Skip to main content
    • Aa
    • Aa

Consensus Statements Regarding the Multidisciplinary Care of Limb Amputation Patients in Disasters or Humanitarian Emergencies: Report of the 2011 Humanitarian Action Summit Surgical Working Group on Amputations Following Disasters or Conflict

  • Lisa Marie Knowlton (a1), James E Gosney (a2), Smita Chackungal (a3), Eric Altschuler (a4), Lynn Black (a5), Frederick M Burkle (a6), Kathleen Casey (a7), David Crandell (a8), Didier Demey (a9), Lillian Di Giacomo (a10), Lena Dohlman (a11), Joshua Goldstein (a12), Richard Gosselin (a13), Keita Ikeda (a14), Andree Le Roy (a15), Allison Linden (a16), Catherine M Mullaly (a17), Jason Nickerson (a18), Colleen O'Connell (a19), Anthony D Redmond (a20), Adam Richards (a21), Robert Rufsvold (a22), Anna LR Santos (a23), Terri Skelton (a24) and Kelly McQueen (a25)...

Limb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies. Expanded planning is needed for a multidisciplinary surgical care team, inclusive of surgeons, anesthesiologists, rehabilitation specialists and mental health professionals. Surgical providers should approach amputation using an operative technique that optimizes limb length and prosthetic fitting. Appropriate anesthesia care involves both peri-operative and long-term pain control. Rehabilitation specialists must be involved early in treatment, ideally before amputation, and should educate the surgical team in prosthetic considerations. Mental health specialists must be included to help the patient with community reintegration. A key step in developing local health systemsis the establishment of surgical outcomes monitoring. Such monitoring can optimizepatient follow-up and foster professional accountability for the treatment of amputation patients in disaster settings and humanitarian emergencies.

Corresponding author
Corresponding Author: Lisa Marie Knowlton, MD, MPH Division of General Surgery, University of British Columbia, 910 West 10th Avenue, Room 3100, Vancouver, British Columbia Canada V5Z 4E3, E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

5. MD Landry , C O'Connell , G Tardif , A Burns . Post-earthquake Haiti: the critical role for rehabilitation services following a humanitarian crisis. Disability and Rehabilitation, 2010; 32(19): 16161618.

7. O Merin , A Nachman , G Levy , MJ Schwaber , Y Kreiss . The Israeli Field Hospital in Haiti – Ethical Dilemmas in Early Disaster Response. N Engl J Med, 2010;362(38): 13.

25. Oda . Crush syndrome sustained in the 1995 Kobe, Japan, earthquake; treatment and outcome. Ann Emerg Med (1997) vol. 30 (4) pp. 507–12.

27. Buckenmaier . Continuous peripheral nerve block for battlefield anesthesia and evacuation. RegAnesth Pain Med (2005) vol. 30 (2) pp. 202–5.

28. Neal . ASRA practice advisory on local anesthetic systemic toxicity. RegAnesth Pain Med (2010) vol. 35 (2) pp. 152–61.

30. D Lohman , R Schleifer , JJ Amon . Access to Pain Treatment as a Human Right. BMC Med. 2010;8:8.

31. F Brennen , D.B Carr , M Cousins : Pain Management: A Fundamental Human Right. Anesthesia and Analgesia. 2007;105(1):205221.

32. R Craven : Ketamine. Anesthesia. 2007;62(Suppl 1):4853.

33. Bonanno . Ketamine in war/tropical surgery (a final tribute to the racemic mixture). Injury (2002) vol. 33 (4) pp. 323–7.

34. T Schnittger : Regional anesthesia in Developing Countries. Anesthesia. 2007; 62(Suppl. 1):4247.

37.American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the peri-operative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2004;100:15731581.

38. Bone . Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. RegAnesth Pain Med (2002) vol. 27 (5) pp. 481–6.

40. Barbosa . Neuraxialanaesthesia for lower-limb revascularization. Cochrane Database Syst Rev (2010) (1) pp. CD007083.

41. Martin . Severe phantom leg pain in an amputee after lumbar plexus block. RegAnesth Pain Med (2003) vol. 28 (5) pp. 475–8.

42. Scheman . Flashback and nightmares after surgery under neuraxial anesthesia: a report of two cases. Arch Phys Med Rehabil (1998) vol. 79 (5) pp. 579–81.

44. VS Ramachandran , D Rogers-Ramachandran , S Cobb . Touching the phantom limb. Nature. 1995 Oct 12;377(6549):489–90.

45. BL Chan , R Witt , AP Charrow , A Magee , R Howard , PF Pasquina , KM Heilman , JW Tsao . Mirror therapy for phantom limb pain. New Engl J Med. 2007 Nov 22;357(21):2206–7.

46. VS Ramachandran , EL Altschuler . The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain. 2009 Jul;132(Pt 7):1693–710.

48. A Gawande . Casualties of War – Military Care for the Wounded from Iraq and Afghanistan. N Engl J Med. 2004;351:24712475.

49. JC Clasper . Regional anesthesia, ballistic limb trauma and acute compartment syndrome. JR Army Med Corps. 2010 Jun;156(2):77–8.

50. SJ Mannion , E Chaloner . Principles of war surgery. Br Med J 2005; 330:14981500.

62. BK Potter , CR Scoville . Amputation is not isolated: an overview of the U.S. Army amputee patient care program and associated amputee injuries. J Am AcadOrthop Surg. 2006;14:S188S190.

64. K Chu . Improving Effective Surgical Delivery in Humanitarian Disasters: Lessons from Haiti. PLOS Medicine. 2011;8(4):14.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 2
Total number of PDF views: 26 *
Loading metrics...

Abstract views

Total abstract views: 266 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st September 2017. This data will be updated every 24 hours.