CPR, one of the most universally proven emergency lifesaving techniques, was invented by Austrian surgeon Peter Safar in the late 1950s. He dubbed his emergency medical method the ABCs and was nominated for the Nobel Prize three times for this and his other achievements. Unfortunately, although his method saved millions, he was unable to resuscitate his own daughter when she was stricken by a fatal asthma attack.
CPR: INFANT
1. Place two of your fingers on the breastbone.
2. Place your other hand on the infant’s forehead to keep the head tilted back and the airway open.
3. Using your two fingers, give thirty chest compressions. Don’t do as with adults, though—compress the chest only about half an inch to one inch each time.
4. With the infant’s head tilted back, cover the infant’s mouth and nose with your mouth and give two gentle breaths.
5. At two-minute intervals assess for signs of circulation and breathing, and continue to perform this method until breathing begins or until EMS arrives.
A good friend of mine went to work for the fire department shortly after leaving the SEAL teams. He had been in the department for only a few weeks when he made the front page of the newspaper for saving an elderly lady from a burning house. There he was, front page, giving CPR. John was just being John, however; you don’t have to be a Navy SEAL to do what he did—save a life!
On the flip side, another good friend, also turned firefighter, was given the nickname “Dr. Death” because out of ninety-nine CPR attempts he wasn’t able to save anyone. This wasn’t his fault. I tell this story to stress the importance of getting to the victim as soon as possible. It’s a race against the clock, and every second a person’s heart is not beating brings them closer to death. After about a minute without CPR, the chances of resuscitation are greatly reduced.
So, now that your injured person is breathing and has a heartbeat, you must identify other injuries and primarily stop any bleeding. You need to continue to monitor the patient’s vital signs (breathing and heart rate), as these can change at any time.
Stopping the Bleeding
You must understand and practice methods to stop bleeding in order to be prepared for an essential element of survival medicine. During catastrophes, accidents, and survival situations, expect to see blood. Whether the result of a bullet, knife, car crash, or fall, bleeding is bleeding and requires immediate attention. As you know, blood is our vital fluid, and if too much is lost, you’re dead. Take action, and don’t get freaked by the amount of blood you might see. The faster you can focus and remain alert, not panicking over the amount of blood you may or may not see, the more likely it is that you’ll be able to take positive actions to save your life or the lives of those around you.
First, examine the body for signs of major bleeding, such as large pools of blood or blood-soaked clothing. Expose the wounded area by cutting away clothing if you have scissors or a knife, or find a way to see where the bleeding is coming from. Blood loss has to be stopped, or the efforts in rescue breathing or CPR will be for naught.
When I was on SEAL Team One, my platoon chief, who had been a SEAL for sixteen years, was a truly tough guy—been there, done that—but he still couldn’t stand the sight of blood. We had to wake him up every time he had to get a shot. It was classic.
You can usually detect if there is major bleeding by color, since bright red, spurting bloods comes from arterial wounds, while a darker red bleeding is usually venous, or from smaller veins. Arteries are larger and are a source from which a lot of blood can be lost quickly, causing sudden death. You must be calm and unhesitating. Once you find the source of the bleeding, place your fingers or hand on the wound to apply direct pressure, which frequently helps to stop the more rapid loss of blood. If bleeding continues, and you do not suspect a fracture or a broken bone at the wound area, then try to elevate the arm or leg, for instance, above the level of the heart, while continuing to apply direct pressure.
What looks cool in movies isn’t always the right thing to do. So don’t dig the bullet out and don’t cauterize the wound with a glowing red-hot knife.
Dressing the Wound
As soon as bleeding subsides, try to wrap and cover the wound with what’s called a field dressing, such as gauze or bandaging. Utilize the dressing to apply continuous pressure to the source of bleeding, wrapping it tightly. If no sterilized field dressing is available, use the cleanest cloth on hand. At this point, the bleeding must be stopped, so use homemade bandages made from T-shirts, socks, or any other garment within reach.
• Field dressing is what’s applied directly to the wound to control and stop bleeding.
• Pressure dressing is added and put over the wound and wrapped very tightly, even using a knot above the wound to create additional pressure on the dressing.
Once you have good pressure applied to the wound, keep it in place and monitor it. The moment it becomes soaked with blood, apply new dressings directly over the old dressings. Remember, the less a bleeding wound is touched and disturbed, the quicker the natural coagulants will have a chance to kick in and help to quell the blood flow.
If all this fails to control bleeding, then work on identifying a nearby pressure point. For wounds on arms or hands, pressure points are located on the inside of the wrist, the place where you’ve seen doctors and nurses feeling for a pulse by using their fingers. Another pressure point is on the inside of the upper arm (called a brachial artery). For wounds of the legs, the pressure point is near the crease of the groin (called a femoral artery). Try to apply pressure to these areas.
Lastly, if there is broken glass, for example, or something impaled in the wound, and the object is sticking out, don’t at first try to remove it in the field. Instead, stabilize the object with bulky dressing made from the cleanest material available. If possible, try to keep the limb that is bleeding elevated. Sometimes, pulling out the impaled object will make the wound larger, and the first course of action is to control blood loss.
When a Tourniquet Is Needed
If none of this works, you then need to resort to fashioning a tourniquet, defined as any device that can be twisted and constricted tightly around a limb and above the wound to cut off the blood flow to the area. It can be placed around an upper arm or thigh and then tightened to stop the flow of blood.
With one exception, a tourniquet should be used as a last resort, when all other methods have failed, as it stops circulation and, if improperly applied, could kill a person. However, if there is an amputation or a loss of any part of the upper arm, forearm, thigh, or lower leg, then a tourniquet is the first course of action and essential. Apply a tourniquet to an amputated limb before attempting to use field or pressure dressings. Incredibly, I’ve seen that when there is nothing but a stump left for a leg, it oftentimes shows very little bleeding. Nevertheless, apply a tourniquet above the area first and foremost.
Do not apply a tourniquet if there is an amputation to only part of a hand or part of a foot, as this could adversely affect the remaining fingers or toes and cause all the otherwise healthy digits to get cut off from circulation, killing the cells in these areas. Use only a pressure dressing to control bleeding for these types of wounds.
During missions, there was a reason we always had several tourniquets on us when we went outside “the fence.” These were tied and placed where you could access them using only your right or left hand, if need be, and brilliantly designed for self-application. You just always hoped that you came back with as many tourniquet straps still unused as when you left.
MAKE A TOURNIQUET
Ideally, tourniquet bands will be made from a cloth or flexible material, cut into two-inch-wide strips. Many other things can operate as tourniquets—belts, ties, headbands, waistbands, towels, duffel bag straps, or dress socks. Keep your wits and improvise with what is at hand. Do not use thin wires, electric cords, or shoestrings as tourniquet bands, as these will cut into the flesh.
For best results, ap
ply regulated pressure, wrapping the cloth around a stick and twisting until tight. Also, try to find something to serve as padding to place between the limb and the tourniquet band. Sometimes you can just use the casualty’s shirtsleeve, their trouser leg, or the part of the clothing you removed to see the wound.
SELECT A TOURNIQUET SITE
The upper arm or high up on the thigh are ideal places to apply tourniquets. Select an area about two to four inches above the edge of the wound or amputation. For maximum tourniquet effectiveness, if the wound is anywhere from the knee down, then apply the band just above the knee. If the wound is on the lower part of the arm, then put the tourniquet slightly above the elbow. Do not apply a tourniquet band directly over a joint where you see a broken bone or suspect a fracture; it will not be effective.
APPLY A TOURNIQUET
1. If the victim is still wearing clothes, simply smooth out the fabric of the sleeve or pants before putting on the tourniquet.
2. Put the tourniquet band above the wound area.
3. Make a half knot, as if beginning to tie a shoelace.
4. Put your stick or other rigid object on top of the half knot and then finish making the knot so the twisting object won’t come loose.
5. Then twist the stick or whatever you are using until the tourniquet is tight and you see the bleeding has subsided.
You may still see some darker blood from a vein continue to ooze even after the tourniquet has been properly applied, but the bright red arterial blood should stop. The tourniquet will be so tight as to cut off a pulse to all parts of the body that are below the tourniquet. However, don’t be fooled into thinking the blood has stopped and loosen the tourniquet. Doing so could allow the wound to start bleeding again, which could be fatal.
USE WITH CAUTION
A tourniquet stops all circulation below where it is applied. Make sure you keep the tourniquet exposed so that others who might come after you can see it; in survival situations, you may have to leave the victim behind as you continue on with your escape, for example. Hopefully, medical personnel will follow, and you must make it obvious to them that a tourniquet has been applied. You should even draw the letter “T” on the person’s forehead and indicate the time the tourniquet was applied. A tourniquet left on too long will kill the cells in the entire limb, even if it is the only way to stop bleeding and save the victim’s life.
Protecting Wounds and Stabilizing Fractures or Dislocations
You’ve done well to this point and stopped bleeding and have your casualty breathing. Now you have the time to do a more thorough physical exam. You want to identify any additional injuries or conditions that may also be life-threatening. Remember to keep monitoring the patient’s vital signs (breathing and heart rate), as they can change at any time.
This is not like an annual checkup type of exam. You’re under field conditions, and in the lingo of EMTs it’s called a rapid trauma assessment. Yet you have to look over the body from head to toe, primarily searching for tenderness. If the person is conscious, they will react if you touch a certain spot. Also, look for swelling or deformities. As if frisking someone, though gently, use both hands and work your way down the body front and back.
FRACTURES
There are more than two hundred bones in the human body, and during accidents and survival situations, chances are some of these are going to break or get fractured. The distinction between a fracture and a break in the bone is really only a measure of how damaged the bone is. Depending on what bone is fractured or broken, however, this can be a life-threatening medical emergency or just a really painful inconvenience.
The American Academy of Orthopedic Surgeons defines fractures this way:
Closed or simple fracture: The bone is broken, but the skin is not lacerated.
Open or compound fracture: The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.
Transverse fracture: The fracture is at right angles to the long axis of the bone.
Greenstick fracture: Fracture on one side of the bone, causing a bend on the other side of the bone.
If you have time to identify the fracture and apply a splint before moving the victim, do so. But make a situational assessment, and if you must remove the casualty (and yourself) from immediate danger, such as to escape from a burning vehicle or move out of the line of fire before treatment, then make that call and act accordingly.
Identify the fracture
In all situations, try to expose the area where you suspect the broken bone to be. Try to loosen clothing or anything that might be applying more pressure to the nonbleeding broken bone area. If it is on the arms, remove any jewelry that could limit circulation. Even check the victim’s pockets to see if there is anything that will put undue pressure on the break. If the bone is on any part of the legs other than the feet, then make sure you leave the casualty’s boots or shoes on. If you must keep moving, he will need them later on.
Stabilize the fracture
Even the smallest broken bone is very painful, because it is causing tissue damage around the area of the break. In the field, you are not going to try to do anything but “immobilize the fracture,” which means attempting to relieve pain and prevent additional injury. If an arm or leg is fractured, applying a splint is the most effective way to stabilize the area. In emergency medicine, the general principle is “splint the fracture as it lies.” Don’t try to snap it back in place; instead, the idea is to try to merely support the limb until you can get proper medical attention.
Splints
The purpose of a split is to minimize the movement to the fractured area or bone. A splint may be a special device carried by EMTs, but in survival medicine, you’ll likely have to improvise. Look for something rigid, such as a plank of wood, a pole, even a tree branch. Rolled-up newspapers or an unloaded rifle are other things you can possibly use as a splint. You will also need something to tie the splint in place. Strips of cloth or a belt can be used.
1. Apply the splint to the affected area in the position in which you find it. Do not try to set it back in place or realign the bones.
2. When tying the splint in place don’t overtighten the strips. This is not a tourniquet. Check to make sure you haven’t tied the strips too tight by pinching something like fingers or toes below the splint. The injured should feel this pinch. If they don’t, the straps are too tight.
3. It’s the inflammation around the injury that is causing pain, so if ice is available, apply liberally, placing an ice pack firmly on the area. You want to try to reduce the swelling, which can be aided by elevating the limb or joint above the heart.
DISLOCATIONS AND SPRAINS
Dislocated bones or sprains are injuries to the musculoskeletal system and are often not an actual fracture. Dislocation means the bone is out of its normal alignment, while a sprain is a twist or injury to the muscles around the bone. All can be very painful and immobilizing. Do not ask the casualty to move the injured area to test to see how much pain it causes. Ice is good for sprains and dislocations, but after twenty-four to forty-eight hours, heat is more effective in reducing pain. A splint can also be used for these types of injuries, depending on the body part. Especially if you must keep moving, a splint can prevent further injury.
TRANSPORTING INJURED
There are a number of ways to help the injured get out of harm’s way. The simplest—if you are capable—is called the fireman carry, which requires hauling the person over your shoulder. In reality, this will be slow and difficult to do over a long period of time. If there are a few people gathered with you, work as a team. For example, the two-man carry is performed when the injured is transported by having one person stand between the legs and grab them while the other person slings the injured’s arms over the shoulders. Both rescuers are facing in the same direction and are moving with the injured’s legs first. A third form of transportation is the improvised pull-and-haul,
which is performed by employing a dragline, made from rope, belts, etc. These are placed around the chest and under the armpits to drag the injured from danger. You could also create a makeshift stretcher with a blanket or similar item. Place the injured onto it and pull them to safety.
The two words you never wanted to hear the training instructors say were “Man down.” It meant that in addition to the 110-degree heat and 100-percent humidity you were performing contact drills in, you now had to carry or drag one of your teammates, who was simulating injury. It was a real dick dragger! But when the real bullets started flying, these drills were invaluable. In SEAL Team we say: “Sweat in training, so you don’t bleed in war.”
SHOCK
Our circulatory system continuously flows like a river through our veins and arteries, distributing blood to all parts of the body, bringing oxygen and nutrients to the tissues. If that system fails, resulting in an insufficient flow of oxygen to the vital organs, then the body goes into a medical condition known as shock. If a person remains in this state too long, the vital organs will fail, ultimately causing death. Shock is made worse by fear and pain. Prevention and treatment methods for shock are basically the same.
Causes of Shock
If blood isn’t flowing properly, then the main pump, the heart, is usually not functioning properly. The most common cause of shock is a heart attack. But it can also be caused by a reduction in the volume of blood and a sudden loss of fluids. Some other causes of shock include: external or internal bleeding and fluid loss from severe diarrhea, vomiting, or burns. What’s happening to a person going into shock is that the blood supply is being diverted from the surface of the body, which keeps our bodies at a regulated temperature, and is instead being sent to the core of the body, trying to sustain the vital organs. Sudden redistribution of the circulation can be spotted. Look for the following early warning signs:
Seal Survival Guide Page 28