SA国际传媒

By Mike McEvoy, PhD, NRP, RN, CCRN; Kevin Spencer, MD, P.Eng.

Ring entrapment is a medically significant, time-sensitive emergency that has evolved in complexity over recent years [1]. As new, harder ring materials have become commonplace (e.g., tungsten carbide, titanium, stainless steel and smart rings), legacy ring removal tools have increasingly proven ineffective [2, 12].

In the absence of modernization, medical professionals sometimes improvise with non-medical strategies using repurposed hardware tools. These improvised methods expose patients to unnecessary risks and delay definitive care.

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Case: Ring removal

An 11-year-old girl presented to her local emergency department after being unable to remove a friend鈥檚 gift 鈥� a moderately-sized ring of unknown material 鈥� from her right ring finger.

Initial at-home remedies, including application of lubricants and string-wrap techniques, were unsuccessful. String-wrap techniques are often attempted by lay persons and repeated in the emergency setting. Although sometimes described as effective in mild cases, tightly applied string-wrap methods with repurposed materials like dental floss or suture material can cause micro-trauma to finger tissues and exacerbate finger swelling [1].

In this case, repeated string-wrap attempts worsened swelling and led to the need for definitive intervention. Following at-home attempts at removal, swelling worsened and her finger began to discolor, leading her family to seek emergency care.

First emergency department encounter

At the local emergency department, clinicians attempted to remove the ring using conventional string-wrap techniques, followed by a traditional manual ring cutter 鈥� a hand-operated device with a built-in finger guard.

Manual ring cutters, listed as FDA Class 1 medical devices, were originally designed for softer metals, such as gold and silver. They often fail when faced with modern, harder materials, such as steel, titanium or tungsten carbide [3].

In this case, the manual cutter failed to achieve ring removal, and clinicians escalated to improvised strategies and tools, including trauma shears, a bolt cutter and, ultimately, a Dremel-style high-speed rotary tool.

The improvised use of repurposed hardware-store tools like Dremels in clinical care highlights a concerning deviation from medical standards. These tools have crept into use in emergency practice despite:

• Published case reports of harm, including thermal burns, lacerations and other injuries [4, 11, 12]
• Manufacturer warnings [5]
• The lack of FDA clearance [6]
• The lack of validated finger guards and cooling techniques

In this case, the improvised techniques caused thermal injury, coupled with trauma from the other instrumentation, leading to significant emotional distress to this 11-year-old girl. The patient later recalled, 鈥淚t was burning my finger ... I was crying ... I thought they were going to cut my finger off.

The patient was ultimately transferred to a regional pediatric center.

Escalation with patient transfer

At the regional pediatric center, healthcare professionals repeated similar legacy and improvised strategies 鈥� still without success. The patient described multiple providers 鈥渢rying everything they could think of,鈥� and her father likened it to 鈥渨atching her go through torture.鈥�

The cumulative failed strategies resulted in worsening edema, finger bleeding and, ultimately, consideration of hand surgery for ring removal. As discussions began around surgical options, the patient became increasingly anxious, describing feeling as though her 鈥渇inger might have to be cut off.鈥� Her father observed escalating swelling, finger damage from failed removal attempts and emotional trauma.

EMS intervention and case resolution

(Photo/Courtesy Kevin Spencer)

After nearly 6 hours across two hospitals, Chatham EMS District Chief Michael 鈥淩icky鈥� Royal, who happened to be at the pediatric center for another matter, identified an opportunity to intervene. Deploying the 鈥� a modern, FDA-registered, made-for-purpose medical device 鈥� Chief Royal executed a safe, efficient two-point cut that removed the ring in minutes, resolving the crisis without surgery [7].

Chief Royal described the procedure: 鈥淲hen I began, they were obviously upset. The finger was purple and very swollen,鈥� he recounted. 鈥淏ut after I made the first ring cut, the tone changed. They saw for the first time that this problem was going to be solved. Within about 10 minutes, I had cut the ring twice, the ring was removed, and the finger color began to improve.鈥�

Unlike improvised methods, modern regulated medical devices incorporate safety features, usability protections and essential performance standards into their design, manufacturing, labeling and lifecycle management [6]. When non-medical tools are used, this entire protective framework is bypassed. These safeguards 鈥� while not always visible to frontline users 鈥� can make a critical difference in outcomes.

Prevalence of ring entrapment

Ring entrapment is a common occurrence among the general population. In a survey of U.S. adults, over 55% reported wearing rings [2]. Of those ring wearers, over two-thirds had experienced a stuck ring at some point in their lives. While not all cases required medical attention, just over a quarter of respondents who had a stuck ring reported seeking healthcare intervention.

The gradual normalization of improvised workarounds likely originated from the limitations of legacy ring removal equipment. As ring materials became increasingly resistant to cutting, traditional removal tools began to fail more frequently 鈥� consuming clinical resources and delaying care [10-12]. When improvised solutions are then introduced, the risks shift from inefficiency to direct potential for patient harm from the use of these tools. Modern ring materials demand modern solutions.

Today, improper management of ring entrapment is a patient safety issue, reminding us of the principle of non-maleficence highlighted in the Hippocratic Oath: 鈥渇irst, do no harm.鈥� Awareness should begin with an understanding that ring entrapment is a medically-significant problem that can escalate into a time-sensitive and finger-threatening medical emergency, and that the use of repurposed hardware-store tools introduces significant risks, including burns, lacerations, fragmentation hazards, regulatory violations and increased liability exposure.

This case highlights how EMS, fire/rescue, and hospital clinicians can deliver safe, definitive and professional care by adopting made-for-purpose, modern, medically regulated devices. Here, 10 minutes of effective care by a prepared EMS professional superseded several hours of unsuccessful interventions across two healthcare institutions.

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Be prepared for the next patient

This case serves as a powerful reminder: an 11-year-old girl鈥檚 finger was at stake. Modernization and preparedness are no longer optional.

As ring designs and materials evolve, so must emergency response strategies. Hospitals, EMS, and fire/rescue agencies should prioritize access to medically appropriate equipment. Education programs that deliver ring entrapment content should emphasize the pitfalls of improvised strategies and unregulated tools in patient care.
By doing so, we can ensure that the next patient facing a similar ring entrapment emergency receives definitive, safe, efficient and professional treatment.

This EMS intervention resulted in the Georgia EMS Association鈥檚 Tim Peebles Champion of Children Excellence and Advocacy award being granted to Chief Royal in April 2025.

REFERENCES

1. Mellick L. Ring Removal Techniques and Challenges. Emergency Medicine News. January 4, 2022. Available at:
2. Spencer K, Cowper-Smith C. Ring Entrapment Management in Urgent Care: The Case for FDA-Registered Medical Devices. Urgent Caring. 2025; Q1:10鈥�13.
3. U.S. Food and Drug Administration (FDA). Code of Federal Regulations, Title 21, 搂 880.6200 Ring Cutter. Available at:
4. Quinto ES Jr, Dowbak JM. Digital Thermal Necrosis Resulting in Amputation After Removing a Tungsten Carbide Ring With a High-Speed Metal Burr: A Case Report. The Journal of Bone and Joint Surgery. 2024 May 17;14(2):e23.00467.
5. Dremel Operating/Safety Instructions 鈥� Dremel 100, 200, and 3000 Models Page 5. Available at:
6. U.S. Food and Drug Administration (FDA): Overview of Device Regulation. Available at:
7. Emesih J, Staple L. A Novel Cutting Device for Ring Removal: Case Study. Journal of Emergency Medical Services (JEMS). September 14, 2023. Available at:
8. Staple L, LeBlanc C. A Novel Approach to Ring Removal: Compression Device. Journal of Emergency Medical Services (JEMS). June 16, 2020. Available at:
9. Sayler L, LeBlanc C. Compression Devices as an Alternative Approach After Unsuccessful Ring Removal Attempts. Cureus. 2022 Feb 9;14(2):e22003.
10. Ramesh BA, Satish Kumar J. Ring Finger Necrosis Due to a Ring. Indian Journal of Surgery. 2017 Aug;79(4):367鈥�368.
11. Brock, S., Kuhn, W. Removal of Constricting Bands Using the Dremel Drill. Academic Emergency Medicine. Nov. 1999, Volume 6, Number 11; 1182-1183.
12. Kapickis M, Kutz J. Case Report: Titanium alloy ring crush injury. American Journal of Emergency Medicine. 2007 1084.e3-1084.e5

ABOUT THE AUTHORS

Mike McEvoy, PhD, NRP, RN, CCRN
Mike McEvoy is the EMS coordinator for Saratoga County, New York; the immediate past chair of the EMS Section Board of Directors for the International Association of Fire Chiefs (IAFC); and current chair of the National Registry of EMTs (NREMT) Board of Directors. Additionally, Mike is a nurse clinician in the cardiac surgical ICU at Albany Medical Center, and a paramedic supervisor with Clifton Park & Halfmoon Ambulance. He is also the chief medical officer for West Crescent Fire Department and an author/editor of EMS textbooks and educational materials.

Kevin Spencer, MD, FCFP(EM), P.Eng.
Dr. Kevin Spencer is a dual-trained emergency physician and professional mechanical engineer with over 14 years of experience at the intersection of frontline clinical care and medical technology innovation. He serves as an assistant professor in the Department of Emergency Medicine at Dalhousie University and as a medical control physician for Emergency Health Services in Nova Scotia, where he provides medical oversight for prehospital care systems. As CEO and co-founder of Ring Rescue Inc., Dr. Spencer has led the development and regulatory clearance of made-for-purpose medical devices for managing ring entrapment, including the Dolphin Ring Cutter. His work has helped establish new clinical protocols and supported safe adoption across emergency departments, urgent care centers, EMS, and fire/rescue systems throughout North America. Dr. Spencer is a recognized subject matter expert in ring entrapment, with publications and contributions to clinical education and healthcare risk management on this topic.