This article was published January 2014 in the "Backcountry Safety" column of the Hunt Alaska Magazine.
Story by Jon Hunt
“Once you pull the trigger, the work begins.” Oh, so true. This past fall, one of the hunters in our group shot a caribou in the early evening. Nightfall rapidly approached as we worked under the shared glow of a single headlamp (only one of us packed a light). As both arms were elbows deep in the cavity of this bull, my hunting partner blindly cut away at the esophagus and trachea with his blood covered hands. As he held the Havalon scalpel knife, I couldn’t help but consider the potential severe laceration that many hunters experience at a moment like this. So often at this point, our attention is diminished by the inhalation of kamikaze white socks (my partner also forgot his head net), or the dreaded hike back across the beaver ponds and willows that seemed to swallow us. Not to mention the exhaustion, dehydration, hunger and general concern over the fresh bear skat that we passed few steps back. Any combination of these factors create a potentially dangerous scenario among hunters. Luckily, we didn’t suffer from any injuries that evening, but the risk is ever present. Let’s take a deeper look at backcountry wound care.
During first aid courses, the topic of severe bleeding is one on which we spend significant time. Another concern among most hunters is wound closure. People often ask me what I like better: Super Glue, sutures or duct tape? These appear to be favorites among many Alaskan hunters. Inevitably, for those who are interested, we end up discussing how to stop the bleeding, minimize infection, and close the wound.
STOPPING THE BLEEDING:
Most bleeding can be resolved by direct pressure. A sterile dressing along with gloves to prevent disease transmission is always preferred. Prior to 2010, the typical lay-level responder courses emphasized the value of elevating the injured extremity (to reduce blood flow), applying ice (to constrict blood vessels), or using pressure points to reduce blood flow to the extremities. The 2010 guidelines in most National First Aid courses now have a primary focus on direct pressure to a bleeding wound and stabilizing the injury so no further harm occurs. The use of tourniquets, if bleeding is not controlled by pressure, has become recommended protocol.
Two of my favorite items to show during first aid class are QuikClot and the SWAT Tourniquet. The QuikClot Sport Silver, manufactured by Z-MEDICA, is available in 25-gram and 50-gram packets. Opening the vacuum-sealed packet reveals a sterile mesh pouch that contains the QuikClot hemostatic sponge material to be placed directly over the wound. QuikClot accelerates clotting and stops bleeding fast. Due to its antibacterial properties, the Ionic Silver makes the product ideal for hunters traveling remotely. A QuikClot Sport version without Ionic Silver is available and significantly less expensive.
The SWAT-Tourniquet is manufactured by TEMS Solutions. The acronym stands for Stretch-Wrap-And-Tuck. Its unique design creates a multi-purpose tourniquet and trauma care device. This 4” wide x 4’ long thin elastic band stretches and wraps around the extremity, providing a tourniquet, pressure dressing or elastic wrap for splinting. Symbols printed on the device help prevent over-tightening. This life-saving device is a great addition to any first aid kit because it is compact and relatively lightweight.
The use of tourniquets is traditionally seen as a last resort, when the limb is sacrificed in order to save the victim’s life. Be aware, there is ongoing debate among medical professionals as to best practice of how to use a tourniquet and when to remove it, especially in remote scenarios. There are many manufacturers of professional grade tourniquets; they can also be easily improvised in the field. Other related products include: Combat Application Tourniquet (C-A-T), Israeli Bandage, Celox, and QuicClot Hemostatic Gauze.
Infection is a life-threatening concern in the backcountry, so knowing the signs of infection is important. Some of these include: redness, swelling, pain, point tenderness and drainage from the wound. In addition, a warm feeling around the injury site, fever, foul smell at the wound site, streaks going toward the heart and lymph node swelling are indications of infection. Hot compresses may help to draw pus out of a wound, but oral antibiotics may be necessary and worth packing. Many wilderness first aid courses suggest that if the infection does not improve after 12 hours, a rapid evacuation is necessary.
There are too many possible mechanisms of injury to discuss here, but let’s revisit the knife-wound scenario. A simple laceration like this is relatively easy to clean and to close. This is especially true when compared to a severely jagged wound (like a bear mauling). Such a wound is hard to clean and probably would need to be left open, packed with sterile moist gauze and then bandaged with a sterile dressing. This would allow it to drain until the victim reaches definitive medical care. Please be aware that treating a laceration over a joint or fracture has the potential for a bone infection and would need immediate medical attention.
Hands down, my preferred method for cleaning a laceration is to irrigate the wound with clean water, saline, or an iodine solution. This is best done with an irrigation syringe, using short blasts while holding the wound open. This can be easily improvised by using a zip-lock bag or dry bag with a pinhole to offer a minimal amount of pressured irrigation. Tweezers are often necessary to remove tiny particles of debris that were not flushed out.
During wilderness first aid classes, we use a pig’s foot with multiple kinds of tissue damage. After we rub debris into the injury, students are able to experience the difficulty of cleaning a wound properly. This is a good skill to practice before actually having to do it in the field.
Finally, it’s time to consider closure of a wound. I’m not a proponent of sutures, Super Glue or duct tape for wound closure in the field, primarily because the wound is likely not cleaned thoroughly and will probably result in complications from infection.
I don’t carry Lidocaine or a sterile suture kit, and I don’t practice doing sutures on a regular basis. Unless you are a doctor, this is an unlikely solution for you as well. Sutures improvised in the field will be painful and generate an increased risk of infection. Super Glue would close a wound, and was even used for that purpose in the Vietnam War. If you do choose to close a wound in the field my favorite method after cleansing and irrigation is to use Wound Closure Strips (Steri-Strips). Adventure Medical Kits makes a compact “Wound Medic” kit that contains liquid iodine, an irrigation syringe, and Steri-Strips. This is an economical and compact kit that could supplement your first aid kit.
Once again, we see that “an ounce of prevention is worth a pound of cure.” Be careful and deliberate in your actions while hunting. Consider carrying some additional supplies to help manage severe bleeding, to irrigate lacerations and bandage the wound.
Jon Hunt, an avid hunter and fisherman, is an Alaska resident and licensed Wilderness First Responder. He is the owner of Frontier Safety and Supply, which offers training in Wilderness first-aid, CPR/AED and standard first-aid. The company also offers a web-store that sells first-aid kits, survival gear, emergency preparedness supplies and high-end outdoor products. Visit the store at www.FrontierSafetyAndSupply.com or call Jon at (907) 301-5155