19.3 Bleeding, Burns and Shock

After you have controlled traffic and protected the air-passage, two further killers at a Guyana crash are blood loss and shock. Burns and scalds — from spilled petrol on fire, a ruptured radiator after an overheat on the Linden Highway, or hot metal — can produce both pain and shock. This section follows Emergency First Aid for Caribbean Communities, the GPF package first-aid book, together with the Road Traffic Code crash instructions on dressings and fluids. Use the book’s steps. Do not substitute a different household remedy because it is popular in a Georgetown kitchen.

Bleeding

Wounds cause pain, lead to loss of blood, and can easily become infected. You reduce those dangers by covering the wound with the cleanest cloth you can find and fastening that pad firmly. A triangular bandage or other suitable material will do. Only touch a wound if you have to — you may have to if there is serious bleeding.

The book’s headline is: direct pressure and raising the wound are the best ways to control bleeding. Always use direct pressure first.

Direct pressure: press a clean piece of cloth or your hand over the wound and keep pressing until bleeding stops or until qualified aid is available. The Road Traffic Code’s crash page says the same in roadside language: stop bleeding with dry dressings or clean handkerchiefs and firm manual pressure, then bandage firmly with a handkerchief or other material. Do not wait. Lie the casualty down. Raise the limb when the book allows it. Stop the bleeding with available materials.

Raising (elevation): if you raise a wound above the level of the heart, it will reduce the bleeding. This can be done when the wound is on the head, neck, arm, or leg. Do not raise a wound if it hurts the casualty. Do not raise a wound if you think there are internal injuries or broken bones. After a high-speed impact on an open road, a painful limb may be fractured; elevation that twists a break is not first aid.

A pressure bandage is a thick pad of cloth (a compress) tied firmly over the wound to stop bleeding. The bandage replaces the pressure of your hand. You may need it because you need your hands free, because the wound is too big for your hands to cover, or because you have more than one casualty. The book’s method:

1. Raise the wound.
2. Keep using direct pressure while you tie the bandage.
3. Fold or roll a piece of cloth into a pad big enough to cover the whole wound.
4. Place a large piece of cloth over the pad which is on the wound.
5. Pull steadily on both ends of the bandage while you wrap it around the wound, so you put pressure on the wound.
6. Try to tie the knot over the wound. This adds to the pressure.

Always use direct pressure if you can. The bandage is a substitute for your hands, not a reason to skip pressure.

For a smaller wound, if you have time and the bleeding is not the emergency:

1. Wash your hands with soap and water if possible.
2. Clean the wound and the skin around it with the cleanest water you can find (drinking water) and soap. Use the cleanest cloth you have. Clean outwards from the wound.
3. Cover the wound with the cleanest piece of cloth (pad) you have. Cover a small wound with a band-aid.
4. Fasten the pad.
5. Tell the casualty to keep the wound and the bandage dry.
6. Stop all large wounds from moving. Immobilize them.
7. If necessary, call qualified aid.
8. If there are signs of infection (swelling, redness, pain, smell, or fever), the casualty needs qualified aid.

Shock

When there is not enough blood to fill the circulatory system, the person suffers from shock. The book lists causes: severe bleeding, burns, drowning, falls, diarrhoea, vomiting, poisoning, great fear, and pain. A crash can supply several of those at once. The blood provides the brain with oxygen. If the brain does not get oxygen the body will die. Shock can stop the brain getting oxygen. It can cause death.

The book’s shock drill:

1. Check that the casualty is breathing. If not, give artificial respiration. If he is breathing, continue.
2. Check whether the casualty is conscious. If not, put him in the recovery position. If he is conscious, continue.
3. Lie him down. Raise his feet. You can use a pillow, blanket, or similar.
4. Stop all bleeding.
5. Give first aid for any injury.
6. Comfort and reassure him. Talk to him and show that you care.
7. He should not be too hot or too cold.
8. Call qualified aid.

That is the prescribed order. Do not skip breathing to tuck in a blanket. Do not walk a shocked casualty around a Georgetown junction to keep circulation going. Do not sit the person in a chair and offer tea. The Code still forbids anything to drink — alcohol, tea, or other fluid — because the casualty may require an anaesthetic at hospital. Comfort is talk and care, not a flask.

Burns and scalds

Burns can be dangerous and may be very painful. This depends on the size of the burn. If the burn is bigger than the palm of the hand of the person burned, you must call qualified aid. It is important never to put anything but clean, cold water on a burn.

When somebody is burned, the aims are to reduce pain, prevent shock, and prevent infection.

The book’s steps:

1. Remove the cause of the burn, or remove the casualty from the cause.
2. Put all burns at once in the cleanest cold water you can find.
3. Keep the burned area under water until the pain goes away. This can take a long time but do not cease until the pain stops.
4. If you cannot put the burn under water, cover it with a piece of clean cloth soaked in clean cold water.
5. Change these cloths until the pain stops.
6. When the pain stops, cover the burn with the cleanest piece of cloth you can find. Fix it gently with a bandage. This helps to prevent infection.

Remember for all burns:

1. Reduce pain by using cold clean water.
2. Cover the burns lightly.
3. If the burn is bigger than the palm of the hand of the person burned, prevent shock and call qualified aid.
4. Never open blisters.
5. Never pull away clothes that are burned to the skin.
6. Remove rings, if possible, where hands or arms are burnt, as there will be swelling.

Do not spread butter, grease, oil, toothpaste, or rum on a burn. The book allows clean cold water on the burn itself, then a clean cover. The Road Traffic Code crash page tells you to cover burns with dry dressings or clean handkerchiefs and bandage with handkerchief or other material — that is the covering material in a car kit, used after cooling when you can cool, or as the clean cover when you cannot immerse the part. It is not permission to skip water when water is available, and it is not permission to use grease.

A radiator scald after an overheated engine, or flame from spilled petrol (remember no smoking at the leak), is treated with this same water-then-cover sequence once the person is away from the cause. If the burned area is larger than that person’s palm, treat for shock and get qualified aid. Keep the casualty not too hot and not too cold while you wait.

On any Guyana road — Georgetown, New Amsterdam, Bartica, the East Coast, or a highway verge — the learner’s first-aid job ends when qualified aid takes over. You control the scene, protect breathing, stop bleeding, cool and cover burns the way the Caribbean book states, treat shock, and you do not pretend a handkerchief is a hospital.