Wilderness Survival - Medical Emergencies
(Adapted from the U.S. Army Survival Manual)
Medical problems and emergencies you may be faced with include
breathing problems, severe bleeding, and shock.
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
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
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 (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.
Control panic, both your own and the victims. 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
Open Airway and Maintain
You can open an airway and maintain it by using the following
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 victims mouth
clear of any foreign objects, broken teeth, dentures, sand.
Step 3. Using the jaw thrust method, grasp the angles of the
victims 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 victims 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 victims breathing by performing
Step 6. There is danger of the victim vomiting during mouth-to-mouth
resuscitation. Check the victims 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.
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
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.
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
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.
Raising an injured extremity as high as possible above the
hearts 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.
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 (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.
Use caution when applying pressure to the neck. Too much pressure
for too long may cause unconsciousness or death. Never place
a tourniquet around the neck.
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.
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.
Steve's Notes: Tourniquets are rarely recommended
now. If they are used, it is best to frequently release the pressure
to allow some circulation. This prevents tissue death and later
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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Emergencies - Part Two
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