Field amputation: Response planning and legal considerations inspired by three separate amputations

Authors

  • Alexander Raines , MD
  • Jason Lees , MD
  • William Fry , MD
  • Aaron Parks , JD
  • David Tuggle , MD

DOI:

https://doi.org/10.5055/ajdm.2014.0141

Keywords:

trauma, mass casualty, field amputation, disaster, dismemberment, Good Samaritan

Abstract

Background: Surgical procedures in the field are occasionally required as life-saving measures. Few centers have a planned infrastructure for field physician support. Focused efforts are needed to create teams that can meet such needs. Additionally, certain legal issues surrounding these efforts should be considered. Three cases of field dismemberment inspired this call for preparation.
Methods: In one case, an earthquake caused the collapse of a bridge, entrapping a child within a car. A through-knee amputation was required to free the patient with local anesthetic only. The second case was the result of a truck bomb causing the collapse of a building whereby a victim was trapped by a pillar. After retrieval of supplies from a local hospital, a through-knee amputation was performed. The third case involved a young man whose arm became entangled in an oil derrick. This patient was sedated and intubated in an erect position and the arm was amputated.
Results: Fortunately, each of these victims survived. However, the care these patients received was unplanned and had the potential for failure. The authors feel that disaster teams, including a surgeon, should be identified in advance as responders to a disaster on short notice. Legal issues including statespecific Good Samaritan laws and financial support systems must also be considered.
Conclusion: As hospitals and trauma systems prepare for disaster situations, they should consider the eventuality of field dismemberment. This involves identifying a team, including a surgeon, and devising an infrastructure allowing rapid response capabilities, including surgical procedures in the field.

Author Biographies

Alexander Raines , MD

Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.

Jason Lees , MD

Department of Surgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.

William Fry , MD

Department of Surgery, University of South Carolina, Columbia, South Carolina.

Aaron Parks , JD

Attorneys at Law, Rubenstein & Pitts, PLLC, Edmond, Oklahoma.

David Tuggle , MD

Department of Surgery, Section of Pediatric Surgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.

References

Massarutti D, Trilo G, Berlot G, et al.: Simple thoracostomy in prehospital trauma management is safe and effective: A 2-year experience by helicopter emergency crews. Eur J Emerg Med. 2006 ; 13: 276-280.

Eckstein M, Suyehara D: Needle thoracostomy in the prehospital setting. Prehosp Emerg Care. 1998 ; 2: 132-135.

Hessert MJ, Bennett B: Optimizing emergent surgical cricothyrotomy for austere environments. Wild Environ Med. 2013 ; 24: 53-66.

Macintyre A, Kramer E, Petinaux B, et al.: Extreme measures: Field amputation on the living and dismemberment of the deceased to extricate individuals entrapped in collapsed structures. Disaster Med Public Health Prep. 2012 ; 6(4): 428-435.

Kragh J, Walters T, Baer D, et al.: Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009 ; 249: 1-7.

Calland V: Extrication of the seriously injured road crash victim. Emerg Med J. 2005 ; 22: 817-821.

Ebraheim N, Elgafy H: Bilateral below-knee amputation surgery at the scene: A case report. J Trauma. 2000 ; 49: 758-759.

Sharp C, Mangram A, Lorenzo M, et al.: A major metropolitan “field amputation” team: A call to arms … and legs. J Trauma. 2009 ; 67: 1158-1161.

Jaslow D, Barbera J, Desai S, et al.: An emergency departmentbased field response team: Case report and recommendations for a “go team.” Prehosp Emerg Care. 1998 ; 2(1): 81-86.

Frisch T: International Search and Rescue Advisory Group (INSARAG): Guidelines and Methodology. New York, NY: United Nations-Office for the Coordination of Humanitarian Affairs, April 2012. Available at http://www.ifrc.org/docs/idrl/I927EN.pdf. Accessed March 5, 2014.

Macintyre A, Barbera J, Petinaux B: Survival interval earthquake entrapments: Research findings reinforced during the 2010 Haiti earthquake response. Disaster Med Public Health Prep. 2011 ; 5: 13-22.

Macintyre A, Barbera J, Smith E: Surviving collapsed structure entrapment after earthquakes: A “time-to-rescue” analysis. Prehosp Disast Med. 2006 ; 21(1): 4-19.

Foil MB, Cunningham P, Hale J, et al.: Civilian field surgery in the rural trauma setting: A proposal for providing optimal care. J Natl Med Assoc. 1992 ; 84: 787-789.

Hudson M, Moore G: Defenses to malpractice: What every emergency room physician should know. J Emerg Med. 2011 ; 41(6): 598-606.

National Library of Medicine: Hippocratic Oath. Bethesda, MD: National Library of Medicine, February 7, 2012. Available at https://www.nlm.nih.gov/hmd/greek/greek_oath.html. Accessed March 5, 2014.

Brown OW: Good Samaritan statutes: A malpractice defense for “doing the right thing.” J Vasc Surg. 2010 ; 51: 1572-1573.

Prosser W, Keeton W, Dobbs D, et al.: Prosser and Keeton on Torts. St. Paul, MN: West Publishing Co, 1984: 213.

Downloads

Published

01/01/2014

How to Cite

Raines , MD, A., J. Lees , MD, W. Fry , MD, A. Parks , JD, and D. Tuggle , MD. “Field Amputation: Response Planning and Legal Considerations Inspired by Three Separate Amputations”. American Journal of Disaster Medicine, vol. 9, no. 1, Jan. 2014, pp. 53-58, doi:10.5055/ajdm.2014.0141.

Issue

Section

Case Studies