Wilderness Doc: Pre-Hospital Care in Mass Casualty Shootings

This article from Wilderness Doc discusses a key difference in civilian vs military shooting injuries and how, because of the difference, the first aid focus for civilians may be better served with blod clotting bandages than tourniquets — Pre-Hospital Care in Mass Casualty Shootings.

 

You will likely recognize the above picture as a CAT tourniquet. As programs such as Stop The Bleed and others have focused on the use of tourniquets in the field, these have become a popular item for most to carry in our kits. This is for good reason too. Studies and data coming from military experience in Afghanistan and Iraq have shown, these devices are no longer to be considered the “last ditch” efforts we once thought. That being said, what does the data show about efficacy or applicability of this data in civilian shootings as we have recently seen in El Paso and Dayton?

This very question was addressed in the May/June 2019 edition of the Air Medical Journal. Three studies by Smith, Butler and de Jager were used to discuss differences between the battlefield and civilian injuries. Interestingly, military injuries tend to be to extremities. This is due to several reasons. First, many soldiers are injured by high explosive devices and the fragments coming off of them. Secondly, the battlefield and the highly armed nature of the two sides on the battlefield, tends to separate the combatants much further than what is seen in the civil setting. This separation makes shots to vital areas such as the torso, head and neck less likely. Finally, soldiers tend to wear body armor that covers vital areas. While not fool proof, especially against higher caliber and more powerful rounds, it can protect against many rounds, especially if shot from a distance.

What does this difference mean for civilian first responders in such scenarios? It means that chest, back and head shots are much more likely. These areas are, obviously, not amenable to tourniquet placement. So, while still important, we need to adjust training and prepare our first responders for what they are more likely to see. In particular, the authors advise focusing on chest wounds. While there are many who have survived head shots, the chest can be far more survivable. Focusing on pressure and hemostatic impregnated gauze as well as chest seals and decompression may be the next line in pre-Hospital treatment. Also, ensuring such first responders are well versed in all forms of artificial airways can be lifesaving…

Click here to read the rest of the article at Wilderness Doc.

Doom and Bloom: Dental Kits Off the Grid

The Altons at Doom and Bloom Medical have a good post covering the items you need to have in an off grid or austere medicine dental kit.

Poor dental health, however, can cause issues that affect the work efficiency of members of your group in survival settings. When your people are not at 100% effectiveness, your chances for survival decrease. Anyone who has experienced a toothache knows how it affects work performance.

When modern dental technology is not an option, an ounce of prevention is worth a pound of cure. This strategy is especially important when it comes to your teeth. By maintaining good dental hygiene, you will save your loved ones a lot of pain (and yourself a few headaches).

Let’s discuss some procedures that both you and I know are best performed by someone with experience. Unfortunately, you’re probably don’t have a dentist in the family. The information here will at least give you a basis of knowledge that may help you deal with some basic issues.

The Prepared Family’s Dental Kit

dental kit

some components for a dental kit

The prepared medic will have included dental supplies in their storage, but what exactly would make sense in austere settings? You would want the kit to be portable, so dentist chairs and other heavy equipment wouldn’t be practical.

In the past, we’ve mentioned that gloves for medical and dental purposes are one item that you should always have in quantity. Avoid sticking your bare hands in someone’s mouth. Hypoallergenic nitrile gloves are, in my opinion, superior to latex. For additional protection, masks should also be stored and worn by the medic. The simple “earloop” versions will do for dental exams.

dental “elevators” loosen ligaments that hold decayed teeth in place

Other items that are useful to the off-grid “dentist” include:

  • Dental floss, dental picks, toothbrushes, toothpaste (or baking soda)
  • Dental or orthodontic wax as used for braces; even candle wax will do in a pinch. Use it to splint a loose tooth to its neighbors.
  • A Rubber bite block to keep the mouth open. This provides good visualization and protection from getting bitten. A large-sized pink eraser would serve the purpose.
  • Cotton pellets, Cotton rolls, Q tips, gauze sponges (cut into small squares)
  • Commercial temporary filling material, such as Tempanol, Cavit, or Den-temp.
  • Oil of cloves (eugenol), a natural anesthetic.It’s important to know that eugenol might burn the tongue, so be careful when touching anything but teeth with it.  Often found in commercial preparations.
  • Red Cross Toothache Medicine (85% eugenol)
  • DenTemp Toothache Drops (benzocaine )
  • Zinc oxide powder; when mixed with 2 drops of clove oil, it will harden into temporary filling cement.
  • Spatula for mixing (a tongue depressor will do)
  • Oil of oregano, a natural antibacterial.
  • A bulb syringe to blow air and dry teeth for better visualization, and as a diagnostic tool to elicit discomfort in damaged teeth.
  • A 12cc Curved irrigation syringe to clean areas upon which work is being done.
  • Scalpels (#15 or #10) to incise and drain abscesses
  • Dental probes, also called “explorers”.
  • Dental tweezers
  • Dental mirrors
  • Dental scrapers/scalers to remove plaque and probe questionable areas
  • Spoon excavators. These instruments have a flat circular tip that is used to “excavate” decayed material from a tooth. A powered dental drill would be a much better choice, but not likely to be an option off the grid.
  • Elevators. These are thin but solid chisel-like instruments that help with extractions by separating ligaments that hold teeth in their sockets. #301 or #12B are good choices. In a pinch, some parts of a Swiss army knife might work.
  • Extraction forceps. These are like pliers with curved ends. They come in versions specific to upper and lower teeth and, sometimes, left and right.
dental_extraction_forcep

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Click here to read the entire article at Doom and Bloom.

Doom and Bloom: Dengue Fever – A Rising Pandemic

The Altons at Doom and Bloom Medical have an article up on Dengue Fever , its current pandemic status, symptoms, treatment and precautions.

 

  • aedes aegypti mosquito

    Singapore dengue outbreak: Nearly 9000 cases through July – Outbreak News Today

    Nicaragua declares alert over dengue fever – Washington Post

    Bangladesh grapples with country’s worst dengue outbreak – Miami Herald

    Three headlines about Dengue Fever this year? No, actually they’re all headlines just from one day: Aug 1st, 2019. Dengue fever is a true pandemic, with community wide outbreaks in various regions throughout the world. Indeed, rates of Dengue infection are thought to have increased greatly since 1960 due to encroaching civilization and population growth in warmer regions. As a resident of South Florida, I believe that the development of residential air conditioning around that time may have precipitated the explosion in potential victims.

    rash in dengue patient

    What is Dengue fever? It’s an infection caused by a virus that’s transmitted to humans by mosquitoes. If you live between latitude 35 degrees north and 35 degrees south, and lower than 3000 feet elevation, you’re in Dengue territory.

    And you’re not alone. An estimated 400 million people get infected with the Dengue virus every year. Luckily for the grand majority, they don’t even know they have it. 96 million cases, however, aren’t so fortunate and develop sickness.

    The mosquito in question is the Aedes Aegypti, but other species may possibly spread it. A mosquito bites a human with the Dengue virus and becomes infected. It doesn’t get sick, but the virus is now in its saliva for life. The mosquito passes Dengue onto the next human through its next bite.

    Just a few diseases transmitted by mosquitoes

    There are actually four different but related viruses that cause dengue fever, but the symptoms are similar. If you’re in the unlucky minority that gets sick, you can expect to see signs about four to seven days after the infectious bite…

     

Click here to read the entire article at Doom and Bloom.

Doom and Bloom: Heat Wave Safety

The Altons at Doom and Bloom Medical have an article up — Heat Wave Safety — on the dangers of heat exhaustion and heat stroke. Once on an early morning march during AIT at Ft. Benning, I saw a young soldier collapse from heat stroke. He was rushed off in the back of a truck with a drill sergeant performing CPR. I wish that I or someone else would have noticed the signs before it became so serious.

Summer is here and the Midwest and East is experiencing record high temperatures in a major heat wave. Officials predicted a high-risk situation as the heat index surpasses heat indexes in 90s and 100s, and in some case, the 110s. Close to 200 million people might be affected in 32 states, according to the U.S. weather service.

The “heat index”, by the way, is a measure of the effects of air temperature combined with high humidity.  Above 60% relative humidity, loss of heat by perspiration is impaired exposure to full sun increases the reported heat index by as much as 10-15 degrees F. All this increases the chances of heat-related illness.

We can expect the power grid to be challenged by tens of millions of air conditioning units set on “high”, and we can expect to see some major health issues if the electricity goes out and people have to fight the heat with hand fans, like they did in the “good old days”.

You might not consider a heat wave to be a natural disaster, but it most certainly is. Heat waves can cause mass casualties, as it did in Europe when tens of thousands died of exposure (not in the Middle Ages, but in 2003). They’ve already experienced one bad one this year and are predicted to have another in the near future. India, Pakistan, and other underdeveloped tropical countries experience thousands of heat-related deaths yearly.

So how exactly does heat kill a person? Your body core regulates its temperature for optimal organ function. When core body temperature rises excessively (known as “hyperthermia”), toxins leak, inflammation occurs, and cells die. Fatalities can occur very quickly without intervention, even in those who are physically fit. Even in modern times, hyperthermia carries a 10% death rate, mostly in the elderly and infirm.

 

Click here to read the entire article at Doom and Bloom.

Doom and Bloom: Snake Bite First Aid

The Altons at Doom and Bloom Medical have an article up – Snakebites: First Aid and Prevention. As rattlesnakes are fairly common, venomous, pit vipers in our area, it behooves us to be prepared to treat and avoid bites.

Rattlesnake
Warm weather wakes humans up from their hibernation, but it also wakes inhabitants of the Great Outdoors as well, such as snakes. Inevitably some hiker, camper, or hunter experiences a face-to-face (or face-to-ankle) encounter with a slithering serpent.

Of the 3000 species of snakes on planet Earth, only about 400 are venomous. In North America, those that inject venom into their victims are either pit vipers or elapids. Pit vipers include species of rattlesnakes, water moccasins (cottonmouths), and copperheads. One species or another exists everywhere in the U.S. except for Maine, Alaska, and Hawaii. Elapids include coral snakes, found mostly in the South.

A word about venom: Notice I don’t say “poison”. Poisons are absorbed in the gut or through the skin, but venom must be injected into tissues or blood via fangs or a stinger. Strangely, it’s usually not dangerous to drink snake venom unless you have a cut or sore in your mouth. Having said that, please don’t try this at home.

U.S. PIT VIPERS

Pit vipers account for most snakebites in North America. The “pit” refers to a heat-sensing organ located between the eye and nostril on each side of a triangular head. The eyes have slit-like pupils. Pit vipers include:

Rattlesnakes: Of all pit vipers, rattlesnakes contribute the most to snake bite statistics in the U.S. They get their name from a structure at the end of their tails which makes a loud rattling noise when shaken. The “rattle” serves as a warning to discourage nearby threats.

Copperheads: The copperhead looks similar to a rattlesnake but without the rattle. As the name suggests, it is often copper-colored or pinkish-tan with darker bands.

Water Moccasins: These snakes are very comfortable in water. This snake has no rattle, so is relatively silent, as if walking in “moccasins”. Its response to threats is opening its mouth wide and exposing its whitish oral cavity before biting. This behavior gives it the nickname “cottonmouth”. The water moccasin may have a pattern when young, but as an adult is almost black in color. Its thick body differentiates it from other water snakes, which tend to be slender.

U.S. ELAPIDS

Coral Snakes are related to the king cobra. They’re brightly-colored but unassuming creatures that are rarely aggressive. Their small fangs are less effective in delivering venom than pit vipers. A coral snake tends to deliver venom by holding on and “chewing” on its victim, unlike vipers, which strike and let go quickly.

The marks left by venomous snake bites have a distinct appearance due to the hollow fangs at the front of the mouth. This differs from non-venomous snakes, where the bites have a more uniform appearance.

Not every bite from a venomous snake transmits toxins to the victim; indeed, 25-30% of these bites will be “dry” and seem no worse than a bee sting.  This could be due to the short duration of time the snake had its fangs in its victim or whether the snake had bitten another animal shortly beforehand…

Coral Snake

Click here to read the entire article at Doom and Bloom.

Doom and Bloom: Summer Cryptosporidium Infections

The Altons at Doom and Bloom Medical have an article up describing cryptosporidium parasite infections – symptoms, treatment, and prevention.

Summertime is when you cool off with a dip in the pool, but this year you might be sorry you did. The Centers for Disease Control and Prevention are urging citizens to protect themselves against a hardy parasite called Cryptosporidium.

Public and private pools alike are being colonized with the nasty bug, better known as “Crypto”.  The organism lives in the intestines of infected people and animals. Crypto spreads in pool water when someone who is sick with the parasite goes swimming and has a loose bowel movement in the water. Because of their more liquid nature, diarrheal stools spread the microbe faster than formed ones.

Cryptosporidium

Cryptosporidium is so tough that it can live for up to ten days in the presence of bleach. This year, there are more outbreaks in recreational waters than usual. The frequency has risen an average of 13% annually since 2009. In the last decade, over 400 incidents were reported in the U.S., leading to sickness in 7,500 people.

Note: Organisms that cause sickness in a population are known as “pathogens”.

Swallowing water from pools, hot tubs, and swimming holes isn’t the only way you can get infected. Day care centers and other venues with a large number of small children can also lead to contamination. Contact with infected animals may also pass the organism.

SYMPTOMS OF CRYPTO INFECTIONS

Crypto lives here

Infection with Crypto leads to a disease called “cryptosporidiosis”. Within two to ten days after exposure, the victim starts to have nausea, vomiting, and watery diarrhea that can last for weeks. Other symptoms of the illness may include fever, stomach cramps, and weight loss…

Click here to read the entire article at Doom and Bloom.

Doom and Bloom: Eye Injuries

The Altons at Doom and Bloom Medical have an article up on Eye Injuries. Try to protect your eyes so that you don’t have to do any of this.

The human body is truly a miracle of engineering, from head to toe.  Your skull is just one example. It’s shaped in such a fashion that your eyes are recessed in bony sockets, which helps to protect them from injury. Despite this, there are many different activities of daily living, not to mention daily survival, that can cause traumatic injury to your eyes.

Here are some:

  • Accidents while using tools
  • Splatter from bleach and household chemicals
  • Debris flung while doing yard work
  • Grease splatter from cooking
  • Chopping wood
  • Hot objects near your face, like a curling iron (do people still use curling irons?)

The list goes on and on; heck, you could damage your eye by popping a cork on a bottle of champagne (if you could find champagne off the grid).

The grand majority of eye injuries are avoidable with a little planning but, despite this, it’s likely that the group medic will have to deal with someone’s eye injury at one point or another.

Foreign objects in the eye cause immediate symptoms, especially if they injure the sensitive cornea. You will see the victim complain of:

  • Eye pain or pressure
  • Tearing up
  • Light sensitivity
  • Frequent blinking
  • Redness (a “bloodshot” eye)
basic eye anatomy

The patient will usually tell you that they feel something in their eye. The most common location will be under the upper eyelid…

Click here to read the entire article at Doom and Bloom.

American Partisan: First Aid in a Wilderness Setting

American Partisan has a two part article on wilderness first aid by former combat medic.

First Aid in a Wilderness Setting, Part I

Wilderness First Aid, Part II

After having a Positive Mental Attitude to survive, and once you’ve located Shelter, the next on the list of priorities is First Aid. This will likely be in a wilderness environment. Just so we can put a label on this, lets look at some definitions.

Wilderness is defined as “An uncultivated, and inhospitable region.”

First Aid is defined as “help given to a sick or injured person until full medical treatment is available.”

I’ll go a step further with defining this by saying wilderness, medically speaking, is an hour or more from the time the incident occurred, to treatment in a definitive care facility. Wilderness First Aid is also all about Improvising. We often can’t lug around an ALS ambulance with us or pack our gear with with the contents of a paramedic’s trauma bag. We can take minimal supplies and the rest is improvising. We can splint a leg fracture or configure a c-collar with a sleeping pad. We can use a bandana as a trauma dressing.

In a wilderness medical setting as well as the urban setting, we can categorize our patient as either Medical or Trauma. A medical patient in my experience as a former Combat Medic and Wilderness EMT seems to be more subjective, which means they tell you what’s wrong with them more than you can see it objectively. With trauma, it’s the opposite. A person who crashes their mountain bike on a trail and has an open fracture to an arm is pretty self-explanatory.

S-A-B-A

S-A-B-A stands for “Self-Aid / Buddy-Aid”. Self-Aid sounds easy when we know how we feel and pretty much know we crashed a bike or twisted an ankle on the trail. Except for that, we might have to perform some functions with only one hand, reduced or no vision, and not being able to move around because of trauma to our bodies. I would emphasize to practice applying a dressing & bandage to yourself with the use of one arm or blindfolded. This can be done while sitting on the couch watching TV. Buddy Aid is being able to medically assist another person…

Related:

American Partisan: The Partisan’s First-Aid Kit

John Mosby: Tourniquets, Chest Seals, and Pressure Dressings

Following up on the recent post about newly approved by the CoTCCC tourniquets, John Mosby of Mountain Guerrilla has written a piece – Tourniquets, Chest Seals, and Pressure Dressings, Oh My!discussing med kit you should be carrying if you are carrying a firearm.

pocket med

 

Tourniquets get a lot of digital bandwidth in tactical and preparedness virtual circles. Rightfully so, since they’ve demonstrably saved a …ton of lives over the last two decades of combat. Unfortunately though, in the process of bludgeoning a deceased equine, in order to overcome decades of medical institutional inertia about the supposed hazards of tourniquet use, many people—myself included, unfortunately—have neglected to make it a point to discuss the surrounding issues.

Let’s start with this, just to get it out of the way:

If you carry a gun, and you’re not carrying a tourniquet or two, you’re either LARPing, or you’re a… idiot. The fact is, a “gunfight” implies bilateral ballistics, and the enemy gets a vote. If you assume your one box of ammo a month “practice” regimen means you’re automatically a far better marksman than the bad guy you are going to end up in a gunfight with, well, I’ve got an 8 ounce jar of fairy dust I’ll sell you cheap, and it’s guaranteed to make you stronger, faster, higher flying, and generally more attractive to members of your preferred sex.

Sure, you COULD try using your belt or handkerchief or what-the-…-ever to improvise a tourniquet, but experiential research and laboratory study both pretty clearly demonstrate they are a piss-poor substitute, and don’t work particularly well (which is not the same thing as saying they DON’T work, AT ALL. I know people who have saved lives with improvised tourniquets, and you may too. Both they, and their patients, probably would have appreciated a manufactured, quality, tourniquet).

That having been said, we’ve got to look at the circumstances surrounding battlefield wounds, versus our likely circumstances, to see if tourniquets are even MOST of the answer, let alone all of the answer.

Click here to read the entire article at Mountain Guerrilla.

May is National Stop the Bleed Month

The top cause of preventable death in trauma is bleeding. 20% of people who have died from traumatic injuries could have survived with quick bleeding control.

May is National Stop the Bleed Month, bringing Bleeding Control (B-CON) Instructors and students together for a month of training – free of charge in many places. Go to bleedingcontrol.org to find a class.

On Saturday May 11th, Dr. Jacobo Rivero will be teaching a free stop the bleed class in Prosser from 9:00 am to 11:00 am. The class will also be taught on June 8th and July 13th at the same location and hour.

Call 786-6601 to RSVP for Dr. Rivero’s classes. Space is limited.

Location: PMH Vineyard Conference Room
723 Memorial St, Prosser, WA

In Umatilla, the course will be taught on May 22nd at the Good Shepherd Medical Center conference room 2 from 8:00 am – 11:00 am. Call 541-667-3509 to register.

Related:
Prehospital tourniquets in civilian settings significantly decreased mortality

Doom and Bloom: Important Aspects of Tactical Combat Casualty Care

Dr. Alton at Doom and Bloom Medicine has a short article and video dealing with Tactical Combat Casualty Care.

You may have heard me reference something called “TCCC” in previous articles, podcasts, or videos. TCCC, sometimes called T3C or T triple C, is a term that means Tactical Combat Casualty Care. It represents the recommendations with regards to prehospital care of soldiers who have incurred traumatic injuries on the battlefield. Established in the mid-1990s, TCCC guidelines have become so widely accepted that many law enforcement and civilian medical personnel have adopted them.

And well they should. These protocols were developed at the cost of painful lessons in the field in Iraq and Afghanistan. It is thought that there were 1000 preventable deaths in these conflicts. If you add civilian injuries during the same time period, the number of preventable deaths might number in the hundreds of thousands. The TCCC’s primary goals is to save lives, prevent additional casualties, and, in true military fashion, complete the mission…In survival settings, you can’t duplicate the care given at a field hospital or a trauma center. Your final outcomes won’t always be happy. You might, however, use some of the methods in MARCH/PAWS to possibly save the life of those who would otherwise die during or in the aftermath of a disaster…

 

Doom and Bloom: Which Antibiotics to Have for Survival

The Altons at Doom and Bloom Medical have an article up about Which Antibiotics to Have in Survival Settings. This material is covered in detail in their new book about antibiotics, but they have made a brief summary in this article.

…If a disaster throws you off the grid, your risk of traumatic injury increases but also that of infection. When someone thinks of an infectious disease event, they envision a deadly epidemic. Any catastrophe, however, can increase the number of people with infections. When I say “catastrophe”, I’m not talking losing power from a storm for three days; I’m talking about a true long-term survival scenario.

In these horrific events, dirty wounds, contaminated water, poorly prepared food, and inadequate sanitation will turn previously healthy people into desperately sick ones. With antibiotics in your medical storage, you have a good shot of nipping those infections in the bud. Not having them could lead to tragic consequences.

One of the most frequent questions I receive from readers, listeners, and viewers is which antibiotics to have on hand in survival settings. I have received a flurry of these lately in response to our new book “Alton’s Antibiotics and Infectious Disease”: The Layman’s Guide To Available Antibacterials in Austere Settings. In the book, I discuss, well, antibiotics and infectious disease: The infections to be expected in those knocked off the gird and the antibiotics obtainable by the average citizen that help prevent otherwise avoidable deaths.

(NOTE: I don’t sell antibiotics nor own any part of a company that does.)

Certainly, it would be great if you had the financial resources to have all of the medications we talk about in Alton’s Antibiotics and Infectious Disease, but that’s beyond the means of almost everyone. You’ll probably need to pick a limited number to stockpile, but which? Chances are, if you lined up 10 doctors, you’d get 10 different answers.

Your choices would depend on the infections you’re most likely to encounter. Is it wound infections you’re concerned about, or intestinal infections like dysentery or cholera? Does someone in your group have a medical condition that makes them prone to a certain infection? Certainly, one drug doesn’t cure all.

Without knowing your individual situation, I can’t give you specifics.  I can, however, still give you my personal recommendation of a few antibiotics available in aquarium and avian form that would be assets in my survival medicine cabinet…

Click here to read the entire article at Doom and Bloom Medical.

Doom and Bloom: Hypothermia in March?

The Altons at Doom and Bloom Medical have an article up about the dangers of hypothermia and how to treat and avoid it. Twenty-five percent of deaths in blizzard conditions are due to hypothermia (the majority are from traffic accidents.) Locally, March has been a bit colder and snowier than usual, so it’s good to keep these dangers in mind. Below is only a brief excerpt. Please read the entire article.

When March comes along, you might think that Spring has sprung. But old man Winter isn’t done with us yet. Although the month of March may exit like a lamb, it often enters like a lion. The Midwest and Northeast can attest to this fact from cold temperatures and heavy snows just in the last few days.

Even in March, winter storms (this one is named “Scott”) occur every year in the United States; Scott brought a foot of snow to some areas. Extreme weather can cause fatalities among the unprepared. In blizzard conditions, 70% of deaths occur due to traffic accidents and 25% from hypothermia from being caught outside during the blizzard.

The key word is “outside”. If a blizzard knocks you off the grid as Scott did to 60,000 people, you might be tempted to travel to someplace warmer, but that’s how most deaths occur from winter storms.

This winter has already seen deadly cold snaps where people have found themselves at the mercy of the elements. Whether it’s on a wilderness hike or stranded in a car on a snow-covered highway, the physical effects of exposure to cold (also called “hypothermia”) can be life-threatening…

TREATING HYPOTHERMIA

If you encounter a person who is unconscious, confused, or lethargic in cold weather, assume they are hypothermic until proven otherwise. Immediate action must be taken to reverse the ill effects.

Important measures to take are:

Get the person out of the cold. Move them into a warm, dry area as soon as possible. If you’re unable to move the person out of the cold, be sure to place a barrier between them, the wind, and the cold ground.

Monitor breathing. A person with severe hypothermia may be unconscious. Verify that they are breathing and check for a pulse. Begin CPR if necessary.

Take off wet clothing. If the person is wearing wet clothing, remove gently. Cover the victim with layers of dry blankets, including the head, but leave the face clear.

Share body heat. To warm the person’s body, remove your clothing and lie next to the person, making skin-to-skin contact. Then cover both of your bodies with blankets. Some people may cringe at this controversial notion, but it’s important to remember that you are trying to save a life. Gentle massage or rubbing may be helpful. Avoid being too vigorous.

Give warm oral fluids, but only if your victim is awake and alert. If so, provide a warm, nonalcoholic, non-caffeinated beverage to help warm the body. Coffee’s out, but how about some warm apple cider?

Use warm, dry compresses. Use a first-aid warm compress (a fluid-filled bag that warms up when squeezed), hand warmers wrapped in a towel, or a makeshift compress of warm, not hot, water in a plastic bottle.

These go in special places: the neck, armpit, and groin. Due to major blood vessels that run close to the skin in these areas, heat will more efficiently travel to the body core. Others areas you might warm include the hands and feet, but avoid applying direct heat to amy area. Don’t use hot water, a heating pad, or a heating lamp directly on the victim. The extreme heat can damage the skin, cause strain on the heart, or even lead to cardiac arrest…

There is much more in the article. Click here to read the whole article at Doomandbloom.net.

Sagebrush (Artemisia Tridentata) – Medicinal Uses

Recently researching the treatment of infections without antibiotics, my investigations meandered to the – ubiquitous in our area – sagebrush plant, artemisia tridentata. It is mentioned as a boundary medicine wash in Marjory Wildcraft and Doug Simons’ video Treating Infections without Antibiotics (transcript). The following article from the blog Celebrating Gaia’s Herbal Gifts summarizes most of the information that was available around the internet about the medicinal use of sagebrush, Artemisia Tridentata-Big Sagebrush, a Valuable Medicinal Herb. It may be apropos to note that there are also a lot of non-medicinal uses for sagebrush for the preparedness/survival-minded, including for fire-starting, cordage, baskets, pillow-stuffing, insect repellant, paper-making, etc.

IMG_3765

Sagebrush Country

I live in the big sky country,  the high desert of Central Oregon.  Everywhere I look I see Big sagebrush (Artemisia tridentata).  The genus Artemisia comprises hardy herbaceous plants and shrubs, which are known for the powerful chemical constituents in their essential oils. In a  search of artemisia on the USDA plants database in Oregon there are 150 species of artemisia that appear. The name Artemisia comes from Artemis, the Greek name for Diana. There are any number of artemisia species that are popular in our modern herbal materia medica,  from wormwood to mugwort.   The intent of this post is to continue to explore my bio-region and develop herbal protocols based on the use of local plants and to that end, sagebrush (artemisia tridentata) will certainly play a  role.  This is by no means a definitive article but a written documentation of my search through the literature related to traditional uses and potential current applications.

My exploration of plants always starts through the eyes of First Peoples/Native American’s, who have had a long relationship with using artemisia species throughout North America.  The focus of this blog is to explore the use of Artemisia tridentata, which is mostly relegated to the western states. Big sagebrush and other artemisia species are therange dominant plants across large portions of the Great Basin.

Any number of tribes used artemisia tridentata including tribes affiliated with my bio-region, Okanagan-Colville, Paiute, Shuswap and the Thompson.  Many of the tribes used it similarly. These uses include the following:  respiratory and gastrointestinal aids, cold and cough remedy, antirheumatic both internally and externally, antidiarrheal, ferbrifuge, dermatological aid, eye wash, gynecological aid, analgesic, diaphoretic, emetic, pulmonary aid, and antidote for poisoning.  All parts of the plant were used including the leaves, stems, seed pods, branches and roots.

tridenta

Artemisia tridentata

It was used both externally and internally.*   Externally it had many uses including: as a poultice of fresh and dried leaves for chest colds, as a wash made of the leaves and stems for cuts and wounds, as a leaf decoction for an eye wash, the leaves were packed into the nose for headaches, the ground leaves were used as a poultice along with tobacco for fever and headaches, the leaves were powdered and used for diaper rash or packed into shoes for athlete’s infection, a decoction of the leaves were mixed with salt and gargle for sore throat, mashed leaves were used for toothaches, a leaf decoction was used in a bath for muscular ailments. *  There are many references to it being used internally as an infusion or decoction, but as one informant indicated it was too strong and powerful to drink, “you wouldn’t have any more kids, no children”.  Internal use is not recommended due to some chemical constituents found in the plant.  There are many references to artemisia being inhaled for headaches, for spiritual cleansing, to produce sweat and rid the body of colds, respiratory infections and pulmonary issues.

Artemesia annua

Artemisia annua

An interesting fact is that the Paiute’s and Okanagan-Colville indicated that they used a decoction of leaves for malarial fever, which is also similar to the use of other artemisias around the world.  Most of artemisia’s research as an antimalarial is focused on Artemisia annua (sweet annie).   Artemisia annua is a very interesting plant and is the source of the most powerful antimalarial drug ever discovered, artemisinin.  It is also being investigated in treatment of breast cancer.

Many of its traditional uses can be attributed to artemisia’s active medicinal constituents including camphor, terpenoids, and tannins. Sagebrush essential oil contains approximately 40% l-camphor; 20% pinene; 7% cineole; 5% methacrolein; and 12% a-terpinene, d-camphor, and sesqiterpenoids.  The essential oils present account for its use in inhalation.  Sesquiterpene lactones are among the prominent natural products found in Artemisia species and are largely responsible for the importance of these plants in medicine and pharmacy.

For my own purposes I can definitely see incorporating it into liniments, antiseptic washes, chest poultice, fumigation, powdered for use as foot powder.  Although there is tremendous oral history of its internal use I personally would be hesitant and look to other herbal options.

A few of my references:

Adams, James D., Garcia, Cecilia.,  Healing with Medicinal Plants of the West. Abedus Press, 2009.

Moreman, Daniel E., Native American Medicinal Plants.  Timber Press, 2009.

Parks, Willard Z.  Notes of the Northern Paiute of Western Nevada, 1933-1944.  Compiled and edited by Catherine S. Fowler.  University of Utah, Anthropological Papers, Number 114, 1989.

See also the sagebrush entry from Herbalpedia.com.

Doom and Bloom: Patient Transport in Austere Settings

The Altons at Doom and Bloom Medical have another good article up — this time on what you do when you need to transport a patient and there is no ambulance: Patient Transport in Austere Settings. The article discusses stabilization as well as many different field-expedient stretcher/transport options.

 What happens when you need transport and there’s no ambulance?

In normal times, your main goal upon encountering an injured or ill person is to transport them to a modern medical facility as soon as possible. In cases where there is a risk of spinal or neck trauma, you will read that the victim should not be moved until emergency personnel arrive.

That’s all well and good in situations when the ambulance is just a few minutes away, but what about when you’ve been knocked off the grid due to a disaster?

Even in normal times, there are circumstances where a victim must be moved despite the risk. These mostly involve common sense judgements, such as when there is an immediate danger from, say, a building on fire or in danger of collapse.

Probably a good idea to move the patient

When help is not on the way, however, you will have to decide whether your patient can or cannot be treated for their problem at their present location. If they cannot, you must consider how to move the victim safely.

Before deciding whether to transport, a patient must be stabilized as much as possible. This means assuring open airways, controlling bleeding, splinting orthopedic injuries, treating hypothermia, and more. If you are unable to do this with the materials at hand, consider having a group member get the supplies needed to make transport safer. If possible, gather a team to assist you before you move the victim. Knowing the amount of help available allows you to choose a method of evacuation that will cause the least trauma to both patient and medic.

MOVING THE VICTIM ONTO THE STRETCHER

Without stabilization, a neck injury can occur even if not part of the original trauma

When moving a trauma patient, you should be concerned about the possibility of a spinal injury, especially if there is:

• Head or neck trauma
• Altered mental status
• Pain in the head or neck
• Weakness, numbness, or paralysis in the extremities
• Loss of bladder control

A person with a possible spinal injury should be “logrolled” onto a stretcher as a unit without bending their neck or back if at all possible. A cervical collar and supportive blocks with straps can be used to secure the spine of at-risk patients. An unstable neck, especially in an unconscious victim, could easily be traumatized even if not involved in the original trauma. Keep the head in alignment with the spine during transport.

“logrolling” position

If you have several helpers, transporting the patient is easier but requires coordination. You, as medic, will serve as leader of the transport team. This entails making sure the patient is transferred to the stretcher safely, but also that all team members lift and move at the same time. Simple “Prepare to Lift”, “Lift”, and “March” commands should suffice to get everyone on the same page…

Click here to read the entire article at Doom and Bloom.