Rare is the horse owner who hasn’t retrieved a horse from the field only to find a fresh wound of some sort. Horses seem to always look for new ways to hurt themselves and, as their caretakers, we are the first responders when they succeed.

Effective first aid, of course, requires having access to wound-care supplies and the skills to use them correctly. Equally important is having the knowledge base to determine which wounds you can manage on your own and which require a call to the veterinarian.

To help you on both fronts, we’ve prepared a practical guide to equine wound first aid. Read it now, before there’s a crisis. That way you can stock up on supplies and fill in any knowledge or skill gaps you might have. Then, when the inevitable injury happens, you’ll be ready to do what’s necessary, whether that means delivering care yourself or calling your veterinarian.

Wound triage: Five questions to ask

Wound first aid begins well before you reach for Betadine and bandages. The first critical step involves a variation on the concept of triage—the sorting of patients depending on the urgency of their need for care—in which you decide, based on the severity of the wound, whether you will treat it yourself or seek immediate veterinary assistance.

In making this decision, the nature of the injury is only one factor. You’ll also have to consider the resources you have on hand, your skills and experience in wound care, and even your comfort level with handling the situation. Managing some injuries will involve a straightforward process, while other injuries most definitely will not. It’s ultimately up to you to make that distinction. Answer the following five questions to determine the best course:

 Is this wound near a joint or another critical structure?

Any wound over or near a synovial structure (joint, tendon sheath, bursa) requires a call to your veterinarian, who will immediately take steps to prevent infection and aid healing. An infection within these structures imperils a horse’s athletic future and often his life.

“Familiarize yourself with equine anatomy so you can recognize wounds that are close to these vital structures,” says Kim MacKinnon, DVM, an associate veterinarian at Avon Animal Hospital based in Windsor, Nova Scotia, Canada. As a general rule, a cut on a “meaty” and stationary area, like a hindquarter or shoulder, is less likely to be near a synovial structure than one on a bony and highly mobile area, like a leg. Of course, if you see any structure that could be bone, tendon or muscle within a wound, call your veterinarian immediately.

Is this wound near an eye?

Injuries to and around a horse’s eye can look alarming, even when they aren’t particularly serious. Conversely, some that look minor have the potential to become significant. It can be extremely difficult to tell the difference, and making the wrong decision puts your horse’s vision at risk. For instance, treating a swollen eye with the wrong medication can lead to a devastating fungal infection. When an eye is involved, the risk of making a mistake is simply too great, so call a veterinarian.

Is the horse in obvious pain or significantly lame?

If your horse seems to be overreacting to a seemingly small wound, take him seriously. Chances are, there’s something more serious afoot. “For example, a small cut over the forearm that’s causing lameness may indicate a hairline fracture to the radius,” explains Jesslyn Bryk-Lucy, DVM, cAVCA, associate professor of equine studies at Centenary University in Hackettstown, New Jersey.

Beyond lameness or flinching, signs of extreme physical discomfort can include sweating, agitation and withdrawn behavior. Another reliable indicator of pain is an elevated heart rate. A pulse rate greater than 50 beats per minute suggests that a horse is uncomfortable and his wound is more serious than it looks.

Is it a puncture wound?

Puncture wounds, which are deeper than they are wide, usually don’t bleed much and may appear minor. But don’t be deceived—puncture wounds can be extremely serious. The warm, moist and oxygen-deprived environment within a puncture wound is ideal for bacteria to thrive. If the exterior surface of the wound heals before the interior fills in, that bacteria will flourish, potentially triggering a raging local or systemic infection. A puncture wound needs to be explored and cleaned by a veterinarian. These wounds may require specialized bandaging techniques and a course of antibiotics. If you discover a puncture wound, or suspect a small gash might be one, call the veterinarian immediately.

There’s one other key caution about puncture wounds. If the offending object is still embedded do not pull it out. And that’s especially true if the wound involves a hoof or an eye. Let the horse stand quietly with the item still in place until the veterinarian arrives. The tract the object followed will provide a veterinarian important information on the structures affected.

“It’s counterintuitive to leave a nail in a horse’s foot until the veterinarian arrives,” says Bryk-Lucy. “However, it’s the best thing to do. Radiographs with the nail in the foot are the best way to determine the structures that may have been affected. The hoof capsule contains many vital structures, so we must carefully investigate whether any of them may have sustained trauma.”

Could the wound need sutures?

Deep, jagged or gaping wounds are likely to need suturing, as are those that involve underlying tissues like fat or muscle. “Sutures, staples or tissue glue may be required to close wounds deeper than superficial abrasions,” says MacKinnon. “Full-thickness lacerations warrant a call to your veterinarian.”

The idea that the window for suturing “closes” after a certain number of hours is a bit misleading—a veterinarian can always debride a wound that has started to contract, essentially creating a fresh one to suture. But this is more complicated, and expensive, than suturing an original wound. If a wound appears more than skin-deep, touch base with your veterinarian and maybe send an image (see “Telemedicine for horses,” page 32) to ensure it is not a candidate for suturing. If there is any possibility a wound may need stitches, do not treat it with any spray, powder or ointment. All of these make it difficult, if not impossible, to safely close a wound.

First aid: Three essential wound-care skills

Every wound is different, and each needs individual consideration and care. To do this effectively, you’ll need an established wound-care skill set to call upon. Here are three skills that will come in handy no matter what type of wound you are faced with:

SKILL #1: Stanch bleeding:

 It doesn’t matter how long you’ve kept horses—the sight of blood pouring out of a wound is going to cause concern or even panic. Thankfully, the correct course of action is simple: Grab the cleanest cloth you have at hand—sterile bandages are best, but a towel, your shirt, or even a saddle pad will do, and press it gently but firmly against the wound. That’s it; just apply pressure. Do not use any coagulant products or try to fashion a tourniquet.

Still bleeding?

If no fresh blood appears on the outside of the cloth after 15 minutes of pressure, you can peek under to see if the bleeding has stopped. Keep in mind that wounds in some locations bleed more than others without necessarily being more serious—a small cut on the head, for instance, will bleed more actively than an abrasion on the hindquarters.

Apply pressure

If the wound is still bleeding after 15 minutes, replace the cloth and call your veterinarian. Should the fabric become soaked with blood at any point, don’t remove it—just place another directly over it and call the veterinarian. If possible, use a bandage to hold the cloth in place while you wait for the veterinarian to arrive. And if the wound is spurting bright red arterial blood, call for veterinary help immediately.

A fact that can be very reassuring to repeat to yourself as you apply pressure to a wound is that a horse can lose a significant amount of blood without severe risk. “Bleeding becomes life-threatening if they lose about 20 percent of their blood volume, which represents eight liters, or just over two gallons,” explains Jeremy Frederick, DVM, DACVIM, of Advanced Equine of the Hudson Valley, in Wappingers Falls, New York. “That’s a lot of blood.” For reference, it would take two gallons of paint to cover the walls of a 12-by-12-foot stall.

SKILL #2: Cleansing:

 Dirt, splinters or other debris will prevent a wound from healing well. Foreign objects introduce bacteria into wounds and facilitate the proliferation of infection. Contamination also increases the chances a wound will leave a scar, which besides being cosmetically undesirable can have effects on range of motion and increase the likelihood of re-injury. Thoroughly cleaning a wound is an important skill. Here are the three basic steps to follow.

Start by carefully removing any large pieces of debris that fall away easily with a slight touch.

Save whatever you remove: If complications arise, your veterinarian might find it useful to examine these objects. A few important points: If you have to “pull” on anything to remove it, stop and consult with your veterinarian. (And remember, do not remove an object embedded in a puncture wound. Leave it in place and call the veterinarian immediately.)

Once large debris is gone, flush the wound with plain tap water or a physiologic saline solution.

If you don’t have the latter on hand, you can make your own by dissolving two tablespoons of table salt in a gallon of distilled water. Whether you deliver the cleansing liquid by garden hose, spray bottle or syringe, use the minimum amount of pressure to fully rinse the wound surface. Excessive force can aggravate the injury. A pressure of 10 to 15 pounds per square inch—about the amount of pressure you would use to wash your hands—will effectively remove approximately 80 percent of the contaminating material. Keep rinsing until the water flowing off the wound runs clear.

Scrub it gently but firmly with gauze squares.

You can’t see all contaminants with the naked eye so gently scrubbing will help ensure that the surface of the wound is truly clean. Use plain water or a solution made specifically to clean wounds. To prevent your wash solution from becoming contaminated, pour water or saline onto the square rather than dipping the square into the solution. Discard each square as it becomes soiled with dirt and blood. Continue scrubbing until the gauze remains clean of visible dirt and only stained by a little fresh blood. A thorough, gentle scrub session may take as long as 15 to 20 minutes.

SKILL #3: Bandaging:

Not all wounds need to be bandaged but it’s important to know when and how to apply bandages. Part of this skill is knowing when bandages are not needed or are even counterproductive. For example, most small cuts and abrasions heal quickly and well when left uncovered, so long as they are kept clean and free of irritation. But some wounds need the extra protection a bandage can provide.

Does it need to be covered?

The decision of whether to bandage largely depends on a wound’s location and depth. Leave high wounds uncovered; put low wounds under wraps. Wounds above the elbow and stifle, that are free of contamination, are likely to scab over and heal well on their own because of the relative immobility of the horse’s torso and the superior circulation at or above the heart level. Likewise, shallow wounds rarely need to be covered. Because they tend to form strong scabs very quickly, superficial scrapes and abrasions can be left open to the air. On the other hand, a wound that penetrates all skin layers needs the protection of a bandage to prevent bacteria from invading the underlying structures.

Once a wound is cleaned and you have decided a bandage isn’t necessary, the next step is to consider applying your preferred wound care treatment (see “Ointments, Creams, and Other Topicals,” page 30). After that, just keep an eye on the healing progress, re-applying topical medication as necessary in the coming days.

If you decide to bandage a wound, start with a nonstick dressing that allows fluid to escape while holding any medication in place. This dressing can be a simple gauze square but make sure it’s big enough to cover the entire wound. Over this base layer, apply gauze wrap to hold the dressing in place. Then, add a layer of sheet or roll cotton to further protect the wound and absorb any extra fluids. Finally, secure the entire dressing with an elastic veterinary bandage. Some injuries may also benefit from the addition of a standing bandage for extra protection, but that’s not necessary for most minor wounds.

Keeping the bandage in place

The trick is to makes sure the bandage will stay in place but is not so tight that it restricts circulation or damages tissues. You can access plenty of “how to” videos online. But there is no substitute for having a trusted friend or veterinarian watch your technique and provide real-time feedback until you are confident in your skills.

Keep in mind that bandages will need to be changed regularly—every other day at the least—until the wound has closed enough to keep out contaminants. During each bandage change, you’ll want to check for healing progress and for signs of infection. And of course you’ll want to call your veterinarian if something seems amiss.

With the right supplies and knowledge base, most people are perfectly capable of handling minor and most moderate abrasions, lacerations and similar wounds their horses incur. Even so, some horse owners simply may not want to. If you are squeamish about the sight of blood, or an injury to your horse causes anxiety that may prevent you from thinking clearly—or if you simply don’t feel as if you can deal with an injury—it’s never wrong to call your veterinarian for guidance or help.