First Aid

Rapid treatment of injuries can often spell the difference between living and dying. the tips presented here are for your use in the event that you find yourself in a survival situation and should only be used if no other options are available. As with anything seek out and get training in first aid, it could save the life of someone you love.
Triage
 Triage is the sorting of causalities by the severity of their injuries. Triage is done when ever there are more patients then you have the resources to handle, that could be anywhere from 2 to 200 patients. It all depends on what you have available to treat those that are injured and the number of personnel you have to treat them. There are four different categories in triage: The decision on who gets treated and who does not and what order the causalities are treated lies in the hands of the person with the most medical training at the scene of the incident. Often times that is the your teams' medic. It is a job that know one wants, yet has to be done in order to do the most good for the most people with the limited resources on hand.

And what if you have major resources to fall back on? Triage is still done the same way. I know from first hand experience what it is like to make the call on who lives and who dies. It is the crapiest thing I have ever had to do in my life and I have the ability to call on 5 medivac choppers and over 15 ambulances to move people to a Level 1 Trauma Center. Yet I still had to leave those that stood no chance for survival lying where I found them.

I hope that your groups' or teams' medic never has to make that call when TSHTF.

Doc

    Cold Weather injuries are often over looked by those of us who do not live in areas of the country where cold weather is the norm. To that end here a few tips.

Temperature alone is not a reliable guide as to whether a cold weather injury can occur. There are many additional factors which in various combinations determine cold injury occurrence. these factors include: As well there are other factor that can increase a person's chance of receiving a cold injury. they include: Now that we've hit on the factors that can increase a person's chances of getting a cold injury let's talk about HYPOTHERMIA.
both wind and water chill are forms of hypothermia. When a person dies from "exposure" it usually means hypothermia. Hypothermia means the lack of temperature, or more to the point, the bodies "core" temperature. The condition results when heat loss exceeds the body's production and retention of heat. The body can lose heat through: Thus sitting on wet clothing, sitting on cold surfaces, handling cold objects, contact with cold liquids, or even breathing extremely cold air can cause hypothermia. An unprotected head can loss up to 3/4 of the total body heat produced. And wet clothing extracts heat 240 times as fast as dry clothing.

The symptoms of hypothermia include:

The treatment of hypothermia is as follows: the proper equipment and training are great advantages when it comes to a cold injury. It does not take long to become a victim of cold injury so take a few extra minutes before setting out in cold weather to grab that extra coat or the warm gloves. Remember you can always take something off that you are wearing but you can't put on what you didn't bring with you.
other cold injuries are Immersion Foot also called "Trench Foot" is caused by the feet being exposed to cold wet conditions for extended periods of time without allowing time for the feet to get properly dried and warmed. This can, and often does, cause debilitating problems with your feet. Your best defense is to keep your feet as dry and warm as possible under the conditions you find yourself in.

Another more serious condition is frost bite. Frost bite is the actual freezing of your flesh. Although there are varying degrees/depths of frost bite they should ALL be treated as serious medical emergencies.
Tips for frost bite:
NEVER rub the frozen part(s) with snow, this can cause even more damage.
DO NOT thaw the frozen part(s) if there is a chance of refreezing, it is better to leave the part frozen then to thaw it and have it refreeze. If you know that it is going to be awhile before you can get proper medical attention or in a survival situation you stand a better chance of not having the frost bitten part amputated if it is left frozen. If you are in a position that you can stay warm and do not have to worry about refreezing then you should use a buddies body heat to thaw the part. Put feet inside of a coat and shirt directly on your buddies chest. Place hands in your arm pits or crotch. If you are inside and have access to tepid water (99-101 degrees F.) then rapid re-warming of the area is indicated. Watch for the signs and symptoms of hypothermia and shock, and again, if there is a chance that the part can be refrozen DO NOT thaw the part. Seek out advanced medical care as soon as possible.
Unlike the warmer months, what you think is "just plain old tired" may very well be death in the winter months.

FIRST AID


It is highly recommended that you seek CRP and first aid training. The knowledge that you gain may help you to save the life of someone you love.
 

Minor Wounds and Burns

For minor cuts and bruises it is important that you clean the wound thoroughly. Bleeding is not a major concern with small cuts and bruises, infection on the other hand is. Gentle clean the wound and wash the skin around the wound.  Apply a disinfectant solution such as iodine, betadine, hydrogen peroxide, etc.( make sure to dilute full strength antiseptics with sterile saline in a 50/50 ratio) and then cover the wound with a sterile dressing (Band-Aid).

Minor burns may be caused by flames, hot liquids, chemicals, electricity, or the sun. If you receive a minor burn you should immerse or flush the affected area with cold water until the pain subsides (about 5 minutes).
Minor burns are those that only cover small areas of the skin but may have some blistering. Or burns that cover large areas of skin but have no blistering (sun burns). If blistering is present DO NOT “pop” the blisters. Cover them with dry sterile dressings to help keep them clean and protect the skin. Under no circumstances should you ever put butter, shortening, mustard, “pickle juice” , lard, etc. on ANY burn.

If a burn that has blistering or charring occurs that involves the face, hands, or genitals call 911 right away!
Cover the effected area with dry sterile dressings and wait for EMS to arrive. Do not use any burn creams or other remedies on these types of burns.

Foreign Bodies in the Eye

If  foreign material gets into the eye DO NOT rub the eye! If the foreign object is beneath the upper eyelid grasp the eyelashes and and pull the lid away from the eye. Hold the lid in this way until tears start to freely flow. If this fails to work try the technique shown below (figure a). If the foreign object is glass, metal, or can not be removed. Cover BOTH of the persons eyes and get them to the emergency room ASAP.

If caustic or irritating material like battery acid, ammonia, etc. gets into the eye, immediately flush the eye with large amounts of water. When the person feels that the burning has stopped, bandage Both eyes and take them to the emergency room.


Controlling External Bleeding
Controlling external bleeding can be done many ways:
Extremity Wounds
Before applying any dressings, examine the victim to determine if there is more then one wound. For example a bullet will generally make an entrance and exit wound with the exit usually being larger then the entrance. Make sure to find all of the victims wounds.
Next cut away and remove any clothing around the wound to help prevent further contamination of the wound (tearing the clothing may result in rough handling of the wound).
Thoroughly clean the wound with soap and water. For large wounds rinse the wound thoroughly and cover the wound with dry, sterile dressings (4x4’s, 5x9’s, etc.), then using bandaging material (Kling, Kerlex, clean sheets, cut T-shirts, etc.) wrap the dressing tightly. Do not use so much pressure that you cut off the pulses distal (away from the heart) to the injury but enough that the dressings are held firmly in place.
If the bleeding has not stopped put another, larger, group of dressings OVER the first set and add another layer of bandaging material over that, again wrapping it tightly.
If after that the wound is still bleeding elevate it above the level of the heart and apply digital direct pressure, that is use the your hands directly over the dressings to apply pressure. If there is a possibility that the limb may be fractured you should NOT use elevation. The next step to control bleeding is the use of “Pressure Points”. To use a pressure point you simply apply pressure to the artery nearest the wound.
(See pressure points chart)
If after you have applied pressure dressings, digital direct pressure, and elevation the bleeding has not stopped then you would want to use a tourniquet. Tourniquet's are the LAST resort and should only be used to stop severe bleeding that can not be controlled any other way! Once a tourniquet is placed it should never be loosened and should only be removed by a doctor. Place the tourniquet around the limb between the wound and the trunk of the body. Try to place the tourniquet 2”-4” above the wound. (NEVER place a tourniquet directly on a wound!) When possible place the tourniquet over a smoothed down sleeve or pants leg to prevent the skin from being pinched or twisted. (Damaging the skin may deprive a surgeon of the skin and require the amputation of more of the limb then might otherwise be needed). Protection of the skin reduces pain. (Application of a tourniquet usually means that the effected limb will be amputated below the tourniquet site. So use care in the application of tourniquets). Tighten the tourniquet only tight enough to stop the flow of blood. If a pulse can be felt in the intact wrist or foot of the affected limb before the application of the tourniquet, stoppage of the pulse will let you know that it is tight enough. After the tourniquet is properly tightened, arterial (spurting) bleeding will stop right away; but bleeding from the veins in the lower part of the limb will continue until they drain of blood already in them. DO NOT try to stop this bleeding.
(See diagram for tourniquet placement)
The next thing to do after you have dressed and bandaged all the person's wounds is to treat for shock. Shock occurs when the amount of blood a person has does not meet the demand for blood that the person's body has. Shock can and often does kill. To treat for shock position the person on their back, loosen any restrictive clothing (shirt collars, pants, etc.), elevate their feet above the level of their heart (4” – 6”), and cover them with blankets or coats to keep them warm and keep them calm. Make sure that 911 has been called and that medical help is on the way.
(See shock treatment diagram)

Wounds of the Chest and Abdomen


All wounds to the chest should be covered by occlusive dressings (Vaseline gauze, saran wrap, clean trash bag liner, etc.) prior to placing sterile dressings over the wound and bandaging it (this includes wounds to the upper back).
If the person has a large abdominal wound with organs protruding DO NOT try to put them back in! Just cover them with moist, sterile, bulky dressings and treat for shock. Under no circumstance should you ever give someone with an abdominal wound anything to eat or drink.

Pressure Points



Dressings & Bandages


Fractures


There are two types of fractures, open and closed. Open fractures are fractures that have pieces of the bone protruding through the skin. Usually there is bleeding that goes along with this type of fracture. NEVER try to push the bone ends back under the skin. Instead place bulky, dry, sterile dressings over the bone ends and splint in the position you find the extremity in.
Closed fractures usually have no external bleeding. If someone has a closed fracture DO NOT try to straighten it out. Splint it in the position you find it in. Be very careful not to move broken limbs around too much as this can cause an increase in pain as well as possibly cut arteries and veins near the fracture site.



Moving Victims


The only time that you should move an accident victim is if they are in further danger to their life. You must weigh the benefits and hazards of moving them carefully. Moving someone with a neck injury that can still move all their fingers and toes could result in paralysis or death. You must use good, sound common sense when it comes to moving the victims of accidents. “Life over limb” is a good measuring stick to go by. Ask yourself “Can this person die if I do not move them?” If the answer is yes then you should do so. If on the other hand they are not in any immediate danger of loosing their life you should leave as they are and wait for emergency medical personnel to arrive.
If you must move someone that you think may have neck or back injuries you should do everything you can to keep the neck and back in a straight line. Making sure to keep the neutral alignment of the neck and back (neutral meaning the position the neck and back are in when a person lies “flat” on the floor).
One way to do this is to drag the person by grasping their shirt at the shoulders, supporting their neck in a neutral position with your arms and pulling them backwards along the ground.

If on the other hand you do not have reason to think that there may be a neck or back injury the fireman's carry can be used.

Anyone who has fallen 5’ or more, been in an auto accident, been struck in the head, or you just think may have a neck or back injury should be treated as such. Always remember that when it comes to moving injured persons that “life over limb” is the first rule and the second is “Dead hero's can't save lives”. Do not put yourself into any situation that you can not safely get yourself and the victim out of.
If in doubt about your ability to safely extricate someone from a potentially life threatening situation WAIT for trained rescue personnel.



How to Apply a Tourniquet

First Aid Kits


Below are listed the contents of first aid kits both for you as an individual and for use in your 72 hr kit. These lists are good basic starting points for you to build upon. You will need to tailor them to fit your situation by adding the things that you think you will need (blood pressure medication, heart pills, etc.).

Personal First Aid Kit

72 hr Kit First Aid Kit

I strongly urge you to seek out and get training in CPR and First Aid through the American Red Cross, The American Heart Association, or by taking an EMT course. I hope that the information that I have put together will be helpful to you and your loved ones.
Doc

Wound Care


The use of antibiotics after TSHTF may or may not be available, therefore as an alternative I give you the following.
Doc

Given some of the draw backs of antibiotic therapy after TSHTF the use of granulated sugar for the treatment of infected wounds offers a practical and proven approach. Sugar therapy consists of every day granulated sugar and povidone-iodine to enhance wound healing.
First, as with any wound, clean and debrid the wound, make sure that bleeding has stopped and the patient is in a stable condition as far as blood loss. (A wait of 24-48 hours is ok prior to application of the sugar/PI solution. During the delay a simple dressing of PI is applied.)
Deep wounds are treated by pouring granulated sugar into the wound, filling all cavities, and covering the wound with sterile gauze sponges soaked in PI solution.

Superficial wounds are treated by coating a PI soaked sterile gauze with approx. .65-.70 cm thickness of sugar and applying to the wound.

In a couple of hours the sugar is dissolved into a "syrup" by the body fluids drawn into the wound. The effect is osmotic shock on the bacteria since they need water for growth. this "syrup has little antibacterial effect though and may accelerate rather then inhibit growth of bacteria. It is for this reason that the wound must be cleaned with water and repacked 1-4 times a day (or as soon as the sugar turns into "syrup") with more sugar so as to keep drawing fluid from the environment of the bacteria.

A supplier of a commercially available sugar/ PI compound is distributed by:
Sugardyne Pharmaceuticals Inc.
Greenville, MS 38701

I hope that this information will help in your preparedness preparations.

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Here are some links to first aid related sites: