A major metropolitan "field amputation" team: a call to arms ... and legs

As early as 1979, suggestions were made to establish amputation teams and protocols in major metropolitan areas. It was recognized that preplanning on such calls would be valuable to carrying out rescues of that nature. Since then, questionnaires and collegial conversations reveal the existence of such teams remains the exception in our nation's cities.

Our team was formed in 1984 after an emergency medical service request for a surgeon to perform an amputation on a person who had become entrapped with both arms in an industrial candy press was made. In its current form, the team consists of an attending trauma surgeon, a resident surgeon, a registered nurse, and a pilot, all hospital based. Equipment is limited to medications for sedation and pain control, two units of uncross-matched blood, and a prebundled duffle bag of bandages, a scalpel, various saws, and hemostats. Transportation to the scene is provided by the helicopter based at our level II trauma center.

Since its inception, the team has been activated three to four times per year, resulting in nine amputation rescues. Three of these cases, presented here, are from an unusually busy 5 weeks during the spring of 2008. The first case involves a tree shredding device, the second, an industrial auger, and the third, a forklift and a steel toed boot. In these cases, the utilization of the amputation team resulted in successful patient rescues and outcomes.

A field amputation team can be an integral part of any emergency medical service system, filling an infrequently used but helpful adjunct to emergency care.