Last October, a 47-year-old motorcyclist in the UK crashed and tried very hard to die.
As a result of blood loss and injury his heart stopped. Without emergency aid, he would have remained dead. Fortunately for our British biker, a physician was on the scene. He was not a surgeon, but he did what surgeons do — he operated. But not in the hospital. He operated on the asphalt, opening the biker’s chest, controlling bleeding, and manually compressing the heart to get it to start again. Wow!
An awesome story but it is only one part. The rest of the tale is the IV access placed by the EMS paramedics, IV fluids infused under pressure, and emergency medications delivered as a push designed to rescue an arrested heart. All of these are essential in saving a dying patient and supporting heroic measures. This was a superb team effort.
How heroic is opening a chest on the roadside, stopping bleeding, and performing open cardiac massage (squeezing the heart in a very particular fashion to provide blood flow)? Very! Surgeons do extraordinary things in and out of the operating room — but they are generally done in the hospital, with lots of tools and a team to help.
Opening a chest requires something really sharp, and no small amount of intestinal fortitude. We use a scalpel in the hospital, and perhaps the ambulance had one for the doc to use. Or he had one in a convenient emergency pack in his vehicle (I do). Personal protective gear such as gloves are easily found in the ambulance. After that, not much more is needed unless you would like to do something inside once you open the chest!
The leading cause of preventable death after injury is bleeding, making hemorrhage control a priority. You may be familiar with this as a result as the American College of Surgeons Committee on Trauma STOP THE BLEED program. Surgeons use clamps, suture and staples to control bleeding. Virtually none of those are available in the field. What to do?
Only three things are available in the field once the chest is open: packing bandages around bleeding structures, especially if the bandages make things clot (excellent for bleeding around ribs); putting a finger (or two) in a hole to plug it (works for holes in the heart); twisting an organ around its vascular supply to shut off all blood flow (great for the lung).
There are few details on what was done, but it worked. The most notable risk is infection. Without the skin prep with an antibacterial solution, isolation of the area of the incision and antibiotics we usually use, this survivor was at high risk for infection throughout that incision, as well as within his chest cavity. Small price to pay to be alive!
Is this a standard approach? Not at all. For one thing, it is quite rare to have a physician at the scene of a crash in the United States, where the approach favors rapid transport to a trauma center instead of doing a lot of work in the field. Doctors on ambulances are much more common outside of the United States. You may recall that whether to spend time providing care outside of the hospital was central to the colorful “discussions” around the death of Princess Diana.
In this very unique case, quite unusual work in the field was lifesaving and the story has a happy ending. The doctor’s heroism was recognized — he received a commendation. The rider survived and made it to celebrate his daughter’s wedding. (Better than the doctor's plaque!) And the best part? The rider and the doctor were reunited, enjoying the bond that only comes from restoring that most precious thing — life.