A casualty who is bleeding is one of the most alarming and dramatic emergencies on board a boat. A small amount of spilt blood goes a long way, and looks appalling, particularly when mixed with a few litres of seawater.

Even after seeing plenty of trauma in my career so far, haemorrhage happening in front of me still has a strong emotional impact, particularly if it is my own.

If the bleeding (haemorrhage) is not stopped rapidly, ‘shock’ may develop and on a boat in the middle of the ocean, this will be life-threatening. ‘Shock’ is the situation where there is not enough blood going to the body’s vital organs.

Immediate action is crucial; there is no time for one’s brain to stop working – it has to stop the bleeding. Nothing clever or complicated is required – just simple things, done very well, at the right time (ie immediately).

Bleeding may be external, in which case it is pretty obvious there is a problem, or it may be internal, which is more difficult to recognise, assess, and to stop. Causes of internal bleeding are:

• Blunt trauma to the chest or abdomen
• Penetrating injury to the chest or abdomen
• Arm and leg bone fractures, particularly the femur
• Pelvic fracture
• Other causes – stomach, intestines, uterus

How to stop bleeding

• Direct pressure
  • the easiest, quickest way of stopping external bleeding;
  • Use gloves if available – you don’t know where other’s blood has been;
  • Apply very firm pressure to the point from where the blood is coming;
  • Press on either side if there are bones sticking out, in case of limb bone fracture;
  • Continue until the bleeding stops.
• Tourniquet
  • Used in extreme circumstances
  • May dangerously reduce blood flow to distal arm or leg
  • However, it may save someone’s life;
  • Either equip the vessel with a trauma tourniquet, or just use a sail tie or the like, with a ‘Spanish Windless’ to tighten;
  • However, you have to keep a very close eye on the casualty, and medical help is absolutely required as an emergency.
• Splinting
  • Put the broken ends of the bones back as close as possible to the normal position
  • Splint firmly (not too tight) in that position
  • If fractured pelvis, hold together with a strap or sling around the pelvis
  • There are plenty of emergency limb splints and pelvic binders available.
• Immobilisation
  • Keeping the casualty still, in their bunk, gives any clot that forms the best chance of staying in place, sealing up the bleeding point, especially for internal bleeding.
• Elevation
  • Elevating the part of the body, usually leg or arm, will reduce bleeding from veins and skin
  • Unlikely to be effective with arterial bleeding
• Stitching
  • Putting the wound edges back together and stitching or stapling them in place stands a good chance of stopping bleeding
  • Needs specialist kit and medical training.
• Pro-clotting agents
  • Haemostatic dressings and pro-clotting compounds – these agents stimulate blood to clot and can be used to limit major haemorrhage. Such agents include Celox and Quikclot. The type of agent can be either granules or impregnated gauze for wound packing.
  • Tranexamic acid injection
    • Used in cases of major haemorrhage. Must be given intravenously, and only in consultation with a doctor. Again – a case for emergency evacuation.

Medications that may complicate blood loss

• Medicines such as aspirin, warfarin, clopidogrel, rivaroxaban thin the blood and are used commonly with people with heart conditions. They make bleeding much worse and should be stopped in the bleeding casualty, if possible.

Further information

The Skipper’s Medical Emergency Handbook

MSOS

Nick Stael Von Holstein 

nick@msos.org.uk