The basic principles of open/puncture wound care apply, even though of course these wounds are especially sinister versions of punctures. Don't forget that the basics still apply. If they're all you remember, you will do a good job. That said, I've learned a bit about this stuff, so I'll offer some advice.
Shrapnel wounds Edit
As for shrapnel wounds, the basic principles apply. They're essentially just punctures with impaled objects. Don't remove the shrapnel. If the shrapnel is still piping hot (it will be if you're on-scene when the injury occurs), DO NOT REMOVE IT. You will want to pull it out. DON'T EVEN TOUCH IT. It's going to be too hot to grab, even if you're wearing a latex glove. But don't use pliers or tweezers, either. IRRIGATE THE SITE.
Infection is almost guaranteed with shrapnel wounds. Irrigate and cool them (same procedure) immediately, and get the patient to advanced care even if the wound is not immediately life-threatening.
Don't use direct pressure on shrapnel wounds. Most shrapnel wounds won't bleed all that much. So loose, sterile dressing is the way to go.
In the event that Emergency Care is unavalable and removal is needed, follow these steps.
- 1). Locate entry wound.
- 2) . Attempt to locate exit wound, it will generally be larger than the entry although not always on the other side.
- 3). if none is found, sterilize a probe and locate ALL debris internally.
- 4). Using forceps and antiseptic remove all debris. Give stitches to both sides if needed.
- 5). If wound is to the torso, neck or legs, have an Evac Team remove them on a stretcher to a safe zone.
Indirect pressure points Edit
Remember the indirect pressure points (femoral and brachial). Use them if you can't stop bleeding. You need to be careful with direct pressure on bullet wounds same as shrapnel wounds. If they've hit an artery and are hanging around, you might cause more damage with direct pressure. Even if there is a clear exit wound, with an M16 round you can't be sure the whole bullet exited. Sometimes it splinters. Indirect pressure would in that case be the way to go.
Eventually (I know this sounds dismal) after you treat a few bullet wounds you'll start to recognize how big the exit wounds should be for different sized fragments on different parts of the body. Even then, you cannot be sure there are no fragments left at the wound site. I like trains.
Also, you should find out if the surgeons at the hospitals closest to you know what to do with a tourniquet. If you can talk to the local medics about this, whether they have used TQs and what their success rate has been, you'll get a better idea of whether you want to implement one ever. I can't give advice on protracted care scenarios (1 hour + to advanced care). Maybe others will feel more comfortable advising. It's much more complicated, as goes without saying...
However, I can say you should go straight to a TQ anytime there's an amputation or an extreme avulsion involved. As I'm sure you are aware, amputations are pretty common with explosives. Strapping up the stump will be part of your C step during your initial assessment.
- OP* Army SOP, at least when I was training, is 60-90 minutes MAXIMUM with a tourniquet. I have have also done this on myself for 45 minutes to procure treatment for a deep leg wound. YMMV, but as far as I know, they're fine for short-term care lasting no longer than 90 minutes.
Please see Initial assessment.
This material is intended as a training supplement. Reading this material is no substitute for first aid / medical training with a qualified trainer. We encourage you to pursue ongoing education, reviewing and upgrading your skills-- for the safety of both yourself and anyone you treat.