First Aid: From Sprained Ankles to Gunshot Wounds, by Big Country

As an avid outdoorsman, survivalist, Eagle Scout and Emergency Medical Technician (EMT) in training I know the importance of first aid and how it can mean the importance of  life and death. The proper first aid training is crucial in an ever changing world. I will discuss how to make a proper Individual First Aid Kit (IFAK) that you can use for self and buddy aid. How to treat sprains, broken bones, environmental emergencies, bleeding control and sucking chest wounds.

IFAK- Choosing the right bag or case is very important. Make sure it can hold all of your gear and is easy to use for one handed operations. If you are on a limited budget Wal-Mart sells multi use hunting bags and cases or you can check out Coleman’s Army Surplus. Another good bag is the Condor tactical Rip-Away EMT pouch that has MOLLE attachments that can be mounted on a backpack, vest or an optional shoulder harness. This pouch also has a Velcro design which lets you take off the pouch itself without removing the whole pouch from your equipment. This product is only $20. The contents of your first aid kit may vary depending on your personal needs. My kit contains medical tape, an LED penlight, several packs of Quikclot clotting sponges, several pairs of latex powder free gloves, tourniquets, bandages, alcohol prep pads, EMT/trauma shears, tweezers, tongue depressors (they make good finger and wrist splints) various sizes of ACE wraps and an assortment of bandages, gauze pads and Band-Aids. You can find these items at your local Wal-Mart, outdoor supply center or if you’re brave enough go to your local Emergency room and just ask for supplies and use a cover story on why you need the supplies. If you want the combat grade supplies just shop online.
 
The essence of First Aid: Stop life-threatening danger, protect an injured or ill person from further harm, and get proper medical help for the patient.

ABCs:
Airway- Open up the airway by the lift and tilt method, tilt the head up and lift open the mouth this creates an open airway for the patient if you believe there is a neck injury thrust the jaw forward

Breathing- Check for signs of air movement, the chest will rise and fall or you may be able to hear shallow breathing if not, then start CPR.

Circulation- Check for a pulse this can be checked by placing two fingers on the carotid artery in the neck (this is used for non-responsive patients or if you can’t find a radial pulse in either wrist) To check for a radial pulse place two- three fingers in the notch below the thumb, you may have to move around until you can find it. Do not check with your thumb because your thumb has a pulse of its own. Also check for major bleeding, open up clothing and examine your patient. This all together should take no more than 15-20 seconds upon initial contact.

Basic First Aid

Shock- When a person is injured or under great stresses his/her circulatory system might not provide enough blood flow to all parts of the body. Warning signs: feeling of weakness, confusion, fear, dizziness, quick weak pulse. Rapid shallow irregular breathing, vomiting, extreme thirst. Restore breathing and circulation, control bleeding, treat pain and treat wounds. Lay the patient down and elevate his or her feet 10-12 inches up to restore blood flow to vital organs. The new doctrine and theory says not to elevate the feet but most medical professionals still suggest doing this. If there is no head, neck or spine trauma then elevates both the feet 10-12 inches and the torso 30-45 degrees also. Also keep the patient warm with blankets, clothing and etc. Even if there are no signs for shock treat for it anyway. 

Sprained Ankle: Don’t remove your shoe it will help support your ankle if you must keep walking. Wrap the ankle and shoe/boot all with an ace bandage or triangular bandage (handkerchief, etc.) Once done traveling remove the footwear and raise your leg and apply ice packs or cool towels to help reduce swelling. To wrap the ankle start the bandage at the bottom of the persons shoe or boot and wrap around several times. Once that has been completed start the bandage in a “figure 8” motion. This will help support the ankle. This method can also be used for sprained wrists.
 

Broken Bones: Two types – Closed and Open. Closed fracture is a fracture in which the bone did not break the skin also referred to as a simple fracture. Open fracture is when the bone pierces the skin also referred to as a compound fracture. To treat closed fractures simply splint the broken bone to immobilize it from moving. a good saying is “splint it where it lies” you can simply use tongue depressors for fingers and smaller breaks, tree limbs that are as straight as possible or even a thick magazine you can also buy Sam splints at local outdoor retail shops. Cushion under a splint is also good in which it helps it fit better you can use a sleeping pad, cloth, roller bandages or whatever is handy at the time. Once the splint has been placed bind the two splints together. Compound fracture: wrap the bone exiting the skin with gauze or sterile bandages the risk of infection are much greater with broken skin. After treating the piercing bone splint the leg or arm to prevent further harm. If bleeding is present control the bleeding first.

How to make a sling: Support an injured hand, arm, collarbone or shoulder with a sling made from a triangular bandage or neckerchief. Tie an overhand knot in the largest angle of the triangle. Place the sling over the chest with the knot at the elbow of the injured limb and one over the opposite shoulder. Bring the free end of the sling up and over the other shoulder and tie the two ends together behind the neck using a square knot. A square knot is simply using two free ends of a rope or bandage and using the right free end placing it over the left taking it under and then left over right and pull together just remember “right over left, left over right”

Some key notes when splinting: Assess the patient’s Pulse, Motor function and Sensation (PMS). If there is a fracture in the leg check the pulse in the foot to make sure there is still blood flow getting to that part of the body if not you have a more serious problem on your hands. With the Motor function see if the patient can wiggle his/her toes or rotate he foot again do not cause any further harm to the patient. Last is the Sensation seeing if the patient can actually feel you touching his or her foot, pulling of leg hair and etc. All of these will provide crucial information about the extent of the fracture. When splinting make sure the splint itself extends several inches beyond the joints above and below the injury. After splinting check the PMS again.


Environmental Emergencies:

Hypothermia

(The following table is reproduced from an excellent paper on Environmental Emergencies by Capt. Tony Carraro.)

Stages of Hypothermia:

Body Temperature

(Fahrenheit )

Body Temperature

(Celsius)

Symptoms

99-96

37.0-35.5

Shivering

95-91

35.5-32.7

Intense shivering, difficulty speaking

90-86

32.0-30.0

Shivering decreases and is replaced my muscle rigidity. Jerky movements are produced, thinking is less clear, comprehension is dulled

85-81

29.4-27.2

Becomes irrational, loses contact with the environment, pulse and respirations are slow

80-78

26.6-20.5

Loses consciousness and doesn’t respond to spoken words. Heartbeat slows the cardiac arrest occurs.

First Aid for Hypothermia: Remove all wet clothing from the victim and change him/her into warm dry clothing. Don’t have him/her perform exercises; it’s okay in the beginning stages of hypothermia but the further it progresses the worse it becomes. Place warm water bottles underneath the armpits, and the groin area. Also apply a stocking cap to the patient’s head. All of these areas are the most at risk places to lose warmth. If necessary place yourself in a sleeping bag with the person. If he/she is awake and alert gradually give warm liquids at a slow rate.

Frost Bite: Get the patient out of the cold environment. Warm the affected area gradually. If this does not help heat water to between 100 degrees Fahrenheit – 105 degrees Fahrenheit. You should be able to stick your own finger or hand in there and not feel any discomfort. Do not apply any pressure to the frost bite area.

Hyperthermia

First Aid for Hyperthermia: Some signs and symptoms of hyperthermia are muscle cramps usually in the legs and abdomen. Weakness or exhaustion, rapid shallow breathing and a weak pulse. If the patient has moist, pale and normal to cool skin remove the patient from the heat if not possible lay him/her in a shady spot with their legs slightly elevated. Remove or loosen the patient’s clothing to help cool down the patient. If he/she is awake and not feeling nauseated have him or her sip cool drinks of water. Apply cool moist towels under the armpits and forehead. You can also apply instant cold packs if water is scarce which in times of emergencies it will be. Also be sure not to cool the body too quickly or you’ll send the patient into shock.
In any emergency survival situation you’ll come across people with weapons .Whether this be bow and arrows, firearms, knives, stones, baseball bats or even old fashioned tomahawks all will cause trauma. With this come soft tissue injuries and a number of other life threatening injuries. In the matter of external bleeding there are three types: Arterial which is the spurting of blood, pulsating flow and bright red in color. Venous (veins) which is a steady flow and dark red in color all the way to simple scratch or nick which is a cause of your capillary bleeding which is slow and has an even flow to it. A person can bleed out in a matter of seconds to minutes without the proper control of bleeding.

The simplest way to control bleeding of any aspect is to apply direct pressure. If the bleeding is mild and not too severe apply a sterile dressing with adequate pressure to help clotting. If the bleeding is severe or spurting quickly apply direct pressure with your hand DON”T WASTE TIME. Once bleeding has been controlled apply a pressure bandage. Never remove a bandage that has been placed to stop/control bleeding this can destroy clots and or skin. If the bandage has become soaked in blood apply another bandage directly over it and hold direct pressure.

Application of a tourniquet: This is to be done as a last resort. Have your partner or the patient (if he is responsive) hold and maintain direct pressure until the tourniquet is in place. Select a site no further than two inches from the wound. The tourniquet should be placed in between the wound and the heart (above the wound). If you do not have a tourniquet you can use a triangular dressing or a cravat. Wrap the bandage around the injury and tie a knot over the pad. Slip an ink pin, stick or anything hard into the knot and tighten until the bleeding is controlled.

Sucking Chest Wound

When the chest cavity is open to the atmosphere it is commonly called Sucking Chest Wound. Each time he/she breathes air can be sucked into the opening and the patient will have difficulty breathing. Some signs and symptoms of this include a “sucking” sound when the patient inhales, has a wound to the chest, and gasping for air. When treating someone with a sucking chest wound maintain an open airway. Apply an occlusive dressing that is at least two inches larger than the wound itself. If there is an exit wound also apply the same type of dressing to it also. When creating this dressing tape down all sides except for one this will create a flutter valve to help with breathing. When the patient inhales it prevents air from entering the chest cavity upon exhaling it allows trapped air to escape through the untapped section of the dressing. While preparing the dressing quickly place your hand over the wound this will provide crucial lifesaving moments. If an occlusive dressing is not available you can use a section of your latex glove, packaging from sterile bandages, and a section of a trash bag or plastic grocery sack. There are also many types of chest seals on the market today for less than $20.

With all of this information I hope it will provide you some basic knowledge of how to treat and respond to non-life and life threatening injuries. In some instances without the proper advanced level of care required for situations such as sucking chest wounds and internal injuries such as a broken femur that punctures the femoral arty they are sure to die but with the proper first aid you may add several minutes to days and months of life that they might not would have if it wasn’t for you. Study, take courses and save a life.

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