How to Avoid Being Killed in a War Zone Page 12

  Take the arm furthest away from you over to their nearest cheek, palm out.

  Lift up the furthest knee to a bend. Hold that with one hand and their head and palm with the other, and gently roll them over into a foetal position. Their head should now be resting on their hand.

  Make sure the airway is open by tilting the head back slightly. And for stable support, ensure the straight thigh and bent knee are at right angles to each other.

  Recovery position for babies

  Hold the baby in your arms as shown in the diagram below. Their head should be tilted slightly downwards to stop them choking on their tongue or vomit.

  Recovery position for a suspected spinal injury

  As it can be very dangerous to move someone with a suspected spinal injury, approach with extreme caution, as follows.

  If the casualty is stable, leave them as they are on the ground. One person should be assigned to make sure they do not move their head. That person needs to get comfortable as they could be there for some time. Extra support, such as towels or clothing, can be put around their hands to relieve the strain.

  If the casualty is having trouble breathing, you might be forced to move them into a recovery position. This should be done as a last resort. It is the same process as the normal recovery position (see Recovery position for babies), except that somebody holds the head while the turning process happens. They must continue to hold the head stable after the turn has happened, so, as before, they need to get comfortable.

  The Heimlich manoeuvre

  With adults and children over the age of around seven, stand behind your choking patient, who should be leaning forward. Wrap your arms tight around them, creating a fist with your closed hands between their stomach and the bottom of the breastbone. It is where you hiccup from – the diaphragm. Give yourself plenty of room to move your hands, then pull sharply back and up, lifting them if necessary with the force. Carry that out five times. Stop, give five more hits between the shoulder blades, then repeat the Heimlich manoeuvre. Continue alternating the procedures until the obstruction is coughed up. Do not give up – keep trying.

  With young children under the age of around seven, the Heimlich manoeuvre is very different. Lay them on their back and use the force of just two fingers in an upward thrust movement.

  Immobilizing fractures

  The best way to stop a broken limb moving is to splint it. You can use anything – a fence post, a ski pole, a walking stick, a windscreen wiper, a roll of newspaper… even a magazine wrapped around a break works well. Splinting is a matter of logic and listening to the patient.

  If a limb is broken, you need to make sure that the areas above and below the injured area are immobilized. For example, if you’re dealing with a broken shin bone, you would immobilize the knee and the ankle. Use splints either side of the limb if possible, and put padding between them and the body to avoid bruising. Tie any knots on the uninjured side.

  If there is nothing you can use as a splint, tie the injured limb to the body: one leg to another, for example. Put padding in any natural gaps and tie with wide pieces of cloth above and below the injury. Tie any knots on the uninjured side.

  Be prepared to adapt. If you cannot move the broken limb straight, or if the break is at a joint such as the knee or elbow, splint as they are – bent. You can splint one bent leg to another, or put a bent arm inside a sling.

  If the neck is broken, wrap a large scarf around it as tightly as you can without affecting the person’s ability to breathe. Alternatively, wrap a folded newspaper around it. If the person is lying down, put something heavy at either side of the head.

  If the back is broken, minimize all movement. Put something heavy at either side of the head and all around the body to prevent movement.

  If a sling is needed, use material that isn’t too stretchy. Fold it into a triangle and slide it under the broken arm, keeping the shorter pointed end towards the elbow. Tie the long ends behind the neck. There are in fact several ways to put on a sling, so experiment with folds and knots until the patient is comfortable.

  A full sling should be used for any injury to the lower part of the arm, or to immobilize a limb if the collarbone has been broken or a shoulder dislocated.

  If there is a splint on the upper arm or elbow, it might only be necessary to tie the sling around the wrist.

  Pressure points to control bleeding

  There are several places on the body where arteries flow near the surface and pressure can be applied to stop bleeding elsewhere. The idea is to press on a point between the casualty’s heart and their wound to stem the flow. You will need to move your finger around a bit to find the right spot.

  Tourniquets

  The subject of tourniquets is very controversial in the medical community because people have lost limbs when they have been applied too tightly or left on for too long. Note the following rules:

  • They should be used only when trying to tie the end of an artery.

  • They can be applied in only two places – around the upper thigh near the crotch, or on the upper arm near the armpit. They cannot and should not be applied to other parts of the body.

  • The tourniquet should be made of a cloth around 3 cm wide so that it does not cut into the limb or damage any nerves.

  • Wrap it around the limb at least three times and tie a loose knot (A). Put a stick or pen on top of the knot (B) and tie another knot over the top (C). Twist the stick until the blood stops flowing, then tie a piece of string around the top of the stick to stop it unwinding (D).

  • Check that fingers, toes and nails are not turning blue as this is a sign that the tourniquet is too tight and needs to be released immediately.

  • Release the tourniquet frequently to allow blood to flow back into the limb.

  • When the flow has stopped try to locate the severed artery so that you can tie the end with some string or fishing line sterilized in alcohol or by boiling. Then release the tourniquet slowly to see if it has worked.

  • Never leave a tourniquet on long-term or unattended.

  Treating wounds

  • Preferably wearing latex or vinyl gloves, apply pressure with your fingers or a dressing of some sort until the bleeding stops. Be careful to avoid pressing down on anything stuck in the wound, such as gravel or glass.

  • Raise the limb if you can while carrying out subsequent treatment.

  • Clean the wound – with cooled, boiled cloths if you have nothing else – but do not remove any foreign objects and dead flesh unless there is no hope of professional help any time soon. If you must do so, use a pair of sterile tweezers.

  • Gently apply antiseptic from the inside out to avoid passing infection inwards from unclean skin.

  • Apply a dressing. If blood shows through, put another one on top, and reapply as often as necessary. The dressing will need to be changed if it smells or gets wet, or if the wound becomes infected.

  • A deep, clean cut might need stitches. For this you need a sterilized needle and sterilized thread, and should start in the middle of the wound, working towards either end. You need to make individual stitches, pulling the two sides together and knotting the ends of the thread for each stitch.

  • Butterfly stitches, which are actually plasters, require even more deftness to apply. One clean hand, preferably the casualty’s, should hold the cut tight while you open and apply the sticky butterfly stitches.

  Warning: Try to get a tetanus shot as soon as possible after cutting yourself. This nasty infection is not caused by rust, as so often believed, but rather by bacteria found everywhere in the wild. If left too long, tetanus will cause painful lockjaw. Make sure your tetanus jabs are up to date before you travel.

  When your help is unwanted

  There are all sorts of reasons why someone might refuse your help. Hypothermic patients, for example, will be disorientated and unable to listen to your advice about what they should be doing to help themselves. People with a head i
njury also often have the illusion that they know what is best. And someone in a lot of pain might think it would be better for them to die right there than to go through the added pain of your trying to move them somewhere safe. Refusal could also be a cultural thing. A woman might not accept treatment from a man, or her family might refuse on her behalf even if she agrees.

  The only advice here is to go in slowly. Approach with open hands and face and don’t rush a patient into doing something that might feel awkward for them. They might have a panic attack or go into shock if they are taken by surprise. Sometimes it would be better to instruct people they trust to do the work for you. The best approach always depends on the particular circumstances.

  Following your instincts can get you into trouble. By the time I got to Iraq in 2003, I was better prepared than previously, having reminded myself of Red Cross basics. After a bomb at the UN shattered a hot Baghdad afternoon, my colleagues and I hurried to the scene. We were there for a story, not to help, but we spent the first 20 minutes ferrying people to the local hospital in our two cars. I stood still for a minute in all the mayhem. The man next to me looked into my eyes and then collapsed, a pool of his blood rushing out on the grass. I could see a piece of shrapnel, like a huge deformed salad bowl, stuck in his side. Ambulances were nowhere near and I knew it would be better if he were lying on his other side, off the shrapnel, so I rushed in without thinking and was trying to roll him over. Suddenly, I was surrounded by a crowd of men and aware that I had run out wearing only a small T-shirt, not my usual billowing Iraq-friendly ‘Dad shirt’. In their eyes I was a practically naked girl groping a man. I stepped back and left the scene altogether to murmurs of ‘whore’ in Arabic. The man died, but there was little I could do.

  /A–Z OF MEDICAL EMERGENCIES

  Abdominal injuries

  Basic cuts to the abdomen can be treated like any other wound – simply cleaned and dressed. But if some of the guts are exposed or even falling out, different treatment is required.

  Action: Do not dress the wound. Do not attempt to put anything back inside. Doing the latter could cause further damage and will make the surgeon’s job more difficult. Keep the extruding organs damp and covered until you can get proper medical attention.

  Warning: Do not give the patient food or water. They will need an operation, and it could be dangerous for them to ingest anything if there is injury to their intestines. Just wet their lips instead.

  Allergies

  Bee stings, milk, latex (gloves or condoms), anaesthetic, pollen, dust, nuts, shellfish and many other things can be deadly to some people. If you are working in a team, you need to find out about any health issues your colleagues have and how to deal with the symptoms when they present themselves. If any of you suffer from a serious allergy, the details should be written on the individual’s body armour and helmet. It’s also advisable to wear a medical warning bracelet (see Recovery position for adults and children).

  First signs: Mild reactions may include struggle for breath; rash or swelling of lips, tongue, face, feet or hands; itchy eyes; tender stomach; if an allergen (the cause of the allergy) has been ingested, it may lead to diarrhoea or vomiting. More serious reactions may show as more extreme forms of these symptoms. The throat may swell, making it hard to breathe. This could sound like hyperventilation or an asthma attack. The allergy may also present as shock (see Shock), which might eventually lead to loss of consciousness.

  Action: If anti-allergy medication is carried, use it. This is likely to be epinephrine (previously called adrenaline in Europe) which may be in a container that looks like a pen. The commonest brand is EpiPen®.

  You take off the lid and the safety release, place the needle firmly against the thigh (it can go through clothing) and it should automatically inject the patient. You can give a dose of epinephrine every five minutes if it doesn’t work initially.

  Carry on treating the symptoms of the allergic reaction. If you see the signs of shock, raise the person’s legs and calm their breathing.

  If the allergic reaction is not something you have come across before, seek help amongst the locals. They are probably used to it.

  Some weird insect took a liking to my neck in Kosovo. It bit me and it hurt. We were in a small village and my medical kit had almost too much in it. I sought local advice, and a woman applied the leaves of a plant to the affected area for immediate relief. Nick Toksvig

  Amputation

  You will need a saw. Some survival kits come with a sort of bendy saw. If not, a large penknife saw will do if you are desperate. Desperation is when the choice is between losing limb or life – trapped under a concrete pillar in a burning building, that kind of thing.

  Action: Make a tourniquet (see Tourniquets) with the aim of seeking out the main arteries after the amputation is done and tying them closed. The tourniquet is only temporary and should not be left on long.

  Take a deep breath and steady your hand. Cut through the skin; it will retract. Cut through the muscle; it will retract. Cut through the bone. Immediately begin the search for the arteries (the big blood vessels that are gushing blood) and tie them closed with sterile thread (boil it if necessary, except if it is plastic, in which case you should soak it in a mild bleach or sterilizing solution).

  Release the tourniquet and place a light bandage over the end of the stump. Begin treatment for shock (see Shock). Breathe again.

  Asthma attack

  The victim of an asthma attack will usually know what to do if they are a regular sufferer, but it is good to know how to support them.

  First signs: You will hear the person struggling to get breath into their narrowed air passages, which go into spasm during an attack.

  Action: If they are a regular asthma sufferer, immediately seek out their ‘reliever’ inhaler (in the UK and many other countries these are colour-coded blue, rather than brown which is a preventative; but this coding is not universal so ask the patient). Sit them in a position they find most comfortable. Do not lie them down. Take the lid off the inhaler and place the hollow mouthpiece in their mouth. Ask the patient to breathe in as slowly as they can and then try to hold their breath as you press down the top of the cartridge. It should be one fluid movement. If they have difficulty coordinating this, then push the end of the inhaler into a plastic or polystyrene coffee cup and use it as a mask.

  A mild attack should ease within minutes. However, seek further treatment before it happens again or gets any worse.

  If the attack is more serious, it will not ease. The person will become exhausted, managing only to whisper as they become more breathless. If necessary, you can give 1 puff of their inhaler every minute up to 20 puffs. If they fall unconscious, begin the ABC checks (see ABC – the first checks). Most importantly, you must open the airway. Call for urgent help as soon as possible and continue ABC until it arrives or the sufferer is stabilized.

  Bites (see Avoiding creatures that bite)

  Bleeding

  Minor wounds will stop bleeding when pressure is applied, with or without a bandage. After a short time the blood will begin to clot naturally and stop the wound from bleeding. If the wound is in an arm or a leg, you can raise the limb at the same time as applying pressure in order to slow the blood pumping on the wound. Once the bleeding has stopped or eased, apply a dressing or stitches (see Treating wounds).

  Large wounds are treated in a similar way, but you need to apply pressure for longer. First pack the wound with a large dressing, as clean as possible, then put pressure on top of that for 5–10 minutes. This should stop or significantly slow the bleeding. After that, wrap a bandage around the dressing to keep the pressure up. Once the bleeding has completely stopped, put on a new dressing if possible or apply stitches (see Treating wounds).

  If you see blood frothing from the chest, this is serious as it can lead to a collapsed lung (see Collapsed lung).

  Arterial wounds are evident when blood pumps out fast and at high pressure. There is too much gushin
g for the blood to clot, but it must be stopped. You can try putting pressure at the point where the blood is spurting from, or you can try cutting off the flow to that artery further up the limb or body (see Pressure points to control bleeding and Tourniquets).

  Internal bleeding is difficult to diagnose and there is nothing you can do about it, but you should look out for the signs: pain; external bruises; hardness if it is in the abdomen; bloody discharge from the ear, mouth, nose, anus, vagina or urethra. If any of these signs are present, get the casualty to hospital as fast as possible. While waiting for expert help, you can prepare the patient for shock (see Shock).

  Burns

  The treatment of a burn depends upon its severity or depth.

  First-degree burns are superficial, like sunburn, affecting only the epidermis or outermost layer of skin and causing no blisters.

  Second-degree burns are slightly deeper, reaching below the outer layers of skin and blistering up. The blisters contain fluid released from the tissues below. These burns usually heal well, but can be dangerous if across more than 20 per cent of the body (10 per cent in a child). In that case, the massive loss of fluid from all those blisters can kill through shock (see Shock). You can judge the extent with the palm of your hand, which has an area of about 1 per cent.

  Third-degree burns are deep, affecting all the layers of skin, and may reach down as far as the nerves and muscles. In this case the casualty can’t feel pain because the nerve endings have been burnt. However, it is important to keep the burn protected and clean as even a small third-degree burn left untreated could become septic and therefore deadly.