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Basic Survival Medicine

Basics of Survival Medicine

In regular life, prevention of illness and injury is important, and you generally have a variety of treatment options if you get sick or hurt. In the wild, though, there are no doctors or hospitals, so keeping yourself healthy is absolutely critical.

Still, you might break a bone or contract a nasty tick bite in spite of your best efforts. In this guide, we'll cover both preventative and curative steps to help maximize your chances of making it back to civilization in (relatively) good shape.

Maximize Your Resistance to Illness and Injury with Basic Hygiene, Nutrition, and Safety

Fortunately, the best things you can do for your health in the wild are also the easiest. When you've been outdoors for several days, it's awfully tempting to skip things like washing your socks and balancing your macronutrient intake, especially if you're in a dangerous survival situation with no way to know when — or if — help is coming. However, that's the most important time to pay attention to those dull, everyday details. Staying clean, well-rested and well-fed is crucial to both your physical and psychological health.

Hygiene

When you're gross and smelly, it's not merely uncomfortable. Being dirty increases your risk of contracting an illness or infection, makes you more susceptible to rashes and sores and eventually takes a toll on your mental health, which makes it more difficult to think clearly — and thus more difficult to survive.

Keeping Your Skin Healthy

Keeping your skin healthy

In the wild, you'll never be as clean as you normally are with the wonders of running water and electricity, but you should strive to get as close as possible. If you have access to reasonably clean water, bathing daily is ideal. Be careful not to swallow untreated surface water, as it's likely to make you sick. Although you probably won't have soap, you can approximate its function simply by scrubbing your skin with a mildly abrasive cloth or item of clothing (that's all soap is, after all: a microscopically abrasive substance that physically removes dirt).

If bathing isn't possible, take a sponge bath with a wet rag or scrap of cloth, paying special attention to your feet, armpits, groin, thighs, and other hard-to-clean areas that get a lot of friction when you're walking all day. These areas are danger spots for blisters, sores, and rashes, all of which make traveling less comfortable and can eventually develop into more serious injuries, which can in turn become infected.

When you sleep or take a long rest, try to expose your skin to as much fresh air as possible unless the weather prohibits it. This will help to keep you dry. Skin that's excessively moist for long periods invites various infections, as well as injuries like trench foot, a condition that leads to tissue death and infection. Similarly, if it's raining, snowing, or humid, be sure to warm up and dry off as often as is feasible.

Finally, be sure to wash your clothes in reasonably clean water whenever you have an opportunity. If nothing else, air them out while you sleep (dirty and dry is better than dirty and sweat-soaked).

How to Brush Your Teeth without a Toothbrush or Toothpaste

How to Brush Your Teeth without a Toothbrush or Toothpaste

Like soap, toothpaste is valuable primarily as an abrasive substance that physically scrubs away gunk. For a few days or weeks at a time, you can make do by rubbing your teeth with a rough cloth or the corner of a shirt. Be sure to rub hard, but not so hard as to cause pain.

Alternatively, most any non-toxic tree can be used to fashion a basic toothbrush; oak, maple, and dogwood are popular choices that have been used this way for centuries. Simply cut a branch roughly the size and thickness of a toothbrush, cut or chew off the bark, and chew on one end until the fibers start to come apart and form rough "bristles," then use it like a toothbrush.

If you have light or ultralight (4-pound to 1-pound) fishing line, you can very gently floss with it. Be careful doing this, though — fishing line isn't designed for flossing and can cut your gums. Use just enough pressure to remove large particles from between your teeth and don't force the line into tight gaps.

In the wild, it's especially important to brush and/or floss immediately after each meal to increase your resistance to painful and distracting conditions such as gingivitis.

Foot Care

Foot Care

If you're alone in nature for a long time, chances are you'll be doing a lot of walking. The best way to keep your feet in good shape is to limit how much you walk. If you don't have a pressing need for speed or some other immediate emergency, take it slow and rest frequently.

Everyone's feet and general endurance thresholds are different, but on average, most people can walk for about four to six hours per day without incurring moderate or severe foot problems. However, that assumes that you have clean socks, properly fitted shoes, and good walking habits that are well-suited to the terrain. If you lack any of those things, walk less if you can afford to.

Even with proper foot care, you'll almost inevitably get cuts or blisters on your feet if you're walking for days at a time. Keep cuts clean, dry, and covered with bandages or clean cloth until they heal.

Blisters come in two main varieties: friction and blood blisters. The main difference is whether the blister is filled with serum (a clear, watery fluid) or blood, but you can treat them both in the same way. If the blister is in a location that isn't particularly bothersome, just leave it alone and gently clean the area several times a day.

If a blister is causing significant discomfort, you can pierce and drain it as often as needed, but don't remove the skin; doing so will substantially increase both healing time and risk of infection. Be sure to clean and disinfect the knife or needle as thoroughly as you can before each use (heating it evenly over an open flame for a minute or so is usually the best option if you don't have alcohol or other disinfectants). Once you've drained a blister, cover it with a bandage or cloth inside your sock and change this dressing several times a day.

Hydration and Nutrition

Hydration and Nutrition

Maintaining a healthy diet and adequate hydration outdoors is obviously important. Finding water in a survival situation (if there's any to be found) is relatively straightforward.

Choosing the right foods to eat is a bit trickier, and not only because your options will be far more limited than they are at the grocery store. Most people get the majority of their calories from either fat or, more commonly, carbohydrates. To the extent possible, you should try to maintain your usual diet in a survival situation, at least in terms of the ratio of fat, carbs, and protein that you normally consume.

In much of the world, meat is easier to come by in the wild than are most vegetables that are both edible and palatable to humans. Meat is an excellent source of fat and protein but a poor source of many essential vitamins and minerals. If your normal diet is heavy on carbs (150 to 200+ grams per day), you might feel crummy for days or weeks as you adjust to a low-carb diet. However, as your body adjusts to using fat and protein as its primary fuel sources, your hunger and energy levels will stabilize. You may even find that you feel better than ever in these respects.

Consuming an adequate variety of vitamins and minerals tends to be the hardest part of eating well outdoors. If you're lucky enough to find edible wild berries or fruits such as apples and oranges, you can cover some of your vitamin A, B and C needs that way. Regular and moderate exposure to sunlight should provide sufficient vitamin D, and you can get calcium and iron from red meat and bone marrow or broth. Many beans, seeds and nuts are good sources of folic acid. Vitamin E, vitamin K and zinc are most commonly found in leafy green vegetables and so are harder to come by in many regions. Fortunately, these are less crucial to your short-term health, and most people can go weeks or months without them.

Sleep

Sleep

Getting consistent, high-quality, restful sleep is paramount in survival situations. Being well-rested keeps your immune system functioning, elevates your mood, helps to stabilize your energy level, and provides myriad other benefits that can help to keep you from getting sick or injured.

Whenever possible, bed down for the night (or day) in a secure, comfortable shelter, and allow time to find or build one as needed. Consider working and traveling at night if it's especially hot during the day or if you don't want to be found by people who may be less than friendly. In either case, strive to sleep at roughly the same time and for the same length of time each day.

Dos and Don'ts of Overland Travel

While traveling on foot, keep these basic tips in mind to maximize your energy efficiency and minimize your risk of injury:

  • Travel on flat land whenever possible. Climbing and descending hills and mountains burns a lot of energy — more than taking a half-mile detour, in many cases.

  • Find or craft from a tree branch a walking stick roughly as tall as you are. These simple devices are surprisingly effective at reducing strain on your back, hips, and knees. They also have dozens of other uses, such as checking the depth of water or mud, as levers for moving heavy objects, and as effective, easy-to-use self-defense weapons.

  • On flat, hard ground, develop a habit of placing each foot down in a heel-to-toe motion with an easy, flowing stride. Avoid flat-footed plodding and shuffling; walking in this way wastes a lot of energy and creates more friction between your foot and your sock or shoe. A more flat-footed stride is best for deep sand or gravel, though you should avoid such terrain if possible. If you must walk up a steep hill, use your thigh and gluteal muscles, rather than your knees, to do most of the work.

  • Whenever possible, walk only where you have a clear view of the ground for at least ten feet in all directions. Not only does this help you avoid holes and tripping hazards, it'll help you steer clear of places where snakes and other dangerous wildlife might be hiding.

  • Slow down and use extra caution on bumpy terrain, in tall grass, or in an area where many holes are present. In particularly rough spots, use your walking stick to check the ground for stability before placing your foot down. It's not hard to roll, sprain, or break an ankle in such conditions.

Emergency First Aid

Sometimes, no matter how careful and proactive you've been, injuries and illnesses happen anyway. A basic understanding of how to treat both the most serious and the most common ailments is an indispensable tool in the survivalist's mental toolbox.

Managing Severe Bleeding

Managing severe bleeding

There are three types of bleeding: capillary, venous, and arterial. Capillary blood is fairly bright red and comes from wounds that bleed slowly and mildly, such as paper cuts and scratches. No treatment is necessary other than periodically washing and bandaging the area.

Venous blood is dark red — almost black — and comes, as the name suggests, from your veins. When a vein is punctured or severed, it bleeds steadily and at a rate that may seem alarming, but is rarely life-threatening. In nearly all cases, firm pressure on the wound will stop venous bleeding after a few minutes. Elevating the injury above the level of your heart will help as well.

Arterial bleeds are a true emergency. Your major arteries are deep within your body and so cannot be cut except by grave trauma. Arterial blood is bright red and pumps quickly, in time with your heartbeat. Left untreated, an arterial bleed can be fatal within two minutes.

When you're alone in the wilderness, you don't have the luxury of other people's hands and minds — and you certainly can't afford to hesitate. To treat an arterial bleed, apply pressure as hard as you can about six inches proximal to the wound (that is, closer to your heart) or at the origin of your brachial or femoral artery. If your neck is bleeding, use two or three fingers to apply firm pressure to the carotid artery between your heart and the wound.

If you manage to stop the bleed with pressure, continue to hold that pressure for at least thirty minutes. Releasing the pressure before the wound has had a chance to partly clot will result in continued bleeding. If the wound is on an arm or leg, bandage it with a thick layer of clean cloth or bandages and tie them firmly in place, with the knot directly over the wound and cinched as tightly as possible. Never tie or cinch anything around your neck, even in the event of an arterial bleed.

Do not move any more than absolutely necessary for the next several days. After about six hours, you can loosen the pressure on the dressing, but it should remain somewhat tight. After one day, very gently clean the outside of the wound and begin changing the dressing every eight hours or so.

If the bleeding does not immediately cease or slow to a manageable trickle with very hard pressure, pack QuikClot directly into the wound if you have some. If you don't, you'll need to quickly apply a tourniquet. If you don't have a CAT (Combat Application Tourniquet), use a belt or rope and cinch it as tight as you can about six inches proximal to the wound. Tourniquets are extraordinarily painful when applied correctly and, if left in place for more than a few hours, can necessitate amputation of the limb — but with an uncontrolled arterial bleed, you may have no other option.

Treating Hypovolemic Shock

Treating Hypovolemic Shock

Hypovolemic shock occurs when there is insufficient blood in the circulatory system to carry oxygen to and remove waste from the vital organs. It's almost always caused by bleeding, whether external, internal, or both. If you're injured badly enough to suffer hypovolemic shock, then hopefully, the bleeding that caused it is external; there's virtually nothing you can do by yourself to treat severe internal bleeding.

Telltale signs of hypovolemic shock follow shortly after a significant loss of blood (about 1–3 liters in adults) and can include pale, cool, clammy skin; lightheadedness; dizziness; confusion; lethargy; agitation; chest or stomach pain; nausea; headache; rapid breathing; elevated heart rate; and decreased blood pressure.

There's an easy way to estimate your blood pressure without any equipment.

  • If you can feel your pulse in your wrist, then your blood pressure is adequate for the time being.

  • If you can feel your pulse in your groin, but not in your wrist, then your blood pressure is moderately low.

  • If you can feel your pulse in your neck, but not in your groin or wrist, then your blood pressure is dangerously low.

Once you've gotten the bleeding under control, lie down and elevate your feet above your heart to enlist the aid of gravity in concentrating blood in your core. Drink several liters of water over several hours in small, frequent sips, unless you feel nauseous. In that case, refrain from drinking or eating until the nausea passes.

Provided you've adequately treated the injury that caused it, treating hypovolemic shock is relatively simple and you should gradually feel better over the next few hours. Take it easy and limit your physical activity until the causal injury has mostly healed. Eat some extra calories for a few days to recover more quickly.

Treating Sprains and Fractures

Hydration and Nutrition

In most cases, it's fairly easy to tell the difference between a sprain and a fracture. Sprains are painful, but fractures are extraordinarily so. If you sprain an ankle or wrist, or pull a muscle, ice the area for short periods (if ice is available) and rest it until it heals over a few days. Very gentle stretching may help to relieve pain. Avoid walking on a sprained ankle if possible.

Fractures are broadly categorized as "open" or "closed." Open fractures are those in which the skin has been broken and bone fragments are protruding through it, whereas closed fractures haven't broken the skin. In either case, you'll have severe pain, swelling, and reduced motion.

To treat a closed fracture of a long (arm or leg) bone, gather splinting supplies before you begin. You'll need two or three sturdy pieces of material, such as wood, roughly as long as your shin, thigh, or forearm — whatever the case may be. You'll also need several feet of rope, bandages, or strips of cloth. Pull or stretch the affected limb, toe, or finger such that the fractured bone returns to its normal anatomical position and hold it there. This will be extremely painful, but it must be done.

Splint the fracture by placing the rigid material on either side of the limb or digit, then tie the splints firmly in place in above and below (but not on top of) the location of the fracture. You'll also need to immobilize the joints above and below the fracture. Do so by wrapping a thick layer of cloth or bandages around your wrist, ankle, elbow, or knee such that it's difficult or impossible to flex or extend it. In the case of a finger or toe, simply splint and immobilize the whole thing.

Open fractures are more dangerous and far more difficult to treat in the wilderness, which is why it's so important to avoid them at all costs. You probably won't be able to get the bone to return to its normal position. If you can't, splint the limb as best you can and keep the broken skin gently covered — although you should know that it will almost certainly become infected. Seek help as soon as possible, but take great care to avoid moving the broken limb. Open fractures leave sharp bone fragments that, if moved around, can cut or sever major blood vessels.

Treating Infections

Treating Infections

Unfortunately, there isn't much you can do to treat infections without access to antimicrobial medications. The best thing you can do for open wounds is to wash them frequently with clean water, keep them tightly covered, and change the dressings at least twice a day.

General symptoms of systemic infections include fever, chills, and lethargy, but other symptoms can vary widely depending on what you've come down with. If you suspect you have such an infection, drink plenty of water, get lots of rest, and wait for your immune system to fight it off — which may take a week or longer. If you think you might have a serious, potentially life-threatening infection, it may be better to try to get to a hospital as quickly as possible, even though traveling while sick is deeply unpleasant. There aren't always clear answers; try to weigh the pros and cons as best you can.

Prevention and Treatment of Hot and Cold-Weather Injuries

Prevention and Treatment of Hot and Cold-Weather Injuries

If you have adequate food and water, heat injuries aren't too difficult to avoid. If you're in an area where the temperature is consistently over 90°F/32°C, travel at night if possible, when it's much cooler. If you can't avoid traveling while it's hot, take frequent breaks, drink as much water as you can spare, and stay out of the sun as much as possible.

Heat injuries exist on a spectrum of severity. If you feel noticeably hot and sweaty, or if you start having muscle cramps, find some shade and take a long rest before you risk heat exhaustion or heat stroke. If you experience severe muscle cramps, pale and clammy skin, hot and/or dry skin, headaches, nausea, confusion, an unusually fast pulse, or loss of consciousness, immediately find shelter, loosen your clothing, moisten your skin, and take small sips of water (too much water at this stage can make things worse).

Cold-weather injuries tend to be harder to prevent, especially if you don't have clothing appropriate to the environment. If possible, wear multiple layers of loose-fitting clothing and travel with the wind, not into it. In severe, potentially life-threatening snow or blizzard conditions, never stop moving until you find warm shelter. Your body's natural inclination will be to stop and rest to conserve energy and heat, but doing so will likely prove fatal; you may slip into unconsciousness (without even feeling sleepy) and never wake up.

Chilblain is pain, reddening, swelling, and/or itching of the skin, usually on the fingers, toes, ears, and nose. All symptoms are mild and chilblain causes no permanent damage, but it can progress to frostbite if the air is below 32°F/0°C and if exposure is prolonged. Treat chilblain by covering the affected skin with warm clothing and, if possible, get out of the cold long enough to warm up.

Frostbite can occur in temperatures below 32°F/0°C. Symptoms include severe numbness, blistering, swelling, yellow or waxy skin, and severe pain after rewarming. Treat frostbite by gradually warming the area, but don't do so if you suspect the tissue will freeze again before you can find help; tissue damage gets significantly worse if the same cells freeze multiple times.

Hypothermia is a lowering of your core temperature below 95°F/35°C. If you can't avoid being exposed to below-freezing temperatures, keep moving and do aerobic exercise as needed to warm up — but avoid excess sweating. Wet clothing will quickly freeze and further increase your risk of cold-weather injuries. Symptoms of moderate to severe hypothermia include excessive shivering, loss of coordination, confusion, and slurred or muffled speech. If you notice any of these symptoms, find warm shelter as soon as possible.

Pain Management

Pain Management

Unfortunately, a great many plants often touted as medicinal are likely or definitively ineffective. There are a few exceptions: Using willow bark, you can make tea that functions similarly to aspirin, and aloe vera sap can alleviate the pain from mild burns — these are well-known medicinal plants and their efficacy has been strongly supported by science. However, unless you are absolutely certain of a particular plant's usefulness as medicine, it's best not to rely on herbs to manage pain.

Instead, try more general pain management strategies, such as "3x3" breathing. If you're in pain, inhale slowly over three seconds, hold it for three seconds, and exhale slowly over three seconds. Also, try to remain calm and avoid focusing on the illness or injury that's causing you pain. These simple mental tricks won't suppress pain completely, but they can help mitigate it.

There's a lot to cover about survival medicine, even at the basic level. What you lack in materials in a survival situation, you'll be able to make up for with knowledge and resourcefulness. Hopefully, this guide is useful to you as an introductory primer and will provide invaluable information in the worst case scenario.

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