Jackie Figueroa is alive today because every single thing went according to plan, says Michelle McNutt, MD, associate professor of acute care surgery with McGovern Medical School at UTHealth Houston and affiliated trauma medical director of the Red Duke Trauma Institute at Memorial Hermann-Texas Medical Center. “Patients who are critically injured like this, they often survived because everyone that touched them—in the pre-hospital setting, in the emergency room, in the operating room, orthopedic surgery, trauma surgery, rehabilitation—every single person had a part to play. That’s what it takes.”
Early in the morning of, 23-year-old Figueroa and her then boyfriend were driving on backroads from Huntsville, Texas to Madisonville, Texas. Figueroa had fallen asleep and her boyfriend, who was driving, lost control of the vehicle, sending it careening up a hill and into a tree. Figueroa was thrown from the vehicle and for the next four hours lay on the side of the road, floating in and out of consciousness.
EMS Calls for Memorial Hermann Life Flight®
At 6:30 a.m., a passerby called 911, and two units from Walker County EMS were dispatched. Supervisor Nick Coronis was the first to arrive on the scene and called for Memorial Hermann Life Flight. Paramedics Melissa Meitzen and Robert Edmonds and trainee Courtney Wolfe were on the second unit. Overnight, temperatures had dipped into the low 40s. When EMS arrived, Figueroa had an undetectable blood pressure, very little pulse and her body temperature was 81.7 degrees.
“It took us a while to get baseline vitals on her because she was so cold,” says Walker County EMS Paramedic Melissa Meitzen. “We covered her in blankets, put hot packs in her armpits and groin, and began administering warm fluids. Our assessment indicated a possible abdominal or pelvic injury, so we got her on the backboard, used a blanket to bind her pelvis and waited for Life Flight.
“When Life Flight arrived, they brought their stretcher over, hung blood and we unloaded her. Life Flight nurse Michele Bourgeois, RN, suddenly said, ‘Start CPR.’ The patient had coded, just out of nowhere. We got their chest compression device, they loaded her up, and my partner and I thought that was the end of it. We didn’t think she would make it.”
Aviation Decision Shaves Critical Minutes
“So many things fell into place that day,” says Bourgeois. “Our South Base had been dispatched to take the flight. We were in another area, but our pilot calculated that we could get there faster”.
“When we landed, we were directed to the female patient in the ambulance. She was as white as a sheet and barely responsive, and the only thing I heard her say was, ‘I’m thirsty.’ It was obvious she needed blood. So, following protocol, we immediately started blood transfusing, placed a pelvic binder, gave her medicine to increase her blood pressure and intubated her. Then we lost pulse.”
Administered Several Units of Blood as Part of En-Route Resuscitation Efforts
Life Flight Nurse Chris Oliver, RN, recalls the scene in the hospital’s Emergency Center. “We walked in the ER and one of the physicians in the ER says, ‘Hey, I have a pulse.’ At that point, it was full steam ahead,” says Oliver.
“When trauma centers get the page for a blunt trauma patient with 30 minutes of chest compressions prior to arrival, there is not a lot of hope for survival,” says Dr. McNutt. “We are very aggressive at our resuscitation strategies because of this scenario right here.”
Grade 5 Shattered Spleen
The trauma team, led by Dr. McNutt, was ready in the Hybrid OR. “The patient had liters of blood in her abdomen, the majority of which was coming from her spleen,” says Dr. McNutt. “So we rapidly controlled that with our fingers then ligated the bleeding vessels and removed the injured spleen.”
“She also had an injury to her liver, which we were able to control surgically. An X-ray shot in the trauma bay revealed a pelvic fracture and evidence of bleeding, so we performed an exploratory laparotomy in the Hybrid OR, packing off the bleeding, before continuing resuscitation.”
“We also activated what’s called IR STAT, a unique process we developed a few years ago to get our affiliated interventional radiology colleagues with UTHealth Houston to the bedside quickly for bleeding trauma patients. They were able to stop the bleeding from her pelvis by embolizing some of the arteries in her pelvis.”
Dr. McNutt summarizes the chain of events and efforts to save Figueroa’s life. “It’s a “scene-to-OR” process. From the bystander who called 911 and activated local EMS, who in turn activated Life Flight, who took over resuscitation efforts and transported the patient here as fast as possible, to the hospital-based trauma team—built with multiple specialties, expertise and capabilities in mind—activated and ready to take over on arrival; all of these pieces are intended to work together to give our patients the opportunity to survive and recover from traumatic injuries like hers. As a level 1 Trauma Center, we do this every day.“
"A Walking Miracle"
Figueroa, a mother of two, was still recovering, walking with the aid of a walker, 2 1/2 months later. “I am trying to stay positive,” she says. “God worked through everyone who put their hands on me that day. If it weren’t for Him, I wouldn’t be here. I am a walking miracle.”
Learn more about the Red Duke Trauma Institute at Memorial Hermann-TMC, one of the country's busiest Level I trauma centers, and Memorial Hermann Life Flight, Houston's only non-profit hospital-based medical program.
