Pulling Lives From the Rubble : From Vietnam to Oklahoma, Doctor Works in Wake of Disaster--Natural and Man-Made

Twenty-five years ago, Dr. Richard Hoech participated in daring jungle rescues of U.S. soldiers wounded in a secret war fought by small Army units in Laos and Cambodia.

Hoech, 57, an emergency medicine specialist, continues his participation in daring rescues today--but the rescues he performs are vastly different.

Hoech heads California Task Force 5--the Orange County-based search and rescue team dispatched to Oklahoma City to search for bodies after the bombing of the Alfred P. Murrah Federal Building last month.

While the rescues in Southeast Asia presented Hoech with special difficulties, the rescue efforts he and his team embark on now offer new challenges that have changed the art of saving people’s lives under tense situations.

Hoech, who spent two years in Vietnam before leaving the Army in 1971, still relies on some of the battlefield techniques he learned in the jungle and on a new procedure known in the search and rescue community as “rubble pile medicine.”

Rubble pile medical procedures are practiced by no more than 30 elite search and rescue teams in the United States, and are used mostly for saving people trapped in buildings following natural disasters and the man-made kind.

Hoech emphasized that rubble pile medicine is not merely pulling people out of buildings.

“Essentially, that’s what we used to do until five years ago, when we began to learn from the earthquake in the Philippines,” said Hoech, referring to the 7.7-magnitude quake that hit the island of Luzon in July, 1990. “People who were trapped under concrete and rubble were rescued, brought out alive only to develop cardiac dysrhythmia [an erratic heartbeat] a few minutes later and die.”

Rescue team doctors soon realized that it was potassium and lactic acid that caused the dysrhythmia and death. The deadly combination built up in a person’s limb when it was crushed under a heavy object and circulation was cut off.

When a heavy object was lifted from a person, circulation was restored to the limb, flushing the potassium and lactic acid throughout the body. The patient would die minutes later.

“We learned some painful lessons. The quickest way to kill a patient is to allow the potassium and lactic acid to circulate back into his body by lifting the beam that pinned him down,” said Hoech, who has been working at Western Medical Center-Santa Ana since 1977 and has been practicing medicine since 1967.

Now, doctors and paramedics know to prevent this by premedicating the patient with bicarbonate, glucose or insulin.

Hoech said he and his team prepare for such predicaments as best they can and train regularly at an Army base in San Luis Obispo.

When a trapped patient is located in the rubble pile, doctors and rescue workers begin working as one, said Dr. Audrey Konow, 47, of Yorba Linda, a team member.

“As a doctor, you start thinking, ‘How can I help the rescue workers do their job effectively and what do I have to do to help the patient?’ You have to make decisions about how to start an IV and assess a patient when all you see is part of a thigh. Sometimes you have to assess the medical needs of a human being by observing only a thigh,” Konow said.

Do you continue giving a trapped patient standard care until rescue workers can lift an object off his leg, hoping to save the limb, or will his life be jeopardized by further delays in getting him to a hospital?

“Sometimes it’s not an easy decision. At what point should you amputate to save the patient?” Konow said. “At what point do you say, ‘We have a live human being here and if we don’t extract him soon with or without a limb he’ll be dead.’ ”

Hoech said that “in 25 years of doing this type of medicine, I’ve never seen two disasters alike.”

“We’ve never gone into a disaster totally prepared for what we were facing. This is because nobody planned the disaster, we just plan the rescue. It sounds like a cliche, but we really learn something new from each mission. Our people returned from Oklahoma City with ideas for new equipment and tactics,” Hoech said.

The Orange County team is made up of six doctors and 62 paramedics, firefighters, structural engineers and dog handlers. At least two doctors and 22 tons of supplies accompany the group whenever they are deployed to a disaster.

Konow and Dr. Scott Brown, 36, of Mission Viejo went with the team to Oklahoma City. Hoech, who helped start the group five years ago, was eager to go, but the two doctors’ billets were already filled.

Using the improvisation skills he learned in Vietnam, Hoech was able to make the trip anyway by listing himself as one of the rescue dogs on the manifest when he learned that the teams’ two dogs were being left behind. Almost immediately after arriving in Oklahoma City, he contracted pneumonia and went to the hospital himself.

He said members of the team today perform the same feats Army medics practice in combat.

“My paramedics today aren’t much different from the 91 Charlies [Army medics] I worked with in Vietnam,” Hoech said. “They and the other members of the team are a real task-oriented group that borders on the heroic.”

Most team members have participated in rescues stemming from other disasters, including the Loma Prieta and Northridge earthquakes, and have seen just about every imaginable form of trauma. Their mission to Oklahoma City was made easier because they knew going in that they were being dispatched only to retrieve bodies. The team recovered 20 bodies.

“We knew we weren’t going there on a mission to save lives and that helped us to stay focused,” Konow said. “What we weren’t prepared for was the bonding we developed with the people from Oklahoma City. We didn’t anticipate that and that made it difficult to leave.”

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Profile: Dr. Richard Hoech

Age: 57 Hometown: Pasadena Education: Graduated from California College of Medicine, now UCI Medical School Medical specialty: Emergency and trauma medicine Began practicing: 1967 Current practice: At Western Medical Center-Santa Ana, since 1977 Other practice: Head of California Task Force 5 (Orange County-based search-and-rescue team) since it formed in 1990 Military background: U.S. Army Reserves, 1966; active duty, 1968-71; went through airborne and Special Forces schools; served as Special Forces doctor in Vietnam, 1968-70 Resides: Dana Point Family: Wife, Nelda, and four children On Oklahoma City mission: “We knew we were going in to optimize what was already a really crappy outcome. We focused on our mission, which was to retrieve bodies. The people in Oklahoma City deserved closure.”

Source: Dr. Richard Hoech

Researched by H.G. REZA / Los Angeles Times