The toddler loved to climb and previously had taken spills from a greater height but it was his response to the awkward fall that worried his mum, a former nurse.

“He went to sleep straight after he fell. I had a bad feeling and decided I needed to check his pupils,” Mrs McAlister said.

She found one of his pupils was enlarged, a sign that the impact on the right side of his skull may have caused a serious head injury.

Within 15 minutes Mrs McAlister had Archie at Albury Hospital’s emergency department where a medical team had been convened. Archie was semi-conscious and his condition deteriorating.

A CAT scan revealed a large blood clot between his brain and the skull was expanding.

More frightening was the realisation there was no time to get Archie to Melbourne for life-saving surgery.

“He had a subdural haematoma or haemorrhage and his brain had already shifted because of the pressure on it,” Mrs McAlister said.

“It was a bad prognosis.”

Her husband, Paul, said it had been terrifying to see his youngest child lying semi-conscious in hospital.

Emergency nurse practitioner Marienne Shanahan was on duty when the emergency department was told paramedics were bringing in a 14-month-old patient with a head injury.

“The problem is that someone in Archie’s condition might be so unconscious that he would be unable to breathe on his own,” Ms Shanahan said.

“That trauma call initiated our bringing together an anaesthetist, surgeon and paediatrician, as well as the emergency department staff.

“By the time he arrived, we had a team to go to surgery.”

Mrs McAlister said while Archie had taken an unlucky fall, his luck came in with the response to his injury.

Within two hours, paediatric surgeon Tracey Merriman, in consultation with neurosurgeons at Melbourne’s Royal Children’s Hospital, operated to relieve pressure on Archie’s brain. She removed a five square centimetre piece of his skull that allowed access to remove the clot.

Soon after, Archie was transferred by a specialist paediatric team by air ambulance to Melbourne. He did not require further surgery there.

“Dr Merriman had done such a great job here that he didn’t need another operation in Melbourne,” Mrs McAlister said.

“We are so fortunate to have her here.

“Without her, his outcome may have been very different.”

Mr McAlister said his son’s surgery and recovery was “nothing short of a miracle”.

Archie spent a week in the Royal Children’s and has returned wearing the helmet he will need until the gap in his skull either grows over or is filled with a bone graft.

He will have another scan next week to check his progress before returning to Melbourne to see specialists there.

Yesterday it was a bright and happy boy who returned to Albury Hospital with his parents and four older sisters to meet those who saved his life.

“These outcomes make it rewarding for all concerned,” Ms Shanahan said.

Mrs McAlister said instinct as well as her medical training had encouraged her to call the ambulance when Archie fell.

“He has had an incredibly unlucky fall but he has been so incredibly lucky afterwards.”