wound, its general nature, the extent to which it is likely to become contaminated with foreign matter, and what special dangers must be guarded against. Of special concern in a wartime setting is the velocity of wound causing missiles (bullets or shrapnel). A low velocity missile damages only the tissues it comes into contact with. On the other hand, a high velocity missile can do enormous damage by forcing the tissues and body parts away from the track of the missile with a velocity only slightly less than that of the missile itself. These tissues, especially bone, may become damage-causing missiles themselves, thus accentuating the destructive effects of the missile.
Having classified the wound into one or more of the general categories listed, the corpsman will have a good idea of the nature and extent of the injury, along with any special complications. This information will aid in the treatment of the victim.
There are three basic rules to be followed in the treatment of practically all open soft tissue injuries: to control hemorrhage, to treat the victim for shock, and to do whatever you can to prevent infection. These will be discussed, along with the proper application of first aid materials and other specific first aid techniques.
Hemorrhage is the escape of blood from the vessels of the circulatory system. The average adult body contains about 6 liters of blood. Five hundred milliliters of blood, the amount given by blood donors, can usually be lost without any harmful effect. The loss of 1 liter of blood usually causes shock, but shock may develop if small amounts of blood are lost rapidly, since the circulatory system does not have enough time to compensate adequately. The degree of shock progressively increases as greater amounts of blood escape. Young children, sick people, or the elderly may be especially susceptible to the loss of even small amounts of blood since their internal systems are in such delicate balance.
Capillary blood is usually brick red in color. If capillaries are cut, the blood oozes out slowly. Blood from the veins is dark red. Venous bleeding is characterized by a steady, even flow. If an artery near the surface is cut, the blood, which is bright red in color, will gush out in spurts that are synchronized with the heartbeats. If the severed artery is deeply buried, however, the bleeding will appear to be a steady stream.
In actual practice, you might find it difficult to decide whether bleeding is venous or arterial, but the distinction is not usually important. The important thing to know is that all bleeding must be controlled as quickly as possible.
External hemorrhage is of greatest importance to the corpsman because it is the most frequently encountered and the easiest to control. It is characterized by a break in the skin and visible bleeding. Internal hemorrhage, which will be discussed later, is far more difficult to recognize and to control.
The best way to control external bleeding is by applying a compress to the wound and exerting pressure directly to the wound. If direct pressure does not stop the bleeding, pressure can also be applied at an appropriate pressure point. At times, elevation of an extremity is also helpful in controlling hemorrhage. The use of splints in conjunction with direct pressure can be beneficial. In those rare cases where bleeding cannot be controlled by any of these methods, you must use a tourniquet.
If bleeding does not stop after a short period, try placing another compress or dressing over the first and securing it firmly in place. If bleeding still will not stop, try applying direct pressure with your hand over the compress or dressing.
Remember that in cases of severe hemorrhage, do not worry too much about finding appropriate materials or about the dangers of infection. The basic problem is to stop rapid exsanguination. If no material is available, simply thrust your hand into the wound. In most situations, direct pressure is the first and best method to use in the control of hemorrhage.
Bleeding can often be temporarily controlled by applying hand pressure to the appropriate pressure point. A pressure point is a place where the main artery to the injured part lies near the skin surface and over a bone. Apply pressure at this point with the fingers (digital pressure) or with the heel of the hand; no first aid materials are required. The object of the pressure is to compress the artery against the bone, thus shutting off the flow of blood from the heart to the wound.
There are 11 principal points on each side of the body where hand or finger pressure can be used to stop hemorrhage. These points are shown in figure 4-21. If bleeding occurs on the face below