IMPROVED HANDLES FOR A PREHOSPITAL AMPUTATION SAW To the Editor:—There have been several reports of trapped patients requiring emergent limb amputa- tions to facilitate extrication in the civilian prehospital setting. 1,2 Some authors recommend that large emergency departments capable of sending a physician to the field develop a kit with prehospital amputation supplies assembled and ready to deploy in the event a field amputation becomes neces- sary. 3 This simple step of prepara- tion can save time and potentially improve outcomes in critically injured patients. In preparing such a kit for our institution’s prehospital rapid response team, we chose to include a standard surgical manual bone saw (Gigli saw). We noted that the saw was supplied as an inexpen- sive flexible disposable blade, with a pair of reusable stainless steel handles available separately (Fig. 1). The standard metal handle is surprisingly dainty, and would be difficult to hold and manipulate in the less-than-optimal positioning and conditions to be expected in the field. Further, the cost of the handles ($95–$140 per pair) was felt to be prohibitive for equipment that would rarely, if ever, be used. To address these issues, we have developed and fabricated an inex- pensive replacement for the manual bone saw handles. A length of 0.5- inch (1.3-cm) diameter PVC plumb- ing pipe is cut into two 4.25-inch (10.8-cm) sections. Into each is inserted a 1.5-inch (3.8-cm) hook, perpendicular to the length of pipe at the halfway point. The inner por- tion of the pipe is then filled with fast-drying Epoxy Repair Putty (Midwest Fastener Corporation, Kalamazoo, MI), which is able to withstand the heat and pressure of autoclave sterilization. This both secures the hook and adds mass to the handles. These handles can be easily fabri- cated from supplies available at a hardware store for less than $10. They are large and heavy enough to be firmly gripped in the field and can be sterilized in a standard fash- ion. We feel that these features make them a significant improve- ment over the small, expensive standard Gigli handles for applica- tion in the prehospital environment. Importantly, users of this type of handle should note that the loops at each end of the flexible saw blade should be enlarged slightly to fit easily on the hooks of the han- dles by inserting and twisting a surgical clamp (or similar tool). We recommend that this be done prior to use and that the blade and han- dles be packaged and sterilized together, ready for use in the field. WILLIAM P. BOZEMAN, MD DAVID J. VUKICH, MD Department of Emergency Medicine University of Florida Health Science Center Jacksonville, Florida References 1. Kampen KE, Krohmer JR, Jones JS, Dougherty JM, Bonness RK. In-field extremity amputation: prevalence and protocols in emergency medical servic- es. Prehosp Disaster Med. 1996;11:63-6. 2. Foil MB, Cunningham PR, Hale JC, Benson NH, Treurniet S. Civilian field surgery in the rural trauma setting: a proposal for providing optimal care. J Natl Med Assoc. 1992;84:787-9. 3. Jaslow D, Barbera JA, Desai S, Jolly BT. An emergency department–based field response team: case report and recom- mendations for a “go team.” Prehosp Emerg Care. 1998;2:81-5. 415 LETTER TO THE EDITOR FIGURE 1. The Gigli saw blade (top), standard handle (bottom), and custom-fabricated handle (left).