What do you do when a bone is sticking out and help is an hour away?

Every family has a story or two that gets told at every gathering, and in the family of Gail, our Head of Training, there is one about her uncle and the boar.

As her brother told it, Uncle Anthony was out in the yard feeding the boars when one of them charged. It hit her uncle hard enough to snap his leg, and when he looked down there was bone sticking out and a lot of blood. They lived rurally where emergency help isn't around the corner, so he did the only thing he could think of, which was to army crawl across the yard and into the house to find their aunt. Aunty Shirl, the story goes, took one look and taped it all back up.

It was 1975. Gail was young, and went on believing every word of it for more than fifty years. It turns out the story has had some embellishment along the way, and we will get to what really happened at the end. First, though, the legend asks a very good question.

What should you do when a bone is sticking out?

Call 111, control the bleeding by pressing around the bone and not on it, cover the wound, and keep the limb still exactly as you found it. Do not push the bone back in, and do not try to straighten the leg.

A break where the bone has come through the skin is called an open fracture, and it brings two problems at once, which are bleeding and the risk of infection. Here is how we teach people to handle it.

1. Check for danger first. If there is an angry boar in the yard, it is still there, and you are no help to anyone if it gets you too.

2. Call 111 early. Put the phone on speaker so your hands are free, and tell the call taker exactly what you can see.

3. Control the bleeding. Press firmly on either side of the wound with clean cloths or dressings, and keep your pressure off the bone end itself.

4. Cover the wound and the bone. Use a clean dressing and build padding up around the bone so that nothing presses down on it. A light, damp dressing goes over the bone itself. (If it's normally inside the body and is now sticking out of the body - keep it damp)

5. Keep the leg still, just as it is. Pack rolled towels, blankets or jackets along both sides so it cannot move, and leave the straightening to the people with the pain relief.

6. Keep them lying down and warm. Watch for shock, which looks like pale, cool, clammy skin, fast breathing and becoming vague, restless or feeling sick.

7. Give them nothing to eat or drink, because they are very likely heading for surgery.

Which means, with love, that the family boar legend gets two things wrong. Army crawling across a yard on an open fracture adds dirt, pain and blood loss, so staying put and yelling is the better plan when there is anyone in earshot. And taping it all back up is the one thing we would probably avoid.

What changes when help is an hour away?

The steps stay the same, but you will be doing them for much longer, because first aid is often a lot of waiting. In urban areas you are holding things together for shorter period of time, while out on a farm or in the bush you are the care until the ambulance or the helicopter arrives.

So the call to 111 comes before almost everything else, because the clock on that hour only starts once they know. Give them your exact location, including the RAPID number on your gate if you have one, and describe what you can actually see, since that is what decides who and what they send. If there is no phone coverage where you live or work, a personal locator beacon or satellite phone is worth every cent.

Then settle in to look after the whole person and not only the leg. Get something underneath them as well as over them, because the ground takes heat faster than the air does. Keep an eye on the foot below the injury, and tell the call taker if it turns pale, cold or numb. If the bleeding will not slow with firm pressure, say so straight away and they will talk you through what to do next. And keep talking to the person, because a calm voice does more than most people expect.

Want to practise this before you need it?

Reading about an open fracture is one thing, and working through it with your hands on a scenario is another. Our NZ First Aid Certificate course covers bleeding, fractures, shock and managing a scene when help is a long way off, and the next one runs on 21 and 22 October in Christchurch.

Book your place on the NZ First Aid Certificate course

So what really happened?

Gail messaged her aunt to check the details for this post, and her aunt laughed.

What actually happened is that the pigs were having a fight, her uncle happened to be standing in the way, and one of them flattened him. It caught his knee from the side and pushed the joint sideways, further than any knee joint is meant to go. And then comes the part her brother clearly found too dull to keep, which is that there was nothing to see. There was no bone, no blood and no kneecap out of place, only a man on the ground with a knee that would not hold him, and who then spent a few weeks on crutches.

That is the version worth learning from, because serious injuries can look just like it. You do not need to see bone to treat a leg as badly hurt. If someone has taken a heavy hit and cannot stand on the leg, the first aid is the same as for the legend her brother retold her. Minus the pressure to stop blood: keep it still in the position that hurts least, support it on both sides, keep them warm, and call 111.

Her brother's version has had decades of polish, and we would not change a word of it at the dinner table. On the phone to 111, though, the plain version is the one that gets the right help sent, so say what you can see and let the story grow later.