Exploit Your Environment

Let’s say that someone in your work environment is seriously injured and needs help. Look around you. What do you have that could be used as a tourniquet, an occlusive dressing, a splint or a pressure bandage? Unfortunately, not everyone will have one of our D.A.R.K.’s (Direct Action Response Kit) on them if something happens—even though they should! And....sometimes things happen that are even beyond the scope of the D.A.R.K.

Those of us who work in an environment where we have a lot of commercial items readily available, myself included, tend to get a little spoiled by that luxury. Now, imagine having to utilize what you have around you and what's on hand to assist someone with a traumatic injury of some sort. Field expedient first-aid items are all around us.

Hemorrhage? What if you don't have a TQ handy. Can you make one? Absolutely. As long as you have the right material available. Remember, TQ's work not only from the force of the compression but also from the surface area being compressed. So, you'll need a compression band at least 1" wide so that you don't cut into the tissue and create more trauma. You'll also need a windlass (the thing you turn to tighten the tourniquet) and you'll need something to secure the windlass.
What can you use? Look around you. Belts, bandanas, scarves, shemaghs, backpack straps, sleeping back straps, rifle slings…etc. The list goes on and on. You don’t want to use anything like paracord, wire, bootlaces, rope or anything small that can cut the tissue. Remember, wider is better. What about a windlass? How about a carabiner, pistol mag, SureFire E2D or similar light, a stick, etc. Think outside the box. Also, you don’t want to make it too complicated as you have only a short period of time to get this thing on and get the vessel occluded before the victim loses too much blood and either goes into shock or, worse, dies.
Just like with a commercial TQ, and especially with a field expedient one, you must constantly reassess for any loosening of the TQ and re-bleeding. It is vital to watch for signs and symptoms of shock and constantly monitor the Level of Consciousness (LOC) of the victim.

Airway? Not a whole lot we can do here other than the Recovery Position. The recovery position is a great position for the unconscious casualty because it does a lot of things at one time; 1) Keeps the head in a neutral position. 2) Keeps the tongue off the back of the airway 3) Lets any vomit, blood or other drainage go out of the mouth and down onto the ground. The goal is to keep the tongue off of the back of the airway and keep that airway protected. Remember you don’t want to be placing anything in anyone’s airway that wasn’t designed to go there unless you have the training and it’s in your scope of practice. Remember “Primum Non Nocere”…”First, Do No Harm.”
C-Spine precautions? You can roll up cardboard and tape it to either side of the head. Same with towels, blankets, shoes, boots, etc. The goal is to keep the head in a neutral position and limit lateral movement. No tape? Use a belt or other similar strap to secure the head and remember to watch out for the airway so as not to occlude it. Remember, if the victim starts to vomit, turn them to the side as a unit to avoid twisting the head/neck. Keep them on their side until their airway is clear. If you have more than one casualty, use the recovery position.

Breathing? So someone has a thorax injury and you don’t have HALO Seals. Anything which is airtight and extends at least a couple of inches beyond the wound border and can be secured in place with tape or other devices can be a very effective occlusive dressing. Plastic bags, packing materials, duct tape, electrical tape or anything else which can create an airtight or three-sided seal can be utilized. The same principals apply to these as they do to commercial dressings. Watch for signs and symptoms that indicate the development of a tension pneumothorax, burp the wound if necessary and always, always, always…check for an exit wound and if found, treat accordingly.

Circulation? Direct pressure remains king in non-life threatening hemorrhages. Try to find some sort of material which can cover your hands to prevent blood or other body fluids from reaching your skin, grab some absorbent material (t-shirt, towels, pants leg, etc), hold pressure and keep the bleed controlled. If one dressing becomes saturated, place another over it and continue to put the pressure on it. These materials can also be used as expedient packing into a wound. Don’t worry about “giving them an infection” as this is the least of your worries right now. Antibiotics will come in copious quantities later at a definitive care facility. You can use shirt sleeves, jacket sleeves, belts or other compressive device to make a field-expedient pressure dressing as well. Place a golf ball or smooth rock or anything that size underneath a layer of material as you compress it to focus pressure down into the wound. Constantly monitor for any re-bleed or signs and symptoms of shock.

Neuro or “Da Brain”?? Keep the head elevated as best you can if there’s the possibility of a head injury and don’t give them anything by mouth as head injury victims can vomit and that increases intracranial pressure, which is bad. Keep talking to them, looking at their pupils and monitoring for any improvement or degradation in their condition.

Fractures? Don’t have a SAM Splint handy? How about using lumber, sticks, rolled up newspaper or magazines bound in duct tape, table legs, notebooks, etc. The big thing with splints is to remember to immobilize the joint above and below the fracture, pad for comfort and don’t tie anything over the fracture site. Check Circulation (cap refill), Motor Function (wiggle fingers/toes) and Sensation (ask if they can feel tapping or pinching on an area distal to the injury) before and after splint application, keep it elevated and compressed and check for further underlying injuries.

Those are just a few of the biggies and there are many, many more field-expedient items which could be utilized. Try to carry items that are multi-purpose and you won’t be disappointed. The key is to get the proper training initially so that you know what to look for should you find yourself in an austere environment with little to no resources. You may say to yourself, “I really need a pressure bandage.”, but by knowing the rationale behind it’s use and the mechanics of it, you’re able to fashion one out of improvised materials and do the job.
Stay calm, think outside the box, utilize what’s in your environment, constantly reassess your victim and get your MacGyver on!
Keep if simple. Keep it safe.

-Pocket Doc