Thursday, December 1, 2011

What to Do When Help is NOT On the Way

What would you do in a post-SHTF scenario if your partner or a member of your group suffered a severe, deep cut to a leg or arm with a tool such as a machete or axe?  What if the blow was so hard the blade penetrated not only flesh but nearly severed the bone in the limb as well?  It's not far-fetched at all that a person could suffer such a cut by accident or in an intentional attack.

When I was traveling through the Caribbean on my solo sea kayak journey of 1988-90, I met a young man in the town of Samana, in the Dominican Republic, who had suffered just such a horrible wound at the hands of a jealous husband wielding a machete.  He was lucky to have survived, as the attacker meant to split his skull with it.  Using his forearm to block the vicious strike, he almost lost the arm, but absorbed most of the force before it hit his face.  Far more stitches than I could count encircled the forearm that was slashed to the bone and another row extended from the top of his scalp all the way across his forehead, eyebrow, bridge of his nose and cheekbone.  All this just from one strike.  While it is certain he would have been killed instantly if he had not sacrificed his arm to block the blow, if he had been in a situation where he could not get quick medical attention, he probably would have bled out from the cut artery in his arm anyway. 

So what would you do in a case like that if you couldn't get outside help?  I was thinking about this a lot over the last two days as I worked on a scene in my current book project (the post-apocalyptic novel I'm now writing) in which one of the characters is cut almost the same way.  Getting to a hospital or calling for an ambulance is out of the question, so what choices does the person attending the victim have?  Stopping the flow of blood is obviously the first priority, and depending on the severity and location of the wound, you may have only minutes to do so.  Applying a tourniquet used to be the accepted wisdom, but it is now known that doing so almost guarantees the loss of the limb.  Applying direct pressure is much safer, and can be just as effective.  As it happens, just as I was sorting through various references on the correct way to do this, a message came through on my Twitter account informing me of a new follow by James Hubberd@thesurvivalMD, and the timing could not have been better. 

I followed the link back to his website: The Survival Doctor, and found an excellent resource on just the kind of trauma first aid information I was looking for.  Dr. Hubberd's blog posts only go back to September, but all of them are informative, with illustrations and videos that show and explain in simple terms how to deal with some pretty severe medical emergencies in the field.  Dr. Hubberd is a family M.D. with 30 years of experience in the field. What's interesting about his approach, is that as his site title suggests, he's writing this for those interested in medical preparedness in the event of a disaster, social upheaval or other situation where you're isolated and "help is not on the way."  I think this site is going to be a useful resource for all of us and I've added The Survival Doctor to my blogroll so we can all look forward to learning something new from Dr. Hubberd's updates.  And thanks to the quick-thinking actions of his brother who knew just the right thing to do because of this new site, my badly-slashed character will not only live, but may even regain full use of his right arm again.


  1. Way cool post, when or if Bad Times come around, we'are all going to be playing doctor (not the good kind) and learning how to take care of some major wound emergencies would be really good to know.

    Especially if you live alone - a broken leg in that situation would be very difficult to treat. That advice about taking extra care in the wild (don't jump and choosing your route carefully) pays off.

  2. You're welcome, Dr. Hubbard. Keep up the good work!

  3. Your information on tourniquets is not correct. Properly applied and removed in a timely fashion even a makeshift tourniquet can save a life without loosing a limb.

  4. Anonymous, you're right that a properly-applied and removed makeshift tourniquet can save a life without losing a limb. The key is "properly applied and removed" and I think that's why most doctors and first aid experts recommend direct pressure instead. The risk factor in using a tourniquet is too high since most people would not know how to apply one properly or when to remove it before it's too late. Without a doubt, I'd rather lose a limb than bleed to death, as would anyone else I'm sure.

  5. Back in 2008 I took an EMT course at the local collage. At the time I was going to go in to the medical industry until I started to learn about the various disease types i could encountered. Things that would make the AIDS virus look like a minor head cold in comparison. As a result, I decided other career options. I did however complete the course so i could have the skill needed to provide medical and trauma assistance to family and friends.

    The major thing we were taught in the course was the order in which to treat trauma injuries. ABC in that order. Airway, Breathing, Circulation. If the airway is blocked then B and C don't mean a damn thing. If you can't breath you wont live. Breathing, same thing If "A" is clear and and your body isn't breathing, Circulation don't matter. Once you checked A n B then worry about C. Most trauma related emergencies to the limbs can be controlled with by direct pressure and the use of pressure points. Including a completely severed limb. Once you applied the dressing, never remove it. if it is still bleeding add more bandages and keep applying direct pressure. Tourniquets should only be used as an absolutely last resort when all else has failed. If you find yourself applying on. You need to write the time and location of the tourniquet. Commonly written on the forehead. I.E. (T L/A 1340) Apply it about 3 to 4 inches above the injury so that when possible the doctors can use the skin to fold over the injury after they cut the bone out. Also if you can find the limb, wrap it in a towel, shirt or what ever is available and put it on ice. In the event it can be salvaged. With any luck in the scenario described above you will still be able to get the person to a hospital vice waiting for them to come to you. Further I strongly recommend that everyone take an EMT course or go through the American Red Cross (ARC)and take the professional rescuer course. This will help you out a long ways. The professional rescuer course is one step below that of an EMT in terms of what is covered. The course taught by ARC is very affordable.

  6. Just came across this one--great post and cool resource Scott. Thanks for sharing.

    My teaching on tourneys is similar to what Anonymous stated above. I sat in some classes with a Fire Marshall with 30 years in the dept. He said that in his 30 years he had never applied one. Even in cases of complete severance, arteries that are normally pulled taut under tension, actually recoil slightly and can usually be stopped by pressure and elevation.

    On the other hand, applying a tourniquet can cause tissue to go necrotic in a matter of minutes...


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