Dirty Medicine, by J.V. in Tacoma, Washington

Everyone of the survival mindset has thought many times over about what tactical items they may need, whether it is in a BoB, in a patrol configuration, or in a secure retreat location.  However with my various talks with numerous survivalists, not too many have given any sort of extensive thought to how to perform some basic medical procedures.  Sure everyone knows that a minor surgical kit might be beneficial or that some Lactated Ringers intravenous solutions would help out.  However many individuals do not actually know how to use these items, at least from my experience.

Starting off one of the absolute best books for any form of survival medicine would be Ditch Medicine, available from Paladin Press.  Another useful piece of reference material is the NATO Emergency War Surgery Handbook. The important thing to remember is first off that these are not the only good books available on the subject.  Also one should realize that while reading books of this type, the aforementioned two, in particular, is that when they are talking about “war injuries” that does not mean that war is the only place it could happen.  Accidents and injuries happen all of the time.

As a medically trained and trauma trained individual, my “standards” may seem a little different, however there is logic to my madness, which I will explain as it occurs.  There are 3 basic steps involved in all sorts of tactical medicine, regardless of injury type, location, or severity.  Those are 1. Stop the bleeding.  2. Start the breathing. 3. Treat for shock.  The first step should be in and of itself self explanatory.  Here is where I will differ in my ways of stopping the bleeding from most that has been taught.

If you find yourself in a tactical situation (patrol, under attack, E&E situation) use a tourniquet such as the Combat Application Tourniquet (CAT) placed approx 2-4 inches above the bleeding site.  Every member should have one of these on their body at all times during a Bug Out/Patrol situation, preferably in a unit standardized location.  This will allow the injured person to remain with their finger on the trigger.  “The best preventive medicine is overwhelming firepower.”  Contrary to popularly-held beliefs, recent studies from Iraq have shown that tourniquets can be left on for days without irreparable tissue damage occurring.  Not that I would leave a tourniquet on for that long myself but a few hours to return to a safe location, or defeat the hostile threat, will obviously not hurt anything.

Once the firefight stops or the person is evacuated back to the secure location is when you can begin to treat the wounded area for any continuing injuries.  For example you could now clamp off blood vessels or place wet packed gauze into the site to reinforce any clotting that may or may not have occurred already.  After you have dressed the wound you can slowly release the pressure on the tourniquet constantly checking for any uncontrolled bleeding and adjusting your dressings as needed until the bleeding is fully controlled.  You could also use some suture material to actually tie the vein itself off, this will completely stop the bleeding and if done properly will allow for the tourniquet to be removed.  This would have no adverse affect on the affected limb or body part as there is a number of duplicate veins inside each limb.  If this were an artery you could still tie it off, however you will have to be extremely careful that you are 100% certain there is a backup artery available to supply that limb or body part with fresh blood.  A simple chart of blood vessels in the human body would be invaluable at this point.

The most important thing to remember in a survival situation is that no matter how much you clean everything with the limited number of supplies you will have on hand you will never be able to obtain 100% sterilization.  Do not spend 10 hours trying to sterilize something when just 15 minutes will suffice. 

Another important item to note is how exactly does one start an intravenous (IV) line?  Sure, we all know that IV fluids, especially when someone has been bleeding or is bleeding still, are very important.  However there are a vast majority of people that have no idea how to actually start an IV.  The most important part of starting an IV line actually occurs before you even think about opening a needle/catheter.  Assemble everything prior to putting the needle in the arm/leg/forehead/wherever you can.  Put the tube on the IV bag/bottle, “charge” the drip chamber by squeezing and releasing it, open the stop gate and drain all of the air out of the line, get tape items ready, place all of these items close to where you plan on inserting the IV line at.  Now you are finally ready to start an IV line.  I prefer the Over-the-needle- catheter type of IV catheters, as I find these easiest for novices to use.  Using this style of catheter all one must do is insert the needle and catheter combo into the vein until they see blood fill the flash chamber, directly above the catheter.  Once blood is seen you simply use your index finger to “push” the catheter off the needle and into the vein.  Make sure to hold the needle barrel with at least your thumb and middle finger and push only with your pointer finger on the catheter tab.  Once this is done and the catheter can move no further into the vein, i.e. it is all the way against the skin, you simply flick your thumb and middle finger back until you hear a click.  Now is the other tricky part, with your right hand place the IV tubing under your arm and route it so the end just barely dangles in your palm with the tube wrapped above your thumb, take your left hand and apply firm pressure on the vein immediately above the catheter’s termination point.  Slowly grasp the needle barrel with your right thumb and forefinger, at the same time grasp the colored plastic part of the catheter with the thumb and forefinger of your left hand while still holding pressure on the vein.  Slowly twist the needle barrel to the right until it spins freely, now you can replace the barrel with the tubing connector of the IV line.  Start the fluids flowing and you are completely done, except for taping up the site, which should be self explanatory.  If done properly the patient will not lose a single drop of their diminishing blood supply.  I recommend running the first liter of IV solution full steam, wide open also known as bolus.  This will rapidly expand the volume inside the blood vessels and allow the system a better chance of returning to normal.  Do not however run more than 2 liters bolus under any circumstances.  I typically will estimate blood loss and run that much bolus and then run the rest of the fluid in that bag at [a slower] keep vein open (KVO) rate.  I do this as slowly as I can while still keeping the vein open, if vitals start taking a dive I can readily switch back to bolus and give more fluids.

The only thing left to convey is to read and practice (pigs, both live and dead make good substitutes for humans in the present times) and become knowledgeable and comfortable with your medical skills should the need ever arise where you are forced to use them.