Field amputation is not thought of very often, and for good reason. It is unpleasant, uncommon, and not very safe. I’m going to spend the next few days on this topic, starting with some of the facts.
In reality, field amputation is talked about much more often that it is actually performed. There is one old paper that is cited frequently which consisted of a survey of EMS directors 19 years ago! A total of 143 people responded and noted the following:
- There were 26 amputations over a five year period
- The most common mechanism was motor vehicle crash
- 53% were performed by a trauma surgeon and 36% by an emergency physician. (Who did the other 12%???)
- No training was available for this procedure
- Only 2 EMS systems had an existing protocol
An informal poll of trauma surgeons at the recent American College of Surgeons meeting in San Francisco showed that only 5 had ever been called to do a field amputation, and only 2 had actually done it.
Uncommonly performed procedures are always problematic. It is extremely difficult to keep skills sharp and to remember the protocol (or even where to find it). Furthermore, these procedures are prone to error and pose considerable risk to all.
Reference: In-Field Extremity Amputation: Prevalence and Protocols in Emergency Medical Services. Prehospital and Disaster Medicine 11(1):63-66, 1996.