The first rule in any of these commonly occurring situations described is to remain calm, reassure the victim and try to keep them quiet and under control. Then examine the victim as quickly as possible, looking for the cause of the distress. Follow the rules of first aid and begin by examining the victim’s breathing and air passage but remember, the reason you need to be quick is that death might come from a bleeding artery sooner than from a blocked air passage, and you need to be open to all possibilities.
Dealing with an Air Passage Obstruction
How to open an air passage and keep it open: First check whether the obstruction is total, or only partly obstructed. Ask the victim to cough or say something; if he can do one of these things, he should be able to clear the obstruction himself. At this point, you should not try any hands-on methods, but remain at his side and be ready to act if he becomes unconscious, in which case you will clear his air passage and perform mouth-to-mouth resuscitation.
If your quick exam indicates that the obstruction is total, you will need to act, administering abdominal thrusts to clear the obstruction. If you have determined that you need to apply mouth-to-mouth resuscitation, begin by clearing out any object that might be in the victim’s mouth. Run your finger around in his mouth looking not only for any foreign matter, teeth that might have broken off, dentures, sand, etc.
Now you will use the “jaw thrust method”. Plant your elbows firmly on the ground or floor below the victim and grab the lower jaw, lifting with both hands to move the jaw forward. Open the lower lip with your thumb if the victim’s lips are shut. Now, pinch the nose and, keeping it closed, blow two breaths; allow time for the lungs to deflate, keeping a close watch to see if his chest shows any sign of rising or falling. Also listen for air that might escape during a breath being exhaled, and also check to see if you feel any air on your face that might have come from the victim exhaling. If these breaths don’t do the job of getting the victim to breathe on his own, you’ll have to keep up the mouth-to-mouth resuscitation in order to keep his breathing going. Be aware, however, that a victim may vomit during this process, so check his mouth periodically, and if he has vomited, clean out his mouth. After you have successfully cleared the airway, CPR (cardiopulmonary resuscitation) might be called for, but this would happen only if any major bleeding has been brought under control. Instructions can be found in several reference books commonly available.
How to Deal With Bleeding
In a survival situation, you almost certainly will not have the option of transfusion that is available in any ordinary emergency room, and it is crucial that you be able to control profuse bleeding without any delay. As we have seen, death can come in a matter of minutes if heavy bleeding is not stanched. Bleeding is classified into internal bleeding and external bleeding. External bleeding, which is the type you’re likely to be dealing with in the survival situation, can be subdivided into the following categories:
Blood leaving the heart always flows through the arteries. If an artery is cut, bright red blood will come out in spurts that match the beat of the heart. The blood in the arteries is flowing under high pressure, so the blood flow from a cut artery is very rapid. This is why bleeding from a severe arterial cut is considered the most serious, and if not controlled quickly, can lead to death in a matter of minutes.
Venous bleeding (blood flowing from a cut vein) is easier to control than arterial bleeding. Veins carry the blood that has circulated through the body and is flowing back to the heart. If a vein is cut, the blood comes out in a steady flow, and is not bright red, but has a darker hue, and even bluish.
Everyone is familiar with capillary bleeding. It’s the kind of bleeding that is caused by minor cuts. Capillaries are very tiny blood vessels that serve to connect veins with arteries. Bleeding from the capillaries is relatively easy to control by direct pressure. Other methods are indirect pressure (also known as pressure points) or elevating the affected part, or applying a tourniquet.
Direct Pressure Method
This method of choice for controlling external bleeding is to apply direct pressure – you apply pressure directly over the wound firmly enough and long enough to seal the injured area as well as to stop the bleeding. If you have maintained direct pressure for half an hour without success — that is, the bleeding hasn’t stopped — a pressure dressing is called for. Made of thick layers of gauze or other similar material, the pressure dressing is placed directly over the wound. Wind a bandage around it to hold it in place. You want it to be tight, but be careful not to constrict blood circulation. The pressure dressing will get soaked with blood after a time, but must be left in place. Only after a day or even two days is it advisable to remove the pressure dressing and put a smaller dressing in its place. In a survival situation in which there is no immediate expectation of outside help, change the dressing every day and carefully inspect the wound for signs of infection.
Even if the victim is bleeding heavily, you can stop it or at least slow it by pressing on the artery or vein out of which the blood is coming. Simply press with a finger or two rights where the blood is coming out, and keep the pressure on until you can get a pressure bandage working, elevate the area, or take any of the other measures necessary.
Elevating the Body Part
The point of elevating a body part (generally an arm or a leg) is to slow the blood loss. This occurs because when you raise an extremity as high as possible above the heart, you’re helping the blood flow back into the heart and thereby lowering the pressure of the blood at the site of the injury. Elevation will not completely stop blood loss, however, and must be used in conjunction with direct pressure. An additional point about elevation: when using elevation to treat a snakebite victim, the extremity must be elevated only to a level below the heart.
Pressure points are points near the body surface where the main artery going to the site of the injury can be felt by the fingers, and you can therefore apply pressure at that spot with your fingers in order to slow the bleeding until a pressure dressing can be applied. Using pressure points is not as effective a method for controlling arterial bleeding as direct pressure, however. There’s a rule of thumb for a finding pressure point if you have forgotten the exact locations: locate the end of the joint just above the site of the injury, and apply the pressure there. For example, the pressure point for a hand is the wrist, and for a foot, it’s the ankle.
Only use a tourniquet if you have tried direct pressure and the other methods listed above and the bleeding is still severe. The use of a tourniquet can cause more damage than it prevents, so use it wisely. Left in place too long, tourniquets can cause gangrene, which will likely mean that the limb will later be amputated. If you tie the tourniquet incorrectly, you also risk damaging the tissue at the injury site.
When you do decide to use a tourniquet, follow this procedure: put it around the limb – legs or arms, between the injury and the victim’s heart. Don’t put the tourniquet on the injury. Put it about three to five inches away from the injury, toward the heart. Thread a stick through the cloth of the tourniquet and twist it. This will tighten it – but stop as soon as blood stops flowing out of the injury. As soon as it’s tight enough, tie the other end of the stick to the leg or arm so that it won’t come loose.
Now is the time to clean the wound and put a bandage on it. If you have put a tourniquet on yourself and you are alone, don’t take off your tourniquet. If you are working on someone else, however, release the pressure for a minute or two, then tighten again, wait ten or fifteen minutes, release pressure again for a minute, and continue with that cycle.
- Great caution must be used when applying pressure to the neck, since there is a point, at which the pressure may be too strong and be held in place for too long a time, and the victim may slide into unconsciousness, and even death can be the result.
- A tourniquet must never be used on the neck of a victim.