After spending four days with a group of industrial first responders I have enough hand and finger crush, degloving, and amputation stories to last the rest of my careers as an EMS educator. I was really surprised at the frequency which the students respond to hand and finger trauma ranging from simple lacerations to full arm crush incidents that involve complex and long extrication.
These are Everyday EMS Tips for hand and finger trauma emergencies.
1. Ensure that all machinery is turned off and locked from being turned on before assessing the severity of injury.
2. Only return power to machines, if required for extrication (to back out a crushed hand or arm) under the watchful guidance of machinery experts.
3. If sending someone to search for an amputated finger, hand, or arm make sure they know:
- what they are looking for
- how to handle the body part
- how to package the body part
- where to bring the part to
4. Remember amputated body parts should be wrapped in gauze, placed in a plastic bag, and placed on ice (not in ice).
5. Don’t assume that a body part can’t be reattached. Let the patient and their doctor make that decision. One of the students had part of her pointer finger amputated many years ago. To her surprise and continuing delight the finger was reattached hours after the amputation and has near 100% normal function.
6. It is often more safe to assess and treat the patient away from the area of injury. The work area may be small, elevated, noisy, dirty, and have ongoing dangers. If the patient is ambulatory, without a MOI for spine injury, move to a safer location as soon as appropriate.
7. Control bleeding with well-aimed direct pressure. Most of the students reported that the amputation and degloving injuries they have assessed (and experienced) had minimal bleeding.
8. Use a splint to minimize movement of the injured finger, hand, or extremity. A good splint helps with pain control.
9. Whenever possible transport the amputated body part with the patient. If the body part is not located before transport is initiated label the bag with the patient’s name and other identifiers. Transport the body part to the patient’s current location which may be different from the original transport destination.
Are you aware of online education resources specific to EMTs and Paramedics? Share those resources in the comments area.
This is the 11th post in the Everyday EMS Tips 31 Days of Continuing Education series.