Life-Saving Under Pressure: KnowEMS Webinar Examines Rare Field Amputation

In a gripping and highly instructive session, the KnowEMS consortium hosted a webinar focusing on one of the most challenging and high-stakes procedures in emergency medicine: a field amputation. The webinar, held on June 26 as part of the EU-funded KnowEMS project, centered on a real-life incident from May 12, 2025, when Israel’s national EMS provider, Magen David Adom (MDA), was called to a catastrophic construction site collapse.

The webinar brought together emergency medical professionals, trauma experts, and rescue personnel to reflect on the complex operation — one that required extreme decision-making, rapid coordination, and a rare surgical intervention under life-threatening conditions.

The Incident: Race Against Time at a Collapsed Construction Site

Upon arriving at the scene of a construction site collapse, MDA teams initially believed the trapped worker was deceased. However, after coordinated efforts with Fire and Rescue personnel, responders were able to partially clear the debris and discovered the victim was alive — albeit in critical condition.

The worker’s left leg was pinned under a large mass of unstable earth. Rescue teams determined that any attempt to remove the debris manually or with tools could trigger a total collapse of the site. In consultation with MDA’s Deputy Director General and trauma specialists at Sheba Medical Center, a rare but necessary decision was made: a field amputation had to be performed to save the worker’s life.

High-Risk Procedure, High-Stakes Conditions

A surgical team — including Sheba Medical Center’s Director of Trauma, a senior orthopedic surgeon, and an anesthesiologist — was urgently dispatched to the site by ambulance, bringing essential equipment and blood supplies. However, the operation was complicated by the hazardous conditions:

• The unstable terrain limited movement and posed a risk of further collapse.
• Sedation and intubation were impossible due to the victim’s position.
• The amputation had to be performed quickly, using pain management only.

Despite the constraints, the team successfully amputated the leg and evacuated the patient. He is now in recovery at Sheba Medical Center, thanks to the swift and collaborative response.

Lessons Learned: Coordination, Training, and Safety

The webinar emphasized several key takeaways from the incident:

• Cross-sector cooperation — between EMS, hospital staff, and Fire and Rescue — was instrumental in achieving a positive outcome.
• Safety management on scene emerged as a critical concern. It was unclear who was responsible for overall scene safety, posing risks to responders.
• EMS personnel are generally not trained for scenarios involving field amputations, highlighting a need for broader education and preparedness.
• Scene organization needs improvement:
  • Too many EMS personnel were near the unstable zone without defined roles.
  • A clear evacuation route for the casualty should have been established earlier.
• Joint decision-making between medical and rescue experts, with constant reassessment, was vital to both the patient’s survival and the safety of responders.
• A practical clinical lesson: tourniquets should be applied “high and tight”—as limb shape may shift post-amputation, causing a poorly placed tourniquet to slip.

A Rare but Crucial Case Study

Field amputations are an absolute last resort — performed only when the risk of death is immediate and all other options are exhausted. As highlighted during the session, this case serves as a powerful learning opportunity for EMS teams across Europe and beyond.

The KnowEMS initiative continues its mission to strengthen emergency medical services through real-world case studies, expert exchange, and cross-border collaboration — ensuring that EMS systems are prepared, not just for routine emergencies, but for the most exceptional challenges they may ever face.