Shocked by frostbite amputations, med students take action

Frostbite so severe that it requires the removal of a limb or finger should be rare in an American city in the 21st century. But last year, UB medical students Steve Gangloff and Chelsey Ciambella found out how common it is among some populations.

During their rotation in vascular surgery at Erie County Medical Center (ECMC) last winter — a tough one, even by Buffalo standards — they became familiar with frostbite and its devastating consequences.

“I was actually shocked,” Gangloff recalls. “I had no idea that amputations were so common. Every single day we were doing an amputation.” The leading causes were diabetes and frostbite.

“I was awestruck by the fact that the disfiguring surgery was easily preventable with proper winter apparel,” adds Ciambella. “It was clear that there was an opportunity to better serve our community.”

That realization led them to start asking frostbite patients if they owned hats or gloves. Most did not. So the students founded Prescription4Warmth, a nonprofit organization dedicated to purchasing new hats, gloves and socks for frostbite victims.

Since last year, Prescription4Warmth, working with ECMC and the Lighthouse Clinic, has provided approximately 600 frostbite patients with warm hats and gloves. As a result of increased donations to the group, patients now also receive thermal socks, chapstick and information on how to avoid frostbite in the future.

Gangloff and Ciambella also treat frostbite at the Lighthouse Clinic in Buffalo, a nonprofit, drop-in clinic for uninsured patients that is managed, funded and staffed by UB medical students and faculty-physicians. Most frostbite patients are uninsured and are homeless or have a psychiatric illness.

One of the worst cases at ECMC was a homeless man who had fallen asleep in the snow.

“This patient had deep frostbite in all 10 of his fingers, meaning the tissue was completely dead in each finger,” Gangloff says. “He required an above the knuckle amputation of every finger, including his thumbs.”

After surgery, the patient required in-hospital physical and occupational therapy to learn how to use eating utensils specially designed for amputees.

“The surgery ultimately saved his life because the necrotic tissue can cause sepsis and death if not treated promptly,” Gangloff says, adding that once the frostbite progresses that far, there is no hope for tissue regrowth or recovery.

“He was a grateful, kind and humble man who was very appreciative of the help we gave him,” he recalls. “This encounter was one of my most emotionally moving experiences in medical school.”

Gangloff and Ciambella are inductees of UB’s Richard Sarkin/Medical Emeritus Faculty Chapter of the Gold Humanism Honor Society (GHHS), the national honor society of peer-selected medical students who exhibit compassion and humanism toward patients and their fellow classmates. They approached faculty director, Sergio Hernandez, with their idea.

“Steve and Chelsey identified this need, providing protection from frostbite for our area’s vulnerable individuals, many of whom I treat as an inpatient psychiatrist,” says Hernandez, professor of psychiatry at the Jacobs School of Medicine and Biomedical Sciences. “When they explained the program, I thought, ‘Why didn’t I think of that?’ They not only thought of the idea, but they made it happen.”

“Steve was asking, ‘how could this happen in 2015?’” recalls Marcia Sarkin, who runs the Richard T. Sarkin Foundation for Medical Education in memory of her late husband, a UB professor of pediatrics. “It was eye-opening.”

The students obtained a donation from the foundation, which supports local students inducted into the GHHS. Members of the foundation’s board were supportive and solicited additional donations from alumni.

“We utilize 100 percent of donations for the purchase of warm items,” Gangloff says. “We stretch the money as far as we can by purchasing items in bulk from wholesalers.”

The Richard Sarkin/Medical Emeritus Faculty Chapter recently voted to include Prescription4Warmth as one of its official activities.

“Steve and Chelsey didn’t just have the idea, they also made sure that when they graduate this spring, Prescription4Warmth will continue,” Sarkin says.