Sierra Samaritans - National Ski Patrol

outdoor
emergency care
BY STEVE DONELAN
that’s a wrap: wound
bandaging made easy
A
Among the first skills that patrollers learn
is how to control severe bleeding, but
that’s only one aspect of proper emergency
care. Because open wounds are an
invitation to bacterial infection, it’s also
important to know how and when to
clean a wound, dress it, and secure it with
an appropriate bandage.
Foreign matter and dead tissue in
wounds are potential growth sites for
harmful bacteria that can increase and
multiply in a matter of hours. If not
removed, contamination in the original
wound can spread infection that the body’s
defenses may not be able to control—
because the immune system protects only
living tissue. While antiseptics may slow
down bacterial growth, they are no substitute
for cleaning a wound and protecting it
from subsequent contamination.
WOUND CLEANING
Cleaning and getting debris out of a
wound requires forceful irrigation and is
important if the patient is two or more
hours away from hospital care. Otherwise,
just apply a dressing and bandage and
leave the wound cleaning to the hospital.
If bleeding is severe, however, you should
stop the bleeding immediately without
trying to clean the wound Also, never try
to scrub an open wound in the field,
because that will introduce more contamination
and can cause further damage.
When the patient is far from the hospital,
flushing the wound will help ensure
that it remains free of contamination that
can lead to infection. Wound irrigation
syringes are designed to do the job, but if
you don’t have one you can improvise
with a clean Ziplock® bag. Fill the bag
with clean water, seal it, and punch a pinhole
in a bottom corner using a penknife
or small scissors. Hold the bag over the
wound and squeeze. You may need to use
tweezers to remove debris that will not
flush out, then irrigate the wound some
more. If your tweezers are not sterile, you
can at least clean them with benzalkonium
chloride, a standard antiseptic available
on moist towelettes sealed in foil.
For the last irrigation, you can use an
antiseptic such as 10 percent povidoneiodine
(Betadine), diluted to 1 percent by
mixing one part antiseptic with 9 parts
clean water. You might also put some
diluted antiseptic on the dressing before
applying it to the wound. However, if you
don’t have Betadine, clean tap water is
still very effective.
While antibiotic ointments are heavily
advertised, no independent studies have
found that they have any antibacterial
action, and there is a possibility that they
may cause an allergic reaction in the
patient. For wilderness situations, you
might want to consider a traditional antiseptic
from your food supply: honey.
Many recent studies suggest that honey—
especially the dark, unprocessed kind—is
more effective than modern antiseptics.
In Australia, medicinal honey (irradiated
to make it sterile) is sold for this purpose.
The sugar in honey kills bacteria by
dehydrating them (which is why sugar
also helps preserve food against spoiling),
and unprocessed honey also has an ingredient
that generates a low level of hydrogen
peroxide in the wound, which acts as
an antiseptic.
DRESSINGS
Once the wound has been thoroughly irrigated,
you need to protect it. A dressing
literally covers the naked wound to help
prevent contamination, and a bandage or
strips of tape hold the dressing in place.
Sterile gauze pads are the most common
dressings, especially in the 4-by-4-inch
size. They are absorbent, which helps form
a clot by trapping and holding enough
blood for the fibrin and fibrinogen to
coagulate before it can be flushed away by
the flow of uncontrolled bleeding. But if
bleeding is not a problem, a non-stick
dressing will be more comfortable and
easier to remove when it is time to change
the dressing. Non-stick dressings have a
porous non-adhering layer over the
absorbent pads. To remove stuck dressings
or tape, there are several tricks that can
minimize discomfort. First, if there is hair
underneath, always peel in the direction
that the hair grows. Second, as you peel,
dab alcohol (e.g., from an alcohol prep
pad) under the stuck dressing or tape.
Alcohol dissolves the adhesive.
Another type of dressing, particularly
useful for burns and abrasions, features a
soothing water-based gel sandwiched
between thin sheets of plastic. To use it,
peel off the plastic from one side and lay
the sheet of gel on the wound. If you are
going to cover the gel with a sturdier
dressing, you can also peel off the top
layer of plastic. This dressing is sold under
brand names such as Spenco 2nd Skin®
and Burn Aid®.
THE ART OF BANDAGING
Most of the traditional bandaging techniques
have disappeared from emergency
care courses and books, as the growth of
the EMS system reduced the need for
extended care by lay people; and bandages
applied by urban EMTs only need to stay
on during a short ambulance ride to the
hospital. Patrollers, however, still need to
know how to apply bandages that will
62 Ski Patrol Magazine | Winter 2005