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-Reader Submitted Article
Wound Care in Survival Situations
I would like to share some insight into attending to wounds in
an emergency situation. During and immediately after any natural
disaster, be it as a hurricane, earthquake, flood, or even social
unrest, your access to medical care will be limited, restricted
for some unknown length of time or even denied by circumstances.
Those are the times you will be called upon to act to keep the person's
body alive, intact and in the best physical shape possible pending
professional care.
I am an avid advocate for preparing yourself and family for the
worse of times. The first and most important item for any list of
survival kit items you are planning to aquire is knowledge. This
is even more critical during a medical emergency care and healthy
living during your need to survive. A backpack or footlocker full
of medical supplies are worthless if you are not educated and properly
trained how to use the items. Begin your intended survival kit purchases
by first spending a few bucks in the most cost effective manner;
that is to take formal classes in first-aid and even more advanced
courses if available to you. A Red Cross basic course in first-aid
should be available to you in your local.
Thoughts About Wound Care: I suppose everyone has experiences
with cuts, scrapes or "rug-burns" or even having a small
chunk of skin ripped out of our hide. Many have, or perhaps seen
another, whose cut is a little wide or long enough and we hear the
words "I think you need stitches". In a civilized world
and place, there is absolutely nothing wrong going to a doctor's
office or hospital and being treated for these "soft-tissue
injuries". But remember here we are talking about being in
a disaster or other survival situation and a doctor or hospital
may not be a viable option. You have to be the doctor and hospital
during those times and having the basics of how to care for and
bandage wounds comes into play.
In an emergency care situation away from professional care due
to delay in treatment, keep the following order of care in mind:
1. Control bleeding,
2. Preventing infection and,
3. Follow-up wound care to reduce likelihood of infection.
Bleeding. Immediately after bleeding starts the body itself
will rapidly begin different processes to stop the flow of blood.
The problem is sometimes we need to perform techniques to allow
time for the body's methods to kick-in and become effective or stem
the flow of bleeding that in the short term is too overwhelming
for the body to deal with.
One way the body tries to stop bleeding is by shutting off the
bleeding arteries or veins; this includes the big ones and smallest
ones in the skin. The blood vessels have small muscle like organs
similar to a doughnut surrounding a stick. Their day-to-day role
is in circulating the blood in our body. The body is also capable
of causing these "doughnuts" to clamp off the vessel(s)
and stop the bleeding very effectively. Before everyone gets to
screaming, yes platelets and other body substances do play a role
in controlling bleeding and I will mention them a little later on.
In our attempts to "control bleeding" normally we are
giving the body time to try and shut off the vessels and close off
blood coming out of torn/cut tissues on its own.
- The first and ideal method to control bleeding that is vastly
underused and that is basic direct pressure to the wound.
I have seen complete leg amputations, vast denuding of tissue
and other seriously bleeding injuries controlled completely solely
with direct pressure. Direct pressure means simply using the cleanest
thing you have at the moment. Medical gauze, clothing, or whatever
is available (even a bare hand if that is all you have), and applying
it to the wound with slight to medium pressure. After putting
on the "dressing" and putting some pressure on it, the
key is not to remove it for about ten (10) minutes to allow the
platelets to form their plugs and the other vessels to clamp down.
That means no "peeking to see if the blood has stopped"
or to "see how bad it is". I tell folks that every time
they remove the pressure from the wound the clock (and bleeding)
starts over again. So give it time to stop the bleeding before
allowing your curiosity to get the better of you. If after you
attempt applying direct pressure to the wound for the 10 minutes
and the bleeding has stopped, merely go on to bandaging the wound.
If there is still some bleeding, apply additional pressure again
or use a pressure dressing (as taught in your previous first-aid
training) and normally it is sufficient.
- If there is still "serious bleeding" after attempting
the direct pressure, then resort to using one of the many pressure
points (again using the proper locations as taught in your
training) available to you. Using a pressure point is likened
to squeezing a water hose to stop the flow of liquid. It works.
After gaining control over the bleeding for several minutes, ease
up on the pressure a little and see if the serious bleeding has
stopped. Not all bleeding may have stopped and minor bleeding
calls for use the application of direct pressure to the injury,
as described above. If the bleeding is still rather severe you
must re-apply pressure to the "water hose" and it stops
the bleeding. If you have a second pair of hands to help, a field
expedient method of doing this is to place a wadded up dressing
or balled-up shirt or even pair of socks over the proper artery
and wrapping it with a snug bandage. I do not mean a tourniquet,
but tight enough to apply pressure to the "water hose"
artery to stop the bleeding. Simply watching to see when the bleeding
is under control tells you there is enough pressure. Then tie
the bandage, rope or whatever you are using to wrap the dressing
with, directly on top of the dressing. This will buy you time
to get the person to a doctor. If in the field, leave the pressure
on for awhile and then loosen it slowly to see if the bleeding
has stopped.
- The last resort available to you in the field (unless trained
how to do one of the emergency surgical methods like a venous
cutdown) is a tourniquet. This is the application of whatever
you have available, rope, belt, vines or clothing, wrapping it
around the limb and clamping it down to stop all blood flow below
the tourniquet. (again you know how from your previous training.
Right?) If using a tourniquet and the time it needs to be
applied is short before professional care is given, there probably
will not have permanent damage. If it takes too long to get proper
surgical care, the limb might be lost but the person will live
and that is the most important thing in emergency care. In a longer
time survival situation, the next concern is infection taking
hold. That leads me to my next topic.
Infection. After the bleeding is under control, your second
efforts are directed at preventing an infection starting in the
wound. Prevention of infection that could kill the person is serious
stuffs in a survival situation where proper medications and surgical
techniques are not available to you. If you used a gauze or clean
material to stop the initial bleeding, you already have begun the
prevention of infection. The next steps are:
- Clean the wound. This will start some bleeding again but the
bleeding (unless lots of blood) is OK. Using any potable water
(water you can drink) is gently flushed into the wound to dislodge
and flush out any gross dirt and debris and other foreign matters.
If you have available some antiseptic wipes, minor wounds can
be wiped off with these alone but do not use on large or deep
wounds. After rinsing the wound it will probably need a bit of
cleaning out. Hydrogen peroxide and gauze works well here. Plain
old soap works for minor injuries or penetrating wounds if that
is all that you have. If you can, use a piece of gauze to gentle
wipe out inside the wound to get as much crud and crap as possible.
Then flush again. Use as much water at hand for the flushing out
the wound is important. One of the larger 20-50 cc syringes or
a bulb syringe works pretty very well but don't squirt the water
with heavy pressure, merely a steady flow. After cleansing the
wound, some more direct pressure with gauze may be needed.
- OK, the wound is clean. Now comes protecting the opening in
the skin (wound). Minor cuts, as an option, can have one of the
varieties of first-aid creams applied. If the wound is deep or
wide, leave those creams off for they will cause more problems
than solving them. (The tissues will within minutes begin to wall
itself off from the outside world and attacking germs without
the creams and some of the creams hinder this natural process).
Apply a dressing, sterile gauze, or a piece of cloth which has
been boiled and dried, loosely over the wound. You do not want
to make it airtight for that will lead to infection. You are only
trying to keep the wound from getting more dirt and junk inside
and if needed, letting pus get out. The "dressing" (gauze,
cloth) now needs to be held in place with a "bandage".
Many fancy dressing come with first-aid kits and can be used,
but remember to not apply them tightly. You are not trying to
strangle the wound, just trying to keep your dressing in place.
Tape, medical, duct or even electrical tape can be used to put
a couple of strips over the dressing to hold it in place.
- Now the wound is clean and has been bandaged the best you can,
so what's next. That is to keep the wound from becoming infected.
If the dressing becomes really dirty replace it with a clean one.
In most situations do not pull off the dressing as that will only
lead to pulling off scabs that have formed and increasing the
probability of infective organisms getting inside. All wounds
will become somewhat red in color and tender to the touch. It
is normal. If the wound has become very red in color, swollen
and painful and especially if a fever starts, it has become infected.
If you are stranded for awhile and need to treat it this is what
is best to do; first open the wound if it has closed or you foolishly
used sutures, to let the pus to drain out. You can facilitate
the drainage by applying warm (not boiling hot) compresses to
the wound. The heat will tend to attract the pus so the wound
needs to be opened, or the pus will be drawn into other tissues.
If your water supply is restricted, try warming a flat rock. Wrap
it up in some clothing and place it against the infected area.
Gentle rinsing with hydrogen peroxide, if on hand, will help get
the infection out of the wound. If you have a wide spectrum antibiotic
available, this is the time to use it. Maggots will eat away dead
and infected tissue in an opened wound, but you need to be able
to identify the proper bug for it to work and if you can find
them in your part of the woods.
- If you are dealing with an amputation, leg, arm, finger, toes
the procedure is the same. Clean by rinsing well with water. Do
not apply first-aid creams and such to the exposed tissues. Apply
sterile or boiled (dry) dressing and clean bandage. Do not cut
off ragged or hanging tissues or try to put the skin back in place.
Either can lead to sever infections and is best left up to a surgeon
to repair.
Bumps, lumps, sprains and stains. These will resolve on
their own without help but you can make the healing time shorter
and less painful by remember the word "ICE". All of these
type injuries are accompanied by swelling. The swelling presses
down on nerves making it hurt; the more the swelling the more the
pain. We can't stop it totally, but the goal is to quickly reduce
the swelling as much as possible. "ICE" works.
- "I" stands for ice or cool. Applying cold as quickly
as possible and then for the first 24 or more hours helps slow
fluids from leaking out of the tissues which is the cause of the
swelling. I recommend applying real ice or snow for 10 minutes
every 20-30 minutes. (wrap the ice/snow in cloth before applying
to skin) I suspect in a survival situation you forgot to drag
along your refrigerator, but there are still things you can use.
Those instant cold packs are nice, but they tend to wear out pretty
fast. Of course snow or outdoor ice is great if available. Streams
are a good source to cool the part if you have one. If not, have
you ever thought of taking a partially submerged rock out of the
ground and placing the injured part against the cool side of the
rock? The undersides of most rocks stay damp and cool. (I say
partially submerged for it was totally submerged you couldn't
see it).
- "C" stands for compression. Again we are striving
to reduce the swelling by minimizing fluids from seeping out of
the wound but this also makes the injured part feel better. Those
elastic bandages in the first-aid kit work perfectly, but do not
over tighten with them. If none of those are available, use snug
fitting roller gauze, a piece of cloth or whatever is available.
Whatever you use, do not over tighten it. We don't want to cut
off the blood supply. After wrapping, if you can slide a finger
under the bandage without trouble its ok, but if not, the bandage
is too tight and needs to be loosened.
- "E" stands for elevation. This is one thing that is
important to do, yet most of us find excuses for not doing around
the house much of the time. We don't need to hang upside down
from a tree limb for this simple yet effect technique to help
us heal. The idea is to get the injured part slightly raised above
the level of our heart. That is all that it takes. This assists
the blood and other fluids to be returned to the heart thereby
reducing the amount of fluid at the site. Try to do this for a
few days if your situation allows
Sutures. Leave them alone! If you are not properly schooled
in debridement of a wound (removing and cutting out dead or infected
meat from the body) suturing will lead to bad (i.e. life-threatening)
infections in all but the most minor of cuts. And these wounds will
heal quickly naturally without sutures. It will leave a scar but
that is better than loss of a limb or life trying to be fancy in
the woods. Even in a hospital setting, large gapping wounds are
left open for days to prevent or control infections if they start.
The body's tissues will wall itself off in an attempt to prevent
germs from entering. Secondly, it you close up the wound with skin
sutures and the wound is a bit deep, you will cause a pocket of
air below the skin. This pocket is warm, moist and no air can get
inside…that is the perfect setting for infections to begin
and pus to accumulate. Thirdly, sutures can let infections creep
along the material inside the body and cause an infection by themselves.
This is a concern in a civilized normal environment, so don't add
to more possible problems in a survival situation with sutures.
If the wound is a big gapping wound, flush it out and then take
rolled-up gauze, unroll it and loosely stick it in the wound until
you can get to a doctor or hospital. If it is going to be awhile,
use a couple of pieces of tape or strips of clothing to partially
close the wound. This will bring the tissues together somewhat to
help keep out dirt yet allow air to get in and pus to get out.
Minor Surgical Kits. Don't waste your time even thinking
about buying one. Most physicians hesitate at performing "minor
surgery" and normally refer the patient to a trained surgeon.
The reason being is that there are many structures such as blood
vessels, nerves, tendons, etc. under the skin that do not need to
be cut and severed by accident. When even doctors who know the general
location of these structures and have been trained in surgical techniques
shy away from doing something, take the hint and don't do it. If
there is a blister, boil or abscess needing care, you will find
something to care for it in the field. (A soda or beer bottle works
pretty good. Put hot water into the bottle and put the opening around
the boil. It will draw the boil to a head, the skin pops open and
it drains).
Nothing replaces knowledge of medical first-aid, and proper training
is a necessity. If you are serious about survival planning, take
the first step and get professional and certified training from
an organization like the Red Cross or as offered in many colleges.
This was written not as a professional & definitive guide for
medical care for wound management, rather a few personal concepts.
Therefore I do not take responsibility for any damages arising for
this article.
-Jerry B Blaine
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