The Key to Success: Teamwork

Abstract

A worker in a printshop attempts to remove a foreign object from moving print cylinders. During a brief moment of inattention, the cylinders catch the sleeves of his shirt and both of his arms are drawn into the machine. Despite a nearly instantaneous shut down of the equipment by one of his colleagues, both arms are trapped up to the elbows. Because of the unusual circumstance, EMS dispatch decides to send a physician to the scene along with the ambulance. When the emergency physician, a senior resident in emergency medicine, arrives at the scene with two paramedics, he finds a patient with a reduced level of consciousness standing in front of the print cylinders. The worker’s colleagues are supporting him in a standing position. With the help of the paramedics, the physician places a large-bore peripheral IV line in a vein of the dorsal foot and starts volume resuscitation. With repetitive small boluses of ketamine and midazolam, the patient receives adequate analgesia and sedation, while the two paramedics with help from two workers construct a small temporary platform adjacent to the print cylinders. Assessment of the situation by the machine technician reveals a difficult and protracted disassembly. Since the printshop is not far from the local hospital, the emergency physician contacts the operating room and requests a surgeon and anesthesiologist to come to the scene. Because the patient is young and an amputation would impose severe risks, the emergency physician and surgeon decide not to amputate the patient’s extremities. Meanwhile, the fire department arrives and, after the anesthetist has deepened the analgesia and sedation, help the machine technician with the difficult task of disassembling the press. Two hours later, both arms are freed from the printing machine. Sudden pulsating bleeding is stopped by the inflation of upper extremity tourniquets that the paramedics had placed on both arms before they were released from the machine. The patient is intubated on site and transferred to the operating room. Due to the rapid and coordinated rescue and surgical intervention, both extremities are saved with a good degree of functionality.