In brief
In press and machine accidents, the first step is to stop the machine, isolate its energy and call 112; bleeding is then controlled with direct pressure and, if necessary, a tourniquet. The severed part is wrapped in a clean cloth, bagged, cooled without direct contact with ice and sent with the casualty. A person trapped for a long time is at risk of crush syndrome; the entrapment time is noted and reported to the medical team.
Why are the first minutes decisive in a press accident?
Accidents on presses, guillotines, rollers and machines with gear systems often result in amputation or crushing of the hand and fingers. In these injuries, the casualty's future life is largely determined by what is done in the first minutes: how quickly the bleeding is stopped, how the severed part is preserved and how long it takes the casualty to reach hospital. First aid for amputation is therefore not an instruction to "act fast" but a series of steps whose order has been learned in advance.
This article describes the sequence the first aider on site will follow. Press lines are common in metalworking, automotive supplier and machinery manufacturing plants in and around Bursa; the steps described can be added directly to these plants' emergency plans. The article does not replace first aid training; the procedures should only be carried out by certified first aiders. For the certification process, see our article on how to get a first aid certificate.
Safety first: stop the machine, isolate the energy
The first principle of first aid is protection: if the hazard at the scene continues, the person helping can also be injured. In a press accident, the following is done in the first 60 seconds:
- Press the emergency stop button. Make sure the machine cycle has stopped.
- Isolate and lock out the energy. Isolate electrical, hydraulic and pneumatic energy at the main switch and valves; if possible, apply lockout and tagout. For details, see our LOTO article.
- Do not try to bring the ram back yourself. If the hand is trapped in the die, call the maintenance supervisor for a safety block to stop the ram descending uncontrollably and to open the die safely. A movement in the wrong direction can make the injury worse.
- Call 112. State the location, the type of injury ("finger amputation", "hand trapped in a press") and the casualty's level of consciousness clearly. Do not hang up during the call; follow 112's guidance.
- Call the workplace first aid team and assign one person to meet the ambulance at the factory gate.
First aid for amputation: controlling bleeding
In an amputation or severe crush injury, the greatest danger is bleeding. After putting on gloves, follow this order:
- Direct pressure: Place clean gauze or a clean cloth on the wound and press firmly with the palm of your hand. If the cloth becomes soaked with blood, do not lift it; add a new one on top and keep pressing.
- Pressure bandage: When the bleeding slows, secure the cloth with a bandage; check the circulation in the fingertips.
- Tourniquet: If there is an amputation of the arm or leg, or if the bleeding cannot be stopped with direct pressure, a tourniquet is applied. Note the time it was applied and tell the medical team; do not loosen the tourniquet yourself.
- Shock measures: Lay the casualty down, cover them, keep them calm by talking to them and monitor their consciousness and breathing.
In finger amputations, bleeding can often be controlled with direct pressure. Decide on a tourniquet according to the criteria taught in first aid training.
Preserving and transporting the severed part
Correctly preserving the severed part keeps the surgical team's options open. The following steps are applied for transporting the severed part:
- Find the part; if it is on the machine or in the swarf tray, retrieve it after the energy has been isolated.
- Wrap it in clean gauze or a clean cloth without rubbing it or cleaning it with chemicals.
- Put the wrapped part in a clean plastic bag and seal it.
- Place this bag in a second bag or container containing ice and water.
- Write the casualty's name and the time of the accident on the container.
- Send the part in the same vehicle as the casualty and hand it over to the medical team.
| Do | Do not |
|---|---|
| Wrap the part in a clean cloth and bag it | Do not put the part directly on ice |
| Put the bag in a second container filled with iced water | Do not freeze the part or immerse it in alcohol or cologne |
| In a partial amputation, support the part in its natural position and bandage it | Do not sever partly attached tissue or try to put it back in place |
| Label the container and send it with the casualty | Do not send the part in a separate vehicle or later |
| Note the time of the accident | Do not neglect the casualty's care to look for the part |
The division of tasks becomes important here: while one first aider deals with the bleeding, the second prepares the severed part.
Crush injuries and crush syndrome
A crush injury occurs when a heavy load or machine part traps part of the body. A crush that looks minor from the outside can involve serious damage to muscles, blood vessels and bones. If the person has been trapped for a long time, there is also a risk of crush syndrome: substances released from damaged muscles enter the circulation when the pressure is removed and can affect the heart rhythm and kidneys.
The practical consequences for the first aider on site are:
- Note the entrapment time. Tell 112 and the medical team how long the person has been trapped.
- If possible, time the lifting of the load with 112's guidance. In prolonged entrapment, removing the load can lead to sudden deterioration; the medical team wants to arrive prepared for this.
- Do not delay rescue if there is a threat to life. If there is a fire, a gas leak, the possibility of a second collapse or of the machine moving, the person is moved to a safe area immediately.
- Do not give food or drink. The casualty may be taken into surgery.
- Send them to hospital even if the visible wound is small. Internal damage to a crushed hand or foot may not be apparent at first.
Division of tasks on site
If everyone runs to the casualty at the same time during an accident, critical tasks are missed. Write the roles into the emergency plan in advance:
| Role | Task | Who takes it on? |
|---|---|---|
| Machine responsible | Emergency stop, energy isolation, making the ram safe | Line leader or maintenance technician |
| 1st first aider | Bleeding control, shock measures, monitoring consciousness and breathing | Certified first aider |
| 2nd first aider | Preparing the severed part, recording the entrapment time | Certified first aider |
| Communication | Calling 112, meeting the ambulance at the gate | Shift supervisor or security guard |
| Area responsible | Moving onlookers away, protecting the scene | Line leader |
Under the First Aid Regulation, there must be one first aider for every 20 employees in less hazardous workplaces, every 15 in hazardous workplaces and every 10 in very hazardous workplaces. A first aider certificate is valid for 3 years; refresher training is taken within the 3 months before it expires. In shift-based plants, think of this number separately for each shift; having no certified person on the night shift is a common gap. You can enter certificate expiry dates and refresher training periods in our OHS calendar tool.
Gauze, bandages, a tourniquet, gloves and bags need to be ready near every line. For the equipment list, see our article on first aid cabinet contents, and for scenario-based practice, see our emergency drill guide.
How do you practise the scenario in a drill?
A role table that stays on paper is of no use at the time of an accident. You can dedicate one of the emergency drills that must be held at least once a year to a finger amputation scenario on a press line. A short tabletop rehearsal followed by a 15–20 minute exercise on site is usually enough:
- Write the scenario: "On the night shift, the operator's right index finger was severed on press number 3." Shift and line details should be realistic.
- Rehearse the machine step: The line leader demonstrates the emergency stop, energy isolation and securing the ram with a safety block on the actual machine.
- Rehearse the first aid steps: Direct pressure, bandaging and a tourniquet are applied on a manikin or volunteer; the second first aider bags and labels a model part.
- Test communication: 112 is not called, but the call script is said out loud; the person who will meet the ambulance goes to the gate and is timed.
- Check the equipment: Are the tourniquet, gloves, bags and ice source really near the line?
- Review: Which step was delayed, and who did not know what? Record the results on the drill form and in the emergency plan.
Night shift and weekend teams are the groups most often missed in drills; run the scenario on these shifts in rotation too.
After the accident: reporting, investigation and prevention
The work does not end once the casualty has reached hospital:
- Reporting: The occupational accident is reported to the Social Security Institution (SGK) within 3 working days after the accident (Law No. 6331, Art. 14/2). For the steps, see our article on what to do after an occupational accident.
- Investigation: Root causes are investigated, such as why the guard was disabled, whether energy isolation was carried out during die changes and pressure on cycle time. Our articles on press safety and machine guarding guide the measures on the machine side.
- Risk assessment: An occupational accident is one of the situations that requires the risk assessment to be renewed without waiting for the due date.
- Return to work: Before returning to work, the injured employee receives additional training on the causes of the accident and ways of protection (Law No. 6331, Art. 17/4); the workplace physician assesses fitness for duty on return.
In our workplace physician service we prepare the first aid organisation and first aider planning together with the business, and in our emergency plan service the machine accident scenarios and division of roles. For risks specific to metal and machinery manufacturing, see our metal and machinery sector page.
Frequently Asked Questions
Is a severed finger put in ice?
Not directly. The finger is wrapped in a clean cloth and placed in a sealed bag; this bag is placed in a second container filled with iced water. Direct contact with ice can damage the tissue.
Is a tourniquet needed for a finger amputation?
In most finger amputations, bleeding can be controlled with direct pressure. A tourniquet is applied if there is an amputation of the arm or leg or if the bleeding does not stop with pressure. The time of application is noted and the tourniquet is not loosened until the medical team arrives.
Should a hand trapped in a press be pulled out immediately?
First the machine's energy must be isolated and the ram prevented from descending. Opening the die is done by the maintenance supervisor. If the person has been trapped for a long time, decide on the timing of removing the load together with 112 if possible; if there is a fire or a second hazard, do not delay the rescue.
Is it necessary to send an employee with a crush injury but no bleeding to hospital?
Yes. In crush injuries, damage to muscles, blood vessels and bones may not be visible at first; with prolonged entrapment there is also a risk of crush syndrome. The casualty should be assessed at a healthcare facility.
A physician assigned for the time your hazard class requires: pre-employment and periodic examinations, fitness-for-work reports and health surveillance.
Bursa SİSTEMER OSGB Technical Team — written from the field experience of our OHS specialists and workplace physicians. Legal information is valid as of the publication/update date; contact us for an assessment specific to your business.