Stop the Bleeding How to keep your life--or someone else's--from oozing away

We were miles away from civilization when the knife slipped and my camping partner drove the blade deep into his thigh. Dark blood was immediately everywhere, soaking his trousers and dripping through his fingers to the ground. This was serious. Something had to be done right away!

A bleeding wound can take a life in a matter of minutes. Hesitation (even for a few minutes) or taking the wrong approach can have grave consequences. Faced with an emergency that involves bleeding, it's important to understand the nature of the wound and take appropriate action.

The circulatory system includes three types of blood vessels--capillaries, veins and arteries. A trauma can open these vessels and allow the blood to escape through external bleeding. Bleeding can be caused by a scrape (abrasion), slice (incision), gash (laceration), puncture or amputation. Here's how to deal with each situation.

NASTY SCRAPES

Capillary bleeding presents itself as a slowly oozing wound. Abrasions such as a skinned knee are common causes of capillary bleeding. Treat as follows:

* Check the wound for any dirt or foreign matter and gently remove it.

* Swab the wound with a diluted antiseptic solution.

* If you determine that a dressing is necessary (sometimes it is not), it should be a dry, non-adherent type.

SERIOUS GASHES

In venous bleeding (from the veins), dark red blood pours from the wound slowly but steadily. This type of bleeding is more serious and can be caused by cuts, gashes or punctures to the skin.

* Check the wound for foreign objects.

* Apply pressure to stop the bleeding.

* Apply a non-adherent dressing.

* Wrap with a roller bandage.

* Immobilize and elevate the injury to above the level of the heart.

PUNCTURE WOUNDS

Sometimes, a puncture will involve an impaled object. These wounds must be treated differently.

* Do not disturb the impaled object.

* Apply pressure to stop the bleeding.

* Stabilize the impaled object, so that it cannot move.

* Apply a roller bandage.

* Immobilize and elevate the injury to above the level of the heart.

* Get the victim to an emergency medical facility immediately.

WORST-CASE SCENARIOS

Arterial bleeding produces spurts of bright red blood. The arteries are the direct supply lines from the heart, so the heartbeats generate the spurting action. This type of bleeding is life-threatening.

* Check for foreign matter in the wound.

* Apply direct pressure to stop the bleeding.

* Apply a non-adherent dressing and cover it with a pad.

* Lay the victim down.

* Immobilize and elevate the injury to above the level of the heart.

* Apply a roller bandage.

* Treat for shock.

* Call an ambulance, or transport the victim to an emergency medical facility immediately.

WHAT TO DO

Doctors and paramedics have specialized equipment that is not generally carried by the average outdoorsman, but there are four emergency techniques you can use to stop bleeding.

Direct pressure should ideally be done with sterile dressings, applied directly on top of the injury. If a dressing isn't readily available, use the heel of your hand. In extreme cases, it may be necessary to stick your fingers directly into the wound to plug the leak. Add dressings and retract your fingers (but maintain pressure) as the bleeding slows. Do not release direct pressure until the bleeding has halted and remains stopped when a roller bandage has been applied.

Pressure-point control may be added to direct pressure to slow the flow of blood to a severe injury. Apply pressure between the wound and the heart over the artery that feeds the bleeding.

Elevation of the injury to above the level of the heart can help slow the flow of blood. Admittedly, this is not always possible. Combined with direct pressure and/or pressure-point control, elevation of the wound is a valuable technique.

A constricting bandage (tourniquet) may be a last resort in life-threatening situations involving amputation or total failure of your ability to stem the massive flow of blood after attempting all other life-saving techniques. Generally speaking, if you decide to use a tourniquet to halt blood flow, you are deciding to save a life but lose a limb due to the crush damage to the tissue where it is applied.

WHAT WOULD YOU DO?

As you and your fishing buddy climb down a riverbank, he stumbles and does a face-plant against the trunk of a tree. When you reach him he appears all right--except for all the blood gushing out of his nose. What do you do?

A. Lay him flat on his back, elevate his feet and treat him for shock.

B. Apply pressure-point control to the arteries in his neck to reduce blood flow to his nose.

C. Have him sit on a log, lean forward and pinch his nose shut.

D. Apply a dry, non-adherent dressing and a roller bandage.

(For answer, see page 107).

The answer is C. According to the American Academy of Otolaryngology (head and neck surgery), minor nosebleeds should be treated as follows:

1. Sit with your head leaning forward; 2. Pinch the nostrils shut, using your thumb and forefinger in such a way that the nose's midsection is being gently squeezed; 3. Hold for 15 minutes, breathing through your mouth; 4. At the same time, apply cold compresses to the area around your nose; 5. For the next 24 hours, make sure your head is elevated above the level of your heart; 6. Wait 24 hours before blowing your nose, lifting heavy objects or exercising.

Quick Tip DANGEROUS BLOOD LOSS

The average adult has six liters of blood. The loss of even one liter in an adult, or half a liter in a child, is considered to be very dangerous.