Auckland HEMS has recently added a Gigli saw to the medical pack in case a patient requires prehospital amputation. Fortunately the team has not yet been required to perform this procedure. Anecdotally, prehospital amputations that have been performed by paramedic staffed EMS in the Auckland area in recent years have involved near-total amputation due to injury itself, with limbs attached with minimal skin or soft tissue.
EMJ published an excellent review article of the procedure in 2010, which covers indications, contraindications, and technique. Click HERE for the full pdf (secure area limited to ADHB staff, who have access to this journal via the Philson Library at the University of Auckland School of Medicine)
The Medical College of Wisconsin has produced 3 educational videos, and made available a field manual for physicians who provide assistance to fire crews and EMS in the field.
Click HERE for a brief case report of a prehospital amputation performed by an anaesthetist and a urologist using a torch, some ketamine, and a Leatherman tool following the 2013 Christchurch earthquake.
Sydney HEMS has also produced a video, complete with a maudlin French musical accompaniment (!) demonstrating use of the Gigli saw on a deer limb:
FIELD AMPUTATION: Introduction
FIELD AMPUTATION: Upper limb
FIELD AMPUTATION: Lower limb
FIELD AMPUTATION: Australian deer has a rough day
This presentation is from the ANZCA Airway Management and Trauma Special Interest Group Meeting in June 2013. It is delivered by Minh Le Cong (RFDS medical officer, Assistant Professor in Retrieval Medicine, and the world’s most ardent advocate for ketamine..)
If you haven’t already checked out Minh’s superb prehospital website, click HERE