SALT LAKE CITY — New protocols mean trauma surgeons at University Hospital are now fully enabled to perform life-saving amputations in the field at a moment's notice, the hospital announced this week.
Such amputations are often necessary when a victim is pinned, crushed or trapped somewhere and thus cannot be transported by a medical helicopter, said Dr. Ram Nirula, trauma medical director at University of Utah Health.
"We've created a policy and a protocol that allow us to timely mobilize our surgical team to get to the field quickly," Nirula said. "That actually requires a number of different elements that not only require a surgeon but requires several individuals including our … AirMed personnel who can provide necessary care to the patient while surgery is going on."
"It also requires some resources to actually perform the surgery. It (also requires) blood and the necessary people to bring that patient back to the hospital for further definitive care."
Because University Hospital is considered a Level 1 Trauma Center, logistics must also be in place, he said, to ensure that there are "teams of individuals" left behind at the facility itself "to provide care for the rest of the population should other injured persons come to the hospital."
Standing on the helipad at University Hospital, Nirula displayed all the tools needed to perform an amputation, minus the cooler of several blood and plasma units needed in such situations. The tools, including a saw, a tourniquet and plenty of gauze, fit into a case not much larger than a lunchbox.
The small case carries a lot of responsibility, as do the surgeons trained in giving field amputations, Nirula said.
"This has been recognized as a need for decades that we need to be able to have … surgical teams do this," he said. "The need doesn't happen frequently, but it happens often enough where you need to have some experience and training in order to provide these services and have it work fluidly."
Nirula estimated the U.'s surgical teams may end up doing on-scene amputations up to one to two times per year. Because those emergencies are rare, trauma surgeons at the hospital will periodically drill on how to respond, he said.
University Hospital is one of fewer than 10 hospitals around the country with established plans in place for transporting trauma surgeons to the scene where a person requires "life over limb" rescue, said Dr. Toby Enniss, a trauma surgeon.
"Doing the amputation is not really a technically demanding procedure," Enniss said. "The issue is that we need to be capable and prepared to deal with a critically injured, unstable patient and have the ability to improvise and problem solve basically on the fly in very austere environments."
Enniss has previously earned recognition for his work in one such less-than-favorable environment, when a 19-year-old man became trapped between a load of steel and a freight car at a railroad yard in South Salt Lake in August 2012. Enniss performed an amputation below the knee of the man's left leg at the scene, and today he is a healthy husband and father, the doctor said.
But Ennis also said the incident "really demonstrated this barrier within the trauma system" for patients who cannot be transported.
"Arranging for transportation out to the scene, gathering the supplies and personnel that we would feel we would need at the scene, and arranging for a second helicopter to transport the surgical team to the scene, that whole process took roughly an hour, hour and a half to mobilize everything that was necessary," he said.
Now, Enniss said, "with this program and this protocol and our capabilities, that process would take all of about 10 or 15 minutes, thereby saving what is precious time for a critically injured patient who is not able to be extricated from a dangerous scenario."
Performing an amputation in an unsterilized, potentially even chaotic setting brings with it added risks, including the strong possibility of infection, Ennis said, but it is much preferable to the alternative of an untimely death.
"What we often say in trauma is — somebody needs to survive in order to get an infection," he said.