What Initial Actions Should Be Taken by Survival Medics?
Prior to anyone participating in an outdoor adventure in the wilderness, it is highly recommended they attend and pass a first-aid course provided by professionals. It is only through proper professional education that the various techniques associated with providing life saving measures can be taught and learned correctly.
In an emergency situation, in which several people may be injured, it is imperative that responding survival medics pause long enough to inspect the immediate vicinity. This inspection should focus on discovering any hidden dangers that could disable the medic, such as fire, unstable structures, falling debris, exposed electric wires, and or hazardous wreckage that has the potential to cause injury and/or death. When possible a preliminary exam should be conducted on the injured person without moving them; however, if there are still dangers present, it may be necessary to transport the patient to a safer location.
Upon discovering an injured individual and addressing the situation, it is of utmost importance that you remain focused on the three most significant priorities. Known by the acronym ABC, those priorities are; Airway, Breathing, and Circulation. With that in mind, check to insure that the injured individual is breathing and that their airway is unobstructed. Once this has been established, check for pulse and any signs of serious bleeding. If blood loss is significant attend the injury and reduce, or stop the flow of blood. If the person in unconscious, then inspect them for potential spinal injuries. If spinal injuries are present and identifiable, do not move the injured person as this may result in further exacerbating the injury, or cause death.
If no spinal injury is present, then place the injured individual in the “recovery position.” The recovery position is performed by placing the individual face down with a leg and arm, on the same side of the body, bent at the knee and elbow. This protective position is designed to keep the unconscious, immobile, and injured individual from choking should they have the urge to vomit.
WHAT ARE THE TOP PRIORITIES FOR TREATING INJURED PATIENTS?
In any survival situation the recommended procedure for prioritizing treatment of patients follows the ABC format explained above. You must first check for breathing. If the victim is unable to breathe on their own, it then becomes necessary to inspect the airway for obstruction, restore proper breathing through CPR (Cardio-Pulmonary Resuscitation), maintain that breathing and ensure a heartbeat by checking for pulse. You can check for pulse by pressing your fingers against the thumb side of the injured person’s wrist, or near their windpipe which can be located along the angle of the jawline. After those initial steps you must locate and control any signs of significant blood loss by cleaning, disinfecting, and dressing any and all wounds and/or burns. Once any blood loss has been controlled, the next step in the process should entail the immobilization of any and all fractured bones. After fractures have been attended to the patient must be treated for shock.
How to Properly Maintain Respiration/Breathing
As mentioned earlier, the first order of business is finding, enrolling, and taking a professionally certified CPR course. The information taught in such a class will provide you with the required knowledge on how to perform the life saving techniques of restoring and maintaining respiration, checking and inspecting airways for obstructions, and restoring and maintaining a heartbeat. In the event an injured person stops breathing, and/or their heart stops beating, they are considered “clinically deceased.” Within 4-6 minutes of this occurrence, damage to the brain begins; 10 minutes after the heart stops beating the individual is considered “biologically deceased.” At this stage significant, irreversible brain damage has occurred, and restoration of respiration and heartbeat is considered impossible. Clinical death on the other hand, in many cases, can be reversed without significant damage to the brain or body. When an individual stops breathing it is normally a direct result of one of the following reasons:
- Oxygen deprivation. The injured person is unable to breathe because the environment they are in lacks sufficient oxygen to accommodate their demands.
- Chest compression. The injured person is unable to draw breath because an object too heavy to move is resting on their chest.
- The injured person is unable to breathe due to an abundance of liquid occupying the lungs.
- Electrical shock. The injured person is unable to breathe because they have come in contact with an exposed, ungrounded electrical device.
- Inflammation of airways. The injured person is unable to breathe due to inhalation of smoke, toxic gases, and/or flame from a fire.
- The injured person is unable to breathe because something is blocking the upper airways.
- The injured person is unable to breathe due to face/neck injuries, or an obstructive object has become lodged in the nasal and/or nasal cavities.
How to Perform Mouth-to-Mouth Resuscitation
In the event mouth-to-mouth resuscitation is called for in an emergency situation, the following information should serve you well. The first step in the procedure involves placing the injured person on their back, this is best done by rolling the body from the side. Kneel down next to the midsection of the patient, place one hand behind the neck, and use the opposite hand to grasp the belt, or waistline of the person’s pants, then gently roll them towards you, cradling and supporting the head and neck throughout the process. Now you must open the airway and inspect for breathing, and/or obstructive material. To do this you have to tilt the head back and raise the chin slightly. This is done by placing a firm hand on the forehead of the injured person and applying gentle pressure in a backwards motion, while simultaneously using the fingers of your other hand to lift the chin. This will result in the head tilting backwards and the oral cavity opening, and with any luck it will also open the airway. Do not use this procedure on individuals suspected of having a spinal injury as it may aggravate the injury and cause further damage.
Once those steps have been performed you must visually check the mouth and airways for obstruction, clearing anything that you come across. Now tilt your head so that your eyes are looking down the length of the injured person’s body, and lower your ear towards their mouth. You are doing two things at this time; listening and feeling for breath against your ear, and visually checking the patient’s chest for signs of shallow breathing.
In the event the victim is not breathing, pinch off the nasal passages with a thumb and forefinger, then place your open mouth over the patient’s open mouth, creating a tight seal, and begin blowing directly into their lungs with 4 full breaths. When blowing these breaths into the injured person, do so fast enough to prevent deflation of their lungs before you are able to submit the next breath. As you are delivering these breaths, inspect the chest cavity to determine whether or not it is rising and falling automatically. After delivering the initial four breaths, administer repetitious breaths at the rate of 12 per minute, or until the patient begins breathing on their own. Remember, you have approximately 10 minutes before biological death is declared, so do not give up prematurely. If you are unable to deliver the breath to the lungs, the chest will not rise and the air being blown into the patient causes the mouth-to-mouth seal to become compromised, then there is an obstruction in the airways. Clear the obstruction if visible, if the obstruction is not visible, refer to the techniques used to address choking which will be covered in a later segment of this article.
For situations in which mouth-to-mouth resuscitation is impossible, such as when attending to an individual with severe facial lacerations along the jaw, chin, or mouth area, or when the mouth cannot be successfully opened, it is possible to perform mouth-to-nose resuscitation. To do this simply cover the individual’s mouth with one hand, place your open mouth over their nose, and breathe into them as described above.
How to Perform Single Person CPR During a SHTF Situation
CPR procedures are only necessary in the event an injured individual’s heart ceases to function entirely. When CPR procedures do become necessary in order to save a life, the attending medical personnel will be tasked with breathing for the person, while also performing chest compressions in order to force the heart to continue pumping and circulating the blood within the body. Under optimum circumstances this procedure can successfully restore the person’s heartbeat.
The first step of CPR involves properly positioning the patient. The injured person must be placed on their back with their chest facing up; roll them as described above if necessary. The next step consists of locating the proper compression point. This is done by using the index and middle finger of your hand, tracing it up the inner edge of the injured person’s rib cage until they find the conjunction of the ribs, also called the sternum. From the sternum, measure two finger widths up towards the head, and place the heel of your other hand on this spot. Attempt to be accurate when locating this compression spot as it will place the heel of the hand directly over the heart, which is exactly where it needs to be.
Now that you have located the correct compression point with the heel of one hand, place the heel of the other hand on top of the first and interlock your fingers. You should now be on your knees next to the patient and ready to perform CPR. Rise up on your knees, while keeping your interlocked hands on the compression point, until such a time as your shoulders are directly above your hands and perpendicular to the patient’s chest. Begin chest compressions at this time. Each compression should depress the chest of the patient approximately 2” and consist of strong, even, and rhythmic movements. CPR for adults should be administered at a rate of 80 compressions per minute. CPR for children and teenagers should be administered at a rate of 100 compressions per minute, and for infants at the rate of 120 compressions per minute.
There is no set amount of time for determining when to cease performing chest compressions. In the event you are performing chest compressions alone, continue doing so until paramedics arrive to relieve you, someone else offers to assist, or the patient makes a full and complete recovery. Bear in mind that gasping for air is not an indicator that full recovery has been achieved. In fact, gasping is normally a result of cardiac arrest and indicates that the procedures you are performing are having a positive impact on the patient.
If there are two people performing CPR on the same victim, then one of them is referred to as the “compressor,” while the other is referred to as the “ventilator.” The compressor performs chest compressions at the rate of 60 per minute, while the ventilator delivers one breath for every five chest compressions. As the CPR is being performed the ventilator should check for pulse every couple of minutes. When conducting the pulse check the ventilator will check for pulse while compressions are being made, then they will instruct the compressor to cease performing compressions momentarily while the pulse is checked again. By doing this the ventilator is ensuring that the compressions are in fact circulating blood throughout the body as intended, and consecutively checking to see if the individual’s heart has begun beating again on its own.
If the ventilator discovers no pulse they give the instruction to continue performing chest compressions while they begin administering breaths at the rate of one for every five compressions. If the ventilator discovers a pulse, yet the patient still is not breathing, then the ventilator informs the compressor that a pulse has been identified, and instructs the compressor to continue procedures, while the ventilator also continues performing their half of the procedures. Should the ventilator discover a pulse, and the patient has regained the ability to breathe on their own, then the CPR procedures can be discontinued and the treatment of any and all other injuries can begin. When working as a two-man CPR team it is often advisable to switch positions if/when necessary to prevent exhaustion or fatigue from adversely affecting the person tasked with performing the compressions.
How to Help Someone Who is Choking
Choking is a very stressful, panic stricken experience to endure, especially if you are the person choking. As a bystander it can be equally stressful when trying to provide assistance. Without knowing what the person is choking on, the helpful bystander must perform procedures designed to assist restoring the ability to breathe freely, while simultaneously attempting to calm the victim. Some of the signs that indicate an individual is choking and in need of assistance include, but are not limited to;
- The person exhibits an inability to speak. They may be opening and closing their mouth in an attempt to communicate, but nothing recognizable as speech is forthcoming.
- The person choking may begin grasping and/or clawing at their throat and neck area in an attempt to dislodge the obstruction.
- The person choking exhibits signs of labored breathing in conjunction with sounds of wheezing that stem from the lack of oxygen.
- The person choking is unable to force the obstruction free by the act of coughing due to the inability to inhale enough oxygen to generate the amount of force necessary to dislodge to object blocking the airways.
- A choking person who has lost consciousness may have a blue hue to their skin which indicates a serious lack of oxygen.
- The chest of an unconscious person will not rise and fall naturally if they are choking and in need of oxygen.
If you are attending to a conscious person who is suffering from choking, the proper response consists of performing the Heimlich maneuver. This is done by standing behind the person who is choking. First instruct the person to bend forward slightly at the waist, then deliver four solid, open handed slaps to the back of the individual, directly between the shoulder blades. Follow this by reaching both hands around the victim, interlocking your hands into fists, then bringing them between the waistline and rib cage of the victim and performing four upward thrusts in quick succession. If this fails to dislodge the obstruction and restore normal breathing, then repeat the back slaps followed by the Heimlich maneuver until such a time as the object is dislodged and breathing has been restored, or until the patient loses consciousness.
If/when the patient loses consciousness lay them on the ground resting on their side. Administer four solid back blows, followed by four solid abdominal thrusts using the heel of your hand. If this is still unsuccessful, then place the individual in the CPR position and prepare to perform those procedures in an attempt to dislodge any object and restore normal breathing.
How to Control Excessive Bleeding and Stop the Loss of Blood
Excessive bleeding results in significant blood loss, and is one of the leading causes of death resulting from untreated, or improperly treated, life threatening injuries. If/when a person suffers from such an injury, it will be necessary to take immediate action. Direct pressure is often touted as the first procedure to attempt in an effort to stop the flow of blood. Direct pressure should be applied to the exact point where bleeding is occurring. If the excessive blood loss involves one of the four limbs, or extremities, then make sure that appendage remains elevated above the heart. This will reduce the ability of the heart to pump blood into the extremity and may help stem the flow of blood. You can use any material at your disposal to apply direct pressure as long as it is clean.
Continue applying direct pressure for a period of 5-10 minutes, then check and inspect the wound to ensure blood loss has stopped, or slowed significantly enough to discontinue applying direct pressure. Once the flow of blood has been stopped, use clean cloth material to cover the wound and keep it clean.
Tourniquets are considered a last resort for stopping the flow of blood, and should only be applied if/when the victim suffers from uncontrollable blood loss. If/when a tourniquet is considered as the only viable option left for stopping the loss of blood, there are only four places on the human body where they can be applied properly; around either upper arm, just beneath the armpit, or around either upper thigh, in close proximity to the groin area. The simplest way to manufacture a tourniquet is by ripping cloth into 2” strips.
Wrap a length of cloth around the affected appendage and tie half a square knot in it. Place a stick, approximately ½”-1” in diameter on the half knot and tie another half square knot over it, then reinforce with a double knot. At this point you simply need to twist the stick to tighten the tourniquet until the bleeding comes to a halt.
Tourniquets are considered last resort options because applying them can, and often does, result in amputation of the appendage. This happens because the tourniquet prevents the continued flow of blood to the affected limb. The longer the appendage is prevented from receiving blood supply, the more the soft tissue begins to die. Once tissue dies, it cannot be rejuvenated. In order to prevent amputation, it is recommended that the tourniquet be loosened every 10-15 minutes, for a period of 1-2 minutes. This will allow the blood to reenter the affected limb and help keep tissue alive.
Internal bleeding is another story entirely, and one that requires professional medical assistance. It is seldom a “simple injury,” as identified in the title of this article, and as such will not be covered in depth. Suffice to say that if an individual exhibits signs of internal bleeding, then the recommended course of action consists of placing the injured person on their back, elevating their legs and feet above the position of their heart, keeping them as warm and comfortable as possible, and hoping for immediate rescue. Do not, under any circumstances, attempt to treat internal bleeding without proper education; there stands a very good chance that you will exacerbate the condition and cause further damage.
How to Apply Bandages & Treat for Shock
Once you have determined that the wound has stopped bleeding, it will be necessary to clean and dress the affected area in order to prevent it from remaining exposed to infectious disease, dirt and debris. The first step in the process of treating the wound requires irrigation with clean clear water, or with a sterile saline solution if available. The wound should be cleaned from the center to the outer edges. The wound should then be closed with butterfly sutures if available. Next you will want to apply a light coat of antibiotic ointment to the wound area. Finish off by applying a sterile gauze dressing and wrapping with an equally sterile bandage.
Dressings should be changed periodically or when they become damp with blood, begin emitting an offensive odor, or if the patient begins to complain about increased levels of pain, and/or a throbbing sensation, which can be an indicator that the wound has become infected. When applying bandages make sure it is not so tightly wrapped that it cuts off circulation to the injured limb. One way to test the application of a bandage and ensure it is not cutting off circulation is by depressing the finger/toe nail of the limb being treated. If color flows back into them when you release it, then the bandage is fine. If no color reappears then the bandage is too tight; it needs to be loosened to restore circulation.
Dressing and bandages should be changed every day unless otherwise contaminated as explained above. When changing dressings and bandages be sure to cleanse the wound as much as possible. This may include irrigating the wound, applying disinfectant and antibiotic ointments, as well as gently scrubbing away any crusty dead skin tissue. Try not to aggravate the injury or reopen the wound when changing dressings and bandages.
Suturing an open wound is something that should only be considered if a wound is too deep to close with butterfly sutures. Suturing an individual who has not been given local anesthetics to dull the sense in the affected area, may be difficult at best, depending on the individual’s personal pain threshold. In the event you do have to suture a wound closed, irrigate the wound, stop the flow of blood, and then begin the sewing process. Each and every stitch should penetrate to the bottom of the wound. This will help ensure that the entire wound heals collectively and at the same time. Each suture should be tied off individually using a square knot. The stitches should remain in place for no less than 10 days at which time they can be removed with a small pair of scissors. To remove the stitches cut one strand near the knot, then using a set of tweezers, grasp the knot and pull the thread through.
Now that you have the wounds treated and bandaged, it is time to address shock. Shock is a medical condition that can occur for any number of reasons; the excessive loss of blood, excessive loss of bodily fluids through perspiration, diarrhea and vomiting, or as a result of broken bones which will reduce the volume of blood flowing through blood vessels that are in close proximity to the affected area. To treat shock victims, make sure they are breathing freely, allow them ample space to rest, and ensure that they are kept warm. You are basically allowing the shock to wear off.
How to Treat Sprains, Strains, Dislocations and Fractured Bones
If you spend a significant amount of time participating in outdoor adventures, then there is a relatively decent chance you are familiar with sprains, strains and dislocated joints. These types of injuries are commonplace, and are often the preliminary problem that result in a survival situation taking shape. In laymen’s terms, a “strain” occurs when a muscle has been overstretched or torn completely. A “sprain” occurs when connective tissue around a joint has been stretched or torn completely. A “dislocation” occurs when the entire joint is jarred out of its normal position.
Sprains and strains are fairly easy to treat and follow similar protocols for treatment. The affected appendage needs plenty of relaxation and rest. If pain is present, or persists, apply cold packs to ease the discomfort. In a survival situation this may entail finding a cold running creek, stream, or river and submerging the limb long enough to numb it. Keep the injured appendage immobilized as much as possible during the healing process and after several days begin reintroducing movement and mobility to the injury, continuing this process until full flexibility returns.
Dislocated joints are a bit more difficult to contend with. The limb closest to the dislocated joint must be gently stretched away from the joint, then moved back to its normal position and relaxed back into place. This procedure must be done as soon as possible after the dislocation, otherwise swelling may occur and complicate effective procedures from being effectively applied. This, in turn, could result in permanent deformity over the course of time. Once the joint has been properly replaced inspect the victim for signs of nerve damage. If nerve damage is present, repeat the procedure of stretching the limb away from the joint and allowing to relocate gently. In the event a sprain, strain, or dislocation occurs to an arm, utilize a support sling to help keep the limb immobile and allow time to heal.
“Fractured bones,” refers to any crack, complete break, or chipping of a bone. In medical terminology fractures come in two forms; open and closed. Open fractures refer to those cases in which the bone has snapped to such a degree it has penetrated the skin and remains exposed to the elements. Closed fractures refer to those cases in which the bone has snapped, yet has not punctured the outer layer of skin.
Closed fractures are easier to treat than open fractures for obvious reasons. The process calls for checking the victim’s pulse to ensure damage has not impeded circulation. In situations where circulation has been impeded it becomes necessary to restore proper blood flow to the appendage, otherwise tissue may begin dying and result in an amputation being necessary. If it is discovered the circulation has been impeded, grasp the limb and apply traction in the form of gently, yet continuously, pulling the broken limb away from the affected area, moving it gingerly towards the position it would normally hold, and then allowing it to gently relax into position. Once circulation has been restored, apply a splint to the injured area securely, and immobilize the injury entirely.
Open fractures are more difficult to address, primarily because there will likely be excessive blood loss, so the first step of treatment involves stopping the flow of blood, which we covered in an earlier section. Once the loss of blood has been stopped, the wound must be flushed with water to remove any contaminants, such as bone chips, dirt, and debris. With open fractures the bone must be reset before dressings, bandages and splints can be applied correctly. This is done by gently pulling the broken bone away from the wounded area, aligning it where it would normally rest, and then allowing it to gently reset into place. As soon as this has been done, it is important to visibly and physically inspect the area to ensure proper bone alignment has been achieved. If bone alignment is achieved, then fashion a splint to the injury immobilizing it entirely. Make sure the splint provides ample space for attending individuals to continue treating the wound area itself without needing to remove and replace the splint, if possible.
Fractured ribs, skulls and spinal injuries are possible during a survival situation. They are not however simple injuries. Attending to these types of injuries requires professional medical assistance. Attempting to move, or treat, a victim suffering from any of these categories of injuries, could result in permanent paralysis or death. If fractured ribs have not punctured the lungs, they may be treated with bandages and given time to heal, otherwise medical professionals should be consulted as soon as possible.
What Do You Need to Do Right Now?
First things first, register for, attend and complete a First Aid course. At the beginning of this article we shared links for online First Aid courses; while this will provide you some valuable insight as to what can be expected, and will give you a certificate of training, it is highly recommended that you take these courses locally so that if you have any questions or concerns you can have them addressed by professional medical personnel.
Upon completion of the First Aid Course, you may also want to consider taking additional Field Medicine courses, if available in your area. Field Medicine goes hand in hand with Combat Medical Training, and Combat Medical Training is what the federal government spends millions of dollars teaching to military troops who may see time on an actual battlefield. The techniques and training for this type of environment are always being updated. As a matter of fact, Combat Medical Training is also responsible for the invention of several new tools designed to save lives under the most traumatic conditions.
You will also need an emergency preparedness medical kit. This First Aid kit should contain items you are familiar with using. While it might be a nice idea to purchase a $3,000 medical emergency kit, if you only know how to use $50 worth of the equipment, then the purchase was inefficient. Unlike other professions, the medical field is not a place you want to begin experimenting with items in the kit, as that may be a recipe for absolute disaster.
First aid is an extremely important aspect of survival. To put things in perspective, the leading cause of death on the battlefields of combat zones throughout history has been excessive blood loss, rather than the injuries themselves. The majority of injuries incurred by soldiers are survivable provided proper treatment in the field is administered. The problem is, there are not enough combat medics to address the injuries when they occur. As part of your survival plan it is recommended that each and every person who is a participant in your group, learn and understand first aid and survival medical procedures.