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1 Cincinnati Survival Preparedness Group Basic Medical & First Aid 101

2 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) Agenda

3 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 asked throughout the session. However, keep in mind that medicine is an incredibly exhaustive topic that we cannot cover in grand detail. Please be conscious of time.

4 Introduction Do you truly know how to prepare for medical-oriented situations? Perception vs. Reality

5 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

6 Introduction Disease, exposure, and famine are more likely causes 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?

7 General Patient Physical Assessment Sammi Zipf

8 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.

9 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?

10 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.

11 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

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

13 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

14 Air Quality NIOSH (N95) Masks filter 95% of particulates >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, it is best only for quick protection, general particulates, care for the sick, etc. Note: We will not be covering radiological air contaminates.

15 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 increase your body temp. Just ensure you do not sweat!

16 Shelter - Hypothermia Prevention / treatment continued… –Understand convection, conduction, radiation & evaporation in 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 in base 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 and rain. 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!

17 Shelter - Hypothermia Prevention / treatment continued… Special Tips –Slowly reheat victims. “After drop” is a condition where if the patient is warmed too quickly, or is active too quickly after being hypothermic, 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 to be 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

18 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-freezing causes more damage. –Use lukewarm water or body heat to warm extremity. –Do not use hot packs or fire to warm. This will cause too drastic of a change. Also, they will not be able to immediately tell what 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 and separate digits with cotton balls to prevent rubbing.

19 Shelter – Photokaratitis Definition – UV damage to the cornea of the eyes. Can be prevalent 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 for emergency 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

20 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 cramps weakness, 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.

21 Shelter - Sun Burns / Poisoning Insert Movie

22 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

23 Shelter – Blisters Definition – Blisters are serum filled pockets under skin that 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 sterile needle, 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.

24 Shelter – Trench Foot Insert Movie

25 Shelter – Trench Foot Definition – Constriction of feet blood vessels thereby reducing oxygen and nutrients to the feet. Over time (in as little as 24hr) the foot can have tissue/nerve damage. Unlike frostbite, it does not 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 all crystals are dissolved as it can cause burning if too concentrated.

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

27 Some plant Anatomy for Identification Shelter – Poisonous Plants

28 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 in summer, but can be reddish orange in 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” Shelter - Poisonous Plants


30 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 Shelter - Poisonous Plants


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


34 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)

35 Insert Movie Shelter – Insects/Parasites

36 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

37 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

38 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 Shelter – Insects/Parasites

39 Water – Disease Prevention Four ways of treating/purifying water –Boiling As soon as clear water comes to full boil it 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 permanganate Works best in “warm” water ~65F (next slides) –Distillation Boiling and condensing fluid. (Next slides)

40 Water – Disease Prevention Chlorine – (safest) let sit for 60 minutes Treating water with household bleach containing 5.25-8.25 percent chlorine Volume of Water to be TreatedBleach Solution to Add 1 quart/1 liter5 drops 1/2 gallon/2 quarts/2 liters10 drops 1 gallon1/4 teaspoon 5 gallons1 teaspoon 10 gallons2 teaspoons 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

41 Water – Disease Prevention Distillation techniques

42 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 vegetation respiration –Water from dew collection (depends from where)

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

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


46 Hygiene – Dental Prevention Stock toothbrushes, toothpaste, rinse, & floss. Eat less processed, non-sticky, less sugar foods. Purchase tooth scalers and 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 temporary survival toothpaste. –Green twigs with ground ends can be used as a tooth brush and pick. –Salt water can be used as a daily rinse. –Coconut oil (oil pulling) 1 tbls for 10-20 minutes

47 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 oxide powder (2 drops + small amount zinc oxide) –Permanent filling using “Glass Ionomer” requires experienced handling but can be purchased online.

48 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 oil to numb pain or use Orajel.

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