Miley Cyrus’ Bob Mackie Grammy Dress Led to Surprise Fan Moment for the Designer… in an Ambulance (Exclusive)

Bob Mackie met a big fan of his work in the most unlikely of circumstances.

The fashion designer, 85, tells PEOPLE that after recently taking a bad fall, he ended up having a fan encounter that warmed his heart. Mackie was on his way to see the Radio City Christmas Spectacular while in New York City on a press tour for the new documentary about his life and career, Bob Mackie: Naked Illusion.

“When the hospital sent the ambulance to pick me up, the girl who was part of the crew showed me a picture of an imitation of my dress she made,” Mackie says. It was the dress he designed that Miley Cyrus wore to perform her Record of the Year-winning hit “Flowers” at the 2024 Grammy Awards

Karina Smegal was finishing up a shift with her partner when they got one last call.

“The call said that there was an elderly man that fell down over near The Rockettes,” Smegal tells PEOPLE. “I’m evaluating his wounds, and I’m talking to his assistant and explain we have to get this man to the hospital. And at some point, somebody comes by and takes our picture.”

The strange moment made Smegal realize her patient was someone notable. At that point, Mackie hadn’t shared his name.

“I asked for his ID, and he gives me his Medicare card, and it says ‘Robert Mackie’ on it. I’m familiar with Bob Mackie, not Robert Mackie, so I didn’t make the connection.”

After a few minutes of chatting, he explained that he lives in California but was here to do press. “In that moment, it clicked for me,” Smegal recalls.

“I heard his assistant call him Bob, and I’m like, ‘Oh my God, I’m treating Bob Mackie here, in the back of my ambulance! So that was very surreal.”

The two continued to chat on the way to the hospital. While in the ambulance, Smegal realized Mackie had designed Cyrus’ Grammy dress. The EMT had recreated the look herself in October to celebrate Halloween. Smegal showed Mackie the photo of her recreation of the silver-embellished design, which featured a bralette and cut-out at the chest with asymmetric tassels swinging from the skirt.

“She pulled her phone out of her wallet while she’s in uniform with the cap and the whole thing, and she says, ‘I made Miley’s outfit to wear on Halloween,’ and pulled out a picture,” Mackie recalls.

Smegal vividly recalls the moment of realization. “I was like, ‘Oh my God. What are the odds that I had literally just spent all of this time finding a Halloween costume literally like two months ago, and now the guy who originally designed that costume is sitting in the back of my ambulance?” she says with a laugh.

“I’m like, ‘This is my one chance. I’m never going to see Bob Mackie again.’ So I show him my photo and he’s like, ‘Oh my Gosh, this is incredible.’ ”

“She was so excited! And her dress was pretty close!” Mackie says of the costume. “It was really cute. She was sweet as can be. I had a friend with me who was a choreographer, and he says, ‘Do you dance?’ She said, ‘I was a cheerleader.’ ”

Smegal was touched by his genuine reaction to her imitation of his work. “He was such a sweetheart about it. There he is, injured and in pain, and he’s just talking to me about how I admire his work.”

“It was a funny little thing and Bob had the biggest smile across his face,” she continues. “He was just so happy somebody had gone through the effort to try to recreate one of his most famous looks and his work speaking to another generation. So he was very happy about that.”

“I was living on a high after that, but I can’t disclose patient information as a healthcare provider, so while I was screaming internally, I couldn’t tell anybody,” Smegal adds. “It’s been great to now have the ability and permission to speak about this and tell everyone I met him, because he’s such a sweetheart. It was one of the best patient interactions I’ve ever had.”

Cyrus recently purchased the original Grammy dress for an undisclosed amount in an auction that celebrated Mackie’s work.

“This dress represents more than a performance — it’s a celebration of the relationship between music, artistry and glamour,” Cyrus said, per a press release. “This performance was a pivotal moment in my life, and to have Bob Mackie’s support in securing it means the world to me.”

Mackie, 85, said of Cyrus, “Miley’s performance at the 2024 Grammy Awards marked an unforgettable moment in her career. As the designer of this dress, I couldn’t imagine it on anyone else. That girl was born to perform!”

Smegal says it “means a lot” that Mackie was impressed with her work.

“It’s a fun anecdote to get to tell people. I’m from Maryland, so I’ve never met a celebrity before. It certainly feels like a very authentic New York experience. Every New Yorker has one of those stories about that time they ran into somebody famous. It’s very cool and super special knowing he was so flattered by my Halloween costume. It’s surreal.”

Bob Mackie: Naked Illusion is currently playing in select theaters.