How should you treat an open wound in the backcountry?
If someone were to get an open wound in the back country, say a knife slipped while cooking dinner and sliced the person, how would you treat that?
We already have one question about using whiskey, however I would like to know the correct treatment assuming you have a up to date first aid kit.
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- Control the bleeding with elevation and tight bandaging.
- Clean the wound with alcohol (I've also used hand sanitizer).
- Get medical help for deep lacerations .. or ..
- Periodically replace the dressings and look for infections (if found, go back to step 2).
Very important to make sure the person doing the care has used hand sanitizer or other means to prevent any bacteria from getting onto the dressings.
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A good wilderness first-aid reference is included below to give you a better grasp on how to handle different wounds. Here's some key points for a wound like a knife wound you described. Note that the best first-aid will depend on the details of the wound, the wounded, and what conditions are present for treatment (who's around, how far is advanced help, what materials are available, etc.)
Apply pressure to wound using something absorbent and preferably sterile to prevent excessive bleeding. I've done this using cotton bandanas and clothing before. Sterile gauze would be better. There may be still better designed items for this. Do this until bleeding is controlled. If bleeding cannot be controlled, you may need to use a tourniquet to restrict blood flow to the wound, which is a dangerous treatment. If the wound is on a head, don't apply pressure, rather wrap the wound with extra absorbancy.
After bleeding is controlled, you'll want to clean, close, and dress the wound to prevent infection. Throughout this process, the more sterile the items involved the better. Cleaning is first done mechanically, using hands to tweezers or whatever your have to remove coarse debris from in and around the wound. Cleaning moves on to rinsing around and then in the wound, preferably with clean water, with enough pressure and volume to really rinse out exposed flesh. You may need to hold the wound or parts of it open at this point to help rinse it. More and more I hear alcohol and other sterilizing solutions should not be used as it interferes with your body's own defensive and regenerative abilities.
Use medical tape and bandages to close and cover the wound once it is clean. If you cannot clean the wound, do what you can to prevent it from getting dirtier but make sure the wound has air flow and can drain as needed. Dressings should not restrict circulation much if at all - this part is about facilitating healing and preventing additional contamination.
Writing this I remember some important things I learned when dealing with wounds in the wilderness.
Control bleeding before you rinse. Cut and in a panic, I once poured water on a deep and dirty slice thinking I needed to get it clean ASAP. This was the wrong sequence for two reasons: It ended up being that the best thing I had to control bleeding wasn't totally clean, so the water was really needed after that point. The other, more important issue is that by rinsing the fresh wound, I washed away blood that would have been better to keep in place and serve to slow additional bleeding and eventually clot the wound and defend against infection. (That latter point is according to a doctor I consulted, and it makes sense in retrospect.)
Antiseptic rinse can be good. The whiskey thread you linked to points out some subtlety about this. I think it ultimately depends on the conditions and what's available, to decide whether or not to try and sterilize the wound to any extent more than clean water rinsing. Sometimes water is best, I think especially if your body is going to need to resist or fight infection with little help from the outside later on. Sometimes it's better to clean the wound with hydrogen peroxide, alcohol, or some other kind of sterilizing solution, then keep it protected until you're in better conditions to get outside help and heal yourself. Sometimes, you know and have access to plants that can treat your wound well - I've seen herbalism in the field work well, but I don't know it well enough to make any recommendations beyond acknowledging it.
Ultimately you want the wound to: lead to as little blood loss as possible; be rinsed of outside debris and contamination; be able to use your body's natural defenses and healing, which includes the need for some air flow; and be able to stay free of outside debris and contamination. All the while, the healthier you can stay overall, the better, and I think that includes maintaining some careful level of activity to ensure good blood flow.
See Wounds and Wound Infection on page 73 and Wound Care on page 108 of the Red Cross Wilderness and Remote First Aid: Emergency Reference Guide.
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Open wounds are treated the same in the back country as they are treated in your kitchen:
DEPT
- Direct Pressure
- Elevation
- Pressure Point
- (now's a good time to call 911, if bleeding so far is uncontrolled)
- Tourniquet
Direct pressure - apply bandage or cloth or clothing to the wound. Never remove the cloth/bandage, as that will remove the clot and repeat the bleeding again.
Elevate the wound above the heart if possible.
Pressure Point - apply pressure to the arteries (not veins) which supply blood to the affected area, at a point between the wound and the heart, and at a place closer to the wound, which crosses a bone. This reduces pressure and supply of blood to the wound; the closer to the wound you do this, the less you affect other areas of the body which aren't injured.
Tourniquet - last resort; do this when you expect to lose a limb. Once applied, never remove - let emergency personnel handle this. If you do apply a tourniquet, mark the approximate time on the victim's head. Use a pen or blood to do this.
It is a debatable topic to remove dressings; remember that the priority is to stop blood. When you are at home recovering from surgery, your discharge instructions may call for dressing changes. But there, you are in a controlled environment with easy access to help, and, blood flow has largely been controlled already - that's why you were sent home.
But when you are in the wild, there is no guarantee of medical care coming soon. Therefore, your priority for wound care is to control and prevent further bleeding. A distant second priority is healing. Wounds should be kept relatively moist, as this promotes reepithelialization (healing). The bloody gauzes you use are moist.
Also, to prevent infection, the body itself has its own enzymes which it uses for autolytic debridement, a process the body performs to dissolve necrotic tissue.
Even if you determine that the wound has more or less healed, and the removed dressing doesn't indicate more bleeding, the wound should still be kept covered and moist; this protects it from injury, and prevents it from drying as that will slow down the healing.
One more thing: in the wild, you need to watch out for predators. Discarding bloody dressings can invite animals, you want to minimize this risk.
Keep the bandages on as long as possible.
As to giving liquids:
American Red Cross is ambiguous, Army manuals say absolutely DO NOT.
The issue is if the person goes unconscious; in this case, they could expel their stomach contents and then choke. The Army manual states you should turn the head if you must leave the victim unattended to prevent choking - and to not administer food or liquid.
Having said that, not every one goes into shock upon bleeding. In this case: yes, give fluids.
Also, don't give aspirin (that reduces blood's ability to clot), don't give acetominophen (that can upset the stomach and cause vomiting), and don't give ibuprophin or any NSAID, as that reduces swelling - the very thing the body does to reduce blood flow to an area that is injured. And it can mask other injuries that need to be looked at - like headaches and stomachaches. Basically: suffer the pain. If it's Really, Really bad, then Tylenol, Advil, or aspirin isn't going to help anyway.
Check and Treat for Shock (Army Study Guide)
First Aid/CPR/AED PARTICIPANT’S MANUAL (American Red Cross)
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First of all you need to control what is life threatening. Control the bleed. Lay them down and elevate the wound if necessary. Apply sterile dressings (or the closest thing you have to sterile). As it continues to bleed apply more dressings. Blood goes through a clotting process and if you pull the dressings it has to start over.
Then assess the situation. Get them comfortable and warm. Give them something to drink. Ask them how they feel and if they are on medication. Clean the wound is secondary at this time. Make a long term plan. If are going to extricate and get them to a hospital in a few hours then only clean and dress if you have the materials to do it right. If it is going to be longer than 24 hours to get professional medical care then clean the best you can. If you used everything you have sterile then boil some clothes. Even if you don't have an antiseptic you have soap. You will find products call first aid antiseptic. Good old soap is better than whiskey. It not realistic to carry the volume of peroxide required to irrigate a wound in the back country. If you have a wound like that then you need to make plans to get them to a medical facility. You don't have a big rush. You are not going to have a serious infection in 48 hours.
Just a cut cooking is not likely to be life threatening. Control the bleed with a dressing. Clean with soap and water. Then some antiseptic if you have it. I don't see using whiskey unless you don't even have soap. Let it dry and apply the best dressing you have. If you are out of sterile dressing then boil some clothes and hang them out to dry.
An up to date first aid kit can mean a lot of stuff. Build your own and take a first aid class. American Red Cross has a wilderness first aid. Ony in the back country would you be in a situation of longer term care. No off the shelf first aid kit is going have the volume to control a major bleed and that is what is going to kill some one.
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