Open Heart Surgery Saved Stab Victim

Open Heart Surgery Saved Stab Victim

Dr Luke Banks and HEMS Paramedic Alex Walker arrived on the scene of a stabbing in a remote Lincolnshire town at night as first responders were assessing the victim who was unconscious. The patient had suffered a stab wound to the chest and on carrying out an ultrasound, Luke immediately saw a blood clot around the heart which threatened to stop it beating. Amid a busy scene working with police, first responders and the ambulance service, the team were under pressure to think fast and think differently. The specialist trauma centre was at least 80 minutes away and the patient was at risk of going into cardiac arrest without intervention.

Luke and Alex had to work with other responders, forming a flash team, and make time-critical complex decisions in the best interests of their patient. They knew that the patient needed to be in hospital, in the hands of specialist cardiac trauma surgeons, but also knew that they were at such risk of deterioration that they may not have been able to get to hospital without cardiac arrest occurring from the ongoing bleeding and the pressure building around the heart.

Luke and Alex briefed their newly-formed team on the plan. They were to simultaneously deliver an emergency anaesthetic alongside performing open heart surgery, right there at the scene of the incident.

The police provided lighting to illuminate the operative field and Luke opened up the patient’s chest at the roadside. He found a massive blood collection around the heart, which was slowly stopping beating. The blood was drained and all hands were on deck as Luke asked a first responder to put his hand inside the chest and manually clamp an artery to maintain blood flow to the heart and the brain. Luke stitched the heart and performed an internal heart massage, whilst Alex performed an emergency blood transfusion.

The heart restarted 30 minutes after they began surgery, and the team began their journey by ambulance to the specialist trauma hospital.  Unfortunately the bleeding in the patient’s chest was steadily getting worse.  Luke had managed to close the wounds with stitches and surgical staples but the patient needed a further blood transfusion.  The team had exhausted their supply but fortunately another LNAA team were on duty nearby and were able to rendezvous enroute to hospital with further blood to help stabilise the patient.

Alex had called Prof Anil Hormis who was the Top Cover Consultant that night and he provided advice before contacting Nottingham’s Queen’s Medical Centre that the team were on their way and to brief them on events so far. This advice from someone who was not directly involved in the emotion of the scene was crucial to offload some of Luke and Alex’s cognitive load and to prepare the hospital for what they were about to receive. On arrival, the patient was taken straight into theatre for specialist care.

The patient, who had in essence, sustained a fatal stab wound survived and walked out of hospital following recovery.

LNAA Medical Director Gareth Davies said: “Luke and Alex’s work was pivotal to the survival of this patient. The patient deteriorated quickly at scene and was a few seconds from their heart stopping. They used all of their training and experience to recognise and diagnose the issues and backed this up with their anaesthetic and surgical skills to keep the patient alive. Throughout the mission they used their initiative, showed great leadership and judgment, as well as technical operating ability. Without a doubt the patient would not have made it to hospital let alone survive without their intervention and support from the police, the ambulance team and colleagues on scene. There are literally only a handful of patients around the world that have survived injuries like this. The team should feel really proud of themselves, it was an incredible achievement. We feel really proud of them.”