How to Treat Lacerations in the Field
A cuts are one of the most common injuries in the field. And whether you accidentally slide a broad head down your forearm or you slice your hand with a skinning knife, the response is the same—you’ll need first aid in the field.
8. Learn the Jargon
Slices and slashes can come in all shapes and sizes, but you don’t have time for a linguistics lesson when someone’s blood is dripping on the ground and your squeamish hunting buddy is turning a mossy shade of green from nausea. Now is a good time to learn what these two terms mean:
These wounds come in all shapes and sizes, from clean and simple straight cuts to jagged wounds in odd shapes. We get the word from the Middle French term, lacération, which means a “breach or rend made by tearing,” and that word is based on the Latin word lacerationem, which means to “tear, rend, or mutilate.”
This is the cutting injury I dread the most. An avulsion is a cut wound that does more than slice into you. It separates tissue away from the body. Think, an apple peeling that is still attached, and you’ve got it. These rarely heal well in austere settings, and they often lead to the loss of the separated tissue and an infection in the pocket underneath of the loose tissue.
7. Pack Your Kit
You can build your own first aid kit piece by piece or buy one fully stocked. Whichever route you go, you’ll want to have the right supplies to deal with bleeding wounds in the field. Here’s a quick rundown of your most vital supplies:
Dressings – Sure, you could stop bleeding with your bare hand or some old rag you found, but bandages are better for bleeding control. You’ll want to carry multiple dressings in several different sizes. Pack your kit with small things like Band-aids for simple cuts. Load up with 4x4-inch pads, and one or two larger trauma pad dressings. Rolled gauze is also very useful as a dressing material, wound packing, or as something to bind other dressings in place.
Tourniquet – For heavily bleeding limbs, a tourniquet may save the day. Make sure you have practiced with it and can put it on yourself as well as someone else in less than 15 seconds.
Hemostatic Dressings – (advanced clotting sponges) or gauze can act where a tourniquet can’t (on the torso, for example). Make sure you read the product label and learn to use it properly.
Gloves – Latex-free gloves are important for your protection. It’s said that no good deed goes unpunished, and you don’t want to contract a blood-borne disease as a result of rendering aid. Carry at least two pairs of Nitrile exam gloves in your first aid kit.
Disinfectant – Choose whichever disinfectant makes sense to you, but keep in mind that hydrogen peroxide and some other disinfectants can actually slow down the healing process. I also like to carry a few alcohol wipes to clean up after treatment is rendered. Soap and water is a great thing to have available, which is surprisingly effective at cleaning wounds.
Tape – This is your easiest way to hold dressings in place and keep wounds covered. This should be a high-quality medical tape or a name brand duct tape.
Trauma Shears – If you have to cut off garments, cut through belts and straps, or do any lighter cutting tasks, a pair of trauma shears can handle it all.
6. Determine the Danger
So how bad is the cut? If you’re not accustomed to seeing human blood flowing, it can be a little hard to determine the severity of an injury. When treating a cut injury on someone else, take a second to protect yourself from blood-borne pathogens by donning some examination gloves. Then look for the source of the bleeding by opening or removing any clothing that covers the wound. There may be other injuries that are hidden by the clothing. Once you’ve found the bleeding, determine if it’s a life-threatening injury by looking for the following:
Spurting blood coming out of the wound.
Bleeding that won’t stop.
A pool of blood on the ground.
Clothing or bandages that are completely soaked in blood.
Traumatic tissue or limb loss.
Confusion or loss of consciousness in a bleeding victim.
5. Be Safe About It
If you’re acting as a Good Samaritan, call for back-up and assess whether it’s safe to help.
Step 1 – If anyone in the party has mobile phone reception, call 9-1-1 yourself or tell someone else in the group to call 9-1-1 (Make sure they are within earshot, so you’re sure they connected).
Step 2 – If you’re not sure how the person got injured, assess the scene to ensure your own safety. You won’t be much help to the victim if you get hurt too.
Step 3 – Stay alert. While rendering first aid, pay attention to your surroundings. If you’re concerned that your safety is threatened during treatment, get yourself and your patient to a safer location.
Step 4 – Treat their mind and emotions, as well as their wound. It’s important to consider your bedside manner when rendering first aid in grave situations. Do your best to stay calm and reassure the injured person. If they are alert, they may even be able to help you. Ask them to hold something or do some other small job. The distracting task may allow them to focus on something other than the injury and their pain.
4. Use Your Kit
If someone in your group or you have a life-threatening bleeding injury from a limb and no tourniquet is available—or if someone bleeding from the neck, shoulder or groin—grab your trauma first aid kit and get to work. They may only have minutes left without medical intervention.
Make An Assessment
Cut away or open the clothing over the wound, and wipe off any pooled blood to see the wound better. If there is an embedded object—don’t remove it. If the wound is gaping, don't probe around in it or try to irrigate it. Your top priority is to control the bleeding.
Use Your Supplies
For mild to moderate open wounds, use a hemostatic sponge or gauze to pack the wound, or use plain gauze rolled into a ball. Cover the wound with a flat dressing and apply pressure with both hands directly on top of the injury. Unless it’s an injury to the eye or there is an embedded object in any part of the body, push down hard and hold pressure to stop bleeding. Immobilize the injured body part as much as possible. Continue applying pressure until relieved by medical responders.
3. Apply A Tourniquet
With life-threatening bleeds, time is not on your side. You can always try direct pressure first, but if the bleeding is severe, go straight to the tourniquet. These tools for bleeding control date back to the Middle Ages, with the first recorded military use in 1647 at the battle of Flanders. Initially, they were just strips of cloth twisted tightly with a stick acting as a windlass. Today, commercially available tourniquets come in several different styles.
How to Use a Tournique
For a bleeding limb that is spurting blood or cannot be controlled with pressure, wrap the tourniquet around the limb as high up as you can reach above the bleeding site. For a leg injury, go high on the thigh. For an arm injury, go above the bicep. For tourniquets with Velcro fasteners, pull the end of the strap as tightly as possible and secure it before twisting the windlass. Continue twisting until the bleeding stops. Clamp or otherwise secure the windlass, and write the time that the tourniquet was applied (ideally, on the patient with a marker). The use of a tourniquet will hurt, but sometimes it’s the only way to control life-threatening bleeding in the field.
2. Pack the Wound
In some areas, like the hip and shoulder, a tourniquet cannot be applied. The most practical field treatment to close large blood vessels in those areas is wound packing. You’ll know you need it when direct pressure over the wound is not enough to staunch the flow of blood. Basic wound packing involves the forceful insertion of gauze into the open wound. It’s going to be messy, and yes, if the patient is conscious, they will probably scream.
For larger wounds, use an EMT trick called the “power ball” to stop bleeding. Wrap up the end of a gauze roll to create a round ball of cotton, then jam it down into the wound. Follow the power ball by inserting all of the gauze that the cavity will hold. You’ll want to have gauze mounding up over the wound. Again, this an aggressive and invasive act, but it can compress tissues inside the wound channel and squeeze off severed veins and arteries. Finish by applying another flat dressing over the surface of the wound and keep pressure on the wound until relieved by medical responders.
1. Treat The Bleeding Without Your Kit
It happens. We lose our gear or forget to bring it. It doesn’t have to be a death sentence if you are severely injured and caught without a trauma first aid kit. Here’s what you can still do without any medical supplies.
First, try direct pressure. This instinctive response is often the right response. When medical supplies are absent, use your bare hands or a piece of cloth to apply heavy pressure to the wound with both hands. It’s also helpful to elevate the wound if it’s on a limb.
The second technique you can try is the use of pressure points. This technique is always used as a supplement to direct pressure, and it does require some education in human anatomy. For limb wounds, learn where the femoral arteries and brachial arteries run (through the groin and the inside center of the upper arms, respectively). You’ll also want to learn how much pressure to apply. This is more like crimping off a garden hose than performing medicine, but it can help to slow the blood flow. You may also need to improvise dressings, and clothing items can often pass for bandages. If the bleeding continues, consider using a strong cloth strip or slender belt as a tourniquet.