We all love battle scars, right? Unfortunately, a bleed in the wrong place or at the wrong time can leave you in a bit of strife. But a few simple tips will help you manage the wound in the field and avoid the not-so-glorious (and a little embarrassing) task of arranging a medical evacuation and calling quits on your trip. Please note that the accompanying photos have been staged and are for demonstration and field-practice purposes only
For any open wound that is bleeding heavily, the priority is to stop the bleeding, treat for shock and make arrangements for transport to definitive medical care. Often in the wilderness situation, definitive care will be delayed, or may have to be administered by the group.
For a major open wound, you can save the victim’s life just by stopping or slowing the loss of blood using ‘Pressure, Elevation and Rest’. Apply direct pressure over the bleed site using hands initially (with a protective barrier such as gloves or plastic bag to prevent transmission of infection to or from the first-aider) until you can find some more permanent resources (bandages, tea towels, shirts). Elevate the wound if possible, by putting it in a sling or supporting it over a raised object such as a rolled-up swag or pack. This uses gravity to slow the blood flow and allow a blood clot to form.
Everyone appreciates a little R&R. Rest and reassurance slows the heart’s rate and force of contraction thereby slowing blood flow.
Shock occurs when there is insufficient supply of blood to the body’s organs. The body can compensate for this for a small amount of time, by shutting down blood flow to less important areas, such as the skin, and altering the pumping activity of the heart. However, if left untreated, this will eventually lead to the casualty’s demise. They will appear cold, clammy, pale and confused or anxious.
Elevate the person’s legs to keep blood in the upper portion of the body, if no other injuries are suspected. The casualty needs to be kept warm. Insulate them from above and below. Cold ground draws huge amounts of heat from the body. Insulate using whatever means are readily available (tent fly, swag, blankets, tarps, jackets) until you have time to set up a more hardy and comfortable shelter. Protection from the wind and rain are equally important. Wrap the person up, using sleeping bags, thermal emergency blankets, jackets or tarps, but make sure that their injuries are accessible for monitoring and further treatment.
In an isolated or survival situation, infection control is more important than most people suppose. While an infection won’t kill you in minutes, it can kill in days. Proper wound care is more extensive than tying on a few strips of torn up t-shirt or a bandage and changing it whenever it looks putrid. If you are likely to be waiting for several hours, particularly in a tropical environment, infection will set in quickly, therefore any wound, however small, needs to be properly cleaned and protected (after controlling bleeding, of course).
It has been said that “the solution to pollution is dilution”. Aggressive irrigation techniques should be employed. Use saline tubes (found in standard first-aid kits) to flush out the wound, using a high-pressure stream to wash away contaminants. If this is not available, sterile water boiled for five minutes then cooled, will do the job, if applied with a syringe or bag with a small hole in it, for extra water velocity.
Simply tipping water over the wound does not effectively flush material from it. If you have no means of jet irrigation, or it is ineffective, you will need to scrub the wound. This will reduce the amount of harmful bacteria to a level where the body’s defensive mechanisms can cope with it. This needs to be done quickly, as it damn well hurts and the victim won’t be your best friend afterwards. The line “this will hurt, but you will feel much better once it’s over!” may protect you from a left hook to the jaw but lying to the patient about pain is not recommended, as they may never trust you again.
Vigorously rub with a clean cloth (sterilise by boiling) or gauze – don’t use yesterday’s hunting shirt with pig blood all over it! The rougher the material, the better, as it will slough away dead tissue, dirt and foreign bodies. This procedure is best done with two people: one to play doctor and the other for moral support and fly shoo-ing. So, spread the wound, blast it with water and scrub away as you enjoy the retribution of those early years when your mate stole your girlfriend, ditched you at the pub, or crashed your first car.
Unless you are trained in wilderness medicine (or you are John Rambo), suturing in the field is generally not recommended. However, a thoroughly cleansed wound should be closed and covered so as to conserve the good work you did with the cleansing phase and assist in good wound healing.
Tape closure of wounds using ‘steri-strips’ or butterfly wound closures can be fiddly, but if done well, will minimise scarring. If the laceration can be held together with tape, pinch the edges close after thoroughly removing debris, and apply small pieces of strip dressings horizontally across the two edges, repeating along the length of the wound. Any tape will do, though beware that sweating and movement will disturb the tape. Cover with a non-stick wound dressing and bandage in place securely.
For scraping-type injuries (grazes), cleanse with a mild detergent and cover. These wounds usually have minimal bleeding and the resulting scab formation will lift dirt and particles as it heals, but make sure that you remove particles from any deep sections so that the scab does not heal over them.
Puncture wounds have a small opening but can be quite deep, so often don’t look as serious as they are. Depending on the source of the puncture (arrow, knife, pig tusk), infection is a major concern. Unless there is life-threatening blood loss, briefly allow the wound to bleed to effect irrigation. Cleanse with soapy water, using the scrubbing technique if possible.
Deep narrow wounds should not be taped shut. Instead, apply a warm compress for 20 minutes every two hours and cover over with sterilised clothes or bandages. This enhances the body’s natural inflammatory process to try and remove infection before the wound closes over. Seek medical aid urgently.
These types of injuries can be quite dangerous due to the potential for damage to underlying structures, therefore a large penetrating object should not be removed, and should be protected from further movement. If a blood clot has already formed around the object, removing it will cause further bleeding and possibly rupture blood vessels, nerves and other underlying structures. Apply a ring pad that wraps firmly around the object and bandage in place. Evacuate this person ASAP if their condition allows, or bring in medical aid.
Large gaping wounds
Large gaping wounds should be treated as for a laceration, with special attention paid to protecting from blood loss and shock. Such wounds can result in organ protrusion, particularly in the abdominal region. For protruding organs, cover them with plastic. DO NOT push them back in place. Humans aren’t animals. I hate to break it to you, but performing autopsies on animals to find your broadhead doesn’t quite qualify you as a surgeon.
Deciding whether the injury is serious enough to warrant evacuation, or can be effectively treated in the field, is up to the common sense of the first-aider and condition of the casualty. Evacuation is definitely needed when there is major blood loss or shock, the casualty’s tetanus immunisation is not up to date, there are signs of infection or a high likelihood of developing one, and severe pain. Antibiotics are recommended if the wound is from a fracture, animal bite, or has contacted contaminated water, so some patients will need to see a doctor regardless of how well the wound is cleaned.
Above all, if you are unsure, or the casualty’s condition is questionable, seek help. While there is a lot less glory in bringing home a sick mate than a four-legged trophy, it will keep you out of a lot of trouble with his cranky wife.