He was trapped. And the fire department couldn’t get him out.
Hector Ruiz had climbed into a confined space at the Alhambra iron foundry where he worked. After finishing his effort to unblock a screw conveyor, Ruiz went back in to retrieve a tool, but a co-worker didn’t see him. The co-worker turned on the machine with Ruiz still inside, pulling him into the mechanism and entangling his legs in the machinery.
“I started screaming,” said Ruiz through an interpreter, “but it was too late.”
The Alhambra Fire Department raced to the scene but was unable to rescue Ruiz. That’s when the firemen called the Los Angeles County+USC Medical Center Hospital Emergency Response Team (HERT). LAC+USC maintains a trained, designated team for events like this, complete with prepacked bags of instruments and medications, protective gear and a protocol for rapid deployment. The team is usually dispatched by helicopter to anywhere in Los Angeles County.
The team is designed for situations exactly like this.
“The team is designed for situations exactly like this,” said Elizabeth Benjamin, assistant professor of clinical surgery. “When the pre-hospital team is unable to extricate a patient, the HERT team is designed to bring a piece of the operating room into the field to provide medical assistance and perform amputations if necessary.”
Though the team is small — it consists of trauma surgeon Benjamin, emergency room resident Wally Bugg and emergency nurse Stephanie Kern — Benjamin said it was a group effort that made it all work.
Emergency response team arrives on the scene
The HERT members were joined on the scene by Marc Eckstein, professor of clinical emergency medicine and medical director for the Los Angeles Fire Department, and emergency fellow Saman Kashani.
In 100-degree weather, with masks in place, Benjamin, Eckstein and Bugg crawled through a small opening. It was dark and full of black dust. Ruiz’s legs were entangled in the screw and there was no way to move him.
“The doctor told me we would need to amputate my legs to get me out,” Ruiz said.
The team put tourniquets around Ruiz’s legs and gave him an anesthetic. There was no spare space for medical equipment inside the machine, so the Alhambra firefighting crew formed a literal fireman’s line. When the team needed an anesthetic, it sent the request down the chain of men and women and a syringe was passed back hand to hand.
So many people came together and worked as one.
“It was nothing short of amazing,” Benjamin said. “I’m humbled by what that group of people was able to accomplish. So many people came together and worked as one.”
Because the screw was surrounded by a metal chamber, it was difficult for the team to get to Ruiz’s legs. The fire crew managed to reverse the screw a bit to give the HERT team room to work, but it was still unable to use its usual instruments to perform the amputation. Once again, the team improvised — this time using a construction saw from the site to free Ruiz from the machine.
Ruiz was anesthetized but still conscious through the entire ordeal.
“He was incredibly calm,” Benjamin said. “I can’t imagine what he went through mentally. He is a remarkable human being.”
Complications in the ambulance
The line of firefighters helped to maneuver Ruiz onto a stretcher. The HERT team started for the hospital, but Ruiz was not out of the woods yet. He went into cardiac arrest in the ambulance. The team intubated him and performed CPR to revive him.
When the team returned to the hospital, dozens of people were already mobilized and ready. An operating room was prepared with nurses and anesthesiologists already in position.
“When we rolled back in, it was the greatest sight ever,” Benjamin said. “It was so hot and we were so emotionally exhausted. To see the entire emergency room and the entire trauma team ready to go was incredible. That kind of training and support is why I work at USC.”
Ruiz immediately went into surgery to stop the worst damage and then had a follow-up surgery to stabilize the amputations. Within a week, he was off a ventilator and a nurse was helping him to sit up and move around, his family by his side.
Benjamin praised the Alhambra Fire Department for having the scene completely controlled when the HERT team arrived.
“There must have been a hundred men and women on the scene,” she said. “They were calm, organized and had prepared the scene to be safe for us.”
A team effort
In March, the entire HERT team received a Clinical Excellence Award from the State of California’s Emergency Medical Services Authority for the rescue. Benjamin said that it was possible because of multiple departments and dozens of people coordinating perfectly. She also cited the influence of Trauma, Emergency Surgery and Surgical Critical Care division Chief Demetrios Demetriades.
“Dr. Demetriades is the reason this all worked so well. It’s the environment that he creates that allows us to prepare and do these kinds of things,” Benjamin said. “And the level of support that he gives us is incredible.”
Vaughn A. Starnes, Distinguished Professor and chair of the Department of Surgery, expressed his admiration for the team as well.
“This rescue exemplifies the kind of training and teamwork we strive for at Keck Medicine [of USC]”, he said. “I could not be prouder of this team and the dozens of staffers who contributed to their success.”
A remarkable recovery
The division of Trauma, Emergency Surgery, and Surgical Critical Care holds a reunion for trauma survivors every spring. This year, Ruiz will speak about his experience and his remarkable recovery. In addition to the HERT team from USC, members of the Alhambra Fire Department have also been invited, as so many of them have expressed a wish to see Ruiz again.
Ruiz has been fitted with prostheses and is re-learning how to walk with a physical therapist. His medical team has been touched by his positive attitude.
“He is unbelievable. He has been incredibly thankful to everyone,” Benjamin said. “To have that selfless perspective so soon after is amazing.”
Ruiz credits the support of his wife Graciela for his positive outlook.
“She has always been by my side,” he said.
And he credits the quick thinking and coordination of the HERT team.
“They made all the right decisions for me to survive.”
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