By Ol’ Tennessee Ridgerunner
On any working homestead, injuries are common. Motorized equipment, building materials, power and hand tools, vehicles, livestock, weapons and electrical equipment – contact with all these items has the potential to cause wounds of some degree at your retreat. Most minor abrasions, lacerations and punctures can be effectively treated with pressure, cleansing, an antibiotic and covering with a Band-Aid. But are you prepared for a more serious, potentially life-threatening injury?
In a grid down situation, injuries on the rural homestead can be a serious issue, particularly for a pair of elderly homesteaders living alone. Getting wounded when there’s no access to trained medical care can turn ugly in a hurry. A small cut, not properly treated, can drop you just as easily as a rifle shot. Infection is the number one killer in any disaster situation. An estimated two out of every three deaths in a calamity are caused by infection. So it’s important that you take care of small lacerations immediately and continue treating them until healed enough that infection is not a risk.
Training and supplies
Most preparedness-minded folk recognize that a stockpile of medical supplies, including antibiotics, is extremely important. When the grid goes down in any natural disaster, be it a hurricane, earthquake, tornado, flood or social unrest, medical provisions become just as valuable as food and water. But a locker full of medical supplies is worthless if you are not properly trained how to use them. In an austere survival situation, you are on your own.
We cannot overemphasize the fact that a single individual with basic medical knowledge can make a difference in the lives of many others. When there are no doctors, every rural homesteader needs to know how to treat basic injuries and illnesses and to have a well-stocked emergency first aid kit. It’s always wise to take a certification course in First Aid and Basic Lifesaving Skills at a local Red Cross or hospital. By taking progressively advanced first aid classes and even Wilderness EMT/EMS courses, your chances of survival in a disaster scenario are significantly increased. Advanced first aid training can give you the skills and experience you need to evaluate and treat most minor and some major injuries you may be faced with.
Course of action
Here’s a scenario. Your spouse is injured while bush hogging the upper pasture. There’s a large gash in his calf gushing blood just below the knee. Are you prepared to correctly treat your partner on site when they suffer a severe injury to an artery?
This is a lifesaving course of action taken from the US Army Survivor Manual 21-76: Control panic, both your own and the victim's. Reassure the victim and try to keep him quiet. Perform a rapid physical and situational evaluation. Look for the cause of the injury (but DO NOT follow the old “ABCs” of first aid (Airway, Breathing, Circulation). Recent warfare experiences in the Middle East have taught combat medics that when you have no access to blood products, it’s now “CAB.”) You must always address circulation (blood loss) problems first, followed by airway and breathing checks. A victim may die from arterial bleeding quicker than from an airway obstruction.
First priority: bleeding control
You must identify the source of and control serious bleeding immediately because replacement fluids normally are not available and the victim can die within minutes. Severe bleeding from any major blood vessel is extremely dangerous. The loss of one liter of blood produces moderate symptoms of shock. The loss of two liters produces a severe state of shock that places the body in extreme danger. The loss of three liters is usually fatal.
To identify the source of life-threatening bleeding, open any clothing over the wound so you can see it clearly. By removing clothing, you can see injuries that may have been hidden or covered. The remainder of this course of action is taken from the Stop the Bleed campaign.
How to find and identify “life-threatening” bleeding. Examples include:
• Blood spurting out from a wound.
• Blood that won’t stop coming out of a wound.
• Blood pooling on the ground.
• Clothing soaked with blood.
• Bandages soaked with blood.
• Loss of all or part of an arm or leg.
• Bleeding in a victim who is now confused or unconscious.
Compress and control
There are a number of techniques to stop bleeding. They all have one thing in common - compressing a bleeding blood vessel in order to stop the bleeding.
If you don’t have a trauma first aid kit:
Apply direct pressure on the wound (Cover the wound with a clean cloth and apply pressure by pushing directly on it with both hands)
Take any clean cloth (for example, a shirt) and cover the wound.
If the wound is large and deep, try to “stuff” the cloth down into the wound.
Apply continuous pressure with both hands directly on top of the bleeding wound.
Push down as hard as you can.
Hold pressure to stop bleeding. Continue pressure until relieved by medical responders.
If you do have a trauma first aid kit:
NOTE: A trauma first aid kit will include at a minimum: A C-A-T tourniquet, several feet of hemostatic combat (bleeding control) gauze, and EMT trauma compression (Israeli) bandages.
For life-threatening bleeding from an arm or leg where a tourniquet is NOT available OR for bleeding from the neck, shoulder or groin: Pack (stuff) the wound with a bleeding control (also called a hemostatic) gauze, plain gauze, or a clean cloth, then apply pressure with both hands. If you don’t have bleeding control gauze, you can apply Celox clotting powder directly into the wound and compress it. Celox is more difficult than hemostatic gauze to remove from a wound.
1) Open the clothing over the bleeding wound.
2) Wipe away any pooled blood.
3) Pack (stuff) the wound with bleeding control or combat gauze (preferred), plain gauze, or clean cloth.
4) Apply steady pressure with both hands directly on top of the bleeding wound.
Push down as hard as you can.
5) Hold pressure to stop bleeding. Continue pressure until relieved.
Using your trauma first aid kit:
For life-threatening bleeding from an arm or leg and a tourniquet is available:
Apply the tourniquet - When I was a Boy Scout in the stone-age, they warned us to avoid using tourniquets because they feared it would result in an unnecessary amputation. Not so today. Combat medics and civilian EMTs routinely apply tourniquets for severe bleeds.
1) Wrap a CAT tourniquet around the bleeding arm or leg about 2 to 3 inches above the bleeding site (be sure NOT to place the tourniquet onto a joint - go above the joint if necessary).
2) Pull the free end of the tourniquet to make it as tight as possible and secure the free end.
3) Twist or wind the windlass until bleeding stops.
4) Secure the windlass to keep the tourniquet tight.
5) Mark the time the tourniquet was applied.
Note: A tourniquet will cause pain but it is necessary to stop life-threatening bleeding.
After bleeding is controlled, the most critical part is cleaning debris and bacteria from the wound. This will be uncomfortable for the victim, but essential to do expeditiously so the body can start repairing itself.
Most wounds encountered in an off-grid setting will be dirty. If you try to close a dirty wound, such as a gunshot, you have isolated bacteria, bits of clothing, and dirt in the body. Very soon, the wound will become infected. An infected wound is red, swollen, and hot. In extreme cases, an abscess forms and fluid accumulates inside. The infection, known as sepsis, can spread to the bloodstream and literally kill you. So it’s very important to do the first cleaning correctly and thoroughly. Make sure you have some form of antiseptic, bandages, salve, clean cloths and tweezers to remove debris. Use potable water in a syringe to flush the wound and gauze to wipe out debris.
After debris removal, antiseptic is probably the most important component because it’s going to kill bacteria and other germs that can slow down the healing process or cause infection. In a survival situation, it doesn’t take long for infections to become septic and then you’re in serious trouble. Many injuries that require closure (and some that don’t) should be treated with antibiotics in oral or topical form to decrease potential for infection. Natural substances with antibiotic properties, such as garlic or raw unprocessed honey, may be useful in survival scenarios.
Normally, it makes sense to close up a laceration within six hours to facilitate healing and prevent infection. Minor cuts get antiseptic and a Band-Aid. After rendering first aid, you have to make a decision. Any long cut that goes beyond the top layer of skin or is deep enough to see into might need to be closed with stitches. Long, deep or wide cuts may be closed with steri-strips, tapes, staples, sutures or medical superglues. You can also close a wound located over a joint or other moving part, such as the knee, because movement will constantly stress the wound and prevent it from closing by itself. A wound that gapes open loosely might be closed without undue pressure on the skin.
In a disaster where there are no rescuers, you have to be your own doctor. Your decision to close an open wound could make the difference between proper healing and an infected jumble. Closing a wound that should be left open can do more harm than good, and could possibly put someone’s life at risk. So a decision to close a wound is not automatic. If the wound has areas of skin torn out or hanging flaps, or the edges of the skin are so far apart that they cannot be stitched together without undue pressure, the wound should be left open. Another reason to leave a wound open is if it has been open for more than eight hours because airborne bacteria have probably already populated the wound. In addition, puncture wounds from animal bites are loaded with bacteria and should be kept open in austere settings.
Leaving a wound open allows you to clean the inside frequently and directly observe the healing process. It also allows inflammatory fluid to drain out of the body. In addition, if you’re truly in a long-term survival scenario, the suture material or staples you have won’t be replaced. It’s important to know when closure is absolutely necessary and when it’s not.
With a clean wound, you can apply a loose dressing of sterile gauze or a piece of cloth that has been boiled and dried. Don’t make it airtight because that leads to infection. You want to keep the wound from getting more dirt inside and drain if needed. The dressing is kept in place with a bandage. Tape, medical, duct or even electrical tape can be used to hold a dressing in place, but don’t apply it tightly. If you are still unsure, you can choose to wait 48 to 72 hours before closing a wound to make sure that no signs of infection develop. Some wounds can be partially closed, allowing use of a drain to avoid the accumulation of inflammatory fluid.
This synopsis is probably more than most people want to know about wound care, but on the homestead, it’s useful to have a basic understanding of the human body and treatment options for common conditions. Consider taking an emergency first aid course at a local Red Cross or hospital. By taking progressive steps towards an advanced proficiency in disaster first aid, the chances of survival for you and your family are significantly increased. Learn these skills now before you really need them. You can find more useful articles on homesteading challenges at this site. This post was written as a general overview, not as a professional or definitive guide for medical care or wound management. The author takes no responsibility for any damages arising for this post.