Wound Care Guest post by Ishabaka
In my opinion, our medical system will be one of the first to collapse during a major catastrophe.
We have a shortage of primary care doctors in the U.S., a shortage of emergency rooms, a shortage of nurses, and most hospitals have gone to a “just in time” ordering system, where they stock two to three day’s supplies vs. several weeks.
Plus our hospitals are utterly dependent on electricity, although the all have backup diesel generators – but what happens when the diesel tanks are empty.
Furthermore, especially in an outbreak of contagious disease, many hospital personel will just not show up, be injured, or caring for ill or injured family members at home.
I can tell you from personal experience, our national medical disaster preparedness is a sad joke. Think Katrina, but ten times worse.
The incidence of wounds will skyrocket after a catastrophe due to broken glass, chainsaw injuries, people falling off ladders, and on and on. Therefore, I’m writing this article on how to take care of basic wounds when the system has collapsed.
A wound requires four simple things to heal: blood flow, oxygen, nutrients, and the ABSENCE OF INFECTION. If possible, a member of the group who’se wounded should get some extra food, and a vitamin pill a day.
In terms of oxygen and nutrients, these are all provided by blood flow. This brings up the subject of tourniquets. Tourniquets should ONLY be used as a measure of last resort, to prevent the patient from bleeding to death.
Remember – direct pressure stops 99% of bleeding. Take a piece of cloth, ball it up and press HARD against the bleeding area for five minutes by your watch – which will seem like five hours – then check and see if the bleeding has subsided – only if three or four attempts fail should a tourniquet be used.
Direct pressure will stop bleeding from major arteries – I know, I’ve stopped lacerated femoral arteries from bleeding with direct pressure.
If a tourniquet is used, two hours is the maximum time for the arms, four hours for the legs.
If that time is exceeded, the tourniquet must be completely released for a while to allow blood flow, or you will wind up with a dead arm or leg. By the way, “gangrene” just means dead tissue in medicalese.
The most common problem that you will face with wounds is infection. Surgeons classify wounds into two types: clean, and dirty. A clean wound is, for example, when you cut your finger on a broken glass while doing the dishes.
A severely dirty wound is when you cut your finger with a trowel while digging in the garden Organic material is the WORST form of contamination.
I do not suggest home suturing under any circumstances, and here’s why – if there are any germs in the wound – you’ve just sealed them in – and infection is very likely.
In a VERY clean wound, you could use butterfly bandages, Steri-Strips or Crazy Glue (yes, you can buy surgical skin glue, but it is just Crazy Glue at $150 per milliliter).
All other wounds should be CLEANSED, and then left OPEN to heal by TERTIARY INTENTION – medicalese for skin growing in from the sides. This allows the body to extrude germs from the wound in the form of pus.
Over 3-7 days, the body will convert most dirty wounds to clean wounds by it’s natural immune system if the wounds are left OPEN. This may seem too basic, but wash your hands before working on the wound.
Now, how about cleaning wounds?
First, if there are any large pieces of debries, such as twigs, leaves, or gravel – remove them with tweezers. Most antiseptics KILL healthy tissue and dead tissue is FERTILIZER for bacteria.
If it stings when you put it in your eye – it kills healthy wound tissue. Under no circumstances would I use tincture of iodine, or any form of alcohol. Really, washing using mild soap and water is a good way to clean most dirty wounds.
If you have Betadine SOLUTION (NOT soap), mix 1/4 Betadine with 3/4 water. Hydrogen peroxide is helpful as it’s bubbling action helps lift dirt out of a wound.
Be aware that a bottle of hydrogen peroxide becomes inert 2-4 weeks after opening, no matter how tightly you close it.
Next, I suggest everyone include in their first aid kit a 30 or 50ml syringe. Fill with water and press as hard as you can – this basically pressure washes the wound, and has been proven time and again to reduce infection.
If there is tissue with ground in dirt (for example, the patient slid down the road), and the dirt can’t be removed by washing or irrigation, it must be cut out.
This can be done with scissors, a scalpel blade, or a sharp knife. Remove as little tissue as possible. Also, any dead tissue must be removed. Dead tissue will look purple, and WILL NOT BLEED. Cut back until you get bleeding tissue – bleeding tissue is alive.
Now you have a cleaned wound – what next?
If you want, you can apply some antibiotic cream. I don’t think they help any, but they don’t hurt. If at all possible, give the patient antibiotics. I suggest cephalexin 500mg twice a day.
If I could only have two antibiotics during a crisis they would be cephalexin and doxycycline, but I haven’t time to go into that here. HOT TIP! Tetanus is everywhere.
The only reason thousands of Americans don’t die of tetanus as people do in many third world countries is because we have tetanus shots.
I can pretty much guarantee tetanus shots will not be available during a crisis, so get one NOW if you haven’t had one in the last 5 years.
Everyone wants to close wounds, and that is exactly the wrong thing to do with anything except a perfectly clean wound. You want to KEEP THE WOUND OPEN so the body can “pus out” any germs and foreign material present.
The best way to do this is to pack the wound open – so the edges can’t come together, with clean cotton (boiling is a great way to field sterilize instruments and bandages). Then wrap the wound with a LARGE amount of cotton.
The #1 mistake I see in bandaging is too small a dressing. It needs to absorb the pus and blood that will ooze from the wound.
I laugh when I see “first aid kits” with 2″ x 2″ pieces of sterile gauze. Get 4″ x 4″ or 6″ x 6″ – you can always fold these or cut them if necessary, but you can’t make a 2″ x 2″ piece of gauze cover a 5″ wound.
The bandage should not be too tight. Most wounds swell up a lot in the 1st. 24 hours, and you don’t want your bandage to turn into a tourniquet.
If, after several hours, the patient complains the bandage is too tight, or hurts a lot – CUT IT OFF and apply a new bandage.
Wounds at joints (knuckles, knees, etc.) should be splinted just like a fracture, or continued movement of the joint often makes it impossible for new tissue to grow over the wound.
Now, here’s the tough part – the whole bandage must be removed and replaced at least once a day – this will HURT. If you have any pain meds, even Tylenol, give them to the patient one hour before the dressing change.
Liquor is still a great anesthetic – you are going to have to rip the bandage off the surface of the wound, which hurts like heck -but removes all kinds of contaminants.
After about a week, if the wound was small, new skin will have grown back over the wound – congratulations – you saved the patient.
With a big wound, you will often get bright pink, granular type tissue – this is called “granulation tissue” and is good news – it’s a normal part of healing, skin will grow in from the edges and cover it up.
Now all you need is a protective bandage to keep dirt out. You can apply an antibiotic ointment, Vaseline, or honey (an effective disinfectant) to the granulation tissue as you don’t want to rip it off during dressing changes.
Now, the toughest part of all – field amputation. Dead tissue does not heal. It promotes wild growth bacteria which will inevitably kill the patient. Dead tissue looks purple/green.
If you press your thumb against it, it will not blanch and then get it’s color back (try this on your forearm). So, dead tissue must be removed.
This can be done with a knife, saw (preferably hacksaw) and fishing line. Boil all supplies and bandage material.
You do not want to take off too much tissue – so start where it looks bad and work your way up – when you come to bleeding tissue – that’s where you want to amputate.
Cut the soft tissue with a knife – any tissue that doesn’t bleed must be cut out. You will encounter some large bleeding arteries and veins.
If you have some Quick Clot, this would be a good place to use it – otherwise grasp each vessel sideways with a hemostat or a Kelly clamp so the bleeding stops, and tie fishing line in four granny knots just above your instrument.
If you did right, when you release the instrument, there should be no bleeding from the vessel.
Saw the bone. Please, do NOT cauterize the stump with a red hot piece of iron! You will just convert live to dead tissue. Apply a very large bandage, and give antibiotics if available. Change dressings just like you would for a dirty wound.
Lastly, the art of bandaging using only strips of cotton is a long-dead, as you can now buy pre-formed bandages to fit any part of the body. Try applying a cloth strip bandage to the shoulder or hip so it doesn’t fall off.
I recommend you get a WWII or early nursing manual of bandaging for your survival library. Those old nurses could perform miracles with strips of cotton. Amazon.com carries quite a few.
Everyone should have a couple of gallons of bleach. Buy the cheapest brand. Mixed one part bleach with 9 parts water, it is excellent for killing bacteria, mold, and mildew. It will kill all germs in blood spills, including HIV a hepatitis C.
Many items and even homes were saved after Katrina with plain old bleach. It is NOT for use in wounds, but if boiling is not an option, soaking surgical (or improvised surgical) instruments in 1/9 bleach provides pretty good sterilization.
WARNING! Never mix bleach with ammonia – this produces chloramine gas which is a lung irritant. I have treated many people with this in the E.R., and at least half of them need to be admitted to the hospital.
As an aside, part of my prepping includes collecting used or cheap medical supplies, so when there are no hospitals or clinics, I can turn my spare bedroom into a clinic. I’ll gladly take payment in food, .22 ammo, firewood, etc. (In fact, I’d gladly take that stuff now).
Believe it or not, you can pay $25,000 for a medical exam table that is electronically controlled, with all the bells and whistles – or you can make one out of a sheet of 3/4″ plywood, 2 x 4′s, some foam, and a sheet of vinyl.
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Awesome post. Do you know of any medical textbooks that cover surgical procedures like you described above? My medical library is lacking material in that category.
I’m not sure what your qualifications are, but there are majors errors in your post here. You sound to me like a military corpsman (or corpse man as the president says), or possibly a nurse. Those two tend to know just enough to hurt someone and not enough to actually be qualified to open their mouths.
Working in the medical field, I am told, routinely, that when talking to patients you may not answer questions above your qualifications. The stuff in this post goes beyond first aid, into the realm of M.D. required advice. It is extremely irresponsible to give poor advice based on things that you say you “know.”
I highly question that assertion that you’ve managed to stop blood flow from a major artery with only direct pressure. This is laughable and silly.
You’d better pray to god the bullshit you’re spewing here doesn’t get someone killed.
I believe the author is approaching this in the context of a catastrophic event where we may not have access to professional medical help. Personally, I would trust a survivalist with military training anyday to treat me over allopathic medical personnel. Not to say that all are the same – but many people have become seriously incapacitated or died as a result of allopathic philosohpies and practices (i.e.: overuse of synthetic and debilitating prescription drugs, abuse of surgical procedures as the only way to treat before other methods).
Good post, Fresh air and sunshine is the best disinfectant in the world.
And you can use a sterile normal solution to soak the bandage before you “tear it off”. Get a good book on basic surgical procedures and study it. Or better yet, bring a doctor, RN, or Paramedic into your group. I do have a question, if a group could bring in a certified Paramedic Instructor would your readers deem it worth the expense in resources? Just curious. You are either medically trained or have access to medical personnel. Good on you. Like I said good post.
Great post!
I have read that should infection set in that a bandages soaked in a saline solution can be used to pack the wound. The bandages must be changed daily and it will scar but that it will allow for the wound to heal.
Can you confirm if this is acurate…
Thanks!
M.D. – Look up ” Dakins solution.” It was invented by a ww1 doctor for sterilyzing wounds. made from bleach, baking soda, and water.
Prepared N.D. – unfortunately I don’t know of any such books. I’ve been an E.R. doc for 26 years – five of them in a trauma center, so I use the big ‘ol
medical textbooks
Doc – you are right, sterile saline solution is best. I was assuming a prep group would not have this available, as it is bulky, and must be ordered from a medical supply store. You are describing wet to dry bandaging, which is the ideal technique. To clarify – you pack the wound with wet bandages, the wrap with dry ones. The wet ones dry out over 24 hours and this makes even more of the gunk stick to them, so you get more out of the wound when you remove the bandage.
I am all for committed groups of preppers working together, and if you can get a trained medical person of any type – that’s great.
Fresh air and sunshine are great. The U.V. rays in sunshine kill many bacteria.
Lake Lili – you are describing wet to dry bandaging. Again, this was ideal. My article was more directed towards a prep group that had no medical person and very basic medical supplies. Yes, wounds that heal by tertiary intention leave large scars – but what would you like – a big scar, or death by gangrene and sepsis (blood poisoning)?
Stephen – we used Dakin’s solution back when I was in medical school (74 – 78), but it is no longer used. It’s the bleach – it kills healthy tissue.
If anyone wants to post questions I’d be happy to answer them as best I can.
If you have big bucks the ultimate wound cleanser is Shure-Cleanse. It is a detergent solution that is so mild you can put it in your eye, but is expensive.
Last tip – the National Institutes of Health came out with new vaccine recommendations for adults this year. Just like you should get a tetanus shot, you should get the other vaccines you need – check with your doctor. In particular, I recommend getting hepatitis A and hepatitis B.
Very last tip – In the E.R., I find that most accidents and injuries happen when people are in a rush “I had to get the last of these studs cut before sundown, so I was in a rush with my cut-off saw, and cut off my thumb”.
Try not to do dangerous things in a rush – I know this will be impossible at times – but. Also, get a good pair of safety glasses – you do NOT want to get a piece of steel in your eye.
Great post! I am posting a link to it for all my non-medical friends.
About your Sure-Cleanse tip… will Baby Shampoo work as a substitute? It is supposed to be non-irritating to the eyes, and I can vouch for that!
All wounds scar… Period! I have seen a post-op GYN patient with sub-cutaneous fat necrosis healed by tertiary intent. With daily wet-to-dry bandage changed in a shower and wound scrubbing with Hibiclens the wound healed better than other sutured wounds I have seen! This method is longer and requires more attention to detail on keeping the wound clean, but it works and the results are just as good.
Great post – also, GET TRAINING – CPR, basic first aid, etc. are all available from local sources.
Little scrapes and cuts that we casually treat and take for granted in our current infrastructure will become life threatening when there is no available medical care, or if we are surrounded by sewage floods like post-Katrina and recently in Tennessee, Ohio, and other states this year.
I have a question.
1) With the collaspe of pharmacy outlets drugs will become very limited. Drugs with expiration dates will usually last well beyond that date. Is this correct?
2) IV’s do not have a long expiration date and will degrade very quickly. Do you suggest an alternative to an IV? or IV storage without electricity?
3) Do you have a suggestions for improvised suture? I have used sewing thread, and unraveled boot laces.
Dustin – great point about training, and how what are minor wounds today could be life-threatening when the health care system collapses. One of the things you might look into is volunteering in you’re local hospital’s E.R.. You won’t be doing anything medical – but if you watch, and ask questions, you’d be surprised how much the staff are willing to teach you. Another thing – if your area has a volunteer ambulance service – become a volunteer E.M.T. Either job will also help those who are prone to freaking out at the sight of blood/wounds – a surprisingly common problem.
With regard to medications – I had a talk with an old-time pharmacist, and he said expiration dates are a joke – basically a ploy by Big Pharma to sell more meds. Medications (vitamins too) should be stored in a dry place at a moderate temperature. Many are still good at 2 -3 times their “expiration date’. Besides, they don’t all expire at once. If half the molecules of your antibiotic pill have gone bad, but half are still good – you still have a useful pill.
As for IV’s – are you referring to IV meds? Normal saline, which is sterile salt water, does not need refrigeration and basically lasts indefinitely. If you have one IV solution, it’s the one to have. There are, of course, many meds that need refrigeration – insulin being the big one. Nearly all vaccines, including tetanus shots need refrigeration – that’s why I say get ‘em now. Some things just won’t be possible in a post-collapse society, and again, I’m writing for the prepper/group who doesn’t have a medical person, and very limited supplies.
My suggestion for improvised sutures is monofilament fishing line. You want a monofilament suture. Woven sutures, like real silk sutures, string, and bootlaces are full of nooks and crannies where bacteria can grow, and there is no blood supply – essentially like dead tissue. Get a needle that fits your fishing line, boil both before using – but remember, most wounds are best not sutured – only really clean ones. Dental floss is another alternative, and has a lot of other survival uses.
I didn’t want to get too technical, but here goes – delayed primary closure is a good alternative for some unclean, but not filthy wounds. In this case you pack the wound open, give antibiotics if available, and in about 5-7 days, when the wound looks clean and is no longer forming pus – or is covered with healthy looking granulation tissue – it’s pretty safe to suture it. This greatly reduces patient down-time. If the wound starts looking funky (puffy, red, oozing pus, red streaks going up limb from wound – remove all sutures IMMEDIATELY and let wound heal by tertiary intention. Don’t remove some sutures – they must all come out.
If you are going to actually buy some sutures, I suggest 4-0 Polypropylene or nylon with a PS-2 needle. If I had to pick one do-it-all suture that’s what I’d chose.
Another common mistake is the treatment of boils or abscesses. Because they are filled with pus, blood cannot reach the inside. You can give all the antibiotics you want – they can’t reach the bacteria in the pus. Likewise, local salves are totally useless. There is an old surgeon’s saying “The best antibiotic for an abscess is a number 11 Bard-Parker blade”. That means you have to cut the thing open for the pus to drain. Not a pinprick, not a little 1/8″ puncture wound – you have to cut the WHOLE thing open from one end to the other, then allow it to heal by packing open. The best advice I can give you for any wound is – if in doubt, leave it open.
What a good and thorough article, I really like it. There’s only one thing that I would include which I did not find, hopefully I didn’t miss it, is 500 PPM (parts per million) colloidal silver. You can purchase the expensive liquid or make it at home which I do and works just as well, if not better, than what is sold on store shelves. Colloidal silver is a known anti-viral and anti-bacterial killer and is amazing stuff! 500 is the recommended dosage and for anyone wondering if that’s too strong, the answer is no. Or, like they did during certain epidemics way back when, stick a pure silver pacifier in your mouth and suck on it and eat off utensils that are made of silver like rich people used to do.
I have a colloidal silver kit too, and need to make up some fresh batches.
Here is a tip: if you have an AC powered unit and need to make a batch if the power is down for a long time, just use two 9V batteries clipped together and some copper wire to connect to your electrodes. That works for Quart sized batches in distilled water. Use little or no Sea Salt. Take care to not short the batteries out as they can explode. The commercially sold units have a resistor inside that limits current if shorted out.
SrvivlSally – you are correct, we are just becoming aware of all the medical uses for colloidal silver. One example – you can now buy operating room drapes impregnated with colloidal silver, which kill bacteria, fungi and viruses that come in contact with them. I think in the next ten years we will see colloidal silver wound cleansers and dressings that will beat anything on the market now. Colloidal silver is not irritating, and does not kill live tissue – only germs.
Do you have an emergency medical blog we can access?
No, sorry, I don’t have a blog. I read M.D.’s blog and saw that he was busy and interested in guest posts so I came up with the wound care one. I’d be glad to do another if M.D. wants. Couple of ideas are fracture care, triage (a really knotty subject when the chips are truly down), care of the head-injured/intoxicated, and psychiatric problems in survival situatations.
Or anything anyone else can think up. I would have to clear it with M.D. first.
Ishabaka,
I’d love to have you write a regualar medical post – send whatever you think is appropriate …
Other interesting topics:
Treatment of gunshot wounds (incl. buckshot/birdshot)
Treatment of knife wounds (slash or stab wounds)
Treatment of infection (once you have one)
Cauterizing (when and if it would make sense)
Tourniquets (types, uses, any good tools for this to add to your aid kit)
Stretchers (ditto, any good ones for a preparedness kit)
Slings/Casts/Immobilizers
Dealing with Fever
Dealing with exhaustion, stress, etc. (preventatives, treatments)
great post …thank you. would really like to hear more. how about pulling a tooth… or removing a bullet?
I for one would like to see you do a regular series. Your expertise is far beyond anything I have seen on the net. Thank you so very much, you have helped me a lot in my preps. And given me a lot of very very useful information.
I agree with Doc, hopefully you and M.D. can work something out. I’ve been looking for information of this type for a long time now.
I recommend Outdoor Emergency Care which is used by the National Ski Patrol. Very useful and assumes that you may be dealing with an accident or other medical emergency without access to EMS.
Available at their website.
Ishabaka–Very good advice…well done! I’m a physician of 36 years’ experience, worked in ERs, been a family doc, delivered 300 babies, etc. and have practiced in some very remote areas, some with technology and supplies, some not, like the savannah in the most isolated part of Honduras. I can vouch for the accuracy of pretty much everything you describe.
There is a book for lay people having to deal with combat and disaster medicine. Although it is pricey as it is intended that NGOs buy it and donate it to third world areas it is well worth having a a survival book.
The title is “War Surgery” by doctors; Hans Husum MD, et al.
Published by Third World Network, 228 Macalister Road, 10400 Penang, Malaysia.
ISBN 983-9747-12-6 Pb, 983-9747-14-2 Hb
I bought my copy about 5 years ago. It was around $120.00 then
Cheers.
MD/Ishabaka,
Do you have any thoughts on the use of maggots for emergency treatment in this type of situation?
After you’ve located your maggots on a manure pile … be sure to give your little friends a bubblebath, a rinse and then preferably a few hours of suntanning before putting them into any wounds of people you care about.
Great article. Sorta hits home with me. About a month ago I lost my balance while cutting firewood and cut my knee open with a chainsaw. Not a huge wound in either depth or breadth but I managed to nick a blood vessel – probably a small artery, judging by the bright crimson blood that started to come out. It was a clean wound so I didn’t bother with the doctor visit. Didn’t have the money anyway. I tried to immobilize my knee as much as possible with an Ace bandage. Even put in a couple of sutures that I had lying about the place. It still worked its way back open after a few days so I just let it do its natural healing thing. After about three weeks it got a little red and was oozing pus so I got the wound soft in a warm shower, removed the scab and salved it with some Tri-Sporin type cream and bandaged it for 24 hours. No more infection and now it is well on its way to being healed. When I first got to my house after I had cut myself I went straight to the shower with a bottle of Betadine solution and sprayed the wound with a blast of hot water from the hand-held shower head and then doused it with Betadine. I think that was the key. Plus, as I said, it was a clean wound and I put a clean paper towel over it as soon as I could when I was out in the field. I know – it wasn’t sterile but it was the best I could do in a pinch.
So whether society is on the verge of collapse or not – you can treat your own wounds. It just hurts like hell when you put in stitches without anaesthesia. And the skin on your knee is real thick. Like a baseball glove. I found that out.
A form of infection control that also promotes healing used in the third world since the time Napolean’s military surgeons discovered it’s effects …
packing wounds with granulated sugar. Has the effect of drying the wound and denying any infection a wet environment. Yes the wound can weep lymph into the sugar and liquify thus making it a potential host for infection but the wound should be inspected for this recleaned and repacked regularly.
It has proven an effective method and promote the tertiary healing of draining limb wounds that previously refused to close.
It’s not used for wound care in the western world as it seems primitive and tribal to western medicine.
It was illustrated as wound care for gunshot in the movie “Shooter”. It’s not hollywood, it works and is used in Africa, Asia and the Carribean as primitive First Aid wound care.
I have head about a mod of this method. You mix the sugar with betadine slave and place it in the wound. Of course, you should change it daily along with the bandages…
My Mom used Sugar and a few drops of Turpentine oil on our bad cuts when I was growing up. They never got infected and didn’t hurt either. I might substitute Betadine for the Turp these days. The sugar really speeds healing.
While I consider alot of this stuff great I think one thing is very wrong with it.
This statement is completely wrong “Tourniquets should ONLY be used as a measure of last resort, to prevent the patient from bleeding to death.”
Tourniquets should be used first in any case of major bleeding. Their are a host of reasons for it but it breaks down into a few basic ones.
First any loss of blood is bad…
“against the bleeding area for five minutes by your watch – which will seem like five hours – then check and see if the bleeding has subsided – only if three or four attempts fail should a tourniquet be used.”
The amount of blood you can lose in 15/20 minutes can be alot… add in that you may have more then 1 major injury and you maybe the only one there to help or you must help yourself.
Applying a tourniquet first stops the blood period. You can then inspect the wound to see just how bad it is and take a moment to plan what your going to do to fix it. If you come upon a person who bleeding you may have no idea where the wound is due to blood, other wounds, cloths, etc. The time it take you to find and figure out how bad the wound is could mean the difference between saving the person and them dying. A tourniquet stops bleeding in seconds where you could take minutes to find the wound.
If your by yourself you my not be strong enough or be able to reach the wound to apply a proper amount of pressure right away. With the help of the tourniquet you can reduce blood pressure to the area thus requiring you apply less pressure. You can also buy time to get others to help or to move to a position to help yourself. Stopping the bleeding is your first and most important priority.
Second and far more important issue is that you maybe in danger at your current location. Sitting around for 15 min applying pressure could result in your death. Applying a tourniquet right away allows you to start running or leaving a danger area quickly with little blood loss.
Almost all military units in iraq/afgan now officially or unofficially apply tourniquets first to any known major wound. This goes for security company personal as well.
The “myth” of the “last resort option” that is the tourniquet was created because it you to be that you needed to be a “highly trained professional” to remove a tourniquet. Its just that a myth. Applying a tourniquet for 10-30 minutes will have no permanent effect on the vast majority of people.
Doc,
Here are a couple of methods that work in animals, and I assume they would work on people, but I stick to the species I’m trained to work with (at least for now).
Really BIG wounds that are going to take a long time to heal can be cleaned as described above, filled with granulated sugar (the same stuff you put in your iced tea), then covered with gauze and wrapped. The bandage should be changed once-twice a day and the sugar washed out of the wound. Pat dry, fill with sugar and bandage. The nice thing about this is that bandage changes are less painful- a lot of the gunk comes out of the wound when you wash out the sugar. This works on degloving injuries on cats/dogs when owners can’t afford the preferred surgical debridement, gel bandages, skin graft, etc.
My favorite debridement solution for wounds on horses is 2 tsp Adolph’s meat tenderizer in a pint of water- mix it up in a spray bottle and apply twice a day after flushing the wound (10 minutes with a water hose is the easiest way on a horse). Bandage the wound afterwards. This solution helps enzymatically debride dirty wounds, and all wounds on horses are dirty wounds.
Dan,
I would avoid maggots for wound debridement. It could be done but you risk increasing the bacterial load. Stick with a wet to dry dressing after liberal irrigation.
In English – Boil some water and make sure its cooled off, use a large syringe and flush the wound out. Pack the wound with CLEAN gauze that was soaked in a saline solution (again, you could boil water) and change the dressing daily. I would avoid using maggots unless you really know what your doing.
Any time you use insect therapy (maggots, leeches) you risk more harm than benefit. The idea behind maggot therapy is that the larvae eat up the necrotic tissue and leave the healthy tissue. This issue is better addressed in the article by trimming out the dead tissue with tweezers/fine scissors or the like. In a fresh wound, you wont see this right away, it may take days to become apparent. So leave it open and pack it with sterile gauze. If you can prevent or reduce infection the body can usally handle the rest.
Thanks for all the thumbs up. I wouldn’t mind doing a regular series, but I suggest you contact M.D. – after all, it’s his site.
I know there are some books about medicine for non-medical folks, but I haven’t read them, so I can’t comment.
Dave – same thought came to me last night – dental care. While I have pulled a few teeth over the years, I’m no dentist – it would be great if a dentist could write a guest column. Pulling bullets is vastly overrated.
Bullets are inert – the body doesn’t react to them. You can leave ‘em in forever. The two problems with gunshot wounds are the damage to bone/muscle/organs they cause, and infection. It’s organic material that causes wound infection. Inert material, such as metal, plastic and glass generally do not. Also, having a lead bullet in you will not cause lead poisoning.
Leishman – yours is high praise indeed. Doesn’t stand for leishmaniasis does it? Anybody figure out what my name stands for?
Finally maggots – good question. Maggots are a great way to clean out a filthy wound, because – they only eat dead tissue – they will not eat living tissue.
How would you recommend getting antibiotics to put away for storage? I’ve heard people talk about using veterinary medicine, but even then, you need a prescription. I’d love to put some antibiotics back for when they are not readily available, but I am running into a brick wall. Any help from anyone would be greatly appreciated!
serfsup – that is a tough situation. First, antibiotics are not “controlled substances” like morphine or Valium, and there are no rules (at least in
Florida, where I live) against doctors prescribing antibiotics to preppers.
I can order bottles of 500 antibiotic tabs very cheaply, and did for a few friends during the anthrax scare. You are going to have to search until you find a sympathetic doctor – then, I’d be honest – explain about prepping and why you want the antibiotics. Sorry, but the Florida State statutes say I have to physically see a patient to prescribe medicine, unless it is a serious emergency, so I can’t help you, or other readers.
I’ve a selfish interest in fundamental wound care: between lifelong shop work, children and sports, injuries resulting in abrasions, breaks, contusions, concussions and open wounds have been a fact of life.
Well, that and a wife that believes emergency care involves slapping you when you’re out cold while dialing 911.
Training for even the least of medical care positions is becoming a more involved proposition.
Furthermore, CE requirements, while understandable, place additional burdens on maintaining active status eligibility as well as being a ripe opportunity for excluding the lay people who’ll actually be on-site when an event occurs.
Sadly, many volunteer rescue squads are being supplanted by gov’t/union shops so go rural(?) for less expensive training that emphasizes care beyond the golden hour – the outdoor care track mentioned above as an example.
Seems like a modicum of oft repeated KISS training for the maximum number of people available at little to no cost through the widest possible assortment of venues would be of tremendous value.
Sources for your two spec’d antibiotics?
Liked the tip about a solution that is eye friendly being wound friendly but perhaps not a good idea to check potential solutions that way?
Along that line though, from personal experience, small, basic sterile saline eye care solutions lightly buffered and with hydrogen peroxide for use with contacts have been perfect for my travel bag and it never gets questioned when going through security. Plus it puts out a stream that does a good job irrigating the wound.
Soaking with warm sterile saline – for extremities, I make my own by boiling saltwater and allowing to cool below 120F(?) is also a staple of care for moi as it not only appears to frequently help the wound but also provides an excuse to park my butt for a bit.
And suturing yourself or others without consistent practical training? I’m a little leery of doing so myself and would prefer others that practice upon me be pretty competent but on the other hand, tying off a bleeder? Yup. I’ll be hoping a local fisherman is at hand.
Perhaps I came down too hard on tourniquets – they do have their place.
On the other hand, if you have the time, and bleeding can be controlled by direct pressure, I think that’s best. The example of having a wounded person in a dangerous place, with need for immediate evacuation, I agree – put on a tourniquet fast and beat feet.
Maggots shouldn’t be obtained from a manure pile :D they should come from flies that lay eggs in wounds. Maggots are currently being used in modern medicine for some wounds. Leeches are used for re-implantation of severed digits.
Granulated sugar is a great idea – I should have thought of that.
If you want to practice suturing, get yourself a raw chicken thigh or breast with the skin still on. Slice a wound about 2″ – 3″ long with a razor blade and about 3/4″ deep and have at it, then have at it. I agree, suturing takes skill and experience,
as I keep emphasizing, and others have given examples – packing a wound open is simple and safe.
I should have added: re silver, you can get silver nitrate ointment (by prescription). It is the standard of care for use on burns, but works very well on all other wounds. You put it on after cleaning the wound – kills germs, but not live tissue.
Finally – what a dummy I am – I’m married to an optometrist for heaven’s sake – you can buy saline solution for cleaning and using for wet to dry dressings – just buy a bottle (or case) of saline solution used for cleaning contact lenses – it’s sterile, and comes in a squeeze bottle – great for irrigation.
The burn ointment is Silver Sulfadene or Silvaderm. That stuff is amazing. I Know.
The nitrate was used in Babies eyes at birth, for years.
Garlic. Keep it handy. I keep chopped garlic in a small jar mixed with a little olive oil. Aside from using it for cooking, it make a great anti-bacterial salve. I use it on any cuts I get and it works better than any anti-bacterial cream. It also appears to be absorbed thru the skin.
You and also take it internally. Just swallow a teaspoon of it in the morning and at night.
Garlic is an effective antibacterial but I would consider mixing it in pure water or Aloe Vera Juice if you have a plant in your home. When you mix garlic with olive oil you risk bacterial growth in the solution. It’s best to keep antibacterial herbs in dry storage then prepare them on the fly as needed.
The antibacterials such as garlic and goldenseal have their limitations (notice botulism can still occur even though an “antibacterial” is present in the solution when stored incorrectly). It’s much safer to go with Colloidal Silver if you can and save Garlic for the times you’re in a pinch.
Actually, olive oil has its own anti-bacterial properties. I have yet to have a mixture of garlic and olive oil go bad on me … but then, I cook with it too!
I was a battlefield medic in Gulf I. My daughter is now about to become a battlefield medic. I have just a few nits to pick.
1. Tourniquets should be your first resort for stopping bleeding. Just don’t leave them on. Stop the bleeding, get to a safe place, figure out the wound and how to treat it and then take off the tourniquet and treat it. The tourniquet will buy you time to figure things out and get calmed down without having the wounded bleed out.
2. Medication expiration dates. Some medications become poisons after they expire – aspirin and tetracycline come to mind. If they smell or look funny, toss em. Otherwise, they are probably fine. Make sure that anything you stock-pile, you know what it is supposed to smell like. Write it on a sticky note and put it on there. You can also find out what the spoiled smell is if you google it now – and stick it on the bottle.
3. Insect therapy – very dangerous stuff. You really have to know what you are doing to do that type of therapy. Leaving maggots in or leeches on too long and you will do more harm than good.
Also, I will second the concepts put forth on colloidal silver, saline solution and sugar. I’ve never heard of garlic, but it sounds right. There are several books on Amazon about how to find natural medicines in the wild for nearly anything – pain, infection, etc. A good emergency care book, a good herbal medicine book and a good herbal foods book should be a staple in everyone’s prep-kit…with copies of the important things for every member of the group.
Having a little more time to comment, I would like to reiterate my recommendation of Outdoor Emergency Care, the training manual used by the National Ski Patrol. I have been a patroller for some thirty years, as well as a hunter, fisherman and hiker. I have been involved in hundreds of rescues and treatments for injuries and illnesses from the mundane to the life threatening. During that time the training we use has undergone many changes and has been massively expanded. The material we now require new patrollers to absorb is roughly equivalent to basic EMT. In my area, we permit EMTs to challenge our qualification test, and OEC certified folks are allowed to challenge the EMT test.
The main differences between basic OEC and EMT training relate to dealing with medical emergencies and injuries which may involve hazardous situations, difficult environmental conditions, necessity of rescue, triage in multiple casualty situations, and the care and treatment of injuries and other medical emergencies in recreational or back country situations where immediate access to the EMS system is unavailable. (I learned the hard way about triage many years ago when I was confronted with a multiple injury situation without backup in my third year as a patroller, long before triage principles were part of our training. I made avoidable errors, which fortunately did not ultimately result in any harm.) It is assumed that you may be unable to access the EMS for some time, perhaps for an extended time. The considerations and techniques are specifically designed for those situations and would be directly applicable in survival situations.
Our training sessions were available to anyone who was interested, not just candidate patrollers. We scheduled ours for a couple of evenings a week for, I think, about eight weeks. The last non-patrollers in our local training sessions were DNR employees. Anyone interested who lives in ski country might have access to these courses. The hands on aspects of the classes are invaluable. But the manual itself would be a tremendous resource if a copy was at hand, and anyone who had studied it would be far better off than an uninformed person, even if the manual was not handy.
I was talking with one of my nephews who’s a Navy Corpsman who was working with Marines in Iraq, and he used tourniquets all the time too. Thing to think about is: the military has a fully functional health care system. From the medic or corpsman in the field, the field hospital, the hospital ship or base hospital, to very advanced hospitals in Germany or the U.S., they have access to all sorts of things – from blood transfusions to brain surgeons, which will not be available to isolated groups of preppers.
A 19 year old healthy military member who sustains a gunshot wound to the abdomen has a pretty fair chance of surviving. With a group of preppers, that would be a 100% fatal wound.
This is excellent information and is useful even when the medical system does not collapse. Or when you are traveling in a country where you would rather solve the problem on your own rather than go to the local hospital.
Oooh. I can’t believe no one has heard of “Where There Is No Doctor” by David Werner. It can be downloaded free of charge from healthwrights.org. It is the self-care medical bible. I am amazed that apparently all those “serious” about survival who view this site have never heard of it! When I was a Peace Corps Volunteer in the early age of the institution it was provided to all volunteers. In fact, the book provided the information I needed to self-diagnose for hepatitis A and seek immediate care. This indispensible book must be in the library of anyone serious about survival and emergency preparedness. You’re welcome.
Yes, a gut-shot would be tough to treat without a trauma surgeon back at the aid station to take care of it.
But, I still would recommend tourniqets as a first resort in the field for several reasons:
- any blood loss is bad and needs to be stopped so you can stabilize the patient and/or get them to safety – ABCs first, but that doesn’t help much if they are bleeding out
- it gives you time to start an IV, if you can, and replace blood volume
- it gives you time to properly assess ALL the patient’s wounds. The bleeder isn’t always the most life-threatening or there could be multiple wounds or even multiple causes of bleeding from one wound
- it is always good to know for sure if it is an artery, as that could change how you deal with the wound – deep wound pressure to stop the artery and then general area pressure to stop the rest.
- it gives you time to get out the pressure dressings and be ready and even stuff the first one in the wound.
The tourniquets we used in the field were purely to stop the bleeding and give us the time needed to perform more important tasks. We would put on the tourniquet, secure the environment, start an IV, rinse and assess all wounds, get our gear in order and then release the tourniquet. If we didn’t have time and the chopper was inbound, we might leave it on and let the aid station deal with it, but it usually took a while to get a chopper on-site and we took the time to use pressure to stop the bleeds and left the tourniquet as a last result to use if there was still bleeding when the chopper arrived.
Today, as I understand it, the do something similar, but they load the wound up with quick-clot, let it sit a minute and then release it and pour on more quick-clot until it stops.
I think the big distinction is that tourniquets stop the blood flow as opposed to stopping the bleeding. You have to deal with the bleeding. The tourniquet is just a tool used to buy some time to deal with the bleeding. It is way better, IMO, to have all the dressings out and organized and ready to be applied. With a big bleeder, you are going to have to use several and it doesn’t help if you stop applying pressure while you are digging around for another 6×6 or pressure dressing.
Super/Crazy glue is not the same thing as surgical glue / dermabond.
Again, I’m not disagreeing – uncontrollable bleeding, or having to evacuate from a dangerous site – tourniquet hands down – but you’re still in the military mind-frame. There ain’t gonna be no IV’s, choppers, aid stations, or even field dressings. Your field dressing is probably going to be someone’s used t-shirt. Military medicine – is great – for the military – who have billions of dollars to spend on their medical system. It just won’t apply to an isolated group of preppers, who will be lucky if they have a nurse or paramedic in their group. An abdominal wound requires a surgeon, intravenous antibiotics, possible blood transfusion, an operating room with supplies and instruments, and on, and on. The military has all this. The life expectancy of a prepper with a GSW to the abdomen will be 0.
I will leave this to the reader to decide if they want to follow what I’m about to say but I’ll tell you that it is something I learned as a child in the 50′s in the rural south. I’ve done it many times on wounds from minor cuts to deep puncture wounds that should have been but were not sutured up.
Wash the wound with kerosene or diesel fuel. Soak a rag in the fuel and tie it around the wound. Within 24 hours it will be well on it’s way to healing and the wound will not be sore.
The most severe wound I ever treated this way was when I was 21 years old in the early 70′s. I was working in the tobacco fields as a summer job when I was home from college. I was harvesting tobacco on foot and barefooted when I stepped on a jagged broken bottle partially buried in the ground. The wound was in my instep and was about 1″ long and 3/4″ deep. I went to the farmers tobacco barn and took his the fuel line loose from his barn burner and let diesel fuel run through the wound for about half a minute. Then I tore a piece of dirty burlap off of the curtain on the “tobacco truck”, soaked it in fuel and tied it around my foot. I walked on that foot the rest of the day, barefooted with only the burlap tied around it. The next day it was fine. Within a week it was completely healed and left only a small scar.
I know some of you think I’m crazy and I’m not suggesting you do this unless you have no other options but it will work and is totally painless.
I don’t know how it would work for very severe, life threatening wounds but I wouldn’t hesitate to try it as a last resort.
Interesting and useful article and comments. Thanks, Ishabaka (that’s “Crazy Doctor” in Japanese–医者馬鹿).
Charles Pomeroy – Hai! So desu. Watashi wa yabuisha mo desu, yo.
Sorry – I can’t read or write characters.
Tampons (yes the ones females use) for deep puncture wounds and gunshot wounds. It stops or reduces bleeding.
Jello for cuts. I don’t know if it works better than just sugar, never had the chance to compare the two.
Yes – last night that was something I was thinking I should have added – tampons, and also maxi-pads – great absorbent dressings, and large too.
Also, this is something your prep group may actually have.
If anything, this post has highlighted the need for proper safety equipment.
That kevlar gear isn’t looking as pricey now.
@ boqueronman
Thanks for the tip on “Where There Is No Doctor”. I checked it out and ordered a copy.
I also recommend “Being Your Own Backwoods Doctor” by Dr. E. Russel Kodet and Bradford Angier.
I believe the author is approaching this in the context of a catastrophic event where we may not have access to professional medical help. Personally, I would trust a survivalist with military training anyday to treat me over allopathic medical personnel. Not to say that all are the same – but many people have become seriously incapacitated or died as a result of allopathic philosohpies and practices (i.e.: overuse of synthetic and debilitating prescription drugs, abuse of surgical procedures as the only way to treat before other methods).
Here is my “saline solution”
* 4 tsp. salt
* Eye dropper
* 2 tsp. baking soda
* 32 oz. distilled water
If water has been opened or is old (like in months or years) boil it.
Let it cool.
Mix above ingredients keep remainder sealed.
I also keep betadine solution. You can mix with above 1 part betadine to 4 parts saline solution.
There are two types of betadine:
1. A solution, sold over-the-counter (OTC) for cleaning minor wounds and used in hospitals to prepare a patient’s skin prior to surgery.[ Solutions are 10% povidone-iodine in water.
2. A ‘surgical scrub’, which is a mixture of povidone-iodine and detergent, sold OTC as a skin cleaner and disinfectant hand wash and used for cleansing hands prior to surgery and other aseptic procedures.
The “Dakins solution” is used in third world countries today. Anyone using it (or making it) needs to know that the mixture is .025 and NOT 0.25. If you mix it too strong it kills tissue and causes pain. and the soda should not be considered optional. Also you should not continuously use it for more than 7-10 days.
Something not mentioned here is the many uses of vinegar. Vinegar is an excellent antibacterial agent. I use it daily in a 50-50 solution to keep surfaces safe. It has medical uses also. In the absence of bleach you could use vinegar.
As stated sugar and honey have been used for years.
My mother used a mixture of sugar and kerosene on my cuts (minor and major and one terrible) as a child. She could also put in sultures with fishing line better than any I have ever got since from a doctor or nurse.
I saved some large syringes from various sources and after boiling and sealing in bags are ready for use. I also haunt surplus stores for various items including medical gear. You can never have enough bandages, cotton or other expendables. Just make sure the wrapping/packaging is still secure and has not been compromised.
Tampons and Maxie pads AND duct tape are like stated above mandatory in your kit.As far as medicines Mexico has them and will sell them, but beware, some of them are crooks and the meds you order will be fake. And no, I don’t know how to tell them apart. Canada has been shut down for many meds since last year. Like stated, just keep hunting a doctor who will help.
The way I learned the use of tourniquets was from my time in the Boy Scouts (and not much more in the Army). If the bleeding is more than you can stop from pressure, you apply a tourniquet (usually taught as a belt with a stick to turn it) and you released the pressure on the tourniquet (while treating the wound) every fifteen minutes. Stuffing the wound (if it wouldn’t stop, even with a tourniquet) with what ever was available, be it moss, shreds of clothing or even dirt and applying pressure while someone went for help.
Fix the breathing, stop the bleeding was the two things drummed into our heads.
Concerning wounds. Cleaning is the most important. My grand kids yell and scream as I scrub out their almost daily wounds and then of course “doctor” them and give them hugs and kisses and maybe an ice cream cone. They wonder what is in the giant ex-blood container that I keep all my medical stuff locked up in. I tell them it is my doctor stuff and never ever mess with it!
All above is knowledge gained from books, the net and living. No guarantees nor money back.
Papa Ray
P.S. I keep two large bottles of garlic oil as well as two large bottles of garlic and its oil, rotating them as needed.
About 5 years ago my mother was diagnosed with breast cancer. When she came home after her mascectomy I was responsible for her daily dressing changes. The one thing I learned is this: When taking care of wounds you will go thru an ENORMOUS amount of supplies including bandages, tape, gloves etc. So stock up several times the amount you think you need. Just a lesson learned thru first hand experience.
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