# In field amputations



## Achilles (Dec 8, 2012)

Just a few questions regarding in field amputations....

Does your agency have anything in the protocols regarding in-field amputations? I'm sure it is pretty infrequent that an amputation needs to be performed in the field. But what if it does, Suppose the nearest trauma surgeon is an hour away, Should a department have someone that is trained in amputating? It would be a last resort for an entanglement as you can't always take something apart to where you can get the PT out. Is there even a need for this to be placed in protocols? Use in man made disaster or natural disaster may be beneficial. What are your views on Field amputations.


Thanks,
Andrew


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## rwik123 (Dec 8, 2012)

The only facility we transport to is a Level 1. It falls under major trauma in our protocols...bilateral large bore access, fluid bolus ect.


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## JPINFV (Dec 8, 2012)

rwik123 said:


> The only facility we transport to is a Level 1. It falls under major trauma in our protocols...bilateral large bore access, fluid bolus ect.




I believe the topic is about performing prehospital amputation, not management of amputations.


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## Clare (Dec 8, 2012)

There are several reports of out-of-hospital amputations during the Christchurch earthquakes.


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## Medic Tim (Dec 8, 2012)

Clare said:


> There are several reports of out-of-hospital amputations during the Christchurch earthquakes.



Were they done by physicians? ICPs? Or whoever was on scene?


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## Clare (Dec 8, 2012)

Medic Tim said:


> Were they done by physicians? ICPs? Or whoever was on scene?



They were done by doctors; one was a urologist I remember that much.  

http://tvnz.co.nz/national-news/dr-describes-earthquake-amputation-4040987


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## rescue1 (Dec 8, 2012)

Achilles said:


> Just a few questions regarding in field amputations....
> 
> Does your agency have anything in the protocols regarding in-field amputations? I'm sure it is pretty infrequent that an amputation needs to be performed in the field. But what if it does, Suppose the nearest trauma surgeon is an hour away, Should a department have someone that is trained in amputating? It would be a last resort for an entanglement as you can't always take something apart to where you can get the PT out. Is there even a need for this to be placed in protocols? Use in man made disaster or natural disaster may be beneficial. What are your views on Field amputations.
> 
> ...



Maryland allows for the activation of Shock Trauma's Go-Team, which is a team of nurses and doctors from the hospital flown to the scene by the state police helicopter, or transported by private ambulance by ground in inclement weather. The usual reason for the activation is for amputations due to extreme entrapment. 

Maryland usually doesn't have the most steller EMS protocols, but being able to get a trauma surgeon in 30 or so minutes from almost anywhere in the state was nice. I never activated the team while I was there though.


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## VFlutter (Dec 8, 2012)

rescue1 said:


> Maryland allows for the activation of Shock Trauma's Go-Team, which is a team of nurses and doctors from the hospital flown to the scene by the state police helicopter, or transported by private ambulance by ground in inclement weather. The usual reason for the activation is for amputations due to extreme entrapment.
> 
> Maryland usually doesn't have the most steller EMS protocols, but being able to get a trauma surgeon in 30 or so minutes from almost anywhere in the state was nice. I never activated the team while I was there though.



Shock Trauma has a new grad RN residency program in their Trauma ICU. I was so tempted to apply and move there just for that


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## STXmedic (Dec 8, 2012)

I've been a part of one, which was fairly recently. I transported the trauma surgeon to the scene, and was his second pair of hands. Our HEMS medics were in charge of sedation. 

As far as a paramedic doing a field amputation, I don't see it happening; there certainly aren't any protocols set forth on it, either.


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## JPINFV (Dec 8, 2012)

I know the county hospital that I did my gen surg rotation at (Arrowhead Regional Medical Center) has a go bag in the trauma bay for field amputations. I don't know what the activation procedure is for it though.


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## mycrofft (Dec 8, 2012)

Slip in a couple quarters?


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## james88 (Dec 8, 2012)

Roy Desoto and John Gage almost had to perform one. :unsure:


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## Handsome Robb (Dec 8, 2012)

We don't have a protocol for it but I'm pretty sure that in a situation where we needed one a quick phone call would get a Trauma Surgeon to the scene either by HEMS, PD or one of our supervisors in a timely fashion.

Haven't heard of it happening here though.


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## FLdoc2011 (Dec 8, 2012)

I'm not a surgeon or in the field so I can't speak to protocols around here.  But generally speaking I don't see this being in the EMS realm.   In those rare instances it's needed I think it's going to be a matter of getting a surgeon to the scene, via whatever protocol needs to be activated. 

Extreme rural situations may be another issue, if its just not possible to get a surgeon there.

Any reports of EMS performed amputations in rural settings?


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## EMDispatch (Dec 9, 2012)

rescue1 said:


> Maryland usually doesn't have the most steller EMS protocols, but being able to get a trauma surgeon in 30 or so minutes from almost anywhere in the state was nice. I never activated the team while I was there though.



I've had the experience of activating them, and having them stand down. We were quoted 45 minutes plus travel time for activation on a Sunday afternoon. Unfortunately with the weather we have here, half the time we would wouldn't be able to fly them, so we'd have a significantly longer wait. 

I think FDNY at one point had 1 or 2 designated field surgeons, but I read that many years ago before they implemented their rescue and haz-tac programs.


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## NJEMT95 (Dec 9, 2012)

NJ has 2-3 trauma surgeons on call in fly-car type vehicles that can be called to scenes for prehospital amputations. They also can perform blood transfusions.

http://www.jems.com/article/major-incidents/monoc-program-brings-physicians-ems-call


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## ExpatMedic0 (Dec 9, 2012)

This is of course hear say, and a crazy tale... so cut me some slack,- but cool story.
I know a 20 year veteran Paramedic that I worked with for a while. He came close to doing a field amputation but did not actually go through with it. First on scene, on arrival medic found a man trapped in a car on fire, secondary to an MVA. He was partially engulfed in flames and literary burning to death on arrival. The entire inside of the car was ablaze. Patient appeared to be GCS 15 screaming in agony for help.

The medic I know tried everything he could to free him, including burning his own hands trying to free the man, but to no avail. The man had 1 extremity pined that was keeping him from being extracted. The paramedics ambulance had a "sawzall" and the fire department was no where to be seen. He grabbed the sawzall and returned to the man. He was ready to do a field amputation right then and there, but luckily the extremity had been burned so badly the tissue simply sluffed off. So on one last try the medic pulled him out of the vehicle. 

Pretty crazy to think about right? I am sure the chances of this happening are slim, but it can still happen. What would you do?


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## medicsb (Dec 9, 2012)

NJEMT95 said:


> NJ has 2-3 trauma surgeons on call in fly-car type vehicles that can be called to scenes for prehospital amputations. They also can perform blood transfusions.
> 
> http://www.jems.com/article/major-incidents/monoc-program-brings-physicians-ems-call




Those vehicles are staffed by either EM docs or EMS fellows.  Regardless, they could do an amputation, But I imagine that they might call in a surgeon if possible.

There is an EM doc in Philly, Dr. David Jaslow, that has done 2 amputations.  One while he was an EMS fellow in DC (I might be wrong on this part) and the other was done in Bucks County, PA.  

There was a discussion on this topic on trauma.org.  There seemed to be a consensus, if i recall correctly, that there should only be protocolization of physician notification and retrieval, but no protocol for the actual procedure.  Some suggested a good tourniquet and using anything that could cut the limb (e.g. circular saw or jaws of life if need be).


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## NJEMT95 (Dec 9, 2012)

Then of course, there's _Chicago Fire_ where a firefighter uses a saw to amputate a guy's leg and record his dying words to his wife...


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## ExpatMedic0 (Dec 9, 2012)

NJEMT95 said:


> Then of course, there's _Chicago Fire_ where a firefighter uses a saw to amputate a guy's leg and record his dying words to his wife...



say what? source?


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## rescue1 (Dec 9, 2012)

MCERT1 said:


> I've had the experience of activating them, and having them stand down. We were quoted 45 minutes plus travel time for activation on a Sunday afternoon. Unfortunately with the weather we have here, half the time we would wouldn't be able to fly them, so we'd have a significantly longer wait.
> 
> I think FDNY at one point had 1 or 2 designated field surgeons, but I read that many years ago before they implemented their rescue and haz-tac programs.



What part of the state were you in? I was across the Bay from Baltimore, so a flight would be maybe ten minutes, but by ground would be around 1.5 hours. 
My friend flew one in in PG County last year for that man stuck in the industrial machine, but I don't think they amputated.


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## medichopeful (Dec 9, 2012)

schulz said:


> say what? source?



http://en.wikipedia.org/wiki/Chicago_Fire_(TV_series)


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## EMDispatch (Dec 9, 2012)

rescue1 said:


> What part of the state were you in? I was across the Bay from Baltimore, so a flight would be maybe ten minutes, but by ground would be around 1.5 hours.
> My friend flew one in in PG County last year for that man stuck in the industrial machine, but I don't think they amputated.



Farther south on the Delmarva, below Washington. I think the biggest factor on that time quote was that it was a Sunday. It was an interesting experience calling up Syscom and going through the process.


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## ExpatMedic0 (Dec 10, 2012)

medichopeful said:


> http://en.wikipedia.org/wiki/Chicago_Fire_(TV_series)



HAHA ok its a tv series, n/m


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