Boating First Aid: Cuts and Bites

The sole operator of a fishing boat that was miles off the Alaskan coastline inadvertently got his finger caught in a winch. The result was profuse and serious bleeding. As he struggled to find a towel to wrap around the injury and realized the seriousness of his predicament, he called the U.S. Coast Guard Station in Sitka, gave his location and explained what had happened. The Coast Guard ran some numbers and determined it would be at least two hours before assistance could be given because of the distance, so his call was patched through to the station's Senior Medical Officer Lt. Commander Leslie Wood who proceeded to talk him through the steps that had to be performed — and quickly. Sit down, he was told, apply direct pressure to the finger and hold your hand above your heart. He followed the instructions and within five minutes, the fisherman's finger stopped bleeding.;

There's one lesson, among many, in that incident: 911 isn't always able to come alongside to assist in a medical emergency on the water. Cuts suffered on a boat can be serious if not properly treated, but today, that fisherman is back at work off the Alaskan coast.

Treating a Cut

A fish knife or perhaps even a fish spine that suddenly slices a hand or an arm when the boat is hit by an unexpected wave can be dangerous. Leslie Wood has seen it happen on commercial boats as well as recreational boats. Cuts go with the territory and this is when some basic first aid is invaluable.

• Apply direct pressure to the wound.
• Elevate it above the level of the heart.
• Sit the victim down — lie them down if they are feeling lightheaded. This works to stop the bleeding in the vast majority of cases.

"I once got to do that very thing for a gentleman who had accidentally cut and severed his radial artery in his wrist," Wood remembers. "He was bleeding and had just put a towel on the wound but didn't know to put firm pressure at the site of the wound or elevate the arm above the level of his heart. He could have bled to death from this injury, but it only took 10 seconds of very basic first aid to completely stop the bleeding."

More serious cuts require using pressure points if direct pressure and elevation fail to stop bleeding, but this technique is difficult and probably not very useful in most field settings. "A pressure point is nothing more than both hands applied to an area where an artery goes over a bony prominence or firm structure near the cut," Wood explains, "but it requires familiarity with anatomy and training to be effective. In this setting, a tourniquet would be my next choice for profuse extremity bleeding that hasn't been controlled by direct pressure and elevation."

The whole idea of a tourniquet is to keep blood from getting to the wound that isn't closing or clotting. This too must be done quickly and can involve placing a belt or a rope over a pad that is between the heart and the wound. Sometimes it is tightened using a pencil or a stick to stop the bleeding.

For the less severe cuts, once the bleeding has been controlled, there's more to do.

Here's What a Boater Onboard Should Do:

Any wound incurred out on the water needs prompt attention," Wood says. "The sooner the wound is cleaned and washed out (irrigated) and foreign body decontamination is removed, the less likely the wound is to become secondarily infected."

To accomplish this, do the following:

• Antiseptic solutions such as povidone iodine 3-5%, chlorhexidine, hydrogen peroxide, and alcohol will kill bacteria and are useful in cleaning a grossly contaminated wound but will also kill tissue when used in an open wound. They offer no advantage over sterile water as a wound irrigant.
• Soapy water is antibacterial even though it doesn't contain agents that kill bacteria. It's useful in cleaning a grossly contaminated wound or soaking a puncture wound.
• Sterile water is the gold standard for wound irrigation. In the field where resources may be limited, use the cleanest water available. Commercially bottled drinking water or boiled drinking water would be the best, followed by potable tap water. As a guide, think of using 4-5 ounces of water per inch of wound length.
• A key concept is to flush a wound to remove foreign body contamination such as dirt, fish slime, etc. Use lots of clean water.
• Many marine wounds may have lots of contamination that is less easily flushed out - such as the scrape against the rock covered in barnacles. The calcified coverings of barnacles are brittle and break off into small pieces in wounds. Wood carries a brush in her medical kit for such instances — a soft scrub brush, nailbrush, or toothbrush could be used for this purpose. Using a scrub brush soaked in antiseptic solution, she will gently scrub across the wound to remove the contamination.

Bandaging a Cut

"For minor cuts and scrapes where I know that the individual is going right back to fishing afterward, I like using transparent bandages after appropriate wound care," Wood says. "They keep water out and keep the wound clean but they won't hold up to prolonged immersion in water or rubbing. So I will often reinforce them with self-adherent wrap such as Coban(tm) and plan to have the individual inspect them to make sure the bandage is still intact. Standard adhesive bandages such as traditional Band-Aids(tm) are adequate until they get wet. Then they trap water and just keep the wound wet without keeping contamination out."

Puncture Wounds

Every trailer boater with a love of fishing probably has a story about a fishhook that somehow finds a hand or finger or arm, and in many of those stories that finger or hand or arm belongs to the boater. The big issue here is what kind of harmful bacteria is on the hook before it comes in contact with the skin. Night crawlers, squid and minnows can be filled with less-than-desirable microbes so it's important to treat the wound quickly. Lt. Cmdr. Wood says a fishhook, by its nature, isn't going to come out of the flesh very easily. "Care must be taken in treatment of a fishhook injury," she warns, "because you don't want to cause further damage to the underlying tissue." Remove any attached line, bait, or other hooks from the hook that is embedded.

Then do the following:

• Remove any other barbs from the hook that is embedded (example - treble hook).
• If the fishhook is in an area of the body where there is high risk of causing more damage in trying to take it out-such as the eye or eyelid-then don't. Stabilize it in place with a dressing and seek medical attention.
• Many fishhooks may be removed by using the following method: begin with downward pressure applied to the shank (the longest part) of the fishhook. As this is done, the barb is backed out along the point of entry. In the event the barb is actually sticking out of the skin, cut it off with wire cutters and remove the hook from the skin.

Bites and Stings

Boaters along the Chesapeake Bay know what a sea nettle can do. And boaters along both coasts are no doubt familiar with what can happen when coming into contact with a jellyfish. In most cases, touching a tentacle of either is going to be more irritating than serious; exceptions include the Atlantic Portuguese Man-of-War or the Australian Box Jellyfish which can be lethal.

If stung by a jellyfish, dousing the affected area with vinegar (also called 5% acetic acid) is a good all-purpose decontaminant. If it's a sea nettle, a number of Trailering Club Members put Old Bay Seasoning on the sting while others recommend rubbing the area with baking soda or meat tenderizers. This slows the nettle's venom from getting into the skin. Shaving the area with a razor can remove any attached tentacles and decrease further venom release. (Don't use it to shave your face later.) Some report success using adhesive tape to pull off the venom-producing nematocyst discharge from the skin.

In the case of bee stings, signs of a serious allergic reaction such as difficulty breathing or lightheadedness require immediate medical attention. If you have a bee sting allergy, this would be the time to use that EpiPen your medical provider gave you for just such an event. For mild bee stings, cold packs are helpful. Honeybees and yellow jackets often leave stinger and venom apparatus behind. Scraping that off will decrease risk of more venom getting into the wound. Avoid plucking it out with tweezers, which may milk the venom into the wound. Home remedies such as baking soda slurry or paste (baking soda and water) or meat tenderizers are of dubious worth but the latter is often regarded as effective and is unlikely to cause harm. Topical or oral antihistamines may be helpful as well.

Remember, always get professional medical help as quickly as possible.