Traumatic Amputation
Objective: Stop bleeding from the stump first. Package the amputated part so a surgeon might use it. Do not delay a sick patient to search for the part.
Why this matters
The amputated part may be on the ground, and the stump is still bleeding. Stop the bleeding first. Package the part second. Do not delay a sick patient to search for the part. A patient who dies cannot use a replanted hand.
- Use a tourniquet or firm direct pressure until bleeding from the stump actually stops.
- Rinse off obvious dirt only if your protocol allows. Wrap the part in dry gauze, seal it in a plastic bag, and put that bag on ice. Do not soak the part in ice water.
- Write the time. Notify a replant-capable hospital if your system uses one.
- Stop the stump bleeding first.
- Dry wrap, bag, then cool. Do not soak the part in ice water.
- Save the patient's life before you save the part.
Clinical sequence
- Stop stump bleeding with a tourniquet or firm direct pressure. MARCH still applies: massive hemorrhage, airway, respirations, circulation, then hypothermia and head injury.
- Package the part. Rinse off obvious dirt only if protocol allows. Wrap it in dry gauze, seal it in a bag, and cool the bag on ice. Do not put the part in ice water. Ice directly on the tissue, or freezing, damages it.
- Write the time. Notify a replant-capable destination if your system uses one. Then move the living patient.
Teaching points
- Save the life before the limb. Run MARCH. Then package the part.
- Cool, do not freeze. Keep the part cool. Ice against the tissue, and soaking in ice water, both damage it.
- Partial amputation: splint the part in place. Do not complete the amputation unless your protocol says otherwise.
- Time still matters for replant. It does not matter more than stopping the bleeding.
Common errors
- Searching for 20 minutes for a fingertip while the stump is still bleeding and the patient is in shock.
- Putting the part in ice water so it soaks and freezes.
- Skipping a tourniquet because it "is only a finger" when the wound is a hand or a wrist.
Practice
One-minute check
A circular saw has taken off a hand and the stump is spraying. Say the first 30 seconds out loud. Include how you package the hand and what you will not soak it in.
Related: Tourniquets.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; your protocol decides
- TCCC / CoTCCC — hemorrhage control first
- ATLS education — amputated part cooling themes — not in ice water
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.