Dear Editor:
I read with interest the letter regarding the need for first aid supplies and would like to address a few issues this gentleman and others might wish to consider for the next time an injury occurs. With all due respect to those who recommend buying lots of battle dressings and gauze, it is unlikely that one could truly buy enough to last for a prolonged TEOTWAWKI situation. While it is advisable to have adequate supplies on hand for most minor injuries, people would also do well to learn a few basics of first aid wound care and to consider other everyday options to supplement dressings for injuries.
Stopping bleeding (called “hemostasis” in medical jargon) is a first priority; keeping the wound clean is important but not at the sacrifice of hemostasis. Pressure is the key to stopping bleeding for first aid providers but another effective more advanced technique to decrease the amount of bleeding from a wound is to approximate the edges of the wound. This can be accomplished by pushing the wound from the sides to bring the skin edges together and then using something to hold them. For small wounds liquid bandages like New-Skin work but for larger wounds think tape, even if it’s duct tape (which would not be my first choice since it tears the skin when taken off but is better than nothing.) Take care not to allow the tape to circle an extremity completely because the non-stretchy tape is then a tourniquet. Once the skin edges are approximated put a sterile gauze over the wound and apply pressure to stop the bleeding. Pressure needs to be applied steadily for a minimum of by-the-clock 15 minutes or longer if needed to stop the bleeding. If the first gauze becomes saturated with blood, do not remove it but reinforce with a heavier dressing and continue to apply pressure. This reinforcement does not have to be sterile; a clean washcloth or towel can suffice. Taking the bandage off the wound will remove the clot that has formed and cause fresh bleeding, increasing the amount of blood loss. Washcloths, towels and cotton items of clothing (cotton underwear and socks are the right size) can all be used to bandage wounds if the item is clean. It is preferable to have the dressing material freshly laundered using bleach in the washing process and dried on high heat in the dryer but if time will not allow this just go to the sock drawer and pull out clean items to use. Alternatively an item that works well and is usually found in any home with women in the child-bearing years is a sanitary napkin. Buy the ones that are individually wrapped which will keep them cleaner prior to use.
Once the bleeding has stopped, if no medical care is available for several days, wound closure using butterfly-type bandages can be accomplished. Make your own the right size with adhesive tape by cutting elongated wedges out of the long sides of the tape and placing the narrow area over the wound. Place one end over the skin on the far side of the wound away from you, pull gently until the edges of the wound are touching and then place the end near you on the near skin edge. This gives enough leverage to the tape to allow it to hold the wound closed. Suturing a dirty or contaminated wound virtually ensures that you will get infection but using butterfly closures allows enough space for drainage to occur and decreases the risk of abscess formation. Use more than one butterfly if the wound is long enough that one will not provide closure for the entire length.
In a situation where medical supplies cannot be restocked and professional medical care is not available an option to maintain a supply of sterilized dressing materials is to use a pressure canner for sterilization. Place clean dry bandage material folded loosely in a canning jar with lid and ring. Process it in a pressure canner at 15 pounds of pressure for 30 minutes to approximate a medical autoclave. Use all of the appropriate precautions in use of the pressure canner, including letting the canner decompress to zero pounds pressure before opening the canner lid. To my knowledge there are no studies to compare the sterility of dry materials processed in this manner compared to a medical autoclave but in a TEOTWAWKI medical setting I will use instruments and supplies processed in this way rather than no attempt at sterilization at all.
Last but not least, please heed the advice of experienced hikers and wilderness experts. Don’t leave an injured party alone. They are better cared for with you there improvising than being left with no one to assist them if things take a turn for the worse. The worst situation would be for you to be stranded somewhere “out there” trying to get assistance and the patient’s condition to worsen when the injury could have been adequately dealt with using materials you already had at hand. – Ladydoc
About the Author: “I am a Family Medicine physician with over 25 years of practice experience, including several years in an Emergency Room setting.