title: 'Time critical' rapid amputation using fire service hydraulic cutting equipment.
abstract: BACKGROUND
  Entrapped trauma victims require extrication, which, on rare occasions, may involve amputation of a limb. Standard extrication techniques sometimes fail or may be impossible, leading to the death of the entrapped victim. We propose that the use of fire service hydraulic cutting equipment can be used effectively to urgently amputate a limb, where conventional techniques are unusable.
  
  
  METHODS
  The study aims to determine: (i) the potential use of this equipment to achieve expeditious life-saving amputations and (ii) the effect the fire service hydraulic cutting equipment has on the bony and surrounding soft tissues. Initially a porcine limb was used followed by fresh-frozen cadaveric lower limbs. We recorded the time, number of cuts, proximal fracture propagation and quality of bone cut when performing amputations at five levels.
  
  
  RESULTS
  The experiment confirms that faster guillotine amputations in human cadaveric lower limb specimens can be achieved by using fire service hydraulic cutting equipment. Overall, the average time to complete an amputation in these ideal experimental circumstances at all five levels was quicker using the hydraulic cutting equipment. Either one or two cutting actions were required to achieve the amputation using fire service hydraulic cutting equipment. The degree and proximal extent of the comminution were greater using the fire service hydraulic cutting equipment.
  
  
  CONCLUSIONS
  If circumstances and time constrains allow, a conventional amputation technique carried out by a trained medical practitioner would be preferable to the use of the fire service hydraulic cutting equipment. However, we feel that this technique could be used to perform emergent amputation under trained medical supervision, if it is felt that a standard amputation technique would take too long or the environment is too restrictive to perform a standard amputation safely.
authors.affiliation: Department of Orthopaedics & Trauma, North Cheshire Hospitals NHS Trust, Warrington, Lovely Lane WA5 1QG, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: McNicholas
authors.forename: S J
authors.initials: SJ
authors.lastname: Robinson
authors.forename: I
authors.initials: I
authors.lastname: Polyzois
authors.forename: I
authors.initials: I
authors.lastname: Dunbar
authors.forename: A P
authors.initials: AP
authors.lastname: Payne
authors.forename: M
authors.initials: M
authors.lastname: Forrest
mesh_terms: D000671:Amputation, Surgical / Q000295:instrumentation* / Q000379:methods; D000818:Animals; D000842:Ankle / Q000601:surgery; D002102:Cadaver; D004630:Emergencies; D004638:Emergency Treatment / Q000295:instrumentation* / Q000379:methods; D061388:Firefighters; D006801:Humans; D007866:Leg / Q000601:surgery*; D013552:Swine; D013997:Time Factors; D006113:United Kingdom