This comprehensive guide will outline the standard medical procedures for first responders, and the steps required to treat traumatic injuries. Survival hinges on your ability to properly respond to common injuries and life threatening injuries. With little access to EMT’s, nurses and doctors, you’re going to have to save your friend or family member’s life.
As previously reviewed in our Bug Out Bag Article, an EMT/First Aid Kit is essential. Ensure your kits are properly sterilized and adequately stocked with; bandage scissors (knife can be used in emergencies), forceps/mini scalpel, airway kit, compresses, tourniquets, hazmat materials, Mylar blanket, burn dressing, ammonia inhalants, eye pads, bandages and etc.. You can get these bags fully stocked around $50-75.
First Aid Guide Medical Safety Guidelines
- Always wash hands thoroughly before and after treatment
- Always wear disposable gloves that are puncture free
- Properly dispose of contaminated materials in properly labeled red bags (when available)
- Never recap used needles
- Use only sterilized needles and sharp instruments
- Provide peer training when available
Soft Tissue Injuries and Wounds
Soft tissue injuries involve the skin, subcutaneous tissues, and underlying musculature. An injury to these tissues is commonly referred to as a flesh wound. These injuries are usually extremely painful.
Inspect for any underlying fractures and splint if fracture is suspected. To secure limbs to a splint; belts, neckerchiefs, rope, or any suitable material may be used. If possible, tie the limb at two places above and two places below the break.
Expose all wound sites while clearing the wound of any loose foreign material (shrapnel, dirt, debris and etc.). Apply dressing and bandages to all open wounds and control bleeding.
Edges of the wound may need to be drawn together prior to dressing these wounds by using a sterile needle and thread using that should be included in your first aid kit. When closing wounds there is no ‘one right way’ other than ensuring your sutures adequately closes the wound.
Stabilize the object, if the object impedes transportation to a secondary staging area, careful shortening of the object may be requiring by immobilizing the object. Do not remove the object unless it interferes with CPR or causes a complete airway obstruction.
Cover the evisceration with sterile, saline soaked dressing. Support the evisceration with additional dressings while maintaining warmth.
Gun Shot Wounds
When possible, identify the type of weapon and caliber used. Immediate evacuation to a secondary staging area is typically required. Access the patient’s entry and exit wounds. Expose the wound site and treat the injury as per the above listed guideline. Clear the wounds of all foreign and loose material, including ammunition fragments including the bullet itself when proper medical facilities are not available. Control bleeding while considering internal bleeding, fractures, and injuries to underlying organs and structures. Pay close attention to the patients vitals and be prepared to manage cardiorespiratory distress or arrest.
External and Internal Bleeding
Early recognition of blood loss, internal or external, is critical in managing a hemorrhaging patient. This early recognition allows shock to be managed early and aggressively by controlling external bleeding.
Survey the patient while controlling any major bleeding, applying direct pressure using a gloved hand or sterile dressing. Have the patient rest the injured area and elevate the limb affected, when appropriate use pressure points to the wound, if bleeding is not controlled by direct pressure use a tourniquet as a last resort. If bleeding persists apply additional dressing and pressure as needed in layers. Never remove dressings once applied.
Administer high concentration oxygen by non-re-breathe mask and assist ventilation as required. If shock is present treat accordingly. Survey the area again and assess the distal color, warmth, circulation and movement prior to application of dressings and bandages, and reassess after applying bandages. Examine all wounds for penetrating or impaled objects, prior to applying direct pressure and dressings remove all loose surface material.
If a dressing becomes blood soaked, apply additional dressings over the original dressing. Secure all dressing appropriately so they do not slip while maintaining pressure on the wound site. Reassess.
Minimize patient movement and suspect underlying fractures, internal injuries. If no surgical staff is present and no one is capable of performing the operation the patient will die in a short amount of time.
Bleeding from Orifices
Apply loose dressings externally to absorb blood and prevent infection; do not pack the orifice with dressings. Seek immediate help from medical staff.
Use of a Tourniquet
Application of a tourniquet should be used as a last resort to control bleeding. The tourniquet should be made from wide material such as 7-10cm (3-4in) wide cravat or blood pressure cuff. Prior to application distal circulatory and neurological status must be assessed. Tourniquets should be applied as close to the injury as possible and if the injury is below the knee, the tourniquet must be applied above just tight enough to stop the bleeding. If a blood pressure cuff is use it should be inflated to 30mm Hg above systolic. Tourniquets may be released after two hours if bleeding discontinues.
Amputations are extremely traumatic and can focus all of the treatment to one injury, while other life threatening injuries and illnesses could be present. Amputations are emotionally difficult to deal with for the patient and those involved.
Shock will almost certainly need to be treated. The use of tourniquets can be implemented above joints and any anesthetics available may be used. If no further medical help is available the wound must be cauterized immediately after application of the tourniquet and after the area has been cleaned. Locate all of the severed parts and rinse gently with sterile saline to remove loose debris and gross contamination (do not scrub). Wrap the severed parts in sterile saline soaked dressings and inside a labeled plastic bag. Place the bag in a container that has been filled with ice and water.
Fractures and Dislocations
Plaster of Paris is one of the most common methods used to immobilize a limb. This cast is made from a preparation of gypsum that sets hard when water is added. Operation procedures depend on the location and severity of the fracture, for example:
- Closed or simple fractures - the two ends of the broken bone are lined up and held in place. The limb is thoroughly bandaged then the wet plaster is applied. Sometimes, once the plaster is dry, the cast is split into two and the two halves are then re-bandaged on the outside. This allows for any swelling that may occur.
- Open or compound fractures – these have to be thoroughly cleansed in the operating room to remove debris prior to being set because a broken bone exposed to the open air is at increased risk of infection.
- Long bones – long bones, like the bone of the thigh (femur), are difficult to keep aligned and, in adults, are generally treated by internal nailing. Children may need traction for a couple of days prior to setting in a cast. Once the two ends of bone start to show signs of healing, the leg and hip joint should be immobilized in plaster of Paris. In other cases, pins are inserted above and below the fracture and secured to an external frame or ‘fixator’ under a general anesthetic.
Eyes, Ears, Nose and Throat Injuries
Management of injuries of the eyes, ears, nose, and throat focuses on airway management and initial stabilization of the injury. Bilateral comparisons can assist in identifying injuries and changes.
If a foreign object is present locate the object and attempt to remove object with the edge of a sterile dressing or rubber-tipped tweezers while avoiding the application of pressure to the object, causing the object to retreat further into the eye. Do not attempt to remove the foreign object if embedded in the lid or globe. If unable to remove the object place dressing over the eye and advise the patient to limit eye movement.
If the orbit is injured treat any open wounds using Soft Tissue Injury Guidelines previously reviewed. If the eyeball is injured treat all open wounds and protect the eye using a cone or cup over the insured eye with bulky sterile dressings positioned to prevent the application of pressure. Do not apply pressure.
Impaled Objects should not be removed, but should be immobilized by securing the object using a cone or cup over the impaled object with bulky sterile dressings positioned to stabilize the eye and prevent eye movement.
Do not attempt to put the eye back in its socket and cover the eye with moist and sterile saline soaked dressings. Secure the eye using a cone or cup over the avulsed eye and bulky sterile dressings positioned to stabilize the eye and prevent eye movement.
Burns (Corneal Abrasions)
Treat as per burn guidelines and apply moist, sterile and saline soaked dressings loosely over the eye(s).
Treat as per burns guidelines and avoid contaminating parts of the patient, including patient’s other eye and orifices. Remove any contact lenses if present and use water to thoroughly flush the eyes, while refraining from the use of chemical antidotes or neutralizing agents. Irrigate under the eyelids and direct the stream of water away from the uninjured eye.
Soft tissue injures should follow established guidelines and injuries should be handled gently, as there is often considerable pain accompanying ear injuries.
Fluid & Blood Discharge
Do not use direct pressure while applying bulky sterile dressings, assess patient for possible skull fracture and treat for shock if appropriate.
Do not attempt to remove the object when medical personnel is available, and when the wound in non-life-threatening. With difficult visualization, it is likely the object has been embedded in the ear tissue, or may not be easily accessible. Avoid pressing the object further into the ear cavity and place bulky dressing over the ear.
Do not remove the object when medical personnel will soon be available. However, immobilize and secure the object using bulky sterile dressings positioned to stabilize said object, preventing further movement.
Locate and save avulsed parts and treat using standard Soft Tissue Injury guidelines.
Establish ABC’s (Airway, Breathing, Circulation), control bleeding and apply cold packs to the nose, while making preparations and precautions for vomiting to likely occur. Do not allow patient to blow nose and position the patient upright and learning forward, while cautioning the patient to avoid swallowing and to spit out any blood.
Nose bleeds could indicate head injury so avoid pinching the nostrils and in cases associated with head injury in an unconscious patient, maintenance of the airway is the first priority. Section may be required to keep the airway clear and dressings should be placed below the nostrils to control further bleeding.
Do not attempt to remove embedded objects while establishing ABC’s. Control bleeding when present by applying dressings below the nostrils and applying cold packs to the nose (if required).
Maintain a high level of suspicion for cervical spine injury while continuously monitoring the patient for a compromised airway due to swelling. Ensure any direct pressure applied to control hemorrhaging does not compromise the airway. If external bleeding from the neck cannot be controlled with direct pressure control the bleeding by using the carotid pressure point. Pressure should not be applied to both carotid arteries at the same time.
Establish ABC’s and consider inhalation injury with potential airway compromise if any of the following clinical indicators are present;
- History of altered mental status
- History of confinement in a burning environment
- Singed eyebrows and/or nasal hair
- Carbon deposits in orifices
- Acute inflammatory changes in the oropharynx (area around the uvula)
- Carbonaceous sputum (Burns to the nose, mouth and face)
- Explosion with burns to head or torso
Presence of these findings suggests acute inhalation injury requiring immediate care and close monitoring for changes in the patients respiratory status, immediate medical help should is required. Burn treatment requires you to remove all jewelry, and external objects that have not been effused. Do not apply ointment to burns and do not pop/rupture blisters. Cold compresses should not be used for paint control, but cool saline or water should be applied to the burns until the burning process has stopped. Maintain high concentration of oxygen delivery. Do not allow your patient to walk.
This guide focuses on injuries that are most likely to happen when the SHTF and can be treated, injuries that require surgical help and assistance were not explained for obvious reasons. However, you can continue to read more advanced procedures.