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U of U Health develops guidelines for emergency amputations in the field

SALT LAKE CITY -- The University of Utah Hospital has developed a new program they say will be critical for patients who need emergency amputations outside of a hospital.

A trauma surgical team will be able to assemble in minutes to leave the hospital and travel to a remote location and tend to patients who are physically unable to leave the scene.

“We’ve taken what was an hour and a-half process of mobilizing the team to the scene to where now, with this program and this protocol and with our capabilities, that process would take 10 to 15 minutes, thereby saving what is precious time for a critically injured patient,” said Dr. Toby Enniss, the University of Utah Hospital Associate Trauma Medical Director and director of Acute Care.

Dr. Enniss recalled a time in August 2012 where he was called out by the Salt Lake City Fire Department to come to a South Salt Lake rail yard, where a 19-year-old man from Denver, Colorado was pinned by a steel plate inside a rail car. Officers worked to extricate him but were unable to move him.

“He was too badly trapped, too badly mangled to be able to salvage the leg and it was really a matter of, if we tried to salvage the leg he would have died there at the scene,” Enniss said.

The fire department said the man had probably been stuck inside the car for eight hours before someone found him. Once the department called The U of U Hospital for help, it took the surgical staff 90 minutes to organize and get out to the man. There was no procedure in place to handle an out-of-the-hospital amputation.

“In trauma we talk about the ‘golden hour,’ in which patients who are potentially salvageable have a limited amount of time where they can be salvaged, but that means getting them to the appropriate care," Enniss said.

“This has been recognized as a need for decades, that we needed to have a forward surgical teams to do this," said Dr. Ram Nirula, The Medical Trauma Director for U of U Health. "The need does not happen frequently, but it happens often enough.”

Dr. Nirula said research out of Texas found that within five years, a surgical team was needed outside of the hospital 26 times.

“Roughly, about five times a year they are activating this protocol,” Dr. Nirula said. “I would suspect that given our population size we may have to activate this once or twice a year.”

The man who Dr. Enniss and his team and AirMed saved is now a husband and a father. Dr. Enniss removed the lower half of his left leg below the knee to save his life.

At the time he was trapped, Dr. Enniss said his body was hemorrhaging blood from internal injuries, and that is why they could not waste time trying to salvage his mangled leg.

Along with the new protocol, surgical supplies and tools were also made ready to go if needed by a patient, including multiple bone saws, tourniquets and dressings.