On-Site Amputation
This story is told by police sergeant Kevin G. Thompson and Dr. Andy Sullivan, an orthopedic surgeon at Children`s Hospital:
Sergeant Thompson: A fire captain almost up against the north wall said he had found another victim alive, a woman. He pointed to a large pile of concrete. I could now hear this lady talking to us. She was very calm and did not sound as if she was in pain. I bent down and looked but could only see a small part of her lower back. I looked at what was on top of her–tons and tons of concrete covered almost all of her. I felt absolutely useless, and I knew the fire captain felt the same. It was in his eyes and face. We had only our hands, no tools to work with, but the captain was on his radio asking for equipment. I noticed debris falling; as I looked up, I could see that about ten feet above us was a ten-by-twenty-foot slab of concrete hanging by only a couple of two-inch pieces of rebar. I knew that if it fell, we would die.
Dr. Sullivan: Only one person at a time could be in the space. We were told that if we felt any movement at all, we were to immediately crawl out. It became obvious that the woman`s right leg, trapped by concrete, was totally destroyed below the knee. If we attempted to move the materials on top of her, almost certainly further collapse would occur, crushing her to death. The only solution seemed to be to amputate. Her left leg was free, as were her left arm and upper chest. I crawled down and gained access to her by lying on top of her (later I found out that both of her lungs had been crushed and that in her right chest she had a collapsed lung with blood in the lung cavity). I cut two strands of nylon rope and gradually made a tourniquet by working both of them under her right leg, digging through rubble with my hands to gain enough room. Suddenly, the firemen yelled that we had to evacuate….
Sergeant Thompson: When we were told that we could go back, I went into the pit with my flashlight. I asked the woman her name, and she said, “Daina.” I tried to crawl as close to her as I could. I was about two feet away, but a huge concrete beam was between us. As I lay there, I felt water dripping on me. I looked up with my flashlight and realized that the “water” was blood dripping from a crushed body above us. It was as if the concrete were bleeding. There was all this equipment beside me–jaws-of-life, power saws–and I didn`t know to use it. I felt so useless. I looked back up the tunnel and saw a lone fireman and yelled up to him. He came down and said he knew how to use the equipment. As he lay there assessing the situation, blood dripped onto his yellow helmet until it became a red helmet. He backed out of the hole, saying, “It looks bad.” I asked his name. He said it was Jeff. In the next two to three hours in that hole with him, I grew to respect Jeff as a true hero.
Later, when the firemen had removed enough debris for me to see Daina for the first time face-to-face, I said, “It`s great to see you, Daina. Hang on. It won`t be much longer.”
Dr. Sullivan: The time outside was probably fortuitous: It allowed us to plan. Crawling back into the space, I realized the only way we could extract the patient was by a through-the-knee amputation. We had the firemen position a harness under her chest so that once the amputation was complete, we could pull her rapidly out onto a spine board. I discussed the choice with the patient. While tearful, she understood. I was fearful she might not survive much longer. She was already hypothermic, hypotensive, and having difficulty breathing.
Sergeant Thompson: A fresh crew of firemen came down and relieved Jeff, who had been working non-stop for several hours. A doctor asked me to go outside and bring him a trauma kit. I located a kit and started back down. I was stopped by a fire captain and he told me I couldn`t go back. At first, I wanted to push my way down, but I realized he was just doing his job and I was tired and ready to get out.
Dr. Sullivan: Daina agreed to the surgery. I crawled back out. Dr. Stewart had selected a dose of Versed, and Dr. Tuggle crawled in and administered the anesthetic intramuscularly. Although we had some Demerol, we were afraid that it would suppress her respiration and stop her breathing. Versed had the advantage of being hynotic and amnesic. Lying on top of Daina, I twisted the two nylon ropes with a stick to cut off remaining circulation to the leg. Using disposable blades and eventually an amputation knife, I was gradually able to work my way through the knee. Once the ligaments, tendons, and muscles had been cut, I cut through the remaining arteries, veins, and nerves at the back of the knee. The tourniquets worked so that she was not at risk of bleeding to death. We were then able to crawl out. The firemen were able to get on the harness and pull her out onto the spine board.
From the book In Their Name , edited by Clive Irving, Project Recovery OKC. Copyright © 1995. Reprinted with the permission of Random House, Inc.
