How to Care For Wounds When the Medical System Has Collapsed
by M.D. Creekmore
In my opinion, our medical system will be one of the first to collapse during a major catastrophe.
We have a shortage of primary care doctors in the U.S., a shortage of emergency rooms, a shortage of nurses, and most hospitals have gone to a “just in time” ordering system, where they stock two to three day’s supplies vs. several weeks.
Plus our hospitals are utterly dependent on electricity, although the all have backup diesel generators – but what happens when the diesel tanks are empty.
Furthermore, especially in an outbreak of contagious disease, many hospital personel will just not show up, be injured, or caring for ill or injured family members at home.
I can tell you from personal experience, our national medical disaster preparedness is a sad joke. Think Katrina, but ten times worse.
The incidence of wounds will skyrocket after a catastrophe due to broken glass, chainsaw injuries, people falling off ladders, and on and on. Therefore, I’m writing this article on how to take care of basic wounds when the system has collapsed.
A wound requires four simple things to heal: blood flow, oxygen, nutrients, and the ABSENCE OF INFECTION. If possible, a member of the group who’se wounded should get some extra food, and a vitamin pill a day.
In terms of oxygen and nutrients, these are all provided by blood flow. This brings up the subject of tourniquets. Tourniquets should ONLY be used as a measure of last resort, to prevent the patient from bleeding to death.
Remember – direct pressure stops 99% of bleeding. Take a piece of cloth, ball it up and press HARD against the bleeding area for five minutes by your watch – which will seem like five hours – then check and see if the bleeding has subsided – only if three or four attempts fail should a tourniquet be used.
Direct pressure will stop bleeding from major arteries – I know, I’ve stopped lacerated femoral arteries from bleeding with direct pressure.
If a tourniquet is used, two hours is the maximum time for the arms, four hours for the legs.
If that time is exceeded, the tourniquet must be completely released for a while to allow blood flow, or you will wind up with a dead arm or leg. By the way, “gangrene” just means dead tissue in medicalese.
The most common problem that you will face with wounds is infection. Surgeons classify wounds into two types: clean, and dirty. A clean wound is, for example, when you cut your finger on a broken glass while doing the dishes.
A severely dirty wound is when you cut your finger with a trowel while digging in the garden Organic material is the WORST form of contamination.
I do not suggest home suturing under any circumstances, and here’s why – if there are any germs in the wound – you’ve just sealed them in – and infection is very likely.
In a VERY clean wound, you could use butterfly bandages, Steri-Strips or Crazy Glue (yes, you can buy surgical skin glue, but it is just Crazy Glue at $150 per milliliter).
All other wounds should be CLEANSED, and then left OPEN to heal by TERTIARY INTENTION – medicalese for skin growing in from the sides. This allows the body to extrude germs from the wound in the form of pus.
Over 3-7 days, the body will convert most dirty wounds to clean wounds by it’s natural immune system if the wounds are left OPEN. This may seem too basic, but wash your hands before working on the wound.
Now, how about cleaning wounds?
First, if there are any large pieces of debries, such as twigs, leaves, or gravel – remove them with tweezers. Most antiseptics KILL healthy tissue and dead tissue is FERTILIZER for bacteria.
If it stings when you put it in your eye – it kills healthy wound tissue. Under no circumstances would I use tincture of iodine, or any form of alcohol. Really, washing using mild soap and water is a good way to clean most dirty wounds.
If you have Betadine SOLUTION (NOT soap), mix 1/4 Betadine with 3/4 water. Hydrogen peroxide is helpful as it’s bubbling action helps lift dirt out of a wound.
Be aware that a bottle of hydrogen peroxide becomes inert 2-4 weeks after opening, no matter how tightly you close it.
Next, I suggest everyone include in their first aid kit a 30 or 50ml syringe. Fill with water and press as hard as you can – this basically pressure washes the wound, and has been proven time and again to reduce infection.
If there is tissue with ground in dirt (for example, the patient slid down the road), and the dirt can’t be removed by washing or irrigation, it must be cut out.
This can be done with scissors, a scalpel blade, or a sharp knife. Remove as little tissue as possible. Also, any dead tissue must be removed. Dead tissue will look purple, and WILL NOT BLEED. Cut back until you get bleeding tissue – bleeding tissue is alive.
Now you have a cleaned wound – what next?
If you want, you can apply some antibiotic cream. I don’t think they help any, but they don’t hurt. If at all possible, give the patient antibiotics. I suggest cephalexin 500mg twice a day.
If I could only have two antibiotics during a crisis they would be cephalexin and doxycycline, but I haven’t time to go into that here. HOT TIP! Tetanus is everywhere.
The only reason thousands of Americans don’t die of tetanus as people do in many third world countries is because we have tetanus shots.
I can pretty much guarantee tetanus shots will not be available during a crisis, so get one NOW if you haven’t had one in the last 5 years.
Everyone wants to close wounds, and that is exactly the wrong thing to do with anything except a perfectly clean wound. You want to KEEP THE WOUND OPEN so the body can “pus out” any germs and foreign material present.
The best way to do this is to pack the wound open – so the edges can’t come together, with clean cotton (boiling is a great way to field sterilize instruments and bandages). Then wrap the wound with a LARGE amount of cotton.
The #1 mistake I see in bandaging is too small a dressing. It needs to absorb the pus and blood that will ooze from the wound.
I laugh when I see “first aid kits” with 2″ x 2″ pieces of sterile gauze. Get 4″ x 4″ or 6″ x 6″ – you can always fold these or cut them if necessary, but you can’t make a 2″ x 2″ piece of gauze cover a 5″ wound.
The bandage should not be too tight. Most wounds swell up a lot in the 1st. 24 hours, and you don’t want your bandage to turn into a tourniquet.
If, after several hours, the patient complains the bandage is too tight, or hurts a lot – CUT IT OFF and apply a new bandage.
Wounds at joints (knuckles, knees, etc.) should be splinted just like a fracture, or continued movement of the joint often makes it impossible for new tissue to grow over the wound.
Now, here’s the tough part – the whole bandage must be removed and replaced at least once a day – this will HURT. If you have any pain meds, even Tylenol, give them to the patient one hour before the dressing change.
Liquor is still a great anesthetic – you are going to have to rip the bandage off the surface of the wound, which hurts like heck -but removes all kinds of contaminants.
After about a week, if the wound was small, new skin will have grown back over the wound – congratulations – you saved the patient.
With a big wound, you will often get bright pink, granular type tissue – this is called “granulation tissue” and is good news – it’s a normal part of healing, skin will grow in from the edges and cover it up.
Now all you need is a protective bandage to keep dirt out. You can apply an antibiotic ointment, Vaseline, or honey (an effective disinfectant) to the granulation tissue as you don’t want to rip it off during dressing changes.
Now, the toughest part of all – field amputation. Dead tissue does not heal. It promotes wild growth bacteria which will inevitably kill the patient. Dead tissue looks purple/green.
If you press your thumb against it, it will not blanch and then get it’s color back (try this on your forearm). So, dead tissue must be removed.
This can be done with a knife, saw (preferably hacksaw) and fishing line. Boil all supplies and bandage material.
You do not want to take off too much tissue – so start where it looks bad and work your way up – when you come to bleeding tissue – that’s where you want to amputate.
Cut the soft tissue with a knife – any tissue that doesn’t bleed must be cut out. You will encounter some large bleeding arteries and veins.
If you have some Quick Clot, this would be a good place to use it – otherwise grasp each vessel sideways with a hemostat or a Kelly clamp so the bleeding stops, and tie fishing line in four granny knots just above your instrument.
If you did right, when you release the instrument, there should be no bleeding from the vessel.
Saw the bone. Please, do NOT cauterize the stump with a red hot piece of iron! You will just convert live to dead tissue. Apply a very large bandage, and give antibiotics if available. Change dressings just like you would for a dirty wound.
Lastly, the art of bandaging using only strips of cotton is a long-dead, as you can now buy pre-formed bandages to fit any part of the body. Try applying a cloth strip bandage to the shoulder or hip so it doesn’t fall off.
I recommend you get a WWII or early nursing manual of bandaging for your survival library. Those old nurses could perform miracles with strips of cotton. Amazon.com carries quite a few.
Everyone should have a couple of gallons of bleach. Buy the cheapest brand. Mixed one part bleach with 9 parts water, it is excellent for killing bacteria, mold, and mildew. It will kill all germs in blood spills, including HIV a hepatitis C.
Many items and even homes were saved after Katrina with plain old bleach. It is NOT for use in wounds, but if boiling is not an option, soaking surgical (or improvised surgical) instruments in 1/9 bleach provides pretty good sterilization.
WARNING! Never mix bleach with ammonia – this produces chloramine gas which is a lung irritant. I have treated many people with this in the E.R., and at least half of them need to be admitted to the hospital.
As an aside, part of my prepping includes collecting used or cheap medical supplies, so when there are no hospitals or clinics, I can turn my spare bedroom into a clinic. I’ll gladly take payment in food, .22 ammo, firewood, etc. (In fact, I’d gladly take that stuff now).
Believe it or not, you can pay $25,000 for a medical exam table that is electronically controlled, with all the bells and whistles – or you can make one out of a sheet of 3/4″ plywood, 2 x 4′s, some foam, and a sheet of vinyl.
h/t Sharon N Lance Palmer
by M.D. Creekmore
In my opinion, our medical system will be one of the first to collapse during a major catastrophe.
We have a shortage of primary care doctors in the U.S., a shortage of emergency rooms, a shortage of nurses, and most hospitals have gone to a “just in time” ordering system, where they stock two to three day’s supplies vs. several weeks.
Plus our hospitals are utterly dependent on electricity, although the all have backup diesel generators – but what happens when the diesel tanks are empty.
Furthermore, especially in an outbreak of contagious disease, many hospital personel will just not show up, be injured, or caring for ill or injured family members at home.
I can tell you from personal experience, our national medical disaster preparedness is a sad joke. Think Katrina, but ten times worse.
The incidence of wounds will skyrocket after a catastrophe due to broken glass, chainsaw injuries, people falling off ladders, and on and on. Therefore, I’m writing this article on how to take care of basic wounds when the system has collapsed.
A wound requires four simple things to heal: blood flow, oxygen, nutrients, and the ABSENCE OF INFECTION. If possible, a member of the group who’se wounded should get some extra food, and a vitamin pill a day.
In terms of oxygen and nutrients, these are all provided by blood flow. This brings up the subject of tourniquets. Tourniquets should ONLY be used as a measure of last resort, to prevent the patient from bleeding to death.
Remember – direct pressure stops 99% of bleeding. Take a piece of cloth, ball it up and press HARD against the bleeding area for five minutes by your watch – which will seem like five hours – then check and see if the bleeding has subsided – only if three or four attempts fail should a tourniquet be used.
Direct pressure will stop bleeding from major arteries – I know, I’ve stopped lacerated femoral arteries from bleeding with direct pressure.
If a tourniquet is used, two hours is the maximum time for the arms, four hours for the legs.
If that time is exceeded, the tourniquet must be completely released for a while to allow blood flow, or you will wind up with a dead arm or leg. By the way, “gangrene” just means dead tissue in medicalese.
The most common problem that you will face with wounds is infection. Surgeons classify wounds into two types: clean, and dirty. A clean wound is, for example, when you cut your finger on a broken glass while doing the dishes.
A severely dirty wound is when you cut your finger with a trowel while digging in the garden Organic material is the WORST form of contamination.
I do not suggest home suturing under any circumstances, and here’s why – if there are any germs in the wound – you’ve just sealed them in – and infection is very likely.
In a VERY clean wound, you could use butterfly bandages, Steri-Strips or Crazy Glue (yes, you can buy surgical skin glue, but it is just Crazy Glue at $150 per milliliter).
All other wounds should be CLEANSED, and then left OPEN to heal by TERTIARY INTENTION – medicalese for skin growing in from the sides. This allows the body to extrude germs from the wound in the form of pus.
Over 3-7 days, the body will convert most dirty wounds to clean wounds by it’s natural immune system if the wounds are left OPEN. This may seem too basic, but wash your hands before working on the wound.
Now, how about cleaning wounds?
First, if there are any large pieces of debries, such as twigs, leaves, or gravel – remove them with tweezers. Most antiseptics KILL healthy tissue and dead tissue is FERTILIZER for bacteria.
If it stings when you put it in your eye – it kills healthy wound tissue. Under no circumstances would I use tincture of iodine, or any form of alcohol. Really, washing using mild soap and water is a good way to clean most dirty wounds.
If you have Betadine SOLUTION (NOT soap), mix 1/4 Betadine with 3/4 water. Hydrogen peroxide is helpful as it’s bubbling action helps lift dirt out of a wound.
Be aware that a bottle of hydrogen peroxide becomes inert 2-4 weeks after opening, no matter how tightly you close it.
Next, I suggest everyone include in their first aid kit a 30 or 50ml syringe. Fill with water and press as hard as you can – this basically pressure washes the wound, and has been proven time and again to reduce infection.
If there is tissue with ground in dirt (for example, the patient slid down the road), and the dirt can’t be removed by washing or irrigation, it must be cut out.
This can be done with scissors, a scalpel blade, or a sharp knife. Remove as little tissue as possible. Also, any dead tissue must be removed. Dead tissue will look purple, and WILL NOT BLEED. Cut back until you get bleeding tissue – bleeding tissue is alive.
Now you have a cleaned wound – what next?
If you want, you can apply some antibiotic cream. I don’t think they help any, but they don’t hurt. If at all possible, give the patient antibiotics. I suggest cephalexin 500mg twice a day.
If I could only have two antibiotics during a crisis they would be cephalexin and doxycycline, but I haven’t time to go into that here. HOT TIP! Tetanus is everywhere.
The only reason thousands of Americans don’t die of tetanus as people do in many third world countries is because we have tetanus shots.
I can pretty much guarantee tetanus shots will not be available during a crisis, so get one NOW if you haven’t had one in the last 5 years.
Everyone wants to close wounds, and that is exactly the wrong thing to do with anything except a perfectly clean wound. You want to KEEP THE WOUND OPEN so the body can “pus out” any germs and foreign material present.
The best way to do this is to pack the wound open – so the edges can’t come together, with clean cotton (boiling is a great way to field sterilize instruments and bandages). Then wrap the wound with a LARGE amount of cotton.
The #1 mistake I see in bandaging is too small a dressing. It needs to absorb the pus and blood that will ooze from the wound.
I laugh when I see “first aid kits” with 2″ x 2″ pieces of sterile gauze. Get 4″ x 4″ or 6″ x 6″ – you can always fold these or cut them if necessary, but you can’t make a 2″ x 2″ piece of gauze cover a 5″ wound.
The bandage should not be too tight. Most wounds swell up a lot in the 1st. 24 hours, and you don’t want your bandage to turn into a tourniquet.
If, after several hours, the patient complains the bandage is too tight, or hurts a lot – CUT IT OFF and apply a new bandage.
Wounds at joints (knuckles, knees, etc.) should be splinted just like a fracture, or continued movement of the joint often makes it impossible for new tissue to grow over the wound.
Now, here’s the tough part – the whole bandage must be removed and replaced at least once a day – this will HURT. If you have any pain meds, even Tylenol, give them to the patient one hour before the dressing change.
Liquor is still a great anesthetic – you are going to have to rip the bandage off the surface of the wound, which hurts like heck -but removes all kinds of contaminants.
After about a week, if the wound was small, new skin will have grown back over the wound – congratulations – you saved the patient.
With a big wound, you will often get bright pink, granular type tissue – this is called “granulation tissue” and is good news – it’s a normal part of healing, skin will grow in from the edges and cover it up.
Now all you need is a protective bandage to keep dirt out. You can apply an antibiotic ointment, Vaseline, or honey (an effective disinfectant) to the granulation tissue as you don’t want to rip it off during dressing changes.
Now, the toughest part of all – field amputation. Dead tissue does not heal. It promotes wild growth bacteria which will inevitably kill the patient. Dead tissue looks purple/green.
If you press your thumb against it, it will not blanch and then get it’s color back (try this on your forearm). So, dead tissue must be removed.
This can be done with a knife, saw (preferably hacksaw) and fishing line. Boil all supplies and bandage material.
You do not want to take off too much tissue – so start where it looks bad and work your way up – when you come to bleeding tissue – that’s where you want to amputate.
Cut the soft tissue with a knife – any tissue that doesn’t bleed must be cut out. You will encounter some large bleeding arteries and veins.
If you have some Quick Clot, this would be a good place to use it – otherwise grasp each vessel sideways with a hemostat or a Kelly clamp so the bleeding stops, and tie fishing line in four granny knots just above your instrument.
If you did right, when you release the instrument, there should be no bleeding from the vessel.
Saw the bone. Please, do NOT cauterize the stump with a red hot piece of iron! You will just convert live to dead tissue. Apply a very large bandage, and give antibiotics if available. Change dressings just like you would for a dirty wound.
Lastly, the art of bandaging using only strips of cotton is a long-dead, as you can now buy pre-formed bandages to fit any part of the body. Try applying a cloth strip bandage to the shoulder or hip so it doesn’t fall off.
I recommend you get a WWII or early nursing manual of bandaging for your survival library. Those old nurses could perform miracles with strips of cotton. Amazon.com carries quite a few.
Everyone should have a couple of gallons of bleach. Buy the cheapest brand. Mixed one part bleach with 9 parts water, it is excellent for killing bacteria, mold, and mildew. It will kill all germs in blood spills, including HIV a hepatitis C.
Many items and even homes were saved after Katrina with plain old bleach. It is NOT for use in wounds, but if boiling is not an option, soaking surgical (or improvised surgical) instruments in 1/9 bleach provides pretty good sterilization.
WARNING! Never mix bleach with ammonia – this produces chloramine gas which is a lung irritant. I have treated many people with this in the E.R., and at least half of them need to be admitted to the hospital.
As an aside, part of my prepping includes collecting used or cheap medical supplies, so when there are no hospitals or clinics, I can turn my spare bedroom into a clinic. I’ll gladly take payment in food, .22 ammo, firewood, etc. (In fact, I’d gladly take that stuff now).
Believe it or not, you can pay $25,000 for a medical exam table that is electronically controlled, with all the bells and whistles – or you can make one out of a sheet of 3/4″ plywood, 2 x 4′s, some foam, and a sheet of vinyl.
h/t Sharon N Lance Palmer
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