I’ve spent the last week writing about the nuances of field amputation. I’ve heard from a number of readers about who does it at their facility. Keep in mind that this is a very rarely performed procedure. The few times I’ve been called out in the field, the prehospital providers have conveniently managed to extricate the patient just prior to my arrival. Whew!
Various providers (prehospital, emergency physician, surgeon) may provide this “service” at various places around the world. In the US, it is usually a physician, and typically a surgeon. In my opinion, anyone can be trained to do a basic field amputation.
Much depends on local policies and procedures, training, and availability. Prehospital providers are on scene in most cases, so it makes sense that they could do a field amputation with appropriate training. Emergency physicians have more experience with airway management, sedation, and anesthesia, and can thus add value to the process.
But again, in my opinion, a trauma surgeon is the best choice for performing this procedure. They have the technical skills, and are usually facile with anesthesia and sedation. But they also have a deep understanding of the anatomy involved, and the eventual reconstruction process. This allows them to tailor the amputation to optimize the eventual recovery from this operation. The surgeon does not necessarily have to resort to a guillotine type amputation. And they are better versed in performing amputations that involve the upper extremity, as well as more proximal amputations (shoulder, upper thigh). And if unexpected bleeding occurs that cannot be controlled by a tourniquet, they know what to do.
The only downside to using a physician is availability. There will always be extra time involved in getting them to the scene since they are typically hospital-based, whereas the prehospital providers are already present and are used to working in an austere environment.
Bottom line: There is no cookbook for developing a field amputation policy and procedure. Look at your local resources, and the logistics imposed by environment, traffic, your hospital, and other factorss. Then look at my previous posts and figure out what works for you. And finally, make the process as simple as possible. Due to the very rare need for field amputation, you will need to periodically review the process and location of your packs so people don’t forget.