IMMEDIATELY AFTER a traumatic amputation, prompt first aid limits blood loss, prevents shock, and increases the victim's chance for a successful reimplantation. Applying first aid with skill in this frightening situation also helps calm the victim and bystanders.
Treat the victim first
If the victim is alert, tell him to cover the wound with clean, dry material and apply firm pressure while you put on protective gear. If bleeding is severe or he's feeling light-headed, have him lie down and elevate his feet to increase blood pressure. (Act to preserve the amputated part only after the bleeding is controlled.) Take necessary actions to protect yourself from injury, such as turning off dangerous machinery. Direct someone to call 911, then intervene as follows.
* Assess the victim. Be alert for any conditions that might be a more immediate threat than blood loss, such as airway or breathing problems.
* Examine the amputation site. If it's actively bleeding, apply firm, direct pressure with layers of dry dressing over the wound and elevate the site above the victim's heart level. If this doesn't control the hemorrhage, apply pressure over the pulse points of arteries proximal to the wound.
* Continue to pile dry dressings over the injury. Don't remove saturated dressings, which could disrupt clots. Apply an elastic bandage or blood pressure cuff, if available, to provide compression proximal to the bleeding site. Prepare to apply a tourniquet if the hemorrhage appears to be life-threatening and other techniques to stop the bleeding aren't working.
* Take baseline vital signs. Find out how and when the injury occurred and whether the victim has a medical condition or takes medication that predisposes him to hemorrhage.
Preserve the severed part
Take these actions to preserve the amputated part.
* If the part isn't completely severed, use the bulky dressings applied for hemorrhage control to splint the injured area and protect it from further trauma. If amputation is complete, wrap the part in clean, dry gauze or other dressing material-sterile is best.
* Place the gauze-wrapped part in a watertight plastic bag and seal the bag. Get a container for water-a larger plastic bag will do-then add 1 part ice to 3 parts water to make a slurry.
* Immerse the bag containing the amputated part in the slurry. Don't let the body part get wet or freeze, which can jeopardize the potential for reattachment. Make sure the amputated part is transported with the victim to the hospital.
Pass on information
Report to the emergency medical service providers how and when the injury occurred as the victim or bystanders described it. Note any first-aid measures he used before seeking help, if applicable. Communicate your assessment findings, emergency care interventions, and his response. The time the body part was amputated and the techniques used to preserve it are especially important.
Ordinary items you can use to help
* sterile gauze or any clean, dry material. Washcloths, towels, clothing, and even feminine hygiene products such as sanitary napkins will work.
* several sealable watertight plastic bags of various sizes
* ice and water
Dressing up to give first aid
* Consider keeping clean gloves in your purse, car, jacket pockets, and in home and auto first-aid kits for ready access. Replace them at least once a year because exposure to heat and cold can cause the material to crack.
* Use eyeglasses, ski goggles, or lab glasses as eye protection in a pinch.
* A surgical mask or face shield is useful to protect against spattering blood, but you can use a scarf or similar item when you're in a hurry.
Linda Laskowski-Jones is the director of trauma, emergency, and aeromedical services at Christiana Care Health System, Christiana Hospital, in Newark, Del. Meet Ms. Laskowski-Jones, who's speaking at the Nursing2006 Symposium in Las Vegas, Nev., April 18 to 21, 2006.
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