Wilderness Doctor: Part 2 Shock
The horrible facts about dealing with shock in the wilderness
Wilderness first aid courses are focussed on a surprisingly few calamities you might encounter. The reason for this is both the simplicity and predictability of the human body and the limited resources available. The wonderfully focussed struggle you will be engulfed in if in the wilderness if you are a first responder to someone hurt will have two frightening aspects. Coping with shock, and coping with shock. That is to say, mental shock and physical shock. The shock of seeing your friend tumble down a scree slope in a sickening, chaotic way. The shock at finding her, after an eternity of slow but panicked clawing down an impossible slope, all the while listening to chilling screams.
Worse than that though. The kind of moaning screams that you hear from someone too tough to call out for help. They know help is coming. But agonized moaning at the desperate realization as they see the devastation that was their body. So it’s part scream, part yell, part crying, all through clenched teeth, staring at blood and bone. The horrifically misplaced and broken, once perfect legs. This is the first shock you will face. The fantastically debilitating moment that will live with you forever. And if you don’t get past that shock, and quickly, then her shock, an altogether different kind of shock, the physical, the medical, the massive blood loss kind will kill her.
It’s incredible to see, to witness. In desperate situations, how people freeze. It seems to happen more often than not. Certainly, you learn quickly in emergency courses, that someone must immediately take charge and loudly. This is because when arriving into a chaotic situation, panic freezes peoples minds in an unbelievable way. If you’ve ever seen emergencies caught on video or been in one, you will remember two types of rescuers. Those doing a lot and others, blank and staring, frozen with shock. Their minds desperately trying to comprehend the chaos. So, the person taking charge and shouting orders is key both for initiating order and action, but oddly to break anyone out of this paralysis. Overcoming this kind of shock is step one. Step two is dealing with your friend rapidly losing blood, and her bodies desperate attempt to keep oxygen rich blood flowing to her brain.
The human body is tremendously rugged. It’s ability to survive is phenomenal, and damage like this, an injury with rapid blood loss is something that the body deals with incredibly. It certainly seems that it is a wonderful culmination of a dizzying array of an evolutionary striving for perfection. The human body has an intricate set of priorities, and the brain receiving oxygen is number one. To this end it directs your body to a magnificent array of automatic, that is, out of your conscious control, changes. In an instant blood vessels at the wound constrict to slow blood loss. Blood at the wound site stick to the wound, clotting. Stop to consider this for a moment. As she tumbled down the scree slope and bloody gashes opened up, her body was healing from the first instant. Blood was there, clotting, beginning to, beginning the battle to survive. I mentioned the body is tremendously rugged. The more you learn about how it fights to survive, the more you drop your jaw in amazement. And that’s just the first instant of shock.
The bodies next reaction will be to keep blood pressure up, heartbeat becomes rapid, skin grows pale as peripheral blood vessels constrict to draw blood to the core. Sweating occurs and nausea and vomiting from a sudden rush of blood away from the abdomen. This is stage one, aptly called compensatory shock, and of course happens in an instant. Now this is this nightmare moment. What do you do? The answer at least, is simple. You have to fight the blood loss, and this is done by applying pressure to the wound with an absorbent dressing. That is, any fabric, a shirt or whatever. Hold it hard against the wound with the heel of your hand.
This now, is the most of what you can do for twenty minutes. Certainly, if you can elevate the wound, that will help too. But now, twenty minutes is the amount of time it seems where the body either deals with this, starts to that is, or is overcome.
Now we can turn to the facts and averages. A body can lose about a litre of blood and walk away. If you’ve ever given blood, you gave about a half a litre. More than a litre though, you pass into a world of grasping to survive, that, lucky for you, kicks in a phenomenal array of compensating actions. In short, your body is programmed to survive. To an incomprehensible extent, your body is programmed to fight.
If your friend loses more than a litre of blood, their body will take more drastic measures. That is reduce further the amount of oxygenated blood to the extremities. Their skin will turn from pale to bluish as sweating begins in earnest as they become anxious and their heart rate increases and consciousness fades. Breaths become shallow and fast. This is called progressive shock, or more alarmingly, decompensatory shock. Survival is still possible, however the next stage is called irreversible shock, and it comes with an altogether different set of symptoms. All of them spectacular, and at least one bewildering.
As the body enters irreversible shock, the body simply runs out of options. Blood loss becomes great enough to not bring enough oxygen to the brain. The vital organs now, lacking blood flow, have accumulated waste in the system poisoning it all. The body becomes unresponsive, breathing goes from rapid and shallow, to slow and laboured. Blood pressure becomes undetectable. Then something astonishing may happen. Both wonderful and nightmarish. Sometimes during this stage, the body releases a massive surge of energy. Blood pressure and consciousness return in an instant. A gasp of life erupts from the life that just bled to death. This incomprehensible phenomenon is not rare, however, ending in survival is.
My friend made it. Months later, when we talked about it over drinks, and awkward, silent stares. She told me something I never expected. She could recall every instant. Everything about that day. But the thing that she remembered the most, wasn’t the pain. Or how she felt herself dying, losing consciousness. Her open eyes becoming dark. The thing she remembered was my face. I didn’t remember it, but she did. She says I smiled at her the whole time. And said, “you’ll be OK.” Over and over. She said she knew she’d be alright.
I didn’t remember saying that, and smiling. But when she first told me about it, I did remember. I made myself forget part of that day. But now, I remembered, smiling, looking in her eyes, telling her that. I also remembered how I knew it wasn’t true. She couldn’t make it. I’d never seen so much blood. But I kept saying that. Over and over, with a smile. It was sincere. She believed it, and it made it true. Months later, taking this first responder course, I learned how unbelievably important it is to reassure and comfort an injured person. How it can calm and slow respiration, slow blood loss. Believing that you will survive helps you survive. I didn’t know that then, but I did it anyway. I don’t know how I managed to smile and say those things I surely didn’t believe.
Our bodies are incredibly rugged. We’ve evolved to survive such incredible traumas. But, I still pause once in a while and smile. I evolved in my mind, beyond my comprehension, a response to another persons shock, a response, that along with her increased blood pressure, reduced blood flow to her skin, perspiration, and all the rest. I told her, convincingly over and over, “you’ll be OK, you’ll be OK, you’ll be OK.” She tells me that made the difference. I felt the rare feeling of knowing both that I did something and didn’t do it. I did it, but had no choice. My body, along with her automatic shock state, was in a different kind of shock. Her body was in physical shock with massive blood loss. Mine was in psychological shock with the situation. But I know now, from psychological shock to physical shock. My mind took over and did the right things.
Shock took on a new meaning for me that day. I never saw, in my course much mention of that aspect of treating shock, beyond the importance of comforting words.
“You’ll be OK.” Despite all the bleeding, the hopelessness, the silence. Where breathing in gasps through gritted teeth is the only sound. I said that over and over and smiled. I think about that moment all the time and smile. I can’t help it. Just like I couldn’t help saying that and smiling that day. I can’t think about it now and not smile.
In ways we can’t comprehend, our bodies are rugged.