TFTC #19 Wound Dressing Protocols

by Travis Vickerson Jul 31st 2020

So the unthinkable happens! Maybe it’s a skin sacrifice to the Silky handsaw gods, or even suffered the fate of a turning chainsaw chain on unprotected skin. What now! Due to the inherent tearing forces of chainsaw chains, this wound is going to bleed significantly more than that of a stabbing wound. The more damage will directly result in more bleeding. Chainsaws are designed to cut and tear through solid wood with ease, so the effect on your body will be beyond traumatic!

When you’re watching your life bleed out of an open wound is no time to process your treatment options – now is the time to act! 

Most of us have a basic understanding of wound management, but let’s review the essentials and the different options in dressing wounds.

Let’s discuss the steps you need to take when the incident occurs:

Safe Place Icon

1. Get in a Safe Place (Within Reason).

This means if you’re running your chainsaw…. STOP! If you’re climbing and cut yourself with a handsaw, get in a position where you not at risk of further injury or falling.

Blood Flow Icon

2. Apply Direct Pressure.

This forces the flow of blood to slow or stop, and allow the body’s natural ability to close the wound. This is known as coagulation. When applying pressure you want to apply light pressure with a wound dressing. Here are the dressing options available:

      1. Combination Dressing – a sealed dressing that has lots of absorption capability.
      2. Compression Dressing – very similar to a Combination Dressing but has a fastening system attached. The dressing should be applied with light pressure and is “hands-free” once attached.
      3. Sterile Dressing Pad – several compacted layers of gauze to be applied directly to the wound. These pads are available in various sizes – 2"x 2", 4" x 4", 6" x 6" and many others.
      4. Impregnated Blood Clot Dressing – sponge gauze material that has a chemically infused covering or has a chemical component inside the dressing. When this chemical gets in contact with blood a reaction occurs and the wound is closed through cauterization. You can also get this chemical in granular form that is poured directly onto a wound. Used by the military for rapid clotting, this product is very effective but requires immediate medical attention to remove the chemical agent from the affected area.
Elevate Icon

3. Elevate the Wound.

This is done to limit the body’s vascular system and reduce blood flow to the wound. This isn’t always feasible to do, but if possible place the wound above the heart. This will greatly reduce blood flow and let clotting occur more easily.

Tourniquet Icon

4. Tourniquet.

This is a final resort, and should be applied with caution. If a tourniquet is left on the body for a prolonged period of time, irreversible damage could occur.  However, a tourniquet is a “life over limb” situation. You want to apply a tourniquet when severe blood loss is occurring, and where the possibility of losing the affected body part is a better outcome than blood loss resulting in death. The average adult human has 6L of blood in their body, and a laceration to a large blood vessel, such as the femoral or radial artery, could result in complete blood loss in less than 5 minutes. If warranted, the application of a tourniquet needs to be applied quickly and only in “life or death” situations.

So, back to our situation. The blood is flowing and what do you reach for?

Selecting the correct size dressing for the wound is essential. You wouldn’t want to put a beach towel on a 1" cut, or a 2"x 2" gauze pad on a 6" laceration. Also, choosing first aid dressings to carry on your saddle is key, since room and weight are a consideration. I choose to only carry three items that I would use to save my own life while awaiting rescue: I carry a Combination Dressing, a Tourniquet and an Impregnated Blood Clot Dressing. These three items should allow me to stop most large vessel bleeding by using them independently, or together as a blood clotting pressure dressing.

Once the dressing is applied to any wound, avoid the urge to replace it with a fresh dressing. This can pull off any coagulated blood that has worked to seal the wound. If bleeding is still occurring, add dressings on top of the previous dressings.

Lastly, contact emergency services immediately and have them arrive to your location.  Even if upon their arrival you no longer need their assistance, it’s better to have them on the jobsite in the event the situation gets worse or you're unable to control the bleeding. Also – let emergency services know if there has been a large amount of blood lost, so they can bring plasma (blood) and start the infusion at the scene.

All arborists know that a serious cut on the jobsite is inevitably going to happen. It’s a “when”, not an “if” situation. When these accidents occur, make sure to address to wound immediately and have the proper wound management and first aid supplies on hand. This will not only reduce blood loss, but make the healing process go faster. Finally, if you’re not sure about calling emergency services, do it! As the old saying goes…… better safe than sorry.

Climb safe. Cut Safe.

Travis Vickerson (@travisvickerson) is an active arborist, trainer, and presenter focused on the education of safety and training. He has a passion to create a safer and more efficient industry. Travis is the author of the book Leadership for TODAY: Leadership for those who keep life civilized.