[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.
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.
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.
 |
| This is not a very helpful photo, in retrospect. |
 |
| 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.
