Tag Archives: first aid

Drowning

Photo by PM3 John DeCoursey

10/04/14
To Do Today:


Drowning is suffocation by liquid. It can lead to death and ongoing health problems. A drowning victim inhales water into the lungs or the throat closes by reflex so that little or no water can enter the windpipe. In either case, a victim can no longer breathe.

Drowning itself is quick and silent, although it may be preceded by distress which is more visible. A person drowning is unable to shout or call for help, or seek attention, as they cannot obtain enough air. The “instinctive drowning response” is the final set of autonomic reactions in the 20 – 60 seconds before sinking underwater, and to the untrained eye can look similar to calm or safe behavior. Persons trained in rescue learn to recognize drowning people by watching for instinctive movements in two categories:

Distress: People in trouble, but who still have the ability to keep afloat, signal for help and take actions.

Drowning: People suffocating and in imminent danger of death within seconds. This includes:

    • Passive drowning: People who suddenly sink or have sunk due to a change in their circumstances. Examples include people who drown in an accident, or due to sudden loss of consciousness or sudden medical condition.
    • Active drowning: People such as non-swimmers and the exhausted or hypothermic at the surface, who are unable to hold their mouth above water and are suffocating due to lack of air. Instinctively, people in such cases perform well known behaviors in the last 20–60 seconds before being submerged, representing the body’s last efforts to obtain air. Notably such people are unable to call for help, talk, reach for rescue equipment, or alert swimmers even feet away, and they may drown quickly and silently close to other swimmers or safety.

Drowning begins at the point a person is unable to keep their mouth above water; inhalation of water takes place at a later stage. As mentioned, drowning can be quick and unspectacular and media depictions as a loud, violent struggle have much more in common with distressed non-swimmers who may well drown but have not yet begun. In particular, an asphyxiating person is seldom able to call for help. The Instinctive Drowning Response covers many signs or behaviors associated with drowning or near-drowning:

  • Head low in the water, mouth at water level
  • Head tilted back with mouth open
  • Eyes glassy and empty, unable to focus
  • Eyes open, with fear evident on the face
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Trying to roll over on the back to float
  • Uncontrollable movement of arms and legs, rarely out of the water.

Other warning signs drowning is that the victim may call for help and has an expression of dread or panic. But typically a victim that is active and drowning may not call for help because he is trying to conserve his air and will not speak. Another symptom of drowning is when the victim thrashes at the water’s surface. If the victim stops or grows calmer, he has likely been overcome by fatigue, hypothermia, or a lack of air. At this stage, the victim usually has 20 to 60 seconds before going under the water’s surface.

Drowning can also happen in ways that are less well known:

  • Deep Water Blackout. Caused by latent hypoxia upon ascent from depth, where the partial pressure of oxygen in the lungs under pressure at the bottom of a deep free-dive is adequate to support consciousness but drops below the blackout threshold as the water pressure decreases on the ascent. It usually strikes upon arriving near the surface as the pressure approaches normal atmospheric pressure.
  • Shallow Water Blackout. Caused by hyperventilation prior to swimming or diving. The primary urge to breathe (more precisely: to exhale) is triggered by rising carbon dioxide (CO2) levels in the bloodstream. The body detects CO2 levels very accurately and relies on this to control breathing. Hyperventilation artificially depletes this, but leaves the diver susceptible to sudden loss of consciousness without warning from hypoxia. There is no bodily sensation that warns a diver of an impending blackout, and victims (often capable swimmers swimming under the surface in shallow water) become unconscious and drown quietly without alerting anyone to the fact that there is a problem; they are typically found on the bottom.
  • Secondary drowning. Inhaled fluid can act as an irritant inside the lungs. Physiological responses to even small quantities include the extrusion of liquid into the lungs (pulmonary edema) over the following hours, but this reduces the ability to exchange air and can lead to a person “drowning in their own body fluid.” Certain poisonous vapors or gases (i.e., burning fuel, toxic materials, or chemical vapor on/near the water surface), or vomit can have a similar effect. The reaction can take place up to 72 hours after a near drowning incident, and may lead to a serious condition or death.

Treatment

If the victim is not breathing, begin rescue breathing. Place the victim on his back, tilt head back to open airway, pinch the nose, and give two full breaths. If the victim does not inhale during the first two breaths, reposition his head and attempt two more breaths. Check for a pulse. If a pulse is present, but the victim is still not breathing, continue rescue breathing. If a pulse is not present, begin CPR. WARNING: If the victim has no pulse and is not breathing, administer CPR immediately. If the victim does have a pulse but is not breathing, give rescue breathing only. If the victim has a pulse and is breathing, DO NOT give CPR—CPR could prove fatal. Continue first aid until medical help arrives. A victim who is not breathing and has no pulse may appear dead. DO NOT decide that death has occurred. Continue with the prescribed treatment.


 

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Coldest

freezing-cold-2

09/19/14
To Do Today:


COLD INJURIES IN COASTAL ENVIRONMENTS

Hypothermia, frostbite, and trench/immersion foot are the most popular cold injuries for students during the winter. Photokeratitis (snow blindness) will be covered sometime later as it usually occurs during sunny summer months. Please make sure to read the notes on carbon monoxide poisoning at the end of the post.

HYPOTHERMIA

A common belief that extremely cold temperatures are needed for hypothermia to occur is not true as most cases occur when the temperature is between 30 and 50 degrees Fahrenheit.

Simply, hypothermia occurs when heat loss from the body exceeds the body’s ability to produce heat. Contributing factors include:

  • Air temperature
  • Ambient temperature
  • Wind chill
  • Wet clothing
  • Cold water immersion
  • Improper clothing.
  • Exhaustion.
  • Alcohol intoxication, nicotine and drugs such as barbiturates and tranquilizers.
  • Injuries. Those causing immobility or major bleeding, major burn and head trauma.

Signs and symptoms

The number one sign to look for is altered mental status; that is, the brain is literally getting cold. These signs might include confusion, slurred speech, strange behavior, irritability, impaired judgment, hallucinations, or fatigue.

As hypothermia worsens, victims will lose consciousness and eventually slip into a coma.

Shivering. Remember that shivering is a major way the body tries to warm itself early on, as it first begins to get cold. Shivering stops for two reasons:

  • The body has warmed back up to a normal temperature range.
  • The body has continued to cool. Below 95F shivering begins to decrease and by 90F it ceases completely.

Obviously, continued cooling is bad. So if a victim with whom you are working, who was shivering, stops shivering, you must determine if that is because he has warmed up or continued to cool.

A victim with severe hypothermia may actually appear to be quite dead, without breathing or a pulse. However, people who have been found this way have been successfully “brought back to life” with no permanent damage. The body of those who expire from hypothermia will exhibit a temporary warmth of the skin. So remember, you are not dead until you are warm and dead.

Prevention. Prevention is always better (and much easier) than treatment.

  • Cold weather clothing must be properly warm and cared for.
  • Keep your clothing as dry as possible.
  • If your feet are cold, wear a hat. Up to 80% of the body’s heat can escape from the head.
  • Avoid dehydration. Drink 6 – 8 quarts per day.
  • Eat adequately.
  • Avoid extreme fatigue and exhaustion.
  • Increase levels of activity as the temperature drops. Do not remain stationary when the temperature is very low. If the tactical situation does not permit moving about, perform isometric exercises of successive muscles.
  • Use the buddy system to check each other for signs/symptoms of hypothermia.

Treatment of Hypothermia

  • Make the diagnosis.
  • Prevent further heat loss.
  • Remove the victim from the environment (i.e., into a shelter).
  • Insulate the victim.
  • Rewarm the victim by zipping two sleeping bags together. Pre-warm the bag by using the body heat of another. Place the victim in the bag with two stripped companions inside the bags on both sides of the victim (insert dirty jokes and snide remarks here).
  • Medevac if possible.

Other Points to Remember

  • Fluids. If the victim is mildly hypothermic, give hot/wets.
  • If worse than mild, give him/her nothing by mouth.
  • Avoid, if possible, excessive movement of the victim, as his/her heart may actually stop beating if it is jarred.
  • Major Wounds. Apply first aid to major wounds first, before attempting to re-warm the victim. Re-warming a victim who has bled to death does little good.
  • Never give alcohol to hypothermia victims.
  • Even after you have started re-warming a victim, he/she must be constantly monitored. Don’t forget about the victim.

FROSTBITE

Frostbite is the actual freezing of tissues. When in a survival/SERE situation, rewarming a severe frostbitten area may not help. It is best to be vigilant of your situation prior to showing signs of frostbite as frostbite is a somewhat preventable injury, even in a desperate situation. It is critical, once frostbite has occurred, that you seek medical attention.

  • Dress in layers. Keep comfortably cool. If you begin to become uncomfortable, add layers.
  • Keep clothes dry. If clothing (especially socks and gloves) become wet, change them. This may mean you have to change sock 4-5 times a day.
  • Dress properly. If the wind is blowing, wear the correct protective layer.
  • Avoid dehydration. When dehydrated, the amount of blood available to warm your fingers and toes goes down, increasing the risk of frostbite.
  • Try to avoid starvation. Remember – food is fuel – and the body uses that fuel to make heat.

Signs and Symptoms

  • Ears, nose, fingers and toes are affected first.
  • Areas will feel cold and may tingle leading to….
  • Numbness which progresses to…
  • Waxy appearance with skin stiff and unable to glide freely over a joint.

Treatment

  • Frostbite is classified into three different degrees: Frosting, Superficial Frostbite, and Deep Frostbite.
  • Frosting will revert to normal after using the technique of body heat rewarming. Hold the affected area, skin to skin for 15 minutes. Rewarm face, nose, and ears with hands. Rewarm hands in armpits, groin or belly. Rewarm feet with mountain buddy’s armpits or belly.
  • If affected area cannot be rewarmed in 15 minutes, Superficial Frostbite or Deep Frostbite is suspected. Do not attempt to further rewarm. Splint the affected area. Protect the affected area from further injury. Medevac as soon as possible. DO NOT RUB ANY COLD INJURY WITH SNOW. Do not massage the affected area. Do not rewarm with stove or fire: a burn injury may result. Loosen constricting clothing. Avoid tobacco products.

Any frostbite injury, regardless of severity, is treated the same – evacuate the casualty and re-warm in the rear. If not possible, find shelter and seek friendly indigenous medical care. If the tactical/survival situation prohibits evacuation, no consideration should be given to re-warming frostbite in the field. The reason is something-called freeze – thaw – re-freeze injury.

Freeze – Thaw – Re-freeze injury occurs when a frostbitten extremity is thawed out, then before it can heal (which takes weeks and maybe months) it freezes again. This has devastating effects and greatly worsens the initial injury.

In an extreme emergency it is better to walk out on a frostbitten foot than to warm it up and then have it freeze again. Also:

  • Treat frozen extremities as fractures – carefully pad and splint.
  • Treat frozen feet as litter cases.
  • Prevent further freezing injury.
  • Do not forget about hypothermia. Keep the victim warm and dry.

Once in the rear, a frostbitten extremity is re-warmed in a water bath, with the temperature maintained at 101F – 108F.

TRENCH FOOT / IMMERSION FOOT

Trench foot / immersion foot is a cold-wet injury to the feet or hands from prolonged (generally 7 – 10 hours) exposure to water at temperatures above freezing.

Signs and Symptoms. The major symptom will be pain. Trench foot is an extremely painful injury. Trench foot and frostbite are often very difficult to tell apart just from looking at it. Often they may both be present at the same time. Signs include:

  • Red and purple mottled skin.
  • Patches of white skin.
  • Very wrinkled skin.
  • Severe cases may leave gangrene and blisters.
  • Swelling.
  • Lowered or even absent pulse.
  • Trench foot is classified from mild to severe.

Prevention. Avoiding trench foot/immersion foot is aimed simply at preventing cold, wet and immobile feet (or hands).

  • Keep feet warm and dry.
  • Change socks at least once a day. Let your feet dry briefly during the change, and wipe out the inside of the boot. Sock changes may be required more often.
  • Exercise. Constant exercising of the feet whenever the body is otherwise immobile will help the blood flow.

Treatment. All cases of trench foot must be evacuated. It cannot be treated effectively in the field.

While awaiting evacuation:

  • The feet should be dried, warmed, and elevated.
  • The pain is often severe, even though the injury may appear mild; it may require medication such as morphine.
  • In the rear, the healing of trench foot usually takes at least two months, and may take almost a year. Severe cases may require amputation. Trench foot is not to be taken lightly.

 

NOTES ON CARBON MONOXIDE POISONING

Cold environments probably mean you will spend time inside some sort of shelter and have some sort of fire or other heat source. It is critical you have airflow and fresh air built into your setup. Carbon Monoxide is no joke.

Carbon Monoxide (CO) is a heavy, odorless, colorless, tasteless gas resulting from incomplete combustion of fossil fuels. CO kills through asphyxia even in the presence of adequate oxygen, because oxygen-transporting hemoglobin has a 210 times greater affinity for CO than for oxygen. What this means is that CO replaces and takes the place of the oxygen in the body causing Carbon Monoxide poisoning.

Signs/Symptoms. The signs and symptoms depend on the amount of CO the victim has inhaled. In mild cases, the victim may have only dizziness, headache, and confusion; severe cases can cause a deep coma. Sudden respiratory arrest may occur. The classic sign of CO poisoning is cherry-red lip color, but this is usually a very late and severe sign, actually the skin is normally found to be pale or blue.

CO poisoning should be suspected whenever a person in a poorly ventilated area suddenly collapses. Recognizing this condition may be difficult when all members of the party are affected.

Treatment. The first step is to immediately remove the victim from the contaminated area.

  • Victims with mild CO poisoning who have not lost consciousness need fresh air and light duty for a minimum of four hours. If oxygen is available administer it. More severely affected victims may require rescue breathing.
  • Fortunately, the lungs excrete CO within a few hours.

Prevention. Ensure there is adequate ventilation when utilizing a fire or other chemical/mechanical heat source near your shelter.

Human Bodies

13398210_SA

09/16/14
To Do Today:

  • PT – 45min run / strength – leg group / abs
  • Describe what tasks are necessary in a survival situation, or, what should a basic field survival kit enable you to do.
  • List the components of a basic field survival kit.
  • List additional items you would like to add to your personal kit. Provide specific reasons why for each item.
  • Begin to assemble your personal field survival kit.

Rule of Three’s for extreme situations:

  • You have 3 minutes without air
  • You have 3 hours to find/build shelter (to regulate body temperature)
  • You have 3 days to find potable water
  • You have 3 weeks to find a reliable food source

The Rule of Three’s assumes a reasonably fit person. Fitness is critical to preventing injuries, having the stamina to work (survive, evade, etc.) long hours over many days, and having the strength to lift or move heavy things (like water containers, logs, etc.). Success in hostile environments or when facing capture necessarily requires athletic abilities beyond the basics. Strive to continually improve and be prepared. As the saying goes, the more you sweat in peace, the less you bleed in war.

AIR

An average person will only survive for 3 minutes without air.

Survival situations may begin/include a plane crash into the ocean, an automobile accident that puts you into a lake/river, a fall through the ice, or just getting into water over your head. When you have time to prepare mentally, you can add a few seconds to the clock.  Also, when going under, its not necessarily about the time, its about the task. Swimming/working/struggling/fighting while breath-holding will obviously take seconds off the clock as your muscles use the available oxygen in your body more quickly.

Time frames to remember during a drowning situation (add 60-90 seconds for those who are in better physical condition or who may be trained):

  • 0-30 seconds. Even an untrained person should be able to hold their breath for 30 seconds. If you cannot, practice.
  • 30 seconds to 1 minute. Airway may start to constrict. Lips start to discolor. Panic sets in.
  • 1 to 2 minutes. Grey-out to loss of consciousness.
  • 2 to 5 minutes. The heart can stop. The victim has a good chance of survival if rescued now and CPR can be performed.
  • 5 minutes plus. Permanent brain damage is occurring as each second passes. Death.

SHELTER (REGULATING BODY TEMP)

Core body temperature should be held within 2°F of 98.6°F. Actions that keep your body in this zone are called Thermoregulation. Thermoregulation can be the difference between living and dying and is the practice of controlling your core temperature. People die each year from power outages during heat waves or winter weather. Simple variations in environmental temperatures between 30° and 50° have wreaked havoc and many die from hypothermia (too cold) or hyperthermia (too hot).

Minimal fluctuations to core temperatures over a long period of time can also stress the body and throw vital systems into chaos. In the event of persistent stress, the body will actually break down at the cellular level. If your temperature suddenly plummets, the proteins in your cells clump together leaving “gaps” filled with water that can potentially freeze and shred cell membranes. When the body overheats, cells can become too warm and essentially leak or even explode.

Hypothermia is the condition when your core temperature plummets below approximately 96°F. Variables to this include age, sex, percentage of body fat, etc.  Suffering from even mild hypothermia can cause your body to burn through calories trying to keep vital organs heated, cutting into the body’s food stores. Your body will also limit the amount of blood flowing to your extremities making them more susceptible to damage and impairment.  Shivering is another way for your body to create heat to keep you warm.  While shivering, your body is creating tiny muscle contractions, thereby using energy and heating up the body.  Unfortunately, shivering also burns through food stores in the process.

Hyperthermia is when your core temperature soars above approximately 100°F.  Again, this can vary, but this gives you a good guideline for sustaining a healthy condition when exposed to less than ideal temperatures.  Generally, in the case of hyperthermia, your body will succumb to dehydration.  Your body’s first line of defense is to circulate more than four quarts of blood per minute, dilate the blood vessels, and open the skin up to let the excess heat out. When this fails, heat exhaustion and heat stroke are soon to follow.

WATER

A person cannot survive without water for more than a few days. Your body loses water through normal body processes (sweating, urinating, and breathing) and during normal activity the kidneys can excrete more than 1 to 2 quarts of water per day. A normal body will also evaporate almost a a quart per day depending on temperature and activity. Heat exposure, cold exposure, intense activity, high altitude, burns, or illness, can cause your body to lose more water.

FOOD

The body will survive several weeks without food. However, without an adequate supply to stay healthy your mental and physical capabilities will deteriorate. Food supplies the body with the necessary nutrients and energy to function.

Food sources are plants, animals, and fish that provide calories. To produce energy, the body uses calories. Proteins, fats, or carbohydrates produce calories. Of these three, certain ones produce better energy than others do. Animal meat is an excellent source for caloric intake, although nuts from pine cones can supplement it.

  • Protein. Proteins are comprised complicated molecules with chains of amino acids. There are numerous kinds of amino acids which cannot be synthesized or combined from other food elements in the body and must be consumed in the diet. However, for those thinking that small game will be their sole source of protein, a pure protein, low fat diet can cause fatality in 3-8 weeks from Rabbit Starvation, a term used for living on a small game diet. Find and consume supplemental proteins like dandelions, nuts, bark, and legumes.
  • Fat. Fats serve as the main storage form of energy. Fats produce energy and heat. Fats are best obtained from bone marrow, liver, or the stomach portion of fish
  • Carbohydrates. Carbohydrates are known as the quick energy food and produce lots of heat. They are stored in the liver and muscles. These organs can be markedly depleted by fasting for as short as 24 hours. Cattails, nuts are a source for carbohydrates.
  • Fiber. Fiber prevents irritable bowel syndrome. In the Falklands campaign the British had a major constipation and diarrhea problem. This was largely caused by dehydration and a low fiber diet. Grasses and pine needles are a good source of dietary fiber.
  • Vitamins. Vitamins are essential to metabolic functioning of the body and exposure to cold compounds this function. Our bodies cannot make vitamins so we must provide them in our diet. Most edible plant life contains many different vitamins. Associated illnesses from long term deficiency are Scurvy (vitamin C) a physical disease and Beriberi (vitamin B1) a mental disease. Vitamins can be found in the cambium layer of trees, pine needles, and stinging nettle.
  • Minerals. Be primarily concerned with Iron. Iron acts as a thermoregulator and Iron deficiency causes a 9% decrease in heat energy production. Consuming only 1/3 RDA of iron results in a 29% greater heat loss during cold exposure. Animal blood, dandelions, stinging nettle, and bone marrow provide the major source of iron. Ensure these foods are properly prepared if available.

A NOTE ON HYGIENE

Cleanliness is an important factor in preventing infection and disease. It becomes even more important in a survival/SERE situation.

Areas to pay special attention to are the feet, hands, armpits, crotch, and hair. Visual and physical inspections should be conducted daily for injury, parasites (i.e., ticks, leeches, etc.) and insect/animal bites. Hands and finger nails should be kept as clean as possible to prevent infection and sickness. Expose all body areas to the sun in moderation when possible in order to kill bacteria and parasites on/in the skin. Expose feet to open air at every opportunity (alcohol based sanitizers applied to damaged skin that has been wet for prolonged periods ((i.e., feet)) seems to work well).

Teeth are another important area to keep clean. Brush your teeth each day either with a toothbrush, or if you don’t have one, make a chewing stick. A chewing stick is made out of a twig about 6 to 8 inches long. Chew one end of the stick to separate the fibers. Now brush your teeth.