Lower limb amputation by emergency medical technicians: a case report from scene

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Agricultural Safety

Background:

• Agricultural machinery trauma presents unique prehospital challenges.
• Rural settings often involve delayed emergency care and complex extrication.
• This case details the management of severe lower limb agricultural trauma.

Purpose of the Study:

• To describe the prehospital management of a severe agricultural machinery-related lower limb injury.
• To highlight the decision-making process and execution of a field amputation by EMTs.
• To identify challenges and training needs for managing complex trauma in rural environments.

Main Methods:

• A 45-year-old male tractor driver sustained severe lower limb entrapment.
• Emergency Medical Technicians (EMTs) applied the XABCDE protocol for initial assessment and management.
• A field amputation of the lower limb was performed by EMTs due to extrication difficulties and injury severity.

Main Results:

• The patient experienced severe, intractable pain despite initial management.
• Field amputation was performed to facilitate extrication and transport.
• Ground ambulance transport was utilized due to prolonged helicopter response times.
• The patient arrived at the hospital with a decreased level of consciousness.

Conclusions:

• EMTs faced challenges including family involvement, inadequate pain control, and lack of specialized equipment.
• Prolonged emergency response times and the psychological impact on providers were significant factors.
• Formal integration of rare, complex trauma scenarios into EMT training is crucial.
• Post-mission psychological support for emergency responders is essential.