He was trapped. And the fire department couldn’t get him out.

Hector Ruiz had climbed into a confined space inside a hopper at the iron foundry where he worked, to clean and unblock the huge auger screw conveyor at the bottom. After finishing, Ruiz went back in to retrieve a work light, but a coworker didn’t see him do so. The coworker turned on the machine, which pulled Ruiz into the rolling auger screw mechanism and entangled his legs in the machinery.

“I started screaming,” said Ruiz through an interpreter, “but it was too late.”

The Alhambra Fire Department raced to the scene, but they were unable to extract Ruiz from the machine. That’s when they called the Los Angeles County + USC Medical Center Hospital Emergency Response Team (HERT). LAC+USC maintains a trained, designated team for events like this, complete with pre-packed bags of instruments and medications, protective gear and a protocol for rapid deployment, which includes being dispatched by helicopter to anywhere in Los Angeles County.

The team recently was recognized by the state for its work in emergency situations, including saving Ruiz’s life.

Operating in the field

“The team is designed for situations exactly like this,” explained Elizabeth Benjamin, MD, PhD, assistant professor of clinical surgery at the Keck School of Medicine of USC. “When the pre-hospital team is unable to extricate a patient, the HERT team is designed to bring a piece of the operating room into the field to provide medical assistance and perform amputations if necessary.”

Though the actual HERT team is small — trauma surgeon Benjamin, emergency room resident Wally Bugg, MD, and emergency nurse Stephanie Kern, RN — Benjamin emphasized that it is a group effort to effectively help patients in the field.

The three HERT members were joined on the scene by Marc Eckstein, MD, MPH, professor of clinical emergency medicine and medical director for the Los Angeles Fire Department, and emergency fellow Saman Kashani, MD.

In 100-degree weather, masks in place, Benjamin, Eckstein, and Bugg crawled through a small opening and into the hopper. It was dark and full of black dust, and the space was so cramped that Ruiz was bracing his arms against the inside of the funnel in order to avoid being trapped further. His legs were entangled in the screw and there was no way to move him.

“The doctor told me we would need to amputate my legs to get me out.” Ruiz said through an interpreter.

The team put tourniquets around Ruiz’s legs and gave him an anesthetic. There was no spare space for medical equipment inside the machine, so the Alhambra firefighting crew formed a literal fireman’s line. When the team needed anesthetic, they sent the request down the chain of men and women and a syringe was passed back hand-to-hand.

“It was nothing short of amazing,” Benjamin said. “I’m humbled by what that group of people was able to accomplish. So many people came together and worked as one.”

Because the screw was surrounded by a metal chamber, it was difficult for the team to get to Ruiz’s legs. The fire crew managed to reverse the screw a bit to give the HERT team room to work, but they were still unable to use their usual instruments to perform the amputation. Once again, the team improvised – this time using a construction saw from the site to free Ruiz from the machine.

Ruiz was anesthetized but still conscious through the entire ordeal. “He was incredibly calm,” Benjamin said. “I can’t imagine what he went through mentally. He is a remarkable human being.”

Teamwork continues at hospital

Hector Ruiz attends the Trauma Survivors Reunion, where he was one of the speakers. (Photo/Anthony Jackson)

The line of firefighters helped to maneuver Ruiz out of the hopper and onto a stretcher. The HERT team started for LAC+USC, but Ruiz was not out of the woods yet. Ruiz went into cardiac arrest in the ambulance. The team intubated him and performed CPR to revive him.

When the team returned to the hospital, dozens of people were already mobilized and ready for them. An operating room was ready with nurses and anesthesiologists already in position.

“When we rolled back in, it was the greatest sight ever,” Benjamin remembered. “It was so hot and we were so emotionally exhausted. To see the entire emergency room and the entire trauma team ready to go was incredible. That kind of training and support is why I work at USC.”

Ruiz immediately went into surgery to stop the worst damage, then had a follow-up surgery to stabilize the amputations. Within a week, he was off a ventilator and a nurse was helping him to sit up and move around, his family by his side.

Benjamin praised the Alhambra Fire Department for having the scene completely controlled when the HERT team arrived. “There must have been a hundred men and women on the scene,” she said. “They were calm, organized and had prepared the scene to be safe for us.”

HERT recognized by state

In March, the entire HERT team received a Clinical Excellence Award from the State of California’s Emergency Medical Services Authority for the rescue. Benjamin stressed that it was all possible because of multiple departments and dozens of people coordinating perfectly. She also cited the influence of trauma, emergency surgery, and surgical critical care division chief Demetrios Demetriades, MD, PhD, professor of surgery at the Keck School.

“Dr. Demetriades is the reason this all worked so well,” Benjamin said. “It’s the environment that he creates that allows us to prepare and do these kinds of things. And the level of support that he gives us is incredible.”

Vaughn A. Starnes, MD, Distinguished Professor and chair of the Department of Surgery, expressed his admiration for the team as well. “This rescue exemplifies the kind of training and teamwork we strive for at Keck Medicine,” he said. “I could not be prouder of this team and the dozens of staffers who contributed to their success.”

Ruiz has been fitted with prostheses and is re-learning how to walk with a physical therapist. His entire medical team has been touched by his positive attitude.

“He is unbelievable. He has been incredibly thankful to everyone,” Benjamin said. “To have that selfless perspective so soon after is amazing.”

The division of trauma, emergency surgery, and surgical critical care holds a reunion for trauma survivors every spring. At this year’s reunion on May 5, Ruiz spoke about his experience and his remarkable recovery. “Life goes on whether you’re sitting or standing,” he said. “With the help of God and with the help of science, I will walk again.”

In addition to his care team from USC, the members of the Alhambra Fire Department who assisted with the rescue also came to the event, as so many of them wanted to see Ruiz again.

Ruiz credits the support of his wife Graciela for his positive outlook. “She has always been by my side,” he said. And of course, he credits the quick thinking and coordination of the HERT team:

“They made all the right decisions for me to survive.”

— Lex Davis, with translation by Melissa Melgoza