An arrow wound is a form of penetrating trauma that is immediately life-threatening due to the potential for massive internal injury and rapid blood loss. This injury requires immediate, professional medical attention; contact emergency medical services (EMS) without delay. The arrow, often tipped with a broadhead, can puncture vital organs or major blood vessels. The first aid steps outlined here are strictly for stabilizing the patient until trained professionals arrive, as they are not a substitute for hospital-based trauma care.
Initial Assessment and Emergency Response
Following a traumatic injury, first assess the scene and the patient. Before approaching the injured person, ensure the area is secure from ongoing danger, as personal safety is the priority. Once the scene is safe, immediately contact emergency services, stating the nature of the injury and the exact location.
A rapid primary survey should follow, focusing on the patient’s Airway, Breathing, and Circulation (ABC). Check if the patient is responsive and if the airway is clear of obstruction, especially if the arrow is near the neck or face. Monitor the patient’s breathing pattern, noting if it is shallow, labored, or absent, and begin rescue breathing or CPR if necessary. Assess the severity of the bleeding and the patient’s level of consciousness to gauge the trauma’s impact.
Carefully expose the wound site by cutting or gently removing clothing to view the injury without disturbing the arrow. Note the precise location of the wound, such as the chest, abdomen, or an extremity, as this informs the medical team about potential internal organ damage. Look for a possible exit wound, which indicates a through-and-through injury, and plan to stabilize the arrow at both entry and exit points if present.
Handling the Impaled Object
The single, overriding principle when dealing with an arrow wound is to never attempt to remove the impaled object. The arrow acts as a temporary plug against the wound channel, which significantly slows or prevents blood loss from severed vessels. Removing the arrow would immediately release this pressure, potentially triggering severe hemorrhage.
The arrow’s presence maintains a degree of hemostasis, despite potential damage to major arteries or veins. Furthermore, the fletching and barbs are designed to catch and tear tissue upon removal, causing extensive additional damage to surrounding structures. Only medical professionals in a sterile environment with surgical control can safely remove the penetrating object.
Focus on stabilizing the arrow shaft to prevent any movement. Movement of the shaft can cause the arrow tip to saw through internal tissues, magnifying the damage. Use bulky dressing material, such as clean cloth or gauze, to pack around the entry wound where the shaft protrudes. Build up a protective ring of material until the arrow is completely supported and unable to shift.
Secure the bulky dressings firmly in place with tape or a bandage, ensuring it does not wrap circumferentially around the torso or neck, which could restrict breathing or circulation. If the arrow shaft is long and prohibits safe transport, it may be necessary to carefully cut the shaft down. This must be performed without moving or jarring the arrow, ensuring the remaining portion is fully stabilized.
Controlling Blood Loss and Preventing Shock
After stabilizing the arrow, control any external blood loss occurring around the wound edges. Apply direct, firm pressure to the tissues surrounding the impaled object. Take care not to press down on the arrow shaft itself, which could drive it deeper or cause it to shift. The goal is to compress bleeding vessels without dislodging the arrow’s stabilizing effect.
While controlling external bleeding, monitor the patient for signs of hypovolemic shock, a life-threatening condition caused by a sudden drop in blood volume. The signs of traumatic shock include a rapid and weak pulse, pale skin, and an increased rate of breathing. The patient may also exhibit confusion, anxiety, or a reduced level of consciousness as the body attempts to compensate for inadequate oxygen delivery.
Signs of Shock
- Rapid and weak pulse.
- Pale or ashen skin that feels cool and clammy.
- Increased rate of breathing.
- Confusion or reduced level of consciousness.
If you suspect shock, lay the patient flat on their back and elevate their legs slightly (6 to 12 inches) to encourage blood flow back to the core organs. Do not elevate the legs if a spinal injury is suspected or if movement causes increased pain. Loosen any restrictive clothing around the neck, chest, or waist to aid circulation and breathing.
Maintain the patient’s body temperature by covering them with a blanket or coat, as cold worsens the effects of shock and impedes clotting. Keep the patient still and offer calm reassurance, since anxiety can elevate heart rate and increase oxygen demand. Continue monitoring the patient’s pulse and breathing until EMS arrives.
Preparing for Medical Intervention and Follow-Up
The period before EMS arrival involves continuous vigilance and preparation for the handover of care. Do not leave the patient unattended; monitor their responsiveness, breathing, and pulse rate. Be ready to report any changes in their condition to the medical team immediately upon arrival.
Gather relevant information about the incident, including the exact time the injury occurred and how the arrow entered the body. Inform medical personnel about the materials used for stabilization and the amount of external blood loss observed. This report helps the trauma team plan for safe removal and surgical repair.
Once the patient is in EMS care, the focus shifts to post-hospital concerns, including the risk of infection and tetanus. An arrow wound creates a deep puncture that drives foreign material and bacteria into the tissues. The patient will require a tetanus booster if their vaccination status is not current or unknown, and they will likely receive prophylactic antibiotics to minimize the risk of sepsis.