Paramedics amputate man's leg to save his life

Epi-do

Epi-do

I see dead people
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FORT WAYNE, Ind. -

Indiana paramedics were forced to take extreme action and amputate part of a man's leg, in order to save his life. The man was driving a truck carrying cabbage when he slammed into a barrier early Tuesday morning in Fort Wayne.
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Read the rest of the article HERE.

That would be quite the run! I am glad I wasn't the one that had to make that decision, and can't help but wonder what I would do if I found myself in similar circumstances.



Edit to add:

Additional article with more details - Amputation Frees Pinned Trucker
 
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Sheesh. I wonder what the crew used for instruments on that.
 
Wow. I'm surprised they didn't grab the surgeon from the hospital and bring him to the scene to perform the amputation. I mean, in 10 hours you'd have time...
 
chaz90 said:
Wow. I'm surprised they didn't grab the surgeon from the hospital and bring him to the scene to perform the amputation. I mean, in 10 hours you'd have time...
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Yes I agree.

Field amputations were something that was always spoken of. Never really knew it happened. kinda like snipe hunting
 
chaz90 said:
Wow. I'm surprised they didn't grab the surgeon from the hospital and bring him to the scene to perform the amputation. I mean, in 10 hours you'd have time...
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Indeed.. Are field amputations within a P's scope? Even with on-line medical direction?
 
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Household6 said:
Indeed.. Are field amputations within a P's scope? Even with on-line medical direction?
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I think scope becomes kind of a series of loose guidelines in a situation like this. With medical control on line and everyone realizing that options have basically run out, exceptions would have to be made to the normal rules. As I mentioned earlier, I would guess many systems would send out a surgeon or at least an ED Doc to the field in rare situations like this. Apparently in my system they came very close to picking up our medical director from the ED one day and bringing him to a pediatric trauma call with extremely prolonged extrication.

Really though, it can be hard to envision scenarios that are this rare. A few friends and I talked about field amputations during paramedic school as a kind of extreme "what if." There are a few examples in the literature of paramedics performing them, and a few more of advanced medical care being brought out of the hospital to the scene. I know that Shock Trauma in Baltimore keeps a "go team" staffed/on call and available for the state of MD and possibly some surrounding areas for situations like this. I don't remember what their staffing is for sure, but I believe they keep a trauma surgeon, possibly an orthopod, possibly an anesthesiologist, and probably a nurse ready to go on these calls along with their specialized equipment made portable. That's probably the best idea, but most areas don't have the resources to make a team like that feasible.
 
Chaz, when I look at this situation, I keep comparing in my mind it to the medics in Jersey who preformed a C-section on a dead woman. They had a surgeon talk them through it, but they were still investigated for operating outside their scope.

Is Shock Trauma in Baltimore the place that filmed that failed shotgun suicide attempt they showed us in airway class? The one from the 1980's where they had a conscious patient with no face?
 
Household6 said:
Chaz, when I look at this situation, I keep comparing in my mind it to the medics in Jersey who preformed a C-section on a dead woman. They had a surgeon talk them through it, but they were still investigated for operating outside their scope.
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NC instituted a Patient Without a Protocol policy to help with these situations, and the draft 2012 Statewide protocols had a policy in place for extenuating circumstances ("Extraordinary Measures"):
NC 2012 Draft Protocols said:
  • Extraordinary Measures / Care is defined by circumstances not specifically addressed by any treatment protocol
  • To maintain the life of a patient, it may be necessary, in rare situations, for On-Line Physician Medical control to direct ALS providers to perform care not detailed within the medical treatment protocols, agency policies or agency procedures
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It required the following 5 criteria to be satisfied (after exhausting all available protocols):
NC 2012 Draft Protocols said:
  1. Provider and on-line physician agree measure not addressed within the protocols, policy, or procedures
  2. Provider must feel capable of correctly performing procedure
  3. Measure and response to measure must be documented at receiving facility
  4. Measure and circumstance must be reviewed by medical director as quickly as reasonably possible
  5. Performance Improvement Review must also be completed
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It never made it into the 2012 protocols, but talk is there to bring it back for later. However, it was and still would be removed in our area as it was felt random ED docs may use it to get us to perform unnecessary interventions in circumstances where rapid transport clearly would have been preferred.
 
In my mind, the difference between the C Section case and field amputations are the alternatives. In the C Section case, the conclusion was that EMS should have simply performed CPR and transported, which was certainly an option available to them. In this case though, what was left? The patient was obviously alive, and for whatever reason, the doctor was unable to get to the scene in the appropriate amount of time. Again, I'm purely speculating here of course, but realizing the patient needed to get to the hospital and that extrication by the usual methods was impossible, this really is the only choice they could have made after consulting with med control. I'm grateful I wasn't on this call and hope I never encounter anything quite like it...
 
Don't forget in some states, (Missouri and Texas come to mind) there is no state scope of practice. It is up to each medical director to set a "scope of practice" for his service. Between that and morals, I'd be willing to do any procedure I felt comfortable with if it meant saving a life.
 
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