"This is one of the most severe injuries I have seen in a child. His case highlights how important the whole health care team is."

--John Lawrence, M.D.

UI trauma team helps Amish boy overcome long odds after near-fatal accident

Eli Bontrager was barely alive when his parents rushed him to the emergency room on July 1 of this year. It was among the worst child trauma cases ever seen at University of Iowa Hospitals and Clinics--indeed, one physician later calculated that upon arrival, the boy had only a 14 percent chance of survival.

The accident that nearly killed the energetic youth occurred on the Bontrager family's livestock and vegetable production farm near Kalona, Iowa. Eli, who was then just 20 months old, was playing behind a horse-drawn wagon.

"The driver of the wagon didn't realize Eli was there," said Eli's father, John, 36. "He backed over the boy, and then when somebody yelled a warning, he stopped. The wheel was over Eli's abdominal area. Then the wagon went forward, releasing him."

The toddler was carried into the Bontrager's home, where his parents initially thought he might just be knocked out or in shock. But within five minutes the family knew Eli was not just dazed, and after another five minutes they knew he was seriously injured: "There was no color in his lips or tongue, and his eyes rolled back in his head," said his mother, Dorothy, 37.

The family has no car, so to get to Children's Hospital of Iowa, located at UI Hospitals and Clinics (about 10 miles from their farm), they asked a neighbor for a ride. By the time the family arrived in Iowa City, the situation had deteriorated: some members of the admitting trauma team thought Eli--a motionless, gray baby who barely had a pulse and whose body was making no effort to breathe on its own--might already be dead.

Lee Faucher, M.D., an assistant professor of surgery who specializes in trauma and burns, was a member of the multidisciplinary team on hand that Tuesday morning. As part of the resuscitation process, he made sure Eli was intubated (a tube was slid into his trachea to assist with breathing) and connected to an intravenous (IV) machine to receive fluids, and then he began examining the boy. "Physically, there was only a small abrasion on Eli's left cheek, and we assumed there was internal bleeding," Faucher said.

Inside the operating room, Faucher discovered that Eli's liver had been split nearly in half and he was bleeding to death. At this point, John Lawrence, M.D., a pediatric surgeon and associate professor of surgery, joined Faucher. "My impression when I entered the operating room was that Eli likely wouldn't survive and that if he did, he might very well have significant neurological impairment," Lawrence said.

The team worked feverishly to avoid that outcome, removing a portion of the boy's liver and repairing holes in his inferior vena cava, the main vein collecting blood from the lower part of the body. Before they were through, "Just about all Eli's blood had been lost and replaced," Faucher said.

The National Trauma Data Bank's 2002 report indicates that out of 430,557 trauma patients, just 9 percent had an Injury Severity Score (ISS) greater than 24. ISS is the number predicting the probability of death. At University of Iowa Children's Hospital, only 5 percent of all traumas in children ages one to four had an ISS greater than 24, and 50 percent of this population died.

Eli's ISS was 26, but thanks largely to the efforts of his trauma team--including nurses, respiratory therapists, the DeGowin Blood Center, and everyone involved in the Emergency Treatment Center, operating suites, anesthesia, and Pediatric Intensive Care Unit--Lawrence believes the boy will have no long-term problems related to the accident.

"Eli seems to have made a complete recovery," John Bontrager said. "We're very impressed with the care he received, but we definitely believe a higher power was in control all the time."