Amputation & Parts
Objective: Stop stump bleeding first, package the part so it might be usable, and do not delay the living patient for a finger hunt.
Why This Is Hard
The finger is in the grass and the stump is spraying. Crews hunt the part while the patient bleeds out. TCCC/ATLS: hemorrhage first. The part is second.
- Tourniquet or pressure on the stump until it stops.
- Part: rinse gross dirt if protocol allows, dry gauze, plastic bag, then that bag on ice — not soaking in ice water.
- Label time. Notify a replant-capable destination if your system uses one.
Field Rules (Education)
- Life over limb. MARCH. Then the part.
- Cooling: avoid direct ice on tissue and avoid freezing. Ice water macerates.
- Partial amputation: splint in place, do not complete it unless it is a thread and protocol says so.
- Time still matters for replant, but a dead patient cannot use a hand.
Field Pitfalls
- Hunting a finger for 20 minutes while the stump pumps.
- Part floating in ice water.
- No TQ because “it’s just a finger” when it is a wrist.
Practice
60-second drill
Partner: circular saw, hand off, spraying stump. First 30 seconds including how you package the hand.
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; protocol still wins
- 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
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.