Miranda was riding home from school on a motorized minibike when he was hit by a vehicle and then dragged by a semitruck, resulting in catastrophic injuries. Initially rushed to a nearby Level II trauma center to be stabilized, Miranda had injuries so extensive and life-threatening that physicians there decided the best chance to save his life was to transfer him to Cedars-Sinai.  

“As a Level I trauma center, Cedars-Sinai is prepared to deal with highly complex cases like Albert’s,” said Galinos Barmparas, MD, medical director of Trauma in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. “Even with our team’s extensive resources and expertise, it’s still a miracle Albert is alive, with the injuries he sustained.”

Major crush injuries to Miranda’s left leg required an amputation up to his hip. He also had a broken pelvis, a damaged urethra, and he battled severe infections from wounds he suffered after he was dragged on the road. Miranda required more than 20 surgeries and the expertise of physicians across multiple specialties, including trauma, orthopedics, plastic and reconstructive surgery, urology, pediatrics, physical therapy, and more.

“I never thought I'd be in a situation like this in my entire life, but here we are,” Miranda said. “But after, like, a long way coming, I've met new people here who've treated me well. And I'm actually glad that they wanted to work with me. ... So it made [Cedars-Sinai] feel like home.”

Barmparas said more than 100 healthcare workers helped Miranda get to this point.

“Patients may survive the initial hit and the initial surgeries,” Barmparas said. “But if they don't have the specialists and the resources, they may not be able to make it.”

Electric and gas-powered bikes that can travel upward of 25 miles per hour, like the one Miranda was riding at the time of his accident, are a safety concern for Barmparas, who oversees trauma surgery at Cedars-Sinai.

“These vehicles are dangerous. I can tell you that I see motorized bike, e-bike and electric scooter injuries in the trauma bay on a regular basis,” he said. “Patients come in all the time with traumatic brain injuries, facial fractures and other life-altering trauma.”

The accident occurred in late September, so Miranda spent the winter holidays, as well as his 17^th birthday, in the hospital. But in that time, he has made tremendous strides in his recovery and has regained some mobility with the assistance of a wheelchair and walker.

“It feels a little surreal, I think, the progress that we have seen from him,” said Romina Kim, MD, a pediatric hospitalist with Cedars-Sinai Guerin Children’s. “From not even being able to get out of bed to now walking with the walker. He’s a completely different kid from the one that we saw six months ago. It’s quite a miracle.”

Now, after more than five months in the hospital, Miranda is finally being discharged from Cedars-Sinai to continue his recovery at a rehabilitation center.

“Next is actually the rehab,” Miranda said. “I don't know how long I'll be there, but I hope it's a short amount of time so I can just get home already.”

The Cedars-Sinai team recently celebrated Miranda’s discharge with a celebration walk and send-off tunnel, waving pompoms and cheering him on as he made his way down the hallway of Cedars-Sinai Guerin Children’s. His physicians are encouraged by his resilience and how far he’s come not only with his physical, but also mental recovery from this traumatic event.

“He has a lot of dreams and aspirations,” Kim said. “And with the kind of attitude that he has, he can really become whatever he wants. I think he's going to do great things.”

As for Miranda, he is looking forward to getting stronger so he can get back to his normal routine and spend time with his friends. Still, he says he’ll miss his Cedars-Sinai care team.  

“Everyone has been so supportive and that's what keeps me positive,” Miranda said. “You know, if they want something good for me, I want something good for me as well.”

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What do all those changes have in common? The ability for trauma surgeons to be more deliberate when every second counts, said Margulies, director of Acute Care Surgery in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai.  

“One of the biggest advancements we’ve made is actually knowing when we can avoid an operation,” said Margulies, who joined Cedars-Sinai in the early 1990s and was medical director of Trauma for more than 25 years.

It was 1984 when Cedars-Sinai was first designated a Level I Adult Trauma Center and, after its most recent evaluation and recertification by the ACS COT, it continues to be one of the longest-running Level I centers in Los Angeles County.  

“Maintaining Level I status for our hospital ensures that patients in our community have access to a center capable of managing any injury, no matter the severity, with the full spectrum of subspecialty support,” said Galinos Barmparas, MD, medical director of Trauma at Cedars-Sinai. “Patients can expect coordinated, expert and compassionate care delivered by a team that lives and breathes trauma readiness.”

Advancements in Care

Early in Margulies’ career, trauma patients often required more invasive, exploratory surgery to determine a diagnosis, Margulies said. But as imaging technologies improved, the care team could make better-informed decisions.

“The increased quality and speed of CT scans have made a big difference,” Margulies said. “And bedside ultrasound also became more common in the ’90s with the focused abdominal sonography in trauma—or FAST—exam, which allows us to make more rapid assessments of critically ill patients and provide more minimally invasive care when appropriate.”

Aside from better treatment techniques and technologies, Margulies said the types of trauma injuries he sees have also shifted.

“Before seatbelt laws were strictly enforced and airbags were required in cars, we saw a lot of head injuries and extreme traumas from ejection following motor vehicle collisions,” Margulies said. “Now that some of those safety measures are in place, we actually see more pedestrians hit by cars, potentially due to distracted driving.”

Margulies also noted that, because the patient population is getting older, many traumas the team treats now are a result of falls.

The trauma team at Cedars-Sinai has grown over the past 40 years as well. In 1999, ACS rules for Level I trauma centers began requiring an attending surgeon to always be on-site, 24 hours a day, seven days a week, 365 days a year.

“There were five of us who were attendings at that time, so I practically lived at the hospital,” Margulies said.

Since then, the team has more than doubled to 11 attending surgeons on faculty, with the expectation to grow. Additionally, all Cedars-Sinai trauma surgeons have completed a fellowship in surgical critical care.

What the Future Holds

Cedars-Sinai will continue to be evaluated by the ACS COT every three years to be redesignated as a Level I center.

“This reverification is both a validation and a reminder of the tremendous daily effort by our trauma team. It represents not just excellence in meeting national standards but a sustained commitment to continuous improvement and compassion in trauma care,” Barmparas said. “Every verification cycle is an opportunity to reflect on how far we’ve come and how we can keep pushing the standard forward for our patients and community.”

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