Field Amputation

1

Who can perform a field amputation?

Field amputation is a rare procedure; therefore, preplanning is necessary. EMS providers in some areas may be faced with the prospect of having to perform a field amputation. It would be desirable to be in contact with medical control to discuss the procedure before proceeding. Having multiple trained providers will also facilitate a smooth procedure. Additional providers may be needed to assist in sedation and airway management.

Ideally, any field amputation should be performed by an appropriately trained provider from the nearest hospital. This may be an emergency physician, an orthopedic surgeon, or a trauma surgeon. Additional personnel might include an operating room (OR) scrub nurse and/or anesthesiologist. Having a preplanned “go team” is one way many hospitals have planned for these types of rare events. While hospital personnel may have medical expertise, they are not usually familiar with working on an uncontrolled scene. If available, emergency physicians trained in EMS would be an excellent resource as they are comfortable operating in a prehospital setting and managing complex trauma patients.

2

What are the indications for a field amputation?

Field amputation is a true “life-over-limb” procedure. The most common indication for a field amputation is when the patient either cannot be extricated or the time to extricate the patient will be too lengthy given the extent of the patient’s injuries. Another indication is the patient has life-threatening injury to an area of the body that cannot be accessed due to the manner in which the patient is entrapped. Field amputation should also be performed if the entrapped limb is mutilated, nonviable, or only hanging on by small amounts of tissue. The viability of a limb, however, is difficult to ascertain in a field, and as such, this indication should be utilized with caution. The environment the patient is in is also a factor. If the patient’s life is in imminent danger secondary to the environment, including fire, extreme cold, submersion in water, structural collapse, or chemical exposure, a field amputation may also be indicated, if it is safe for the provider to do so. The final indication is if the amputation is being performed on a deceased patient who is blocking the ability to access other patients who may be injured.

3

What are the contraindications for a field amputation?

The contraindications for performing a field amputation are relative if the indications earlier were met. The decision to perform a field amputation should only be made in conjunction with the technical rescue team, in order to ensure that all other options have been considered. Additionally, there are times when the patient can be extricated by cutting away any entangled clothing or by giving the patient enough analgesia to relax and loosen the entrapped limb. It is also possible that you only need to remove some soft tissue in the area to allow the remaining limb to be freed. If this is the case, a full-field amputation should not be performed.