Human blood on deck. We all want bloody decks but not this kind!
The other day while fishing a beach on the backside of Catalina with a buddy and our sons, I heard a nervous voice call out a “Medical Emergency” on the VHF. The hair on the back of my neck stood up. My buddy and I both work in the Surgery department and quickly gave each other that look. My son asked, “Dad, are you going to help them??” I nodded yes. I quickly fired up the boat and pegged the volume on the radio, only to quickly realize they were 25 miles away at SCI, NOT Catalina. At this point, one could only guess how long it would take the Coast Guard to arrive… Not knowing their knowledge base, situation, or comfort level, I was able to offer some quick advice over the radio. In a situation like this, quick action MUST be taken. We were relieved to find out the angler was well cared for by nearby boaters and crew.
This was thought-provoking. My buddy and I started to discuss the fact that many people likely don’t know how to handle the trauma that is likely to happen occasionally on a boat, especially now that these beast tuna or swords are around that are requiring multiple gaffs or harpoons.
I thought I would try to focus more on some basics that we use in the hospital setting to stop the bleeding that we encounter in the OR, the ER, and sometimes even in the clinic setting.
The first thing to keep in mind is that you need to try to remain calm. It is a great idea to put out a distress call ASAP obviously, but realize by the time help arrives, it may be over…It doesn’t take long for somebody to get into trouble.
Put on latex gloves if you have them. The most important thing is applying pressure to the area. One of the most common mistakes that is made while holding pressure is covering the wound with a pile of gauze and holding a palm over the wound. You will be much more effective in controlling the bleed if you can fold a 4×4” gauze into a 1” square and get a fingertip (or two depending on the size of the wound) directly over (sometimes into) the bleeding vessel. Direct pressure should be held for at least 10-15 minutes. Do NOT remove initial gauze, as this will strip clots off of the wound and start the bleeding up again. Don’t peek sooner! Assuming you got the bleeding controlled with pressure, now take some 4×4” gauze and fold them in half to make a pressure dressing about 2” thick and bolster them down tightly on top of the initially placed gauze using an Ace wrap or Ezmark tourniquet.
In the less likely event that bleeding cannot be controlled with direct pressure, I would apply a tourniquet above the wound. If it’s an arm wound, apply it above the elbow, or thigh for a leg wound. Document the time the tourniquet was applied. You can use a belt, rope, BP cuff (inflate to 250 mm hg), or the aforementioned Ezmark. Tighten it down until the bleeding at least slows or stops. It may still require pressure on the wound. You can tape or clamp the Ezmark in place with surgical clamps. When the coast guard or EMTs arrive, tell them NOT to take your dressing down. Leave it in place until you get to the hospital in front of a Surgeon.
As I said before, most bleeding can be stopped with direct pressure. If it’s bright red and pumping, it’s arterial. Darker blood is usually a venous bleeder, which can also gush depending on location. If the bleeding is slow and from the wound edges, again, just hold pressure.
Surgicel or Quick Clot is handy to have on hand for oozy wounds. We see this a lot with patients on blood thinners. If you have a superficial contaminated wound that isn’t bleeding too much from bite or fillet knife, consider flushing it out with 50/50 normal saline (bottled water will do) and Betadine or Peroxide. Then flush it with just Saline or water again. The solution to pollution is dilution!
If there is a gaff or hook in an entry wound, removal needs to be considered if the object is going to prevent pressure from being applied to the bleeder. If there is a foreign object embedded into someone that is not associated with bleeding. You may consider leaving it in place and let the hospital staff deal with it. Hope this helps.
Be safe out there!
