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MEDICIAL

BASIC SURVIVAL MEDICINE

MEDICAL EMERGENCIES
Medical problems and emergencies you may face include
breathing problems, severe bleeding, and shock. The following
paragraphs explain each of these problems and what you can
expect if they occur.

BREATHING PROBLEMS
Any one of the following can cause airway obstruction,
resulting in stopped breathing:

Foreign matter in mouth of throat that obstructs the
opening to the trachea.

Face or neck injuries.

Inflammation and swelling of mouth and throat caused by
inhaling smoke, flames, and irritating vapors or by an
allergic reaction.
“Kink” in the throat (caused by the neck bent forward so
that the chin rests upon the chest).

Tongue blocks passage of air to the lungs upon
unconsciousness. When an individual is unconscious, the
muscles of the lower jaw and tongue relax as the neck
drops forward, causing the lower jaw to sag and the tongue
to drop back and block the passage of air.

SEVERE BLEEDING
Severe bleeding from any major blood vessel in the body is
extremely dangerous. The loss of 1 liter of blood will produce
moderate symptoms of shock. The loss of 2 liters will produce a
severe state of shock that places the body in extreme danger. The
loss of 3 liters is usually fatal.

SHOCK (acute stress reaction) is not a disease in itself. It is a
clinical condition characterized by symptoms that arise when
cardiac output is insufficient to fill the arteries with blood under
enough pressure to provide an adequate blood supply to the
organs and tissues.

LIFESAVING STEPS
Control panic, both your own and the victim’s. Reassure
him and try to keep him quiet. Perform a rapid physical exam.
Look for the cause of the injury and follow the ABCs of first aid.
Start with the airway and breathing, but be discerning. In some
cases, a person may die from arterial bleeding more quickly than
from an airway obstruction. The following paragraphs describe
how to treat airway, bleeding, and shock emergencies.

OPEN AIRWAY AND MAINTAIN
You can open an airway and maintain it by using the
following steps:
• Step 1. You should check to see if the victim has a partial
or complete airway obstruction. If he can cough or speak,
allow him to clear the obstruction naturally. Stand by,
reassure the victim, and be ready to clear his airway and
perform mouth-to-mouth resuscitation should he become
unconscious. If his airway is completely obstructed,
administer abdominal thrusts until the obstruction is
cleared.
• Step 2. Using a finger, quickly sweep the victim’s mouth
clear of any foreign objects, broken teeth, dentures, and
sand.
• Step 3. Using the jaw thrust method, grasp the angles of
the victim’s lower jaw and lift with both hands, one on
each side, moving the jaw forward. For stability, rest your
elbows on the surface on which the victim is lying. If his
lips are closed, gently open the lower lip with your thumb

Figure 4-1. Jaw Thrust Method

• Step 4. With the victim’s airway open, pinch his nose
closed with your thumb and forefinger and blow two
complete breaths into his lungs. Allow the lungs to deflate
after the second inflation and perform the following:
.. Look for his chest to rise and fall.
.. Listen for escaping air during exhalation.
.. Feel for flow of air on your cheek.

• Step 5. If the forced breaths do not stimulate spontaneous
breathing, maintain the victim’s breathing by performing
mouth-to-mouth resuscitation.

• Step 6. There is danger of the victim vomiting during
mouth-to-mouth resuscitation. Check the victim’s mouth
periodically for vomit and clear as needed.
NOTE: Cardiopulmonary resuscitation (CPR) may be necessary
after cleaning the airway, but only after major bleeding is under
control. See FM 21-20, Physical Fitness Training, the American
Heart Association manual, the Red Cross manual, or most other
first aid books for detailed instructions on CPR.

CONTROL BLEEDING

In a survival situation, you must control serious bleeding
immediately because replacement fluids normally are not
available and the victim can die within a matter of minutes.

External bleeding falls into the following classifications
(according to its source):

• Arterial. Blood vessels called arteries carry blood away
from the heart and through the body. A cut artery issues
bright red blood from the wound in distinct spurts or pulses
that correspond to the rhythm of the heartbeat. Because
the blood in the arteries is under high pressure, an
individual can lose a large volume of blood in a short
period when damage to an artery of significant size occurs.
Therefore, arterial bleeding is the most serious type of
bleeding. If not controlled promptly, it can be fatal.

• Venous. Venous blood is blood that is returning to the
heart through blood vessels called veins. A steady flow of
dark red, maroon, or bluish blood characterizes bleeding
from a vein. You can usually control venous bleeding more
easily than arterial bleeding.

• Capillary. The capillaries are the extremely small vessels
that connect the arteries with the veins. Capillary bleeding
most commonly occurs in minor cuts and scrapes. This
type of bleeding is not difficult to control.

You can control external bleeding by direct pressure,
indirect (pressure points) pressure, elevation, digital ligation, or
tourniquet. Each method is explained below.

Direct Pressure
The most effective way to control external bleeding is by
applying pressure directly over the wound. This pressure must
not only be firm enough to stop the bleeding, but it must also be
maintained long enough to “seal off” the damaged surface.
4-42. If bleeding continues after having applied direct pressure
for 30 minutes, apply a pressure dressing. This dressing consists
of a thick dressing of gauze or other suitable material applied
directly over the wound and held in place with a tightly wrapped
bandage (Figure 4-2, page 4-12). It should be tighter than an
ordinary compression bandage but not so tight that it impairs
circulation to the rest of the limb. Once you apply the dressing,
do not remove it, even when the dressing becomes blood soaked.
Figure 4-2. Application of a Pressure Dressing

Leave the pressure dressing in place for 1 or 2 days, after
which you can remove and replace it with a smaller dressing. In
the long-term survival environment, make fresh, daily dressing
changes and inspect for signs of infection.

Elevation
Raising an injured extremity as high as possible above the
heart’s level slows blood loss by aiding the return of blood to the
heart and lowering the blood pressure at the wound. However,
elevation alone will not control bleeding entirely; you must also
apply direct pressure over the wound. When treating a snakebite,
be sure to keep the extremity lower than the heart.

Pressure Points
A pressure point is a location where the main artery to the
wound lies near the surface of the skin or where the artery passes
directly over a bony prominence

(Figure 4-3). You can use digital
pressure on a pressure point to slow arterial bleeding until the
application of a pressure dressing. Pressure point control is not as
effective for controlling bleeding as direct pressure exerted on the
wound. It is rare when a single major compressible artery
supplies a damaged vessel.

Figure 4-3. Pressure Points

If you cannot remember the exact location of the pressure
points, follow this rule: Apply pressure at the end of the joint just
above the injured area. On hands, feet, and head, this will be the
wrist, ankle, and neck, respectively.

Maintain pressure points by placing a round stick in the
joint, bending the joint over the stick, and then keeping it tightly
bent by lashing. By using this method to maintain pressure, it
frees your hands to work in other areas.

Digital Ligation
You can stop major bleeding immediately or slow it down by
applying pressure with a finger or two on the bleeding end of the
vein or artery. Maintain the pressure until the bleeding stops or
slows down enough to apply a pressure bandage, elevation, and so
forth.

Tourniquet
Use a tourniquet only when direct pressure over the
bleeding point and all other methods did not control the bleeding.
If you leave a tourniquet in place too long, the damage to the
tissues can progress to gangrene, with a loss of the limb later. An
improperly applied tourniquet can also cause permanent damage
to nerves and other tissues at the site of the constriction. If you
must use a tourniquet, place it around the extremity, between the
wound and the heart, 5 to 10 centimeters (2 to 4 inches) above the
wound site. Never place it directly over the wound or a fracture.

Figure 4-4, page 4-15, explains how to apply a tourniquet.

After you secure the tourniquet, clean and bandage the
wound. A lone survivor does not remove or release an applied
tourniquet. However, in a buddy system, the buddy can release
the tourniquet pressure every 10 to 15 minutes for 1 or 2 minutes
to let blood flow to the rest of the extremity to prevent limb loss.

WARNING
Use caution when applying pressure to the neck.
Too much pressure for too long may cause
unconsciousness or death. Never place a
tourniquet around the neck.
Figure 4-4. Application of Tourniquet

PREVENT AND TREAT SHOCK
Anticipate shock in all injured personnel. Treat all injured
persons as follows, regardless of what symptoms appear

(Figure 4-5, page 4-17):

• If the victim is conscious, place him on a level surface with
the lower extremities elevated 15 to 20 centimeters (6 to 8
inches).
• If the victim is unconscious, place him on his side or
abdomen with his head turned to one side to prevent
choking on vomit, blood, or other fluids.

• If you are unsure of the best position, place the victim
perfectly flat. Once the victim is in a shock position, do not
move him.

• Maintain body heat by insulating the victim from the
surroundings and, in some instances, applying external
heat.
• If wet, remove all the victim’s wet clothing as soon as
possible and replace with dry clothing.

• Improvise a shelter to insulate the victim from the
weather.

• Use warm liquids or foods, a prewarmed sleeping bag,
another person, warmed water in canteens, hot rocks
wrapped in clothing, or fires on either side of the victim to
provide external warmth.

• If the victim is conscious, slowly administer small doses of
a warm salt or sugar solution, if available.

• If the victim is unconscious or has abdominal wounds, do
not give fluids by mouth.

• Have the victim rest for at least 24 hours.

• If you are a lone survivor, lie in a depression in the ground,
behind a tree, or any other place out of the weather, with
your head lower than your feet.

• If you are with a buddy, reassess your patient constantly.
Figure 4-5. Treatment for Shock
BONE AND JOINT INJURY
You could face bone and joint injuries that include
fractures, dislocations, and sprains. Follow the steps explained
below for each injury.

FRACTURES
There are basically two types of fractures: open and closed.
With an open (or compound) fracture, the bone protrudes through
the skin and complicates the actual fracture with an open wound.
Any bone protruding from the wound should be cleaned with an
antiseptic and kept moist. You should splint the injured area and
continually monitor blood flow past the injury. Only reposition the
break if there is no blood flow.

The closed fracture has no open wounds. Follow the
guidelines for immobilization and splint the fracture.

The signs and symptoms of a fracture are pain, tenderness,
discoloration, swelling deformity, loss of function, and grating (a
sound or feeling that occurs when broken bone ends rub together).

The dangers with a fracture are the severing or the
compression of a nerve or blood vessel at the site of fracture. For
this reason minimum manipulation should be done, and only very
cautiously. If you notice the area below the break becoming numb,
swollen, cool to the touch, or turning pale, and the victim showing
signs of shock, a major vessel may have been severed. You must
control this internal bleeding. Reset the fracture and treat the
victim for shock and replace lost fluids.

Often you must maintain traction during the splinting and
healing process. You can effectively pull smaller bones such as the
arm or lower leg by hand. You can create traction by wedging a
hand or foot in the V-notch of a tree and pushing against the tree
with the other extremity. You can then splint the break.

Very strong muscles hold a broken thighbone (femur) in
place making it difficult to maintain traction during healing. You
can make an improvised traction splint using natural material

(Figure 4-6, page 4-19) as explained below.
Figure 4-6. Improvised Traction Splint

• Get two forked branches or saplings at least 5 centimeters
(2 inches) in diameter. Measure one from the patient’s
armpit to 20 to 30 centimeters (8 to 12 inches) past his
unbroken leg. Measure the other from the groin to 20 to 30
centimeters (8 to 12 inches) past the unbroken leg. Ensure
that both extend an equal distance beyond the end of the
leg.

• Pad the two splints. Notch the ends without forks and lash a
20- to 30-centimeter (8- to 12-inch) cross member made from
a 5-centimeter (2-inch) diameter branch between them.

• Using available material (vines, cloth, rawhide), tie the
splint around the upper portion of the body and down the
length of the broken leg. Follow the splinting guidelines.

• With available material, fashion a wrap that will extend
around the ankle, with the two free ends tied to the cross
member.

• Place a 10- by 2.5-centimeter (4- by 1-inch) stick in the
middle of the free ends of the ankle wrap between the cross
member and the foot. Using the stick, twist the material to
make the traction easier.

• Continue twisting until the broken leg is as long or slightly longer than the unbroken leg.

• Lash the stick to maintain traction.
NOTE: Over time, you may lose traction because the material
weakened. Check the traction periodically. If you must change or
repair the splint, maintain the traction manually for a short time.

DISLOCATIONS
Dislocations are the separations of bone joints causing the
bones to go out of proper alignment. These misalignments can be
extremely painful and can cause an impairment of nerve or
circulatory function below the area affected. You must place these
joints back into alignment as quickly as possible.

Signs and symptoms of dislocations are joint pain,
tenderness, swelling, discoloration, limited range of motion, and
deformity of the joint. You treat dislocations by reduction,
immobilization, and rehabilitation.

Reduction or “setting” is placing the bones back into their
proper alignment. You can use several methods, but manual
traction or the use of weights to pull the bones are the safest and
easiest. Once performed, reduction decreases the victim’s pain
and allows for normal function and circulation. Without an X ray,
you can judge proper alignment by the look and feel of the joint
and by comparing it to the joint on the opposite side.

Immobilization is nothing more than splinting the
dislocation after reduction. You can use any field-expedient
material for a splint or you can splint an extremity to the body.

The basic guidelines for splinting are as follows:
• Splint above and below the fracture site.
• Pad splints to reduce discomfort.
• Check circulation below the fracture after making each tie
on the splint.

To rehabilitate the dislocation, remove the splints after 7 to
14 days. Gradually use the injured joint until fully healed.

SPRAINS
The accidental overstretching of a tendon or ligament
causes sprains. The signs and symptoms are pain, swelling,
tenderness, and discoloration (black and blue).

When treating sprains, you should follow the letters in
RICE as defined below:
• R–Rest injured area.
• I–Ice for 24 to 48 hours.
• C–Compression-wrap or splint to help stabilize. If possible,
leave the boot on a sprained ankle unless circulation is
compromised.
• E–Elevate the affected area.
NOTE: Ice is preferred for a sprain but cold spring water may be
more easily obtained in a survival situation.

BITES AND STINGS

Insects and related pests are hazards in a survival
situation. They not only cause irritations, but they are often
carriers of diseases that cause severe allergic reactions in some
individuals. In many parts of the world you will be exposed to
serious, even fatal, diseases not encountered in the United States.

• Ticks can carry and transmit diseases, such as Rocky
Mountain spotted fever common in many parts of the
United States. Ticks also transmit Lyme disease.

• Mosquitoes may carry malaria, dengue, and many other
diseases.

• Flies can spread disease from contact with infectious
sources. They are causes of sleeping sickness, typhoid,
cholera, and dysentery.

• Fleas can transmit plague.

• Lice can transmit typhus and relapsing fever.

The best way to avoid the complications of insect bites and
stings is to keep immunizations (including booster shots) up-todate,
avoid insect-infested areas, use netting and insect repellent,
and wear all clothing properly.

If you are bitten or stung, do not scratch the bite or sting; it
might become infected. Inspect your body at least once a day to
ensure there are no insects attached to you. If you find ticks
attached to your body, cover them with a substance (such as
petroleum jelly, heavy oil, or tree sap) that will cut off their air
supply. Without air, the tick releases its hold, and you can remove
it. Take care to remove the whole tick. Use tweezers if you have
them. Grasp the tick where the mouthparts are attached to the
skin. Do not squeeze the tick’s body. Wash your hands after
touching the tick. Clean the tick wound daily until healed.
TREATMENT

It is impossible to list the treatment of all the different
types of bites and stings. However, you can generally treat bites
and stings as follows:

• If antibiotics are available for your use, become familiar
with them before deployment and use them.

• Predeployment immunizations can prevent most of the
common diseases carried by mosquitoes and some carried
by flies.

• The common fly-borne diseases are usually treatable with
penicillins or erythromycin.

• Most tick-, flea-, louse-, and mite-borne diseases are
treatable with tetracycline.

• Most antibiotics come in 250 milligram (mg) or 500 mg
tablets. If you cannot remember the exact dose rate to
treat a disease, 2 tablets, 4 times a day, for 10 to 14 days
will usually kill any bacteria.

BEE AND WASP STINGS
If stung by a bee, immediately remove the stinger and
venom sac, if attached, by scraping with a fingernail or a knife
blade. Do not squeeze or grasp the stinger or venom sac, as
squeezing will force more venom into the wound. Wash the sting
site thoroughly with soap and water to lessen the chance of a
secondary infection.

If you know or suspect that you are allergic to insect stings,
always carry an insect sting kit with you.

Relieve the itching and discomfort caused by insect bites by
applying—
• Cold compresses.
• A cooling paste of mud and ashes.
• Sap from dandelions.
• Coconut meat.
• Crushed cloves of garlic.
• Onion.

SPIDER BITES AND SCORPION STINGS
The black widow spider is identified by a red hourglass on
its abdomen. Only the female bites, and it has a neurotoxic
venom. The initial pain is not severe, but severe local pain rapidly
develops. The pain gradually spreads over the entire body and
settles in the abdomen and legs. Abdominal cramps and
progressive nausea, vomiting, and a rash may occur. Weakness,
tremors, sweating, and salivation may occur. Anaphylactic
reactions can occur. Symptoms may worsen for the next three
days and then begin to subside for the next week. Treat for shock.
Be ready to perform CPR. Clean and dress the bite area to reduce
the risk of infection. An antivenin is available.

The funnelweb spider is a large brown or gray spider found
in Australia. The symptoms and the treatment for its bite are as
for the black widow spider.

The brown house spider or brown recluse spider is a small,
light brown spider identified by a dark brown violin on its back.
There is no pain, or so little pain, that usually a victim is not
aware of the bite. Within a few hours a painful red area with a
mottled cyanotic center appears. Necrosis does not occur in all
bites, but usually in 3 to 4 days, a star-shaped, firm area of deep
purple discoloration appears at the bite site. The area turns dark
and mummified in a week or two. The margins separate and the
scab falls off, leaving an open ulcer. Secondary infection and
regional swollen lymph glands usually become visible at this
stage.

The outstanding characteristic of the brown recluse bite is
an ulcer that does not heal but persists for weeks or months. In
addition to the ulcer, there is often a systemic reaction that is
serious and may lead to death. Reactions (fever, chills, joint pain,
vomiting, and a generalized rash) occur chiefly in children or
debilitated persons.

Tarantulas are large, hairy spiders found mainly in the
tropics. Most do not inject venom, but some South American
species do. They have large fangs. If bitten, pain and bleeding are
certain, and infection is likely. Treat a tarantula bite as for any
open wound, and try to prevent infection. If symptoms of
poisoning appear, treat as for the bite of the black widow spider.

Scorpions are all poisonous to a greater or lesser degree.
There are two different reactions, depending on the species:

• Severe local reaction only, with pain and swelling around
the area of the sting. Possible prickly sensation around the
mouth and a thick-feeling tongue.

• Severe systemic reaction, with little or no visible local
reaction. Local pain may be present. Systemic reaction
includes respiratory difficulties, thick-feeling tongue, body
spasms, drooling, gastric distention, double vision,
blindness, involuntary rapid movement of the eyeballs,
involuntary urination and defecation, and heart failure.
Death is rare, occurring mainly in children and adults with
high blood pressure or illnesses.Treat scorpion stings as you would a black widow bite.

SNAKEBITES
The chance of a snakebite in a survival situation is rather
small, if you are familiar with the various types of snakes and
their habitats. However, it could happen and you should know
how to treat a snakebite. Deaths from snakebites are rare. More
than one-half of the snakebite victims have little or no poisoning,
and only about one-quarter develop serious systemic poisoning.
However, the chance of a snakebite in a survival situation can
affect morale, and failure to take preventive measures or failure
to treat a snakebite properly can result in needless tragedy.

The primary concern in the treatment of snakebite is to
limit the amount of eventual tissue destruction around the bite
area.

A bite wound, regardless of the type of animal that inflicted
it, can become infected from bacteria in the animal’s mouth. With
nonpoisonous as well as poisonous snakebites, this local infection
is responsible for a large part of the residual damage that results.

Snake venoms not only contain poisons that attack the
victim’s central nervous system (neurotoxins) and blood
circulation (hemotoxins), but also digestive enzymes (cytotoxins)
to aid in digesting their prey. These poisons can cause a very
large area of tissue death, leaving a large open wound. This
condition could lead to the need for eventual amputation if not
treated.

Shock and panic in a person bitten by a snake can also affect
the person’s recovery. Excitement, hysteria, and panic can speed up
the circulation, causing the body to absorb the toxin quickly. Signs
of shock occur within the first 30 minutes after the bite.

Before you start treating a snakebite, determine whether
the snake was poisonous or nonpoisonous. Bites from a
nonpoisonous snake will show rows of teeth. Bites from a
poisonous snake may have rows of teeth showing, but will have
one or more distinctive puncture marks caused by fang
penetration. Symptoms of a poisonous bite may be spontaneous
bleeding from the nose and anus, blood in the urine, pain at the
site of the bite, and swelling at the site of the bite within a few
minutes or up to 2 hours later.

Breathing difficulty, paralysis, weakness, twitching, and
numbness are also signs of neurotoxic venoms. These signs
usually appear 1.5 to 2 hours after the bite.

If you determine that a poisonous snake bit an individual,
take the following steps:
• Reassure the victim and keep him still.
• Set up for shock and force fluids or give by intravenous
(IV) means.
• Remove watches, rings, bracelets, or other constricting
items.
• Clean the bite area.
• Maintain an airway (especially if bitten near the face or
neck) and be prepared to administer mouth-to-mouth
resuscitation or CPR.
• Use a constricting band between the wound and the heart.
• Immobilize the site.
• Remove the poison as soon as possible by using a
mechanical suction device. Do not squeeze the site of
the bite.

You should also remember four very important guidelines
during the treatment of snakebites. Do not—
• Give the victim alcoholic beverages or tobacco products.
Never give atropine! Give morphine or other central
nervous system (CNS) depressors.
• Make any deep cuts at the bite site. Cutting opens
capillaries that in turn open a direct route into the blood
stream for venom and infection.
NOTE: If medical treatment is over 1 hour away, make an
incision (no longer than 6 millimeters [1/4 inch] and no deeper
than 3 millimeters [1/8 inch]) over each puncture, cutting just
deep enough to enlarge the fang opening, but only through the
first or second layer of skin. Place a suction cup over the bite so
that you have a good vacuum seal. Suction the bite site 3 to 4
times. Suction for a MINIMUM of 30 MINUTES. Use mouth
suction only as a last resort and only if you do not have open
sores in your mouth. Spit the envenomed blood out and rinse your
mouth with water. This method will draw out 25 to 30 percent of
the venom.

• Put your hands on your face or rub your eyes, as venom
may be on your hands. Venom may cause blindness.

• Break open the large blisters that form around the bite
site.

After caring for the victim as described above, take the
following actions to minimize local effects:
• If infection appears, keep the wound open and clean.
• Use heat after 24 to 48 hours to help prevent the spread of
local infection. Heat also helps to draw out an infection.
• Keep the wound covered with a dry, sterile dressing.
• Have the victim drink large amounts of fluids until the
infection is gone.

WOUNDS
An interruption of the skin’s integrity characterizes
wounds. These wounds could be open wounds, skin diseases,
frostbite, trench foot, or burns.

OPEN WOUNDS
Open wounds are serious in a survival situation, not only
because of tissue damage and blood loss, but also because they
may become infected. Bacteria on the object that made the
wound, on the individual’s skin and clothing, or on other foreign
material or dirt that touches the wound may cause infection.

By taking proper care of the wound you can reduce further
contamination and promote healing. Clean the wound as soon as
possible after it occurs by—
• Removing or cutting clothing away from the wound.
• Always looking for an exit wound if a sharp object,
gunshot, or projectile caused a wound.
• Thoroughly cleaning the skin around the wound.
• Rinsing (not scrubbing) the wound with large amounts of
water under pressure. You can use fresh urine if water is
not available.

The “open treatment” method is the safest way to manage
wounds in survival situations. Do not try to close any wound by
suturing or similar procedures. Leave the wound open to allow
the drainage of any pus resulting from infection. As long as the
wound can drain, it generally will not become life-threatening,
regardless of how unpleasant it looks or smells.

Cover the wound with a clean dressing. Place a bandage on
the dressing to hold it in place. Change the dressing daily to
check for infection.

If a wound is gaping, you can bring the edges together with
adhesive tape cut in the form of a “butterfly” or “dumbbell”

(Figure 4-7).

Use this method with extreme caution in the absence
of antibiotics. You must always allow for proper drainage of the
wound to avoid infection.

Figure 4-7. Butterfly Closure

In a survival situation, some degree of wound infection is
almost inevitable. Pain, swelling, and redness around the wound,
increased temperature, and pus in the wound or on the dressing
indicate infection is present.

If the wound becomes infected, you should treat as follows:
• Place a warm, moist compress directly on the infected
wound. Change the compress when it cools, keeping a
warm compress on the wound for a total of 30 minutes.
Apply the compresses three or four times daily.
• Drain the wound. Open and gently probe the infected
wound with a sterile instrument.
• Dress and bandage the wound.
• Drink a lot of water.
• In the event of gunshot or other serious wounds, it may be
better to rinse the wound out vigorously every day with the
cleanest water available. If drinking water or methods to
purify drinking water are limited, do not use your drinking
water. Flush the wound forcefully daily until the wound is
healed over. Your scar may be larger but your chances of
infection are greatly reduced.
• Continue this treatment daily until all signs of infection
have disappeared.

If you do not have antibiotics and the wound has become
severely infected, does not heal, and ordinary debridement is
impossible, consider maggot therapy as stated below, despite its
hazards:

• Expose the wound to flies for one day and then cover it.

• Check daily for maggots.

• Once maggots develop, keep wound covered but check
daily.

• Remove all maggots when they have cleaned out all dead
tissue and before they start on healthy tissue. Increased
pain and bright red blood in the wound indicate that the
maggots have reached healthy tissue.

• Flush the wound repeatedly with sterile water or fresh
urine to remove the maggots.

• Check the wound every 4 hours for several days to ensure
all maggots have been removed.

• Bandage the wound and treat it as any other wound. It
should heal normally.

SKIN DISEASES AND AILMENTS
Boils, fungal infections, and rashes rarely develop into a
serious health problem. They cause discomfort and you should
treat them as follows:
Boils

Apply warm compresses to bring the boil to a head. Another
method that can be used to bring a boil to a head is the bottle
suction method. Use an empty bottle that has been boiled in
water. Place the opening of the bottle over the boil and seal the
skin forming an airtight environment that will create a vacuum.
This method will draw the pus to the skin surface when applied
correctly. Then open the boil using a sterile knife, wire, needle, or
similar item. Thoroughly clean out the pus using soap and water.
Cover the boil site, checking it periodically to ensure no further
infection develops.
Fungal Infections
Keep the skin clean and dry, and expose the infected area
to as much sunlight as possible. Do not scratch the affected
area. During the Southeast Asian conflict, soldiers used
antifungal powders, lye soap, chlorine bleach, alcohol, vinegar,
concentrated salt water, and iodine to treat fungal infections with
varying degrees of success. As with any “unorthodox” method of
treatment, use these with caution.

Rashes
To treat a skin rash effectively, first determine what is
causing it. This determination may be difficult even in the best of
situations. Observe the following rules to treat rashes:
• If it is moist, keep it dry.
• If it is dry, keep it moist.
• Do not scratch it.

Use a compress of vinegar or tannic acid derived from tea
or from boiling acorns or the bark of a hardwood tree to dry
weeping rashes. Keep dry rashes moist by rubbing a small
amount of rendered animal fat or grease on the affected area.

Remember, treat rashes as open wounds; clean and dress
them daily. There are many substances available to survivors in
the wild or in captivity for use as antiseptics to treat wounds.

Follow the recommended guidance below:
• Iodine tablets. Use 5 to 15 tablets in a liter of water to
produce a good rinse for wounds during healing.
• Garlic. Rub it on a wound or boil it to extract the oils and
use the water to rinse the affected area.
• Salt water. Use 2 to 3 tablespoons per liter of water to kill
bacteria.
• Bee honey. Use it straight or dissolved in water.
• Sphagnum moss. Found in boggy areas worldwide, it is a
natural source of iodine. Use as a dressing.
• Sugar. Place directly on wound and remove thoroughly
when it turns into a glazed and runny substance. Then
reapply.
• Syrup. In extreme circumstances, some of the same
benefits of honey and sugar can be realized with any highsugar-
content item.
NOTE: Again, use noncommercially prepared materials with
caution.

BURNS
The following field treatment for burns relieves the pain
somewhat, seems to help speed healing, and offers some
protection against infection:

• First, stop the burning process. Put out the fire by removing
clothing, dousing with water or sand, or by rolling on the
ground. Cool the burning skin with ice or water. For burns
caused by white phosphorous, pick out the white
phosphorous with tweezers; do not douse with water.

• Soak dressings or clean rags for 10 minutes in a boiling
tannic acid solution (obtained from tea, inner bark of
hardwood trees, or acorns boiled in water).

• Cool the dressings or clean rags and apply over burns.
Sugar and honey also work for burns with honey being
especially effective at promoting new skin growth and
stopping infections. Use both as you would in an open
wound above.

• Treat as an open wound.
• Replace fluid loss. Fluid replacement can be achieved through
oral (preferred) and intravenous routes (when resources are available)

CAUTION Unpasteurized honey has been known to contain
botulinum, which affects young children mostly.
Discontinue treatment if vomiting, double vision, fever, or
muscular paralysis occur.

One alternate method through which rehydration
can be achieved is through the rectal route. Fluids do not
need to be sterile, only purified. A person can effectively
absorb approximately 1 to 1.5 liters per hour by using a tube
to deliver fluids into the rectal vault.
• Maintain airway.
• Treat for shock.
• Consider using morphine, unless the burns are near the
face.

ENVIRONMENTAL INJURIES
Heatstroke, hypothermia, diarrhea, and intestinal parasites
are environmental injuries you could face in a survival situation.
Read and follow the guidance provided below.

HEATSTROKE
The breakdown of the body’s heat regulatory system (body
temperature more than 40.5 degrees C [105 degrees F]) causes a
heatstroke. Other heat injuries, such as cramps or dehydration,
do not always precede a heatstroke. Signs and symptoms of
heatstroke are—
• Swollen, beet-red face.
• Reddened whites of eyes.
• Victim not sweating.
• Unconsciousness or delirium, which can cause pallor, a
bluish color to lips and nail beds (cyanosis), and cool skin.

NOTE: By this time, the victim is in severe shock. Cool the victim
as rapidly as possible. Cool him by dipping him in a cool stream.
If one is not available, douse the victim with urine, water, or at
the very least, apply cool wet compresses to all the joints,
especially the neck, armpits, and crotch. Be sure to wet the
victim’s head. Heat loss through the scalp is great. Administer
IVs and provide drinking fluids. You may fan the individual.

You can expect the following symptoms during cooling:
• Vomiting.
• Diarrhea.
• Struggling.
• Shivering.
• Shouting.
• Prolonged unconsciousness.
• Rebound heatstroke within 48 hours.
• Cardiac arrest; be ready to perform CPR.

NOTE: Treat for dehydration with lightly salted water.
CHILBLAINS

Frostnip begins as firm, cold and white or gray areas on the
face, ears, and extremities that can blister or peel just like sunburn
as late as 2 to 3 days after the injury. Frostnip, or chilblains as it is
sometimes called, is the result of tissue exposure to freezing
temperatures and is the beginning of frostbite. The water in and
around the cells freezes, rupturing cell walls and thus damaging
the tissue. Warming the affected area with hands or a warm object
treats this injury. Wind chill plays a factor in this injury;
preventative measures include layers of dry clothing and protection
against wetness and wind.

TRENCH FOOT
Immersion or trench foot results from many hours or days
of exposure to wet or damp conditions at a temperature just above
freezing. The nerves and muscles sustain the main damage, but
gangrene can occur. In extreme cases the flesh dies and it may
become necessary to have the foot or leg amputated. The best
prevention is to keep your feet dry. Carry extra socks with you in
a waterproof packet. Dry wet socks against your body. Wash your
feet daily and put on dry socks.
FROSTBITE
This injury results from frozen tissues. Frostbite extends
to a depth below the skin. The tissues become solid and
immovable. Your feet, hands, and exposed facial areas are
particularly vulnerable to frostbite.

When with others, prevent frostbite by using the buddy
system. Check your buddy’s face often and make sure that he
checks yours. If you are alone, periodically cover your nose and
lower part of your face with your mittens.
Do not try to thaw the affected areas by placing them close
to an open flame. Frostbitten tissue may be immersed in 37 to 42
degrees C (99 to 109 degrees F) water until thawed. (Water
temperature can be determined with the inside wrist or baby
formula method.) Dry the part and place it next to your skin to
warm it at body temperature.

HYPOTHERMIA
It is defined as the body’s failure to maintain an inner core
temperature of 36 degrees C (97 degrees F). Exposure to cool or
cold temperature over a short or long time can cause
hypothermia. Dehydration and lack of food and rest predispose
the survivor to hypothermia.

Immediate treatment is the key. Move the victim to the best
shelter possible away from the wind, rain, and cold. Remove all wet
clothes and get the victim into dry clothing. Replace lost fluids with
warm fluids, and warm him in a sleeping bag using two people (if
possible) providing skin-to-skin contact. If the victim is unable to
drink warm fluids, rectal rehydration may be used.

DIARRHEA
A common, debilitating ailment caused by changing water
and food, drinking contaminated water, eating spoiled food,
becoming fatigued, and using dirty dishes. You can avoid most of
these causes by practicing preventive medicine. However, if you
get diarrhea and do not have antidiarrheal medicine, one of the
following treatments may be effective:
• Limit your intake of fluids for 24 hours.
• Drink one cup of a strong tea solution every 2 hours until
the diarrhea slows or stops. The tannic acid in the tea
helps to control the diarrhea. Boil the inner bark of a
hardwood tree for 2 hours or more to release the tannic
acid.
• Make a solution of one handful of ground chalk, charcoal,
or dried bones and treated water. If you have some apple
pomace or the rinds of citrus fruit, add an equal portion to
the mixture to make it more effective. Take 2 tablespoons
of the solution every 2 hours until the diarrhea slows or
stops.
INTESTINAL PARASITES
You can usually avoid worm infestations and other
intestinal parasites if you take preventive measures. For
example, never go barefoot. The most effective way to prevent
intestinal parasites is to avoid uncooked meat, never eat raw
vegetables contaminated by raw sewage, and try not to use
human waste as a fertilizer. However, should you become infested
and lack proper medicine, you can use home remedies. Keep in
mind that these home remedies work on the principle of changing
the environment of the gastrointestinal tract. The following are
home remedies you could use:
• Salt water. Dissolve 4 tablespoons of salt in 1 liter of water
and drink. Do not repeat this treatment.
• Tobacco. Eat 1 to 1 1/2 cigarettes or approximately 1
teaspoon (pinch) of smokeless tobacco. The nicotine in the
tobacco will kill or stun the worms long enough for your
system to pass them. If the infestation is severe, repeat the
treatment in 24 to 48 hours, but no sooner.
• Kerosene. Drink 2 tablespoons of kerosene, but no more.
If necessary, you can repeat this treatment in 24 to 48
hours. Be careful not to inhale the fumes. They may cause
lung irritation.
NOTE: Tobacco and kerosene treatment techniques are very
dangerous, be careful.
• Hot peppers. Peppers are effective only if they are a steady
part of your diet. You can eat them raw or put them in
soups or rice and meat dishes. They create an environment
that is prohibitive to parasitic attachment.
• Garlic. Chop or crush 4 cloves, mix with 1 glass of liquid,
and drink daily for 3 weeks.

HERBAL MEDICINES
Our modern wonder drugs, laboratories, and equipment
have obscured more primitive types of medicine involving
determination, common sense, and a few simple treatments.
However, in many areas of the world the people still depend on
local “witch doctors” or healers to cure their ailments. Many of the
herbs (plants) and treatments they use are as effective as the
most modern medications available. In fact, many modern
medications come from refined herbs.

WARNING
Use herbal medicines with extreme care, and only
when you lack or have limited medical supplies.
Some herbal medicines are dangerous and may
cause further damage or even death.

Best medical techniques for treating medical conditions in the field:

•    Wounds: Apply only pressure dressings to stop bleeding-unless an artery has been cut, as by a blast- hurled piece of glass. If blood is spurting from a wound, apply both a pressure dressing and a windlass-type. tourniquet. Loosen the tourrnquet pressure about every 15 minutes, to allow enough blood to reach the flesh beyond the tourniquet and keep it alive. There is a fair chance that clotting under the pressure dressing will stop blood loss before It becomes fatal.

• Infected wounds: Do not change dressings frequently. The formation of white pus shows that white corpuscles are mobilizing to combat the infection. In World War I, wounded soldiers in hospitals suffered agonies having their wounds cleaned and dressed frequently; many died as a result of such harmful care. In contrast, before antibiotics became available late in World War II, casts and dressings on infected wounds sometimes were not changed for weeks. (Actual treatment in China and India resulting from such “benign neglect” of American soldiers’ wounds neglect that helped save limbs and lives.)

•   Pieces of glass deeply embedded in flesh: Do not probe with tweezers or a knife in an attempt to extract them. Most glass will come out when the wounds discharge pus.

•    Burns: Do not apply grease, oil or any other medicine to the burned area. Cover the area securely with a clean. dry dressing or folded cloth. Do not change the dressing frequently. [For most burns, the bandage need not be removed until the tenth to fourteenth day. Give plenty of slightly salted water: about I teaspoon (~.5 grn) of salt per quart (or liter), preferably chilled. in amounts of I to 3 liters daily. “]

•    Broken bones: Apply simple splints to keep the bones from moving. Do not worry about deformities; most can be corrected later by a doctor. Do not attempt traction setting of broken bones.

•    Shock: Keep the victim warm. Place blankets or other    insulation    material    under    him.    Do    not    cover him with so many blankets that he sweats and suffers harmful tluid losses. Give him plenty ofslightly salted water [about a teaspoon of salt in a liter (or quart) of water].

•    Heat prostration: Give adequate fluids. includ- ing slightly salty water.

•    Simple childbirth: Keep hands off. Wait until the mother has given birth. Do not tie and cut the cord unless a potent disinfectant is available. Instead, use the primitive practice of wrapping the cord and the placenta around the infant until they dry. Avoid the risk of infecting the mother by removing the rest of the afterbirth: urge the mother to work to expel it.

•    Toothache: Do not attempt to pull an aching tooth. Decaying teeth will abscess and fall out. This is a painful but seldom fatal process—one which was endured by most of our remote ancestors who reached maturity.

 

 

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