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Wilderness/SHTF Wound Management

18K views 104 replies 22 participants last post by  since9 
#1 ·
I've seen a lot of threads about first-aid classes and first-aid kits.

All of these things are great, but they presume that definitive medical care (i.e. a hospital) is readily available, and all you need to do is keep a patient alive for a few minutes until help arrives.

Which, of course, made me ask the question "well, what if the only definitive care is you?" and "what if there are no hospitals anymore?".

This article describes what to do with wounds when you're out in the woods (an "austere environment") and you can't get to a hospital easily. It still presumes that evacuation to definitive care is eventually possible (e.g. with tourniquets), but it nonetheless gives great information about what to do with wounds. It also suggests things that people would want to have in a SHTF medical kit, which you won't necessarily have in your "I live in the civilized world" medical kit.

http://www.wemjournal.org/article/S1080-6032(14)00112-4/fulltext
 
#3 ·
That is a great resource!

Personally, if your "first aid" kit does not have pressure dressings in various size I don't see the point. I recommend a cauterizing pen, an epi pen, big and small butterflies (glue if you know how to use it), as well as a bunch of full tubes of anti-biotic ointment.

Any kit that just has Band-Aids and items for minor cuts/irritations is nearly worthless. To me first aid is for something serious, not anything that will take a Band-Aid to fix. Those are just to get my kid to quit crying.
 
#4 ·
The interesting thing is that, for big contaminated wounds (which, let's face it, are the ones we are worried about), the recommendation is that they be left open to heal by secondary intention (from the inside out) with good wound management. Doing that (including wet-to-dry dressings) is something that most people don't know how to do, but can easily be learned even with little medical training.

My SHTF medical kit will contain:
- a couple of towels, that can be cut up and boiled for dressings. Or used for regular towel things.
- one or two ACE bandages
- a high-quality standard suture kit (which has forceps and a clamp, so can be used for more than just sewing)
- a variety of different types of suture
- a couple of vials of lidocaine for local anesthesia
- a few needles and syringes
- a scalpel handle, and a bunch of #11 scalpel blades
- a large syringe and IV catheter (for wound irrigation)
- some form of hemostatic agent
- > "over the counter" pain relievers for use and barter.
- Zofran (medicine to stop barfing, because if someone needs fluids, I won't be starting any IVs and carrying around liter-bags of saline - they're gonna have to drink)
- one or two oral antibiotics, definitely including Bactrim

Other stuff, like a tourniquet, will be things that I have for other reasons, that can be repurposed to serve a medical function. I don't want to be weighed down by a medical kit. Although if I stay at home, I can do a lot more with just the stuff I have stored in my cabinet.
 
#5 ·
Dr. Gimme Coffee I am just a welder . Anyone traveling with me will be at a extreme disadvantage on the medical side .

Don't get me wrong i have done IM type shots for my son , choking , know CPR., and some common sense stuff . But the large trauma's i am not going to be the best person for it . I just have basic first aid kits .
 
#7 ·
Some of the stuff just can't be treated outside a hospital. Those are the people, in a SHTF world, who get the "I'm sorry, but you're not going to make it" talk.

But other stuff can be learned easily. For a big, non-fatal wound, you pick out the obvious contaminants. You squirt about a liter of drinking water under moderately high pressure around inside the wound. You take a wad of gauze or a piece of towel, wet it with drinking water (not too wet), and put it inside the wound, then cover it with an ACE wrap. In a few hours, the wet stuff dries, so you pull it out and do it again, over and over until the wound heals (that's a wet-to-dry dressing). Easy-peasy! Much easier than CPR, which is completely useless when the SHTF.

Of course, I will also gladly barter my services for a good pointy metal stick.
 
#6 ·
Sometimes the "best" person to stabilize a patient is worthless next to the person who is there. There are a whole host of procedures and maneuvers that I would be unwilling to attempt beyond first aid that I would most certainly attempt (on a loved one no less) if no advanced care was forthcoming. If you don't it's very possible that you'll be doing something far worse with a hacksaw or a shovel in the near future.

I have everything you recommend except:

- a couple of vials of lidocaine for local anesthesia
I have the spray.

- a large syringe and IV catheter (for wound irrigation)
Don't have.

- XXXXXXXXXXXX
Don't have (for obvious reasons)

- Zofran (medicine to stop barfing, because if someone needs fluids, I won't be starting any IVs and carrying around liter-bags of saline - they're gonna have to drink)
Don't have.

- one or two oral antibiotics, definitely including Bactrim
Don't have Bactrim, but I do have some old azithromycin.

I'm going to get some anti-nausea medication (over the counter) to put into it. I also keep antidiarrheal, and tummy pills as well as smelling salts. There is a large bottle of iodine in there too, which has more functions that just wound dressing. It's also nice to have nice to have some preformed splints or splint material for broken appendages (along with a few Ace Bandages) rather than having to improvise them. It kind of sucks we can't have sedatives, strong pain medication, and other prescription drugs in your SHTF medical kit as a civilian, but I can certainly understand the reason why not. Whisky has worked for a long time in a pinch.
 
#9 ·
Sometimes the "best" person to stabilize a patient is worthless next to the person who is there. There are a whole host of procedures and maneuvers that I would be unwilling to attempt beyond first aid that I would most certainly attempt (on a loved one no less) if no advanced care was forthcoming. If you don't it's very possible that you'll be doing something far worse with a hacksaw or a shovel in the near future.

I have everything you recommend except:

- a couple of vials of lidocaine for local anesthesia
I have the spray.

- a large syringe and IV catheter (for wound irrigation)
Don't have.

- XXXXXXXXXXX
Don't have (for obvious reasons)

- Zofran (medicine to stop barfing, because if someone needs fluids, I won't be starting any IVs and carrying around liter-bags of saline - they're gonna have to drink)
Don't have.

- one or two oral antibiotics, definitely including Bactrim
Don't have Bactrim, but I do have some old azithromycin.

I'm going to get some anti-nausea medication (over the counter) to put into it. I also keep antidiarrheal, and tummy pills as well as smelling salts. There is a large bottle of iodine in there too, which has more functions that just wound dressing. It's also nice to have nice to have some preformed splints or splint material for broken appendages (along with a few Ace Bandages) rather than having to improvise them. It kind of sucks we can't have sedatives, strong pain medication, and other prescription drugs in your SHTF medical kit as a civilian, but I can certainly understand the reason why not. Whisky has worked for a long time in a pinch.
Iodine! Forgot that - will add Betadine to the kit. According to the article, irrigating an animal bite with a mixture of water and Betadine can prevent rabies, and I sure as heck won't have rabies vaccine with me.

BTW: all I ever use is Ibuprofen.
 
#16 ·
If it's nonvenomous, it's just another wound. If it's venomous, then you either live or you don't. Unless you want to schlepp antivenin around and learn how to dose and administer it. Treatment and supportive care of an envenomation is probably too extensive to undertake in a SHTF scenario. Better just to avoid snakes. An overwhelming number of snake bites happen because the person who is bitten is drunk.
 
#14 ·
Great resource and something I'm sure we could all learn more about from you as well! Thanks for posting!!
 
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#25 ·
Hey, I was trained in hospitals (okay, granted, one of those hospitals was a public hospital in New Orleans, and we had to improvise a lot, but we still had operating rooms!). This is new learning for me, too - I'm trained to keep people alive until the surgeon gets there, not to keep people alive with a small bagful of stuff until the person gets better.

Seriously - if you have to choose between a US-trained doctor and a doctor trained in a developing country, pick the guy from the developing country. Those people can do a lot more with a lot less stuff.

I've been to a few wilderness medicine lectures, but I haven't taken a whole wilderness medicine course. Someday I'll do that, and I'll share anything I learn. Don't expect that in the near future, though. First I have to take my defensive pistol series, then some self defense courses...
 
#24 ·
Clean tap water will likely be a problem. Water run through a filter pump and treated with a little betadine is probably the most feasible substitute.

I don't get that statement either.
 
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#26 ·
That's been proven many times over - tap water is just as good as sterile saline. The bacterial content of tap water is so minimal that it doesn't contaminate a wound at all. We use tap water whenever possible in the ER, although all the irrigation devices that are available are set up to use a bottle or a bag of saline.

In a SHTF world, of course, there is no tap water. I guess I would just boil whatever water is available. Some microbes do survive boiling, but none of those cause wound infections.
 
#27 ·
Well, I'm just gonna throw it all out there.

I have put a lot of thought into this subject, but have almost zero REAL knowledge. Fully admit it.

I have bought a nurses drug guide book, first-aid, medical, student medical, college books, first responder, and otherwise types of books on the subject of medicine. maybe 20 in all. I haven't read them nor do I know what's good from bull.

I have a lot of animals, and have a lot of veterinary antibodies, but know little about their use.

I have a military type "field surgical kit" - with no idea how to use

I do not have a suture kit, or is there one in that ^^ ?? (I guess I do have some heavy gauge leather sewing needles, dark ages here we come!)

I do not have Bactrim or Zofran.

I do have mucinex, for adults and kids. Tylenol, aspirin, and advil, LOTS. cold medicine, benedryl, including the topical version. lots of Neosporin. enough hyrdocortizone

no epi pen.

gauze by the truck load, lots of non stick pads, many ace bandages and that blue stuff that sticks to itself. tape. lots of different types of tape

I do have some hemo-static gauze. not enough probably.

I do have a few bottles of sterile saline.

got the market cornered on all types of rubber gloves. (even the heavy dishwasher style)

got masks and safety glasses.

I've always been one to be good for thoroughly, gently, cleaning and dresses small wounds. I've always been decent at it I think. but I seriously need some real skills here.
 
#28 ·
Wow!! This actually has me thinking very hard.
I think SHTF and I'm ready with weapons, ammo, Food and water...
A simple dog bite or cut from rusty nail can kill me!
I believe my next mission will be to learn more about situations where Medical help will be needed.
I have a set of well trained and well informed friends that will come together.
We all have something to contribute that will be essential to our survival as a team but we are lacking in medical.
Gimme,,,, you have brought up points that myself and I believe many of us are lacking in.
we are great in self defense and preparedness but that is useless if we cant stay healthy or alive due to sickness or wound.
I have a lot to think about.
 
#33 ·
The fact is, a lot of people will die, and they'll die from things that can easily be treated today.

Even if I cart around my kit, with my Bactrim and Zofran in it, eventually that stuff will run out, too. Then we'll have to learn to make them again. I will probably carry around some "how to make Bactrim" information (it's one of the older antibiotics, too, so hopefully doesn't require fancy equipment).

I was always taught that "stuff doesn't save lives. Knowledge saves lives". I hope that's true.

IMHO, the most important thing I got from the article was "know how to clean a wound, know how to keep a wound open, and how to take care of an open wound".
 
#29 ·
More stuff:

For people who are collecting antibiotics (fish-tank or otherwise):

A lot of the sources that recommend which ones to get are old. You also don't want to carry around a ton of antibiotics. It's also a drag, and expensive, to keep up with the expiration dates, and to replace the expired ones. Unless you are allergic to Sulfa drugs, get Trimethoprim/Sulfamethoxazole (TMP/SMX), also known as Bactrim. It is the only oral antibiotic we have that treats MRSA, and it is very effective against it. MRSA accounts for a very large percentage of wound infections.

Bactrim also treats upper respiratory infections, diarrheal illnesses including Shigella (although most diarrheal illnesses resolve on their own, and should be allowed to do so), and urinary tract infections. It's very versatile. For me, if I'm only going to carry one antibiotic, Bactrim will be it.

Another important rule of antibiotics: don't treat a bacterial infection unless it's actually there. Except in a few cases, there is absolutely no value to start antibiotics "just in case" - in fact, when you do that, you are setting yourself up for getting a wound infection with some organism that's resistant to the antibiotic you just gave the person. Most upper respiratory infections are viral - no antibiotics for those, either.
 
#34 ·
See, I actually knew most of that. Not so much about Bactrim, but the rest. Still don't know enough about the proper use of antibodies. "know just enough to get in trouble" - is exactly what I DON'T want to do.
 
#38 ·
I was discussing this issue with a friend,,, if SHTF and there is mass looting and hysteria,,,
We may be better off going to the hospital while everyone is looting the supermarkets but we
are still at a disadvantage because we have no clue what we are looking for, where to find it and how to use it.
I'm thinking that we need a DR in our group.
 
#39 ·
You will probably find one at the hospital you're evacuating to.

The food will be really bad, though.

And lots of looters.

I figure I'll probably be at a hospital when the SHTF. I'll grab some pillowcases, take as much stuff as I can carry, and go someplace where there are no people. Of course, if I'm at the hospital, then I'll have no weapons. So I'll have to trade for one of those .22s that Jaeger will give me.
 
#42 ·
I recommend everyone take a first aid course.

I took a 6 week course offered by our city's fire department. We went over every type of disaster, including nuclear events. They taught us treatment of wounds, splinting broken bones, CPR, exposure to chemical and nuclear weapons, etc. We even practiced how to properly go through a burning building and help evacuate the wounded.

It was GREAT STUFF!!

Also, don't overlook info on treating burns. With no power, people will be trying to start fires - and I foresee a lot of accidental burns.

Everyone should also know how to shut off natural gas to your house.

And for those who are looking for like-minded people to bug out with, I recommend an EMT or nurse - and a pharmacist. Fortunately, my group has that - so I'm not too worried about medical care and antibiotics.

Edit to add: Make sure everyone is up-to-date on tetanus and other vaccines.
 
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#46 ·
Depends on how long you need to survive!

Up to an hour - anyone who knows how to put on an adequate dressing is fine.
A few days - anyone who can do wound care will work.
A few years/repopulate the world/re-establish society - you need people who know how to (or can figure out how to) administer anesthesia, take out an appendix, perform a c-section, diagnose and treat diseases appropriately, make opiates, ether, and antibiotics, and teach the next generation how to do it all.

The scary thing about the S hitting the F is that eventually, all the things expire, run out, or go bad. You need a whole bunch of people who can make new things again, out of only natural supplies.

I read a book once where the author made the point that the survival of humans in the post-apocalypse was really dependent on books, so that we could re-learn everything we've learned thus far.

But for now, wet-to-dry dressings. And Bactrim.
 
#47 ·
Don't forget the CELOX.

Also I did learn basic suturing but, I got more educated by an individual with a lot more medical smarts than I possess and have instead opted for the Wound Closure Strips...which everyone should have. :yup:

Also do not forget Moleskin & Blist-O-Ban. Foot blisters can stop folks dead in their tracks.
 
#48 ·
Don't forget the CELOX.

Also I did learn basic suturing but, I got more educated by an individual with I lot more medical smarts than I possess and have instead opted for the Wound Closure Strips...which everyone should have. :yup:

Also do not forget Moleskin & Blist-O-Ban. Foot blisters can stop folks dead in their tracks.
One great trick I learned about blisters: clean the blister really well, then take a scalpel or a really clean sharp knife and cut along one side of the base of the blister. Squeeze the blister goo out. Squirt in some Dermabond (skin glue; in a pinch, clean KrazyGlue will do). It hurts like no pain I have ever experienced before, but the pain only lasts a few seconds. After that, it makes a nice hard sealed thing, like a callus. You can put your shoes back on and keep going. I've heard that baseball players do this, although I can't verify that. And it hurts. Of course, I recommend that you don't do anything like this without the proper medical guidance, but if the S really does hit the F, you may need to do it yourself. Don't say I didn't warn you about the pain.
 
#49 ·
Reminder that any prescription meds that you have in your B.O.B. must be in their original bottles with the pharmacy label intact (& medication must match the bottle label) or you could be in deep doo-doo should the rule of law still be in place.
 
#50 ·
Regarding painful debilitating blisters. Even if you have fantastic fitting proper and tested footwear - if any person that you are traveling with does not then you will need to either help them out by treating their blisters, carry them...OR leave them behind.
 
#54 ·
Yea, I was going to say that a brick of .22s is probably ripping you off for medical attention if none is available. If my kid was sick and needed your help I'd open my gun safe and the APF (ammunition production facility) and you can take what you can carry.
 
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