I got my first survival knife when I was 8 years old and my mom (yes, it was my mom and not my dad who gave me the knife!) was very clear about the safety rules.
That didn’t stop me from slicing my fingers open a few times while whittling sticks. These knife injuries happened while we were far away from medical help (and before the era of cell phones so no way of calling 911).
Knife wounds are one of the most common backcountry injuries. And, if we keep in mind the potential robbers and serial killers lurking in the woods (such as this recent case), there is also the risk of stab wounds.
You can't always call 911.
So, whether you are a prepper, outdoors person, or homesteader, if you believe in being self-reliant, then you’ll want to know how to treat a knife wound.
Start by downloading our first aid supplies checklist.
Click the checklist to get a printable version.
1. Have the Victim Lie Down
The crazy thing about knife wounds is that, because of adrenaline and extreme stress, knife victims don’t always notice their injuries until later.
As the person administering first aid, you want to take advantage of this initial shock period and get the victim to lie down.
- The patient won’t be able to see his/her knife wound while lying down. This will prevent the patient from freaking out.
- Reduces the risk of injury from falls due to dizziness
- Stabilizes the victim
Of course there are exceptions to this rule. As EMS1 talks about here, you wouldn’t put knife wound victims on their back if the wound was to the back or if lying down will affect the patient’s airways.
2. Remove Clothing Around Area
3. Put On Gloves or Wash Hands
It is easy to want to skip this step during an emergency situation. However, if you don’t take the 20 seconds required to put on gloves, you could infect the wound with your dirty hands.
If you don’t have gloves to put on, then wash them thoroughly. At the very least, rub some antibacterial hand sanitizer on them first.
4. Get Bleeding Under Control
The human body has approximately 10 to 12 pints of blood. The body can usually lose 1 pint of blood without severe effects.
- A loss of 2 pints of blood will lead to shock.
- A loss of 5 to 6 pints of blood will cause death. (Source)
Here’s the scary thing: if the knife wound hit an artery, the rate of blood loss can be very fast. According to this college professor, fatal exsanguination from an arterial wound may only take 20 seconds to a couple minutes. Even venous bleeding could cause death in 4 to 5 minutes if the wound was large enough.
Know What Type of Bleeding You Are Dealing With
- Arterial Bleeding: The blood will be SPURTING out. It will be a bright red color.
- Venous Bleeding: The blood will be oozing out. The blood will be a darker color.
- Capillary Bleeding: The blood will slowly come out. It will eventually stop on its own.
Applying pressure to the wound will help stem the flow of blood. In cases of arterial bleeding, you will also want to apply pressure to the major artery leading to the wound. You will need to use both hands for this!
For example, if the knife wound is in the thigh, you will need to apply pressure to the femoral artery.
According to JEMS, 10 to 15 minutes of direct pressure should be enough to control bleeding of most wounds you’d encounter in backcountry.
Reposition the Victim
The heart is what pumps blood throughout the body. If the wound location is below the heart, then blood loss will occur faster. To prevent this, position the victim so the wound location is above the heart.
For example, if the knife wound is in the leg, have the victim lie down and elevate the legs.
Seal Sucking Chest Wounds
One of the worst possible knife wounds is a stab to the chest which penetrates the lungs. The outside air entering the lung will cause it to collapse, and the victim will die quickly
For this types of knife wounds, it is critical that you seal the wound ASAP to prevent air from getting into the lung. As MD Lawrence Heiskell talks about here, this can be done by putting any of these over the wound:
- A credit card
- Duct tape
- Plastic bag
- Your own hand
Even with this step, there could still be complications from pressure buildup. Thus, Heiskell recommends having a Chest Seal in your first aid kit.
When to Use Tourniquet
One common first aid myth is that you should use a tourniquet to stop the flow of bleeding. Sure, using a tourniquet will stop the blood – but could also destroy the limb. So, only use a tourniquet if you are prepared to spare the victim’s limb in order to stop the blood loss.
For more on this, Backpacker has a good article here.
5. Decide Whether to Remove the Knife
The knife is still in the wound? Under normal circumstances, you should never remove the knife. But, as JEMS talks about here, you might need to remove it if there is no help available.
Before you remove the knife, you better make sure you are ready to stop the flow of blood which is likely to start gushing out immediately!
6. Clean the Knife Wound
Once the bleeding has stopped, you’ve got to get the wound clean to prevent infection. Cleaning a wound is always an important part of first aid, but it is particularly important when you are far away from professional medical help.
The last thing you need is to get an infection which develops into gangrene or spreads throughout your body.
A common medical saying is, “The solution to pollution is dilution.” In other words, you need to dilute the wound site to get out any contaminants which would lead to infection.
- Use tweezers to remove large pieces of debris in the wound.
- Use at least 1 liter of fluid to clean each wound.
- Saline solution is best for cleaning wounds. If not available, use sterile water (boiled for this purpose).
- Direct the fluid at a perpendicular angle from about 1 to 2 inches from the wound.
- You must use enough force to dislodge any foreign debris in the wound, but not so much force that the tissue will be damaged or the debris will get pushed deeper into the wound.
If Water is Limited or Not All Debris Can Be Removed:
Hopefully you have supplies in your first aid kit. You can use a 1% povidone iodine rinse to clean the wound. Or, in a pinch, peroxide or alcohol will work.
Josh at The Survival Place notes that salt is a great natural cleanser. You can mix tbsp. of salt with 1 cup of warm water to make your own saline solution for cleaning the wound.
Apply Antibiotic Ointment
Apply copious amounts of antibiotic ointment over the wound. Not only does this help prevent infection, but also can help prevent the dressing from sticking to the wound.
As Hartley Brody notes, antibiotic ointments are NOT a substitute for cleaning a wound. You still need to flush the wound very well (no matter how much the patient is screaming of pain) before applying the ointment.
7. Decide Whether to Close the Wound
Under normal circumstances where you can call 911 or go to the hospital, you should NEVER close a knife wound. This will just trap bacteria and other contaminants in the wound, leading to infection. If you do close the wound, the nurses will just open it up for cleaning at the hospital.
But we aren’t talking about normal circumstances here!
The purpose of closing a wound is to reduce airspace, prevent further contamination, and to speed up healing.
Yet, if a wound is closed and develops an infection, the pus won’t be able to drain and life-threatening infection can develop.
Thus, the safest way to treat a knife wound is to leave it open!
Leave a Knife Wound Open Under These Circumstances:
- The wound is infected
- The wound has been exposed to the air for more than 6 hours
- There is dead tissue in the wound (dead tissue is disclosed and won’t bleed)
- The edges of the wound are so far apart that closing it would tear the skin or put pressure on the skin
- The wound is from an animal or human bite (I know we are talking about knife wounds here, but just want to remind you to NEVER close an animal bite because they are teeming with bacteria!)
Close the Wound Under These Circumstances:
- The wound is large and refuses to stop bleeding
- The wound penetrated through the entire skin (you’d be able to see underlying tissues)
- The wound has been open for less than 6 hours
- The wound is over a joint or moving part of the body and won’t close by itself
- The wound is gaping open and won’t be able to close without your intervention
If You Are Unsure What to Do:
Doctor Joe Alton over at Doom and Bloom recommends a “delayed closure” if you aren’t sure whether to close the knife wound. This means waiting 72 hours to see if any signs of infection develop. If they don’t, then close the wound.
An “open wound” does not mean you leave it open to the elements. The wound still must be covered (dressed) to prevent contaminants from entering it. Remember, even the air contains bacteria, so the wound must be dressed at all times.
- Apply antibiotic or antibacterial ointments (as talked about here, honey can also be used)
- Wet a sterile dressing in saline solution or sterile water (read why wounds should be kept moist here)
- Apply the wet sterile dressing over the wound
- For large wounds, you’ll need to pack the dressings into the wound
- If you don’t have any sterile dressings, you can boil rags or pieces of clothing
- Use dry tape or a bandage to hold the dressing in place
- The tape or bandage holding the dressing should be loose
- Clean spider webs can be used over the dressings and under the tape as a natural antibacterial layer
- The wound should be dry before closing it
- Unless you a trained medical professional, don’t try to suture the wound
- Use butterfly bandages to close the wound
- If you don’t have butterfly bandages, you can use pieces of adhesive tape to make a butterfly closure
- Cover the closed wound with dressing or bandages
- Avoid using tape to cover the closed wound; it is hard to remove with further damaging the wound when you monitor the wound
Here you can see a video of how to close a wound with duct tape;
8. Monitor the Wound
Regardless of whether you left the wound open or closed it, you need to monitor it for signs of infection.
For Open Wounds:
You’ll need to change the dressings every 12 to 24 hours. Be careful that you don’t open the wound when you remove the dressings. Apply ointment to the wound before putting on the dressing each time. The ointment helps prevent the dressing from sticking to the wound and speeds up healing.
If you don’t have enough sterile dressings, you can boil the used ones to sterilize them before reapplying them.
A bit of redness or pus is normal as the wound heals. However, if the skin gets very painful, hardens, turns bright red, or is hot to the touch, then a serious infection is likely developing. Re-clean the wound, take antibiotics if you have them.
For Closed Wounds:
Even if you closed the wound, you still need to monitor it. If the wound area starts to swell up, get red and crusty, or stink, then an infection has developed.
You’ll need to reopen the wound and clean it again. Leave the wound open this time and start saying your prayers!
Want to get prepared for medical emergencies? Read this post on How to Take Your First Aid Skills to the Next Level.
“Dug mug cut gauze 3” (CC BY-NC-ND 2.0) by patrix
“Emergency Bleeding Control” (CC BY-SA 3.0) by KVDP
“Direct pressure and elevation” (CC BY-SA 4.0) by Mike6271
“after first cleaning of one wound KK:4” (CC BY-NC-SA 2.0) by teresehart