Basic Medical & First Aid 101

Meetup.com Cincinnati Survival Preparedness Group Basic Medical & First Aid 101

Agenda • Class Expectations • Introduction • General Patient Assessment • Medical Preventions&Treatments • Air, shelter, water, food, hygiene,microorganisms, mental/emotional. • Triage Patient Assessment • Physical Trauma & Interventions • Medical Kit Contents • Specific Conditions (if time)

Class Expectations • Class covers likely/predictable conditions with practical prevention & treatment. • Disease, exposure, musculoskeletal issues, external trauma, etc. • Class will not / cannot cover conditions that require detail investigative diagnosis or internal trauma that requires major intervention. • This class is an open forum where questions can be askedthroughout the session. However, keep in mind that medicine is an incredibly exhaustive topic that we cannot coverin grand detail. Please be conscious of time.

Introduction • Do you truly know how to prepare formedical-oriented situations? • Perception vs. Reality

Introduction Some contributing factors that elevate medical needs (disease, exposure, etc)arising: • Ill-prepared population • Hygiene / trash / public utilities • Lack of supplies / Med Facilities • Displacement/Inadequate shelter • Crowding & Riots • Deceased Persons • Disturbed environment • Water contaminates • Food contaminates • Air contaminates

Introduction • Disease, exposure, and famine are more likelycauses of death than trauma alone. • Civil War, ~2/3 of soldiers • WWI, ~1/3 of soldiers • 1990-2008, <15%Reduction has been due to more efficient weaponry and advances in medicine. However, will that be available to you?

General Patient Physical Assessment SammiZipf

General Patient Assessment Patient Questionnaire – First assess mental status/alertness. Mental status (AVPU) • Alert: pt is awake and can communicate • Verbal: pt will respond to talking or shouting • Painful: pt will respond to pinching or sternal rub • Unresponsive: no response from pt If pt is alert or can understand verbal commands, proceed to questionnaire.

General Patient Assessment Use the acronym SAMPLE • S: Symptoms. What ailment and where? • A: Allergies: Any known allergies? • M: Medications: Taking what medications? • P: Pertinent History: Medical or Family history? • L: Last Oral Intake: Medications or food recently? • E: Events leading up to incident/ailment?

General Patient Assessment Based on patient questionnaire, you may perform a site specific assessment of the ailment. However, a general assessment should be conducted as well: • Head to toe evaluation (Examples) • Trauma – Additional sites of trauma? • Allergies – Other areas with rashes or swollenness?Sometimes patient is unaware as they are focusing on only one aspect of their ailment.

General Patient Assessment Normal Vital Guidelines • Pupils (PEARL – Pupils Equal And Reactive to Light) • Pulse – 60-100 bpm • Radial, Carotid, Brachial • Respirations – 12-20 bpm • Blood Pressure – 120/80 mmHg • Body Temperature – 97.6 – 99.1F

Medical Prevention &Treatments “An ounce of prevention is wortha pound of cure.” - Benjamin Franklin

Prevention Prioritization 3/3/3/3 rule (+2): You will only survive: • 3 min without air • 3 hours without shelter • 3 days without water • 3 weeks without food • (+1) Hygiene • (+1) Mental Stability Keep in mind, the old and the young are most susceptible to all these conditions

Air Quality NIOSH (N95) Masks filter 95% ofparticulates >0.3 micron. For reference, 0.2 micron is the standard pore size for sterile filtration. However, as these masks do not seal around you face, itis best only for quick protection, general particulates, care for the sick, etc.Note: We will not be covering radiological air contaminates.

Shelter - Hypothermia Definition - Body temperature below 97.6 - 95°F (or cooler) • Symptoms • Patient will display signs of slurred speech, uncoordinated movements, & uncontrolled shivering. In some cases (20-50%)hypothermia leads to paradoxical undressing. • Preventions / Treatment • Do not drink alcohol (vasodilator) • Do not eat ice or snow for water. • Be Careful with high blood pressure meds (vasodilator) • Do heat up fluids and drink to increase your internal temp. • Eat large meals prior to going to bed. • Try to breath through your nose instead of your mouth(Reduces heat loss from respiration) • Perform brisk exercises to work your muscles and increaseyour body temp. Just ensure you do not sweat!

Shelter - Hypothermia Prevention / treatment continued… • Understand convection, conduction, radiation & evaporationin preparing and using your structural and clothing shelters!Example: Space blankets • Layer clothes • Avoid Cotton – “Death Cotton” • Marino wool is excellent as it keeps you warm while still wet. Invest inbase layers and socks that are Marino wool. • Down is a superior insulator but is compromised when severely wet. • Fleece is an acceptable insulator as well as synthetics. • Have a hard shell to prevent heat loss through wind convection andrain. • Use mitten style gloves instead of fingered gloves for maximum heat. • Pack at least two hats to rotate if you sweat. Marino wool is also good! • Sleeping situations • Only sleep in dry clothes. Take off those you wore. • Fill in “dead space” of your sleeping bag with dry clothes. • Air out your sleeping bag to prevent moisture buildup. • Do not cover your mouth in your sleeping bag (respiration moisture) • If you have severely inadequate shelter, DO NOT SLEEP!

Shelter - Hypothermia Prevention / treatment continued… • Special Tips • Slowly reheat victims. “After drop” is a condition where if thepatient is warmed too quickly, or is active too quickly after beinghypothermic, cold blood from the extremities will return to the heart and cause cardiac arrest or ventricular fibrillation. • Depending on the case, severely hypothermic victims will need tobe treated for shock, cardiac arrest. • Heat rocks for long term heat retention • Put hot water in water bottles as heat packs. • Place “heat packs” at core arteries (hypothermia is more deadly than frost bite) • Body-to-Body warming is less effective but possible

Shelter - Frost Bite Definition – Freezing of cellular tissue • Symptoms • Cold, completely numb, hard, and/or discolored (pale/blue/black) skin. Occurs to extremities (ears, nose, feet, hands, etc.) • Preventions • More or less same preventions as hypothermia:Stay dry & warm! • Do not smoke (causes vasoconstriction of extremities) • Be careful with vasoconstrictive meds (Hypotension meds, antihistamines, amphetamines) • Treatment • Do not treat unless you can keep the extremity warm. Re-freezingcauses more damage. • Use lukewarm water or body heat to warm extremity. • Do not use hot packs or fire to warm. This will cause toodrastic of a change. Also, they will not be able to immediately tellwhat is “too hot” as their nerves are numbed. • Do not move digits or apply pressure as this causes tissue damage.After re-warming, cover the affected area in gauze dressing andseparate digits with cotton balls to prevent rubbing.

Shelter – Photokaratitis Definition – UV damage to the cornea of the eyes. Can beprevalent in snow (snow blindness) or summer. • Symptoms • Not noticed until several hours after exposure. • Increased tearing, bloodshot eyes,uncontrollable eye twitching, eye pain,and feeling of sand or grit in eye • Preventions • Wear sunglasses! • Make slits in duct tape, birch bark, or similar material foremergency sunglasses • Put charcoal underneath the eyes to reduce reflection • Treatment • Get out of the sun and into the shade or keep eyelids shut. • Healing can be quick 1-3 days if not severe. • Use saline drops to alleviate pain / itchiness • Pain / anti-inflammatory medication can help

Shelter - Heat Stroke Definition – Failure of the body to effectively regulate body temp. Occurs when body temperature approaches 104°F. • Symptoms • Fever, throbbing headache, dizziness, red & hot/dry skin, muscle crampsweakness, nausea and vomiting, rapid heartbeat, shallow breathing,seizure, inability to sweat, or even unconsciousness. • Preventions • Wear loose light clothing. Light Marino wool also keeps you cool! • Allow for frequent rest in the shade or save work until the afternoon. • Lower elevation in valleys or highly dense forests may help with cooling. • Drink plenty of water (6-8oz every half hour during intense work). • Avoid diuretics or other simulants (coffee). • Pay attention to urine color. Dark urine is a sign of dehydration. • Dry tongue is also a good indicator of dehydration. • Treatment • Get out of the sun and into the shade! No Activity! • Give cold water to drink. • Submerse the individual in cold water (ideal) • Pour water over the individual and fan air (evaporation). • Use cold packs in the same areas as hypothermia.

Shelter - Sun Burns / Poisoning • Insert Movie

Shelter - Sun Burns / Poisoning Definition – Sun poisoning is severe sun-burn to the skin. Could you effective haul your BOB with a bad burn? Could that burn result in skin chaffing that leads to infection? • Symptoms • Obvious burns to the skin. Depending on degree of burn, blisters may be present. Can also have effects of fever, nausea, chills, dizziness, rapid breathing/pulse, dehydration or shock. • Preventions • Wear sunblock and appropriate clothing. • Stay in the shade if possible. • Re-prioritize work hours. • Avoid medications that can cause photosensitivity • Avoid handling citrus oils. • Treatment • Get out of the sun and into the shade! No Activity! • Use aloevera for soothing relief • Topical steroids (hydrocortisone 1%) can reduce swelling • Anti-inflammatory pain meds can be used. • Cool water • Blisters – Will cover in following sections

Shelter – Blisters Definition – Blisters are serum filled pockets under skinthat can be caused by burns, friction, or other irritation. • Preventions (feet) • Ensure you break in your footwear prior to a bug out situation. • Keep your feet dry! • Keep extra socks, foot powder, and moleskin in your kits. • If moleskin does not work, stop walking to prevent further complication. • Not related to blisters necessarily, but keep nail clippers in your bag.Ingrown toenails can create infection. • Treatment • Small blisters: leave alone if possible (prevents infection/heals faster) • Blisters that are leaking, large blisters (~1”), blisters located in areas where friction cannot be avoided (joints, foot sole, etc.): Clean the area with an anti-septic, pop the blister with a sterileneedle, and drain the fluid. Cover with appropriate bandages.Neosporin or anti-septic essential oils (tea tree or lavender oil) may be used to help prevent infection.

Shelter – Trench Foot • Insert Movie

Shelter – Trench Foot Definition – Constriction of feet blood vessels thereby reducingoxygen and nutrients to the feet. Over time (in as little as 24hr)the foot can have tissue/nerve damage. Unlike frostbite, it doesnot require freezing temperatures (60F) • Symptoms • Cold, swollen, white/grey foot that feels numb, heavy, and is painful/prickly. • Preventions • Same as all other foot care. Keep feet dry, clean and warm. If feet are moist and general conditions are wet, do not wear socks to bed. Allow feet to dry out as much as possible. • Avoid smoking and other vasoconstrictors (e.g. – frostbite) • Treatment • Warm feet with lukewarm water and then keep dry/warm. • Epsom salt water bath (follow bag instructions) • Potassium permanganate water bath (1:10,000 dilution).3-4 crystals per liter of water. (Used in WWI)Rough estimate is a pink solution (right picture). Ensure allcrystals are dissolved as it can cause burning if too concentrated.

Shelter - Poisonous PlantsRefer to “The Sure-fire Poison Ivy and Poison Oak Identification System”for great detail on identification.

Shelter – Poisonous Plants Some plant Anatomy for Identification

Shelter - Poisonous Plants • Poison Ivy • Compound leaf (leaves of 3 let it be) • Center leaf has a longer petiolule than lateral leaflets and is usually larger. • Leaflets are bright to dark green insummer, but can be reddish orangein early spring and in the fall. • Can be a shrub or a vine • Vines display “hair” and can range from thin to thick (several inches) • White/cream berries in late fall through spring. • Leaf lobes are not always consistent. Some forms look like “mittens”

Poison Ivy & Look A-likes

Shelter - Poisonous Plants • Poison Oak (not common near Ohio) • Also 3 leaves (let it be) • Center leaf has a longer petiolule than lateral leaflets and is usually larger. • Lobed wavy leaf margin • Velvet underside of leaf • Velvet stems • Grows as Vine or Shrub

Poison Oak

Shelter - Poisonous Plants • Poison Sumac • Small shrub/tree less than 30 feet • Pinnately compound leaves (7-13)with alternate arrangement. • Dark brown stems flecked with darkerbrown spots • Smooth matt texture to leaves seldom have fine hairs. • Grows hanging white berries in the fall • Edible Staghorn Sumac very commonin Ohio and is edible!

Staghorn SmoothPoison Sumac

Shelter – Poisonous Plants • Treatments • Rubbing OH can help prevent spread(Better to use Witch Hazel) • Cucumber slices • Apple Cider Vinegar • Baking Soda Paste • Oatmeal paste • Topical Corticosteroids • Jewel weed (wild medicinal)

Shelter – Insects/Parasites • Insert Movie

Shelter – Insects/Parasites • Insects can: • Cause anaphylaxis (whole body allergic reaction) • Cause disease via bite transmission:(most common ones in NA) • Rickettsial diseases (bacteria) • Rocky Mountain Spotted fever (ticks) • Bubonic Plague (Yersinia pestis– fleas) • Lyme disease (bacteria – ticks) • West Nile Virus (virus – mosquitos) • Cause disease via secondary infection: Chiggers / bed bugs / Louse (Typhus) • Cause disease via carry-over: • Flies (only one example) • Regurgitation on food, fecal carry-over, etc. • Shigella(dysentery) • Vibrio cholerae (dysentery) • Salmonella

Shelter – Insects/Parasites • Insect/Parasite Prevention (in terms of shelter) • Commercial Deet products (ticks, mosquitos, chiggers, etc.) • Body washing (louse) • Tuck clothing when hiking • No walking barefoot (hook worms) • Green/punky wood to smoke out insects/kill bacteria (pine and juniper work well) • Essential Oils • citronella, catnip, peppermint, rosemary, eucalyptus, tea tree, clove, lemongrass, geranium, lavender. • Wild garlic/onions/leeks, Jewelweed, Yarrow • Mud bath (extreme situations). Parasites(e.g. hookworms) may live in cesspool conditions.)

Shelter – Insects/Parasites • First clean & sanitize the bite area. • Treatment for itching/inflammation • Commercial Products • Calamine Lotion • Hydrocortisone creams • Benzocaine creams • Other Remedies • Cornflower + Apple Cider Vinegar paste • Witch Hazel • Lavender, eucalyptus, or tea tree oil • Plantain poultice (wild edible/medicinal) • Jewelweed (wild medicinal) • Clear nail polish

Water – Disease Prevention • Four ways of treating/purifying water • Boiling • As soon as clear water comes to full boilit is safe to drink in terms of microbes. • Filtration • Must have at least 0.2 micron filtration.Pre-filter if the water is very dirty • Chemical treatment • Chlorine, iodine, potassium permanganateWorks best in “warm” water ~65F (next slides) • Distillation • Boiling and condensing fluid. (Next slides)

Water – Disease Prevention • Iodine – let sit for 20-30 minutes • Using a 2% iodine solution, you can add about 5-10 drops to 1L of water. Let sit for 20-30 minutes. If water is not clear, use the upper range of these measurements. • Potassium Permanganate – let sit for 1-2hr • 1:10,000 dilution (3-4 crystals per liter of water).“If it’s pink, it’s safe to drink • Chlorine – (safest) let sit for 60 minutes

Water – Disease Prevention Distillation techniques

Water – Other sources • Safe to drink without processing • Rain collected in clean containers(drink same day) • Water from trees (early spring)(birch, maple, others) • Water from vines • Water from plant vegetationrespiration • Water from dew collection(depends from where)

Food • Safe food practices • Clean: clean hands and sanitizecooking utensils (will cover later) • Cook: For most meats, ensure internal tempof meat is 165F. To be safe, ensure180F. • Separate: Avoid cross contamination. • Refrigerate or preserve effectively • Canning • Follow recipe exactlyCan store for years (essentially sterile) • Dehydration (meats) • Cook first to 165F, then dehydrate.Stores for 1-2 months

Food The following example is bacteria found onthe hands after handling commercial chicken breasts vs. hand washing after handling the chicken.

Before Hand Washing After Hand Washing

Hygiene – Dental Prevention • Stock toothbrushes, toothpaste, rinse,& floss. • Eat less processed, non-sticky, less sugarfoods. • Purchase tooth scalersand mirror. • Get all major dental work done now! • Non-commercial alternatives • Homemade toothpaste recipes or baking soda may be used. • Charcoal dust can be used as a temporarysurvival toothpaste. • Green twigs with ground ends canbe used as a tooth brush and pick. • Salt water can be used as a dailyrinse. • Coconut oil (oil pulling) 1 tbls for 10-20 minutes

Hygiene – Dental Treatment Cavities or lost fillings • Symptoms • Pain when drinking water or eating • A hole or black spot on the tooth • Pain if food gets in the hole • No pain when you tap on the tooth • Treatment • Remove loose filling/food • Clean/rinse the area. • Apply temporary cement or clove bud essential oil + zinc oxidepowder (2 drops + small amount zinc oxide) • Permanent filling using “Glass Ionomer”requires experienced handling but can bepurchased online.

Hygiene – Dental Treatment Gum Disease • Symptoms • Raw, red, loose, and/or bleeding gums • Teeth may be loose near area • Bad breath/bad taste in mouth • Treatment • Clean mouth with soft brush daily. • Remove tartar if present with scaler. • Rinse with H202 for 3 days if bleeding.Continue to rinse with salt water (4 cups ea day) until condition improves. 1 cup ea. day maintenance. • Apply diluted clove bud essential oilto numb pain or use Orajel.

Basic Medical & First Aid 101