‘I FEEL A PULSE’: HOW ASHLYN KRELL WAS BROUGHT BACK TO LIFE
PART FOUR IN A SERIES
On Feb. 12, 2017, Ashlyn Krell drowned.
Her soaking wet, lifeless body was carried up a deep ditch on a spinal board from her crashed Toyota Corolla, which had been submerged, upsidedown, in a water-filled construction hole along Highway 401 near London, Ont.
“In total, between the 911 call and having her on a stretcher, was 27 minutes,” said paramedic Shireen Jackson, who was there to help transport Ashlyn to hospital.
The young woman had no pulse. Her skin was a very pale grey. Some foamy substance was leaking from her mouth.
But she wasn’t bleeding and there didn’t seem to be any outward physical injuries, “which was kind of odd after what she’d been through,” said veteran paramedic Ken Jones.
At the top of the ditch, Jackson had primed Fanshawe College paramedic student Marco Sanchez for intensive CPR (cardiopulmonary resuscitation) that would start as soon as Ashlyn was up the slope.
They would be treating the case as a cardiac arrest.
Once Ashlyn was in their hands, the paramedics took over the rescue chain.
Jackson noticed Ashlyn’s arm had slipped off the board. She lifted it so it wouldn’t get caught between the stretcher and the ambulance.
“And there was bruising and swelling starting in her hand,” she said.
She wondered if the woman on their stretcher had tried to fight her way out of the sinking car.
In the minds of the paramedics, there were some reasons for hope.
“Being in cold water was the most beneficial thing for her,” said Adam Bennett, an EMS supervisor at the scene.
“Drowning is a horrible way to lose your pulse to begin with. (But) that cold water is what decreased the oxygen demand for her brain and her other organs,” he said.
Along with Jones, Jackson and Sanchez, a second paramedic crew — made up of Shawn Hunsberger, Jen Stade and paramedic student Adam Kueneman — had gone to the crash scene in case there were more patients.
Jones and Hunsberger are advanced-care paramedics, an accreditation allowing them to perform critical medical and advanced lifesupport interventions. The ambulances are equipped like mini-hospitals. That would prove crucial in the few minutes the team had to prepare Ashlyn for transport.
Her clothes were cut away for the defibrillator pads. Jackson was working with the students “and making sure we were doing good CPR and also analyzing the heart rhythms.”
At first, Ashlyn’s heart rate was a flat line, meaning no pulse. But after two minutes of CPR, paramedics could see on the monitors that there was some electrical activity, but still no pulse.
While Sanchez, Kueneman and Jackson continued with CPR, Hunsberger moved to Ashlyn’s head to put in an airway while Jones worked at getting medication into her body.
Jones realized quickly that Ashlyn’s veins had contracted and an intravenous line would be impossible to hook up. The epinephrine, an adrenalin drug, would have to go in intraosseous — through the bone. Jones drilled a small hole into Ashlyn’s shin bone and when he reached the marrow, hooked up the cardiac medication and fluids.
Ashlyn was ready for transport.
The driving conditions were still tricky. Jackson guided the ambulance along the slippery road and had to wait for fire trucks at another crash nearby to move out of the way.
In the back, “Adam was controlling the bag valve mask, helping her breathe. Marco was doing chest compressions and I was monitoring the rhythm on the monitor as well as the IV (intravenous line),” Jones said.
“About a minute after we pulled away from the scene, Marco said, ‘I feel a pulse.’ ”
OPP Const. Emad Haidar had a sinking feeling as he followed behind the ambulance in his cruiser.
He saw the paramedics rush Ashlyn into triage at the hospital and stood outside the emergency room suite, thinking about the young woman’s family and the grim task he thought lay ahead to tell them she was gone.
Jones came out. He told Haidar they had a heartbeat.
Haidar pulled out his water-soaked cellphone and called back to the crash scene to Sgt. Perry Graham to give him the incredible news.
By now Haidar knew the woman whose life was hanging by a thread was Ashlyn Krell. He used his phone to scour social media to see if there was a Facebook profile.
He found her wedding pictures from two years earlier, images of her husband and family. He found out her husband’s name, Brayden. He read Brayden’s Facebook blog that spoke of their deep love.
He called Graham back and said he knew how he could contact Ashlyn’s husband.
Dr. Terry Skoretz had been briefed just before the paramedics wheeled Ashlyn into the hospital.
Skoretz knew Ashlyn was already beating some odds. He’d heard that “some pretty amazing things had happened to get her out and with some very early attempts at resuscitation, they got a heart rate.” But that was all he knew. Ashlyn was rushed into triage and the medical team began to document her medical story.
Already, there were some positive signs. But there were concerns about a possible head injury from the high-speed crash into the culvert, or brain damage because of lack of oxygen.
And above all, Ashlyn was cold — so cold.
Normal body temperature is about 36 C. The first temperature reading for Ashlyn in the trauma room was between 28 and 29 C, “certainly severe hypothermia.”
Skoretz spoke in the hallway to Const. Peter Reintjes — who had finally agreed to go to hospital, likely because he saw it as a good excuse to check on Ashlyn’s status. The police officer, who had jumped into the frigid water at the crash site, drew him a diagram of the scene, describing the force of the collision and how the car had flipped into the water.
Skoretz said he couldn’t recall a case exactly like hers, involving a high-speed crash and full cold-water submersion.
That posed a bit of a medical head scratcher. In patients who’ve had a cardiac arrest and don’t wake up, cooling their bodies often helps in the recovery. Rewarming her too fast could spark a series of harmful chemical body reactions.
But with traumatic head injuries, cooling can often be harmful to the brain. It wasn’t clear if Ashlyn had a head injury or whether her brain swelling was triggered by her heart stoppage.
The initial ABC assessment — airways, breathing, cardiac — showed betterthan-expected results.
Then came Ashlyn’s initial CT scan, a specialized X-ray that allows medical professionals to see inside the body. It didn’t show any major bleeding or skull fractures — very good news, indicating no surgery would be needed.
“Once we were aware there was no obvious head injury that required operations, we were optimistic anything we saw was related to the drowning and cardiac arrest,” Skoretz said.
That meant there was no urgency to warm up her body. The decision was made to allow Ashlyn to warm up slowly and naturally without intervention, with the help of some blankets. But there was brain swelling and her neurological assessment was grim. There was no response in her pupils. She wasn’t moving.
Ashlyn’s coma score, the assessment for brain activity, was a three — as low as it could be.
Skoretz said there was a head-to-toe evaluation for any obvious injuries. A bedside ultrasound and some quick X-rays revealed multiple fractures in her pelvis. A waist-only girdle was wrapped around her to keep her pelvis in place.
A chest X-ray wasn’t as dire as expected, considering she’d drowned.
But Ashlyn was still fighting for her life.
Brayden Krell had begun to worry as the minutes ticked past the expected time when his wife said she’d be home.
She’d sent him a text at about 8:30 p.m. from her parents’ home in Waterloo that she was about to get on the road to London, about 116 kilometres away, and should be home in an hour or so.
By 10 p.m., there was still no Ashlyn.
He texted and called her cellphone, but knew she never has her phone out when driving.
The weather was miserable. Maybe she just pulled over to wait out the storm, he thought.
Their relationship was built on love but sparked by their deep Christian faith. They’d been married for two-and-ahalf years after meeting at a Power To Change conference in Toronto. Their connection was practically instant.
The Christian ministry has chapters at several universities in Canada. Brayden, originally from British Columbia, belonged to a chapter at Western University, where he studied political science and philosophy.
Ashlyn was a music major at Queen’s University in Kingston. Her whole life had been influenced by her family’s deep roots in missionary work.
Her parents had taken her and her three siblings all over the world. Ashlyn was born in Austria while her parents were working in Europe for 17 years. She’d done her own missionary work in Africa with her parents.
The time stood at 11 p.m. and still no Ashlyn. Brayden put the James Bond movie Skyfall on TV, thinking “there’s no way I could sit through an entire movie and her not be home.”
The movie ended. Brayden couldn’t sleep.
Finally, the phone rang. It was Ashlyn’s brother, Dustin. “Did you hear the news?” he asked Brayden.
“Ashlyn’s been in a very bad car accident. She’s in the hospital and we’re on our way.”
Brayden called his neighbour for a ride. He pulled himself together and headed downstairs when his phone rang again. This time, it was Const. Emad Haidar — the OPP officer — at the hospital, just as two police cars rolled up to the house.
Haidar instructed him to call his number when he arrived so he could take him to the intensive care unit.
“I didn’t really know any details at that point,” Brayden said. “I just knew it was bad.”
Brayden Krell’s life had taken an abrupt turn.
Two large, wet police officers, one in a uniform covered in mud, were sitting with him at a hospital as his wife fought for her life.
Reintjes laid out the terrible situation: “I’m not a doctor and they have a pulse. But you need to prepare yourself. This is very bad. She was underwater for at least 25 minutes. I don’t know how this is going to work out.”
“I don’t want to hear this now,” Brayden said.
Reintjes and Haidar both nodded and sat quietly. They stayed with Brayden for the next couple of hours.
It was almost 4 a.m. when a trickle of family began to arrive. The officers decided they could leave.
Before they left, Haidar, a devout Muslim, spoke softly to the young husband.
“I will pray for you and your family.”
Saturday: The Recovery
BETWEEN THE 911 CALL AND HAVING HER ON A STRETCHER, WAS 27 MINUTES.