Field Amputations; Prehospital and Disaster Medicine 1996

I have not yet concluded my opinion on field personnel performing field ampuatations. However, as with many other situations, I think we often find ourselfs adapting to "what we can make fit." You would assume (as dangerous as that is) that someone requiring a "field amputation" would need this procedure in a rather short amount of time. I cannot understand why you would be amputating a limb off your patient after "calling the 'amputation team,' going to intercept with them, and then flying back out to your scene." I realize that not every situation is ideal, but if you can spend this much time trying to remove the limb, you'd think the FD could have the patient extricated by this point. The true need for field amputation should be an emergent one (with emergent meaning now or never!) Other than in this setting, the procedure should be somewhat non-exsistant. As much as the importance of establishing a defenitive airway, so is the need to be able to safely access your (entire) patient. Not much can be done watching from the sidelines. Life over limb I'd say. The protocol should not be geared toward who can amputate the limb, rather when it is appropriate to "saw then soar."

You all have some great opinions, thanks!

Cannon Tubb, LP, FP-C

In-Field Extremity Amputation: Prevalence and Protocols in Emergency Medical Services

Kathryn E. Kampen, MD,¹ Jon R. Krobmer, MD, FACEP,^2,3Jeffrey S. Jones, MD, FACEP,² J.M. Dougherty MD, FACEP,⁴Robert K. Bonness, MD, FACEP⁴1. Department of Emergency Medicine, Hackley Hospital, Muskegon, Michigan
2. Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, Michigan, and College of Human Medicine, Michigan State University, East Lansing, Michigan
3. Kent County Emergency Medical Services, Grand Rapids, Michigan
4. Akron General Hospital, Northeast Ohio University College of Medicine, Akron, Ohio

Correspondence:
Jon R. Krohmer, MD, FACEP, EMS Medical Director
Kent County EMS
678 Front, NW, Suite 235
Grand Rapids, MI 49594 USA

Key Words: EMS training, extremity amputations, prehospital

Abbreviations:
EMS = emergency medical services

Received: 15 November 1994
Accepted: 15 June 1995
Revisions Received: 14 September 1995

Abstract

Objective: To determine current experience, attitudes, and training concerning the performance of in-field extremity amputations in North America.

Design: Cross-sectional, epidemiological survey.

Participants: Emergency medical services (EMS) directors from the 200 largest metropolitan areas in North America and attendees at the 1992 Mid-Year National Association of EMS Physicians Meeting.

Interventions: The survey consisted of five questions focusing on demographic and operational data, the frequency of occurrence of the performance of in-field amputations, personnel responsible for performing the procedure, existing written protocols for the procedure, and the scope of training provided.

Results: A total of 143 surveys was completed. Eighteen respondents (13%) reported a total of 26 in-field extremity amputations in the past five years. The most common cause for the injuries requiring amputations was motor-vehicle accidents. In the majority of cases (53.2%), trauma surgeons were responsible for performing the amputation, followed by emergency physicians (36.4%). Of respondents, 96% stated that there was no training available through their EMS agencies related to the performance of in-field extremity amputations. Only two EMS systems had an existing protocol regarding in-field amputations.

Conclusions: The results suggest a need for established protocols to make the procedure easily accessible when needed, especially in large metropolitan EMS systems. This information should be emphasized during EMS training and reinforced through continuing education.
Prehospital and Disaster Medicine, 1996; 11(1 ):63-66.