Wound Care in Survival Situations

I would like to share some insight into attending to wounds in an emergency situation. During and immediately after any natural disaster, be it as a hurricane, earthquake, flood, or even social unrest, your access to medical care will be limited, restricted for some unknown length of time or even denied by circumstances. Those are the times you will be called upon to act to keep the person's body alive, intact and in the best physical shape possible pending professional care.

Wound Care in Survival Situations

I am an avid advocate for preparing yourself and family for the worse of times. The first and most important item for any list of survival kit items you are planning to acquire is knowledge. This is even more critical during a medical emergency care and healthy living during your need to survive. A backpack or footlocker full of medical supplies are worthless if you are not educated and properly trained how to use the items. Begin your intended survival kit purchases by first spending a few bucks in the most cost effective manner; that is to take formal classes in first-aid and even more advanced courses if available to you. A Red Cross basic course in first-aid should be available to you in your local.

Thoughts About Wound Care: I suppose everyone has experiences with cuts, scrapes or "rug-burns" or even having a small chunk of skin ripped out of our hide. Many have, or perhaps seen another, whose cut is a little wide or long enough and we hear the words "I think you need stitches". In a civilized world and place, there is absolutely nothing wrong going to a doctor's office or hospital and being treated for these "soft-tissue injuries". But remember here we are talking about being in a disaster or other survival situation and a doctor or hospital may not be a viable option. You have to be the doctor and hospital during those times and having the basics of how to care for and bandage wounds comes into play.

In an emergency care situation away from professional care due to delay in treatment, keep the following order of care in mind:
1. Control bleeding,
2. Preventing infection and,
3. Follow-up wound care to reduce likelihood of infection.

Bleeding. Immediately after bleeding starts the body itself will rapidly begin different processes to stop the flow of blood. The problem is sometimes we need to perform techniques to allow time for the body's methods to kick-in and become effective or stem the flow of bleeding that in the short term is too overwhelming for the body to deal with.

One way the body tries to stop bleeding is by shutting off the bleeding arteries or veins; this includes the big ones and smallest ones in the skin. The blood vessels have small muscle like organs similar to a doughnut surrounding a stick. Their day-to-day role is in circulating the blood in our body. The body is also capable of causing these "doughnuts" to clamp off the vessel(s) and stop the bleeding very effectively. Before everyone gets to screaming, yes platelets and other body substances do play a role in controlling bleeding and I will mention them a little later on. In our attempts to "control bleeding" normally we are giving the body time to try and shut off the vessels and close off blood coming out of torn/cut tissues on its own.

• The first and ideal method to control bleeding that is vastly underused and that is basic direct pressure to the wound. I have seen complete leg amputations, vast denuding of tissue and other seriously bleeding injuries controlled completely solely with direct pressure. Direct pressure means simply using the cleanest thing you have at the moment. Medical gauze, clothing, or whatever is available (even a bare hand if that is all you have), and applying it to the wound with slight to medium pressure. After putting on the "dressing" and putting some pressure on it, the key is not to remove it for about ten (10) minutes to allow the platelets to form their plugs and the other vessels to clamp down. That means no "peeking to see if the blood has stopped" or to "see how bad it is". I tell folks that every time they remove the pressure from the wound the clock (and bleeding) starts over again. So give it time to stop the bleeding before allowing your curiosity to get the better of you. If after you attempt applying direct pressure to the wound for the 10 minutes and the bleeding has stopped, merely go on to bandaging the wound. If there is still some bleeding, apply additional pressure again or use a pressure dressing (as taught in your previous first-aid training) and normally it is sufficient.
• If there is still "serious bleeding" after attempting the direct pressure, then resort to using one of the many pressure points (again using the proper locations as taught in your training) available to you. Using a pressure point is likened to squeezing a water hose to stop the flow of liquid. It works. After gaining control over the bleeding for several minutes, ease up on the pressure a little and see if the serious bleeding has stopped. Not all bleeding may have stopped and minor bleeding calls for use the application of direct pressure to the injury, as described above. If the bleeding is still rather severe you must re-apply pressure to the "water hose" and it stops the bleeding. If you have a second pair of hands to help, a field expedient method of doing this is to place a wadded up dressing or balled-up shirt or even pair of socks over the proper artery and wrapping it with a snug bandage. I do not mean a tourniquet, but tight enough to apply pressure to the "water hose" artery to stop the bleeding. Simply watching to see when the bleeding is under control tells you there is enough pressure. Then tie the bandage, rope or whatever you are using to wrap the dressing with, directly on top of the dressing. This will buy you time to get the person to a doctor. If in the field, leave the pressure on for awhile and then loosen it slowly to see if the bleeding has stopped.
• The last resort available to you in the field (unless trained how to do one of the emergency surgical methods like a venous cutdown) is a tourniquet. This is the application of whatever you have available, rope, belt, vines or clothing, wrapping it around the limb and clamping it down to stop all blood flow below the tourniquet. (again you know how from your previous training. Right?) If using a tourniquet and the time it needs to be applied is short before professional care is given, there probably will not have permanent damage. If it takes too long to get proper surgical care, the limb might be lost but the person will live and that is the most important thing in emergency care. In a longer time survival situation, the next concern is infection taking hold. That leads me to my next topic.

Infection. After the bleeding is under control, your second efforts are directed at preventing an infection starting in the wound. Prevention of infection that could kill the person is serious stuffs in a survival situation where proper medications and surgical techniques are not available to you. If you used a gauze or clean material to stop the initial bleeding, you already have begun the prevention of infection. The next steps are:

• Clean the wound. This will start some bleeding again but the bleeding (unless lots of blood) is OK. Using any potable water (water you can drink) is gently flushed into the wound to dislodge and flush out any gross dirt and debris and other foreign matters. If you have available some antiseptic wipes, minor wounds can be wiped off with these alone but do not use on large or deep wounds. After rinsing the wound it will probably need a bit of cleaning out. Hydrogen peroxide and gauze works well here. Plain old soap works for minor injuries or penetrating wounds if that is all that you have. If you can, use a piece of gauze to gentle wipe out inside the wound to get as much crud and crap as possible. Then flush again. Use as much water at hand for the flushing out the wound is important. One of the larger 20-50 cc syringes or a bulb syringe works pretty very well but don't squirt the water with heavy pressure, merely a steady flow. After cleansing the wound, some more direct pressure with gauze may be needed.
• OK, the wound is clean. Now comes protecting the opening in the skin (wound). Minor cuts, as an option, can have one of the varieties of first-aid creams applied. If the wound is deep or wide, leave those creams off for they will cause more problems than solving them. (The tissues will within minutes begin to wall itself off from the outside world and attacking germs without the creams and some of the creams hinder this natural process). Apply a dressing, sterile gauze, or a piece of cloth which has been boiled and dried, loosely over the wound. You do not want to make it airtight for that will lead to infection. You are only trying to keep the wound from getting more dirt and junk inside and if needed, letting pus get out. The "dressing" (gauze, cloth) now needs to be held in place with a "bandage". Many fancy dressing come with first-aid kits and can be used, but remember to not apply them tightly. You are not trying to strangle the wound, just trying to keep your dressing in place. Tape, medical, duct or even electrical tape can be used to put a couple of strips over the dressing to hold it in place.
• Now the wound is clean and has been bandaged the best you can, so what's next. That is to keep the wound from becoming infected. If the dressing becomes really dirty replace it with a clean one. In most situations do not pull off the dressing as that will only lead to pulling off scabs that have formed and increasing the probability of infective organisms getting inside. All wounds will become somewhat red in color and tender to the touch. It is normal. If the wound has become very red in color, swollen and painful and especially if a fever starts, it has become infected. If you are stranded for awhile and need to treat it, this is what is best to do: first open the wound if it has closed or you foolishly used sutures, to let the pus to drain out. You can facilitate the drainage by applying warm (not boiling hot) compresses to the wound. The heat will tend to attract the pus so the wound needs to be opened, or the pus will be drawn into other tissues. If your water supply is restricted, try warming a flat rock. Wrap it up in some clothing and place it against the infected area. Gentle rinsing with hydrogen peroxide, if on hand, will help get the infection out of the wound. If you have a wide spectrum antibiotic available, this is the time to use it. Maggots will eat away dead and infected tissue in an opened wound, but you need to be able to identify the proper bug for it to work and if you can find them in your part of the woods.
• If you are dealing with an amputation, leg, arm, finger, toes the procedure is the same. Clean by rinsing well with water. Do not apply first-aid creams and such to the exposed tissues. Apply sterile or boiled (dry) dressing and clean bandage. Do not cut off ragged or hanging tissues or try to put the skin back in place. Either can lead to severe infections and is best left up to a surgeon to repair.

Bumps, lumps, sprains and stains. These will resolve on their own without help but you can make the healing time shorter and less painful by remember the word "ICE". All of these type injuries are accompanied by swelling. The swelling presses down on nerves making it hurt; the more the swelling the more the pain. We can't stop it totally, but the goal is to quickly reduce the swelling as much as possible. "ICE" works.

• "I" stands for ice or cool. Applying cold as quickly as possible and then for the first 24 or more hours helps slow fluids from leaking out of the tissues which is the cause of the swelling. I recommend applying real ice or snow for 10 minutes every 20-30 minutes. (wrap the ice/snow in cloth before applying to skin) I suspect in a survival situation you forgot to drag along your refrigerator, but there are still things you can use. Those instant cold packs are nice, but they tend to wear out pretty fast. Of course snow or outdoor ice is great if available. Streams are a good source to cool the part if you have one. If not, have you ever thought of taking a partially submerged rock out of the ground and placing the injured part against the cool side of the rock? The undersides of most rocks stay damp and cool. (I say partially submerged for it was totally submerged you couldn't see it).
• "C" stands for compression. Again we are striving to reduce the swelling by minimizing fluids from seeping out of the wound but this also makes the injured part feel better. Those elastic bandages in the first-aid kit work perfectly, but do not over tighten with them. If none of those are available, use snug fitting roller gauze, a piece of cloth or whatever is available. Whatever you use, do not over tighten it. We don't want to cut off the blood supply. After wrapping, if you can slide a finger under the bandage without trouble its ok, but if not, the bandage is too tight and needs to be loosened.
• "E" stands for elevation. This is one thing that is important to do, yet most of us find excuses for not doing around the house much of the time. We don't need to hang upside down from a tree limb for this simple yet effect technique to help us heal. The idea is to get the injured part slightly raised above the level of our heart. That is all that it takes. This assists the blood and other fluids to be returned to the heart thereby reducing the amount of fluid at the site. Try to do this for a few days if your situation allows

Sutures. Leave them alone! If you are not properly schooled in debridement of a wound (removing and cutting out dead or infected meat from the body) suturing will lead to bad (i.e. life-threatening) infections in all but the most minor of cuts. And these wounds will heal quickly naturally without sutures. It will leave a scar but that is better than loss of a limb or life trying to be fancy in the woods. Even in a hospital setting, large gaping wounds are left open for days to prevent or control infections if they start. The body's tissues will wall itself off in an attempt to prevent germs from entering. Secondly, it you close up the wound with skin sutures and the wound is a bit deep, you will cause a pocket of air below the skin. This pocket is warm, moist and no air can get inside…that is the perfect setting for infections to begin and pus to accumulate. Thirdly, sutures can let infections creep along the material inside the body and cause an infection by themselves. This is a concern in a civilized normal environment, so don't add to more possible problems in a survival situation with sutures.

If the wound is a big gaping wound, flush it out and then take rolled-up gauze, unroll it and loosely stick it in the wound until you can get to a doctor or hospital. If it is going to be awhile, use a couple of pieces of tape or strips of clothing to partially close the wound. This will bring the tissues together somewhat to help keep out dirt yet allow air to get in and pus to get out.

Minor Surgical Kits. Don't waste your time even thinking about buying one. Most physicians hesitate at performing "minor surgery" and normally refer the patient to a trained surgeon. The reason being is that there are many structures such as blood vessels, nerves, tendons, etc. under the skin that do not need to be cut and severed by accident. When even doctors who know the general location of these structures and have been trained in surgical techniques shy away from doing something, take the hint and don't do it. If there is a blister, boil or abscess needing care, you will find something to care for it in the field. (A soda or beer bottle works pretty good. Put hot water into the bottle and put the opening around the boil. It will draw the boil to a head, the skin pops open and it drains).

Nothing replaces knowledge of medical first-aid, and proper training is a necessity. If you are serious about survival planning, take the first step and get professional and certified training from an organization like the Red Cross or as offered in many colleges. This was written not as a professional & definitive guide for medical care for wound management, rather a few personal concepts. Therefore I do not take responsibility for any damages arising for this article.

-Jerry B Blaine