Gordon Graham, a former police officer, lawyer, risk management expert and Lexipol co-founder, would classify a field amputation as a low-frequency, high-risk incident in his four-quadrant classification for categorizing incidents. Because field amputations are rare, we must prepare for them through training and preplanning, especially with response partners. Learn the 3 questions you should be prepared to answer when activating the surgical team in this analysis by Lexipol Editorial Director Greg Friese, MS, NRP.
Carol Robinson
pennlive.com
FULTONDALE, Ala. — It was a rescue scenario like no other, truly a matter of life and death.
An EF-3 tornado with estimated winds of 150 mph blew through Fultondale, decimating entire neighborhoods and toppling a 100-year-old oak tree that landed on the leg of Arnoldo Vasquez-Hernandez as he was shepherding his wife and three children to the basement of their Lykes Boulevard home.
Over the next five hours, paramedics, EMTS, police, firefighters, UAB surgeons and nurses and even neighbors would team up in a series of actions that culminated in a rare on-site surgery to remove Vasquez’s leg and free him from entrapment. The rescue workers involved said it was one of the most intense moments of their careers.
“At the end of the day, we’re there to save someone’s life. Not their hand or their foot,” said Fultondale medic Brandon Sharp. “Life is more important than limb.”
Vasquez and his wife, Eloisa, clean commercial properties for a living. Just an hour before the tornado hit, they had been at work cleaning the Vestavia Hills municipal buildings, including the fire department which would later be instrumental in saving his life.
The couple returned home just as the storm traveled over their house, and they rushed to get to their safe place. Eloisa and the kids made it to safety, but Vasquez was trapped, with no way out.
Mt. Olive EMT Brandon Fuller, 26, knew once the tornado had passed that there was likely a significant amount of damage and devastation left behind. Though he was off duty, he called Fultondale Fire Chief Justin McKenzie who quickly told him, “We need you to come on.”
Fuller teamed up with a Fultondale police officer and the pair went out in search of those in need. They heard a call that someone was trapped and immediately headed that way. “We got to Lykes Boulevard and you couldn’t even recognize the neighborhood,’' Fuller said. “I grabbed my jump bag and started running that way, hollering at whoever could hear me.’'
When he found the Vasquez home, about 11:15 p.m., the entire upstairs had collapsed onto the first floor. Fuller found a hole in a door and crawled under a tree until he found Vasquez. “He was at the top of the stairs. He was actually shielding his daughter, pushing them downstairs,’' Fuller said. “He almost made it to the basement before the tree came down on him.”
Fuller said the tree that fell on Vasquez was at least six feet in circumference. Vasquez’s leg was pinned underneath. “He was awake and conscious,’' Fuller said. “I told him, ‘Hey, I’m not going to leave you here. I’m going to stay with you.”
The EMT didn’t have a radio so yelled at officers outside to send help. He requested heavy rescue specialists, air bags, and anything else he could think of that might be of use. “In the back of my mind,’' he said, “I knew it was going to be a daunting task to get him out.”
About 15 to 20 minutes later, Fultondale medic, 24-year-old Brandon Sharp, arrived on the scene. “I told him what we had. We got some fluids going in him,’' Fuller said. “Sharp put a tourniquet on his leg. Because of the tree, we couldn’t see how much he was bleeding, but we knew it was going to be bad.”
The conditions couldn’t have been any worse. The floor leading to the basement was collapsing. “I knew if we moved the tree an inch or the house an inch, it would have all come down on us and it would have made the situation worse,’' Fuller said.
Sharp said he was stunned at what he saw when he got there. He doled out equipment for officers to help him carry up hills, over trees and under unsteady power lines. When he arrived, he saw the downed oak tree. “I was just baffled,’' he said. “Trees like this aren’t supposed to fall.”
“We started doing the paramedic stuff but in the back of my head, I was feeling kind of useless,’' he said. “Yes, we’re kind of helping him but then we’re not because we can’t.”
A neighbor was there, serving as a translator for the first responders. Fuller and Sharp said it was about an hour before the heavy rescue help arrived. Vestavia Hills Fire Department got there first, followed by Birmingham Fire and Rescue Service.
Vestavia Hills firefighter paramedic Lawrence Pugliese said he got the call about 11:30 p.m. They rushed to the scene but were still about 300 yards out from the home when they’d driven as far as they could. He ran the rest of the way.
“The house was actively collapsing,’' Pugliese said. After about two hours, “we had exhausted all of our resources to do any further care,’' without the help of UAB surgeons and nurses.
Pugliese called UAB trauma surgeon Dr. Don Reiff and told him what was happening. For the next couple of hours, there would be a flurry of calls and preparations to get a team together and on the ground in Fultondale.
Meanwhile, the Vasquez home was becoming increasingly unstable. A BFRS firefighter made everyone leave the house except those essential for Vasquez’s ongoing care. “I wasn’t going to leave him,’' Fuller said. “By that time, we were four, or five, hours in. Me and Sharp had been taking turns getting up to walk around and stretch.”
At UAB, doctors and nurses were preparing for their trek to Fultondale to do something never done around here – an in-the-field amputation. The team was made up of Reiff, Department of Emergency Medicine Dr. Blayke Gibson, trauma/burn nurse manager Sherichia Hardy, and director nursing services at UAB’s free-standing ER in Gardendale India Alford.
Reiff said he got the first between midnight and 1 a.m. and was on standby if no other solution could be determined. About 2 a.m., the decision was made to send the team to the site. Everyone working in the UAB emergency department that night pitched in making preparations and gathering supplies. Within 20 minutes, they were ready to leave.
Hardy and Alford were transported to the Vasquez home by ambulance with needed fluids and blood. Gibson had gathered together the surgical tools and was driven to Fultondale by a UAB police officer. Reiff took his personal car to the scene.
Hardy and Alford got there first and set up a makeshift supply table in the Vasquez basement. “When I heard for sure that Dr. Reiff and Dr. Gibson were coming, my heart just was glad,’' Hardy said. “The firefighters had come to us and said they were going to allow (Vasquez) to call his family because at that moment it was looking pretty grim in terms of being able to get him out safely.”
“I was just very grateful the first responders were able to think quickly and engage us and I was able to help perform the nursing care with him when he was there as well as in the ambulance.”
“When they showed up, everybody took a sigh of relief,’' Pugliese said. “The clock was ticking because the house was actually collapsing.”
Lifts or jacks were being used to temporarily support the house so that the medical workers could do what they needed to do. “At least 10 different agencies were there working together,’' Pugliese said. “It was a miracle. It was beautiful.”
Reiff and Gibson said they had never performed surgery in the field and haven’t heard of anyone else doing so in the Birmingham area. “It was novel,’' Reiff said.
The first responders and medical workers explained to Vasquez and his family, through an interpreter, what had to happen. They were told, “In an effort to save his life, we’re going to have to sacrifice a part of his lower extremity,’' Reiff said. “I think he had seen the efforts of the fire departments and heavy rescue units trying to extricate him with and with their best efforts, they could get him out. I think he understand that to preserve his life, this was going to be necessary.”
“He said, ‘Whatever you have to do to get me out,’’' Gibson said.
Vasquez spoke with his family before the surgery. “At first he was hesitant, and I think he said his kids were asleep and he didn’t want to wake them, but we pretty much told him, ‘You need to talk to them,’’' Fuller said. “Like any operation, anything could happen. But we had a lot of faith in the doctors there. They were beyond awesome.”
The on-site medical staff sedated Vasquez and then carried out the surgery as the trapped man lay at the top of the basement stairs. EMT Fuller stood on the fallen oak tree and held a flashlight over Vasquez so the surgery could be performed.
The actual amputation, done just above the knee, only took about 10 minutes and then Vasquez was taken to UAB. He’s since had several surgeries and has a long road to recovery, but Reiff is optimistic about his future. “I think he’s going to have a normal life,’' the doctor said.
For now, Vasquez remains hospitalized. Two different GoFundMe accounts have raised more than $70,000 combined for the family. Donations can be made here and here.
Despite the trauma suffered by the family, everything worked out as best it could under the dire circumstance of that night, according to those involved. “The right people in the right place at the right time all working together,’' Reiff said, “was really amazing.”
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