First Aid for Major Trauma: Crushes, Amputation, Impalement

When a lot of people think of First Aid, they think of bandages and gauze, cuts and scrapes, and controlling small amounts of bleeding. But First Aid is also administered while waiting for medical treatment for more serious injuries (learn about First Aid Basics for Minor and Severe Cuts).

In this article, we'll cover three First Aid procedures for three types of severe injury: crushes, accidental amputations, and impalement.

First Aid for Crush Injuries

Crush injuries are caused when a body part (or the entire body) is caught between or under a heavy object like a vehicle, boulder, or machine (learn the Top 5 Warnings for Caught-On and Caught-in-Between Hazards).

In workplace settings, they might happen as a result of:

• Tractor rollovers
• Using or moving heavy equipment
• Moving large or heavy items
• Logging operations

Crushing puts such intense pressure on the body that the victim may experience excruciating pain, bruising, bleeding, broken bones, or nerve injuries. Often the only visible damage is to the tissue, however, which can mask the seriousness of the internal injuries.

First Aid Procedures

If you witness a crush injury that is severe or has trapped an individual, here’s what to do.

1. Call 9-1-1 or your local emergency number right away if any of the following applies:
   1. The injury is the result of major trauma or motor vehicle accident
   2. There is heavy bleeding or mangled body parts
   3. You suspect a head, neck, back, or hip injury
   4. A body part (usually the end of a limb, finger, or toe) lacks sensation or is turning blue
   5. The victim shows signs of shock or has difficulty breathing
   6. The victim is unconscious or unable to move
2. Try to safely remove the heavy object from on top of the victim as quickly as possible (provided you won’t cause any further injury by doing so)
3. If you cannot safely remove the object, keep the victim calm and comforted while you await emergency personnel

If the victim isn’t trapped, you may be able to apply some basic first aid:

• Clean visible wounds with water
• Apply ice (wrapped in a towel) to the injury to reduce swelling
• Using a clean towel or cloth, apply pressure to the injury site to stop bleeding
• If you suspect a fracture, immobilize the injury site
• If the victim is feeling faint, turning grey, or hyperventilating, begin treatment for shock by loosening restrictive clothing and, if possible, elevating the legs above the head

First Aid for Accidental Amputations

According to OSHA, most amputations involve fingers or fingertips and occur when workers are using unguarded or inadequately guarded equipment.

Industrial equipment is a common culprit for work-related amputations, including:

• Mechanical power presses
• Powered and non-powered conveyors
• Roll-forming and roll-bending machines
• Food slicers and meat grinders
• Band saws
• Drill presses
• Table or portable saws.

There are two types of amputation:

• Complete amputation: a body part is completely removed
• Partial amputation: a large portion of the body part is cut off, but it remains attached to the body

The ideal outcome of an accidental amputation is the reattachment of the body part. This isn’t always possible, and the success depend on:

• What body part was affected
• The condition of the amputated body part
• How much time has elapsed since the amputation
• The health of the injured person

First Aid Procedures

To deal with this major trauma, refer to the following first aid steps:

1. Call 9-1-1 or your local emergency number
2. Stop the bleeding by having the injured person lie down, if possible, and elevating the injured area
3. If you suspect a head, neck, back, or leg injury, do not move or reposition the victim
4. Using a clean towel or cloth, apply steady and direct pressure to the wound (if there’s an object lodged in the wound, apply pressure around the object)
5. Monitor and treat for shock by calming the victim down and covering them with a coat or blanket
6. Save the amputated body part for emergency personnel
   1. Rinse it with clean water to remove dirt or debris, but do not scrub or use soap
   2. Wrap the part in sterile gauze or a clean cloth and place it in a clean plastic bag
   3. Pack the bag in ice

First Aid for Impalement

Impalement is a form of injury in which an object has punctured the soft tissue and remains embedded in the body. Slivers, for example, are technically a type of impalement, though they are incredibly minor and rarely require medical treatment. In more serious cases, larger objects may impale the leg or thigh, abdomen, chest, shoulder, head, or eye.

Impalement hazards are perhaps most common on construction sites. OSHA standard 29 CFR 1926.701(b) specifically deals with the impalement hazard created by rebar (exposed steel reinforcing bars), which account for a significant portion of construction accidents. Other potential impalement hazards include lightning rods, debris, protruding nails, and scrap lumber and steel.

First Aid Procedures

In any impalement case, the first step is to call for immediate medical assistance – 9-1-1 or your local emergency number. Then, follow these First Aid measures:

1. Stabilize the impaled object to prevent movement that could cause further injury, including serious internal damage
2. Do not attempt to remove the object – the object puts pressure on the wound inside and removing it could trigger extensive bleeding
   1. There are two exceptions:
      1. If the impaled object is in the way of the injured person’s airway
      2. If the injured person needs CPR and the object is in the way
3. If you must remove the impaled object, immediately apply direct pressure to the wound to control the bleeding
4. Keep the victim in a stable position until medical help arrives, as any movement of the object could cause damage to surrounding tissue
5. Monitor and treat for shock by keeping the injured party calm and, if possible, covering them with a blanket

Beyond the Injury

Crushing, amputation, and impalement injuries can be shocking and require extensive medical intervention, but the First Aid steps required to prevent further damage are quite simple.

It’s important to remember, though, that the impact of this type of serious injury goes beyond the injured worker. It can be gruesome or disturbing and cause psychological distress or trauma to those who witness the incident. Fostering a strong work culture and open lines of communication can help employers effectively reach out to employees after a traumatic event to reassure them and prevent further accidents.