Emergency Field Amputation in a Resource‑Limited Setting: A Case Report

Emergency Field Amputation in a Resource‑Limited Setting: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Emergency Field Amputation in a Resource‑Limited Setting: A Case Report Sweta Khuraijam, Dr Siddharth Shah, Dr. Jugindra Sorokhaibam, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6920230/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Sep, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted 9 You are reading this latest preprint version Abstract Background Emergency field amputation is an exceptionally sporadic but potentially life-saving intervention in extreme trauma scenarios, particularly in resource-limited environments. Case Presentation We describe a 16-year-old male with a severe crush injury to the proximal thigh, entrapped in industrial machinery. After prolonged, unsuccessful extrication efforts and worsening risk of hemorrhagic shock, a trauma team performed an on-site high-thigh guillotine amputation under ketamine sedation. The patient was stabilized and transferred to a tertiary center for definitive care and rehabilitation. Discussion This case illustrates key challenges in rural trauma care, including decision-making under pressure, ethical consent acquisition, multidisciplinary coordination, and procedural improvisation. The case also highlights the absence of structured field amputation protocols in civilian EMS systems. Conclusion Emergency field amputation should be included in trauma training and protocol development, particularly in rural or industrial settings. Structured algorithms, simulation training, and ethical frameworks are essential to optimize outcomes in rare but high-stakes scenarios. field amputation prehospital trauma care emergency surgery rural EMS case report protocol development Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. Introduction Field amputation in civilian settings is rarely performed and even more rarely documented. While common in military medicine, its inclusion in civilian emergency protocols remains limited. In rural or industrial settings, delays in extrication and transport can necessitate such radical measures. This report underscores the importance of multidisciplinary preparedness for such scenarios. 2. Case Presentation A 16-year-old male became trapped in an industrial brick molding machine, resulting in a severe crush injury to the right proximal thigh. The injury was sustained at approximately 8:00 AM. Initial responders, including local EMS and fire personnel, attempted mechanical extrication using industrial tools but were unsuccessful after over five hours. Upon evaluation, the trauma team found the patient hemodynamically stable but at high risk of deterioration due to active hemorrhage, ischemic pain, and progressive tissue necrosis. The limb was visibly mangled with devascularized and non-viable tissue extending up to the inguinal region. An ATLS-based primary survey showed: Airway: Patent Breathing: RR 22/min, SpO₂ 97% on 2L O₂ Circulation: BP 130/90 mmHg, HR 126 bpm, with active hemorrhage Disability: GCS 15 Exposure: Severe crush injury, abrasions on back and forearms Given the critical condition, verbal consent was obtained from both parents after an urgent explanation of the prognosis and the necessity of the intervention. Sedation was administered using ketamine (total 50 mg IV), maintaining airway reflexes. Field amputation was executed using available tools: a surgical bone saw and scissors, with ligation of the femoral artery and vein to achieve hemostasis. The wound was dressed with pressure bandages and tourniquets, and the patient was transported to the hospital for definitive surgery. At the tertiary center, a hindquarter amputation and subsequent debridement were performed under general anesthesia. Skin grafting was completed on Day 2, and the patient received extensive postoperative care, including physical therapy and psychiatric support. He was discharged home in a stable condition and continues rehabilitation with a multidisciplinary team. 3. Discussion Emergency field amputation in a civilian setting is rarely reported in the literature. It presents a convergence of logistical, procedural, ethical, and emotional challenges that few trauma teams are trained to handle in real time. This case exemplifies a worst-case trauma scenario in a resource-limited, rural setting. 3.1 Unique Challenges of Field Amputation The trauma team encountered a unique scenario requiring both technical and ethical competence. The primary considerations included: Lack of sterile operating conditions Absence of standard surgical equipment Limited ability to monitor vital signs continuously Ethical urgency to obtain informed consent without delay Cross-functional team dynamics among EMS, surgical staff, and firefighters 3.2 Ethical Complexity Informed consent in a field setting under duress is inherently compromised. While verbal consent from the patient’s parents was obtained, the context—a high-stakes, emotionally volatile environment—limits the thoroughness of the consent process. Nevertheless, given the imminent threat to life, the decision complied with emergency medical ethical principles that prioritize saving life over preserving limbs. 3.3 Procedural Considerations Field amputations are rarely taught or simulated in civilian trauma education. This case highlights the need for integrating procedural algorithms that include scoring systems like the Mangled Extremity Severity Score (MESS) 1 and checklists for resource improvisation. Training for rapid vascular control, pain management in the field, and hemostatic techniques is essential. 3.4 Interdisciplinary Coordination The efficiency of the procedure hinged on interagency collaboration. Roles were divided between team members from EMS, surgical services, and fire rescue. A designated team leader ensured coordinated decision-making and task delegation, which minimized delay and reduced errors under pressure. 3.5 Psychological Aftermath Both the trauma team and the patient faced psychological repercussions. Field amputations are emotionally charged, and post-event debriefing and mental health support should be embedded into trauma care protocols. 3.6 Protocol Development Recommendations We propose the following guidelines be considered for future trauma system enhancements: Integration of Field Amputation Protocols in national EMS and disaster manuals 2,3 . Availability of Emergency Surgical Kits , including bone saws, sterile blades, vascular clamps, and sedation agents. Simulation Drills that include ethical role-playing and interdisciplinary response planning 4 . Consent Frameworks allowing dual-physician approval in incapacitated patients. Mental Health Support Systems for trauma providers post-field surgery 5,6 . 4. Conclusion This case illustrates the life-saving potential of emergency field amputation in a civilian context and underscores the need for structural, educational, and procedural preparedness. By incorporating such rare but necessary procedures into rural trauma planning and national EMS protocols, survival outcomes can be significantly improved for future patients in similarly austere conditions. Declarations Funding: The authors declare that no funding was received for the preparation of this manuscript, or the clinical care described in the case report. Ethical approval: Not Applicable Conflict of interest: The authors declare no conflicts of interest. Data availability: All relevant data are available upon reasonable request. Author Contributions Dr. Sweta Khuraijam – Conceptualization, prehospital intervention, manuscript drafting. Dr. Siddharth Shah – Surgical planning, literature review, manuscript editing. Dr. Jugindra Sorokhaibam – Operative support, clinical supervision, critical manuscript review. Dr. Kalpesh Ram – Data collection, case documentation. Dr. Nabakishore Haobijam – Operative technique, literature synthesis. Dr. Praneetha Vijayan – Anesthesia management, ethics consultation, follow-up coordination. All authors have read and approved the final manuscript and meet ICMJE authorship criteria. CONSENT TO PUBLISH Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. References Bosse MJ, et al. A prospective evaluation of the Mangled Extremity Severity Score. J Bone Joint Surg Am. 2001;83(5):793–7. Webb LX, Bosse MJ, Castillo R. High-energy open fractures. Orthop Clin North Am. 1993;24(3):457–63. Schultz CH, Koenig KL. Disaster management and field amputation. Prehospital Disaster Med. 1992;7(4):368–74. Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings. J Trauma. 2002;53(2):201–12. Hirshberg A, Mattox KL. Planned reoperation for severe trauma. Ann Surg. 1995;222(1):3–8. Smith J, Greaves I. Emergency field amputations: a review. Emerg Med J. 2003;20(5):357–60. Supplementary Materials Supplementary files 1 and 2 are not available with this version. - Supplement 1: Field Amputation Readiness Checklist - Supplement 2: Prehospital Entrapment Decision Algorithm (based on MESS and clinical criteria)" Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Sep, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted Editorial decision: Revision requested 26 Jul, 2025 Reviews received at journal 14 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviews received at journal 09 Jul, 2025 Reviewers agreed at journal 09 Jul, 2025 Reviewers invited by journal 09 Jul, 2025 Editor assigned by journal 07 Jul, 2025 Submission checks completed at journal 07 Jul, 2025 First submitted to journal 18 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6920230","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":482933570,"identity":"8301be1d-d0bb-48f9-a45e-5aba7478453c","order_by":0,"name":"Sweta 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Introduction","content":"\u003cp\u003eField amputation in civilian settings is rarely performed and even more rarely documented. While common in military medicine, its inclusion in civilian emergency protocols remains limited. In rural or industrial settings, delays in extrication and transport can necessitate such radical measures. This report underscores the importance of multidisciplinary preparedness for such scenarios.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cp\u003eA 16-year-old male became trapped in an industrial brick molding machine, resulting in a severe crush injury to the right proximal thigh. The injury was sustained at approximately 8:00 AM. Initial responders, including local EMS and fire personnel, attempted mechanical extrication using industrial tools but were unsuccessful after over five hours.\u003c/p\u003e\u003cp\u003eUpon evaluation, the trauma team found the patient hemodynamically stable but at high risk of deterioration due to active hemorrhage, ischemic pain, and progressive tissue necrosis. The limb was visibly mangled with devascularized and non-viable tissue extending up to the inguinal region.\u003c/p\u003e\u003cp\u003eAn ATLS-based primary survey showed:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAirway: Patent\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBreathing: RR 22/min, SpO₂ 97% on 2L O₂\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCirculation: BP 130/90 mmHg, HR 126 bpm, with active hemorrhage\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDisability: GCS 15\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eExposure: Severe crush injury, abrasions on back and forearms\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eGiven the critical condition, verbal consent was obtained from both parents after an urgent explanation of the prognosis and the necessity of the intervention. Sedation was administered using ketamine (total 50 mg IV), maintaining airway reflexes. Field amputation was executed using available tools: a surgical bone saw and scissors, with ligation of the femoral artery and vein to achieve hemostasis. The wound was dressed with pressure bandages and tourniquets, and the patient was transported to the hospital for definitive surgery.\u003c/p\u003e\u003cp\u003eAt the tertiary center, a hindquarter amputation and subsequent debridement were performed under general anesthesia. Skin grafting was completed on Day 2, and the patient received extensive postoperative care, including physical therapy and psychiatric support. He was discharged home in a stable condition and continues rehabilitation with a multidisciplinary team.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eEmergency field amputation in a civilian setting is rarely reported in the literature. It presents a convergence of logistical, procedural, ethical, and emotional challenges that few trauma teams are trained to handle in real time. This case exemplifies a worst-case trauma scenario in a resource-limited, rural setting.\u003c/p\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Unique Challenges of Field Amputation\u003c/h2\u003e\u003cp\u003eThe trauma team encountered a unique scenario requiring both technical and ethical competence. The primary considerations included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eLack of sterile operating conditions\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAbsence of standard surgical equipment\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLimited ability to monitor vital signs continuously\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEthical urgency to obtain informed consent without delay\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCross-functional team dynamics among EMS, surgical staff, and firefighters\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Ethical Complexity\u003c/h2\u003e\u003cp\u003eInformed consent in a field setting under duress is inherently compromised. While verbal consent from the patient\u0026rsquo;s parents was obtained, the context\u0026mdash;a high-stakes, emotionally volatile environment\u0026mdash;limits the thoroughness of the consent process. Nevertheless, given the imminent threat to life, the decision complied with emergency medical ethical principles that prioritize saving life over preserving limbs.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Procedural Considerations\u003c/h2\u003e\u003cp\u003eField amputations are rarely taught or simulated in civilian trauma education. This case highlights the need for integrating procedural algorithms that include scoring systems like the Mangled Extremity Severity Score (MESS)\u003csup\u003e1\u003c/sup\u003eand checklists for resource improvisation. Training for rapid vascular control, pain management in the field, and hemostatic techniques is essential.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Interdisciplinary Coordination\u003c/h2\u003e\u003cp\u003eThe efficiency of the procedure hinged on interagency collaboration. Roles were divided between team members from EMS, surgical services, and fire rescue. A designated team leader ensured coordinated decision-making and task delegation, which minimized delay and reduced errors under pressure.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Psychological Aftermath\u003c/h2\u003e\u003cp\u003eBoth the trauma team and the patient faced psychological repercussions. Field amputations are emotionally charged, and post-event debriefing and mental health support should be embedded into trauma care protocols.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Protocol Development Recommendations\u003c/h2\u003e\u003cp\u003eWe propose the following guidelines be considered for future trauma system enhancements:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIntegration of Field Amputation Protocols\u003c/b\u003e in national EMS and disaster manuals \u003csup\u003e2,3\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eAvailability of Emergency Surgical Kits\u003c/b\u003e, including bone saws, sterile blades, vascular clamps, and sedation agents.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSimulation Drills\u003c/b\u003e that include ethical role-playing and interdisciplinary response planning\u003csup\u003e4\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eConsent Frameworks\u003c/b\u003e allowing dual-physician approval in incapacitated patients.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eMental Health Support Systems\u003c/b\u003e for trauma providers post-field surgery\u003csup\u003e5,6\u003c/sup\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThis case illustrates the life-saving potential of emergency field amputation in a civilian context and underscores the need for structural, educational, and procedural preparedness. By incorporating such rare but necessary procedures into rural trauma planning and national EMS protocols, survival outcomes can be significantly improved for future patients in similarly austere conditions.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: The authors declare that \u003cstrong\u003eno funding\u003c/strong\u003e was received for the preparation of this manuscript, or the clinical care described in the case report.\u003c/p\u003e\n\u003cp\u003eEthical approval: Not Applicable\u003c/p\u003e\n\u003cp\u003eConflict of interest: The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003eData availability: All relevant data are available upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Sweta Khuraijam \u0026ndash; Conceptualization, prehospital intervention, manuscript drafting.\u003c/p\u003e\n\u003cp\u003eDr. Siddharth Shah \u0026ndash; Surgical planning, literature review, manuscript editing.\u003c/p\u003e\n\u003cp\u003eDr. Jugindra Sorokhaibam \u0026ndash; Operative support, clinical supervision, critical manuscript review.\u003c/p\u003e\n\u003cp\u003eDr. Kalpesh Ram \u0026ndash; Data collection, case documentation.\u003c/p\u003e\n\u003cp\u003eDr. Nabakishore Haobijam \u0026ndash; Operative technique, literature synthesis.\u003c/p\u003e\n\u003cp\u003eDr. Praneetha Vijayan \u0026ndash; Anesthesia management, ethics consultation, follow-up coordination.\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript and meet ICMJE authorship criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT TO PUBLISH\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient.\u003c/p\u003e\n\u003cp\u003eA copy of the consent form is available for review by the Editor of this journal.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBosse MJ, et al. A prospective evaluation of the Mangled Extremity Severity Score. J Bone Joint Surg Am. 2001;83(5):793\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eWebb LX, Bosse MJ, Castillo R. High-energy open fractures. Orthop Clin North Am. 1993;24(3):457\u0026ndash;63.\u003c/li\u003e\n\u003cli\u003eSchultz CH, Koenig KL. Disaster management and field amputation. Prehospital Disaster Med. 1992;7(4):368\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eFrykberg ER. Medical management of disasters and mass casualties from terrorist bombings. J Trauma. 2002;53(2):201\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eHirshberg A, Mattox KL. Planned reoperation for severe trauma. Ann Surg. 1995;222(1):3\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eSmith J, Greaves I. Emergency field amputations: a review. Emerg Med J. 2003;20(5):357\u0026ndash;60.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Supplementary Materials","content":"\u003cp\u003eSupplementary files 1 and 2 are not available with this version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size: inherit;\"\u003e- Supplement 1: Field Amputation Readiness Checklist\u003c/span\u003e\u003cbr\u003e\u003cspan style=\"font-size: inherit;\"\u003e- Supplement 2: Prehospital Entrapment Decision Algorithm (based on MESS and clinical criteria)\u0026quot;\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"field amputation, prehospital trauma care, emergency surgery, rural EMS, case report, protocol development","lastPublishedDoi":"10.21203/rs.3.rs-6920230/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6920230/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmergency field amputation is an exceptionally sporadic but potentially life-saving intervention in extreme trauma scenarios, particularly in resource-limited environments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe describe a 16-year-old male with a severe crush injury to the proximal thigh, entrapped in industrial machinery. After prolonged, unsuccessful extrication efforts and worsening risk of hemorrhagic shock, a trauma team performed an on-site high-thigh guillotine amputation under ketamine sedation. The patient was stabilized and transferred to a tertiary center for definitive care and rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case illustrates key challenges in rural trauma care, including decision-making under pressure, ethical consent acquisition, multidisciplinary coordination, and procedural improvisation. The case also highlights the absence of structured field amputation protocols in civilian EMS systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmergency field amputation should be included in trauma training and protocol development, particularly in rural or industrial settings. Structured algorithms, simulation training, and ethical frameworks are essential to optimize outcomes in rare but high-stakes scenarios.\u003c/p\u003e","manuscriptTitle":"Emergency Field Amputation in a Resource‑Limited Setting: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 00:34:03","doi":"10.21203/rs.3.rs-6920230/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-26T11:20:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-14T10:59:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173391702613856438663760922429818110763","date":"2025-07-09T11:17:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-09T08:22:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136826211932387927780464668230211244279","date":"2025-07-09T08:11:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-09T07:52:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-07T04:55:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-07T04:55:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2025-06-18T07:18:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2b1198b-4ef9-46f7-90fe-bcfd8ca4b02f","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:02:01+00:00","versionOfRecord":{"articleIdentity":"rs-6920230","link":"https://doi.org/10.1186/s12245-025-00986-1","journal":{"identity":"international-journal-of-emergency-medicine","isVorOnly":false,"title":"International Journal of Emergency Medicine"},"publishedOn":"2025-09-30 15:56:59","publishedOnDateReadable":"September 30th, 2025"},"versionCreatedAt":"2025-07-17 00:34:03","video":"","vorDoi":"10.1186/s12245-025-00986-1","vorDoiUrl":"https://doi.org/10.1186/s12245-025-00986-1","workflowStages":[]},"version":"v1","identity":"rs-6920230","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6920230","identity":"rs-6920230","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}