Field Amputation

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Hey, everybody! Today we are going to talk about field limb amputation.

I know what you are all thinking… No, I’m not crazy. Yes, you’ll probably never do one. No, this is not a common procedure. You just might, however, be in a situation on Air Care where knowing how to correctly perform this procedure can safe a life. 

First, let’s provide a little background on the pre-hospital limb amputation. The procedure itself has gained much more press in the FOAMed world and the emergency medicine and pre-hospital literature since the 2010 earthquake in Haiti during which early physician responders were faced with large numbers of patients trapped under debris and few responders with familiarity or basic working knowledge of the procedure (Lorich et al, 2010). A few of case reports and articles surfaced around this time and the field amp even made an appearance in an episode of the popular television show ‘Greys Anatomy’ in 2011. 

So I was told… 

…by a friend…

There are no case series published in the literature, however. British trauma surgeon Dr. Keith Porter has a nice article published in the British Medical Journal describing his personal experiences with three (THREE!) pre-hospital limb amputations and some nice information regarding the procedure (Porter, 2010).  There are no solid published epidemiologic data on this in the United States, but a survey given to North American EMS directors at a meeting of the National Associated of EMS Physicians (NAEMSP) in 1992 suggested that there had been 26 pre-hospital limb amputation procedures performed in the previous five years in the departments of the 143 respondents (Kampen et al, 1996). Most of these cases were due to motor-vehicle crashes, structure collapse, and industrial/farming accidents. A number of more contemporary US case reports are well chronicled in a thorough United States Fire Administration report referenced below (Mustafa). The common themes are a critically ill patient with an entrapped limb, non-existence of pre-existing protocols, and chaos related to medical direction and provider authority to perform the procedure. 

The bottom line is that the pre-hospital limb amputation is a rare but potentially life-saving procedure that we should all be familiar with. 

Now… Lets get our hands dirty…

Indications

  1. Need for rapid/emergent removal of the patient from their environment due to life-threatening factors that are either situational or patient-centered/medical in nature AND entrapment of a limb that would be amenable to field amputation otherwise preventing the emergent removal of the patient from their environment.

Contraindications:  (Relative)

  1. Entrapment of a limb at a proximal location so as to not allow proper placement of a tourniquet to control bleeding.
  2. Environmental or situational consideration as to make the procedure unsafe for the provider.

References

  1. Colella, M Riccardo. "Field EMS Physician Limb Amputation Training and Guidelines." MCW : Field EMS Physicians. Medical College of Wisconsin Department of Emergency Medicine, 2015. Web.
  2. Kampen, K E "In-field extremity amputation: prevalence and protocols in emergency medical services". Prehospital and disaster medicine 11(1):63-66, 1996.
  3. Lorich, Dean G., Devon M. Jeffcoat, Neil R. Macintyre, Daniel B. Chan, and David Leonard Helfet. "The 2010 Haiti Earthquake: Lessons Learned?" Techniques in Hand & Upper Extremity Surgery 14.2 (2010): 64-68.
  4. Macintyre, A. "Extreme measures: field amputation on the living and dismemberment of the deceased to extricate individuals entrapped in collapsed structures". Disaster medicine and public health preparedness (1935-7893), 6 (4), p. 428. 2012.
  5. Mustafa, Ivan A. "Field Limb Amputations Used as an Extrication Option in Complicated Entrapments or Disaster Events." (n.d.): n. pag. United States Fire Administration, Seminole County Fire Department, unk. Web.
  6. Porter, K. M. "Prehospital Amputation." Emergency Medicine Journal 27.12 (2010): 940-42. Web.
  7. Weingart, Scott. "Prehospital Amputation." EMCrit. Emcrit.org, n.d. Web. 11 Apr. 2015.
  8. Zils, Steven W., Panna A. Codner, and Ronald G. Pirrallo. "Field Extremity Amputation: A Brief Curriculum and Protocol." Academic Emergency Medicine 18.9 (2011): E84. Web.