An arrow wound is a severe form of penetrating trauma where a foreign object remains lodged in the body. This type of injury carries an immediate risk of catastrophic blood loss and internal organ damage. The goal of first aid in this extreme circumstance is not to provide definitive treatment but to stabilize the victim and preserve life until trained medical professionals arrive. You must contact emergency medical services immediately, as time is a determining factor in survival for severe penetrating injuries.
Immediate Safety and Patient Assessment
Before approaching the injured person, ensure the scene is safe, confirming there is no remaining danger from the archer, wildlife, or environmental hazards. Your safety and the victim’s safety must be the initial priority. Once the scene is secure, quickly assess the victim’s level of consciousness and perform a rapid primary survey focusing on immediate life threats.
The assessment begins with establishing if the victim is responsive and if their airway is open and unobstructed. Next, check for effective breathing, noting the rate and depth of respirations, especially if the arrow is lodged in the chest or neck area. Finally, check for signs of severe hemorrhage, as uncontrolled bleeding is the leading cause of preventable death in trauma. Address any immediate life-threatening issues, such as a blocked airway, before focusing on the specific wound.
The Decision on Arrow Shaft Removal
The most important rule in managing an arrow wound is to never remove the impaled shaft. The arrowhead and shaft are likely providing a mechanical seal, or tamponade, against damaged blood vessels and internal tissues. Removing this physical plug will release the pressure and can immediately trigger massive, uncontrollable hemorrhage. Such bleeding would be nearly impossible to stop in a field setting.
Pulling the arrow out can also cause devastating internal damage as the broadhead tears through tissues and organs. The broadhead is often designed to cut and may create a larger path of destruction upon exit than upon entry. The only time removal should be considered is if the shaft is obstructing the victim’s airway or absolutely prevents the performance of cardiopulmonary resuscitation (CPR). Removal should still be avoided if professional help is imminent.
If the arrow shaft is long and hinders safe transport, you may need to shorten it. Use a saw or similar tool to carefully cut only the protruding portion outside the body, making sure to avoid any vibration or movement of the impaled section. Even a shortened shaft must be secured to prevent any movement that could increase internal trauma.
Stabilizing the Impalement and Controlling Hemorrhage
With the arrow remaining in place, the focus shifts to controlling the blood loss that may be occurring around the impaled shaft. You must apply pressure around the arrow shaft and the wound entrance, not directly onto the object or the wound itself. Applying pressure directly could inadvertently push the arrow further into the body or cause it to shift.
Use bulky dressings, clean cloths, or improvised materials to create a ring or donut shape around the arrow shaft at the entry point. This stabilizes the arrow, preventing side-to-side movement and minimizing further tissue damage. Once the dressings are in place, secure them firmly with tape or a bandage without putting tension on the arrow itself. Check both the entry and exit points, if present, and stabilize them separately in the same manner.
While managing the wound, monitor the victim for signs of shock, which can develop rapidly following severe trauma and blood loss. Indicators of shock include pale, cool, and clammy skin, an increased heart rate, and confusion or altered mental status. Keep the victim lying flat and covered to maintain body temperature. Reassure the victim and keep them calm and still until the arrival of emergency medical services.
Monitoring and Preparing for Medical Transport
Continuous monitoring of the victim’s condition is necessary while awaiting emergency responders. Regularly reassess their level of consciousness and observe their breathing pattern, as internal injuries can rapidly compromise lung function. Keep a close eye on the dressings for signs of continued or increased bleeding, which indicates a need for more pressure around the impalement. If the dressing becomes saturated with blood, apply additional layers over the top rather than removing the blood-soaked material.
When emergency medical services arrive, provide a concise report of the situation. This report should include the time the injury occurred, the location of the wound, an estimate of how much blood was lost, and all first aid measures that were performed.