One of the most important skills for the family medic to master is the ability to rapidly stop bleeding (also known as “achieving hemostasis”). In survival scenarios, bleeding can occur from various sources; anything from a fall on uneven terrain to a hostile encounter with another group.
Failure to properly treat bleeding wounds can lead to unnecessary deaths among members of mutual assistance groups off the grid. The military has learned painful lessons on just how true this is. A 2013 study reported in Military Times found that a significant number of combat deaths in Iraq and Afghanistan between 2001 and 2011 might have been survivable with rapid action from those at the scene.
The Committee on Tactical Combat Casualty Care (CoTCCC) was originally established by the United States Special Operations Command in 2002. Although administrative oversight has shifted over the years, the official responsibility for determining correct strategies still lies with its members, including specialized medical providers from the various armed services. A larger, working group is constantly identifying alternatives that might improve outcomes among our personnel.
The painful lessons learned by the military benefit the survival group medic. With the right knowledge, training, and equipment, lives can be saved. A caregiver with a tourniquet and the knowledge to properly use it will be more successful than one without. In addition to tourniquets, there are commercially-available hemorrhage control (also known as “hemostatic”) agents that effectively stop even heavy bleeding.
The ideal hemostatic agent is one that works quickly, is easily portable, has few complications, and does not interfere with tissue healing. It must also be available at a reasonable price. Unfortunately, the most effective dressings like QuikClot, Celox, ChitoSam, and others aren’t cheap; it would be difficult, financially, for the average citizen to stockpile enough to deal with multiple bleeding wounds. This is especially true in long-term disaster settings.
It’s clear that a caregiver in austere settings must improvise once the commercial supplies are gone. What options are out there that could help stop the bleed besides just applying direct pressure and hoping for the best?
Direct pressure with both hands and your full weight on the wound may be successful, but what if it isn’t? Wounds with mild to moderate bleeding but not amenable to tourniquet use may benefit from direct pressure and a natural blood-clotting agent.
NATURAL HEMOSTATIC AGENTS
What natural products would work to stop bleeding? The answer might be growing in your own backyard. Certain plants are known for their blood-clotting abilities; it’s important to either grow them in a medicinal garden or know where to find them in the Great Outdoors. Granted, some of the items listed below may not yet have hard scientific proof of effectiveness. Despite this, they might be all you have when the commercial materials run out.
Yarrow (Achillea millefolium), was known in ancient times as “herba militaris” for its use in staunching the flow of blood from wounds. Indeed, the Greek hero Achilles is said to have carried it during the Trojan war. It’s native to temperate regions almost everywhere in the Northern Hemisphere from sea level to altitudes of 11,500 feet.
To stop bleeding, yarrow is normally used as a powder made from grinding dried leaves and flowers, but applying fresh plant material in a poultice is also acceptable. Cover with gauze and apply pressure. Elevate if the wound is in an extremity.
Cayenne pepper (Capsicum annuum) isn’t just meant to spice up your meal: The capsaicin in it is thought to have a coagulating effect on mild bleeding as well as some antibacterial properties. To be effective, you have to use a lot of the most potent cayenne you can find in powder form. Pour it directly on the wound, cover with gauze or other cloth, and apply pressure for several minutes. Multiple applications may be needed.
Won’t cayenne pepper powder burn when applied? Having applied it on myself and seen it applied to bleeding injuries in dogs, the answer seems to be “not much.” Others, however, have told me it, indeed, does burn, so the response depends on the individual.
For dental bleeding after an extraction, black or green tea (Camellia sinensis) may be used. Teas contain tannins, which are thought to help blood to clot by making vessels constrict. They may also have antiseptic properties. Teas with caffeine are thought to be more effective.
Take a tea bag that’s been steeped and allowed to cool. Wrap it in thin gauze and place on the bleeding area with pressure. For bleeding after a tooth extraction, have the patient bite down on the tea bag gently but firmly in the now-empty socket. If bleeding is from the inside of the cheek or other area in the oral cavity, place against the bleeding area and apply pressure on the area from outside with the mouth closed.
Some believe that tea compresses may also help with mild external cuts on the skin. Press a dry green or black tea bag against the wound, cover with gauze or other cloth, and apply pressure.
Witch hazel is a temperate North American shrub. “Witch” does not refer to practitioners of magic, but the Middle English word for “bendable.” Distilled witch hazel has an astringent effect which tightens skin, constricts small blood vessels, and promotes clotting. Apply a small amount to a compress and press on the wound. Pure witch hazel can be found at most drugstores.
Other common plants that have an astringent effect include plantain, rose, and horsetail. Be aware that people may sometimes be allergic to certain plants, so monitor closely for rashes, itching, or other signs of a reaction.
Many question the effectiveness of some of the options discussed in this article. I understand that but, in desperate times, desperate measures must be taken, and we must use all the tools in the medical woodshed. Remember what Theodore Roosevelt once said: “Do what you can, with what you have, where you are.”
In part 2, we’ll discuss other options, plus how to improvise hemostatic dressings.
Joe Alton MD
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