Typically, trauma surgeons don't travel outside their hospital operating rooms to work, but Thursday, Dr. Orlando Morejon of Saint Francis Medical Center flew to be at a patient's side as emergency crews worked to extricate him from a grain bin auger.
It was the first time the hospital had been asked to provide support on scene.
When he arrived by helicopter at MFA Agri Services in Advance, Mo., Morejon said the man -- identified as Joshua Blankenship, 29, of Zalma, Mo. -- was trapped after his left leg was pulled through an opening in the grain bin floor -- up to his hip -- by the auger blade.
"The best way to describe the auger is as an oversized drill bit," Morejon said during a news conference Friday at Saint Francis. "His leg was caught in two different areas where the blades had actually dug into his leg at the mid-thigh and between the knee and the ankle."
Blankenship's leg was pinned in four locations, but thanks to Morejon's guidance and the efforts of emergency personnel, not only was Blankenship's life saved, but his leg was saved as well.
"The leg is viable all the way down to the toes," Morejon said. "There remains a question of the functionality, meaning nerve injury. He will be at risk for infections because of the nature of the injuries. He does have the leg. I believe he has a very good chance of surviving this with the leg intact."
From the time he landed, Morejon was on scene for more than an hour.
"As soon as we lifted him out, I was able to quickly clamp everything off and prevent significant blood loss at the scene," Morejon said.
Having a trauma surgeon on site helped make the extrication a tactical one, said Dexter, Mo., fire chief Don Seymore in a phone interview Friday.
"Our main concern was if we relieve the pressure from the entanglement, he would start massive bleeding that would not be able to be stopped," Seymore said. The way his leg was caught in the auger blade created a tourniquet, he said.
Seymore has rescued people from grain bins before, but he said this was the toughest situation he's seen.
Once Saint Francis was asked to assist, Morejon went about making sure he had all the equipment he would need to bring to the scene, including specialized instruments and saws.
"I went in prepared for all contingencies," he said. "I wanted to be ready to control bleeding and, if necessary, perform an emergency amputation on-site to extricate him," Morejon said.
Blankenship was placed on oxygen and given IV fluids and blood transfusions on site in anticipation of the blood loss as he was untangled from the auger.
"I don't think this could have taken place if it were not for a system that was already fine-tuned," Morejon said. "Not just the hospital system, but our interaction with Air Evac and the ground crews in Stoddard County. There had to be great communication and there was," Morejon said.
He said he credits divine providence for there being a helicopter already on the landing pad at Saint Francis when the call came in.
As of Friday, Blankenship was listed in fair condition, Morejon said.
"His vital signs are stable, he is expectedly in some pain because he sustained significant injuries," Morejon said. "He's not out of the woods, but from what I've seen so far I think he can go on to live a very happy, very fruitful life. He will have scars of various kinds, but given what we had to start with, I think we maximized the outcome."
Tentative plans were for Blankenship to be moved to a St. Louis hospital for more specialized orthopedic care.
Morejon started work as a trauma surgeon at Saint Francis since 2006, left in May 2008 and returned in October 2011.
211 Saint Francis Drive, Cape Girardeau, Mo.