Experiences from Afghanistan: Traumatic lower extremity amputation in the combat zone

Experiences from Afghanistan: Traumatic lower extremity amputation in the combat zone

Background
Improvised explosive devices (IEDs) are a frightening weapon used by terrorists in the both the Afghanistan combat zone and in the civilian environment. In this presentation, the experiences of a former Australian Army Advanced Medical Operator in relation to the treatment of traumatic lower extremity amputations in the combat zone are discussed.

Methods
In addition to Australian Army medical practices and procedures, a personal narrative approach is used to discuss the management of traumatic amputations in a combat zone.

Results
Patients with traumatic amputation from an IED rarely have one isolated injury. Shrapnel injuries, burns, barotrauma, fractures and internal haemorrhage are commonly present as well. In the military setting, there are two phases of care in the field. First, in the ‘care under fire phase’ tourniquets are applied if possible, or direct pressure and haemostatic agents are used as an alternative. Tension pneumothoraxes are decompressed and immediate evacuation is then arranged. Second, the tactical field care phase involves spinal precautions, further haemorrhage control, the application of wound dressings and tractions splints and the administration of pain relief and IV fluids. Last, all interventions must be secured correctly to facilitate a rapid aero-medical evacuation.

Conclusion
While the combat zone differs greatly to the civilian environment, many of the principals involved in the treatment of traumatic lower extremity amputation are similar. These involve haemorrhage control, treating life threatening injuries, and rapid extrication and transport to definitive care.