After leaving the military, I worked for a short time in an ammunition factory. Expensive loading machines have a tube full of shock sensitive primers and one day, a primer stack blew up while a coworker was clearing a malfunction, amputating his thumb.
Amputations are something I have some experience with. I’ve had to work on many different forms of traumatic amputations in different environments. From austere locals to clinical settings and I’ve learned a few things along the way that might help if you witness this common injury at your place of work.
Not only is there a risk of losing a finger on the jobsite, amputations are a possibility at home as well with table saws being a frequent culprit.
Do you wear a wedding ring or other type of phalange decoration? Rings can cause serious complications and might result in amputation as well.
A Degloved Finger, or Ring Avulsion, is an injury that occurs when a ring gets caught on a structure and the muscle and skin of the finger is stripped away from the bone. Like pulling a glove off the finger.
This happens more often than you might think and something I’ve frequently taken care of in rough environments. Metal rings and hard work are not good companions. When ever I go to the field, I always recommend to the people on my team they take off their wedding rings and stow them in a pocket, or on a chain around their neck.
Another option is to get rid of metal rings altogether and opt for one of those silicone rings that seem to be everywhere. They look great, it’s a sign to everyone you work hard for a living, and bonus, they keep the meat on your finger from being stripped away like a chicken wing on game night.
Rings are also risky to have on your hands if you receive an injury to your hand that causes swelling. This swelling can build to the point where the ring begins to act like a TQ and blood flow is stopped altogether.
The swelling also causes the Ring to become wedged in place with no hope of removal without cutting the ring off with a special device, cleverly named the “Ring Cutter.” This awesome little device cuts through the ring without cutting into the skin.
Soft metal rings, like gold and silver, are fairly easy to cut through, but if your ring is made out of tungsten, titanium, or some other substance known for strength, it’s substantially more difficult to cut the ring off.
Extremities like fingers can be severed by a clean cut or from crush injuries. Clean cuts are best if you get the chance to choose because it means there’s a greater chance the digit can be saved. Obviously, this isn’t a guarantee, but surgeons have a better chance of saving the finger if the cut is clean.
Clean cuts also mean that the arteries might contract and pull back into the stump. This is good for bleeding control since it means that there might not be significant bleeding, if any at all.
Be very careful when handling the injury. Traumatic amputations often result in the shattering of bone. These bone shards can be very sharp and can easily puncture or lacerate your skin.
There isn’t much to be done in an emergency setting besides direct pressure on the wound if it’s bleeding badly. Wrap the wound with lots of gauze for comfort and transport the casualty to the hospital.
But wait! You need to find the finger(s).
What to do with the Finger
If the amputation is from spinning blade like a table saw, the finger might have been thrown somewhere and more difficult to locate. Try to find it if you can, but don’t make this the initial priority. See to the casualty first before finding the lost digit or send someone else to find it while you work.
Be aware that we should be checking the victim carefully for any other injuries as well.
It’s possible the injury caused the casualty to pass out, fall down and hit their head. Don’t become too focused on obvious wounds. Try to view the casualty as a whole and thoroughly inspect them, especially if unresponsive or confused.
Ask the casualty if they're injured anywhere else. If they aren’t responsive, ask anyone who might have witnessed the injury what happened.
When you do find the appendage, try to brush away any debris (like sawdust) before preparing it to be transported with the casualty.
Take some paper towels, gauze, or other clean material, and wrap the finger in a few layers to help protect it from freezing. We want to keep it cool, not frozen, so don’t just put it directly on ice. Place the wrapped finger in a zip-loc bag and place that bag into another bag filled halfway with an ice water slurry if possible.
This way, the body part is floating in the ice water, but not directly contacting the tissue since it’s protected by the paper towels and other sealed bag.
If you don’t have any ice at your job site, have someone run over to a nearby food truck, or fast food restaurant and ask them for a cup of ice. If you tell them it’s for a guy that just had a finger cut off, the ice is usually free.