On I-95 in northern Maryland, a toddler was trapped in an overturned SUV. Emergency rescue teams had labored for hours trying to remove 2-year-old Steven Gomez, whose leg was extended through the SUV’s back window and wedged between the car’s roof and a highway guard rail. Worried that additional attempts to move the vehicle could amputate the child’s leg, they decided to wait for the Johns Hopkins team now en route, before proceeding.
Aboard the Maryland State Police helicopter cutting through choppy wet weather toward the scene, surgeon Fizan Abdullah had with him a Gigly saw, Bulldog clamps and other surgical equipment used for amputations. Accompanying him were Johns Hopkins surgical nurse John Kerr, who had grabbed the instruments from the hospital’s OR, and adult anesthesiologist Tina Tran.
“We had tried eight million ways to get the child out,” says rescue worker Cathy Farrell, a member of the Elkton Maryland Volunteer Fire Department, on the scene that day. “We saw no way to move the car off him, without crushing him. His femur was fractured, his foot was turning blue and getting cold and we couldn’t find a pulse. Then we heard that Johns Hopkins was assembling a pediatric team.”
The pediatric surgeon-on-call at Johns Hopkins that Sunday afternoon, June 13, Abdullah had sped from his home in the Fells Point area of Baltimore up the hill to the hospital, and quickly assembled what is known in medical parlance as a “go team,” a rapid-response surgical team that travels directly to the site of a trauma where an individual is trapped. Laden with bags of supplies and trays of equipment, Abdullah, Kerr, Tran and pediatric colleagues trailed out onto Hopkins Children’s rooftop helipad toward a waiting Maryland State Police helicopter.
“It looked like a train of pack animals without the animals,” says pilot Norman J. Molter, who was “burning fuel on the rooftop,” he adds, for an immediate lift off, hoping to take advantage of a temporary break in bad weather that had grounded aviation earlier.
With all on board, the call was made to the Elkton, Md. crash site: Johns Hopkins was en route and about 15 minutes out.
As the official pediatric shock trauma center for the State of Maryland, Hopkins Children’s routinely works with the Maryland Institute of Emergency Medical Services Systems (MIEMSS)
“Children generally don’t get caught in a vehicle. In a crash, they’re generally ejected,” says clinical nurse practitioner Susan Ziegfeld, manager of the trauma and burn program at Hopkins Children’s. “The possibility of what happened to this little boy was about one in a million, and because of that we don’t currently have a formal pediatric ‘go team.’ But, I think that’s going to change.”
When the rescue workers at the Cecil County crash site asked Liz Berg, coordinator of the Pediatric Transport Service at Hopkins Children’s, if she could pull together a pediatric “go team,” she said she would try: “I didn’t know if it was possible until I spoke with Dr. Abduallah, but we had to do something. University of Maryland’s shock trauma had referred them to us because their own team specializes in adult care.”
Berg called Abdullah and Kerr. Hopkins Children’s own helicopter and pediatric transport team were out on another call. Maryland State Police, hearing that Johns Hopkins was trying to put together a “go team,” volunteered a chopper. But thunderstorms were coming in. How soon could its team be ready?
As personnel and aviation scrambled in Baltimore, MIEMSS medical director Richard L. Alcorta directed Steven’s medical care. Medics had placed IV lines in the child to keep him hydrated, administered pain relief to keep him comfortable and injected saline and bicarbonate to help prevent “crush syndrome.” With crush syndrome, damaged muscle can release into the bloodstream a surge of the by-products of muscle breakdown – notably myoglobin, potassium and phosphate, which can lead to cardiac arrest and kidney damage. Medics had also placed a loose tourniquet around the child’s leg, in preparation for possible amputation. “The hope,” says Alcorta “was that if we had to amputate, the Hopkins surgeon would at least be able to save the child’s life.”
Arriving on the scene at the same time as her Hopkins colleagues was pediatric anesthesiologist and critical care specialist Jamie Schwartz. The medical director of the Pediatric Transport Team at Hopkins Children’s had raced to the site from Delaware, where she was visiting family, via a succession of police cruisers.
"Before we left Hopkins, Liz had told us Jamie was on her way, but we didn’t know whether she’d be able to make it in time,” says Abdullah.
Once on the ground on I-95, Abdullah ran over to the SUV. He threw himself underneath and peered up at the trapped child. “From my perspective as a surgeon, my first thought was that we could amputate and possibly reattach the leg back at Hopkins,” he says.
Then, moving in for a better view of the leg and metal pressing upon it, Abdullah glimpsed a tiny square of empty space between a portion of the child’s compressed flesh and the guardrail. Could they move the car just an inch in a given direction, he called out to the rescue team, standing by with a crane attached to the vehicle.
The surgeon could see that his little patient was in shock and breathing fast. “We were running out of time,” he says.
The tiny move by the crane made, a rescuer called out that he thought he could now see a small bit of “breathing room” between the child’s foot and the guard rail.
“I knew it was now or never,” says Abdullah. “I figured some pressure was relieved. So I pulled like I’d never pulled before. I was thinking that I’d rather deal with a mangled extremity than amputate it.”
He gave three mighty tugs. After each, Steven’s leg moved a little more. Then, the child was free.
In a “span of seconds,” says the surgeon, Steven was placed in a head-restraint collar and his leg wrapped. Out from underneath the SUV, Abdullah looked up to see Schwartz standing amidst the tremendous crowd of onlookers and shouted to them to let her through.
He, Schwartz and a paramedic, with Steven, climbed aboard Molder’s waiting police chopper, which took off for Hopkins Children’s. En route, the child became hypotensive, his blood pressure dropping dramatically. “We were filling and exchanging syringes of saline to inject into the child while we ourselves were being thrown around in the helicopter due to weather,” says Abdullah. “It was a wild ride.”
At Johns Hopkins, Steven’s mother received word of her son’s dramatic rescue. Delfina Orella had been driving the vehicle on the rain-slick road when it crashed and flipped multiple times. Also on board were her daughter, her sister-in-law and her children. All had survived. Orella had been transported to Johns Hopkins for evaluation and treatment while Steven was still trapped in the car.
“When I left, I did not know what would happen to him, whether I would ever see him alive again or whether he would lose his leg,” she says.
Two days later, she was reunited with many members of the rescue team, when they visited Steven at Hopkins Children’s. “Thank you, thank you,” the Hyattsville, Md. resident told them, between hugs. “You gave our son a second chance at life. We are so grateful.”
From his hospital bed, his leg encased in a blue cast, Steven gazed up at his visitors, some of whom had brought balloons. On occasion he wiggled his toes – on both feet. Hours later, he would return home.
“The EMS team did a terrific job stabilizing this child at the crash site,” says Abdullah, who was performing emergency surgery on another little patient, the day of the visit. “They did everything right and moved heaven and earth to try to protect and help him.”
Standing outside Steven’s hospital room, awaiting his turn to peek in at this wonder child and meet his family, Alcorta had some praise of his own: “What Dr. Abdullah did showed guts, courage and exceptionally good medical decision-making.”
Ziegfeld later asked Abdullah why he bounded underneath an SUV that rescue workers feared could shift at any moment, crushing him. “It was the adrenaline, I guess,” he replied, “that compelling need we all felt that we had to save him.”
Learn more about the Pediatric Transport program at Hopkins Children's.