The team at HealthFirst was appalled to hear of the deaths and injuries – both physical and psychological – on Monday 15th April in Boston, USA. Our thoughts are with the affected people and their families – and also with the emergency service personnel and First Aid volunteers who went to their aid.
Often when we hear of horrific events like this, it can cause us to examine our own skills and motivations to help if ever we were in a situation like that. There have been news reports of traumatic amputations (loss of a body part like a hand, arm, leg, foot etc) at the scene. Do you know what to do in the case of such an injury?
(1) Check the area is safe before approaching an injured person. Call the emergency services or be sure someone else has. Protect yourself by wearing plastic disposable gloves if available.
(2) Check if the person is responsive and is breathing. Start cardiopulmonary resuscitation if they are not breathing or put them in the recovery position if they are breathing but unresponsive.
(3) Try to reassure the injured person by looking at them and speaking calmly. Remember they may have been deafened by a blast. Amputation is very frightening and painful.
(4) Control the bleeding by applying direct pressure to the wound (with a sterile pad if possible), lie them down and elevate the injured area. Bandage the area if possible. If the bleeding continues and becomes life-threatening, a tight band (‘tourniquet’) tied higher up the leg or arm may be used to save their life. However, a tourniquet is best avoided if you can control the bleeding by direct pressure and elevation as it can damage the tissues further down the arm/leg.
(5) Identify and save any severed body parts and make sure they stay with the injured person. Gently rinse the body part if the cut end is dirty and wrap it in a clean, damp cloth. Then put the part in a sealed plastic bag. Place this plastic bag into another bag (or box) of an ice-water mixture (ideally at 4°C). The cooling of the body part can increase the time it may be reattached by the surgeons from 4-6 hours to about 18 hours. Do not put the body part directly in water or ice as it will freeze and damage the cells.
Remember that saving their life is more important than saving the severed part. Do not put the body part ‘back’ in place and never throw any parts away. Even if the limb can’t be reattached, some of the nerves and tissues may be used for reconstructive surgery.
(6) Keep the person warm and raise both their legs if it isn’t painful to do this. Check them for other injuries eg cuts, fractures and give first aid for these.
(7) Stay with the person until the emergency medical team arrives.
These are simple maneuvers that anyone can do to help save a life and a limb. Come and practice them on a friendly HealthFirst First Aid Course, taught by a supportive British or American trained doctor or nurse.
The psychological ‘first aid’ is so important too – remember that not all limbs can be reattached (do not give the injured person false hope) but many amputees do much better with a good, well-fitting prosthesis than a poorly functioning real leg or arm.
By Dr Penny Fraser