The power outage has persisted for 40 days, transforming what initially seemed like a temporary blackout into a grave situation. Both the fire and police departments are overwhelmed, and the 911 system has been inoperative for weeks.
Nowadays, roving gangs frequently roam the streets, making it perilous to venture outside your home. Your neighbor arrives at your doorstep, his wrist tightly wrapped in a blood-stained T-shirt. He appears disoriented, pale, sweaty, and is breathing rapidly. Collapsing in your doorway, you notice that his hand has been completely severed at the wrist.
In this survival scenario, with the EMS system non-functional, you must confront various traumatic injuries that commonly arise. You are on your own, tasked with addressing whatever you can while your patient is still breathing.
1.Gun Shot Trauma
In the absence of EMS services during a survival situation, knowing how to address gunshot wounds becomes crucial. If you’ve received first aid training, you’re likely familiar with the “ABC” concept, which stands for Airway-Breathing-Circulation. However, when dealing with a gunshot wound, your first priority should be circulation.
- Stop the bleeding: Apply direct pressure, elevate the affected area, and use a pressure bandage in that order. If available, the Israeli Emergency Bandage is recommended. In the absence of specialized materials, you can improvise with a towel or bandana. If direct pressure doesn’t control the bleeding, consider applying a hemostatic agent like Quick Clot or Celox while maintaining pressure.
- Address shock: Treat for shock concurrently with the other steps. Keep the victim covered for warmth unless there’s a need to examine the wounds.
- Examine the entire body for wounds: Don’t solely rely on identifying entry and exit wounds, as bullets can cause complex injuries. They may hit bones, fragment, and travel anywhere within the body. Some bullets are designed to inflict multiple injuries.
For gunshot wounds in the arms or legs involving bones: Treatment steps:
- Direct pressure, elevation, and pressure bandage: Follow the same steps as before. Elevate the wound above the heart and apply a pressure bandage. If bleeding persists, use your fingers to apply pressure to the brachial artery for arm wounds or the femoral artery for leg wounds.
- As a last resort for extremities, consider a tourniquet: In critical situations, the choice may come down to saving a limb or saving a life.
- Swelling or suspected bone injury: Rapid swelling indicates internal bleeding or potential bone damage. In such cases, splinting the area is necessary.
For gunshot wounds in the abdomen, with a focus on organ protection: Treatment steps:
- If the wound is open and exposes the intestines, find a moist and sterile dressing to cover the wound and protect the organs. Immediate medical care is crucial to avoid bleeding to death or severe infection.
- The victim should refrain from consuming anything orally until the pain subsides, waiting a day or two. Although challenging, this step is vital. Intravenous (IV) fluids would be helpful during this time.
For gunshot wounds in the chest, considering air sucking and potential spine injuries: Treatment steps:
- Open chest wounds, known as “sucking chest wounds,” can cause a collapsed lung due to air entering the chest cavity. To mitigate this, close the wound using an occlusive dressing. If commercial chest seals aren’t available, improvise with a plastic bag taped on three sides.
- Exercise extreme caution when moving victims with chest wounds, as the spine is located at the back of the chest. Minimize movement to avoid spinal cord damage. If the heart, lungs, spine, or major blood vessels are affected, and expert medical care isn’t accessible, options in a survival situation are limited.
- In most cases, it’s advisable not to remove an embedded bullet. It’s challenging to locate and may be obstructing a major blood vessel. Unless there’s an initial infection, the body usually adapts to metallic fragments without severe complications, as evidenced by many military personnel living with shrapnel in their bodies.
2. Traumatic amputation
The treatment of a patient who has experienced an amputation is influenced by various factors. The initial priority lies in managing potentially life-threatening conditions. However, managing amputations resulting from blunt trauma becomes complex due to concerns about additional injuries.
Blunt trauma amputations often occur in situations involving high-energy transfer, such as collapsed buildings after an earthquake, auto or industrial accidents, or debris from a tornado.
These accidents frequently entail the possibility of multisystem trauma, requiring vigilance for other injuries. It is crucial to bear in mind that the most apparent injury may not always be the most significant. Partial amputations should be evaluated and treated as if they were fully intact.
In cases of complete amputation without access to an intact EMS system, the chance of saving the severed limb for possible reattachment is non-existent.
- The primary focus is to immediately control major bleeding by applying direct pressure and elevation. If pressure and elevation fail, tourniquets can be utilized. Place the tourniquet as close to the amputation site as possible.
- The next priority is to sustain and support essential life functions. Measures such as airway control and maintaining body temperature can help delay the onset of life-threatening shock. Aggressively flush the area with a diluted solution of Betadine (povidone-iodine) or sterilized saline solution using a 60cc to 100cc irrigation syringe. In the absence of commercial sterile solutions, studies suggest that clean drinking water can help keep the wound clean in austere environments.
- Apply a saline-moistened sterile dressing over exposed tissue to minimize further contamination or injury. Cover it with a dry, sterile gauze dressing. Replace the dressing at least once a day, or more frequently if possible.
- If an extremity is involved, it should be splinted to provide support and stabilization.
3. Head trauma, Concussion, Skull fracture
Head injuries can be categorized into three groups:
- Prolonged unconsciousness (more than five to 10 minutes)
- Brief loss of consciousness
- No loss of consciousness
Prolonged unconsciousness: If a victim remains unconscious for more than five to 10 minutes, it indicates a significant brain injury. Start by assessing the victim’s airway and perform rescue breathing if necessary. Due to the potential for associated neck and spine injuries with severe head trauma, it is crucial to immobilize the victim’s spine.
In a survival situation where immediate evacuation is not possible, maintain spine immobilization and ensure the victim’s head is pointed uphill. Be prepared to roll the victim onto their side if they vomit. Continuously monitor the airway for signs of obstruction, such as noisy or labored breathing, as well as a decreasing respiratory rate.
Brief loss of consciousness: Short-term unconsciousness followed by the victim waking up after a minute or two and gradually regaining normal mental status and physical abilities indicates a concussion. Concussions typically do not result in permanent damage, but the victim may experience confusion or amnesia about the event and repetitive questioning.
At a minimum, closely observe the victim for at least 24 hours and restrict them from engaging in potentially hazardous activities. Regularly interrupt their normal sleep every three to four hours to briefly assess their condition and ensure they can be easily awakened. If the victim becomes increasingly lethargic, confused, combative, or displays any other concerning signs (outlined under “No loss of consciousness” below), without access to an intact EMS, your only option is to focus on maintaining and supporting essential life functions such as the airway and breathing.
No loss of consciousness: When an individual hits their head but does not lose consciousness, it is usually not a cause for serious concern. They may experience a mild headache, a concussion, bleeding from a scalp wound, or a noticeable bump on their head. However, certain symptoms should raise alarm, including:
- Progressive worsening headache
- Gradual deterioration of consciousness from alertness to drowsiness or disorientation. Confirm the victim’s orientation by asking their name, location, date, and what happened. If they correctly answer all four, they are oriented x 4.
- Persistent or projectile vomiting (vomiting that shoots out under pressure)
- Significant difference in pupil size
- Unexplained bleeding from the ear or nose or clear watery fluid draining from the nose
- Bruising behind the ears or around the eyes without direct injury to those areas
If any of these symptoms arise, immediate medical attention is necessary. In a survival situation without access to EMS services, focus on maintaining and supporting essential life functions, including airway and breathing, while seeking the best available resources and assistance.
A fracture of the skull is generally not life-threatening unless it is accompanied by an underlying brain injury or severe bleeding. Signs of a skull fracture include an uneven sensation when touching the scalp, drainage of blood or clear fluid from the ears or nose without direct trauma to those areas, and discoloration around the eyes (“raccoon eyes”) or behind the ears (known as Battle’s sign).
Scalp wounds are common following head injuries and tend to bleed profusely due to the rich blood supply in the scalp. Fortunately, applying direct pressure to the wound with a gloved hand can usually control the bleeding. It may be necessary to maintain pressure for up to 30 minutes.
To clean the area, use a 60cc to 100cc irrigation syringe and flush it vigorously with a diluted solution of Betadine or sterilized saline solution. If commercial sterile solutions are unavailable, studies suggest that clean drinking water can effectively keep the wound clean in austere environments. After cleaning, cover the wound with a dry, sterile gauze dressing and secure it with a bandage wrap. Replace the dressing at least once a day, or more frequently if possible.
4. Chest trauma/Collapsed lung
In a survival situation, various types of thoracic injuries can occur, such as gunshot or knife wounds, injuries from falling debris, or other impairments. Prompt recognition and treatment of these injuries are crucial. Here are some ways to identify chest trauma:
Patients with a pneumothorax, characterized by holes in the lungs, will exhibit respiratory distress, including difficult breathing (dyspnea), rapid breathing (tachypnea), and rapid heart rate (tachycardia). They may also have reduced or absent breath sounds on the affected side of the chest. Additionally, they commonly experience pain while breathing.
A closed pneumothorax occurs when there is trauma, either blunt or penetrating, without an external wound to the chest wall. This is often caused by a broken rib that punctures the lung tissue. The signs and symptoms of a closed pneumothorax are similar to other types of pneumothorax, including respiratory distress and possibly reduced or absent breath sounds on the affected side.
Chest decompression involves releasing the trapped air within the pleural cavity. The fastest method for this is needle decompression. The needle should be inserted perpendicular to the chest wall, between the second and third ribs (counting from the top), without angling it towards the mediastinum. It is essential to avoid damaging any structures within the mediastinum. If successful, you may hear a rush of air, particularly in a quiet environment.
A sucking chest wound is a specific type of pneumothorax where air is drawn into the thoracic cavity through a wound in the chest wall, rather than through the airways into the lungs. This occurs because air follows the path of least resistance. Breathing in and out may cause the chest wound to bubble with blood.
To address a sucking chest wound, it is important to apply an occlusive dressing over the wound site. Treatment involves placing an airtight dressing over the wound and securing it with tape on three sides, forming a seal while allowing excess air to escape.
5. Severe cuts and puncture wounds
In medical terms, deep wounds refer to injuries that penetrate more than ¼ inch below the skin’s surface. These types of wounds pose a higher risk of damaging ligaments, major blood vessels or arteries, tendons, or organs. The depth of the wound can result in both internal and external bleeding.
Deep wounds commonly include cuts or puncture wounds. Before addressing a wound, it is essential to protect yourself and the victim from blood-borne illnesses by wearing nitrile gloves. Alternatively, you can use improvised materials such as plastic bags or a towel.
Direct Pressure: Apply pressure on the injury with your hand and elevate it above the heart level. If this stops the bleeding but it resumes when pressure is released, create a pressure dressing and apply direct pressure to a pressure point.
Upper Arm/Elbow Wounds: Locate the brachial artery on the inner side of the arm above the elbow bone, between the large upper arm muscles.
Groin/Thigh Wounds: Identify the femoral artery in the middle of the crease at the bottom of the groin, between the groin and the upper thigh (commonly known as the “bikini line”). This artery may require significant pressure; press down with the heel of your hand to reduce circulation.
Lower Leg Wounds: Press the back of the knee directly behind the kneecap to access the popliteal artery. Avoid bending or moving the leg to find a more convenient location. Reach around to the back of the leg and apply pressure upward.
Hand/Feet Wounds: On the inside of the wrist, move away from the thumb toward the forearm’s tip. For foot wounds, trace above the front/top of the foot where it meets the shin. In both cases, remember to check for a pulse before applying pressure. If these methods are unsuccessful, apply a tourniquet and tighten it until the bleeding stops.
Burns can occur frequently in survival situations and can range from minor to severe cases.
Burns often happen unexpectedly and can lead to life-threatening situations, long-term disfigurement, and loss of function. When caring for burns in a survival scenario, the focus should be on clothing, cooling, cleaning, covering, and providing comfort through pain relief.
Cool the burn to alleviate the pain. Hold the burned area under cool (not cold) running water for 10 to 15 minutes or until the pain subsides. Alternatively, apply a clean towel dampened with cool tap water.
Remove any rings or tight items from the burned area quickly and gently, before swelling occurs. Avoid breaking small blisters (no larger than your little fingernail).
If blisters do break, gently clean the area with mild soap and water, apply an antibiotic ointment, and cover it with a nonstick gauze bandage.
Applying moisturizer or aloe vera lotion/gel may provide relief in some cases. If necessary, administer over-the-counter pain relievers like ibuprofen (Advil, Motrin IB), naproxen sodium (Aleve), or acetaminophen (Tylenol).
Avoid using aspirin products due to the risk of bleeding and platelet inhibition.
Ensure the safety of the burned individual and protect them from further harm. If it can be done safely, make sure they are not in contact with smoldering materials, exposed to smoke, or excessive heat. If emergency medical services (EMS) are available, it is advisable not to remove clothing stuck to the skin. In a survival situation, use a large-gauge syringe to irrigate the burn thoroughly and remove any embedded clothing fragments.
Check for signs of circulation, such as breathing, coughing, or movement. Administer CPR if necessary. Remove jewelry, belts, and other restrictive items, especially from around the burned areas and neck.
Burned areas tend to swell rapidly. Avoid immersing large severe burns in cold water, as it may cause hypothermia or shock due to decreased blood flow and lowered blood pressure. Elevate the burned area if possible, raising the wound above heart level.
All partial- and full-thickness burns should be covered with sterile dressings. Use a fine mesh gauze (e.g., Telfa) after cleaning the burn and applying a thin layer of topical antibiotic.
The frequency of dressing changes can vary from twice daily to once a week. Dressings should be changed whenever they become saturated with excessive exudate or other fluids. During each dressing change, gently remove the topical antibiotic by washing the area. Then, reapply fresh antibiotic ointment and a new dressing.
In any medical situation, prioritizing personal safety and using available resources wisely is crucial. While these guidelines offer valuable information, seeking professional medical assistance whenever possible is highly recommended to ensure the best possible care for injuries and conditions. By being prepared and knowledgeable, individuals can increase their chances of effectively managing medical emergencies in survival scenarios.
This article has been written by James H. Redford MD for Prepper’s Will.
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