Alcor News Bulletin
                 ---------------------------
                 Number 11: March 23rd, 2003




     Yet Another Unexpected Case in Southern California

                     by Charles Platt


At the end of February this year we initiated a brief 
standby for A-1234, an elderly woman in Southern California 
(whose signup documents requested confidentiality). Although 
she was suffering from severe circulatory problems and had 
been admitted to an ICU with pneumonia, she managed to 
recover, and we discontinued our standby. Subsequently she 
relocated in a nursing home in Hollywood.

On Saturday March 22nd at 8:02 AM Mountain Standard Time a 
staff member at the nursing home found that A-1234 had 
suffered cardiac arrest. Attempts to revive the patient were 
unsuccessful, and the nurse called Alcor's emergency number 
at approximately 8:15 AM. (All times in this report are in 
MST, which is one hour later than Pacific time during the 
winter months.)

Dr. Jerry Lemler contacted me at my home in northern Arizona 
around 8:20 AM and said he would coordinate activities in 
Scottsdale while I would organize the Southern California 
response. I telephoned one of our California coordinators, 
Bobby June, who was not entirely happy to be woken since he 
had been up partying for most of the night. Still, he 
tackled the task of finding a van that we could rent to 
transport the patient to Arizona. I was worried that renting 
the vehicle might be the most time-consuming task in the 
transport operation. This concern turned out to be correct.

I called our other Southern California coordinator, Todd 
Huffman, who had been planning to go snowboarding with a 
friend and had already started driving out of Los Angeles. 
He promptly changed his plans and returned home to grab a 
backup meds kit. Next I checked my map of Southern 
California volunteers and found that Peter Voss was located 
closest to the nursing home. Peter was awake and ready to 
respond. He left his house to retrieve our primary standby 
equipment from its storage location before continuing to 
the nursing home.

Alcor's paramedic Larry Johnson, in Phoenix, tried 
unsuccessfully to contact A-1234's son, an Alcor member 
possessing durable power of attorney for health care for the 
patient. Under California law the nursing home could refuse 
to release the patient without signed consent from the next 
of kin, and the son was the only person who could provide 
this. Since he was probably 60 miles away and is legally 
blind, I didn't know if it would be physically possible for 
him to reach the nursing home and sign a release within a 
short time. However, after I asked our California mortician 
Joe Klockgether to discuss this situation with staff at the 
nursing home, they agreed to waive the requirement for a 
signed release. Mr. Klockgether also had a copy of the death 
certificate which we had prepared in advance when we 
arranged the standby for the same patient at the end of 
February.

In the meantime the nurse who had discovered A-1234 had 
injected heparin, had administered chest compressions, and 
had placed ice around the patient. Peter Voss had collected 
our kit and was on his way, and Todd Huffman would soon be 
joining him.

The patient's son received our messages and called me, and I 
told him the news about his mother. He seemed calm but said
that the death had come as a surprise, since his mother's 
health had been improving during the past couple of weeks.

By 10 AM our team members were at the nursing home and I 
asked Larry Johnson to give instructions via the phone to 
Todd Huffman regarding medications. (Larry had considered 
flying to Los Angeles himself, but clearly he would have 
been unable to get there in time.) Larry described to Todd 
the technique for putting the patient in the Trendeleburg 
position, which causes the external jugular veins to become 
distended. This enabled Todd to place an IV line. It was 
then relatively easy to push the various medications that we 
use to mitigate ischemic injury.

I checked back with Bobby June, who was having difficulty 
finding a truck that we could rent. Trucks often tend to be 
in short supply for last-minute rentals on a weekend, 
because this is when many people move personal possessions. 
Finally Bobby found a truck that was available reasonably 
close to the nursing home. Peter went to collect it while I 
conferred with our medical advisor, Dr. Steve Harris, 
regarding the option of doing a washout before the patient 
was moved to Arizona.

Intravenous cooling is many times faster than cooling by 
external application of ice or icewater, and for each 10-
degree (Celsius) reduction of temperature, we halve the 
metabolic rate. If a patient's temperature is reduced from 
35 (close to normal) to 5 (our terminal target value), 
theoretically we reduce the rate of ischemic injury by a 
factor of eight. 

On the other hand, I realized that in order to perform the 
washout our transport team would have to leave the 
Interstate highway, find the lab where our surgical team 
consisting of Steve Harris, Sandra Russell, and Joan 
O'Farrell were located, wait for the procedure to be 
completed, and then drive back to the Interstate and 
continue to Arizona. Depending on how much difficulty our 
surgeons might have in obtaining vascular access, I 
estimated that the detour could cost us three hours. Since 
the patient's temperature was already down to 21 degrees 
(measured via a nasopharyngeal probe which had been placed 
by team members at the nursing home), we were already 
halfway from normal body temperature to the target terminal 
temperature. With concurrence from Steve Harris I decided 
that it would make better sense for the patient to go 
straight to Arizona, packed in ice, with occasional chest 
compressions along the way.

I called Alcor Central and told Jerry Lemler that the 
patient's probable arrival time would be between 6 PM and 7 
PM. He suggested that I didn't need to come to the operating 
room myself, since he had assembled adequate staff for the 
procedure.

The patient entered the facility at 7:02 PM with a probe 
temperature of 4.1 degrees Celsius. When I called Alcor at 
8:30 PM I was told that neuroseparation was complete and 
perfusion had begun. I was very relieved to learn that no 
one could find any evidence of blood clotting. Todd Huffman 
can take much of the credit for this by having managed to 
place the IV and administer heparin and streptokinase, in
resonse to the valuable instructions from Larry Johnson. 
Another fortuitous factor is that the patient had been 
taking Coumadin, an anticoagulant medication, before 
she died.

No edema was visible, and despite a moderate flow rate, by 
11:30 PM the patient exceeded the concentration of 
cryoprotectant necessary to vitrify. We can regard this as a 
successful case, especially since it occurred with no prior 
warning. Less than eleven hours elapsed from the moment when 
we received the emergency call to the time when the patient 
arrived at our facility. Our only concern is that the time 
of death remains unknown, since nursing homes typically do 
not monitor patients constantly. It is possible that A-1234 
arrested several hours before she was found at 7:02 AM. 

The question of whether to take time for washout and 
intravascular cooling of California patients during the 
transport phase remains unresolved. Clearly the procedure is 
necessary when a patient is located farther away and we want 
to achieve rapid initial cooling prior to a relatively 
lengthy transport. Washout is also advisable if the patient 
has a higher initial temperature, has been collected by a 
mortuary service, or is close to the location where the 
procedure can be done. But when our own team members have 
collected the patient without any paperwork problems and can 
reach Alcor from Los Angeles in less than seven hours, the 
simplicity of this option is attractive. 

Once again we thank our Southern California team for 
performing outstandingly at short notice. We regret the loss 
of A-1234, a longtime Alcor member who would have been 83 
next month and showed great courage and tenacity in dealing 
with her health problems. We're thankful that she opted for 
cryopreservation, and hope that her decision will be justly 
rewarded in a future world where death and aging are no
longer regarded as inevitabilities.

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                  New Job Titles at Alcor

Alcor's CEO, Dr. Jerry Lemler, has assigned new job titles 
to Larry Johnson, Charles Platt, and Michael Riskin, and has 
clarified Alcor's organizational structure.

Larry Johnson, who joined Alcor earlier this year, will play 
an increasingly important role in standby work and is now 
Director of Clinical Services.

Charles Platt is now Chief Operating Officer. His 
responsibilities will include standby and rescue activities, 
O.R. procedures, facility expansion, ambulance and vehicle 
conversion, cooldown procedures, and long-term storage 
protocols, as well as website maintenance.

Michael Riskin, Ph.D., who serves as Vice-President and 
Chairman of the Board, now has the additional title of Chief 
Financial Officer. He will have ultimate fiduciary oversight 
responsibilities to include budgetary review, capital 
raising activities, and management of the accounting 
department. Additionally he will supervise the membership 
department in all facets of its operations. 

Below is a current list of Alcor personnel and independent 
contractors. Each full-time employee is identified with an 
asterisk.

CEO:
   Dr. Jerry Lemler*

Reporting to the CEO:
   Bill Haworth (Public Relations Counsel)
   Charles Platt (COO)
   Michael Riskin (CFO)

Reporting to the COO:
   Tim Carney (Consulting Engineer)
   Hugh Hixon* (Facility Engineer and Alcor Research Fellow)
   Larry Johnson* (Director of Clinical Services)
   Dr. Jose Kanshepolsky (Surgeon)
   Jeff Kelling (Scrub Nurse)
   Paula Lemler (Human Resources Administrator, Projected)
   Dr. Nancy McEachern (Surgeon)
   Mike Perry* (Patient Care Associate)
   Jerry Searcy* (Special Projects Operative)
   James Sikes* (Facility Operations Manager)
   Mathew Sullivan* (Director of Suspension Readiness)

Reporting to the CFO:
   Jennifer Chapman* (Membership Administrator)
   Joe Hovey* (Comptroller)
   Jessica Sikes* (Administrative and Membership Associate)
   Katherine Waters* (Accounting Manager)



Alcor News is written primarily by Charles Platt.
Contents are copyright 2003 by Alcor 
Foundation but permission is granted to reprint any whole 
news item, so long as Alcor is credited as the source and 
the reprint includes our URL at http://www.alcornews.org.