First Aid Basics : Wound Management

The FIRST AID modules provide information on caring for injuries and sickness in a backcountry environment when you are hours or even days away from definitive medical care, with focus on what is commonly encountered in the mountains. These modules only provide an overview, but are not meant as adequate instruction for beginners. While traveling in remote, wilderness areas ensure you group includes qualified wilderness medicine professionals, or get a WFA, WAFA or WFR certification yourself.

Minor scratches, cuts, abrasions and wounds are common and to be expected during backcountry travel. Most open wounds are easily managed and do not required evacuation. Significant, uncontrolled bleeds and infected wounds become a cause of concern and qualify as life threats that needs immediate first aid, evacuation and definitive medical care. Minor wounds, when left unmanaged, can become life threats. It is important to pay attention to all wounds and be vigilant with their care.

EQUIPMENT FOR FIRST AID KIT

• Gauze bandages and pads
• Elastic/ACE wrap
• Gloves
• Betadine
• Tincture of benzoin
• Antibiotic cream/ointment
• Tweezers
• Irrigation Syringe
• Potable water

TREATMENT PROCESS

Priorities

• Control Bleeding
• Reduce the risk of infection
• Promote tissue healing

CONTROL BLEEDING

• Direct Presure: Use a gloved hand to apply pressure directly onto the bleeding site. For heavy bleeds, you will have to apply a significant amount of pressure, enough to cause pain. Direct pressure applied for a few minutes generally works for most minor wounds.
  
  
• Pressure Dressing: Place a gauze pad directly on and/or in the wound. Bandage it with a gauze wrap to secure the dressing in place. You may need to use an elastic wrap for heavier bleeds. If the bleeding is controlled after 2 hours, you can loosen the dressing. Reapply if bleeding continues.
  
  
• If all above efforts fail, apply a tourniquet. Do not attempt a tourniquet unless you have been professionally instructed and are certified to do so. You may end up cutting off circulation to the point of tissue death.
  
  

REDUCE THE RISK OF INFECTION

• Clean the wound
  
  1. Protect yourself with gloves, glasses and clothes
  2. If the wound is bleeding very lightly, don’t be concerned about stopping the bleed. Inspect the wound.
  3. Use clean, potable water, possibly with Betadine or soap to clean in and around the wound. Use pressure irrigation with a syringe to clean deep wounds.
  4. Use water or tweezers to force any foreign matter out of the wound. While using tweezers, take care not to rupture blood vessels.
  5. Identify high risk wounds - bites, visibly dirty wounds, punctures or gaping wounds that sometimes accompany open fractures.
  
  
• Close low risk wounds
  
  1. After bleeding is controlled and the wound is cleaned, remove any hair from the wound.
  2. Apply tincture of benzoin around the wound. Do not apply inside the wound.
  3. Making the wound edges touch each other, close with a butterfly bandage or an improvised closure strip.
  4. Consider antibiotic cream or ointment over the wound.
  5. Dress the wound.
  
  
• Leave open high risk wounds
  
  1. Clean as described.
  2. Pack with moist, sterile gauze.
  3. Dress the wound, as described below.
  4. Change the packing and dressing daily.
  5. Consider antibiotics.
  6. Evacuate all high risk wounds.
  
  

PROMOTE HEALING

• Dress the wound
  
  1. Apply a sterile dressing like a gauze pad or a semi permeable membrane like Tegaderm.
  2. Cover with surgical fabric tape or a non-stick dressing like Spyroflex.
  
  
• Continually look out for symptoms of infection
  
  1. Localized - redness, pus in tissues, hardness of wound
  2. Transition - heat, swelling beyond wound site, increasing pain, lymphatic streaking
  3. Systemic - Weakness, chills, fever, nausea, vomiting, unresponsiveness
  4. Evacuate all wounds with symptoms of systemic infection, and wounds that don’t heal despite appropriate care.

• Treat small infected wounds
  
  1. Clean the wound again. This may require removing scabs.
  2. Heat compress 3 times a day for 20 minutes.
  3. Splint and immobilise if the wound site is on an extremity.
  4. Consider antibiotics.