We’ve discussed the numbers behind and indications for performing field amputation for trauma. Now it’s time to look at the logistics. There are two main considerations here: getting to the scene, and staying safe. The following presumes that the procedure will be done by a physician who is based at the trauma center. It will be different if performed by other trauma professionals.
Getting there includes an obvious problem: what happens when the physician leaves the hospital? During the daytime, others may be available, although they may have other responsibilities to keep them busy. At night it becomes more of an issue, as they may be the only surgeon or ED physician available for the hospital. And once involved in the field amputation process, they may be unavailable for hours.
The easiest solution is to utilize the backup trauma surgeon. All Level I and II centers must have one. There are two possibilities here: the in-house trauma surgeon leaves and the backup proceeds to the hospital for coverage (if in-house), or the backup surgeon is transported leaving the on-call surgeon to manage as usual.
The choice is up to the trauma center, but this is an issue that needs to be thought out in advance. The best solution takes geography into consideration. Since most transports to the scene will be made by helicopter, it is easier to use the trauma center’s helipad to pick up the on-call surgeon. If an in-house surgeon is not used, consideration must be given to the nearest safe landing zone and this may mean that an out-of-house surgeon would have to travel to the hospital for pick-up.
Once on scene, the physician must ascertain that the area of the incident is safe. This is important for the well being of the patient, the rescue crews and the patient. If the scene cannot be made safe, it is not possible to render care, even if the patient is in grave trouble.
Bottom line: Each trauma program must think through these details in advance and develop a policy for who goes to the scene and how they get there. And safety for all is of paramount importance.
Tomorrow I’ll discuss equipment and drugs needed for this procedure.