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EMERGENCY CARE

Medical problems and emergencies you may be faced with include breathing problems, severe bleeding, and shock.

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 mouth-to-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.

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 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.

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.

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. 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.

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.

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. 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.

Prevent and Treat Shock

Anticipate shock in all injured personnel. Treat all injured persons as follows, regardless of what symptoms appear:

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 pre-warmed 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.

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 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.

Note: 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.

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.