Jenifer Fernandes Veloso was simply doing her job, photographing the Crim Festival of Races on August 23. Veloso is a communications officer for the Charles Stewart Mott Foundation and was taking photos and video of racers from around the course for a work assignment when a dire medical emergency caused a rapid shift in gears.
Veloso was using a golf cart for the day to haul her equipment to different spots along the course, and her partner Sarah Satkowiak and Sarah’s father Pete were serving as her chauffeurs. Near the 8-mile mark of the course, a little before 10 a.m., Veloso and the Satkowiaks were waved over by racers who thought their cart might be a medical crew. They had encountered a person laying face down on the Crim course just past Powers Catholic High School and were trying to get help. All three quickly sprung into action to assist. As far as trios equipped to handle unexpectedly being thrust into an emergency, it doesn’t get much better.
Sarah Satkowiak, who currently works as a public health nursing supervisor for sexual health and family planning at the Genesee County Health Department, spent eight years as a combat medic in the Michigan Army National Guard and became a licensed EMT during that time. During her military service, she completed her nursing degree at the University of Michigan-Flint in 2017 through the Veteran Bachelor’s of Science in Nursing (VBSN) program and worked at Hurley Medical Center for approximately five years, where she became Advanced Cardiac Life Support (ACLS) certified, Trauma Nursing Core Course (TNCC) certified, and worked in Hurley’s Emergency Department. After leaving Hurley, she worked as a flight nurse in northern Michigan and became certified as a Critical Flight Registered Nurse (CFRN). Flight nurses provide advanced critical care during medical emergencies while patients wait for transfers to medical facilities.
Veloso, also a UM-Flint nursing graduate, became a nurse in 2016 and also worked in the Hurley Emergency Department on the trauma team, which includes Emergency Severity Index (ESI) training. She’s also ACLS and TNCC certified. After working at Hurley, she worked as a travel nurse and then as a nurse in the COVID-19-dedicated ICU at the University of Michigan-Ann Arbor during the height of the pandemic. She eventually began working at a surgery center part-time to explore non-nursing career opportunities in photography, journalism, and communications, but has maintained her nursing license.
Pete Satkowiak is a retired Flint Township firefighter who worked in the department for 27 years and has been trained in CPR and other vital first responder skills.
That lengthy list of experiences is relevant because, as they quickly discovered, the person down on the ground was not just dealing with a head injury as onlookers thought, the medical emergency was far more severe and would require more emergency expertise than bystander CPR or other basic lifesaving procedures that non-medical professionals are typically trained in.
“We were coming around MSD (Michigan School for the Deaf), and we just saw a crowd of people,” Sarah said. “A lady waved at us and asked if we were with an ambulance. We were like … well, not exactly, but what’s going on? She just said they need help down there. I was driving and I just pulled over to the side as fast as I could.”
The person was on his side, but his face was down on the ground and they could tell he had a head wound that was bleeding. The other racers who stayed to help just knew the man fell, but didn’t know if he simply tripped or if something else happened. Veloso and Satkowiak began inspecting him and noticed he was turning purple and had some foam in his mouth, so they thought he possibly had a seizure that caused the fall.
“We were at his side and I was trying to rub him, it’s called a sternal rub where you take your knuckles and rub them into someone’s chest,” Sarah said. “It hurts most people, it hurts very bad usually, but he didn’t respond, which is a very bad sign.”
They held his neck and carefully rolled him over to see if he had any other injuries and did an intervention to “thrust” his jaw, which opens up an airway in case a patient’s tongue rolls back into their throat and they can’t breathe. That intervention is also painful if you’re conscious and he also didn’t respond to that.
“A lot of times, it stimulates people to breathe. I thought, best case scenario, we do this, and he breathes, but that didn’t change anything,” Sarah said. They also couldn’t find a pulse.
“Sarah said, ‘We gotta start CPR,’” Veloso said. “So Pete and I just said okay, we’ll help you.”
The three of them took turns doing chest compressions, and others who stayed to help kept calling 911 to let ambulances know the severity of the situation. A third nurse also arrived as CPR was happening and she also took turns. While one person was doing compressions, the others were counting.
In an emotional and inspiring moment that truly embodies the spirit of support, neighborliness, and taking care of one another that the Crim Festival of Races represents, the crowd of bystanders joined in.
“I started clapping the rhythm for my dad, and then everyone standing around started clapping out the rhythm for him too,” Sarah said. “I thought that was amazing, just everyone’s way of like encouraging each other and trying to do what they could to help.”
“That carried over into everybody,” Veloso said. “It felt good, it felt really good to be supported by the people behind us. Everyone immediately knew what we were doing, and backed up to give us space, but they were still like, ‘What can we do?’ to support him. It was just love.”
After several rounds of CPR, a Patriot Ambulance unit was able to get through the crowd and arrive. They told the EMTs they needed an airway and brought a device called an i-gel, which is used to manage a patient’s airway, and an oxygen tank in a bag. Sarah quickly inserted the i-gel into the patient’s airway. That allowed them to start using an Ambu Bag to provide ventilation for the patient while CPR continued.
“So instead of having to breathe for them, now you just get to squeeze this bag that’s now connected to their advanced airway continuously,” Sarah said.
By then, other medics were arriving on the scene to help. Another Patriot medic was able to help get pacer pads, which tell medical professionals what “rhythm” a person is in and can provide a shock if they have a shockable cardiac rhythm, applied. A Genesee County medic arrived and brought a LUCAS device, which allowed them to finally stop having to do manual chest compressions. They were also able to get IV access in the patient.
After the pads were on, a paramedic said that the patient was in ventricular fibrillation (VFib), a life-threatening cardiac rhythm that can lead to sudden cardiac arrest.
“We said, ‘Okay, we gotta shock him,’” Veloso said. “I was standing over him, another girl backed off, Sarah was still bagging him, and the paramedic said ‘Okay, shock!’”
They also gave the patient epinephrine, which is both a hormone and a medication that can increase heart rate, blood pressure, and oxygen intake. But doses of it have to be spread out, and treating a patient laying on a street during a road race, with EMTs and first responders from multiple organizations (Flint Fire Department and UM-Flint campus police had also arrived by then) now on the scene in addition to the people who initially found and began treating the patient isn’t exactly conducive to remembering the immense amount of details that require close attention in a life-threatening situation. The sequence in emergencies like this is actually vital.
“There’s a mnemonic in healthcare or CPR, that’s like A, B, C – airway, breathing, circulation,” Sarah said. “And, if you don’t address those things in that order, you’re not gonna be able to appropriately resuscitate someone or keep someone alive.”
She created a system in a pinch though – she had a pen and was marking important parts of the timeline and other details out on her thigh as everyone worked.
“She wrote down the time that the patient got the epi on her thigh. Like, that’s how hardcore the whole situation was,” Veloso said. “Because once you give epinephrine, you can only give it so many times in a cardiac arrest. So you have to know.”
By then, with multiple people on the scene, there was enough of a moment for Veloso and the Satkowiaks to catch their breath. And their first thought went to who the patient they were helping was on a personal level – they didn’t even know whose life they were working tirelessly to save yet.
“Sarah said, we have to identify this person,” Veloso said. “So we checked his bib and at least learned his first name. So it was like, okay, at least we know his name now.”
The entire time on the scene, Sarah managed the patient’s airway, a critically important part of the intervention that requires an immense amount of training and experience. When it was time to check for a pulse again, his pulse had returned.
“Generally, in regular nursing care, it doesn’t usually involve a lot of advanced interventions,” Sarah said. “You can’t place airways, you can’t do certain medications or procedures. If I had just been a regular nurse and hadn’t been trained when I worked at Hurley, I wouldn’t have been able to place airways and intubate people and critical things like that. Only CFRNs (Certified Flight Registered Nurses) can intubate. The whole situation, the outcome, we were just very lucky.”
By the time he was on the stretcher and about to be moved into an ambulance, he was even starting to move a little, and his blood pressure was returning to a more normal level.
“Before he even got in the ambulance, we had pulses back. He had a clear airway and was starting to have purposeful movement,” Veloso said.
Later, a video posted by the Genesee County Sheriff Department on Facebook did confirm the patient had a heart attack and survived and was recovering. Veloso and Sarah Satkowiak reached out to Hurley nurses to inform them of what happened and let them know the patient was coming.
Pete Satkowiak was happy to play a role in assisting during the emergency, but also had a bonus role of being a proud parent as his daughter and daughter-in-law knew exactly what to do and kept the scene organized while keeping the patient alive until paramedics arrived.
“Jen and Sarah kicked into emergency mode, and for once I was taking orders on what to do from them!,” he said. “I helped a little, but they truly saved his life. I will remember this day forever.”
In addition to being relieved that the patient survived and that they happened to be by the scene, Veloso and Satkowiak are grateful for the extensive training they received at Hurley.
“There are nurses in the Hurley ER who do things like this that save peoples’ lives five, six times every night,” Satkowiak said. “The only difference is like, we did it on the side of the road during the Crim.”
As the only level one trauma center for adults in the region, the volume of patients Hurley’s Emergency Department serves, as well as the often dire injuries or medical issues patients there are facing, both Veloso and Satkowiak, who are Flint natives and live in the College Cultural Neighborhood, had a crash course in how to handle unimaginably stressful situations. Hearing from some of the mentors who trained them after they helped save a patient during the Crim was extremely meaningful.
“Michelle Helzerman and Terri Bates, they trained me as a trauma nurse,” Veloso said. “And to have both of them call me and tell me I did a good job … There are so many incredible nurses like them, and we knew what to do because of them. I just learned from the best.”
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