A stab wound in a remote environment is a life-threatening injury requiring immediate intervention. This deep puncture can sever major blood vessels or penetrate organs, causing rapid blood loss and contamination. Since the wilderness delays definitive surgical care, temporary field stabilization is the primary goal. Decisive action is required to manage potential catastrophic hemorrhage and internal damage.
Immediate Priorities: Scene Safety and Rapid Assessment
Before approaching an injured person, ensure the environment is safe to prevent becoming a second casualty. The initial assessment involves quickly identifying ongoing threats, such as an assailant, unstable terrain, or environmental hazards. Once secure, establish communication immediately, if possible, to initiate a professional rescue or evacuation plan.
The next step is a rapid primary survey, assessing for immediate life threats using the Airway, Breathing, and Circulation (ABCs) framework. Check for responsiveness and ensure the airway is clear, listening for noisy or obstructed breathing. A quick visual sweep identifies the location and severity of the stab wound to determine the sequence of treatments.
Critical Step: Controlling Massive Hemorrhage
Stopping massive blood loss is the most important action, as death can occur within minutes. For most external bleeding, firm, constant direct pressure over the wound is the first and most effective intervention. Use the cleanest material available, such as sterile gauze or a clean piece of fabric, pressing down with force to compress the injured vessel.
If the wound is deep, direct pressure may not be sufficient, requiring wound packing. This involves tightly stuffing the wound cavity with gauze or a hemostatic dressing. Push the material down until the bleeding stops, maintaining pressure directly into the deepest part of the wound to exert pressure on the damaged vessel wall.
A tourniquet is reserved for life-threatening extremity bleeding that does not stop with direct pressure or wound packing. Place the device high on the injured limb, two to three inches above the wound, and tighten it until all bleeding ceases and the pulse below is no longer palpable. This provides a temporary, lifesaving measure by completely occluding arterial blood flow.
Managing Impaled Objects and Evisceration
If the object that caused the stab wound remains lodged, it must never be removed in the wilderness setting. The impaled object may be acting as a mechanical plug, preventing fatal hemorrhage. Removing it prematurely results in immediate, uncontrollable blood loss impossible to stop in the field.
The priority is to stabilize the object to prevent movement during patient handling and transport, which could cause further internal damage. Achieve stabilization using bulky dressings, such as rolled gauze or clean cloth, placed around the object to create a protective ring. Secure these materials firmly without applying downward pressure on the object.
In cases of abdominal evisceration, where internal organs are protruding, they must not be pushed back into the abdominal cavity. Cover the exposed tissue immediately with a clean, non-adherent dressing to protect it from contamination and drying out. Use plastic wrap or similar water-impermeable material to keep the dressing moist, preserving tissue viability.
Stabilizing the Patient and Preventing Shock
After controlling the bleeding, the next immediate threat is hypovolemic shock, resulting from blood volume loss and inadequate oxygen delivery. Signs of shock include a rapid, weak pulse, shallow breathing, and cool, clammy skin. A change in mental status, such as confusion or anxiety, suggests the onset of shock.
Treatment focuses on maximizing remaining circulation and preventing metabolic complications. Position the patient lying flat; elevating the feet slightly can help return blood to the core unless a head or chest injury is suspected. Maintain core body temperature by insulating the patient, as hypothermia impairs clotting ability.
Continuous monitoring of vital signs provides data on treatment effectiveness and shock progression. Check the pulse rate, breathing frequency, and level of consciousness every five to fifteen minutes, documenting changes. Maintaining a calm presence minimizes emotional stress, reducing systemic demand on the circulatory system.
Wound Protection and Preparation for Evacuation
Once immediate life threats are managed, attention shifts to wound protection for the duration of the evacuation. Stab wounds carry a high risk of infection due to environmental contaminants. While deep cleaning is best left to a surgical setting, covering the wound with a clean dressing minimizes further contamination.
Monitor the applied pressure dressing or wound packing frequently for signs of continued bleeding. If the dressing becomes saturated, add new material on top of the original layer and reinforce pressure, rather than removing the initial dressing which could dislodge a clot. Check the integrity of any impaled object stabilization regularly to ensure it remains immobile.
If movement is necessary, the patient must be moved with extreme caution to prevent aggravating the injury or dislodging stabilized objects. Movement should be minimized, and any transfer must prioritize maintaining the stabilization of the wound and the patient’s spine. The goal of field care is to preserve the patient’s condition until professional medical extraction can transport them for definitive surgical repair.