A paper in EMJ compares various methods for performing field amputations. I can’t say I ever had to do one myself. However, some of the people I work with have performed amputations on rapidly deteriorating entrapped trauma victims.
Most them have relied on the standard Gigli technique where they scalpel the soft tissues and cut the bone with the Gigli saw. Apparently it is painfully slow, especially as it is performed on a trauma patient that is super sick. One colleague recommends using the firemens’ pneumatic cutters.
Cadaver study comparing four amputation methods. All techniques relied on equipment that is readily available in the prehospital environment.
Time to full amputation of the femoral bone being the primary outcome. Secondary outcomes was the quality of the cut as graded by a home-made scaling system (1= Very poor cut to 5=excellent quality smooth cut with minimal tissue injury).
The methods compared were
- The classic Gigli technique where soft tissues are cut with a scalpel followed by Gigli-ing the bone.
- Fire service hacksaw.
- Holmatro ‘Jaws of Life’ pneumatic cutters.
- Battery driven reciprocating saw cutting through soft tissue and bone.
The Reciprocating saw was the fastest, achieving amputation at 22 seconds with high quality cuts. Unfortunately it resulted in significant spraying and aerosolisation of blood and tissue that would require a visor and a FFP3-grade breathing protection.
The Holmatro achieved amputation at 53 seconds. Some remaining soft tissue was cut with trauma shears. This technique resulted in the worst quality cuts as it resulted in significant bone splintering and soft tissue injury.
The Hacksaw required 88 seconds and resulted in excellent quality cuts. Authors noted that this technique required someone stabilising the leg.
The Gigli saw technique required 91 seconds.
The Jaws of Life cutters is a reasonable alternative to the Gigli as it is much faster. The reciprocating saw less so given the aerosolisation and risk of contamination.
I recommend downloading and reading the paper. It is open access and lives here: