Medical Supplies, Part 4: Open/Bleeding Wounds
The injury that most non-professionals are most fearful of is the open/bleeding wound. With the right supplies, however, even heavy bleeding can be staunched successfully. A discussion of the procedure for stopping hemorrhage in a wound can be found in some of our other articles; this article will talk specifically about items to stockpile in your medical storage.
Don’t downplay the importance of taking first responder classes. Even though they teach you how to stabilize and transport a patient rather than how to deal with the issue from beginning to end (as would be necessary in a survival setting), they are highly valuable. Many are offered regularly by your local municipality. Consider volunteering at your local ER to desensitize yourself to bleeding and fractures. There’s a paralysis of sorts that affects people who aren’t used to seeing bleeding or broken bones; with many wounds, precious time (and blood) could be lost if action isn’t taken quickly.
Supplies To Stop Bleeding
Besides knowledge, the well-prepared medic will have:
Gauze: Bulk non-sterile gauze (some of our kits carry bricks of 200 at a time) is valuable as a medical storage item to apply pressure to bleeding areas. Even one hemorrhagic wound could require you to use all the dressings that you had accumulated over years of stockpiling.
Dressings come in squares of varying sizes, roller bandages to wrap around the area, and highly-absorbent pads of various sizes (not technically “gauze”). Carry a variety to increase the versatility of use. Although I recommend storing tampons, it is more for its traditional use than to treat gunshot injuries, which vary in size (especially exit wounds). A tampon would not always be the right size for the cavity created by the missile; they are best used for nose bleeds combined with compression. Maxi-Pads are excellent items for your medical storage, however.
Specialized Pressure Dressings: It’s difficult to keep pressure on a wound with your hands without becoming tired, so special dressings like the Emergency Bandage™ (aka the Israeli Battle Dressing) allow you to wrap wounds that have the tendency to bleed. These are an absorbent pad with an elastic bandage that comes with a hinge onto which the hook is wrapped. Each turn of the wrap increases the pressure on the wound, which can help control the bleeding. Here’s a video on its use:
Tourniquets: In circumstances where bleeding can’t be stopped with pressure alone, a tourniquet may do the job. Tourniquets can be improvised with a bandanna and a stick or they can be high-tech commercial items such as the CAT or SOFT-T tourniquet. It’s important to know that tourniquets can be as dangerous as they are life-saving, as they stop circulation to uninjured areas beyond the level of the wound. Only leave a tourniquet in place as long as is necessary to control the bleeding. After two hours in place, a tourniquet begins to cause tissue death.
Blood-Clotting Powders/Dressings: Also known as “hemostatic agents”, these are effective, although expensive, and easy to use. Available as a powder or powder-impregnated dressings, Celox™ (the most popular brand) is made from Chitosan, a component of crustacean shells. Celox™ will even stop bleeding in patients on blood thinners. Although it is made from shrimp shells, the company states that can be used on people allergic to seafood. Some hemostatic agents turn into hard, crumbly material which is difficult to remove after the crisis has passed. Celox, however, turns into a gel that is much simpler to deal with. Also, Celox gauze can be used, when wet, as a reasonable burn dressing.
When The Bleeding Is Controlled
With significant wounds, your work isn’t finished just because you have controlled the bleeding. Dealing with open wounds in an austere setting requires good judgment as well as supplies. Most of these wounds should be kept open, and you’ll need supplies that allow you to maintain a good environment for healing until it closes on its own by a process called “granulation”. In a remote homestead or survival setting, you never know when or if help will be on its way. You’ll need to be ready to care for that wound from beginning to end.
To care for an open wound, you’ll want:
Antiseptics, Sterile Gloves, and Other Personal Protection Gear: As mentioned earlier in this series.
Sterile Gauze: Although non-sterile gauze is often used to stop hemorrhage, sterile dressings are best to use in open wounds as they heal. With commercial sterile saline or water solutions (or even boiled water), you’ll provide the type of environment that newly forming cells need to fill in a wound. Dry sterile dressings to cover the moist dressing in the open wound will help keep the area clean.
Certain dressings, such as “Telfa™”, are non-stick and especially useful for burns or other injuries where removal might be painful. Some burn dressings like “Xeroform™” are dipped with petrolatum to protect healing areas where the skin was damaged or burned off. Xeroform™ is a popular dressing because it is easy to use and is effective in the management of many different types of open wounds. Honey has also been used for this purpose, but make sure to get the raw, unprocessed version.
Wound Closure Equipment?: Closing a wound is risky but there are circumstances where it may be appropriate. Always start with the least invasive method such as Steri-Strips or even duct tape fashioned as butterfly closures. Tincture of Benzoin is an adhesive liquid that comes in ampules that will help secure the tape. Super glue is a safe method unless you happen to be allergic to the chemical (Cyanoacrylate). It is used in underdeveloped countries without incident. To check for allergy, place a drop on the inside of your forearm and observe for signs of rashes, itches, or other changes over the next day or so.
Sutures and Staples: These can form a strong closure, but they also add more punctures to the skin that could become infected. In our classes, we emphasize that learning how physically “throw” a stitch is much less important than developing the judgment as to when they should and shouldn’t be used.
In circumstances where they might be appropriate, silk and nylon are best for skin closure. Absorbable sutures such as “catgut” and Vicryl are often (not always) best for deep layers. Here’s our article on choosing the right suture material: http://www.doomandbloom.net/choosing-the-right-suture-material/
Antibiotics: With an open wound, the risk of infection is much greater. Various oral antibiotics are helpful to prevent wound infection: Cephalexin(Fish-Flex), Clindamycin (fish-Cin), Doxycycline (Bird-Biotic), Amoxicillin (Fish-Mox), and Sulfamethoxazole-Trimethoprim (Bird-Sulfa) come to mind. Bacitracin or Triple Antibiotic Ointment is a good choice to place on a closed wound or around the edges of an open wound. You can find detailed information on all these in other articles on our website or, of course, our Survival Medicine Handbook.
Additional Supplies for open wounds: Dry sterile dressings to cover the moist dressing in the open wound will help keep the area clean. Medical tapes to hold the bandages in place are needed and come in cloth, self-adhesive, and paper (least allergenic). You’ll want to monitor the patient for fevers, a sign of infection, so have a thermometer in your medical kit.
The challenge of being responsible for handling severe injuries and bleeding is daunting, even to some medical professionals. Some training, supplies, and a level head will give you the best chance of saving a life in a situation where the buck stops with YOU.