Field amputation: response planning and legal considerations inspired by three separate amputations

Area of Science:

• Disaster Medicine
• Surgical Procedures
• Emergency Response

Background:

• Life-saving surgical procedures in the field are occasionally necessary but lack planned infrastructure.
• Few medical centers are equipped to support field physicians during emergencies.
• The need for dedicated disaster response teams, including surgeons, is highlighted.

Observation:

• Three cases of field dismemberment (through-knee amputation, arm amputation) occurred due to entrapment in disaster scenarios (earthquake, building collapse, industrial accident).
• These procedures were performed under challenging conditions, including local anesthesia only or sedation, and required improvisation of resources.
• All patients survived despite the unplanned and high-risk nature of the interventions.

Findings:

• Unplanned field dismemberment procedures, though life-saving, carry a significant potential for failure.
• Proactive identification and establishment of disaster response teams, including surgeons, are essential for rapid deployment.
• Legal considerations, such as Good Samaritan laws, and financial support systems must be addressed for field surgical interventions.

Implications:

• Hospitals and trauma systems must incorporate the possibility of field dismemberment into disaster preparedness plans.
• Developing an infrastructure for rapid response, including surgical capabilities in the field, is critical.
• Establishing pre-identified surgical teams and protocols can improve outcomes in mass casualty incidents involving entrapment.