The Survival Doctor’s Guide to Wounds

What to Do When There Is No Doctor

by James Hubbard, MD, MPH

© 2012 by Hubbard Publishing LLC

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

IMPORTANT CAUTION—PLEASE READ THIS!

Use of the information in this book is AT YOUR OWN RISK, intended solely for self-help, in times of emergency, when medical help is not available, and does not create a doctor–patient relationship. DO NOT USE THIS INFORMATION INSTEAD OF SEEKING QUALIFIED MEDICAL PERSONNEL.

Readers are strongly cautioned to consult with a physician before acting on the information described in this book.

This book is based on information from sources believed to be reliable, and every effort has been made to make the book as complete and as accurate as possible based on information available as of the publication date, but its accuracy and completeness cannot be guaranteed. Despite the best efforts of the author and publisher, the book may contain mistakes, and the reader should use the book only as a general guide and not as the ultimate source of information about the subject of the book.

The book is not intended to reprint all of the information available to the author or publisher on the subject, but rather to simplify, complement, and supplement other available sources. The reader is encouraged to read all available material and to learn as much as possible about the subject.

The author and publisher are not engaged in rendering medical services, and the book is not intended to diagnose or treat medical or physical problems. If medical, professional, or other expert assistance is required by the reader, please seek the services of a competent expert.

This book is sold without warranties of any kind, express or implied, and the publisher and author disclaim any liability, loss, or damage caused by the contents of this book.

>> Back to “How to Use This Book.”

Table of Contents

Important Caution—Please Read This!

About This Book

How to Use This Book

Section 1: Pressure’s On: Basic Care For Most Cuts

Step 1. Stop the Bleeding.

Step 2. Determine Whether the Wound Is Life-Threatening.

Step 3. Assess the Damage.

Step 4. Treat the Cut.

Section 2: Bites, Bones, and Switchblades: Advanced Care-Instructions for Specific Cuts

Small Cuts

Cuts That Are Unusually Deep and Large

Stab Wounds

Bites

Cuts Associated With Broken Bones

Mouth and Tongue Cuts

Section 3: Honey Bunches of Gauze: How to Keep Bacteria Out Without the Essentials

What to Do When Water Is Scarce

Sweet Treatment: Using Honey As an Antibiotic

Salve Treatment: Mupirocin—the Killer Ointment

Section 4: How to Make Your Own Closures and Dressings

How to Make a Pressure Dressing

How to Apply a Tourniquet

How to Close a Wound Using Duct Tape

How to Close a Scalp Wound Using Hair

Appendix

Arteries Versus Veins

How to Sterilize Instruments

Supplies

General

Infection Fighters

Additional Preparation Tips

Quick Overview for Emergencies

Acknowledgements

About the Author

Other Books by Dr. Hubbard

About This Book

The roads are underwater. All lines are down. Cell phones aren't working. No medical expertise is available. What do you do?

If there’s a disaster and you can’t get help, this information’s for you—survival medicine for hurricanes, earthquakes, tornadoes, floods, social upheaval, or anytime you're isolated.

I’ve been a family doctor for over thirty years. I’ve practiced in small and large towns, worked in emergency rooms and in clinics.

I’ve come to realize that many smart people don’t know the basics about medicine. Now, I’m not putting that down. Put me near a leaky faucet, and my wife hides the tools. But if I have a flooded basement and can’t get a plumber, I know how to turn off the water supply.

I’ve seen able people who don’t know to put pressure on a cut to stop it from bleeding. But even if you know how to do this, what if the wound is bad and you have no medical assistance? What if you can't get help for days?

I think about this every time there’s a disaster like a hurricane or earthquake. I thought of it after the Japan nuclear disaster and after the London riots: What if those people can’t get out of their house and medical personnel can’t get to them—for hours, days? Worse, what if their phone lines are down? What if the ERs are packed, or damaged themselves?

Please, please, I beg, don’t ever use this information instead of seeing qualified medical personnel. This book is for times when that is not possible—improvisational, last-ditch medical treatment to keep you alive until help is on the way.

James Hubbard, MD, MPH

How to Use This Book

The Survival Doctor's guides are among the first books to be written around interactive links. As best as is possible with computers, I use the links to mimic my decision-making process.

Instead of writing, “If this is a scalp cut, flip to page such and such; when you’re through, flip back to the original page,” I can write, “If this is a scalp cut, click here.” You click the link, and like magic, you read about scalp cuts. Then you click back. No frantic page turning.

In case you learn better visually, I've also created exclusive how-to videos and emergency-length, shortened versions of public ones to complement the text. Look for links to them under sections labeled “Watch It!”

Download this book to your smartphone, laptop, and tablet. Make sure it’s on the one you’ll have with you on the hike or the camping trip—and on the one with the most battery life for when the electricity goes off. Because that’s when you’ll need it.

Of course, you can print the pages out, laminate them, and use them the old-fashioned way for backup just in case. Just do it before you need the information.

However you decide to store the book, be sure to read it before an emergency strikes. That way, if you're in an urgent situation, this information won’t be completely new to you.

Warning: I can share my general knowledge, but I can’t download my experience. Not all injuries go by the guidelines. There are in-betweens. Complications occur. No information in this book should ever take the place of seeing your health-care provider. If you can get expert care, by all means, do so. If you can’t, do so as soon as possible. The information contained here hopefully can help until you can get to that expert medical advice and treatment, or it can get to you. Please read the full disclaimer at the beginning of the book.

Section 1

Pressure's On: Basic Care for Most Cuts

The site of blood can best the strongest of us, especially if the blood is your own. I’ve had many a man or woman, both victims and onlookers, faint with the smallest of cuts. It’s an involuntary reflex. They just can’t help it. But you can prevent it.

If you feel like you’re going to faint, sit down and put your head between your legs. Better yet, lie down and bend your knees. You’re no good to anyone lying there unconscious with a knot on the back of your head. Many times you can still stop the bleeding in that position anyway.

With most cuts, treatment is really rather easy. (Yeah, easy for me to say.) But people see the blood and panic. You don’t know the number of times someone’s come in with a gushing cut or with a wound wrapped lightly in a blood-soaked cloth when all they had to do was apply pressure. After all, you only have so much blood to spare.

In this chapter, I've explained four basic steps to take when someone gets cut, in order of priority. You’ll notice actually treating the wound is last. If you’ll memorize steps 1 and 2 you’ll be way ahead of most people. After those steps you can stop, take your time, and read about the rest.

Step 1. Stop the Bleeding.

This is the first and most important step, and it must be done whether you’re expecting to get medical help or not.

Bleeding is the most immediate threat to life. Plus, the more bleeding there is, the harder it will be to check out the injury. And then there's the slipperiness. Even an ooze of blood will make taping or gluing the cut next to impossible.

Note: Especially if you're treating someone else, put on clean plastic or latex gloves to protect both yourself and the other person.

First, try direct pressure. That means pressure right on the wound. Most bleeding stops with this method in five to ten minutes. If you're treating a cut finger, squeeze around the wound with your other hand. For a larger area, push down with your palm. Use a clean rag if available. If there's a broken bone nearby or underneath, try to press carefully enough that you don't move the bone.

Second, if it won't stop bleeding, consider the following:

- A small artery could be cut, which makes the bleeding hard to stop. Apply pressure proximal to the wound (on the side closest to the heart). Hold it for up to fifteen minutes.

- For big gashes with a lot of bleeding, try packing the wound with a bunch of clean cloth and applying pressure. If this doesn’t work you can use any commercial quick-clotting material. Wipe away excess blood before using, and follow the label's instructions.

- If the cut is associated with a broken bone that's out of place, traction (steadily pulling on the bone without jerking) to get it better in place might stop the bleeding.

- You may have to apply a tourniquet as a last resort.

***

Watch It!

Click here to watch a video about how to stop the bleeding (TheSurvivalDoctor.com/bleeding).

***

FAQ: Why is this little cut bleeding so much?

As a rule, sharp cuts bleed more than dull, at least at first. (Dull cuts pull more on the blood vessels, causing them to spasm). This has nothing to do with the cut's severity. Face and finger wounds also tend to bleed more because there's a denser blood supply there.

***

>> Back to “Quick Overview for Emergencies.”

Step 2. Determine Whether the Wound Is Life-Threatening.

With some cuts, not getting expert help can be life-threatening, even after you've stopped the bleeding. You need to use that extra effort to get to a doctor as quickly as humanly possible if:

- You can’t stop the bleeding with pressure (because if you keep using that tourniquet, gangrene will set in).

- The chest cavity or abdominal cavity has been punctured (because of the risk of unseen bleeding and extreme likelihood of serious infections). Start antibiotics if getting expert medical help is impossible.

- A neck wound involves the airway. Apply ice packs for swelling.

- A large artery is cut. (The blood usually spurts, and the tissue distal to the wound—on the side away from the heart—becomes cool and dark. Learn more in "Arteries Versus Veins.") If the artery is not surgically reconnected within hours, the tissue will die due to lack of blood supply. After that, the dead tissue needs a surgical amputation, or it’s sure to get an infection that will spread into the healthy flesh and the bloodstream. You can get very sick and even die. Until you can get to a doctor, start antibiotics, if available, after you stop the bleeding. This might give you some extra time.

>> Back to “See What's Been Cut.”

>> Back to “Quick Overview for Emergencies.”

Step 3. Assess the Damage.

Now that you've dealt with the immediate threats to life, you can stop for a moment and breathe. It's time to take stock of the situation—to assess what damage was done so you can decide what to do next. In this step, you'll be checking the cut's depth, damage and dullness.

A. Check the depth.

The deeper the wound, the more likely a large artery is involved, making the wound bleed more and cutting off important circulation. That makes it more essential to get medical help as soon as possible.

If it's a puncture wound, approximate how deep it goes by checking the object that did the puncturing.

>> Back to “Quick Overview for Emergencies.”

B. See whether anything has been cut besides skin, fat and muscle.

Ask yourself the following questions:

- Is the area distal to the wound (the side away from the heart, toward the fingers or toes) becoming cold or discolored? If so, that's a sign that you may have cut an essential artery. Try applying a little less pressure to make sure you’re not losing circulation simply because you’re pressing too hard. If that doesn't fix the tissue, this may be a life-threatening situation.

- Do you think you've broken a bone close to the cut? If so, the bone is at high risk for getting seriously infected. See "Cuts Associated With Broken Bones."

- Is the area distal to the wound (away from the heart) numb? You may have severed a nerve. In itself, this is not an immediate emergency. You usually have a few days to see a surgeon before it becomes irreparable.

- Have you lost movement? You may have cut a tendon. Again, not an emergency, but it needs to be seen within a few days for repair.

>> Back to “Quick Overview for Emergencies.”

C. Determine the type of cut.

If it's a dull or jagged cut—say from a chainsaw—don’t get complacent just because it doesn’t bleed a lot. These types of cuts tend to pull and bruise the blood vessels more, making them spasm and get smaller. The cut may be pretty severe yet not bleed much at first. Later, it may bleed more.

In turn, if it's a small cut from a sharp object, such as a knife, don’t panic if it bleeds more. The blood vessels don’t spasm as much with sharp cuts.

***

Watch It!

Click here to watch a video about how to assess a cut (TheSurvivalDoctor.com/assess).

***

Step 4. Treat the Cut.

Finally, it's time to get down to treatment. In a disaster situation, consider preventing infection to be a top priority, given that you may not be able to hop over to the doctor for antibiotics.

So you'll start by cleaning the wound. Then, if your wound is like most bad cuts, you'll need to close it. No suture kit? Not to worry. Guess what silver, sticky substance substitutes swimmingly. Lastly, you'll put on antibiotic ointment, cover the cut and go into maintenance mode.

A. Clean the wound.

The cleaner a cut, the less the chance for infection.

If the wound is more of a scrape, pick out the debris, and wash the scrape. If the dirt is ground in, you may have to scrub a bit and then skip to phase C.

Otherwise, run the cut under tap water, or use the cleanest water you have. If your tap's off or you need to disinfect the water, see "What to Do When Water Is Scarce."

If you have enough, use four ounces of water or more per inch of cut—twice as much if the cut is deep. If you suspect a fracture also, use ten to twenty ounces per inch. (There are eight ounces in a cup.)

Caution: Take special care if you’re at high risk for infection. Clean the cut well, and consider taking an antibiotic—or at least use an antibiotic ointment or honey (not for babies)—if:

- You have a chronic disease, such as diabetes (because you heal slower, and your wounds are more likely to get infected).

- You think the injury has involved the bone. You want to prevent a bone infection if at all possible. That's much harder to treat and can cause serious damage.

- You can’t clean the wound adequately because it’s too deep, grimy, or painful.

- You haven’t had a tetanus shot within ten years.

If any of these conditions apply and you can't see a doctor right away, try to within a couple of days.

***

Watch It!

Click here to watch a video that shows how to irrigate a cut (TheSurvivalDoctor.com/irrigate).

***

>> Back to “Quick Overview for Emergencies.”

B. Close the cut.

If the cut gapes open or is over a joint, and bleeding is under control, close it unless it's one of the cuts listed in "Exceptions" below. If you know how to suture or use a skin stapler, now’s the time to do that. (If you use a skin stapler, be sure you have a staple-remover instrument also.)

You'll learn how to close a cut without sutures or staples in these chapters:

- “How to Close a Wound Using Duct Tape”

- “How to Use Hair to Close a Scalp Wound”

- "Small Cuts"

Exceptions: The following cuts should not be closed:

- Cuts unusually deep and large that won’t stop bleeding without pressure

- Puncture wounds

- Bites

- Cuts inside the mouth

***

Watch It!

Exclusive demonstrations filmed just for you:

- How to numb a cut with lidocaine (TheSurvivalDoctor.com/numb)

- How to staple a cut (TheSurvivalDoctor.com/staples)

- How to suture a wound (TheSurvivalDoctor.com/suture)

***

>> Back to “Quick Overview for Emergencies.”

C. Cover the cut.

First, apply antibiotic ointment or honey (again, not for babies). Then cover the wound. Use gauze, clean cloth—whatever you have to keep dirt out of it. Tape the dressing down.

If the cut is oozing blood, you might want to try a pressure dressing.

Safety note: If the wound is on an extremity and you wrap it, keep an eye on the area distal to the cut (the side furthest from the heart). If it turns blue or dark, loosen the bandage. The discoloration may mean this area is not getting sufficient blood flow and could become permanently damaged. See an expert as soon as possible to try to save the tissue.

D. Keep the cut clean and dry.

Daily, remove any dirt, dried blood, and debris from around the cut. Add a little antibiotic ointment if you have it. Honey is a good alternative for most people.

Keep the wound covered with an adhesive bandage, cloth and tape, or a cloth wrapped around it. You can air it out during the day if you don’t foresee doing activities that might get it dirty or wet. This can be helpful in healing and keeping the surrounding skin from becoming macerated (soft).

***

FAQ: How do I know whether a cut is infected?

It's infected if the tissue around your cut, however small, becomes swollen, more tender, or redder, or the cut oozes a cloudy pus.

***

>> Back to “Bites.”

>> Back to “Quick Overview for Emergencies.”

Section 2

Bites, Bones, and Switchblades: Advanced Care-Instructions for Specific Cuts

Some wounds just don’t want to cooperate. This section goes into those.

Other than for small cuts, the theme is don’t close a wound you can’t thoroughly clean. You’d just be giving bacteria a warm, moist, protected nest in which to grow.

Small Cuts

Small nicks or lacerations similar to paper cuts should be washed, bandaged, and kept clean and dry.

You can try using superglue to seal wounds that aren't over joints and that are shallow—say a quarter-inch deep or less. If the glue doesn’t keep the wound closed, treat it as you would any other wound.

>> Back to "Close the Cut."

Cuts That Are Unusually Deep and Large

A deep, large cut may never stop bleeding without constant pressure. Closing this kind of cut is difficult because the tape you'll probably need to use won't stick. In fact, some wounds like this are better off not closing anyway because they’re hard to clean or an open space of tissue will be left underneath the closed skin.

Instead pick out any noticeable debris, and pack the wound with gauze or clean rags. Apply antibiotic ointment or honey. Then use a pressure dressing.

>> Back to “Close the Cut.”

>> Back to “Quick Overview for Emergencies.”

Stab Wounds

Stab wounds, or puncture wounds, are deeper than they are wide. They’re usually caused by a knife or a stick or something similar. You can’t see all the damage.

Scenario 1: The chest or abdomen is stabbed. Try to approximate the depth by looking at the stick or knife. If you think the object may have punctured the chest or abdominal cavity, it becomes more important to seek expert care as soon a possible due to the risk of severe infection.

Scenario 2: The area around the wound begins to swell immediately. The object may have cut an artery. Apply pressure. Usually that and a pressure dressing will stop the bleeding. Very rarely you might need a tourniquet.

Scenario 3: You don't have either of the above problems, and the puncture wound is not severely bleeding. Wash the wound as best you can, apply antibiotic ointment or honey, and use a pressure dressing. Since it’s going to be difficult to see how well you’ve cleaned the deepest part, do not close.

>> Back to "Close the Cut."

>> Back to “Quick Overview for Emergencies.”

Bites

Usually, a bite should be treated like a stab or puncture wound: Stop the bleeding (normally not a problem), irrigate it well, and apply pressure. If it's not severely bleeding, wash the wound as best you can, and continue with part C ("Cover the Cut") in "Step 4. Treat the Cut." Only close a bite wound if it's gaping open, and then, close it as loosely as will just hold it together.

Bite Wounds Are Dirty Wounds

That "wash the wound" step is key with bite wounds. The difference between them and stab wounds is bites may pose more risk for infection. It depends on what bit you and where.

Bites on the hand tend to get more seriously infected than on the arm. A hand infection intertwines with all those tendons and becomes harder to treat. So treat hand bites more aggressively. Make sure you irrigate the wounds well, and start oral antibiotics or mupirocin ointment, if available.

What Bit You?

Dog bites are the least likely bites to get infected, but the big dogs can cause deep bruising. You also have to worry about rabies if you don’t know the status of the dog’s vaccinations. Get to a doctor for preventive shots. Rabies is a killer, and there’s nothing you can do for home treatment if you get it. (Even doctors probably won't be able to cure it.) If you cannot get to a doctor, pen the dog up for ten days if possible. If it shows signs of illness, you'd better try your best to get those rabies shots right away. By the time you show signs of illness, it's too late.

Human bites are more likely to get infected, especially on the hands. Wash well. Consider using mupirocin or oral antibiotics if any redness develops.

Cat bites are the most likely bites to get infected. A cat’s mouth is filled with nasty bacteria. One minute you have some minor puncture wounds. Then, within hours, it’s a swollen, red mess. Start antibiotics at the first sign of infection. The best one for cat bites is amoxicillin clavulanate (Augmentin) if you’re not allergic to penicillin. Cats can also have rabies.

***

FAQs

What about wild animals?

Depending on your area of the country, skunks, raccoons, and foxes can have rabies. For more information check the CDC's website. Rabid bats are a risk everywhere. And, apparently, a bat bite is so small it’s sometimes impossible to find. So, if one touches you, or you find one in a room where you’ve been asleep, you have to assume you may have been bitten and you need rabies shots ASAP.

Rabies is deadly. Don’t risk it. If you’re bitten by a nonvaccinated animal, see a doctor.

What if I absolutely cannot see a doctor for a bite from an animal that could have rabies?

Your best bet of not getting rabies, other than getting the shots, is to wash the wound immediately and vigorously with soap and water. If you can, pen up the animal for ten days to watch for signs of illness.

***

>> Back to "Close the Cut."

>> Back to “Quick Overview for Emergencies.”

Cuts Associated With Broken Bones

When a bone breaks through the skin, the break is called an open, or compound, fracture. If you have a cut and even suspect a broken bone nearby that happened in the same injury, treat it as an open fracture. You can’t be certain that the bone didn’t poke its way out sometime during the injury. Even a millisecond of bone exposure greatly increases the risk of a bone infection.

Stop the bleeding as you would otherwise. Just apply the pressure more carefully so you don’t move the bone.

If the bone is out of place and the bleeding won’t stop, you might apply traction to get it better in place. (Grip the end of the extremity, and pull with a gradual increasing force for about a minute. Never jerk.) This might stop the bleeding.

Priority With Open Fractures: Preventing Infection

Bone infections are very hard to cure. You can lose a limb, or your life. Get professional medical treatment right away, if at all possible. If that’s impossible, then:

- Irrigate the wound vigorously and thoroughly with water. Use ten or twenty ounces or more per inch—as much as you can spare. (For more on irrigation, see "What to Do When Water Is Scarce.")

- Keep the cut open; don’t tape or stitch it closed. Just keep it covered—maybe packed with clean gauze. Use antibiotic ointment or honey, if available.

- Re-irrigate the cut once or twice a day.

- Start antibiotics, if available. If not, mupirocin ointment is worth a try.

>> Back to “Second, if won’t stop bleeding.”

>> Back to "See What's Been Cut."

>> Back to "Clean the Wound."

>> Back to “Quick Overview for Emergencies.”

Mouth and Tongue Cuts

A mouth cut is one of the easier wounds to treat. Granted, it’s painful and tends to get infected. But we don’t stitch the mouth, inner lips, inner cheeks, tongue, or gums unless the wound is big and gaping or won’t stop bleeding.

If you have a cut inside your mouth:

1. Clean the cut. Pick out any obvious debris. Irrigate the cut with water: Swish it in your mouth, or squirt it into the cut. (No running water? See "What to Do When Water Is Scarce.")

2. Stop the bleeding. Stuff a clean cloth between the cut and your gum or teeth. (No cloth? Squeeze, pinch—apply pressure of some sort. Ten minutes should do it.) Ice the cut for five to ten minutes, if possible. You can use the ice as part of the compression inside the mouth to stop the bleeding or wrap cloth around the ice and use it on the outside.

3. Start an antibiotic, if available. You can expect any mouth cut to get swollen, painful, and infected. The mouth is full of bacteria. There’s no way to keep the wound sterile.

4. Eat soft food, don’t chew on that side, and avoid salty foods. (They make the cut sting.)

***

FAQs

What if the cut extends through to the outside cheek, chin, or lips?

Clean the outside, and tape it like you would any other cut. (But keep the inner mouth or tongue wound open.)

What if the outside colored part of the lip is cut?

That’s more of a problem. You want it to grow back straight, so a doctor should see it ASAP. If that’s not possible, tape it back as straight as you can, keeping the colored edge as even as you can.

What if I partially tear the tongue frenulum (that little piece of skin that attaches my under-tongue to my lower mouth) or the lip frenulum (connecting the upper lip to the gum)?

Don’t worry. Just follow these instructions, and it’ll grow back together unless it’s a really bad cut.

Why don't you stitch mouth cuts?

There's no way to keep the wound dry or bacteria-free. Bacteria can attach to the stitches and make the infection worse. Also, infected wounds need to be able to drain if bacteria and pus build up. Otherwise, all that stuff might get trapped, and you'd have an abscess.

***

>> Back to “Close the Cut."

>> Back to “Quick Overview for Emergencies.”

Section 3

Honey Bunches of Gauze: How to Keep Bacteria Out Without the Essentials

When you're in a disaster situation, not only do you not have a doctor, but you may not have a way to get even the most basic medical supplies.

In this section, you'll find makeshift tips to get yourself some clean, pseudo-running water and even an antibacterial treatment from the kitchen.

What to Do When Water Is Scarce

No matter how pristine-looking, mountain streams are full of parasites. Animals don't have outhouses, after all. Their stuff goes right down the river. Pond water is also loaded with bacteria just waiting to make you deathly ill. Even rainwater isn't safe. So, to clean wounds, it's best to use disinfected water.

How to Make Running Water

If you do have clean water in plastic jugs and your tap's just not running, you can create water pressure for irrigating wounds. Just use a safety pin to punch a hole in the bottom of a full jug. Then let the water flow out of the hole onto the wound.

Alternatives to Water

If water is scarce, use peroxide. Alcohol is okay, including liquor, but be aware that it’s going to hurt worse.

How to Disinfect Water

Disinfecting water is relatively simple, and the process will make it drinkable too.

Step 1: Filter the water.

If the water is cloudy, strain it through a clean piece of cotton fabric (gauze is fine), or a coffee filter.. This removes debris and bacteria. Then let the water sit for a couple of hours to let residual sediment settle. Pour all but the sediment into another container.

Step 2: Use one of the following options to disinfect your water:

A. Boil the water.

Just bringing the water to a boil will disinfect it. Some would say, to be safe, boil the water for one minute. If you have a lid, keep the lid on for a few extra minutes after you turn off the heat source.

OR

B. Add chlorine.

Add two to four drops of unscented, 5 percent chlorine bleach to each quart (four cups) or liter of water. That’s eight to sixteen drops per gallon. Mix it well. Wait thirty minutes or so before drinking the water.

OR

C. Add iodine.

Add one iodine tablet, five to ten drops of 2 percent iodine solution, or eight to sixteen drops of 10 percent iodine-povidine (Betadine) solution to each quart of water. Mix. Wait at least thirty minutes.

OR

D. Use the sun’s UV rays.

If none of the other options are available, and if the sun is shining, set a clear, glass container of water (such as a mason jar) in the sun for eight hours. Be sure the top is covered. Place the container on a black surface. It needs a minimum of four hours of sunlight. The more the better.

These are but a few ways to disinfect water. None of these methods removes toxins, poisons, or any chemicals from the water. I don’t know of any improvisational method that does.

***

FAQ: How much water should I store to make sure I'm prepared?

Preparation—even better! Buy some gallon or five-gallon, containers to use for drinking. Keep them full. Even unopened bottled or chlorinated water should be renewed every six months or so. Check for an expiration date.

You need to drink at least two quarts of water per day. There are four quarts in a gallon. So one gallon would last you two days. Fourteen gallons would last a week for a family of four. You may want few gallons extra for bathing and cleaning wounds. In fact, I would suggest at least two gallons per person per day since you'll need more with heavy activity or in hot weather.

If you have any warning your tap water is going to be off, fill all the bathtubs as reservoirs.

***

>> Back to "Clean the Wound."

>> Back to "Cuts Associated With Broken Bones."

>> Back to "Mouth and Tongue Cuts."

>> Back to "How to Close a Scalp Wound Using Hair."

>> Back to “Infection Fighters.”

Sweet Treatment: Using Honey As an Antibiotic

If you don’t have antibiotic ointment, honey’s a great antibacterial for wounds. It kills bacteria and helps cuts, scrapes, burns, bedsores—even ulcerated leg wounds in people with diabetes—heal, and there have been plenty of studies to prove it.

In my mind you can’t have enough honey. It’s tasty and good for coughs too. The fact that it kills bacteria is why it stores forever. Just keep it sealed. If it turns to sugar, gently heat it. Or use it in its granular form. It’s all the same.

Warning

Babies have died from eating honey because of botulism spores. Honey can contain a few of them, though not nearly enough to hurt an adult. They've also never been known to cause harm in wounds. Still, to be safe, don’t use honey on children under two years old unless it’s the kind you buy sterilized. Sterilized honeys such as Medihoney have been zapped clean of bacteria and can be found at pharmacies.

How to Use Honey As an Antibiotic Ointment

Option 1: Apply liberally. If the wound is deep, pour it in. For scrapes and abrasions, paste it on. Then cover the wound and seal it with tape.

Option 2: Apply the runny honey to gauze or clean cloth first, pop the material on the wound, and seal it with tape.

If the bandage remains clean and dry, only change it every day or two. You may have to change it sooner if the wound is oozing a lot of fluid on its own.

How Honey Works As an Antibiotic

Honey's high sugar concentration dehydrates bacteria. Plus, it’s acidic, and most bacteria hate that.

Honey also produces a small amount of hydrogen peroxide when it's mixed with a little fluid—say, from the wound. Unlike the commercial kind, this peroxide is dilute enough to not irritate or inflame the skin.

Researchers are finding other ways honey works as an antibiotic. For example, it may stimulate the body’s natural bacteria-fighting white blood cells to get to work.

Some honeys are more antibacterial than others. The New Zealand manuka honey is particularly popular in medical circles.

***

FAQ: What if I don't have honey?

Sugar’s next best. Surround the wound with petroleum jelly, and sprinkle the sugar in the middle. Apply a bandage, and replace it at least every 24 hours.

***

>> Back to “Clean the Wound.”

>> Back to “Cover the Cut.”

>> Back to “Keep the Cut Clean and Dry.”

>> Back to “Cuts That are Unusually Deep and Large.”

>> Back to “Stab Wounds.”

>> Back to “Cuts Associated with Broken Bones.”

>> Back to “Infection Fighters.”

>> Back to “Quick Overview for Emergencies.”

Salve Treatment: Mupirocin—the Killer Ointment

Mupirocin is an expensive prescription antibiotic ointment, but it's very handy.

Unlike the over-the-counter antibacterial ointments, which reduce your risk of getting an infection, mupirocin actively treats the infection like an oral antibiotic does.

Because of widespread use, some bacteria are becoming resistant to mupirocin, so use it only if you have an active infection and not just for preventive purposes.

>> Back to "Bites."

>> Back to “What Bit You?”

>> Back to “Cuts Associated with Broken Bones.”

>> Back to “Antibiotics.”

Section 4

How to Make Your Own Closures and Dressings

Here are some tips on what to do if you don’t have that just-right closure material on hand. Or if suturing or stapling a cut isn’t your thing. All you need is tape, maybe a little clean cloth, and if you're getting really fancy, some strong string, and you're ready to rumble.

How to Make a Pressure Dressing

Pressure dressings are bandages that press down on a wound. Most of the time, this is to stop the bleeding.

Don’t wrap the dressing all the way around an extremity if you can help it. If you wrap any bandage too tight around an extremity, you've got a tourniquet. Same story if the extremity swells and the bandage has no give. You’ve cut off blood supply coming from the arteries, and the tissue distal to the dressing (the side farthest from the heart) is going to die.

Instead, think bulk.

Add extra layers of gauze, or bunch up some clean cloth. Sanitary napkins are an option. When you tape the dressing down, the bulk will press down on the wound, but it will also have some give so it doesn’t cut off circulation.

Tape it down firmly—about one-half or two-thirds around if it’s an extremity. Or use an elastic bandage instead of tape. Wrap it firm but not too tight. You should be able to stick a couple of fingers under the wrap.

If the hand or foot gets discolored, cold, or tingly, loosen the compression bandage immediately. Until you can readjust it, you can press on the bandage with your hand to stop the bleeding.

***

FAQs

When do I need a pressure dressing?

If you’ve applied pressure for about ten minutes and it’s still bleeding, it might be time for a pressure dressing.

What's a compression dressing?

It's a pressure dressing. So are compression bandages and pressure bandages.

***

>> Back to “Cover the Cut.”

>> Back to “Cuts That Are Unusually Deep and Large.”

>> Back to “Stab Wounds.”

>> Back to "How to Apply a Tourniquet."

>> Back to “Quick Overview for Emergencies.”

How to Apply a Tourniquet

A tourniquet is a last resort. If you cut off the blood supply for too long, you could lose a limb. Of course, that's better than losing your life.

Use sturdy material about two inches wide. A belt might do. Place it just above the wound—on the side toward the heart. Wrap it just tight enough to stop the bleeding. You can use a stick to twist the ends of the material tighter.

Loosen the tourniquet every few minutes to let blood flow to the extremity. If the bleeding stops, loosen it for longer and longer times—five seconds, ten, etc.—until you can get rid of it and apply a pressure dressing.

>> Back to "Second, if it won’t stop bleeding."

>> Back to “Determine Whether the Wound is Life-Threatening.”

>> Back to “Stab Wounds.”

>> Back to “Determine Whether the Wound is Life-Threatening.”

How to Close a Wound Using Duct Tape

If you need to close a cut but don't have sutures, a skin stapler or butterfly bandages, you can use duct tape.

1. Dry the wound.

2. Cut or tear the tape into strips about one-half-inch wide and two inches long.

3. If you have glue, apply it to the skin (not the actual wound) to help the tape stick.

4. Starting at one end of the laceration, stick half the length of the strip to one skin edge, close the cut using your hand, and stick the tape to the other side, closing the wound tightly.

5. Keep applying strips until you get to the other end of the cut, leaving small spaces between the strips so the wound can get air.

***

Watch It!

Click here for a quick demonstration of how to close a wound with duct tape (TheSurvivalDoctor.com/tape).

***

>> Back to “Close the Cut.”

>> Back to “Cuts That Are Unusually Deep and Large.”

>> Back to “How to Close a Scalp Wound Using Hair.”

>> Back to “Quick Overview for Emergencies.”

How to Close a Scalp Wound Using Hair

If the cut is on the scalp and the person has hair that's an inch or more long, you have built-in butterfly strips! You can close the scalp cut by crossing strips of hair and gluing them down.

First, if the cut is bleeding, apply gentle pressure as you would with any other cut. However, if you have any concern the skull could be broken, be very careful. You don’t want to depress the bone inward toward the brain. (A broken skull is a rare injury, though, and needs a lot of force, like a hit by a hammer or a hard fall on a rock.)

1. Wash the blood out of the hair as best you can.

2. If you have strong thread or dental floss, snip it into four-inch strips.

3. Use your fingers to dig through the hair and find the cut.

4. Part the hair away from the cut until you can see the whole wound.

5. Clean out debris, and irrigate the wound with water.

6. Lay one strip of the thread, if you have it, lengthwise on the open cut.

7. Start at one end of the cut. From one side of the cut, twist a sprig of hair between your thumb and index finger. Do the same on the other side with your other hand.

8. Cross the sprigs over each other like making an X. Pull with enough tension to close the part of the wound under the sprigs.

9. Tie the thread around the crossed sprigs to keep them in place.

10. Glue the sprigs down.

11. Repeat steps 6 through 10 until the wound is closed.

***

Watch It!

Click here to watch a demonstration of how to close a scalp wound using hair (TheSurvivalDoctor.com/hair).

***

FAQ: What if I'm bald or my hair is too short?

No hair? Use glue and tape like you would for other cuts. Hair too short to tie? Shave it off before applying the glue and tape.

***

>> Back to “Close the Cut.”

>> Back to “Quick Overview for Emergencies.”

Appendix

By now, you’ve probably already linked to the chapter on how to tell an artery from a vein. If not, you’ll find it in this section. Please read it. It’s basic information everyone needs to know before treating a serious wound.

You’ll also find a section on how to sterilize your instruments. When treating wounds, bacteria is your enemy. It’s always lurking, trying to find a way to sneak in. Sterilizing instruments that are going to touch the wound is one good way to keep it from catching a ride. Remember to wash your hands and the wound also.

If you can stop the wound from bleeding, clean the bacteria out, and close the wound in a sterile manner, you have a good chance of the wound healing with few complications.

Arteries Versus Veins

You can bleed to death from either a vein or an artery, but a cut artery generally poses more problems.

Arteries are too deep to see from your skin surface, but sometimes you can feel the pulsing. They pump oxygenated blood fresh from the lungs and heart to our tissues. If the arterial pipeline is cut off, the tissue dies.

Arteries also have thicker walls than veins—walls that actively pulsate and pump. So it’s harder to stop an artery's blood flow. And in order for the blood to clot, the flow must stop.

How to Tell the Difference Between a Cut Vein and a Cut Artery

Just remember: Arteries spurt. Veins don’t. Arteries pump blood away from the heart. Veins drain blood back to the heart.

If the blood is oozing out of your wound, you've cut a vein. The blood is probably also a darker color because it doesn’t have as much oxygen. Stop the bleeding with about five minutes of direct pressure or pressure just distal to the wound (toward the fingers or toes). Remember, it’s draining back to the heart.

If the blood is spurting, it’s an artery. An artery may need more pressure to stop the bleeding. Use direct pressure or pressure proximal to the wound (the side closer to the heart). If that stops the bleeding, hold the wound for up to fifteen minutes if you can. Then pack it with clean cloth, and apply a bandage. The bleeding should be under control before trying to close the wound with suture or tape (after removing the cloth packed inside).

***

FAQ: What about little cuts?

Small cuts and scrapes are most often to capillaries. These blood vessels connect arteries to veins and are very small. Bleeding from capillaries can usually be stopped fairly easily. Even if they’re squirting, a little pressure for five to ten minutes does the trick.

***

>> Back to "Second, if it won’t stop the bleeding."

>> Back to “Determine Whether the Wound Is Life-Threatening.”

>> Back to "See What's Been Cut."

>> Back to “Stab Wounds.”

How to Sterilize Instruments

Unless you have a commercial autoclave and a power source, or some prepackaged sterile products, you’re going to have to make do. First, always clean any obvious debris off your instruments. Clean with soap and water or alcohol. Use a cloth or brush if needed.

A couple of quick methods for sterilization are:

1. Heating the instrument.

Hold the part that’s going to touch the injury under an open flame. If the handle is also metal, find something to hold the instrument with so you don’t burn your fingers. When the part under the flame is red, that’s enough. Let it cool and you’re ready. If I have alcohol, I also like to dip it in that just for good measure.

2. Using a disinfectant.

If you don’t have fire and you're in a hurry, you can wipe the instrument off with a clean cloth soaked in iodine, povidine, or alcohol. No clean cloth? Dip the instrument in the solution and stir it around for ten seconds.

If you have more time you can:

1. Boil.

This is good method for larger instruments or those that might melt under the flame. Let the instrument soak in boiling water for twenty minutes.

2. Use a disinfectant longer.

Soaking the instrument for twenty minutes is better than just the wiping/dipping method.

What to Do Before and After the Procedure

Always wash your hands. Wear clean gloves, if available, to protect yourself and the patient.

Immediately after the procedure is finished, any object that came in contact with infectious bodily fluids should be washed down with disinfectants.

Supplies

General

Latex gloves (vinyl, if there’s a chance of allergies). Use dishwasher gloves if you don’t have a pack of disposable ones. It’s good to have a few pairs of sterile gloves also.

Small scissors.

Several safety pins.

Gauze pads, three inches by three inches—several packs. At least a pack or two should be sterile.

Coban-type self-adherent wraps. The three- or four-inch-wide is the most useful.

Elastic bandages. The three- or four-inch-wide is the most useful with these too.

Adhesive bandages (Band-Aids), various sizes.

Duct tape or surgical tape.

Hypoallergenic or paper tape in case of a reaction to the regular kind.

Sutures (with attached needle and a needle holder) or staples (with remover) if you know how to use them.

Superglue.

Infection Preventers

Antibiotic ointment, such as Triple Antibiotic, Bacitracin, or Neosporin.

Honey. The best for antibiotic use is manuka or Medihoney.

Matches (or a lighter) and candles in a waterproof container.

Potable water. You’re going to need at least two quarts per person per day to drink. Then there’s boiling, irrigating wounds, and washing. That’s, say, two gallons per person. Depending or your perspective, I’d say have fourteen gallons per person minimum. Have some chlorine or iodine on hand to disinfect more water. (See "What to Do When Water Is Scarce.") If you have preparation time just prior to a disaster, fill all your bathtubs up before the water goes out.

Antibiotics

Some good oral antibiotics for skin infections are cephalexin, erythromycin, and amoxicillin/clavulanate. Plain amoxicillin will do if that’s all that's available, but a lot of staph bacteria is resistant to it. Ciprofloxacin is another alternative, as is mupirocin ointment.

Always consult medical personnel before using antibiotics, if available. Be aware of side effects and allergies. If you start use, continue for seven to ten days unless your doctor says otherwise.

Additional Preparation Tips

Keep current on your tetanus shots. They last about ten years. Since you’re preparing for a time when you can’t get to doctor, consider giving yourself a little cushion and getting a booster about every seven years.

Local courses on first aid, CPR, and injury management are musts.

>> Back to ‘Determine Whether the Wound is Life-Threatening.”

>> Back to “Clean the Wound.”

>> Back to “Bites.”

>> Back to “What Bit You?”

>> Back to “Cuts Associated With Broken Bones.”

>> Back to “Mouth and Tongue Cuts.”

Quick Overview for Emergencies

If you’re in an emergency and have a general idea of what to do but need some basic reminders and quick links, come to this page.

1. Put on clean latex or plastic gloves. If you don’t have disposable gloves, the dishwasher type will do.

2. If it's a mouth cut, go to “Mouth and Tongue Cuts.” If there's a broken bone with the cut, see "Cuts Associated With Broken Bones."

3. For other cuts, stop the bleeding by applying pressure.

4. Use extra effort to get to a doctor as quickly as possible if: (a) you can't stop the bleeding, (b) a stab has punctured the chest cavity or abdominal cavity, (c) a neck wound has profuse bleeding or involves the airway, or (d) a large artery is cut (the tissue on the side of the wound away from the heart becomes cool and dark). If any of those situations applies, also follow the applicable instructions in "Determine Whether It's Life-Threatening."

5. Check the depth. (Deep? See a doctor ASAP.)

6. Check what's been cut. If there's a nearby broken bone, numb area, or lost movement, follow the applicable instructions in part B of "Assess the Damage."

7. Clean the wound. Use extra care for wounds associated with broken bones or bites.

8. If the cut is large deep and won't stop bleeding without pressure, see "Cuts That Are Unusually Deep and Large."

9. Close the cut if (a) bleeding is under control, (b) the cut gapes open or is over a joint, AND (c) it's not caused by a bite or stab wound. Use strips of duct tape if necessary. If you're closing a scalp wound, click here.

10. Apply antibiotic ointment or honey. (Don't use honey on babies.)

11. Cover the wound with clean cloth or gauze, and tape the dressing down. If the cut is oozing blood, consider a pressure dressing. If you wrap material around an extremity, make sure it doesn't cut off circulation. (If the tissue turns dark, loosen the bandage, and see a doctor ASAP.)

12. Continue with the covering and maintenance instructions in parts C and D of "Treat the Cut."

Acknowledgments

This book has been a collaboration with my daughter, Leigh Ann Otte, who not only edited it but helped me put it in language a nonmedical person can understand. Her website is LAwordsmith.com.

I also thank my daughter, paramedic Beth Nelson, for her valuable input, and Pam, my wife, who knows more about nutrition, natural medicine, and nonmedical disaster-preparation than I ever will.

About the Author

James Hubbard, MD, MPH, grew up in Pontotoc, Mississippi, and now lives in Colorado Springs, Colorado. He's practiced family and occupational medicine in rural towns and large cities.

Dr. Hubbard's mission is to spread medical knowledge as far and wide as he can so people are empowered to live healthier, safer lives. To that end, he teaches down-to-earth survival medicine at his blog TheSurvivalDoctor.com so everyone can be prepared. He also publishes the health-information website MyFamilyDoctorMag.com.

Dr. Hubbard is a member of the American Medical Association, American Academy of Family Physicians, and American College of Occupational Medicine, and a prior member of the American College of Preventive Medicine and Wilderness Medicine Society. He has a master of public health and a medical degree.

Other Books by Dr. Hubbard

Dr. Hubbard is also the author of The Survival Doctor's Guide to Burns, available from TheSurvivalDoctor.com. Learn the best tips for makeshift burn treatment that anyone can do—even when there is no docor.

More The Survival Doctor's Guide books are coming soon! To be the first to hear about them—and to get more lifesaving, makeshift medical tips, subscribe to Dr. Hubbard's blog at TheSurvivalDoctor.com.

Table of Contents

Copyright

Note to reader

About This Book

How to Use This Book

Section 1: Pressure's On: Basic Care for Most Cuts

Step 1. Stop the Bleeding.

Step 2. Determine Whether the Wound Is Life-Threatening.

Step 3. Assess the Damage.

Step 4. Treat the Cut.

Section 2: Bites, Bones, and Switchblades: Advanced Care-Instructions for Specific Cuts

Small Cuts

Cuts That Are Unusually Deep and Large

Stab Wounds

Bites

Cuts Associated With Broken Bones

Mouth and Tongue Cuts

Section 3: Honey Bunches of Gauze: How to Keep Bacteria Out Without the Essentials

What to Do When Water Is Scarce

Sweet Treatment: Using Honey As an Antibiotic

Salve Treatment: Mupirocin—the Killer Ointment

Section 4: How to Make Your Own Closures and Dressings

How to Make a Pressure Dressing

How to Apply a Tourniquet

How to Close a Wound Using Duct Tape

How to Close a Scalp Wound Using Hair

Appendix

Arteries Versus Veins

How to Sterilize Instruments

Supplies

General

Infection Preventers

Additional Preparation Tips

Quick Overview for Emergencies

Acknowledgments

About the Author

Other Books by Dr. Hubbard