It is a warm and beautiful fall day. The Attack One crew is eating dinner when it's dispatched for a "motor vehicle accident with injury" on a small, quiet residential street. As they approach the accident, they first note only a parked construction truck with a few paint marks on it. Ahead is a small car, with no damage obvious to the rear or driver's side. But several bystanders are standing next to the passenger side of the vehicle, and a nearby police officer is placing a towel over something in the street.
Approaching the vehicle on foot, the crew finds an entirely different scene. In the passenger seat is a young man in acute distress. His right arm has been amputated, and bystanders have covered it in a towel, and fashioned a tourniquet from a man's belt to control the bleeding. The entire passenger side of the car is filled with blood, and it is covering the side of the car. In the backseat is a young woman, who is groggy and has a lot of blood on her as well. An older man and one of the police officers who arrived before Attack One are sitting on a curb in front of the car; both have vomited. It is now clear what the other police officer has covered with a towel and is standing over: the young man's right arm.
A man who identifies himself as the father of the young woman is able to explain the scene. His daughter and her boyfriend had just finished dinner with the family and were pulling out of the driveway at a low rate of speed. The young woman was driving, and didn't notice the construction truck parked just off the end of the driveway. She sideswiped the truck, and unfortunately her boyfriend in the passenger seat had his arm outside the window. The arm was torn off.
Hearing the screams of the young people, the family and some neighbors ran out to assist, and one of the neighbors thought to wrap the arm in a towel and try to control the bleeding. When direct pressure wouldn't work, another neighbor took off his belt and made it into a tourniquet.
The daughter is uninjured, but had passed out after trying to help, so they laid her in the backseat. Seeing the injury and blood, some neighbors also got ill, as did the first-arriving police officer.
The Attack One paramedic assumes control of the right arm stump and tourniquet from the bystander, and does a quick assessment of the young man. He is in extreme pain, but can report that nothing else is injured. His airway is uncompromised, and he has no respiratory distress, with adequate perfusion and brisk capillary refill in the left hand. He has suffered significant bleeding from his amputated arm, and the paramedic notes large amounts of blood in the seat, on the floor, on the window, and down the outside of the car and into the street.
The Attack One crew immediately requests another ambulance to assist with the other persons, and prepares the young man for transport. The paramedic attempts to look at the end of the stump to confirm the blunt type of amputation, and notes there is a jagged edge, with parts of exposed muscle, blood vessels and other tissue. There is active bleeding from the stump when the belt slips, so the paramedic replaces the belt with a blood pressure cuff inflated to about 150 mmHg and clamped. This provides a more comfortable way to keep a tourniquet in place.
The crew slips the patient out of the car. Because his clothing is so bloody, they leave it in the car and place him in a sheet. They quickly start a large-bore IV line in the left arm and administer morphine. They place the amputated arm in the ambulance with the patient. It is supported on a long arm board, with dressings loosely applied to the skin surface and a small amount of saline used to dampen the dressings. The other incoming fire and EMS crews will evaluate and manage the young lady and bystanders.