Early recognition

A limb or part of a limb has been severed from the rest of the body.

First aid steps

1. Access emergency medical services (EMS).
2. If the wound is bleeding heavily, apply pressure to the wound to stop the bleeding. Follow the steps for Severe bleeding and also treat the person for Shock. Once the bleeding has been controlled, complete the rest of the steps listed here.
3. If the amputation is partial:
   a. Advise the person to keep the limb as still as possible, preferably in a position of normal alignment to protect it from further                    amputation.
   b. Use a sterile bandage or dressing, or clean cloth, to cover the wound and keep the limb in place.
4. If amputation is complete:
   a. Use a sterile bandage or dressing, or clean cloth, to cover the wound.
   b. Keep the amputated body part dry and cool. To do this, place the amputated body part in a clean, watertight, plastic bag, and                  firmly seal it. Place this inside a larger bag of ice and water until it can be taken to a medical facility.

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CAUTION

• Do not immerse the body part directly in water or place it directly on ice as this may damage the tissue and make it more difficult or impossible to reattach it.
• Do not straighten an angulated fracture or dislocation.
• If the distance to the hospital is reasonable, do not allow the injured person to eat or drink because anaesthetic may be required. If the distance to the hospital is very far and the person is responsive, they may sip water.

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Access help

• Tell EMS about the injury so they can prepare or bring appropriate equipment.

Refer to the Severe bleeding topic for additional education considerations, which have not been repeated here.  

Context considerations

• Amputation may occur in particular industrial settings where there is heavy, sharp or fast-moving machinery; and in conflict settings, where they can be caused by explosions of land mines. Case-based examples or scenarios should be used to support learning where these instances might occur. Exploring the most likely incidents that could result in amputation in the local setting will give context and relevance to the subject.  This knowledge can be learned through research before the session or could be posed as a question to the group.
• Amputation care kits containing material and instructions to properly store, and transport amputated body parts are available and could be useful in some contexts.

Learner considerations

• Use of video or photographs can enable realistic exposure to the subject and an opportunity to see the graphic nature of some injuries. They should be used with due sensitivity of appropriateness to the learner group.

Facilitation tips

• Due to the traumatic nature of amputation, learners might be sensitively encouraged to share stories about experiences. Roleplay where groups of learners might learn how to respond quickly, using team-based skills, and including peer support could be effective.
• Amputation is a particularly graphic and psychologically affecting injury where the injured person has lost a ‘piece of themselves’.  This can be very disturbing for them, but also for first aid providers. As such, it is important to spend time exploring the barriers that may affect people’s willingness or confidence to provide first aid in the presence of amputation.  The permission to explore the fact that they might be afraid or squeamish gives learners an opportunity to develop strategies to overcome these barriers in real life.
• Bystanders and family members are invariably more distressed when amputations have occurred, often more so than the injured person themselves (who can display a ‘protective dissonance’). Empathy and support for them should also be discussed.
• Emphasise that timely intervention to stop bleeding is vital and may be a life-saving action and simple actions can be very effective. They should have confidence that their actions will make a real and positive difference.
• Tourniquets may be used if direct pressure does not control the bleeding. (See Severe bleeding.) Note that in an amputation, the tourniquet may not entirely stop the blood flow (due to blood loss through the ‘middle’ of the bone.) This will be minor, and not gushing but the first aid provider should know that if this is seen, it does not mean that the tourniquet is not working.

Facilitation tools

• Images of amputation injuries might be useful here. Especially if it is possible to demonstrate the injury, tell the story of treatment and show the final healed result in the same person; a full ‘patient story’.  This will go a long way to providing confidence to act. 
• For child learners consider age-appropriate imagery. Presenting the possibility of a return to a near ‘normal life’ at the story end will achieve the same aims without fear.

Learning connections

• This topic should be taught in conjunction with Severe bleeding, focusing on the use of direct pressure, and (where permitted locally) tourniquets and/or haemostatic agents.
• Severe bleeding from an amputation injury is likely to result in Shock.
• It may be useful to teach this topic with reference to the first aid for a fractured bone (See Fractures, sprains and strains.)
• Learners may benefit from making connections to topics such as Psychological first aid or Traumatic event.