[The Strenuous Life] Surviving Shia

[The Strenuous Life] First Aid I

NOTE: This post is written to satisfy the ‘Demonstrate treatment of an open wound,’ ‘Demonstrate the correct use of a tourniquet and explain when one should/should not be used.’ and ‘Explain the symptoms and treatment for shock’ requirements of the First Aid Badge

In addition to the badges, The Strenuous Life contains both daily and weekly challenges. The daily challenges include doing an hour of physical activity (typically just my daily workout), and doing a good deed (often satisfied by performing some volunteer work for or donating some money to the Effective Altruism movement). The weekly challenges are called Agons, and they range from physical fitness testing to giving a compliment every day for a week. While I don’t want to spoil them for anyone who hasn’t seen them, suffice to say that in addition to the badge requirements above this post also relates to an Agon I did ages ago.

I think it is worth prefacing this by noting that I am in no way a medical practitioner and this should in no way be interpreted as medical advice. If anything I say here contradicts a legitimate source, trust the other source (and please let me know so that I can update this post). The only way to really learn first aid is to get formal training with experienced instructors, which I strongly recommend for everyone.

In the remainder of this post, I will highlight some differences between civilian first aid (as it was taught to me) and military/survival first aid, explain how to treat open wounds, including when and how a tourniquet should be employed (including a brief demonstration on yours truly), and then outline the symptoms and treatment for shock.

If you’ve had any sort of formal first aid training in the past, it is very likely you’ve encountered some form of the ABCs. During my civilian first aid qualification course, I was taught DRSABCD – Danger, Response, Send for Help, Airway, Breathing, Compressions, and Defribillation (a word which I am still yet to spell correctly on the first attempt). These steps are focused on keeping someone as stable as possible until advanced care arrives (in the form of paramedics/EMTs). Modern emergency services aim to keep the expected response time well under fifteen minutes in an urban area – but what if you aren’t in a modern urban area?

In extreme or remote situations, you may not be able to rely on fast first responders, and you may need to adjust your treatment priorities. In a combat first aid course, I was introduced to a variation on the ABCs: DRCABC – Danger, Response, Catastrophic Haemorrhage (deal with major, life-threatening bleeding), Airway, Breathing, Circulation (deal with minor bleeding). Since then I’ve also come across the additional steps of D – Disability, and E – Evacuation, mostly pertaining to wilderness survival situations.

Todays post focuses on the ‘C’ of Catastrophic Haemorrage. Situations exist where exsanguination (bleeding to death) is the highest priority for first aid treatment, in particular if help is an uncertain or long distance away. If uncontrolled, rapid bleeding is occuring, than it should be your priority to control it. An important aside: It may be difficult for non-trained (or even trained) individuals to distinguish between bleeding that merely looks bad, versus bleeding that immediately threatens life, so I’ll reiterate my recommendation for formal training.

Today let’s use the highly plausible hypothetical posed by the classic song, Shia La Beouf. If you’ve not yet enjoyed this audiological wonder, please listen to it now.

So, for the purposes of this post we can assume that any Danger has been addressed (you’ve just beheaded the actual cannibal who caused your wound), checking for a Response is not necessary (as you are still conscious), and you can’t Send For Help (because you are lost in the woods and your phone is dead), and have now correctly identified that the bleeding must be immediately controlled. In a perfect world, you’ve also been able to put on your first aid gloves.

Looks pretty serious to me!

Before we can assess what level of treatment the bleeding requires, we have to fully expose the wound. Remove any clothing around the injury, cutting it where necessary. Note that if an object or clothing is embedded in the wound that it should be left in place, and you should simply remove as much clothing around it as possible. You should now have a better idea of the magnitude of the bleed. If upon getting a better look at the injured area you no longer assess the bleeding rate as critical, you should continue on with DRCABCDE.

However, if controlling the bleeding remains a top priority, you next apply firm, direct pressure to the wound site. Again, if in a perfect world you can apply a sterile gauze pad, but if that isn’t available, a makeshift bandage is far better than nothing. If this stops the bleeding, continue on with DRCABCDE.

Finally a good use for my Sophomore Orientation t-shirt

If you cannot stop the bleeding with direct pressure, and/or the dressing you have applied becomes soaked through with blood, you may need to apply a tourniquet.

The historically bad reputation of the tourniquet has been almost completely repaired. No longer seen as a last ditch attempt to stop bleeding that would almost certainly result in amputation, the tourniquet is now a standard part of the EMS/Combat medic tool kit. While an uncontrolled major hemorrhage can kill in minutes, a tourniquetted (OK I have even less idea how to spell this than deffib.. derberb.. that word I said earlier) limb is unlikely to suffer any lasting damage in less than two hours. That said, after this window closes, the likelihood of nerve damage and/or amputation begins to increase – which is less of a consideration in an urban environment, but could be extremely relevant in a wilderness survival situation.

The bottom line is, if bleeding from a limb won’t stop, or looks severe enough to cause rapid death – a tourniquet may be appropriate. This is a good point to remind everyone that I’m definitely not a medical expert of any sort, so please please please don’t substitute this advice for that of a real professional. If you want to learn first aid, I can’t recommend getting course qualified enough  (try here if you live in Australia).

Once the decision is made to use a tourniquet, you’ll need two components – something long, strong and strap-like to act as the tournique itself, as well as a torsion device to tighten it enough to stop the bleeding. You should probably also have something to hold the tightened torsion device in place, which can be the ends of the tourniquet itself or a separate item.

Axe only necessary if you must behead a cannibal prior to administering first aid.

The tourniquet should be applied two inches closer to the body than the wound, except where that would place it over a joint – in which case it should be applied just above the joint. After you’ve identified the application site, wrap the tourniquet around the limb and tie it once with a simple overhand knot. Then place the torsion device over the knot, and secure it with a double overhand knot.

This is not a very helpful photo, in retrospect.

Rotate the torsion device until the bleeding from the wound below the tourniquet stops completely (this will likely be painfully tight). Finally, secure the torsion device in place, most likely by tying it to the upper limb. Immediately write the current time somewhere on the tourniquet – this can be vitally important triage information when medical assistance arrives.

My foot was completely numb at this stage, and I didn't even fully tighten the damn thing.

Now that the first ‘C’ has been addressed, finish up the mnemonic – ensure the victim has a clear Airway and is still Breathing (in the hypothetical here, you are impressively still conscious so can safely skim through this check). The next ‘C’ is notionally Circulation, but my understanding is it really references the diagnosis and treatment of any other less urgent conditions. If the victim has just suffered bleeding severe enough to require a tourniquet, odds are good they are also going to be suffering from shock (hypovolemic shock, in this case).

Shock can have many causes, but each displays similar system (associated with a drop in blood pressure and general not-OK-ness). Cool, clammy, or even blue tinged skin, physical weakness and mental confusion, rapid breathing, and eventually unconsciousness all point to shock. Ultimately proper medical treatment is enormously important (I mean, it already was in this situation thanks to the tourniquet), but as a first aider the best you can do is recline the victim on the back, potentially elevating their feet (I found mixed reviews of this as a treatment), keep them warm with blankets, and if they are able to take fluids, slowly hydrate them.

In a real wilderness survival stuation, you’d now develop a plan for contacting/finding help (that’s the Disability and Evacuation section of our acronym). I’ll likely cover some of the basics of Wilderness Survival in another post (you guessed it, for another badge). But for now at least – you’re finally safe from Shia LaBeouf.