Medical Emergencies - Part Two
(Adapted from the U.S. Army Survival Manual)
Prevent and Treat Shock
Anticipate shock in all injured personnel. Treat all injured
persons as follows, regardless of what symptoms appear (Figure
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
Maintain body heat by insulating the victim from the surroundings
and, in some instances, applying external heat.
If wet, remove all the victims 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.
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
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
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 patients 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
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,
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 victims
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
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
To rehabilitate the dislocation, remove the splints after
7 to 14 days. Gradually use the injured joint until fully healed.
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
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.
Ticks can carry and transmit diseases, such as Rocky Mountain
spotted fever common in many parts of the United States. Ticks
also transmit the Lyme disease.
Mosquitoes may carry malaria, dengue, and many other diseases.
Flies can spread disease from contact with infectious sources.
They are causes of sleeping sickness, typhoid, cholera, and dysentery.
Fleas can transmit plague.
Lice can transmit typhus and relapsing fever.
The best way to avoid the complications of insect bites and
stings is to keep immunizations (including booster shots) up-to-date,
avoid insect-infested areas, use netting and insect repellent,
and wear all clothing properly.
If you get bitten or stung, do not scratch the bite or sting,
it might become infected. Inspect your body at least once a day
to ensure there are no insects attached to you. If you find ticks
attached to your body, cover them with a substance, such as Vaseline,
heavy oil, or tree sap, that will cut off their air supply. Without
air, the tick releases its hold, and you can remove it. Take
care to remove the whole tick. Use tweezers if you have them.
Grasp the tick where the mouth parts are attached to the skin.
Do not squeeze the ticks body. Wash your hands after touching
the tick. Clean the tick wound daily until healed.
It is impossible to list the treatment of all the different
types of bites and stings. Treat bites and stings as follows:
If antibiotics are available for your use, become familiar
with them before deployment and use them.
Predeployment immunizations can prevent most of the common diseases
carried by mosquitoes and some carried by flies.
The common fly-borne diseases are usually treatable with penicillin
Most tick-, flea-, louse-, and mite-borne diseases are treatable
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
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 -
A cooling paste of mud and ashes.
Sap from dandelions.
Crushed cloves of garlic.
Spider Bites and Scorpion Stings
The black widow spider is identified by a red hourglass on
its abdomen. Only the female bites, and it has a neurotoxic venom.
The initial pain is not severe, but severe local pain rapidly
develops. The pain gradually spreads over the entire body and
settles in the abdomen and legs. Abdominal cramps and progressive
nausea, vomiting, and a rash may occur. Weakness, tremors, sweating,
and salivation may occur. Anaphylactic reactions can occur. Symptoms
begin to regress after several hours and are usually gone in
a few days. Threat for shock. Be ready to perform CPR. Clean
and dress the bite area to reduce the risk of infection. An antivenin
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.
Scorpions are all poisonous to a greater or lesser degree.
There are two different reactions, depending on the species:
Severe local reaction only, with pain and swelling around
the area of the sting. Possible prickly sensation around the
mouth and a thick-feeling tongue.
Severe systemic reaction, with little or no visible local reaction.
Local pain may be present. Systemic reaction includes respiratory
difficulties, thick-feeling tongue, body spasms, drooling, gastric
distention, double vision, blindness, involuntary rapid movement
of the eyeballs, involuntary urination and defecation, and heart
failure. Death is rare, occurring mainly in children and adults
with high blood pressure or illnesses.
Treat scorpion stings as you would a black widow bite.
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 animals mouth.
With nonpoisonous as well as poisonous snakebites, this local
infection is responsible for a large part of the residual damage
Snake venoms not only contain poisons that attack the victims
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 persons 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
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 neurotoxin 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
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
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.
Steve's Notes: Many authorities now recommend against
using either of the techniques above (suction cups or mouth).
It is easy to cause more damage and difficult to get much 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
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Emergencies - Part Three.
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