I-90 crash: Making the extraordinary ordinary
COEUR d’ALENE — Dr. Edward DeTar and Dr. Marcus Torgenson have performed more than 1,200 leg amputations combined over the course of their careers. But, until Thursday, neither Kootenai Health surgeon had amputated a leg inside the cab of a semi-truck.
"It was a very, very small place for a surgery," Torgenson said during a press conference at Kootenai Health on Friday. "It's obviously a stressful situation, but the setup and preparation made something extraordinary kind of ordinary."
On Thursday morning, multiple emergency response agencies were called to the scene of a three-semi accident on icy Interstate 90 near the Rose Lake interchange. One of the men involved in the accident, 54-year-old Aleksey Tikhonov of Soap Lake, Wash., was trapped in his truck, his right leg sandwiched under a pile of logs and debris.
Kootenai EMS System Chief Christopher Way said the first EMS official on scene recognized the gravity of the situation and immediately made a call to the emergency room at Kootenai Health.
"This isn't something we do on a regular basis — or ever, for that matter," Way said. "This isn't even something we practice or discuss."
About 20 people helped DeTar and Torgenson prepare to leave the hospital, along with Dr. David Wineinger, an anesthesiologist, and nurse Carmen Sincerbeaux. Torgenson said, while being transported to the scene in an EMS vehicle, he knew Tikhonov's leg was trapped and amputation was likely the only way to get the man to the hospital alive.
"It was a very remarkable situation we found ourselves in," Wineinger said.
After arriving on scene, the trauma team began preparing for surgery. Wineinger worked to prepare and sedate Tikhonov, while Torgenson and DeTar monitored the situation on each side of the semi. When Torgenson climbed up onto the vehicle, he said his first response was that it didn't look safe.
However, a firefighter reassured Torgenson he could do his job without worrying about anything else.
"The quiet confidence of the first responders translated over to us," Wineinger said. "It's something I will never forget."
Although he said it was hard to describe how cramped the inside of the vehicle was, Torgenson said the driver's seat was pushed back into the sleeping compartment, and there were logs pushing vehicle debris down onto Tikhonov's leg. The surgeon needed to lie down, face underneath Tikhonov's feet and beneath the vehicle's steering wheel, before beginning the surgery.
In a hospital setting, Torgenson said an amputation typically requires 45 minutes to an hour of surgery.
In the middle of Interstate 90, the surgery lasted 10 minutes.
Less than 40 minutes after the trauma team arrived on scene, Tikhonov had his right leg amputated, was transported to an emergency vehicle and prepared to head to Kootenai Health.
"This doesn't happen with just one person," Torgenson said. "It was reassuring knowing we were all together working for a common goal."
Tikhonov is still at Kootenai Health, and is listed in fair condition. An occupant with him, Vasil Bugaychuk, 47, Soap Lake, was in the sleeper compartment and also sustained injuries in the accident. He was transported to Providence Sacred Heart in Spokane, where he is listed in serious condition.
The drivers of the other two semis involved in the wreck were uninjured. All three drivers were wearing seatbelts.