Would you know what to do if your hunting partner had a serious injury and was losing blood fast?
A bleeding wound is deemed “serious” if the rate and level of blood loss are potentially life-threatening. This type of wound could be the result of a gunshot, animal attack, or motor-vehicle accident. The wound itself could be a deep laceration or cash, an impalement, or the partial or full severing of a limb or appendage. These are ghastly things to see or experience, but they happen. Since a person with a punctured or severed artery can bleed to death in as little as three minutes, it’s important to know the right way to respond, and to proceed quickly.
From a first-aid standpoint, there are three types of external bleeding: arterial, venous, and capillary. Arteries are large vessels that carry freshly oxygenated blood away from the heart. The flow is rapid and pressurized, which is why arterial bleeding is so abundant and dangerous. Arteries narrow and branch into smaller arterioles, which in turn reduce into a network of tiny vessels called capillaries. Capillaries deliver oxygen and nutrients to the body’s cells, while also removing wastes and carbon dioxide. The waste-filled blood then passes into venules, which connect to larger veins en route back to the heart, where the circulatory process is repeated.
This bit of simplified medical understanding can help identify and evaluate the kind of bleeding that’s taking place. Capillary bleeding is slow, often more of an ooze, and is usually bright red. It is low-volume and normally easy to stop. Venous bleeding (blood loss from veins) usually comes out in a steady flow, which can be copious and sometimes life-threatening, depending on the size of the opened vein. Although all blood reddens when it meets outside air, venous blood can be noticeably darker, more maroon-colored, than capillary or arterial blood.
Arterial bleeding is, of course, the most dangerous. The large vessels and fast, pressurized flow can literally pump blood out of the body in heartbeat-synchronized jets or spurts. Arterial blood is bright red with fresh oxygen, but the key indicator is the beat to beat out pumping of blood, which can kill a person (or trigger fatal volume shock, to be discussed later) in as little as three to five minutes. Therefore, arterial bleeding is a number-one first-aid priority, meaning it must be dealt with as quickly as possible before other injuries or conditions are addressed.
Applying Direct Pressure to the Wound
The first and usually best way to stop external bleeding are by applying direct pressure to the wound, using the heel of your hand. You might first need to pull, cut, or (carefully) tear away clothing so that the entire wound is exposed. Ideally, the wound should then be covered with four or five layers of sterile gauze pad or wraps of three-inch roller gauze. (Both pads and rolled gauze should be part of every first-aid kit.) If a sterile dressing isn’t available, use the cleanest absorbent material you can find, such as a towel, bandana, shirt, and so on. Lacking even that, you may be forced to use only direct hand pressure, without any dressing, to stop the blood flow.
Since other people’s blood can transmit serious diseases such as HIV and hepatitis, it’s always best to put on sterile, nonpermeable gloves (latex or other synthetic) before ending another person’s wound. The gloves also help protect against accidental infection of the wound site, so the protection factor works both ways. Surgical-style gloves are light and easy to carry. Keep a good supply in every first-aid kit. You can also put a few gloves in a small Ziploc bag and tuck that into a back or side pocket. That way they’ll always be available, no matter where you are.
Light bleeding wounds will stop flowing fairly quickly under direct pressure, but serious bleeding generally takes longer to stanch. The usual guideline is to maintain direct pressure on the wound for at least ten minutes. This gives severed vessels time to close (via spasms of the vessel walls) and allows early blood clot formation.
Once you’ve placed a dressing over the wound, do not lift it to see if the bleeding has slowed or stopped Lifting the dressing to peek at the wound can tear away dotting seals and restart or increase blood flow. Keep the dressing in place and under firm, direct pressure. If the dressing soaks with blood, add another layer of dry dressing atop it and continue the pressure. With serious wounds, it can take twenty minutes or more of direct pressure to completely stanch the bleeding.
Elevating the Wound Site above the Victim’s Heart Level
When possible, aid the direct-pressure method by elevating the wound site above the victim’s heart level. A person lying down with a leg wound, for instance, can benefit from having the leg lifted and propped onto an object such as a box, pack, rock, or log. A sitting person with an arm or hand wound can hold or prop the arms overhead or at least above shoulder level. Do not attempt to elevate a limb if you know or suspect there is a broken bone associated with the wound. Lifting could accidentally aggravate the damage and initiate more bleeding.
Another aid to the direct pressure method is an ice pack or cold compress above the dressing (never below it, against the skin) to help trigger vessel spasms and slow blood flow.
When the bleeding appears to have stopped, apply a pressure bandage to keep the original dressing (and clot seals) in place. Do this by wrapping the dressing firmly with an elastic bandage, several wraps of roller gauze, or whatever is at hand, such as a torn-off length of cloth. Don’t wrap so tightly that you inhibit circulation below the wound. (Numbness, tingling or bluing fingertips or toes are signs that you need to loosen the wrap.) Lastly, knot, pin, or tape-wrap the pressure bandage to hold it in place.
If the outside dressing begins to soak through or drip blood, the bleeding has resumed and needs more direct-pressure treatment.
In cases of animal attack, vehicle accident, or gunshot, multiple wounds are a real possibility, and you should always make sure you are treating the most serious bleeding wound, first. With a high-velocity gunshot, the exit wound may be larger and more serious than the entrance wound. This could go unnoticed if, for instance, the victim is lying on his back after being shot from the front. In this type of situation, the person could bleed out from the back while the entrance wound is being given all the attention.
In cases of impalement, as from a blade, broadhead, sharp object, or fragment, meant, the general rule is: Do not remove it. Removal could cause additional injury or exacerbate bleeding. Instead, secure the object in place with gauze and/or other bandaging and tape, so that it moves as little as possible during the evacuation.
Do not try to clean, disinfect, or close a serious bleeding wound. Leave that work to the emergency professionals. Your job is. to stop the bleeding, so that the victim can: survive long enough to be evacuated out to medical aid.
What if direct pressure doesn’t stop the bleeding? This can happen in extreme situations, usually involving partial or full severing of an artery and/or limb. Also, with some specific types of wounds, direct pressure simply can’t be used–say, a broken thigh bone has cut the adjacent femoral artery and a jagged edge of bone is jutting out through the skin. Arterial blood is spurting out next to the fractured bone. The direct pressure method might be impossible to apply without aggravating the injury. In this type of case you have to do whatever you can to stop the blood loss, and that means using a tourniquet.
A tourniquet is a tightened band around an arm or leg, designed to cut off all blood flow to the wound. Of course, this also stops blood circulation to the remainder of the limb.
If the tourniquet is kept on long enough, the blood-deprived tissue dies and must be amputated. Thus the general guideline: If you use a tourniquet you are deciding to risk the loss of a limb in order to save a life. Obviously, this is a tough call, but sometimes it’s a decision that must be made.
To properly fashion a tourniquet, use a soft band of material at least two inches (but no more than four inches) wide. Do not use narrow or hard-edged things such as a good race, stiff leather belt, cord, or rope, unless there is no other option. Thin or hard-edged materials can eventually cut through the skin and cause bleeding to resume at the tourniquet site. Three-inch roller gauze makes a quick and effective tourniquet. Lacking that, you could use a shirt or other piece of doth rolled into a three-inch, flattened band. Wrap the gauze or cloth band at least twice around the limb, between the wound and the heart, as close to the wound as possible, but not directly on it. Place a stick or stiff rod over the wrapped band, then make another wrap over the stick. Twist the stick sideways to tighten the band. Tighten only until the bleeding is controlled. Then use the rest of the gauze or cloth band to square-knot the stick into place. Be sure to note (and write down if possible) the exact time the functioning tourniquet is applied.
How you proceed from here is a matter of some debate. Traditionally, the rule has been to gently release the tourniquet every fifteen to twenty minutes. This allows some circulation below the wound, reducing the likelihood of later amputation. If bleeding resumes at the wound, the tourniquet is re-tightened for another Fifteen- to twenty-minute period, and so on.
However, some experts (such as John Klatt, who teaches emergency first aid to military medics, sportsmen, and others), now say that once a tourniquet is applied, it should not be released except by a professional in a medical facility. The rationale is that a loosened tourniquet not only reopens dotted wounds, it can also cause a sudden, severe drop in blood pressure. The victim passes out, the heart begins pumping harder to restore pressure, and severe bleeding resumes. According to this viewpoint, loosening the tourniquet in the field actually, lowers the victim’s odds of survival.
Once you have stopped serious bleeding, there is one more vital concern to keep in mind. Anyone who loses a high quantity of blood is in danger of suffering from volume shock. This is a potentially life-threatening, progressive condition, and should be considered a true emergency. Symptoms can include paling of the skin (or an ashen look for dark-skinned people); clammy (moist and cool) skin; rapid, shallow breathing low blood pressure; increased heart rate; weak and rapid pulse, and possible anxiety, confusion, and/or restlessness. One quick way to test for low blood pressure is to check “capillary by pressing down on the victim’s fingernail (or toenail) bed with your thumb. The nailed will whiten under pressure. When you release pressure, a reddish/pink color should return in two seconds or less. If the recoloring takes more than three seconds, you can assume lowered blood pressure and the possibility of shock.
Field treatment for volume shock is limited but vitally important. First, control the bleeding. Next, have the victim tie back (if’ injuries allow). Elevate the victim’s feet and legs twelve to sixteen inches. This helps keep blood in the core organs and brain. (However, do not elevate the legs if the person has a severe head injury, broken legs, or a spine injury.) Next, keep the person covered and warm. Insulate from below as well as above if possible. the lithe victim is conscious and can swallow without a problem, have him/her sip a sugar-sweetened liquid or nutrient drink, as much as can be comfortably conned wild in small sips. Get the victim to professional medical care as soon as possible.