Basic Survival Medicine

Foremost among the many problems that can compromise a survivor’s ability to return to safety are medical problems  resulting from parachute descent and landing, extreme climates, ground combat, evasion, andillnesses contracted in captivity. Many evaders and survivors have reported difficulty in treating injuries and illness due to the lack of training and medical supplies. For some, this led to capture or surrender. Survivors have related feeling of apathy and helplessness because they could not treat themselves in this  environment. The ability to treat themselves increased their morale and cohesion and aided in their survival and eventual return to friendly forces. One man with a fair amount of basic medical knowledge can make a difference in the lives of many. Without qualified medical personnel available, it is you who must know what to do to stay alive.

REQUIREMENTS FOR MAINTENANCE OF HEALTH
To survive, you need water and food. You must also have and apply high personal hygiene standards.Water Your body loses water through normal body processes (sweating, urinating, and defecating). During averagedaily exertion when the atmospheric temperature is 20 degrees Celsius (C) (68 degrees Fahrenheit), the average adult loses and therefore requires 2 to 3 liters of water daily. Other factors, such as heat exposure, cold exposure, intense activity, high altitude, burns, or illness, can cause your body to losemore water. You must replace this water. Dehydration results from inadequate replacement of lost body fluids. It decreases your efficiency and, if injured, increases your susceptibility to severe shock. Consider the followingresults of body fluid loss:

• A 5 percent loss of body fluids results in thirst, irritability, nausea, and weakness.

• A 10 percent loss results in dizziness, headache, inability to walk, and a tingling sensation in the limbs.

• A 15 percent loss results in dim vision, painful urination, swollen tongue, deafness, and a numb feeling in the skin.

• A loss greater than 15 percent of body fluids may result in death.

The most common signs and symptoms of dehydration are—

• Dark urine with a very strong odour.

• Low urine output.

• Dark, sunken eyes.

• Fatigue.

• Emotional instability.

• Loss of skin elasticity.

• Delayed capillary refill in fingernail beds.

• Trench line down center of tongue.

• Thirst.

• Last on the list because you are already 2 percent dehydrated by the time you  crave fluids.

You replace the water as you lose it. Trying to make up a deficit is difficult in a survival situation, and thirst is not a sign of how much  water you need. Most people cannot comfortably drink more than 1 liter of water at a time. So, even when not thirsty, drink small amounts of water at regular intervals each hour to prevent dehydration. If you are under physical and mental stress or subject to severe conditions, increase your water intake. Drink enough liquids to maintain a urine output of at least 0.5 liter every 24 hours.

In any situation where food intake is low, drink 6 to 8 liters of water per day. In an extreme climate, especially an arid one, the average person can lose 2.5 to 3.5 liters of water per hour. In this type of climate, you should drink 14 to 30 liters of water per day.

With the loss of water there is also a loss of electrolytes (body salts). The average diet can usually keep up with these losses but in an extreme situation or illness, additional sources need to be provided. A mixture of 0.25 teaspoon of salt to 1 liter of water will provide a concentration that the body tissues can readily absorb.

Of all the physical problems encountered in a survival situation, the loss of water is the most preventable. The following are basic guidelines for the prevention of dehydration:

• Always drink water when eating. Water is used and consumed as a part of the digestion process and can lead to dehydration.

• Acclimatize. The body performs more efficiently in extreme conditions when acclimatized.

• Conserve sweat not water. Limit sweat-producing activities but drink water. 

• Ration water. Until you find a suitable source, ration your water  sensibly. A daily intake of 500 cubic centimeter (0.5 liter) of a  4-3  sugar-water mixture (2  teaspoons per liter) will suffice to prevent  severe dehydration for at least a week, provided you keep water  losses to a minimum by limiting activity and heat gain or loss. 

You can estimate fluid loss by several means. A  standard field dressing  holds about 0.25 liter (one-fourth canteen) of blood. A soaked T-shirt  holds 0.5 to 0.75 liter. You can also use the pulse and breathing rate to estimate fluid loss. Use the following as a guide:

• With a 0.75 liter loss the wrist pulse rate will be under 100 beats per  minute and the breathing rate 12 to 20 breaths per minute. 

• With a 0.75 to 1.5 liter loss the pulse rate will be 100 to 120 beats per minute and 20 to 30 breaths per minute.

• With a 1.5 to 2 liter loss the pulse rate will be 120 to 140 beats per minute and 30 to 40 breaths per minute. Vital signs above these rates require more advanced care.

Food
Although you can live several weeks without food, you need an adequate amount to stay healthy. Without food  your mental and physical capabilities will deteriorate rapidly, and you will become weak. Food replenishes the substances that your body burns and provides energy. It provides vitamins, minerals, salts, and other elements essential to good health. Possibly more important, it helps morale. The two basic sources of food are plants and animals (including fish). In varying degrees both provide the calories, carbohydrates, fats, and proteins needed for normal daily body functions. Calories are a measure of heat and potential energy. The average person needs 2,000 calories per day to function at a minimum level. An adequate amount of carbohydrates, fats, and proteins without an adequate caloric intake will lead to starvation and cannibalism of the body’s own tissue for energy.

Plant Foods
These foods provide carbohydrates—the main source of energy. Many plants provide enough protein to keep the body at normal efficiency. Although plants may not provide a balanced diet, they will sustain you4-4 even in the arctic, where meat’s heat-producing qualities are normally essential. Many plant foods such as nuts and seeds will give you enough protein and oils for normal efficiency. Roots, green vegetables, and plant food containing natural sugar will provide calories and carbohydrates that give the body natural energy. The food value of plants becomes more and more important if you are eluding the enemy or if you are in an area where wildlife is scarce. For instance—

• You can dry plants by wind, air, sun, or fire. This retards spoilage so that you can store or carry the plant food with you to use when needed.

• You can obtain plants more easily and more quietly than meat. This is extremely important when the enemy is near.

Animal Foods
Meat is more nourishing than plant food. In fact, it may even be more readily available in some places. However, to get meat, you need to know the habits of, and how to capture, the various wildlife. To satisfy your immediate food needs, first seek the more abundant and more easily obtained wildlife, such as insects, crustaceans, mollusks, fish, and reptiles. These can satisfy your immediate hunger while you are preparing traps and snares for larger game.

Personal Hygiene
In any situation, cleanliness is an important factor in preventing infection and disease. It becomes even more important in a survival situation. Poor hygiene can reduce your chances of survival. A daily shower with hot water and soap is ideal, but you can stay clean without this luxury. Use a cloth and soapy water to wash yourself. Pay special attention to the feet, armpits, crotch, hands, and hair as these are prime areas for infestation and infection. If water is scarce, take an “air” bath. Remove as much of your clothing as practical and expose your body to the sun and air for at least 1 hour. Be careful not to sunburn. If you don’t have soap, use ashes or sand, or make soap from animal fat and wood ashes, if your situation allows. To make soap—

• Extract grease from animal fat by cutting the fat into small pieces and cooking them in a pot.

• Add enough water to the pot to keep the fat from sticking as it cooks.

• Cook the fat slowly, stirring frequently.

• After the fat is rendered, pour the grease into a container to harden.

• Place ashes in a container with a spout near the bottom.

• Pour water over the ashes and collect the liquid that drips out of the spout in a separate container. This liquid is the potash or lye. Another way to get the lye is to pour the slurry (the mixture of ashes and water) through a straining cloth.

• In a cooking pot, mix two parts grease to one part potash.

• Place this mixture over a fire and boil it until it thickens.
   

After the mixture—the soap—cools, you can use it in the semiliquid state directly from the pot. You can also pour it into a pan, allow it to harden, and cut it into bars for later use. Keep Your Hands Clean Germs on your hands can infect food and wounds. Wash your hands after handling any material that is likely to carry germs, after visiting the latrine, after caring for the sick, and before handling any food, food utensils, or drinking water. Keep your fingernails closely trimmed and clean, and keep your fingers out of your mouth. Keep Your Hair Clean Your hair can become a haven for bacteria or fleas, lice, and other parasites. Keeping your hair clean, combed, and trimmed helps you avoid this danger.

Keep Your Clothing Clean
Keep your clothing and bedding as clean as possible to reduce the chance of skin infection as well as to decrease the danger of parasitic infestation. Clean your outer clothing whenever it becomes soiled. Wear clean underclothing and socks each day. If water is scarce, “air” clean your clothing by shaking, airing, and sunning it for 2 hours. If you are using a sleeping bag, turn it inside out after each use, fluff it, and air it.

Keep Your Teeth Clean
Thoroughly clean your mouth and teeth with a toothbrush at least once each day. If you don’t have a toothbrush, make a chewing stick. Find a twig about 20 centimeters long and 1 centimeter wide. Chew one end of the stick to separate the fibers. Now brush your teeth thoroughly. Another way is to wrap a clean strip of cloth around your fingers and rub your teeth with it to wipe away food particles. You can also brush your teeth with small amounts of sand, baking soda, salt, or soap. Then rinse your mouth with water, salt water, or willow bark tea. Also, flossing your teeth with string or fiber helps oral hygiene. If you have cavities, you can make temporary fillings by placing candle wax, tobacco, aspirin, hot pepper, tooth paste or powder, or portions of a ginger root into the cavity. Make sure you clean the cavity by rinsing or picking the particles out of the cavity before placing a filling in the cavity.

Take Care of Your Feet
To prevent serious foot problems, break in your shoes before wearing them on any mission. Wash and massage your feet daily. Trim your toenails straight across. Wear an insole and the proper size of dry socks. Powder and check your feet daily for blisters. If you get a small blister, do not open it. An intact blister is safe from infection. Apply a padding material around the blister to relieve pressure and reduce friction. If the blister bursts, treat it as an open wound. Clean and dress it daily and pad around it. Leave large blisters intact. To avoid having the blister burst or tear under pressure and cause a painful and open sore, do the following:

• Obtain a sewing-type needle and a clean or sterilized thread.

• Run the needle and thread through the blister after cleaning the blister.

• Detach the needle and leave both ends of the thread hanging out of the blister. The thread will absorb the liquid inside. This reduces the size of the hole and ensures that the hole does not close up.

• Pad around the blister.

Get Sufficient Rest
You need a certain amount of rest to keep going. Plan for regular rest periods of at least 10 minutes per hour during your daily activities. Learn to make yourself comfortable under less than ideal conditions. A change from mental to physical activity or vice versa can be refreshing when time or situation does not permit total relaxation.

Keep Camp Site Clean
Do not soil the ground in the camp site area with urine or feces. Uselatrines, if available. When latrines are not available, dig “cat holes” and cover the waste. Collect drinking water upstream from the camp site. Purify all water.

MEDICAL EMERGENCIES
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 (Figure 4-1).

• 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.

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 notremove 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 themain 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. 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 (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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