Dr. Ashesh Mehta was at home, sound asleep at 6:45 Sunday morning when the telephone rang.

A police officer had suffered a life-threatening brain injury in a car accident less than an hour earlier. The officer was now at Nassau University Medical Center.

Mehta asked that a CT scan be sent to his home computer, and within minutes he was studying the image. There, on the left side of the officer's head, a large blood clot was visible.

"I knew what I was dealing with right away," said Mehta, a North Shore- Long Island Jewish Health Systems neurosurgeon who was on call at NUMC.

Swift work by the surgical team at NUMC -- who credit the quick rescue action of a New York City firefighter at the scene -- has led to hope for Officer Kenneth Baribault, who was critically injured when a vehicle traveling at 75 mph, operated by a suspected drunken driver, plowed into his police cruiser.

Baribault was sitting in his patrol car after having stopped another suspected drunken driver on the LIE near Exit 46, the Sunnyside Boulevard/Plainview exit. Much of what will now transpire for Baribault hinges on a series of actions taken Sunday morning, soon after he was whisked from the accident scene to the hospital in East Meadow.

At 7:30 a.m., Baribault was being stabilized and prepped for surgery when Mehta arrived. The highest priority: relieve pressure on Baribault's swelling brain. So the neurosurgeon and his team removed part of the 30-year-old's skull, the size of a "small saucer," then the blood clot itself.

Mehta made an incision under the skin in Baribault's abdomen and placed the skull section there for safekeeping. It can be retrieved later for reattachment.

To further relieve pressure and to monitor the blood pressure there, Mehta also inserted a drain. The operation was completed by 8 a.m.

Dr. Glenn Faust, the chairman of surgery at the East Meadow hospital, said Baribault was in "critical but stable condition" yesterday and was showing "good signs."

Late yesterday, Faust said Baribault's sedation had worn off and he "sat up in bed a little bit" when he heard someone from his family speak. "He is moving, and moving quite a bit," Faust said. After that, doctors decided to sedate him again to allow his body to heal, he said.

"He's still got a long, long way to go," Faust said.

In a news conference yesterday, Faust took pains to credit a man he described as Baribault's "angel," New York City firefighter Philip Scarfi. He was the man who ran across six lanes of traffic to pull the officer from the car and alert Nassau police that one of theirs was down.

That, he said, allowed Mehta and his team to operate within a critical time period to relieve pressure on the brain and, they hoped, stave off further injury.

Mehta said studies have found that relieving pressure on the brain within three hours of an injury is critical to ensuring the best possible outcome. "We did it within two hours so he has that going for him," said Mehta, director of epilepsy surgery at Long Island Jewish Medical Center in New Hyde Park.

Faust said the officer has also spontaneously moved his legs, shown signs he can breathe without help from a ventilator and has required no medication to keep his blood pressure stable.

Still, Faust and Mehta emphasized that Baribault's prognosis is uncertain. The next few days and weeks remain crucial.

"It's completely unpredictable," Faust said. The only thing we know is that fast change right now is bad."

Dr. Mark Eisenberg, chief of neurosurgery at Long Island Jewish Medical Center, concurred when he was told of Baribault's movements. "This tells us the brain is beginning to work and function," he said. "But it doesn't tell us ultimately how he's going to do. ... It's way too early to tell."

While his swollen brain remains the chief concern, Baribault also suffered a severe pelvic injury. If the officer remains stable, orthopedic surgeons will operate on him tomorrow, Faust said.

Dr. Charles Ruotolo, the chairman of orthopedic surgery at NUMC, said that his pelvis was "displaced," as ligaments were torn in front and back of his pelvis.

Faust said an "erector-set"-like mechanism with screws to hold bones in place will be attached to the outside of Baribault's body.

Dr. Jeffrey Richmond, an orthopedic trauma surgeon at North Shore University Hospital in Manhasset, said the pelvic ligaments are the strongest in the body. Said Richmond: "It takes a tremendous amount of force to rip those."

Staff writer Laura Rivera contributed to this story.

Emergency care

Neurosurgeons at NUMC performed a craniotomy on police officer Kenneth Baribault to relieve swelling and pressure to his brain.

HOW THEY SABILIZED HIM

Officer Kenneth Baribault was brought to Nassau University Medical Center after his Nassau police cruiser was rear-ended by another car. Dr. Ashesh Mehta, the neuro-surgeon who operated on Baribault, described the following sequence of events, which took place from 6:45 a.m. to 8 a.m.

Officer was stabilized to ensure he could breathe and that his blood pressure was sufficient.

He was given a CT scan that showed a large blood clot on his left side.

He was taken to the OR, where a large section of his skull "about the size of a small saucer" was removed on the left side so that the clot could be removed and to relieve pressure on the brain.

A drain was inserted to remove excess fluid and also as a monitor for his blood pressure.

The skull portion that was removed was surgically inserted in a flap under the skin of the abdomen. It can be surgically reattached at a later date.

Other reasons for craniotomy:

Brain tumors

Weakness in blood vessels

Areas of infection in the brain

Severe nerve or facial pain

Epilepsy

SOURCE: HOWSTUFFWORKS.COM, MAYFIELDCLINIC.COM