First Aid

From TEOTWiki

When in a survival situation, especially in the wilderness, it is important to understand the fundamentals of First Aid. Whenever possible have a complete first aid kit and a book of techniques. It is also wise to take a first aid course, and that's good advice for anytime.

A good diet, cleanliness and appropriate clothing will lower the risk of illness or physical accident as well.

Disease, infection and insect bites can often be avoided when maintaining a proper diet. It is important to bathe daily but if this is not possible be sure to wash your hands frequently. Soap can be made using ashes and animal fat or by boiling the inner bark of a pine tree.

Remember ABC: Airway (ALWAYS first) Breathing and Circulation

Contents 1 First Aid Kit 2 Initial Assessment 3 Not breathing 4 Shock 5 Bleeding 6 Joint Dislocation 7 Sprain 8 Fractures 9 Concussion 10 Heat exhaustion 11 Sunstroke 12 Cramping 13 Burns 14 Snowblind 15 Frostbite 16 Friction Blisters 17 Headache 18 Snake Bites 19 Stings 20 Hypothermia 21 Hyperthermia

First Aid Kit

A First Aid kit is a valuable tool to help combat the unexpected. One should have a wide assortment of supplies for maximum versatility. Compact ready assembled first aid kits can be good, but some carry little in the way of supplies, usually enough to cover a day or two hike (granted, with severely bad luck) and not much else.

The bare minimum kit:

• 2 boxes (60 count or thereabouts) of assorted sterile self adhesive bandages
• 1-2 rolls of waterproof bandage tape. These often come in 50yd. rolls, in little tin cases.
• 3-4 3" gauze bandage rolls. These usually come in 4yd rolls, in sterile packaging. These obviously won't remain sterile after opening, but can still be usable if they're kept clean.
• A box of pressure closing (Like Ziploc™) sealing sandwich bags, these have multiple uses, for storing pills, opened gauze, assortments of other loose supplies, and can even be used to keep a severed finger in a pinch.
• 3 Tubes of Triple Antibiotic ointment (Neosporin or equivalent) to dress wounds. This kills lots of harmful bacterias and can help prevent infection.
• A pair of scissors, for cutting cause, removing dressings, etc.
• Elastic compression (ACE) bandages
• 2 bottles of Hydrogen peroxide, to disinfect scrapes and cuts, and clean wounds. Can also be used as a mouthwash if you don't mind a rusty taste in your mouth, and foam if your mouth is particularly dirty.
• 2 bottles of 70% Isopropyl Rubbing Alcohol, this will cleanse and sterilize instruments such as knives and needles, and can clean minor cuts quite effectively (beware, it will sting) Higher percentages are sold, but alcohol is very hygroscopic, and an open container of 91% rubbing alcohol will absorb enough water from the air to bring it's content down to 70% in about 40 minutes. 70% is stable.
• A bag of cotton balls, to use with the alcohol.
• 6-12 Sterile gauze pads, in 3"x3" and 4"x4" sizes.
• A pair of tweezers
• A blanket
• Hand Sanitizers or other soaps. (Alcohol can also be used to sanitize the hands)
• Asprin - not only for general headache relief, but it can help a patient survive a heart attack.

Kits can be much more in depth than that above, multiple additions can be made to cover your specific needs, such as:

• Splints
• CPR masks
• Epi-pens if people with severe allergies are nearby.
• Ready mix soft Drink mix packets (Kool-Aid™) - not only does it mask the flavor of iodine used to clean water, but supplies easily metabolized sugar in the case of insulin shock in diabetics.
• Insulin - if you have pill or powder formed insulin you can keep it in your first aid kit. Liquid insulin often requires refrigeration, look under the Cold Storage section for possible solutions if an electric refrigerator is not available.
• Aspirator (suction device, a bulb and tube device such as used to clear airways for infants.
• Moleskin - Blister treatment bandages.
• Petrolatum gauze pads (If you need to use these, get to a doctor, they're normally intended for sucking chest wounds)
• Powdered hemostatics, to promote blood coagulation.
• Protective equipment such as goggles, masks, gloves and aprons. Avoid latex products for hypoallergenic alternatives if possible.
• Q-tips have multiple potential uses.
• Irrigation syringe
• Distilled Water
• Saline solution (Coconut water works in dire emergencies, true fact!)
• Burn gel - substituteable for Aloe
• Smelling salts
• Calamine lotion for itching bites.
• Antihistamines for itching, allergies, and for most, a mild sleep aid.
• Petroleum jelly
• And many more...

Some people in the medical professions have access to even better goodies for your kit, povidone-iodine for example, is a great antiseptic. Ask any nurse or doctor buddies if they can grab a 10 ounce bottle of Betadine, which is the brand name version of it, ask them for advice on the rest of your kit too!

A final note, if you think you need more of one thing or another, get it! There is no such thing as having too many supplies in your kit, but there's definitely such a thing as having too little.

Initial Assessment

If an accident occurs in the wilderness it will be your responsibility to deal with the situation. The specific sequence of actions when dealing with this situation is:

1. Remain calm, providing your patient with quiet, efficient first aid treatment.
2. Keep the patient warm and lying down. Do not move this injured person until you have discovered the extent of the injuries.
3. Start mouth-to-mouth artificial respiration immediately if the injured person is not breathing.
4. Stop any bleeding.
5. Give your patient reassurance. Watch carefully for signs of shock.
6. Check for cuts, fractures, breaks and injuries to the head, neck or spine.
7. Do not allow people to crowd the injured person.
8. Do not remove clothing unless it is imperative.
9. Decide if your patient can be moved to a proper medical facility or doctor. If this is not possible, prepare a suitable living area in which shelter, heat and food are provided.

Not breathing

If breathing has stopped, begin mouth-to-mouth resuscitation. Place the patient on his/her back and follow these steps:

DANGER TO SPINE FIRST- check for open airway and position carefully to avoid spinal cord injury, to provide ventilations - either mouth to mouth or natural breathing which may return after positioning.

1. To open the airway, lift the patient's neck and tilt the head back.
2. Keeping the neck elevated, pinch the nostrils to prevent air leakage.
3. Place your mouth completely around the victim's mouth and blow, watching for chest expansion.
4. After removing your mouth, listen for air leaving the patient's lungs and watch for the chest to fall. Check for an airway blockage if the chest does not rise.

Repeat these steps approximately 12 to 15 times per minute. If treating a child, cover the nose and mouth with you mouth. Use smaller puffs of air and repeat this method 20 to 25 times per minute.

Shock

Shock is a depression of all of the body processes and may follow any injury regardless of how minor. Factors such as hemorrhage, cold and pain will intensify shock. When experiencing shock the patient will feel weak and may faint. The skin becomes cold and clammy and the pulse, weak and rapid. Shock can be more serious than the injury itself.

Use the following method to prevent and control shock:

1. When treating injuries:
   1. Restore breathing (Mouth to Mouth)
   2. Stop bleeding by dressing open wounds tightly
   3. treat breaks and fractures, setting is important for proper healing, but setting may increase shock, splint the affected area or wrap tightly if splinting is not an option - on the ribs for example)
2. If there are no head or chest injuries place the patient on his/her back with the head and chest lower than the legs. This will help the blood circulate to the brain, heart, lungs and other major organs.
3. If severe head and chest injuries are present elevate the upper body. If chest injuries are present, elevate the injured side to assist in the functioning of the uninjured lung.
4. If the injured person becomes unconscious, place him/her in a face down position to prevent choking on blood, vomit or the tongue.
5. Keep your patient warm and under shelter.

To help remember positioning for shock, repeat this rhyme - "face is pale, raise the tail; face is red, raise the head"

Bleeding

To control bleeding, elevate the wounded area above the heart and apply pressure using either gauze, clean cloth, dried seaweed or sphagnum moss. Use pressure at the pulse point between the injured area and the heart if bleeding fails to stop. If bleeding still persists, use a tourniquet between the injury and the heart. This method should only be used in extreme situations. After bleeding has been controlled, wash the wounded area with disinfectant and apply a dressing and bandages.

Joint Dislocation

Dislocation happens when the ligaments near a joint tear, allowing the movement of the bone from its socket. It is unwise to treat a dislocation unless you are a trained professional as permanent damage may occur. The affected extremity should be supported using a sling or other device and pain controlled with aspirin or other suitable drugs.

Note: Pulses on the most distal portion (wrist or ankle) of the extremity must be checked regularly as dislocation can pinch nerves and blood vessels - if there is no pulse present, limb must be manipulated to return circulation.

Sprain

Treat sprains by applying cold to the area for the first 24 hours then once the swelling has subsided, let the sprain sit for a day. Apply heat the following day to aid in the healing process. The sprain should be splinted and rendered immobile until the pain has completely disappeared.

Fractures

Signs that a fracture is present include:

1. Pain at the affected area.
2. The area may or may not be deformed.
3. The victim is unable to place weight on the area without experiencing pain.
4. A grating sensation or sound may be present during any motion of the injured area.

Treatment is as follows:

Note: If in doubt, treat the injury as a fracture.

1. Splint the joints above and below the fracture.
2. If the fracture may penetrate the skin, it could be necessary to apply traction to straighten the deformity.
3. Be sure to pad your splints.
4. Check the splint ties frequently to be sure they do not hinder circulation.
5. Cover all open wound with a clean dressing before splinting.
6. If the area cannot be splinted, wrap tightly with an athletic tape or ace bandage.

Concussion

The head should be elevated about 30 degrees- check frequently for changes in mental status, check pupils.

Concussions or other head injuries are often accompanied by a leakage of watery blood from the nose or ears. Other symptoms may include convulsions, an unresponsiveness of the pupils or headache and vomiting. Keep the injured party warm, dispense a pain killer regularly and allow time for the body to rest and repair.

If symptoms persist, get to a doctor as soon as possible.

Heat exhaustion

Heat exhaustion is not uncommon when water is not sufficient. The body becomes dehydrated and salt-depleted, resulting in nausea, faintness, a weak, rapid pulse and/or cold and clammy skin. Treatment includes plenty of rest, liquid and salt tablets.

Sunstroke

Sunstroke may occur when the body is exposed to excessive sun. The body becomes overheated and provides too much blood to the circulatory system resulting in a flushed, hot face, rapid pulse, headache and/or dizziness. Treat sunstroke by resting in a cool area and applying and consuming cold liquid. Prevent sunstroke by wearing proper headgear.

Cramping

Muscle cramps occur when the muscle accumulates excessive lactid acid or a loss of salt through perspiration. Treatment includes resting, deep breathing and stretching. Restore the salt balance immediately.

Burns

There are 4 degrees of burn (though there are two types of Second degree burns):

1. First Degree burns are superficial, only affecting the top layer of skin, resulting in a dry chapped burn. Sunburn and similar burns are First degree. These can be treated with simple application of Aloe or Triple Antibiotic ointment. They can be painful, but more often are accompanied by an itching sensation. The skin will often peel as the burn heals, adding to the itchiness. These usually heal after a week or so.
2. Second Degree burns come in two types, and are generally moist.
   1. Superficial or Papillary Burn - These are burns that result in blistering of the skin. For these Second degree burns, apply gauze (or clean strips of cloth) covered in Triple Antibiotic ointment to the affected area and bandage. The patient should consume more water than usual, and antibiotics can help prevent infection. These can take up to three weeks to heal. After the initial healing, petroleum jelly can be used to keep the area moist.
   2. Deep or Reticular Burn - burn farther into the skin and may actually burst blood vessels. They often show as bloody blisters.Treat as above, but check the wound after a day, If the skin is necrotic, use a sharp sterilized knife (and a steady hand!) to trim the dead skin away. Apply a burn ointment or triple antibiotic to the layer underneath and rewrap the burn. Antibiotics will help stave off infection, but it's a great idea to get to a hospital or doctor if possible. This burn can progress to a Third degree which will require excision. If all goes well, this burn can heal in about a month.
3. Third degree burns are burns all the way through the skin, resulting in a dark brown and grey charred looking area that must be excised. It may even require drastic measures such as amputation.
4. Fourth degree burns have burnt all the way through the skin and underlying tissue, and possibly through the bone as well. Fourth degree burns are very likely to result in death if the person is not shock stabilized and hospitalized right away.

Snowblind

Symptoms of snowblindness include scratchy or burning eyes, excessive tearing, sensitivity to light, headache, halos around light and temporary loss of vision. Bandage the victim's eyes and use cold compresses and a painkiller to control the pain. Vision will generally be restored after 18 hours without the help of a doctor. Always wear snow goggles or sunglasses in snowy areas to prevent snowblindness.

Frostbite

Frostbite occurs when the tissue of an area, most commonly the toes, fingers or face, is frozen either from direct exposure to the elements or high wind. First degree frostbite turns the area cold, white and numb. When heated the area becomes red and can be compared to a first degree burn. A blister will form after warming with second degree frostbite. Dark skin, gangrene, and a loss of some skin and tissues is common in third degree. Fourth degree frostbite causes irreparable damage. The affected area will remain cold and lifeless and generally a part of the area is lost. With adequate clothing frostbite can easily be avoided. Superficial frostbite may be treated by cupping one's hands and blowing on the affected area, warming from another warm hand or, with fingers, placing them in your armpits. For more severe cases, medical aid should be sought.

Friction Blisters

Blisters are the painful, and common, result of ill-fitting footwear. At the first sign of discomfort, remove boots and socks and place a piece of adhesive tape over the affected area. If it is absolutely necessary, open a blister by first washing the area thoroughly then inserting a sterilized needle into the side of the blister. Apply disinfectant and a bandage.

Headache

Headaches are often experienced in the mountains due to inadequate eye protection, tension in the neck, constipation or "water intoxication", a swelling of the brain tissue which happens when the hiker has sweated excessively over a period of days and consumed large quantities of water without taking salt tablets. Aspirin may be used to alleviate the pain but one should find the source of headache to prevent further discomfort. More information can be found on the Medicine page.

Snake Bites

It is a good idea to have a commercial snakebite kit in your First Aid kit.

DO NOT

• Attempt to suck out the poison by mouth unless there is NO OTHER ALTERNATIVE.
• Slice the skin open to remove venom, you just allow the venom to reach untainted areas easier.

DO

• Keep the person calm. Restrict movement, and keep the affected area just below heart level to reduce the flow of venom.
• Remove any rings or constricting items because the affected area may swell. Create a loose splint to help restrict movement of the area.
• If the area of the bite begins to swell and change color, get to a doctor.
• Monitor the person’s vital signs -- temperature, pulse, rate of breathing, blood pressure. If there are signs of shock (such as paleness), lay the victim flat, raise the feet about a foot, and cover the victim with a blanket.
• Get medical help as soon as you can.

Stings

Most insect stings are harmless unless you are allergic. Remove the stinger with a scraping motion from the edge of a knife or credit card (Do not attempt to pluck the stinger out, you will just squeeze more venom into your skin) then apply baking soda paste to soothe. If the site becomes infected, see a doctor.

Hypothermia

When the temperature of your body falls to a level at which your vital organs can no longer function you are experiencing hypothermia or exposure sickness. Hypothermia will develop rapidly and is caused by cold, wet and/or windy weather that chills the body at a speed faster than it can produce heat. A lack of energy-producing food and proper clothing will heighten the speed at which hypothermia will affect you. Always remember to bring extra clothing. It is important to hike at the speed of the slowest member of your party. Take frequent breaks and keep a close watch for members experiencing signs of fatigue. Exposure sickness generally occurs in temperatures of less than 10 C (50 F).

Symptoms are easily recognizable:

• Feeling cold and constantly exercising to keep warm.
• Uncontrollable shivering and numbness.
• Violent shivers. Your mind becomes slow and starts to wander.
• Violent shivering ceases and muscles begin to stiffen and become un-coordinated. Exposed skin becomes blue and thoughts are foggy. Victim usually lacks the capability of realizing how serious the situation is.
• Pulse and respiration slows.
• Victim will not respond and becomes unconscious.
• The section of the brain controlling the heart and lungs ceases functioning.

Treatment must be quick and efficient:

1. Move the victim to a sheltered area, out of the elements.
2. Remove wet clothing and replace with dry clothes and if possible, a sleeping bag.
3. Wrap warm rocks and place them near the patient.
4. Do not let the victim fall unconscious.
5. Give the victim a warm, non-alcoholic drink.
6. Allow another person in the sleeping bag to share body heat.
7. Exhale warm air near the vicinity of the patients mouth and nose.

Hyperthermia

Hyperthermia is a result of the body being overheated due to increased air temperature, solar or reflected radiation, poorly ventilated clothing, a low fitness level or excess bulk.

Symptoms include:

• Heat cramps may occur and should be treated by moving the victim to a shady area and supplying water and salt tablets.
• Heat exhaustion is a mild form of hyperthermia and includes symptoms such as headache, dizziness, fainting, clammy skin, blurred vision, nausea and vomiting. Treatment is the same as heat cramps.
• Heat stroke is the most serious degree of hyperthermia. The victim will have little or no perspiration, a hot and flushed face, full pulse, and become either apathetic or aggressive. Cool the victim as quickly as possible paying extra attention to the head, neck and chest. If the bodies temperature continues to rise, unconsciousness, delirium, convulsions and ultimately death may occur.

To avoid hyperthermia, avoid strenuous activity on hot days, wear loose clothing and shade your head, and drink plenty of fluids.