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Introductory comments by mankindsmanycrossroads.com:
The following guide was originally published as an emergency wilderness medicine guide and was written by a forum member named FishsurferIII for Life After the Oil Crash Forum. In actuality it certainly applies to a disaster event where there is no professional medical resources available and consequently it can become very useful to you. It is written in a very laid back casual manner as one member would write to another. The content though is well done.

It is not meant to replace traditional medical attention rendered by medical professionals. It is meant as a guide as to what to do in the event emergency medical attention is needed in a remote location and professional medical providers are not available.

The actual forum post begins here:

I thought it would be a good idea to throw down a quick list of common wilderness medicine issues.  Something that can be printed and carried with ease, something that people can use without having to buy an expensive guide, that most likely isn't even tailored for wilderness medicine.  I'll try to keep it simple and easy on the eyes and brain for now. I'm going to include natural ideas as well as conventional. At the end of this 3 or 4 part series, i will include a list of medical items you are going to want on hand post peak.  For under a hundred dollars hopefully.   

First off, the best medicine is the medicine you don't have to practice.  Prevention, Caution, and Awareness are your best friends.  But sometimes, even the best of us get caught in a humdinger of a situation.  I've done it myself on several occasions.  Partly out of desperation, partly being stupid for just a split second. 

I'll lay this out in this format. Condition:, Signs and Symptoms, Potential Treatments.  A three pronged process.
Normally, as a provider, you do not want people diagnosing others or themselves.  But that doesn't matter for these purposes.  You are going to have to use your best judgment in the field.

Begin by thinking like this when considering the issue at hand.

Think of your body as a cohesive unit of cause and effect.  Its a highly maintained network of synapses, musculoskeletal movement, physiologic functions, and chemical reactions.  All talking to one another, trying to interpret information, and providing the appropriate status of function. 

Your bodies best state of being, it is in a state of Homeostasis. 
Defined: "a relatively stable state of equilibrium or a tendency toward such a state between the different but interdependent elements or groups of elements of an organism, population, or group"  ~Merriam Webster

Some basic relationships you need to know before you start diagnosing yourself.  A.K.A., Anatomy and Physiology.  You can spend years studying this. Its painful to do.  But we do not need to work down into the microscopic level of life here.  You need to understand the basics, so that you can correlate issues and identify causes. From the head down, the vital organs and then systems, what they do, how they work in a few sentences or less.

Brain: It regulates virtually all human activity through the nervous system. It is the base of operations.  When something happens, you must consider the brain as a source of injury, traumatic, infectious, or otherwise.  The head is fragile, take care of it.

Heart:   It is a machine the moment it starts working until it stops.  It is mainly an involuntary electric controlled organ.  What the hell does that mean?  Your brain is sending electrical signals which actuates the cardiac muscle cells of the heart, through a branching network of nodes, which have routes to operate when the heart muscle is not damaged, as well as routes and options to keep the heart functioning when it is damaged. Your normal sitting heart rate should be between 60-100. Avoid to much fat in diet, as well as salt content. Eat lots of veggies, fruits, and grains. In the latoc, ooften your workout will be simply fat-burning. You need to occasionally a few days a week, make it a cardio workout by doing exercises that will increase your heart rate around 150 beats per minute or more.  Some guys like Lance Armstrong can pump out nearly 190-200 beats a minute finely tuned.  You need large lungs for that oxygen requirement though.  You don't for a basic cardio workout, so do it. 

Lungs:  Your lungs are sacs of tissue that exchange air, most importantly oxygen, to the non-oxygenated blood (venous) in exchange for carbon dioxide.  You breathe in roughly 20% oxygen from air, and exhale 16% or so in return.  The rest is nitrogen.  Your body monitors Oxygen levels oddly, by monitoring CO2 levels.   

Kidneys: Your kidney's are part of a filtering system, that regulates body fluids and minerals.  It can determine what to let go, and what to keep in.  It balances Ph, regulates blood pressure through sodium ion balance, and monitors plasma volume, secreting hormones to act as an anti-diuretic, it keeps the water in you if you need it.  Also, it helps regulate red blood cell production, it can act as a diuretic by monitoring the mean pressure of the artery, the tone of the vascular system (diameter of arteries and veins), and  releases vitamin D, which regulates Calcium and Phosphorous levels throughout the body. It does alot of things. Which is why dehydration sucks and creates real problems very fast.  Its located on your posterior (your back) about in the middle. On either side of your spine, there are two Kidney's, normally speaking.

Liver:  It is yet another extensive, large organ working for you.  It plays a large role in metabolism and function, it stores glycogen (short term energy), decomposition of red blood cells, synthesis of plasma proteins, and of course detoxification. Its on your right side below your lung.  You can feel it right now with your hand. 

Spleen:  This is on the opposite side of your liver, it stores a reservoir of blood, destroys red blood cells, and functions also as a part of your immune system. 

Gallbladder: Primarily aids in digestion, by storing bile.  The ucky brown/green goo in your fecal operations. 

Pancreas:   Aids in digestion also, but also secretes important hormones such as Insulin and Glucagon.  Its keeping your blood sugar in check. 

The stomach, eyes,bones, intestines, sex organs, and bladder are rather self explanatory, but obviously important.  One more though.

Your skin It protects you from the environment, pathogens, regulates temperature, controls evaporation, insulation, sensation (your first line injury monitor), synthesis of Vit. D, and protection of Vit. B. folates. Skin in the post peak environment will be very oily.  This occurs when it loses moisture. I dont expect us to be applying lotion to make up for the ruggedness of our daily activities. Leave it oily, but be sure to clean it off at the end of the day to avoid uncomfortable skin conditions.  Otherwise, its a welcome situation compared to being dried out and loss of skin function to an extent. 

Some common injuries and conditions in a wilderness environment.

Hypoglycemia - your blood sugar is low.  You will feel yourself getting hotter, flushed, and weak.  You will lose focus and concentration.  You will feel nervous and physically shaky.  You will perspire, sweat, more so than you normally would. This occurs normally in a field environment as a response to a fasting condition or over-exertion.  Not enough food! If it continues long enough, you will lose consciousness and potentially die. Your brain needs sugar to operate.  Treatment: A low fat diet is important, as well as reasonable sugar intake. You can develop an addiction to sugar and fats, your body says it wants more by dropping your blood sugar rapidly (by introducing more Insulin, the opposite of sugars) to trigger you into eating something sweet or fatty.  Its like an addiction, can get worse over time.  In the wilderness, you can treat emergently by administering straight sugar, followed by something substantial to eat.  Sugar in the wild can be found in higher doses in fruits, tree sap (the easiest in my neck of the woods).  Some also look at adrenal insufficiency as a causal factor, the adrenal gland releases epinephrine and norepinephrine as well as cortisols (steroids) and androgens.  The most important factor in addressing insufficiency is stress.  You can reduce it with Ginseng, Licorice Root, and good old fashioned meditation.  This may help your body regulate blood sugar drops, which often occur during very physical activity, like the ones occurring during gardening or chasing an MZB out of your neighborhood.  Basically, when your stressed, your body fights or flights, releasing hormones to aid in that effort, it also increases demand for sugars.  Eat regularly, on a schedule if possible, and do not engage in physical activity if you don't have to without a good balanced meal onboard. Keep stress minimal by technique of your choosing.     

Dehydration:  This is a big no no.  Your body is mostly composed of water.  Just like oil, your body, like your commute to work, doesn't work well without fluids.  You'll get nowhere fast.  This can be caused by a variety of reasons.  Heavy prolonged activity, poor water intake, general illness, prolonged  exposure to dry air, blood loss from trauma, hyperthermia, vomiting, diarrhea, and burns to name a few.  Your body is constantly seeping out fluids as it filters, regulates and controls your bodies operations.  Keep water flowing at all times, thats the best prevention.  You'll know you are dehydrated best by monitoring your urine output.  How often are you going?  Hopefully several times a day.  What color is it?  Light yellow or clear (good) or is it amber or even brown? Does it have a strong odor?  Is your urine cloudy also, pay attention to that as well.  Also, you can check your skin turgor.  This is simple, just pinch your skin on your arm, it should snap back in place within a second or less.  If it does not, you are dehydrated.  You can also look at your veins, are they reduced in size?   Treatment-  drink something already!  Make sure its clean though.  If not, you hopefully already know how to make it clean.  Whenever you or someone else is injured or sick, doesn't matter the cause, give them fluids...even more than normal.  Often, Dehydration can become a secondary problem that occurs because of another primary issue, don't create even more problems from being dehydrated, its a cascading affect.  Your body will enter organ failure if its parts cannot operate.  Its very difficult to come out of that without modern medicine.

Hyponatremia:  This is low serum sodium, your blood isn't salty enough.  This happens especially when large fluid losses occur (see above condition).  You might as well treat your body in this light along with Dehydration when it happens.  The symptoms are basically the same.  Some risk factors that may make you more vulnerable are a lower body weight, being female, excessive drinking of water (water intoxication), extended performance and exertion, and kidney disfunction.  Treatment: Fluid replacement or stop drinking! If you are in a state of excessive fluid loss, either from dehydration or lost blood volume, you need to re-introduce fluids slowly.  Otherwise, it will just flow through you suddenly making the condition worse.  Look for something salinic(salty) also while re-introducing fluids; seafood, carrots, beets, meats and kelp are great sources of salinity in a pinch. If you have salt available in its own form, you can mix it in with your fluid solution in drinkable quantities.  You do not want to re-introduce this to fast either.  Some people on medications can also be naturally prone, so know who you are before tshtf. 

Bleeding:  This is a no brainer, no blood = no life.  It is the river of life inside you.  Preferably it works best inside your body and not in a coagulated pool.  How do you stop it?  Several basics ways, in this order, Direct Pressure, Elevation, Pressure Points, and  worst case scenario a Tourniquet.  Venous blood is dark and oozing, Arterial Blood is bright red and spurting. Example: If you have a serious arm laceration, and your artery is spurting blood into the air, place direct pressure (even if its not sterile), elevate the arm, and place pressure on your brachial artery located at the bicep (big arm muscle on top) and ventral (a.k.a. just next to your bicep closest to your body).  If a tourniquet is applied, you need to open it every 30 minutes if you can, just for a second or so, otherwise, tissue downstream may become affected in a negative manner from decreased blood flow.  Tourniquets can be made of nearly anything.  I've used one that I made by ripping down a vine off a tree and twisting it tight with a strong stick, tie in place for effectiveness. A belt, a shoelace, or even clothes can be used.  You might have to be creative.  Your body has the ability to clot and plug almost all major bleeding.  But it takes time.  Baby yourself while you heal.  Avoid raising your blood pressure while healing, if you have not lost too much blood, only drink a bit of water to prevent too much volume and increased blood pressure. If you are certain you have lost a large amount of blood, drink by all means.  Your body holds  6 quarts of blood. The human system can operate with losses in the range of 15-30% respectively.  Loss greater than 40% will require rapid infusion of fluids, you wont be able to do that in a wilderness environment.  That means death.  Loss of consciousness occurs around the 30% mark preceded by confusion.  Get someone to drink early in the slow entry into hypovolemic shock,  a staged process I'll discuss later, volume in the field environment by mouth is most likely your only resource, besides elevating the legs and forcing blood back to the vital organs.  Your legs hold a good amount of your blood.  Also, the healthier you are, the faster your body will respond and initiate protective actions to blood loss from trauma.

Section 2
The last section went over some basic info about common internal issues like Dehydration, Bleeding, Sodium Levels, and Hypoglycemia.  All 4 are individual problems of themselves, or problems that can occur one after another.  Thats why I grouped them like that.  When you see one, its highly likely you'll also be dealing with the other as well.  I know, it sucks, but thats what usually happens.  Apart from bleeding, the other three issues are basically preventable if you pay enough attention to your body.  In the post-peak world, your going to have to get used to listening to your body.  Meaning, taking note of your bodily functions, your performance, your energy levels, your urine output, your intake and frequency of other outputs, and other things.  Some of it is purely like a gut feeling, you have a hunch your missing something and your body is telling you, eat some greens, drink some water, wash your body, etc...  The body has a funny way of telling you what you need.  However, because we are Westernized mutants of a very very lush and convenient world, many of you have maybe lost touch of listening and feeling your needs as they occur, before they become a problem.  Tribal folks can do this, so do others, you will have to do so as well.  Thats something you can practice now before tshtf, give it a shot. 

The next segment will go over some common trauma issues in a post peak environment.  You will probably come across these things with yourself or others, especially in the period before people start learning to adapt to their new foreign surroundings. Thats going to take time, its a dangerous world without electricity and finally manicured lawns, roads, and other man-made and natural surroundings not being kept up by man and his machines.  The world will turn into a harsh industrial wasteland, full of hazards at every turn.  Scraps of metal (had your tetanus updated yet), unstable structures, rampant insects and animals recapturing their environment, hazardous materials leaking into your communal spaces and stomping grounds, broken glass and rubble, fires, and probably a million other things around us.  So, what can you do about all that?  Frankly, not much other than kick up your situational awareness meter a few notches to the high setting.  Even so, you're going to be faced with minor and major injuries along your way.  Either yourself or others.  You need to know what to do. 

As I said, this section will cover some trauma injuries and treatments.  Some may not be familiar to you, and you can't really practice most of them.  We all have a first at everything, someones life may depend on you so take some notes or print this out, buy a field guide or something.  I have done all of these procedures and cases at one point or another, in mostly non-hospital environments.  Some work well, some create more problems if you don't make the right decision.  Regardless, your not expected to make Doctor like decisions with perfect medical accuracy.  Your no ER doc for sure most likely, but you can play one for the time being if you absolutely have no other choice.  No evacuation, nobody to run to, and the seconds counting down. 

First, lets look at the concept of trauma and what it means to your body and vitality. 

Physical Trauma defined:  "an injury (as a wound) to living tissue caused by an extrinsic agent"

Temporal (time) aspects of Trauma injuries (General):  -minor trauma not involving multi-systems, such as a minor fracture or laceration, are not as much time sensitive as they are a pain in the ass, to be blunt.  Trauma that involves multi-systems, is generally correlated with a rather severe mechanism of injury (such as a fallen tree, an explosive blast and burn injury, or fall greater than 2 stories) is time sensitive and falls under the conditions people in emergency medicine term as meeting the criteria for treatment within "the golden hour".  What this simply means, is that this person is going to be potentially fixable and treatable within the first hour of the injury.  Beyond that, the persons chances are greatly reduced without definitive care, usually surgery under modern definitions.  I may get into some field surgery later on, I will go over some minor surgical procedures anyone can do to save some one in this segment.

Fractures:   

Fractures occur in several dozen forms.  You may have heard of hairline fractures, butterfly fractures, closed fractures, open fractures, and spiral fractures to name a few of them.  They are complex sometimes to treat.  But in a field PO environment, no doctors around to help you, the best you can hope for includes healing without much complication or total fubar state and potential for death.  Yes, fractures can kill you, if its in the right spot (a pelvis fracture for example).  I'll go from simple to basic, by body part, not tailoring treatment for modern medicine and surgery.  We're talking basics here, thats all you can hope for in the post peak world, unless of course you happen to be a orthopedic surgeon. 

Arm and Leg Fractures:

Your arm consists of many hand bones (27 bones) as well as the Ulna (the bone on the bottom of your forearm) the Radius ( the bone on top of your forearm) and the Humerous (the biggest bone that your biceps and triceps are hanging onto). 

Ulna, Radius, and Humerous fracture: Sometimes its hard to determine if something is fractured, generally, if its very painful, swelling exists, and deformities obviously (if they are present at all), then you have a fracture. Treatment Well, this isn't the Mayo Clinic, I'm not going to tell you what to really do about it.  But what you CAN do about it for now.  First, is the fracture obviously deformed? (Does it look strange and abnormal, does it freak you you out).  If so, take off their jewelry or watches or really anything that can impede circulation or potentially become stuck on the wrist or otherwise through swelling...now, realign the fracture to its most normal position.  This is not what your told to do right now, with a hospital nearby, trust me they wont like you if they find out that you did this.  So do not do this unless your in a truly wilderness post peak no hospital environment.  Realign the fracture, you may feel the bone "scratching" against the other part of the broken bone.  Yes, this will freak you out.  But do it, so they don't have to deal with a deformity. It may help to slightly place traction, (pull out on the fracture while pushing the the other side away from you, slide the bone back into place as best you can.  This may hurt, but its quite possible you will relieve them of major pain at the same time.  I've seen people go from screaming to nothing after resetting the bone back into place. 

Take note, there is nowhere in your body that you will not be dealing with other things while you "fix" it.  Especially blood vessels, muscles, tendons and ligaments.  You must be gentle, yet at the same time forceful enough to get the job done. 

On your arms you have arteries and veins that run right alongside every major bone. They are fixed to them of sorts.  You do not want to cause internal bleeding from being to forceful and lacerating an artery while moving a splintered sharp bone back into place.  So do it ever so cautiously. There is some recourse to this.  Check a pulse before, after, and even during realignment.  Now, if you are setting a fracture on the Ulna, it makes no sense to check a pulse for good circulation in the antecubital space (a.k.a. your elbow area, where they place needles for donating blood or giving IV's commonly)  You are going to have to check circulation BELOW the injury.  In the case of an ulna fracture, check for a pulse on the wrist. Same goes for a Radius bone fracture.  A Humerous fracture can be checked in the antecubital space.  And do check these things folks, you need to know if setting the fracture has caused an occlusion of the artery especially or the vein.  If so, realign the fracture until you get it right.  This can be an issue, and take several attempts until you get it right.  You can also check circulation by assessing any numbness and tingling, as well as capillary refill on the fingers (push down on your fingernail and then let go, it should turn red to white within a few seconds if normal) Thats your blood refilling the capillary spaces under your nail beds.

Finally, as with all fractures, you are going to want to cast or in our case splint the fracture.  With an arm fracture, its very difficult to splint it efficiently and effectively.  Once the bone has been set, and the person is done calling you an asshole, or not, you need to splint the arm by using several things. 

Ulna and Radius Splinting:     
1. Place a board, or other hard flat item, approx. the length from just past the elbow to just under the hand. 
2. Give the person a sock, or other item that can be held comfortably (a rubber ball, a shotgun shell, etc...) and have them hold it in their hand. 
3. Wrap the concoction with strips of cloth from your clothing, or even possibly something else like green cordage like vines etc...  Make it tight enough to keep the board and arm in one position, but not so tight to screw up their circulation, secure it with tape, knots, etc...
4. Sling and Swath the arm, take a square piece of cloth, fold it in half into a triangle, wrap the bigger portion of the triangle under the arm, with the arm going through the triangle.  Take one end and bring it behind, the other in front, and tie it around the neck so the arm is parallel with the ground or perpendicular with the ground. Also, you need to swath the arm to the body.  This keeps it from swinging out and close to the body.  You can wrap a piece of cloth around the arm and under the arms around the torso, don't make it to tight. Monitor circulation for at least 30 minutes after the procedure and intermittently after that.  Numbness and loss of a pulse is a good sign your going to have to start over.   

These bones will take some time to heal.  The healing process for bones is wonderful, they do it naturally.  The capillary blood vessels reattach and grow themselves to one another, the bone starts to begin creating new bone, and finally everything comes together as one bone again.  For the arms, it can take as soon as 3 weeks for children, 6 weeks for teens, and longer for adults.  To be safe, I would give your arm at least 6 weeks, if not 7, before performing anything substantial with it. Smoking also slows down your healing process by the way, so take this opportunity to quit.  Unless its for pain control, you get the picture...  Generally, use the post peak living condition to quit smoking.  Duh.   

Leg Fractures:

Pretty close to what you do for arms, but modified, and with some more focus on arteries.  You leg mainly consists of the Femur (thigh bone), the Tibia and the Fibia (the two bones from your knees down to your ankles).  You also have a Patella bone (kneecap) as well as foot bones which in total give you support and motion for a hefty amount of weight.  Nonetheless, these bones are more pronounced from a size standpoint and general construction.  You also have arteries running along the bones. The main one being the Femoral artery.  People have actually died from internal bleeding into the leg.  If you think about it, how much blood can you fill up into your leg?  Its a good amount. 

A fracture of the femur is going to require you to place traction on it.  If you have two people, one can push while the other pulls.  If your going it alone, your going to have to place your leg in their groin area (i know i know, ha ha ha, you wont be laughing), then pull back with your hands on top of the foot.  This will relieve the person of pain momentarily and also hurt in the process.  The traction allows for the bones to be straightened out, and for the arteries and other blood vessels to "snap" back into place.  So. if you have a deformed femur fracture, and the artery is "kinked up" (remember you can check this by assessing the pulse and cap refill), then you can straighten it all out before you set it.  Setting it in line while under traction by yourself is hard to do.  Basically, your going to simply perform traction...look for alignment..redo as needed, but try to avoid that. Move it up, down, left or right, or all 4 until the leg seems to be straight again if you absolutely have to, otherwise let the traction realign the bone.  Do it slowly obviously.  When your finished, check circulation, rinse and repeat until it looks right.  Its gonna hurt.  If you can give them a pain med, or even a shot of whiskey for god sakes, then do it.

Splint by taking a sturdy stick, or other rigid apparatus, and fix it to the injured leg.  Make sure you try to tie the rigid splint in 4 places.  Two above the knee, and two below the knee.  You can place padding on the top of the splint near the groin area.  Get it as high and low as comfortable. Splint with the foot at 90 degrees if possible. This person is going to be bed or ground ridden for quite sometime.  Eventually, the person may be able to use crutches to move around.  But for now, set up a shelter around them, or use a tarp or other long piece of material (like a tent) to drag them into safety.  Keep them warm, give them fluids, feed them, they are your baby for the next week or two at least.  If you went so far to splint them and set the fracture, you might as well finish the job right. 

This injury requires alot of attention to the circulation.  The only place thats going to be available most like to do this is at the foot, the pedal pulse, or possibly the anterior tib pulse, but not likely.  Take off the socks, place you fingers between the big toe and the  one next to it, use two or three fingers, do not press down to hard, it will be faint most likely.  Press on the nails of the foot also and check the cap refill time.  The anterior tib pulse can be felt by locating the shin, just above the ankle, feel for the muscle that faces outwards, check for a pule between that muscle and the shin bone (the tibia).  For me, my anterior tib is easier to find than a pedal pulse.  Everyone is different, someone people are nearly impossible to find without doppler. 

Open Fractures:   

These are fractures that feature the bone actually extruding out from the skin.  Its nasty.  I've seen open humerous and femur fractures open myself.  They are the more common ones. 

These are a bit more tricky.  Now your dealing with infection issues, the skin has been broken and the bone and other tissues are exposed.  The best thing you can do to prevent this is properly irrigating the wound and bone with copius amounts of clean, if not sterile water.  I personally would boil water first, let it cool and then gently and slowly pour it over the open fracture and bones and the laceration.  Let the water remove the bacteria and debris.  If you have to, go ahead and gently brush off dirt, twigs, or other materials.  Dont touch it to much though, the last thing you need to do is put your dirty fingers in a dirty wound.  Use some sterilized tweezers if you have them in a swiss army knife or hopefully your medical pack.  If you have iodine or other sterilizing agents use those to top it off after the water irrigation.  You need to pour at least 2 liters over the wound.  Place traction on the bone, it should snap below the skins surface, if not, help it along...gently.  Set the fracture, then suture the wound if you can.  I'll go over that later, its easy to do and anyone can do it. 

Don't expect to heal normally back to full operation status.  Your gonna probably have a bumb arm or leg, or a limp etc...  But its better than having a totally worthless extremity that never healed anywhere close to what it could have been if you had intervened and tried to place it back into a better position.  Without x-rays, screws and plates, and an operating room...this is as good as its going to get. 

Fractured Pelvis:   You ever wonder why grandma died from a simple broken hip or pelvis?  Well, this fracture happens to be probably the most deadly fracture you can have.  Its loaded jam packed like a WHO concert with blood vessels.  Its a very high traffic area as far as blood circulation goes.  Everything going to your legs and back goes through the pelvis on top of internal organs with their own blood supplies.  Its a very very very risky fracture. 

How to check for a fractured pelvis:  You place both hands on the sides of the pelvis, gently lean on the pelvis and also push in on the pelvis.  Any movement of the pelvis in any direction or pain should be considered as a fractured pelvis. 

You only get one chance to move the pelvis!!!

There is nothing for you to "set".  All that you can do is to stabilize the Pelvis.  And thats what your going to do, only once, by taking a piece of cloth, 6-8 inches wide (a pelvic binder), and gently wrap around the pelvis and secure.  This will require you to get underneath (the butt), by lifting the pelvis up gently and as little as possible. And more moves than this is going to place this person at risk of death, if they are already not at risk.  You can severe blood vessels quite easily by making unnecessary movements.  Use your one movement to simply stabilize the Pelvis. 

Also, elevate the legs, gently (they are connected to the pelvis), to treat for shock. 

Along with the Pelvis, you should try and wrap the abdomen as well, this can lessen the potential for blood to enter into the bodies cavity by reducing the amount of space available for that to occur, by wrapping the abdomen with a good 8 or 10 inches of wrapping around the entire abdomen. 

They will be bed ridden for quite sometime.  Its going to take weeks and weeks for this to heal, as with other fractures. 

Theres a good chance this person is simply going to bleed out and die if the fracture happened to hit a major blood vessel.  Count your blessings and say a prayer for this kind of injury. 

Chest Trauma:

Chest trauma can suck.  Not much you can do about it.  Unless your a surgeon.  But doing some of these things can give them a chance. 

Some minor traumatic injuries. 

Clavicle and Scapula:  
The clavicle (collar bone) is the little short lengthed bone that runs from shoulder to just under the neck attaching near top of your sternum. The Scapula (shoulder blade), attaches the humerous with the clavicle.  Injuries to the clavicle are common, injuries to the scapula are not.  For both, sling and swath the arm(s) and monitor shortness of breath and tension pneumothorax (discussed further down). 

Broken Rib: Can be identified with pain localized to the rib, and/or crepitation (crackling or popping sound) when touching the affected rib.  Check also for increased pain upon inspiration (breathing in). Look at both lungs at the same time while breathing, ask yourself if one side goes up or down at a different rate than the other.  If so, treat for pneumothorax.  Sling and Swath to support injured side.  Continue monitoring for pneumothorax.

Flail Chest Injury:   This is a segment of broken ribs, broken in two or more places.  They move independently of themselves, this is a very very dangerous injury.  I treated a Captain in the Navy who got this after falling off his bike, go figure.  He lived.
Look for one side of the chest going in while the other goes out.  You'll know what it is when you see it.  This is life threatening. 

Place a padding of sort, a roll of gauze, something relatively flat really, along with something like a ziplock bag filled with sand or whatever weight measure you can come up with.  Place it on the flail segment directly, this will help stabilize it somewhat and reduce the pain potentially.  Wrap gently with a piece of 8 -10 inch cloth around the chest keeping it in place.  Getting this to heal on its own is hard and takes time.  Evacuation is the best option, it needs to be treated professionally honestly, but if you cant you cant.  Secure it and monitor their breathing condition for any signs of pneumothorax. 

Sucking Chest Wound:  No, this isn't an erotic move out of the Kama Sutra, this is a hole in the chest, penetrating trauma of a sort, a gun shot wound, arrow from a MZB's crossbow, or whatever. 

This injury is a hole, that extends into the pleural space allowing air to move in and out interfering with breathing.  Everytime you take a breathe, you are sucking air in, and not much is getting back out.  Your lung will collapse soon if not treated. 

Treatment is simple, place a piece of plastic in the shape of a square, tape it on three sides, got it 3.  This acts as a "valve" of sorts.  Only allowing air to escape but not come back in.  Well, hopefully, if you have done it right.  Monitor for Pneumothorax. 

Pneumothorax and Tension Pneumothorax:

When it gets to this point, things are bad, very bad most likely.  Your going to have to resort to extreme measures to save this persons life.  But it works.  Ive done it both in field and clinical settings, mixed results in the end sum total...but its better than not doing anything. 
Pneumothorax is air leaking into the plural space causing the lung to collapse.  A Tension Pneumothorax occurs when pressure builds up on one side of the lung and presses into the Heart and compromises circulation. 

When it comes down to figuring out what to do, use these clues to guide you? 

Is the Trachea deviated to one side?  Are the Jugular Veins distended (bulging outward like they are going to explode?), is the person only able to say more than 1 or 2 words?  They need intervention fast. They may not even have this presentation, they might just have a fast heart rate and difficulty breathing.  Normal breathing rate is 12-20 breathes a minute.  Much fast for children and especially infants.   

In a hospital environment, the person would get a chest tube ( thoracostomy).  A quick surgical procedure to relive tension and get the pressure off the heart muscle while relieving breathing.  You can't do this in the latoc environment, you wont have the equipment. 

The next best thing is to do an emergency needle thoracostomy. This means you have to do something less than desired.  You may have seen it in the movies.  Its a bit more complex than that, but not really. 

Take a decent sized needle, from an IV, preferably a 16 gauge or a 14 gauge ( i know you have this right?).  You have to have a hollow needle to do this, the chest must be decompressed, so the air needs to flow out.

Find the second rib and the third rib.  Find the space in between those in the center of that side of the chest. Usually about inline with the nipple, midclavicular.  Take the 14 or 16 gauge needle, slowly push it directly into the chest, at a 90 degree angle (straight up and down), keep going in until you can hear a whoosh of air.  Once you get to this point, remove the needle but leave the canula (plastic outer part of the IV needle on the outside.  Take a piece of plastic and wrap it around the top of the canula outside the chest, tape it on the bottom leaving a valve like action for air to come out but not come in.  Continue monitoring the person for an improved heart rate, improved breathing, and relief of trachea deviation, jugular vein distension (JVD) and normal speaking patterns.  They will hate you for doing this if they are conscious, but if they heal and live to tell about it they will thank you. 

This segment will go over assessments, soft tissue injuries, and a few misc. items.

The assessment is the most important thing in medicine.  Despite all the tools, precise hands, and quick thinking; you will have no basis from which to form an educated opinion about an injury to yourself or others.  it does not matter if you are treating yourself or someone else, following the same steps in a very organized practiced fashion will help you catch things most uneducated on the subject would miss. 

Example:  I was on a team competing in an adventure race, multiple event wilderness race like a la eco-challenge.  My team consisted of 3 guys and one gal.  We were all practicing medicine at the time, two doctors, a nurse, and myself the only one with wilderness and combat medicine training.  We were ascending to the top of a mountain to get coordinates for the next segment, the lady in t he group was running in the middle of our team pack, the PA and Dr. up front, me and the back to clean up the mess. As we were running up a very steep incline, basalt based and very treacherous, the lady fell into a small 5 ft hole and cut up her legs.  I was about ten feet behind her, as she fell, i noticed a snake slithering away the opposite direction.  I jumped down in this hole alongside the doctors who had already begun to splint her ankle and put gooey anti-biotics all over her.  I told them to stop, I pulled off the splint, looked closely at the front of her shin, didn't see anything.  I rolled her on her side, took a look at her calf, there was a snake bite.

  I knew the species, a Malaysian pit viper, not a real fun thing.  But this was the source of her pain, not the stupid cuts and scrapes and ankle.  I'm sure that hurt, but the bigger problem at hand was this snake, which has a venom that can destroy muscle tissue, cause necrosis, allergic reactions, extreme swelling, breathing difficulty, and serious infection.  On top of the mountain, there was no time to delay treatment and carry her out.

 Long story short, i used a snake bite kit to pull out whatever superficial venom was left in the wound, i placed her leg lower than her heart to prevent circulation, i irrigated it with every drop of water I could gather, a few gallons at least...and took off her shoes and socks and ankle bracelet.  A wrap bandage was placed to slow the movement of venom throughout the bloodstream (do not use a tourniquet) and the site was immobilized via splinting.  We lost the race of course, because we took her down the mountain, all 2000 feet straight down at dawn with little light.  She made it through with divot looking scar from the tissue destruction and some sutures, but it seemed she had avoided the worst of things.

 Now, if those Dr's had just wrapped her up and tried to carry her down, that toxin would of caused much more damage, it could have possibly been life threating.  They failed to do an assessment properly, to look for secondary causes of the fall into the hole.  As if she meant to fall into it?  She didn't know she had even gotten bit, she just fell from the pain and fell in the wrong place, a hole, which confused the whole situation. See what I mean, you have to consider everything as a cause for medical problems in the field (or anywhere for that matter), that all starts with a good assessment, a remaining methodical about it everytime you treat an injury.

An Assessment Method:

This is cake folks, its so common sense.  But its vital to think like this, because when seconds count, its extremely... extremely easy to overlook and miss a step, miss a snake bite...catch my drift.  By the time you figure something out, it may be too late. 

Go in this order: Should take less than a minute or two.

First is it safe for you to help them?  if not, wait or make it safe. 

Are they conscious?
Do they have a solid intact airway, are they breathing?  If not, make them breathe now.  Mouth to mouth etc.... dont forget to pinch the nose and life the head back.  Remove foreign objects, consider heimlich maneuver if you cannot get air in the lungs and they are unconscious.  You can do this either from behind or while they are laying down.  Look it up. 
Do they have a pulse?  If not, chest compressions.  If you witnessed the death, and you are there within a few seconds, you can do what old people still sometimes do, you perform a precordial thump...ie...you take both hands into a fist, and make a solid pound onto there chest, where the heart is.  This has actually worked, but its rarely done as most people do not witness cardiac arrest or they have a defibrilator on hand. This is only for a witnessed cardiac arrest, make sure they have no pulse before doing this, or they might be really mad at you.  Again, it takes some good force to get that to work.  But nonetheless...

An easy way to remember these steps is to use a mnemonic,  A,B,C, a.k.a. airway, breathing, circulation...  and in that order. If they are not breathing, they wont have a pulse, always secure the airway and breathing before you even think about working on the heart with compressions.     

If they are conscious:

Follow these steps along with the A,B,C,'s...

Your going to physically perform a hands on assessment.  Ask them if they feel pain as you do this. 
Head: Feel with both hands, starting at the top of the head, feel for skull fractures, lacerations, material embedded in the skin etc...  Look for lacerations, contusions, etc... 
Face:   Place gentle pressure on the forehead, work down towards and around the eye sockets, feel for fractures, crepitus, look at the eyes...are the pupils dilated or constricted?  Look in the ears, see blood?  Look in the nose, feel the cartilage, blood, or pain. have them open the mouth, look for broken teeth, missing teeth, blood in the airway, etc... 
Neck:     Look at the Trachea...is it deviated?  Look at their arteries and veins, are they oversized and pulsating?  Feel behind the neck, run your fingers along the cervical vertebrae, the back side of the neck, do they have pain? 
Shoulders: Feel the scapula and clavicle...is there pain?  Squeeze inward a lightly, is that painful? 
Chest:  Feel the ribs, all of them, are there any breaks or pain?  Look at the breathing, is it bilateral and equal...ie...does the chest move up and down at the same rate?
Arms: Feel the arms working from the shoulder to the fingers, feel for breaks, look for obvious deformities, look for lacerations and blood, look for signs of edema. Ask if they have pain here. 
Abdomen:  Lightly feel the abdomen, press down and move from segment to segment thinking of the abdomen as 4 quadrants.  If nothing, do it again, except this time, push down harder, really feel the guts, your looking for internal bleeding and pain, ask yourself if it feels normal?  Can you feel a cavity filled with fluids?  Is the gut bloated?  Is the pain more muscular than visceral?  You can take two fingers, tap on the four quadrants, and listen for a change in sound, it should be basically about the same. You can sometimes narrow down where the problem is, but at this point, its just extra information, all you need to know is if they are having pain in the area. 
Pelvis:    Be gentle, as mentioned earlier, this is a very vascular area, a mis-treated pelvis fracture can be fatal.  Lightly palpate the wings of the hips, the boney part sticking out.  Gently press in and forward, does it hurt?  if so, see section on pelvis fracture. 
Legs:  Check the leg bones, look for obvious deformities, look for contusions, scrapes, lacerations, and other injuries.  Feel the entire leg, front and back. Look at the feet, is there anything obviously wrong with that picture, like a foot sticking in the wrong direction?   
Backside:
If you have to, you can do this by yourself, but preferably, have three people.  One for the head, two for the body, roll them on one side in unison, while on their side, feel the spine for fractures and injuries, look for obvious contusions, lacerations, bullet holes, snake bites, rashes, swelling, and whatever else that is out of place. 

Your done.  That should have taken about a minute or so to do.  Keep them calm, tell them what you see, ask them what they feel. 
Make a list of priorities.  ABC's a question?  Secure them, have them focus on breathing, keep it even, in control.  If they are having issues with vomiting, have them lie on their side.  Something like a serious bite, can cause vomiting, same with a head injury.  Differentiate and treat. Do they need serious intervention? See thoracostomy...   If bleeding is present next, treat it. Stop it, by the four means I gave you, by whatever means.  If they bleed to death while your wrapping a sprained ankle, then you have chosen the wrong path grasshopper.  Basically, treat the most life threatening injuries first; scrapes, cuts, bruises, later.  Do they have broken bones next?  Stabilize them, splint, set, and make them comfortable.  This process often can reduce the pain from a borken bone as mentioned earlier.  Do they have internal issues like a ruptured spleen?  Remember where that is right?  Give fluids and monitor.  After all is said and done in the initial treatment, begin the secondary issues.  Do you need to suture them?  Irrigate the wound, bandage, etc...?  Do it now, these are left last because they probably are not serious.  You can stop them from bleeding if it is oozing too fast with a pressure bandage.  If this is arterial, you have to treat it along the same lines as if the person is not breathing.  Bright Red and spurting = bad, fix it.  A hemostatic bandage is an excellent thing to have in your packs folks, these things save lives, but they are pricey.  Watch, wait, re-assess vital signs (Breathing Rate, Heart Rate, and Blood Pressure) 

These brings me to this...how the hell do check someones vital signs without a blood pressure cuff and stethoscope?  It much easier than you think, its a bit archaic and sometimes very questionable academically and in a hospital environment a no no really...but it works in a field environment. Its all that you have.  Your going to use the pulse locations to judge how healthy the blood pressure is.  Keep in mind, a healthy normal BP is 120/80.  Now, check the wrist first.  Can you feel it? If so, the blood pressure is at least 80/something.... if you cannot feel that, check the femoral pulse (its in the inner leg, right next to the groin, very deep so feel for it ), if they have this, you can say non-academically the BP is at least 60-70/ something....  If you cannot feel this, check the neck (carotid), if they have this, the BP is at least 60-70/ something....  If they do not have this pulse, the blood pressure is very low, there are multiple causes that can occur to make this happen...treat for shock and give fluids by mouth or IV, which you will hopefully have.

 In an emergency, where this person is obviously struggling, and it obvious this is a BP and heart issue, you can do something about it.  If they have a fast heart rate, above 150 say, continuously for several minutes, low blood pressure or not, chest pain likely, and decreased consciousness, you are going to perform what is called a Vagal Maneuver.  This is a non-pharmaceutical way to fix the fast heart rate, that has been sustained, and to stabilize the blood pressure and recover consciousness.  Do not teach people this, it can seriously hurt you if you do not truly need this.  You are using the Vagus nerve to trigger a parasympathetic response to the heart of tone and conduction.   

There are 2 common ways, both can be used.  The first is simply having the person, or yourself, bear down as if your going to have a bowel movement.  Squeeze down and hold.  Release, and repeat. Do it for a minute or two.  Re-assess heart rate, has it helped?  If you are having someone else do this, monitor the heart rate while they are doing it, when it gets down to 100 heart beats a minute, stop!  Sometimes this can happen fast, sometimes it wont do anything.  If it doesnt work, do another Vagal maneuver called Carotid Massage.  Lie them down, hyper-extend the next back, feel for the carotid pulse on the right side, apply a gentle massaging motion for 5 to 10 seconds.  Re-assess, check heart rate, are they confused?  If this does not work, wait 2 minutes and repeat again, 5-10 seconds. 

If none of this does anything, repeat from the top, this time place a cold watered down towel over the face, this is normally only used for kids.  But were getting desperate, so do it, Ive seen it help in adults in a few occasions.  Very rare though.  If you have ice, thats even better.  The colder the better.  Do not do these Vagal Maneuvers without great caution.  In a hospital environment, its pretty rare, people with stroke, bruits, etc... will not get this done to them.  At this point though, in a wilderness environment, this is all you have left.  Be careful, you can kill them doing this.  In all seriousness.  Last ditch move at best.     

If this doesn't work, keep running through everything again.

I'll do soft tissue injuries next...

Some books:

Merck Manual 17th Edition 19.99
Merck-Manual-Diagnosis-Therapy-Centennial

Special Operations Forces Medical Handbook, ring bound and waterproof, my favorite, 400 dollars...ouch.  Might find it cheaper.

http://www.amazon.com/Special-Operations-Forces-Medical-Handbook

Medicine: For Mountaineering and Other Wilderness Activities

http://www.amazon.com/Medicine-Mountaineering-Other-Wilderness-Activities

Medical Dictionary,  if you want to understand what the other books are telling you, and you have little to no background, this will help you greatly. 

http://www.amazon.com/Merriam-websters-Medical-Dictionary-Merriam-Webster

Merck 1800's Era Book, great because it has the old remedies of the old days before modern medicine (what you will be dealing with), mostly handmade herbal stuff.  Its hard to find such a collection in such a jam packed book, and its only 2 bucks, leather bound.  Pocket sized. 

http://www.amazon.com/Mercks-Manual-Materia-Medica-Ready-Reference

Alrighty, here a is a basic field kit.  Note, this is more or less designed for actual wilderness medicine.  Not really a homestead kit.  Something more mobile than that, something you could bring on horseback or while out hunting or bugging out.  Im trying to look for things that are reasonably priced yet of decent quality to be meaningful.   


1.  Field Suture/Surgical Kit
http://www.amazon.com/Molle-Military-Field-Surgical-Instrument

2. Hemostatic Bandages
http://www.amazon.com/CELOX-Hemostat-Blood-Coagulent-Packet/

note: if you buy these two together, it is discounted.  The hemo bandages are used to clot arterial bleeds or whatever major bleeding you need to stop in an instant.  The stuff works. 

3.  Kerlix Gauze Wraps
http://www.amazon.com/Kerlix-Gauze-Bandage-Rolls-yards

Buy lots of these, they are invaluable and cheap. Hospital grade stuff.  ]

4.  4x4 Gauze 200 ct
http://www.amazon.com/Curity-Gauze-Sponges-12-ply-2634

These are cheap as well, invaluable, get lots of them.   

5.  Scalpel Blades
http://www.amazon.com/Scalpel-Blades-10-Bx-100/
They snap into a scalpel handle in your surgical kit.  Use for trimming up tissue from lacerations or whatever needs to be cut on the body safely and in a sterile manner. 

6.  Sutures (4.0 Nylon) good all around size and strength suture of hospital grade. 

Surgical+Sutures

7.  Medical Tape

E_Transpore+1%22+Plastic+Tape

8.  Betadine  -the standard topical microbicide kills nearly everything. 

http://www.metromedicalonline.com/l01068.html

9.  Chest Dressings for those pesky GSW's and other fun penetrating trauma, to alleviate pneumothorax.   

http://www.narescue.com/Hyfin-Chest-Seal-P93C205.aspx

10.  Combat Tourniquet

Combat-Application-Tourniquet-C-A-T---Tactical-Black-

11.  Reusable Sam Splints  very cool and very versatile.  Can bend anyway you need them to splint something. 

http://www.amazon.com/Padded-Aluminum-SPLINT-4-25-36/

12.  Bacitracian Ointment  - can never have enough anti-bacterial ointments

http://www.amazon.com/FOUGERA-BACITRACIN-OINTMENT-TUBE/

13.  Trauma Sheers -they can cut through steel but they are perfect for cutting off clothes, boots, and bandage applications. 

http://www.amazon.com/TRAUMA-BANDAGE-SCISSORS-UTILITY-SHEARS

14.  Large Trauma Dressing -god forbid you have to use it, but if you need to really pack a wound or cover a large area, these large dressings are what you need.  The little ones just wont cut it. 

http://www.amazon.com/Dynarex-MULTI-TRAUMA-EMERGENCY-DRESSING/

15.  Moleskin  - good for blisters and any other areas especially on the feet getting tender.  Like a second skin. 

http://www.campingsurvival.com/mopldrscpran.html

16.  Apinol  - oil used for local anesthetic and antiseptic

http://www.campingsurvival.com/appinoillocm.html

17.  Colloidal Silver

http://www.campingsurvival.com/cosias.html  -patented high strength formula, bacterial infections treatment 

18.  Burn Gel

http://www.amazon.com/WATER-JEL-BURN-GEL-PACKETS

19.  Betadine Swabs   - good for smaller lacerations and cleaning of wounds

http://www.amazon.com/Iodine-Swabstick-3swabs-Povidone-Solution

20.  Acquire angiocath (IV's) 14, 16 gauge for wound irrigation and chest decompressions or whatever other use you can find.  Requires a prescription, seek and get it if you can.  Same with things like Lidocaine injections for local anesthetic for suturing or nerve blocks etc...  I keep some basic medicines on top of the other things mentioned to include motrin (800mgs) tylenol, cold medicine, allergy medicine, toothache stuff, etc...  Dressings, get lots of them.   

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Last edited on ... March 15, 2007
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