When someone is injured — after calling 911 — you must do a quick yet thorough overview of their injuries. You need to gain a basic understanding of what happened (the mechanism of their injury), so ask the wounded person what happened, what’s wrong and where they are experiencing pain.
If they can’t tell you, ask any witnesses (unless you are one). Then figure out what will kill them first and address it. This will most likely be one of two things: lack of breathing or bleeding.
I’m going to split the following into two sections: penetrating trauma (gunshot and stab wounds) and blunt trauma (sudden deceleration injuries such as falls, car accidents and trampling).
There Will Be Blood
With penetrating trauma, unless there has been a massive loss of blood or significant damage to or destruction of a vital organ, the chances are pretty good the person can survive. If an arm or leg is affected, it is usually fairly easy to tell if there is significant bleeding from vascular injury.
- If they are bleeding briskly and blood is pumping (arterial), put a tourniquet on them with whatever you have available — a belt, shoelaces or torn piece of clothing — and put it on as tightly as you can using something that serves as a torque until you lose the pulse and the bleeding stops. If the bleeding is oozing out (venous), you can do the same thing, but you won’t need to tighten it as much — you can preserve the pulse
- If the injury is to the pelvis, things can get complicated in a hurry. A ton of blood can disappear in the pelvis and before you know it the patient has lost liters. If you suspect pelvic bleeding, simply hold deep pressure — even if it hurts. Pain doesn’t kill. Loss of blood does
- If the injury is to the abdomen, try to find the entrance and exit. If the liver (right upper abdomen inside and under rib cage), spleen (deep left upper abdomen) or kidneys (midback/flanks beneath the rib cage — the right one is a little lower) have been hit, hold constant pressure to stanch the bleeding. Don’t worry about checking to see if the bleeding has stopped — it won’t stop. You need to hold pressure until EMS arrives or you get to a hospital
- If the injury is to the chest, watch their breathing. If it is getting hard for them to breathe, they may have a tension pneumothorax (which compresses the lungs) or their chest may be filling with blood. If it is tension, it means that there is a hole in their chest sucking in air but the air can’t get out. As the pressure builds, they have less space for their lungs to fill.
The solution for tension pneumothorax is putting another hole in the person’s chest to relieve the pressure and then installing a one-way valve so more air is not sucked into their chest.
Of course, I can’t teach you how to do that here. Besides, it’s not something nonmedical professionals should do unless there is no other choice to save that person’s life.
Also, if their chest is filling with blood, the patient needs a chest tube and probable surgery to find and fix the source of bleeding — neither of which can be done in the field.
If the injury is to the head or neck, simply hold pressure to the source of bleeding if you’re able. Remember — scalp injuries bleed A LOT.
Blunt trauma is more complicated and insidious. If a person cannot be revived at the scene, they will probably not be revived at the hospital. The main things are to keep them breathing and to stop the bleeding — so the same principles apply as above. However, I’m going to add a few extra bits here.
In blunt trauma, you want to move the patient as little as possible and keep their spine in line. Let me repeat: Keep them as immobile as possible.
- If you see a broken bone that is obviously deformed, apply a splint to provide stability and prevent movement of the broken part. This helps reduce further soft tissue, vascular and nerve damage and helps decrease pain. You can fashion a splint out of any rigid material and then attach it to the limb with tape, shoestrings, clothing, belts, etc.
- Pay attention to the patient’s airway and keep it straight and open so air can flow as freely as possible. Hold the head in line and do not move it — you are protecting their neck and spinal cord. You can tilt their head back very slightly or thrust their jaw forward just a little to keep their airway open and the back of their throat clear
- If the patient vomits, log-roll them onto their side as a single stiff unit with the assistance of a couple other people in order to prevent aspiration of vomitus into their lungs.
I recommend reviewing this information often as well as watching a few videos on basic first aid. I hope you never need to use any of these skills. But if you do, at least now you know the basics.