Prehospital amputation: a scoping review

Cases of severe or complex entrapment pose significant challenges for prehospital clinicians for several reasons. First, the nature of complex entrapments may mean access to provide lifesaving interventions is limited. Second, extrication techniques may create further hazards to both rescuers and patients, such as destabilisation of surrounding structures. These cases are often associated with road traffic crashes (RTC), but may also result from incidents involving industrial machinery and following structural collapses.

Entrapment can be categorised as physical, in which a patient cannot be removed without intervention to create space, or medical, in which factors such as suspected injuries prevent immediate extrication (Fenwick and Nutbeam, 2018). The rate of physical patient entrapment following an RTC is low. A study of all RTCs in the West Midlands requiring fire and rescue service (FRS) attendance for extrication between October 2010 and March 2012 found the rate of physical entrapment to be 12% (36/296) (Fenwick and Nutbeam, 2018). Nonetheless, the length of the prehospital phase of care has been demonstrated to be a significant factor in mortality following trauma (Brown et al, 2016) and entrapment has been observed to be a contributory factor in extending this time period (Dias et al, 2011; Nutbeam et al, 2014).