Outdoor hobbies are my favorite hobbies, but they can also be the most dangerous.
Statistically speaking, hiking and hunting have lower rates of injury and death than football or soccer, but getting injured in the wild is more likely to result in permanent harm.
That’s because there are no ambulances or hospitals outside of civilization.
While it’s smart to carry a long-range radio so you can contact help, it’ll still take hours for rescue to arrive. Death by arterial exsanguination (bleeding) takes minutes.
Do you know how to stop bleeding before you or your hunting partner bleeds to death?
Disclaimer: I’ve had some first aid training, but I’m not a medical professional. The following is not the advice of a medical professional, and I recommend you seek out training as well.
Wilderness Threats and Priorities
Whether you’re hiking in the Sonoran Desert or climbing a mountain in the Rockies, there are sharp objects all around you.
You could slip and come down wrong on a rock, gashing open your leg.
You could swing a survival hatchet incorrectly and hit yourself.
You could take a shot at a game animal, miss, hit a rock, and get hit by the ricochet.
In my case, it was a .22 bullet while squirrel hunting.
Are any of these scenarios likely to happen?
But if you don’t learn how to deal with them, then you won’t know what to do when the unlikely happens.
There are three priorities to focus on when you’re bleeding out in the woods:
- Stop the bleeding.
- Protect the wound.
- Prevent shock.
There’s a fourth, too, but it’s a much lower priority:
- Prevent infection.
I’ll cover why that’s not as important later. For now, though, let’s focus on keeping you from bleeding to death.
1. Stop the Bleeding
Your priority when dealing with a wound, whether it’s on city streets or deep in the forest, is to stop the bleeding.
That’s because you can rapidly die of blood loss if an artery is spurting blood outside your body.
Called “exsanguination,” this is more dangerous with arterial wounds than with venous wounds, but even an open vein can cause a life-or-death scenario.
Generally, you can tell an arterial bleed from a venous bleed with these observations:
- Is the blood bright red or dark red?
- Is it coming out with force or slowly bleeding?
In both cases, the former are signs of an arterial bleed; the latter, a venous bleed.
You can spend more time putting on gloves and disinfecting tools if you’re facing a venous wound. However, if you’re bleeding from an artery, you need to stop the flow as soon as possible!
Do Not Remove Major Foreign Objects
If you’re bleeding because you have a branch or knife impaled in you, the first step is to…
…leave it alone!
A major foreign object inside your body is doing part of the work for you by blocking blood vessels. You’ll bleed more with it removed, so leave it inside until a surgeon can take over.
Apply Direct Pressure
The fastest way to slow down blood loss is to apply direct pressure to the wound.
Grab it and hold tightly. If someone else is bleeding and they can do this, have them apply direct pressure themselves so you have both hands free.
If you’re running out of hands, use something else. Jam your knee into the wound or hold it tightly to your body while you lean the other side of your limb against a rock. Anything to apply direct pressure.
The point of this is not only to slow down the rate of blood loss but also to promote coagulation, which is when your blood cells turn into a sort of glue and block off the open area.
More effective than applying pressure to the whole wound is digital ligation, but it’s more difficult to perform.
Digital ligation is applying direct pressure to the bleed vessels with your fingers. You don’t need to use as much pressure. Just hold your finger against the opening.
Good luck finding that open blood vessel, though.
Elevate the Wound
Your heart has difficulty pumping blood upward.
This means that, if it’s possible, you should raise your hurt limb above your heart.
This isn’t always possible, but doing so will slow down the blood flow and make the blood more likely to coagulate.
Block Pressure Points
Unless you took a cut to your heart, the blood needs to travel to the wound.
You can slow and even stop blood loss by cutting off circulation at a pressure point between the heart and the wound.
Major pressure point locations are the brachial artery (inside your upper arm), carotid artery (sides of your neck), and femoral artery (groin and inside your thighs).
I’ve heard one military medic say that the first thing he’d do when he saw leg bleeding was to stick his knee in the victim’s crotch. That would slow down blood loss even before he could apply direct pressure.
Note that this should be a temporary measure until you can stop the bleeding through other means.
Also, if you have a head wound, only block one half of the carotid artery. Don’t apply pressure to both sides of your neck unless you hate having a working brain!
Use a Tourniquet
Once controversial, using a tourniquet has become standard medical practice for dealing with massive external hemorrhaging.
A tourniquet is something that wraps around a limb and cuts off blood flow, which is called distal arterial occlusion.
There is a measure of danger in this, but it’s not as dangerous as thought in years past. According to modern research, your limbs can survive up to 6 hours without blood.
Even if it takes you longer to get rescued than 6 hours, it’s better to lose a limb than to lose your life.
Tourniquets can only be used on limbs and should never be applied to a neck!
There are many tourniquet designs out there. My favorite is the C-A-T Gen 7 by North American Tactical. Any TCCC (Tactical Combat Casualty Care) approved tourniquet is good, though.
You want to apply the tourniquet between the wound and heart. If the source of bleeding is obvious, place the tourniquet three finger-widths above the wound, then tighten it according to the directions.
If the wound is deep and you can’t see exactly where the blood is coming from, or if you have a very limited time in which you can deal with the wound, then apply the tourniquet “high and tight.”
You do this by going as high on the limb as you can without crossing a joint and applying the tourniquet right under that joint.
For example, if you took a bullet to your bicep, apply a tourniquet to yourself right under your armpit.
The tourniquet needs to be tight; you should not be able to fit three fingertips under it. This will hurt.
If you’re applying a tourniquet to someone else, and they hate you more than the wound, you’re doing it right.
While it’s best to use a purpose-made emergency tourniquet, nature is wonderful about sending problems your way when you don’t have the appropriate tools.
However, it’s not terribly difficult to make an improvised tourniquet.
You need some rope or cloth, which can be torn from clothing. Bandanas may work, too. You also need a sturdy branch several feet long and a way to lash it down.
Here’s how to use an improvised tourniquet:
1. Tie cloth around the limb (either right above or “high and tight”).
2. Stick the branch between the cloth and the limb until it’s halfway through.
3. Rotate the branch, using it as a windlass to tighten the cloth.
4. Once it’s tight enough and parallel to the limb, lash it in place.
You may need to reevaluate the tourniquet’s tightness due to material stretch or changing pressure in the victim’s body.
Some old advice was to loosen the tourniquet occasionally to allow blood to the limb, but we now know that’s not necessary and, in fact, can be dangerous due to increased shock risk and tourniquet weakening.
2. Protect the Wound
Once you have the bleeding under control, it’s time to protect the open wound from foreign contaminants and encourage further clotting.
Pack (or Dress) the Wound
Wound dressing is gauze or another (hopefully) sterile material applied directly to the open wound to catch the blood and hold it inside the wound.
This promotes coagulation.
You should pack the wound with a modicum of pressure. Loose dressing is ineffective.
Do not replace bloody dressing, because that will pull coagulated blood away from the wound and cause it to reopen. Instead, add more gauze on top.
Bandage the Wound
Once you have dressing against the wound, you need to hold that dressing in place with a bandage.
You can use a bandage from a first–aid kit for this. If you don’t have one of those, you can also use a bandana or strips of torn clothing.
The primary goal of a bandage is to hold the dressing in place with some pressure against the wound.
3. Prevent Shock
Even once you’ve taken care of the wound itself, the patient can still be harmed by hypovolemic shock.
This type of shock affects people who’ve lost one-fifth of their blood volume or more.
Watch out for cold skin, a pale coloration, blue lips and fingernails, complaints about feeling chilly, headaches, fatigue, nausea, fast breathing, fast heart rate, confusion, and unconsciousness.
The first thing you need to do with someone in shock is to get them warm. Give them a blanket or coat. Even cuddle with them if you need to.
After that, you want to position them so their heart doesn’t have trouble pumping blood to their brain.
Lay them with their feet above their head if they’re conscious, and lay them on their side if they are unconscious.
Finally, you want to improve their blood volume. If they’re awake, then give them fluids. Salt and electrolytes are recommended, but merely giving water is good.
Of course, you shouldn’t give them liquids if they’re not conscious. They may drown!
4. Prevent Infection…?
Notice how I didn’t give much thought to sterility and preventing infection?
That’s because infections kill in weeks, not hours or minutes.
Your number one goal with an open wound is to get it to stop bleeding. If you need to use contaminated equipment to do so, so be it.
Infections can be cured in the hospital, but you need to be alive in order to get to the hospital.
That said, it’s still a good idea to be as clean as possible. Keep sterile medical supplies in your hunting pack, rinse the wound with clean water, and wear gloves if you can.
Avoid alcohol or hydrogen peroxide for cleaning wounds. They irritate raw flesh and can slow down healing.
Field Expedient Wound Disinfection
There are several natural resources you can use to attempt to disinfect a wound.
Many herbs have antibacterial properties. You can make a tea with them, soak a cloth in the tea, and apply it (once cool!) to the wound.
Onion, sage, and white oak bark are some examples. You can find more, but make sure you know how to identify them!
Honey also has antibiotic properties and promotes healing as well.
We all like to think we can avoid injury when exploring the wilderness.
However, nature is a cruel mistress and accidents will happen.
So, it’s important to know how to stop bleeding without the advantage of modern medicine.
Remember your priorities:
- Stop the bleeding.
- Protect the wound.
- Prevent shock.
If you can do this while preventing infection, all the better. But bleeding from an artery can cause death in seconds.
Get trained and stop the bleed!