HYANNIS – Things were quiet enough at Cape Cod Hospital on Nov. 16 that general surgeon on call Lawrence M. Novak, MD, FACS, was about to catch up with some paperwork after visiting some patients.
Then came the call from some EMTs in South Yarmouth: “We’ve got a gentleman who got his leg cut off in a wood chipper. He’s bleeding actively. We’re coming in.”
“When that happens, it starts an emergency algorithm of treatment at Cape Cod Hospital,” said Dr. Novak. “One person calls the trauma surgeon. One person calls the trauma helicopter. One person calls the O.R. By the time he got there, we already had a five-minute head start.”
Landscaper James Blaney was feeding branches into a tree chipper when a branch entangled him and his left leg was pulled into the machine.
“He had an isolated lower extremity injury, and that was it,” said Dr. Novak. “So I said, ‘We’re not transferring him for two reasons. One, we don’t have to. And two, I’m not sure he would survive the trip.’
“We mobilized the resources that we already had at our disposal. It was all hands on deck in the ER. Within five minutes or so, he was in an operating room.”
The Team
ER doctor Craig S. Cornwall, MD, oversaw Blaney’s initial treatment. In the operating room, Dr. Novak worked with a team that included neurosurgeon Paul Houle, MD, FAANS, and surgical resident Andrea Madiedo; anesthesiologists Wade T. Goolishian, MD, and Kevin Vilsaint, MD, MPH; CRNA Mary Orme; RN circulators Georgia Bourne and Charlene Defazio; and OR tech Angela Nardone.
“One of the arteries had an exsanguinating bleed, meaning he was bleeding to death,” said Dr. Novak. “We got control of that easily. Once we stopped the bleeding, it was assessment and evaluation.”
While the surgeons prepared to remove dead tissue and planned how to construct the area above the knee, another part of the team was giving Blaney blood transfusions and checking his heart rate and blood pressure.
The two-hour surgery was a great success, he said.
“Without the knee, it’s going to be more work for him to ambulate with a prosthetic limb, but he should be able to do it.”
A 21st Century Response
Dr. Novak praised the efforts of all involved, including Blaney’s fellow landscapers.
“One of his co-workers knew to put a belt around his thigh. When you see blood squirting out of somebody’s leg, you have to do something, and you think, ‘What would they do on ‘Grey’s Anatomy’ or in the movies?’ So they put a tourniquet on, which was great. That prevented him from bleeding to death at the work site.”
When paramedics from the Yarmouth Fire Department arrived on the scene, they put on a more effective tourniquet.
“The trick to trauma when people are bleeding is to get them into the hospital as quickly as possible, and they did a great job transporting him here,” said Dr. Novak.
From start to finish, Blaney had a lot of good people getting him through the ordeal, he said.
“In my opinion, it’s about Cape Cod Healthcare being a 21st century, modern healthcare institution with a 21st century ER, a 21st century O.R. and a 21st century anesthesia department,” he said.
“It was a team approach of the entire Cape Cod Healthcare organization and the pre-hospital team. It speaks to how the Cape is all about neighbors taking care of neighbors; all of us working together.”
An Added Challenge
Dr. Novak discussed an additional challenge to treating Blaney, who was taking Vivitrol, a prescription medication used to treat opioid addiction.
“When he came in, he didn’t want any narcotics because he didn’t want to get addicted again. We were able to manage his pain without any narcotics, morphine or strong medication. When he woke up from the surgery, we gave him an epidural, like pregnant ladies get. We made him numb from the belly button down.
“We’re getting a pain consult from (Cape Cod Healthcare pain specialist) Dr. Kevin Kelly in the chronic pain department. Our plan is to help him manage his pain, even when he goes home, without any narcotics at all because he’s motivated to not use them.”
Blaney was on track to be released from the hospital soon, Dr. Novak said.
“It was an unusual injury. I’ve been on the Cape almost 20 years. I hope it’s at least another 20 years before we have another accident like this.”
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