Development in the Dallas suburb of Plano, Texas, has been fast increasing in recent years—and with it, emergency preparedness officials began to notice—the use of construction cranes and pieces of heavy machinery.
It was only a matter of time, they thought, before someone gets trapped.
So last year, first responders and the local hospital partnered to come up with a plan to create a team that could respond in that worst-case scenario: when a patient needs amputation out in the field.
The team, which already was put to use for the first time in February, allows paramedics to contact a trauma surgeon at Medical City Plano. That surgeon will come to the site of the construction accident and extract a patient from a piece of equipment or other debris through amputation.
The process allows for a quicker trip to the hospital, as trauma patients fare best when treated in the "golden hour" after an accident, said Mark Gamber, M.D., a critical care physician and the intensive care unit director at Medical City Plano.
Gamber is also the medical director who works with one of the two major fire companies in Collins County, Texas. He was able to bridge the gap between emergency response personnel and the hospital staff to begin discussions on building a prehospital amputation team.
"There's a leap of faith in a paramedic potentially calling a trauma surgeon and saying, 'I need you to stop everything you're doing and come to my scene,'" Gamber told FierceHealthcare. "And what if they're wrong?"
First, he said, they worked to educate the team to ensure that paramedics were reaching out to trauma surgeons when appropriate. Gamber said his existing relationship with some of the hospital's trauma surgeons was crucial to luring them into the program.
Once clear protocols were established for when it was appropriate to deploy the team, Medical City Plano staff assembled a kit for the trauma surgeons to use should they be sent to a dig site. In addition to surgical supplies, trauma doctors bring blood for transfusions and ketamine sedatives to the site to perform the procedure, Gamber said.
The team also had to consider a plan to ensure trauma care at the hospital was covered if a surgeon was called out to an emergency at a construction site, Gamber said. If the team is deployed, another member of the trauma team will be called in to cover any surgical needs that may arise at the hospital while the doctor on duty is at the scene.
Gamber said they researched medical techniques used by the military as well as literature on other surgical response teams. The approach is very similar to treatments for a soldier in the field who is injured by an explosive device, he said, and techniques were adapted from military protocols to fit the needs of Plano's patients.
The idea for the team turned out to be terrific foresight. They were deployed for the first time in February, only six months after the team was created. A man was caught in a piece of ditch-digging equipment, and first responders could not free his trapped leg. Medical City Plano's trauma surgeon arrived on the air ambulance that was called to take the patient to the hospital.
The patient lost his leg, but he survived the ordeal and is learning how to walk again.
"Procedurally, for the first time we did something, it went really, really well," Gamber said. "I really think if we hadn't had this process in place, this guy wouldn't have survived."