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Hand injuries account for nearly 10 percent of all emergency department visits in the U.S. A 2008 study at the U.S. Army Institute of Surgical Research, Burn Center at Fort Sam Houston looked at the hand injuries sustained during Operations Enduring Freedom and Iraqi Freedom. They found in a retrospective review of the U.S. Army Institute of Surgical Research Burn Registry that 451 military personnel were admitted during a 34-month period and 239 had sustained hand burns. This clearly dem­­­­­onstrates that hand protection in a combat environment is paramount.

img_7273.gifIn the civilian tactical environment hand injuries are also commonplace. Breaking and raking windows, breaching doors and clearing rooms all put our hands at risk for injury. Nothing can be more debilitating to an individual than the loss of function of all or part of a hand. Even the loss of a finger can be devastating. Although, with time most individuals can adapt to such a disability, the goal is to prevent such injures by protecting your hands with appropriate gear.

Intricate in design and function, the hand is an incredible work of art and anatomy. Form follows function in the hand and any injury to the underlying structures of the hand carries the potential for a serious disability.

Rapid Evaluation
The primary goal with injuries to the hand is an accurate and rapid initial medical evaluation. Once an injury occurs, the tactical medic should begin medical treatment rapidly to prevent both short-and long-term effects.
The hand consists of 27 bones if you include the eight bones of the wrist. When the other associated structures such as nerves, arteries, veins, muscles, tendons, ligaments, are considered, the potential for a large variety of injuries becomes greater.

Hand injuries can be divided into four general categories: (1) lacerations (2) fractures and dislocations, (3) soft tissue injuries and amputations and (4) burns.

The potential for devastating injuries increases tremendously when medical attention is delayed. Even the smallest cut or seemingly innocent hand injury could require advanced treatment to prevent significant loss of function. Remember all hand injuries require a medical evaluation because even the most insignificant hand injury can have the potential for serious loss of function.

Any laceration that may require sutures to repair warrants a complete medical evaluation. Minor burns do not require immediate medical evaluation. Internal damage to the hand can also occur, and is hidden out of plain view deep within the hand, such as lacerations of tendons. These can be treated at a later date by a hand surgeon with good results but you do not want to miss them in your evaluation. Injuries to the hand causing the following symptoms generally require emergency medical attention at a hospital’s Emergency Department:

• Severe pain, loss of motion or strength, obvious deformity or amputation, signs of infection, such as tenderness, redness, swelling, pus, fever, or exposure of underlying structures (ie: tendons, bones, joints, arteries, veins, or nerves), burns, around a finger, hand, or the wrist.

Hand Injury Treatment
Field care for hand injuries initially involves some smart first aid techniques. The following is a solid checklist of what’s needed depending on the situation.

Lacerations:
• Apply pressure to the wound to stop bleeding
• If possible, wash dirt or debris from the wound
• Cover the wound to prevent further contamination or injury
• Do not remove large foreign bodies such as nails, hooks, or knives

Fractures and dislocations:
• Rapid field reduction if possible
• Immobilization by splinting or buddy taping
• Cover, if the bone is exposed, with clean gauze
• Ice may help decrease the pain, but never apply for more than 20 minutes and never directly to skin

Soft tissue injuries and amputations:
• Apply pressure to stop bleeding
• Cover with damp bandage, if possible
• Elevate the hand above the heart
• Retrieve amputated body part. If possible, cover, keep damp, and place near ice to cool
• Do not place body part in direct contact with ice in order to prevent freezing

Burns:
• Thermal (heat) burn: Cool with water
• Chemical burn: Irrigate with lots of water
• Frostbite: Re-warm with warm-water bath or soak, then cover.

Additional Treatment:
• Pain medication
• Antibiotics if needed
• Tetanus shot if indicated

Beating Infections
Human or animal bites require thorough cleansing and irrigation to reduce the risk of infection. Puncture wounds such as cat bites and wounds where tissue is crushed such as human and dog bites are particularly likely to become infected. The risk of infection increases when these wounds are sutured. Most bite wounds require antibiotics and close follow up to assure healing and a good outcome.

You already know that preventing an injury is better than treating one. The hand is clearly one of the most critical parts of the body to protect from injury because even with the best treatment, just about any injury leads to some loss of function.

Tactical gloves can protect your hands, specifically the nerves, which can become injured if the palm suffers a direct blow. In addition to protecting your nerves, gloves can protect your skin from direct wounds and cuts. At the International School of Tactical Medicine, we are as concerned about preventive medicine as we are about educating and training good effective tactical medics. The next time you deploy make sure you and your team members have adequate hand armor. Remember you can’t shoot back if your hands are injured.

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