By BCE
There is almost a preparedness fixation with gunshot wounds and having sachets of quick-clot in your first aid kit. But in terms of bang for your buck, there other things which are frequently overlooked and very under-rated that much more likely to be life-saving than your hemostatic agent.
Use soap and water to wash your hands.
This to me something that seems so incredibly simple and but it seems lost completely on some. Can you honestly say you have never forgotten to wash your hands after going for a poo?
It is almost unanimously accepted that the understanding of microorganisms spreading infectious disease and the connection that hand washing substantially reduces transmission of disease has been the single most important advance in medicine ever.
Simply forgetting once to wash your hands can result in transferring bacteria from your hands to food, your mouth, or into others’ wounds (if you are caring for them) and exposing them or you to a potentially fatal infection.
While the use of soap is important – the action that is most important is the friction of the rubbing of the hands combined with the water washing the bacteria away. So even in the absence of soap, there is still real value to hand washing (and drying – removing the bacteria containing water).
Drink clean water.
This goes hand in hand with (1) – germ theory explains why you need to be extremely important with your drinking water.
No matter how thirsty you are, taking the time to ensure the purity of water is vital – regardless if it is filtration, chemical sterilization, or boiling, it is time worth taking. While you may get away with it 9/10 or 49/50 the risk isn’t worth it, especially in a grid down situation where a serious gastrointestinal infection can be fatal.
Learn how to open an airway and position a patient.
If you are unconscious (regardless of the cause) you are in significant risk of obstructing your airway. Every day people die due to hypoxic brain injury which has been caused by them being knocked unconscious (in car accidents, while playing a sport or falling from a height or collapsing due to a medical problem) and obstructing their airway.
Simply opening their airway with a slight head tilt and lifting their jaw forward and then placing them on their side can be life and brain-saving.
Here’s how to apply direct pressure to stop bleeding.
Quick-clot is great. Tourniquets are great. Israeli Bandages are great.
But for 95% of wounds you are likely to encounter in an SHTF situation, the direct application of firm pressure to the site of bleeding (be it arterial, venous or capillary) for 10-15 minutes will usually result in the cessation of bleeding.
The human body is a wonderful thing – if a blood vessel is damaged we have been designed to patch the hole. When a break in the integrity of the blood vessel occurs, immediately platelets in the blood start attaching to the hole to try and cover it over and clotting factors in the blood are attracted to the site and clot forms. For small wounds, this process doesn’t need any help and if you do absolutely nothing it will stop bleeding over a few minutes. Bigger wounds need some help and direct pressure compressing the vessels wall and slowing the bleeding helps while the process can occur. This is also where hemostatic agents also work by improving or encouraging the clot, but for the clear majority of patients firm, direct pressure is all that is required.
The pressure needs to be precise and focused. But even arterial injuries can be managed with focal direct pressure. Tourniquets and hemostatic compounds can have a role – but direct pressure is usually the lifesaving act.
Some wounds (think. Traumatic amputation or a big destructive wound caused by a .308) aren’t as easily dealt with. But for most the wounds you deal with direct pressure at the site of bleeding will stop it.
Don’t throw out your compression bandages or tourniquets but also understand that 95% of wounds will not require them and potentially matters can be made worse by using them first and neglecting basic dressings and direct pressure.
Even for bigger wounds, if there is an area of heavy bleeding within it, focal direct pressure on the area of heavy bleeding, can be very effective.
Oral Rehydration Formula (ORT) can save a life.
Sick and injured people often feel nauseous and are reluctant to drink. In response to the sickness or injury, their gut is often sluggish and not working as well as normal. Hence the reluctance to give oral fluids and why we default to IV fluids frequently.
ORT is a good way of delivering fluid and electrolytes and it uses the body’s own special pumps within the bowel to absorb these. But it isn’t widely used due to the above problems – if you give the patient a big glass to drink they will vomit it up or it will distend their stomach and not go anywhere.
The trick is small amounts often. Five mls every 2-3 minutes = 150mls an hour = 1.5 Litres in 10 hours – a reasonable volume. It is labor-intensive, but if you have no alternative it works. This approach has been demonstrated to work in moderate to severe dehydration, shock due to blood loss and in patients with severe burns (up to 20-30%). If you have an anti-emetic (an anti-nausea drug) you can give the patients one of these first and this method is more effective still – but even if you don’t – it is a good way to fluid resuscitate people who are moderately dehydrated or shocked.
Who I am
My background is as an acute critical care doctor who has worked and taught extensively around austere medicine and medicine in remote environments for nearly 30 years and I have been writing about survival medicine for 20 years now. What I write is always just my own opinions and ideas and you are welcome to not agree with me or think I am completely mad.
Some of the things I teach and write about aren’t best practices in the modern world of medicine – but they are safe and pragmatic approaches to often-complex problems. Any comments and ideas are put forward purely for interest and education and I wouldn’t expect you to take anything I say as gospel and you must verify medical facts for yourself, but hopefully, some of what I post will be useful and point you in the right direction.
About the Author
BCE is a Critical Care doctor who has 25 years’ experience in pre-hospital, remote and austere medicine. He has been a prepper/survivalist for even longer and pessimistically thinks a grid-down long-term collapse is not far away. He is passionate about improving medical knowledge within the prepper community and he is currently working on a book about truly primitive medicine and improvisation. He lives somewhere south of the equator on a Doomstead in a (hopefully) quiet isolated part of the world.
He helped write and edit the book “Survival and Austere Medicine” which is available for free download at https://www.ausprep.org/manuals and from a number of other sites and for purchase (at cost) from Lulu at http://www.lulu.com/shop/search.ep?contributorId=1550817
Questions, comments, and criticisms are welcome – post here and he will respond.
I agree with BCE’s comments but would add my 2 cents 🙂 Not just hand washing but a working understanding of Sanitation with hard copies of material on how to safely dispose of human waste like the Human Manure Handbook and such. Cholera, Typhoid and other wonderful 3rd world deadly diseases are mostly from improper disposable of human waste fouling drinking water supplies.
Also medically useful if you simply cannot get a severely dehydrated person to drink the oral rehydration solution is to use rectal enema technique. Messy but very useful in mountain medicine when trying oral rehydration will create a severe aspiration problem. You still need to use safe boiled and cooled to lukewarm drinking water (can add salt and sugars) as you don’t need to introduce parasites into a weaken persons system.
A person can shoot you and you might die, drinking fecal contaminated water WILL kill you in a horrible manner with out a lot of modern medical help.
Thank you for this article and your previous article on Organic Prepper, “The Grim Reality of Survival Medicine in Austere Conditions”.
And the link to the book “Survival and Austere Medicine” which is “available for free download at https://www.ausprep.org/manuals and from a number of other sites and for purchase from Lulu at http://www.lulu.com/shop/search.ep?contributorId=1550817 “.
My two cents: I learned from experience, always keep the fingernails short and clean. Scratched my back inadvertently and about time I was able get it lanced there was a huge boil, with pain that felt like a stabbing knife, and an abscess that required multiple packings. Tegaderm bandages are good to have on hand along with basic medical instruments, forceps, tweezers (ticks) to lancets. Gonna say, compared to the Civil War Medicine kit, we have many more options now.
Many thanks to the ER personnel for their work. If anyone wants to be a valuable community member, learn EM, wilderness medicine or paramedical skills.
In addition to BCE’s book for your essential library, recommended by another OP writer,
https://www.hamiltonbook.com/the-ultimate-survival-medicine-guide-emergency-preparedness-for-any-disaster
“Survival and Austere Medicine” Chapter 26 has a very good guide to medical Reference Books.
After taking a quick overview of the book, how much is there on foot and knee injures considering some people will be bugging-out/migrating long distances?
Great article. And I second the comment about fingernails. I hate those dragon lady nails that some women wear! Do you realize how much bacteria is under there? EEWW! A woman can have attractive nails of reasonble length without some of the procedures that now pass for manicures.
Cleanliness is next to Godliness for a reason. Please make sure that bathing is part of your survival prepping. That means soaps, WATER, lotions, and wash rags & towels. I wonder how many preppers have a stocktank ready for action? Your bathroom bathtub or shower will probably not be useable in a grid down situation. Clean skin is less susceptible to bacteria, fungus, clogged pores, etc.
lest we forget boy scout 101 it’s stop ,look , take a deep breath, think clearly then got to work
rules to follow treat breathing first , then bleeding , then shock , transport after patient is stabilzed
and broken limbs imobilized
We have all heard about quick clot. I took a class about a year or so ago and was told the old quick clot that had the granules in the package could actually kill you. First the wind could get them in your eyes but the little granules gets in the blood stream and travel. When they reach the heart is when they could hurt or kill you. I use to have them in my kit but now I bought the new cloth quick clot. I have not heard many people talk about this. to me that is pretty scary.
Great info..always in the lookout for new/updated info! i make it a practice to clean my hands all the time when out and about with a alcohol gel..never know who’s touched what out there!!
what re hydrating formulas/drinks do you recommend??
… yet, another post.
A note on gloves, “While an exact shelf life time period is dependent on what specific material the gloves are made of and storage facilities, a general rule of thumb is three years for disposable natural latex gloves and up to five years for disposable nitrile gloves.”
A while back I worked briefly in medical supply. Cross-contamination is a key element in healthcare. Contact, airborne, and droplets are some ways diseases are transmitted. Protected clothing, gowns, face-shields, masks ie. N-95, booties, etc. would be good to have in supply. Body bags or heavy mil plastic sheets have multiple uses. Note: lime is a preservative. Vinegar, baking soda, hydrogen peroxide and honey are disinfectants.
Crash carts could be one reference for emergency procedures.
https://en.wikipedia.org/wiki/Crash_cart
http://www.outpatientsurgery.net/resources/forms/2004/pdf/OutpatientSurgeryMagazine_0410_crashCart.pdf
While not everyone will have a defibrillator or suction machine around, crash carts are instructional.
Btw: A rant and rave.
While I have met some great nurses Not all RNs are equally competent. Pay attention if they put on and remove gloves when they enter and leave a patient’s room. Check their finger nail length. I have noticed some personnel walk from an Isolation Room into a clean supply room without removing their PPE protective clothing and ramble though various supplies because they were too busy to read the shelve labels. Read, they didn’t know the proper name of the supply.Or, being too lazy to make it to a Supply Room they would rather take supplies out of a Crash Cart. My opinion, if someone doesn’t understand why that is criminal they shouldn’t be working in a medical environment.
Some items such as catheters are a “Tower of Babel’ in terminology. Depending on where they worked nurses have their pet names for an item. Who knew a “Christmas Tree” is an adapter and a “Red Robin is a catheter … and red. A typical “stat” call would be for a red catheter? O.K., what type and gauge? Reply from caller: ““Red” and you pick a gauge”. Out of sixty catheters I would deliver all twenty of the red ones to show the difference to the RN and explain why the patient might not appreciate a 32 fr gauge catheter.
What does this have to do with prepping? If you will be working with other people, make sure they’re all on the same page.
I find it interesting that Selco picked EMT (I believe) amongst his other talents, as a profession.
AMEN! there is a VERY large disparity in knowledge and talent /attitude between individuals…. JUST because they have a license as a nurse, doctor, EMT, CNA or whatever they are, does NOT equate to that individual being of any real use in a given situation. There are many who have licenses who are NOT competent in all areas – as an example ER staff do not make good ICU staff [some can but most do not] the reverse is also true. There ARE a lot of skills that transfer over, A lot of the issue is attitude …
Like your info, hate your site as it does not offer print friendly option..most of us need to print for our 3 ring binders as we are getting ready for when we can not refer back to the internet. Please a update .
Pinning isn’t really my biggest love, finding what you want in your own stuff when you are an avid pinner is a little frustraating for me.
I lke to print to pdf of favorite posting by my “newsletter pals.” I KNOW, I’m a cheapskate who hasn’t bought one of your books, and may never, hard to say. Money could pick up.. Anyway, I do understand but still wish your posts had a print icon. Thanks for listening, I am a big fan.
How to print out any of Daisy’s articles (or just archive them digitally)
For anyone wanting to print any of Daisy’s articles to paper, one easy way is to use a “Save to PDF” extension in your browser. Some browsers have that already built in, but for the ones that don’t, you’d need to go shopping through whatever extension catalog works with your browser.
I’m lazy, and preferred not to have to go through that shopping and extension testing process — not all “Save to PDF” extensions perform equally as well, and you can’t count on their description to disclose their faults. So my solution, which has worked beautifully for several years, was to download and install the Russian browser Yandex. Its built-in “Save to PDF” feature consistently preserves embedded links (which is a major benefit considering the great value of such links in many of Daisy’s articles).
It can even translate foreign language web material into English — so then the “Save to PDF” operation can preserve that translated version. The only downside I’ve found is that switching on the “Reader Mode” (which shuts off most, but not all, ads) also shuts off the “Save to PDF” feature. When one goes back to all the ads showing again, “Save to PDF” becomes again available.
Once that entire web page is saved to a PDF file, then it’s easy to print from there. As an example, the PDF I just created from this article (“5 Simple Pieces of Lifesaving Advice…”) — including the comments — became a 22 page PDF, and easy to print. Obviously, you can save 50% on the paper needed (and the shelf storage space needed) if you have access to a duplex printer (that prints on both the front and back side of the paper).
I also believe in having several different browsers on my PC, because some browsers do a better job with some challenges than others, and I always try for “simple and reliable” whenever possible.
So it’s not necessary for Daisy to spend real money to smooth our way in printing, since totally free methods are easily available to us all.
—Lewis
“Wash your hands! Wash your hands! Wash your hands!” even the two year old grandkids know that Nana is a hand-washing nut!
As one of the commenters mentioned, not all medical folks are equal, even with equivalent credentials. I have worked with some RN’s who I wouldn’t let touch my family members! And those long nails – if an RN has long nails, she/he have absolutely no understanding of infection control.
We play a card game with grid-down scenarios and water availability is one of them. My stance is that once the grid goes down, the large creek behind our house is off-limits. We would have absolutely no idea who put or did WHAT in the water upstream. We have a 6-acre lake on our property that is close to the house. No one else has access to it. That would be our primary water source – after being decontaminated, of course.
If you want info to print off – the World Health Organization has some very detailed downloads about water, health, breastfeeding, rehydration, etc. They include recipes for rehydration drinks – usually water, salt, sugar, flavoring. They were written for people going into third world situations and are written for non-medical people.
Great article.
So true about the nails. I watched an RN with long nails struggle with her nitrile gloves and wondered how easy it would be to puncture through those gloves. I wondered about the myriad of hands over my mom’s gut wound having a look-see.
I loved this article because the points are the main things to have memorized and mastered for times when panic rules. First things first. Then there is more time to think and assess what comes next after some deep calming breaths. Laypeople need some simple guidelines for peace of mind. Thank you! Thank you!
These basics work well with any emergency when the kit is not handy.