Amputations are high-acuity, time-sensitive injuries that can occur in a wide range of environments; from industrial and farm machinery to motor vehicle collisions, power tools, and even sharp-force trauma. The mechanism can vary significantly, from clean surgical-like separations to severe crush or avulsion injuries, each presenting unique challenges for prehospital care. Regardless of the cause, early recognition and proper management are critical to patient outcomes. Effective hemorrhage control, preservation of the amputated part, when possible, and rapid transport decisions all play a vital role in improving survival and the potential for reattachment.

This month’s Tip of the Month is intended to support paramedics in assessing and prioritizing management of traumatic amputations, including effective hemorrhage control and appropriate preservation of the amputated part, in accordance with Ontario BLS and ALS-PCS standards.

You and your partner have been dispatched to a 38 year old male involved in a workplace accident. On arrival, you find the patient with complete amputation of three fingers on the left hand at the proximal phalanx, accompanied by significant hemorrhage. The patient appears pale, anxious, and in distress.

A coworker has retrieved the amputated digits and placed all three in a single bag directly on ice, which is handed to you on scene.

Questions we need to ask ourselves:
1) What are your immediate management priorities for this patient?
2) Is hemorrhage control adequate? If not, what additional interventions are required?
3) Has the amputated tissue been packaged properly? If not, what modifications are needed?
4) What elements are critical to include in your documentation?

Management Priorities:

“LIFE, LIMB, FUNCTION” Control hemorrhage, preserve tissue, minimize scene time where possible.

STOP THE BLEED
Pressure - pressure dressings- quick clot- tourniquet (if warranted)

• Re assess effectiveness of your care early and often, hemorrhage control is paramount.

MANAGE THE STUMP
With a COMPLETE amputation we need to cover the stump(s) in moist, sterile dressing and support with dry dressings on top. Immobilizing along with elevating can help manage this pt where it is possible.

With a PARTIAL amputation, we want to place in anatomical position(where possible) , and splint to prevent movement of body part. We need to be sure to assess and document the state of CSM distal to the injury/injuries.

PRESERVE THE PART - Critical Aspect

Rinse amputation of any gross contamination using sterile water, wrap the amputation in a moist, sterile dressing and place in a water tight, individual bag. We then need to place the amputation in an ice water slurry.

What we DO NOT WANT TO DO.

We want to avoid placing the amputated part directly on ice , we DO NOT want to soak the amputated part in water directly, and we DO NOT want to freeze this body part, just keep it cool.

Expected Actions 

• Immediate hemorrhage control (tourniquet if required)
• Manage for early shock
• Correct packaging: ensure no direct ice contact
• Rapid transport with early notification
• Full documentation including CSM (if applicable), care provided, and tissue handling

Even small amputations (e.g., fingers or toes) carry significant functional impact and require the same systematic approach.
Early, appropriate care directly influences surgical outcomes.