Page 63 - PJ MED OPS Handbook 8th Ed

Field Amputation for Extraction/Extrication
Principles:
• Perform an amputation if unable to extract or extricate patient due to time or tactics that
preclude patient and mission safety, or it is technically impossible to extricate the limb.
○ Tactical considerations include enemy contact and threat
○ Technical safety may include concerns regarding further or impending structural collapse,
environmental dangers, fire, etc.
○ Disentanglement procedures have been exhausted or are deemed futile
○ Time: Life over limb; the patient’s overall condition is deteriorating
○ The limb is entrapped and mangled beyond recognition and is attached by minimal soft
tissue
• If a second PJ or medical asset is available, document agreement of need for amputation with
name/date/time.
• Perform the amputation as distal (low on the extremity) as possible – save as much length
as possible.
Guidelines:
• Assess patient and provide MARCH PAWS treatment if time and tactics permit.
• Obtain IV/IO access, intranasal route as back up.
• Document confirmation of need to amputate by 2nd PJ/Medic if present.
• Inform the patient of the need to do this to save his/her life.
• Provide sedation per Procedural Sedation Protocol if patient is responsive and if tactically
feasible.
• Administer Ertapenem IV/IO/IM peri-amputation; don’t delay procedure to administer
antibiotics.
• Administer local anesthetic with lidocaine circumferentially and deeply. Aspirate and confirm
not in a vessel.
• Check and prep equipment – scalpel/knife, bone saw/sawzall (with or without bone blades),
4 combat gauze, Kerlex/adaptic dressings, ACE wraps/duct tape/cravat or other item to wrap
the stump effectively.
• Use universal precautions as able.
• Place 2 tourniquets as distally as possible, never over a joint.
• Clean site if possible – water, betadine or soap if available.
• If it is a completion amputation (soft tissue only) a scalpel can be used. If a scalpel is unavail-
able, a knife or trauma shears can be used (clean dirt, rinse with water, and wipe blades with
alcohol first).
• If the limb is entrapped and intact, incise the limb circumferentially outside to in, cut down
to bone. Once in contact with bone, use the bone or a hand saw to saw through. (Hand saws
used for pruning bonsai trees have been recommended by USAR teams).
• The entire amputation can be performed with a sawzall by cutting through in one cut without
the initial circumferential incision. If tactical situation permits, utilize fresh blade and con-
sider wrapping the incision site in a few wraps of duct tape prior to making this cut.

NOTE: Using this method will induce significant vibration to the casualty and should be
considered based on equipment available and tactical situation.

Chapter 6. Surgical and Medical Procedures n 61