How to Administer First Aid Without Bandages or Gauze

Injuries usually happen suddenly and without warning. Many of us are unprepared for first aid, and it is often only when we find a pharmacy to purchase bandages and other necessary items, or when we reach a hospital in the case of more serious injuries, that we realize we lack supplies. In such situations, we must manage the wound using whatever we can find. To meet the core objectives of first aid – stabilizing the victim, preventing infection, controlling bleeding, and immobilizing in the case of suspected fractures – you must 'think outside the box' and use whatever materials are available to you. You should also consider improving your knowledge by enrolling in first aid and CPR courses offered by the Red Cross or the Heart Association.

Evaluate the Situation. Even though you may feel the urge to assist, if you become injured yourself, you won't be able to help anyone. Before approaching the victim, ensure there are no immediate dangers, such as traffic, unstable buildings, fallen power lines, fast-flowing water, violent incidents, explosions, or hazardous gases in the vicinity. If any risks persist and approaching the victim is too dangerous, call for help and prioritize your safety. Only proceed to assist when it is safe to do so. Additionally, you may need to wear any available personal protective equipment, such as gloves, to prevent bloodborne infections from the injured person.

Obtain Consent. Before proceeding with first aid, you must obtain consent from the injured person, either verbally or through gestures. You should introduce yourself, explain your level of training, and then ask if you may provide assistance.

• In cases where the victim is unconscious, disoriented, mentally impaired, or severely injured, consent is assumed, and you are allowed to proceed with helping.
• For children, you must get consent from the parent or guardian. If they are absent and the situation is life-threatening, consent is assumed, and you may assist the child.
• If the injured person refuses help, you must respect their decision, even if the injury is severe and life-threatening.

Assess Vital Functions. This follows the ABC principle: A - Airway, B - Breathing, and C - Circulation. Lay the victim on their back and tilt their head and neck to better assess their condition.

• If the victim is conscious, speak to them while you perform the assessment to help calm them down and lower their heart rate. If possible, try to direct their gaze away from the wound.

Check the Airway. If the person is unconscious and there is no risk of neck or spine injury, place one hand on their forehead and the other under their chin. Gently push their forehead back with one hand while lifting the chin with the other hand to open the airway. Always ensure the airway remains open, and check for any obstructions in their mouth.

• If conscious, the victim may inform you whether their airway is blocked.
• If there is a suspicion of neck or spine injury, use the jaw-thrust technique: grasp both sides of the jaw and lift it upward to open the airway without compromising the neck or spine.

Check for Breathing. Observe the chest for movement, listen for air entering and exiting the lungs, and feel the breath by placing your face close to the victim's mouth.

• If unconscious but breathing normally, the victim should be placed in the recovery position: lying on their side with the head tilted back, one arm under their head and the other bent or extended. The top leg should be bent to stabilize and prevent the victim from rolling forward. Do not place the victim in the recovery position if there is a suspected spinal injury. Continue monitoring their breathing.
• Check for a pulse. You don't need to measure it; just ensure there is a pulse. You can quickly detect a pulse by placing two fingers on the victim's neck, in the hollow area beside the windpipe. Apply gentle pressure.
• If the victim is not breathing, perform CPR (Cardiopulmonary Resuscitation). Remember, recent research shows that chest-compression-only CPR is as effective as the traditional method, which includes both compressions and rescue breaths.
• For emergency preparedness, you should attend a CPR training course to learn the correct procedure and get hands-on practice.
• Be aware that CPR is not a clean process. Chest compressions often lead to broken ribs. Prepare yourself for this outcome.

Check for Circulation. After checking for breathing, observe for any signs of severe bleeding. Once you confirm the victim is breathing, you can begin addressing open wounds by applying direct pressure and elevating the injured area above the level of the heart. Part 3 will provide more details on this topic.

• Look for signs of shock. Keep the victim warm and comfortable. Both shock and blood loss can lead to a drop in body temperature. You may cover the victim with a blanket, jacket, or any available item to maintain warmth.
• Allow the victim to remain as calm as possible. Whether sitting or standing, they should be kept calm and composed.

Call for Help. Once the victim's condition is stabilized, quickly contact Emergency Services for assistance. If the victim is still bleeding, ask someone else to call for help while you continue to assist them. To ensure effectiveness, you must designate a specific person. Instead of shouting into the crowd, point to someone and say, 'You! The person in the blue shirt! Call 115!'

• If you are the only one present, use your phone to call for help. If you don't have a phone, look for a passerby or a place that may have a phone available.

Clean the Wound. Wash and clean the wound with anything you have available. Clearly, drinking water is the first choice – if it's safe to drink, it can also be used for cleaning wounds. If clean water is unavailable, you may also use carbonated drinks, like cola. If you're lucky enough to find a small bottle of hand sanitizer, use it to clean the wound.

• Stop using anything that could increase the risk of infection, such as fruit juices, ointments, or milk. The same applies to polluted water from ponds or rivers. If you're near the coast, let the ocean clean the wound. Saltwater can act as a substitute for saline solution, helping cleanse the wound.

Let Water Flow and Clean the Wound. Rinsing the wound under running water is highly recommended and one of the best methods to prevent infection.

• If you have clean drinking water, let it flow over the wound for several minutes. Ideally, use about 2 liters of water – roughly the amount in a large soda bottle.

Pat the Wound Dry. Find something to help you dry the wound, such as a piece of cloth, a towel, or other soft materials. Avoid using anything with fibers, as they may leave behind strands that could stick to the wound.

Remove Dirt and Debris from the Wound. If you are in a remote area with no water or liquids, use a piece of clothing to clear any debris from the wound. Try to select the cleanest part of your shirt or pants for this task.

Inspect the Wound. It's crucial to assess the seriousness of the blood loss you need to address. After cleaning the wound, check its depth and look for signs of blood vessel damage, such as blood spurting or pulsing with the heartbeat. On average, the human body contains about 8 liters of blood, and losing 10% of it can result in severe consequences, including fainting and inadequate blood supply to essential organs.

• At this point, also evaluate the depth of the wound: wounds deeper than 1 cm typically require stitching once medical assistance is available.
• Do not remove any object embedded in the wound. Leave it in place: it is helping to control bleeding. Removing it could make the bleeding worse. In such cases, medical professionals are needed to safely remove the object without damaging internal organs or causing excessive blood loss in the process.

Stop the Bleeding. If no gauze or bandages are available, apply firm pressure to the wound using a clean and absorbent material, such as a shirt, cloth, or socks. If the material becomes soaked with blood, do not remove it, as doing so could disrupt any clotting that has formed. Instead, place another clean material on top and continue applying pressure.

• If any object is still stuck in the wound, press firmly around it. Pressing down on the wound helps slow the bleeding.
• If the wound is open and bleeding heavily, try to cover it with a cloth, blanket, or tampon, if available, and apply pressure. At this stage, stopping the bleeding is more important than worrying about infection.
• Some first aid training suggests using the edge of a credit card to 'seal' the wound. It’s a convenient tool as many people carry one. Not only does it help stop the bleeding, but it can also prevent air from entering the wound if it’s a chest injury, thus preventing pneumothorax (collapsed lung).
• If bleeding is profuse, use one hand to apply pressure on the major artery leading to the injured area, while the other hand continues to press on the wound. These are called 'pressure points.' For example, to reduce bleeding from the arm, press the inner part of the upper arm just above the elbow or below the armpit. For leg injuries, press just below the knee or at the groin.
• In certain situations, you may need to use a tourniquet. A tourniquet should only be applied to limbs when pressure alone is insufficient to control severe bleeding, or if there is a life-threatening injury, such as when an arm or leg is crushed or severed.

Elevate the Wound Above the Heart. This helps reduce blood loss. If the victim can sit, encourage them to sit upright. If they cannot, assist them if possible.

• Do not let the victim walk. Walking, especially running, can act like a second pump on the circulatory system, which, like the heart, can worsen many medical conditions.

Cover the Dressing Area. Since there is no gauze or bandages, use a piece of clothing (shirt, jacket, socks, etc.) or other items (from a tent, raft, etc.) to cover the wound once bleeding has slowed or stopped. Alternatively, you can use a branch to cover the wound and stop the bleeding. Look for a branch with large leaves that can fully cover the wound. Depending on the local flora and fauna, you might even find plants with medicinal properties, such as the Willow tree.

• Avoid using tissues or toilet paper, as they are too fragile and could cause further harm with paper scraps or tears. Any absorbent fabric can be used to press the wound.
• Do not remove or move the material used to cover the wound, as this could disrupt clotting and cause the bleeding to resume. Once the material becomes soaked with blood, place another layer on top.
• Be extra cautious with chest wounds. Cover the wound with materials such as aluminum foil, plastic bags, or cling film. Only cover three sides and leave one side open to allow air to escape rather than enter the pleural cavity. If air enters the pleural cavity, the patient may suffer from a collapsed lung.

Tighten the Dressing. Tear fabric into strips or use tape, rope, or string to secure the dressing in place. Be sure not to tighten it too much, as this could restrict blood flow to the injured area.

• If there are no available materials to secure the dressing, simply continue to apply pressure to help form a blood clot.

Be Cautious When Moving the Injured Person. Only move them if they are in immediate danger, such as from a fire, explosion, or other potential threats. If the victim falls and complains of neck pain or is unable to move their arms or legs, do not move them. If spinal cord injury is suspected, keep the victim in place until emergency responders arrive with a stretcher and neck brace. Stabilize them in their current position and call for emergency help immediately.

• Any movement could lead to paralysis. Therefore, reassuring the victim while waiting for help is the best course of action in this situation.
• For fractures in other areas, such as the arms or legs, provide first aid only if help will not arrive soon, as moving and treating the fracture could do more harm than good. However, if immediate medical care is unavailable, you can assist with stabilizing the bone and alleviating pain by following the steps below.

Create a Sling. If the upper limb is injured, such as an arm, you can easily fashion a sling using a shirt or sweater. Carefully place the uninjured hand outside the shirt while the shirt is draped around the neck. Pull the shirt up to the elbow, bend the elbow at a 90-degree angle, and allow the forearm to rest on the fabric that’s been raised. This will safely immobilize the shoulder, elbow, forearm, and wrist.

• If you have scissors or other tools, you can also cut a shirt or other fabric, such as a pillowcase, to create a more traditional sling. Cut the fabric into a square (about 250 cm²), then fold it diagonally into a triangle. Place one end of the sling under the arm and over the shoulder, and the other end over the opposite shoulder. Tie the ends behind the victim’s back.
• The sling not only helps alleviate pain significantly but also keeps the broken bone immobilized.

Use a Splint to Support the Broken Limb. Do not attempt to realign the bone. To create a splint, you can use whatever materials are available or nearby. Look for a rigid object such as a wooden board, a stick, or even a rolled-up newspaper.

• The splint should extend beyond the joint above and below the break. For instance, if the lower leg is fractured, the splint should stretch from above the knee to past the ankle.
• Cardboard is an excellent material for stabilizing lower limbs. You may need to modify the cardboard by tearing or cutting the edges so that it fits around the injured area. Place the flat cardboard on the ground, slide it underneath, and wrap it around the leg. Secure the cardboard with tape, rope, or fabric torn from your clothing. Don’t forget to fold the edges of the box under the injury to help stabilize the joint – a fall can be incredibly painful in such a situation. Do not attempt to move the lower limb; keep it in the most comfortable position for the victim.

Wrap the Splint. Use clothing, towels, blankets, pillows, or any soft material you have. Secure the splint in place over the injured area using belts, rope, shoelaces, or any convenient object. Be cautious when placing the splint to avoid causing further injury. Wrap it securely to ensure the splint is fixed but does not apply extra pressure on the injury site.

Minimize Swelling. If you have ice, such as in an icebox or a cooler bag, apply it to the injured area to reduce swelling. In an emergency, you can use anything cold, like a can of soda straight from the fridge.

• Always call for help when possible. While waiting for emergency responders, continue to monitor the victim’s airway, breathing, and circulation.

• This article does not replace professional medical advice, emergency treatment, or formal first aid training.