Dr Nick Johnson1,2
1LifeFlight Retrieval Medicine, Australia, 2Adult Retrieval Victoria, Melbourne, Australia
Pre-Hospital traumatic limb amputation is an uncommon yet potentially life-threatening scenario, presenting technical challenges to the Retrievalist with often significant patient consequences. It is both a time and treatment critical event requiring immediate on-scene assessment coupled with accelerated decision making. As a result, cases are often viewed as high interest events with much to be learned from, particularly when patients require an emergent amputation due to entrapment in the field.
We present the results from a five-year audit of cases where complete or near complete traumatic limb amputation took place, located in Queensland between 2015 and 2020. These patients were managed and transported by the crews of LifeFlight Retrieval Medicine.
The data described includes patient demographics, incidence, mechanism and pattern of injury, as well as ongoing management.
Although an infrequent occurrence, cases have steadily increased, particularly where injury has been caused by industrial machinery or motor vehicle collision. Associations are drawn between pattern of injury and the increased need for intensive resuscitation and blood product administration, allowing for some degree of predictability for preparation in the future.
From this case review, potential improvements in Pre-Hospital intervention are discussed including the correct administration of blood products, timely application of tourniquets, as well as clear documentation of events.
We conclude by briefly summarising two significant cases of traumatic limb amputation where both patients were entrapped and required a carefully coordinated extrication. A complex multi-disciplinary approach by the Emergency services is described, highlighting how the immediate needs of the patient must be balanced with scene safety working in the Pre-Hospital environment.
Biography:
Nick is an Emergency Physician originally from the UK who is now based in Melbourne, with an enthusiastic interest for Pre-Hospital and Retrieval Medicine. He has worked with LifeFlight Retrieval Medicine in Queensland for several years and is currently part of the team at Adult Retrieval Victoria