# Hawkmiles guide to fixing Major Life Threats



## PreparedRifleman73 (Nov 2, 2012)

I made a similar post in the health and medicine forum, which you can find here. I realized it may be more helpful to not only provide a list of what you may need, but to provide a little more information on emergency medicine. I have learned so much and gotten so much help from others here, that I want to contribute where I can.

I will use blue to denote things you need and things to avoid.

*What This Post Is and Isn't*

This post is about providing emergency medical care, primarily on yourself, within the context of SHTF. It is based on operating out of a decent sized Bug-Out-Bag or Get-Home-Bag; it is certainly not based on a complete medical bag. It is not the be-all primer on taking care of your family medically at your home or Bug-Out-Location. It is a guide to staying alive while moving fast and light, so that you can get to your home or BOL to access more definitive preps and help. I cannot emphasize this enough: this guide is about how to keep yourself alive while you travel, not those around you.

*My Training and Experience*
_"Training means learning the rules, experience means learning the exceptions."_

I currently work full time on an Advanced Life Support ambulance service and have for several years. This has brought a lot of experience in prehospital emergency medicine, transportation and initial emergency care in a hospital setting. I was also a combat lifesaver in the Army and am an Eagle Scout (hey don't knock it!). I have extensive wilderness emergency medical training, but not nearly as much experience. I'm rather new to being a "prepper" but I have trained and been employed by my state's Department of Homeland Security and Emergency Management and my FEMA region's Medical Reserve Corps.

*Major Life Threats, 0-72 Hours*
_"Air goes in and out. Blood goes 'round and 'round. Any deviation is a problem."_

The statement above says it all. It really refers to the "ABC"s of emergency medicine. Those stand for:

*Airway:* This refers to your physical airway, mouth and nose down to your lungs. Obviously, we'd like to keep that open. The interventions you can perform on yourself are rather limited though. Most people can tolerate the self-placement of an oralpharyngeal airway or nasalpharyngeal airway. First of all, these are not defintive airways as they are not invasive enough or secure enough. More secure airways would be Endotracheal tubes, King-LTD airways, Laryngeal Mask Airways, Combitubes, etc... Second, someone who needs an airway is going to certainly be less than responsive and likely unconcious. That means, if _you_ actually need one yourself, you won't be in any shape to provide that appropriate intervention on yourself. So, _next!_
Do NOT buy airways for your bug-out-bag.

Note for those with COPD or severe allergies: If you suffer from things like Asthma, Emphasema, etc.. you are certainly more likely to have _non-trauma related_ airway obstructions. These would provide a chance for you to intervene! You can prevent this by carrying an inhaler, of course!
If you have severe allergies (_Read: Causing anaphylaxis or closing of the airway_) you are likely already prepared. If you normally have an epi-pen handy, be sure to include one in your bug-out-bag. If you have an allergy that only causes hives, remember that the mechanism for things like hives and the mechanism for things like airway compromise are entirely separate.
Do NOT carry these interventions if you don't already need them.

*Breathing:* Ya gotta breathe! But you're not going to carry oxygen or ways to deliver it (NRB, NC, BVM, etc...) of course. When we examine dangerous grid-down bug out scenarious, we are talking _trauma_, not medical.
The most dangerous and most self-correctable traumatic compromise to your breathing is going to be a collapsed lung. This would be caused by something pentrating your chest and your lung. When you breathe, the area around your lung fills with air or blood. The pressure can become greater then the pressure _in_ your lung, preventing your lung from filling with air. This is also known as a pnuemothorax which can complicate into such things as tension-pnuemothoraxes, hemopnuemothoraxes or even tension-hemopnuemothoraxes. You can even develop flail chest segments which move paradoxically from the rest of your chest.

Regardless, the appropriate intervention is a 3-sided occlusive dressing. First, place something over the "hole" that is clean and won't allow air to pass through or absorb fluid. This could be a ziploc bag or saran wrap. Tape it down on 3 sides. You want the open side facing down for fluid to drain; keep in mind this would be different if you were walking versus laying down. This will not instantly fix the problem. It will certainly prevent it from getting worse, and if done right will gradually improve it. It should look like so:








Do NOT buy expensive, bulky and useless dressings for thse type of wounds. You do NOT need an "asherman" dressing, trust me. 

*Circulation:* Bleeding to death would pretty much suck, wouldn't it? Years ago, civilian emergency medicine rarely used tourniquets. You tie it up, your limb changes color and you lose it, right!? Not so much. Our current wars in Iraq and Afghanistan haven't done many people here much good. _But,_ they have provided us with some real life experience regarding tourniquets. With that in mind, here's the right way to handle bleeding...

If you have a small oozing bleed (think of cutting your fingertip), it's pretty manageable. Put a band-aid on it or tape a small dressing on it.

Maybe you've got a bigger cut that is flowing pretty good (think of a deep laceration to your arm or leg). Put a dressing on it, elevate the wound if possible and hold direct pressure. If it bleeds through, add another dressing (do _NOT_ remove the current dressing). If that bleeds through and the bleeding is uncontrolled, it's tourniquet time!

If you had that large flowing cut and you couldn't control it, you get to use your cool tourniquet. I recommend the Combat Application Tourniquet above anything else. 







Sure, you can rig up a tourniquet with other stuff in your BOB, but you'll pass out and bleed out while you're fidgeting with it.

Slide the tourniquet on a few inches above the source of the bleeding. Tighten it up until the blood flow is a trickle or even just a small flow. Then, you can apply a dressing on it and it will probably be well managed. Secure the tourniquet and the dressing and you're good to go. _*DO NOT*_ keep turning the tourniquet until the bloodflow completely stops. That's a good way to lose a limb. Jot down the time with the permanent marker you have elsewhere in your bag, for future reference. The odds of losing your limb are MUCH lower than you think. But, don't remove the tourniquet yourself. A clot could break loose and kill you in various irreversible ways. That'd suck!

Also, if you have a major gushing bleed, don't **** around with the other steps. Go right to the tourniquet! The most likely cause of this would be an artery being severed. It will gush and pump, often to the beat of your heart (which is gonna be pretty damn fast at this point). It's cool, but don't mess around and stare at it...you'll pass out!

A quick note on QuikClot: You do NOT need it. There's a good chance that people will crucify me for this. That's fine, buy it and carry it. It doesn't take up that much space. But for god's sake, don't use it. Yes, it is highly effective at controlling bleeding. Yes, it may prevent you from having to resort to a tourniquet. But, as we talked about already, tourniquet application really isn't that bad. QuickClot is pretty nasty stuff to remove. It will cause a lot of tissue damage trying to remove it. And the odds of infection are pretty high. It is very "cool" but it isn't going to do much for you when SHTF. Just put on a tourniquet, okay?​​
*Snap! You Broke a Bone!*

Broken bones hurt. But, they won't kill you unless they severed a major artery. In which case, control the bleeding. Basically, you just need to _immobilize the joint above and below the break_. Try to immobilize in the position on comfort. Make sure you still have good circulation when you are splinting. You can test this by feeling for a pulse or moving your fingers/toes.

If you break your __ Immobilize your __:
Upper arm- Shoulder and elbow
Lower arm- Elbow and wrist
Upper leg- Hip and knee
Lower leg- Knee and Ankle
Collarbone- Better figure out a new way to carry that BOB! ​
To immobilize joints all you need is:

4 Large Dishcloths
SAM Splint (Link)
A stick/board (find one)

With this being said, here's how to immobilize those joints:

*Shoulder Immobilization:*
A picture says a thousand words, check this out:














*Elbow or Knee Immobilization*
If the position of comfort is bent then go for the picture above. But the ideal way to do it is to place a stick or board on each side of the elbow. Use the dishcloths to tie the boards above and below the elbow. You can either do this with a straight elbow or a bent elbow.

*Wrist or Ankle Immobilization*
Bust out the SAM Splint. You form it to the position of comfort. Tie it to your leg or arm with dishcloths. You can even use a SAM splint as a custom funnel. Form it in any shape you need and pour water or whatever down it. It's great multi-purpose.








*Hip Immobilization*
Keep in mind, we're not talking about a broken him, but your upper leg being broken (Femur). The ideal case is to use a backboard, but that isn't gonna make you very mobile is it!? Basically, use a long board all the way past and above your hip. Tie it up as best you can. You're gonna be able to move your hip, but try to place weight on the other one.

*Open Fractures:*
Open or compound fractures are where the bone is sticking out. This is common with a femur fracture. Control the bleeding if needed. Then, go ahead and immobilize like normal. Do NOT move the bones back into place. That requires VERY special equipment and training to be performed on scene. And, it will immobilize you. Be careful about moving around, it doesn't take much to bleed out from your femur. And hey, this might provide you with some hope: if you broke _both_ of your femurs and they are bleeding...you're pretty much gonna die!

*Some Things I'd Buy*

*Trauma Shears:*







Get a good pair of trauma shears like these. You'll want the 7 1/2 inch ones. They will cut through boots, even high-quality Carharrt overall zippers. Hell, they'll even do it while hanging upside from a silo in -20*F...just saying! The Life hammer is cool, but this will do the trick on a budget.

*Medical Tape:* Buy CLEAR and WIDE tape. Don't buy the white stuff. Don't buy different widths. Clear sticks better and the wide stuff can very easily be ripped narrower.

*Bandages: * Buy some sterile _individually_ wrapped 4x4 dressings. You can stack em up and tape em anywhere.

Also, buy sterile 5x9 abdominal dressings for your kit. These will cover large wounds well. You can even leave it in the package and use the package as an occlusive dressing!

*In Conclusion:*

Thanks for reading! I intend to provide a guide later that extends beyond the 72 hour mark and also addresses interventions you can perform on those around you. And remember, as long as too much fit hasn't hit the shan yet, you will always have outstanding emergency medical professionals to respond and assist you in a moment's notice:








Thanks! Good luck out there!


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## laverne (Nov 18, 2012)

Great post.


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## Dakine (Sep 4, 2012)

Great post! 

I'm taking my NR exam next week, but for me it's about cool new stuff to learn, not a career change. Thanks for the advice from a pro and I hope people take a look and learn something new!


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## PreparedRifleman73 (Nov 2, 2012)

Dakine said:


> Great post!
> 
> I'm taking my NR exam next week, but for me it's about cool new stuff to learn, not a career change. Thanks for the advice from a pro and I hope people take a look and learn something new!


Good luck!


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## BillM (Dec 29, 2010)

When I was a Boy Scout in 1962 I earned a merit badge in advanced first aid.

We were taught to reduce a compound fracture and how to do a Trachiotomy with a fountian pen and a pocket knife.

I wonder if my training is still relivant ?


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## Outpost (Nov 26, 2012)

hawkmiles said:


> This post is about providing emergency medical care, primarily on yourself,


(much deleted, but only for brevity)

Hawk, the words "freakin' awesome" are a pitiful understatement!

*VERY* nicely done!

I've snagged and bagged your entire post and saved it locally....

Thank You!


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## bahramthered (Mar 10, 2012)

I'm glad someone with some experience is present to answer questions. Thank you for the post.


I do have to ask a few questions.

Does your opinion of tourniquets depend on the likelihood of rescue/evac to a hospital? If I'm a week from help should I follow the same advice as someone 30 mins from help?

Second is for quick cot your obviously against it. Are you against it in all situations or just some? Does the same opinion apply to a slash which needs a stitches as to a life threatening bleed? And does the availability of medical treatment matter to your opinion.


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## PreparedRifleman73 (Nov 2, 2012)

BillM said:


> We were taught to reduce a compound fracture and how to do a Trachiotomy with a fountian pen and a pocket knife.
> 
> I wonder if my training is still relivant ?


If you've been trained to reduce a compound fracture, have at it! I think that is something that needs to be taught in person. I considered addressing that and suturing, but felt a message board post wouldn't do them justice. In SHTF, it could make a non-ambulatory person able to walk. If you're gonna try it on yourself, maybe you should carry some vodka in the BOB haha.



bahramthered said:


> Does your opinion of tourniquets depend on the likelihood of rescue/evac to a hospital? If I'm a week from help should I follow the same advice as someone 30 mins from help?
> 
> Second is for quick cot your obviously against it. Are you against it in all situations or just some? Does the same opinion apply to a slash which needs a stitches as to a life threatening bleed? And does the availability of medical treatment matter to your opinion.


Ultimately, if your artery is completely severed, Quikclot is going to have the same effect as a tourniquet - it will occlude the artery. QuikClot is more likely to cause an infection, as you're introducing a foreign substance into our bloodstream. Also, if you're able to do some crude repair of the artery in the field after SHTF, you can do that with a tourniquet. If you used Quikclot, you're still going to have to dig that out.

Now if it's not completely severed, QuikClot is still an issue. A tourniquet will reduce the blood flow (pressure) so that you can control the bleed. The body parts distal (further away or "down-stream) to the cut will still receive circulation and will not rot and die. QuikClot will completely occlude the artery, suffocating the rest of your limb off from oxygen. And again, an introduction of a foreign body.

*If you are close to definitive care or far away, the reasons for and against QuikClot are different. But ultimately, my opinion is that it is unnecessary on the extremities. If however, you had a major bleed you couldn't control in your chest or abdomen (where you can't tourniquet) it would be better than nothing POST-SHTF.*


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## Canadian (Dec 14, 2008)

AED - is also very good to have and simple to use.


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## Dakine (Sep 4, 2012)

Canadian said:


> AED - is also very good to have and simple to use.


AED's are expensive, but people put money into FSA plans and may not realize this is a covered purchase. If you are near the end of your plan (it's incorrect to say they term at the end of the calendar year, mine has been extended to end of march twice) then you might think about buying one if you have excess left over funds.

an AED costs about $1200 but if you buy from some places you get shopper dollars, those add up fast, especially if you are dropping $1200... so you've got some serious cash coming back to you on 4x4's, wound cleaning fluids, SAM splints, qwik clot, and all of that kind of stuff.


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## PreparedRifleman73 (Nov 2, 2012)

And, of course, you aren't going to use an AED on yourself.


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