This case series was reported to describe the creation and use of dedicated "on-call" teams for field amputations. Although the recent catastrophic earthquake in Haiti followed the publication of this article, it highlights the relevance of the content described here for wilderness and disaster early responders.
A trauma surgeon and resident from Methodist Dallas Medical Center formed the nucleus of this team and treated all of the cases in this report. Their first team was conceived in 1984 and equipped with a Gigli saw, a Liston amputation knife, a scalpel, hemostats, gauze dressings, tourniquets, betadine, gloves, morphine, nitrous oxide, diazepam, and two units of uncross-matched O-negative blood. On average, they responded to 3 to 4 calls per year and spent 1 to 3 hours on scene before returning via helicopter.
Three cases are described in this report, all of which resulted in field amputation after unsuccessful extrication by emergency medical service (EMS) personnel using multiple techniques during different attempts. For example, a cleaner's leg became entangled in a chevron auger and could not be freed by reversing the machine and cutting it with saws or the Jaws Of Life (Hurst, Shelby NC). The use of a cutting torch was deemed to be more dangerous than field amputation and this team extricated the patient. Through cases like this one, the team concluded that it was important to consider the inclusion of appropriate team members and equipment, team member comfort with fieldwork, command hierarchy, communications, media interactions, crowd control, informed consent, transportation, and debriefing. Although this paper focuses solely on an urban environment, its perspectives and insights are applicable to extrications that might happen in a disaster or wilderness setting.