Basic Survival Medicine - 2

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 withhis 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.

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 forimmobilization, 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.
   

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 theuse 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 injuredarea.

• 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 youwill 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 boostershots) up-to-date, avoid insect infested areas, use netting and insect repellent, and wear all clothing properly.

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 witha 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. Threat 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 graduallyspreads 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.

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 thickfeeling 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 one-quarter 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-to-mouth 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.
  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.

• 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.

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 lothing, 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).

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, considermaggot 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 redblood 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:

• 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.

Again, use noncommercially prepared materials with caution.

Frostbite
This injury results from 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. When with others, prevent frostbite by using 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 mittens. Do not try to thaw the affected areas by placing them close to an open flame. Gently rub them in lukewarm water. Dry the part and place it next to your skin to warm it at body temperature.

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.

• Rest 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 aheatstroke. 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 compresses 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.

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.

Hypothermia
Defined as the body’s failure to maintain a temperature of 36 degrees C (97 degrees F). Exposure to cool or cold temperature over a short or long time can cause hypothermia. Dehydration and lack of food and rest predispose the survivor to hypothermia. Unlike heatstroke, you must gradually warm the hypothermia victim. Get the victim into dry clothing. Replace lost fluids, and warm him.

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.

HERBAL MEDICINES
Our modern wonder drugs, laboratories, and equipment have obscured more primitive types of medicine involving determination, common sense, and a few simple treatments. In many areas of the world, however, the people still depend on local “witch doctors” or healers to cure their ailments. Many of the herbs (plants) and treatments they use are as effective as the most modern medications available. In fact, many modern medications come from refined herbs.

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