Todd Van Guilder knew he was in trouble the second he flew off his bike during a ride along the Cuyuna Lakes Mountain Bike Trails in central Minnesota.

He sat up to brush himself off and saw white spots in his vision, he said. When he closed his eyes and reopened them, the spots turned to a solid wall of bright white light.

“My buddy who had been riding in front of me came back and asked, ‘Are you okay?’” recalled Van Guilder, a regular mountain biker who lives in Eagan, Minn., near the Twin Cities.

He and his friend were visiting the 50-mile mountain biking park in the woods on Sept. 12 for some adventure and exercise, he said.

“I was wearing a helmet, but when I took the fall on my bike, I landed really hard on my stomach and chest,” Van Guilder said. “I could hear where my buddy was, but I couldn’t see him. I told him, ‘I think I have a bit of a problem.’”

Van Guilder didn’t realize how big the problem was. About 30 minutes later, as he lay in the woods, he would need an emergency tracheotomy — a surgery to make a lifesaving airway in his neck.

After his friend called 911, paramedics arrived on the scene and saw that he was having difficulty breathing, he said.

The six medics realized that they needed a tank of oxygen from the ambulance in the parking lot, which was three-quarters of a mile down the trail. They asked aloud whether someone would run down and retrieve it before the situation became more dire, Van Guilder said. A police officer on the scene volunteered, and jogged back down the trail.

It was a lucky moment.

Just then, Jesse Coenen, an emergency room doctor from Hayward, Wis., passed the officer running down the trail.

Coenen, 38, was visiting the trails that Sunday afternoon to pedal off stress from working 13-hour days in the ER.

When Coenen learned that the officer was racing to fetch an oxygen tank, he and his friend offered to help. They hurried down the trail on their bikes, asked the ambulance driver for the oxygen tank, then pedaled it back to the scene.

By this time, Van Guilder was unconscious and the members of the medical crew said they were preparing to intubate him — insert a tube in his throat — to make it easier for him to breathe with a manual resuscitator, also called a bag valve mask, Coenen said.

He said he took in the situation for about 30 seconds, then told the EMTs that he was a doctor.

“I quickly realized this was a serious situation,” said Coenen, who works at Hayward Area Memorial Hospital. “They told me that the guy had fallen off his bike and that a helicopter had been dispatched. They were helping him to breathe, but it was necessary to make sure that his breathing was adequate.”

After several attempts by Coenen to guide an intubation tube down Van Guilder’s throat failed because he was unable to see the windpipe, the medics tried to clear saliva away with a portable suction device.

That also failed, Coenen said, and he knew there was only one option left to deliver air to Van Guilder’s lungs and save his life: an emergency tracheotomy.

“His oxygen level had started to drop, and I was getting concerned,” the doctor said. “I figured he might have anywhere between 10 and 20 minutes before he died. That’s when I decided to enter the windpipe through the neck.”

Coenen asked the EMTs if they had any tools he could use. One of them rummaged through a bag and produced a scalpel, while another removed her antiseptic gloves, turned them inside out and handed them to him, he said.

“Cutting somebody’s neck like this is a rare procedure, even for a doctor,” Coenen said. “I’d done it before on mannequins and a pig cadaver, and I knew by heart how to do it. I’d just hoped I would never have to.”

He made a two-incision cut beneath Van Guilder’s Adam’s apple, he said.

“The paramedic was prepared with the tube in her hand and it didn’t fit, so I had to make the incision wider,” he said. “I figured that he had maybe just a few minutes before his heart stopped, so I was relieved when it finally worked and the tube fit.”

It was a success — the tube was put into place, allowing a paramedic to manually deliver oxygen through the bag valve mask.

Once Van Guilder’s oxygen levels had risen, paramedics were able to carefully transport him down the trail to the parking lot using a one-wheeled, flat medical gurney similar to a wheelbarrow, Coenen said.

“I have to say that I wasn’t optimistic he would live when they took him away in the helicopter,” Coenen said. “His condition had deteriorated, and I was concerned he might have a brain bleed.”

But at the hospital, after doctors gave him stitches to close up the incisions in his neck and treated him for a traumatic brain injury, Van Guilder rallied.

He was monitored for 10 days before he was released to go home on Sept. 22 to his wife and teenage daughter.

“Miraculously, I had no broken bones,” Van Guilder said. “They don’t know what caused the white spots in my vision or exactly why I couldn’t breathe. But they believe it could be related to the trauma of falling.”

Other than a scar from the tracheotomy, Van Guilder said, he went home with nothing more than a scab on his right arm and some minor road rash on his left knee. He is on a soft-food diet for a while, but once his throat is healed, he’d like to take Coenen out to dinner, he said.

“I talked to him on a Zoom call and told him how grateful I am that he happened to be there that day at that precise moment,” Van Guilder said. “I’m obviously extremely fortunate. What are the odds?”

Coenen said he’s happy that he chose that trail to ride on that weekend. He was able to finish his ride that afternoon and was relieved when he learned that Van Guilder had survived his ordeal.

“It all fell into place in multiple parts,” he said. “The paramedics and first responders were absolutely crucial. If they hadn’t had a scalpel, I don’t know what would have happened.”

“I stumbled onto the scene,” he said. “It’s a lesson to us all that you never know who you’re going to encounter.”

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