As an instructor, I have found that cuts (mostly to the feet) have been overwhelmingly the most common injury that I have had to deal with while on the water. This is probably due to the environment in which I lead most of my trips which is in shallow bays and tidal estuaries of Southern New England where creatures such as razor clams make their home. I recall one week of kids kayak camp in Duxbury, MA where cuts to the feet became an epidemic. It seemed like every time I turned around there was either a participant or an instructor that needed to be bandaged up. One cut was so bad that we had to send the recipient to see a doctor for a few stiches. Through this experience I learned a lot about the management of this sort of injury and, more importantly, how to prevent it from happening.
There’s something about the sight of blood that makes people squeamish (I’ve witnessed a fair number of my medical school classmates “go down” at the sight of it). For this reason cuts can be a very intimidating thing to deal with but thankfully they are one of the most straight-forward injuries to manage. Their management involves a protocol that includes: evaluation, protection, and, most importantly, stopping the bleeding. Let’s look at this protocol step by step:
The first two pieces of the “stop bleeding protocol” should happen very quickly. First, you need to evaluate the location of the cut and the severity of the bleeding. Thankfully, the most common cuts that a sea kayaker will encounter are mere flesh wounds to the extremities. Almost all of these cuts will produce only small amounts of bleeding that is easy to stop. When this is the case then the situation is totally manageable on the water and you can confidently assure the recipient that direct pressure and a bandage should do the trick. Other cut locations such as on the face may produce more bleeding but are also easily managed and should not cause alarm. My general rule is that if the cut looks like it should be on an episode of ER then it probably should be! Some examples when I’d want to get more qualified help involved include cuts with: potential for lots of blood loss (big, deep, squirting), impaled objects, sensitive location such as the eye or torso, and high risk for infection. During this 10-15 second evaluation phase you should be getting those rubber gloves out of the top of your first aid kit and putting them on.
The most important thing to do in the management of a bleeding cut is to stop the bleeding. This is accomplished by applying direct pressure over the site of the cut. Let’s take the standard sea kayakers cut to an extremity as an example. You’ve determined that the cut is manageable and you’re ready to deal with it. First, take some fresh water and quickly flush out any sand or debris from the wound. Next, take a few sterile gauze pads from the first aid kit and place them over the wound. Apply direct pressure over the wound using your gloved hand for a period of 10-15minutes or until bleeding is stopped. You can even have the recipient apply direct pressure themselves! Resist the temptation to remove the gauze to check on the status of the bleeding. The phrase “a watched pot never boils” rings very true in this situation and removing the gauze will only interrupt the clotting and make the process take longer. To evaluate if your efforts to stop the bleeding are working simply inspect the edges of the gauze to see if it is becoming saturated. If so then add another layer of gauze to the top. Another trick to help slow the bleeding is to raise the recipient’s wound above the level of their heart. This may be tricky to do while on the water but rafting up with multiple group members can help to stabilize the situation.
Once the bleeding is controlled it is time to construct a suitable dressing. Through my experience I have found that adhesive bandages are absolutely no good in the salt-water environment. Everything is wet and the adhesive quickly fails. For this reason I have stocked my first aid kit with gauze pads, roller gauze, an elastic bandage, and duct tape. Place a couple of sterile gauze pads over the wound and secure them in place by rapping the extremity with roller gaze or the elastic bandage. Make sure that the wrap is tight enough to provide pressure over the wound but not so tight as to restrict circulation. This can be checked by depressing the recipients toe nail. The nail bed should go white when you press it and then the pink color should return when you release it. For added security I will sometimes wrap this standard dressing with duct tape in order to keep it from sliding off and getting soaked with water. Finally, instruct the cut recipient to clean the cut at home, monitor it for signs of infection as it heals, and seek further advice if the process becomes unusual.
As with most of the common sea kayaking injuries, cuts are highly preventable. After our foot cutting epidemic in Duxbury we instituted a new rule that required participants and instructors to wear close-toed shoes while paddling as most of the cut recipients had been either barefoot or wearing flip-flops. Water shoes, diving booties, and even an old pair of sneakers do a great job or protecting your feet while paddling. The rule worked so well that I didn’t have to patch up a single foot for the rest of the summer! Also, the success of closed-toed footwear moved up to second (only behind the PFD) on my list of the most important pieces of safety gear needed for sea kayaking!
Happy and Safe Paddling!
-Kayak Dave
Note: Obviously this post covers only the most common and general example of cut management. For a more thorough tutorial and more advanced examples I recommend consulting an excellent book on the subject entitled “Medicine for the Outdoors” by Paul Auerbach or seeking formal instruction in a Wilderness First Aid course.