Wednesday 15 April 2009


So, you’re a character in a movie, and you’ve just been in an action scene. You’ve been fighting off, either the hero, or the villain of the picture and mostly likely you’re on the run from the law, or have no access to a hospital or any sort of medical practitioner. What do you do? You’re only option is self-medicating yourself, whether it’s self-surgery, self-suture, bullet removal etc.

The most common form of cinematic self-medication is 'cauterizing of the wound', the act of burning the wound to stop the bleeding, a method most dramatically demonstrated to us in Rambo III:

Removing shrapnel from Stallone's waist in RAMBO III

After some mondo action and bloodshed John Rambo finds himself with an annoying piece of shrapnel embedded in his waist. Unfortunately he’s without his trusty needle and thread, but ‘MacGyver's’ a solution with a little gunpowder and a flame. Rambo carefully pushing the metal out of his body, then tears apart a bullet and yikes! pours the gunpowder into the open wound, then inserts an enflamed twig into his body to ‘cauterize’ it. 

Cauterizing Chow Yun Fat’s Wound in THE KILLER

After the famous cabin shootout and escape from the white jumpsuit wearing gunmen John and Inspector Li escape into the woods to rest. Li helps John fix the bullet wound on his arm with the same Rambo technique. Opening up a shell casing, pouring gunpowder on the open wound and lighting himself on fire. Thank God for the twig John clenches on to relieve the pain of having one's appendage partially exploded.


Going back to 1970, Don Siegel's western "Two Mules for Sister Sara" may have been the first use of cinematic cauterization. The unlikely heroic duo of Clint Eastwood as a mercenary and Shirley MacLaine as a nun, both travelling to Mexico to help in their revolution. After an attempt to blow up a train Clint is shot in the shoulder with an arrow, nothing a simple cauterizing technique of pushing through the arrow along with some lit gunpowder couldn't fix.

Arrow Wound in BRAVEHEART

After the Battle of York, that old Scottish dude, the elder Campbell played by John Cosmo gets a nasty arrow to the shoulder. With some whisky to dull the pain, his fellows warring lads proceed to pull out the arrow, then blast the wound with a red hot poker. Ouch.

Thank God for the basic element of fire which seemingly can seal up just about any wound. In real world practise, you may want to think twice before applying that hot poker to your skin, or lighting yourself on fire with gunpowder. Here's the real medical take on cinematic cauterization, courtesy of Toronto-based doctors, Dr. Michael McDonald and Dr. Jennie Johnstone:

In the setting of a penetrating trauma wound with a non-sterile object (arrow, bullet, shark bite), the major immediate concerns are hemorrhage and infection. Severe hemorrhage can be fatal within minutes while infection is more insidious, claiming victims within 72 hours. Cauterization in the “Rambo” sense of the word refers to the application of a heat source directly into the wound in an attempt to stem the blood loss and sterilize the region of any bacteria. Although theoretically attractive, this practice paradoxically creates more injury; even if large blood vessels are spared from thermal damage, layers of surrounding inflamed and necrotic tissue coalesce into an ideal medium for harmful bacteria to grow and spread.

Anecdotally, cauterization may have been used with some measure of success prior to availability of antibiotics and antiseptic surgical techniques (approximately 100 years ago) in rare circumstances. For example, in the amputation of a limb, the benefit of cauterizing the stump to control bleeding from large arteries, which was almost always fatal, exceeded the risk of dying from subsequent septic shock. Today, however, an individual forced to self-manage a penetrating injury in the absence of immediate medical care should instead focus efforts on damage control. This is best accomplished by 1) applying continuous pressure to any accessible wound until the bleeding stops and 2) moving any dirty external debris, keeping the surrounding area clean with alcohol or boiled water. These simple measures may offer the best chance for survival until proper medical attention has been found.

Cauterization isn't the only method of self-medication we've seen on screen. Here are some other, though not necessarily medically-sound, techniques:

Anton Chigurh’s Knee (NO COUNTRY FOR OLD MEN)

During the impeccably choreographed street shootout scene Moss manages to throw a hail of buckshot into Chigurh’s knee. When the opponents crawl away injured but alive they both have to repair their own damage before continuing on their journeys. Watching Chigurh direct the attention of the pharmacy staff away with a gasoline tank explosion outside, makes us think that’s he’s done this before – scary. This allows the mop-headed villain to steal his tools and go about his business. While at his hotel room, the procedure of cutting off his pants, cleaning the wound, injecting painkillers into his shot knee and removing the bullet fragments is given squirm-inducing bold close-ups from the Coen Bros. I can’t even imagine how he would repair his broken arm at the end of the film.

Stitches for Rambo (FIRST BLOOD)

After a violent escape from the Sheriff’s office of Backwater USA, the softspoken, former Green Beret, John Rambo retreats to the woods fending off the ineffectual National Guard and local police. After falling a hundred feet from a rockcliff, Mr. Rambo is left with a nasty slice on his arm. Since he’s out in the woods all by himself, suddenly that needle and thread kit which always seemed useless in a compass, has a purpose. With precision we watch as Rambo sews up his arm, as the wound oozes out some wonderful blood squirts.

Removing Arnie’s Eye (THE TERMINATOR)

Perhaps it’s not fair to use Terminator as an example, because he’s technically a robot, but what the hell. With patient skill James Cameron shows his terminator perform some masterful surgery to his damaged eye. The grossest moment is no doubt when Arnie puts the scalpel into his eyeball thus freeing it up for removal. Of course Stan Winston’s animatronic special effects make it all look so real and gruesome and nothing a handy pair of black sunglasses couldn't hide.

Ash’s Chainsaw Arm (EVIL DEAD II)

One of the greatest fanboy scenes ever is Sam Raimi’s hilarious satire of Hollywood ‘montage scenes’. While fighting off the evil spirit which took control of his own arm, Ash ‘wins’ the battle by chopping off his own arm, which leaves our hero minus one appendage. No need to worry, a trip to the toolshed will fix that. With a series of quick cuts we watch Ash construct his now-famous chainsaw arm out of scrap metal accompanied by his sawed-off boomstick. Groovy.

Flourescent Flesh Wound (PREDATOR)

Midway through 'Predator', Dillon and his overmatched commando unit manage to fight the Alien off. In a wonderfully edited sequence, once again, realized by the master of physical and mechanical effects, Stan Winston, we get to see the vulnerability of the Predator for the first time. Alone in the trees the Predator opens up a neat little first aid kit on his arm, which has just the right instruments to heal his nasty flourscent blood-filled leg wound. The sequence is capped off with a loud bellow of pain which reverberates throughout the jungle. 

So think twice about emulating the methods used by these cinematic action heroes, consult a doctor first before performing any of these techniques.


Thomas Pluck said...

Now that was a great read. This post is what being a film nerd is all about.

There's a smaller subset of "removing the bullet" scenes, such as in Ronin and Master and Commander: The Far Side of the World.

Alan Bacchus said...

Thanks Tommy. Indeed bullet removal would make a great addendum or related posting.

Mr. Placebo said...

Aw, I would've rather seen this made into an episode of Mythbusters.

Anonymous said...

Drs. McDonald and Johnstone's debunking of movie-wound-cauterization is like seeing the Wizard behind the curtain in Oz. I have been educated, but at the loss of my action-movie-going innocence. I can no longer look at Rambo and see a realistic action hero.

Michael Kealy

Anonymous said...

Also missing is the post-amputation cautery of Kirk Douglas's right wrist in The Vikings

Anonymous said...

I think they cauterise a wound on Skeet Ulrich in 'Ride With The Devil', too.