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Bringing the operating room to the field: lessons learned from on-scene field amputations
Jennie S Kim1, Elizabeth R Benjamin2, Saman Kashani3
1Trauma, Emergency Surgery, and Surgical Critical Care, USC School of Medicine, Los Angeles General Medical Center, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
Summary
A well-organized Hospital Emergency Response Team (HERT) is critical for rare on-scene limb amputations. Regular drills and efficient protocols ensure rapid response and improve patient outcomes in complex extrication scenarios.
Area of Science:
- Emergency Medicine
- Surgical Response
- Disaster Preparedness
Background:
- Complicated field extrications may necessitate on-scene limb amputation by a surgical team.
- While rare, such events demand an organized and efficient response for optimal outcomes.
Purpose of the Study:
- To describe the Los Angeles County Hospital Emergency Response Team (HERT) program.
- To analyze cases and identify areas for performance improvement in emergency response protocols.
Main Methods:
- Description of the HERT program organization.
- Multidisciplinary quality improvement process analyzing two critical incident cases.
- Review of team activation, communication, and medical decision-making.
Main Results:
- Timeliness of HERT activation significantly impacts extrication success.
- Regular multidisciplinary drills enhance rapid and effective team activation.
- Post-event analysis of timelines, provider coordination, and communication is crucial for improvement.
Conclusions:
- A well-organized, rehearsed protocol is essential for HERT activation and transportation.
- A trained, designated team, pre-packaged surgical supplies, and effective communication are key components.
- Continuous critical analysis of all response phases prepares for future critical events.
