Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T06:01:48.007Z Has data issue: false hasContentIssue false

Extreme Measures: Field Amputation on the Living and Dismemberment of the Deceased to Extricate Individuals Entrapped in Collapsed Structures

Published online by Cambridge University Press:  08 April 2013

Abstract

Collapsed structures, typically as a result of earthquakes, may result in individuals entrapped by their limbs under heavy structural elements. In addition, access to living persons may be blocked by the deceased. Individuals are often critically ill by the time they are found, and rapid extrication is warranted. This and other factors may necessitate field amputation of an extremity on a living person or dismemberment of the deceased to achieve a rescue. Although case reports have described industrial, mining, and transportation accidents, few discuss this potential in collapsed structures. Also, few specifically outline the indications or the decision process and associated administrative procedures that should be addressed before conducting these procedures. This report presents a review of the literature along with a limited case series. A discussion regarding relevant decision making is provided to encourage the development of protocols. An international consensus statement on these procedures is provided.

(Disaster Med Public Health Preparedness. 2012;6:428-435)

Type
Special Focus
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.de Bruycker, MGreco, DAnnino, I, et alThe 1980 earthquake in southern Italy: rescue of trapped victims and mortality. Bull World Health Organ. 1983;61(6):10211025.Google Scholar
2.Noji, EKArmenian, HKOganessian, A. Issues of rescue and medical care following the 1988 Armenian earthquake. Int J Epidemiol. 1993;22(6):10701076.CrossRefGoogle ScholarPubMed
3.de Ville de Goyet, C. Stop propagating disaster myths. Prehosp Disaster Med. 1999;14(4):213214.Google Scholar
4.Barbera, JAMacintyre, AG.Urban search and rescue. Emerg Med Clin North Am. 1996;14(2):399412.CrossRefGoogle ScholarPubMed
5.Cone, DC. Rescue from the rubble: urban search & rescue. Prehosp Emerg Care. 2000;4(4):352357.Google Scholar
6.Macintyre, AGBarbera, JASmith, ER. Surviving collapsed structure entrapment after earthquakes: a “time-to-rescue” analysis. Prehosp Disaster Med. 2006;21(1):417, discussion 18-19.Google Scholar
7.Macintyre, AGBarbera, JAPetinaux, BP. Survival interval in earthquake entrapments: research findings reinforced during the 2010 Haiti earthquake response. Disaster Med Public Health Prep. 2011;5(1):1322.Google Scholar
8.Jagodzinski, NAWeerasinghe, CPorter, K. Crush injuries and crush syndrome—a review: part 1: the systemic injury. Trauma. 2010;12:6988.Google Scholar
9.Sever, MSVanholder, RLameire, N. Management of crush-related injuries after disasters. N Engl J Med. 2006;354(10):10521063.Google Scholar
10.International Search and Rescue Advisory Group (INSARAG). Guidelines and Methodology. Geneva, Switzerland: Field Coordination Support Section (FCSS), Office for Coordination of Humanitarian Affairs (OCHA), United Nations; 2010:9298.Google Scholar
11.Finch, PNancekievill, DG. The role of hospital medical teams at a major accident. Anaesthesia. 1975;30(5):666676.Google Scholar
12.Stewart, RDYoung, JCKenney, DAHirschberg, JM. Field surgical intervention: an unusual case. J Trauma. 1979;19(10):780783.Google Scholar
13.Ebraheim, NAElgafy, H. Bilateral below-knee amputation surgery at the scene: case report. J Trauma. 2000;49(4):758759.CrossRefGoogle ScholarPubMed
14.Ho, JDConterato, MMahoney, BDMiner, JRBenson, JL. Successful patient outcome after field extremity amputation and cardiac arrest. Prehosp Emerg Care. 2003;7(1):149153.Google Scholar
15.Dunn, ELWynn, JPolanco, L. A rare case of bilateral upper extremity field amputation. J Air Med Transp. 1989;8(11):45.Google Scholar
16.Jaslow, DBarbera, JADesai, SJolly, BT. An emergency department-based field response team: case report and recommendations for a “go team.” Prehosp Emerg Care. 1998;2(1):8185.Google Scholar
17.Kelly, JBThompson, AS IIIGervin, AA. Field leg amputation by a paramedic. Prehosp Emerg Care. 1999;3(1):77.Google Scholar
18. McNicholas, MJRobinson, SJPolyzois, I, et al“Time critical” rapid amputation using fire service hydraulic cutting equipment. Injury Int J Care Injured. 2011;42:13331335.Google Scholar
19.Snook, R. Extrication of trapped casualties. Br Med J. 1969;4(5681):478480.Google Scholar
20.Foil, MBCunningham, PRGHale, JCBenson, NHTreurniet, S. Civilian field surgery in the rural trauma setting: a proposal for providing optimal care. J Natl Med Assoc. 1992;84(9):787789.Google Scholar
21.Sharp, CFMangram, AJLorenzo, MDunn, EL. A major metropolitan “field amputation” team: a call to arms … and legs. J Trauma. 2009;67(6):11581161.Google Scholar
22.Porter, KM. Prehospital amputation. Emerg Med J. 2010;27(12):940942.Google Scholar
23.Kampen, KEKrohmer, JRJones, JSDougherty, JMBonness, RK. In-field extremity amputation: prevalence and protocols in emergency medical services. Prehosp Disaster Med. 1996;11(1):6366.Google Scholar
24.Osmond-Clarke, H. Emergency amputations: lower limb. Ann R Coll Surg Engl. 1967;40(4):216218.Google Scholar
25.Clasper, J, Lower Limb Trauma Working Group. Amputations of the lower limb: a multidisciplinary consensus. J R Army Med Corps. 2007;153(3):172174.Google Scholar
25.Kirkup, JR. Interpretations of amputation by society, patients, and surgeons. In: A History of Limb Amputation. New York, NY: Springer; 2007: chap 9:96109.Google Scholar