Anarchism

Anarchafeminism

Anarchist University

IMPROVISED MEDIC'S SUPPLIES

This booklet is NOT intended to replace a serious first aid course such as Industrial First Aid. This IS intended to advise already trained Activist Medics on how to improvise supplies for a small field "dressing station". Some activists may choose not to seek Establishment treatment. Their main concern is "can I deal with this myself....or do I need to involve a Doctor?" We shall discuss homemade sterile dressings, sterilizing instruments, antiseptics, plus a special section on accessing burns and explosion blast- injuries.

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Making and Sterilizing Dressings

"Dressings" are the sterile pads that go directly upon a wound. "Bandages" are the wrappings that hold the dressing in place. Many dressings may be homemade from certain sorts of scrap cloth. Different kinds of cloth have different characteristics. Several rolls of "adhesive tape" are a necessary item, also a small bottle "tincture of benzoin" (Friar's Balsam). This is painted on the whole skin (not the wound) with cotton swabs, and when dry the tape will stick there so much better. You will need a bandage scissors (often sold Hardware as "super scissors"), and a small 5" to 6" curved locking hemostat (sport fisherman's supply, or Radio Shack) to change the dressings with. When not in your hand this hemostat is rested within a jar of sterile Saline solution, not merely placed upon a tabletop or the ground. The "official" surgical purpose of a hemostat is to close torn spurting arteries until tied off with thread noose..called a ligature...leave the tails long. A sharp pointed tweezers called a "splinter forceps" are also needed. Get several pairs of latex gloves in your size to protect yourself from blood borne diseases. A plastic apron is a good idea too. Get a disposable plastic pail with a snap-on cover, and make a big X shaped slit in the cover. Felt-pen mark this pail BIOHAZARD , as it will contain dirty dressings etc., the whole thing being burned up in a campfire later. (Do not toast marshmallows!)

1. Open Weave Cotton: light and porous, therefore suitable for head, ear, eye, etc. but may be used for any part. They are cheap, and make good dressing pads that may be burned when dirty. Disadvantage is cotton gives no support and slips around off the wound when used as a bandage.

2. Calico (white or brown cotton): Washes well, gives firm support and is suitable for limbs and joints. Being inelastic and non-porous they tend to be hot and uncomfortable.

3. Domette (mixture cotton/wool): Very good bandage as it is elastic, porous, and gives good support. It is durable and washes well. This cloth is expensive.

4. Flannelette (cotton imitating flannel): Cheaper than real flannel, washes well and gives firm support. It is also highly flammable.

5. Flannel (wool): Strong, warm, gives excellent support especially good for abdominal bandages. Disadvantage is that it does not wash well without shrinking or hardening.

6. Elastoplast: a special elastic fabric that gives support to sprains etc. Silk crepe is nearly as good.

7. Nylon parachute cloth (or cut from an old night gown) makes an excellent dressing for burns as it is more non-stick than regular cloth.

Suitable rags are carefully washed using soap and a bit of "washing soda" in the wash water. This soda such as "Arm and Hammer So Clean" removes most traces of greases and impurities, note the directions for removing blood stains. The ancient and famous "Triangle Bandage" can be cut lengthwise from old bed-sheets, with the triangle base about 5 1/2 feet long. Most first-aid books will explain how to fold and use triangle bandages. For Dressings, cut out the standard sizes of cloth as shown in the illustrations, usually pieces 16" square or 8" square. Dressing pads are then folded down into the standard 4" square or 2" square as shown. Abdominal Pads are dressings for large areas, or to act as a "soaker" for leaking wounds. (Sanitary napkins and disposable diapers can also be used as dressings.) Each dressing pad is individually wrapped in stout brown paper from grocery bags, and labelled with a waterproof felt pen. These packets are to be sterilized using either dry heat (baked), or wet pressurized heat (autocalave or pressure cooker). Note that simple boiling in water does NOT ensure total sterility. Instruments may be bound up in cloth packs, closed with a two wraps of masking tape and felt-pen labeled. Instrument hinged joints (such as on hemostats) should be unlocked for good penetration of steam. Packs each containing one matched pair of rubber gloves should marked with their size, also gloves should be dusted inside with Talc Powder which is finely crushed soapstone. In the event you do not have equipment for real sterilizing, the cloth may be hot steam-ironed for this is much better than plain rags. Hot dry sunlight such as is found on deserts or beaches in Summer may help: 6 hours or more direct sunlight both sides of the cloth hung upon a clothes line.

Dry heat in an oven: cloth dry goods, glassware, instruments and needles 60 minutes at 320F. For oils ointments, waxes, powders 120 minutes at 320F.

Wet heat in a pressure cooker, use the vegetable steaming basket placed above the water level. Maximum size for all "autoclave" packs is 12 X 18 inches. You must reach a minimum of 15 psi and 250F. (121C.) for at least 15 minutes to be sure of sterilization. If your cooker has a pressure gauge maintain 17 psi as this will assure 250F. min. Allow 30 minutes for instrument packs or linen, then 15 minutes to dry by residual heat when removed from pressure cooker.

Rubber goods need 15 minutes of pressure heat, then 15 to dry by residual. You will need a kitchen tongs to remove the very hot packs from the pressure cooker! Be sure you know how to safely depressurize the cooker before opening the lid. Packs should be dated when removed from sterilizer and are outdated in 4 weeks. In high humidity such as jungle or rainforest, 2 weeks is the safe limit.

"Dip" sterilization of instruments:

In field situations, formal sterilization may not be possible. First clean dirty instruments (of wound fluids) by boiling them a few minutes in water along with a bit of washing soda. Your two main instruments (bandage scissors and small curved hemostat) may then be dip-sterilized by hanging the business end down in a jar of disinfectant. Straight DETTOL is good soak for 20+ minutes or so. Equal parts Alcohol and LYSOL Disinfectant for 30+ minutes is good, but then needs to be rinsed off in sterile Saline solution before instrument is used. If you have the necessary skills; home-made suture needles may be threaded with plain undyed silk thread (trout fly tying supply) and stored in vials or test tubes of alcohol/Lysol. These also must be rinsed off in sterile saline just before use. You will of course need a small locking needle-holder forceps, do not use your fingers. However most small gashes (not upon fingers, toes or joints) may be held closed with "butterfly closures" cut out of adhesive tape.

By the way sterile "normal Saline solution" may be made by dumping 1 dram (very approx. just under a level teaspoon) table-salt into 1 pint strongly boiling water. Now pour this hot into heat proof jar (such as home canning jar) and cap. This solution when cool is the preferred method for washing out wounds...use a clean janitor's trigger-spray bottle that can be adjusted between gentle spray (moisten wound) and squirt stream (flush out wound). The funny shaped plastic "kidney dish" will fit snug against most contours of the body and catch the draining wash water. Note that saline is the ONLY wash to be used near the eyes!

Antiseptics are of terrible importance! During WW1 battlefield fatalities were reduced nearly 40% by providing each soldier with a couple of ounces of liquid antiseptic and a large wrap bandage called a "shell dressing". Thus infection was proved nearly equal in danger to the wound itself. Most of the first-aid creams sold in drugstores are not very good, and quite expensive. "Dettol" is a good all-purpose liquid antiseptic, follow directions for proper dilution. "Betadine" (10% iodine/povidone) solution is a Third World medical necessity. A thick gritty paste of Betadine and white sugar has been used to keep wounds clean while awaiting a surgeon termed "delayed primary closure". This paste, called "Sugardine", must be replaced as soon as it loses its gritty quality and dilutes to a syrup in the wound. A truly excellent!! salve for small skin wounds is "Bag Balm" (hydroxyquinoline sulphate in base of vaseline/lanolin) a Veterinary medicine costing only about $10 for a 10-ounce green tin can. Hydrogen Peroxide 3% solution is good to foam dirt out of narrow deep wounds that don't require sutures; in all other cases flush with sterile Saline solution. Alcohol is used on unbroken skin and equipment only. The previously mentioned Lysol Disinfectant is only for cleaning equipment and the sick room, not for use upon wounds.

BURNS:

Never run and fan flames, drop and roll to snuff burning clothing. Immediately the contained heat damage should be reduced by cooling with clean cool water within 5 minutes of injury, and continued for max.10 minutes. Do not cool more than 10 min., or more than 20% of body surface or risk thermal shock...never apply ice! Synthetic clothing may melt and leave plastic globs in the burn...these garments may have to be cut away. To intelligently manage a burn you must consider depth of the burn, and percentage of the total body area damaged. There may be respiratory damage if patient has decreased consciousness, was burned within a confined space, there are facial burns, or exposure to significant amounts of smoke or hot gases. Watch face and neck for signs of swelling... this is very dangerous and may block airway! You may need to introduce Plastic Airway, even assist breathing with rescue breathing "pocket mask" or hose from welding oxygen tank (that's the GREEN tank and hose!). Inspect mouth and nose, have patient cough up and spit, look for soot that may indicate inhaled smoke. Symptoms of lung damage include hoarseness, chronic coughing, rapid breathing and/or high pitched breathing (stridor), fluid in lungs making a splashing sound in your stethoscope, blue colored skin (cyanosis). In extreme cases the vocal cords may swell up and block breathing totally! This could require an advanced procedure called "laryngoscopic orotracheal intubation" wherein a breathing tube is steered down the throat using a special optical instrument. This tube has a balloon- like portion that is then inflated to hold the swollen vocal cords open.

As you study burns you shall see that a lot of injury could have been avoided if Activists in the field wore leather boots, gloves, crotch protection, goggles and filter mask. Also those protective garments serve to mask faces and prints. A current Tetanus shot is available cheap or free from most Public Health centers. In the event that a dirty wound develops tetanus, the fatality rate can approach 40% so just don't risk it...get your shot in advance.

First degree burns involve only the top skin "epidermis" and should not require Hospitalization if less than 40% to 50% of the body. Signs are: reddened skin, blanches with pressure. Treatment involves cold water compresses, never exceeding 20% of body surface. Cold towels are effective upon trunk or face. "Noxema" cream or Aloe Vera gel helps soothe pain areas.

Second degree burns reach the underskin "dermis" and can involve serious loss of body fluids causing shock as they approach 10% of body. Signs: red or mottled with swelling and blister formation. Surface may have wet appearance and is painfull even to air currents. A light cloth covering such as clean sheets may deflect these painful air movements. Minor 2nd burns should be OK if body fluids are replaced and pain and infection are controlled. This class of burn we may be able to treat, and is the main scope of this section...see the following info on fluid replacement etc. The possible problems are shock from fluid loss, infection, and pain from these factors. Do not break blisters unless they show signs of infecting. 2nd degree burns that requires Hospitalization are:

1. More than 10% body surface.

2. To hands, feet or crotch.

3. Smoke inhalation injury that may close the throat or may have damaged lungs.

Third degree burns reach the fat layer and even muscle tissue. Signs: skin is dark and leathery, but may appear translucent, mottled or wax white. Surface is usually dry but can be moist. This is a serious emergency requiring Hospital treatment. 3rd degree burns usually require restorative surgery to replace skin (it will not grow back over) and repair muscle damage.

"Rule of Nines" the burns are divided into multiples of 9% of the whole body surface thus:

Head and neck 9%, front trunk 18%, back trunk and buttocks 18%, arms hands and shoulders 18%, crotch 1%, front legs and feet 18%, back legs and feet 18%. From these guidelines you should be able to rough estimate the area of burned surface. Note that for irregular burns one side of the patient's hand covers 1% of the body and can be used as a ruler: 3 hands= 3%.

Burns suggesting real Hospitalization and rapid transportation are:

1. Any burn with smoke inhalation injury.

2. Any burn causing serious loss of consciousness.

3. Any class of burn more than 10% of body surface.

4. Any serious burns of face or near eyes.

5. Electrical burns.

6. Burns encircling a limb. May require an operation called "escharotomy".

7. Major burns to crotch, hands or feet.

8. Any 3rd degree greater than 2%.

If the burn is to be treated without a Hospital here are some points:

1. Cover burn with a sterile pad.

2. Clean skin area around burn with damp swabs perhaps a bit of soap. Ideal is a bit of Betadine or Hibiclens in the water. Do not allow runoff to flow onto other injured areas.

3. Remove and discard original pad.

4. Spray clean the burn gently with previously boiled (then cooled) water, or sterile Saline. The adjustable nozzle on the trigger-spray bottle shows it's worth here..just enough force to remove dirt without unnecessary pain. Don't break blisters unless they show infection. A small sharp sterile curve-bladed scissors are used to cut away (debride) contaminants and dead tissue that won't wash loose.

5. Apply topical antibiotic burn cream such as Silvadene, Furacin, or Sulfamylon, and cover with non-stick dressing such as sterile thin nylon. Lacking these, consider plain Vaseline thinned with a bit of Mineral Oil and baked in a jar to sterilize contents: 120 minutes at 320F.

6. Bandage just snug enough to hold the dressing, never to apply pressure. All burns of the neck head and crotch should be dressed but not bandaged. Burns of hands joints and truck should be bandaged.

7. Do NOT splint burned extremities. Have patient keep hands and feet elevated if practical, especially if these are burned.

8. The dressing should be changed every day using Saline spray to loosen it if necessary.

9. Oral Fluid replacement Therapy: In general there is little danger of serious shock in burns covering less than 20% of the body and these can be handled with oral fluid replacement. Where IV routes are not available this oral fluid replacement can be lifesaving in burn cases up to 35% of surface. Moyer's Solution is 1/2 teaspoon tablesalt and 1/2 teaspoon baking soda in 1 quart of water. The drink should be chilled and may be flavored with Koolaid and sugar. The best way of evaluating fluids in the body is by the urine output: correct adult is 30 to 50 c.c. of urine per each hour elapsed on average. With at least that much "overflow" you are certain the patient is correctly hydrated.

10. If infection appears and you have the materials and skills, consider antibiotics such as Vancomycin or penicillin.

11. The ideal air temperature for a large-burn patient's room is 75 to 80F. with no draughts.

Special burns such as chemical and electrical are beyond the scope of this article. However one important case should be covered: white phosphorus burns from Incendiaries. This material imbedded in the flesh will continue to burn often giving little plumes of white smoke and a garlic odor. These areas must at once be irrigated with fresh water to cool the flesh and deprive the phosphorus of oxygen. The particles can now be neutralized with a water solution containing 1% copper sulfate (bluestone) and 5% sodium bicarbonate (baking soda). This solution should be applied only for a short time then washed off with water spray to avoid copper toxicity. The phosphorus particles will now be stained blue-black and can be removed with splinter forceps...never your fingers! Never cover these burns with copper sulfate soaked dressings, rather use Saline soaked ones.

Primary BLAST INJURIES result from sudden pressure changes in the body resulting from the shock wave of an explosion. Internal injuries vary depending on the frequency of the blast waves and the transmission medium. For examples: blast in air does relatively little damage, especially if the mouth is open and the ears plugged. Blast through water does little damage to solid structures of the body, but can injure organ cavities such as lungs, abdomen etc. Blast vibrations transmitted through solid material such as a vehicle frame or a wall upon which you lean, can produce breaks in major blood vessels without rupturing the skin.

The most common injuries are: "ruptured tympanic membrane" (ear drum damage) from an air blast. Symptoms sudden pain and maybe bleeding from the ear, with various amount of hearing loss. Treat by cleaning off outer ear canal, leave inside alone!

"Blast Lung" shows pain in chest, possibly bloody froth upon breathing, rapid pulse with bluish skin (cyanosis), with maybe abdominal rigidity. Treat by not moving patient for first 48 hours until stable. Give oxygen for cyanosis. Severe Shock may demand I.V. fluid (such as Ringer's), then give slowly (micro-drip set) with close attention to vital signs. Atropine sulphate may be given I.M. to diminish secretions. Antibiotics should be considered for severe cases.

"Blast Abdomen" is very dangerous: shows as abdominal pain that then stops, then comes back again very severely. May frequently shit mixed with bright blood and/or difficulty with urination. Severe cases need surgery for internal bleeding, evacuate as soon as possible. Meanwhile no food, drink or medicine by mouth; so consider nasogastric (N.G.) tube and contact Doctor for advise on antibiotics. Secondary injuries such as fractures and tissue trauma are treated as usual.