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Thread: Srupp's First Aid Thread

  1. #1
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    Srupp's First Aid Thread

    Steven, the thread was too long for a forum post so I've split it into two:

    EMERGENCY TREATMENT OF BLEEDING IN THE FIELD


    This presentation is a brief overview on the subject of emergency treatment of bleeding in the field. It is meant to present principles rather than strict guidelines. Every situation is different, and as such you are the one who will be there and need to adapt and overcome each and every obstacle.
    A disclaimer is presented here: I hold no responsibility for how this information is handled or administered. It is my sincere objective, goal, to present principles that every hunter or outdoorsman can apply in their specific emergency.
    Do No Harm:
    Whatever you do, do to the level of your training: you are protected by the Good Samaritan Act, provided you stay within your level of training. What a normal, competent individual would do with your training in your situation. You are not expected to perform surgery.
    Minor Cuts And Bleeding:
    Minor cuts and bleeding are most readily controlled by applying pressure and elevation. Most minor bleeding lacerations stop within ten minutes with moderate pressure and elevation. Some alcohol wipes and Band-Aids will suffice. The biggest issue with minor lacerations and cuts is infection. In the outdoors, gutting moose, etc….concerns include less than optimal personal hygiene, water resources that are less than pristine…keeping the dressing in place.
    Having your small first aid kit for bleeding in your pack, on your person, means that when the accident occurs, you have the first aid supplies to deal with the injury. For a minor cut this would mean a sterile gauze pad, an alcohol wipe, and a couple of Band-Aids. Obtaining a small container of small, medium and large Band-Aids, as well as knuckle Band-Aids (which also work exceptionally well over the tip of the finger) is a good idea.
    Small cuts can happen from a moose bone shard puncturing your hand, or by a sharp sheep rib; the jagged edge of the soup lid; nicking your finger; while cutting up a deer; caping a pronghorn, etc. In our situation as hunters it usually involves a dead animal, a knife, inattention, fatigue, and working too fast.
    Most of the cuts will involve the hand, and are usually minor. However, we do have arteries, that if cut, will be almost impossible to stop. Trust me on this one! Squirting arterial lacerations need the intervention of a plastic surgeon; and as such cannot be dealt with in the field. And I will elaborate on this further on, under major, severe bleeding.


    What is normal – what is severe – how do we tell…The normal adult requires numerous systems to operate perfectly, even if compensating:

    • Pump: The heart must be capable of moving oxygenated blood throughout the body, and especially to the brain: it must be capable of adapting for increased demand loads.
    • Pipes: The blood vessels and arteries are the pipes and conduits for this blood to move throughout the body. These pipes must be intact, ie. not cut or disrupted; able to expand and contract as required, to help move the blood.
    • Blood: Roughly ten units in an average adult human for volume. The loss of even two units of blood is an emergency; can be life-threatening, and must be avoided at all costs.



    When the body detects any of these systems out of the norm, it compensates. When we lose blood, the heart beats faster and stronger to compensate for the loss and to keep the same amount of oxygen that is in the blood entering the brain.
    When we lose blood the pipes constrict, making for stronger, more forceful delivery of the remaining blood to the brain. There is less reserve standing by in the pipes.
    When we have inadequate perfusion to the brain, this is a condition we call shock.
    When not enough blood is received by the brain, the body attempts to adapt and overcome. The pulse increases from a normal of around 70…to 100…120…140…This is an attempt by the body, through the heart, to maintain a minimal amount of blood; hence oxygen to the brain.
    The blood vessels constrict and you will have peripheral shutdown. The hands and feet will go cold as the body tries to keep the blood and oxygen in the centre core to the vital organs, including the brain.
    As there is less blood to the face and hands and feet, they will appear pale and feel cold. Part of the reaction of the body for severe loss of blood will be sweaty skin.
    As there is less blood going through the lungs, the respiratory system tries to keep the same amount of oxygenated blood headed towards the BRAIN. This results in faster and laboured breathing. Trying to do more with less.
    This is shock. When it gets to be severe…there will be no radial pulses at the wrist; the pulse will be above 140 or so at rest, the patient will be lightheaded or even unconscious. The respirations will be fast and laboured. The skin colour will be white.
    We have so many items at our disposal as hunters and outdoorsmen to injure ourselves and cause bleeding - we have axes, knives of various sizes – all extremely sharp. We have broad heads, and we have firearms. Added to steep cliffs for falls, pokey sharp branches and sticks. And also falls, which result in damage to hard tissue…bones… causing tears and cuts when they break through skin.
    So now we will look at how we can limit the effects of bleeding so that we never get to the place of having our patient become shockey…
    Principal Number One:

    • Have your first aid equipment on you, in your back pack. It does no good having it back in town, or even back in camp. You can have additional supplies at camp, however, you must carry some supplies at all times. Mind readers do not need first aid supplies; they will know what and where to avoid.
    • Keep your supplies small and compact; pared down to the essentials so that you do not mind hauling them up and down the mountains.
    • Practice with the gear you plan to take with you. Sit around the house before you leave and practice putting on a knuckle bandage on the tip of the finger, applying gauze or a tensor bandage. Children make most accommodating patients. Practice.

    Principal Number Two:

    • There are going to be situations where it will be beyond your abilities. You are expected to do your best, to at least try…however, knowing when to call in the experts is a skill. You must have reliable communications. The life and limb of someone may depend upon this. Remember, the British Columbia Ambulance Service does make house calls…yes, even on the side of the mountain! But this is always daytime service. In very limited situations, the 442 out of Comox has been used. They are night rated, but very seldom used in civilian service in my experience.
    Political correctness is fascism pretending to be manners-- George Carlin

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  3. #2
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    Re: Srupp's First Aid Thread

    Principle Number Three:

    • All our goals in wilderness pre-hospital emergency survival as it pertains to blood loss and bleeding is directed at limiting the loss of blood.

    Principle Number Four:

    • Direct Pressure: This is always the first, and best action when there is blood loss. We are talking moderate to severe bleeding. The nature and severity of the bleed will dictate the action. Massive bleeding will require instant direct pressure via the palm of your hand directly over the bleed. If it is not a fracture, significant pressure is needed. Rubber gloves, gauze pads, and other bleeding suppression supplies can be dug out and be ready for use…but apply that direct pressure as soon as you can. Infection, and non- sterile techniques take a distant second, backseat priority to blood loss. Always.
    • Spraying arterial bleeds are pretty noticeable; and while direct pressure is applied, the thought process is that this is beyond my control or abilities and we must be making attempts at a higher level of medical intervention. This is the time, and sooner is better.

    Principle Number Five:

    • Dressings: Apply a sterile gauze dressing over the wound. Once that dressing is in place it does not get removed. Ever. If it bleeds through the first dressing, add more over it. Keep adding if the dressing becomes saturated and soaked through. If it appears that the bleeding has stopped, DO NOT remove any bandages to check. If you run out of bandages, use clothes, towels, space blankets. Improvise…Adapt…Overcome.
    • I personally carry a pressure dressing: what some call an Ace bandage, or an Israeli dressing: tie with enough pressure to stop the bleeding, but not cut off circulation distally.
    • Gauze rolls, while effective for keeping a gauze dressing in place, DO NOT provide enough constant pressure to keep the bleeding stopped; a tensor bandage can.

    Principle Number Six:

    • Elevate the affected area above the level of the heart: a laceration to the hand: pressure on the hand, lifted up to the head level. This allows gravity to assist you to reduce the blood pressure to the limb, helping stop the bleed. An axe to the foot: lay the patient down and elevate that leg.
    • Severe lacerations : We lay the patient down. So that if a drop in blood pressure occurs, they do not pass out, fall down, and create more injuries. This also assists by allowing the heart to contract less forcefully, lowers the blood pressure, and creates less bleeding.



    Principle Number Seven:

    • For severe bleeding there are pressure points:
    • For the hands and lower arms: on the inside of the arm between the bicep and humerous, press along the humerous and roll towards the bicep.
    • For the lower legs: follow the pant line as if it had been ironed with a crease running up the centre of the pant front…where it meets the crease of the leg at the hip…press down with hard pressure, with a karate style edge of open hand, while using your other hand to add more pressure.

    So...Preparation:

    • Pressure direct
    • Position of the injured part


    • Position of patient
    • Pressure points


    • There are different types of injuries that cause bleeding, no matter how caused, external lacerations are basically cuts.
    • The best treatment by far is to avoid these…cut towards your chum, and not your thumb.
    • Usually direct pressure is sufficient for most normal cuts.
    • The most dangerous cuts are arteries in your hands or your wrists: medical emergencies demanding medical intervention.
    • However, sometimes the knife penetrates or punctures: it goes in embedded tip first. These penetrating injuries often hide the depth and severity of the injury, blood loss.
    • If something penetrates the human body…leave it there. The absolute best item to control bleeding is the item that penetrated, punctured, and made the wound. It fits the wound channel 100%, so again, leave it there in place.
    • Place a slit in the gauze, slide it over the penetrating object, make a ring pad, circle and stabilize the penetrating object in place. If the object is a branch or something long, cut if off gently so not to disturb the wound. A knife, a stick, anything that penetrates the human body is a medical emergency.
    • A severe finger cut can be bandaged up, and it is splinted to the adjacent finger…less movements help keep the wound stay closed.
    • A severe laceration to the leg is splinted to the adjacent leg using a blanket in between.
    • Sometimes bleeding is caused by fractures. A severe fall can cause a fracture; which is an injury to hard tissue, ie. an arm, leg, ribs. The sharp broken off bones can be as sharp and as bad as a knife cut: you treat the bleeding the same, with the addition of splinting. If the bone is broken but the skin is not, this is called a simple fracture, or a closed fracture. Where the bone pokes through the skin, this is called a compound fracture. A serious bleeding issue could be due to a significant fall, where the liver splits apart due to the pressure of landing, or a rib breaks off and lacerates the liver.
    • If there is a history of a significant fall, about fifteen feet or more, and the signs and symptoms of shock are present, this is a medical emergency.
    • Any bleeding or injury to a patient who is taking ASA therapy as a preventative cardiac protocol, or those at increased risk of CVA (stroke) who are currently taking Coumadin or Warfarin in a therapeutic dose are all at risk of a ******ed clotting process and this makes stopping bleeding much more difficult. They often exhibit a sensitivity to bruising.
    • It must be noted that most patients with significant bleeding will often become thirsty. It is imperative that you give them nothing to drink or eat. They are NPO (nothing per oral). That is a rule.

    For truly significant bleeding, there are a couple of last stop measures…

    • There is QUICK CLOT III…or CELOX bandage or powder. Both are chemical agents that cause extreme clotting and a life or death chance at stopping deadly bleeding.
    • Beyond this, there is a last resort…one to be used in life over limb and not to be taken lightly…this is a TOURNIQUET.
    • If you decide to purchase the Quick Clot or the Celox, and you need to apply it, ensure that you keep the packaging and hand it to the paramedic or life flight crew, as well as with the time you applied it.
    • Same goes for the tourniquet…ensure you mark on the forehead of the patient the time you applied the tourniquet. And follow directions for when to temporarily release pressure in order to try to save the limb.





    This is a List of Potential Products to Pack With You Always for Treatment of Wilderness Bleeding:



    • A one-page guide to emergency first aid…we all have brain farts…emergencies can be very upsetting; disrupting the memory. Have a one-page guide in your pack.
    • Crazy Glue…for small, minor cuts.
    • One compress bandage…Ace or Israeli
    • One gauze roll
    • Five sterile gauze pads
    • One tensor bandage
    • Twelve Steri-Strips or butterfly closers
    • One small Friars Balsam
    • One aluminum Mylar blanket
    • Four pairs of Nitrile gloves
    • Twelve small alcohol wipes
    • Neosporin for infection (at camp)
    • Two feminine hygiene pads (make excellent base layers for serious cuts)
    • One roll of Transpore tape
    • One roll of white electrician tape
    • Generation Three Quick Clot…or Celox gauze or powder
    • Makings of a tourniquet…or store-bought one
    Political correctness is fascism pretending to be manners-- George Carlin

  4. #3
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    Re: Srupp's First Aid Thread

    Quite the read, thanks for posting Steven...

  5. #4
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    Re: Srupp's First Aid Thread

    Thanks Srupp threw my Quickclot Trama pak back into my pack.Also have the Israeli kit just need to watch the video on that one again.
    BCWF

    Benjamin Franklin once said: "Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety."

    “I prefer the saddle to the streetcar and star sprinkled sky to a roof, the obscure and difficult trail, leading into the unknown, to any paved highway, and the deep peace of the wild to the discontent bred by cities…it is enough that I am surrounded by beauty.”
    - Everett Ruess

  6. #5
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    Re: Srupp's First Aid Thread

    Bump....thanks
    Steven

  7. #6
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    Re: Srupp's First Aid Thread

    Thanks for this Srupp!

  8. #7
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    Re: Srupp's First Aid Thread

    Great info there, thanks for sharing Srupp

  9. #8
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    Re: Srupp's First Aid Thread

    This is some great info thanks.

  10. #9
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    Re: Srupp's First Aid Thread

    Thanks for sharing! Those pressure points to stop bleeding really are interesting. I am planning on taking a level 3 first aid or do you think it's overkill?

  11. #10
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    Re: Srupp's First Aid Thread

    Hmmm IMO..level 3 is for workplace..lots of concentrating on WCB standards, totaly different than remote wilderness emergency with limited first aid suplies" I would be looking for a emergency outdoor wilderness survival first aid course.or even advanced course..not level 3 ofa"..imo.
    Cheers
    Steven
    Experienced instructor...field experience not book learning....big difference. .
    My hardest decisions in this presentation. .what to include. What not to.keep it simple but informnative. .
    The addition of urine output is designed for ICU "not wilderness first aid..too may variables..it realy was challenging to keep it at the length I did.
    Happy to answer pm questions on bleeding..and feedback on worthwhile? For couple more.fractures..care of unconscious victim.hypotermia. .heat exhaustion. Heat stroke.cardiac.chest pains..etc
    If there is interest.if the bleeding presentation was at the correct level, audience..
    Cheers
    Steven

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