Wound Care and Trauma Management

Preparation Steps

• Build a trauma kit and keep it accessible: include a commercial tourniquet (CAT or SOFTT-W), hemostatic gauze (QuikClot or Celox), a pressure bandage (Israeli bandage), nitrile gloves, medical tape, and trauma shears.
• Take a Stop the Bleed course or Wilderness First Aid course — hands-on bleeding control training significantly improves outcomes.
• Know that uncontrolled external bleeding is the leading preventable cause of traumatic death and that bystanders who act quickly save lives.
• Keep a trauma kit in your vehicle, home, and workplace — not just a standard first aid kit.
• Learn to recognize signs of severe blood loss: rapid weak pulse, pale or ashen skin, cold and clammy skin, confusion, or loss of consciousness.

Immediate Actions

• Call 112/911 immediately or have a bystander call while you begin care.
• Apply direct pressure to the wound with gloved hands and a clean cloth or dressing — maintain firm, continuous pressure for at least 5 minutes without lifting the cloth to check.
• For limb wounds (arm or leg) that do not stop bleeding with direct pressure: apply a commercial tourniquet 5–8 cm (2–3 inches) above the wound, tighten until all bleeding stops, and note the exact time of application on the tourniquet or the casualty's skin.
• For deep wounds that cannot be effectively compressed from outside (junctional wounds at the groin, armpit, or neck): pack the wound cavity tightly and completely with hemostatic gauze, then apply firm pressure over the packing for at least 3 minutes.
• For suspected open chest wounds: apply a vented chest seal over the wound; if unavailable, use an improvised seal (plastic bag, credit card) taped on three sides, leaving one side open to prevent air from becoming trapped in the chest cavity.
• Keep the casualty warm using an emergency thermal blanket — trauma patients lose body heat rapidly, and hypothermia worsens bleeding.

What to Avoid

• Never remove a tourniquet once it has been applied in the field — removal can cause fatal re-bleeding and requires hospital-level care.
• Do not use improvised tourniquets made from thin cord, rope, wire, or belts — these cause severe tissue damage without effectively stopping blood flow.
• Do not attempt to clean or irrigate a wound before bleeding has been completely controlled — hemorrhage control is always the first priority.
• Do not give the casualty anything to eat or drink if there is any possibility of surgery being required.
• Do not leave a casualty with serious bleeding alone even briefly — maintain monitoring and reassurance until EMS arrives.

Supplies Needed

• CAT (Combat Application Tourniquet) or SOFTT-W tourniquet.
• Hemostatic gauze (QuikClot Combat Gauze or Celox Gauze).
• Israeli pressure bandage (emergency bandage).
• Chest seals — vented type (e.g., HyFin Vent or Halo Seal).
• Nitrile examination gloves (several pairs).
• Trauma shears for cutting clothing.
• Medical tape.
• Emergency thermal (mylar) blanket.

Recovery Steps

• Tourniquet application time must be reported clearly to arriving EMS personnel — write it on the tourniquet strap or on the casualty's forehead in permanent marker if available.
• Never remove the tourniquet in the field — leave it for medical professionals in a controlled setting.
• Monitor the casualty continuously for signs of shock: increasing pallor, confusion, labored breathing, or loss of consciousness.
• Any wound that required a tourniquet requires surgical evaluation — ensure the casualty is transported to appropriate surgical care.
• After the event, document everything you did, the time sequence, and the materials used; this information is critical for the receiving medical team.