Nic Pax

Nicholas Pax has a passion for the outdoors. When he’s not working as a local paramedic, he is a part-time arborist and processes what he removes into firewood on his property in Elizabeth, Colorado. While he was working alone one day in April 2023, a piece of wood got turned on the conveyor belt feeding his equipment. Impulsively, he reached for it, and his glove got caught, pulling Nic’s arm under the belt.

“The emergency stop for the machine was on the other side of the machine, so I couldn't reach it. I had to come up with a plan real quick,” Nic said. His one saving grace: a protective jacket was making his arm too large to be pulled deeper into the machine. Knowing the damage was getting worse with each second, he summoned all his strength and pulled. Four times, five times — the belt was moving so fast, he got pulled back down each time. “Then the adrenaline just kind of took over. And I said, ‘I either got to get my arm out of here or I'm going to die here.’ I gave it one last time and broke free. When I looked down, basically the entire top of my hand was gone,” he said.

Nic initially contemplated driving himself to the hospital but realized the severity of his condition, especially with the pain and potential shock setting in. He swallowed his pride and called the dispatch team, whom he knew well. Expecting he might pass out waiting for paramedics from the neighboring town to arrive, he gave dispatch one final request: “Tell the fire engine I’ll be lying in the middle of my driveway, so don’t run me over.”

He stayed awake for the minutes it took for them to arrive and was able to walk into the waiting ambulance. During transport to the hospital, Nic's pain was excruciating from the third-degree burns and the suspected compartment syndrome, which was restricting blood flow to his injured hand from excess swelling. He requested to go to HCA HealthONE Sky Ridge. It was the closest, and he knew many staff members in the Emergency Department.

The trauma team at Sky Ridge took x-rays of Nic’s hand, which surprisingly showed no fractures but confirmed the much more dangerous compartment syndrome. Time to save his hand was running out. Sky Ridge arranged for an HCA HealthONE AirLife helicopter transport to HCA HealthONE Swedish, where his physicians had already been consulting with Dr. Benson Pulikkottil, a double-board certified plastic and hand surgeon and medical director of the HCA HealthONE Swedish Burn and Reconstructive Center.

“I was very glad to have the burn team at Swedish and Dr. Pulikkottil, specifically, throughout this whole process. He never said, you know, ‘We might have to amputate your hand.’ He knew that I knew that was a possibility, but he was always very focused and confident and was like, ‘We're going to make this happen,’” Nic said.

The first task was stabilizing the wound and keeping it clean. A wound vac applied a gentle sucking pressure to pull tissues together and prevent infection. The extent of his injuries was so severe that it took more than a week to remove damaged tissue. With most of his skin missing and severe damage to tendons and ligaments, Dr. Pulikkottil recommended an advanced procedure to help Nic’s body restore blood flow to crucial parts of his hand to save it: an abdominal skin flap. An incision is made in the patient’s abdomen, and the hand is surgically covered and connected to the healthy donor tissue. Nic was confident it was his best option. “If you're in this situation and that needs to happen, he's the doctor to do it, you know. And not just here locally; I know that people have flown in from all over the country specifically for him to do these procedures.”

“This is a challenging procedure,” said Dr. Pulikkottil. “Nic is an independent guy; he loves the physicality of being a paramedic and working on his land. The abdominal flap was the right choice for him because it preserved the most function. To see what he’s able to do now is really a testament to our continuum of care.”

The flap and follow-up surgeries were a success. Skin grafts were used to protect the recovering musculature of Nic’s hand. Similar to the effect of the wound vac when his injury was still fresh, Nic’s care team prescribed nearly three months of hyperbaric therapy. Lying in a pressurized, pure-oxygen chamber speeds up healing and fights infection.

Initially, Nic could only curl his fingers because of his damaged tendons. But soon he could make a strong fist, allowing him to resume work with his fire company just six months after the accident. With strength training through the Burn and Reconstructive Center’s hand therapy program, Nic is recovering more movement as his treatment progresses.

“Obviously, I would like to get back to 100% and be able to get back to what I was doing, you know, being able to take care of my land and taking care of patients as a paramedic. Everyone at Swedish has been fantastic in helping me get closer to that, from Dr. Pulikkottil and his team to the nursing staff in Burn ICU and the support staff. Thank you all.”

Learn more about the American Burn Association-Verified Burn and Reconstructive Center at HCA HealthONE Swedish, our Level 1 Trauma Center and HCA HealthONE AirLife.