How OHSU’s field surgical team prepares to respond to emergencies

When a climber was trapped under a boulder on Mount Hood over Memorial Day weekend, the field surgical team at Oregon Health & Science University responded. The team is trained to operate on patients outside of the hospital to free them from collapsed buildings, crashed cars and other emergency situations.

Justin Regner is the trauma medical director and division head of trauma, critical care and acute care surgery at OHSU. He oversees the field surgical team and joins us to share more about its work.

Note: The following transcript was transcribed using AI and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. When a climber was trapped under a boulder on Mount Hood over Memorial Day weekend, the field surgical team at Oregon Health & Science University responded. This team is trained to operate on patients outside of the hospital to free them from collapsed buildings, crashed cars and other emergency situations.

Justin Regner oversees the team. He is an associate professor of surgery and the trauma medical director at OHSU, and he joins us now. It’s great to have you on Think Out Loud.

Justin Regner: Thank you so much for having me and getting a chance to talk about our work.

Miller: I want to start with this call that your team responded to on Memorial Day weekend, starting with information. How much information do you get from the people who are already on the scene?

Regner: That’s a great question. It can vary depending on their training. But usually they give us a heads up of what the scene’s like, and then how stable the patient is, and what equipment they may have at the scene to assist us.

Miller: In this case, what did you hear?

Regner: We heard that we had a patient trapped under a boulder and ice, kind of in an isolated area on Mount Hood. There was a team of pre-hospital care providers that had gotten to the patient. They were unable to extract the patient, and they were worried about him becoming hypothermic and having other injuries that could potentially cost him his life up on the mountain.

Miller: So then you and others get in a helicopter. That’s the next step?

Regner: Pretty much so. For this particular one, yes, we would get in a helicopter. If it’s local, we may get an ambulance. But someone has to be able to get us to the scene as quickly as possible, and there’s no real way to get to someplace this far away without a helicopter.

Miller: Can you give us a sense of what’s going through your mind as you’re flying in a helicopter from the roof of OHSU on the way to Mount Hood?

Regner: Well, thankfully, they give us a headset. And oftentimes we can connect with the pre-hospital providers at the scene and we can start to run through what the patient’s vital signs are, are they’re awake, what the other injuries are, what resources they provided them … So we can kind of start mapping out, in our head, a scene of what the patient is and what we may have to do once we arrive there.

Miller: How long does the flight take?

Regner: This one takes about 30 minutes and some change.

Miller: What did you find when you arrived?

Regner: Well, thankfully, just before we landed, the team was able to get a lot of their high alpine gear and pneumatic devices, and they were able to lift the boulder just enough to extract the patient. They then saw that he had some open injuries and placed a tourniquet on his arm. We were able to just take the patient from the scene without actually having to operate this time.

Miller: Just to be clear – and this gets gruesome, but you’re a surgeon [and] this is your work – the basic idea is that it’s always better, for a lot of obvious reasons, to operate on somebody in an operating room in a sophisticated Western hospital, as opposed to halfway up a mountain. But sometimes you need to cut someone’s limb off in order to free them to get them to safety. Is that the basic idea here?

Regner: That’s the basic idea. We always do the best we can to choose life over limb. Some patients are trapped and the only injury they have is the extremity. If that’s the case, often us arriving on scene to ensure the patient is stable gives the pre-hospital team enough time to get high-level equipment in to move buildings, cars, boulders around so the patient can be extracted safely. Occasionally, you’ll have a patient who will be trapped, but they have other injuries to maybe their head, their chest, their abdomen, their pelvis that, without timely care, they could die at the scene.

In those cases, they call us because they don’t have time to secure the scene or extract the patient. And we really have to get the patient extracted from the site, which often requires an amputation so that we can get them to the hospital to treat their head injury, their chest injury or their abdominal injury that’s gonna take their life fairly quickly.

Miller: How common are field surgical teams, like the one that you manage at OHSU, around the country?

Regner: I wouldn’t say they’re super common. I would say each major metropolitan area has probably had some event that has led to a team being developed for a whole metropolitan area. So LA has a team for the entire LA basin. Where I came from in Texas, we had a couple of farm events that required us to have a team that covered essentially all of Central Texas. Central Texas is, if you map out what I covered in Texas on Oregon, it’s almost half the state.

So they’re not terribly common, and they’re usually major metropolitan areas or they’re areas like OHSU where a majority of the state is rural. You have a lot of events happen where you can’t get your typical teams to them and you have to take a surgeon to the patient to deliver care.

Miller: As I noted, this was a climbing accident. What other situations might a team like yours get called out for?

Regner: In Portland, there can be a lot of different things between earthquakes, building collapses, logging accidents. Climbing accidents are actually pretty common. Patients can get stuck in ravines. There can be major automobile accidents where patients run off the road, and they’re in a situation where the car is in a precarious situation and you’ve got to extract the patient as quickly as possible. That’d probably be the most common for Oregon.

Miller: I imagine the engineering challenge of carefully lifting a very heavy object that is pinning someone’s body down … That seems like a major challenge in and of itself, doing that in a way that’s not going to make an injury worse.

Regner: Oh, that is, yes. So Portland Fire, they drill on these issues quite frequently. They have an amazing setup where they have a big campus and they can design car accidents, building collapses, tree collapses on their facility, and create a scenario almost lifelike. And they have mannequins that have vital signs, and the mannequins can talk. So when they send their teams there they can actually see injuries on the patient, know what their vital signs are, know how the patient’s actually [inaudible]. Then they go through scenarios to set up all their equipment to extract these patients safely.

Miller: How many times have you actually been called out for real calls?

Regner: In my career, myself or my team, in the last 15 years, have been called out four separate times.

Miller: Obviously, for each one of those situations, for the individual or their loved ones, this is life or death and crucial to have your support. But four times over the course of your career, or four times in the last 15 years, it does show how rare these are.

Regner: Yeah, the more common scenario is we get called up from the pre-hospital saying, “Hey, we have a field extraction event. I need y’all on standby and ready.” So that happens probably three or four times a year. We’ll get called. The team will get ready, and then we’ll get the call saying “the patient’s stable, we were able to take our time and get the patient extracted safely.” So that’s the more common scenario. Everyone gets ready to mobilize and our pre-hospital providers are able to get the patients safely extracted.

I would say, probably on average, once every two to three years this happens. That’s how it is for my colleagues across the nation that do this. It’s about once every two to three years that they actually have to fully deploy to do it. Whereas, they get several calls a year where they have to get everyone ready, but they don’t end up having to deploy.

Miller: It seems like what just happened in May is a kind of hybrid of those, where you were called out, and as you noted, just as you’re arriving, they were able to extricate.

Have you ever had to operate when you’ve been called out?

Regner: Yes, that was actually the first one that I was ever a part of. Since then, I’ve been to the scene numerous times. Thankfully, all the team really needed was for me to be there and maybe bring blood for the patient, to stabilize the patient long enough for the pre-hospital team, the extraction team, to get the patient extracted. With pre-hospital blood, we’re able to stabilize patients a lot more than we did in the past so that these events, thankfully, are less common than they were probably previously.

Miller: But the first time you got called out, you actually did have to operate. I imagine that’s not something you forget.

Regner: No, it’s not.

Miller: What are you able to share with us from that day?

Regner: It was a patient stuck in a combine out in farmland, Texas. It was an unfortunate event. It was an elderly gentleman who was actually training his grandson to use the equipment, and he went down to check on something, and a lever was pushed that wasn’t meant to be pushed. I don’t think anyone will ever really know. He basically had his lower extremity trapped in the combine and mangled.

This was pre-tourniquets, so we did not have tourniquets back then readily available. He had a belt on his leg and he had lost a lot of blood. For the pre-hospital providers, it wasn’t that they couldn’t necessarily get him extracted, it was that he had lost so much blood they needed me to get there and get him extracted immediately. They didn’t have time to do anything.

So that’s basically what happened. I think in today’s world with tourniquets and pre-hospital blood, they probably could have gone through the extraction process and brought him to us safely. But this was before a lot of things were in play that we now do as everyday therapy.

Miller: You mentioned the various scenarios that Portland Fire and Rescue are able to put together for training. How do you train though as a hospital team? What you’re describing is what you very rarely but might have to do: surgery halfway up a mountain, or in a field, or in a forest, or on a city street, in the case of a building collapse, or the big one, an earthquake. It seems so different from surgery in a clean operating room. How do you actually stay ready and get trained?

Regner: That’s actually the hardest part of doing this. The skill set, the manual skill set is relatively straightforward for us. The mental skill set to adapt to ever-changing environments that our pre-hospital teams do every day is very different. When we’re in the trauma bay, in the ED, or in the operating room, it’s a very controlled environment. We have teams of people in place. It’s safe. We’re not worried about ourselves. We’re only worried about the patient.

When we get deployed into a field surgical event, you don’t know quite the scenario you’re gonna arrive in. The boulder scene would be safe for us, it’s just unusual. But I’ve taken care of patients who were trapped on ravines where, if I had to do it, they were gonna have to put me in a harness and rappel me over the side of a wall.

Miller: So if that had happened, you would have been hanging as you did the surgery?

Regner: Correct. So that mental aspect is the hardest part to train. I’ve been in a situation where a patient was trapped in a semi. There was active diesel pouring out. They couldn’t get it controlled. They’d already had several fires and they didn’t think they would be able to get the patient extracted before the diesel potentially caused an explosion and took the patient. I mean, there, I was worried about being involved in the blast. So learning to deal with that aspect of the mental challenge is way different than the safe environment of a trauma bay or an operating room.

Miller: When I think of people who seek out the career that you did, maybe this is unfair, but I imagine some version of thriving on the adrenaline. But what you’re describing here, it’s more like a terrifying action movie scene with diesel spurting out, and will the existing flame hit the diesel before the person is saved? It seems very different from what probably even most trauma doctors think they’re signing up for.

Regner: That’s a fair statement. I would say people who go into trauma, we may enjoy a little bit of thrill seeking as part of our life. So a good number of us, while that would be scary, we would also be like, “Man, we’re never gonna get a chance to do this again. Let’s go do this.” Some of my colleagues will be like, “Yeah, I’m never gonna do that. I’ll let you go do that. I’ll stay here and wait for the patient to come back.”

Miller: And being on this field trauma team, this is a voluntary job? You don’t just sign people up for it?

Regner: It’s technically voluntary. It’s strongly encouraged, but it is voluntary. I cannot make anyone leave the hospital and go do this. But most of my team understands the necessity that if this happens, we’re this patient’s last chance at life. So we’re willing to sacrifice our discomfort if that means someone else has a chance to live another day.

Miller: From the beginning, you’ve been emphasizing the interactions you have with what you’ve been calling the “pre-hospital team,” which I imagine are search and rescue or paramedics, the first responders who are providing their version of expert medical care. How would you describe the relationships you build with these other teams?

Regner: I think the people who go into those teams, they’re super high functioning, regimented individuals who usually have military or some training background that makes it, for us, easy to talk to, because they’re very streamlined in their thought process. They have a clear and concise goal of how they want to achieve what they’re going through or how to get the patient out.

It really becomes two people bouncing ideas off each other, who understand what’s at stake. And they learn from us, and every single time I do one of these, I learn something new every single time. Their minds work differently than mine. Their training is different from mine. I come away a much stronger person for having the opportunity to learn from them and interact with them.

Miller: Dr. Regner, thanks very much. I appreciate talking with you.

Regner: All right, thank you so much.

Miller: Justin Regner is a trauma medical director at OHSU.

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