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affect patients' ability to care for themselves and do a job for the rest of their lives. EMS providers cannot change a primary injury but may reduce secondary injuries and long-term impact on the patient if they provide outstanding care and minimize the risk of infection, tissue loss and poor blood f low. Injuries that involve mangled tissue, contamination, severe displacement of normal anatomy and loss of blood supply are the ones that can beneft most from early care. Hands and feet have remarkable abilities to recover from wounds, especially in younger patients. For injuries causing severe damage to hands and feet, the management process will include these steps: • Deal immediately with any life- threatening injury, if present. • Manage any uncontrolled bleeding. This can occur in patients who are on blood-thinners, and those with injuries that cut a blood vessel at an angle. • Control pain, including ice, elevation and pain medication. • Remove any dirt and debris from the wound, and any pieces of material like gloves, shoes, socks or other fabrics. • Save any tissue found. Treat it gently, clean it, keep it moist (not soaked) and cooled. • Place the injured extremity on a splint, with the bones in alignment with the way the extremity usually is. If it is twisted, untwist gently to reduce ongoing strain on the blood vessels and nerves. • Once it's in a straightened position, use capillary refll and if possible a pulse oximeter to help confrm the ends of the fngers or toes are being perfused. • Remove the patient to a hospital prepared to manage severe extremity wounds. • Don't make statements to the patient that provide either too much or too little hope. In a prior column we reviewed the body parts that, because of their specialized functions and compo- sition, are extremely difficult to replace. 1 It is good to make this list part of training on injuries. These parts include: • Fingers and toes (particularly the thumb and great toe); • Large pieces of scalp; • Teeth; • Eyelids (probably the most intri- cate structure that is hard to replace on the body); • Pinna; • Lip; • Nipple; • Nose; • Genitalia. Each of these pieces of the body, if amputated or nearly amputated, is treated the same way in prehospital care: Treat the tissue gently, clean it, moisten but don't soak it, and cool it. The only exception is teeth, which if possible are rinsed and placed back in the empty socket or somewhere safely in the mouth. Replant success with amputated parts depends on the mechanism of injury, length of time not attached and associated injuries. The best recovery of any tissue is when there is a sharp mechanism of injury, short time of detachment, no damage (especially crush injury) to the body part it needs reattached to, younger age and no underlying medical problems. REFERENCE 1. Augustine J. Needle in a Racetrack. EMS World, www. emsworld.com/article/10320971. James J. Augustine, MD, is an emergency physician and the di- rector of clinical operations at EMP in Canton, OH. He serves on the clinical faculty in the Department of Emergency Medicine at Wright State University and as an EMS medical director for fre-based systems in Atlanta, GA; Naples, FL; and Dayton, OH. Contact him at jaugustine@emp.com. Copyright granted for this article for department use only up to 20 copies. CASE REVIEW Learn more at TRANSACT-TECH.com or call 1-877-748-4222 For fre , police , EMS , insurance, public utilities, delivery vehicles, you name it Multiple mounting options : in-dash, vertically, horizontally, upside-down, whatever No paper feeding hassles – just print and go Internal battery optional USB standard interface, Wi-Fi or Bluetooth ® optional No need for a separate paper mounting unit – thermal paper roll is integrated FULL-PAGE MOBILE PRINTER SOLUTION. FINALLY, PAPER AND PRINTER INTEGRATED INTO ONE. For More Information Circle 20 on Reader Service Card 24 DECEMBER 2014 | EMSWORLD.com