Site and situation assessment The responder
should identify what caused the avulsion and if
necessary neutralize its ability to do further dam-
age. This includes turning off the power to any
machinery or equipment that caused an avulsion
injury.
Responder personal protection measures Latex
gloves, which the responder should put on before
approaching the injured person, are essential for
personal protection from bloodborne pathogens as
nearly always there is moderate to heavy bleeding
with avulsions.
First response actions Substantial bleeding is
likely at the site of the avulsion. The first person
to respond should take every practical effort to
stop the bleeding. When possible, salvage the
avulsed body part and protect it by wrapping it in
sterile gauze moistened with sterile water or
saline, if possible, and placing it in a plastic bag or
container. Put the container in a portable cooler
with ice around it and transport it to the hospital
with the wounded person. Time is of the essence,
however; the longer the avulsed part remains sep-
arated from the body the less likely the surgeon
will be able to successfully replant it.
Follow-through An avulsion injury requires a
physician’s prompt evaluation and treatment, usu-
ally surgery either to replant the body part or sur-
gically débride and repair the avulsion site.
See also BLEEDING CONTROL; BLOOD; PATHOGEN.
bleeding control The measures necessary to stop
bleeding. Bleeding occurs when an injury dam-
ages the walls of the BLOODvessels, allowing blood
to escape.
Though profusely flowing blood may rapidly
become life threatening, the amount of blood pres-
ent or obvious is not always a good indication of the
injury’s severity. ABRASIONS (scrapes) and minor
LACERATIONS(cuts) may appear to bleed extensively
when they damage large numbers of the tiny blood
vessels in the dermis (middle layer of the SKIN) and
the subcutaneous layer, as these tissues contain a
rich supply of blood. Wounds to the face and head
tend to bleed especially profusely though often are
not serious or life threatening. Injuries to the inside
of the MOUTHnot only bleed extensively but the
blood also mixes with SALIVA, appearing as though
there were even more blood. A nosebleed (EPIS-
TAXIS) may also appear to produce a large amount of
bleeding. However, the amount of blood lost with
these types of injuries is usually minor.BLOOD that spurts or surges from the
wound comes from an ARTERYor major
VEIN. Immediately apply pressure firmly
enough to compress the blood vessel
and maintain the pressure until emer-
gency medical personnel take over.Injuries that damage major veins or arteries can
result in rapid loss of blood with risk for SHOCKand
possible death. Bleeding in such circumstances is
heavy and may spurt, gush, or surge from the
injury. Life-threatening bleeding from the injury
may also occur internally or as the result of BLUNT
TRAUMA. Indications of INTERNAL BLEEDINGinclude
rapid swelling in the area of the bleeding and signs
of shock in the injured person.
Site and situation assessment Situations of
criminal VIOLENCEare often not safe for the first
person who arrives to do any more than summon
emergency aid. When injuries are due to animal
bites, the responder must determine that the ani-
mal is no longer present or a threat. MOTOR VEHI-
CLE ACCIDENTSmay result in multiple injuries to the
same person or to multiple people. Rapid SYMPTOM
ASSESSMENT AND CARE TRIAGEis essential to deter-
mine whether any injuries appear life threatening.
Responder personal protection measures Latex
gloves, which the responder should put on before
approaching the injured person, are essential for
personal protection from bloodborne pathogens as
well as to prevent BACTERIA on the responder’s
hands from causing INFECTIONin the wound.
First response actions Bleeding frightens most
people, those who are injured and those who are
providing FIRST RESPONSE alike, especially when
there appears to be a lot of blood. It is important
for the responder to act calmly and comfortingly
as well as quickly.
Use these measures to stop bleeding from an
external injury such as an abrasion or laceration:- Put on latex or latex-type gloves.
- Cover the injury with gauze bandages, a wash-
cloth or towel, or even a wadded piece of cloth-
ing and apply firm, steady pressure.
362 Emergency and First Aid