DISCLAIMER: The following information is not intended, nor should it be assumed to be, a substitute for formal training in First Aid treatment and procedures. This information is presented to raise awareness of some medical conditions which can arise on canoeing, camping or hiking trips so that participants may better prepare themselves for all eventualities. The information presented is not intended to replace advice or instructions given by trained professional medical personnel. Information herein is gleened from various professional medical resources including the US Navy On-line Hospital web site, the American Red Cross web site and other reliable resources. It must be realized that improper or inadequate treatment of injuries can result in damages that sometimes are greater than doing nothing at all. Whenever possible and practical the assistance of trained, professional medical personnel should be summoned to administer treatment for serious injuries. The nature of outdoor recreation is such that injuries sometimes occur in remote areas far from available professional assistance. The information in this section is intended to be a helpful guide for treatment of injuries in such cases when getting professional help is not immediate and the nature of the injuries requires prompt attention. Marc McCord is not a trained medical practitioner, and makes no claim of expertise in treatment of injuries. Marc McCord and Southwest Paddler are not responsible for improper treatment of injuries and resulting damages that may occur.
Bleeding (or hemorrhaging) is the flow of blood from veins, arteries and capillaries, either internally or externally. Veins carry blood to the heart, arteries carry blood away from the heart and capillaries are the very small channels that carry blood to all parts of the body. Blood flowing from a capillary will be slowly oozing, as from a minor cut. Flowing from a vein, blood will be a steady flow of a red or dark red color. Arterial bleeding will spurt from a wound in a bright red color, and is definitely life-threatening - it must be stopped quickly to prevent death to the victim, but it is also difficult to control, especially without proper medical training. It is important to understand how blood flows, why it flows and what can be done to control blood loss without causing the onset of gangriene, a condition that often results in amputation and/or death.
The body of an adult contains roughly 10-12 pints (5-6 quarts) of blood, and can lose about a pint without serious side-effects, as is the case when donating blood. However, a loss of 2 pints will usually cause the onset of shock, and losing 5-6 pints will usually result in death. Depending upon the nature and severity of bleeding, prompt actions should be taken to stop the loss of blood and save the life of a bleeding victim. In the case of an internal broken bone determining the presence and extent of bleeding may be very difficult, but with open fractures it is quite evident. Internal bleeding can be diagnosed by observing blood flow from the mouth, eyes, ears, nose, rectum or other body openings. While severe, there is generally adequate time to calmly think and act with measures that will control bleeding and reduce injury to the victim.
EXTERNAL BLEEDING: Many people react strongly to the sight of blood, especially a large amount of blood, and it is imperative that you not show any signs of emotion when treating a bleeding victim. To do so could cause shock, hysteria and possibly death. You must remain cool, calm and collected at all times when treating a bleeding victim. Even though excessive bleeding can be fatal, there is usually adequate time to carefully think through the situation then take actions to minimize the damage and save the life of the victim by stopping or greatly slowing the blood loss. What may appear to be a severe injury may actually be more superficial - major arteries are usually well protected by bone and muscle, so to damage them requires a serious injury. You can take four actions to control bleeding: direct pressure on or around the wound, elevation of the injury to slow blood flow from the heart, indirect pressure or (as a last resort) use of a tourniquet. BE CAUTIOUS - avoid direct contact with the blood of another person whenever possible to prevent the spread of infectous blood diseases.
APPLYING DIRECT PRESSURE: The most effective method for controlling bleeding, and the method that should be attempted first, is the application of direct pressure. Place a sterile cloth bandage directly over the injury, then secure with a knot or tape tightly enough to stop or reduce bleeding, not not so tight as to cut off circulation. If bleeding continues, then either apply a second bandage directly over the first and secure it, or press down on the wound using your hands or fingers. Under no circumstances should a dressing be removed after being applied unless removed by training professional medical personnel. Direct pressure is something that can be done by either the victim or somebody else.
ELEVATION: Remember, arteries carry blood away from the heart. By elevating an injury above the level of the heart gravity is used to reduce the flow of blood. Elevation may be used in conjunction with other methods of treating a bleeding injury. Elevation should normally be used in conjuntion with direct pressure, but in the case of a fractured bone be sure that the bone is securely splinted first to prevent further injury while elevating the injury. Use a stable object to maintain elevation. Use of an unstable object may result in further injury, and is to be avoided at all times.
APPLYING INDIRECT PRESSURE: Indirect pressure is the application of pressure to vital pressure points within the body. These will usually be points away from the injury, thus the term "indirect pressure". It is important to take a formal First Aid class to learn where pressure points are located and how to apply indirect pressure to them for the purposes of controlling bleeding. Pressure can be applied using the fingers, thumb or heel of the hand to press an artery against an underlying bone or muscle. However, it is vitally important to use indirect pressure with great caution. Too much pressure can severely restrict blood flow to extremities causing damage to them, and it can also cause a loss of blood flow to the heart leading to serious injury or death. Do NOT apply pressure to the carotid artery in the neck, as to do so can result in cardiac arrest.
Indirect pressure can be used in conjunction with direct pressure and elevation to control bleeding. The most commonly used pressure points are in the arm and the groin areas of the body. The locations of these pressure points and the correct procedure for applying indirect pressure to them, must be thoroughly understood to avoid inflicting greater harm to a victim.
Pressure applied to the brachial artery in the arm or the femoral artery in the groin is usually effective in slowing blood loss. The brachial artery controls blood loss from the lower part of the upper arm and elbow. Located on the inside of the elbow, in the groove between the muscles above the elbow, pressure can be applied by the fingers or thumb to the inside of the arm directly over the bone.
For severe bleeding of the thigh or lower leg pressure can be applied to the femoral artery in the groin, from the front in the center of the crease. The proper procedure is to lie the victim on his or her back, then kneeling on the opposite to the injured leg, place the heel of the hand directly over the femoral artery and press forward. If bleeding is not controlled, then it may be necessary to place the flat part of the fingers of one hand directly over the artery, then prss down on them using the heel of your other hand to apply pressure to the fingertips of the lower hand.
USING A TOURNIQUET: When all else fails to stop or reduce bleeding a tourniquet may be used as a last resort. However, it should ONLY be used as a last resort, and only applied by somebody with an understanding of the proper way to proceed. Improper use of a tourniquet can result in gangriene, amputation of a limb and/or death. A tourniquet should be a folded piece of cloth at least three inches wide and and 6-7 layers thick AFTER folding. It could be a folded triangular bandage, a necktie (though boaters seldom wear them while running rivers), belt, strap, towel, neckerchief, shirt or other item suitable for wrapping around an injured limb. NEVER use wire, cord or any narrow item which can cut the skin or apply concentrated pressure to a small-width area - to do so may result in additional bleeding injuries or restrict blood flow dangerously, causing additional harm to the victim.
To properly apply a tourniquet, follow these procedures:
1. Apply pressure to the proper pressure point between the injury and the heart;
2. Place the tourniquet between the heart and the wound, but leaving at least two inches of uncovered area around the wound - DO NOT place the tourniquet directly over the wound!;
3. Place a sterile pad or other cloth covering directly over the artery;
4. Wrap the tourniquet around the arm or leg TWICE, then tie with a single (half) knot on the upper surface;
5. Place a short stick or other rigid object directly over the half knot, then secure it with a square knot;
6. Twist the stick to tighten the tourniquet until bleeding stops or is controlled;
7. Secure the stick in place to maintain pressure on the artery - Do NOT cover the tourniquet!
8. Using lipstick, a felt tip marker or some other method, make a "T" and the time the tourniquet was attached on the victim's forehead;
9. NEVER loosen or remove a tourniquet once it has been applied - to do so could dislodge blood clots and cause cause additional blood loss, shock and/or death.
Do not touch open wounds with your hands, fingers or anything that may expose the injury to contamination, germs, bacteria or pathogens. Whenever possible, avoid direct contact with the blood of another person. Immediately after treating a bleeding wound wash your hands thoroughly using soap and water (hot water, if available.) The transmission of blood-born diseases cannot be taken for granted. Even if you wore surgical gloves or used another barrier between the wound and yourself, wash your hands thoroughly after treatment is applied. If time allows, it would also be a good idea to wash them before beginning treatment to reduce the chances of introducing contaminants into the wound.
INTERNAL BLEEDING: Injuries resulting in internal bleeding are somewhat more difficult to assess and treat. Though not visible, internal bleeding can result in significant blood loss, shock and death. Look for signs of internal bleeding by observing blood flow from the eyes, ears, nose, mouth, rectum or genital areas. Also look for contusions (bruises) that indicate internal blood flow into the soft tissue of the skin. Internal bleeding may occur without outward signs of injury, broken bones or lacerations of any kind on the outside of the body. Signs of internal bleeding indicate a need of immediate professional medical attention, so waste no time in summoning help. When calling for assistance try to remain calm, give a concise and accurate description of the observed signs of injury and clear directions as to where the victim is located.
Signs of internal bleeding include anxiety and restlessness, excessive thirst, nausea and vomiting, pale and moist skin (cold and clammy feeling), rapid breathing, rapid, weak pulse and bruising or discoloration around the injury area. If internal bleeding is suspected, then follow these procedures IMMEDIATELY:
1. For bruising, apply cold packs to reduce swelling and pain;
2. For severe internal bleeding,
A. Summon professional medical assistance at once;
B. Monitor airway, breathing and circulations (ABC's);
C. Treat for shock;
D. Make the victim as comfortable as possible;
E. Maintain a normal body temperature;
F. Keep the victim calm and reassured that everything is being done to help him or her, and that professional assistance has been called.
NOSEBLEEDING: There are any number of things that can cause nosebleeds including injuries, changes in altitude (in some people), environmental exposures, high blood pressure or disease, among others. It is important to prevent the victim from becoming freightened, as that can lead to shock and death. If the nosebleed is the result of a skull fracture, then DO NOT stop the bleeding! Instead, cover the nose with a loose, dry, sterile bandage and summon professional medical assistance at once. If the nosebleed occurs from other causes, the follow these procedures:
1. Keep the victim sitting up, still, quiet and with the head tilted forward;
2. If the cause of the nosebleed is not a fracture, then pinch the nose shut, put ice packs or cold packs on the bridge of the nose, apply pressure to the upper lip just below the nose, and tell the victim not to pick, blow or rub is or her nose;
3. If the nosebleed is the result of high blood pressure, or if the bleeding continues or restarts, then get professional medical assistance quickly;
4. If the victim loses consciousness, then lay him or her on the side so blood can drain, and get professional medical assistance at once.
If a foreign object is lodged in the nose, then do NOT try to remove it, as doing so may result in nasal damage. Seek professional medical help. Attempts by unqualified persons to remove a foreign object from the nose may result in pushing it further into the nose and increasing the degree of injury. Severe bleeding, either internally or externally, should be treated promptly by trained medical personnel. Do NOT waste time in summoning a doctor or paramedic for such injuries. All bleeding victims should be treated for shock to prevent its onset or to reduce its effects after it has started to occur. What may appear to be minor bleeding to the untrained eye may be a symptom of a major medical condition that requires professional medical assistance quickly.