A stab wound in a remote setting is a severe medical emergency. Since professional medical help may be hours or days away, the immediate priority is stabilizing the victim for evacuation. The goal is not definitive treatment, but managing the two most immediate threats: catastrophic blood loss and hypovolemic shock. All actions must be swift and focused on preserving the patient’s physiological reserves until advanced care is reached.
Ensuring Scene Safety and Assessing the Victim
Before approaching the injured person, confirm the safety of the scene. Rule out re-injury from unstable environments or ongoing threats. Once the scene is secure, don any available personal protective equipment, such as gloves, to reduce infection risk for both parties.
The initial patient assessment should follow the standard trauma sequence, focusing on airway, breathing, and circulation (ABCs). Check for responsiveness and establish communication to determine the victim’s mental status. Visually scan for any other major injuries, as a single stab wound may mask other life-threatening trauma.
Check rapidly for a clear airway and adequate breathing before moving to circulation. If the person is conscious and speaking clearly, the airway is likely open, but still look, listen, and feel for effective breathing. Once breathing is established, shift attention fully to controlling severe external bleeding.
Immediate Control of Hemorrhage
Controlling massive hemorrhage is the most time-sensitive intervention, taking precedence over a compromised airway unless it is completely obstructed. The most direct method for external bleeding is applying firm, well-aimed direct pressure onto the wound site using the cleanest material available. This pressure compresses damaged blood vessels and allows clotting factors to begin working.
If direct pressure fails, deep, non-compressible wounds in the torso, shoulder, or groin require wound packing. Tightly pack the wound cavity with sterile gauze or a hemostatic dressing, pushing the material against the source of the bleeding. Once full, continue applying firm pressure directly over the packed material for a minimum of three minutes to encourage clot formation.
For life-threatening extremity bleeding not controlled by direct pressure or packing, apply a tourniquet. Place the device high on the limb, two to three inches above the wound, avoiding a joint if possible. Tighten it until the bleeding stops completely and the pulse below is undetectable. Mark the time of application clearly for subsequent medical providers.
Stabilizing the Wound Site
After stopping severe bleeding, protect the wound and stabilize any embedded objects. The fundamental rule is never to remove an impaled object in the field. The object may be preventing massive internal hemorrhage, and removing it risks converting a contained injury into a catastrophic one.
Stabilize the impaled object to prevent movement that could cause further internal tissue damage during evacuation. Place bulky dressings, clothing, or improvised materials around the entry point to create a barrier. Secure these materials firmly with tape or a bandage to splint the object against the body.
Chest or abdominal wounds require special consideration beyond simple dressing. A chest stab wound can cause a “sucking chest wound,” where air enters the chest cavity and collapses the lung. This requires an occlusive dressing, such as plastic wrap or a sterile chest seal, placed over the wound. Tape the dressing down on three sides to create a flutter valve, allowing air to escape but not enter.
If an abdominal wound results in evisceration (protruding internal organs), the exposed tissue must be kept moist and clean. Gently cover the organs with a non-adherent, moist dressing, such as a plastic bag or sterile wrap. Cover this with a bulky dressing to protect the area. Do not attempt to push the organs back into the body cavity, as this increases the risk of infection and further damage.
Addressing Shock and Planning Evacuation
Severe blood loss, even when controlled, almost always leads to hypovolemic shock, where the body’s tissues lack sufficient oxygen. Recognize the signs of shock: a rapid, weak pulse, pale skin, altered mental status, and a drop in body temperature. The most important wilderness treatment for shock is addressing the underlying cause, which is the managed blood loss.
Treatment focuses on maximizing the victim’s remaining circulatory volume and preventing heat loss. Insulate the victim from the cold ground, cover them with blankets, and protect them from the elements to maintain core body temperature. While keeping the victim flat is advised, elevating the feet by six to twelve inches can encourage blood flow back to the core organs.
If the victim is conscious and can swallow without nausea, small amounts of fluid can be given, though this will not replace lost blood volume. Continuously monitor the victim’s level of consciousness, breathing rate, and pulse, checking these vital signs every five to fifteen minutes. This assessment determines if stabilization efforts are holding or if the victim’s condition is deteriorating.
The final step is planning and executing the safest and most efficient evacuation, as the victim requires immediate surgical intervention. Choose the transport method carefully to minimize movement of the injured area. Ensure all dressings, stabilized impaled objects, and splints remain secure throughout the journey. Establish and maintain a clear communication plan with rescue services, including precise location and the victim’s status.