This article will be one of a series covering first-aid kits in the field as well as how/when to use the supplies.
Fishing, hunting, camping, and other outdoor activities carry an appreciable amount of risk for injury. Given the inherent risk that is always present, a properly packed medical kit may address some potential injuries and could save your life or that of someone else. The items you carry and the treatment you provide will likely only serve as a temporary solution; seek professional care after treating an injury. In this article, I’ll cover the basics for the treatment of life-threatening bleeding, specifically.
Well-refined knowledge with muscle memory is key to implementing your medical kit. When an emergency happens, you may be tired from long hikes and exposure, which may cause a lapse in judgment or difficulty processing the situation. It’s not the lack of knowledge, it is the effects of hypothermia or hyperthermia, dehydration, and various other environmental ailments that can affect you in the field.
Furthermore, if you sustain a major injury resulting in blood loss, the subsequent state of shock can alter your thought process. Establishing muscle memory by regular practice with tourniquet application, wound packing, applying a pressure dressing, and various other interventions can be vital when you are in that do-or-die situation.
Bleeding (hemorrhage) control is a vital skill to have, one you should be able to perform in stressful scenarios. The items you need in your medical bag are listed below:
- A Committee on Tactical Combat Casualty Care (CoTCCC) recommended tourniquet (I prefer to carry two)
- 4×4 gauze pads (I carry two separate vacuum-sealed bags with five each)
- CoTCCC-recommended hemostatic dressing (x2)
- Gauze roll (recommend compressed)
- Coban or ACE bandage (depending on the length of the Coban, think of having enough to wrap around your upper leg or your abdomen)
- Israeli bandage (x2)
- Roll of medical tape
These items can be used for various types of injuries. If you have a large laceration, 4×4 gauze pads can be enough to stop or slow the bleeding and cover it to protect it from further contamination. You can use Coban or medical tape to keep it in place and apply moderate pressure.
Hemostatic dressings can be used for more severe wounds in conjunction with the Israeli bandage to apply pressure. The indications for hemostatic dressings typically include wounds unresponsive to a limb tourniquet or less severe arterial or venous bleeding that is deeper. If holding pressure over the wound with gauze or your hand doesn’t stop the bleed, then move onto your hemostatic dressing. If the wound is large enough, start by packing the hemostatic dressing into the wound and follow with the gauze roll if the hemostatic dressing does not fill the wound. It is key to pack the wound fully, then apply the Israeli bandage to apply maximum pressure. Regardless of the type of gauze used, pressure should be maintained for three minutes after packing.
If a junctional wound has been sustained and has incurred arterial bleeding, pack the wound with hemostatic dressing. You should never wound pack any injuries to the trunk (abdomen/chest) or skull.
Most moderate to major injuries that incur arterial bleeding will require a tourniquet. To identify arterial bleeding, look for spurting, bright-red blood—the blood will pulse out. Bleeding from a major vein will have a constant flow with darker red blood. The difference of color is due to the arteries carrying oxygenated blood to the various tissues of the body, whereas veins carry deoxygenated blood back to the heart to be oxygenated again.
The tourniquet should be placed approximately 2-4 inches above the wound. Never place a tourniquet over a joint. If the arterial bleed is coming from a joint (knees and elbows) then place the tourniquet above the joint. Types of wounds that tourniquets cannot help with are junctional injuries (groin, axilla, neck). Tighten the windlass on the tourniquet until a pulse is no longer detectable on the affected limb and the bleeding has stopped.
If the wound is on the leg, check for a pedal pulse. If the wound is on the arm, check for a radial pulse. If you can still detect a pulse in the affected extremity, the tourniquet needs to be tightened. Keep in mind the tightening of the tourniquet can be painful, but it’s necessary to stop the bleeding. The key to proper tourniquet application is pulling the strap tight before turning the windlass.
If major injuries are sustained, it is imperative that you do your best to complete initial treatment and seek advanced treatment via 911 or rescue services, depending on your location. Do not wait too long to seek advanced treatment from medical professionals.
As a responsible outdoorsman, you should have plans in mind prior to any wilderness outing. Think about where your resources would be in relation to the area you will be in. How far away are the hospitals and do you have access to 911 or rescue services? Will the trip require a cell phone or a sat phone? These are all things to consider in addition to having a practical first-aid kit with you. I also encourage people to attend a Stop the Bleed course through the American College of Surgeons and/or First Care Provider to receive firsthand training with bleeding control.