Photo by Chris Rakoczy
System strength saved a Salem butcher
By Elissa Bass
Patient Adam Ritchotte (center) stands with some of the team that saved his life after a traumatic workplace accident; (left to right) Dr. Edward Gifford, Samantha Mercer, Adam Ritchotte, Casey Malan and Dr. Jonathan Gates.
March 7 was a regular Sunday at Salem Prime Cuts. The retail shop was closed, and butchers Sean Kelley and Adam Ritchotte were working on a customer request.
Ritchotte, 28, who lives in Baltic and has worked at the popular butcher shop for three years, had a beef shoulder on the stainless steel table. With a six-inch boning knife to separate meat from bone, he made one long, smooth cut from the top, down toward him.
As he neared the bottom, the knife slipped and plunged directly into his groin, near the right hip, almost to the hilt. Without thinking, he pulled it out and clamped his hand over the wound.
“I have to go to the hospital,” Ritchotte thought, making his way out to the parking lot, where Kelley was grilling chicken for their lunch.
Once outside, he paused to unhook his knife belt. As soon as he removed his hand from the wound, blood shot out. A lot of blood. And it was coming fast.
“This is a slaughterhouse,” Kelley said, “so you know what arterial spray looks like. I knew this was really serious.”
They yelled to coworker Sarah Hill to call 911. Richotte laid down on his back on a nearby platform, and told Kelley to put his knee on the wound.
“Bear down as hard as you can,” he told his friend, who laced his fingers through the platform’s grating and, using all his strength, held himself there, knee pressing down until help arrived.
First Responders Answer
Hill actually called 911 twice because those minutes felt like a lifetime. Arriving almost simultaneously were Salem and Gardner Lake fire department crews. American Ambulance paramedics were close behind.
Ritchotte drew from his Army training to have Kelley use his knee for pressure. He served in the infantry from 2012 to 2015, including six months in Afghanistan. He had learned how to stop bleeding from a penetrating wound, which is often seen on the battlefield and, more recently, became more mainstream because of the nation’s mass shootings.
Salem firefighter/EMT Ronald Prezch Jr. took over for Kelley, keeping pressure applied while EMT Cheryl Philopena grabbed all the Quikclot wound-packing materials they had in the ambulance.
Philopena, who turns 66 this summer, has been a Gardner Lake volunteer EMT for 46 years, and credited Kelley with being the first of many that day who saved Ritchotte’s life.
“If it weren’t for Sean, we wouldn’t have had anything to work with when we got there. Adam would’ve died,” she said.
American Ambulance paramedics Patrick Gauthier and Charlie Weinsteiger arrived on scene after Ritchotte was in the ambulance.
Weinsteiger took over for Prezch, applying intense pressure and more clotting gauze. Gauthier started an IV and pain meds. Both kept talking to Ritchotte, keeping him awake for the ride to Backus Hospital.
Weinsteiger, a trained combat medic in the Connecticut Army National Guard, became an EMT in the Guard, and has only been a paramedic since December. On this Sunday, he was precepting with Gauthier, still in his probationary period. He told Ritchotte he was a “68 Whiskey,” putting him visibly at ease.
“When he told me he was a 68 Whiskey (68W is military code for Army combat medic), I knew I was going to be OK,” Ritchotte said later.
ED Head’s Up
Gardner Lake brought Ritchotte to Backus, a Level 3 trauma center. Jeffrey Way, Backus’ EMS coordinator, said ambulances transport patients to the nearest, most appropriate facility for the situation.
Meanwhile, Dr. Edward Gifford, a vascular surgeon on staff at both Backus and Hartford hospitals, was on call that weekend in Hartford. Dr. David Coletti, a trauma surgeon on call at Backus, called to give him a head’s-up that they would be sending a patient suffering from “torrential bleeding” via LIFESTAR helicopter. First, however, the patient needed surgery to stabilize him for transport, he said.
“There are very few patients who are injured so severely that cannot be temporarily stabilized and transferred to another hospital,” Dr. Gifford said, understanding that Ritchotte’s bleeding was undoubtedly life-threatening.
While the entry wound was small — probably about an inch — the damage the knife did inside was great. The common femoral vein, which carries blood out of the leg as part of the body’s circulatory system, was severed. Without it, all the blood the femoral artery was pumping into Ritchotte’s leg had nowhere to go.
Dr. Coletti brought Ritchotte into the OR for “damage control” surgery. He made an incision above the wound and tied off the femoral vein to stop the blood flow. This stopped the bleeding and stabilized Adam, but “there was no way to get the blood out of his leg,” Dr. Gifford said.
“When this happens, the muscles begin to swell and, if the flow isn’t restored, the muscle starts to die.”
LIFESTAR was called. In 45 minutes, Ritchotte was at Hartford Hospital. Dr. Gifford was waiting for him in the OR with Dr. Jonathan Gates, trauma surgeon and medical director of the Hartford trauma program.
“His leg was massive, and hard as a rock. We knew if we didn’t release the pressure, the muscles would die and he could lose his leg,” Dr. Gifford said.
While he made an incision below the knife’s point of entry to reconstruct the tied-off vein, the trauma team began fasciotomies on both sides of the leg — one at the thigh and the other at the calf — to relieve that pressure. Three months later, Ritchotte’s right leg looked like a road atlas of scar tissue. But he can walk and drive, and should eventually regain full use.
The repair Dr. Gifford faced was tricky because the common femoral vein is large in diameter and there aren’t many options in the body for grafting.
In addition, because the injury was caused by a butcher knife that had been cutting raw beef, he said, “I didn’t want to use a prosthetic because of the risk of infection we already had.”
An injury of this type isn’t new to the surgeon who has been practicing about four years after residency training at the Harbor-UCLA Medical Center, a Level 1 trauma center in Los Angeles.
“We had a lot of penetrating wounds, a lot of gunshots and knife wounds,” he said.
Using that West Coast training, he decided on a panel graft which involved taking a piece of a smaller vein, splitting it open and sewing two halves together to be wide enough to reconstruct the severed vein.
Meanwhile, the trauma surgeon made long incisions on both sides of the leg, relieving the pressure and allowing the muscles “to breathe.”
Ritchotte went to the Critical Care Unit with open wounds on both sides of his leg that wouldn’t be closed for a couple days.
When the swelling finally subsided, Dr. Akhilesh Jain, one of Dr. Gifford’s partners, took Ritchotte back to the operating room to close the incisions on his calf and thigh. Typically, with swelling this severe, patients might require a skin graft to cover an open area. But, the Hartford Hospital team used a technique they had learned recently from orthopedic trauma surgeons in online medical forums. Known as “pie crusting,” the technique allowed Ritchotte’s skin to relax and come together so he could ultimately leave the hospital with a more normal, functioning leg.
The story “is a great example of how you build a team to give each patient exactly what they need,” Dr. Gifford said. “You build a system that works so when that call comes in, everyone is ready. You can’t underestimate what everyone did along the way. His co-worker, the first responders, the surgeons at Backus, Hartford Hospital. Each time, those involved recognized the seriousness of the injury, controlled the injury, and got him to us.”
Way decided to use the incident as a teachable moment for the community and organized a “Stop the Bleed” class at Gardner Lake firehouse in May. He invited everyone involved in Ritchotte’s case to attend as a reunion of sorts.
“It’s really infrequent that we see the patient after the recovery,” Way said. “Usually, our relationship ends at the hospital door. To put this together feels significant, because everyone had to work perfectly together for us to even be having this conversation about Adam.”
Philopena, the Gardner Lake EMT, estimated that at least a dozen people are directly responsible for Ritchotte being alive today.
“The stars all lined up for Adam that day,” she said.
Ritchotte, who is married with a 3-year-old son and a second son born in late June, fully understands the effort that went into saving him. When asked about whether it was good to have a co-worker like Kelley save your life, he replied, “One hundred percent. One hundred percent.”
First responders honored
Photo by Jeff Evans
Standing with the patient Adam Ritchotte, fourth from right, and his co-worker Sean Kelley, third from right, are, left to right, Stephanie Philopena, Gardner Lake EMT; Ben Mattingly, Gardner Lake firefighter and EMT; Cheryl Philopena, Gardner Lake EMT; Deborah Cadwell, Gardner Lake EMT; Charles Weinsteiger, American Ambulance paramedic; and Patrick Gauthier, American Ambulance Paramedic.
Kevin Ferrarotti, Hartford HealthCare’s EMS system director, presented the Medical Director Clinical Excellence Award to the nine first responders who worked to save Adam Ritchotte’s life on March 7 when he suffered a near-fatal knife wound working at Salem Prime Cuts.
Ferrarotti made the certificate presentations at the Gardner Lake Firehouse on May 20.
“This is the first time this award has been given in the East Region,” Ferrarotti said. “It is given when the level of care provided goes above and beyond.”
The awards were presented to:
• Charles Weinsteiger, American Ambulance paramedic
• Patrick Gauthier, American Ambulance paramedic
• Ronald Prezch Jr., Gardner Lake firefighter/EMT
• Cheryl Philopena, Gardner Lake EMT
• Ben Mattingly Gardner Lake firefighter/EMT
• Stephanie Philopena, Gardner Lake EMT
• Deborah Cadwell, Gardner Lake EMT
• Alex Blais, Gardner Lake firefighter/EMT
• Kevin Fifield, Gardner Lake firefighter/EMT