This is a guest post by Dan Williams. If you want to guest post on this blog, check out the guidelines here.
There are three main staples to Wisconsin winters: Snow, snow blowers, and amputations.
When the first heavy and wet snow of the year arrives, it is not a matter of if amputations will occur, but rather how many. During the recent blizzard of early December 2009, hospitals in my region of south central Wisconsin were inundated with snow blower induced amputations, deglovings, and crush-injuries.
Though the mechanism of injury has not changed since the invention of the snow blower, the treatment has. These are my Everyday EMS Tips for treatment of traumatic hand and finger injuries:
- INJURY PREVENTION: All good treatment plans begin with injury prevention. Perhaps timely billboard, website, or other postings reminding the side-walk warriors to turn-off the machines, unplug the spark-plugs, and use tools to remove snow jams.
- Determine the extent of injury: Lacerations vs. amputations, number of amputations, extent of bleeding, need for bleeding control.
- Control active bleeding with direct pressure. If needed, apply a tourniquet based on your local protocols. All too often we simply cover these injuries with a loose dressing prior to controlling active bleeding.
- Locate all amputated parts as soon as possible. Keep them as clean as possible.
- Wrap the amputated parts in a DRY and STERILE dressing, and place them in a plastic bag. No more wet dressings…and no more milk baths!
- Transport the parts on a cold-compress or other chilled surface. DO NOT ALLOW THE PARTS TO FREEZE. Do not pack them surrounded by ice. If the tissue freezes, it may not be re-attachable.
- Splint the injury site. Minimizing movement of the injured extremities will go a long way in reducing pain.
- Manage the patient’s pain. Fingers and hands have many nerve-endings. Be aggressive in pain management medication administration if your level-of-care/protocols allow.
- Transport to an appropriate trauma care facility that is capable of managing your patient’s trauma care needs (micro-surgery, plastic surgery)
Dan Williams is a firefighter/paramedic in south central Wisconsin. He is also the coordinator for the South Central Regional Trauma Advisory Council.
