Getting stabbed in the neck is a very bad thing. For one thing there are major arteries (carotids) and veins (jugulars) in the neck. When cut, these bleed profusely. A severed carotid artery will squirt bright red blood in time with the person’s heart beat, while a cut jugular will “gush” darker red blood, also pulsating in time with the heat beat. Additionally, when someone is stabbed in the neck there is the risk of the throat itself being cut, compromising the casualty’s airway. So where should the first aider begin?
Catastrophic Bleeding v Airway
While maintaining an open Airway usually takes priority in first aid, Catastrophic Bleeding always trumps Airway. Either way, the person likely has only a matter of minutes to live without treatment and it’s purely down to which injury proves fatal first. We train first aiders to deal with Catastrophic Bleeding before all else.
Direct Pressure is the Key
Treating Catastrophic Bleeding from a neck wound has its challenges. Unlike a bleed from, say, a brachial (arm) or femoral (leg) artery or vein, necks don’t lend themselves to the use of a tourniquet! So treatment for a severed carotid artery or jugular vein is going to be via pressure. Direct pressure should be applied to the wound using your hand or fingers (preferably gloved to minimise infection). It may be necessary to push your fingers deep into the wound, or even to pinch the artery or vein with your fingers in order to stem bleeding. Remember too that an artery can “spring back” when cut, so you may need to apply pressure higher than the wound’s point of entry. If direct pressure appears to be working you will need to maintain the pressure for at least 10 minutes before clotting begins to take effect.
Packing the Wound
If direct pressure is proving ineffective you will have to try packing the wound. Take a triangular bandage, fold it into a 1 inch strip and then “Z fold” it down it’s length. Next, using your fingers, continue to apply direct pressure as you feed the bandage into the wound, bit by bit until the whole bandage has been pushed inside. Finally, press firmly on the entire bandage to maintain pressure.
Another option when someone is stabbed in the neck is to use a haemostatic dressing or agent such as Celox™ RAPID or Celox™ Haemostatic Granules. When Celox comes into contact with blood it swells, gels, and sticks together to make a gel-like clot. It works independently of the body’s normal clotting mechanism and can clot hypothermic or even heparinised blood caused from the use of anticoagulants to treat thrombosis. Celox can stop bleeding in as little as 1 minute, as opposed to the 10 minutes it might take from direct pressure alone. Bear in mind that you can bleed to death from a carotid artery in as little as 2-3 minutes and Celox – although not cheap (Celox RAPID costs about £40 per dressing) – comes out top as a treatment for Catastrophic Bleeding.
Clearing and Maintaining an Open Airway
Once Catastrophic Bleeding has been controlled, the first aider can move onto clearing the airway and keeping it open. Place one hand on the casualty’s forehead and two fingers under their chin. Then tip their head back. Check whether the casualty is breathing normally (their chest should rise and fall 2-3 time in the space of 10 seconds). If the casualty is not breathing you will need to begin CPR. It should go without saying that, with Catastrophic Bleeding an issue also, you should have already sent someone to call 999/112 for an ambulance. However, if this hasn’t been done, now would be the time! It is vital that you know an ambulance is on the way before you begin CPR on a non-breathing casualty. Remember – CPR alone is unlike to restart a heart that is in cardiac arrest.
Consider too that having been stabbed in the neck, the casualty’s airway may be compromised by blood and other fluids. This might be the reason the person isn’t breathing. Roll the person onto their side using the Recovery Position to clear blood, vomit etc. from their airway. Then check for breathing again. If the casualty is breathing, keep them in the Recovery Position and continue to monitor their Airway and Breathing. And, of course, continue to monitor the point of Catastrophic Bleeding to ensure it doesn’t start up again.