Constitutional Emergency

Field 1st Aid. Each member should have a copy in thier personal gear.

Medical Emergencies
Medical Emergencies................................................................................................................................................1
Breathing Problems...............................................................................................................................................2
Severe Bleeding ....................................................................................................................................................2
Shock.....................................................................................................................................................................2
Lifesaving Steps ....................................................................................................................................................2
Open Airway and Maintain.................................................................................................................................2
Control Bleeding ................................................................................................................................................3
Prevent and Treat Shock ...................................................................................................................................7
Bone And Joint Injury ............................................................................................................................................8
Fractures............................................................................................................................................................8
Dislocations........................................................................................................................................................9
Sprains...............................................................................................................................................................9
Bites And Stings ....................................................................................................................................................9
Treatment.........................................................................................................................................................10
Bee and Wasp Stings ......................................................................................................................................10
Spider Bites and Scorpion Stings .....................................................................................................................10
Snakebites .......................................................................................................................................................11
Wounds................................................................................................................................................................12
Open Wounds..................................................................................................................................................12
Skin Diseases and Ailments .............................................................................................................................13
Boils .................................................................................................................................................................13
Fungal Infections..............................................................................................................................................13
Rashes.............................................................................................................................................................13
Trench Foot......................................................................................................................................................14
Burns................................................................................................................................................................14
Environmental Injuries .........................................................................................................................................14
Heatstroke........................................................................................................................................................14
Diarrhea ...........................................................................................................................................................15
Intestinal Parasites...........................................................................................................................................15
Cold Injuries.........................................................................................................................................................15
Prevent Cold Injuries........................................................................................................................................15
Hypothermia.....................................................................................................................................................16
Frostbite ...........................................................................................................................................................16
Trench Foot and Immersion Foot .....................................................................................................................17
Dehydration......................................................................................................................................................17
Sunburn ...........................................................................................................................................................17
Snow Blindness ...............................................................................................................................................18
Constipation .....................................................................................................................................................18
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Breathing Problems
Any one of the following can cause airway obstruction, resulting in stopped breathing:
Foreign matter in mouth of throat that obstructs the opening to the trachea.
Face or neck injuries.
Inflammation and swelling of mouth and throat caused by inhaling smoke, flames, and irritating vapors or
by an allergic reaction.
"Kink" in the throat (caused by the neck bent forward so that the chin rests upon the chest) may block the
passage of air.
Tongue blocks passage of air to the lungs upon unconsciousness. When an individual is unconscious, the
muscles of the lower jaw and tongue relax as the neck drops forward, causing the lower jaw to sag and
the tongue to drop back and block the passage of air.
Severe Bleeding
Severe bleeding from any major blood vessel in the body is extremely dangerous. The loss of 1 liter of blood will
produce moderate symptoms of shock. The loss of 2 liters will produce a severe state of shock that places the
body in extreme danger. The loss of 3 liters is usually fatal.
Shock
Shock (acute stress reaction) is not a disease in itself. It is a clinical condition characterized by symptoms that
arise when cardiac output is insufficient to fill the arteries with blood under enough pressure to provide an
adequate blood supply to the organs and tissues.
Lifesaving Steps
Control panic, both your own and the victim's. Reassure him and try to keep him quiet. Perform a rapid physical
exam. Look for the cause of the injury and follow the ABCs of first aid, starting with the airway and breathing, but
be discerning. A person may die from arterial bleeding more quickly than from an airway obstruction in some
cases.
Open Airway and Maintain
You can open an airway and maintain it by using the following steps.
Step 1.
Check if the victim has a partial or complete airway obstruction. If he can cough or speak, allow him to
clear the obstruction naturally. Stand by, reassure the victim, and be ready to clear his airway and perform mouthto-
mouth resuscitation should he become unconscious. If his airway is completely obstructed, administer
abdominal thrusts until the obstruction is cleared.
Step 2.
Using a finger, quickly sweep the victim's mouth clear of any foreign objects, broken teeth, dentures,
sand.
Step 3.
Using the jaw thrust method, grasp the angles of the victim's lower jaw and lift with both hands, one on
each side, moving the jaw forward. For stability, rest your elbows on the surface on which the victim is lying. If his
lips are closed, gently open the lower lip with your thumb (Figure 4-1).
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Step 4.
With the victim's airway open, pinch his nose closed with your thumb and forefinger and blow two
complete breaths into his lungs. Allow the lungs to deflate after the second inflation and perform the following:
Look for his chest to rise and fall.
Listen for escaping air during exhalation.
Feel for flow of air on your cheek.
Step 5.
If the forced breaths do not stimulate spontaneous breathing, maintain the victim's breathing by
performing mouth-to-mouth resuscitation.
Step 6.
There is danger of the victim vomiting during mouth-to-mouth resuscitation. Check the victim's mouth
periodically for vomit and clear as needed.
Note: Cardiopulmonary resuscitation (CPR) may be necessary after cleaning the airway, but only
after major bleeding is under control. See FM 21-20, the American Heart Association manual, the
Red Cross manual, or most other first aid books for detailed instructions on CPR.
Control Bleeding
In a survival situation, you must control serious bleeding immediately because replacement fluids normally are not
available and the victim can die within a matter of minutes. External bleeding falls into the following classifications
(according to its source):
Arterial. Blood vessels called arteries carry blood away from the heart and through the body. A cut artery
issues
bright red blood from the wound in distinct spurts or pulses that correspond to the rhythm of the
heartbeat. Because the blood in the arteries is under high pressure, an individual can lose a large volume
of blood in a short period when damage to an artery of significant size occurs. Therefore, arterial bleeding
is the most serious type of bleeding. If not controlled promptly, it can be fatal.
Venous. Venous blood is blood that is returning to the heart through blood vessels called veins. A steady
flow of
dark red, maroon, or bluish blood characterizes bleeding from a vein. You can usually control
venous bleeding more easily than arterial bleeding.
Capillary. The capillaries are the extremely small vessels that connect the arteries with the veins.
Capillary bleeding most commonly occurs in minor cuts and scrapes. This type of bleeding is not difficult
to control.
You can control external bleeding by direct pressure, indirect (pressure points) pressure, elevation, digital ligation,
or tourniquet.
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Direct Pressure
The most effective way to control external bleeding is by applying pressure directly over the wound. This pressure
must not only be firm enough to stop the bleeding, but it must also be maintained long enough to "seal off" the
damaged surface.
If bleeding continues after having applied direct pressure for 30 minutes, apply a pressure dressing. This dressing
consists of a thick dressing of gauze or other suitable material applied directly over the wound and held in place
with a tightly wrapped bandage (Figure 4-2). It should be tighter than an ordinary compression bandage but not so
tight that it impairs circulation to the rest of the limb. Once you apply the dressing,
do not remove it, even when
the dressing becomes blood soaked.
Leave the pressure dressing in place for 1 or 2 days, after which you can remove and replace it with a smaller
dressing. In the long-term survival environment, make fresh, daily dressing changes and inspect for signs of
infection.
Elevation
Raising an injured extremity as high as possible above the heart's level slows blood loss by aiding the return of
blood to the heart and lowering the blood pressure at the wound. However, elevation alone will not control
bleeding entirely; you must also apply direct pressure over the wound. When treating a snakebite, however, keep
the extremity lower than the heart.
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Pressure Points
A pressure point is a location where the main artery to the wound lies near the surface of the skin or where the
artery passes directly over a bony prominence (Figure 4-3). You can use digital pressure on a pressure point to
slow arterial bleeding until the application of a pressure dressing. Pressure point control is not as effective for
controlling bleeding as direct pressure exerted on the wound. It is rare when a single major compressible artery
supplies a damaged vessel.
If you cannot remember the exact location of the pressure points, follow this rule: Apply pressure at the end of the
joint just above the injured area. On hands, feet, and head, this will be the wrist, ankle, and neck, respectively.
WARNING
Use caution when applying pressure to the neck. Too much pressure for too long may cause
unconsciousness or death. Never place a tourniquet around the neck.
Maintain pressure points by placing a round stick in the joint, bending the joint over the stick, and then keeping it
tightly bent by lashing. By using this method to maintain pressure, it frees your hands to work in other areas.
Digital Ligation
You can stop major bleeding immediately or slow it down by applying pressure with a finger or two on the
bleeding end of the vein or artery. Maintain the pressure until the bleeding stops or slows down enough to apply a
pressure bandage, elevation, and so forth.
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Tourniquet
Use a tourniquet only when direct pressure over the bleeding point and all other methods did not control the
bleeding. If you leave a tourniquet in place too long, the damage to the tissues can progress to gangrene, with a
loss of the limb later. An improperly applied tourniquet can also cause permanent damage to nerves and other
tissues at the site of the constriction.
If you must use a tourniquet, place it around the extremity, between the wound and the heart, 5 to 10 centimeters
above the wound site (Figure 4-4). Never place it directly over the wound or a fracture. Use a stick as a handle to
tighten the tourniquet and tighten it only enough to stop blood flow. When you have tightened the tourniquet, bind
the free end of the stick to the limb to prevent unwinding.
After you secure the tourniquet, clean and bandage the wound. A lone survivor
does not remove or release an
applied tourniquet. In a buddy system, however, the buddy can release the tourniquet pressure every 10 to 15
minutes for 1 or 2 minutes to let blood flow to the rest of the extremity to prevent limb loss.
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Prevent and Treat Shock
Anticipate shock in all injured personnel. Treat all injured persons as follows, regardless of what symptoms
appear (Figure 4-5):
If the victim is conscious, place him on a level surface with the lower extremities elevated 15 to 20
centimeters. If the victim is unconscious, place him on his side or abdomen with his head turned to one
side to prevent choking on vomit, blood, or other fluids.
If you are unsure of the best position, place the victim perfectly flat. Once the victim is in a shock position,
do not move him.
Maintain body heat by insulating the victim from the surroundings and, in some instances, applying
external heat. If wet, remove all the victim's wet clothing as soon as possible and replace with dry
clothing.
Improvise a shelter to insulate the victim from the weather. Use warm liquids or foods, a prewarmed
sleeping bag, another person, warmed water in canteens, hot rocks wrapped in clothing, or fires on either
side of the victim to provide external warmth.
If the victim is conscious, slowly administer small doses of a warm salt or sugar solution, if available. If the
victim is unconscious or has abdominal wounds, do not give fluids by mouth.
Have the victim rest for at least 24 hours.
If you are a lone survivor, lie in a depression in the ground, behind a tree, or any other place out of the
weather, with your head lower than your feet.
If you are with a buddy, reassess your patient constantly.
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Bone And Joint Injury
You could face bone and joint injuries that include fractures, dislocations, and sprains.
Fractures
There are basically two types of fractures: open and closed. With an open (or compound) fracture, the bone
protrudes through the skin and complicates the actual fracture with an open wound. After setting the fracture, treat
the wound as any other open wound. The closed fracture has no open wounds. Follow the guidelines for
immobilization, and set and splint the fracture.
The signs and symptoms of a fracture are pain, tenderness, discoloration, swelling deformity, loss of function, and
grating (a sound or feeling that occurs when broken bone ends rub together). The dangers with a fracture are the
severing or the compression of a nerve or blood vessel at the site of fracture. For this reason minimum
manipulation should be done, and only very cautiously. If you notice the area below the break becoming numb,
swollen, cool to the touch, or turning pale, and the victim shows signs of shock, a major vessel may have been
severed. You must control this internal bleeding. Rest the victim for shock, and replace lost fluids. Often you must
maintain traction during the splinting and healing process. You can effectively pull smaller bones such as the arm
or lower leg by hand. You can create traction by wedging a hand or foot in the V-notch of a tree and pushing
against the tree with the other extremity. You can then splint the break. Very strong muscles hold a broken
thighbone (femur) in place making it difficult to maintain traction during healing. You can make an improvised
traction splint using natural material (Figure 4-6) as follows:
Get two forked branches or saplings at least 5 centimeters in diameter. Measure one from the patient's
armpit to 20 to 30 centimeters past his unbroken leg. Measure the other from the groin to 20 to 30
centimeters past the unbroken leg. Ensure that both extend an equal distance beyond the end of the leg.
Pad the two splints. Notch the ends without forks and lash a 20- to 30-centimeter cross member made
from a 5-centimeter diameter branch between them.
Using available material (vines, cloth, rawhide), tie the splint around the upper portion of the body and
down the length of the broken leg. Follow the splinting guidelines.
With available material, fashion a wrap that will extend around the ankle, with the two free ends tied to the
cross member. Place a 10- by 2.5-centimeter stick in the middle of the free ends of the ankle wrap
between the cross member and the foot. Using the stick, twist the material to make the traction easier.
Continue twisting until the broken leg is as long or slightly longer than the unbroken leg. Lash the stick to
maintain traction. Over time you may lose traction because the material weakened. Check the traction
periodically. If you must change or repair the splint, maintain the traction manually for a short time.
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Dislocations
Dislocations are the separations of bone joints causing the bones to go out of proper alignment. These
misalignments can be extremely painful and can cause an impairment of nerve or circulatory function below the
area affected. You must place these joints back into alignment as quickly as possible. Signs and symptoms of
dislocations are joint pain, tenderness, swelling, discoloration, limited range of motion, and deformity of the joint.
You treat dislocations by reduction, immobilization, and rehabilitation.
Reduction or "setting" is placing the bones back into their proper alignment. You can use several methods, but
manual traction or the use of weights to pull the bones are the safest and easiest. Once performed, reduction
decreases the victim's pain and allows for normal function and circulation. Without an X ray, you can judge proper
alignment by the look and feel of the joint and by comparing it to the joint on the opposite side.
Immobilization is nothing more than splinting the dislocation after reduction. You can use any field-expedient
material for a splint or you can splint an extremity to the body. The basic guidelines for splinting are--
Splint above and below the fracture site.
Pad splints to reduce discomfort.
Check circulation below the fracture after making each tie on the splint.
To rehabilitate the dislocation, remove the splints after 7 to 14 days. Gradually use the injured joint until fully
healed.
Sprains
The accidental overstretching of a tendon or ligament causes sprains. The signs and symptoms are pain,
swelling, tenderness, and discoloration (black and blue).
When treating sprains, think RICE—
R
Rest injured area.
I
Ice for 24 hours, then heat after that.
C
Compression-wrapping and/or splinting to help stabilize. If possible, leave the boot on a
sprained ankle unless circulation is compromised.
E
Elevation of the affected area.
Bites And Stings
Insects and related pests are hazards in a survival situation. They not only cause irritations, but they are often
carriers of diseases that cause severe allergic reactions in some individuals. In many parts of the world you will be
exposed to serious, even fatal, diseases not encountered in the United States.
Ticks
can carry and transmit diseases, such as Rocky Mountain spotted fever common in many parts of the
United States. Ticks also transmit the Lyme disease.
Mosquitoes
may carry malaria, dengue, and many other diseases.
Flies
can spread disease from contact with infectious sources. They are causes of sleeping sickness, typhoid,
cholera, and dysentery.
Fleas
can transmit plague.
Lice
can transmit typhus and relapsing fever.
The best way to avoid the complications of insect bites and stings is to keep immunizations (including booster
shots) up-to-date, avoid insect-infested areas, use netting and insect repellent, and wear all clothing properly.
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If you get bitten or stung, do not scratch the bite or sting, it might become infected. Inspect your body at least
once a day to ensure there are no insects attached to you. If you find ticks attached to your body, cover them with
a substance, such as Vaseline, heavy oil, or tree sap, that will cut off their air supply. Without air, the tick releases
its hold, and you can remove it. Take care to remove the whole tick. Use tweezers if you have them. Grasp the
tick where the mouth parts are attached to the skin. Do not squeeze the tick's body. Wash your hands after
touching the tick. Clean the tick wound daily until healed.
Treatment
It is impossible to list the treatment of all the different types of bites and stings. Treat bites and stings as follows:
If antibiotics are available for your use, become familiar with them before deployment and use them.
Predeployment immunizations can prevent most of the common diseases carried by mosquitoes and
some carried by flies.
The common fly-borne diseases are usually treatable with penicillins or erythromycin.
Most tick-, flea-, louse-, and mite-borne diseases are treatable with tetracycline.
Most antibiotics come in 250 milligram (mg) or 500 mg tablets. If you cannot remember the exact dose
rate to treat a disease, 2 tablets, 4 times a day for 10 to 14 days will usually kill any bacteria.
Bee and Wasp Stings
If stung by a bee, immediately remove the stinger and venom sac, if attached, by scraping with a fingernail or a
knife blade. Do not squeeze or grasp the stinger or venom sac, as squeezing will force more venom into the
wound. Wash the sting site thoroughly with soap and water to lessen the chance of a secondary infection. If you
know or suspect that you are allergic to insect stings, always carry an insect sting kit with you. Relieve the itching
and discomfort caused by insect bites by applying--
Cold compresses.
A cooling paste of mud and ashes.
Sap from dandelions.
Coconut meat.
Crushed cloves of garlic.
Onion.
Spider Bites and Scorpion Stings
The black widow spider is identified by a red hourglass on its abdomen. Only the female bites, and it has a
neurotoxic venom. The initial pain is not severe, but severe local pain rapidly develops. The pain gradually
spreads over the entire body and settles in the abdomen and legs. Abdominal cramps and progressive nausea,
vomiting, and a rash may occur. Weakness, tremors, sweating, and salivation may occur. Anaphylactic reactions
can occur. Symptoms begin to regress after several hours and are usually gone in a few days. Threat for shock.
Be ready to perform CPR. Clean and dress the bite area to reduce the risk of infection. An antivenin is available.
The funnelweb spider is a large brown or gray spider found in Australia. The symptoms and the treatment for its
bite are as for the black widow spider.
The brown house spider or brown recluse spider is a small, light brown spider identified by a dark brown violin on
its back. There is no pain, or so little pain, that usually a victim is not aware of the bite. Within a few hours a
painful red area with a mottled cyanotic center appears. Necrosis does not occur in all bites, but usually in 3 to 4
days, a star-shaped, firm area of deep purple discoloration appears at the bite site. The area turns dark and
mummified in a week or two. The margins separate and the scab falls off, leaving an open ulcer. Secondary
infection and regional swollen lymph glands usually become visible at this stage.
The outstanding characteristic of the brown recluse bite is an ulcer that does not heal but persists for weeks or
months. In addition to the ulcer, there is often a systemic reaction that is serious and may lead to death.
Reactions (fever, chills, joint pain, vomiting, and a generalized rash) occur chiefly in children or debilitated
persons.
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Tarantulas are large, hairy spiders found mainly in the tropics. Most do not inject venom, but some South
American species do. They have large fangs. If bitten, pain and bleeding are certain, and infection is likely. Treat
a tarantula bite as for any open wound, and try to prevent infection. If symptoms of poisoning appear, treat as for
the bite of the black widow spider.
Scorpions are all poisonous to a greater or lesser degree. There are two different reactions, depending on the
species:
Severe local reaction only, with pain and swelling around the area of the sting. Possible prickly sensation
around the mouth and a thick-feeling tongue.
Severe systemic reaction, with little or no visible local reaction. Local pain may be present. Systemic
reaction includes respiratory difficulties, thick-feeling tongue, body spasms, drooling, gastric distention,
double vision, blindness, involuntary rapid movement of the eyeballs, involuntary urination and
defecation, and heart failure. Death is rare, occurring mainly in children and adults with high blood
pressure or illnesses. Treat scorpion stings as you would a black widow bite.
Snakebites
The chance of a snakebite in a survival situation is rather small, if you are familiar with the various types of
snakes and their habitats. However, it could happen and you should know how to treat a snakebite. Deaths from
snakebites are rare. More than one-half of the snakebite victims have little or no poisoning, and only about onequarter
develop serious systemic poisoning. However, the chance of a snakebite in a survival situation can affect
morale, and failure to take preventive measures or failure to treat a snakebite properly can result in needless
tragedy. The primary concern in the treatment of snakebite is to limit the amount of eventual tissue destruction
around the bite area. A bite wound, regardless of the type of animal that inflicted it, can become infected from
bacteria in the animal's mouth. With nonpoisonous as well as poisonous snakebites, this local infection is
responsible for a large part of the residual damage that results. Snake venoms not only contain poisons that
attack the victim's central nervous system (neurotoxins) and blood circulation (hemotoxins), but also digestive
enzymes (cytotoxins) to aid in digesting their prey. These poisons can cause a very large area of tissue death,
leaving a large open wound. This condition could lead to the need for eventual amputation if not treated. Shock
and panic in a person bitten by a snake can also affect the person's recovery. Excitement, hysteria, and panic can
speed up the circulation, causing the body to absorb the toxin quickly. Signs of shock occur within the first 30
minutes after the bite. Before you start treating a snakebite, determine whether the snake was poisonous or
nonpoisonous. Bites from a nonpoisonous snake will show rows of teeth. Bites from a poisonous snake may have
rows of teeth showing, but will have one or more distinctive puncture marks caused by fang penetration.
Symptoms of a poisonous bite may be spontaneous bleeding from the nose and anus, blood in the urine, pain at
the site of the bite, and swelling at the site of the bite within a few minutes or up to 2 hours later. Breathing
difficulty, paralysis, weakness, twitching, and numbness are also signs of neurotoxic venoms. These signs usually
appear 1.5 to 2 hours after the bite. If you determine that a poisonous snake bit an individual, take the following
steps:
Reassure the victim and keep him still.
Set up for shock and force fluids or give an intravenous (IV).
Remove watches, rings, bracelets, or other constricting items.
Clean the bite area.
Maintain an airway (especially if bitten near the face or neck) and be prepared to administer mouth-tomouth
resuscitation or CPR.
Use a constricting band between the wound and the heart.
Immobilize the site.
Remove the poison as soon as possible by using a mechanical suction device or by squeezing.
Do not--
Give the victim alcoholic beverages or tobacco products.
Give morphine or other central nervous system (CNS) depressors.
Make any deep cuts at the bite site. Cutting opens capillaries that in turn open a direct route into the
blood stream for venom and infection.
Put your hands on your face or rub your eyes, as venom may be on your hands. Venom may cause
blindness.
Break open the large blisters that form around the bite site.
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Note: If medical treatment is over one hour away, make an incision (no longer than 6 millimeters
and no deeper than 3 millimeter) over each puncture, cutting just deep enough to enlarge the
fang opening, but only through the first or second layer of skin. Place a suction cup over the bite
so that you have a good vacuum seal. Suction the bite site 3 to 4 times. Use mouth suction
only
as a last resort and only if you do not have open sores in your mouth.
Spit the envenomed
blood out and rinse your mouth with water. This method will draw out 25 to 30 percent of the
venom.
After caring for the victim as described above, take the following actions to minimize local effects:
If infection appears, keep the wound open and clean.
Use heat after 24 to 48 hours to help prevent the spread of local infection. Heat also helps to draw out an
infection.
Keep the wound covered with a dry, sterile dressing.
Have the victim drink large amounts of fluids until the infection is gone.
Wounds
An interruption of the skin's integrity characterizes wounds. These wounds could be open wounds, skin diseases,
frostbite, trench foot, and burns.
Open Wounds
Open wounds are serious in a survival situation, not only because of tissue damage and blood loss, but also
because they may become infected. Bacteria on the object that made the wound, on the individual's skin and
clothing, or on other foreign material or dirt that touches the wound may cause infection. By taking proper care of
the wound you can reduce further contamination and promote healing. Clean the wound as soon as possible after
it occurs by--
Removing or cutting clothing away from the wound.
Always looking for an exit wound if a sharp object, gun shot, or projectile caused a wound.
Thoroughly cleaning the skin around the wound.
Rinsing (not scrubbing) the wound with large amounts of water under pressure. You can use fresh urine if
water is not available.
The "open treatment" method is the safest way to manage wounds in survival situations. Do not try to close any
wound by suturing or similar procedures. Leave the wound open to allow the drainage of any pus resulting from
infection. As long as the wound can drain, it generally will not become life-threatening, regardless of how
unpleasant it looks or smells. Cover the wound with a clean dressing. Place a bandage on the dressing to hold it
in place. Change the dressing daily to check for infection. If a wound is gaping, you can bring the edges together
with adhesive tape cut in the form of a "butterfly" or "dumbbell" (Figure 4-7).
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In a survival situation, some degree of wound infection is almost inevitable. Pain, swelling, and redness around
the wound, increased temperature, and pus in the wound or on the dressing indicate infection is present. To treat
an infected wound--
Place a warm, moist compress directly on the infected wound. Change the compress when it cools,
keeping a warm compress on the wound for a total of 30 minutes. Apply the compresses three or four
times daily.
Drain the wound. Open and gently probe the infected wound with a sterile instrument.
Dress and bandage the wound.
Drink a lot of water.
Continue this treatment daily until all signs of infection have disappeared. If you do not have antibiotics and the
wound has become severely infected, does not heal, and ordinary debridement is impossible, consider maggot
therapy, despite its hazards:
Expose the wound to flies for one day and then cover it.
Check daily for maggots.
Once maggots develop, keep wound covered but check daily.
Remove all maggots when they have cleaned out all dead tissue and before they start on healthy tissue.
Increased pain and bright red blood in the wound indicate that the maggots have reached healthy tissue.
Flush the wound repeatedly with sterile water or fresh urine to remove the maggots.
Check the wound every four hours for several days to ensure all maggots have been removed.
Bandage the wound and treat it as any other wound. It should heal normally.
Skin Diseases and Ailments
Although boils, fungal infections, and rashes rarely develop into a serious health problem, they cause discomfort
and you should treat them.
Boils
Apply warm compresses to bring the boil to a head. Then open the boil using a sterile knife, wire, needle, or
similar item. Thoroughly clean out the pus using soap and water. Cover the boil site, checking it periodically to
ensure no further infection develops.
Fungal Infections
Keep the skin clean and dry, and expose the infected area to as much sunlight as possible.
Do not scratch the
affected area. During the Southeast Asian conflict, soldiers used antifungal powders, lye soap, chlorine bleach,
alcohol, vinegar, concentrated salt water, and iodine to treat fungal infections with varying degrees of success.
As
with any "unorthodox" method of treatment, use it with caution.
Rashes
To treat a skin rash effectively, first determine what is causing it. This determination may be difficult even in the
best of situations. Observe the following rules to treat rashes:
If it is moist, keep it dry.
If it is dry, keep it moist.
Do not scratch it.
Use a compress of vinegar or tannic acid derived from tea or from boiling acorns or the bark of a hardwood tree to
dry weeping rashes. Keep dry rashes moist by rubbing a small amount of rendered animal fat or grease on the
affected area. Remember, treat rashes as open wounds and clean and dress them daily. There are many
substances available to survivors in the wild or in captivity for use as antiseptics to treat wound: Again, use
noncommercially prepared materials with caution.
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Iodine tablets. Use 5 to 15 tablets in a liter of water to produce a good rinse for wounds during healing.
Garlic. Rub it on a wound or boil it to extract the oils and use the water to rinse the affected area.
Salt water. Use 2 to 3 tablespoons per liter of water to kill bacteria.
Bee honey. Use it straight or dissolved in water.
Sphagnum moss. Found in boggy areas worldwide, it is a natural source of iodine. Use as a dressing.
Trench Foot
This condition results from many hours or days of exposure to wet or damp conditions at a temperature just above
freezing. The nerves and muscles sustain the main damage, but gangrene can occur. In extreme cases the flesh
dies and it may become necessary to have the foot or leg amputated. The best prevention is to keep your feet
dry. Carry extra socks with you in a waterproof packet. Dry wet socks against your body. Wash your feet daily and
put on dry socks.
Burns
The following field treatment for burns relieves the pain somewhat, seems to help speed healing, and offers some
protection against infection:
First, stop the burning process. Put out the fire by removing clothing, dousing with water or sand, or by
rolling on the ground. Cool the burning skin with ice or water. For burns caused by white phosphorous,
pick out the white phosphorous with tweezers; do not douse with water.
Soak dressings or clean rags for 10 minutes in a boiling tannic acid solution (obtained from tea, inner bark
of hardwood trees, or acorns boiled in water).
Cool the dressings or clean rags and apply over burns.
Treat as an open wound.
Replace fluid loss.
Maintain airway.
Treat for shock.
Consider using morphine, unless the burns are near the face.
Environmental Injuries
Heatstroke, hypothermia, diarrhea, and intestinal parasites are environmental injuries you could face.
Heatstroke
The breakdown of the body's heat regulatory system (body temperature more than 40.5 degrees C [105 degrees
F]) causes a heatstroke. Other heat injuries, such as cramps or dehydration, do not always precede a heatstroke.
Signs and symptoms of heatstroke are--
Swollen, beet-red face.
Reddened whites of eyes.
Victim not sweating.
Unconsciousness or delirium, which can cause pallor, a bluish color to lips and nail beds (cyanosis), and
cool skin.
Note: By this time the victim is in severe shock. Cool the victim as rapidly as possible. Cool him
by dipping him in a cool stream. If one is not available, douse the victim with urine, water, or at
the very least, apply cool wet com-presses to all the joints, especially the neck, armpits, and
crotch. Be sure to wet the victim's head. Heat loss through the scalp is great. Administer IVs and
provide drinking fluids. You may fan the individual.
15
Expect, during cooling--
Vomiting.
Diarrhea.
Struggling.
Shivering.
Shouting.
Prolonged unconsciousness.
Rebound heatstroke within 48 hours.
Cardiac arrest; be ready to perform CPR.
Note: Treat for dehydration with lightly salted water.
Diarrhea
A common, debilitating ailment caused by a change of water and food, drinking contaminated water, eating
spoiled food, becoming fatigued, and using dirty dishes. You can avoid most of these causes by practicing
preventive medicine. If you get diarrhea, however, and do not have antidiarrheal medicine, one of the following
treatments may be effective:
Limit your intake of fluids for 24 hours.
Drink one cup of a strong tea solution every 2 hours until the diarrhea slows or stops. The tannic acid in
the tea helps to control the diarrhea. Boil the inner bark of a hardwood tree for 2 hours or more to release
the tannic acid.
Make a solution of one handful of ground chalk, charcoal, or dried bones and treated water. If you have
some apple pomace or the rinds of citrus fruit, add an equal portion to the mixture to make it more
effective. Take 2 tablespoons of the solution every 2 hours until the diarrhea slows or stops.
Intestinal Parasites
You can usually avoid worm infestations and other intestinal parasites if you take preventive measures. For
example, never go barefoot. The most effective way to prevent intestinal parasites is to avoid uncooked meat and
raw vegetables contaminated by raw sewage or human waste used as a fertilizer. However, should you become
infested and lack proper medicine, you can use home remedies. Keep in mind that these home remedies work on
the principle of changing the environment of the gastrointestinal tract. The following are home remedies you could
use:
Salt water. Dissolve 4 tablespoons of salt in 1 liter of water and drink. Do not repeat this treatment.
Tobacco. Eat 1 to 1.5 cigarettes. The nicotine in the cigarette will kill or stun the worms long enough for
your system to pass them. If the infestation is severe, repeat the treatment in 24 to 48 hours,
but no
sooner.
Kerosene. Drink 2 tablespoons of kerosene but no more. If necessary, you can repeat this treatment in 24
to 48 hours. Be careful not to inhale the fumes. They may cause lung irritation.
Hot peppers. Peppers are effective only if they are a steady part of your diet. You can eat them raw or put
them in soups or rice and meat dishes. They create an environment that is prohibitive to parasitic
attachment.
Cold Injuries
Prevent Cold Injuries
The best way to deal with injuries and sicknesses is to take measures to prevent them from happening in the first
place. Treat any injury or sickness that occurs as soon as possible to prevent it from worsening. The knowledge
of signs and symptoms and the use of the buddy system are critical in maintaining health. Following are cold
injuries that can occur.
16
Hypothermia
Hypothermia is the lowering of the body temperature at a rate faster than the body can produce heat. Causes of
hypothermia may be general exposure or the sudden wetting of the body by falling into a lake or spraying with fuel
or other liquids.
The initial symptom is shivering. This shivering may progress to the point that it is uncontrollable and interferes
with an individual's ability to care for himself. This begins when the body's core (rectal) temperature falls to about
35.5 degrees C (96 degrees F). When the core temperature reaches 35 to 32 degrees C (95 to 90 degrees F),
sluggish thinking, irrational reasoning, and a false feeling of warmth may occur. Core temperatures of 32 to 30
degrees C (90 to 86 degrees F) and below result in muscle rigidity, unconsciousness, and barely detectable signs
of life. If the victim's core temperature falls below 25 degrees C (77 degrees F), death is almost certain. To treat
hypothermia, re-warm the entire body. If there are means available, re-warm the person by first immersing the
trunk area only in warm water of 37.7 to 43.3 degrees C (100 to 110 degrees F).
CAUTION
Rewarming the total body in a warm water bath should be done only in a hospital environment because of the
increased risk of cardiac arrest and rewarming shock.
One of the quickest ways to get heat to the inner core is to give warm water enemas. Such an action, however,
may not be possible in a survival situation. Another method is to wrap the victim in a warmed sleeping bag with
another person who is already warm; both should be naked.
CAUTION
The individual placed in the sleeping bag with victim could also become a hypothermia victim if left in the bag too
long.
If the person is conscious, give him hot, sweetened fluids. One of the best sources of calories is honey or
dextrose; if unavailable, use sugar, cocoa, or a similar soluble sweetener.
CAUTION
Do not force an unconscious person to drink.
There are two dangers in treating hypothermia--rewarming too rapidly and "after drop." Rewarming too rapidly can
cause the victim to have circulatory problems, resulting in heart failure. After drop is the sharp body core
temperature drop that occurs when taking the victim from the warm water. Its probable muse is the return of
previously stagnant limb blood to the core (inner torso) area as recirculation occurs. Concentrating on warming
the core area and stimulating peripheral circulation will lessen the effects of after drop. Immersing the torso in a
warm bath, if possible, is the best treatment.
Frostbite
This injury is the result of frozen tissues. Light frostbite involves only the skin that takes on a dull whitish pallor.
Deep frostbite extends to a depth below the skin. The tissues become solid and immovable. Your feet, hands, and
exposed facial areas are particularly vulnerable to frostbite.
The best frostbite prevention, when you are with others, is to use the buddy system. Check your buddy's face
often and make sure that he checks yours. If you are alone, periodically cover your nose and lower part of your
face with your mittened hand.
17
The following pointers will aid you in keeping warm and preventing frostbite when it is extremely cold or when you
have less than adequate clothing:
Face. Maintain circulation by twitching and wrinkling the skin on your face making faces. Warm with your
hands.
Ears. Wiggle and move your ears. Warm with your hands.
Hands. Move your hands inside your gloves. Warm by placing your hands close to your body.
Feet. Move your feet and wiggle your toes inside your boots.
A loss of feeling in your hands and feet is a sign of frostbite. If you have lost feeling for only a short time, the
frostbite is probably light. Otherwise, assume the frostbite is deep. To rewarm a light frostbite, use your hands or
mittens to warm your face and ears. Place your hands under your armpits. Place your feet next to your buddy's
stomach. A deep frostbite injury, if thawed and refrozen, will cause more damage than a nonmedically trained
person can handle. Figure 15-2 lists some do's and don'ts regarding frostbite.
Do Don't
Periodically check
for frostbite.
Rewarm light
frostbite.
Keep injured areas
from refreezing.
Rub injury with snow.
Drink alcoholic beverages.
Smoke.
Try to thaw out a deep frostbite
injury if you are away from
definitive medical care.
Figure 15-2. Frostbite do's and don'ts.
Trench Foot and Immersion Foot
These conditions result from many hours or days of exposure to wet or damp conditions at a temperature just
above freezing. The symptoms are a sensation of pins and needles, tingling, numbness, and then pain. The skin
will initially appear wet, soggy, white, and shriveled. As it progresses and damage appears, the skin will take on a
red and then a bluish or black discoloration. The feet become cold, swollen, and have a waxy appearance.
Walking becomes difficult and the feet feel heavy and numb. The nerves and muscles sustain the main damage,
but gangrene can occur. In extreme cases, the flesh dies and it may become necessary to have the foot or leg
amputated. The best prevention is to keep your feet dry. Carry extra socks with you in a waterproof packet. You
can dry wet socks against your torso (back or chest). Wash your feet and put on dry socks daily.
Dehydration
When bundled up in many layers of clothing during cold weather, you may be unaware that you are losing body
moisture. Your heavy clothing absorbs the moisture that evaporates in the air. You must drink water to replace
this loss of fluid. Your need for water is as great in a cold environment as it is in a warm environment. One way to
tell if you are becoming dehydrated is to check the color of your urine on snow. If your urine makes the snow dark
yellow, you are becoming dehydrated and need to replace body fluids. If it makes the snow light yellow to no
color, your body fluids have a more normal balance. Exposure to cold increases urine output. It also decreases
body fluids that you must replace.
Sunburn
Exposed skin can become sunburned even when the air temperature is below freezing. The sun's rays reflect at
all angles from snow, ice, and water, hitting sensitive areas of skin--lips, nostrils, and eyelids. Exposure to the sun
results in sunburn more quickly at high altitudes than at low altitudes. Apply sunburn cream or lip salve to your
face when in the sun.
18
Snow Blindness
The reflection of the sun's ultraviolet rays off a snow-covered area causes this condition. The symptoms of snow
blindness are a sensation of grit in the eyes, pain in and over the eyes that increases with eyeball movement, red
and teary eyes, and a headache that intensifies with continued exposure to light. Prolonged exposure to these
rays can result in permanent eye damage. To treat snow blindness, bandage your eyes until the symptoms
disappear. You can prevent snow blindness by wearing sunglasses. If you don't have sunglasses, improvise. Cut
slits in a piece of cardboard, thin wood, tree bark, or other available material (Figure 15-3). Putting soot under
your eyes will help reduce shine and glare.
Constipation
It is very important to relieve yourself when needed. Do not delay because of the cold condition. Delaying
relieving yourself because of the cold, eating dehydrated foods, drinking too little liquid, and irregular eating habits
can cause you to become constipated. Although not disabling, constipation can cause some discomfort. Increase
your fluid intake to at least 2 liters above your normal 2 to 3 liters daily intake and, if available, eat fruit and other
foods that will loosen the stool.

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