Bringing the operating room to the field: lessons learned from on-scene field amputations.

Introduction: Complicated field extrication may require the assistance of a surgical team to perform an on-scene limb amputation. Although a rare event, when needed, an organized and efficient response is critical to successful outcomes.

Methods: The Los Angeles County Hospital Emergency Response Team (HERT) program and the organization of the team is described, and a multidisciplinary quality improvement process reviewed and analyzed two cases and identified areas for performance improvement.

Results: Experience shapes policy and procedures within the HERT program. The timeliness of HERT activation has a major influence on the success of extrication, and regular drills of the multidisciplinary team consisting of trauma surgeons, emergency physicians, nurses, paramedics, and fire department allow for rapid, effective activation. Post-event quality improvement process reviews the timeline of events, provider activation, communication across field and hospital providers, in-hospital events, and medical decision making throughout. Critical analysis of every step helps prepare for any subsequent encounter.

Conclusion: A well-organized and rehearsed protocol to streamline activation and transportation of a well-trained, designated team, in addition to pre-packaged surgical supplies and an effective communication tree are essential elements of a HERT program.