UTSW/BioTel EMS Training Bulletin 15-003

March 2015

UTSW/ Parkland Field Amputation Team Activation   (PDF Here)

Purpose:

1. To provide procedural guidance to UTSW/BioTel EMS Providers for the activation of the UTSW/Parkland Field Amputation Team

Background:

1. UTSW/BioTel Fire Department EMS agencies have significant patient extrication, urban search and rescue, and trauma care skills.
2. Circumstances may arise during extrication or specialized rescue in which advanced medical procedures, such as field amputation, may be necessary.
3. UTSW/BioTel EMS Providers may consult BioTel for possible activation of a specialized UTSW/Parkland Hospital team capable of performing field amputation: a surgeon, a trauma nurse, blood/blood products, specialized equipment and medications.

Procedure:

1. At the request of either the Fire-Rescue scene Incident Commander or the senior EMS Provider on-scene, UTSW/BioTel EMS Providers shall contact BioTel for consultation.
   1. EMS Providers shall also follow their EMS agency-specific guidelines for notification of their chain-of-command with regard to this procedure.
2. BioTel staff will consult with the BioTel Medical Director or Online Medical Control Physician.
3. The UTSW/Parkland Field Amputation Team shall then be activated by BioTel, if such activation is determined to be appropriate.
4. Goal: Field Amputation Team arrival on-scene within 30 minutes of activation.

Patient Care:

1. UTSW/BioTel EMS Providers shall provide the following minimum care to any patient for whom Field Amputation Team activation is considered:
   1. Active hemorrhage control with direct pressure and tourniquets, as needed;
   2. Establish two, large-bore IVs (or IO) in uninjured extremities, if possible:
      1. 250-mL fluid bolus (NS or LR), as needed, to maintain palpable radial pulse or SBP 90 mm Hg (avoid over-resuscitation)
   3. Keep the patient warm and calm:
      1. Judicious use of IV/IO analgesia and/or sedation
   4. Additional supportive care for shock, trauma and other conditions, consistent with UTSW/BioTel EMS Guidelines for Therapy, and per Online Medical Control.

References:

1. UTSW BioTel EMS Guidelines for Therapy:
   1. Treatment Guidelines
      1. Amputation
      2. Pain Management
      3. Shock
      4. Trauma
   2. Policies
      1. Tourniquet