A 21-year-old Gippsland resident is lucky to be alive thanks to a rare and complex surgical procedure performed on the side of the road by an Ambulance Victoria Mobile Intensive Care Ambulance (MICA) Flight Paramedic.
Ambulance Victoria MICA Flight Paramedic Josh Arundale performed his very first in-field finger thoracostomy to help save the life of Tom Gray, who suffered critical chest injuries in a traumatic car crash in February.
A finger thoracostomy is a life-saving procedure where a surgical incision is made in the side of a patient’s chest and a finger inserted to create an opening, allowing blood and air to be released from the space around the lungs. It can be used to treat patients with multiple traumatic injuries when a needle thoracostomy has been insufficient in maintaining the release of pressurised air.
Josh’s life-saving actions and Tom’s early access to pre-hospital blood products helped save Tom’s life.
“I was a MICA Flight intern working alongside a clinical instructor when we responded to Tom’s case and while I had practiced the procedure a number of times in training, I was yet to perform it on a patient,” Josh said.
“When we arrived, Tom was critically unwell and was already receiving advanced care from MICA paramedics on scene, including being placed into an induced coma.
“Our role was to build on the excellent work already underway and continue managing the life-threatening injuries that were contributing to his deterioration.
“The finger thoracostomy was one component of a broader resuscitation effort involving multiple clinicians working together to stabilise Tom and get him to definitive care.
“As the procedure is surgical in nature, it’s important to strike a balance between performing it quickly to prevent further deterioration and maintaining as sterile an environment as possible to reduce the risk of infection”
After Advanced Life Support and MICA paramedics assessed Tom and recognised how serious his injuries were, an Air Ambulance Victoria specialist helicopter crew was dispatched. Nearby MICA Flight Paramedic Toby St Clair was also dispatched to the case by road, to assist with performing critical intervention while the helicopter was on
its way.
Four units of blood products were transported from Latrobe Regional Hospital to the scene, with Toby starting the infusion while Tom was still trapped in his vehicle.
“Our specialist helicopters carry four units of donated blood products, however, we knew we couldn’t wait for the helicopter to arrive as Tom’s blood pressure was dangerously low,” Toby said.
“Getting the blood delivered from the hospital via road is rare and only a small percentage of patients receive blood products in this way.
“The blood had a life-prolonging effect for Tom, giving us enough time to get him out of the vehicle and provide life-saving, pre-hospital care to give him the best chance of survival.”
Once Tom was extricated from the vehicle, Ambulance Victoria crews worked together to complete a needle thoracostomy – inserting two large needles in the front of Tom’s chest to relieve pressure often linked to a collapsed lung.
Despite receiving both the needle thoracostomy and finger thoracostomy, Tom’s blood pressure was not improving. Knowing he needed urgent hospital care, he was airlifted to The Alfred, receiving four more units of blood on the way.
The incident left Tom with significant chest injuries, a broken neck, 10 broken ribs, a crushed liver and spleen, and a minor bleed on the brain.
But thanks to advanced pre-hospital critical care on the roadside, Tom survived and four months on, is recovering well and thankful for everyone who played a role in saving his life.
“I have brief memories from the day but the main thing that stays with me is the feeling of not being able to breathe,” he said.
“I owe the paramedics everything. They saved my life. They helped me when I needed it most and I will be forever grateful.”
Josh said the case was a great example of everything coming together to give Tom the best chance of survival.
“This was a great example of all emergency systems coming together to preserve one life,” he said.
“To have so many highly skilled paramedics on scene is a credit to the work of our communications centre. Everything aligned to minimise the time it took to get Tom to the trauma centre for further care.
“It was an incredible system wide response to a major trauma case in a rural setting.”
