Crush Injuries, Impalement and amputation

Crush injuries generally result from serious car accidents or explosions. There may be part of the body stuck under heavy debris; several broken bones, multiple external bleeding and much internal bleeding; burns from an explosion; severe shock, and deterioration into unconsciousness. If a person is impaled on an immovable object, treatment is similar to that for a foreign object embedded in a wound. An amputation is where a part of the body has been severed. This may occur through a straight and heavy cut or through twisting and pulling under extreme force.

Treating crush injuries

1. Ensure that it is safe to approach the scene. If in doubt, call the emergency services and wait for help.
2. Monitor and maintain airway and breathing and be prepared to resuscitate if necessary.
3. Treat major bleeding and cover smaller wounds with sterile dressings.
4. Keep the injured person still and try to reassure them while waiting for help.
5. Treat for shock.
6. Make an early call for an ambulance and inform medical staff what has happened.

If the injured person is trapped

There are additional risks for the injured person if any part of the body is trapped. Releasing the body may bring on severe shock as fluid leaks to the injured part.

An even greater cause for concern is 'crush syndrome'. Toxins build up around the injury site and are trapped by an object crushing the person. If the object is removed, these are suddenly released into the body, and the kidneys, the organs chiefly responsible for flushing out toxins, cannot cope. This condition can be fatal.

If the person has been trapped for less than 10 minutes

Crush syndrome takes some time to develop. If you can do so, safely remove the object. Treat as for crush injuries above.

If the person has been trapped for longer than 10 minutes

Make an early call for help, explaining the situation, but do not remove the object. Treat as for crush injuries above and reassure the person.

Treating impalement

1. Do not attempt to remove the object or to move the injured person.
2. Provide swift assistance for the injured person, supporting his body weight where possible to prevent any further damage.
3. If bleeding is severe, apply pressure around tile edges of the wound without pressing on the object.
4. Try to stop the object moving around as much as possible, enlisting bystander support where available.
5. Call an ambulance, making sure that you explain the need for cutting equipment or fire service.
6. Treat for shock as best you can.

Treating amputation

1. Your priority is to stop any bleeding at the site of the injury. Apply direct pressure and raise the injured stump. An amputation high on the arm or leg can be accompanied by severe arterial bleeding, particularly if caused by a twisting or tearing movement. Be prepared to apply continuous pressure using several pads as necessary.
2. If the bleeding comes under control, cover the wound with a sterile dressing or clean non-fluffy material tied in place with a bandage.
3. Treat for shock and reassure the person.
4. Call an ambulance, advising that there is an amputation.

For the amputated part

A surgeon may be able to reattach the amputated part.

1. Wrap the part in a plastic bag and wrap the bag in a clean cloth.
2. Place the cloth-wrapped bag in ice and place into a sturdy container. Do not let the ice come into close contact with the amputated part, as this will damage the flesh. Do not wash the amputated part.
3. Label the container with the time of injury and the casualty's name and make sure that you hand it over personally to medical staff.