WHAT STARTED AS A PLEASANT CAMPING TRIP COULD HAVE EASILY TURNED TRAGIC.

A friend was petting a horse in a meadow when the horse unexpectedly kicked her in the head. She managed to stagger over to us despite bleeding from a head wound. Luckily my medical training meant that I was able to evaluate her condition (she needed stitches, but fortunately her skull wasn’t fractured), and arrange to get her taken safely out of the park, and driven to a hospital for treatment. My work in public safety means that I’ve had many opportunities to make a difference, but this one was personal, and helping friends and family has been the most meaningful to me. I’ve learned that having the skills to help someone can transform a potentially scary situation into one that feels manageable.

Not knowing what to do in a difficult situation is a terrible feeling, a feeling of powerlessness. It’s even worse in an emergency, when you don’t have the skills to cope. We often rely on emergency responders to be there when we need them most, but in some crises you may instead have to rely on yourself and the people around you to handle the situation. The skills and gear explored in this section will help you be better prepared to handle a variety of challenging situations, from the everyday to the catastrophic. Easily stressed out or overwhelmed? You’ll learn how situational awareness and crisis management techniques apply to a wide range of scenarios. Wondering about first aid? Learn how to assess shock, handle a seizure, or stop serious bleeding. Are you prepared to defend yourself? Explore different ways to fend off an attack armed with your wits or with something that has a little bit more punch. Not sure how prepared you really are? Get simple guidance on tools, medical supplies, drugs, and protective equipment so you can be ready to handle the next emergency; because having the right basic skills and tools is the first step towards to overcoming adversity.

1 GET THE RIGHT MINDSET

Before you end up in the middle of an accident or disaster, before you ever need a plan, you need to develop the habit of being tuned in at all times to your immediate surroundings. This is called situational awareness, and it’s used by emergency responders and people working in complex—or sometimes hazardous—environments. It’s a kind of relaxed awareness that allows you to recognize any unusual circumstances, hazards, and early stages of problems before they end up evolving into big trouble. Like any other skill, it requires practice, and the best time to use these skills is before problems emerge. When done right, this awareness can change the way that you view the world every day and, in the process, save your life or prevent both large and small issues from catching you by surprise.

2 PRACTICE YOUR AWARENESS

Safety begins with awareness of your environment, but it doesn’t end there. Be ready to act at a moment’s notice. Practice all of the following concepts, regardless of the environment you’re in, and eventually they will become second nature.

BE OBSERVANT Pay attention to the sights and sounds you notice when you are alert and aware.

NOTE THE UNUSUAL Determine any threats based on your own observations, experience, and the feeling that “something’s not right.”

CONSIDER OPTIONS Make your decision based on your training, experience, and circumstances.

TAKE ACTION Let your actions drive the situation and your safety; don’t let the actions of others end up compromising your safety.

KEEP MOVING Don’t panic or fail to act. Mental paralysis could mean the death of you or a loved one.

3 COLOR YOUR PERCEPTIONS

To better understand situational awareness, it’s useful to see it as a scale. More important, you can consciously move up or down the scale as part of stress management or checking in with yourself about how aware you are in the moment. It’s a good exercise to ask yourself occasionally, “What color am I at right now?”

WHITE (UNAWARE) Your head is in the clouds. You are unlikely to notice if anything dangerous is unfolding around you, nor are you be prepared to react. This lack of awareness is aggravated by being distracted or emotional, or having a false sense of security. Physical issues like sleep deprivation, pain, stress, or intoxication can also dull your awareness. This white level of awareness is like being drowsy behind the wheel of your car.

GREEN (RELAXED) This low level of awareness is reserved for very safe places. You’re ready to increase your awareness to Yellow if something unusual happens but isn’t likely to happen. This is how you might feel relaxing at home in a safe neighborhood. Switching back to Green after coming home from dealing with an Orange or Red situation is an important part of consciously managing stress.

YELLOW (AWARE) Calm and alert, you have a relaxed awareness of your surroundings. This is how emergency responders are while on duty. At this level, you’re observant of all things—aware of people, animals, environmental conditions, and the layout or terrain of an area. You can react quickly if your situation changes. This is similar to the alertness needed for normal defensive driving on a busy road.

ORANGE (POSSIBLE PROBLEM) There may be a problem; you’re starting to process information that causes concern for your safety. At this level, you’re noticing that something is wrong and are evaluating options for reacting to the situation. This is an ideal time to proactively move to a safer location or change what you’re doing before things get ugly. Consider this level similar to that needed for driving in very bad weather or on an icy road.

RED (THREAT) You’re in trouble. You have to act now for your safety or defend yourself. The time for assessing options is over. Pick your target or escape route, and move! This level is like reacting to a car pulling in front of you when you’re traveling at high speed in bad weather; there’s a split second to decide whether to hit the car or swerve into another lane. If you have been practicing situational awareness, you’ll already know your options almost instinctively.

BLACK (OVERWHELMED) You’re in panic mode, thinking too much and failing to act. Maybe you’re paralyzed with fear or indecision, or exhibiting panicked or inappropriate behavior (whether or not you’re aware of it). You can get into this mode when, say, you freeze behind the wheel during an accident, hit another car, and flip over. You may not even know what just happened or why you’re upside down. You’re lucky to be alive!

4 SHARPEN YOUR SENSES

Awareness is best practiced daily and supported by training or exercises—the same way that you would develop any other skill. You will never run out of opportunities to practice, either. Any environment could contain threats to your safety, thus making situational awareness a high priority everywhere you go. You can enhance your own natural powers of observation with these simple actions.

ELIMINATE DISTRACTIONS Chatting on your cell phone or listening to music through headphones may seem harmless enough, but they are bad for situational awareness. These and other distractions are likely to rob you of the attention you should be paying to your surroundings. Turn off your music or get off the phone if you sense a need to increase your level of awareness. If you’re on the phone, tell the other party your location and ask them to send help there if you don’t call back in a few minutes. Then hang up and pay attention.

CHECK YOUR SURROUNDINGS Whether downtown or in the suburbs, pay attention to where you are, where you’re going, and alternative routes. Also assess any possible dangers. Remember to look up above as well as around you. A dark alley or a well-lit park can both be dangerous to an unwary person.

WATCH PEOPLE Don’t make excessive eye contact with strangers, who may perceive your stare as a threat. On the other hand, looking down too much can make you look vulnerable. Project confidence with your body language. Check out those around you wherever you go. Categorize individuals simply (e.g., soccer mom, business guy, creepy lurker, possible criminal), as any of these labels will help you to pay attention to the body language and actions of people representing the biggest danger around you.

USE ALL YOUR SENSES Make use of every one of your senses to maintain 360-degree awareness. Smell and hearing can both significantly contribute to situational awareness, especially in a situation that can come from behind or just outside of visual range. Trust your instincts, and if your sixth sense makes you wary, trust that feeling until proven otherwise. Assume that if something seems out of place, it is.

5 SHAKE YOUR TAIL

Usually someone is walking behind you because they just happen to be going your way, but occasionally it may be because they want to harass you, mug you, or worse. Listen to your instincts and take action to avoid being a victim. Here are some tactics to use.

STAY COOL Don’t confront the person following you. Focus instead on getting to safety.

REFLECT ON MATTERS Use windows and mirrors to look back instead of turning around or looking over your shoulder. Both of those actions can give you away.

CHANGE COURSE By changing directions, crossing the street, or making several turns, you can easily verify if you’re being followed.

GET ON CAMERA Keep an eye out for CCTV security cameras and make sure to walk past them, hopefully catching the person on video in the process. Alternatively, you can put your mobile phone into video mode to capture a record of what happens. Don’t point the camera at him in any obvious way; instead try to briefly bring the phone up as if you’re checking it while capturing his image.

STAY SAFE Stay in well-lit areas and avoid deserted places such as alleys or empty side streets.

GO PUBLIC Board public transit such as a bus, subway, or light rail; the more crowded the better. Exit right before the doors close if the pursuer also boards.

BUY SOME TIME Enter a store, restaurant, or another public place to consider your options. You’re more safe with people around. Consider buying a ticket to a movie, then leave the theater through an emergency exit before the tail enters.

GET HELP Call a friend or hail a cab to pick you up, or call the police if you feel unsafe.

CROWD SURF Walk in the middle of a large crowd, if one is available, to stay hidden from view. It’s safer than going walking alone.

6 AVOID AUTOMATIC BEHAVIOR

You know that feeling you get when you’ve driven your regular commute route, or ridden the usual subway, and you realize that you’re now at work without having a conscious thought as to how you got there? You have just engaged in automatic behavior! It’s most easily triggered while traveling along very familiar routes. This can represent a very dangerous threat to your situational awareness. You can avoid falling into automatic behavior by consciously staying in a state of relaxed awareness. Automatic behavior is another way one is in White when they should be in Yellow (see item 3).

7 KEEP YOURSELF IN THE LOOP

The OODA Loop was originally created by military strategist and fighter pilot Colonel John Boyd, and has since become a useful tool in environments including survival, litigation, sports, politics, and business. It’s versatile enough to apply to all sorts of planning, and it can provide a streamlined framework to organize responses in reactive circumstances.

The OODA Loop will help you to thrive in circumstances that are uncertain and evolving. It can be applied to both personal defense and disasters—in fact, it’s useful in just about any situation. Practicing also allows you to move through the decision loop quickly and effectively; a faster understanding of the circumstances will give you a greater edge over your opponent or environment.

As you go through the loop, you must remain willing to restart to react to changing circumstances. In a highly dynamic situation the need to reorient can happen almost continuously. After all, there’s no point in executing a plan after circumstances have changed and thus rendered that plan irrelevant.

OBSERVE Using your situational awareness, gather as much information from your senses and other sources as possible. Assess if any forces in the situation will directly, indirectly, or passively affect you.

ORIENT Analyze your situation while remaining aware of your biases, past experiences, and cultural norms. Use this information to update your perspective on the situation. As new information develops you will need to integrate it quickly to revise your orientation.

DECIDE Decisions in changing circumstances are not fixed; they are fluid and must be reassessed as the loop cycles, prompted by any changes during the observation and orientation stages.

ACT Follow through on your decision, and then immediately return to the Observe stage as you evaluate the effects of your actions.

8 PERFECT AWARENESS THROUGH PRACTICE

While you are walking, driving, or engaging in everyday activity by yourself, try practicing your situational awareness by choosing to dial it up or down consciously. Some find it helpful to say observations out loud or to work together with a friend or family member to “double up” on the eyes and ears of your situational awareness. Or have them randomly ask you questions about your surroundings to make sure you’re actually aware of notable issues. Another technique is to have them ask you for an escape route or what you would choose to do if a specific problem emerged. This sort of regular virtual training for situations that are unpredictable, and thus less accessible to prepare for, has shown to improve decision making when the real thing goes down.

9 ADAPT AND OVERCOME

There is a well-known saying, courtesy of Prussian Field Marshal Helmuth von Moltke: “No plan survives contact with the enemy.” It’s important that, in both your planning process and in reacting to changing circumstances, you maintain a flexible mindset. The “enemy” could be severe weather, an earthquake, or a bad traffic accident—anything unpredictable that can harm you or hamper your progress. So create plans, but be open-minded in order to adjust to the changing circumstances. If you are rigid in your approach, your outcomes will be more limited.

10 CALL EMERGENCY SERVICES

Regardless of where you live, there are emergency numbers available for you to use. Most countries now have a three-digit number for emergency medical services, but there is often more than one number. Some dial directly to a specific agency; there are others for local, state, and national services.

Before traveling to a new place, look up at least the local three-digit emergency number and program it into your mobile phone. If your local emergency number is 911, and you’re traveling to Sweden (where the number is 112 instead) consider programming your phone with it listed as “911 Sweden,” as it’s common to think of your home emergency number first in a high-stress situation. Alternatively, there are smartphone apps with emergency numbers programmed for many countries—great for those who travel frequently.

11 DIAL DIRECT

It’s a lesser-known fact that you can dial to various emergency agencies directly rather than using the three-digit number. It can be worthwhile to look up your local police, fire, and other emergency medical services and add them into your phone. In some areas dialing the three-digit number on your cell phone connects to a central dispatch center to route your call. This can mean additional hold time and delays in getting you the help you need.

Dialing direct skips this step and is also useful in case the three-digit number is overloaded or unavailable. If you also keep your phone programmed with the local nonemergncy numbers, you can report lesser issues without having to use the emergency line.

12 HANDLE IT YOURSELF

This book simultaneously addresses two different sets of circumstances for emergencies you might face: the ones that can occur during everyday unremarkable events, and those happening during large incidents or regional disasters. In both situations you’ll reach a point when you’ll need help and, during normal circumstances, calling local emergency services will be the easiest and best way to do so. However, during a larger incident or in a disaster, telephone lines and emergency resources may be overwhelmed. You may have to rely on the resources you have at hand to handle the situation you’re facing, or transport an injured party directly to the hospital because no ambulances are available.

13 GET PROFESSIONAL HELP

Unless you’re a trained emergency responder or medical professional, much of this section will present things you’ve never had to do before. Under normal circumstances, you’ll hopefully never have to use them, and the instructional items in this book aren’t intended to replace professional training or medical care.

In some cases, this book should only be considered a last resort, but in a disaster situation, it may very well be that you must rely on your own ingenuity and determination to survive. That said, you should always strive to get someone to proficient medical care whenever possible rather than trying something on your own. If you’d like to be better prepared, consider getting trained as a disaster volunteer to build skills and gain experience for when disaster strikes. Not only will you be able to help yourself, you’ll also be a resource for your neighborhood and community.

14 UNDERSTAND AND ACCEPT STRESS

Stress is a part of being human. People experience it in a variety of ways in everyday circumstances, at school, at work, and in family life. However, the type of stress you experience during an emergency or large-scale incident can be severe; understanding how it could affect you or others is an important part of self-care and helping others. Everyone who sees or experiences a disaster is affected by it in some way.

It is, for example, normal to feel anxious about your safety and that of your family and friends immediately following an incident. Other normal reactions include a deep sense of sadness, grief, or anger.

Accepting that all of these reactions and feelings are normal can help you to recover more quickly than the people who are lacking this awareness. Integrating the experience can take a long time, sometimes years, and it isn’t always easy. Seek the help of mental health professionals or support groups if you feel as if you can’t cope on your own.

15 RECOGNIZE SIGNS OF STRESS

People handle stress in many different ways. Even with support and resources, some individuals find themselves unable to cope. Knowing the signs of overwhelming stress can help you decide when to get assistance.

People under significant stress can experience physical reactions including fatigue, unexpected or prolonged cold- or flu-like symptoms, tunnel vision or muffled hearing, headache or stomach problems, or loss of appetite. They may report feeling confused or overwhelmed, with trouble communicating or paying attention. Their emotions may range from sadness, guilt, or frustration to fear, anger, outright denial, or emotional detachment. Conversely, they might also exhibit hyperactivity or hypervigilance, have nightmares or trouble sleeping, wild mood swings, or emotional outbursts. They may feel isolated, afraid of crowds or of being alone.

If you observe someone exhibiting these signs, they may need crisis counseling or stress management support.

16 TEND TO VICARIOUS TRAUMA

It’s important to understand secondary, or vicarious, stress, which can affect people indirectly connected to an incident. Vicarious stress may affect emergency responders or disaster volunteers, family members who help others and their communities cope with the aftermath, or even those exposed to pervasive news coverage of an incident. It’s important to understand how you or others will be affected in this way, especially since the secondary stress that is experienced is real and manifests in much the same way as those who directly experienced the event. You can use the same stress-management strategies for those who are direct victims of a disaster and to help others who may not realize they are affected since they “weren’t there” when it happened.

17 MANAGE YOUR MENTAL HEALTH

There are many healthy ways to manage and cope with stress, and to support others in their stress management. You know what’s best for you in general, but consider accepting the help offered by community programs and resources to make your recovery easier. Your existing support network of family, friends, and any religious institutions may be also affected if the disaster is community wide, so get a mix of support from people who are not directly affected as well as from those who can relate because they’ve shared similar experiences. Recognize that you need to care for your physical, emotional, psychological and spiritual needs.

TEND TO YOUR BODY Get enough sleep and exercise, and eat a balanced diet. Establish a moderate balance between work, pleasure, and downtime.

CONNECT WITH OTHERS Spend time with family and friends. Be open to receiving as well as giving support. As soon as possible after the incident, reestablish your normal family or daily routine while limiting any demanding responsibilities on yourself and your family.

KEEP YOUR SPIRITS UP Use spiritual resources you have available, and be willing to talk to mental health professionals. Or just talk with someone about your feelings even though it may be difficult. It’s important, however, not to force yourself or others to do so.

18 SUIT UP FOR SAFETY

It’s counterintuitive, but personal protective equipment (PPE) is not a good source of safety—it’s actually considered your last line of defense under normal circumstances. In traditional risk management, the best way to handle any risk is to eliminate it entirely, or replace it with a safer option before you have to engage with it. Administrative controls can also be used to raise awareness through the use of signs and safety monitors.

However, in a disaster situation, personal protective equipment may be your only line of defense, which is why it’s so important to have access to PPE. It’s also important to assign somebody to take the role of safety monitor, in order to help to maintain safety in circumstances where better options do not exist.

19 MASK UP

Disasters (and everyday projects) frequently involve exposure to harmful chemicals and toxins, but a mask goes far in protecting your lungs and health. Respirators and dust masks come in a variety of types and ratings. Particulate filters, including dust masks, are disposable or have replacement filters. They protect from airborne particles—including dust, mists, liquids, and some fumes—but not gases or vapors. Not all are created equal, so be sure your mask is the right one for the task.

Particulate filters are rated by the National Institute of Occupational Safety and Health (NIOSH), according to their capacity. The ratings have both a letter and number: N (not oil-proof), R (oil-resistant up to 8 hours), and P (oil-proof beyond 8 hours). Particulate filters are rated 95, 97, or 100, corresponding to the percentage of micrometer particles removed. Filters rated 100 are considered high-efficiency (HE or HEPA) filters.

The most common rating for a disposable dust mask is N95, which filters 95 percent of non-oil-based airborne particles. N95 covers basic but essential safety needs such as mold, allergens, or airborne diseases. If you need the highest level of protection in the widest variety of situations, go for P100.

20 WEAR IT PROPERLY

For the best fit and safety, there are a few useful tips to follow when wearing protective masks.

Adjustable-nosepiece masks fit more effectively, but disposable masks with foam face seals may be more comfortable and effective.

Masks with an exhalation valve may make breathing easier. For higher-risk environments (such as asbestos), choose a non-disposable mask with sealing gaskets.

Replace the mask or filter if you notice changes in smell or taste, or if your throat, nose, or lungs are irritated. Replace it if it becomes damaged or clogged.

21 PUT THE RIGHT ONE ON

This chart will help you decide what kind of mask you should wear, depending on the substance in question.

RATING

N95 OR HIGHER

SUBSTANCES: Allergens, bacteria and viruses, bleach, dust, non-asbestos fibers, insulation, mold, pollen, debris from sanding and welding

N100 OR HE

SUBSTANCES: Asbestos, lead

R95 OR HIGHER

SUBSTANCES: Paint, pesticides, sprays

22 GET GOOD GLOVES

There is a dizzying array of glove options to keep you safe in the field, and each type of glove protects against different hazards. Get to know the pros and cons of a few basic glove types that you’re likely to consider for your PPE needs.

For medical gloves [A] your best material choice is nitrile. These gloves are safe for people with latex allergies—an increasing concern in health care. For improved dexterity, stock up on textured gloves. You can also put on vinyl or polyethylene (plastic) gloves, but they are less protective. Avoid using high-priced durable gloves because, once they have been contaminated with bodily fluids, the gloves are no longer considered safe and should be discarded.

For a general-purpose work glove [B], consider a modern hybrid type that may combine synthetic fibers with leather, plastic, and other materials for the best comfort, dexterity, durability, and grip. The trade-off for this balance is that these hybrids are outdone by gloves specifically designed for just one or two factors. For example, a pair of heavy canvas or leather gloves will be more durable than hybrid work gloves. However, heavy materials need to be broken in, can be incredibly uncomfortable to wear, and may cause blisters or abrasions on your hands.

Tactical gloves [C], sometimes also referred to as police gloves, are good general-purpose wear when not giving first aid or doing search-and-rescue work. They offer a variety of protection such as Kevlar linings to make them puncture- or cut-resistant while also providing excellent grip, warmth and dexterity. Avoid riot gloves or search gloves, since the former are aggressive and can suggest to others that you’re looking for a fight, while the latter offer you very little in the way of protection or warmth, since their primary function is sensitive dexterity while frisking subjects.

23 GET GOOD GLOVES

Any of the disposable medical gloves degrade over time, which reduces their effectiveness in protecting you from potentially contagious body fluids while rendering first aid. While standard procedure is to change gloves after every patient in medical contexts, in other situations people tend to wear the same pair of gloves for many hours at a time, but this is not recommended. Oils from your hands, skin lotion, chemicals, disinfectants, heat, and other elements all degrade the protection of your disposable gloves. When in doubt, replace your gloves!

24 DON’T BE A HERO

Equipping yourself with all of the very best of the personal protective equipment may make you feel like a superhero, but, the reality is, none of this is armor. You should still approach hazards as if you have no PPE on. This way, you’re consciously avoiding any overconfidence you might gain from all the gear that you are wearing. And overconfidence can kill you as it’s killed others in the past. Remember that PPE is your last resort for safety, and the best way to handle risk is to avoid it entirely whenever possible.

25 PROTECT YOURSELF

If you need to aid in a disaster or emergency incident, or if you’re in an official function, you need the right gear for the job. Here’s a list of what you’ll need to wear to have a full suite of personal protective equipment.

PREPARED

HELMET A plastic construction-style hard hat will protect you against any head injuries from things like falling debris.

EAR PROTECTION Wear a pair of workshop or construction- type earmuffs to reduce the risk of hearing damage.

GLOVES To handle debris and protect your hands, you’ll need outdoor work gloves made of heavy canvas and leather. You should also have non-latex medical gloves to protect against fluid contaminants.

BOOTS To stay on your feet, you need to protect them too; a pair of heavy-duty leather work boots with steel toes are your best bet.

EYE PROTECTION A good set of goggles, secured firmly in place, will save your eyes from debris or splashed fluids.

RESPIRATOR An N95-rated filter or HEPA filter mask is best to guard against infectious diseases and other airborne hazards.

REFLECTIVE VEST This will help you stand out as someone who’s there to help, and improve your visibility in the dark or other bad conditions.

KNEE PADS You may not spend all your time standing, especially if you have to work digging through rubble—your knees will thank you for protecting them.

There may be a situation for which you haven’t been properly trained, or, for whatever reason, you don’t have the right equipment with you. If you have to improvise your own PPE, here’s how to keep yourself safer than nothing.

IMPROVISED

EYE PROTECTION Goggles are ideal, but if nothing else, a pair of sunglasses or regular glasses will help shield your eyes.

RESPIRATOR A painter’s dust mask or bandana is not the most protective, especially against infectious substances, but it’ll do in a pinch.

VEST If you don’t have a reflective vest, look for something else bright that stands out well, like a neon-colored or tie-dyed shirt.

BOOTS Rain boots or hiking boots are not as sturdy as work boots or similar footwear; nonetheless, they’ll cover your feet better than flip-flops or sneakers.

HELMET Any head protection is better than nothing; for example, a bicycle helmet, which is already made to guard against head impacts, may be adequate.

EAR PROTECTION Disposable foam earplugs will protect your hearing, though keeping them clean and trying not to lose them when you remove them briefly is a hassle.

GLOVES A set of gardening gloves and/or a pair of rubber kitchen or cleaning gloves will help to keep your hands safe.

26 GET IT ON TAPE

There are lots of different types of tapes available, but not all are created equal. Get familiar with them so you can use the right tool for the right job.

1 STICK WITH THE STANDARD Duct tape, that venerable staple, derives its toughness from a composite of woven cotton cloth that’s been backed with polyethylene and then coated with a high-tack adhesive. This tape can create a waterproof seal, which makes it perfect for everything from HVAC installations to impromptu repairs to almost anything.

2 PRACTICE MEDICINE Medical tape comes in a variety of types, so it’s important to know which are the best for general use. The best tape for general field use is Durapore or Curasilk. Both are strong cloth tapes with good adhesion and a smooth outside texture that doesn’t catch on clothing during movement. They can be used to secure dressings, or for immobilization, and for nonmedical purposes too.

3 GET INTO SPORTS Not to be confused with medical tape, sports tape is great for reinforcing muscles and bones during rigorous physical activity of any kind, whether you’re running for fun or for your life. It can also be used for anatomical tape splints to help reduce swelling, restrict movement to promote healing, and protect from reinjury.

4 CLOSE WOUNDS Steri-Strips, a special type of wound- closure tape, are the bigger, stronger cousin of the butterfly bandage. Commonly combined with tincture of benzoin for a better bond, they’re used after surgery and as a substitute for stitches. Steri-Strips should only be placed on cleaned wounds with no ragged edges. Avoid using paper tape or transparent medical tape; these are not waterproof and don’t work well outside a hospital setting.

5 BE AN ELECTRICIAN Besides the obvious use, electrical tape can be used to mark equipment and, as it comes in a rainbow of colors, is great for color-coding equipment, cords, and connectors. Made of slightly stretchy PVC vinyl, and backed with a pressure sensitive rubber-type adhesive, it peels off easily and usually without residue.

6 REFLECT ON IT Reflective tape comes in a variety of colors and patterns. It can mark equipment, object edges, doorways, openings, and vehicles—really almost anything that you want to be able to clearly mark for high-visibility daytime and nighttime safety.

27 TOOL UP WITH TAPE

Aside from sticking two things together, duct tape can be turned to plenty of other uses. A few obvious ones include sealing cracks—whether found in plastic bottles or glass windows—or patching torn clothing or tents, but the possibilities are nearly endless. If you are using duct tape to fix a broken water bottle or hydration bladder, be sure the surface is thoroughly dry before you apply the tape.

If you’re in need of a light rope or cordage, twist one or more strips together to cover the adhesive side of the tape and form a tight strand. Knots tied in a regular rope can also be reinforced and kept from slipping by simply winding a bit of duct tape around them.

The sticky stuff is also a great insulator. You can line a jacket with strips of duct tape to keep heat in, or cover the surface to keep rain out.

Duct tape can be used to not only seal containers but make them as well. For example, you can create a bowl or cup by placing several strips over your knee or a similarly rounded object, and then reinforcing both sides of the shape you have created with more tape.

While many other forms of adhesive tape have unique, specialized purposes, none can beat duct tape in its versatility, so keep at least one roll of this stuff inside your toolbox or emergency kit.

28 BE A DUCT TAPE DOCTOR

Duct tape is highly useful for putting all sorts of things together—and that also includes the human body. This versatile material can be employed in your medical kit; here are just a few of a multitude of ways.

BANDAGE WOUNDS If you’re out of proper bandages, apply gauze or other sterile dressing to a wound, then carefully hold in place with an appropriately sized strip of duct tape.

REPLACE TWEEZERS Need to remove a splinter or other object in the skin? Apply a little patch of tape and peel or pinch to remove it.

SPLINT A LIMB Use other stabilizing items such as folded cardboard or a pair of sticks to hold the injured limb steady, then wrap with a few strips of duct tape to hold in place.

FASHION A SLING Lay out a triangle of duct tape strips (with each side as long as the patient’s forearm). Add a few strips inside the triangle to make a net to hold the arm. Back the strips with more tape to keep them from sticking, then secure around the arm and shoulder.

29 ESCAPE DUCT TAPE HANDCUFFS

If you’ve found yourself in a situation where your wrists are bound with duct tape, there’s a chance you can actually escape your bonds pretty easily. Hold your hands out in front of you, bring your arms up high over your head, then, with all your strength, bring them back down fast and pull your wrists apart hard. The duct tape may well split under the force.

A note—this works only if your wrists are bound side by side, not crossed, and you will need to have your hands in front of you to make it happen. Remember those things if you need to restrain a dangerous person yourself with duct tape!

30 KEEP PARACORD HANDY

Paracord, was (as the name suggests) first used in parachutes in World War II. In the field, paratroopers discovered that this material was useful for everything from rigging tents to sawing logs. It’s almost as handy as duct tape and is a virtual multitool for emergency kits.

Even better, it doesn’t have to be just spooled up and stashed away. This handy material can be woven into a variety of accessories from lanyards to keychains to belts to bracelets; wound around knife, axe, or tool handles; and, of course, used to lace your boots. Thus, it can be kept right at hand for the moment when you need it. Let’s take a look at some of its many versatile uses.

31 LIFT AND LOWER LOADS (NOT PEOPLE)

Paracord is also known as 550 cord because the most common variant is usually rated to hold a weight of up to 550 pounds (250 kg) before breaking, due to its construction and the several internal strands within the sheath (called the kermantle). It’s a useful stand-in for rope if you need to haul something up to an elevated point, or lower an object instead (even rigging cord in a pulley system to handle heavier items), or drag objects along.

A word of warning, though: If you need rope for climbing, you’re better off using actual climbing rope, which is rated for a much higher weight and is made to handle active loads (such as a person bouncing around a little as they climb) and shock loading (when the rope takes up the weight of a falling object) without breaking. Purpose-made rope is also much thicker; paracord’s versatility is partly in its size, but it’s a thin cord. Trying to climb with it can lead to injury, or it could be easily severed while loaded with your weight.

32 BECOME A STRING SURGEON

Paracord is a wonderful utility material; it also has a wide range of applications for personal and medical use.

SUTURE INJURIES Those same strands can be an emergency substitute for stitching a wound.

TOURNIQUET A LIMB To stop severe, uncontrolled bleeding, wind a few turns of paracord around the limb before twisting the cord with an inserted stick or similar to make a tourniquet (see item 82). Braiding multiple strands together will reduce the risk of limb damage.

TIE SLINGS OR SPLINTS Stabilize broken bones with cardboard, sticks, or other rigid materials, then tie them into place with paracord. You can also make a sling for an injured arm.

RESCUE A RING FINGER If a ring is stuck on a swollen finger, save the digit (and the ring!) with paracord. Wrap a length of the internal strand tightly around the finger from the nail upward, tuck the free end under the ring, and tug slowly. The material’s stretchiness compresses tissues; the smooth weave helps pull the band down with less friction.

33 TIE THREE USEFUL KNOTS

You can read entire books on knots and practice all of the complicated ones, but you really only need to know a few basic knots to get by. If you can’t remember how to tie a knot, no matter how fancy or useful, it’s useless. Focus on learning a few basic knots to use for a variety of needs. Here are three basic ones that are easy to master.

SET UP A SQUARE KNOT This is a classic for connecting two lines. Whether you’re tying a pair of ropes together to make a single longer one, or bundling firewood to carry, a square knot is a sure winner, and it’s also much more secure and stable than its cousin, the granny. You can tie it just by lapping right over left, then left over right.

TIE TWO HALF HITCHES This knot is great for attaching line to a tree or pole, hanging hammocks, and securing tarps for shelters. Wrap the free end around the standing end to make the first half hitch, then wrap it around in the same direction again for the second. Pull tight and you have two half hitches; an overhand knot in the free end keeps it from slipping.

BUILD A BOWLINE The “king of knots” is secure, can be tied one-handed, and won’t stick no matter the load it’s handed. It can be used as a snare, a rescue line, and more. Tie an overhand loop in your rope, then pull the working end through it from beneath. Circle it behind the rope above the loop, then back through the loop, then pull to tighten.

34 DEFEND YOURSELF

In the space between good situational awareness and choosing to carry a weapon is the realm of unarmed self-defense. Even the best of situational awareness can fail, and not everyone wants to carry a less-than-lethal weapon or a gun; for those people, a set of defense techniques represents a better option. And in tactical situations you want to have as many choices as possible; even if you choose to carry something for self-defense, learning a martial art as well is both responsible and smart.

35 GET SCHOOLED

While you can learn a few basic techniques from watching videos online or reading a book, choosing a school to practice with is one of the most important decisions you’ll make. There are a lot martial arts types to choose from, and some people will have strong opinions about which of them is “best” for you. It is very true that there are advantages and disadvantages to every martial art, but there is one decision that is more important than that—namely, which martial art looks fun to you? If you’re not having fun, you’re not likely to keep at it. The style you pick may not be the most aggressive or optimal for street fighting, but it’s unlikely you will face people with real martial arts skills, so you will still have a significant advantage. Besides, life is too short to pick up a practice that you don’t also enjoy.

36 TRY KRAV MAGA

If you’re unsure where to start looking for styles to learn, consider checking out Krav Maga, a martial art with roots in street fighting. Developed in the 1940s as a self-defense martial art for the Israeli Defense Force, it combines techniques drawn from boxing, judo, aikido, and wrestling. It was designed to quickly neutralize threats with simultaneous defensive and offensive maneuvers. Krav Maga today is used by law enforcement and special forces personnel. If it’s good enough for them, it’s likely going to be great for you.

37 KEEP AT IT

For self-defense techniques to be effective, you have to pick a style and practice, practice, practice. Practice is important in order to develop muscle memory, which allows you to react without any hesitation while under attack. Without practice, you quickly lose the ability to perform those skills competently, leaving you in a situation worse than if you had chosen to run away instead.

You should consider martial arts to be a part of your regular workout routine—something you do every week to stay fit and ready. One- or two-day classes offer very limited long-term results because they don’t offer the reinforcement that regular training provides. That said, a set of short-term classes do offer you two benefits: the opportunity to decide if you want to explore the style further, and supplemental training to what you’re already learning. Some training is better than no training, but regular training is still the best.

38 USE YOUR IMAGINATION

One of the worst things that can happen if you are being attacked is that you freeze up and do nothing. Usually this happens because the person has no training and has been confronted by a set of circumstances that he or she hasn’t encountered before. Martial arts training may eventually provide you with the ability to defend yourself against attack, but you have another tool you can use to prepare yourself: mental visualization and rehearsal. This technique has been proven to help people react more effectively by providing virtual mental training for circumstances that you can’t easily simulate. This won’t replace any actual training, but it can still enhance your performance and your reaction times. Visualization works, because when you imagine responding to a situation appropriately and quickly, you are also creating neural patterns in your brain just as if you’d physically performed the action. As with any other training method, visualization needs to be repeated; schedule regular sessions to practice the circumstances you feel you most want to home in on.

RELAX AND FOCUS Take a couple of deep breaths and close your eyes, preferably in a quiet place where nobody will bother you.

SET THE SCENE Say that you want to practice responding to a pickpocket or someone trying to snatch your purse. Visualize the environment where it’ll take place. Are you alone on the street or in a crowded market? Imagine the scenario taking place in different environments so as not to create a rigid model in your mind.

IMAGINE THE MOMENT Once the stage is set, imagine someone approaching you and making a grab. You’ll likely be surprised in real life; imagine being briefly surprised by the attempt but quickly taking control of your actions and awareness.

REACT TO IT Quickly scan for threats or weapons, then grab your stuff back. Yell, “Help, mugger!” as loud as you can and, if the assailant doesn’t release your things, push, elbow, and knee them until he lets go. Visualize being confident, strong, and winning the fight.

HANDLE THE AFTERMATH Imagine getting to a safe place immediately afterward and then contacting law enforcement authorities.

END THE SCENARIO Now, release the mental image, letting it slowly fade. When you’re ready, open your eyes.

39 DO WHAT IT TAKES

If, despite all your best efforts, you end up in a situation where you have no opportunity to become trained in self-defense, and yet you must defend yourself, you’re now in a situation where you must adapt and overcome because you have to.

Studies show that those who have a strong will and don’t give up can do much better in situations such as this. If you’re going in to fight, then fight to win. But also fight for the right reasons. If somebody is stealing your phone, it’s probably not worth the confrontation, but if your own life or the life of a loved one is at risk, then do what it takes to prevail.

40 AVOID KNIFE FIGHTS

Most people who carry a knife think that it ups their chances for survival in, well, a knife fight. But movies about 1950s gangs aside, odds are slim that you’ll end up in an alley with knife-wielding thugs looking to rumble. If you do find yourself in a knife fight, you’ll probably only realize it after you’ve been stabbed.

In most cases, you won’t have time to draw your knife, and someone armed with one is unlikely to give you time to level the playing field. If they already have the drop on you, think defensively because, unless you’re skilled at knife fighting, it’s gonna get messy.

If fact, don’t think of it as a “fight” at all. Fights with weapons escalate and end quickly. If a knife is your best option, then act fast before your adversary has a chance, because he or she will likely attack unpredictably. Even if you “win,” you’ll likely emerge with serious injuries yourself and, depending on the circumstances, such wounds could be fatal. Since most knife-fighting techniques evolved from martial arts, unless you’re proficient in that art your best defense is running away instead of drawing a weapon.

41 HIT WHERE IT COUNTS

Where to aim those punches? Target the most fragile areas of your attacker’s body with a fist or elbow strike; you might stun him long enough to get away. Follow through on each strike, as if aiming for a point just beyond your attacker. This ensures that you transfer the most power into each and every blow. Follow up with more strikes until he or she is overwhelmed, runs away, or gives in. Here are some sweet spots.

• Below ear

• Side of neck

• Base of throat

• Solar plexus

• Armpit

• Lower abs

• Groin

42 THROW A POWER PUNCH

If you have to punch someone, make it count. The difference between a power punch and a weak swat can mean ending a fight quickly or getting beaten up. If you want to pack a wallop, follow these steps.

STEP 1 Choose a target. You can hit any part of the body, but you won’t always have time to select the ideal spot. The good news is that your adversary comes prepackaged with a perfectly centered target: the base of the throat. A well-landed blow will make him gasp for air and momentarily stun him.

STEP 2 Remember your feet; throwing a punch will depend on a solid stance. If you’re right-handed, stand with your feet shoulder width apart, your left foot forward, and your body turned at an angle to the attacker. For lefties, reverse it. Your back leg should support your weight.

STEP 3 Put your weight behind the punch instead of just using your arm strength. Push off of your back foot and, as your arm uncoils, swivel your torso to drive your arm. As your punch extends, shift your weight forward to your front foot, which should come naturally.

43 SHOUT IT OUT

Whatever’s going wrong, if you really need assistance then call for it properly. It’s reflexive to just yelp “Hey!” if someone snatches your purse or your phone and makes a run for it, but to get attention, call for it right. If you’ve been mugged, yell “THIEF!” If there’s something burning, take a deep breath and shout “FIRE!” Calling specific attention to the problem at hand will hopefully get more attention drawn to it.

44 STOCK YOUR TOOLSHED

No matter what advertisers may want you to believe, there’s no one tool that will get you out of every jam. But if you stock up on these essentials, you’ll be well set to face a multitude of issues.

1 TACTICAL KNIFE While hopefully you won’t have to protect yourself from attackers, it could happen, and there’s no harm in having a good self-defense knife just in case. This sort of knife is sometimes used as a backup to firearms by those in the military and law enforcement. They’re rugged and relatively large, with a razor-sharp blade.

2 MULTITOOL The versatile multitool got its start as the venerable Swiss Army knife and has a wide number of fold-out tools including screwdrivers, pliers, saws, and knife blades. Though it’s not as effective as a fully stocked toolbox, it’s a great deal easier to carry with you.

3 RESCUE KNIFE Also known as an EMS knife, this handy tool is commonly carried by all manner of emergency services personnel, from firefighters to police to paramedics. It’s a folding knife with a blade that’s at least partly serrated and features two very important accessories: a seat-belt cutter and a window breaker. If you don’t wear it on your belt, keep one in your car.

4 RESCUE TOOL If you prefer not to keep a knife in your car, then this rescue tool can help you escape from your own vehicle after an accident as well as allowing you to help free others who may be in peril. It’s designed to be mounted inside your vehicle for easy access, and it will break side and rear windows easily and cut seat belts safely.

5 CROW BAR This is the epitome of a tool that you may not use all that often but you will be glad to have one when you need it. In disasters they are primarily used for forcing locks, doors and windows open after being damaged, as well as for various secondary uses such as clearing debris, prying apart boards, removing nails, and even self-defense.

6 UTILITY SHUT-OFF TOOL While you can use regular household tools to shut off your utilities in a pinch, having a combined tool makes it really easy to grab and go or include in your disaster tool kit. Not only does this non-sparking tool allow you to shut off your gas and water, it can also be used to do some light rescue work, such as prying open doors and breaking windows.

7 FOLDING SHOVEL Also called an entrenching tool, these compact spades were originally designed for military use. However, there are a myriad of civilian uses for disasters, winter, camping, and self-defense. Those that have a serrated edge can also be used as a saw. The ability to dig latrines is of special note in disasters when water is scarce or unavailable.

45 FILL YOUR HOUSEHOLD TOOL KIT

Even if you’re not the handy type who likes to fix things, you should still consider having a basic hand tool kit in your home. It’s better to have a tool and never use it than need a tool and not have it. During a disaster or in an emergency you may not have the ability to go buy tools, so having a kit handy becomes an extension of your emergency kit. And who knows, you might also be able to fix something with the tools now that you have them. Household tool kits are often sold in complete packages with a storage case. A good general tool kit includes the following.

• Hammer/mallet

• Saw

• Screwdrivers (Phillips and flat, in various sizes)

• Razor knife

• Wrenches (adjustable and open end, in various sizes)

• Hex keys (in various sizes)

• Wire cutter/stripper

• Pliers (slip-joint and groove-joint)

• Needle-nose pliers

• Digital voltmeter

• Tape measure

• Level

46 CHOOSE A BASIC SELF-PROTECTION GUN

There are many different considerations for whether you want to own a gun and, if so, what kind. If you’re planning to purchase a firearm, and you want to get something with the greatest versatility, consider owning a revolver. They’re slower to load and lack the convenience of semiautomatic magazines, but they have some unique benefits.

First off, revolvers are easier to for beginners to learn and operate than a semi-automatic handgun. Also, they can be fired one handed. Rifles or shotguns require two hands, so if you’ve injured one arm, you can’t safely or accurately use one. Seven- or eight-shot revolvers give you more capacity than the old fashioned “six-shooter.”

Several common revolvers can be loaded with different calibers of ammunition. A .357 Magnum, for example, can be loaded with a lighter .38 Special round if the shooter is less experienced, or unwilling to deal with the stronger recoil of a magnum round. In addition, any revolver can fire a wide range of different loads, from snake shot to self-defense, without the feed problems a semiautomatic has.

These guns are easier to conceal than long guns, and openly carrying a weapon in an urban environment can make you an instant target.

Finally, revolvers are usually cheaper to buy and maintain than other types of handguns and are less likely to malfunction.

47 HANDLE GUNS SAFELY

Regardless if you have a lot of training or have never picked up a gun before in your life, reviewing and knowing these basic gun-safety rules can make the difference between safely handling a gun and an accidental discharge.

ASSUME EVERY GUN IS LOADED Every time you see a gun, pick up a gun, or point a gun, you should assume that it’s loaded. Even if someone unloaded it right in front of you, continue to treat it as if it’s loaded.

ONLY POINT YOUR GUN AT A TARGET Even if the gun is unloaded, never point the muzzle at anything you are not willing to destroy.

KEEP YOUR HANDS TO YOURSELF Do not touch the trigger until the sights are on-target.

BE SURE OF YOUR TARGET Be absolutely sure that you are shooting at what you’re intending to hit and that there are no bystanders anywhere near it. Never shoot at a sound or movement.

HAVE A SAFE BACKSTOP Look beyond your target before you make your shot. High-powered ammunition can travel up to a mile.

CARRY SAFELY Make sure the safety is on and that the barrel is pointing down when you are walking with your gun.

CLIMB CAREFULLY Do not climb up a tree or over a fence with a loaded gun. Hand your gun to a partner with the safety on and have them hand it back to you when you’re done.

SHOOT SOBER Never mix drinking and guns.

CHECK IT OUT Before you use any new or borrowed equipment, go over everything and make sure that it is working properly. Be sure you know how everything operates before you attempt to use it.

STORE SAFELY Store and transport ammo separate from guns, and keep everything under lock and key when not in use.

48 CARRY RESPONSIBLY

The best personal-protection gun is the one you never have to use. A permit to carry a concealed handgun is just that—a permit to carry it. It’s not a permit to use it. Handgun use is covered by laws dealing with self-defense, and those laws apply whether you are carrying a handgun or not.

A gun carries the power of life and death. The responsible concealed carrier will act with greater calm and wisdom than an unarmed person. That means you have to hold yourself to a higher standard, with brandishing your weapon being your last line of defense, not your first. Good situational awareness and knowing how to avoid confrontations before they become potentially violent remain the best approach.

Weapons have the power to end violent confrontations. You may come out alive but the cost of doing so may be high, as you may temporarily lose your liberty, be sued in civil court, incur expensive legal bills, and be put on trial in the court of public opinion. Risk these things when it matters, such as defending yourself from imminent and significant danger; anything less than that simply isn’t worth it.

49 ZAP A BAD GUY

In the self-defense arsenal, between guns and pepper spray, we find tasers and stun guns. While some people use these terms interchangeably for less-than-lethal electrical weapons, they are different types of device.

TASERS This tool shoots barbed electrodes at an assailant, allowing you to use them at a distance—15 feet (4.5 meters) in the case of civilian models.

STUN GUNS By contrast, to use a stun gun you have to be very close to your assailant, as the device is handheld and requires direct physical contact.

Either can be a good option, but ideally you’ll have other methods of defense as well, used in a continuum of force options rather than as a sole source of defense. That said, as a last-ditch tool they can be useful to briefly incapacitate your opponent so that you can safely escape.

50 WIELD PEPPER SPRAY

If you feel the need for a self-defense tool that’s not as serious a commitment as a gun or knife, consider getting pepper spray. Depending on the canister type you buy, they can offer about a 10- to 15-foot (3–4.5 meters) range, and they carry enough juice to discharge multiple bursts. Hollywood has also skewed the perception of how effective pepper spray is—it may not always deter an assailant, and you risk contaminating yourself as much as you might slow down an assailant. Consider taking a class taught by a self-defense school or the local police department to be sure that you use this tool as effectively as possible.

ESSENTIAL GEAR

51 LIGHT IT UP

Darkness is inevitable. Seeing in the dark is a choice. The solution: a flashlight—or flashlights—because you will likely want one wherever you are. Surefire is a longtime leader in the business of high-quality tactical flashlights. Actually, I own one of its original 6P models; it’s lasted about 20 years of hard use. I own several: one for each car, one for everyday carry, and one for work. For work, I eventually upgraded to the LED 6PX Pro, which balances size, power, run time, quality, and price.

A tactical flashlight needs to be small enough to be easily and unobtrusively carried. Generally this is considered to be no larger than the size of your extended palm. The switch on the endcap allows the flashlight to be easily operated with one hand. Surefire lights also have a lockout switch to prevent any accidental discharge while the flashlight is kept in storage.

Your flashlight needs to operate in all weather and handle immersion in water; a good flashlight will last decades and endure harsh conditions. Hard anodized aluminum is tough yet light, making for a solid, reliable body. Incandescent bulbs break easily, burn out unexpectedly, and are inefficient; modern LEDs are comparably indestructible and will provide more light for longer.

To be effective as a self-defense tool (by temporarily blinding and disorienting an attacker in the dark) a flashlight needs to be very bright. Modern LEDs emit 320 or more lumens (the measurement of the total visible light emitted by a source), but anything over 120 is acceptable.

Your flashlight should have a high-output setting for self-defense and a low-output mode for longer battery life in everyday use. Opt for a model with replaceable batteries rather than a recharging type. Rechargeable batteries can be installed into any regular flashlights, and you can easily swap out dead ones for fresh.

If you prefer a flashlight with even more tactical options, consider one with a toothed bezel—for use as a last-ditch self-defense weapon—and a very fast pulsing strobe mode, which can work better than simple bright light to disorient and temporarily blind your assailant.

52 SHINE BRIGHT

There are lots of tactical uses for a flashlight. Here are the most common situations in which you may find a good flashlight to be indispensable.

BE A FIREFLY To move with more stealth, briefly switch your light on to scan the area and your path before proceeding a short distance in the dark. Repeat as necessary until you get to safety.

IDENTIFY FRIEND OR FOE Use your light to verify that an area is clear and, if you spot someone, to see if he or she is armed or not.

DETER ANIMALS Most animals will freeze and then usually run away when blinded by bright light.

BLIND YOUR OPPONENT Shine the light into an attacker’s eyes, then give yourself enough time to flee or to get the upper hand if you need to fight.

LIGHT YOUR SIGHTS If you’re carrying a firearm, you can use the “eye index” technique by holding the light up to the side of your head in order to illuminate both your target and your weapon sights.

DEFEND YOURSELF Flashlights aren’t considered weapons, so they can be carried almost anywhere and used as a last-ditch bludgeon if all else fails.

53 GET A HEADLIGHT

Along with regular flashlights, another tool that you should include in your go bag is an LED headlamp. These are very useful for several reasons: They keep your hands free, they’re designed for long battery life on regular AAA batteries, and they offer a wide variety of settings; some models even have a low-power red LED that preserves night vision and provides even longer battery life. When you realize how useful headlamps are for all manner of household tasks, or changing tires at the side of the road, or while camping, you’ll wonder how you survived so long without several of them.

54 WARD OFF WATER

The current set of ANSI FL1 standards for flashlights has three water-resistance levels. Knowing the strength of each rating will help you decide the best light for you.

IPX4

Splashing water such as rain

IPX7

Submerged to 1 meter for 30 minutes

IPX8

Submerged deeper than 1 meter for up to 4 hours

55 RUN ON SUNLIGHT

During an emergency or disaster it’s common to lose power for extended periods of time—sometimes even weeks. Considering how often we rely on portable devices, a small solar generator allows you to keep using your critical devices long past spare battery packs have died.

I recommend the Goal Zero Yeti series of portable generators. Not only can they charge using a variety of fixed and portable solar panels, they will also charge from AC wall power, along with 12-volt power from most vehicles and vessels.

This generator system has an easy-to-use, informative display and replaceable batteries. It is also chainable to other batteries, so the main unit can extend its capacity. It has five to 10 different output ports (depending on model), to provide a variety of power options for 12 volt, USB, and AC. You won’t need fuel to operate it (thus making it safe to use indoors), and it’s silent since it does not use a noisy internal combustion system to generate power.

56 GET POWER IN YOUR POCKET

When you’re on the move, you might not be able to bring a larger power supply or charging system with you. Under those circumstances, you will need a portable solution that can be stored in your go bag.

Depending on your individual situation and needs, this handy device might even be considered useful as an everyday carry item—for instance, if you’re spending a lot of time in the field away from opportunities to charge your electronics.

Additionally, a portable charger can be useful for when you go camping, hiking, or do other outdoor recreational activities.

Solar chargers that have carabiners or mounting straps are easily attached to your backpack or go bag so that it can work in daylight while you go about your business. You also want to have multiple USB ports, the ability to also charge from AC power, good-quality battery cells and solar panels, and a fuel gauge to show how much power is left in reserve. Some models also have built-in fault indicators, and flashlights run by the unit’s internal power.

Pocket models aren’t much bigger than a tube of lipstick and can carry enough power for a full charge on a mobile phone (depending on your model). Just remember to keep it fully charged so that, when you need it, there will be power aplenty to charge your devices.

57 HACK A VEHICLE BATTERY FOR POWER

While not a long-term solution for the loss of the power grid, this DIY battery system can charge critical electronic devices to give you more than a week’s worth of use. Sometimes, just having access to a limited yet reliable power supply can make a big difference.

If you want to use this system indoors, use an absorbed glass mat (AGM) battery; the traditional lead-acid types can produce harmful fumes. You can purchase a 55 AH (ampere-hour) 12-volt battery from home-improvement or boating stores, or repurpose one from a boat, RV, or other vehicle. You can order batteries with even more capacity, but size and cost will both increase. You will also need a battery wall charger, a cigarette lighter adapter, a cell phone car charger, and a voltmeter to test the setup.

Wear safety goggles and take great care when working with batteries. AGM batteries are less toxic than lead-acid car batteries but still contain acid.

STEP 1 Using the voltmeter, ensure that your battery is fully charged. If you store your battery, check up on it every three months. If the charge drops below 12.4 volts, charge it so it’ll be ready to go when the lights go out. A smart charger with an automatic trickle charge mode will keep the battery fully charged for when you need it.

STEP 2 Attach the cigarette lighter port to your battery. It’s easy—the port attaches to wires with a set of jumper cable–like alligator clips.

STEP 3 Plug in the phone charger, as you would in your car, and charge up your phone. Your results will vary based on the number and capacity of the devices that you’re charging, and the total capacity of the battery, but modern smartphones will recharge about 25 times with your typical fully charged car battery—more so for those larger-capacity marine batteries.

STEP 4 Periodically insert the voltmeter into the cigarette lighter adapter to check on your voltage—you don’t want to run your battery down too far. As when it’s in storage, never let it drop below 12.4 volts.

58 UNDERSTAND BATTERY CAPACITY

The milliampere-hour, abbreviated to mAH, is a unit of electrical charge frequently used to rate the capacity of batteries. In order to understand how large a battery you need to charge one or more of your devices, add up each device’s battery mAH and compare it to the battery that you are using to charge them. You’ll have a good approximation of how many charges you have left in your battery before needing to recharge. Ideally, you’ll want a battery that fully charges the intended device to at least 80% or better. For those looking at large batteries, 1 AH = 1000 mAH.

59 IMPROVISE A FIRST AID KIT

It’s almost inevitable that you’ll run out of some medical supplies no matter how well stocked your kit is. Making use of common household items for first aid is a good way to extend the supplies you do have or to provide aid in circumstances when you don’t have a proper kit on hand. Take a moment to look through your kitchen, bathroom, bedroom, and garage and note how you might be able to use what you already have in your house for first aid.

60 GO TO BEDROOM, BATHROOM, AND BEYOND

Chances are, you have a fair amount of first-aid supplies loose in your bathroom and maybe packed away in a travel kit for when you go on the road. Consider consolidating all of those supplies into one place such as a box or a backpack so that you can easily move the supplies or inventory them when needed.

PACK YOUR SOCKS Instead of Coban or Kerlex, tube socks can be cut to create a bandage cover. Just take a clean sock and cut the foot portion off. Now you can use the “sleeve” to hold bandages in place [A], which is especially useful when having to move a lot after being bandaged.

EXPAND YOUR SPANDEX If you cut a lycra shirt torso into a spiral, or simply cut the sleeve or leg from a lycra garment, you’ll have various lengths of stretch material that can be used in place of Ace bandages to stabilize sprains or strains, or to tie splints in place [B].

GRAB A BANDANA Use a bandana or any square scarf as an arm sling [C]. Regular scarves can be used to secure the sling to the torso more comfortably than a belt.

TAMP DOWN BLEEDING While they are not ideally used for treating severe trauma such as gunshot wounds, tampons and sanitary napkins can be a stand-in for proper trauma dressings and are clean and absorbent. Additional uses include pads as eyepatches or splint padding, and slim tampons for nosebleeds [D].

GET SALTY Epsom salts can be used for many different purposes beyond first aid, so keeping a supply at home is just a good idea in general. For first aid, epsom salts can be used to treat or sooth bites, stings, sunburns, poison ivy [E], blisters, and even as a laxative.

61 RAID YOUR KITCHEN

If you find yourself low on first-aid supplies, you can also consider using a wide variety of kitchen and household goods to substitute. They’re not the perfect tools for the job, but they’ll do in a pinch.

1 KEEP YOUR SPIRITS UP Vodka or other spirits can disinfect equipment or your hands, but you should not clean wounds with it unless there’s no alternative. Drinking alcohol isn’t the best thing for pain management, but it’s better than nothing.

2 COVER BURNS Plastic wrap can be used for partial- and full-thickness thermal burns (though unnecessary for superficial burns and possibly dangerous for chemical burns). Apply just a single layer directly to the wound with no ointment under the plastic, and secure it loosely with gauze.

3 BAG YOUR HANDS Preventing the spread of disease and isolation from infectious body fluids is a basic part of medicine. If you run out of medical gloves, use a plastic bag as a crude mitten. It’s a little unwieldy but better than nothing.

4 SOOTHE WITH VINEGAR Vinegar is a natural antiseptic and, diluted 50-50 with water, can clean minor cuts and abrasions. The same solution can also reduce itching from poison ivy or insect bites, and soothe sunburns with a soaked towel laid on the skin or applied directly with a spray bottle.

5 EMPLOY SAFETY PINS Seemingly a common item found in first aid kits, you’d be surprised at how many have none. You can hold bandages in place with these, and they’re also good for digging out splinters.

6 TENDERIZE STINGS Many unflavored meat tenderizers contain the enzyme papain, which breaks down proteins, thus diminishing the pain and discomfort associated with venom from stings. Don’t leave tenderizer on skin for more than 10 to 15 minutes, as it can cause an irritating reaction itself.

7 HEAL WITH BAKING SODA You can stop stinging, itching, and swelling from insect bites by applying a paste of soda and water on the affected area. To relieve heartburn, indigestion, or upset stomach, dissolve a half-teaspoon of baking soda in a half-glass of water, and drink every few hours as needed.

62 FILL UP YOUR FIRST AID KIT

Ideally, you’ll have a fully stocked first aid kit handy when a medical emergency strikes. However, if you need to improvise, a range of household objects can do double duty in a pinch.

PREPARED

EYE PATCH Not only for pirates, it protects your eye after an injury and blocks light that can exacerbate migraines.

TOURNIQUET A last-ditch measure, but tourniquets can be crucial in stopping life-threatening bleeding.

RING CUTTER This handy device can safely remove a ring from a swollen or broken finger. It’s a standard ER item.

SPLINT Just what the doctor ordered, to stabilizes strains, sprains, and fractures.

CHEST TRAUMA SEAL Used to treat severe penetrating injuries to the chest that have punctured the lungs.

SLING This simple rig allows your arm and shoulder to rest and recover from a range of injuries or strains.

BANDAGE A bandage is one of your more basic first-aid items; it protects injuries from infection and controls bleeding.

BANDAGE STRIPS For longer wounds, bandage strips work like stitches, sealing the wound closed.

IMPROVISED

EYE PATCH If you need to protect an injured eye and don’t have an eye patch, try using a folded-up a sanitary pad.

SLING Scarves make excellent slings—your main goal is just to be sure that the arm is stable and held close to the body.

BANDAGE STRIPS Duct tape can be used to hold a bandage in place or even to seal a wound (see item 28).

BANDAGE Superglue, if applied correctly, can help to safely seal a cut (see item 92).

CHEST TRAUMA SEAL Use tape and plastic wrap (sealed only on three sides) to protect an open chest wound.

TOURNIQUET A stick and a length of rope can be used to improvise a tourniquet. Only do this in life-or-death situations.

FINGER WRAP Wrap a piece of dental floss (or paracord—see item 32) under the rings and ease it off the injured finger

SPLINT Anything rigid like a cane or a hockey stick can be used to stabilize an injury. Tie it on firmly, or use duct tape.

63 BE SAFE ON THE SCENE

In addition to situational awareness, there are some specific considerations for your own safety and that of others when offering help in an emergency. “Tunnel vision” can cause both laypersons and professional responders to risk their own safety unintentionally. If you determine the scene is unsafe, you may not actually be able to help them. Choosing to step back and maintain your own safety when someone is hurt or in danger is never an easy decision, but if you endanger yourself, then there will be another victim. When you’re approaching an incident, look out for various dangers, no matter where it has taken place.

ESTABLISH AREA SAFETY Avoid unstable or dangerous conditions whenever possible and be cautious of any fast-moving vehicle traffic or machinery close to the patient, or any fire, smoke, or chemical exposures in the area.

CHECK FOR WEAPONS Look for anything within reach of the victim, in plain view, or held by others (or if there are any obviously hostile persons).

LOOK UP Check for hazards from above, especially after earthquakes. This could be falling rocks, falling furniture, or an unstable building.

BEWARE ANIMALS Are there any scared or injured animals in the vicinity?

AVOID ELECTRICITY Damaged electronics, power cords, and power lines should all be considered charged and dangerous.

PROTECT YOURSELF Make sure you are wearing the right PPE for the conditions (see item 25).

64 GET SOME SERIOUS TRAINING

You can learn basic first aid from books and smartphone apps, but proper training is still best. Courses are available from various organizations; check the Red Cross, your local fire department, junior colleges, and community centers. Your next question is: “What classes should I take?” That will depend on your free time, personal interest, and needs.

Ideally you should have advanced first aid, CPR, and AED (automated external defibrillator) training. If you’re short on time, a regular first aid class and an abbreviated hands-only CPR class is a good alternative. If you have pets, a pet first aid class may help you get your four-legged friends through times when you can’t get to a vet clinic.

65 GET EDUCATED

If you want to dive deep into medical training, here are a few choices, each of which will give you a different set of tools.

BE A FIRST RESPONDER Emergency medical response (EMR) training is the shortest and easiest to complete. It’s useful for those who want to focus on immediate emergencies, in support of emergency medical services (EMS) in disasters or smaller events.

GET TECHNICAL Emergency medical technician (EMT) courses are more comprehensive, focusing on geriatric issues, ambulance operations, and equipment you’re unlikely to have in your home. This course is more applicable to those interested in volunteering with EMS or having a broad set of skills past immediate first aid.

GO WILD Wilderness EMT training is a great option for those who go camping, hiking, or otherwise spend lots of time in remote wilderness. The skills learned in this class emphasize improvising and helping others with a minimum of resources. However, this class is the most time consuming.

66 TREAT YOUR PATIENTS RIGHT

Regardless of training, one of the most important skills to use, whether treating someone who has a minor scrape or a life-threatening injury, is to help make them feel comforted and safe. But this isn’t a technique you’ll learn in a first-aid class. It’s about approaching an injured person as one human who cares about another. Injured patients are often scared and confused, sometimes in ways that are not immediately obvious.

Reassuring your patient is simple: Tell them that they are safe, that you are there to help them, and that responders are on the way. It may also help to explain what’s happening around and to them. You might have to overstate the obvious, but if a patient is in shock, they might be overwhelmed by events. Your calm narration will reduce their anxiety, and their experience of the trauma can be more easily handled. It’s one of those moments when you really get to be the hero that makes the difference.

Focus on using positive statements that are true and applicable to the circumstances. For example, somebody who is trapped under a beam after an earthquake is hard to reassure when you don’t know how soon responders will get there or when the next aftershock will happen. Circumstances can be challenging, and doing your best will go a long way to helping the injured person know that they are in good hands.

67 BUILD YOUR FIRST AID KIT

Most people think a first aid kit has a few Band-Aids, some aspirin, and a set of tweezers. But a good first-aid kit should be closer to what a professional might carry. These items will all fit into a small box, and won’t cost an arm and a leg—but might save them!

Nonadhesive dressings

Antibacterial ointment

SAM splint

1-inch (2.5-cm) medical tape

Adhesive bandages, including butterfly strips

Anti-inflammatory drugs

Tweezers

Medical shears (a.k.a. EMT scissors)

Disinfectant towelettes

Aloe vera gel

Arm sling

Gauze roller bandages

Sterile compress

Elastic roller bandages

CPR pocket mask

Medical gloves

Electronic thermometer

Space blanket

Coban

Eye wash

Throat lozenges

Wilderness/travel medical guidebook

68 TAKE IT TO THE NEXT LEVEL

If you’ve taken the classes described in item 65, or just have a desire to be even more helpful in a crisis, you might want to add the following items to your stash of medical supplies. If you look for what’s called a “jump bag,” you’ll find that they often come prepacked with these items—and much more!

• BloodStopper bandages

• Chemical cold packs

• Normal saline (for rinsing injuries)

• Oral glucose tablets (for diabetic emergencies)

• Tourniquet

• Stethoscope

• QuikClot (for controlling bleeding)

• Oropharyngeal (OPA) airway kit

• Activated charcoal (for ingested poisons)

• Penlight

• Blood pressure cuff

69 USE YOUR OTC MEDS

If you have a prescription that you need in order to survive, that’s your number-one concern. But it’s also wise to keep a stock of the following over-the-counter medications in your disaster kit.

NAME

IBUPROFEN (Motrin, Advil)

PRIMARY USES: Relieves headaches, cramps, earache, sore throat, sinus/muscle/back pain, stiffness/arthritis, and reduces fever; safe for children

OTHER USES: —

WARNINGS: Increases risk of serious gastrointestinal (GI) bleeding, ulcers, and perforation

ACETAMINOPHEN (Tylenol)

PRIMARY USES: Similar to ibuprofen; generally less effective

OTHER USES: —

WARNINGS: High doses can cause liver damage

ACETYLSALICYLIC ACID (Aspirin)

PRIMARY USES: Similar to ibuprofen and acetaminophen but used less often

OTHER USES: Also treats or prevents heart attack, stroke, and chest pain

WARNINGS: Consult medical professionals before use for cardiovascular conditions

LOPERAMIDE (Imodium)

PRIMARY USES: Treats diarrhea, which can be deadly in events where water and medical care are inaccessible

OTHER USES: —

WARNINGS: —

PSEUDOEPHEDRINE (Sudafed)

PRIMARY USES: Anticongestant, used to treat respiratory infection, allergies, chemical irritation, mild asthma, and bronchitis

OTHER USES: Can be used as a stimulant

WARNINGS: —

DIPHENHYDRAMINE (Benadryl)

PRIMARY USES: Treats symptoms of allergies or respiratory infections, rashes/hives (such as poison ivy), and nausea

OTHER USES: Can also be used as a sleep aid

WARNINGS: —

MECLIZINE (Dramamine)

PRIMARY USES: Relieves nausea, vomiting, motion sickness, vertigo, and anxiety

OTHER USES: Can also be used as a sleep aid

WARNINGS: —

RANITIDINE (Zantac)

PRIMARY USES: Treats heartburn, ulcers, and other stomach issues

OTHER USES: Can also relieve hives

WARNINGS: —

HYDROCORTISONE (Cortizone 10)

PRIMARY USES: The strongest steroid cream available without a prescription; treats painful or itchy rashes, eczema, poison ivy, diaper rash, and minor skin irritations

OTHER USES: —

WARNINGS: —

CLOTRIMAZOLE(Gyne-Lotrimin)

PRIMARY USES: Antifungal used to treat athlete’s foot, ringworm, and diaper rashes

OTHER USES: —

WARNINGS: —

70 USE ANTIBIOTICS WISELY

There are a lot of drugs in this category, and while some are broad spectrum, many are only used for specific infections. It’s not recommended to use antibiotics without professional medical advice, especially if you have a history of allergic reactions, but having some in your kit can be handy in a disaster. Remember, antibiotics are not antiviral drugs and can’t treat flu, colds, coughs, and similar common maladies. You should also finish the entire prescribed amount—stopping when symptoms lessen may create resistant bacteria, and your symptoms can get worse.

NAME

AMOXICILLIN (Amoxil)

PRIMARY USES: Pneumonia, strep throat, ear infections, and salmonella

OTHER USES: Sometimes used to treat Lyme disease

LEVOFLOXACIN (Levaquin)

PRIMARY USES: Respiratory tract infections, cellulitis, urinary tract infections, anthrax, endocarditis, meningitis, traveler’s diarrhea, tuberculosis, plague, and infections that arise after traumatic injuries

OTHER USES: ——

DOXYCYCLINE (Periostat)

PRIMARY USES: Urinary tract infections, chancroid, cholera, Lyme disease, chlamydia, sinusitis, Rocky Mountain spotted fever, bubonic plague, and skin infections

OTHER USES: Used to treat MRSA (methycillin-resistant staphylococcus aureus), malaria, and anthrax

AZITHROMYCIN (Zithromax)

PRIMARY USES: Pharyngitis, respiratory infections, gastrointestinal infections (such as those caused by eating contaminated food), and chlamydia

OTHER USES: ——

CEPHALEXIN (Keflex)

PRIMARY USES: Ear, bone and joint, skin, and urinary tract infections

OTHER USES: May also be used for certain types pneumonia and strep throat

METRONIDAZOLE (Flagyl)

PRIMARY USES: Bacterial vaginosis, pelvic inflammatory disease, pseudomembranous colitis, aspiration pneumonia, intra-abdominal infections, lung abscess, gingivitis, amoebiasis, giardiasis, and trichomoniasis

OTHER USES: ——

CIPROFLOXACIN (Cipro)

PRIMARY USES: Wide variety of infections, including infections of bones and joints, gastroenteritis, respiratory tract infections, cellulitis, urinary tract infections, prostatitis, anthrax, and chancroid

OTHER USES: ——

GENTAMICIN (Gentasol eyedrops)

PRIMARY USES: Eye infections

OTHER USES: ——

71 KNOW COMMON PRESCRIPTION MEDS

If you can’t get medical help in a disaster, knowing what medications do can make a difference. Ideally you should use these only with professional medical advice, as they can be dangerous at the incorrect doses, and some may be addictive or could trigger harmful interactions with other drugs.

FEEL LESS PAIN Plenty of prescription painkillers (many of which combine codeine and acetaminophen) can treat moderate to severe pain. These can help you endure pain that the over-the-counter medications don’t handle as well.

TREAT NAUSEA Zofran (ondansetron), a popular antiemetic that comes in a tablet that dissolves under your tongue, can prevent nausea and vomiting caused by morning sickness, heat or dehydration, and other issues.

STAY AWAKE After a disaster you may be fatigued but need to function anyway. Medications such as Provigil (modafinil) and Adderall (amphetamine) are used by various military forces and others to keep them alert and focused. Use cautiously; sooner or later, your sleep debt will need to be paid off with proper rest.

KEEP CALM Stress and anxiety after disaster is common. Benzodiazepines can be an emotional “reset,” helping you to avoid panic and function better. Common forms include Valium (diazepam) and Ativan (lorazepam), used to treat anxiety, panic attacks, insomnia, seizures, and muscle spasms. These drugs are addictive; occasional use is acceptable, but regular use is cautioned against.

BREATHE RIGHT Ventolin (albuterol sulfate) inhalers can help an asthmatic or someone suffering from chronic obstructive pulmonary disease (COPD) who is having trouble breathing. Unofficial uses include treating difficult breathing associated with respiratory infection.

STOP SERIOUS ALLERGIES EpiPens (epinephrine) are used to treat anaphylaxis—a serious allergic reaction that causes severe swelling and respiratory obstruction—experienced by some people from insect stings or various other substances.

GO (ANTI) VIRAL Tamiflu (oseltamivir) is used to treat and prevent influenza. Thought somewhat controversial, it may be used in a pandemic to reduce risk of death, especially for at-risk populations such as the immunocompromised or elderly, or within 48 hours of contracting flu symptoms.

STOP RADIATION Potassium iodide (KI) helps to prevent radioactive iodine from being absorbed by the thyroid gland during a radiation incident. People should only take KI if advised by public health or emergency management officials, as there are health risks associated with its use.

KEEP CONTRACEPTION Plan B (levonorgestrel), also called the “morning-after pill,” is an OTC drug and can be used up to 72 hours after unprotected sex, a condom failure, or sexual assault. Keeping this in your medical kit may help someone avoid dealing with unwanted pregnancy in the midst of coping with a disaster.

72 KNOW COMMON ALLERGIES

Allergic reactions are generally caused by a few major categories of allergens. Here is an overview of the most common types that may trigger a reaction.

FOOD

Eggs, fish, milk (not to be confused with lactose intolerance), peanuts, shellfish, soy, tree nuts, wheat

DRUG

Anticonvulsants, insulin, penicillin, sulfa drugs, and related antibiotics

INSECT/POISON

Fire ants, bees, wasps, hornets, and yellow jackets

OTHER

Animal dander or hair, mold, dust, latex, cosmetics, and pollens from trees, grasses, or weeds

73 PREPARE FOR ANAPHYLAXIS

Severe allergic reactions from insect stings and other allergens can lead to anaphylaxis, which includes a sudden decrease in blood pressure and difficulty breathing. In extreme instances, the reaction can kill in minutes. Anyone can experience a life-threatening allergic reaction, even if he or she has never had a problem before; other allergies may develop over time and exposure. There are only limited actions you can take in this situation, and you must act early and decisively.

BE PREPARED When traveling or in a disaster, ask all of your companions if they have issues with insect stings or other allergic reactions. If so, find out if they carry an epinephrine auto-injector, such as an EpiPen.

ACT QUICKLY Be alert to the first signs of a serious allergic reaction: skin reactions such as itching (especially around wrists, the insides of elbows, and on the face), hives, pale skin, or swelling of the lips, throat, or anywhere on the face. Beware of constriction of the airway or trouble breathing, wheezing, a weak pulse, or vomiting or nausea. Act at the very first sign of any of these indicators. Do not wait to see if symptoms worsen.

GET HELP Head to emergency medical facilities. If in a remote area or during a disaster, create an evacuation plan: Contact emergency personnel about the potential need for rescue, and plan on where it will take place. If contact isn’t possible, create a plan to transport the person to definitive medical care as quickly as possible.

GIVE FIRST AID Give over-the-counter diphenhydramine such as Benadryl; the liquid form is fastest. This won’t stave off a severe case of anaphylaxis alone—it’s just a first step. Prepare to perform CPR and rescue breathing if symptoms worsen. Prepare to administer epinephrine via auto-injector if available.

USE EPINEPHRINE If the victim begins to experience trouble breathing, use the epinephrine auto-injector as shown in item 74, and do whatever you can to help get them to medical personnel. Time is absolutely critical here. If necessary, perform CPR and rescue breathing. Administer additional epinephrine if available.

74 EMPLOY AN EPIPEN

While anaphylaxis is uncommon, it can be deadly. Milder reactions can be unpleasant and sometimes a little harmful to the victim, but anaphylactic shock can be lethal if left untreated. This allergic reaction can take place in just a few minutes, with the victim experiencing severe swelling and rashes, difficulty breathing, and dangerous changes in blood pressure and heart rate.

If you know that someone is experiencing this sort of reaction, you can help treat it with epinephrine (medical adrenaline) administered by a penlike auto-injector. If you keep one in your medical kit, make sure it’s kept in a stable-temperature environment and is within its expiration date; replace as needed.

STEP 1 Remove injector from the carrying tube and remove the safety cap from the end of the injector.

STEP 2 Grip the shaft firmly, with your thumb on its back. Aim for the thigh or upper arm. (You can even go through a layer of clothing.)

STEP 3 Jab down firmly against the muscle, keeping the shaft of the pen perpendicular to his or her limb. Hold the injector in place for 10 seconds to allow the needle to deploy and the medicine to be administered.

STEP 4 Remove the needle from the victim’s limb, and carefully place the injector back into the carrying tube.

STEP 5 Monitor the victim’s condition and seek medical attention, as he or she may need additional care after the medication wears off.

75 LOOK FOR A MEDIC ALERT

If you come across somebody who is unconscious or no longer can speak due to a possible allergic reaction, take a moment to check for a medical alert bracelet, necklace, or, less common, key-chain, wallet card, or kid’s shoe tag. The reverse side of the tag will have basic information such as his or her name, emergency contact, and critical medical information including allergies, medications, advance medical directives, and medical conditions such as epilepsy, diabetes, or asthma.

76 CALL FOR MEDEVAC

If you are far from the nearest hospital and have a serious medical emergency, you may need a helicopter medevac. When calling for help, request a helicopter rescue. Some dispatch protocols may not allow it, but if a helicopter is sent your way, here are a few important steps to follow.

STEP 1 Establish a safe landing zone. Flat, level ground 100 feet by 100 feet (30 meters by 30 meters) is ideal, clear of sand, gravel, or debris, and far from power lines, trees, poles, or other obstructions.

STEP 2 Get a fix on your position. While standing in the middle of the of the landing zone (LZ), use a GPS and note the latitude and longitude. Pass this information on to the emergency responders.

STEP 3 If the copter is landing in darkness, light up the LZ if you have the resources to do so. If you are using glow sticks, small strobes, or other portable light sources, be sure that you anchor them to the ground securely.

STEP 4 Follow these safety tips when the rescue arrives: Shield your eyes from rotor wash during landing and takeoff, do not approach the helicopter while the blades are turning, and approach it from the side only—never walk around the tail rotor.

77 OPEN AN AIRWAY

The first things that you need to check when assessing an injured person are the ABCs: airway, breathing, and circulation. It’s important to also do the ABCs in this order. Obviously, if you focus on stopping bleeding on a patient that isn’t breathing, you’re not going to have a patient for very long.

The first step to evaluate if someone has a blocked airway is to look, listen and feel for any signs of breathing. If the victim is not breathing, something may be blocking his or her airway, in an unconscious person the most common obstruction is the tongue. To reopen the victim’s airway, perform a simple head tilt/chin lift maneuver.

With the victim lying flat on his or back, place your hand on the forehead and your other hand under the tip of the chin. Gently tilt the victim’s head backward. The weight of the tongue will force it to shift away from the back of the throat, opening the airway.

If the person is still not breathing on his or her own after the airway has been cleared, then you will have to provide rescue breathing.

78 BREATHE FOR THEM

With the victim’s airway clear of any obstructions, support the chin to keep it lifted up and the head tilted back. Pinch the nose with your fingertips and place your mouth over the victim’s, creating a tight seal. If available, a pocket mask (see item 67) will protect you and the victim from communicable diseases. Give two full breaths. Between each breath listen to confirm that air is escaping and watch the chest fall as the victim exhales.

Do not use excessive force when exhaling into the person’s mouth, as this may force air into the stomach, causing them to vomit. If this happens, turn the person’s head to the side, and clear away any obstructions from the mouth before continuing.

If the victim remains unresponsive, without any breathing, coughing, or moving, then begin CPR (see item 85).

79 CONTROL BLEEDING

After you’ve bandaged an injury, if blood is soaking through the bandage, you’ll need to take additional action to control the bleeding. (Remember to wear medical gloves if you’re the one going hands on with the patient.) Don’t remove the soaked bandages; add more on top of the existing ones and apply direct pressure firmly. This constricts blood vessels manually, helping to stem the excessive bleeding. If they are alert enough to do so, a patient can apply pressure directly to his or her own wound. If blood starts to show through the fresh layer of gauze, it’s time to use pressure points.

80 PUT ON THE PRESSURE

In situations where direct pressure is not effective in stopping the bleeding, use the appropriate pressure point to constrict the major artery that feeds the injury. This is usually performed at a place where a pulse can be found. If this proves to be ineffective, it’s time to apply a tourniquet.

AREA BLEEDING

ARM INJURIES

PRESSURE POINT: Brachial artery

LOCATION: Groin area along the "bikini line"

HAND INJURIES

PRESSURE POINT: Radial artery

LOCATION: Behind the knee

LEG INJURIES

PRESSURE POINT: Femoral artery

LOCATION: Inner arm between shoulder and elbow

LOWER-LEG INJURIES

PRESSURE POINT: Popliteal artery

LOCATION: Inside of wrist

81 USE A TOURNIQUET PROPERLY

In the event of severe bleeding, when all other methods to control it have failed, a tourniquet is a device of last resort. It can prevent someone from bleeding to death from a limb injury, although it runs the risk of damaging the limb or losing it entirely in some cases—usually only after several hours. But if you need to use a tourniquet, it can literally be a lifesaver.

STEP 1 If you can, call 911 to get medical help. Expose the bleeding injury, while keeping yourself protected with medical gloves if possible.

STEP 2 Wrap the tourniquet band around the victim’s limb a couple of inches above the bleeding site. Pull the tourniquet tight so that the band cinches down against the limb very firmly, then fasten the band against itself to keep it secure. Never apply a tourniquet to a joint or around the patient’s neck.

STEP 3 Twist the winding rod to continue tightening the band, until bright red bleeding has stopped and the pulse below the wound has ceased.

STEP 4 Secure the winding rod in place so that it does not come loose. Check for any bleeding or a pulse below where the tourniquet has been applied. If bleeding or pulse continues, you may need to tighten the band further or apply a second tourniquet.

STEP 5 Record the time that the tourniquet was applied so that medical professionals can properly treat the injury.

STEP 6 Assess the victim for shock (see item 100), and transport the victim to appropriate medical care as soon as possible.

82 RIG A TOURNIQUET

If you need to help keep an injured victim from bleeding out but do not have a proper medical tourniquet, there are still plenty of good options available for you.

PICK YOUR EQUIPMENT The cinching band of a tourniquet can be made from virtually any manner of broad, flexible, sturdy substance: a leather belt or a rolled-up shirt, the rubber inner tube from a bicycle tire, braided lengths of paracord (see item 32), and lots of others besides—just as long as the material is not so thin as to cut into the tissues and cause more bleeding. Wrap the item firmly around the limb and tie it off with an overhand knot.

TWIST IT TIGHT You can use any sturdy object about the length of your forearm to apply torsion without breaking—a long sturdy stick; a wooden kitchen spoon or plastic ladle; a metal rebar, wrench, or screwdriver; and more. Place it against the cinching band that you’ve made and tie it in place with a square knot (see item 33). Twist it until the bleeding stops, and then secure it from unwinding with another length or cord, strip of cloth, or similar material.

GET HELP SOON Again, record the time that the tourniquet was applied, and get the victim to professional medical care as soon as you can. You’ve saved a life—and now you may be able to save a limb as well.

83 HELP SOMEONE WHO HAS BEEN IMPALED

While it’s not a very common injury, knowing how to handle someone who has been impaled can help save their life. The Possible causes of impaling can include falling onto a sharp object such as rebar or a fence post, or trauma from high-speed accidents that involve cars, trains, or even bicycles.

STEP 1 Do not try to remove the object. Doing so could result in additional tissue damage, rapid blood loss or, if impaled in the chest, a sucking chest wound. Instead stabilize the object so that it doesn’t move while the victim is moved or transported.

STEP 2 If in a remote setting where you need to move the victim without the help of emergency responders, consider cutting the object a few inches away from the injury to help make movement easier. This is usually limited to slender items such as an arrow.

STEP 3 Bandage the wound to stop bleeding and to further stabilize the object. Transport the person to a hospital only if an ambulance or helicopter isn’t available to respond to the accident.

84 DEAL WITH A GUNSHOT WOUND

The severity of gunshot wounds varies due to a number of factors, including where the victim is hit, the caliber of the weapon, and the type of bullet used. Unless you’re in the most dire circumstances in a remote location without hope for rescue, this is not the time to try your hand at any invasive procedures. Get some help—but while you’re waiting for assistance to arrive there are things you can do to help stabilize the unlucky soul who has been shot.

First check the victim’s ABCs (see item 77). If they are not breathing or don’t have a pulse, start CPR (see item 85). If they are breathing and have a pulse, it’s time to control the bleeding. Look for both entrance and exit wounds, and bandage each of them, starting with the most severe one first. If you only find an entrance wound, the bullet is still in the body, leave it alone even if you happen to feel it underneath the skin. If you’re dealing with a shotgun injury, there will be numerous individual wounds to treat. There is really nothing to be gained by plucking out the shot, since disturbing the projectiles might cause more serious bleeding or other damage. And if your tools aren’t sterile, you might also introduce infection. So keep it simple: Stop the bleeding, dress the wound, and let the professionals remove the bullets or shot once the victim is safely at the hospital.

85 ADMINISTER CPR

If you’re preparing for emergencies, you should get trained in CPR—but even without it, you can still help.

STEP 1 Call 911 or other medical help.

STEP 2 Place the heel of your hand on the victim’s sternum, with your other hand on top.

STEP 3 Lock your elbows and use your body weight to compress the chest about 2 inches (5 cm), at 100 compressions per minute.

STEP 4 If you’re trained in CPR, after giving 30 compressions, gently tilt the victim’s head back to open up their airway, and pinch their nostrils shut before delivering two breaths. Repeat steps 2–4 until help arrives or the victim recovers.

86 USE AN AED

Automatic external defibrillators, if used within the first 3-5 minutes of a cardiac arrest, can greatly improve the victim’s chance of survival, from about 5 percent to 70 percent or even higher. Better yet, AEDs are designed to be used by virtually anyone, even without any experience or training. However, an AED will automatically analyze the heart’s rhythm and, if necessary, give a shock to the victim in an attempt to restore the proper rhythm. AEDs will not shock patients who don’t need it.

STEP 1 If you see someone collapse, immediately call 911. If there are other people on scene instruct one of them to call 911 and another to get the AED.

STEP 2 Determine whether the victim is breathing. If so, you know that they have a pulse. If the victim is not breathing, begin CPR.

STEP 3 After the AED arrives, ask a bystander to take over CPR while you apply the electrode pads that are part of the AED to the patient’s bare chest. Instructions will be printed on the package or the AED for doing so. Continuous CPR is important to help save the patient. Continue CPR unless the AED is analyzing or shocking the victim.

STEP 4 Turn on the AED. Follow the visual and voice prompts of the AED to operate it correctly.

STEP 5 If advised, press the “shock” button and continue following the AED’s instructions. If no shock is advised, then continue CPR until help arrives.

87 HELP A CHOKING VICTIM

Someone who’s truly choking cannot breathe or speak. They might grab at their throat, but you must recognize the situation and act quickly.

Stand behind the victim and put your arms around their waist, with one fist below the ribs and above the navel, and your other hand covering your fist [A]. Pull up and into the victim’s abdomen, pressing firmly with both hands. Repeat this motion until their airway is cleared. If you can’t reach around the person or they pass out, lay the victim on their back and perform the maneuver while straddling the legs or hips [B].

If you’re dealing with a very small child or infant who is choking, cradle them in one arm and compress their chest with your fingertips five times [C], alternating this with turning them over and applying five firm slaps to the midback until the airway is cleared.

88 SAVE YOURSELF

If you’re unlucky enough to choke on something while alone, you can still save yourself using a technique similar to the Heimlich. Make a fist and put your thumb below your rib cage, just above the navel. Grab your fist with your other hand, and press it into your abdomen with quick upward movements. If this doesn’t work, you can also use the edge of a table, chair, or railing. Quickly and repeatedly thrust your upper abdomen against the edge. Continue until the object is dislodged and you can breathe again.

LIFE SAFETY APP

FIRST AID

The American Red Cross has a series of apps that cover first aid for both humans and house pets. These will give you hands-on direction complete with full animation, video, step-by-step direction or prompts on how to handle a variety of injuries with related FAQs, preparedness advice, tests, and even a tool to locate the nearest hospital. Like other American Red Cross apps, these are available in English and Spanish, with a wealth of other useful information.

Two other recommended apps are PulsePoint AED and iTriage. The first app can direct you to find the nearest automatic external defibrillator in case you need to help someone in cardiac arrest. The second app provides medical information beyond first aid with a symptom checker, the location of appropriate nearby medical facilities, direct links to useful hotlines such as poison control, and information on a variety of medical conditions, procedures, and medications.

SUGGESTED APPS

• First Aid by

American Red Cross

• Pet First Aid by

American Red Cross

• iTriage

• PulsePoint AED

89 KNOW INJURY TYPES

Wounds are normally categorized by specific terms that describe their characteristics to medical professionals, and understanding these will allow you to make better first-aid decisions and also communicate to emergency responders.

NAME

INCISION

DESCRIPTION: Clean-cut wound as if sliced by a knife

CAUSE: Blades, sharp edges, broken glass

LACERATION

DESCRIPTION: Jagged-edged wound more resembling a tear than a slice; may have multiple branches

CAUSE: Object with broken or serrated edge, or blow from a blunt object

PUNCTURE

DESCRIPTION: Single penetration point; may look small but can extend deep into body, causing severe bleeding or organ injuries; object sometimes remains impaled in wound

CAUSE: Knife or sharp object, bullet wound

ABRASION

DESCRIPTION: Superficial scrape or scratch, usually affecting only skin surface layers

CAUSE: Result of a fall or sliding on a rough surface, often suffered by bicyclists or motorcyclists

CONTUSION

DESCRIPTION: Bruising from capillaries damaged under the skin, causing swelling and discoloration; may be a sign of more serious injuries elsewhere

CAUSE: Blunt objects

AVULSION

DESCRIPTION: Laceration with a flap of tissue mostly torn from the body; difficult to treat due to the nature of injury

CAUSE: Animal bites, motor vehicle collisions

AMPUTATION

DESCRIPTION: Complete loss of a limb, usually with serious arterial bleeding; limbs can be reattached if carefully cooled and transported to the hospital

CAUSE: Industrial accidents, auto accidents, or other trauma that separates a limb from the body

90 SPOT AN INFECTION

Cleansing an injury before bandaging reduces the risk of contamination, but if it becomes infected, spotting it early can help avoid serious complications. Infection symptoms may include increased pain, swelling, redness, or warmth around the injury. There may be red streaks in the skin or pus in the wound, and the patient may have chills or fever.

91 BANDAGE A WOUND

In the area between “this just needs a small Band-Aid” and “I’m going to need stitches” are basic wounds that can be treated as follows.

STEP 1 Wash the wound thoroughly to remove all dirt and debris; soap and water work great. Hydrogen peroxide or alcohol-based products are not recommended because of the discomfort and delay in healing.

STEP 2 Use direct pressure and elevation to control bleeding.

STEP 3 Cover the wound with a sterile dressing or bandage. If bleeding soaks through, stack more bandages over it (don’t remove the dressing). Cover up with gauze, Kerlex, or Coban to secure the dressing.

STEP 4 Take an over-the-counter pain medicine if needed, such as ibuprofen or acetaminophen.

STEP 5 If there is bruising or swelling, apply ice or a cold pack for 20 minutes. Wrap this in a towel or cloth to avoid causing frostbite.

STEP 6 Keep the wound clean and dry until it is healed, which may be a number of days, or even longer depending on severity.

STEP 7 Rest the affected area and avoid intense activity.

92 SUPERGLUE IT

Dermabond is a type of adhesive that can be used instead of sutures to close a wound. It’s similar to, but not exactly the same as superglue. It’s important to note that superglue isn’t actually approved for medical use, but in an emergency or disaster, you must decide what’s the best option for you. It’s equally important to remember that if you’re going to use this method to close a wound that it must be thoroughly and properly cleaned first to avoid infection.

STEP 1 Apply topical anesthetic if available and if needed.

STEP 2 Clean and prepare wound with antiseptic. Dry the surrounding skin.

STEP 3 Manually close the wound with your fingers, and open the superglue.

STEP 4 Gently apply the adhesive to the surface of the laceration. Avoid allowing any adhesive into the wound.

STEP 5 Apply three layers of adhesive, while holding the wound together with fingers for at least 60 seconds after the final application.

STEP 6 Apply a dressing only after the superglue has completely dried. The injury should not be scrubbed, soaked, or picked until the adhesive naturally peels off in five to 10 days.

93 HANDLE A HEART ATTACK

A myocardial infarction, or heart attack, occurs when blood flow stops to part of the heart, causing damage to the heart muscle. A heart attack may result in irregular heartbeat, heart failure, or cardiac arrest. Common causes include lifestyle choices such as smoking; diseases such as diabetes, high blood pressure, and obesity; and genetic family history.

Some heart attacks are sudden and intense but most of them start out in a less unnerving way, with mild pain or discomfort. Sometimes people affected aren’t sure what’s wrong and wait before getting help.

The most common symptom is chest pain or discomfort, which may reach to the shoulder, arm, back, neck, or jaw. It is often in the center or left side of the chest, lasting for more than a few minutes, sometimes feeling like heartburn. Shortness of breath, nausea, cold sweat, or feeling faint or tired may also occur. Women are somewhat more likely than men to experience shortness of breath, nausea, vomiting, and back or jaw pain.

Since this is a potentially life-threatening condition, call 911 or get them to a hospital quickly. Also, have the patient chew an aspirin to help minimize blood clots that may be causing the heart attack.

94 RECOGNIZE A STROKE

A stroke, or a cerebrovascular accident (CVA), occurs when poor blood flow to the brain results in brain damage. There are two main types: ischemic, from lack of blood flow, and hemorrhagic, caused by bleeding. Both result in part of the brain not functioning properly and both are time-critical emergencies. Strokes can happen to anyone at any time, regardless of sex or age, and of those who survive, more than two-thirds have some type of permanent disability. Minutes can make a difference, so recognizing symptoms of a stroke is the key to preventing death or disability.

If you think someone is having a stroke, ask them to smile, lift their arms, and speak a short sentence. If they fail to respond normally, you should call for an ambulance or, if during a disaster no ambulances are available, transport them to a hospital immediately yourself. Remember the mnemonic FAST.

FACIAL DROOPING Is one side of their face numb or drooping? Ask them to smile. Is it uneven?

ARM WEAKNESS Is one arm weak or numb? Ask the person to raise both arms. Does one arm waver downward?

SPEECH DIFFICULTY Are they able to speak? Is their speech slurred or hard to understand? Ask them to repeat a simple sentence. Are they able to do so correctly?

TIME TO CALL 911 If someone shows any of these symptoms—even if the symptoms go away—call 911 and get help immediately. Be sure to note when the symptoms appeared.

Other stroke symptoms include sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, loss of coordination or balance; or sudden severe headache with no known cause. A victim may experience a combination of these symptoms, so if in doubt get them to help immediately.

95 ADDRESS AN ANXIETY ATTACK

Anxiety attacks, also called panic attacks, are episodes of intense panic or fear. They usually occur suddenly and without warning, peak within 10 minutes, and rarely last more than 30 minutes. Shortness of breath and chest pain are sometimes the most significant symptoms; the person may fear incorrectly that they are suffering a heart attack. However, since chest pain and shortness of breath are the hallmark symptoms of cardiovascular illnesses, seeking an emergency medical evaluation is still appropriate to determine the true cause.

SYMPTOMS OF ANXIETY INCLUDE:

• feeling overwhelmed, detached, or unreal

• feeling like you are losing control or going crazy

• heart palpitations or chest pain

• feeling faint, dizzy, or light-headed

• hyperventilation, trouble breathing, or sensation of choking

• hot flashes or chills (particularly in the facial or neck area)

• trembling or shaking

• nausea or stomach cramps

• numbness or tingling throughout the body

• headache or backache

• sweating

• dry mouth or difficulty swallowing

96 HELP THEM CALM DOWN

Being there for somebody who is experiencing an anxiety attack can really make a big difference to their well-being. Here are some ways to help calm someone under these circumstances.

The person will probably have an overwhelming desire to leave where they are; help them get somewhere quiet and secure. Try to reassure the person repeatedly by letting them know that you’re going to help and support them. If you are able to get them into a safe space, reassure them that they are safe.

If the person is having an anxiety attack, get their permission before making physical contact. In some cases, touching without asking can increase the panic and make the situation worse.

Ask the victim what will help them. Sometimes people will know what will help, but may need your assistance to initiate the activity. Accept that their fear is very real to them, and that if you minimize or dismiss the fear in any way you can make the panic attack worse. Let them talk it out or process their experience, for example, by asking them questions in a calm, neutral way. Listen supportively and accept whatever answer is given.

Help the victim to control their breathing by taking slow, deliberate breaths. Ask them to inhale and exhale on your count. Start off by counting out loud, encouraging the victim to breathe in for 2 seconds and then out for 2 seconds. After that, gradually increase the count until their breathing has slowed.

Some panic attacks can also be accompanied by sensations of warmth, commonly around the neck and face. A cool, damp cloth can help minimize this sensation and calm the victim.

Stay with the person until they have recovered from the attack.

97 HELP A SEIZURE VICTIM

Seizures result from abnormal electrical activity in the brain caused by fever, injury, stroke, brain tumors, or certain medications. Seizures occurring on a regular basis are a condition called epilepsy. There are several types of seizures, but tonic-clonic seizures are one of the most significant. The person may go rigid, fall down, and then convulse for a minute or two. Their breathing may also be affected and they may go pale or blue, particularly around the mouth; they may also lose bladder or bowel control.

This can be frightening to see, but isn’t often a medical emergency. Once the convulsions have ended, the person usually recovers slowly. They may appear “spaced out” or unable to easily answer questions for some time after the seizure ends.

If possible, ease the seizing person to the floor. Protect them from injury by moving any hard or sharp objects and put a soft, flat item, such as a pillow, under their head. Make note of how long the seizures last; report the information to medical responders. Place the victim in the recovery position (see item 99) once the seizure is over, and stay with them until recovery is complete. Be calmly reassuring throughout. Do not restrain the person or try to move them unless they are in danger, and do not place anything in their mouth or give them anything to eat or drink until they are fully recovered.

Call an ambulance if the seizure lasts more than a few minutes or they have another seizure without regaining consciousness; if they are injured, have trouble breathing, or become aggressive after the seizure; or if they have other health conditions such as diabetes, heart disease, or are pregnant.

98 PROTECT A PATIENT’S SPINE

The bones of the neck, referred to as the cervical vertebrae or c-spine, may be fractured or displaced if the neck has been twisted, compressed, or hyper-extended due to trauma. This can lead to severing or compression of their spinal cord, resulting in permanent nerve damage and paralysis. Assume someone has c-spine injury if they have neck pain after serious injury such as vehicle or bicycle accidents, falls, sport injuries, or assaults.

If the victim is awake, tell them to keep still and let them know you’re going to help them by immobilizing their neck. Kneel above their head, and place both hands on either side of the victim’s head to steady it. Hold onto their head gently but firmly to prevent movement. Any movement of the cervical spine may make a c-spine injury worse. Until medical help gets there, only release the victim’s head to help with their airway, breathing or circulation, or if it becomes unsafe to remain at the scene.

99 HELP A VICTIM RECOVER

If a sick or injured person is unconscious but is breathing and has no other life-threatening conditions or spinal injuries, they should be placed in the recovery position. Putting someone in the recovery position will ensure their airway remains clear and open. It also prevents vomit or other body fluids to be inhaled or cause choking, both of which can be life threatening.

STEP 1 Kneel on the floor on one side of the person.

STEP 2 Place the arm nearest you at a right angle to their body with their hand upwards above their head.

STEP 3 Tuck the victim’s other hand under the side of their head, so that the back of their hand is touching their cheek.

STEP 4 Bend and lift the knee farthest from you to a right angle.

STEP 5 Carefully roll the person towards you onto their side by pulling on the bent knee and their shoulder.

STEP 6 Once on their side, tuck the bent knee up towards their hips to keep them stable on their side.

STEP 7 Open the person’s airway by doing a head tilt/chin lift maneuver (see item 77) by gently tilting their head back and lifting their chin. Check that nothing is blocking their airway. Stay with the person and monitor their breathing and pulse until help arrives. Reassure the patient while you wait.

100 TREAT FOR SHOCK

In shock, the body’s organs and tissues are not receiving an adequate flow of blood. This is a common condition after an accident and can result in serious damage or even death. It’s best to assume that all parties injured in an accident will develop shock; proactively treat them before symptoms develop. Early treatment can reduce the severity of the shock and help save a life.

STEP 1 Symptoms can include the following: Anxiety, restlessness, or nervousness; confusion or even loss of awareness; rapid pulse; rapid, shallow breathing; pale, cool, sweaty skin; blotchy or bluish skin (especially around the mouth and lips); dilated pupils that are slow to respond to light; thirst; and nausea or vomiting.

STEP 2 Have the victim lie down, keeping their head low. Treat any injuries, such as bleeding.

STEP 3 Elevate the victim’s feet slightly.

STEP 4 Loosen restrictive clothing and belts to help the victim breathe more easily.

STEP 5 Keep the victim warm with blankets or coats.

STEP 6 Calmly talk and reassure the person until help arrives. Do not give them anything to eat or drink.

101 RECOGNIZE A HAIRLINE FRACTURE

A hairline fracture is the medical term for a crack in the bone, rather than a full break. However, should the crack worsen or break entirely, things could get complicated; you might even need surgery to correct the problem.

Hairline fractures are tricky because they can seem more like a strain or sprain than a fracture, which, while painful, may not be swollen, bruised, or deformed and is likely to have more normal function. It’s only when the pain doesn’t decrease after about three or four days that some people will suspect that something else is wrong. If you have an injury that remains painful after several days, get it evaluated. If you’re in a disaster situation where medical attention isn’t easily accessible, it’s best to assume that it’s broken and splint the injury site to protect it.

102 STABILIZE A FRACTURE

Fortunately, a fracture is often a stable injury. Getting to a hospital is always the best recourse, but if medical attention isn’t readily available, splinting and, if it’s needed, setting a bone can help you manage the pain and discomfort. In fact, a closed reduction might be the only way to save the arm or leg. Here’s how you can do it.

ASSESS THE INJURY A fracture usually won’t need any setting, but it might if the bone has broken clean across or diagonally, or is broken in multiple fragments that are jamming into one another. If the bone is protruding from the skin, don’t try to set it. Just splint it in place and cover it with a moist dressing.

CHECK CIRCULATION Press on the skin past the fracture site. The skin should turn white and then change back to pink quickly. Pale or bluish skin, a lack of a pulse in the limb, numbness, or tingling might indicate a loss of proper circulation.

REDUCE THE FRACTURE To decrease swelling, pain, and damage to the tissues caused by any lack of circulation, realign the limb into a normal position by slowly and carefully pulling in opposite directions on both sides of the break. This is usually easiest with two people.

SPLINT THE LIMB Use a splint to keep the break stable and in place.

103 SLING AN INJURED ARM

A sling is the easiest way to comfortably stabilize an arm injury such as a fracture, a severe sprain, or even an especially deep laceration. Knowing how to improvise a sling is useful—especially since you’ll want to do so regardless if you’re on your way to the hospital or if you’re forced to wait until medical care becomes available.

STEP 1 Start with a cloth about 3 feet by 3 feet (1 meter by 1 meter). Lay the cloth out flat, and then fold it once diagonally to make a triangle. (Your first aid kit should contain at least two cloth slings.)

STEP 2 Slip the injured arm into the fold, and bring both ends up around the neck, slanting the forearm upward very slightly.

STEP 3 Tie the corners in a knot, including the one near the elbow to create a pocket for it to rest in. This will naturally allow the forearm to stay in the sling easily.

STEP 4 Use your second sling (if improvising, use a belt) to immobilize the arm against the body. Wrap it around the chest above the forearm and above the problematic zone. Cinch it closed but not too tightly, as circulation is key.

104 SPLINT A LIMB

If someone injures a limb, especially at the joint, immobilization is key to stabilize the injury. Craft a splint with padding (such as some cloth or a T-shirt), tape, cardboard and other flexible material to support the area.

STEP 1 Stop any bleeding using direct pressure or a tourniquet if needed (see item 81).

STEP 2 Check for a pulse below the injury. The inside of the wrist and the top of the foot are common places to check. Remember to use your fingers and not your thumb to check for a pulse (your thumb has a pulse and you might mistake it for that of your patient).

STEP 3 Slide the cardboard or other splint material beneath the limb, and pad it for comfort and stability.

STEP 4 Fold the splint around the limb, securing it with tape, paracord, or other material. The splint should be just tight enough to prevent the limb from shifting but not so tight that it impedes circulation. Secure the splint both above and below the injury for added stability.

STEP 5 Check for a pulse below the injury again. Recheck every 20 minutes or so to make sure circulation isn’t lost. If the patient complains of numbness or tingling, or you can’t find a pulse, loosen the splint slightly.

105 IDENTIFY AND TREAT BURNS

Skin is the body’s largest organ and is made of layers of varying thicknesses. The severity of a burn depends on how deeply into these layers it penetrates, and the treatment varies for each type of burn. Regardless of severity, remove jewelry, belts, and any other restrictive clothing, especially from around the burned areas, as those tissues may rapidly become swollen.

1ST DEGREE Also known as superficial burns, these can be caused by almost anything from hot liquids to excess sun exposure. They heal on their own, but you should remove any constraining jewelry or clothing and apply a cool compress or aloe vera gel. Taking anti-inflammatory drugs may also hasten healing and improve comfort.

2ND DEGREE Flame flashes, boiling liquids, and hot metals cause this burn, which usually penetrates to the skin’s second layer. Blisters will occur, and it will take more than a few days to heal. Flood the site with cool water and trim away any loose skin (but leave blisters intact to prevent infection). Apply burn gel and change nonadhesive dressings daily. If the burn area is greater than 3 inches (7.5 cm) in diameter, or if it is on the victim’s face, hands, feet, groin, or buttocks, visit an emergency room for care if possible.

3RD DEGREE Full-thickness burns are very severe, reaching through all three layers of the skin. Treat the victim for shock and transport them to a hospital. Cover the burns loosely with a sterile burn sheet or use the cleanest cloth available. Do not moisten the bandage, as that can cause hypothermia. Skin grafts and extensive medical care will be required.

4TH DEGREE This burn will damage structures below the skin, such as tendons, muscles, and bones. These burns are very serious and potentially life-threatening, and because this type of burn destroys nerves, the victim may not complain significantly about pain or sensation. Permanent disability and death are both serious possibilities, so it’s critical to evacuate the victim to a medical facility immediately. As with third-degree burns, cover with a dry sterile burn dressing.

106 CARE FOR CHEMICAL BURNS

One of the biggest challenges for dealing with chemical burns is the sheer variety of chemicals and knowing the appropriate response for each. If you do happen to know exactly what chemical is responsible, check the original packaging for first aid instructions. You can also look up the substance’s Material Safety Data Sheet (MSDS), which has additional technical information for fire fighting, protective equipment, and containment and cleanup safety. If you’re not entirely certain as to the nature of the substance causing the burn, follow these general guidelines.

STEP 1 Remove the chemical causing the burn carefully. For dry chemicals, brush off any remaining material. Wear gloves or use a towel or a brush rather than using your hands.

STEP 2 Remove contaminated clothing and jewelry.

STEP 3 Rinse the burn immediately. Run a gentle stream of cool water over the burn for 10 or more minutes. Be sure to avoid any contaminated water splashing into the eyes of the patient.

STEP 4 Loosely apply a bandage.

STEP 5 If needed, take an over-the-counter pain reliever.

107 AVOID LIVE WIRES

If the victim is still being shocked by a source of electricity, or the risk for shock hasn’t been eliminated, you have to keep yourself safe before you can help.

If the person is affected by an indoor power source, shut it off or unplug it, or cut off power at the circuit breaker or fuse box. You can also use a nonconductive object such as a wooden broom handle (if you can, stand on a wooden board, phone book, or similar dry nonconducting surface) to break the circuit. If the power source is outdoors, but no greater than residential power, the same techniques can apply.

Don’t get near high-voltage wires until the power is turned off. Usually the local power company must do so. Since overhead power lines usually aren’t insulated, stay at least 30 feet away if wires are jumping and sparking, or 60 feet in wet conditions. If you feel a tingling in your legs and lower body in the disaster area, you’re on electrified ground; to avoid being electrocuted, hop on one foot away from the source of electricity (as both feet create a full circuit). If a power line falls on a car, instruct the passengers to stay inside until officials say it’s safe.

108 HELP A SHOCKED PERSON

The harmful effects of an electrical shock depend on several factors, including the type of current, voltage, and how the current has traveled through the body. An electrical shock may cause burns, or it may leave no detectable marks. In either case, any electrical current passing through the body can result in severe internal injuries.

The effects of high voltage can include severe burns inside and outside the victim’s body; seizures, confusion, or loss of consciousness; muscle pain and spasms; and difficulty breathing, heart arrhythmia, and cardiac arrest.

If someone has been shocked, call 911 or your local emergency number, especially if the source is a lightning strike or high-voltage wire. (Don’t touch the injured person if he or she is still in contact with the electrical current.) Begin CPR if required, treat any burns, and treat for shock.

109 HANDLE HYPOTHERMIA

As I’m sure you remember from biology class, the ideal temperature for the human body is about 98.6°F (37°C). If a person’s core body temperature drops below 95°F (35°C), you’ve got a case of hypothermia on your hands. Symptoms range from mild chills to coma and even death, depending on how low the core body temperature drops.

Treating hypothermia is simple and direct. Start off by making sure the person is warm and out of danger. If the environment is cold enough to cause hypothermia in the victim, then it’s cold enough to put others at risk, too. Next up: Get the victim out of the cold and then remove any wet clothing. You’ll want to wrap them in blankets or coats and, if possible, place warm water bottles or chemical warmers in the armpits, groin, and stomach. A warm, sweet drink will help—just avoid the old adage about drinking warm booze, as alcohol will actually cause the victim’s body to lose heat faster. Your next move is to get the victim to a hospital as quickly as possible.

110 AVOID FROSTBITE

If you frequently find yourself outside in very cold conditions, learning to avoid frostbite is wise, given the potentially severe consequences. Frostbite prevention involves having a working knowledge of protective clothing against cold and wind.

COVER UP Wear several layers of light, loose clothing to help provide better protection than a single bulky layer of heavy clothing. Choose fabrics suited for the cold (such as fleece, polypropylene, or wool). Avoid restrictive and tight clothing.

PROTECT YOUR EXTREMITIES Wear mittens instead of gloves; if mittens have to be temporarily removed to allow use of the fingers, wear lightweight gloves under them for additional protection. Wear two pairs of socks, and cover the face and head as much as reasonably possible, especially the ears.

BE SELF-AWARE Keep hydrated, and do not drink alcohol or smoke. Avoid staying still for too long, getting wet, or any prolonged exposure to the elements; seek shelter from wind and cold whenever possible. Retreat to warmth and safety if you notice early signs of frostbite: stinging, burning, throbbing, or a prickling sensation followed by numbness.

111 SURVIVE HEAT ILLNESS

There’s heat, and then there’s extreme heat—the kind that skyrockets your core body temperature to 104°F (40°C), making you dizzy and hot to the touch, and even rendering you unconscious. In severe circumstances, heat illness can even be fatal.

The milder of the two heat-related ailments, heat exhaustion, can occur when the body’s temperature gets too high. Victims of heat exhaustion can experience dizziness, nausea, fatigue, profuse sweating, and clammy skin. Treatment is simple: Have the victim lie down in the shade, elevate their feet, and supply plenty of fluids [A].

If someone’s core body temperature reaches 104°F (40°C), they will need immediate treatment for heatstroke, which can be deadly. Aside from an alarming thermometer reading, the easiest signs to identify are hot, dry skin, headache, dizziness, and even unconsciousness. To treat, elevate the victim’s head and wrap them in a wet sheet [B].

Heatstroke is a life-threatening emergency and requires immediate treatment in a hospital setting, as heatstroke can damage the kidneys, brain, and heart if it goes on for too long at too high a temperature.

112 DEFEAT DEHYDRATION

Humans can go a while without food, but a lack of water is an entirely different story. Without a constant supply of potable water, dehydration will set in quickly, along with low energy, poor judgment, and, in extreme cases, the eventual loss of the will to survive.

You should regularly drink fluids, preferably pure water. Don’t wait until you’re thirsty to drink. Get used to being on a hydration schedule and stick to it, especially during disasters.

Your risk of dehydration is just as high in the cold as it is in the heat. Every breath you take releases moisture into the dry air, and when it’s cold, you’re probably less thirsty.

We all know that activity in the heat leads to dehydration if we don’t drink enough water, but it’s worse at high elevation: The air is arid and thin, so you end up breathing harder and sweating more, which in turn accelerates dehydration.

If you begin to experience signs of dehydration, drink clear fluids, including water, clear broths, or electrolyte-containing beverages such as coconut water. An excess of pure water on its own—after you’ve lost salts and other minerals from sweating—can be dangerous.

113 BEWARE COMMON POISONS

We all know it’s important to keep household cleansers, detergent, and bleach away from children. The same goes for medicines—pills can look like candy to kids. But do other dangerous substances lurk in your home?

CHECK YOUR BATHROOM Beware of nail-polish remover, shampoo, and even mouthwash. Due to the ingredients or alcohol content, the majority of personal-care products can be poisonous if ingested.

CLEAR THE GARAGE Pesticides, paints, paint thinners and removers, fuels, and oil are all highly dangerous to inhale or swallow. That’s pretty obvious from the smell, but other substances to watch for include antifreeze and windshield-washer fluid, which, while deadly, are brightly colored and may have a sweet taste or smell.

MAKE YOUR KITCHEN SAFE It’s well known that raw or undercooked poultry or fish can be a source of foodborne illness such as salmonella. Less well known is the fact that uncooked beans also warrant caution. Nearly all varieties, especially red kidney beans, contain substances called lectins, which are broken down by cooking but, if eaten uncooked, can cause nausea, vomiting, and diarrhea.

114 KNOW SIGNS OF POISONING

If you need to evaluate a child for poisoning, or if someone refuses to answer questions about what they may have ingested, as in the case of a suicidal person, you can look for these common signs.

The victim may have burns or redness around the mouth and lips, or burns, stains and odors on their body, clothing, or other objects nearby. They may also have paint, powders, or other liquids around the face and nostrils. Likewise, a strong chemical odor, such as gasoline or paint thinner, may be on their breath. Look for any empty medication bottles or scattered pills, or spilled or empty containers for chemical, paint, or household products.

The individual may show signs of nausea or begin vomiting, become drowsy or unconscious, experience difficulty breathing, or even respiratory arrest. The victim may also be agitated or restless, or seizing or twitching uncontrollably. Assume that the person is poisoned until proven otherwise, and take action on treating a poisoning victim (see item 115).

If the person has no symptoms, but you suspect poisoning, call your regional poison control center. Provide age, weight, and any information you may have about the poison, such as how much of it was ingested and how long since the person was first exposed to it. If possible, it will help to have the pill bottle or container on hand when you call.

115 TREAT A POISONING VICTIM

Helping a poisoning victim can be tricky, since there’s no one-size-fits-all solution. But in every case, it’s vital to find out what the toxin is and seek help.

STEP 1 Call your local emergency number to request help.

STEP 2 If the poison is emitting fumes or there is a strong chemical odor in the room, move the person into fresh air.

STEP 3 Put on gloves, if available, to prevent contamination. Check for any remaining poisonous substance in the victim’s mouth. If you find any, wipe it away. If the poison spilled on the person’s clothing, remove the clothing.

STEP 4 If the victim isn’t breathing, and you have a CPR mask or face shield, and you’re certified in CPR, begin rescue breathing.

STEP 5 If poison got exposed on bare skin or in the eyes, flush with lukewarm water for 20 minutes or until help arrives.

STEP 6 If the toxin is a household product, check the label for advice, or contact your local poison-control hotline. Do not induce vomiting or administer a charcoal slurry unless instructed to do so.

STEP 7 If the victim goes to the emergency room, take the pill bottle or package that contained what was ingested. That will help doctors start proper treatment immediately.

116 DON’T PANIC OVER PREGNANCY

Modern Western society tends to regard labor as a kind of emergency requiring medical intervention. In most situations, however, nothing could be farther from the truth. Women have been delivering babies for thousands of years without the benefit of modern medicine and, unless there is a complication, the delivery can safely be performed just about anywhere. If a mother-to-be is prepared and is in good health, if the location is safe, and if there are aren’t any other known complications, let nature take its course and help deliver a new life into the world.

117 DEAL WITH LABOR

Labor is the first stage of the process that leads to the actual delivery of the baby. Here’s what you can do to help.

STEP 1 Decide whether to transport the mother-to-be to the hospital, call an ambulance, or help deliver the baby. If labor has just started, it will usually be fine to give her a ride to the hospital if that’s what she wants, or call an ambulance if she prefers. If she is late in labor, then the decision will be made for you, and you’ll want to prepare for the delivery.

STEP 2 Time contractions from the beginning of one to the beginning of the next, and note how long they last. If they are 5 or more minutes apart, you have time to get the mother to the hospital if she wants to go. If the contractions are two or fewer minutes apart, then prepare for delivery. If she feels like she’s going to have a bowel movement, delivery is imminent.

STEP 3 Protect the baby from possible infection by washing your hands thoroughly with soap and warm water all the way up to your elbows. If you lack soap and water, use a hand sanitizing product or rubbing alcohol. Wear medical gloves if you have them available.

STEP 4 Prepare the birthing area. Gather several clean sheets or towels. Have the mother undress from the waist down and offer her a clean sheet or towel to cover up. Find a few pillows to help her be positioned more comfortably during delivery. Fill a clean bowl with warm water, and get a pair of scissors, a length of paracord, and a bulb syringe.

STEP 5 Help the mother stay calm. It may help if you speak to her in a low, soothing voice and work to verbally direct her breathing (or take deep, slow breaths along with her).

STEP 6 Help the mother find a comfortable position, or she may want to walk around or crouch down, especially when she has a contraction. Allow her to find her own position of comfort, which may be lying back, squatting, or on all fours.

118 DELIVER A BABY

If the mother has delivered children in the past, the actual delivery can be quite fast, but if it’s her first time it’s normal for the process to take longer.

STEP 1 To avoid exhausting the mother, don’t encourage her to push until she feels an unstoppable pressure. Eventually, the area around the vagina will bulge, and the top of the baby’s head will become visible. Continue to encourage her to push gently between contractions and to take deep, slow breaths to help manage the pain.

STEP 2 Support the baby’s head as it emerges, allowing it to rotate to one side. Don’t pull, as this might hurt the baby.

STEP 3 Keep supporting the baby’s head and neck as a shoulder will normally emerge with the next push. Deliver the other shoulder by gently lifting the body if needed.

STEP 4 The rest of the body will follow quickly. Hold the delivered baby with two hands, one supporting its neck and head. The newborn will be slippery, so dry them off with a towel and tilt their head down with the legs slightly elevated to allow any fluids to drain.

STEP 5 Ensure the baby is breathing. If it’s not crying, rub the body to stimulate it. Gently suction fluids from mouth and nostrils with a bulb syringe. If the baby turns blue, perform infant CPR (see item 119).

STEP 6 If the baby is breathing, place them on the mother’s chest with full-skin contact, and cover both of them with clean towels or a blanket. (The skin contact will stimulate the release of a hormone that helps to deliver the placenta.) Encourage the mother to breast feed the newborn, as it helps reduce bleeding by contracting the uterus.

STEP 7 Massage the abdomen to both assist delivery of the placenta (which can take up to an hour to occur) and help control bleeding—do not pull on the umbilical cord! Once the placenta is delivered, you can wrap it in plastic in case it is needed for inspection.

STEP 8 If an ambulance is on the way, you can wait for them to cut the cord. Otherwise, wait for the cord to stop pulsing, then tie it off in two places a few inches apart and 3 inches (7.5 cm) from the baby using some paracord. Sever the cord between the two knots with sterilized scissors.

119 PERFORM INFANT CPR

If you have helped deliver a baby and they are not crying or moving, you should stimulate them by drying and warming them, rubbing their limbs or body, and checking to see if the infant’s airway is clear of mucus or fluids. A newborn infant should breathe at least 30-60 times per minute, and have a pulse rate between 100 and 160. If they don’t respond to any of the manual stimulation, are turning blue, or don’t have a pulse, then you will need to perform infant CPR.

STEP 1 Hold the baby in one arm with the head in the palm of your hand, or lay them down on a flat, padded surface; keep their head level, not tucked or hyperextended.

STEP 2 Start by delivering 30 chest compressions at a rate of 100 per minute by placing the tips of two or three of fingers in the middle of the infant’s chest, and apply compression to a depth of about 1.5 inches (4 cm).

STEP 3 Open the airway using a head tilt/chin lift, but do not tilt the head too far back. Deliver two rescue breaths by covering their mouth and nose with your mouth and giving just a small puff of air each time.

STEP 4 After two minutes, check for a pulse on the brachial artery, located inside the upper arm. Briefly pause to call for an ambulance at this time.

STEP 5 Continue delivering compressing and breaths at a ratio of 30:2.

STEP 6 After two minutes, check for a pulse on the brachial artery inside the upper arm. Repeat steps 5 and 6 until emergency responders arrive, obvious signs of life return, you become too exhausted to continue, or if the scene becomes unsafe.

120 HAVE A HELPER

Ideally, you will have someone else with you if you are delivering a baby for all kinds of reasons. One vital reason is that they can assist you in the unlikely event that you need to give CPR. Here’s how. With the infant lying on a pad, one person can support the head and deliver rescue breaths. The second will deliver chest compressions by encircling the newborn’s torso with both hands, using his or her thumbs side by side in the middle of the chest instead of two fingertips. The proper compression-to-breath ratio for two-person CPR is 15:2. To maintain effective CPR for as long as possible, switch positions after 2 minutes while checking for a pulse.

121 BE A HELPFUL PARENT

If you’re a parent with a child who’s sick or otherwise in need of medical help, you can still make things easier even if you’re not a medical professional yourself.

HOLD YOUR BABY Sit your child on your lap. It will make them more comfortable while interacting with a stranger.

GIVE COMFORT Reassure your child and keep repeating calming words to keep them calm throughout the experience.

KEEP CALM By remaining calm yourself you’ll help keep your child calm.

BE AN ADVOCATE If the people are not treating your child appropriately, advocate for your child’s needs.

AID WITH INFORMATION Be ready to provide details about your child’s medical history if needed.

122 BE PATIENT WITH LITTLE PATIENTS

Sick children make anxious parents and can often even make medical professionals nervous. Since they can’t always answer questions or say what’s bothering them with any clarity, it’s frequently hard for both parents and paramedics to figure out what’s bothering them. If you’re trying to help a child, you can help them much more easily if you work with them.

Sit or crouch down next to the child so you’re closer to their height. If you speak with a quiet, calm, and confident voice, you’ll be able to easier establish a rapport with the child and make it easier to help them.

Relate to the child and be empathetic. Explain to them what you are doing, step by step, so they are not surprised by what’s happening. Assume the child understand what you’re saying. You can even find a toy or stuffed animal to “treat” first before you start treating the child, so that they may know what to expect.

Make the space in which you’re caring for the child as comfortable as possible. If it’s loud, dark, or cold, move to someplace quieter, with better light, or someplace warmer. Smells, animals, and too many people surrounding a young patient are also factors to consider. Remove anything that might be stressful or upsetting to the child if possible.