Miracle on 66th Street: Patient falls 47 stories and beats impossible odds - Patient Care - @ JEMS.com


Miracle on 66th Street: Patient falls 47 stories and beats impossible odds


 
 

Glenn Asaeda, MD Gary Smiley, EMT-PJose Cruz, EMT-P | | Thursday, September 4, 2008


At approximately 10:15 a.m. on Dec. 7, 2007, multiple calls came into the New York City 9-1-1 system reporting a scaffolding collapse in Manhattan. According to civilian callers, a window washing scaffolding platform had fallen from the roof of a 47-story high-rise building with possibly two victims on the apparatus. Multiple first-response police, fire and ambulance units, including an FDNY EMS Rescue paramedic unit, were dispatched to the scene (see ˙FDNY Deploys ÂRescue Trained Paramedics'Ó atJEMS.com).

On arrival at the scene, the crew of the first ambulance realized the severity of the situation. As first reports from the scene had indicated, there was one fatality and one patient in critical condition, along with the potential for several other victims buried in the rubble of the collapsed scaffold. Ultimately, no other victims were identified.

The surviving victim had fallen approximately 47 stories into an alley between two buildings. EMS providers assessed, packaged, treated and transported the patient through the adjacent building to an awaiting ambulance. They then provided ongoing care while en route to a trauma center located just two minutes away from the scene.

Hospital Care

With multiple fractures and internal and spinal cord injuries sustained, the patient was admitted to the trauma center in critical condition with a grave prognosis. He was immediately taken to the operating room and remained sedated during recovery. Amazingly, 18 days later, the patient began to move his extremities and, on Christmas day, spoke for the first time since the 47-story fall.

Discussion

The clinicians who cared for this patient from the pre- to post-hospital stages have called his survival and recovery nothing short of a miracle. There were no landings to cushion or slow his fall. It was a sheer drop from the 47th floor to the ground. The survivor was actually found in the rubble of the crumpled aluminum scaffolding, while the deceased victim was found thrown from the scaffolding.

Medical literature reports a 50% fatality rate for falls of three or more stories, but survivals from extraordinary heights have also been documented. During World War II, Alan Magee, serving as a B-17 ball turret gunner for the Army-Air Force, jumped out of a disabled bomber from 22,000 feet, crashed through the skylight of a train station and survived. And on Jan. 26, 1972, Yugoslavian flight attendant Vesna Vulovic reportedly survived a fall from 33,330 feet when her plane, a DC9, was blown apart after a terrorist bomb detonated.

One possible reason for survival from such great heights, as cited by the literature, is terminal velocityƒthe theory that, during freefall, an object reaches terminal velocity at around 120Ï130 miles per hour (which some believe can be reached during a 300-feet fall). So the impact made after falling from 500 feet may be very similar to the impact made from a fall of 10,000 feet.

In New York City, the highest previously reported fall survivor fell 19 stories in 2002, with the young man hitting a tree on the way down. Pediatric literature sometimes reports survival of patients from significant falls, but this may be accounted for by a child's immature, bony anatomy, which provides some cushion and give.

As for the window washer in this case, he has already undergone more than nine orthopedic and five abdominal surgeries, as well as a tracheotomy. The physicians caring for him predicted a near-full recovery in approximately one year's time. However, the survivor made an even more dramatic and unexpected recovery; he was transferred to a rehabilitation facility within a month and able to walk unassisted with only a slight limp in fewer than five months.

Was the crumpling of the scaffolding just enough cushion to allow his survival? Did freefalling with the scaffolding allow some air displacement to minimally slow the speed of descent? Whatever circumstances led to his survival, this is definitely an amazing case that will be cited many times in the future.

Lesson learned:Never look at a mechanism of injury and assume your patient could not have survived it.

References

1.
Committee on Injury and Poison Prevention. ˙Falls from heights: Windows, roofs, and balconies.ÓPediatrics 107(5):1188-1191, 2001.

2.http://www.303rdbg.com/magee.html



3.Wikipedia.org



4. Lee B, Eachempati Soumitra R, Bacchetta M. ˙Survival after a documented 19-story fall: A case report.ÓThe Journal of Trauma-Injury Infection & Critical Care 55(5):869-872, 2003.

GlennAsaeda, MD, is the division medical director with the Fire Department of the City of New York as well as an auxiliary police officer with the New York City Police Department assigned to the rescue unit out of the 61st precinct in Brooklyn South.

ParamedicsGary Smiley andJose Cruz are Rescue medics assigned to Station 10 in Manhattan, Division 1.




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Related Topics: Patient Care, Medical Emergencies, Trauma

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