‘Once we had got the driver and passenger out of the front seat, I remembered some of my first-aid training and set about putting it into practice. I cut off the soldiers’ boots and, using the medical kit I had been given, splinted their legs. They were a bit of a mess: the bones were sticking out and I’m pretty sure without the training I would have had no idea what to do. When the medic finally got to us, about 20 minutes later, he was pretty quick to undo one of my splints and redo it. I hadn’t done it up tightly enough. It was clear that a one-week course was no replacement for years of training, but what it meant was that while we had the wait, I didn’t panic and I set about doing something. Without the training, I’m pretty sure I would have been more nervous and less certain of what to do. The incident taught me the importance of preparing for the worst and not going into a war zone without some kind of training.’
BBC correspondent Caroline Hawley agrees in principle, but warns that doing a course is no guarantee of doing the right thing in a medical emergency: ‘When violence strikes unexpectedly you’re caught off guard. In November 2005 I was in Amman, on a break from Baghdad, enjoying the kind of meal out that you could only fantasize about in Iraq, where many of the city’s restaurants had shut down. When the suicide bomber blew himself up in the lobby of the Hyatt Hotel, we had just ordered a beer in the Asian restaurant on the lower ground floor. The sound, of course, was deafening. I snapped my head around to see a column of fire and smoke on the stairway in the middle of the hotel. Then I saw the bloodied bodies – or were they still just about alive? I’ll never know. One man had vomited and defecated. I ran to get the ambulances to come round to our part of the hotel. It was a relief to get away from all the blood. But why didn’t I think to put the injured in the recovery position first? In the shock of it all, I seemed to have forgotten the elementary rules of first aid.’
This same thing might happen to you, so the first lesson is to trust your instincts. So many people I know are nervous of using the medical knowledge they learn. Nervous they will get it wrong. Nervous they won’t remember how to do anything.
Inside hot classrooms after long cold runs in the rain I nodded sleepily through most of my Red Cross training. I had regular updates throughout the year, and thought little had gone in. But two months later, when I was in a car accident in Botswana, I managed to whimper Red Cross instructions to my 12 injured friends while passing in and out of consciousness myself. They hopped into the next car that would take them, and I was left with two friends to wait for an ambulance. I couldn’t move my legs, so we refused several offers of a lift from passing farmers. Dehydrated, concussed and sick with pain from my crushed back, I wanted a doctor with a proper stretcher. It was like holding out for a London ambulance on the edge of the Okavango Delta. Silly. The ambulance did come eventually and four nurses each grabbed one of my limbs and threw me into the back of their dirty van. I thought I would never walk again, but I did…the next day.
The point is that, even in the direst of circumstances, these few pages of medical advice will come back to you. And even if you recall just one paragraph, you could help save someone from worse injury or even death.
I have tried to keep the information brief. Where common sense seems too obvious to mention, I have left it out altogether. I am no doctor, but I have had a few of them look over this text for me.
Warning: You might go out alone, but you are likely to find yourself working or at least living with others if you are in a dangerous place. It is essential that you tell those around you how to deal with any health problems you have: diabetes, asthma, allergies, heart and blood-clotting problems are some obvious ones. As the leader of a team, it is a good idea to start any trip by asking about any health problems amongst your group (see also On the Way In). You need to know how to use your own medical kit and any special medical treatment or equipment belonging to the people around you.
/YOUR MEDICAL KIT
This is a contentious subject. Everyone has a different opinion about what is important. But a medical kit, however small, can help you survive. Keep it packed at the bottom of a grab bag (see Grab Bag), full of other essentials, such as your phone and ID, and check it before each trip.
Your kit should contain:
• Pain relief – aspirin in case someone has a heart attack and non-aspirin for other forms of pain, as some people are allergic and aspirin should not be given to people under 18.
• Water sterilization tablets – to be used when boiling suspect water is impossible (see How to Purify Water).
• Antibiotics – enough for a week’s full course. These can be difficult to get in some places, so they’re worth hoarding when you find a country that sells them without a prescription. Check the expiry date. If giving them to someone else, always ask about allergies, e.g. to penicillin. It’s worth knowing that the names of penicillin-type drugs usually end with ‘cillin’ (for example, amoxicillin, flucloxacillin) so if you can buy something that sounds different, it might be useful for those who are allergic. But check any packaging information first.
• Antihistamine – in cream and pill form, for rashes or insect bites.
• Antiseptic – cream, liquid or spray, or iodine or alcohol wipes. If you choose something like TCP, it can double up as a throat gargle.
• Diarrhoea pills – useful for desperate moments, especially when on the move.
• Salt tablets – to replace all you lose in an injury, or after a long active day when you have perspired freely.
• Butterfly stitches – to hold large wounds in place.
• Plasters and bandages – of all shapes and sizes, plus some sterile gauze pads. Tampons and sanitary towels can also be used to cover wounds: you need enough plaster or sticky tape to hold them in place.
• Vinyl or latex gloves – to avoid introducing infection while you are dressing wounds and to protect you from blood-borne infection, such as hepatitis B. Could also be used short term to keep dressings on fingers and feet dry.
• Condoms – can be used to keep fingers and feet sterile and waterproof for a short period of time. Also useful as portable water carriers or party balloons.
• Small scissors – people never seem to have them when you need to cut plaster or clothing.
• Malaria tablets – I have often skipped these and been lucky enough to avoid getting ill. I have always argued that the side effects outweigh the danger. Here, however, I defer to the advice of Dr Carl Hallam, who has worked in some of the most festering malarial bogs:
‘Take anti-malaria tablets. Europeans do not do well with Malaria falciparum (severe malaria). They can die in 24 hours because they have no resistance. It adds hugely to the workload of doctors already burdened with dealing with other problems locally. If you really feel you can’t take anti-malarials, then take the malaria cure with you [see Malaria]. But you need to learn how to take it and be confident in your diagnosis.’
This view is reinforced by Leith Mushtaq, who told me: ‘It’s not just bullets that can kill you – a mosquito can too.’
To the list above you can add all the extras you might need: asthma inhalers, pills and potions for the relief of cystitis and thrush, an extra pair of reading glasses, blister treatments… These are all things that some people cannot live without.
There are, of course, other medical preparations you need to make too, as outlined in Chapter 1 (see Before you Leave Home).
/FIRST AID
Step 1: Call for help
In a medical emergency you should always call for help, but don’t hesitate to treat the patient if the injury is serious. If you are alone, carry out the first few checks (see ABC – the first checks) and any necessary immediate treatment, such as stopping the flow of blood, then call for help. If the heart has stopped, do CPR (cardiopulmonary resuscitation, see CPR for adults) for one minute, then pause to call for help.
Normal vital signs
Remember that in serious medical emergencies you are really an assistan
t to the doctors who are on their way. You need to take a mental or even written note of any changes in your patient. If you administer drugs, note how much and when.
Step 2: Work out if it’s safe for you to help
Consider the following before you start giving help:
• Are you in the middle of a motorway with cars streaming by?
• Is there a battle going on around you?
• Is the vehicle the injured person is in stable?
Is the engine off?
• Is what just happened to your patient likely to happen to you?
• Is there a chance any fire might spread?
• Is there someone nearby who can help make it safe for you to work with the casualty?
Always be aware that what has happened to your patient could happen to you.
ABC – the first checks
ABC stands for airway, breathing, circulation. Always check these things if the casualty is unconscious, otherwise it’s not necessary: the casualty will be talking to you and it will be obvious what is wrong.
Airway – is the airway open and clear? Is something obstructing the breathing? If so, you need to try to remove it. The casualty can choke on their own tongue if you are not careful. You need to tip their head backwards before you start to check inside the mouth for obstructions. If the mouth is clear, then clearing the airway means putting one hand on their forehead to gently tilt the head back and raising their chin using two fingertips.
Breathing – is their breathing normal? Put your cheek down to their face and listen and feel for breathing. Look to see if their chest is moving. If there are no signs of breathing after 10 seconds, start CPR immediately (see opposite).
Circulation – is the patient bleeding? Do a head-to-toe check (see Head-To-Toe Check) for bleeding and other problems. Bleeding needs to be treated immediately (see Pressure points to control bleeding). It might lead to shock – and that can be deadly.
If all three ABC are fine, place the casualty in the recovery position (see Recovery position for adults and children) and focus on getting some emergency help again before carrying on with second checks (see Recovery position for adults and children).
CPR for adults
Cardiopulmonary resuscitation (CPR) is an essential part of your first-aid armoury. While the chances of bringing someone back to life with CPR are very slim, it can happen, sometimes even immediately. The shock of the pressure on their chest might be enough to kickstart their body again, but probably not. ‘Oh,’ I can hear you thinking, ‘what’s the point then?’
The point is to keep the casualty’s blood moving around their body, pushing the oxygen you have blown into their lungs to their brain and limbs until the professionals arrive with some decent drugs and machinery. You are a replacement for the casualty’s own heart and lungs.
There are two elements to CPR: chest compressions and ‘mouth-to-mouth’ or the ‘kiss of life’. You carry out 30 chest compressions for every two breaths.
If you get confused which way round it is, just think about how many times your heart beats in a minute compared to your breathing rate. We breathe only about 15 times a minute, but our heart needs to beat about 70 times a minute on average.
Chest compressions for adults
Kneeling next to the casualty, find the right place for your hands. You are looking for about two fingers up from the bottom of the breastbone. You place the heel of your hand right in the middle of the chest avoiding the ribs and stomach.
HEAD-TO-TOE CHECK
Wrap one hand through the other and, leaning directly over the casualty so you have your full weight on your hands, push hard down, but not hard enough to break their ribs (a depth of around 5 cm). Let the chest rise again and continue with your next compression. You need to do a total of 30 compressions at a rate of around 100 a minute – quite fast – and then give two long breaths (as described below). You will get tired quickly, so it is good to work in a team to ensure you can keep going as long as possible.
Mouth-to-mouth resuscitation
After 30 compressions you need to administer two long breaths. Make sure the airway is still open after all the up and down movements, then put one hand on the forehead and two fingers on the chin to lift it up. Move the hand on the forehead down to pinch the soft part of the nose and gently open the casualty’s mouth.
Still tilting their neck back and holding their nose, breathe deeply into their mouth. Turn your head and check the chest is rising. If it isn’t, then it’s not working…you need to adjust the head in order to make it work. In total you need to give two of these deep breaths, however many times that means adjusting the head and starting again. The idea is to give the casualty essential oxygen.
Now move back to the chest compressions: another 30 before you give two more breaths. If you are working in a team, you must stop the chest compressions while the breaths are given in order to check that the lungs are rising.
Mouth-to-nose resuscitation
This technique can be used when there are injuries to the mouth, poison or other dangerous substances around it, and in drowning incidents. Create a seal with your mouth over the person’s nose, hold the mouth shut and breathe into the casualty. Then open the mouth to allow the person to breathe out. If they have just been dragged out of water, this will allow them to choke water up without interference from you.
Where toxic substances are involved, you can still do mouth-to-mouth by using a face shield – a piece of plastic with a hole in the middle – which fits over the casualty’s mouth and thus avoids you having to touch the area directly. They are often found in shop-bought medical kits, but you can make one on the spot if necessary: a thin T-shirt will work as a barrier if stretched across the mouth.
Continue CPR for how long?
Most people will tell you to continue for between 45 minutes and an hour. But in reality you will carry on as long as you can if there is a possibility of rescue. This will be a lot easier, of course, if there is a team of you. But if there has been no sign of life after the first five minutes, you are unlikely to see any result until the real doctors arrive. That’s not because you’re doing anything wrong; it’s because the doctors have the right kit, such as drugs, defibrillators and oxygen, and they might even have heart-lung machines back in the hospital.
CPR for babies
By ‘baby’ I mean a child up to the age of three. Carry out all the basic ABC checks (see ABC – the first checks) with extra care as the signs may not be as obvious. If the baby is not breathing, start CPR, as follows.
Emergency breaths first
You need to start by giving the baby a big intake of oxygen as their body does not absorb oxygen as well as an adult’s. Tilt their head back, with one finger this time rather than two. Keep one hand on their forehead. With a baby you need to create a seal over their mouth and nose with your mouth. Give them five initial slow breaths. Remember a baby’s lungs are smaller than yours so the breaths should not be as deep and full as with an adult or older child. Check to see if their chest is rising and falling each time. Then move onto compressions.
Chest compressions for babies
Find the bottom of the baby’s breastbone and move one finger-width up towards the middle of the chest. Take two fingers and use minimal pressure to press the chest down to around a third of its height. Allow the chest to return to normal, then continue with the next compression. Do 30 before you stop to give the baby two breaths. The rate is the same as that for adults – around 100 compressions a minute.
CPR for children
Here I mean children aged between three and 14. Carry out all the ABC checks (see ABC – the first checks) with extra care. As with infants, start by giving five initial breaths (see opposite), this time covering just their mouth with yours. Now move onto chest compressions, following the method of adult CPR, but using just one hand, not two (see CPR for adults).
The second checks
Find out what happened and look for signs
of injury head to toe whether the person is conscious or not (see Head-To-Toe Check). Ask the following questions, if possible, about the patient’s recent and longer medical history:
• What medication they are taking (e.g. asthma inhaler, blood pressure pills)?
• When did they last eat or drink?
• Do they have a condition such as epilepsy, diabetes or anaphylaxis?
Such conditions will affect the way you approach treatment. If the casualty is unable to answer, look for a medical warning bracelet or pendant. These items can look very fancy, so check and double-check.
• Where is their usual medication, such as their insulin injector pen? Take a look at it.
• Do they have any allergies?
• What is their recent medical history, e.g. illnesses, operations and treatment they are already receiving, and what drugs have they taken that day? Write it down.
Recovery position for adults and children
This applies to an unconscious but otherwise unhurt person (not a baby) and should be done only after you have established the following:
• The casualty’s airway, breathing and circulation are stable.
• The head-to-toe check (see Head-To-Toe Check) has not revealed a back or neck injury.
The recovery position is designed to keep the airway open if the casualty is having trouble breathing, and will prevent them choking if they vomit.
With the casualty lying on the floor, kneel at their side. Place their nearest arm out to the side. If they are wearing glasses, remove them.
How to Avoid Being Killed in a War Zone Page 11
