by Joshua Piven
4. Tie off the ends of any blood vessels being pinched.
Use fishing line, dental floss, or heavy thread (in that order of preference) along with a sewing needle if available to carefully tie off the arteries. Pass the line completely around the blood vessel being pinched, as far up as possible. Tighten the first knot down hard, then place several securing knots on top of the first one. You may want to tie the vessel down in two places, in case one of the stitches comes apart later.
5. Clean the stump thoroughly.
Preventing infection is very important:
• Pick out foreign material lodged in the wound.
• Cut off crushed tissue remnants still attached to the stump. Use a sharp knife or scissors.
• Wash the wound, vigorously irrigating it with a stream of water.
6. Optional: Cauterize remaining bleeding sites.
Using an iron or piece of heated metal, identify the vessels that are still oozing blood. This is simpler during irrigation, when debris and clotted blood are washed away. Dab at each vessel lightly with cloth or gauze to allow yourself to see exactly where its end appears in the wound, then apply cautery at that point. Do not worry about completely eliminating bleeding. If rapid bleeding is well controlled, oozing will be controllable once the dressings are applied.
7. Loosen the tourniquet.
As the pressure from the tourniquet decreases, you will be able to check your ties and ensure more ties (or cautery) are not needed. If bleeding is just a moderate ooze, you have been successful and the tourniquet can be removed. To preserve tissue at the stump, do not leave a tourniquet applied for more than 90 minutes.
8. Dress the stump.
Coat the end of the stump with any type of available antibiotic ointment (examples include bacitracin, polymyxin, and mupirocin). Then tightly cover the end of the stump with clean cloth or gauze. Elastic strapping works well to hold the dressing onto the stump end. The tighter the dressing, the less the chance of sustained bleeding.
9. Elevate the stump end as high as possible to allow gravity to assist in slowing further bleeding.
10. Put an ice pack over the dressing.
11. Be prepared to apply and tighten a tourniquet again, should heavy bleeding resume.
12. Treat pain and shock from blood loss.
Use any available pain medication to treat pain from the injury. To treat shock, give the victim animal meat or a liquid containing salt (such as chicken soup). These will help to restore plasma and hemoglobin.
HOW TO PRESERVE THE SEVERED LIMB
1. Gently wash the severed limb with water.
2. Wrap the limb in a moist, clean cloth.
3. Wrap the limb again in watertight material (such as a plastic bag).
4. Keep the limb cold.
Do not freeze the limb. Freezing will destroy tissue. Use a cooler full of ice or a refrigerator.
5. Get to a hospital immediately.
A limb saved in this manner can remain viable for reattachment for up to six hours.
Be Aware
• Traumatic amputation of a limb is not necessarily a fatal injury. In order of severity, the immediate problems that you must deal with are rapid severe arterial bleeding; slower bleeding from cut veins; pain; and infection. Only severe bleeding carries an immediate, life-threatening risk, with the possibility of death in minutes.
• Submerging a severed limb in water may cause damage that could hinder its reattachment. You can, however, place it in a watertight container and then submerge that in a river or lake to keep the limb cool.
HOW TO REMOVE A LEECH
1. Do not attempt to remove a leech by pulling up on its middle section or by using salt, heat, or insect repellent.
Dislodging by squeezing, salting, burning, or otherwise annoying the leech while it is feeding will cause it to regurgitate, most likely spreading the bacteria from its digestive system into your open wound, causing infection.
2. Identify the anterior (oral) sucker.
Look for the small end of the leech. A common mistake is to go immediately to the large sucker.
3. Place a fingernail on your skin (not on the leech itself), directly adjacent to the oral sucker.
4. Gently but firmly slide your finger toward where the leech is feeding and push the sucker away sideways.
When the seal made by the oral sucker is broken, the leech will stop feeding. After the oral sucker has been dislodged, the leech’s head will seek to reattach, and it may quickly attach to the finger that displaced the head. Even if the oral sucker attaches again, the leech does not begin to feed immediately.
5. Displace the posterior (hind) sucker.
While continuing to flick occasionally at the small end, push at or pick under the large end (hind sucker) with a fingernail to cause it to lose its suction.
6. Dispose of the leech.
At this point, the leech may have securely attached itself to the finger you used to remove it. Flick it off—it should detach easily. Once the leech is detached, you can put salt or insect repellent directly on it to keep it from attaching to anything else.
7. Treat the wound.
After the leech’s anticoagulants lose their effect, the wound should heal quickly. Keep the area clean, and cover it with a small bandage if necessary. Avoid scratching the wound. If itching becomes severe, take an antihistamine.
IF A LEECH INVADES AN AIR PASSAGE
Hirudiniasis is a potentially serious condition in which one or more leeches invade a body orifice. In particular, Dinobdella ferox (literally, “the terrifying ferocious leech” or “nasal leech”) has a predilection for airways, where it may cause a blockage or asphyxiation, especially if leeches invade the passage in large numbers. If there is a leech invading your airway and you can breathe, do not attempt to remove it—seek medical attention immediately. If you cannot breathe, take the following steps:
1. Gargle with diluted 80-proof alcohol.
Most distilled liquors—vodka, gin, bourbon, scotch—have the requisite alcohol content. Use a mixture of 50 percent alcohol, 50 percent water. Be careful not to aspirate (inhaling the leech and the alcohol).
2. Spit out the leech.
Alternative
If gargling does not work and the leech is visible, remove it by grasping firmly at the hind sucker and yanking.
Be Aware
• There is virtually no risk of substantial blood loss from leech bites. The wound will continue to bleed for some time after a leech has finished feeding, but this level of blood loss is not dangerous.
• Leeches are generally not known to transmit blood parasites to humans.
• Leeches are more likely to be encountered in still water than in rivers or streams. They are more often found near the edges of clean, clear water than in or near swamps.
• Leeches need a solid surface to hold onto even when they are not feeding. Avoid leeches by staying in the open: Swim in deep, open water, avoid boat docks, and do not wade through areas with submerged branches or rocks. In jungles, remain on trails and be aware of leeches on overhanging branches and vines.
• Both aquatic and terrestrial leeches have incredible senses of perception. They are attracted by vibrations and by body heat, and they have 10 pairs of eyes to detect movement. Keep moving, and check yourself and your traveling companions regularly.
APPENDIX
GENERAL TRAVEL STRATEGIES
EMERGENCY INFO—On a business card, write down emergency contact information and place it in your wallet. Include the names of your doctors, as well as anyone who should be contacted in the event of an emergency. Give your emergency contact a copy of your itinerary, and the name of where you’ll be staying.
BATHROOM EMERGENCIES—If you need a bathroom in a hurry, head for the nearest large hotel. Most hotels have bathrooms on or near the lobby that are usually clean and well-kept. Large, expensive hotels are also good for other services—telephones, faxes, e-mail—and will gladly point you in the right dire
ction.
FRESHENING UP—Department stores are great places to freshen up or reapply makeup. Just head for the sample counters and you’ll find an array of lipstick, makeup, and perfume at your disposal.
TAXIS—When getting out of a taxi, make sure you leave the door open while you are getting your bags out of the trunk; that way the taxi can’t drive off before you get your bags out.
HIDING PLACES—Bras with removable pads are great for hiding money, as are tampon tubes. Not many are willing to invade such private places to find it.
STRATEGIES FOR PACKING
LUGGAGE MARKINGS—Give each piece of your luggage a unique look—tie a bandanna to a handle or purchase a colored luggage tag. Bags often look alike, and even though you may be able to tell one bag from another, not everyone else is as smart as you are. It will also be easier for you to keep track of your bag from a distance. In lieu of locks, purchase plastic ties to loop through your zippers. These are by no means infallible, but may thwart a thief who is looking for a bag that is easy to open.
CHECKED VS. CARRY-ON—Pack items you must have with you in transit or upon arrival in your carry-on. Medicine, toiletries, and a change of clothing (or at least underwear) are essentials. Carry with you any items that would be difficult to replace if your luggage is lost or late. Do not risk losing anything valuable in your checked luggage—most airline baggage is insured for only $1,000. If you are traveling with someone you know well, pack half your clothes in their bag and carry half of theirs in your bag. That way, if one bag gets lost, you both have at least half your possessions.
AVOID WRINKLES—Use plastic dry-cleaning bags between fine garments to keep them from wrinkling. Pack smaller items in zip-lock bags to keep them wrinkle-free.
CREATE SPACE—If you run out of space, zip your suitcase and drop it a few times on the floor. This will compress items a bit and free up space.
AVOID EQUIPMENT-SPECIFIC BAGS—If you are taking valuable electronic equipment with you (such as cameras, video recorders, or laptops), consider packing them in a diaper or baby bag instead of the fancy, easily identifiable cases designed for them. A diaper bag is less likely to be stolen and has a lot of extra pockets for storage.
FALSE WALLET—Prepare a “mugger’s wallet” that contains a small amount of money along with a photo ID (not your driver’s license or passport) and additional, but replaceable, cards, for bulk. Use this wallet for your daily small expenses, but be prepared to surrender it in an emergency. Carry the wallet in your front pocket, and place a rubber band around it. You will feel any attempt to remove it. Turn it sideways rather than up and down—you will notice more easily if someone tries to remove it.
STRATEGIES FOR FLYING
BEST SEATS—For the best seat in the coach cabin, try for a seat in the emergency exit or bulkhead rows. These are assigned on a first-come, first-serve basis at the airport, so get there early. The exit row seats are also obviously some of the safest in the cabin—your nearest exit is no more than a few feet away.
UPGRADES—Getting upgraded is often as simple as asking at the airport or even on the plane. Although some frequent-flier programs require that you purchase a full-fare ticket in order to use miles for an upgrade, you may be able to obtain a “stand-by upgrade” at the time of your flight if you request it. Just make sure you have your frequent-flier number with you, and that you ask the ticket agent if you can go “stand-by for a first class or business class upgrade.” You may be able to get an upgrade by ingratiating yourself with the flight attendants. Some travelers take gifts (cookies, doughnuts) to give the flight attendants upon departure. In other cases, upgrades have been given to passengers who yield their seats to others who might want to sit together. Be nice—not pushy.
CANCELLATIONS—If your flight is canceled (or if a delay will cause you to miss a later connection and require you to rebook), you are better off calling the airline or your travel agent for immediate rebooking. This way, you won’t have to fret in line with the rest of the passengers. As an alternative, go back to the ticket counter at the front of the airport for rebooking if the line at the gate is too long.
Another alternative is to ask that your ticket be endorsed over to another airline that has a more acceptable flight to your destination. Rather than waiting several hours or overnight for the next available flight, seek out a competing airline’s schedule, determine if seats are available, and then contact the airline or your travel agent to insist that your ticket be endorsed over to the other airline. Be sure that they route your luggage correctly.
JET LAG—To beat jet lag, drink a lot of water before, during, and after the flight. Exercise, eat, and sleep well immediately before the trip. Avoid cigarettes and alcohol. Eat lightly in the air. Purchase a small self-inflating pillow to make your sleep more comfortable.
STRATEGIES FOR HOTELS
ROOM UPGRADES—If your reserved room is not available upon arrival, request an upgraded room or another hotel. Also, do not hesitate to complain about broken toilets, dripping showers, or late room service—your stay will be more comfortable when the problem is fixed, and you may get a reduced rate.
FINDING YOUR WAY BACK—If you do not speak the local language, carry a matchbook, card, or brochure with the name and address of your hotel. You can show it to taxi drivers or when asking for directions.
SECURITY—Never use the “Please Make Up My Room” doorhanger in a hotel—it advertises to others that you are not in. Housecleaning will check in and clean your room anyway.
DRYING WET CLOTHES—Hang wet clothes overnight in the bathroom on a coat hanger and leave the light on. They should be dry by morning.
CLIMATE CONTROL—In newer hotels with windows that cannot be opened, the ventilation system may dehydrate you. To avoid waking up with a dry mouth and thirsty feeling, soak a towel in water and drape it over a chair in the room. Place the bottom of the towel in a wastepaper basket. The wet towel will add moisture to the air.
STRATEGIES FOR TRAVEL IN DANGEROUS REGIONS
CHECK BEFOREHAND—The U.S. State Department posts warnings on their website (http://www.travel.state.gov/travel_warnings.html) about recent activities (warfare, terrorism, civil unrest) in all parts of the world.
I.D. PICTURES—If you are traveling with friends, spouses, or children, make sure you all have color pictures of each other in case something happens. Carry a photocopy of your passport identification page and a copy of your credit card numbers in a safe hiding place.
DRESS—Dress conservatively, and do not wear or carry obvious signs of wealth (designer branded clothing, gold watches, expensive jewelry, cameras, CD players, etc.).
PHOTOS—Ask permission before taking pictures; do not try to sneak photos. Do not take photographs of military installations, government buildings, women, the infirm, or the elderly.
FOREIGN EMERGENCY PHRASES
In a foreign land, when a worst-case scenario occurs, it is extremely helpful to know the native language. While we cannot provide you with a complete phrasebook, we have translated several helpful English phrases into Spanish, French, German, and Japanese (transliterated). Even though the local language may be different from all of these, odds are that you will get your point across if you know these key phrases.
Help!
¡Socorro! (Spanish)
Au secours! (French)
Hilfe! (German)
Tasukete! (Japanese)
Stop, thief!
¡Alto, ladrón!
Arrêtez-vous, voleur!
Halt, Dieb!
Mate, dorobô!
Run!
¡Corre!
Courez!
Lauf!
Nigero!
Is there a doctor/pilot/lawyer in the building?
¿Hay un médico/piloto/abogado eneste edificio?
Y a-t-il un médecin/un pilote/unavocat dans le bâtiment?
Gibt es einen Arzt/Pilot/Anwalt im Haus?
Kono biru no naka ni isha/pairotto/bengoshi wa imasuka?
/> Hello—I have been seriously wounded.
Hola—tengo una lesión grave.
Bonjour—je suis sérieusement blessé(e).
Guten Tag—ich bin schwer verletzt worden.
Konnichiwa—watashi wa ôkega wo shite imasu.
I am bleeding profusely.
Estoy sangrando mucho.
Je saigne abondamment.
Ich blute stark.
Watashi wa obitadashiku chi ga dete imasu.
May I use your belt as a tourniquet?
¿Podría yo usar su cinturón para un torniquete?
Je peux utiliser votre ceinture comme tourniquet?
Darfich Ihren Gürtel als Aderpresse benutzen?
Anata no beruto wo karite shiketsutai ni shitemo iidesuka?
May I borrow a towel to wipe up the blood?
¿Me presta una toalla para limpiar la sangre?
Je peux emprunter une serviette pour éponger le sang?
Darfich ein Tuch borgen, um das Blut abzuwischen?
Taoru wo karite chi wo fuite mo iidesuka?
Would you please take me to a clean hospital?
¿Me podría llevar a un hospital bueno?
Pourriez-vous m’emmener à un hôpital propre, s’il vous plaît?
Würden Sie mich bitte in ein sauberes Krankenhaus bringen?
Kirei na byôin ni tsurete itte kudasai masuka?
Is this safe to eat?
¿Se puede comer?
On peut manger ceci sans danger?
Sind Sie sicher, dass man das essen kann?
Kore wo tabetemo daijôbu desuka?
Why is the water brown/green/black?
¿Por qué es turbia/verde/negra el agua?
Pourquoi l’eau est-elle brune/verte/noire?
Warum ist das Wasser braun/grün/schwarz?