hand, Billings’s lack of support for the bill doesn’t help. “At least she’s acknowledging the problem,” Doyle said. “This isn’t an easy issue. The referendum got 55 percent in the county, which shows that it got support, but it also shows there’s opposition.”

And the opposition is organized. During the recent annual Oktoberfest in the Capitol event in Madison, members of the La Crosse Area Chamber of Commerce, La Crosse County Republican Party Chairman Bill Feehan and others actively lobbied lawmakers to oppose the county’s bid to win approval for the premier resort area tax.

Feehan argues that half the tax revenue would be paid for by city of La Crosse residents, but little of the money would go to fix roads in the city.

Doyle, who serves on the La Crosse County Board as well as in the Assembly, noted that the county is responsible for some roads within cities and villages.

And as an acknowledgement that municipal roads are in need of attention, too, the county board approved designating 25 percent of the proceeds from the “tourism tax” will be split every year among the county’s 18 municipalities.

Jane Klekamp, the county’s associate administrator, has been meeting with municipal officials to discuss how the county would divide the municipalities’ share of the tax proceeds. So far, the preferred method is to base the split on the total municipal road mileage.

The municipalities’ estimated $1.6 million share of the tax revenue would amount to $2,116 per year for each of the 756 miles of city, village and town roads. By comparison, the county would get $17,730 annually for each of the county’s 282 miles of road.

The city of La Crosse has the most municipal road miles at just over 192, and it would get $406,960 in additional annual funding based on the proposed split, which means a 21 percent overall funding increase for roads when combined with state general transportation aid.

The city of Onalaska has 89 miles and would get a boost of $188,365, a 28 percent increase. Holmen would get $85,488 (up 41 percent), West Salem would get $47,578 (up 36 percent) and Bangor would get $17,453 (up 34 percent). Campbell’s road funding would go up by 50 percent, with a $41,020 increase, while Shelby would see a 68 percent hike with $95,986 in additional revenue.

Rural towns would feel the most benefit from a split based on road mileage, with 10 towns getting a 96 percent bump in funding, nearly double their current levels. Four towns — Hamilton, Holland, Onalaska and Shelby — would get more money than Holmen as they have higher road mileage totals, and the town of Farmington would get nearly as much as Holmen.

Doyle hopes to get a committee hearing for his bill before the holidays, but a full Assembly vote probably wouldn’t happen until next year. If the bill passes and wins Walker’s signature to make it law, the county board would have to pass a resolution by a two-thirds margin to send it to a binding voter referendum.

One thing Doyle will emphasize in urging support for the bill is that the bill does not raise anybody’s taxes. “What it does is give the voters the ability to decide if they want to raise their own taxes,” he said. “It’s what school districts do every time they have a referendum.”


Billings


Shilling


Doyle