Greg Davenport
Burns are rated by depth as first, second, or third degree, each indicating increasingly deeper penetration. A first-degree burn causes superficial tissue damage, sparing the underlying skin, and is similar in appearance to a sunburn. A second-degree burn causes damage into the upper portion of the skin, with resultant blister formation that is surrounded by first-degree burn damage. A third-degree burn causes complete destruction of the skin’s full thickness and often beyond. In addition, first- and second-degree burns are usually present.
To treat burns, cool the skin as rapidly as possible and for at least forty-five minutes. This is extremely important, since many burns continue to cause damage for up to forty-five minutes, even after the heat source has been removed. Remove clothing and jewelry as soon as possible, but don’t remove any clothing that is stuck in the burn. Never cover the burn with grease or fats, as they will only increase the risk of infection and are of no value in the treatment process. Clean the burn with water (preferably sterile), apply antibiotic ointment, and cover it with a clean, loose dressing. To avoid infections, leave the bandage in place for six to eight days. After that time, change the bandage as necessary. If the victim is conscious, fluids are a must. Major burns cause a significant amount of fluid loss, and ultimately the victim will go into shock unless these fluids are replaced. If pain medications are available, use them. Burns are extremely painful.
Most eye injuries encountered in the wilderness are a result of dust, dirt, or sand blown into the eye by the wind. Symptoms include a red and irritated eye, light sensitivity, and pain in the affected eye. To treat, first look for any foreign bodies that might be causing the irritation. The most common site where dirt or dust can be found is just under the upper eyelid. Invert the lid and try to find and remove the irritant. If you’re unable to isolate the cause, rinse the affected eye with clean water for at least ten to fifteen minutes. When rinsing, keep the injured eye lower than the uninjured to avoid contaminating the other eye. Apply ophthalmic antibiotic ointment, if available, to the affected eye.
Clean all wounds, lacerations, and infections, and apply antibiotic ointment, a dressing, and a bandage daily.
Blisters result from the constant rubbing of your skin against a sock or boot. The best treatment is prevention. Monitor your feet for hot spots or areas that become red and inflamed. If you develop a hot spot, apply a wide band of adhesive tape across and well beyond the affected area. If you have tincture of benzoin, use it. It will make the tape adhere better, and it also helps toughen the skin. To treat a blister, cut a blister-size hole in the center of a piece of moleskin, and place it so that the hole is directly over the blister. This will take the pressure off the blister and place it on the surrounding moleskin. Avoid popping the blister. If it does break open, treat it as an open wound, applying antibiotic ointment and a bandage.
Thorns and splinters are often easy to remove. Cactus spines, however, hook into the skin, and in most cases you’ll need a pair of tweezers or pliers to get them out. If you can’t pull out the spines, don’t panic. They often come out on their own over a period of several days. Whether or not you remove them, prevent infection and protect the area by applying antibiotic ointment, a dressing, and a bandage.
Sun blindness is a result of exposure of the eyes to the sun’s ultraviolet rays. It most often occurs in areas where sunlight is reflected off sand, snow, water, or light-colored rocks. The resultant burn to the eyes’ surface can be quite debilitating. Symptoms include bloodshot and tearing eyes, a painful and gritty sensation in the eyes, light sensitivity, and headaches. Prevention by wearing 100 percent UV sunglasses is a must. If sun blindness does occur, avoid further exposure, apply a cool wet compress to the eyes, and treat the pain with aspirin as needed. If symptoms are severe, apply an eye patch for twenty-four to forty-eight hours.
Bowel disturbances in the wilderness are common and include diarrhea and constipation.
Diarrhea
Diarrhea is a very common occurrence in a survival situation. In the desert, diarrhea can lead to dehydration and hyponatremia. Some common causes are changes in water and food consumption, drinking contaminated water, eating spoiled food, eating off dirty dishes, and fatigue or stress. Diarrhea is almost always self-limiting, and unless you have antidiarrhea medications, treatment should consist of supportive care. Consume clear liquids for twenty-four hours, and follow with another twenty-four hours of clear liquids plus bland foods.
Constipation
Constipation is common in a survival setting. To treat, drink fluids and exercise. Laxatives are contraindicated and rarely needed.
—From Surviving the Desert
U.S. Army Corps of Engineers
Burns may be caused by a variety of agents such as fire, the sun, or any boiling liquid.
There are three degrees of burns:
1. First Degree
2. Second Degree
3. Third Degree
All three require special attention.
FIRST DEGREE BURNS
Symptoms: redness mild swelling pain caused by the sun or heat.
Aid: Submerge in cold water for the length of time the pain persist.
SECOND DEGREE BURNS
Symptoms: redness blisters caused by a severe sun burn, liquid, or fire burn.
Aid: Immerse in cold water for 1–2 hrs. Apply freshly ironed or cleaned bandages, that have been wrung out in ice water, then apply to burn.
THIRD DEGREE BURNS
Symptoms: This degree of burn destroys all layers of the skin, and damages the nerves. May appear white or charred (black). The red blood cells are destroyed. This burn is usually caused by flame, ignited clothing, hot objects, or electricity.
Procedure: Don’t remove clothing attached to burn. Cover burned areas with sterile dressings, or freshly ironed or cleaned linens.
If the hands or feet are involved: Keep them above the heart by elevating them with a pillow. If the face is burned: Have the victim sit up.
If medical aid is more than an hour away:
Give the victim a weak solution of:
1 level teaspoon salt
½ level teaspoon baking soda
1 quart of water
This should be given: ½ glass every 15 minutes. Aspirin may be given for pain.
Seek medical attention immediately!
Cause: food or other particles in the airway.
Procedure: Grab the victim from behind. Lock your arms around his/her abdominal area just above the belly button and below the rib cage. Jerk your arms into the victim’s abdominal area. This should be done in quick thrust to force the food or foreign matter out.
Even though breathing has been restored, foreign matter may still remain, resulting in serious complications. Seek medical attention immediately.
If the barb has not penetrated the skin: Just back the hook out.
If the barb has penetrated the skin: Push the hook on through until the barb comes out the other side. Cut one end of the hook off. Pull the other half on out of the skin, as diagramed:
In any case: Get a tetanus shot
Cause: Using charcoal to dry out a tent.
Symptoms: cherry red color in skin, dizziness, headache
Procedure: Remove victim from hazard, seek medical assistance, loosen clothing, and clear airway. If victim has stopped breathing, begin artificial respiration.
Cause: insufficient amount of blood to the brain.
Symptom: paleness, sweating, coldness, dizziness, numbness in the feet and hands, then blackout.
Procedure: Keep the victim down, loosen clothing, bathe face with a cool washcloth. Examine victim for injury from his/her fall.
Unless recovery is prompt, seek medical attention.
—From Camper’s First Aid
Tod Schimelpfenig
Allergic reactions range from mild to severe, and they can be immediate or delayed. For most people, the allergic response is mild, though often irritating. Hay fever is one example of a mild allergic response. Hay fever sufferers complain of a runny nose, sneezing, swollen eyes, itching skin, and possibly hives. An allergic reaction may also be local, the result of insect stings or contact with a plant. The local reaction is red, swollen, and itching, perhaps with hives, but stays near the point of contact.
First remove the allergen from the patient or the patient from the offending environment. It’s hard to treat a pollen reaction standing under a tree shedding millions of pollen grains or to treat an allergy to dust in a dusty cabin. Antihistamines and decongestants are the usual treatment. The antihistamines treat the underlying reaction, the release of too much histamine. Monitor the patient closely for a developing severe reaction.
An anaphylactic response is a massive, generalized reaction of the immune system that is potentially harmful to the body. Common triggers of anaphylaxis are drugs and some foods; people can also react to bee stings and insect bites. Instead of the mild symptoms of hay fever, anaphylaxis produces asphyxiating swelling of the larynx, rapid pulse, a rapid fall in blood pressure, rash itching, hives, flushed skin, swollen and red eyes, tearing of the eyes, swelling of the feet and hands, nausea, vomiting, and abdominal pain. The airway obstruction and shock may be fatal. Onset usually occurs within a few minutes of contact with the triggering substance, although the reaction may be delayed. Any large areas of swelling, typically involving the face, lips, hands, and feet; respiratory compromise; or shock should be treated with epinephrine.
If you catch the allergic reaction while the patient can still swallow, administer oral antihistamines. When the reaction becomes severe, the anaphylaxis is treated with immediate administration of epinephrine, a prescription medication, to counteract the effects of the histamine. Persons who know that they are vulnerable to anaphylactic shock usually carry injectable epinephrine in an TwinJect or EpiPen. Trip leaders should be familiar with their use and seek the advice of a physician advisor when responding to this emergency.
1. Unscrew the yellow or green cap off of the EpiPen or EpiPen Jr and remove the auto-injector from its storage tube.
2. Grasp unit with the black tip pointing downward. Form fist around the unit (black tip down).
3. With your other hand, pull off the gray safety release.
4. Swing and jab firmly into outer thigh until it clicks. (Auto-injector is designed to work through clothing.)
5. Hold firmly against thigh for approximately 10 seconds. (The injection is now complete. Window on auto-injector will show red.)
6. Remove unit from thigh and massage injection area for 10 seconds.
7. Carefully place the used auto-injector (without bending the needle), needle-end first, into the storage tube of the carrying case for needle protection after use.
–From NOLS Wilderness Medicine
Tod Schimelpfenig
A history of asthma, heart disease, or even a heart attack does not, by itself, prevent someone from paddling a river, climbing a peak, or hiking the Wind River Range. The wilderness first responder will see these medical conditions and should be knowledgeable in their assessment and treatment.
Hyperventilation syndrome is an increased respiratory rate caused by an overwhelming emotional stimulus. The patient becomes apprehensive, nervous, or tense. For example, a person may normally have a fear of heights, and the thought of rock climbing triggers a hyperventilation episode, or a climber may fall and suffer a minor injury but begin to hyperventilate out of fear and anxiety. The hyperventilation can quickly become the major condition affecting the patient.
Signs and Symptoms of Hyperventilation. Signs and symptoms of hyperventilation include a high level of anxiety, a sense of suffocation without apparent physiological basis, rapid and deep respiration, rapid pulse, dizziness and/or faintness, sweating, and dry mouth.
As the syndrome progresses, the patient may complain of numbness or tingling of the hands or around the mouth. Thereafter, painful spasms of the hands and forearms—carpopedal spasms—may occur. The hands curl inward and become immobile. The patient may complain of stabbing chest pain. Rapid respiration increases the loss of carbon dioxide, which causes the blood to become alkaline. The alkaline blood causes the carpopedal spasms.
Treatment for Hyperventilation. To treat hyperventilation syndrome, calm the patient and slow his or her breathing. Coach the patient to breathe slowly. It may take some time before the symptoms resolve. Breathing into a paper bag, once thought to help increase carbon dioxide in the blood, is no longer a recommended treatment.
A pulmonary embolism occurs when a clot (usually from a leg vein) breaks loose and lodges in the blood vessels of the lung. Pulmonary embolus is not uncommon outside the wilderness and can be a tough diagnosis. Decreased mobility—lying in a tent waiting out a storm, for example, or long plane flights—may predispose a person to a blood clot. Smoking and a history of recent surgery or illness that kept the patient in bed are also risk factors. There is an increased tendency for blood to clot in arteries and veins at high altitudes. Dehydration, increased red blood cells, cold, constrictive clothing, and immobility during bad weather have been cited as possible causes.
Signs and Symptoms of Pulmonary Embolism. The patient complains of a sudden onset of shortness of breath and pain with inspiration. Respiratory distress may develop, including anxiety and restlessness; shortness of breath; rapid breathing and pulse; signs of shock, including pale, cool, and clammy skin and cyanosis of the skin, lips, and fingernail beds; and labored breathing using accessory muscles of the neck, shoulder, and abdomen to achieve maximum effort.
Treatment for Pulmonary Embolism. First responders can’t dissolve the embolism in the field. You can identify the respiratory distress, administer oxygen if it is available, and evacuate the patient promptly.
Pneumonia is a lung infection that can be caused by bacteria, viruses, fungi, and protozoa. The inflammation of the alveolar spaces causes swelling and fluid accumulation. Difficulty breathing can result. People weakened by an illness, chronic disease, fatigue, or exposure are especially at risk. Pneumonia can be a serious infection and is a leading cause of death.
Signs and Symptoms of Pneumonia. Signs and symptoms of pneumonia are shortness of breath, fever and chills, a productive cough with green-yellow or brown sputum, and pain on inspiration or coughing. The patient may have a recent history of upper respiratory infection and lung sounds, if you can listen with a stethoscope, may be noisy.
Treatment of Pneumonia. Patients with pneumonia should be evacuated. Encourage the patient to cough and breathe deeply to keep the lungs clear. Hydration is important, and oxygen, if available, will be helpful. The patient may be more comfortable sitting up.
Asthma is an allergic response characterized by narrowing of the airways, increased mucous production, and bronchial edema. Asthma’s exact cause is unknown. We do know that allergy and environmental factors such as molds, cold air, chemical fumes, cigarette smoke, exercise, and infections play a role.
Asthma is usually a reversible condition. The airway narrowing can improve spontaneously or in response to medication. A prolonged, severe asthma attack that is not relieved by treatment is an emergency requiring rapid transport. There are other chronic lung diseases, such as emphysema and bronchitis, in which the breathing impairment is persistent because of destruction of lung tissue and chronic inflammation.
Signs and Symptoms of Asthma. Signs and symptoms of mild to moderate asthma are wheezing, chest tightness, and shortness of breath. The heart and breathing rates are increased. When asthma becomes severe, the patient may be hunched over, bracing the upper body and working to breathe. The patient may be able to speak only in one- or two-word clusters. Lung sounds may be diminished or absent. If the patient becomes sleepy or too fatigued to breathe, the situation is dire.
Treatment of Asthma. Usually the patient treats the asthma by self-administering medication, commonly a bronchodilator, with an inhaler. You may need to help the patient relax and use the inhaler properly; shake it first, hold it in the mouth, exhale, and then depress the device and inhale the mist deeply, holding the breath for 5 to 10 seconds before exhaling. To stabilize the initial exacerbation, aggressive use of the patient’s inhaler (3, 4, or 5 treatments) might be needed. Warm, humidified air can help relax airways and clear mucus. Severe asthma episodes may require medications (epinephrine and steroids) usually not available in the wilderness, and such patients should be evacuated promptly.
Heart disease is a leading cause of death in the United States. Atherosclerosis, a common form of heart disease, slowly builds deposits on arterial walls that narrow the artery and impede blood flow. The narrowed artery can spasm, constrict, or lodge a clot, depriving tissue of blood. If this happens in the brain, the result may be a stroke. If it happens in the heart, it causes chest pain, also known as angina pectoris, or a myocardial infarction, a heart attack. Angina is pain from diminished blood flow. A myocardial infarction is heart muscle damage from blocked blood flow. Sudden death from a heart that beats erratically, or not at all, can be a result of this disease.
Signs and Symptoms of Cardiac Chest Pain. Cardiac chest pain is often described as crushing, tight, pressing, viselike, and constricting. It is below the breastbone and can radiate into the left arm and jaw. Shortness of breath, anxiety, pale sweaty skin, nausea, and dizziness are also common complaints. The pulse may be irregular. If the pain is brought on by physical or emotional stress and is relieved by rest, it may be angina. If it is unprovoked and persists, it may be a myocardial infarction.
Treatment for Cardiac Chest Pain. Figuring out whether nontraumatic chest pain is a heart condition can be difficult under the best of circumstances. Inflammation of the stomach or esophagus, chest muscle strains, rib injury, lung problems, bronchitis, and coughing can all cause chest pain. To complicate the situation, cardiac pain does not always fit the classic pattern and description. A patient with chest pain symptoms that cannot be attributed to a chest injury, lung problem, stomach upset, or muscle strain should be given one-half adult aspirin (160mg) every 12 hours and evacuated. Reduce the demands on the heart by calming the patient and making him or her rest. If available, administer oxygen. If your patient has a history of cardiac chest pain, he or she may have nitro-glycerin, a medication administered by placing a tablet under the tongue.
–From NOLS Wilderness Medicine
Tod Schimelpfenig
There are many, many illnesses that can develop within the abdomen. This section is by no means exhaustive, but it does cover problems that, in our experience, we tend to see in the back-country. The most important part of this chapter is the final section, which reminds us not to worry about diagnosis, but rather to do a sound assessment and decide if the patient meets the evacuation criteria.
Kidney stones occur when minerals precipitate from the urine in the kidney. Approximately three-quarters of kidney stones are crystallized calcium. Predisposing factors for kidney stones include urinary tract infections, dehydration, an increase in dietary calcium, too much vitamin D, and cancer.
Signs and Symptoms of Kidney Stones. As a stone passes down the ureter, the patient experiences excruciating pain that comes and goes with increasing intensity. The pain usually begins at the level of the lowest ribs on the back and radiates to the lower abdomen and/or groin. The patient is pale, sweaty, nauseated, and “writhing” in pain. There may be pain with urination and blood in the urine. Chills and fever are not present. The duration of the pain depends on the location of the stone. Pain is severe while a stone is passing from the kidney to the bladder and stops after the stone has dropped into the bladder. The pain may last as long as 24 hours, but the duration is usually shorter.
Treatment for Kidney Stones. Drinking copious amounts of water may help the patient pass the stone. Pain medication may help. If pain continues for more than 48 hours or if the patient is unable to urinate, evacuate.
Appendicitis is an inflammation of the appendix, usually caused by a kinking of the appendix or by a hardened stool obstructing the opening. Due to the obstruction, mucus builds within the appendix, causing pressure, swelling, and infection. The highest incidence of appendicitis occurs in males between the ages of 10 and 30.
Signs and Symptoms of Appendicitis. The classic symptoms of appendicitis are pain behind the umbilicus (the navel), anorexia, nausea, and vomiting. The usually develop gradually over 1 to 2 days. The pain then shifts to the lower right quadrant, halfway between the umbilicus and the right hipbone. The patient may have one or two bowel movements but usually does not have diarrhea. When you apply pressure with your hand over the appendix, the patient may complain of pain when you remove your hand. This is called rebound tenderness. A fever and elevated pulse may be present. Due to infection and pain, the patient may lie on his or her side or back with legs tucked onto the abdomen (fetal position). There may also be pain when the patient jumps, walks, or jars his or her right leg or side.
Before the appendix ruptures, the skin over the appendix becomes hypersensitive. If you stroke the skin surface with a pin or grasp the skin between the thumb and forefinger and pull upward, the patient may complain of pain. If the appendix ruptures, the pain temporarily disappears but soon reappears as the abdominal cavity becomes infected (peritonitis). If the infection remains localized (abscess), the patient may only run a low fever and complain of not feeling well. The abscess may not rupture for a week or more.
Treatment for Appendicitis. Appendicitis is a surgical emergency. The patient must be evacuated.
Peritonitis is an inflammation of the peritoneum. Causes include penetrating abdominal wounds, abdominal bleeding, or ruptured internal organs that spill digestive juices into the abdominal cavity.
Signs and Symptoms of Peritonitis. Signs and symptoms of peritonitis vary, depending on whether the infection is local or general. The patient lies very still, as movement increases the pain. He or she may complain of nausea, vomiting, anorexia, and/or fever. The abdomen is rigid and tender. The infection causes peristaltic activity of the bowel to stop, so the patient has no bowel movements. Shock may be present. The patient appears very sick.
Treatment for Peritonitis. Peritonitis is a severe infection beyond our capability to treat in the wilderness; treat the patient for shock and evacuate.
Hemorrhoids are varicose veins of the anal canal. They may be internal or external. Constipation, straining during elimination, diarrhea, and pregnancy can cause hemorrhoids. External hemorrhoids can be very painful. Internal hemorrhoids tend not to be painful but bleed during bowel movements. The stool may be streaked on the outside with blood. The patient may complain of itching around the anus.
Treatment for Hemorrhoids. Apply moist heat to the anal area. This can be done with a bandanna dipped in warm water. Rest, increased liquid and fruit intake to keep the stools soft, and/or anesthetic ointments (such as dibucaine, Preparation H, or Anusol) help decrease pain and bleeding.
Decreased resistance of the stomach lining to pepsin and hydrochloric acid, or an increase in the production of these chemicals, may result in ulcers. Stress, smoking, aspirin use, certain bacteria, caffeine or alcohol consumption, and heredity are possible causes.
Signs and Symptoms of Ulcers. The patient complains of a gnawing, aching, or burning in the upper abdomen at the midline 1 to 2 hours after eating or at night, when gastric secretions are at their peak. The pain may radiate from the lowest ribs to the back and frequently disappears if the patient ingests food or antacids.
Is it indigestion, or is it an ulcer? Indigestion symptoms tend to be associated with eating. The patient complains of fullness and heartburn and may belch or vomit small amounts of food. Indigestion worsens when more food is ingested. As time passes and the stomach empties, symptoms disappear. Indigestion tends to be related to a single meal.
Treatment for Ulcers. The primary treatment for ulcers is to take antacids an hour after meals; eat small, frequent meals; and avoid coffee, alcohol, and spicy foods, which increase the secretions of the stomach. Long-term treatment includes rest and counseling to decrease stress. If the ulcer perforates the wall of stomach, symptoms of peritonitis occur.
Abdominal organs are either solid or hollow. When hollow organs are perforated, they spill their contents into the abdominal cavity. Solid organs tend to bleed when injured. Either bleeding or spillage of digestive juices causes peritonitis.
Blunt Trauma. Inspect the abdomen for bruises; consider how the injury occurred to diagnose what, if any, organs may have been damaged. Pain, signs and symptoms of shock, and a significant mechanism of injury are reasons to initiate an evacuation.
Penetrating Wounds. Assume that any penetrating wound to the abdomen has entered the peritoneal lining. Treat the patient for shock and evacuate.
Impaled Objects. Leave any impaled object in place; removal may increase bleeding. Stabilize the object with dressings. If there is bleeding, apply pressure bandages around the wound.
Evisceration. An evisceration is a protrusion of abdominal organs through a laceration in the abdominal wall. After rinsing the bowel you may be able to gently “tease” small exposed loops back into the abdomen. If not, cover the exposed bowel with dressings that have been soaked in disinfected water. Keep these moist to prevent the exposed loops of bowel from becoming dry. Change the dressings daily. Treat for shock and evacuate the patient.
The first responder needs a few simple skills to be able to evaluate the condition of a patient with an abdominal problem.
1. Inspect the abdomen. Position the patient in a warm place, lying down. Remove the patient’s clothing so that you can see the entire abdomen. A normal abdomen is slightly rounded and symmetrical. Look for old scars, areas of bruising, rashes, impaled objects, eviscerations, and distention. Check the lower back for the same. Look for any movement of the abdomen—wavelike contractions may indicate an abdominal obstruction.
2. Listen to the abdomen in all quadrants. Place your ear on the patient’s abdomen and listen for bowel sounds (gurgling noises). An absence of noise indicates an injured or ill bowel. You must listen for at least 2 to 3 minutes in all quadrants before you can properly say that no bowel sounds are present.
3. Palpate the abdomen. With your palms down, apply gentle pressure with the pads of the fingers. Make sure your hands are warm and that you palpate in all the quadrants. Cold fingers or jabbing can cause the patient to tighten the abdominal muscles, thereby impeding the assessment. The abdomen should be soft and not tender. Abnormal signs include localized tenderness, diffuse tenderness, and stiff, rigid muscles (“boardlike abdomen”).
4. Discuss the patient’s condition with him or her. Ask about pain: Where is it located, where does it radiate to, and what is the severity and frequency? What aggravates or alleviates the pain? Are there patterns to the pain (at night, after meals, etc.)? Ask the patient about his or her past medical history. Any past surgery, diagnoses, treatment, or injuries? Any problems with swallowing, digestion, or bowel, bladder, or reproductive organs?
–From NOLS Wilderness Medicine
Tod Schimelpfenig
Diabetes is a disease of sugar metabolism, affecting, by conservative estimates, 10 million Americans. It is a complex disease characterized by a broad array of physiological disturbances. In the long term, diabetic complications include high blood pressure and heart and blood vessel disease; it can also affect vision, kidneys, and healing of wounds. In the short term, the disturbance in sugar metabolism can manifest itself as too much or too little sugar in the blood.
Diabetes is thought to be caused by genetic defects, infection, autoimmune processes, or direct injury to the pancreas. The pancreas produces the hormones, most notably insulin, that help regulate sugar balance. Insulin facilitates the movement of sugar from the blood into the cells. An excess of insulin promotes the movement of sugar into the cells, lowers the blood sugar level, and deprives the brain cells of a crucial nutrient. This disorder is known as hypoglycemia (low blood sugar).
In contrast, a deficit of insulin results in cells that are starved for sugar and an excess of sugar in the blood, disturbing fluid and electrolyte balance. This disorder is known as hyperglycemia (high blood sugar) or diabetic coma.
A healthy pancreas constantly adjusts the insulin level to the blood sugar level. The pancreas of a person with diabetes produces defective insulin or no insulin. To compensate for this, a diabetic takes medication to stimulate endogenous insulin or takes artificial insulin. Treatment plans for diabetics also include diet and exercise.
Hypoglycemia results from the treatment of diabetes, not the diabetes itself. If a diabetic takes too much insulin or fails to eat sufficient sugar to match the insulin level, the blood sugar level will be insufficient to maintain normal brain function.
Hypoglycemia can occur if the diabetic skips a meal but takes the usual insulin dose, takes more than the normal insulin dose, exercises strenuously and fails to eat, or vomits a meal after taking insulin.
Signs and Symptoms of Hypoglycemia. Hypoglycemia has a rapid onset. The most prominent symptoms are alterations in mental status due to a lack of sugar to the brain. The patient may be irritable, nervous, weak, and uncoordinated; may appear intoxicated; or, in more serious cases, may become unresponsive or have seizures. The pulse is rapid; the skin pale, cool, and clammy.
Treatment for Hypoglycemia. Brain cells need sugar and can suffer permanent damage from low blood sugar levels. The treatment of hypoglycemia is to administer sugar. If the patient is awake, a sugar drink or candy bar can help increase the blood sugar level. If the patient is unresponsive, establish an airway, then place a small paste of sugar between the patient’s cheek and gum. Sugar is absorbed through the oral mucosa. Improvement is usually quick after the administration of sugar.
Diabetics who are untreated, who have defective or insufficient insulin, or who become ill may develop a high level of sugar in the blood. Consequences of this may be dehydration and electrolyte disturbances as the kidneys try to eliminate the excess sugar, and acid-base disturbances as cells starved for sugar turn to alternative energy sources.
Signs and Symptoms of Hyperglycemia. Hyperglycemia tends to develop more slowly than hypoglycemia. The first symptoms are often nausea, vomiting, thirst, and increased volume of urine output. The patient’s breath may have a fruity odor from the metabolism of fats as an energy source. The patient may also have abdominal cramps or pain and signs of dehydration, including flushed, dry skin and intense thirst. Unresponsiveness is a late and very serious symptom.
Treatment of Hyperglycemia. This patient has a complex physical disturbance and needs the care of a physician. Treatment is supportive: airway maintenance, vital signs, and treatment for shock. Dehydration is a serious complication of hyperglycemia. If the patient is alert, give oral fluids.
Hypoglycemia usually has a rapid onset; the patient is pale, cool, and clammy and has obvious disturbances in behavior or altered mental status. Hyperglycemia has a gradual onset. Often, the patient is in an unexplained coma, with flushed, dry skin. A fruity breath odor may be present. A patient with hypoglycemia will respond to sugar; a hyperglycemic patient will not, but the extra sugar will cause no harm.
Two questions to ask any diabetic patient are: Have you eaten today? And have you taken your insulin today? If the patient has taken insulin but has not eaten, you should suspect hypoglycemia. The patient will have too much insulin, not enough sugar, and a blood sugar level that is too low to sustain normal brain function. If the patient has eaten but has not taken insulin, hyperglycemia should be suspected. This person has more sugar in the blood than can be transported to the cells.
Most persons with diabetes are very knowledgeable about their reactions and intuitively know if they are getting into trouble. Many diabetics measure their blood sugar levels daily and their urine for ketones. If you’re on a wilderness trip with a diabetic, learn his or her medication and eating routines, how he or she measures his or her blood sugar and his or her daily fluctuations in blood sugar level. This can make you familiar with his or her management of diabetes, and helpful if he or she becomes hypo- or hyperglycemic.
When we’re sick, we’re under stress and we use hormones to fight the infection. Some of these hormones both raise blood sugar and interfere with insulin. The result is that it’s more challenging for diabetics to regulate blood sugar when they are sick. A diabetic should have a “sick day” plan, and the trip leader needs to know what that is. The components of a sick day plan include insulin adjustment, food and fluid intake, and decision points for evacuation such as urine ketone, hyperglycemia, and vomiting. Thresholds for evacuation may be: several days of illness without relief; vomiting or diarrhea for more than 6 hours; moderate to large amounts of ketones in urine; blood glucose readings consistently greater than normal despite taking extra insulin; early signs of hyperglycemia; loss of a sense of control of blood sugar levels.
It is important for persons with diabetes to eat at regular intervals. If there is a possibility that a diabetic’s insulin could be lost or destroyed—for example, by a boat flipping on the river—make sure that someone else in the group is carrying an extra supply. With control and care, diabetics can participate without problems in any activity.
A seizure is a disruption of the brain’s normal activity by a massive paroxysmal electrical discharge from brain cells. The seizure begins at a focus of brain cells, then spreads through the brain and to the rest of the body through peripheral nerves. This electrical disturbance may cause violent muscle contractions throughout the body or result in localized motor movement and possible loss of responsiveness.
The causes of seizures include high fever, head injury, low blood sugar, stroke, poisoning, and epilepsy. Low blood sugar is a cause of seizures in diabetics. Brain cells are sensitive to low oxygen and sugar levels, and if these fall below acceptable levels, a seizure may be triggered. The most common cause of seizures is epilepsy, a disease that manifests as recurring seizures.
The onset of epilepsy is not well understood. Often it begins in childhood or adolescence, but it can also be a consequence of a brain injury. Most persons with epilepsy control their seizures with medication. Interruption of the medication or inadequate dosage is frequently the cause of seizures.
At one time, seizures were attributed to mental illness. The source of these misperceptions may have been the dramatic visual impact of a writhing, moaning person having a seizure. Educating bystanders and group members about epilepsy and seizures can help alleviate such misunderstandings.
Signs and Symptoms of Seizures. The typical generalized seizure begins with a short period, usually less than a minute, of muscle rigidity, followed by several minutes of muscle contractions. The patient may feel the seizure approaching and warn bystanders or cry out at the onset of the episode. The patient suddenly falls to the ground, twitching and jerking.
As muscular activity subsides, the patient remains unresponsive but relaxed. He or she may drool, appear cyanotic, and become incontinent. Pulse and respiratory rate may be rapid. The patient may initially be unresponsive or difficult to arouse, but in time—usually within 10 to 15 minutes—the patient becomes awake and oriented.
Treatment of Seizures. When the seizure has subsided, open the airway, assess for injuries, and take vital signs. Place the patient on his or her side during the recovery phase to help maintain an open airway.
Treatment for a seizure is supportive and protective care. You cannot stop the seizure, but you can protect the patient from injury. The violent muscle contractions of a seizure may cause injury to the patient and to well-meaning bystanders who attempt to restrain the patient. Move objects that the patient may hit. Pad or cradle the head if it is bouncing on the ground. A patient in seizure will not swallow the tongue; however, the airway may become obstructed by saliva or secretions, and the patient may bite his or her tongue.
An accurate description of the seizure tells the physician much about the onset and extent of the problem. In most cases, a seizure runs its course in a few minutes. Repeated seizures, especially repeated seizures in which the patient does not regain responsiveness in between, and seizures associated with another medical problem such as diabetes or head injury are serious medical conditions.
An epileptic patient with an isolated seizure requires evaluation by a physician but does not require a rapid evacuation. These occasional seizures are often due to changes in the patient’s need for medication or failure to take the medication as prescribed. After recovering from the seizure, the patient should be well fed and hydrated and assessed for any injury that may have occurred during the seizure.
A responsive patient can react to the environment and protect himself or herself from sources of pain and injury. An unresponsive patient is in danger. He or she is mute and defenseless, unable to rely on even the gag reflex to protect the airway. Many conditions cause unresponsiveness: head injury, stroke, epilepsy, diabetes, alcohol intoxication, drug overdose, and fever.
A patient who is unresponsive for unexplained reasons poses a difficult diagnostic problem . . . Since obtaining a history of an unresponsive patient is impossible, carefully question bystanders for any background information they may be able to provide.
Often, all you can do is support the patient and transport him or her to a physician for further evaluation. Care for an unresponsive patient includes airway maintenance and cervical spine precautions unless trauma can be ruled out entirely. If you are unsure why a patient is unresponsive, place some sugar between the patient’s cheek and gum. This will help a hypo-glycemic patient and won’t hurt a patient who is unresponsive for any other season.
–From NOLS Wilderness Medicine
Greg Davenport
Treat all snakebites as though poisonous unless you can positively identify the snake as nonpoisonous. Of those that are poisonous, few are ever fatal or debilitating with proper medical intervention. Poisonous snakebites are often categorized as hemotoxic, damaging blood vessels and causing hemorrhage, or neurotoxic, paralyzing nerve centers that control respiration and heart action. Common signs that enveno-mization has occurred include some of the following:
HEMOTOXIC ENVENOMIZATION (RATTLESNAKE, PUFF ADDER, SIDEWINTER, SAND VIPER, HORNED VIPER)
Immediate: one or more fang marks and bite site burning.
5 to 10 minutes: mild to severe swelling at the bite site.
30 to 60 minutes: numbness and tingling of the lips, face, fingers, toes, and scalp. If these symptoms occur immediately following a bite, they are likely due to anxiety and hyperventilation.
30 to 90 minutes: twitching of the mouth, face, neck, eye, and bitten extremity. In addition, the victim may develop a metallic or rubbery taste in the mouth.
1 to 2 hours: sweating weakness, nausea, vomiting, chest tightness, rapid breathing, increased heart rate, palpitations, headache, chills, confusion, and fainting.
2 to 3 hours: the area begins to appear bruised.
6 to 10 hours: large blood blisters often develop.
6 to 12 hours: difficulty breathing, increased internal bleeding, and collapse.
NEUROTOXIC ENVENOMIZATION (CORAL SNAKE, COBRA, KRAITS, MAMBAS)
Immediate: bite site burning may or may not occur, and only a small amount of localized bruising and swelling is often noted.
Within 90 minutes: numbness and weakness of the bitten extremity.
1 to 3 hours: twitching, nervousness, drowsiness, giddiness, increased salivation, and drooling.
5 to 10 hours: slurred speech, double vision, difficulty talking and swallowing, and impaired breathing.
10 hours or more: death is often the end result without medical intervention.
Snakebite treatment centers on getting the victim to a medical facility as fast as you safely can. In doing so, follow these basic treatment guidelines to increase survivability:
• Have the victim move out of the snake’s range, then stop, lie down, and stay still. Physical activity will increase the spread of the venom. If you can do so safely, try to identify the kind of snake. If you can kill the snake, do so and bring it along for identification purposes. Protect yourself from accidental poisoning by cutting off the head and burying it.
• Remove the toxin from the wound site as soon as possible using a mechanical suction device, following the manufacturer’s instructions, or by squeezing for thirty minutes. Don’t cut and suck. This will hasten the spread of the poison and also expose the small blood vessels under the the aid giver’s tongue to the venom.
• Remove all jewelry and restrictive clothing from the victim.
• Clean the wound, and apply a dressing and bandage. Do not pour alcoholic beverages on the wound, and do not apply ice. Circulation to the site is already impaired, and applying ice may cause symptoms similar to severe frostbite. If the bite is on an extremity and you are more than two hours from a medical facility, use a pressure dressing over the wound or constrictive band—not a tourniquet—placed 2 inches above the site, between it and the heart. This will help restrict the spread of the poison.
—Pressure dressing. Place a clean dressing over the bite and cover it with an elastic wrap that encircles the extremity. The wrap should be about 10 inches wide and centered firmly on top of the bite site. Although it should be snug, make sure it isn’t so tight that it cuts off the circulation to the fingers or toes. Nail bed capillary refill should return with two to three seconds, and the victim should have normal feeling beyond the dressing site. To assess capillary refill, press on the victim’s fingernail and count how many seconds it takes for it to resume its pink color once released.
—Constrictive band. A constrictive band is not a tourniquet. It is used to slow down the flow in the superficial veins and lymph system. Use any material that allows you to create a 4-inch-wide band, wrapping it around the extremity so that it is between the bite and the heart. If limb swelling makes the band too tight, it can be moved up the extremity.
• After a dressing or band is applied, splint the extremity. The victim should keep the wound site positioned below the level of the heart.
• Have the victim drink small amounts of water.
• Transport the victim to the nearest hospital.
It’s best to take precautions to avoid snakebites in the first place. Avoid known habitats like rocky ledges and woodpiles. If you see a snake, leave it alone unless you intend to kill it for food. Carry a walking stick that can be used for protection, and wear boots and full-length pants.
The Gila monster and its cousin, the Mexican beaded lizard, are the only two known species of venomous lizards. Both are similar in appearance and habits, but the Mexican beaded lizard is slightly larger and darker. The Gila monster averages 18 inches in length and has a large head, stout body, short legs, strong claws, and a thick tail that acts as a food reservoir. Its skin is coarse and beadlike, with a marbled coloring that combines brown or black with orange, pink, yellow, or dull white. Most of the lizard’s teeth have two grooves that guide the venom, a neurotoxin that affects the nervous system, from glands in the lower jaw. The venom enters the wound as the lizard chews on its victim. Although a bite can be fatal to humans, it usually isn’t. Treatment for lizard bites is the same as that for a snakebite.
Thoroughly clean the site and treat it as any other open wound.
Clean any sting or bite that cannot be identified, and use antihistamines when appropriate. Remove any stingers using whatever means are suitable. In most cases, this is done by scraping a knife or similar item 90 degrees across the stinger. Monitor for secondary infection and treat with antibiotics if one occurs.
If stung, immediately remove the stinger by scraping the skin, at a 90-degree angle, with a knife or your fingernail. This will decrease the amount of venom that is absorbed into the skin. Applying cold compresses and/or a cool paste made of mud or ashes will help relieve the itching and pain. To avoid infection, don’t scratch the stinger site. Carry along a bee sting kit, and review the procedures of its use prior to departing for the wilderness. If someone has an allergic anaphylactic reaction, it’s necessary to act fast. Using the medications in the bee sting kit and following basic first-aid principles will reverse the symptoms associated with this type of reaction in most cases. Regardless of results, it’s best to get the victim to the nearest hospital as soon as possible when anaphylaxis occurs.
The kissing bug is dark brown to black with reddish-orange spots on the abdomen and measures ½ to 1 inch long. It has a cone-shaped head on a long body and three pairs of legs. It usually bites and feeds on the blood of its victim when the victim is asleep. The name kissing bug is derived from the fact that the bug often bites its victims on the lips. These bugs often live inside rodent and birds’ nests and are seen in spring and early summer. The bites may be painful and cause redness, swelling, and itching. In some instances, sensitive individuals can have a serious allergic reaction that causes severe itching, rash, nausea, vomiting, and breathing problems. Anaphylactic reaction can occur in very sensitive people. Treatment involves cleaning the site and using antihistamines when necessary. If allergic, use a bee sting kit and seek immediate medical attention.
Ants, especially fire ants, can produce very painful bites that often leave small, clear blisters on the skin. The biggest concern aside from pain is avoidance of secondary infection. Clean the bite with soap and water, and use antihistamines if needed. If an infection occurs, treat as any other infection. If allergic, use a bee sting kit and seek immediate medical attention.
Remove a tick by grasping it at the base of its body, where its mouth is attached to the skin, and applying gentle backward pressure until it releases its hold. If its head isn’t removed, apply antibiotic ointment, bandage, and treat as any other open wound.
To minimize the number of bites you’ll experience from these pesky insects, use insect repellent and cover the body’s exposed parts with clothing or mud. Insects that carry parasitic, viral, and bacterial agents transmit vector-borne diseases. Common diseases are malaria (in the tropics) and West Nile virus. Since wild and domestic birds carry West Nile virus, it appears to have no boundaries; mosquitoes become carriers when they bite an infected bird. The risk of getting the virus is seasonal, beginning in the spring and reaching its peak in mid-to late August. Approximately 80 percent of those infected will not have any symptoms. When symptoms do occur, they usually only last a few days and include fever, headache, muscle aches, backache, skin rash, and swollen lymph glands. In rare cases the infection can lead to an infection in the brain or its lining. Treatment is supportive and includes rest, fluids, and pain control. If you think you have been infected, you should seek out medical care as soon as possible.
Centipedes inject venom using fanglike front legs. Millipedes have toxins on their bodies that, when touched, are highly irritating. Both can cause redness, swelling, and pain to the bite site. If bitten, clean the area with soap and water. Use a pain medication if needed.
Desert spiders avoid the searing heat by taking cover in burrows or under rocks, emerging at night to eat. The most prominent dangerous spiders of the deserts are the black widow, brown recluse, and tarantulas.
The female black widow has a reddish hourglass on its abdomen.
The brown recluse has a violin-shaped patch on its head and midregion.
BLACK WIDOW
The black widow’s venom is fifteen times as toxic as the venom of the prairie rattlesnake, and it is considered the most venomous spider in North America. However, black widow spiders inject only a relatively small amount of venom and are not usually deadly to adults. Only the female spider is venomous. The black widow female is shiny black and often has a reddish hourglass shape on the underside of her spherical abdomen. Her body is about 1½ inches long. The adult male is harmless, about half the female’s size, with a smaller body and longer legs, and usually has yellow and red bands and spots over the back. The black widow’s bite may be painless and go unnoticed. Symptoms may include muscle cramps (including the abdomen), sweating, swollen eyelids, nausea, vomiting, headache, and hypertension. To treat, clean the site well with soap and water. Apply a cool compress over the bite location, and keep the affected limb elevated to about heart level. Persons younger than sixteen and older than sixty, especially those with a heart condition, may require hospitalization. Healthy people recover rapidly in two to five days.
BROWN RECLUSE
The brown recluse spider is ¼ to ½ inch long, has a yellowish to brown color, and supports a distinct violin-shaped patch on its head and mid-region. Its bite causes a long-lasting sore that involves tissue death and takes months to heal. In some instances, its bite can become life threatening. The bite initially causes mild stinging or burning and is quickly followed by ulcerative necrosis that develops within several hours to weeks. The initial sore is often red, edematous, or blanched, and a blue-gray halo often develops around the puncture. As time passes, the lesion may evolve into ashen pustules or fluid-filled lesions surrounded by red, patchy skin. After several days, the tissue begins to die. Other symptoms include fever, weakness, rash, muscle and joint pain, vomiting, and diarrhea. To treat, clean the site with soap and water, immobilize the site, and apply a local compress. Use a pain medication if needed. The bite site ultimately needs rapid debridement. Transport the victim to a medical facility as soon as possible.
TARANTULAS
Tarantulas have hairy bodies and legs come in a wide range of colors, from a soft tan through reddish brown to dark brown or black. The desert tarantula can grow to be 2 to 3 inches long and is common to the Sonoran, Chihuahuan, and Mojave Deserts of the U.S. Southwest. When confronted, a tarantula will rub its hind legs over its body, brushing off irritating hairs onto its enemy. Skin exposed to this hair is prone to an itching rash. A tarantula bite to humans is rare, and even if venom is injected, it rarely causes more than slight swelling, numbness, and itching. To treat a tarantula bite, clean the site with soap and water, and protect against infection. Treat skin exposures to tarantula hairs by removing the hairs with tape.
Scorpions are among the best-adapted creatures to desert climates. The scorpion has a flat, narrow body, two lobsterlike claws, eight legs, and a segmented abdominal tail. Its upward and forward curved tail has a venomous stinger supplied by a pair of poison glands. Most scorpions are tan to brown in color and range from 1 to 8 inches in length. Their stings are generally painful but not fatal to humans. Other symptoms may include swelling at the site of the sting, numbness, muscle twitching, difficulties in breathing, and convulsions. Death is rare. There are a few species, some twenty worldwide, whose venom is potentially fatal, but survival rates are generally high. A scorpion’s poison is neurotoxic, and treatment should follow that of a neurotoxic snakebite.
The scorpion has a venomous stinger at the end of its tail.
—From Surviving the Desert
U.S. Army
Leeches are blood-sucking creatures with a wormlike appearance. You find them in the tropics and in temperate zones. You will certainly encounter them when swimming in infested waters or making expedient water crossings. You can find them when passing through swampy, tropical vegetation and bogs. You can also find them while cleaning food animals, such as turtles, found in fresh water. Leeches can crawl into small openings; therefore, avoid camping in their habitats when possible. Keep your trousers tucked in your boots. Check yourself frequently for leeches. Swallowed or eaten, leeches can be a great hazard. It is therefore essential to treat water from questionable sources by boiling or using chemical water treatments. Survivors have developed severe infections from wounds inside the throat or nose when sores from swallowed leeches became infected.
—From Survival (Field Manual 21–76)
U.S. Army
Human or other land animal bites may cause lacerations or bruises. In addition to damaging tissue, bites always present the possibility of infection.
Human bites that break the skin may become seriously infected since the mouth is heavily contaminated with bacteria. Medical personnel MUST treat all human bites.
Land animal bites can result in both infection and disease. Tetanus, rabies, and various types of fevers can follow an untreated animal bite. Because of these possible complications, the animal causing the bite should, if possible, be captured or killed (without damaging its head) so that it can be tested for disease.
1. Cleanse the wound thoroughly with soap.
2. Flush it well with water.
3. Cover it with a sterile dressing.
4. Immobilize the injured arm or leg, if appropriate.
5. Transport the casualty immediately to an MTF [medical treatment facility].
Note: If unable to capture or kill the animal, provide medical personnel with any information that will help identify it.
—From First Aid (Field Manual 4–25.11)
Allan Macfarlan
A dog or a man pierced by quills may die because the barbed quills work their way into the flesh and may ultimately penetrate a vital organ. Get to a veterinarian or a doctor as quickly as you can, but if that is impossible, you must pull the quills out yourself with pliers. A dog should be firmly tied with a stick lashed between his jaws so that he cannot bite before you undertake the painful task. Snip the ends of the hollow quills off so that they deflate slightly and can be yanked out more easily. A good disinfectant should be used afterward since porky picks up a lot of dirt on his barbed quills.
—From Exploring the Outdoors with Indian Secrets
Steven Boga
Poison oak, ivy, and sumac contain an irritant called urushiol, a sap found in the roots, stems, and leaves. The plant must be touched, bruised slightly, to release urushiol; you can’t get a rash from just being in the neighborhood.
The best way to escape the wrath of urushiol is to know what the plants look like and stay away from them. Keep in mind the ditty “Leaves of three, let it be” (though if you take that too literally, you’ll miss out on some good berries). The poison plants may cling to the ground or grow up the trunks of trees or along fences. They may look like shrubs, bushes, small trees, or vines. Leaves may be dull or glossy with sawtoothed or smooth edges. In autumn, the leaves may turn orange; in summer, poison ivy has white berries.
If you think you’ve touched poison plants, put on clean gloves and carefully remove your clothing. Wash everything in strong detergent. Wipe off your shoes. Wash your body with soap and water. (You might first try rubbing with an anti-poison ivy lotion such as Tecnu.)
If you develop an itchy rash, try not to scratch. Scratching won’t cause the rash to spread, but it can lead to infection. The blisters don’t contain urushiol, so you can’t pass the rash to another person. However, if you have the oil on your body before the rash develops, you can pass it by touching someone.
Cold saltwater compresses, cool baths, calamine, baking soda, and over-the-counter cortisone cream offer relief. The best product I’ve found for drying up the blisters is Derma Pax. But even if you do nothing, you’ll probably be rid of all traces in less than three weeks.
—From Orienteering
Greg Davenport
Heat rashes often occur in moist, covered areas of the body. These bumpy red irritants can be pretty uncomfortable. To treat, keep the area clean and dry, and air it out as much as you can. If you have hydrocortisone 1 percent cream, apply a thin layer to the rash twice a day.
Prevent sunburn by using a strong sunscreen before exposure to the hot sun. If sunburn should occur, apply cool compresses, avoid further exposure, and cover any areas that have or may become burned.
Muscle cramps are a result of excessive salt loss from the body, exposure to a hot climate, or excessive sweating. Painful muscle cramps usually occur in the calf or abdomen while the victim’s body temperature is normal. To treat, immediately stretch the affected muscle. The best way to prevent recurrence is to consume 2 to 3 quarts of water per day when engaged in minimal activity, and 4 to 6 quarts per day when in extreme cold or hot environments or perhaps even more during heavy activity.
Heat exhaustion is a result of physical activity in a hot environment and is usually accompanied by some component of dehydration. Symptoms include feeling faint or weak, cold and clammy skin, headache, nausea, and confusion. To treat, rest in a cool, shady area and drink plenty of water. Since heat exhaustion is a form of shock, you should lie down and elevate your feet 8 to 12 inches.
Heatstroke occurs when the body is unable to adequately lose its heat. As a result, body temperature rises to such high levels that damage to the brain and vital organs occur. Symptoms include flushed dry skin, headache, weakness, lightheadedness, rapid full pulse, confusion, and in severe cases, unconsciousness and convulsions. Heatstroke is a true emergency and should be avoided at all costs. Immediate treatment is imperative. Immediately cool the victim by removing his or her clothing and covering the body with wet towels or by submersion in water that is cool but not icy. Fanning is also helpful. Be careful to avoid cooling to the point of hypothermia.
Hyponatremia is a potentially fatal condition that can occur under extremely hot conditions. It is caused by a lack of sodium in the blood and frequently occurs when someone drinks too much water while losing high levels of body salt through sweating. Symptoms are dizziness, confusion, cramps, nausea, vomiting, fatigue, frequent urination, and in extreme conditions, coma and even death. To treat, stop all activity, move to a shaded area, treat for shock, and have the victim eat salty foods along with small quantities of lightly salted water or sports drinks. If the victim’s mental alertness decreases, seek immediate help.
—From Surviving the Desert
U.S. Army
Terrestrial altitude can be classified into five categories. Low altitude is sea level to 5,000 feet. Here, arterial blood is 96 percent saturated with oxygen in most people. Moderate altitude is from 5,000 to 8,000 feet. At these altitudes, arterial blood is greater than 92 percent saturated with oxygen, and effects of altitude are mild and temporary. High altitude extends from 8,000 to 14,000 feet, where arterial blood oxygen saturation ranges from 92 percent down to 80 percent. Altitude illness is common here. Very high altitude is the region from 14,000 to 18,000 feet, where altitude illness is the rule. Areas above 18,000 feet are considered extreme altitudes. …
A person is said to be acclimatized to high elevations when he can effectively perform physically and mentally. The acclimatization process begins immediately upon arrival at the higher elevation. If the change in elevation is large and abrupt, some soldiers can suffer from acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), or high-altitude cerebral edema (HACE). Disappearance of the symptoms of acute mountain sickness (from four to seven days) does not indicate complete acclimatization. The process of adjustment continues for weeks or months. The altitude at which complete acclimatization is possible is not a set point but for most soldiers with proper ascent, nutrition and physical activity it is about 14,000 feet.
Immediately upon arrival at high elevations, only minimal physical work can be performed because of physiological changes. The incidence and severity of AMS symptoms vary with initial altitude, the rate of ascent, and the level of exertion and individual susceptibility. Ten to twenty percent of soldiers who ascend rapidly (in less than 24 hours) to altitudes up to 6,000 feet experience some mild symptoms. Rapid ascent to 10,000 feet causes mild symptoms in 75 percent of personnel. Rapid ascent to elevations of 12,000 to 14,000 feet will result in moderate symptoms in over 50 percent of the soldiers and 12 to 18 percent may have severe symptoms. Rapid ascent to 17,500 feet causes severe, incapacitating symptoms in almost all individuals. Vigorous activity during ascent or within the first 24 hours after ascent will increase both the incidence and severity of symptoms. Some of the behavioral effects that will be encountered in unacclimatized personnel include:
• Increased errors in performing simple mental tasks.
• Decreased ability for sustained concentration.
• Deterioration of memory.
• Decreased vigilance or lethargy.
• Increased irritability in some individuals.
• Impairment of night vision and some constriction in peripheral vision (up to 30 percent at 6,000 feet).
• Loss of appetite.
• Sleep disturbances.
• Irregular breathing.
• Slurred speech.
• Headache.
Judgment and self-evaluation are impaired the same as a person who is intoxicated. …
Acute mountain sickness is a temporary illness that may affect both the beginner and experienced climber. Soldiers are subject to this sickness in altitudes as low as 5,000 feet. Incidence and severity increases with altitude, and when quickly transported to high altitudes. Disability and ineffectiveness can occur in 50 to 80 percent of the troops who are rapidly brought to altitudes above 10,000 feet. At lower altitudes, or where ascent to altitudes is gradual, most personnel can complete assignments with moderate effectiveness and little discomfort.
Personnel arriving at moderate elevations (5,000 to 8,000 feet) usually feel well for the first few hours; a feeling of exhilaration or well-being is not unusual. There may be an initial awareness of breathlessness upon exertion and a need for frequent pauses to rest. Irregular breathing can occur, mainly during sleep; these changes may cause apprehension. Severe symptoms may begin 4 to 12 hours after arrival at higher altitudes with symptoms of nausea, sluggishness, fatigue, headache, dizziness, insomnia, depression, uncaring altitude, rapid and labored breathing, weakness, and loss of appetite.
A headache is the most noticeable symptom and may be severe. Even when a headache is not present, some loss of appetite and a decrease in tolerance for food occurs. Nausea, even without food intake, occurs and leads to less food intake. Vomiting may occur and contribute to dehydration. Despite fatigue, personnel are unable to sleep. The symptoms usually develop and increase to a peak by the second day. They gradually subside over the next several days so that the total course of AMS may extend from five to seven days. In some instances, the headache may become incapacitating and the soldier should be evacuated to a lower elevation.
Treatment for AMS includes the following:
• Oral pain medications such as ibuprofen or aspirin.
• Rest.
• Frequent consumption of liquids and light foods in small amounts.
• Movement to lower altitudes (at least 1,000 feet) to alleviate symptoms, which provides for a more gradual acclimatization.
• Realization of physical limitations and slow progression.
• Practice of deep-breathing exercises.
• Use of acetazolamide in the first 24 hours for mild to moderate cases.
AMS is nonfatal, although if left untreated or further ascent is attempted, development of high-altitude pulmonary edema (HAPE) and or high-altitude cerebral edema (HACE) can be seen. A severe persistence of symptoms may identify soldiers who acclimatize poorly and, thus, are more prone to other types of mountain sickness.
Although not commonly seen in mountaineers, chronic mountain sickness (CMS) (or Monge’s disease) can been seen in people who live at sufficiently high altitudes (usually at or above 10,000 feet) over a period of several years. CMS is a right-sided heart failure characterized by chronic pulmonary edema that is caused by years of strain on the right ventricle.
As altitude increases, the overall atmospheric pressure decreases. Decreased pressure is the underlying source of altitude illnesses. Whether at sea level or 20,000 feet the surrounding atmosphere has the same percentage of oxygen. As pressure decreases the body has a much more difficult time passing oxygen from the lungs to the red blood cells and thus to the tissues of the body. This lower pressure means lower oxygen levels in the blood and increased carbon dioxide levels. Increased carbon dioxide levels in the blood cause a systemic vasodilatation, or expansion of blood vessels. This increased vascular size stretches the vessel walls causing leakage of the fluid portions of the blood into the interstitial spaces, which leads to cerebral edema or HACE. Unless treated, HACE will continue to progress due to the decreased atmospheric pressure of oxygen. Further ascent will hasten the progression of HACE and could possibly cause death.
While the body has an overall systemic vasodilatation, the lungs initially experience pulmonary vasoconstriction. This constricting of the vessels in the lungs causes increased workload on the right ventricle, the chamber of the heart that receives de-oxygenated blood from the right atrium and pushes it to the lungs to be re-oxygenated. As the right ventricle works harder to force blood to the lungs, its overall output is decreased thus decreasing the overall pulmonary perfusion. Decreased pulmonary perfusion causes decreased cellular respiration—the transfer of oxygen from the alveoli to the red blood cells. The body is now experiencing increased carbon dioxide levels due to the decreased oxygen levels, which now causes pulmonary vasodilatation. Just as in HACE, this expanding of the vascular structure causes leakage into interstitial space resulting in pulmonary edema or HAPE. As the edema or fluid in the lungs increases, the capability to pass oxygen to the red blood cells decreases thus creating a vicious cycle, which can quickly become fatal if left untreated.
HAPE is a swelling and filling of the lungs with fluid, caused by rapid ascent. It occurs at high altitudes and limits the oxygen supply to the body.
HAPE occurs under conditions of low oxygen pressure, is encountered at high elevations (over 8,000 feet), and can occur in healthy soldiers. HAPE may be considered a form of, or manifestation of, AMS since it occurs during the period of susceptibility to this disorder.
HAPE can cause death. Incidence and severity increase with altitude. Except for acclimatization to altitude, no known factors indicate resistance or immunity. Few cases have been reported after 10 days at high altitudes. When remaining at the same altitude, the incidence of HAPE is less frequent than that of AMS. No common indicator dictates how a soldier will react from one exposure to another. Contributing factors are:
• A history of HAPE.
• A rapid or abrupt transition to high altitudes.
• Strenuous physical exertion.
• Exposure to cold.
• Anxiety.
Symptoms of AMS can mask early pulmonary difficulties. Symptoms of HAPE include:
• Progressive dry coughing with frothy white or pink sputum (this is usually a later sign) and then coughing up of blood.
• Cyanosis—a blue color to the face, hands, and feet.
• An increased ill feeling, labored breathing, dizziness, fainting, repeated clearing of the throat, and development of a cough.
• Respiratory difficulty, which may be sudden, accompanied by choking and rapid deterioration.
• Progressive shortness of breath, rapid heartbeat (pulse 120 to 160), and coughing (out of contrast to others who arrived at the same time to that altitude).
• Crackling, cellophane-like noises (rales) in the lungs caused by fluid buildup (a stethoscope is usually needed to hear them).
• Unconsciousness, if left untreated. Bubbles form in the nose and mouth, and death results.
HAPE is prevented by good nutrition, hydration, and gradual ascent to altitude (no more than 1,000 to 2,000 feet per day to an area of sleep). A rest day, with no gain in altitude or heavy physical exertion, is planned for every 3,000 feet of altitude gained. If a soldier develops symptoms despite precautions, immediate descent is mandatory where he receives prompt treatment, rest, warmth, and oxygen. He is quickly evacuated to lower altitudes as a litter patient. A descent of 300 meters may help; manual descent is not delayed to await air evacuation. If untreated, HAPE may become irreversible and cause death. Cases that are recognized early and treated promptly may expect to recover with no aftereffects. Soldiers who have had previous attacks of HAPE are prone to second attacks.
Treatment of HAPE includes:
• Immediate descent (2,000 to 3,000 feet minimum) if possible; if not, then treatment in a monoplace hyperbaric chamber.
• Rest (litter evacuation).
• Supplemental oxygen if available.
• Morphine for the systemic vasodilatation and reduction of preload. This should be carefully considered due to the respiratory depressive properties of the drug.
• Furosemide (Lasix), which is a diuretic; given orally can also be effective.
• The use of mannitol should not be considered due to the fact that it crystallizes at low temperatures. Since almost all high-altitude environments are cold, using mannitol could be fatal.
• Nifidipine (Procardia), which inhibits calcium ion flux across cardiac and smooth muscle cells, decreasing contractility and oxygen demand. It may also dilate coronary arteries and arterioles.
• Diphenhydramine (Benadryl), which can help alleviate the histamine response that increases mucosal secretions.
HACE is the accumulation of fluid in the brain, which results in swelling and a depression of brain function that may result in death. It is caused by a rapid ascent to altitude without progressive acclimatization. Prevention of HACE is the same as for HAPE. HAPE and HACE may occur in experienced, well-acclimated mountaineers without warning or obvious predisposing conditions. They can be fatal; when the first symptoms occur, immediate descent is mandatory.
Contributing factors include rapid ascent to heights over 8,000 feet and aggravation by overexertion.
Symptoms of HACE include mild personality changes, paralysis, stupor, convulsions, coma, inability to concentrate, headaches, vomiting, decrease in urination, and lack of coordination. The main symptom of HACE is a severe headache. A headache combined with any other physical or psychological disturbances should be assumed to be manifestations of HACE. Headaches may be accompanied by a loss of coordination, confusion, hallucinations, and unconsciousness. These may be combined with symptoms of HAPE. The victim is often mistakenly left alone since others may think he is only irritable or temperamental; no one should ever be ignored. The symptoms may rapidly progress to death. Prompt descent to a lower altitude is vital.
Preventive measures include good eating habits, maintaining hydration, and using a gradual ascent to altitude. Rest, warmth, and oxygen at lower elevations enhance recovery. Left untreated, HACE can cause death.
Treatment for HACE includes:
• Dexamethasone injection immediately followed by oral dexamethasone.
• Supplemental oxygen.
• Rapid descent and medical attention.
• Use of a hyberbaric chamber if descent is delayed.
HAPE and HACE cause increased proteins in the plasma, or the fluid portion of the blood, which in turn increases blood viscosity. Increased viscosity increases vascular pressure. Vascular leakage caused by stretching of the vessel walls is made worse because of this increased vascular pressure. From this, edema, both cerebral and pulmonary, occurs. Hydration simply decreases viscosity.
—From Military Mountaineering (Field Manual 3—97.61)
U.S. Army
The best way to deal with injuries and sicknesses is to take measures to prevent them from happening in the first place. Treat any injury or sickness that occurs as soon as possible to prevent it from worsening.
The knowledge of signs and symptoms and the use of the buddy system are critical in maintaining health. Following are cold injuries that can occur.
Hypothermia is the lowering of the body temperature at a rate faster than the body can produce heat. Causes of hypothermia may be general exposure or the sudden wetting of the body by falling into a lake or spraying with fuel or other liquids.
The initial symptom is shivering. This shivering may progress to the point that it is uncontrollable and interferes with an individual’s ability to care for himself. This begins when the body’s core (rectal) temperature falls to about 35.5 degrees C (96 degrees F). When the core temperature reaches 35 to 32 degrees C (95 to 90 degrees F), sluggish thinking, irrational reasoning, and a false feeling of warmth may occur. Core temperatures of 32 to 30 degrees C (90 to 86 degrees F) and below result in muscle rigidity, unconsciousness, and barely detectable signs of life. If the victim’s core temperature falls below 25 degrees C (77 degrees F), death is almost certain.
To treat hypothermia, rewarm the entire body. If there are means available, rewarm the person by first immersing the trunk area only in warm water of 37.7 to 43.3 degrees C (100 to 110 degrees F).
One of the quickest ways to get heat to the inner core is to give warm water enemas. Such an action, however, may not be possible in a survival situation. Another method is to wrap the victim in a warmed sleeping bag with another person who is already warm; both should be naked.
If the person is conscious, give him hot, sweetened fluids. One of the best sources of calories is honey or dextrose; if unavailable, use sugar, cocoa, or a similar soluble sweetener.
There are two dangers in treating hypothermia—rewarming too rapidly and “after drop.” Rewarming too rapidly can cause the victim to have circulatory problems, resulting in heart failure. After drop is the sharp body core temperature drop that occurs when taking the victim from the warm water. Its probable cause is the return of previously stagnant limb blood to the core (inner torso) area as recirculation occurs. Concentrating on warming the core area and stimulating peripheral circulation will lessen the effects of after drop. Immersing the torso in a warm bath, if possible, is the best treatment.
This injury is the result of frozen tissues. Light frostbite involves only the skin that takes on a dull whitish pallor. Deep frostbite extends to a depth below the skin. The tissues become solid and immovable. Your feet, hands, and exposed facial areas are particularly vulnerable to frostbite.
The best frostbite prevention, when you are with others, is to use the buddy system. Check your buddy’s face often and make sure that he checks yours. If you are alone, periodically cover your nose and lower part of your face with your mittened hand.
The following pointers will aid you in keeping warm and preventing frostbite when it is extremely cold or when you have less than adequate clothing:
• Face. Maintain circulation by twitching and wrinkling the skin on your face making faces. Warm with your hands.
• Ears. Wiggle and move your ears. Warm with your hands.
• Hands. Move your hands inside your gloves. Warm by placing your hands close to your body.
• Feet. Move your feet and wiggle your toes inside your boots.
A loss of feeling in your hands and feet is a sign of frostbite. If you have lost feeling for only a short time, the frostbite is probably light. Otherwise, assume the frostbite is deep. To rewarm a light frostbite, use your hands or mittens to warm your face and ears. Place your hands under your armpits. Place your feet next to your buddy’s stomach. A deep frostbite injury, if thawed and refrozen, will cause more damage than a nonmedically trained person can handle. The chart below lists some do’s and don’ts regarding frostbite.
These conditions result from many hours or days of exposure to wet or damp conditions at a temperature just above freezing. The symptoms are a sensation of pins and needles, tingling, numbness, and then pain. The skin will initially appear wet, soggy, white, and shriveled. As it progresses and damage appears, the skin will take on a red and then a bluish or black discoloration. The feet become cold, swollen, and have a waxy appearance. Walking becomes difficult and the feet feel heavy and numb. The nerves and muscles sustain the main damage, but gangrene can occur. In extreme cases, the flesh dies and it may become necessary to have the foot or leg amputated. The best prevention is to keep your feet dry. Carry extra socks with you in a waterproof packet. You can dry wet socks against your torso (back or chest). Wash your feet and put on dry socks daily.
When bundled up in many layers of clothing during cold weather, you may be unaware that you are losing body moisture. Your heavy clothing absorbs the moisture that evaporates in the air. You must drink water to replace this loss of fluid. Your need for water is as great in a cold environment as it is in a warm environment. One way to tell if you are becoming dehydrated is to check the color of your urine on snow. If your urine makes the snow dark yellow, you are becoming dehydrated and need to replace body fluids. If it makes the snow light yellow to no color, your body fluids have a more normal balance.
Exposure to cold increases urine output. It also decreases body fluids that you must replace.
Exposed skin can become sunburned even when the air temperature is below freezing. The sun’s rays reflect at all angles from snow, ice, and water, hitting sensitive areas of skin—lips, nostrils, and eyelids. Exposure to the sun results in sunburn more quickly at high altitudes than at low altitudes. Apply sunburn cream or lip salve to your face when in the sun.
The reflection of the sun’s ultraviolet rays off a snow-covered area causes this condition. The symptoms of snow blindness are a sensation of grit in the eyes, pain in and over the eyes that increases with eyeball movement, red and teary eyes, and a headache that intensifies with continued exposure to light. Prolonged exposure to these rays can result in permanent eye damage. To treat snow blindness, bandage your eyes until the symptoms disappear.
You can prevent snow blindness by wearing sunglasses. If you don’t have sunglasses, improvise. Cut slits in a piece of cardboard, thin wood, tree bark, or other available material. Putting soot under your eyes will help reduce shine and glare.
It is very important to relieve yourself when needed. Do not delay because of the cold condition. Delaying relieving yourself because of the cold, eating dehydrated foods, drinking too little liquid, and irregular eating habits can cause you to become constipated. Although not disabling, constipation can cause some discomfort. Increase your fluid intake to at least 2 liters above your normal 2 to 3 liters daily intake and, if available, eat fruit and other foods that will loosen the stool.
—From Survival (Field Manual 21—76)
Cecil Kuhne
Hypothermia refers to a lowering of the body’s temperature to a dangerous level. Any boater exposed to cold weather—and especially cold water—can become a victim. Once the body is thrust into cold water, the brain begins to conserve body heat by constricting blood vessels in the arms and legs. Shivering usually (but not always) begins as the body attempts to generate heat. Then the body’s core temperature starts to drop. As it falls below 95 degrees F, there is difficulty with speech. Other symptoms of hypothermia typically include fatigue, apathy, forgetfulness, and confusion. Further decreases in temperature bring on muscle stiffness, irrational thinking, amnesia, and unconsciousness. If the victim becomes unconscious, the situation is extremely serious, and hospitalization is required as soon as possible. Death occurs when the body temperature drops below 78 degrees. In near-freezing water, the time from immersion to death can be as short as ten minutes.
Awareness of the causes of hypothermia—and the speed with which death can result—is the most important aspect of prevention. If you dump in very cold water, get out immediately, even if this means abandoning your boat to swim for shore. Even with protective clothing, hypothermia can set in quickly.
Treatment is simple, and the sooner, the better. First, replace wet clothes with dry ones, and then move the person into a warm shelter. If the person is unable to generate his or her own body heat, rewarming is required. Hot liquids may help, but never give the victim alcoholic drinks, which dilate blood vessels, allowing even greater heat loss. Heat from a supplemental source should also be provided. If it’s not possible to build a fire, body heat from others is helpful. They should be lightly clothed for best results.
Hypothermia can be prevented, to a large extent, by adequate clothing, proper food, and good physical conditioning. The best clothing for cold conditions is a wet suit or dry suit. The food you eat is also important. Sugar and carbohydrates are quickly oxidized to provide heat and energy. The physical condition of the boater is also a factor, so it pays to stay in good shape.
99–96 degrees F. The body starts to shiver intensely and cannot be controlled. The victim cannot do complex tasks.
95–91 degrees F. The victim still shivers violently and has trouble speaking clearly.
90–86 degrees F. Shivering decreases or stops, and the victim cannot think clearly. The muscles are stiff, but the victim keeps his posture. Total amnesia may occur. The victim usually can keep in psychological contact with the environment.
85–81 degrees F. The victim becomes irrational, loses contact with the environment, and drifts into stupor.
80–78 degrees F. The victim becomes unconscious and does not respond to the spoken word. The victim’s heartbeat becomes irregular, and there are no reflexes.
Below 78 degrees F. Death will occur as the result of complications arising from failure of the cardiac and respiratory centers in the brain. These may include cardiac fibrillation and pulmonary edema. There is hemorrhage in the lungs.
Buck Tilton and John Gookin
Frostbite is the localized freezing of tissue, and it often goes hand in hand with hypothermia. Proper treatment of frostbite can save near-frozen tissue and reduce the damage to already frozen tissue.
As with hypothermia, frostbite is progressive. It starts as a superficial problem, with no actual freezing of tissue. Initially, skin is pale and numb, cold to the touch. If you notice it, treat it immediately with passive skin-to-skin contact: cover a nose with your warm hand, stick a cold hand against your warm stomach, or put cold toes against the warm abdomen of a friend. Don’t rub the cold skin, and don’t place it near a hot heat source, because numb tissue is very susceptible to heat injury. The skin should soon return to normal.
Untreated, the condition progresses to partial-thickness frostbite (partially frozen tissue), indicated by pale, numb, cold skin. The skin moves when you gently press on it. This problem looks superficial, and you may not know whether it’s true frostbite until the skin is warmed. Passive warming should begin immediately. Give ibuprofen, if available, and lots of water to drink. If blisters form after warming, you know that the problem was partial-thickness frostbite, and a physician should be consulted as soon as possible. In the meantime, do two things: (1) Leave the blister bubble intact; it protects the underlying tissue and lessens the chance for infection. (2) Be careful to prevent refreezing. Blisters can refreeze quickly, multiplying the damage.
Skin with full-thickness frostbite is pale, numb, and hard—unmoving to gentle touch. Normal field conditions make the warming of deep frostbite impractical. Often, all you can do is remove the clothing from the frostbitten part (unless it’s frozen to the skin), gently bundle the frozen skin in lots of dry insulation, and evacuate the patient. If refreezing is unlikely, however, and you have the means available, full-thickness frostbite is best treated by rapid warming in water of approximately 104 to 108 degrees F (40 to 42 degrees C). Water that is too hot can cause heat damage, and water that is too cold delays warming. Warming is usually accomplished in thirty to forty minutes, but it’s better to err on the side of caution and warm longer than necessary. Soft, dry cotton should be placed between thawed digits; otherwise, contact with the frostbitten skin should be avoided. Pain is often intense, and painkillers should be given when available, before thawing. Ibuprofen started as soon as possible seems to reduce the extent of tissue damage. Keep the patient well-hydrated, and prevent refreezing. Find a doctor as soon as possible.
To prevent frostbite, follow the same guidelines for preventing hypothermia. In addition, wear appropriate clothing; avoid snug clothing that restricts circulation, especially on the feet and hands. Take care to protect your skin from wind and from contact with cold metal and gasoline. Avoid alcohol and tobacco, which can impair blood flow. If your toes start to hurt from the cold, rejoice that the nerves are functional, and stop and warm them to prevent permanent injury.
Nonfreezing cold injury (NFCI), also known as immersion foot or trenchfoot, is a cold-weather emergency resulting from prolonged contact with cold—and usually moisture—which causes inadequate circulation and results in tissue damage. The foot first shows a bit of swelling and discoloration (usually white or bluish), and the patient may complain of numbness. This may be the only sign, unless the damage is substantial. Then, on warming, the foot swells extensively with excess fluid, and the damaged tissue typically looks red. The patient may complain of tingling pain, often severe, that doesn’t let up. Blisters may form, followed by ulcers where the blisters have fallen off, revealing dead tissue underneath. In severe cases, gangrene may result.
If you think that you or a companion is developing NFCI, warm the foot in warm water (as for frostbite), then carefully dry it. You can also keep the foot elevated above the level of the heart while you gently warm it with passive skin-to-skin contact. If the foot looks dirty, carefully wash it before drying it. Do not rub the foot or place it near a strong heat source, such as a fire or stove, both of which can damage the tissue. Start the patient on a regimen of over-the-counter anti-inflammatory drugs (aspirin or, even better, ibuprofen), following the label directions. Keep the patient in dry socks at all times. It will probably take twenty-four to forty-eight hours before the severity of the damage is fully apparent. If the foot is hurting or obviously swollen or develops blisters, get the patient to a physician.
NFCI is encouraged by poor nutrition, dehydration, wet socks, inadequate clothing, and the constriction of blood flow by too-tight boots and socks. Make sure that your boots fit, with plenty of room for your socks, and keep a dry pair of socks on hand at all times (preferably packed in a plastic bag). People who sweat heavily are also more susceptible to NFCI, and an antiperspirant spray can reduce sweating and thus reduce the risk. Periodically, preferably twice a day, dry your feet and gently massage them before stuffing them back into your boots. Do not sleep in wet socks.
Once you have suffered NFCI, it can recur after a shorter exposure to cold, wet conditions. The damage is cumulative, and tends to grow worse with each repetition, along with the possibility of permanent consequences.
—From NOLS Winter Camping
U.S. Army
At sea, you may become seasick, get saltwater sores, or face some of the same medical problems that occur on land, such as dehydration or sunburn. These problems can become critical if left untreated.
Seasickness is the nausea and vomiting caused by the motion of the raft. It can result in—
• Extreme fluid loss and exhaustion.
• Loss of the will to survive.
• Others becoming seasick.
• Attraction of sharks to the raft.
• Unclean conditions.
To treat seasickness—
• Wash both the patient and the raft to remove the sight and odor of vomit.
• Keep the patient from eating food until his nausea is gone.
• Have the patient lie down and rest.
• Give the patient seasickness pills if available. If the patient is unable to take the pills orally, insert them rectally for absorption by the body.
Note: Some survivors have said that erecting a canopy or using the horizon as a focal point helped overcome seasickness. Others have said that swimming alongside the raft for short periods helped, but extreme care must be taken if swimming.
These sores result from a break in skin exposed to saltwater for an extended period. The sores may form scabs and pus. Do not open or drain. Flush the sores with fresh water, if available, and allow to dry. Apply an antiseptic, if available.
These problems are similar to those encountered in cold weather environments. Symptoms and treatment are the same as covered on page 451.
If flame, smoke, or other contaminants get in the eyes, flush them immediately with salt water, then with fresh water, if available. Apply ointment, if available. Bandage both eyes 18 to 24 hours, or longer if damage is severe. If the glare from the sky and water causes your eyes to become bloodshot and inflamed, bandage them lightly. Try to prevent this problem by wearing sunglasses. Improvise sunglasses if necessary.
This condition is a common problem on a raft. Do not take a laxative, as this will cause further dehydration. Exercise as much as possible and drink an adequate amount of water, if available.
This problem is not unusual and is due mainly to dehydration. It is best not to treat it, as it could cause further dehydration.
Sunburn is a serious problem in sea survival. Try to prevent sunburn by staying in shade and keeping your head and skin covered. Use cream or Chap Stick from your first aid kit. Remember, reflection from the water also causes sunburn.
—From Survival (Field Manual 21–76)
U.S. Army
With the exception of sharks and barracuda, most marine animals will not deliberately attack. The most frequent injuries from marine animals are wounds by biting, stinging, or puncturing. Wounds inflicted by marine animals can be very painful, but are rarely fatal.
Sharks, Barracuda, and Alligators. Wounds from these marine animals can involve major trauma as a result of bites and lacerations. Bites from large marine animals are potentially the most life threatening of all injuries from marine animals. Major wounds from these animals can be treated by controlling the bleeding, preventing shock, giving basic life support, splitting the injury, and by securing prompt medical aid.
Turtles, Moray Eels, and Corals. These animals normally inflict minor wounds. Treat by cleansing the wound(s) thoroughly and by splinting if necessary.
Jellyfish, Portuguese Man-of-War, Anemones, and Others. This group of marine animals inflict injury by means of stinging cells in their tentacles. Contact with the tentacles produces burning pain with a rash and small hemorrhages on the skin. Shock, muscular cramping, nausea, vomiting, and respiratory distress may also occur. Gently remove the clinging tentacles with a towel and wash or treat the area. Use diluted ammonia or alcohol, meat tenderizer, and talcum powder. If symptoms become severe or persist, seek medical assistance.
Spiny Fish, Urchins, Stingrays, and Cone Shells. These animals inject their venom by puncturing the skin with their spines. General signs and symptoms include swelling, nausea, vomiting, generalized cramps, diarrhea, muscular paralysis, and shock. Deaths are rare. Treatment consists of soaking the wounds in hot water (when available) for 30 to 60 minutes. This inactivates the heat sensitive toxin. In addition, further first aid measures (controlling bleeding, applying a dressing, and so forth) should be carried out as necessary.
—From First Aid (Field Manual 4-25.11)
U.S. Army
To survive, you need water and food. You must also have and apply high personal hygiene standards.
Your body loses water through normal body processes (sweating, urinating, and defecating). During average daily exertion when the atmospheric temperature is 20 degrees Celsius (C) (68 degrees Fahrenheit), the average adult loses and therefore requires 2 to 3 liters of water daily. Other factors, such as heat exposure, cold exposure, intense activity, high altitude, burns, or illness, can cause your body to lose more water. You must replace this water.
Dehydration results from inadequate replacement of lost body fluids. It decreases your efficiency and, if injured, increases your susceptibility to severe shock. Consider the following results of body fluid loss:
• A 5 percent loss of body fluids results in thirst, irritability, nausea, and weakness.
• A 10 percent loss results in dizziness, headache, inability to walk, and a tingling sensation in the limbs.
• A 15 percent loss results in dim vision, painful urination, swollen tongue, deafness, and a numb feeling in the skin.
• A loss greater than 15 percent of body fluids may result in death.
The most common signs and symptoms of dehydration are—
• Dark urine with a very strong odor.
• Low urine output.
• Dark, sunken eyes.
• Fatigue.
• Emotional instability.
• Loss of skin elasticity.
• Delayed capillary refill in fingernail beds.
• Trench line down center of tongue.
• Thirst. Last on the list because you are already 2 percent dehydrated by the time you crave fluids.
You replace the water as you lose it. Trying to make up a deficit is difficult in a survival situation, and thirst is not a sign of how much water you need.
Most people cannot comfortably drink more than 1 liter of water at a time. So, even when not thirsty, drink small amounts of water at regular intervals each hour to prevent dehydration.
If you are under physical and mental stress or subject to severe conditions, increase your water intake. Drink enough liquids to maintain a urine output of at least 0.5 liter every 24 hours.
In any situation where food intake is low, drink 6 to 8 liters of water per day. In an extreme climate, especially an arid one, the average person can lose 2.5 to 3.5 liters of water per hour. In this type of climate, you should drink 14 to 30 liters of water per day.
With the loss of water there is also a loss of electrolytes (body salts). The average diet can usually keep up with these losses but in an extreme situation or illness, additional sources need to be provided. A mixture of 0.25 teaspoon of salt to 1 liter of water will provide a concentration that the body tissues can readily absorb.
Of all the physical problems encountered in a survival situation, the loss of water is the most preventable. The following are basic guidelines for the prevention of dehydration:
• Always drink water when eating. Water is used and consumed as a part of the digestion process and can lead to dehydration.
• Acclimatize. The body performs more efficiently in extreme conditions when acclimatized.
• Conserve sweat not water. Limit sweat-producing activities but drink water.
• Ration water. Until you find a suitable source, ration your water sensibly. A daily intake of 500 cubic centimeters (0.5 liter) of a sugar-water mixture (2 teaspoons per liter) will suffice to prevent severe dehydration for at least a week, provided you keep water losses to a minimum by limiting activity and heat gain or loss.
You can estimate fluid loss by several means. A standard field dressing holds about 0.25 liter (one-fourth canteen) of blood. A soaked T-shirt holds 0.5 to 0.75 liter.
• With a 0.75 liter loss the wrist pulse rate will be under 100 beats per minute and the breathing rate 12 to 20 breaths per minute.
• With a 0.75 to 1.5 liter loss the pulse rate will be 100 to 120 beats per minute and 20 to 30 breaths per minute.
• With a 1.5 to 2 liter loss the pulse rate will be 120 to 140 beats per minute and 30 to 40 breaths per minute. Vital signs above these rates require more advanced care.
Although you can live several weeks without food, you need an adequate amount to stay healthy. Without food your mental and physical capabilities will deteriorate rapidly, and you will become weak. Food replenishes the substances that your body burns and provides energy. It provides vitamins, minerals, salts, and other elements essential to good health. Possibly more important, it helps morale.
The two basic sources of food are plants and animals (including fish). In varying degrees both provide the calories, carbohydrates, fats, and proteins needed for normal daily body functions.
Calories are a measure of heat and potential energy. The average person needs 2,000 calories per day to function at a minimum level. An adequate amount of carbohydrates, fats, and proteins without an adequate caloric intake will lead to starvation and cannibalism of the body’s own tissue for energy.
These foods provide carbohydrates—the main source of energy. Many plants provide enough protein to keep the body at normal efficiency. Although plants may not provide a balanced diet, they will sustain you even in the arctic, where meat’s heat-producing qualities are normally essential. Many plant foods such as nuts and seeds will give you enough protein and oils for normal efficiency. Roots, green vegetables, and plant food containing natural sugar will provide calories and carbohydrates that give the body natural energy.
The food value of plants becomes more and more important if you are eluding the enemy or if you are in an area where wildlife is scarce. For instance—
• You can dry plants by wind, air, sun, or fire. This retards spoilage so that you can store or carry the plant food with you to use when needed.
• You can obtain plants more easily and more quietly than meat. This is extremely important when the enemy is near.
Meat is more nourishing than plant food. In fact, it may even be more readily available in some places. However, to get meat, you need to know the habits of, and how to capture, the various wildlife.
To satisfy your immediate food needs, first seek the more abundant and more easily obtained wildlife, such as insects, crustaceans, mollusks, fish, and reptiles. These can satisfy your immediate hunger while you are preparing traps and snares for larger game.
In any situation, cleanliness is an important factor in preventing infection and disease. It becomes even more important in a survival situation. Poor hygiene can reduce your chances of survival.
A daily shower with hot water and soap is ideal, but you can stay clean without this luxury. Use a cloth and soapy water to wash yourself. Pay special attention to the feet, armpits, crotch, hands, and hair as these are prime areas for infestation and infection. If water is scarce, take an “air” bath. Remove as much of your clothing as practical and expose your body to the sun and air for at least 1 hour. Be careful not to sunburn.
If you don’t have soap, use ashes or sand, or make soap from animal fat and wood ashes, if your situation allows. To make soap—
• Extract grease from animal fat by cutting the fat into small pieces and cooking them in a pot.
• Add enough water to the pot to keep the fat from sticking as it cooks.
• Cook the fat slowly, stirring frequently.
• After the fat is rendered, pour the grease into a container to harden.
• Place ashes in a container with a spout near the bottom.
• Pour water over the ashes and collect the liquid that drips out of the spout in a separate container. This liquid is the potash or lye. Another way to get the lye is to pour the slurry (the mixture of ashes and water) through a straining cloth.
• In a cooking pot, mix two parts grease to one part potash.
• Place this mixture over a fire and boil it until it thickens.
After the mixture—the soap—cools, you can use it in the semiliquid state directly from the pot. You can also pour it into a pan, allow it to harden, and cut it into bars for later use.
Germs on your hands can infect food and wounds. Wash your hands after handling any material that is likely to carry germs, after visiting the latrine, after caring for the sick, and before handling any food, food utensils, or drinking water. Keep your fingernails closely trimmed and clean, and keep your fingers out of your mouth.
Your hair can become a haven for bacteria or fleas, lice, and other parasites. Keeping your hair clean, combed, and trimmed helps you avoid this danger.
Keep your clothing and bedding as clean as possible to reduce the chance of skin infection as well as to decrease the danger of parasitic infestation. Clean your outer clothing whenever it becomes soiled. Wear clean underclothing and socks each day. If water is scarce, “air” clean your clothing by shaking, airing, and sunning it for 2 hours. If you are using a sleeping bag, turn it inside out after each use, fluff it, and air it.
Thoroughly clean your mouth and teeth with a toothbrush at least once each day. If you don’t have a toothbrush, make a chewing stick. Find a twig about 20 centimeters long and 1 centimeter wide. Chew one end of the stick to separate the fibers. Now brush your teeth thoroughly. Another way is to wrap a clean strip of cloth around your fingers and rub your teeth with it to wipe away food particles. You can also brush your teeth with small amounts of sand, baking soda, salt, or soap. Then rinse your mouth with water, salt water, or willow bark tea. Also, flossing your teeth with string or fiber helps oral hygiene.
If you have cavities, you can make temporary fillings by placing candle wax, tobacco, aspirin, hot pepper, tooth paste or powder, or portions of a ginger root into the cavity. Make sure you clean the cavity by rinsing or picking the particles out of the cavity before placing a filling in the cavity.
To prevent serious foot problems, break in your shoes before wearing them on any mission. Wash and massage your feet daily. Trim your toenails straight across. Wear an insole and the proper size of dry socks. Powder and check your feet daily for blisters.
If you get a small blister, do not open it. An intact blister is safe from infection. Apply a padding material around the blister to relieve pressure and reduce friction. If the blister bursts, treat it as an open wound. Clean and dress it daily and pad around it. Leave large blisters intact. To avoid having the blister burst or tear under pressure and cause a painful and open sore, do the following:
• Obtain a sewing-type needle and a clean or sterilized thread.
• Run the needle and thread through the blister after cleaning the blister.
• Detach the needle and leave both ends of the thread hanging out of the blister. The thread will absorb the liquid inside. This reduces the size of the hole and ensures that the hole does not close up.
• Pad around the blister.
You need a certain amount of rest to keep going. Plan for regular rest periods of at least 10 minutes per hour during your daily activities. Learn to make yourself comfortable under less than ideal conditions. A change from mental to physical activity or vice versa can be refreshing when time or situation does not permit total relaxation.
Do not soil the ground in the camp site area with urine or feces. Use latrines, if available. When latrines are not available, dig “cat holes” and cover the waste. Collect drinking water upstream from the camp site. Purify all water.
—From Survival (Field Manual 21—76)
Greg Davenport
The effects of stress upon a survival situation cannot be understated. To decrease its magnitude, you must not only understand it but also prevail over it. The most important key to overcoming these survival stresses is the survivor’s will. The will or drive to survive is not something that can be taught. However, your will is directly affected by the amount of stress associated with a survival situation.
The environment, your condition, and the availability of materials will either raise or decrease the amount of stress you’ll experience.
Three environmental conditions directly affect your survival: climate (temperature, moisture, and wind); terrain (mountainous, desert, jungle, or arctic); and life forms (plants and animals). Sadly, many people have perished when these influences have been unfavorable. In other situations, however, survivors have been successful in either adapting to the given conditions or traveling to another location that better meets their needs. Understanding how the environment might affect you is the first step to overcoming the unpredictable hardships of nature.
Both the physical and psychological stresses of survival will directly affect your outlook and may even dictate the order in which you meet your needs. To prioritize your needs properly, it is important to make decisions based on logic and not emotion. Recognizing the physical and psychological stresses of survival is the first step to ensuring that this is done.
These stresses are brought about by the physical hardships of survival. Overcoming them requires proper preparation. A good rule for all wilderness travelers is the six Ps of survival: Proper prior preparation prevents poor performance. Properly preparing involves ensuring that your immunizations are up-to-date, staying well hydrated both before and during any outback adventure, and being physically fit prior to traveling into the wilderness.
The amount of time a survivor goes without rescue will have a significant impact upon his will or drive to survive. As time passes, the survivor’s hopes of being found ultimately begin to diminish. With decreased hope comes increased psychological stress. The basic stresses that affect the survivor psychologically are pain, hunger and thirst, heat or cold, fatigue, loneliness, and fear.
The materials available to meet your needs include both what you have with you and what you can find in the surrounding environment. It’s unlikely that a lone survivor will have all the necessary tools and equipment to meet all of his survival needs.
The most important key to surviving is the survivor’s will. The will or drive to survive is not something that can be taught. However, your will is directly affected by the amount of stress associated with a survival situation. Prior preparation and using the three-step approach to survival (stop, identify your needs and prioritize them, and improvise) will help alleviate some of this stress.
Take the time to prepare for each outing. Leave a detailed trip outline along with return times with someone you can trust. Carry gear specific to the trip, and make sure your survival kit is adequate. Be fit for the adventure. Failing to prepare is preparing to fail. Keep the odds in your favor by taking a little extra time to think the trip through and develop contingencies should things go wrong.
STOP
Stop what you’re doing, clear your thoughts, and focus on the problem. Are you lost? Do you have a physical problem that prevents further movement? No matter what the problem is, stop, clear your thoughts, and begin looking at possible solutions.
IDENTIFY AND PRIORITIZE YOUR NEEDS
Recall the five basic elements of survival: personal protection, signaling, sustenance, travel, and health. Recognizing and prioritizing these essentials will help alleviate many of the fears you may have. The exact order in which they’re met will depend upon the effects of the surrounding environment. In addition, your conditions, availability of materials, the expected duration of stay, and the given situation all affect how you meet your needs. For example, shelter is of higher priority in an arctic environment than in a mild climate; in the desert, search for water takes on an especially high priority. Take the time to logically plan how to meet your needs, allowing for adjustments as necessary. Through this process, you can greatly diminish the potentially harmful effects of Mother Nature.
IMPROVISE
Improvising is a method of constructing equipment that can be used to meet your needs. With creativity and imagination, you should be able to improvise the basic survival necessities. This will increase your chances of survival and decrease the amount of stress. For more details on the five-step improvising process refer to page 469.
If you take care of your five survival essentials, health needs should not be an issue. For example, properly meeting your personal protection needs will decrease the odds of environmental injuries (cold and hot injuries). In addition, using the three-step approach to survival will decrease the effects of psychological stress and make you feel more confident about your outcome.
Faith (perhaps the greatest motivator), fear, and pride are three examples of what people have used to overcome what appeared to be insurmountable. Several years back I met a man who told me that his sole motivation for rescue was that his wife had the checkbook. Although I can’t verify the validity of his story, I did find it amusing. What motivates you? Whatever it is, you’ll need to learn to harness it and allow it to produce the energy needed to overcome your preconceived limits.
—From Wilderness Survival
U.S. Army
Any event can lead to stress and, as everyone has experienced, events don’t always come one at a time. Often, stressful events occur simultaneously. These events are not stress, but they produce it and are called “stressors.” Stressors are the obvious cause while stress is the response. Once the body recognizes the presence of a stressor, it then begins to act to protect itself.
In response to a stressor, the body prepares either to “fight or flee.” This preparation involves an internal SOS sent throughout the body. As the body responds to this SOS, several actions take place. The body releases stored fuels (sugar and fats) to provide quick energy; breathing rate increases to supply more oxygen to the blood; muscle tension increases to prepare for action; blood clotting mechanisms are activated to reduce bleeding from cuts; senses become more acute (hearing becomes more sensitive, eyes become big, smell becomes sharper) so that you are more aware of your surroundings; and heart rate and blood pressure rise to provide more blood to the muscles. This protective posture lets a person cope with potential dangers; however, a person cannot maintain such a level of alertness indefinitely.
Stressors are not courteous; one stressor does not leave because another one arrives. Stressors add up. The cumulative effect of minor stressors can be a major distress if they all happen too close together. As the body’s resistance to stress wears down and the sources of stress continue (or increase), eventually a state of exhaustion arrives. At this point, the ability to resist stress or use it in a positive way gives out and signs of distress appear. Anticipating stressors and developing strategies to cope with them are two ingredients in the effective management of stress. It is therefore essential that the soldier in a survival setting be aware of the types of stressors he will encounter. Let’s take a look at a few of these.
Injury, illness, and death are real possibilities a survivor has to face. Perhaps nothing is more stressful than being alone in an unfamiliar environment where you could die from hostile action, an accident, or from eating something lethal. Illness and injury can also add to stress by limiting your ability to maneuver, get food and drink, find shelter, and defend yourself. Even if illness and injury don’t lead to death, they add to stress through the pain and discomfort they generate. It is only by controlling the stress associated with the vulnerability to injury, illness, and death that a soldier can have the courage to take the risks associated with survival tasks.
Some people have trouble operating in settings where everything is not clear-cut. The only guarantee in a survival situation is that nothing is guaranteed. It can be extremely stressful operating on limited information in a setting where you have limited control of your surroundings. This uncertainty and lack of control also add to the stress of being ill, injured, or killed.
Even under the most ideal circumstances, nature is quite formidable. In survival, a soldier will have to contend with the stressors of weather, terrain, and the variety of creatures inhabiting an area. Heat, cold, rain, winds, mountains, swamps, deserts, insects, dangerous reptiles, and other animals are just a few of the challenges awaiting the soldier working to survive. Depending on how a soldier handles the stress of his environment, his surroundings can be either a source of food and protection or can be a cause of extreme discomfort leading to injury, illness, or death.
Without food and water a person will weaken and eventually die. Thus, getting and preserving food and water takes on increasing importance as the length of time in a survival setting increases. For a soldier used to having his provisions issued, foraging can be a big source of stress.
Forcing yourself to continue surviving is not easy as you grow more tired. It is possible to become so fatigued that the act of just staying awake is stressful in itself.
There are some advantages to facing adversity with others. … Being in contact with others … provides a greater sense of security and a feeling someone is available to help if problems occur. A significant stressor in survival situations is that often a person or team has to rely solely on its own resources.
The survival stressors mentioned in this section are by no means the only ones you may face. Remember, what is stressful to one person may not be stressful to another. Your experiences, training, personal outlook on life, physical and mental conditioning, and level of self-confidence contribute to what you will find stressful in a survival environment. The object is not to avoid stress, but rather to manage the stressors of survival and make them work for you.
We now have a general knowledge of stress and the stressors common to survival; the next step is to examine our reactions to the stressors we may face.
Man has been able to survive many shifts in his environment throughout the centuries. His ability to adapt physically and mentally to a changing world kept him alive while other species around him gradually died off. The same survival mechanisms that kept our forefathers alive can help keep us alive as well! However, these survival mechanisms that can help us can also work against us if we don’t understand and anticipate their presence.
It is not surprising that the average person will have some psychological reactions in a survival situation. We will now examine some of the major internal reactions you and anyone with you might experience with the survival stressors addressed in the earlier paragraphs. Let’s begin.
Fear is our emotional response to dangerous circumstances that we believe have the potential to cause death, injury, or illness. This harm is not just limited to physical damage; the threat to one’s emotional and mental well-being can generate fear as well. For the soldier trying to survive, fear can have a positive function if it encourages him to be cautious in situations where recklessness could result in injury. Unfortunately, fear can also immobilize a person. It can cause him to become so frightened that he fails to perform activities essential for survival. Most soldiers will have some degree of fear when placed in unfamiliar surroundings under adverse conditions. There is no shame in this! Each soldier must train himself not to be overcome by his fears. Ideally, through realistic training, we can acquire the knowledge and skills needed to increase our confidence and thereby manage our fears.
Associated with fear is anxiety. Because it is natural for us to be afraid, it is also natural for us to experience anxiety. Anxiety can be an uneasy, apprehensive feeling we get when faced with dangerous situations (physical, mental, and emotional). When used in a healthy way, anxiety urges us to act to end, or at least master, the dangers that threaten our existence. If we were never anxious, there would be little motivation to make changes in our lives. The soldier in a survival setting reduces his anxiety by performing those tasks that will ensure his coming through the ordeal alive. As he reduces his anxiety, the soldier is also bringing under control the source of that anxiety—his fears. In this form, anxiety is good; however, anxiety can also have a devastating impact. Anxiety can overwhelm a soldier to the point where he becomes easily confused and has difficulty thinking. Once this happens, it becomes more and more difficult for him to make good judgments and sound decisions. To survive, the soldier must learn techniques to calm his anxieties and keep them in the range where they help, not hurt.
Frustration arises when a person is continually thwarted in his attempts to reach a goal. The goal of survival is to stay alive until you can reach help or until help can reach you. To achieve this goal, the soldier must complete some tasks with minimal resources. It is inevitable, in trying to do these tasks, that something will go wrong; that something will happen beyond the soldier’s control; and that with one’s life at stake, every mistake is magnified in terms of its importance. Thus, sooner or later, soldiers will have to cope with frustration when a few of their plans run into trouble. One outgrowth of this frustration is anger. There are many events in a survival situation that can frustrate or anger a soldier. Getting lost, damaged or forgotten equipment, the weather, inhospitable terrain, … and physical limitations are just a few sources of frustration and anger. Frustration and anger encourage impulsive reactions, irrational behavior, poorly thought-out decisions, and, in some instances, an “I quit” attitude (people sometimes avoid doing something they can’t master). If the soldier can harness and properly channel the emotional intensity associated with anger and frustration, he can productively act as he answers the challenges of survival. If the soldier does not properly focus his angry feelings, he can waste much energy in activities that do little to further either his chances of survival or the chances of those around him.
It would be a rare person indeed who would not get sad, at least momentarily, when faced with the privations of survival. As this sadness deepens, we label the feeling “depression.” Depression is closely linked with frustration and anger. The frustrated person becomes more and more angry as he fails to reach his goals. If the anger does not help the person to succeed, then the frustration level goes even higher. A destructive cycle between anger and frustration continues until the person becomes worn down—physically, emotionally, and mentally. When a person reaches this point, he starts to give up, and his focus shifts from “What can I do” to “There is nothing I can do.” Depression is an expression of this hopeless, helpless feeling. There is nothing wrong with being sad as you temporarily think about your loved ones and remember what life is like back in “civilization” or “the world.” Such thoughts, in fact, can give you the desire to try harder and live one more day. On the other hand, if you allow yourself to sink into a depressed state, then it can sap all your energy and, more important, your will to survive. It is imperative that each soldier resist succumbing to depression.
Man is a social animal. This means we, as human beings, enjoy the company of others. Very few people want to be alone all the time! As you are aware, there is a distinct chance of isolation in a survival setting. This is not bad. Loneliness and boredom can bring to the surface qualities you thought only others had. The extent of your imagination and creativity may surprise you. When required to do so, you may discover some hidden talents and abilities. Most of all, you may tap into a reservoir of inner strength and fortitude you never knew you had. Conversely, loneliness and boredom can be another source of depression. As a soldier surviving alone, or with others, you must find ways to keep your mind productively occupied. Additionally, you must develop a degree of self-sufficiency. You must have faith in your capability to “go it alone.”
The circumstances leading to your being in a survival setting are sometimes dramatic and tragic. It may be the result of an accident or military mission where there was a loss of life. Perhaps you were the only, or one of a few, survivors. While naturally relieved to be alive, you simultaneously may be mourning the deaths of others who were less fortunate. It is not uncommon for survivors to feel guilty about being spared from death while others were not. This feeling, when used in a positive way, has encouraged people to try harder to survive with the belief they were allowed to live for some greater purpose in life. Sometimes, survivors tried to stay alive so that they could carry on the work of those killed. Whatever reason you give yourself, do not let guilt feelings prevent you from living. The living who abandon their chance to survive accomplish nothing. Such an act would be the greatest tragedy.
Your mission as a soldier in a survival situation is to stay alive. As you can see, you are going to experience an assortment of thoughts and emotions. These can work for you, or they can work to your downfall. Fear, anxiety, anger, frustration, guilt, depression, and loneliness are all possible reactions to the many stresses common to survival. These reactions, when controlled in a healthy way, help to increase a soldier’s likelihood of surviving. They prompt the soldier to pay more attention in training, to fight back when scared, to take actions that ensure sustenance and security, to keep faith with his fellow soldiers, and to strive against large odds. When the survivor cannot control these reactions in a healthy way, they can bring him to a standstill. Instead of rallying his internal resources, the soldier listens to his internal fears. This soldier experiences psychological defeat long before he physically succumbs. Remember, survival is natural to everyone; being unexpectedly thrust into the life and death struggle of survival is not. Don’t be afraid of your “natural reactions to this unnatural situation.” Prepare yourself to rule over these reactions so they serve your ultimate interest. …
It involves preparation to ensure that your reactions in a survival setting are productive, not destructive. The challenge of survival has produced countless examples of heroism, courage, and self-sacrifice. These are the qualities it can bring out in you if you have prepared yourself. Below are a few tips to help prepare yourself psychologically for survival. Through studying this manual and attending survival training you can develop the survival attitude.
Through training, family, and friends take the time to discover who you are on the inside. Strengthen your stronger qualities and develop the areas that you know are necessary to survive.
Don’t pretend that you will have no fears. Begin thinking about what would frighten you the most if forced to survive alone. Train in those areas of concern to you. The goal is not to eliminate the fear, but to build confidence in your ability to function despite your fears.
Don’t be afraid to make an honest appraisal of situations. See circumstances as they are, not as you want them to be. Keep your hopes and expectations within the estimate of the situation. When you go into a survival setting with unrealistic expectations, you may be laying the groundwork for bitter disappointment. Follow the adage, “Hope for the best, prepare for the worst.” It is much easier to adjust to pleasant surprises about one’s unexpected good fortunes than to be upset by one’s unexpected harsh circumstances.
Learn to see the potential good in everything. Looking for the good not only boosts morale, it also is excellent for exercising your imagination and creativity.
Remember, failure to prepare yourself psychologically to cope with survival leads to reactions such as depression, carelessness, inattention, loss of confidence, poor decision-making, and giving up before the body gives in. At stake is your life and the lives of others who are depending on you to do your share.
People under stress have a potential to panic if they are not well-trained and not prepared psychologically to face whatever the circumstances may be. While we often cannot control the survival circumstances in which we find ourselves, it is within our ability to control our response to those circumstances. Learning stress management techniques can enhance significantly your capability to remain calm and focused as you work to keep yourself and others alive. A few good techniques to develop include relaxation skills, time management skills, assertive-ness skills, and cognitive restructuring skills (the ability to control how you view a situation).
Remember, “the will to survive” can also be considered to be “the refusal to give up.”
—From Survival (Field Manual 21–76)
Greg Davenport
A survival and medical kit should be one of the most important items you carry. Sadly, they are often the first item compromised when trying to decrease your pack’s load. Better to carry a little extra weight than to have a debilitating blister forming and be without moleskin, or find yourself without a means of starting a fire during harsh wet and cold conditions.
As a bare minimum a survival kit should carry the ten essentials (see table). I advise, however, that you consider carrying much more. Take the time to review the five survival essentials (covered throughout this book) and consider potential problems when putting your kit together. Try to create a kit that will meet your needs under all situations. Put together several kits: a large one for your pack, a medium-size one for your CamelBak, and a small one that you always have on your person.
Other items you might consider in addition to the ten essentials include a tent or shelter material, paracord for improvising, signaling devices (signal mirror, ground-to-air panel, flares, etc.), water-purifying system, snare wire and fishing gear, wristwatch, note paper and a pencil, toiler paper, and a plastic bag.
I carry my survival gear using a complete yet scattered design. My pack is filled with items that will meet my everyday and emergency needs. In addition, I carry a smaller yet fairly complete kit in my CamelBak (which goes everywhere with me, including on top of my pack during long trips) and a smaller yet comprehensive kit in the cargo pocket of my pants. When carrying my pack, I have safety gear. If I take my pack off and walk around camp with just the CamelBak on, I am covered. Finally, if for some odd reason I find myself separated from my pack and CamelBak, the kit in my cargo pocket covers me. A list of my smaller cargo pocket kit is provided. Take a look and see how it might work for you.
—From Wilderness Survival
U.S. Army
Survival planning is nothing more than realizing something could happen that would put you in a survival situation and, with that in mind, taking steps to increase your chances of survival. Thus, survival planning means preparation.
Preparation means having survival items and knowing how to use them. People who live in snow regions prepare their vehicles for poor road conditions. They put snow tires on their vehicles, add extra weight in the back for traction, and they carry a shovel, salt, and a blanket. Another example of preparation is finding the emergency exits on an aircraft when you board it for a flight. Preparation could also mean knowing your intended route of travel and familiarizing yourself with the area. Finally, emergency planning is essential.
Detailed prior planning is essential in potential survival situations. Including survival considerations in mission planning will enhance your chances of survival if an emergency occurs. For example, if your job requires that you work in a small, enclosed area that limits what you can carry on your person, plan where you can put your rucksack or your load-bearing equipment. Put it where it will not prevent you from getting out of the area quickly, yet where it is readily accessible.
One important aspect of prior planning is preventive medicine. Ensuring that you have no dental problems and that your immunizations are current will help you avoid potential dental or health problems. A dental problem in a survival situation will reduce your ability to cope with other problems that you face. Failure to keep your shots current may mean your body is not immune to diseases that are prevalent in the area.
Preparing and carrying a survival kit is as important as the considerations mentioned above. All Army aircraft normally have survival kits on board for the type area(s) over which they will fly. There are kits for over-water survival, for hot climate survival, and an aviator survival vest. If you are not an aviator, you will probably not have access to the survival vests or survival kits. However, if you know what these kits contain, it will help you to plan and to prepare your own survival kit.
Even the smallest survival kit, if properly prepared, is invaluable when faced with a survival problem. Before making your survival kit, however, consider your unit’s mission, the operational environment, and the equipment and vehicles assigned to your unit.
The environment is the key to the types of items you will need in your survival kit. How much equipment you put in your kit depends on how you will carry the kit. A kit carried on your body will have to be smaller than one carried in a vehicle. Always layer your survival kit, keeping the most important items on your body. For example, your map and compass should always be on your body. Carry less important items on your load-bearing equipment. Place bulky items in the rucksack.
In preparing your survival kit, select items you can use for more than one purpose. If you have two items that will serve the same function, pick the one you can use for another function. Do not duplicate items, as this increases your kit’s size and weight.
TEN ESSENTIALS OF A SURVIVAL KIT
Your survival kit need not be elaborate. You need only functional items that will meet your needs and a case to hold the items. For the case, you might want to use a Band-Aid box, a first aid case, an ammunition pouch, or another suitable case. This case should be—
• Water repellent or waterproof.
• Easy to carry or attach to your body.
• Suitable to accept varisized components.
• Durable.
In your survival kit, you should have—
• First aid items.
• Water purification tablets or drops.
• Fire starting equipment.
• Signaling items.
• Food procurement items.
• Shelter items.
Some examples of these items are—
• Lighter, metal match, waterproof matches.
• Snare wire.
• Signaling mirror.
• Wrist compass.
• Fish and snare line.
• Fishhooks.
• Candle.
• Small hand lens.
• Oxytetracycline tablets (diarrhea or infection).
• Water purification tablets.
• Solar blanket.
• Surgical blades.
• Butterfly sutures.
• Condoms for water storage.
• Chap Stick.
• Needle and thread.
• Knife.
—From Survival (Field Manual 21-76)
Greg Davenport
Illustrations by Steven Davenport
The ability for a person to prevail in a survival situation is based on three factors: survival knowledge, equipment, and will to survive. All are important, but the most important is the will to survive. Unfortunately the will to survive cannot be taught in a book. Increasing your knowledge of survival skills and understanding of related gear, on the other hand, can. One method of increasing your skills and knowledge is through others. It’s with this end in mind that this book has been written. For most of the last twenty years I have used a simple three-step approach to help overcome most survival scenarios. Understanding and using this approach keeps the survivor organized, reduces stress, and ultimately increases the will to survive. It can do the same for you.
SMALL CARGO POCKET KIT ITEMS
As an outdoor educator and wilderness survival expert, I believe a survivor’s needs remain constant regardless of his or her circumstances (climate, terrain, or health). In fact, the only thing that changes in how these needs are met is how they are prioritized and how well you improvise to meet them. The three steps are stop and recognize the situation for what it is; identify and prioritize your five survival essentials for the situation you are in; and improvise to meet your needs (using man-made and natural resources).
Stop and recognize the situation for what it is. If you think you’re lost, you probably are. Stop trying to find that familiar road or rock. Walking when lost burns up daylight and moves you beyond the probable search-and-rescue zone. This common scenario often leads to a cold and frustrating night for both you and search-and-rescue teams. Once you recognize that you are lost, stop wandering around! Use your time to identify and meet your five survival essentials, making a safe and rapid rescue more probable.
Factors that influence survival.
Greg Davenport’s three-step approach to global survival.
Identify and prioritize your five survival essentials. Once you’ve recognized the situation for what it is, it’s time to identify your five survival essentials and prioritize them in order of importance. Take the time to write down your order of preference and be willing to adjust the order as mandated by your constantly changing scenario. The five survival essentials are:
1. Personal protection (clothing, shelter, fire)
2. Signaling (man-made and improvised)
3. Sustenance (identifying and procuring water and food)
4. Travel (with and without a map and compass)
5. Health (mental, traumatic, and environmental injuries)
Health, personal protection, and sustenance needs relate to maintaining life. Signaling and travel relate to returning home. Although these needs are constant, your situation and the environment will dictate the exact order and method used to meet them.
Improvise to meet your needs (using man-made and natural resources). Tap water, refrigerators, heaters, and a nice bed are not part of an outdoor adventure. These needs can often be met, however, with a little imagination, your gear, and what Mother Nature provides.
Since it’s unlikely you’ll have all the necessary resources in your gear, you’ll need to improvise using what you have and what Mother Nature can supply. Sometimes this task is easy, and other times it may stretch your imagination to its limits. Using the following five-step approach to improvising will help in the decision process.
1. Determine your need (shelter, signal, heat, etc.).
2. Inventory your available man-made and natural materials.
3. Consider the different ways you might meet your need (tree-well shelter, snow cave, etc.).
4. Pick the one that best utilizes your time, energy, and materials.
5. Proceed with the plan, ensuring that the final produce is safe and durable.
The only limiting factor is your imagination! Don’t let it prevent you from creating a masterpiece that keeps you comfortable while in your survival situation.
No matter what your circumstances, these three steps will help you during a time when you are uncertain of what tomorrow brings. They keep you organized, on task, and focused on a safe return home.
—From Wilderness Survival