Wrong Place, Wrong Time ... Right Response
February 14, 2013 · No Comments
On a warm August morning, Rashad Craft was leaving his mother’s Suisun City home to pick up his two sons. As he headed down the driveway, he spotted a suspicious, slow-moving car coming down the street.
When the two occupants of the vehicle saw him and got out, the 37-year-old cable technician didn’t flee. “I stood there and watched them come toward me,” he recalled. “Why did I do that?”
While Rashad’s gut instincts warned him something wasn’t right, things started happening too fast for him to react. The pair of young men accosted him by waving a gun in his face and demanding he open the garage door and go inside with them. He refused. During the ensuing struggle Rashad remembers his only purpose was to prevent them from entering the house. “My mother was in there,” he explained. “And it would be the end of me if I went inside with them.”
Suddenly the gun went off and Rashad fell to the driveway, a bullet piercing his back. As the assailants escaped, he yelled for help, but no one responded. “I tried to get up and get inside the house as fast as possible,” he said. The best he could do was crawl into the kitchen, where he lay hollering to his mother.
“My mom was pretty shaken up but calm. The pain felt like I had been hit by a baseball bat. I was feeling numb, gasping for air, scared and panicking. But, I didn’t want to let go,” he remembered.
Rashad may have been in the wrong place at the wrong time, but the minute his mother dialed 9-1-1, a well-trained precision team stepped up to save his life.
Golden Hour Clock Starts Ticking
The NorthBay Medical Center Trauma Team includes highly trained surgeons, Emergency Department physicians and technicians, hospitalists, anesthesiologists, infection control experts, ICU nurses, and more. They have many years of trauma experience—battle-tested in many cases—enabling them to deal with everything from broken bones, dog bites, and industrial accidents to gunshot wounds like the one Rashad suffered.
Suddenly the gun went off and Rashad fell to the driveway, a bullet piercing his back...
His traumatic injury underscores the importance of having a trauma center close to home and the expertise of life-saving emergency response teams standing at the ready, says J. Peter Zopfi, D.O., NorthBay’s trauma medical director, because “it all starts in the field. We call it ‘The Golden Hour,’ when a victim’s chances of survival are greatest if he or she receives prompt emergency care within this time.”
An ambulance crew was dispatched to Rashad’s mother’s home within minutes, and as the paramedics swiftly went into action, a full trauma team activation was sounded within NorthBay Medical Center in Fairfield. That meant an array of specialists immediately assembled in the Emergency Department, awaiting Rashad’s arrival.
The ER team prepared for an initial resuscitation. Then the trauma team, led by a specially trained trauma surgeon, was ready to take over. It was a well-choreographed response backed up by an anesthesiologist, a specially trained operating room crew and other ancillary services, from lab personnel to X-ray technicians.
Experienced Trauma Experts
Upon arrival, paramedics were met by emergency physicians Dr. Rizwan Tokhi and Dr. Rachel Hight, an Air Force trauma surgeon who works at NorthBay Medical Center as a result of a training affiliation agreement with David Grant Medical Center at Travis Air Force Base. The agreement ensures military medical personnel, physicians and nurses are ready for wartime deployment. In this mutually beneficial program, NorthBay can draw on their experience as battlefield surgeons.
“The Air Force’s outreach to the county was intended to help our local community strengthen and develop its trauma programs,” Dr. Hight explains. “We offer our training and experience in a knowledge-sharing relationship that we have with Dr. Zopfi and the NorthBay trauma team, and it has been a very good collaboration. We share tips, ideas, best practices, and Dr. Zopfi can apply or tweak them as they fit into the NorthBay system.”
Fortunately, Dr. Hight was on duty the morning Rashad was shot, and her experience, garnered during a deployment to Afghanistan, proved invaluable. “The paramedics had notified us they were bringing in a ‘penetrating thorax trauma,’ and that immediately puts us on our highest alert,” Dr. Hight says. “These kinds of traumas tend to need the earliest, most active interventions because they can affect the heart and lungs.”
The team found Rashad awake, extremely anxious and toiling to breathe. “The most important thing was to secure his airway,” explained Dr. Wayne Walker, trauma team anesthesiologist, and one of four anesthesiologists on duty 24/7 in NorthBay Medical Center.
“He had lost a lot of blood and was receiving a lot of transfusions. We needed to stabilize his fluids and blood pressure.”
Dr. Hight quickly inserted a chest tube to drain blood from his chest cavity so that breathing was made easier. The team next needed to get Rashad, now somewhat stable under anesthesia, to a CT scanner that would show the severity and location of his wounds and then into the operating room. “Sometimes we don’t have that luxury,” Dr. Hight explains. “Sometimes we have to start surgery right in the ED.”
Fortunately for Rashad, all of this was accomplished well within The Golden Hour.
As a trauma anesthesiologist, Dr. Walker knows a trauma surgeon cannot begin lifesaving work until the patient is safely asleep, with relatively stable breathing and blood pressure. His team is so practiced, he said, “We’re like fire extinguishers: We’re there, the system is in place and we can be used quickly in any emergency.”
Off to Surgery
The CT scan revealed blood in Rashad’s left chest, damage to his liver and possibly to his spleen. During surgery, it was discovered the bullet had just missed his heart, but nicked his diaphragm, damaged a lung, his liver and passed through his stomach. The combined injuries required more than three hours of surgery. Another skilled trauma surgeon, Dr. William Fulton, as well as Dr. Zopfi, assisted Dr. Hight that morning.
“We do want to get patients off the operating table as quickly as possible,” Dr. Zopfi says, “and the fact that he was in surgery for just over three hours was a good sign.”
Intensivist Care in the ICU
The teamwork didn’t stop at the operating room. Rashad was transferred to the Intensive Care Unit and to Dr. Mohammed Qureshi, a critical care intensivist who specializes in internal medicine, critical care and pulmonology. Possessing the right skills to care for Rashad’s injuries, Dr. Qureshi noted, is not unusual at NorthBay. Intensivists are physicians specially trained in critical care medicine and they provide in-hospital assistance for trauma patients around the clock.
“The next day we woke Rashad up, and we were able to get him off the ventilator right away,” said Dr. Qureshi. “Getting someone off a ventilator within 24 hours represents a good success because it prevents the potential development of pneumonia and other complications.”
During the next 72 hours, Dr. Qureshi kept an eagle eye on Rashad’s pain levels and breathing. He served as a vital communication link between trauma surgeons, ICU staff and Rashad’s family.
“We not only treat the patient, but the family,” he explained. “They need to know what is going on, the staff needs to know what is going on, so there are no surprises.”
ICU Nurses Dole Out Tough Love
One other team component, ICU nurses, are the unsung heroes, especially in cases such as Rashad’s, said Dr. Zopfi. “They must have the tough love approach. They know how important it is for the patients to get up, get moving, and get breathing. It’s not something people are so willing to do when they have surgical stitches or chest tubes, as Rashad did.”
“Oh, no, he did not want to get out of bed,” recalls Maureen Allain, R.N., “and his expression was kind of like, ‘You really want me to do this? Don’t you know I’ve been shot?’”
But, she explains, “We have to get them out of bed, expanding their lungs, breathing deep and coughing. We know it hurts and they will have pain, and we can control some of that.” But, she stresses, it takes a whole team—physical therapists, social workers, nurses and family members—to push patients past that pain so they can become ambulatory and more self-sufficient. “Then they can be moved downstairs (to the regular unit) and on to home.”
During the next 10 days, Rashad admits he reluctantly followed his nurses’ steady urging to complete his breathing exercises. “They were tough on me; made me do a bunch of things that were really hard.”
His only setback came 10 days after surgery when his white blood counts started to rise, as did his fever, suggesting an infection or other complication. Enter Dr. Gregory Warner, another member of the trauma team and an infection expert. Fever and inflammation are expected outcomes following gunshot wounds, he said, but not after 72 hours.
“This is when we start asking what else we might be missing,” Dr. Warner says. “We also had to ask, ‘Could he have an abscess in his abdomen, problems with his kidneys or other challenges?’ It’s a balancing act.”
Another CT scan revealed blood clots and fluid in his lungs. On Day 10 of his recovery, Rashad underwent a second surgery—a video-assisted thoracoscopy—to remove the fluid and blood clots, Dr. Warner explained.
His recovery then moved quickly, his appetite improved, he could move easier, and was transferred to a regular medical unit. Sixteen days after the shooting, he was sent home.
Miracles Stack Up
Three months later, Rashad was back coaching football and basketball, driving and caring for his boys, ages 8 and 6.
“This completely changed my life,” says Rashad, whose family has seen more than their share of gun violence. “My brother was murdered in 1999, and so were my grandparents.”
As his mother’s only surviving son, Rashad is extremely grateful to the NorthBay team that saved his life. He returned to NorthBay just before Thanksgiving to express his gratitude to many of those who oversaw his recovery.
“They were very positive and reassuring and it helped my spirits a lot. They really took good care of me. I am indebted to them, because they helped me to recover. I see everything differently now. I see how important it is for me to be here for my kids; they need me the most.
“I cherish my life. I get to wake up and see my boys. They were almost taken from me. My oldest son asks me all the time if I’m in pain, if I’m OK. I tell him, ‘Don’t you worry about me. You just stay in school, and I’ll take care of the rest.’”