Plan & Prepare

Wound Care

Bleeding wounds can lead to serious blood loss, and infection can lead to major health complications. Fortunately, you can prepare for wound care situations with some basic knowledge of how to stop bleeding, how to properly clean a wound, and how to recognize signs of infection. A few simple measures can help keep you and your group safe.

Symptoms and Description

Most bleeding wounds ooze blood. Bleeding can typically be managed by applying direct pressure, but sometimes in extreme arterial injuries, a tourniquet may be required to stop rapid blood loss.

Any wound that occurs in the outdoors is at risk of getting infected. Copious irrigation (rinsing) and high-pressure flushing (such as with a water bottle nozzle) is the first step to minimize infection and increase your chances for a good outcome.

A serious wound is cause for evacuation for medical care. This includes any wound that is gaping open, goes all the way to the muscle layer, is contaminated with debris, or has a risk of cosmetic complications (such as a wound to the face).

Minor wounds on the fingers, toes, or hands are common, and many will heal on their own.

Guidelines for Safe Travel

Always pack appropriate first aid equipment to increase your chance of successfully treating a wound.

If you are going fishing, be familiar with ways to remove a fishhook.

Consider practicing how to improvise a tourniquet, as this skill can save a life.

Packing List

A basic first aid kit should include:

Gloves
Gauze
An elastic bandage
4 x 4 gauze pads
Compressive bandage
Antibiotic cream
Paper tape

Wound Care

Direct pressure to a wound may be necessary to stop the bleed. The smaller the surface area of the applied bandage, the greater the amount of effective pressure to stop the bleed. If a bandage becomes soaked through, remove that pad and apply another thicker one. Try to avoid layering multiple bandages as one soaks through. This disperses pressure and is less effective.

Wound irrigation (rinsing) is an important step to flush out both debris and microscopic bacteria that can cause infection. There is no such thing as too much irrigation. Pressurized wound irrigation (such as with a water bottle nozzle) is most effective at cleaning a wound and minimizing the chances of infection.

If a wound is going to get infected, it will typically happen within the first three days after an injury. It is important to check a wound for signs of infection twice a day and keep a close eye out for concerning symptoms. If available, liberally apply an antibiotic cream over the wound each day.

Wound Management

Whenever possible, consider universal precautions (gloves and eye protection) when dealing with body fluids to avoid transmission of blood borne diseases.
Most wounds are simple and will stop with direct pressure to the wound.
A deep gaping wound, or a laceration to the face or other area that may have a poor cosmetic outcome should be evaluated by medical care for possible closure.
Any wound that is heavily contaminated is at higher risk of infection, these include bites, from both humans and animals.
A wound that may involve underlying tendons or ligaments should be evaluated by medical care. Evaluate for potential loss of range of motion after a deep wound to the extremities
Lacerations to the extremities should be closed within 12 hours to minimize the chance of infection, but a wound to the face can be closed within 24 hours.

Irrigation

Any wound that occurs in the outdoors is at risk of getting infected. Proper irrigation (rinsing) is your best defense against possible infection.

High pressure irrigation can be improvised from the drinking nozzle of a sports bottle. A drinking hose from a hydration bladder hose is lower pressure, and can be considered as a second line option.
Any water safe to drink is safe to irrigate with.
Copious irrigation and flushing out all visible foreign matter is the first step to minimize potential infection. Consider at least 1 L of flushing, the more the better.

Treatment

Application of constant pressure with a clean pad of fabric to the wound usually controls most bleeds, the injury may require 10 – 15 minutes of constant pressure.
The smaller the area of the compressive dressing directly on the wound, the greater the pressure exerted.
It may help to elevate extremity above the level of heart.
If available, consider a tight compressive wrap over the bandage to assist with constant pressure.

Do you or your companion have a wound? If yes, see medical assessment below.

Applying a Tourniquet

Tourniquets are rarely required, but in a situation where an arterial wound in an arm or leg is spurting blood, a tourniquet can save a life.

While tourniquets are generally safe if applied for less than two hours, continued application of a tourniquet may lead to eventual limb loss. Use a tourniquet only as a last resort when life-threatening bleeding is occurring. Consider the question of whether to save a life or limb?

Treatment Options

Secure a band of cloth (at least two inches wide) on the extremity about two inches above the wound (between wound and the heart), and as close to the lowest joint as possible. Do not place over a joint.
Tie half an overhand knot.
Place a stick on top of the knot, this will function as a lever to increase pressure. Finish the half overhand knot over this lever, effectively attaching it.
Tighten the tourniquet by turning the lever (stick) until bleeding stops. This will likely be painful.
Secure the lever with a second band of cloth and tie it with a double overhand knot.
Loosen the tourniquet after twenty minutes to check for bleeding. If bleeding has stopped, leave the tourniquet off. If bleeding continues, reapply tourniquet and note time of application.

If needed, see medical assessment below.

Emergency Red Flags

Too much blood loss can be fatal, and any wound can get infected. Keep an eye out for the following symptoms. These red flags may be cause for evacuation.

Any deep gaping wound with debris in it
Any deep wound over a joint
A wound that may involve underlying tendons or ligaments
A wound to an extremity with loss of range of motion of the arm, leg, hand, foot, fingers or toes
A wound that may benefit from medical care to optimize cosmetic outcome
Any impaled object (other than a fishhook)
Signs of infection, including redness and streaking from wound, pus or foul smell from the wound, fevers, or increasing pain and swelling around wound