Limb Entrapment: Be a STARR to help your patient.

A limb caught in a piece of machinery is with out a doubt an incredibly complex and often confronting incident for first responders. Luckily, our colleagues at The ATACC Group (developers of the Rescue Trauma & Casualty Care Course that TacMed delivers in Australia), have come up with a simple approach to assist with the treatment and extrication of the patient.

Limb entrapment in machinery, such as food processors, manufacturing equipment or construction appliances, is a serious mechanism of injury that can cause severe injuries, ie loss of a limb, or in some cases potentially fatal . It is crucial that first responders know how to respond to these incidents to minimise harm and save life and limb.

The ATACC methodology is called S.T.A.R.R:

1. Stop: Secure the scene by making sure that the machine is turned off and disconnected from any power source before attempting any rescue efforts. This will prevent further harm to the victim and prevent the situation from escalating. Engineers or other machine operators will be a vital resource in helping you secure the scene and assist with the extrication of the patient.
2. Tourniquet: Control any massive bleeding. In limb entrapment incidents, the application of an arterial tourniquet, such as a SOFTT-W or CAT, high on the limb is often required as you may be unable to visualise or access the point of bleeding due to the entrapment.
3. Analgesia: Entrapment injuries can be extremely painful and prolonged incidents. Not only that, but pain is often exacerbated with movement during extrication. Provide appropriate pain management measures to help alleviate the patient's discomfort. Not only is analgesia critical, but ensure you communicate with the patient throughout the rescue to keep them informed about what is happening during the rescue and treatment process. Explain each step of the process and what they can expect. Including the pain they might feel!
4. Release: The release of the entrapment may just be a simple as slipping a foot out of a boot that is trapped or it may be a complex and prolonged rescue which takes hours to disassemble equipment to remove a mangled limb. In some extreme cases, a medical team may be required to amputate a limb on scene to release the patient. In any case, a specialised rescue team is required to assist with the tools to disassemble, cut and/or spread the machinery.
5. Reverse: An alternative to release above, is to reverse. It can be highly effective to manually reverse the machine by hand to remove the entrapped limb. This will depend on the type of mechanism that is trapping the limb and the state of the injury of the limb.

So in summary, while limb entrapments are not a common mechanism of injury, they are often complex and can be prolonged and life-threatening. Use the STARR methodology along with the standard MARCH or SMART treatment mnemonics to help guide your extrication.

If you'd like to learn more, you can attend a TacMed Training course. Learn more HERE.

Ref: Rescue Trauma & Casualty Care Manual, Chapter 8, Page 163-165. https://www.ataccgroup.com/