My wife and I have a slightly morbid joke that, if I am not bleeding, I mustn’t have had fun. To some extent, this is true. I am always reaching into brambles and getting scratched or missing with the hammer or slipping a screwdriver off a screw and into my hand. My shins are permanently scared from tumbles against sharp rocks and errant branches. Flowing blood is a fact of an active outdoors life. Things happen in the woods, on the pitch/field/diamond, and backyard. Even with the best training and care, accidents happen. Knowing what to do when something occurs can be the difference between continuing your activity and something more drastic.

The first thing to do is get some training. There are many places to get training: ARC (American Red Cross), NOLS (National Outdoor Leadership School), and WSC (Wilderness Safety Counsel) are three good organizations to start. The courses are not inexpensive ($200 to $500; ARC costs less, but is not as extensive), but think of it like insurance: It’s something that you never want to use, but you are glad to pay for and have if you need it. Most of what I am going to tell you is from my various Red Cross and other wilderness first aide courses.

The second thing to do is practice. Children and pets make good “patients.” Making it a game with children is good for some quality time, teaches them some basic first aid, and perhaps most important, makes them less fearful so that they (and you) won’t panic as much during the real thing.

The third thing is to have a good “wilderness” first-aid kit. Actually, you should have more than one: A small day-use kit that fits in your back pocket or fanny pack for use on bike rides and such, and a larger one for extended trips where you are far from medical facilities. Adventure Medical and Surviveware make good kits, but others are equally good. Avoid the ones that have 250 or 350 pieces, as most of those pieces are band-aids, alcohol wipes and over-the-counter pain killers.

Many types of injuries can occur when you are out-and-about. Sprains, dislocated phalanges, and broken bones, while serious, are usually not life threatening. This article with deal only with those that involve loss of blood. Blood loss injuries fall into four general categories, and each has its special way of being treated.

Internal

This is probably the most serious since there really isn’t any way to stop the bleeding except through medical intervention. A severe blow to some part of the body causes internal bleeding. On the “mild” side, these are seen as bruising; on the severe side, there might not be any external symptoms, but the victim might experience light-headedness, fainting, dizziness, and swelling at the location of the injury. The victim should be treated for shock, stabilized and taken to the emergency room ASAP.

Spurting

Bright, red blood spurting from the wound is a sign of arterial bleeding. If possible, elevate the injury above the level of the heart, since is the heart that is pumping blood out of the wound. The wound probably will clean itself due to the high pressure, so don’t worry too much about debris. Apply pressure; be aggressive. Use folded cloth to cover the wound and hold in place with your hand(s) or a tightly wrapped strip of cloth. If blood soaks through the cloth, do not remove the cloth. Apply another over the first, as removing the first cloth can remove the clotting that has formed.

If the bleeding does not stop, a tourniquet is the last resort. It is placed above the wound and tightened until the bleeding stops. It is the last resort since it cuts off blood supply to all points below the tourniquet. This means that there is the possibility that the entire limb will be compromised—a nice euphemism for the chance that the victim will lose the entire limb. Again, transport the victim to the hospital.

Flow

Dark, red blood (low oxygen) flowing at a steady rate usually means that a vein has been opened. This is the most common type of shallow cut. Blood in veins is moved by the contraction of muscles, so the less movement, the better. Since there is less pressure in veins, blood has more time to coagulate in the wound. Unlike arterial flow, debris will not be cleared, so the wound should be cleaned first. Clean water will suffice, but a mild solution of salt or a commercial product such as Shur-Clens (already in a squeeze bottle) is better. I have a needleless syringe for this purpose.

Once the wound is clean, apply pressure. An adhesive bandage might be enough. If the wound is large, a folded cloth might need to be used. Once the bleeding stops, wrap the wound in clean bandages. Depending on the severity of the cut, this may be enough, and the wound will heal on its own. Larger cuts probably need stitches.

Some products, generically called liquid bandages, might suffice for this type of would. All are some form of blood-clotter, and again, their use depends on the severity of the wound. I have used WoundSeal Powder and Quikclot. WoundSeal comes with an applicator for nosebleeds. I also have Israeli Bandage Battle Dressing First Aid Compression Bandage, but fortunately have not had to use it. Whereas the first ones mentioned are good for smaller wounds, the Israeli is advertised as being able to stop severe bleeding; and since it is 70 inches long, it will also act as a compression dressing. This one I have in my chainsaw box, although I trust my chainsaw chaps to stop a mishap.

Oozing

Scrapes, scuffs, road rash, strawberries and raspberries are shallow abrasions that do not extend into the lower layers of the skin. They have little blood loss, but hurt like the dickens. This is because, unlike a cut, an abrasion exposes many more nerve endings. While it is highly unlikely that someone will bleed to death due to an abrasion, infection is a real concern since it takes longer for an abrasion to clot and heal. Clean the wound with flowing water or hydrogen peroxide. Try not to scrub the wound. Cover it with a clean bandage. A scab will form in a couple of days; until then, watch for increased redness, which can be a sign of infection.

Even with all the care in the world, bleeding is part of outdoor activities. While avoidance is preferable. it is always best to be prepared for the worst.

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