So I like to be prepared for many situations, and one occurred to me today that I realized I don’t know what to do with. I would like advice.
Every day, I drive down a road that’s ostensibly two lanes and a row of parallel parked cars. For some reason, the cars seem to edge out into the road, so it’s more like 1 3/4 lanes and a row of cars. Because my car is teeny and I need to be in that lane at the next intersection, I drive in the 3/4 lane past the cars. I am always concerned about someone in one of those cars opening their door into oncoming traffic, i.e. me. When people open their doors, they also put at least one leg out in very short order. What do I do it I hit someone and tear off their leg from, say, thigh down, since that’s what would be out of the car?
My first thought is okay, apply pressure. But where? Wholesale to the body side of the wound? Or, since the wound will be very large, should I find the severed artery and pinch that closed and let the rest fend for itself? Is there any point in pushing the leg back where it got ripped from?
If this were to happen while it’s cold out, should I take a moment to toss the leg into a snowbank to keep it cold? Should I pinch veins in the leg to keep the blood in so it can be reattached? Can that even happen to a whole leg? Would it make a difference if the leg had gotten run over in the meantime? We’re under five minutes from a hospital, so very quick response once I call 911.
I was also thinking about elevating the wound, but hard to do because of closeness to trunk. Should I roll the guy unto his side with the wound up? Should I tilt him in his car seat so he’s head down, or would wrestling just make any efforts to reorient him pointless?
I work in customer service, and spend much of my time fantasizing about dismembering the people who call who are either mean to me or stupid or both. Perhaps that has led to a bloodier imagination than usual, but rest assured that even if I knew the guy in the car was the asshat that just made me cry, I wouldn’t hit him on purpose.
First, look to see if he’s breathing.
No, seriously. Almost exactly this scenario is a common “distractor” question in nursing school. The kicker is that after you talk about calling for assistance and applying pressure to the wound…your instructor tells you he’s dead, because you forgot to check to see if the sandwich he was eating lodged into his throat and cut off his breathing. He choked while you were distracted with the bloody amputation. :smack:
Smartass nursing instructors aside, yes, first thing is call 911 and second thing is see if he’s breathing and responsive. If you’re lucky, he’s yelling his head off. That’s an easy way to tell he’s breathing.
If he’s not breathing, you do CPR. Fuck the leg wound. Airway and breathing come before bleeding. Will he bleed out? Quite possibly. But if you only have two hands, you use them where they’re most needed. He may or may not bleed out. He *will *die without oxygen circulating in his body.
If he’s breathing, then you can try to do something about the bleeding. You grab a blanket or a shirt or any sort of large piece of fabric you can find, and you wad it up over the wound on his body and you push down on it - HARD - and you keep holding it steady until the ambulance gets there. If someone hands you some more fabric and the fabric on the wound is getting soaked - do NOT remove the fabric already on the wound. Just put the new dry fabric on top, maintaining as much pressure during the process as possible. Do muck about trying to find arteries and such. If his leg has been severed, there are far more large bleeding things than you’ve got pinchy fingers for.
If there’s a bystander, ask him to get the leg out of the street so it doesn’t get run over by the ambulance. I don’t think you want to put it in a snowbank, given the quick predicted EMS arrival. It could get frostbite and complicate matters. But I’m willing for someone in trauma or EMS to correct me on that.
The person is your first priority. If you can only save the person or the leg, it would be stupid to save the leg. Don’t let the horrifying part of the situation distract you from the important part of the situation.
Granting that tourniquets are not generally recommended any more, but wouldn’t this be the textbook example of where you should use one?
Only if you have an M and a D after your name. Leave it to the paramedics. Emergency bleeding control - Wikipedia
And here I thought this would go straight to silly answers. Thank you for the unexpectedly informative one!
[…quietly reconsiders “Time for Brandy!” post.]
Don’t worry about the leg, it will get itself to the hospital. Possibly before the ambulance. 
Uh, you know what I meant, right? Do NOT. D’oh! :smack:
I always keep Quikclot in my car. Altho a leg amputation is pretty drastic, it’s pretty handy stuff, saved one guy out on the trail.
What a great thread. OP and WhyNot’s rich posts with benefits.
Fantastic cite. Four muscular orderlies had to wrestle it down once it got there, and they complained that it was “unfair” (thats my favorite bit) because it kicked them in the groin.
So, if the OP’s victim is a trained runner, OP at least has that going for her.
I saw what you did there.