Amputation in the field?!

[AnthonyM83]

Eh, nothing about that story seems weird to me.

A guy heard a story where a kid was trapped, car caught on fire, he was burned alive and nothing he could do. Upon hearing that story, I think a lot of people would spend a couple seconds thinking what might've been done and I'd assume amputation would come to mind for the vast majority.

Totally uncommon situation, but on Earth and in EMS, we come in contact with totally uncommon situations per every hundred medic probably once per career...so not that crazy to spend a few minutes considering this or that. I think even the average person who happened upon such a scenario would consider amputation to save the life.

[nsmedic393]

WOW...thats a strange thought process to go down...

I dont think it is completely out of this world that a medic confronted with that situation would consider amputating the childs arm.

Some of my thoughts would be...

1. is the child certainly gonna die because of the fire and am i going to bear witness to him/her burning alive??

2. While i know i dont even have half a clue about how to amputate someones arm, would it be worth it to try knowing the child will die??

3. Do i even have the equipment to perform such a procedure (even if im doing is half assed)

I know the fire department has a half dozen tools that could do the job in a pinch, but if they are on scene i would want them concentrating on putting the fire out, not chopping limbs off.

This is one of those theoretical things that no matter what anyone says...i dont think anybody can say they know for sure what they would do until they are standing there looking at a kid who is trapped by one of his limbs in a car that is on fire. By the grace of god hopefully nobody ever has to be put in that position.

[Scaramedic]

Oh God, this better not turn into a 'I would have done it with my 'Leatherman' thread.

[AnthonyM83]

Oh God, this better not turn into a 'I would have done it with my 'Leatherman' thread.

Real medics use their teeth.

[DwayneEMTP]

To step out even a little further into the ether....

If you had the time, and the means, and it would be an obvious death without the amputation, would you have a legal/ethical duty to act?

I watched a special on Baby Jessica (In the well, right?) about a hundred years ago. When they interviewed the medic he stated that med control (as she was stuck with one leg pointing straight up passed her head) had ordered him to attempt to break the leg to free it, and if not able to do so, to amputate it. He went down into the hole for the last time with the tools to do so. Or so he said on the program.

He said it was an amazing relief that when he cranked on the leg it came free without breaking...

Just a bit of amputation trivia...As heard, but not verified by any means...

Dwayne

[spenac]

Have you ever butchered an animal? Sadly in the field with the limited education we had our amputations would be more along those lines than how a surgeon would do it. I hope none of us are ever placed in that situation.

Now c-section. Not that hard. Especially if taking a live baby out of a dead mom.

[Richard B the EMT]

I went reaching back to 2005 to find this, already posted in the City. This involves a C-Section on a dead woman, although we were talking of field amputations. If a Paramedic team wants to risk their license or certification, the doctor giving them instructions over the Land Line or radio will probably risk his/her license, too. Sounds like a moral, as well as a legal, decision, that I would not want to put on anyone, including folks I am not too keen on (non-EMT City members, btw).

Posted: Mon Jul 11, 2005 9:34 pm

N.J. Paramedics Face Inquiry Over Emergency C-Section

By DAVID W. CHEN

9/27/97 The New York Times

New Jersey health officials are investigating the actions of two paramedics

who performed an emergency Caesarean section on Thursday to deliver the baby of a woman in North Bergen who was in cardiac arrest and could not be revived.

The paramedics acted while consulting by radio with emergency room doctors at Jersey City Medical Center, officials said, but state health regulations forbid paramedics to perform surgical operations. The emergency workers said they believed the procedure was their only hope of saving the baby.

The full-term baby girl survived but is in critical condition; the mother,

who was 37, died.

The two paramedics were placed on desk duty, with pay, pending the outcome of the state investigation, which officials said should be completed next week.

"This was so unusual," said Dr. Leah Ziskin, the deputy commissioner of the state's Department of Health and Senior Services. "Our review is not

complete."

But to hospital and volunteer officials, the only thing clear was that the

two paramedics were heroes, in spite of the rules.

"These two people, a man and a woman, they've gone through probably the most traumatic situation of their professional career, so light duty is more than appropriate," said Bill Dauster, a spokesman for Jersey City Medical Center. "We probably didn't need the state to tell us to do that."

The events, according to spokesmen from the Jersey City Medical Center and the North Bergen Volunteer First Aid Squad, unfolded as follows:

At 5:30 a.m. Thursday, the North Bergen squad received a 911 call from

someone in a residential neighborhood in the uptown section of North Bergen, saying that a woman was not breathing. Two volunteers, who were on the midnight-to-7 a.m. shift, arrived a few minutes later, finding the woman in cardiac arrest, with no heartbeat and no sign of breathing. They tried to revive her, said Mary Ellen Cleveland, the president of the first aid squad.

A few minutes later, two paramedics from the staff of Jersey City Medical

Center arrived at a house in the neighborhood from their base in Weehawken. The woman had still not been resuscitated; the baby was lodged in the birth canal.

"They made a determination that she was dead," Dauster said. "And then they said, 'Oh my God, we have to do this."'

In a telephone consultation with doctors at Jersey City Medical Center, the

paramedics and the doctors made a "joint decision" to try a Caesarean

section, he said. The two paramedics, both of whom were described by Dausteras seasoned, delivered the baby just after 6 a.m.

The baby had no pulse at birth but was revived by the paramedics.

Another ambulance from West New York then came to assist, and the woman and the baby were taken separately to Palisades Medical Center in North Bergen. The woman was pronounced dead at the hospital. The baby was later taken to Jersey City Medical Center.

Officials said they had not yet determined what caused the woman's heart

attack.

Friday, a woman who answered the phone at Palisades Medical Center said the hospital had no comment on the incident. Dauster and Ms. Cleveland declined to give the names of the family, the paramedics or the volunteer emergency medical technicians from the North Bergen squad.

It was the first time anyone at Jersey City Medical Center could recall

such a case, Dauster said. But he added that everyone was proud of the

paramedics.

"What they did was step over what regulators have outlined for them into

the moral arena," he said. "Most people are going to view this as an act of

heroic endeavor; that's how we're viewing it."

The baby, he added, was named Davida by the nurses at Jersey City Medical

Center. She weighed about 10 pounds.

[Dustdevil]

The paramedics acted while consulting by radio with emergency room doctors at Jersey City Medical Center, officials said, but state health regulations forbid paramedics to perform surgical operations.

Ya know, you would think that at least one person at the New Jersey Department of HEALTH would have the medical and medico-legal education to understand that, to be "surgery", it has to be performed upon a living human being. Idiots.

What are they going to charge them with, abuse of a corpse? :roll:

But yeah, in the case of an amputation, they might have a point.

[Just Plain Ruff]

Yeah, I don't know that I have ever heard of a medic in the U.S. actually doing it, but it is certainly a theoretical option. Although, maybe one out of every hundred medics (being generous) in this country actually has enough anatomy education to do it half-way intelligently. I doubt that Mr. Blowhard is one of those elite few. Anybody who talks about calling a doctor first probably isn't up to the task.

This is kind of like the old field C-section on the dead/dying mother thing. Most medics have neither the education nor the ballz to even attempt it, much less pull it off. The chances of you encountering either in a career are astronomically low. But yeah, there have been field C-sections done by medics. By the end of my junior year of nursing school, I felt like I could do one in my sleep.

I guess the answer to your questions are yes and yes. Yes, he's probably a blowhard. But yes, it's an option under extreme circumstances. I can think of a lot of more common and important things to spend your time studying for though, lol.

Dust I worked with one of those medics who did a field C-section. I met the child in question that he c-sectioned out.

Too bad the childs mother died in the crash.

[spenac]

If a Paramedic team wants to risk their license or certification, the doctor giving them instructions over the Land Line or radio will probably risk his/her license, too. Sounds like a moral, as well as a legal, decision, that I would not want to put on anyone,

If life were at stake I would just have to take the chance on getting sympathetic jurors. In my remote area I would probably not be able to even reach a doctor. So if it was let a person die or perform a butcher amputation, I would do the amputation. I hope I never have that choice to make. In my time in the field thankfully we have been able to get patients removed and to the hospital in one piece and allowed doctors to removed the crushed mangled limbs in the hospital.