Prehospital damage-control amputation and packed red blood cell transfusion for severe bilateral lower-limb crush injury in a remote setting: a case report

Abstract

Prehospital damage-control amputation in civilian emergency systems is rare, especially combined with prehospital packed red blood cell transfusion. We report a 30-year-old man with bilateral lower-limb crush injury after entrapment in an industrial roller machine in a remote area. Despite initially preserved blood pressure, he developed marked hemodynamic deterioration and arrived at the hospital with a blood pressure of 74/49 mmHg. Both limbs were non-salvageable. Prehospital bilateral amputation with vascular ligation was performed on scene, followed by transfusion of one local unit of packed red blood cells (~200 ml). He survived after stump revision, intensive care, and rehabilitation. This case describes the sequential use of prehospital hemorrhage control and packed red blood cell transfusion during the same prehospital episode in a patient with a life-threatening entrapment injury and delayed transport.