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A knife carried into an austere environment may have consid-  in manuscript writing and revisions. JM and SM performed
              erable wear and tear and may not be sharpened to the man-  data collection and initial manuscript drafts. SB oversaw data
              ufacturer’s specifications. Considering this, our results may   collection, photography, and manuscript revisions.
              or may not be extrapolated to real-life scenarios because the
              knives were not sharpened between the nine amputations.   Financial Disclosures
                                                                 The authors have no financial disclosures.
              Multiple individuals performed six to eight amputations, and
              differences in their abilities and slight alterations in technique   Funding
              could account for differing success or failure rates. We did not   No company or commercial interest supported or provided
              study inter-amputator differences.                 funding or the equipment for the study. Furthermore, no com-
                                                                 pany provided input to our research.
              The amputators wore only medical gloves, not thicker gloves
              made of synthetic material, leather, or cold weather gloves.   References
              The lack of additional hand protection may have affected the   1.  Porter KM. Prehospital amputation. Emerg Med J. 2010;27(12):
              speed of the cuts and the discomfort experienced with some of   940–942.
              the tools studied.                                 2.  Ho JD, Conterato M, Mahoney BD, Miner JR, Benson JL. Suc-
                                                                    cessful patient outcome after field extremity amputation and car-
                                                                    diac arrest. Prehosp Emerg Care. 2003;7(1):149–153.
              Conclusion                                         3.  Mechem CC, Kohn M. EMS field amputation gives trauma patient
                                                                    a second chance at life. J Emerg Med Serv. 2016;41(6). https://
              In the rare circumstance that a distal limb field amputation   www.jems.com/patient-care/trauma/ems-field-amputation-
              is required in < 2 minutes using a folding multitool or fixed-  gives-trauma-patient-a-second-chance-at-life/
              blade knife, a multipurpose tool with a dedicated saw blade   4.  Jenkins M. Aron Ralston: between a rock and the hardest place.
              and a knife blade could be successfully used. Attempting am-  Outside Magazine. August 2003. https://www.outsideonline.com
                                                                    /outdoor-adventure/exploration-survival/aron-ralston-between
              putations on limbs with diameters < 10.4 cm (4.1 in), such as   -rock-and-hardest-place/
              distal to the shoulder or below the knee, are likely to succeed.   5.  Gander B. Prehospital amputation: a scoping review. J Paramed
              We recommend against attempting amputations on limbs with   Pract. 2020;12(1):6–13.
              diameters > 10.4 cm (4.1 in), such as above the knee, if there   6.  Emmerich BW, Stilley JA, Sampson CS, Horn BG, Pollock KE,
              is a time constraint to complete the amputation. In choos-  Stilley JD. Prehospital amputation: an experimental comparison
                                                                    of techniques. Am J Emerg Med. 2020;38(7):1305–1309.
              ing which of the tools is more prone to amputate a limb on   7.  McNicholas MJ, Robinson SJ, Polyzois I, Dunbar I, Payne AP,
              the first attempt in < 2 minutes, the Leatherman Super Tool   Forrest M. ‘Time critical’ rapid amputation using fire service hy-
              300 multitool was found to be the knife of choice. Even after   draulic cutting equipment. Injury. 2011;42(11):1333–1335.
              multiple attempts, without resharpening, this knife outper-  8.  Leech C, Porter K. Man or machine? An experimental study of
              formed the others in the arena of time and success. Although   prehospital emergency amputation.  Emerg Med J. 2016;33(9):
              the Victorinox Swiss Army Rescue Tool was found to provide   641–644
              more ergonomic comfort to the amputator and appeared to   9.  Holloway TL, Sordo S, Brandfellner HM,Goode AL, Aydelotte
              cut through soft tissue more easily than did the other knives,   JD. The novel utility of common tools for performing field am-
                                                                    putation: What is safe and easy to use? Wilderness Environ Med.
              these metrics would not preclude using the Victorinox over the   2014;25(1):117–118.
              Leatherman. In a rare field amputation scenario, an amputator   10.  Brown JB, Rosengart MR, Forsythe RM, et al. Not all prehospi-
              would likely be removing a single limb to free a victim and   tal time is equal: influence of scene time on mortality. J Trauma
              not cutting through multiple limbs, as the amputators did for   Acute Care Surg. 2016;81(1):93–100.
              this study. Therefore, fatigue of cutting through multiple limbs   11.  Kirk NT, McKeever FM. The guillotine amputation.  JAMA.
                                                                    1944;124(15):1027–1030.
              and the ergonomic comfort would be less of a deterrent. The   12.  Accreditation Council on Graduate Medical Education. Emer-
              importance is for an amputator in a potential austere environ-  gency medicine defined key index procedure minimums. https://
              ment to have comfort knowing that the knife selected to carry   www.acgme.org/globalassets/PFAssets/ProgramResources/EM_
              in a toolbelt has shown the potential to be successful in ampu-  Key_Index_Procedure_Minimums_103117.pdf?ver=2017-11
              tating a distal limb in a short period of time and on the first   -10-130003-693&ver=2017-11-10-130003-693. Accessed 1 May
              attempt. Because these knives may be used for multiple other   2021.
              purposes, the luxury of knowing that the knife will work even   13.  Noblet  T,  Lineham  B,  Wiper  J,  Harwood  P.  Amputation  in
                                                                    trauma—how to achieve a good result from lower extremity
              when previously used and unsharpened grants an added level   amputation irrespective of the level. Curr Trauma Rep. 2019;5:
              of confidence to the operator.                        69–78.
                                                                 14.  Jakob DA, Minneti M, Benjamin ER, et al. Practical assessment
              This study’s results could be considered by prehospital re-  of different saw types for field amputation: a cadaver-based study.
              sponders, combat medics, or adventurers with medical training   Am J Emerg Med. 2021; 45(2):11–16.
              during the selection of knives and multitools when preparing   15.  National Association of State EMS Officials.  National EMS
              gear for wilderness adventures, deployments, or rescue scenar-  Scope of Practice Model 2019 (Report No. DOT HS 812-666).
                                                                    Washington, DC: National Highway Traffic Safety Administra-
              ios. Although a prehospital amputation is rare, and a medical   tion; 2019.
              provider is unlikely to purchase a multitool or knife with the   16.  Colella MR. Field EMS Physician Limb Amputation Training and
              intent of using it for a field amputation, we do recommend   Guidelines. Milwaukee, WI:  Departments of Emergency Medi-
              that one should consider using a tool with a dedicated knife   cine and Pediatrics, The Institute for Health & Equity, Medical
              and saw when attempting a field amputation            College of Wisconsin; 2015.  https://www.mcw.edu/departments
                                                                    /emergency-medicine/divisions/section-of-ems-and-disaster
                                                                    -medicine/field-ems-physicians. Accessed 12 June 2021.
              Author Contributions                               17.  Ho JD, Conterato MR, Mahoney BD, Miner JR, Benson JL. Suc-
              RAB was responsible for the study design, oversight, data analy-  cessful patient outcome after field extremity amputation and car-
              sis, manuscript writing, and revisions. RW and NP participated   diac arrest. Prehosp Emerg Care. 2003;7(1):149–153.

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