Wilderness Medicine, First Aid, and Outdoor Skills
Stop the Bleeding and Protect the Wound

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US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary



Stop the Bleeding and Protect the Wound

2-15. Clothing (081-831-1016)

In evaluating the casualty for location, type, and size of the wound or injury, cut or tear his clothing and carefully expose the entire area of the wound. This procedure is necessary to avoid further contamination. Clothing stuck to the wound should be left in place to avoid further injury. DO NOT touch the wound; keep it as clean as possible.

WARNING (081-831-1016)

    DO NOT REMOVE protective clothing in a chemical environment. Apply dressings
    over the protective clothing.

2-16. Entrance and Exit Wounds

Before applying the dressing, carefully examine the casualty to determine if there is more than one wound. A missile may have entered at one point and exited at another point. The EXIT wound is usually LARGER than the entrance wound.

WARNING
    Casualty should be continually monitored for development of conditions which may
    require the performance of necessary basic lifesaving measures, such as clearing the
    airway and mouth-to-mouth resuscitation. All open (or penetrating) wounds should be
    checked for a point of entry and exit and treated accordingly.

WARNING
    If the missile lodges in the body (fails to exit), DO NOT attempt to remove it or probe
    the wound. Apply a dressing. If there is an object extending from (impaled in) the
    wound, DO NOT remove the object. Apply a dressing around the object and use
    additional improvised bulky materials/dressings (use the cleanest material available) to
    build up the area around the object. Apply a supporting bandage over the bulky
    materials to hold them in place.

2-17. Field Dressing (081-831-1016)

a. Use the casualty's field dressing; remove it from the wrapper and grasp the tails of the dressing with both hands (Figure 2-28).

WARNING

    DO NOT touch the white (sterile) side of the dressing, and DO NOT allow the white
    (sterile) side of the dressing to come in contact with any surface other than the wound.

b. Hold the dressing directly over the wound with the white side down. Pull the dressing open (Figure 2-29) and place it directly over the wound (Figure 2-30).

c. Hold the dressing in place with one hand. Use the other hand to wrap one of the tails around the injured part, covering about one-half of the dressing (Figure 2-31). Leave enough of the tail for a knot. If the casualty is able, he may assist by holding the dressing in place.

d. Wrap the other tail in the opposite direction until the remainder of the dressing is covered. The tails should seal the sides of the dressing to keep foreign material from getting under it.

e. Tie the tails into a nonslip knot over the outer edge of the dressing (Figure 2-32). DO NOT TIE THE KNOT OVER THE WOUND. In order to allow blood to flow to the rest of an injured limb, tie the dressing firmly enough to prevent it from slipping but without causing a tourniquet-like effect; that is, the skin beyond the injury becomes cool blue, or numb.

2-18. Manual Pressure (081-831-1016)

a. If bleeding continues after applying the sterile field dressing, direct manual pressure may be used to help control bleeding. Apply such pressure by placing a hand on the dressing and exerting firm pressure for 5 to 10 minutes (Figure 2-33). The casualty may be asked to do this himself if he is conscious and can follow instructions.

b. Elevate an injured limb slightly above the level of the heart to reduce the bleeding (Figure 2-34).

WARNING
    DO NOT elevate a suspected fractured limb unless it has been properly splinted. (To
    splint a fracture before elevating, see task 081-831-1034, Splint a Suspected
    Fracture.
    )

c. If the bleeding stops, check and treat for shock. If the bleeding continues, apply a pressure dressing.

2-19. Pressure Dressing (081-831-1016)

Pressure dressings aid in blood clotting and compress the open blood vessel. If bleeding continues after the application of a field dressing, manual pressure, and elevation, then a pressure dressing must be applied as follows:

a. Place a wad of padding on top of the field dressing, directly over the wound (Figure 2-35). Keep injured extremity elevated.

NOTE
    Improvised bandages may be made from strips of cloth. These strips may be made from T-shirts, socks, or other garments.

b. Place an improvised dressing (or cravat, if available) over the wad of padding (Figure 2-36). Wrap the ends tightly around the injured limb, covering the previously placed field dressing (Figure 2-37).

c. Tie the ends together in a nonslip knot directly over the wound site (Figure 2-38). DO NOT tie so tightly that it has a tourniquet-like effect. If bleeding continues and all other measures have failed, or if the limb is severed, then apply a tourniquet. Use the tourniquet as a LAST RESORT. When the bleeding stops, check and treat for shock.

NOTE

    Wounded extremities should be checked periodically for adequate circulation. The
    dressing must be loosened if the extremity becomes cool, blue or numb.

*NOTE

    If bleeding continues and all other measures have failed (dressing and covering wound, applying direct manual pressure, elevating limb above heart level, and applying pressure dressing maintaining limb elevation), then apply digital pressure. See Appendix E for appropriate pressure points.

2-20. Tourniquet (081-831-1017)

A tourniquet is a constricting band placed around an arm or leg to control bleeding. A soldier whose arm or leg has been completely amputated may not be bleeding when first discovered, but a tourniquet should be applied anyway. This absence of bleeding is due to the body's normal defenses (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding will start as the blood vessels relax. Bleeding from a major artery of the thigh, lower leg, or arm and bleeding from multiple arteries (which occurs in a traumatic amputation) may prove to be beyond control by manual pressure. If the pressure dressing under firm hand pressure becomes soaked with blood and the wound continues to bleed, apply a tourniquet.

WARNING
    Casualty should be continually monitored for development of conditions which may
    require the performance of necessary basic life-saving measures, such as: clearing the
    airway, performing mouth-to-mouth resuscitation, preventing shock, and/or bleeding
    control. All open (or penetrating) wounds should be checked for a point of entry or exit
    and treated accordingly.

*The tourniquet should not be used unless a pressure dressing has failed to stop the bleeding or an arm or leg has been cut off. On occasion, tourniquets have injured blood vessels and nerves. If left in place too long, a tourniquet can cause loss of an arm or leg. Once applied, it must stay in place, and the casualty must be taken to the nearest medical treatment facility as soon as possible. DO NOT loosen or release a tourniquet after it has been applied and the bleeding has stopped.

a. Improvising a Tourniquet (081-831-1017). In the absence of a specially designed tourniquet, a tourniquet may be made from a strong, pliable material, such as gauze or muslin bandages, clothing, or kerchiefs. An improvised tourniquet is used with a rigid stick-like object. To minimize skin damage, ensure that the improvised tourniquet is at least 2 inches wide.

WARNING

The tourniquet must be easily identified or easily seen.

WARNING

DO NOT use wire or shoestring for a tourniquet band.

WARNING

    A tourniquet is only used on arm(s) or leg(s) where there is danger of loss of casualty's
    life.

b. Placing the Improvised Tourniquet (081-831-1017).

    (1) Place the tourniquet around the limb, between the wound and the body trunk (or between the wound and the heart). Place the tourniquet 2 to 4 inches from the edge of the wound site (Figure 2-39). Never place it directly over a wound or fracture or directly on a joint (wrist, elbow, or knee). For wounds just below a joint, place the tourniquet just above and as close to the joint as possible.

    (2) The tourniquet should have padding underneath. If possible, place the tourniquet over the smoothed sleeve or trouser leg to prevent the skin from being pinched or twisted. If the tourniquet is long enough, wrap it around the limb several times, keeping the material as flat as possible. Damaging the skin may deprive the surgeon of skin required to cover an amputation. Protection of the skin also reduces pain.

c. Applying the Tourniquet (081-831-1017).

    (1) Tie a half-knot. (A half-knot is the same as the first part of tying a shoe lace.)

    (2) Place a stick (or similar rigid object) on top of the half-knot (Figure 2-40).

    (3) Tie a full knot over the stick (Figure 2-41).

    (4) Twist the stick (Figure 2-42) until the tourniquet is tight around the limb and/or the bright red bleeding has stopped. In the case of amputation, dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.

    (5) Fasten the tourniquet to the limb by looping the free ends of the tourniquet over the ends of the stick. Then bring the ends around the limb to prevent the stick from loosening. Tie them together under the limb (Figure 2-43A and B).

NOTE (081-831-1017)
    Other methods of securing the stick may be used as long as the stick does not unwind and no further injury results.

NOTE
    If possible, save and transport any severed (amputated) limbs or body parts with (but
    out of sight of) the casualty.

    (6) DO NOT cover the tourniquet--you should leave it in full view. If the limb is missing (total amputation), apply a dressing to the stump.

    (7) Mark the casualty's forehead, if possible, with a "T" to indicate a tourniquet has been applied. If necessary, use the casualty's blood to make this mark.

    (8) Check and treat for shock.

    (9) Seek medical aid.

CAUTION (081-831-1017)
    DO NOT LOOSEN OR RELEASE THE TOURNIQUET ONCE IT HAS BEEN APPLIED BECAUSE IT COULD ENHANCE THE PROBABILITY OF SHOCK.

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