Trauma in the Field: Bleeding, Wounds, Fractures, Head and Spine, Burns
The order is fixed: catastrophic bleeding, then airway and breathing, then splint, then clean and dress, then evacuate. Photographing the wound for the group chat comes last — or never.
Treat trauma in this order: control major bleeding first, then airway and breathing, then immobilise, then clean and dress, then evacuate. Press firmly on a bleeding wound for 10 minutes without lifting the dressing. Use a tourniquet only if you have been trained, and write down the time. Do not pull out an impaled object, do not force a fracture back into place, and do not move a suspected spinal injury unless the scene is dangerous.
Trauma care in the field is mostly about sequence and restraint. Do the big things in the right order, and resist the urge to do small things first.
Major bleeding
- Direct pressure: clean dressing or clothing over the wound, firm and continuous for 10 minutes. Do not keep lifting it to look.
- Arterial bleeding from a limb that will not stop with pressure: use a tourniquet only if trained, and record the time. Never a rope or wire, and never loosen it.
- Impaled object: do not remove it. Pack and secure around it.
- Elevate the limb, keep the patient warm, watch for shock, and call for help early.
Wounds
- Irrigate with clean water or saline and remove grit and debris. Do not pour alcohol into a deep wound.
- Antiseptic, then a sterile dressing. Change daily and watch for redness, swelling, heat, pain, pus or fever.
- Deep, dirty, animal-bite or rust-related wounds: get medical care promptly and assess tetanus and rabies.
- Do not self-prescribe oral antibiotics. That is a clinician's decision.
Fractures and sprains
- Do not force a fracture back into alignment. Splint across the joints above and below, using a splint, a pole or a sleeping pad, tight enough to hold and loose enough to pass a finger.
- After splinting, check distal pulse, colour and sensation. Numb or white means loosen it.
- Sprains: rest, ice for 15 minutes through a cloth, compression, elevation. No heat, no rubbing with alcohol.
- Suspected hip, femur, spine or pelvis injury: do not carry them on your back. Wait for rescue or a proper litter.
Head and spine
- After a head impact: drowsiness, vomiting, unequal pupils, slurred speech or seizures means call for help immediately.
- Suspected spinal injury: do not move them unless the scene is dangerous. Keep the head and neck neutral and wait for rescue.
- No food or drink for anyone with altered consciousness.
Burns
- Cool running water for 20 minutes. No ice, toothpaste, soy sauce or butter.
- Do not pop blisters. Cover with a clean dressing.
- Large burns, or burns to the face or airway, electrical or chemical burns: call for help immediately. Chemical burns: irrigate copiously with water, and protect yourself first.
Eyes and teeth
- Foreign body in the eye: do not rub. Irrigate, cover both eyes to limit movement, and get medical care.
- Dental injury: do not scrub the tooth. Store an avulsed tooth in milk or saline and see a dentist urgently.
Field trauma care buys time and prevents deterioration. Definitive care happens in a hospital.