Srupp's First Aid Thread

[albravo2]

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.

[albravo2]

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

[HarryToolips]

Quite the read, thanks for posting Steven...

[Buck]

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.

[srupp]

Bump....thanks
Steven

[ajr5406]

Thanks for this Srupp!

[Bunner]

Great info there, thanks for sharing Srupp

[RJHunter]

This is some great info thanks.

[gmachine19]

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?

[srupp]

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

[TARCHER]

I feel you did a geat job Steve. Your years of actual experience worked in your favour. For the vast majority of hunters here it will not be a moon shot to deal with whatever issue comes up. Even having to med

Well done Steve, your years of actual experience favored your presentation. In reality it's not a moon shot, most fellas will only deal with minor treatment. As you know even big trauma bleeding isn't too complicated when you follow the rules. Hell I medivaced.... funny story, sorry. Russ and I took a fella out of central coast who was picking berries, had his dog with him. A few miles from his village. Bark, bark, here comes the dog with a sow grizz 2 big cubs. Long story short the sow lays a lickin on him. Injuries are fractured radius, ulna l arm where the bear bit him. some gaping wounds across belly and flank from claws and bites, no fracture L femur, but as with other grizzly attacks I've done the skull cap gets ripped off which is where the big blood loss comes and tough to get a handle on. Usually lots of kling wrapped tight works. When it bleeds thru don't take it off just wrap more. Of course this guy had a couple litres of normal saline iv and some morphine, good to go. Now the funny part.

[scoutlt1]

Steven, I competely agree that Level 2 or 3 OFA is designed for the workplace.
As someone who has over 20 years of Level 2, I know that much time is spent during the course on paperwork and what is important for both the attendant and the employer to do to be compliant with WCB regulations.
For example, if a worker falls off a crappy old ladder and breaks his or her leg, there are many questions that will have to be answered (and rightly so). If your hunting buddy falls off the camper roof, there won't be a site visit by the WCB inspection/compliance officer.

OFA courses aren't the best for wilderness first aid I agree, but I can say that I've gained a lot of knowledge after all these years of Level 2, some of which I have used out in the bush.

Decent courses for the basics I think.

It is important to "adapt" to the situation in my opinion. Most especially in the wilderness. The more knowledge and experience, the more one can adapt (in my opinion).

Great threads. More to come I hope!

[TARCHER]

So we are flying him to Victoria the jubilee receiving, alls good. We wheel him thru triage heading for the trauma unit. No shit, 2 government issue CO'S( and I have huge respect for CO'S) in fact a decade before all this I was on car in Langford right below the CO'S office. Corporal Smirrel. So Russ was on the foot end of the cot me pushing and 2 CO'S with a lot of gold, not reg constables, step out with theyre note pads and say "hold on a min fellas" We say sorry boys we will chat after this guy sees the doc. We come out and the co gos the normal, whars your name, wheres your base, what time.what happenened blah blah blah. Then he goes what did the bear look like, My partner Russ raises both his arms fingers outstretched and roooaar. NOT a crack of a smile from the two CO chaps. I almost pissed myself and a bunch of other paramedics in line for triage howeled. I stepped up to say we didn't see any bear. We picked him up in Bella Bella 2 hrs after the incident. That was one of the funnier times in 35 yrs

[gmachine19]

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

Didn't realize that. I'll look for a wilderness one then. Thanks!

[srupp]

So we are flying him to Victoria the jubilee receiving, alls good. We wheel him thru triage heading for the trauma unit. No shit, 2 government issue CO'S( and I have huge respect for CO'S) in fact a decade before all this I was on car in Langford right below the CO'S office. Corporal Smirrel. So Russ was on the foot end of the cot me pushing and 2 CO'S with a lot of gold, not reg constables, step out with theyre note pads and say "hold on a min fellas" We say sorry boys we will chat after this guy sees the doc. We come out and the co gos the normal, whars your name, wheres your base, what time.what happenened blah blah blah. Then he goes what did the bear look like, My partner Russ raises both his arms fingers outstretched and roooaar. NOT a crack of a smile from the two CO chaps. I almost pissed myself and a bunch of other paramedics in line for triage howeled. I stepped up to say we didn't see any bear. We picked him up in Bella Bella 2 hrs after the incident. That was one of the funnier times in 35 yrs

Lmao..yup that's Russ..probably big ear to ear smile/ grin happening..

Facial lacerations are kinda a different story..a little blood on/from the face goes a long way..usually not as bad as it looks..with mechanism of injury being unknown sub..grizzly scalp torn back..ya can get messy and more blood. where and how deep is important with facial trauma..
Geez i would have loved to be there when Russ did his best grizzly I'm at at ion. .too funny..
Just trying to help out fellow hunters..
Srupp

[TARCHER]

Thanks Steve, you know Russ. It was so official and of course both us late in our career with the *** you attitude, and the straight faced younger Co gets to what did the bear look like???

[srupp]

Thanks T..going to be laughing about that one for years..so much better knowing both You and Russ..priceless..
Almost peeeed" laughing..only done by senior staff..confident in their place in life and work..
Steven

[xcaribooer]

good stuff. My work recently offered to pay for me to take level 2 first aid so I jumped on the opportunity. my main reason was not so much for being the first aid guy at work but to have these skill for when I'm out playing in the woods with my aging hunting /fishing partners .

[srupp]

OFA..refers to Ocupational first aid..industry..proper application of standardized splints..where wilderness first aid is using what is around..applying principles adapting..and overcoming...can never be too educated but the course is long..expensive..and lots of the course is strict application of standardized rules regulations..WCB..
I don't have a better idea of wilderness courses available..i never thought about them.
Steven

[FortBoy]

thank you for the great information steven. much appreciated.

[Elkhound]

Looks great to me. Thanks Steven

[srupp]

Hmmm you guys are easy..lol no difficult questions. .not Tims questions..lol..
Would it be agreeable for a new subject..fractures#..or environmental emergencies..heat stroke etc..or chest pain..or?
Steven

[Sabre2]

Great info there, thanks for sharing Srupp :cool:

[BeerMan]

If you could post info on chest pains in the field and what to do/and look out for,that would be great. I'm hunting with older partners now,including me,and would like more info if poop hits the fan in the middle of nowhere.

[srupp]

If you could post info on chest pains in the field and what to do/and look out for,that would be great. I'm hunting with older partners now,including me,and would like more info if poop hits the fan in the middle of nowhere.

Hmmm sounds reasonable.i will start some notes..it will be the next presentation..not sure how quickly but it will be next timely topic
Cheers
Steven

[xcaribooer]

Steven, just curious if you think adding an AED machine to the hunting gear base camp list is a good idea?
oh and totally agree that the ofa2 is a wcb based course but still a ton of skills that could come in useful in an emergency. I had never taken anything besides basic 1 day first aid previously and that week of ofa2 was one of the more difficult and stressful things I have ever done .

[srupp]

For a group of individuals who hunt together year after year, hunt out of a base camp yes it would be a great idea..however everyone would need to learn to operate the unit, basic CPR..and rescue breathing with pocket mask or BvM".bag valve mask..
It ups the success rates for some types of cardiac arrest scenario.big issue is speed..being there recognizing the collapse..no pulse fast access to unit with cpr and rescue breathing but not delaying access to chest putting on the chest pads..analyzing..
Speed is essential..some practice would be truly benificial"
Yes it would be exellent idea.
Cheers
Steven

[RiverRunner]

Such an awesome post! Thanks!
As a certified OFA L2 attendant for over 12 years now, I feel its a great course all around. I found the training not to be bogged down to bad by paperwork and regulations, but every instructor I have had has their own approach to it. If an employer is willing to offer training… Take it for sure!
Anyone with some common sense can definitely apply the concepts anywhere out and about. It essentially comes down to the A B C's.
Keeping within the scope of the training, I've modified my pack first aid kit to deal with major bleeds and sprains, just like the recommended supplies you listed. Also a limited amount of meds to deal with diarrhea, allergies, and pain.
I would love to have a personal AED machine to keep in the truck only… but thats quite the personal expense to swallow. Training for them is recommended ….. but not completely necessary as it walks you through the process and has pretty self explanatory diagrams. Lastly it will not engage if the machine's analysis deems it not necessary.
Any first aid training is a good thing.

[srupp]

Watching TV tonight..new product on the horizon. .within 2..3 years..HAEMOGRIP spray..a almost instantaneous blood clotting spray for trauma..from kitchen to MVA" to battlefield trauma.almost instantaneous clotting of even the most gruesome trauma..even better yet..there is a acommpanying spray to reverse the foam spray and allow the trauma surgeon to repair the damage in surgery,
The foam conforms to any wound channel..or shape. .completely.in ambulances with just one attendant..frees his hands for starting IV, assisting breathing etc.in the remote woods..self administered....or reliable stoppage of ALL trauma injuries resulting in bleeding.and is reversal. Was on STEPHEN HAWKINGS" tribute show.
Watch for this product..watched it work..
Steven

[TARCHER]

oh god..........

[srupp]

oh god..........

It's OK Tim..it won't replace you....remember..your retired..lol

Steven