Aviation Survival Part 1 - Lesson 3 - Basic Survival Medicine

 

U.S. Army Aviation Center
Subcourse AV0611 (June 1993)

Aviation Survival Part 1 -
Survival Elements, Psychological Aspects, and Survival Medicine

LESSON 3. BASIC SURVIVAL MEDICINE

 

1. GENERAL

a. Foremost, among the many things that can compromise a survivor's ability to return are medical problems. Injuries commonly associated with a crash or forced landing are sprains, burns, fractures, dislocations, and other types of wounds.

b. Injuries and illnesses peculiar to certain environments can reduce survival expectance. In cold climates, and often in an open sea survival situation, exposure to extreme cold can produce serious tissue trauma, such as frostbite or death from hypothermia. Exposure to heat in warm climates, and in certain areas on the open seas, can produce heat cramps, heat exhaustion, or life-threatening heatstroke.

c. Illnesses contracted during evasion or in a captivity environment can interfere with successful survival. Among these are typhus, malaria, cholera, respiratory diseases, gastrointestinal disorders, and skin infections and infestations.

d. A review of the survival experiences from World War II, Korea, and Southeast Asia indicates that, while US military personnel generally knew how to administer first aid to others, there was a marked inability to administer self-aid. Only basic medical care had been taught to most military members. Repeated emphasis was that even minor injuries or ailments, when ignored, became major problems in a survival situation. Thus, prompt attention to the most minor medical problem is essential in a survival episode. Applying principles of survival medicine should enable military members to maintain health and well being in a hostile or non-hostile environment until rescued and returned to friendly control.

e. Information in this lesson is a basic reference to self-aid techniques and techniques found in folk medicine. The information describes procedures that can maintain health in medically austere situations. It includes items used to prevent and treat injuries and illnesses. Because there is no typical survival situation, the approach to self-aid must be flexible, placing emphasis on using what is available to treat the injury or illness. Medical treatment offered by people of other cultures may be far different from our own. Such treatment may be repugnant to some US military personnel; however, medical aid offered to survivors in non-US cultures may be the best available in the given circumstance. EXAMPLE: In rural areas of Vietnam, a poultice of python meat is used to treat internal lower back pain.

f. The procedures in this lesson must be viewed in the reality of a true survival situation. The results of treatment may be substandard compared with present medical standards. However, these procedures will not compromise professional medical care that becomes available following rescue. Moreover, in the context of a survival situation, they may represent the best available treatment to extend the individual's survival expectance.

2. PROCEDURES AND EXPEDIENTS

Survival medicine encompasses required and available procedures and expedients to preserve health and to prevent, improve, or treat injuries and illnesses. They are also suitable to be self-applied by non-medical personnel or applied to comrades in survival situation circumstances.

a. Survival medicine is more than first aid in the conventional sense. It approaches final definitive treatment in that it does not depend on the availability of technical medical assistance within a reasonable period.

b. To avoid duplicating information generally available, the basic principles of first aid are not repeated.

3. HYGIENE In a survival situation, cleanliness is essential to prevent infection. Adequate personal cleanliness not only protects against disease germs present in the individual's surroundings, but it also protects the group by reducing the spread of these germs.

a. Washing (particularly the face, hands, and feet) reduces the chances of infection from small scratches and abrasions. A daily bath or shower with soap and hot water is ideal. If no tub or shower is available, the body should be cleaned with a cloth and soapy water, paying particular attention to the face, ears, hands, feet, and body creases (armpits, groin, and so forth). After this type of bath, the body should be rinsed thoroughly with clear water to remove all traces of soap which could cause irritation. Soap, although an aid, is not essential to keeping clean. Sand, ashes, loamy soil, and other expedients may be used to clean the body and cooking utensils.

b. When water is in short supply, the survivor should take an air bath. All clothing should be removed and the body simply exposed to the air. Exposure to sunshine is ideal, but even on an overcast day or indoors exposing the naked body to the air for two hours refreshes the body. Care should be taken to avoid sunburn when bathing in this manner. Exposure in the shade, shelter, or sleeping bag helps if the weather conditions do not permit direct exposure.

c. Hair should be kept trimmed, preferably to 2 inches or less, and the face should be clean-shaven. Hair provides a surface for parasite attachment and bacterial growth. Keeping the hair short and the face clean-shaven provides less habitat for these organisms. Wash the hair with soap and water at least weekly. When water is in short supply, comb or brush the hair thoroughly and cover it to keep it clean. Inspect the hair weekly for parasites and remove them if they exist.

d. Unclean hands is the principal means of infecting food and open wounds. They should be washed with soap and water, if available, after handling any material likely to carry germs. This is especially important after each visit to the latrine; when caring for the sick and injured; and before handling food, food utensils, or drinking water. Keep fingers out of the mouth, and closely trim and clean fingernails. A scratch from a long fingernail could develop into a serious infection.

4. ORAL CARE

a. To prevent tooth decay and gum disease, cleanse the mouth and teeth thoroughly with a toothbrush and dentifrice at least once each day. If a toothbrush is not available, a "chewing stick" can be fashioned from a twig. Wash the twig, then chew on one end until it is frayed and brush-like. Teeth can then be brushed thoroughly with the stick. If necessary, wrap a clean strip of cloth around the finger and rub on the teeth to wipe away food particles. If neither toothpaste nor toothpowder is available, salt, soap, or baking soda can be used. Gargling and rinsing with willow bark tea helps protect the teeth.

b. Food debris that has accumulated between the teeth should be removed by using dental floss or toothpicks. The parachute inner core filaments can be separated and used as dental floss. Small twigs can be used for toothpicks. Stimulate gum tissues daily by rubbing them vigorously with a clean finger.

c. Use as much care in cleaning dentures and other dental appliances (removable or fixed) as cleaning natural teeth. Remove and clean dentures and removable bridges with a denture brush or chew stick at least once each day. Brush or rub regularly the tissue under the dentures for proper stimulation. Remove dental appliances at night or for a two- or three- hour period during the day.

5. FOOT CARE Of utmost importance in a survival situation is proper care of the feet, especially if the survivor has to travel. Serious foot trouble can be prevented by observing a few simple rules.

a. Feet should be washed, dried thoroughly, and massaged daily. If water is in short supply, air clean the feet along with the rest of the body. Trim toenails straight across to prevent ingrown toenails.

b. Break in boots before wearing them on any mission. They should fit properly, neither so tight that they bind and cause pressure spots nor so loose that they permit the foot to slide forward and backward when walking. Improvise insoles to reduce any friction spots inside the shoes.

c. Socks should be large enough to allow the toes to move freely but not so loose that they wrinkle. Wool socks should be at least one size larger than cotton socks to allow for shrinkage. Socks with holes should be properly darned before they are worn. Wearing socks with holes or those poorly repaired may cause blisters. Clots of wool on the inside and outside should be removed from wool socks because they may cause blisters. Change and wash socks thoroughly with soap and water daily. Wash woolen socks in cool water to lessen shrinkage. In camp, stretch freshly laundered socks to facilitate drying in the sun or in an air current. While traveling, damp socks can be dried by placing them inside layers of clothing or hanging them on the outside of the pack. If socks are damp, exchange them for dry ones.

d. When traveling, examine the feet regularly for red spots or blisters. Cover tender areas with adhesive tape to prevent blister formation.

6. CLOTHING AND BEDDING Clothing and bedding become contaminated with any disease germs that may be present on the skin, or in the stool or urine, or in nose and throat secretions. Therefore, keep clothing and bedding as clean as possible to decrease the chances of skin infection and the possibility of parasite infestation. Wash soiled outer clothing with soap and water. Change underclothing and socks daily. If water is in short supply, air clean clothing. For air cleaning, take clothing outdoors and air and sun for two hours. Wear air-cleaned clothing in rotation. Turn sleeping bags inside out, fluff, and air them after each use. Change bed linen at least once a week; air and sun blankets, pillows, and mattresses.

7. REST

a. Rest is necessary for the survivor because it restores physical and mental vigor and promotes healing. In the initial stage of the survival situation, rest is particularly important. After tasks requiring immediate attention are complete, inventory available resources, decide on a plan of action, and have a meal. This planning session provides a rest period without a feeling of doing nothing.

b. If possible, plan regular rest periods daily. Time allotted for rest depends on a number of factors including the survivor's physical condition and the presence of hostile forces. Usually, 10 minutes each hour is sufficient. During rest periods, change either from physical activity to complete rest or from mental activity to physical activity as the case may be. Survivors must learn to become comfortable and to rest under less than ideal conditions.

8. INJURY MANAGEMENT

a. Breathing. Lack of breathing is a life-threatening emergency that requires immediate attention. If the problem is the result of an acute upper airway obstruction and other resuscitation methods have failed, then an immediate cricothyroidotomy (an artificial airway) may be required to save the individual's life. A cricothyroidotomy is an opening in the trachea between the thyroid cartilage and the cricoid cartilage that permits air to pass directly from the outside into the trachea without passing through the upper air passages. A cricothyroidotomy is performed as stated in Figure 38 – (Not Included).

CAUTION: This procedure requires specific knowledge and training. Nonmedical personnel should perform it only in a combat survival situation and only as a last resort.

b. Bleeding. It is most important to control bleeding in survival situations where replacement transfusions are not possible. Take immediate steps to stop the flow of blood, regardless of its source. Use the method commensurate with the type and degree of bleeding. The tourniquet, when required and properly used, saves lives; if improperly used, it may cost a life. The basic characteristics of a tourniquet and ways to use it are covered in standard first-aid texts; however, certain points merit emphasis in the survival situation. Use a tourniquet only after every alternative method has been attempted. Gradually loosen the tourniquet after 20 minutes if it is determined that medical assistance will not be available for more than two hours after applying it. If bleeding has stopped, remove the tourniquet; if bleeding continues, reapply and leave it in place. Apply the tourniquet as near the bleeding as possible, between the wound and the heart, to reduce the amount of tissue lost.

c. Pain.

(1) Controlling pain.

 (a) Controlling pain is difficult and essential. In addition to its morale-breaking discomfort, pain contributes to shock and makes the survivor more vulnerable to enemy influences. Ideally, pain should be eliminated. However, this is not always possible, hence measures for pain control are beneficial.

(b) The part of the body that is hurting should be put at rest, or at least its activity restricted. The position selected should be the one giving the most comfort and the easiest to maintain. Splints and bandages may be necessary to maintain immobilization. Elevation of the injured part, with immobilization, is particularly beneficial in throbbing pain. Cleanse open wounds, remove foreign bodies, and apply a clean dressing to protect the wound from the air. Generally, warmth reduces pain (toothache and bursitis); however, in some conditions, applying cold has the same effect (strains and sprains). Warmth or cold is best applied by using water due to its high specific heat. The survivor then can try to determine which is most beneficial.

(2) Reducing pain.

(a) Drugs are very effective in reducing pain; however, they probably will not be available in a survival situation. Aspirin, APCs, and such tablets are primarily intended to combat the discomforts of colds and upper respiratory diseases. These drugs just take the edge off severe pain but should be taken if available. If no aspirin is available, there are some parts of vegetation that can be used.

(b) Most willows have been used for their pain-relieving and fever-lowering properties for hundreds of years. Fresh bark contains salicin which probably decomposes into salicylic acid in the human body. The leaves of wintergreen (checkerberry) made into a tea were used by some Indians for body aches and pains. The boiled bark of the magnolia tree helps relieve internal pains and fever and has been known to stop dysentery.

(c) To be really effective in controlling pain, stronger narcotic drugs are required. During active hostilities, morphine may be available in aircraft and individual first-aid kits. d. Shock.

(1) Circulatory reaction. Shock in some degree accompanies all body injuries; frequently, it is the most serious consequence. In essence, shock is a circulatory reaction of the body to an injury. Changes to the circulatory system initially favor body resistance to the injury (by ensuring adequate blood supply to vital structures), but these changes may progress to circulatory failure and death. All aircrew members should be familiar with the signs and symptoms of shock so that it may be anticipated, recognized, and dealt with effectively. However, the best survival approach is to treat all moderate and severe injuries for shock. No harm is done, and such treatment speeds recovery.

(2) Fluids. Normally, fluids administered by mouth are generally prohibited in the treatment of shock following severe injury. When given by mouth, such fluids are poorly absorbed and may interfere with administration of anesthesia for surgery. In survival medicine, however, the situation is different in that the treatment being given is the final treatment. Survivors cannot be deprived of water for long periods because they are injured; in fact, recovery depends on adequate hydration. Small amounts of tea, coffee, or warm water given frequently early in shock are beneficial if the patient is conscious, can swallow, and has no internal injuries. In later shock, fluids by mouth are less effective as they are not absorbed from the intestines. Burns, particularly, require large amounts of water to replace fluid lost from injured areas. Alcohol should never be given to a person in shock or one who may go into shock.

(3) Psychogenic shock. Psychogenic shock is frequently noted immediately following an emergency, as in a bailout. Psychogenic shock, which occurs even without injury, requires attention to limit it in degree and duration. The degree of this postimpact shock varies widely among individuals, but its occurrence is almost universal. In reality the survivor has passed through two major emergencies almost simultaneously: the aircraft incident leading to the survival situation and the situation itself. Should the survivor be injured (and the majority are), a third emergency is added. It is not uncommon, then, that some psychogenic reaction with circulatory implications occurs. Resistance to this type of shock depends on the individual's personality and amount of training previously received. Treatment consists of stopping all activities (when possible), relaxing, evaluating the situation, and formulating a plan of action before the survival situation begins. 

9. INJURIES

a. Head Injuries.

(1) Head injuries pose additional problems related to brain damage as well as interfering with breathing and eating. Bleeding is more profuse about the face and head area, but infections have more difficulty taking hold. This makes it somewhat safer to close such wounds earlier to maintain function. A cricothyroidotomy may be necessary if breathing becomes difficult because of an obstruction of the upper airways.

(2) In the event of unconsciousness, watch the patient closely and keep him still. Even in the face of mild or impending shock, keep the head level or slightly elevated if there is reason to expect brain damage. Do NOT give fluids or morphine to unconscious persons.

b. Chest Injuries. Chest injuries are common, painful, and disabling. Severe chest bruises or rib fractures require that the chest be immobilized to prevent painful movements of the chest wall. Apply the bandage while the patient deeply exhales. In the survival situation, it may be necessary for you to wrap your own chest. This is more difficult but can be done by attaching one end of the long bandage (parachute material) to a tree or other fixed object. While holding the other end in the hand, slowly roll your body toward the tree. Be sure to keep enough counterpressure on the bandage to ensure a tight fit.

c. Eye Injuries. Eye injuries are quite serious in a survival situation because of pain and interference with other survival functions. The techniques for removing foreign bodies and for treating snow blindness are covered in standard first aid manuals. More serious eye injuries that disrupt the contents of the orbit may require the lids of the affected eye be taped closed or covered to prevent infection.

d. Thorns and Splinters. To reduce the danger of encountering thorns and splinters in survival situations, wear gloves and proper footgear. Promptly remove these agents to prevent infection. Wounds made by these agents are deeper than their width which increases chances of infection by those organisms (tetanus) which grow best in the absence of oxygen. Remove splinters with a sharp instrument (needle or knife), needle-nose pliers, or tweezers. Take care to get all of the foreign body out; sometimes it is best to open the wound sufficiently to properly cleanse it and allow air to enter the wound. When cleaned, treat it as any other wound.

e. Blisters and Abrasions. Foot care is extremely important in the survival situation. Care for blisters and abrasions promptly. If you note redness or pain, stop (if at all possible) to find and correct the cause. Frequently, a protective dressing, bandage, or adhesive is sufficient to prevent a blister. If a blister does occur, do NOT remove the top layer of skin. Opening a blister provides entry for infection. Clean the area with antiseptic, if available, and apply a clean dressing. Treat all open blisters and abrasions in the same manner.

f. Insect Bites. Bites of insects, leaches, ticks, fleas, and chiggers pose several hazards. Many of these organisms transmit lethal diseases, and the bite itself is likely to become infected if it is repeatedly scratched. You should inspect your body frequently for all types of animal parasites and remove them as soon as they are detected. Pay particular attention to areas such as the folds of the skin. Leaches are best removed by applying heat or some other irritant to encourage them to relax their hold on your skin. Ticks, on the other hand, should not be removed with the aid of a heat source because it increases the likelihood that contaminants will be expelled into the bite area. Remove ticks by grasping as much of their body as possible and pulling with steady pressure until it releases its hold on the skin. You can reduce your exposure to animal parasites by avoiding the shady or wooded areas immediately adjacent to open fields. Treat such wounds as any other wound. Apply a cold wet dressing to reduce itching, scratching, and swelling.

g. Fractures.

(1) Proper immobilization of fractures, dislocations, and sprains is even more important in survival medicine than in conventional first aid. In survival medicine rather than merely making the patient comfortable during transport to eventual treatment; the initial immobilization is part of the ultimate treatment. Although immobilizing body parts to help control pain helps, immobilization in the proper position hastens fracture healing and improves the ultimate functional result. In the survival situation, immobilization must suffice for a relatively long period of time. Materials for splinting and bandaging are available in most survival situations. Proper techniques are detailed in most first-aid manuals.

(2) Reducing (setting) fractures is normally beyond the scope of first aid; however, in the prolonged survival situation, correcting bone deformities is necessary to hasten healing and obtain the greatest functional result. The best time for manipulation of a fracture is in the period immediately following the injury, before painful muscle spasms ensue. Apply traction until overriding bone fragments are brought into line (check by the other limb) and the extremity is firmly immobilized. Frequently, it is advantageous to continue traction after reduction to ensure proper bone alignment.

(3) Since plaster casts are not available in the survival situation, improvising an immobilization device is necessary. This may be done by using several parallel, pliable willow branches woven together with vines or parachute lines. Use care so that the extremity is not constricted when swelling follows the injury. In an escape and evasion situation, it may be necessary to preserve the mobility of the survivor after reducing the fracture. This is difficult in fractures of the lower extremities, although tree limbs may be improvised as crutches. With companions, using improvised litters may be possible.

(4) Reducing dislocated joints is similar to that of fractures. Apply gentle, but firm, traction and manipulate the extremity until it "snaps' back into place. If the survivor is alone, the problem is complicated but not impossible. Traction can still be applied by using gravity. Tie or wedge the distal (furthest) portion of the extremity to the fork of a tree or similar fixation point. Then allow the weight of the body to exert the necessary traction, manipulating the joint until the dislocation is reduced.

h. Burns.

(1) Burns, frequently encountered in aircraft accidents and subsequent survival situations, pose serious problems. Burns cause severe pain, increase the probability of shock and infection, and offer an avenue for considerable body fluid and salt loss. Initially, relieve the pain and prevent infection by covering the wound with any clean dressing. This reduces pain and the chance for infection. Further, such protection enhances patient mobility and the capability for performing other vital survival functions. In burns about the face and neck, ensure the victim has an open airway. If necessary, perform a cricothyroidotomy before the patient develops extreme difficulties. Burns of the face and hands are particularly serious as they interfere with the capability of survivors to meet their own needs. Soaking certain barks (willow, oak, or maple) in water leeches acid from the bark. Applying this solution soothes and protects burns through its astringent action. 

CAUTION: Do not apply greases or fats to burns.

(2) Maintaining body fluids and salts is essential to recover from burns. The only way to administer fluids in a survival situation is by mouth; hence, the casualty should ingest sufficient water early before nausea and vomiting from toxicity intervenes. Consuming cooked animal eyes and blood helps restore electrolyte levels if salt tablets are not available.

NOTE: The survivor may also pack salt in personal survival kits to replace electrolytes (1/4 teaspoon per quart of water).

10. WOUNDS

a. Lacerations. Lacerations (cuts) are best left open because of the probability of infection. Clean thoroughly, remove foreign material, and apply a protective dressing. Frequently, immobilization hastens the healing of major lacerations. On occasion (tactical), it may be necessary to close (cover) the wound, despite the danger of infection, in order to control bleeding or increase the mobility of the patient. If a needle is available, the wound may be closed by suturing. Thread may be procured from fabric, clothing, or parachute lines. If suturing is required, place individual stitches far enough apart to permit drainage of the underlying parts. Do not worry about the cosmetic effect; just approximate the tissue. For scalp wounds, you may use hair to close the wound after the wound is cleansed. Infection is less a danger in the scalp area because of the rich blood supply.

b. Abdominal Wounds. In the survival situation, abdominal wounds are particularly serious. Without immediate and adequate surgery, patients with these wounds have an extremely high mortality rate and their seriousness renders patients totally unable to care for themselves. Apply a secure bandage to keep intestines from extruding through the wound. If the intestine is extruded, do NOT replace it because it is almost certain that the results will be fatal. Cover the extruded bowel with a large dressing, and keep the dressing wet with urine or any fluid that is fit to drink. The patient should lie on his back and avoid any motion that increases intraabdominal pressure which might extrude more bowel. Keep the survivor immobile or move him on a litter. Nature eventually takes care of the problem either through death or by walling-off the damaged area.

c. Sucking Chest Wounds. These wounds are easily recognized by the sucking noise and the appearance of foam or bubbles in the wound. These wounds must be closed immediately before serious respiratory and circulatory complications occur. Ideally, the patient should attempt to exhale while holding the mouth and nose closed (Valsalva maneuver) as the wound is closed. This deflates the lungs and reduces the air trapped in the pleural cavity. Frequently, a taped, airtight dressing is all that is needed, but sometimes it is necessary to put in a stitch or two to make sure the wound is closed. 

11. GENERAL TREATMENT

a. Infection. Infection is a serious threat to the survivor. The inevitable delay in definite medical treatment and the reality of the survival situation increases the chances of wound infection. Antibiotics may not be available in sufficient amounts. In survival medicine, you must place more emphasis on prevention and control of infection by applying the techniques used before the advent of antibiotics.

(1) Unfortunately, survivors have little control over the amount and type of infection introduced at the time of injury. However, they can help control infection by wearing clean clothes. Use care to prevent additional infection into wounds. Remove clothing from wounds to avoid contaminating surrounding skin areas. Do NOT touch wounds, regardless of type or severity, with dirty hands or objects. One exception to this rule is the essential control of arterial bleeding.

(2) Promptly cleanse all wounds. Water is the most universally available cleaning agent and should be (preferably) sterile. At sea level, sterilize water by placing it in a covered container and boiling it for ten minutes. Above 3,000 feet, boil water one hour (in a covered container) to ensure adequate sterilization. Water remains sterile and can be stored indefinitely as long as it is covered.

(a) Irrigate wounds rather than scrubbing them to minimize additional tissue damage. Wash foreign material from the wound to remove sources of continued infection. Wash the skin adjacent to wounds thoroughly before bandaging. When water is not available for cleaning wounds, consider using urine. Urine may well be the most nearly sterile of all fluids available and, in some cultures, is preferred for cleaning wounds. Use urine from the midstream flow.

(b) While soap is not essential to clean wounds, a bar of medicated soap placed in a personal survival kit and used routinely does much to prevent the infection of seemingly inconsequential injuries. External antiseptics are best used for cleaning scratches, abrasions, and the skin areas adjacent to lacerations. Used in deep, larger wounds, antiseptics produce further tissue damage.

(c) Nature also provides antiseptics that can be used for wound care. The American mountain ash, found from Newfoundland south to North Carolina, and its inner bark have antiseptic properties; the red berries, containing ascorbic acid, have been eaten to cure scurvy. Sweet Gum bark is still officially recognized as being an antiseptic agent. Water from boiled Sweet Gum leaves is also used as an antiseptic for wounds.

b. Body Defenses. The human body has a tremendous capacity for combating infections if it is permitted to do so. Applying heat to an infected wound further aids in mobilizing local body defense measures. Lukewarm salt water soaks help draw out infection and promote oozing of fluids from the wound, thereby removing toxic products. Poultices of clean clay, shredded bark of most trees, and ground grass seed do the same thing. In addition to the importance of proper rest and nutrition in wound healing and infection control, you should improve the logistics of the injured part. Immobilize the injury in a position to favor adequate circulation to and from the wound. Avoid constrictive clothing or bandages. Despite all precautions, some degree of infection is almost universal in survival wounds. This is the primary reason for the open treatment advocated below.

c. The Open-Treatment Method. This method is the only safe way to manage survival wounds. No effort should be made to close open wounds by suturing or by other procedures. In fact, it may be necessary to open the wound even more to avoid entrapment or infection and to promote drainage. The term "open" does not mean that dressings should not be used. Good surgery requires that although wounds are not "closed," nerves, bone, and blood vessels should be covered with tissue. Such judgment may be beyond the capability of the aircrew member, but protecting vital structures aids in recovery and ultimate function. A notable exception to open treatment is the early closure of facial wounds which interfere with breathing, eating, or drinking. Wounds, left open, heal by forming infection resistant granulation tissue (proud flesh). This tissue is easily recognized by its moist red granular appearance-a good sign in any wound.

d. Antibiotics. Take antibiotics, when available, to control infection. Consensus is that the drug should be a "broad spectrum" drug; that is, it should be effective against any microorganism rather than specific for just one or two types. The exact amount included in survival kits varies with the drug and the basic number and types of infections to be expected. Remember that antibiotics are potency-dated items (shelf-life about four years). Including them in survival kits requires inspecting the kit and replacing the drugs with active medical stocks.

e. Debridement. Debridement is the surgical removal of lacerated, devitalized, or contaminated tissue. Severe wounds may need debriding to minimize infection (particularly of the gas-gangrene type) and to reduce (lower) septic (toxic) shock. In essence, debridement is the removal of foreign material and dead or dying tissue. The procedure requires skill and should only be done by nonmedical personnel in cases of dire emergency. If required, cut dead skin away. Trim the muscle back to a point where bleeding starts and gross discoloration ceases. Damaged fat tends to die and should be cut away. Conserve bone and nerves where possible, and protect them from further damage. Provide ample natural drainage for the potentially infected wound and delay final closure.

f. Drainage. Adequate natural drainage of infected areas promotes healing. Generally, wicks or drains are unnecessary. On occasion, however, it may be better to remove an accumulation of pus (abscess) and insert light, loose packing to ensure continuous drainage. Sterilize the knife or other instrument used in making the incision for drainage to avoid introducing other types of organisms. The best way to sterilize in the field is with dry or moist heat.

g. Dressings and Bandages. After cleansing, cover all wounds with a clean dressing. The dressing should be sterile; however, in the survival situation, any clean cloth helps protect the wound from further infection. A proper bandage anchors the dressing to the wound and affords further protection. Bandages should be snug enough to prevent slippage, yet not constrictive. Slight pressure reduces discomfort in most wounds and helps stop bleeding. Once in place, do NOT change dressings too frequently unless required; external soiling does not lessen the effectiveness of a dressing. Pain and some tissue damage accompanies any removal, and changing dressings increases the danger of infection. h. Maggot Therapy. During World War I, maggots were an accepted treatment for infected wounds. They ate infected and dead tissue from those wounds. Before you decide to use maggots, however, remember that you must expose the wound to flies to introduce maggots. Because of their filthy habits, flies are likely to introduce other bacteria into the wound, possibly causing more complications. Also, maggots invade live, healthy tissue when the dead tissue is gone or not readily available. Despite its hazards, however, consider using maggot therapy when you do not have antibiotics and the wound does not heal, has become severely infected, and ordinary debridement is impossible. 

12. ILLNESSES Many illnesses that are minor in a normal medical environment become major in a survival situation when the individual is alone without medications or medical care. Use standard methods (treat symptoms) to prevent expected diseases since treatment in a survival situation is so difficult. Key preventive methods are to exercise, maintain a proper diet, and maintain a current immunization record.

a. Food Poisoning.

(1) Food poisoning is a significant threat to survivors. Due to sporadic food availability, excess foods must be preserved and saved for future consumption. Methods for preservation vary with the global area and situation. Bacterial contamination of food sources has historically caused more difficulty in survival situations than ingesting so-called poisonous plants and animals. Similarly, dysentery or water-borne diseases can be controlled with proper sanitation and personal hygiene.

(2) If the food poison is due to preformed toxin (staphylococcus or botulism), supportive treatment is best. Acute symptoms occur (nausea, vomiting, and diarrhea) soon after ingesting contaminated food. Keep the patient quiet and lying down, and ensure the patient drinks substantial quantities of water. If the poisoning is due to ingesting bacteria which grow within the body (delayed gradual onset of same symptoms), take antibiotics (if available). In both cases, symptoms may be alleviated by frequently eating small amounts of fine, clean charcoal. In a prisoner of war situation, crush chalk, if it is available, to powder and eat it to coat and soothe the intestines. Proper sanitation and personal hygiene help prevent continued reinfection or spreading infection to others.

b. Skin infections. Boils, heat rash, and fungal infections rarely develop into serious health problems. However, they cause discomfort and should be treated.

(1) Boils. Apply warn compresses to bring the boil to a head. Then open the boil using a sterile knife, wire, needle, or similar item. Thoroughly clean out the pus using soap and water. Cover the boil site and check it periodically to ensure no further infection develops.

(2) Heat rash. Keep the area clean and dry. Apply powder if available. A cold compress may help relieve itching. (3) Fungal infections. Keep the skin clean and dry, and expose the infected area to as such sunlight as possible. Do not scratch or use strong substances such as iodine and alcohol. You cannot “burn out” fungus. 

c. Intestinal Parasites. You can usually avoid infestation of worms and other intestinal parasites if you take preventive measures. For instance, never go barefooted. The most effective way to avoid intestinal parasites is to not eat uncooked meat or raw vegetables that may possibly be contaminated with raw sewage or human feces used as fertilizer (night soil). However, if you should become infested and lack proper medicine, you might try one of the home remedies. Keep in mind, though, that these home remedies are not without danger. Most of them work on the principle of changing the environment of the gastrointestinal tract.

* Saltwater – Mix four tablespoons of salt in one quart of water and drink. Do not repeat this treatment.

* Tobacco – Eat 1 to 1 ½ cigarettes. The nicotine in the cigarettes kills of stuns the worms long enough for your system to pass them. If infestation is severe, repeat treatment in 24 to 28 hours, but not sooner.

* Kerosene – Drink no more than two tablespoons of kerosene. If necessary, you can repeat this treatment in 24 to 48 hours, but not sooner.

* Hot Pepper – Peppers are effective only if they are a steady part of your diet. You can eat them raw or in soups or rice and meat dishes.

d. Diarrhea. This is a common, debilitating ailment caused by such things as a change in water and food, drinking contaminated water, eating spoiled food, becoming fatigued, and using dirty dishes. You can avoid most of these causes by practicing preventive medicine. If you get diarrhea, however, and do not have antidiarrheal medicine with you, you may find one of the following treatments is effective:

(1) Limit your intake to fluids for 24 hours.

(2) Drink 1 cup of strong tea every two hours until the diarrhea slows or stops. The tannic acid in the tea helps control diarrhea. Tannic acid is also found in the moist inner bark of hardwood trees. Boil the inner bark for two hours or more to release the tannic acid. Although this solution has a vile taste and smell, it stops most cases of diarrhea.

(3) Make a solution of treated water and one handful of ground chalk, charcoal, or dried bones. If you have some apple pomace or the rinds of citrus fruit, add an equal portion to the mixture to make it more effective. Take 2 tablespoons of the solution every two hours until the diarrhea slows down or stops.

NOTE: You should drink a lot of liquids to replace the lost fluids. 

13. AVOIDING ILLNESS In a survival situation, the dangers of disease are multiplied. Applying the simple guidelines [that] enable the survivor to safeguard personal health and that of others. 

 1. Keep all immunization shot current.

2. If possible, get seven to eight hours of sleep each night.

3. Purify all water obtained from natural sources before consuming.

4. After each meal, clean and disinfect eating utensils in boiling water.

5. Remove all can, refuse, and food scraps from the camp area and bury them.

6. Exchange wet clothing for dry clothing as soon as possible to avoid unnecessary loss of body heat.

7. Personal items (pipes, canteens, towels, toothbrushes, handkerchiefs, and shaving items) should not be shared.

8. Do NOT soil the ground in the camp area with urine or feces. Use latrines if available. If latrines are not available, did cat holes and cover the waste.

9. Bites and insects can be avoided by keeping the body clean, wearing proper protective clothing and using a head net, improvised bed nets, and insect repellant.

10. Cleanse the mouth and teeth thoroughly at least once daily. Most dental problems associated with a long-term survival situation can be avoided by using a toothbrush and toothpaste to remove accumulated food. If necessary, improvise devices for cleaning the teeth.

11. Never put fingers and other contaminated object into the mouth. Wash hands before handling food or drinking water, before using the fingers to care mouth and teeth, and before and after caring for the sick and injured. Also wash them after handling any material likely to carry disease germs.

14. HERBAL MEDICINE Our modern-day wonder drugs and fine laboratories and equipment have obscured the old-time "country doctor' medicine--determination, common sense, and a few primitive treatments. In many areas of the world, however, people still depend on the local witch doctor or healer to cure their ailments. Many of the herbs (plants) and treatments they use are as effective as the most modern medications available. In fact, many modern medications come from refined herbs. For example, the white, stringy part of the rinds of citrus fruits and the apple pulp (apple pomace) left after pressing out the juice contain pectin. However, you should use herbal medicine with extreme caution and only when you lack or have limited medical supplies. Some herbal medicines are dangerous and may cause further damage or even death. Small doses of valerian root, for example, are effective in treating headaches and insomnia. In doses exceeding 1/2 teaspoon per day, valerian can aggravate the headache condition and cause delusions.