Amputation

Inclusion Criteria: Patients with isolated amputation of any extremity. EMS personnel may also need to refer to Shock Guidelines.

           Basic Level

1. Assess and support ABCs. If the initial assessment is abnormal, minimize scene time. Continue treatment guidelines en route.
   
   
2. Initiate spinal movement restrictions, as needed. If no spinal injury is suspected, place the patient in a position of comfort. If evidence of shock, place the patient supine with the feet elevated and monitor airway closely. Treat shock according to the Shock Treatment guidelines.
   
   
3. Administer oxygen as needed to maintain a SpO2 of at least 96%.
   
   
4. Attempt to control any obvious external bleeding with direct pressure. If unable to control bleeding, apply a tourniquet.
   
   
5. Care of the amputated part:
   a.  Remove gross contaminants by rinsing with saline.
   b.  Wrap in moistened saline gauze and place in plastic bag or container (sterile, if available).
   c.  Seal the container tightly and place in solution of ice water, if available.
   d.  Bring all amputated parts to the hospital, regardless of the condition of the part.
   f.  If EMS personnel cannot locate the part immediately, transport the patient and instruct other field providers search for and transport the part as soon as possible.
   
   
6. Begin transport as soon as possible.
   
   
   Advanced Level
   
   
7. Consider establishing IV access at a TKO rate or use a saline lock.
   
8. Consider ECG and EtCO2 monitor.
   
9. Follow Pain Management guidelines.
   
10. For additional patient care considerations not covered under standing orders, consult BioTel.

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