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.