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John C. Lincoln Trauma Surgery Team Demonstrates the 'Right Stuff'

When the unimaginable happens, survival requires the best from every member of the Level I Trauma team.

A slender, athletic 24-year-old who excels in yoga and piano, Erin McCormick is an honors grad who earned her B.S. at Arizona State University in just three years while working two jobs. Last spring, she planned on law school.

Trauma Surgery in Phoenix - 3883
Maricopa County Sheriff's Office Sgt. Wayne Lupinski provided emergency life-support to Erin McCormick at the scene of her unimaginable accident on Lake Pleasant.

Although Erin is competitive, she's never seen herself as an extreme risk taker. But on the day after her birthday in April 2008, she was in for the greatest risk — her life.

What happened could not have been more unexpected. Erin was peacefully floating on an inner tube in a cove on the north side of Lake Pleasant — when another boat backed up and sucked her into its propeller.

A Life Changed in One Moment

Erin can't tell you much about her horrific injuries and miraculous survival; blessedly, she doesn't remember. But others saw the propeller whirl into the right side of Erin's head and body, chopping her skull, jaw and face; shredding her shoulder, collarbone and torso; slashing her arm to the bone four times between elbow and wrist.

Bleeding from her mangled flesh was prodigious; more urgently, her airway was compromised, which meant breathing was a challenge. Immediately, our community's lifesaving professionals sprang into action, starting with two off-duty nurses who kept Erin breathing until Maricopa County Sheriff's Sgt. Wayne Lupinski arrived in his patrol boat to provide emergency life support and transport to shore.

Mixed jurisdictions in Maricopa County's outlying areas mean multi-agency cooperation is essential. The Sheriff has authority on the water. On shore, Peoria is responsible. In the sky, it's the Department of Public Safety.

Hot Offload

Peoria paramedics Maureen Shannon and William Johnston were there when Sgt. Lupinski docked. They stanched Erin's bleeding while waiting for DPS helicopter Ranger 41 to land and load Erin for transit to John C. Lincoln's Level I Trauma Center.

Ranger 41 is staffed by DPS and Phoenix paramedics. Eric Tarr,DPS, and Fred Grant, Phoenix Fire, kept Erin alive during the 12-minute flight to the hospital's helicopter pad.

"She was a 'blue alert,' the most critical trauma injury," said John C. Lincoln trauma surgeon Peter Ferrara, MD, who was on duty when Erin arrived. "We didn't wait for the rotor blades to stop. We did a 'hot offload.'"

Emergency personnel have been killed by spinning rotors — so hot offloads are reserved for patients within moments of death.

A-B-C of Trauma Care

When someone is that brutally, massively injured, how does the trauma team decide what to do first?

"It's not easy, but it is A-B-C," Dr. Ferrara said. "A for airway — is it open? If obstructed by injury or blockage, it must be cleared first. B for breathing — if necessary, we'll do that for the patient, and C for circulation. That means stop the bleeding, resuscitate the heartbeat and replace lost body fluids and blood — all at the same time!"

Dr. Ferrara immediately took Erin to surgery. While he worked, anesthesiologist Gerry Peiser, DO, "pushed" 40 units of blood into Erin's hemorrhaging body at the rate of almost one per minute. A unit normally takes an hour to transfuse; 40 units is almost three times an adult's blood volume.

Dr. Ferrara removed the multiple pieces of Erin's shattered collarbone, cauterized her shredded subclavian artery and ligated her subclavian vein to stop their bleeding, and began to repair her mangled chest wall.

"Almost all the pieces of the puzzle were there," he said. "It was just a matter of putting them back together."

Superhuman Balancing Act

"Dr. Ferrara was amazing and deserves a lot of credit," commented reconstructive hand surgeon Lloyd Champagne, MD, "but the champion is the anesthesiologist.

"If you've never seen a trauma team in action, you cannot imagine the superhuman balancing act for an anesthesiologist to keep patients alive while putting them to sleep — all while performing heavy-duty physical labor, keeping the blood supply replaced with nonstop transfusions and while tracking her electrolytes and other body chemistry every 20 minutes. Dr. Peiser did a masterful job."

Dr. Peiser is a little more self-deprecating.

Acknowledging he pushed more transfusions into Erin than any other patient, all while pulling blood samples and monitoring and administering the lowest level of anesthesia necessary to keep her unconscious, he simply credited his ability to move quickly under pressure.

He also credits help from nurses and anesthesiologist Thinh Le, MD, who happened to be in the hospital and immediately volunteered.

Plastic and reconstructive surgeon Pablo Prichard, MD, did a brief surgery to prevent Erin's mouth bacteria from infecting her exposed jawbones.

"I would have preferred to do more at that time," Dr. Prichard said. "The earlier you can repair nerve damage, the better the outcome."

But Erin just wasn't strong enough. She went to Intensive Care for further transfusions and stabilization while doctors reviewed X-rays and CT scans of her head, neck, chest, abdomen and pelvis.

Out of Surgery, into Coma

At first, her skull injuries seemed to be the least of her problems, said neurosurgeon Paul LaPrade, MD. "The initial CT scan showed a small skull fracture and a scalp laceration. It only took about 45 minutes to fix that."

Erin woke and was responsive after surgery, but a few hours later went into a coma. A follow-up CT scan showed "the largest epidural hematoma (bleeding between her skull and the tough outer lining of her brain) I've ever seen," Dr. LaPrade said.

Worse, it was squeezing her brain stem, which controls autonomic functions such as breathing. "The brain stem does not like to be depressed," Dr. LaPrade said. "Permanent damage can happen very quickly."

Erin was rushed back to surgery, where Dr. LaPrade evacuated the hematoma to relieve pressure. But a subsequent CT scan showed recurrent and residual brain bleeding, so Erin went for a third neurosurgery.

"All this time, we were pushing blood. Finally, we got enough into her to stop the bleeding," Dr. LaPrade said. "But if she lived, I thought she'd be in a vegetative state. I felt so depressed, so bad for her family."

Hope Arrives

Everything changed the next morning. When Dr. LaPrade came in, Erin was awake, following commands.

"I was very surprised, amazed, thrilled," he said, "so happy for her family. Erin is unique in my experience, the only patient I've had with her level of brain injury whose recovery is so complete. It's a miracle."

It was five days before Erin was strong enough for Dr. Prichard to put her delicate and beautiful face back together. This is tricky business — each side of the face is controlled by a network of five major nerves that branch and sub-branch up and outward from the jaw.

Nerves are microscopic and you can't just sew them together. In cross-section, a nerve is comparable to a cord you plug into a computer — it only matches up in one position.

When you get the two ends matched, you can only stitch the exterior lining, which is finer than a hundred-thousandth of an inch. If you sew the nerve itself, you'll crush it. To complicate matters, you can't see the sutures without a microscope.

In addition, the bony structure of the right side of Erin's face was "much worse than a gunshot," observed Dr. Prichard. "I had to rebuild her eye socket, her cheekbone and her jaw, all of which were in multiple pieces.

Hand Surgery Next

When Dr. Prichard was finished, it was time for hand surgeon Dr. Champagne.

Hand surgery is simultaneously one of the least heralded and most complex surgical subspecialties.

"The human hand is so amazing. We ask it to do so much," Dr. Champagne said. "It can be expressive, a conductor guiding an orchestra. It can be powerful, a workman tossing a 100-pound sack of cement. It can be delicate, with finemotor skills to perform microsurgery. Or it can be emotional, petting a dog.

"The anatomy and neurophysiology required to do all this is equally complex," he said. "A hand is irreplaceable."

Dr. Champagne used all his skills to preserve Erin's arm, wrist and hand functions.

"But don''t call me a hero," he said. "I'm just the last guy onto the boat who did a pretty good job of fixing her hand.

"The real hero in this story," Dr. Champagne said, "is Erin. She is that one patient in a thousand who works so hard, goes above and beyond with rehab and therapy, such a good patient — she makes all her surgeons look good."

Looking Forward to the Future

Erin is awaiting several more operations before her recovery is maximized. Dr. Champagne will do some fine-tuning so Erin can again play the piano. Dr. Prichard is planning some fine-tuning of his own on Erin's face before he tackles the remaining challenge — removing the multiple scars pitting Erin's arm.

Meanwhile, Erin is pondering her future. "She worked as a hospital volunteer when she was a teen," said Erin's mom, Carol McCormick. "She liked helping people, and now she's thinking about nursing instead of law school."

"I am so grateful to all the amazing people who helped me," Erin said. "I can never adequately express how much I appreciate everything that was done for me."

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