SEAL Survival Guide (77 page)

SELECT A TOURNIQUET SITE

The upper arm or high up on the thigh are ideal places to apply tourniquets. Select an area about two to four inches above the edge of the wound or amputation. For maximum tourniquet effectiveness, if the wound is anywhere from the knee down, then apply the band just above the knee. If the wound is on the lower part of the arm, then put the tourniquet slightly above the elbow. Do not apply a tourniquet band directly over a joint where you see a broken bone or suspect a fracture; it will not be effective.

APPLY A TOURNIQUET

1. If the victim is still wearing clothes, simply smooth out the fabric of the sleeve or pants before putting on the tourniquet.

2. Put the tourniquet band above the wound area.

3. Make a half knot, as if beginning to tie a shoelace.

4. Put your stick or other rigid object on top of the half knot and then finish making the knot so the twisting object won’t come loose.

5. Then twist the stick or whatever you are using until the tourniquet is tight and you see the bleeding has subsided.

You may still see some darker blood from a vein continue to ooze even after the tourniquet has been properly applied, but the bright red arterial blood should stop. The tourniquet will be so tight as to cut off a pulse to all parts of the body that are below the tourniquet. However, don’t be fooled into thinking the blood has stopped and loosen the tourniquet. Doing so could allow the wound to start bleeding again, which could be fatal.

USE WITH CAUTION

A tourniquet stops all circulation below where it is applied. Make sure you keep the tourniquet exposed so that others who might come after you can see it; in survival situations, you may have to leave the victim behind as you continue on with your escape, for example. Hopefully, medical personnel will follow, and you must make it obvious to them that a tourniquet has been applied. You should even draw the letter “T” on the person’s forehead and indicate the time the tourniquet was applied. A tourniquet left on too long will kill the cells in the entire limb, even if it is the only way to stop bleeding and save the victim’s life.

Protecting Wounds and Stabilizing Fractures or Dislocations

You’ve done well to this point and stopped bleeding and have your casualty breathing. Now you have the time to do a more thorough physical exam. You want to identify any additional injuries or conditions that may also be life-threatening. Remember to keep monitoring the patient’s vital signs (breathing and heart rate), as they can change at any time.

This is not like an annual checkup type of exam. You’re under field
conditions, and in the lingo of EMTs it’s called a rapid trauma assessment. Yet you have to look over the body from head to toe, primarily searching for tenderness. If the person is conscious, they will react if you touch a certain spot. Also, look for swelling or deformities. As if frisking someone, though gently, use both hands and work your way down the body front and back.

FRACTURES

There are more than two hundred bones in the human body, and during accidents and survival situations, chances are some of these are going to break or get fractured. The distinction between a fracture and a break in the bone is really only a measure of how damaged the bone is. Depending on what bone is fractured or broken, however, this can be a life-threatening medical emergency or just a
really
painful inconvenience.

If you have time to identify the fracture and apply a splint before moving the victim, do so. But make a situational assessment, and if you must remove the casualty (and yourself) from immediate danger, such as to escape from a burning vehicle or move out of the line of fire before treatment, then make that call and act accordingly.

Identify the fracture

In all situations, try to expose the area where you suspect the broken bone to be. Try to loosen clothing or anything that might be applying more pressure to the nonbleeding broken bone area. If it is on the arms, remove any jewelry that could limit circulation. Even check the victim’s pockets to see if there is anything that will put undue pressure on the break. If the bone is on any part of the legs other than the feet, then make sure you leave the casualty’s boots or shoes on. If you must keep moving, he will need them later on.

Stabilize the fracture

Even the smallest broken bone is very painful, because it is causing tissue damage around the area of the break. In the field, you are not going to try to do anything but “immobilize the fracture,” which means attempting to relieve pain and prevent additional injury. If an arm or leg is fractured, applying a splint is the most effective way to stabilize the area. In emergency medicine, the general principle is “splint the fracture as it lies.” Don’t try to snap it back in place; instead, the idea is to try to merely support the limb until you can get proper medical attention.

Splints

The purpose of a split is to minimize the movement to the fractured area or bone. A splint may be a special device carried by EMTs, but in
survival medicine, you’ll likely have to improvise. Look for something rigid, such as a plank of wood, a pole, even a tree branch. Rolled-up newspapers or an unloaded rifle are other things you can possibly use as a splint. You will also need something to tie the splint in place. Strips of cloth or a belt can be used.

1. Apply the splint to the affected area in the position in which you find it. Do not try to set it back in place or realign the bones.

2. When tying the splint in place don’t overtighten the strips. This is not a tourniquet. Check to make sure you haven’t tied the strips too tight by pinching something like fingers or toes below the splint. The injured should feel this pinch. If they don’t, the straps are too tight.

3. It’s the inflammation around the injury that is causing pain, so if ice is available, apply liberally, placing an ice pack firmly on the area. You want to try to reduce the swelling, which can be aided by elevating the limb or joint above the heart.

DISLOCATIONS AND SPRAINS

Dislocated bones or sprains are injuries to the musculoskeletal system and are often not an actual fracture. Dislocation means the bone is out of its normal alignment, while a sprain is a twist or injury to the muscles around the bone. All can be very painful and immobilizing. Do not ask the casualty to move the injured area to test to see how much pain it causes. Ice is good for sprains and dislocations, but after twenty-four to forty-eight hours, heat is more effective in reducing pain. A splint can also be used for these types of injuries, depending on the body part. Especially if you must keep moving, a splint can prevent further injury.

TRANSPORTING INJURED

There are a number of ways to help the injured get out of harm’s way. The simplest—if you are capable—is called the
fireman carry,
which
requires hauling the person over your shoulder. In reality, this will be slow and difficult to do over a long period of time. If there are a few people gathered with you, work as a team. For example, the
two-man carry
is performed when the injured is transported by having one person stand between the legs and grab them while the other person slings the injured’s arms over the shoulders. Both rescuers are facing in the same direction and are moving with the injured’s legs first. A third form of transportation is the
improvised pull-and-haul,
which is performed by employing a dragline, made from rope, belts, etc. These are placed around the chest and under the armpits to drag the injured from danger. You could also create a
makeshift stretcher
with a blanket or similar item. Place the injured onto it and pull them to safety.