! Emergency
Someone is hurt: check in this order
Fix what kills fastest first. Do not get distracted by the loud injury while a quiet one is bleeding out.
Danger
Make sure you will not become the second casualty: traffic, fire, gas, electricity, collapsing structure, deep water. Wear gloves if you have them.
Catastrophic bleeding
Blood spurting or pooling fast? Stop it now, before anything else. How
Response
Shout, tap the shoulders. Awake and talking means the airway is open for now.
Airway
Unresponsive: tilt the head back, lift the chin. Look in the mouth and remove anything visible.
Breathing
Look, listen, feel for up to 10 seconds. Not breathing or only gasping: start CPR. Breathing but unresponsive: recovery position.
Circulation and shock
Pale, cold, sweaty, fast weak pulse, confused? Lie flat, keep warm, raise legs if uninjured. Shock
Head to toe
Then check the whole body, including the back and under clothing. Note times and what you did on paper, even on the casualty's skin.
1 Minutes count
Heavy bleeding: press, pack, tourniquet
An adult can bleed to death from a limb wound in 3–5 minutes. Hard pressure stops almost all bleeding.
Press hard, right on the wound
Use a dressing, cloth or bare hand. Push with straight arms and body weight. Do not lift to look for at least 10 minutes.
Pack deep wounds
A gaping wound in the thigh, armpit, groin or neck: stuff gauze or clean cloth right into the wound onto the bleeding point until it is full, then press on top for 3 minutes (haemostatic gauze) or 10 minutes (plain).
Bandage firmly
Wrap a pressure bandage tightly over the packed dressing. Blood seeping through: add more on top, do not remove the first layer.
Tourniquet for arms and legs
If pressure does not stop spurting or pooling limb bleeding, or you must let go to treat others, apply a tourniquet. See the player below.
Treat for shock
Lie down, keep warm (a lot of heat is lost with blood), nothing to eat. Shock
Applying a tourniquet
- Place it 5–7 cm above the wound, on bare skin if you can, never over the knee or elbow. If you cannot see the wound or there are several, go high on the limb.
- Pull the strap as tight as you can by hand before twisting.
- Turn the rod (windlass) until the bleeding stops and there is no pulse below. It hurts a lot; that is normal. Leg wounds often need a second tourniquet just above the first.
- Lock the rod, write the time on the tourniquet or the forehead, and do not loosen it. Check it has not slipped every few minutes.
A band at least 4 cm wide (triangular bandage, folded scarf, belt) and a strong stick as a windlass, tied off with a second strip. Thin cord, wire and zip ties cut tissue and do not stop deep arteries. Improvised ones often fail: buy a genuine windlass tourniquet and practise on yourself.
A tourniquet left on for more than about 2 hours starts to kill the limb, and after 6 hours loss of the limb is likely. If no surgical help is possible, a trained person may pack and pressure-bandage the wound and then slowly loosen the tourniquet within 2 hours, leaving it in place, ready to retighten if bleeding restarts. Never loosen it on someone in shock or with an amputation.
Nosebleed
Sit up, lean forward (not back), pinch the soft part of the nose firmly for 10–15 minutes without letting go. Spit out blood. Still bleeding after 30 minutes, or after a head injury: serious.
Internal bleeding
Suspect it after a fall, crash or blow to the belly or chest when signs of shock appear without visible blood: swollen, rigid or bruised abdomen, vomiting or coughing blood, black tarry stools. There is nothing to do in the field except keep the person flat, warm and still, give nothing to eat, and get surgical help if any exists.
2 Not breathing
CPR: push hard, push fast
Unresponsive and not breathing normally (gasping does not count): start chest compressions immediately.
Shout for help
Send someone for an AED (defibrillator) if one exists: shops, stations, sports clubs. Switch it on and follow the voice.
Hands in the centre of the chest
Heel of one hand on the lower half of the breastbone, other hand on top, arms straight, shoulders over hands. Person on a firm surface.
30 compressions
5–6 cm deep, 100–120 per minute (the beat of "Stayin' Alive"). Let the chest come fully up between pushes.
2 rescue breaths
Head tilt, chin lift, pinch the nose, seal your mouth over theirs, blow for 1 second until the chest rises. Not trained or not willing: do compressions only, without stopping.
Keep going
30:2 without pauses longer than 10 seconds. Swap rescuers every 2 minutes; quality drops fast when you tire.
| Adult | Child (1 year–puberty) | Baby (under 1) | |
|---|---|---|---|
| Start with | 30 compressions | 5 rescue breaths | 5 rescue breaths (mouth over mouth and nose) |
| Compress with | Two hands | One or two hands | Two fingers or two thumbs |
| Depth | 5–6 cm | 1/3 of chest, ~5 cm | 1/3 of chest, ~4 cm |
| Ratio | 30:2 | 15:2 (30:2 if alone and simpler) | 15:2 |
Drowning, suffocation and most child arrests are caused by lack of oxygen: give the 5 rescue breaths first.
CPR buys time until a defibrillator and hospital care arrive; without them, survival from cardiac arrest is very low. Stop when the person starts breathing normally, when you are exhausted, or when it becomes dangerous. With no advanced help coming and no signs of life after 20–30 minutes, stopping is a reasonable and humane decision. Victims of drowning in cold water and lightning strike are the exception: they sometimes recover after long CPR.
Recovery position
Breathing but unresponsive: roll onto the side, top knee bent forward to stop rolling, head tilted back with the hand under the cheek so vomit drains out. Check breathing every minute. After 30 minutes turn to the other side.
Choking
Can cough: encourage coughing. Cannot cough, speak or breathe: 5 firm back blows between the shoulder blades with the person leaning forward, then 5 abdominal thrusts (fist above the navel, pull in and up sharply). Alternate until it comes out. Babies: 5 back blows face down along your forearm, then 5 chest thrusts with two fingers; never abdominal thrusts. Unresponsive: start CPR.
3 Circulation
Shock: the body running out of blood flow
From blood loss, burns, severe diarrhoea, infection or allergy. It kills even after the bleeding has stopped.
Signs
- Pale, grey, cold clammy skin
- Fast, weak pulse (over 100)
- Fast shallow breathing
- Thirst, anxiety, then confusion and drowsiness
- Little or no urine
Do
- Treat the cause (stop bleeding, cool burns, rehydrate)
- Lie flat; raise legs 30 cm unless leg, hip or spine injured
- Insulate from the ground, cover, keep warm
- Calm, reassure, stay with them
Do not
- Give food or alcohol
- Let them walk around
- Give drinks to someone confused or who may need surgery. In long waits without help, small sips of rehydration solution for a fully awake person are acceptable.
Severe allergic reaction (anaphylaxis)
Swelling of lips, tongue or throat, wheezing, hives spreading fast, collapse, minutes after a sting, food or drug. Adrenaline auto-injector into the outer thigh, through clothes. Repeat after 5 minutes if no better. Lie flat (sit up if breathing is hard). Antihistamine tablets help the itching but do not save a life. Anyone with a known severe allergy should carry two injectors.
4 Cuts
Wounds: clean is everything
Without antibiotics and surgeons, a dirty cut is a bigger threat than the cut itself. The most important tool is a lot of clean water.
Stop the bleeding
Pressure, raise the limb. Heavy bleeding
Wash your hands, wear gloves
Soap and water, then gloves if you have them.
Irrigate hard
At least 0.5–1 L of drinkable (boiled and cooled, or treated) water, squirted with force: a 20 mL syringe, or a clean plastic bag with a pinhole, squeezed. Rinse out every visible bit of dirt. Pull out loose debris with clean tweezers.
Decide: close or leave open
See below. When in doubt, leave it open.
Dress and check daily
Non-stick pad, gauze, tape. Change daily or when wet or dirty. Look for infection each time.
| Close it (strips, glue, sutures by trained hands) | Leave open, pack loosely with moist gauze |
|---|---|
| Clean, straight cut from a clean object | Animal and human bites |
| Less than 6–8 hours old (face and scalp up to 24 h) | Punctures (nail, thorn, knife, gunshot) |
| Thoroughly irrigated, no dirt left | Dirty, crushed, farmyard, soil-contaminated wounds |
| Edges come together without tension | Older than 8 hours, or any sign of infection |
Wound closure strips: dry the skin, lay strips across the cut 3–5 mm apart, leaving small gaps so fluid can drain. Open wounds heal from the bottom up in days to weeks; they can be closed after 4–5 days if they stay clean ("delayed closure").
Clean water does most of the work. Diluted povidone-iodine (weak tea colour) or chlorhexidine are fine for washing the skin around and inside a wound. Do not pour neat hydrogen peroxide or alcohol into a wound: they damage tissue. Clean sterile honey (medical grade) is an effective dressing for burns and wounds.
Tetanus lives in soil and manure and kills about 1 in 5 of those who catch it, even in hospital. Get everyone vaccinated now and keep boosters up to date (roughly every 10 years). There is no field treatment.
Splinters, fish hooks, ticks
Splinter: clean, pull it out along the line it went in; a sterilised needle opens the skin over it. Fish hook: push the point through, cut off the barb, back it out. Tick: fine tweezers right at the skin, pull straight up slowly, no twisting, no burning or oils; clean the bite and note the date. A spreading red ring days to weeks later, or flu-like illness, needs antibiotics (Lyme disease).
5 Infection
Infections: catch them early
Most infections start small and slow. Daily checks and early action stop them from turning into sepsis.
Wound infection
Increasing pain, redness, heat and swelling after day 1–2, pus, bad smell. Open the wound (remove strips), let pus drain, irrigate, warm wet compresses 4 times a day, rest and raise the limb. Red streaks up the limb, spreading redness or fever: needs antibiotics. Draw a pen line around the redness to see if it spreads.
Abscess (boil)
A hot, tender lump that goes soft in the middle. Warm compresses to bring it to a head. A soft, bulging abscess is usually cured by drainage: a clean blade, a small cut at the softest point, let it drain, irrigate, pack loosely. Not on the face near the nose or eyes.
Sepsis: emergency
Infection with any of: confusion or slurred speech, very fast breathing, fast pulse, mottled or bluish skin, very little urine, "I feel like I'm going to die". Needs strong antibiotics and fluids immediately, the most serious situation in this chapter.
Fever and pain
Fever is a defence, not the enemy. Treat it for comfort: fluids, light clothing, rest, and for adults paracetamol or ibuprofen as below. Worry about fever with a stiff neck, a rash that does not fade when pressed with a glass (meningitis), confusion, trouble breathing, or fever lasting more than 3 days.
| Common painkillers, adults | Dose | Maximum | Careful |
|---|---|---|---|
| Paracetamol (acetaminophen) | 500–1000 mg every 4–6 h | 4 g / 24 h (3 g if under 50 kg, drinker, or liver disease) | Overdose destroys the liver, silently. Check combined cold remedies. |
| Ibuprofen | 200–400 mg every 6–8 h with food | 1.2 g / 24 h without a doctor | Not with stomach ulcer, kidney disease, dehydration, late pregnancy; some asthmatics react. |
Children: dose by weight, exactly as on the children's packet. No aspirin under 16.
Antibiotics are the medicines that most change survival odds in a long crisis, and the ones most often misused. Which one, what dose and how long depend on the infection, the person's age, weight, pregnancy and allergies. Ask your doctor now about a supply for your household and written instructions, and keep a medical reference from the Library list. Most coughs, colds, sore throats and diarrhoea are viral and do not need them. Never use fish or animal antibiotics without knowing exactly what they contain, and never old tetracyclines.
Teeth
Brush twice a day even with no toothpaste (a little salt or baking soda works). Toothache: clove oil on a cotton ball on the tooth. Lost filling: temporary filling paste from a pharmacy. A swollen face or jaw with fever is a dental abscess and needs drainage and antibiotics; it can spread into the neck and be fatal.
6 Heat
Burns: cool water, 20 minutes
Cooling within the first three hours reduces damage. With open fires, stoves and candles, burns will be common.
Stop the burning
Stop, drop, roll, or smother with a blanket. Pull away from the heat. Electricity: switch off before touching.
Cool for 20 minutes
Cool (not ice cold) running or poured water. Keep the rest of the person warm: cooling large burns causes hypothermia, especially in children.
Remove rings, watches, tight clothes
Swelling starts fast. Leave anything stuck to the burn.
Cover loosely
Cling film laid on in strips (not wrapped tightly round a limb), or a clean non-fluffy cloth, or a clean plastic bag over a hand. No butter, oil, toothpaste or flour.
Fluids and pain relief
Drink rehydration solution if awake. Painkillers. Raise burnt limbs.
How serious is it
The person's own palm, including fingers, is about 1 % of their body surface.
| Type | Looks like | Care |
|---|---|---|
| Superficial | Red, painful, no blisters (sunburn) | Cool, moisturise, heals in a week. |
| Partial thickness | Blisters, wet, very painful | Leave blisters intact; if burst, trim loose skin, clean, dress with non-stick dressing or honey, change every 1–2 days. 2–3 weeks. |
| Full thickness | White, brown or leathery, painless in the centre | Needs surgery and grafting. Keep clean, prevent infection, fluids. |
Over 10 % in a child or 15 % in an adult (large amounts of fluid lost: shock), any full-thickness burn larger than a coin, burns of the face, hands, feet, genitals or joints, burns all the way round a limb or the chest, electrical and chemical burns, and any burn with soot around the nose or a hoarse voice (airway burn, may swell shut within hours).
Chemical burns: brush off powder first, then flush with water for 20+ minutes; eyes for 20 minutes, holding the lids open.
7 Bones
Fractures, sprains, dislocations: splint it
Most broken bones heal on their own if held still and roughly straight for 4–8 weeks.
Signs of a fracture
- Heard a crack; pain at one spot when pressed
- Deformed, shortened or rotated limb
- Swelling, bruising, cannot bear weight or use it
- Grating feeling
When in doubt, treat as broken.
Splint it
- Immobilise the joint above and below the break
- Pad well: sticks, boards, rolled magazines, a folded sleeping mat, or the uninjured leg
- Tie firmly but not tightly, knots on the splint
- Arm: sling to the chest
Check circulation
Before and after splinting, and every hour: warm, pink fingers or toes, feeling, movement, colour returns within 2 seconds after squeezing a nail. Loosen the splint if they go cold, pale or numb.
If the hand or foot beyond a badly deformed fracture is cold, pale and pulseless, and no help will come, the limb can die. Gentle, steady pull along the line of the bone (in-line traction) to straighten it usually restores blood flow. Stop if it causes a big increase in pain or resistance. Then splint.
Bone through the skin, or a wound over a fracture: control bleeding, irrigate thoroughly with clean water, cover with a clean dressing, splint. Do not push bone ends back in by hand. It carries a very high infection risk and needs antibiotics as early as possible.
Neck and back injury
After a fall from height, a dive, or a crash, with neck or back pain, tingling or weakness: keep the head in line with the body, hands on both sides of the head. Move only if you must (danger, vomiting, airway), rolling the person as a unit with helpers. Breathing always comes first.
Sprains
Rest, cold compress 15–20 minutes every few hours for 2 days, elastic bandage, raise it. Start moving gently within a few days as pain allows. Cannot take four steps or bony tenderness: treat as a fracture.
Dislocations
A joint visibly out of place. Fingers and a dislocated kneecap often go back with gentle straightening. Shoulders and hips need a trained person; the technique for shoulders is learnable on wilderness first-aid courses and is worth learning if you live far from help. Otherwise splint in the most comfortable position.
8 Diarrhoea
Dehydration and diarrhoea: oral rehydration saves lives
Diarrhoea from dirty water was the great killer before sanitation, especially of children. Most deaths are from dehydration, not the germ, and are prevented by one simple drink.
Oral rehydration solution (ORS)
1 litre clean water + 6 level teaspoons sugar + ½ level teaspoon salt
Stir until dissolved. It should taste no saltier than tears. Too salty is dangerous, especially for babies: make it again. Use it within 24 hours. Factory ORS sachets are better (they include potassium); stock them.
| Age | After each loose stool | First 4 hours if clearly dehydrated |
|---|---|---|
| Under 2 years | 50–100 mL | ~75 mL per kg body weight |
| 2–10 years | 100–200 mL | ~75 mL per kg |
| Older and adults | As much as they want, at least 200–400 mL | 2–4 L |
Small and often
A spoonful or sip every 1–2 minutes. Vomiting: wait 10 minutes, then continue more slowly. Most of it stays down.
Keep eating and breastfeeding
Normal food as soon as they want it: rice, porridge, bread, banana, potato, soup. Breastfed babies keep breastfeeding more often.
Zinc for children
10 mg a day under 6 months, 20 mg a day older, for 10–14 days. It shortens the illness and prevents the next one.
Stop the spread
Hand washing, a proper toilet, one carer, disinfect vomit and stool. See Sanitation.
Mild dehydration
Thirsty, darker urine, dry mouth. ORS at home.
Moderate
Restless or irritable, sunken eyes, drinks eagerly, skin pinched on the belly goes back slowly, no wet nappy for 6 hours. ORS by the table above, watched closely.
Severe: very dangerous
Lethargic or unconscious, cannot drink, skin pinch goes back very slowly (over 2 s), cold hands, no urine. Needs intravenous fluids; keep spooning ORS without stopping. In a baby this can kill within hours.
Blood in the stool, high fever, severe belly pain, diarrhoea longer than 2 weeks, "rice water" stools in huge volumes (cholera: adults can lose over 10 L a day and need that much ORS). Loperamide (anti-diarrhoea tablets) is for adults only, and never with blood in the stool or fever.
9 Environment
Hypothermia, frostbite, heatstroke: the weather as a casualty
In a long power cut, the weather injures more people than accidents do. The elderly and babies are hit first.
Hypothermia
| Stage | Signs | Do |
|---|---|---|
| Mild (35–32 °C) | Shivering, clumsy, grumbling, poor judgement ("the umbles": stumbles, mumbles, fumbles) | Shelter, dry clothes, insulation under and around, warm sweet drinks, food, gentle exercise. |
| Moderate to severe (below 32 °C) | Shivering stops, confused, drowsy, then unconscious; slow weak pulse | Handle very gently and keep lying flat (rough movement can stop the heart). Hypothermia wrap: dry, then sleeping bags and blankets, a vapour barrier (plastic, foil), warm bottles wrapped in cloth at the chest, armpits and back. Nothing by mouth if not fully awake. |
No alcohol, no rubbing, no hot bath for severe cases. A very cold person who seems dead may not be: check breathing and pulse for a full minute before starting CPR.
Frostbite
White, hard, numb skin on fingers, toes, nose, ears. Do not rub it or rewarm near a fire. Only rewarm if it will not freeze again: soak in water at 37–39 °C (comfortably warm to your elbow) for 15–30 minutes until soft and red. Very painful; give painkillers. Do not burst blisters. Frozen feet can be walked on to reach safety, but not once thawed.
Heat exhaustion and heatstroke
Heat exhaustion
Sweating, pale, headache, nausea, weakness, cramps. Shade, lie down, loosen clothing, drink ORS or water with a little salt, fan and wet the skin. Better within 30 minutes.
Heatstroke: emergency
Hot skin (sweating or not), confusion, odd behaviour, fits, collapse. Cool immediately and aggressively: immersion in cold water up to the neck is best, or soak with water and fan hard, ice or cold packs at the neck, armpits and groin. Keep cooling until the person is lucid.
Carbon monoxide
Headache, dizziness, nausea, flu-like symptoms in several people or pets in the same room, better when outside. Get everyone into fresh air at once, open windows, turn off the source (stove, generator, grill, heater). Unconscious: recovery position or CPR. Battery CO alarms are cheap: have one in every room with a flame.
10 Prepare
What to stock: the household medical kit
The checklist is saved on this device. Buy real trauma kit and learn to use it, and do a first-aid course: a weekend course teaches more than any page.
Trauma and wound care
Medicines
Tools and knowledge
Storage and expiry dates
- Store medicines cool, dry and dark: not in the bathroom or car. Most tablets and capsules kept this way keep most of their strength for years past the date.
- Liquids, eye drops, suspensions, insulin, adrenaline injectors and nitroglycerin degrade much faster. Replace them on time. Discoloured, sticky or smelly medicines go in the bin.
- Insulin: unopened in a fridge (2–8 °C); the vial or pen in use lasts about 4 weeks at room temperature below 25–30 °C. Without power, a clay pot inside a larger wet clay pot with sand between them (evaporative cooler) keeps it cool in dry climates. Never freeze it.