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Prehospital limb amputation is an uncommonly performed procedure whereby amputation of an entrapped limb is required to facilitate the safe extrication of a patient in a life-threatening situation.
Indications
Note: Given the clinical and psychological implications of the procedure, where possible, consultation with receiving hospital emergency and trauma specialists is highly recommended prior to any prehospital limb amputation.
In all of the following scenarios, the patient has an entrapped extremity:
- Life before limb: Their clinical condition is life threatening and deteriorating and they will almost certainly die if not extricated rapidly.
- Environmental danger: There is a real risk to the patient’s life from further structural collapse or scene safety emergency.
- Non-survivable limb: A completely mutilated non-survivable limb retaining minimal attachment, which is delaying extrication in a non-immediate life threatening situation.
- Scene access: The patient is dead and their limbs are blocking access to potentially live casualties.
- Limb extraction unlikely to be successful: The patient is haemodynamically normal and after an exhaustive multi-disciplinary review of alternative options, amputation provides the only viable means to extricate the patient.
Contraindications
Immediate risk to rescuer making the procedure too dangerous to complete
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Further Reading »
Porter KM. (2010) Prehospital amputation. Emerg Med J. Dec;27(12):940-2.
Weingart S. Prehospital amputation. EMCrit Blog
Codner PA, Zils S (2011). Field Manual. Medical College of Wisconsin.
