AMPUTATION

Inclusion Criteria:  Patients with isolated amputation of any extremity.  EMS personnel may also need to refer to SHOCK and/or PAIN MANAGEMENT Guidelines, and/or the TOURNIQUET Policy.

Basic Level

1. Assess and support ABCs. If the initial assessment is abnormal, minimize scene time. Continue treatment guidelines en route.
2. If trauma or possible spinal injury is suspected, initiate spinal motion restrictions; refer to the SPINAL MOTION RESTRICTION Policy. If spinal injury is not 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 Guidelines.
3. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
4. Attempt to control any obvious external hemorrhage with direct pressure. If unable to control hemorrhage with direct pressure, apply a tourniquet. Refer to the TOURNIQUET Policy.
   1. Improvised tourniquets applied by bystanders and non-medical personnel prior to EMS arrival are not a substitute for a commercial device properly applied by UTSW/BioTel EMS providers.
      1. In such cases, a BioTel agency-approved commercial tourniquet should be applied (but not secured) proximal to the improvised device prior to its removal, if possible. If hemorrhage uncontrolled by direct pressure reoccurs after removal of the improvised device, the commercial tourniquet shall be deployed using the procedure described in the TOURNIQUET Policy.
5. Care of the amputated part:
   1. Remove gross contaminants by rinsing with Normal Saline.
   2. Wrap in moistened saline gauze and place in a plastic bag or container (sterile, if available).
   3. Seal the container tightly and place it in a solution of ice water, if available.
   4. Bring all amputated parts to the hospital, regardless of the condition of the part.
   5. If EMS personnel cannot locate the part immediately, transport the patient and instruct other field providers to search for and transport the part as soon as possible.
6. Begin transport as soon as possible: refer to the DESTINATION Policy.

Advanced Level

7. Consider establishing IV access at a TKO rate or use a saline lock.
8. Implement continuous ECG and ETCO2 monitoring if shock is present, anticipated, or develops.
9. Follow PAIN MANAGEMENT Guidelines.
10. For guidance with tourniquet removal, refer to the TOURNIQUET Policy and consult BioTel.
11. For additional patient care considerations not covered under standing orders, consult BioTel.