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Level I Trauma Center meant the difference between life and death for Paul Bachini

September 23, 2016
Paul  Deborah Bachini

It seemed like any other April day for Paul Bachini, who was out for his daily stroll with his wife near their Feeding Hills home.

But, that fateful day two years ago turned out to be anything but ordinary for Paul, who was hit by a car and sent bouncing off its hood and flying through the air, only to painfully land against a mailbox along the side of the road.

Bachini, left in critical condition, soon found himself on the way to Baystate Medical Center, where a team of trauma surgeons awaiting his arrival at the Emergency Department would soon swing into action to save his life.

Life-Saving Trauma Care

“I remember Paul distinctly. He was very unstable upon his arrival at the Emergency Department. His heart rate was high and his blood pressure was quite low. He had multiple bruises and lacerations and was bleeding all over his body,” said Dr. Andrew Doben, one of a number of six highly-skilled trauma surgeons who make up the hospital’s level 1 trauma center, the only one of its kind in western Massachusetts.

“In retrospect, coming to our trauma center saved Paul’s life,” added Dr. Doben, who noted that Bachini was attended to by nearly every trauma surgeon while in the Emergency Department and during his first 24 hours of care.

Bachini, a retired Agawam schoolteacher, agrees.

“Because of the exceptional treatment and care I received at Baystate, I have been able to carry on a pretty normal life with just a few exceptions,” said the Feeding Hills man, who said he no longer drives or rides his bicycle, and is unable to read books or magazines without special visual aids, because of irreversible damage to his eyes, including the optic nerve in his left eye.

What Wasn't Wrong with Paul?

The question when Bachini arrived at Baystate’s Emergency Department wasn’t so much what was wrong with him as the result of the blunt trauma from the fast moving car, but what wasn’t.

“Paul had a bleed deep in his brain, massive facial fractures, as well as cervical, thoracic, and lumbar spine injures – a break on each of the levels of his spine. He also had a right shoulder injury, as well as collarbone and chest injuries, not to mention a very serious pelvic fracture which was causing him to bleed internally, requiring blood transfusions three times in 24 hours to replace his circulating volume. And, he nearly lost his ear,” said Dr. Doben.

Patients like Bachini, who have serious pelvic fractures that can lead to life-threatening hemorrhaging, often have high mortality rates ranging from 40 to 60 percent, especially when combined with other massive bodily injuries.

“We quickly placed Paul on full life support and began transfusing him with massive amounts of blood, then rushed him to interventional radiology where an attempt was made to stop his internal hemorrhaging through a minimally invasive technique called angiographic embolization,” said Dr. Doben.

“During the angiographic embolization, a small device was inserted into Paul’s arteries to attempt to stop the bleeding with small plugs called coil embolization. This helped to stabilize his bleeding, but only addressed his bleeding arteries. The bleeding from his veins continued and required additional intervention,” he added.

The Bleeding Wouldn't Stop

Bachini was then transported to the intensive care unit (ICU) where his condition was very unstable. The next morning, just before 7 a.m., he was rushed to the operating room where to further control his internal bleeding from his pelvic fracture, they had to surgically open his belly and perform a technique called preperitoneal pelvic packing.

“It was quite unusual to have to perform this procedure, as most patients who undergo angiographic embolization do not need it,” said Dr. Doben.

Preperitoneal pelvic packing involves making a surgical incision and placing large gauze pads into the hole that is bleeding.

“Think of it as plugging a hole in a drain pipe with a piece of gauze,” explained Dr. Doben.

“As Paul began to improve, we were able to bring him back to the operating room to remove his pelvis packing and close his abdomen, remove his tracheotomy, and operate on his face. Over the ensuing week, he continued to improve and was weaned from life support. He eventually returned to the operating room where plastic surgeons, key team members in our Trauma Services, performed facial reconstruction,” he added.

From Hospital Care to Rehab

Following his discharge from the hospital, after spending some two weeks in the ICU, Bachini spent several weeks in a rehab facility where he underwent physical and occupational therapy and they helped him to get back on his feet, literally.

“They helped me to strengthen my legs and I needed some speech therapy and had to relearn how to swallow after having a tracheotomy,” said Bachini.

“But, I have to say that the folks at Baystate were wonderful and made sure that before I even left the hospital for rehab, that I was functional and healthy enough to leave,” he added.

Baystate Medical Center is the only American College of Surgeons-Committee on Trauma verified Level 1 Trauma Center in western Massachusetts – featuring a three-bay resuscitation area – providing the highest level of expert trauma care for the most seriously of injured adults and children from car crashes to gunshot victims to falls. According to the Centers for Disease Control and Prevention (CDC), treatment at a Level I Trauma Center increases a patient’s chance of survival by 25 percent.

Featuring a Rooftop Helipad

Level I Trauma Centers like Baystate provide 24-7 a multidisciplinary team of doctors, nurses and other clinical and support staff, along with state-of-the-art medical imaging and diagnostic and other specialized resources for trauma patients. The hospital’s trauma center also has a Helipad equipped with an elevator that opens directly into the trauma unit.

Along with Level I designation, trauma centers are required to conduct research, to support a surgical residency program, and respond to a volume of at least 600 major trauma patients per year. Annually, Baystate’s Trauma Services responds to approximately 2,200 patients at the hospital’s Emergency Department, which is recognized as the busiest in the entire state.

If anything at all good came out of this unfortunate circumstance, Bachini said it is his newfound understanding of the intense need for blood donors and for having a bountiful supply of blood on hand at the hospital, so others like him in times of a medical crisis will live.

“I took plenty of withdrawals,” said Bachini about the many transfusions he needed throughout his stay at the hospital, especially during his initial treatment in the Emergency Department.

Avid Blood Donors

“As a result of my injuries, my daughter and her fiancé, Andy, have become avid donors at Baystate’s Blood Donor Center,” he added, noting he cannot donate at this time because of the accident.

It was while his daughter, Danielle, was donating blood one day that a nurse from Agawam – whose three children all had Bachini as a teacher – recognized her name and asked if she thought her father might be interested in telling his story at the hospital’s upcoming Blood Donor Appreciation event.

“To stand in front of those donors and thank them for what they do, giving of themselves so others can live, well, it was very touching. I got to meet with some of them and thank them personally for what they do. It is important as anything else that goes on in the hospital,” said Bachini.

But, that wasn’t the first time the former trauma patient had returned to the hospital to express his thanks.

A Really Big Thank You

“After I left rehab and life began to return to somewhat normal for us, we returned to Baystate with plates of cookies in hand to thank and speak with the physicians, nurses and other medical staff members who were so instrumental in my care. I wanted to let them know how much I appreciated them saving my life,” said Bachini,

In addition to the good words he had to say about his care, Bachini is eternally grateful for one other thing.

“Miraculously, the car didn’t touch my wife who was right beside me,” he said.

(In addition to Dr. Doben, other trauma surgeons attending to Bachini during his initial hours and recovery at Baystate were Drs. Reginald Alouidor, Eleanor Winston, and Ronald Gross, chief, Trauma, Acute Care Surgery and Surgical Critical Care.)