Trauma

June 23, 2023

On June 3, 2022, what was supposed to be a fun, lighthearted celebratory family boat ride for Vincent Koenig's preschool graduation turned into something far more serious. His dad, Jeremy Koenig, planned a surprise fishing trip for him and his siblings, Jack, Felix and Hazel, on a boat the family purchased the previous fall. Vincent's mom, Rachel M. Koenig, P.A.-C., a physician assistant in Senior Services at Mayo Clinic Health System (MCHS) in Red Wing, Minnesota, was planning to attend the Red Wing High School graduation ceremony for her cousins.

The family boat exited the no-wake zone. Jeremy stopped the boat to lower the motor farther into the water. But it failed and would not restart. Their boat stood at a 90-degree turn, which Rachel explains is a tricky Mississippi River turn near Red Wing's Bay Point Park. Simultaneously, a barge was traveling upriver, right into the Koenig's path.

Without a running engine, Jeremy could not move the boat out of the way. The barge did not have time to fully stop — though it came close — or divert. The barge hit the Koenig's boat.

Suddenly, chaos ensued for the Koenig family. The impact threw the entire family, all wearing life jackets, into the river. Jack, the oldest child, swam across the water to the park. Felix floated toward a good Samaritan in a nearby dinghy who took him ashore.

Vincent and Hazel were pinned under the Koenig boat. Jeremy found Hazel quickly, and the good Samaritan took her ashore. Vincent did not reemerge or bob up in his life vest as Jeremy expected. He desperately tried to find his son.

Next, a pontoon owner towed Jeremy and the damaged boat to shore while Jeremy continued to search for Vincent. When they arrived ashore, Jeremy spotted a clue to Vincent's whereabouts: He saw a flash of bright orange, the color of the bottom of Vincent's shoes.

Unbeknownst to Jeremy and those assisting and watching the family, the Koenig boat had dragged Vincent, pinned underneath, during the tow to shore, approximately 500 yards. Vincent spent 10 to 12 minutes underwater. Horrified, Jeremy wondered if Vincent's life vest had caught on the boat's seat during the crash.

Vincent's resuscitation and assessment

Vincent was not breathing. First responders had arrived and started CPR. They drove him by ambulance to MCHS in Red Wing, where a team began resuscitation.

Rachel then received a frightening phone call from the sheriff's deputy accompanying Jack at the park, telling her a crash had occurred. A second call from the deputy with her husband and other children notified her that Vincent was taken to the emergency department. She frantically drove there, where she encountered the medical team continuing to perform lifesaving measures for Vincent.

Rachel didn't know whether her son was alive. Resuscitation continued. She felt comforted that a friend, Doug S. Larsen, P.A.-C., a physician assistant, was working in the emergency department that day, along with Michael J. Giorgi, M.D., an emergency medicine specialist and a mentor from Rachel's physician assistant training.

The Red Wing team initiated an eConsult with a neurologist and trauma professionals at Mayo Clinic in Rochester, Minnesota. One of the eConsulting physicians directed Vincent's code. A Rochester pharmacist consulted on ketamine infusion and other medication dosing for Vincent. The Red Wing team stabilized him, then put him in a helicopter for transfer to Mayo Clinic in Rochester. Rachel was reassured to note that the helicopter flight nurses seemed like moms. She also felt that God was comforting her through the power of the Holy Spirit wrapping arms around her.

"It was the darkest moment of my life, yet I had profound peace," she says.

Rachel's aunt and uncle drove her to Rochester. En route, she received a reassuring phone call.

"The flight nurse called when the helicopter landed," says Rachel. "She told me Vincent was stable the whole ride."

Meanwhile, first responders treated the rest of Rachel's family at the scene of the crash, then put them in ambulances for assessment at MCHS in Red Wing. After physicians looked at Jeremy and his children, he took them home.

At Mayo Clinic in Rochester, Rachel keyed in on the trauma team's communication.

"I was impressed with the team and how honest they were as they explained the facts," she says. "They told me about the likelihood of brain injury with Vincent's being submerged so long. They laid out timeframes, walking me through what to expect."

The Mayo Clinic trauma team took Vincent to the trauma bay for assessment and scans. The team indicated that he had a submergent injury in which anoxic brain injury was a key concern, says Denise B. Klinkner, M.D., M.Ed., a trauma surgeon at Mayo Clinic in Rochester and director of its pediatric trauma center.

"Vincent had been down and out for a long time," she says.

Vincent's MRI confirmed that he had no anoxic brain injury, but he did have hypoxic brain injury. Vincent had experienced a cardiac arrest and undergone CPR in Red Wing. Initially, the trauma team was unsure whether Vincent had internal trauma. They later found that he had a grade 2 spleen laceration.

"They were preparing to put him on ECMO," says Dr. Klinkner. "It's not frequently done in trauma, but the team considered it with his lungs healing, to rest them. His lungs were inflamed due to water intake. But he stabilized quickly."

Vincent's Mayo Clinic inpatient journey

Vincent spent one week in the pediatric ICU at Mayo Clinic, which is where Dr. Klinkner met him as she rounded on patients over the weekend.

"He was unable to speak when I met him," says Dr. Klinkner. "Vincent was awake, but there were oral secretion issues. We didn't want him to aspirate."

Vincent then spent three days in general pediatrics. Over the next weekend, Vincent recovered enough that the pediatric team considered him an inpatient rehabilitation candidate. Vincent spent six weeks in rehab. His brain injury and other medical conditions continued to improve. Two months after the boat crash, Sherilyn W. Driscoll, M.D., a pediatric physiatrist at Mayo Clinic in Rochester, discharged him.

"It wasn't the summer we were anticipating," says Rachel, who took him home accompanied by the rest of the family. "His incident happened on the first day of summer break."

Vincent's at-home recovery

At home, Vincent needed to relearn almost everything: He had to learn to talk, swallow and hold a pencil. Now he can run, jump and swim with a floatation device, Rachel says. He returned to school in fall 2022.

"His motor function is coming back bit by bit," says Rachel. "He works with speech therapy, OT and PT at MCHS in Red Wing and does speech, OT and PT at school — about 10 therapy hours a week."

During the 2022-2033 theater season, Vincent performed in a play, "The Frog Prince," as a Venus' flytrap, at Red Wing's Sheldon Theatre.

"Vincent's biggest challenge now is delayed speech," Rachel says. "There's some silence and response delay when you talk to him. It takes a long time to get words out."

Rachel says strangers can understand 80% to 85% of his speech.

Vincent requires significant time and attention due to his injuries. Rachel says his siblings have been extremely supportive amid these needs.

"It puts things in perspective," she says. "This crash brought us together on a whole new level."

Rachel says Dr. Driscoll predicts that Vincent will continually improve, though he may have a new baseline.

"She said she doesn't think many people survive what Vincent went through," Rachel says. "She also thinks that his future condition is not entirely predictable because each child's injury and response to it is unique."

Rachel says Vincent remains a happy boy. His kindergarten teacher reports that he is driven and a class leader.

"Tying his shoe is frustrating — his fine motor skills still need work," Rachel says.

Dr. Klinkner says Vincent's falls are now rare, and he is working on handwriting, cutting with scissors and higher level balance.

Advice for parents of an injured child

Rachel has suggestions for parents whose child has been injured, tips you can pass along to patients' families:

Ask questions. There is never a stupid question about your child's injury. Just ask. Medical professionals will help find resources.

Practice self-care. Taking care of yourself as the parent is crucial, such as resting while your child rests. Take care of your mental health and get professional counseling as needed.

Accept help. Parents with an injured child should not try to do it all. Instead, accept help from others. Complete strangers in Red Wing arrived at the Koenig's door to help them, and the community gave their family excellent support, says Rachel.

"It's easy to get overwhelmed, caught up in emotions and looking at the past," says Rachel. "It's better to take baby steps toward the future."

For more information

Refer a patient to Mayo Clinic.