Uncle Jake

[Kaisu]

One of my co-workers (not working with him now, but he's still working) did a field amputation of a leg. Patient was trapped under a train, seriously injured, similar to the patient in the scenario. It would have taken 20 minutes to move the train. The medic took the leg off and transported the patient. He didn't have to saw bone - there was soft tissue holding the leg on.

The patient died in the ED.

[HellsBells]

Yes. Never mind you might not be allowed to do it, the question is if you could, would you do it?

Depends, if its just soft tissue holding the leg on...maybe. Otherwise, I have no experience in amputations, particularly ones at the mid femur. I'm no doctor, but I'm pretty sure that if I severed his femoral artery, that would be bad for him. Not only that, with the position he is in I don't want to sedate him to the point he needs, positive pressure ventilation. On the other hand, if I start hacking at his leg without full sedation, I'm thinking hes going to react rather violently, which is problematic, considering the new apendage in his chest. So, even with total carte blanche regarding field amputation, I think not.

[DartmouthDave]

Hello,

No. In this situation a field amputation is not warranted.

There is no guarantee that you or the flight team will be able to amputate the leg any faster that the Fire Services could extricate the patient. Second, there is no guarantee that the leg can be amputation with enough skill to prevent excessive bleeding and stress to the patient. Third, do you actually have the equipment needed to pull it off? Lastly, the patient is sick. But, how sick has yet to be determined. I have seen patient with horrific injuries turn out to be fairly stable while the one with a bump on the leg be gravely ill?

Keep the patient warm, control pain, and fluids as needed. Also, as noted above, take a closer look at the second patient as well.

Transport the entrapped patient ASAP to the trauma center. Transport the walking patient (barring any troublesome finding) to the local hospital.

Cheers…

[Kiwiology]

The second patient is fine, just few cuts and a bit of gravel rash

Uncle Jake is pretty crook, the Fire Service tell you they need at least an hour to get him out.

The actual patient was fluid loaded, anaesthetised with ketamine and one of the Helicopter Doctors amputated his leg.

I'm not saying it should be done, I would certainly consider it however and am interested in seeing what others think.

Edited June 7, 2012 by Kiwiology

[Kaisu]

Limb before life. If you can do it, and the helicoptor docs obviously could.. then I think it's a legitimate action.

[DFIB]

Docs do that sort of thing often particularly if they are surgeons. I have only assisted in one amputation. It was a controlled environment. DartmouthDave has some good points.

I would absolutely hate to have to attempt an amputation in the field for more reasons than I can can imagine. In fact I can only think possibly one instance where I might consider it.

[Asysin2leads]

If a leg is only being held on by a few pieces of soft-tissue and it is preventing rapid extrication, then I think you should do what needs to be done to save this person's life. If it is mangled but still attached, then I think the best course of action would be to throw a doctor who is qualified on the chopper and have him land and perform the procedure. If your level I has a helicopter but no orders or procedures allowing a physician to perform a field amputation, then I'd say that is an issue that needs to be addressed. If you perform the amputation yourself, you have to be cognizant that you are performing out of your scope of practice, and be ready to defend your actions at an inquiry. If you honestly, truly feel that it is necessary to save the person's life, then you should do what is in the best interest of the patient.