If someone has been struck by lightning, you can touch them. But if the injuries allow it, you need to move them away from the site of the incident as quickly as possible before you start treatment. Despite the well-known saying, lightning does actually like to strike the same place twice. Continue with treatment from ABC to secondary checks and deal with their symptoms while waiting for help.
Fever
Usually a sign of other illnesses, fever can arise from infection in the ear, throat or teeth, measles, chickenpox, cholera, flu or meningitis (see Meningitis), but the basic symptoms are the same.
First signs: Temperature above 37°C; cold and shivering, but sweating; headache and pains all over the body.
Action: Put the casualty to bed and give lots of cool liquid to replace that lost by sweating. Painkillers may help to bring down the temperature.
Fire
• Switch off all electricity in the room, pulling out the plugs if necessary. Turn off the mains. If you are not sure what the source of the fire is, use a heavy blanket rather than water to put it out. Water on an electrical fire or a flaming pan of fat will make the problem worse.
• If the room is filled with smoke, stay low. Air will be clearest at floor level. Shut the door of the room you are in and put a blanket along the bottom of it. Now open a window.
• If someone’s clothes are on fire, move them to the floor so they aren’t standing up any longer – that way the flames won’t rise up to their face. Wrap them in a heavy blanket and roll them on the ground until the flames are out.
• If someone has suffered burns, see Burns.
Fractures
In the field, particularly if you’re a long way from the nearest hospital, you might need to reset broken bones, so it’s a good idea to learn how to hold them in place until you can get some professional help.
Closed fracture
This type of fracture is described as ‘closed’ because the skin is not broken.
First signs: Pain and tenderness, even to the lightest touch. Swelling will start almost immediately. The limb may look distorted or appear shorter than the other limb. If the patient moves, they might feel the bones grating together. Do not try to do this as a test.
Action: If you are expecting medical help to arrive soon, do not attempt to put the bone back in its correct placement. Simply immobilize it (see Immobilizing fractures) and wait for the expert.
If you are not expecting medical help any time soon, you can try using traction, which involves slowly pulling the limb until the ends of the bone fall into place. If you have a helper, keep the traction up while you apply the splint and immobilize the limb (see Immobilizing fractures).
Open fracture
First signs: The bone pierces the skin. It will be very painful and will need professional attention as soon as possible.
Action: Clean and dress the wound, as there is a risk that both the wound and the bone will get infected.
If the limb is too bent by the fracture to splint, you will need to straighten it. You are not trying to put it back in the correct place – you simply want to move it so that you can immobilize it (see Immobilizing fractures) and thus prevent further damage. It is best to do this as soon as possible, before swelling starts, and preferably when the patient is already unconscious. After that, seek medical attention.
Frostbite (see Frostbite)
Head injury
My most recent experience of a head injury was when a friend slipped after several hours of drinking and dancing and hit his head on a table. The blood rushed out – a metre-wide pool about 5 mm thick. We spent five hours in hospital with him, where he was checked and double-checked, but he was fine. In fact, the cut turned out to be tiny – just enough for a 2-cm disco scar and a dramatic tale to tell.
It was a typical head injury: tons of blood and lots of panic, but ultimately nothing much to worry about. I hope that is the worst you ever see. But the reason the doctors paid so much attention to my friend was the risk of brain damage.
First signs of significant brain injury: A fall in the level of consciousness so that the casualty does not open his eyes, except possibly very briefly; does not reply to you, or makes just an incoherent noise; and makes only a generalized withdrawal of a limb to a painful stimulus rather than a purposeful movement. Very dangerous signs of bleeding in the brain are if one pupil (the black centre of the eye) is bigger than the other, or if blood or clear liquid discharges from the eyes, ears or nose. If these signs are present, the casualty needs urgent medical attention.
Action: When signs of brain injury are present, or the casualty is unconscious, dress the wound (see overleaf) and leave the person in the recovery position (see Recovery position for adults and children) with their airway open. Make regular checks of their breathing, circulation and responses to touch or sound till help arrives.
If the casualty is conscious and has no signs of brain injury, sit them upright against a wall. Cover the wound with a clean dressing and apply pressure with your hand until the bleeding slows. Clean the wound, then put another dressing on the injury and keep it in place with a bandage or strip of material. (see Malaria tablets for information about dressings.)
Heart attack
The usual cause of a heart attack is a blockage or clot that cuts off the blood supply to a part of the heart muscle. This condition always needs medical attention.
First signs: Chest pain that does not ease with rest; the pain can shoot up to the jaw and down both arms. Difficulty breathing; collapse, suddenly or after a spell of dizziness; blue lips and ashen skin; irregular pulse; great fear.
Action: You need to take the strain off the heart, so sit the casualty down and place support around them so they can rest.
If the casualty is conscious, get them to take an aspirin – 300 mg. It will thin the blood and help to take the strain off the heart. If they have their own medication, help them take it.
Keep checking their breathing, pulse and responses to sound or touch. If they stop breathing, begin CPR (see CPR for adults).
Heatstroke (see Heatstroke)
Hyperventilation (see Panic attack)
Hypothermia (see Hypothermia)
Infection
If a wound has not begun to heal within 48 hours, it is infected. In fact, it is hard to avoid infection occurring if you are not in a totally sterile environment.
First signs: Increasing redness around the wound; swelling and heat in the injury and surrounding area. The more dangerous stage is when a red line trails off from the wound to a nearby gland. That means the infection is spreading. Then there will be fever – hot head, sweating and shivering (see fever).
Action: Change the dressing as often as possible. If the wound is stitched, remove the stitches and drain any pus. You can do this by using heat to draw it out. Soak a cloth in hot water, let it cool a little, then place it on the wound. Take a rock heated in the fire, wrap it in a towel and apply that to the wound on top of its dressing.
If there is a red line leading away from the infected area, you need to seek medical attention as soon as possible and start on a course of antibiotics.
In desperate straits urine can act as an antiseptic. During my British Army training, I remember there were a lot of boys who offered to pee on my badly blistered feet after we’d run 10 kilometres carrying a large log between the six of us. I can only think it was something to do with marking their territory. I opted to wait until I could see the army nurse back at base, but all he offered was antiseptic. Boring.
Inhalation of smoke/fumes
Anyone who has inhaled smoke or fumes is likely to have a low concentration of oxygen in their blood, so getting them into fresh air is a priority.
First signs: In the case of smoke, the nose or mouth will be blackened with soot; there may also be mouth blisters or swelling; redness and swelling of the tongue; difficulty breathing or talking. With fumes there will be headache; breathlessness; confusion; impaired consciousness.
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nbsp; Action: The inhalation of smoke, carbon monoxide, carbon dioxide or solvents and fuels are all treated in the same way. Before attempting rescue, open the door or window to let fumes escape, but only if you can avoid exposing yourself to the fumes. You can prevent some inhalation of smoke by placing a mask over your nose and mouth, but gases are impossible to filter.
Sit with the casualty in fresh air, either at an open window or outside, and help them to normalize their breathing. Check their vital signs – pulse, breathing and level of consciousness (see here) – until help arrives. Note that after smoke inhalation, the airways can swell even hours after the patient seems fine. While you are on the way to hospital, keep the neck and chest free of clothing and feed the casualty sips of cool water and ice to relieve the pain.
Warning: Make sure your gas oven, heating system or indoor fires are all well ventilated to guard against poisoning. If you are not sure, leave a window open at night.
Lightning strike (see Electrocution,)
Malaria
Early diagnosis and treatment of malaria is key. If you are in a malarial area, you need to keep a close eye on yourself and your team. This illness should not be taken lightly – it can be deadly.
Malaria incubates for some time, usually developing three weeks after the infected bite, but it can take up to 10 months to appear.
First signs: Flu-like symptoms; perhaps also vomiting, diarrhoea, coughing and yellowing of the eyes (because it targets the liver); can develop into bleeding problems, shock, kidney failure and coma. Cerebral malaria can lead to seizures and a temporary sort of mental illness.
Action: Treat what you can, such as the diarrhoea and fever, but you need to get the person to a hospital as soon as possible. Meanwhile, keep them as quiet and cool as you can. Stress is not good for malaria.
The best approach to malaria is to avoid getting it in the first place. Areas where the skin is thin are the most vulnerable – wrists, inner arm, neck and ankles – so long sleeves and socks are essential. Cover yourself in whatever repellent works for you, and soak your socks in the stuff too. Get yourself a mosquito net that is soaked in repellent and learn how to use it properly – there should be no gaps and it should not touch your skin. Ask advice from others as to what natural repellents work for them. Vitamin B12 and Marmite are two that I know of.
Then there are the pills. Ask your doctor for advice about anti-malarial drugs, such as Artesunate, Fansidar, Amodiaquine and Malarone. Locals might not take them, but that does not mean you should follow their lead. They might have built up a resistance to the parasite. It is important to choose the right drug for your circumstances and different ones are advisable depending on where you are, so expert help is essential. Note that Artesunate must be used in combination with another drug – Coartem is probably the best brand name.
Malnutrition
Journalists working in war zones often come upon terrible hardship, and it’s really difficult not to help when starving children are involved. However, Laura Tyson, who has worked in many humanitarian disasters, advises caution: ‘In the aftermath of the tsunami a Sky TV News crew found a seven-year-old boy called Martunis, who had been stranded up a tree for 17 days in a flooded area, having been separated from his parents. He survived on noodles and other stuff floating by. The Sky team, who saved his life, fed him army ration packs as he was so malnourished, but this was a bad mistake. If someone is malnourished, high-calorie ration packs can make them very sick indeed. And he was, but he recovered later. The correct response is, ideally, to seek medical help before giving them any food of your own that they may not be used to digesting.’
With either adults or children, don’t be tempted to meet starvation with a doughnut. The recovery from malnutrition should be gentle and strictly confined to certain foods in certain quantities or it can lead to further complications.
GARLIC: A FRIEND INDEED
Meningitis
First signs: Flu-like symptoms, but with pain in the limbs; eyes sensitive to light; stiff neck; in an infant the soft spot on the top of the head may be tense or bulging; in the related but much more serious condition septicaemia, a distinctive rash with purple spots develops, sometimes in minutes; if you press a glass over them, the spots do not fade.
Action: Treat like a normal fever (see fever) until the distinctive rash appears, then rush to hospital for treatment. If you are more than two hours from a hospital, give an antibiotic at four times the usual dose. Repeat every two hours if there is still no chance of medical attention.
Nosebleed
People always seem to think there is a secret trick to stopping a nosebleed, but there ain’t. The key is to avoid sniffing, as that will start the bleeding again. You need the blood to clot. The patient will naturally want to avoid having blood running down their throat, so lean them forward, hold the soft part of the nose and wait for the bleeding to stop. They need to continue breathing through the mouth for some time after it has stopped to avoid the urge to sniff.
Panic attack
Seeing awful or strange things for the first time, or experiencing dramatic events, can lead to symptoms that might puzzle or frighten you. I once woke up from a nightmare breathing very heavily and with my heart beating at a hundred miles an hour. I was hyperventilating (over-breathing), and passed out several times from the effects of it, but I thought I was having a heart attack. Eventually, I managed to get help and go to a hospital. There I learnt that hyperventilating can last hours, whereas a heart attack usually lasts only minutes. I also learnt that hyperventilating is just one of the symptoms of a panic attack.
First signs: Racing pulse; dizziness; sweating and cramps in the hands and feet; difficulty getting air out of the lungs (hyperventilation).
Action: Deal with the hyperventilation because relieving that will alleviate the other symptoms. Breathing in and out of a paper bag is no longer recommended as a way of calming hyperventilation. Instead, move the person to a quiet place, away from crowds, and get them to focus on their breathing, encouraging them to take slow, regular breaths. Hold them firmly, reassuring them that you are there to help.
Shock
This is not the kind of shock you might feel after experiencing a robbery or receiving bad news. That’s emotional shock, which can be cured by drinking a large mug of sugary tea. The type of shock arising from injury is a lot more serious. It means there is inadequate blood circulating and this may cause the heart, kidneys, brain or other vital organs to be deprived of oxygen. This type of shock can kill you.
Causes of shock
While there are multiple causes of shock, the most common are:
• Massive fluid loss – usually blood from internal or external bleeding, but it can also be caused by diarrhoea, vomiting, serious burns or severe constipation that leads to colon problems.
• Heart problems – these can stop the blood moving fast enough around the body to carry oxygen to your most vital organs
• Spinal cord injury
• Hypothermia – when the body’s core temperature drops below 35°C
• Low blood sugar
• Severe allergic reaction
• Drug overdose
• Major infection
First signs: Racing pulse; pale, clammy skin; sweating. As it gets worse, the pulse may fade away altogether at the wrist. The casualty will start to pant with shallow breaths. Their skin will go grey, they will feel dizzy and sick, and be screaming for water. In the final stages they will become aggressive. They will gasp and yawn for air, then fall unconscious before their heart stops.
Action: Treat the cause of the shock as best you can until the professionals arrive. You need to get as much blood as possible to the person’s heart and brain. Raise their feet or lay them on a slope with their head pointing downhill.
Poor circulation will make them cold, so keep them warm with a blanket or with your own body heat. Avoid applying anything very hot, such as a close radiator or a hot-water bottle, as it might dist
urb the flow of blood, which shrinks away from the heated area to try to cool the body down.
The symptoms of shock can be worsened by pain and fear, so give reassurance. Although the patient will be very thirsty, just wet their lips or give sips of water, no food. They need an empty stomach in case emergency surgery is required later.
Spinal injury
You won’t need me to tell you how dangerous it is to move someone with a spinal injury. The spine and brain are the two most fragile parts of the body, and two of the most difficult to assess in terms of injury. If there is any suspicion of a spinal injury, particularly to the neck, you must be extremely cautious (see Recovery position for a suspected spinal injury and Pressure points to control bleeding).
Sprains
A sprain involves the tearing of muscles or ligaments around a joint, but it can feel as painful as a break and should be treated like one initially.
First signs: Swelling and bruising; pain increases when the joint is moved.
Action: Immobilize the part as early as possible (see Immobilizing fractures). Loose crêpe bandaging will work. It should not be too tight in case of further swelling.
Pack ice onto the affected area or soak in cool water as often as possible, and raise the limb to reduce swelling at night.
If your boot is already on when you sprain your ankle and you still have some walking to do, leave it there. The moment you take it off, it will swell up like a balloon, and then you are stuck carrying your boot and hopping along on one leg.
Stroke
A stroke is a collapse in part of the brain after a disruption to the blood supply. It can affect people in any number of ways, from a vague sloping of the eyes to death. As a result, strokes are notoriously difficult to recognize. Even the victim might not recognize the effects.
How to Avoid Being Killed in a War Zone Page 14
