Digital Ligation

You can stop major bleeding immediately or slow it down by applying pressure with a finger or two on the bleeding end of the vein or artery. Maintain the pressure until the bleeding stops or slows down enough to apply a pressure bandage, elevation, and so forth.

Tourniquet

Use a tourniquet only when direct pressure over the bleeding point and all other methods did not control the bleeding. If you leave a tourniquet in place too long, the damage to the tissues can progress to gangrene, with a loss of the limb later. An improperly applied tourniquet can also cause permanent damage to nerves and other tissues at the site of the constriction.

If you must use a tourniquet, place it around the extremity, between the wound and the heart, 5 to 10 centimeters above the wound site (Figure 4-4). Never place it directly over the wound or a fracture. Use a stick as a handle to tighten the tourniquet and tighten it only enough to stop blood flow. When you have tightened the tourniquet, bind the free end of the stick to the limb to prevent unwinding.

After you secure the tourniquet, clean and bandage the wound. A lone survivor does not remove or release an applied tourniquet. In a buddy system, however, the buddy can release the tourniquet pressure every 10 to 15 minutes for 1 or 2 minutes to let blood flow to the rest of the extremity to prevent limb loss.

Prevent and Treat Shock

Anticipate shock in all injured personnel. Treat all injured persons as follows, regardless of what symptoms appear (Figure 4-5):

• If the victim is conscious, place him on a level surface with the lower extremities elevated 15 to 20 centimeters.

• If the victim is unconscious, place him on his side or abdomen with his head turned to one side to prevent choking on vomit, blood, or other fluids.

• If you are unsure of the best position, place the victim perfectly flat. Once the victim is in a shock position, do not move him.

• Maintain body heat by insulating the victim from the surroundings and, in some instances, applying external heat.

• If wet, remove all the victim's wet clothing as soon as possible and replace with dry clothing.

• Improvise a shelter to insulate the victim from the weather.

• Use warm liquids or foods, a prewarmed sleeping bag, another person, warmed water in canteens, hot rocks wrapped in clothing, or fires on either side of the victim to provide external warmth.

• If the victim is conscious, slowly administer small doses of a warm salt or sugar solution, if available.

• If the victim is unconscious or has abdominal wounds, do not give fluids by mouth.

• Have the victim rest for at least 24 hours.

• If you are a lone survivor, lie in a depression in the ground, behind a tree, or any other place out of the weather, with your head lower than your feet.

• If you are with a buddy, reassess your patient constantly.

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