At first, July 24, 2019 seemed like an ordinary night for Adam Fifield. The last thing he remembers from that day is enjoying a meal with a few friends. But from there, things go black for a little while.
“The next thing I remember after that is waking up in the ICU four days later,” says Adam.
Because that night, in the blink of an eye, the 25-year old Charlotte resident was struck head on by an SUV at a high rate of speed. Although the full extent of his injuries wasn’t yet known, Adam had severely injured his left leg, pelvis and left forearm, along with multiple lumbar spine fractures.
Luckily, Cabarrus County EMS, along with Harrisburg Fire Department, arrived on scene 4 minutes after being dispatched. Cabarrus County Sheriff’s Deputy arrived just before EMS and placed a tourniquet on Adam's leg to control massive bleeding before EMS were able to arrive to administer TXA, a drug used to help control internal bleeding.
“Patient care was smooth and seamless," remembers lead paramedic Sandra Lambert. "We had help from allied agencies (Harrisburg Fire and Cabarrus County Sheriff’s Office) and were able to transfer the patient to the helicopter in an efficient manner."
He would be transferred to Carolinas Medical Center (CMC)'s F.H. "Sammy" Ross, Jr. Trauma Center, the region’s only Level 1 trauma center, where he’d rely on the Atrium Health teams to undergo a rare lower extremity amputation and begin his months-long journey toward recovery. Along the way, Adam and his family would witness the expertise and collaboration that goes into providing Level 1 trauma care.
Springing into action
In trauma, there’s no time to waste. So as a group of highly trained EMTs got to Adam at the roadside, the team at CMC was springing into action and getting ready for surgery.
“We perform the same routine every time we admit a new trauma patient,” explains John Green, MD, one of the surgeons who performed Adam’s surgery. “A team is there when the patient arrives, then we go down a set algorithm so we don’t miss any injuries.” Everyone on the team has a role and a job during this time. The trauma team leader will sketch out a plan for directing care. This might include going to radiology for X-rays, the ICU or, in Adam's case, directly to the operating room to control bleeding.
“With Adam, time was truly of the essence,” says Gaurav Sachdev, MD, another member of Adam’s surgical team. “Adam’s injury was devastating and could probably be compared to an injury one might sustain during military combat. So our first goal, as always, was stopping the bleeding.”
It wouldn’t be easy. But thanks to the expert work of the first responders, Adam’s bleeding stopped. With that hurdle cleared, the team at CMC could now begin thinking about reconstruction — which in this case called for a rare surgical procedure.
A rare surgical procedure
Few at CMC had seen a lower extremity injury as severe as Adam’s. Half of his pelvis had been torn off and the surrounding muscle had come out with it. All of the organs around the pelvis were involved, along with of course a serious wound. The team quickly realized they would have to remove Adam’s entire left leg as well as the left side of his pelvis. It’s a procedure known as a hemipelvectomy — and it’s just about the rarest form of lower extremity amputation.
“At our job there’s always something new and surprising,” explains Dr. Green. “We’ve seen severe fractures, but I have no reports of anything like Adam’s injury happening at our hospital.”
But even though this was such a complex injury involving so many different symptoms, the surgical team could fall back on their algorithm and expertise to address this unpredictable injury in a predictable, systematic way.
“I sometimes like to compare it to a jigsaw puzzle,” says Dr. Sachdev. “Each new surgery is like a new puzzle. You open up the box and you know the pieces and you know what you want to accomplish. It’s just a matter of figuring out how to get there and complete the puzzle.”
“In the case of my injury, there were no clear instructions for surgery,” says Adam. “You don’t open a book and read the steps you need to take. So I’m so thankful Dr. Green and his team were able to go in there and use their experience and expertise to make sure the surgery was successful.”
This initial surgery took about an hour of concentrated work from a team of experts. Once it was successful, Adam moved on to several other operations. Reconstruction would be an ongoing process — but already the trauma center had made big strides in terms of stabilizing Adam and getting him on the way to recovery.
A positive attitude amid challenges
Adam spent a grueling six days in the surgical trauma ICU, then moved to the trauma step-down unit for a month and a half. During this time, the physical and occupational therapy teams worked with Adam to help him sit up in bed and in a chair.
Adam’s care team was blown away by his strength as he navigated this grueling recovery. “I never saw him break down. He just seemed so resilient the whole time,” says Dr. Green. “We felt like he was active and involved in the care, working alongside us. This kind of teamwork makes everything easier.”
“There were a lot of tough times there in the hospital,” admits Adam. “The outlook I had was that I somehow survived this extreme accident. So the best thing I can do for myself now is stay positive and work towards my main goal of getting home as soon as I can.”
Adam was fortunate enough to have his devoted family by his side the whole way. “My parents and my twin brother Austin were there every single day I was at the hospital, talking to me and just helping me pass the time,” says Adam. “I couldn’t have asked for more support than I got.”
On September 13, 2019 — less than two months after his injury — Adam was transferred to the Atrium Health University City long term acute care facility (LTAC) for three weeks. Then after a few weeks in rehab at Atrium Health’s Carolinas Rehabilitation, he was ready to go home.
The importance of Level 1 trauma care
Adam has come a long way since that fateful night in July — and is focused on improving his mobility, getting a prosthetic, and getting back to his full-time job as an engineer. His incredible progress is a testament not only to his personal strength, but also to the power of Level 1 Trauma care.
“Level 1 means we’re available 24/7, with no notice whatsoever,” explains Dr. Sachdev. A Level 1 Trauma Center must also have trauma surgeons, a 24/7 blood bank, and an operating room with the capacity to handle anything from an individual injury to a mass casualty. Additionally, the hospital must publish original research and commit themselves to quality improvement in order to main Level 1 status.
Even at such a large, complex hospital, the personal touch matters. Adam remembers how the staff at CMC quickly helped him move into a new room when it became clear his room wasn’t large enough to accommodate all the visitors he was getting.
“I built a great relationship with so many of the nurses there,” says Adam. “They always knew when to come into my room and help — I didn’t even have to call them, they just knew. And everyone always communicated so clearly with me.”
“The people in Charlotte, myself included, are so lucky to have this system, starting with the paramedics at the roadside all the way to late-stage rehab,” says Dr. Sachdev. “It’s reassuring to know such a talented group is here to help if something happens.”
And a patient like Adam is a reminder of the vital work being done in the hospital every day. “Stories like Adam’s are really rewarding for us,” says Dr. Green. “These successes really motivate us to keep fighting and be the best trauma center we can be.”
