Wound care and first aid

Improvising at the moment of injury costs the minutes that decide the outcome. In one box, kept closed and checked monthly: 20 cloth strips boiled, dried and wrapped for dressings; 2 m of wider cloth for pressure bandaging; a 5 cm-wide strap and a stick as a windlass tourniquet; a blade and scissors, boiled; honey; splint material and padding; a sling; and a means of irrigating — a clean bottle with a pinhole in the cap.

Store 5 litres of cooled boiled water beside it, dated, and replace it weekly. Nothing in the box is used for anything else.

Press directly on the wound, hard, and hold for a full 10 minutes by the clock. Most bleeding stops. Do not lift the dressing to look — that restarts it. If blood comes through, add another dressing on top and keep pressing. Raise the limb if you can.

If pressure cannot control a limb bleed, apply the tourniquet: 5 cm wide, 5–8 cm above the wound, never over a joint, tightened until the bleeding stops and the pulse beyond it is gone. Write the time on the casualty's forehead. Do not loosen it to check.

1–2 litres of cooled boiled water per wound, squirted through a pinhole in a bottle cap so it arrives as a jet — pressure is what lifts bacteria and grit out of tissue. Wash around the wound with soap; keep soap, alcohol, iodine and hydrogen peroxide out of it, as all of them kill the cells that heal the wound while barely denting a contaminated surface.

Pick out visible gravel, splinters and dirt with a boiled blade tip. Work in good light, and stop when you cannot see anything more to remove.

A wound is contaminated if it is more than 6 hours old, was made by an animal or human bite, is a puncture, or came from soil, dung or dirty water. Do not stitch, tape or glue any of those. Pack it with clean damp cloth, dress it, and change the packing daily, letting it close from the base upward.

Clean, fresh, straight cuts less than 6 hours old may be closed. Anything on the hand, foot or face heals better open than badly closed.

Honey is one of the few pre-industrial dressings with modern evidence behind it: it draws fluid out of the wound, it is acidic, and it produces hydrogen peroxide slowly as it dilutes. Use about 20 ml per 10 × 10 cm of wound — enough to coat the bed and the packing, not a smear — cover with a boiled cloth, and change it daily or whenever fluid soaks through.

Raw honey keeps indefinitely and needs no processing. Crystallised honey works; warm it to pour.

Cool running water at about 15–25 °C for a full 20 minutes, started within 3 hours of the burn — this reduces both depth and pain, and nothing else you can do matters as much. Remove rings, bracelets and unstuck clothing while cooling, before swelling starts. Then cover loosely with clean cloth or cling film. Never butter, oil, ash, toothpaste or ice — ice deepens the injury.

Estimate the area with the casualty's own palm and fingers, which is about 1% of their body. Anything over 15% in an adult or 10% in a child needs fluids: give oral rehydration solution steadily, as much as they will take, and expect to keep it up for 24–48 hours.

Before touching the limb, check what is beyond the break: pulse, warmth, colour, and whether they can feel your touch. Splint in the position found, immobilising the joint above and the joint below, padded, tied firmly but never so tight that you cannot slide a finger under the tie. Recheck the pulse and sensation immediately after tying, and every 30 minutes.

An open fracture — bone visible or a wound over the break — gets irrigated and covered, and the bone is not pushed back in. Pull a limb straight only if it is pulseless and cold, in which case gentle traction to restore the pulse outranks the pain it causes.

Look at every wound once a day in daylight. Draw a line around any redness with charcoal and write the date on it — spread beyond that line is the decision point. Act on: a red line tracking up the limb, fever above 38 °C, spreading redness, swelling, pus, a foul smell, or crackling under the skin. Your tools are drainage (open an abscess with a boiled blade, along the skin lines, and keep it open), irrigation, rest, elevation and fluids.

Then train the group: everyone learns bleeding, burns and fractures, and two people at least can run all three without being told. The person who knows first aid is statistically likely to be the casualty. See the first-aid guide.