I hear a lot of stories, particularly out here in Colorado/Utah, about climbers and hikers who end up having to cut their own arm off after getting it stuck between a rock and a hard place. Suppose this happens to me and I have my forearm trapped under a boulder and I happen to have a nice sharp knife handy. What would be the best way to proceed? Should I go for the elbow-joint or saw through the top of my radius and ulna? Is there any chance of coming back for the trapped portion and having it reattached? How can I avoid bleeding to death? What about passing out during the operation due to the pain? Would it be better to wait until I am delerious from dehydration, and can I expect any help from endorphins once I get started?
No help on the actual (and interesting) question, but you do realize that the majority of those links point to two guys, right? I don’t think it happens nearly as often as “a lot of stories” suggests.
Well, a tight torniquet before you get started is essential, obviously.
Well, you’d need to tie a tourniquet around your arm to keep from bleeding out, and save the elbow if you can. Your anaesthetic will have to be desperation.
Befopre getting to that stage, though, I’d try making a small cut in the trapped arm near the wrist and see if the blood will supply enough lubrication for me to yank myself free.
With nothing but a nice sharp knife, hope it is substantial and go for the elbow.
By the time you coud get out, get treatment, and get back for the remains, (unless it is refrigerator weather) for collecting the dismembered part it would be beyond salvage.
On second thought if you are accident prone stay out of the woods/mountains/remote uninhabited places.
While the elbow is definitely easier to cut thru, sparing the elbow and cutting thru bone further down will enable you to get much more use out of your future prosthetic limb.
Same thing with the lower extremity. Below knee amputations are easier to rehab from than at-knee or above the knee.
However, auto-surgery trauma would be lessened and the chance for survival probably enhanced by cutting thru a joint rather than thru bone.
Would it be wrong to insert a joke about “TWIN BODY POWERED PROSTHESES WITH MATCHING DORRANCE #5X STAINLESS STEEL HOOKS”?
…'cuz I’m thinking that would be in poor taste.
I’d imagine that the best thing to do in that condition is to convienantly have a collapsible hospital and team of very tiny surgeons in your pack.
Barring that, I’d assume it would be best to do it when you’re as hydrated as possible. Being dehydrated is never a good thing, and I’m not sure how it would help you in a traumatic situation like that.
Aron Ralston’s book, as a matter of fact, gives a pretty good step-by-step description of the amputation. Since it seems to have worked pretty well for him (after a fashion), you should probably give it a read.
He mentions that he was able to use the boulder he was pinned under as leverage to break the bones in his arm, which is why he didn’t have to go through his elbow, FYI. He also said that severing the nerves was the most painful part. Surprise, surprise.
Qadgop the Mercotan is right (Qadgop the Mercotan is always right, so far as I can tell from a year or two of reading his posts - is elfbabe around to witness to any time when there has been a deviation from this established protocol?), but bone is hard to cut through.
I usually work on bodies with scalpels, which are basically razor blades on a stick (new ice cream idea for the Addams Family!), and Stryker saws. I also have scissors, gut scissors, and long blades, but I use those almost only on organs once out of the body. I can tell you that it’s nearly impossible to cut through even a thin rib bone with a scalpel. Ain’t gonna happen. Dulls the scalpel and eventually the razor blade breaks.
A Stryker saw works great, but takes time on an arm bone. And you won’t be packing a saw and electrical generator convenient to the rock that fell on you.
I have never tried to saw through an arm bone with a thick knife blade such as you might have in a Swiss army knife. I don’t have the time, and it dulls the blade. But I suspect the major effort and leverage it would require in the presence of severe pain and ongoing bleeding would take just too darn long.
Solution: Saw through the bone in the region of fracture. I’m assuming, if there is a boulder lying on your forearm, the bones are broken. (Two bones, remember - ulna and radius - twice the work.) The fracture will be angled and difficult to cut through, but if you keep twisting the arm to expose new muscle, you can do it.
Also: Tourniquet is good, but may not offer enough control of bleeding. People in the bad old days used to tie vessels off with string without asepsis (see Horatio Hornblower series for wonderful dramatization). True, you get infection, but some people survived infection even back then before antibiotics and sterile debridement as followup (see: peglegged pirates and other seamen), whereas nobody survives bleeding out. So you’ll be better off if, as you identify vessels, you can tie them off before severing them.
Doing this one handed is entirely possible, but takes practice. In my days as a surgery resident (prior to pathology) we always brought lengths of suture into lecture halls with us, so as to practice tying knots around the arms of the chairs. (We always left the knotted strings in place when the lecture was over, too - staff used to refer to them as “medical student macrame”). I am still quite dexterous at a two handed knot, although it has been many years since I could tie the one handed knot. But it takes about thirty practices to begin to get dexterous, so I suggest you find a surgeon or resident who doesn’t mind taking five minutes to teach you, buy some string, and start to practice.
Maybe I’ll go back to practicing, too. You never know when you’ll have to cut off your arm…