Emergency Situation: Pausing for lunch while hiking in a remote region of Zion National Park, you pull out your pocketknife. After slicing a few pieces of dry salami, you begin to fold the blade back. But with your hands covered in oily salami goodness, the knife slips and accidentally slices something less tasty: your finger. What should you do?
Solution: Consider presliced salami for the next trip.
As with all wounds, the first step is always to stop the bleeding, using direct pressure. This allows the blood to coagulate, though the wound might still seep a bit. Use gauze from your first-aid kit pressing on the cut to slow the bleeding. Elevate your hand above your heart and be patient: Lacerations (particularly deep wounds) might continue to bleed for several minutes. As the gauze becomes soaked, add clean gauze to cover the wound without removing the original gauze. This helps encourage coagulation.
Once you believe the bleeding has slowed or stopped, carefully remove the gauze and check the wound. If it appears to be fairly superficial, clean it with an alcohol swab from the kit (yes, it will sting), with soap and water, or at the very least just irrigate it with water. For a small wound, put an adhesive bandage on it (with some gauze directly over the cut, if need be) and you’re good to go.
For a deeper cut that does not clot, you’ll need to take additional steps to stop the bleeding. Essentially, what you’ll do is construct your own butterfly bandage, which is used to treat lacerations that might be deep but are not very wide. These bandages are wider at the ends than they are in the middle and are used to pinch/pull the two sides of skin together to assist coagulation. They won’t take the place of stitches, but they should at least help slow the blood flow until you can visit an emergency room. You’ll need someone to help with this procedure.
First, use scissors to cut a piece of 1-inch-wide cloth tape to about 2 inches long. In a pinch, you can use duct or any other variety of tape, as long as it’s sticky. Next, fold the tape in half in the middle, sticky side facing out. It might be helpful to fold the tape over a narrow, stiff piece of cardboard. Using scissors, cut two notches on either side of the tape. Unfold it. The tape should now have four notches, two above and two below the fold. Carefully take hold of the two center sections and fold them in, one atop the other, and press them together. You should now have a bandage with two sticky “wings” on either side of a narrow, non-sticky section.
Clean the wound with alcohol. Pinch together the two sides of the cut while your helper carefully places the bandage next to the area, affixing one sticky side first, placing the narrow (non-sticky) section across the laceration, and then pressing the other sticky section to the skin. You might need two for a long cut.
Finally, place some clean gauze over the butterfly followed by a regular bandage for protection. It’s quite possible that a deep cut will continue to weep for a while; this is normal. Once you’re back to civilization, you should have the cut examined by a doctor. If your tetanus booster is not up to date, you can expect a shot, along with the physician’s admiration of your fieldwork.
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Hi Josh,
I am interested in how you make butterfly bandage. Can you detail in steps with picture or make a clip in youtube?
Thanks
John
The advice (twice) to use alcohol to clean cuts is contrary to the advice of B.S.A. in Boys’ Life this year and the Wildness First Aid syllabus, and to the advice of the Red Cross, Mayo Clinic, Cleveland Clinic, and Wilderness Medical Society. So we have yet another internal inconsistency within BSA literature and one that seems clearly in error.
re: “Clean the wound with alcohol.”
No. Just no. Flushing the wound with clean water is good. Soap and water around a superficial cut is fine. But for a deep cut, the bleeding itself is what cleans out the wound. Alcohol (or worse, hydrogen peroxide) will only serve to irritate the wound and could restart the bleeding.
(Yes, there are situations where deep cleaning of a wound is necessary but if you are at the point that you are debriding a wound, you are WAY past first aid.)
Hi Josh,
I am also interested in your instructions for making a butterfly bandage in the field.
However, I wanted to correct one item from your article. Current guidelines (see links below) suggest *not* using alcohol to clean a wound. Clean running water or saline solution, and/or mild soap and water, is all that should be used to clean a laceration. While alcohol will kill germs present, it will also kill healthy cells and can cause further inflammation at the wound site.
Alcohol should be reserved for cleaning tweezers if needed to remove debris from a cut.
–Matt
http://www.mayoclinic.org/first-aid/first-aid-cuts/basics/ART-20056711?p=1
http://www.advancedtissue.com/debunking-myths-wound-care/
http://www.webmd.com/a-to-z-guides/wound-care-10/slideshow-wound-care-dos-and-donts
http://familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/first-aid/first-aid-cuts-scrapes-and-stitches.printerview.all.html
Too many Scouts and Scouters suffer minor to very serious injuries of hands due to accidents with knives or other “edged weapons.”. While this may sometimes be humorously referred to as “earning the finger-whittling merit badge,” it is a common and very serious, yet largely preventable mechanism of injury. Many of these injuries result in severe bleeding, joint-capsule injuries and sometimes sever tendons and nerves, and may result in infection, all of which can be very serious requiring surgical repair to prevent disability and tissue loss.
Prevention of injury through use of appropriate safety equipment should be a key element of Scouting training. The use of cut-resistant gloves designed for wear by food handlers can largely
prevent such serious injuries and should be a part of available safety gear whenever any Scout or Scouter is using a knife whether for wood carving or for food preparation. Scout handicraft instructors at camps should encourage the use of such safety gear when appropriate. These gloves are inexpensive and can be found on various websites [such as Amazon] or through commercial kitchen and food distribution vendors.
I totally agree with all who have pointed out the use of alcohol in cleaning the wound! EGADS!!!! talk about inducing extra pain!!!! water ; soap and water, will be fine; one could daintily clean with an alcohol wipe, any dried blood far away from a wound; but that left on, isn’t a crime…and I say that from an experienced ED career !