Wound care and first aid

In an emergency the order is fixed, and it exists so that the most urgent killer is dealt with first.

1. Danger. Make sure the thing that hurt them will not hurt you. A second casualty helps nobody.
2. Catastrophic bleeding. Blood pumping or pouring out — deal with it before anything else. See the next section.
3. Airway. If they are not talking, tilt the head back and lift the chin. Clear anything visible in the mouth.
4. Breathing. Look, listen and feel for up to 10 seconds. Not breathing normally — start CPR. Breathing but unconscious — the recovery position: on their side, top knee bent forward, head tilted back so fluids drain out.
5. Circulation and shock. Pale, cold, clammy, fast weak pulse, confused: lay them flat, keep them warm from below as well as above, and look for hidden bleeding.

CPR: hands in the centre of the chest, arms straight, push 5–6 cm deep at 100–120 per minute, letting the chest come fully back up each time. 30 compressions, then 2 breaths; if you cannot or will not give breaths, keep compressing without stopping. For drowning, give 5 rescue breaths first. Without a defibrillator few adults survive a cardiac arrest; CPR matters most in drowning, choking, hypothermia and children, where the heart can restart.

Choking, adult or child over one year: if they cannot cough or speak, 5 firm back blows between the shoulder blades, then 5 abdominal thrusts — fist above the navel, sharp inward and upward pulls. Alternate until it clears. Infants: 5 back blows face-down along your forearm, then 5 chest thrusts with two fingers. Never abdominal thrusts on an infant.

1. Direct pressure — hard, and for 10 minutes without lifting to look. Put a pad of cloth on the wound and push down with the heel of your hand, or kneel on it. Lifting to check restarts the bleeding and the clock. If blood soaks through, add more cloth on top; do not remove the first layer.

2. Pack deep wounds. Where a wound is a deep hole — in the armpit, groin, neck or a large muscle — pressure on the surface misses the bleeding vessel. Push clean cloth into the wound, feeding it in with a finger until the cavity is full and tight, then press hard on top for 10 minutes.

3. Tourniquet — for a limb bleeding that pressure cannot stop.

• Place it 5–8 cm above the wound, between the wound and the heart, never over a joint.
• It must be wide — at least 4 cm. A belt, a folded triangular bandage, a strip of strong cloth. Never wire, string or thin cord: narrow bands cut into tissue and do not close the artery.
• Tighten until the bleeding stops, using a stick through the knot as a windlass, and lock the stick in place. It will be extremely painful. That is how you know it is tight enough. A loose tourniquet is worse than none: it stops blood returning from the limb while arterial blood still pumps in.
• Write down the time it went on — on the skin, on the tourniquet.
• Do not loosen it to 'rest' the limb unless the bleeding can definitely be controlled another way. A tourniquet on for under about two hours rarely costs the limb; bleeding to death costs everything.

4. Treat for shock. Lay the person flat, keep them warm, give nothing by mouth if they are drowsy, and reassess every few minutes.

Irrigate — it is the most important thing you will do.

1. Wash your hands with soap. See the sanitation guide.
2. Flush the wound with a lot of clean water under pressure. Drinkable water is enough — boiled and cooled if the source is doubtful. At least a litre for an ordinary cut, several litres for a large or dirty wound. Pressure comes from a syringe, a plastic bag with a pinhole, or a water bottle with a hole in the cap, squeezed hard, held a few centimetres from the wound.
3. Remove every piece of dirt, grit, wood and cloth you can see, with boiled tweezers or a clean cloth. Scrub gently if needed.
4. Cut away clearly dead tissue — grey, black, shredded, not bleeding — with boiled scissors. Dead tissue is where infection starts.
5. Irrigate again.

Then decide — close it, or leave it open?

Local infection shows as increasing redness, heat, swelling and pain after the second day, and pus. A red streak running up a limb from a wound is infection spreading along the lymph vessels, and is urgent.

Sepsis is infection overwhelming the body, and it kills within hours to days. Suspect it in anyone with an infection who develops any two of:

• Confusion or unusual drowsiness
• Fast breathing — 22 or more breaths a minute
• Low blood pressure — a weak, fast pulse, fainting when sitting up, mottled or grey skin

with a fast heart rate above 90, fever or a low temperature, and often a feeling that something is very wrong. Sepsis needs antibiotics and fluids. If any exist anywhere within reach, this is when to get them.

What works without antibiotics:

• Drain abscesses. A tense, painful swelling full of pus will not heal until it is opened. Incision and drainage is the definitive treatment even in modern medicine. Cut into the softest point with a boiled blade, let the pus out, irrigate the cavity, and pack it open.
• Open the wound. If a closed wound becomes infected, remove the stitches or strips and let it drain.
• Remove foreign bodies. A splinter left inside keeps an infection going indefinitely.
• Elevate, rest, keep warm, and push fluids — oral rehydration solution if the person is losing fluid.

Tetanus comes from soil and dung in a wound, often a small puncture. 3–21 days later: jaw stiffness ('lockjaw'), difficulty swallowing, then painful muscle spasms. Once it starts it is frequently fatal. Vaccination prevents it; where there is none, thorough cleaning, removal of dead tissue and leaving the wound open are the only protection.

Suspect a fracture with deformity, point tenderness over the bone, inability to bear weight or use the limb, swelling, or a grating feeling. If in doubt, splint it — splinting a sprain costs nothing.

1. Check beyond the injury first: colour, warmth, feeling, movement, and capillary refill — press a nail until it whitens; colour should return within 2 seconds.
2. Splint the joint above and the joint below the break. A broken forearm is splinted from hand to above the elbow.
3. Pad everything, especially bony points, and fill the gaps between splint and limb.
4. Rigid splints — sticks, boards, a rolled mat, a curved sheet of metal or bark — bound with wide strips, not over the break itself.
5. Check beyond the injury again. Loosen the splint if the fingers or toes go pale, blue, cold or numb.
6. Arm: splint, then a sling. Leg: splint the legs together with padding between them if nothing else is available.

Open fractures — bone through the skin — are the highest infection risk on this page. Irrigate thoroughly, cover with a clean moist dressing, splint, and do not push the bone back in. They need surgical care.

Dislocations are easier to put back in the first hour, before muscle spasm locks them. A dislocated finger can often be reduced by pulling straight along its length. A shoulder, hip or elbow needs someone trained if at all possible — forcing one can break the bone or tear the nerve and artery beside it.

1. Stop the burning. Remove the person from the source; smother flames; strip off hot or chemical-soaked clothing unless it is stuck to the skin.
2. Cool with cool running water for 20 minutes. Not ice, not iced water — both deepen the injury. Cooling helps even up to 3 hours after the burn. Keep the rest of the person warm: a large burn cooled while the body gets cold kills by hypothermia.
3. Remove rings, bracelets and tight clothing near the burn before it swells.
4. Cover loosely with cling film or a clean, non-fluffy cloth. Never butter, oil, toothpaste, flour or dung.
5. Leave blisters intact.
6. Give fluids. Anything more than a small burn loses water through the damaged skin — give oral rehydration solution if the person is awake and can drink.

How big is it? The person's own palm, including the fingers, is about 1% of their body surface. Burns over about 10% in a child or 15–20% in an adult need fluids beyond what most people can drink, and are life-threatening without medical care.

How deep? Red and painful — superficial, heals in days. Blistered, wet, very painful — partial thickness, heals in 2–3 weeks if kept clean. White, leathery, brown or charred and painless — full thickness: the nerves are destroyed, it will not heal on its own, and it needs surgical care.

Chemical burns — brush off dry powder first, then flush with water for at least 20 minutes. Quicklime and lye are covered in the lime guide. Electrical burns look small on the skin and hide deep damage and heart rhythm problems.

Hypothermia. Core body temperature below 35 °C. Mild — shivering, clumsy, slurred speech, poor judgement: get them out of wind and wet, into dry insulation, off the ground, and give warm sweet drinks. Share body heat in a sleeping bag. Severe — below about 32 °C, shivering stops, confusion, drowsiness, slow pulse: handle very gently — rough movement can trigger a fatal heart rhythm. Keep them horizontal, insulate completely, and warm the trunk — armpits, chest, groin — not the arms and legs, which returns cold blood to the heart. Nobody is dead from hypothermia until they are warm and dead: people have recovered after hours of no detectable pulse.

Heat stroke. A hot person who becomes confused, collapses, or stops making sense has heat stroke until proven otherwise, and it kills. Cool first, move second. The best method is immersion in cold water up to the neck; otherwise soak them and fan hard, and put wet cloths or ice at the neck, armpits and groin. Stop when they become lucid. Heat exhaustion — heavy sweating, faintness, headache, nausea, still thinking clearly — needs shade, rest, cooling and fluids with salt, and turns into heat stroke if ignored.

These are common, found near people, and each is treated badly because it is mistaken for something harmless or treated with folklore. Learn the tell and the one right response. Plant hazards that poison when eaten are in the foraging guide.