Pieces and Parts

You're driving to the range, sipping your coffee one morning and all of a sudden the motorcycle in front of you wobbles and crashes on the highway. The driver careens down the road on his back, over the shoulder of the road and impacts a road sign support post with the right side of his body and cartwheels into the ditch. You pull over, turn your flashers on, call 911 and give them your location and the nature of the accident, grab your D.A.R.K. (Direct Action Response Kit) and head down to the ditch. The motorcyclist still has his helmet on and is yelling for help and waving at you with both arms. The only problem with that is that one of his arms is missing below the elbow and he's losing a lot of blood. What do you do?

So, we're now dealing with a traumatic amputation and the very real possibility of this person bleeding to death from a massive hemorrhage. At this moment, the most important thing is to stop the bleeding. Utilize the TQ in your D.A.R.K. Put your gloves on and apply the TQ high on the affected limb so that it's compressing the artery against the long bone in the upper arm, the humerus. Tighten it until ALL of the bleeding stops. No oozing allowed. Then you grab the 4” Emergency Bandage out of the kit and dress the stump with some good in-line axial pressure. Make sure any exposed bone is dressed and covered as well. Remember, bone tissue is living tissue. The less it’s damaged, the better the outcome will be. The care you take of the bone in an amputation may mean the difference between an articulating and a non-articulating prosthesis and that’s a huge quality of life issue. Keep talking to them and reassuring them that help is on the way and to stay in the fight.

If the victim is talking to you and is alert and conscious, you've got airway, breathing, circulation and “Da Brain” covered. Look them over carefully for any other injuries and utilize the other kit portions as necessary. Ask them if they remember what happened, what day, month and year it is. Do a quick pupil check. The helmet is open faced and isn’t impeding the airway. Monitor and reassess the TQ to ensure it's tight and utilize the Emergency Bandage to dress the stump to cover any bone. Remember, bone is living tissue and we don’t want it to become contaminated or die as bone death can greatly impact quality of life issues when it comes to prosthetics. Continue to monitor and assess the victim for any changes. Since it's cold outside, get a space blanket or something underneath them and cover them up to prevent hypothermia and monitor for signs and symptoms of shock.

Now, what do we do with the amputated body part? Get the body part, wrap it in a towel you grabbed out of your trunk, douse the towel with your bottled water and slide it into the gallon-sized ziploc bag that held your sandwiches in the cooler for the day. Close the bag securely and place that bag in the cooler on top of the ice while you wait for EMS to arrive.

Never put an amputated or degloved body part directly on ice as that kills the tissue. However, wrapping the part in a moist cloth and putting it into a plastic bag and putting that on ice can increase tissue viability up to 12 hours!

Make sure your scene is safe.

Control any life-threatening hemorrhage.

Monitor A,B,C's and Neuro Status.
Check for any other injuries and monitor for any re-bleed.
Watch for and treat any signs and symptoms of shock.
Continue to reassess frequently until EMS arrives.
Take care of the amputated body part.
Get a new cooler.