First Aid
This page is dedicated to first aid and medical issues. It will be updated frequently with current and interesting articles.
Got Water?
August 2008
Prior to the Six Day War in 1967 the Israeli army supplied each soldier with 1 quart of water per day. One quart per day! After testing water consumption and performance levels during and after long marches, the army found that a well watered soldier was a better soldier. The result was a change in SOPs to increase water consumption to 1 quart per hour. One quart per hour! Water consumption was one significant factor contributing to the success of the Israeli army during that engagement.
Since the militia suffers from a severe lack of organized re-supply and is not “well-regulated”, it is critical that the modern militia man do all he can to maintain proper hydration on his own. This article will outline some steps that can be taken to keep one-self hydrated in the field, especially in extended engagements.
The first thing to do is not to skimp on how much water you try to pack from the start. In the summer, plan on taking AT LEAST two quarts. I’ve seen guys cheat before, only packing one quart or only filling one quart for a one day FTX. You fight like you train boys and girls, don’t forget it. Get used to the weight, space, and logistics of two quarts somewhere on your LBV or LBE. Don’t think you’ll figure it out later, incorporate it now into all your gear.
Next, plan on packing a couple gallons or a case of bottled water in your truck or car at all times. It may come in handy in other ways or other situations, but you might be glad you had this water if your truck is parked at the ‘base’ or field operations center during a call-up. Remember, we’re not well-regulated (yet?). This may be your only source of re-supply for a while if you are called-up away from your local AO.
Third, if you’ve got some money to spend on yourself or have set up a militia budget like you should, put a QUALITY water filter on your list. First, if you forgot to pack water in your car/truck, you’ll have a way to at least filter water you find. Second, it will serve as backup to the truck water, if you are stuck in the field for longer than expected. There are a few kinds to check out, all will have to pass your ease of use, likeability test. Plan on a hundred bucks for a good filter. Ceramic filters like the MSR version are easy to use, slightly bulky, but filter thousands of gallons. Katydn makes several varieties suitable for field use as well. One I have been experimenting with is a UV light purifier. Requires batteries, but is very compact and easy to use. Whatever you decide on, decide on something and get familiar with how to use it quickly. There may not be a lot of time to suck up the water you need and keep on the move.
Fourth, know where the water sources are in your AO. Is it the city lake, is the branch feeding the Missouri River, is it a neighbor’s pond? Make a mental note where to get water all over your county. If the call-up is in your AO, your unit commander will need to know this for future re-supply efforts if no bottled or tap water is available.
Next time we’ll talk about where all this water goes and what to do about it.
Bottoms up!
Got Water Pt. 2
September 2008
Ok, so you’ve sucked down that quart per hour all day and now you’re dancing like a 4 year old, trying to get the XO’s attention. But at the end of the day, your not as sore as you would have been or as tired; if you’ve been eating properly too, you won’t get any cramps either. Good job militia man!
Water was our friend here. Could it ever be our enemy? Yes it can and this article will tell you how.
As you shoot, move and communicate in the field, your muscles use energy and that creates heat. The natural response is for the body to start perspiring (sweating). When the body perspires, it is trying to get heat out of the body to keep the organs, notably the brain, from getting fried. Water on the skin is evaporated into the air when it comes to the surface and takes heat with it.
Now all this is fine and dandy on a hot day (assuming you have good personal hygiene), but what about when it’s cold outside? All that water coming off your skin is doing a great job of getting the heat out of the body, but with the moisture not getting picked up by hot air, it sits in your clothes and continues to siphon off heat when your body is done sweating. BAD. Hypothermia is the condition we are describing here. When the temperature of the body drops just a few degrees, the body will start showing signs quickly.
Beyond reddend and cold extremities, things we all get every winter when outdoors, some things to be on the lookout for in the field (when exposure time is longer) are loss of dexterity in the hands, loss of muscle movement, uncontrollable shivering and altered mental status. These conditions make for poor shooting, moving, and communicating.
The best treatment is prevention! The best prevention in our situation is to maintain layers with the appropriate types of material. Avoid cotton as the layer next to the skin. Use man-made fibers that will not hold the water next to your skin instead. Or if you have no nerve endings, use wool, nature’s best fiber insulator.
After an appropriate selection of materials next to the skin, use layers of most any type to stay warm and finish it off with something waterproof. Layers serve two purposes: 1) they trap air more effectively adding insulation and 2) layers can come off at the appropriate times to help regulate your sweating and reduce it down as much as possible. By consciously monitoring your sweating in the cold temps, you can reduce your chances of going into even mild hypothermia.
Let’s say you forgot to listen to the medic and wore a cotton t-shirt with cotton pants. You’re going to get hypothermia when you get wet and it won’t take long for you to be hating life. The things your medic will do include getting you out of wet clothes as soon as possible, covering you with a blanket, and letting you warm up slowly and naturally. He will not (read: you should not) put a hot pack on your cold parts, rub your cold parts, or put hot water on you. All of these are dangerous and could lead to death in some cases. The goal will be to get you dry and layer you up until core temperature has returned to normal.
To summarize: Select appropriate clothing for the cold environment, stay away from cotton. Then layer up and keep the sweating to a minimum. Be on the lookout for hypothermia symptoms and alert your medic if you notice any conditions mentioned above.
1. http://en.wikipedia.org/wiki/Hypothermia
Just a few tips from Doc:
October 2008
This is the time to start preparing for the up coming cold weather. . You have no idea what could be ahead. You could be stuck on the side of the road and it might not be due to anything you caused.
In our vehicles we should keep certain supplies besides the first aid kit. Let us face the facts, if you are prepared an emergency can be down graded to a mere in convenyence.
A list of things to consider carrying for the up coming winter:
1. Blanket or something similar to keep you warm
2. Food to sustain you for 2 to 3 days
3. At least one thermos your choice of warm beverage (coffee, hot chocolate, tea). NO ALCOHOL!!!
4. Change of clothing (hypothermia dose not take long to set in if you are wet)
Remember take care of your self, you maybe the only one you can count on
MEDICS CORNER
NOVEMBER 2008
A little late in posting this December medical post for all the right reasons. Lots of family and food after Thanksgiving, then getting ready for Christmas in between working and all the other things a person does.
Let's talk about the cold, specifically let's talk about your cold feet and hands in a call-up. First the feet. I know the most miserable memories I have from any winter outing have always been because I didn't get the right boots on, the right socks on, or both. Its the first thing that makes me want to give up whatever I'm doing and go inside. What to do?
First get some wool socks - merino wool socks with a 70-85% wool content. These dudes will soak up the sweat and still give insulative value. Major department stores have them for 6-7 bucks per pair, I recommend 3-4 pair minimum. Don't use cotton! Soaks up water and it just gets worse from there. Boots - I'm pretty picky about my boots but picky doesn't mean expensive. What I have found to work well is buying a larger size of the same boot that I normally wear with thick winter or wool socks. The fit and feel is the same and I get customized insulation. I find this beneficial as boots with insulation will eventually soak up sweat, dirt, and oils and lose their insulative value. The socks are of course removable and washable.
Now your hands. I highly suggest you take advantage of these peaceful, cold winter days and try shooting with a cold, stiff hand. Then put your gloves on try shooting with a cold stiff hand. You'll probably want to figure out how to avoid having that sensation again. Just like layers work for the torso, they work for the hands. You may have to experiment with different types of setups, depending on what kind of dexterity you want. Some like gloves with mittens over the top. Some like multiple gloves. Some like combinations with trigger finger accessibility. Since dexterity is a must at all times to access the trigger, to reload, to access gear, to adjust gear, to use tools, keeping the hands warm is worth investigating. Don't assume you'll be able to stick them in your coat or pants; you might be on the march or on OP with binoculars. I have found any setup that will allow handwarmers to be inserted and kept on the back side of the fingers works well. When you winterize your 3rd and 2nd line gear, make sure a good supply of handwarmers is included in the repack.
Well, don't get to fat this Christmas and New Year's. Remember, the call could come at any time...
Stay safe!
James
The Greek word means, to flow through. Diarrhea, at best unpleasant, at worst, fatal, Yep, unchecked, diarrhea is one of the deadliest medical problems, especially in children in undeveloped countries. I won’t go into exact mechanisms, but will give a few points to remember. First lets go through the common presentation of Montezuma’s revenge. Say you hop on a plane and fly to Mexico to spend a few days at a remote village on the Yucatan Peninsula. One of the places you chose to dine at is roadside café, with the usual 3 walls. All looks clean, and one of the family is busily washing the dishes in the rear of the establishment. Fast forward to the day before you are due to depart, and you are suddenly fiercely attacked by your own digestive system. The ride to the airport, 95 mi, and 5 hr’s could not be more miserable. Only slightly less miserable is the flight home, and now you have the most memorable part of your vacation, to talk about. So, what happened? Well the water the kid was washing the dishes in, came from of course, up stream. Normally this wouldn’t be a big deal, and it wasn’t to the locals, but the day before you dined there, a small herd of cattle loitered upstream a couple of miles, and tainted the water with their feces. The locals have an immunity to the bacteria from such events, so it is of little consequence to them. Now the question, is our water safe here? I suspect that most all of us get our water from a public utility, such as a city or rural water supply district, that either uses deep wells, or surface water, such as a river, and is filtered, and treated usually with chlorine to kill bacteria. But is it all killed? Every so often a water supply entity does what is called “shocking” which is just putting a substantially higher amt of chlorine in the water to kill off the bacteria that have developed an immunity to the standard chlorine dose. No one tells you they do it, but you can usually smell it. If there were that much chlorine in a creek or stream, it would be called a toxic spill, and the DNR would have the whole thing roped off. Ok, I digress. Ever hear of WD? Hikers know it as wilderness diarrhea, and it is no different from the crud you had on vacation. Bacteria in the water from upstream, at a beaver pond finds its way into a hikers gut, through poor sanitation, when washing cookware. Here is my point. Water in a creek, river, or even a vestal pool, has had something, or someone, taking a dump in it. If you get your water from the Missouri River, there have been a lot of someones doing that, before it’s your turn. You have just got to believe that any water source you encounter, other than treated, is going to be poison to your gut. Having said all that, the only way to be 100% sure there are no bacteria, or virus’s in the water, is to boil it. Time, and energy right? Ok, there are other ways to get decent drinkable water, with nearly the same level of safety. Your chlorine and iodine tabs will work in a pinch, but are not suggested for long-term use. I have done a little checking, and I believe that a two-step approach may be best. A filter with a porosity of 1 micron or less, followed by UV treatment. You men can do the same checking that I can, but price wise, I think both units could be had for a little over a hundred dollars. If time is a factor in getting water, the filter could be used by itself, with just slightly higher risk of infection. I hope that all of you carry anti diarrheal meds in your kits, but beware that these med’s will not offer relief in all cases. As always, prevention is the best cure. Don’t jeopardize the mission. Pvt Simmons
Addressing the “Blues Clues” Greetings men, and Ladies. Tis the season for Joy abounding! Or is it? While a paramedic is never called upon to treat depression, as it is out of the scope of expertise, we are given a brief -“too brief”- list of signs to look for , to identify depression. Mood swings, change in eating, or hygiene, tendency to want to withdraw, excessive need for sleep, nocturnal insomnia, self medicating with alcohol, or drugs, inability to find pleasure in activities, or hobbies, inability to function at work, irritability. These are just some of the symptom’s, and can be exacerbated by any number of stimuli. Recent divorce or loss of loved one, and sometimes, the loss can be years old, and just remembered more at a time of yr when the loss occurred. In winter, the shorter hr’s of daylight have a negative effect on most of us. Loss of job, “I wonder how many that will affect this year”. For some, health issues dominate. My father in law has been battling cancer for over 5 yr’s, and will be on chemo therapy for the rest of his life. As an “upper” tho, he is getting a hospital bed delivered to the house, and looks forward to finally being able to sleep in a bed again. The small things it takes to make some people happy. I envy him in that he isn’t worried about losing his job, as he gave it up voluntarily 7 yr ago. Ok, back to the mainstream. Let’s keep an eye on one another this season. If your wife , husband, son, daughter, grandparent, brother, sister, PVT, SPC, 2LT, SGT, LTC, are acting a little, different than usual, maybe invite them to coffee or just say something to get their attention, and let them know you care. We spend a lot of time training for injuries and trauma in the field, but we spend a whole lot more of our life in the “everyday” mode of living. While I have never been asked to treat someone for depresson, I have been called to a scene, where the sufferer chose to treat it themselves.The treatment they chose was both permanent, and irreversible. Be aware, be proactive, be safe.
A Spring Thing
MARCH 2009
Poison ivy and oak
By now most of us have heard that familiar phrase ... "leaves of 3 let them be." it's true unless you enjoy an itchy agony. Time to dispel a few myths so that you are better prepared.
1."Poison ivy is contagious"-rubbing the rash won't spread it to other parts of your body or to any other person. It is urusiol oil, the sticky, resin like substance that causes the rash. If that's on your hands then the rash can be spread.
2. "You can get poison ivy by being near the plants"-direct contact is needed to release urusiol oil. However, forest fires, direct burning or trimmers and mowers can cause the oil to become airborne.
3. "Leaves of three let them be"-true for poison ivy and oak, but poison sumac has up to 7 to 13 leaves on a branch.
4. "Don’t worry about dead plants"-urusiol oil stays active on any surface, including dead plants, for up to 5 years.
5. "I'm immune to it"-90% of people are allergic. It's just a matter of time and exposure. The more times you are exposed to it the more likely you are to break out from it.
Calamine lotion helps to treat. A room temperature bath mixed with 1/2 cup of baking soda helps. White distilled vinegar applied to rash is known to work. If your rash is severe or has gone into eyes and or throat seek medical attention.
Stinging insects
Be careful of honeybees, hornets, wasps and yellow jackets as it gets warmer outside. If you encounter any flying insects, remain calm and quiet and move slowly away. Many of them are just foraging for food, so try not to smell or look like a flower. Avoid bright colored clothing and perfume The smell of food attracts, so be careful when cooking, eating or drinking sweet drinks like soda and juice outdoors. If you get stung by a honeybee and it has left it's stinger in your skin, remove it within 30 seconds to avoid receiving more venom. Scrape it with your fingernail and avoid squeezing as this forces more venom into the skin. Hornets, wasps and yellow jackets usually don't leave their stingers. Remain calm and brush these insects away with deliberate movements to avoid more stings. Quietly and immediately leave the area. NEVER swat at a hive or nest as these insects can and will swarm to protect themselves.
-If you are allergic and have an epinephrine pen or syringe, use it immediately.
-Elevate affected arm or leg and apply ice or cold compress.
-Gently clean any blisters with soapy water to avoid secondary infections, do not break open blisters.
-Use topical steroid ointments or oral antihistamines to help itching.
-See you doctor if swelling progresses or infection occurs.
Although it's not a "stinging" insect, a reminder that mosquitoes will be out and about. They are known to transmit various diseases such as malaria and the bird flu. If you plan on going into the great outdoors, pack and use an insect repellant that contains "DEET."
Venomous snakes
All of Missouri's venomous snakes are pit vipers, which means they have an opening on each side of the head, called a sensory pit.
Osage viper-grayish brown to pinkish tan. Heads may have some pink or orange color thus the name "copperhead". Average length is 24-36 inches. Usually found on rocky hillsides or the edges of forests. They also spend time among trees and in the brush along streams as well as abandoned farm buildings They will vibrate their tail when alarmed. Found in the northern two thirds of Missouri.
Western cottonmouth or water moccasin-"cottonmouth" is derived from the white colored lining of it's mouth. When alarmed it opens it's mouth widely showing the cotton-white lining. Usually black with little or no pattern or dark brown with darker bands on the back. Length is from 30-42 inches. They live in swamps, oxbow lakes, in the Southern Ozarks, rocky streams and river sloughs. It can deliver a fatal bite. Found in the Southeastern portion of Missouri and throughout the Ozark region.
Timber rattlesnake-Missouri's largest venomous snake. Generally tan or yellowish tan with markings of dark brown and a change of blotches on neck area to bands near the tail. Also there is a rust colored stripe down the back. Length is 36-60 inches. This snake lives on rocky, wooded hillsides. This species is found statewide through Missouri.
Eastern Mississauga rattlesnake or swamp rattler-this snake is gray to dark gray with numerous brown or gray-brown blotches. The belly is dark gray or black and the end of the tail has a small rattle. Length is 18-30 inches. This snake lives in marshy areas or wet prairies. These snakes are rare and are considered an endangered species. It's venom is highly toxic. It's found scattered in the northern half of Missouri.
Western pygmy rattlesnake-one of the smallest species of rattlesnake in North America. General color is light grayish-brown with a row of small, dark brown spots on the back and sides. Most with a rust colored stripe down the back and has a very tiny rattle on the end of it's small tail. Length is 15-20 inches. Usually found under rocks. The sound of it's rattle is like a faint buzz. Although not fatal, the bite victim should still seek immediate medical attention. Found in the eastern Missouri Ozarks.
Pit vipers have two characteristics at the site of a bite. 1-Intense pain within five minutes and 2- Swelling among other symptoms such as; Weakness, rapid pulse, numbness, tingling sensations, bruising, bleeding disorders, vomiting, an unusual metallic taste and confusion. If bitten by a poisonous snake, immobilize area. Wash with soapy water if available. Apply a tourniquet 2-4 inches upstream from the bite area. The tourniquet should be snug but you should be able to slide one or two fingers under it, otherwise it's too tight and may cause further damage. Use a venom extractor if you have one and leave in place for at least 30 minutes. Never use ice or cold packs as these may result in greater harm. Get to the emergency room immediately.
Spiders
Black widow-The male of this species usually flees from being disturbed but may bite if consistently provoked. Glossy, black bodied females with a distinct red hourglass shape on it's abdomen. Large females reach lengths of 8-10 mm while males grow to less than half this size. It usually makes it's irregularly shaped web under flat rocks, logs, along embankments or in outbuildings. The web has a tiny funnel into which it can retreat if bothered. A black widow bite results in delayed pain at the wound site. Severe abdominal cramps, muscle tightness or soreness, headache, nausea and sweating usually follow. Swelling in the hands, feet or eyelids may be noticed but usually not at the bite site. It is unusual for a bite to cause death but you should seek medical attention immediately.
Brown recluse-usually grayish-yellow-brown in color with gray hairs and a violin shaped marking on the top and darker legs that are long and slim. Females are larger than males averaging 9mm. These are poisonous as the black widow with the exception that with recluses - both male and female are poisonous. Their small, irregular, untidy webs can be found under rocks and stones in the southern Ozarks but are most encountered indoors in little used drawers, closets and other small hiding places. When bitten by a brown recluse swelling, redness and tenderness at the bite area may occur after 8 hours or less followed by chills, nausea or fever. More commonly, after several days the skin surrounding the bite may ulcerate, eventually forming a deep, open wound that is slow to heal and susceptible to infection. Death from a recluse bite is extremely unlikely but if you experience a developing wound as previously mentioned, seek medical attention.
That concludes this article. I hope the information is useful and helpful. If you are planning trips in the great outdoors this spring, please pack a simple first aid kit. Bring insect repellant and for goodness sake, if you know you are allergic to stinging insects, carry epinephrine or benadryl with you. Have fun all and be safe.
"Doc" Rick
Summer is Here
July 2009
July 2010
Remember the counsel you got from some wise person in your past or present, one who had been down the rough roads of life and was trying to help you avoid the problems he/she had encountered? One admonition you may have at one time heard was “Don’t sweat the small stuff!”.
Tackling daily living, that’s great advice. In the end, we’re all worm food, just a matter of when, for all of us. In the grand scheme of things, sweating the small stuff only causes more worry and waste than anything. You can’t do much about what you can’t control.
One place this adage does NOT apply is the “small stuff” of being a combat ready citizen. I like to call them the little things.
So you’ve got your first line, second line, and third line gear all laid out. You’ve researched Tire Iron’s prolific posts on combat readiness, strategy, and tactics (http://tireironscorner.blogspot.com). There’s still some things to consider depending on your AO. Little things in the battlefield environment, like the whole in the dike, tend to get bigger if left unattended. Let’s walk through some little things that you can pay attention to now and be prepared to address right away and save yourself lots of heartache later. Imagine if you’d forgotten the following: Sunscreen, sunglasses, ear plugs, mole skin, broken in boots, or socks.
Sunglasses or eye protection – how annoying is it to have something in your eye and just how good of a shot will you be if you’re fighting a gnat or piece of sand in your eye? Have a plan for eye protection.
Sunscreen – Typically combat attire has one covered nearly head to toe. What about operating in a base camp or area where no contact is expected? You might be involved in digging or fortifying the place and may want to shed some excess layers to accomplish the task. Let’s say you get ordered out the next day to patrol, but whoops, you forgot to put on sunscreen and that friggin’ LBV is absolutely killing your sunburn. Where is your mind going to be half the time - thinking about the discomfort most likely? Have a plan for sunscreen.
Ear plugs – A commonly missed piece of battle gear is ear protection. “I’ll just ride it out.” is a common response. “I don’t want to be able to miss any sounds.” Fair enough, but you can invest in simple protection that will allow you to hear the enemy and still hear your grandkids ask you about your service later on. There are more expensive units that I recommend that amplify quieter sounds and reduce sounds above 85 or so decibels. If you’re not into that kind of expense, try these: http://www.midwayusa.com/viewProduct/?productNumber=453211 Made for indoor or outdoor situations, they’ll reduce some noise and maybe keep you from saying “Eh?” all the time when you are teaching new recruits but not at the expense of hearing the OPFOR.
Footwear – boots, socks, moleskin – There’s lots of little things in the foot area to think about. Do you have broken in dependable boots for walking? Can you seriously say your boots will give you no problems after 10 days in the field and 100 miles later? Don’t skimp on socks! Get in the habit of changing them at least once per day, i.e. two pairs per day of work. Pre-emptive sock changing can avoid athlete’s foot, blisters, and soreness. Should you have a problem with either of the first two, have some moleskin to take care of those blisters. Yeah, you can tough it out on a blister, but you don’t have to. I’ve heard duck tape also works in a pinch.
These few little things come from the ‘School of Hard Knocks’ from which I obtained a bachelor’s. Hopefully you can just get the honorary degree – it’s like the real thing, but you didn’t have to pay for it.
You know yourself better than anyone else on your team. This list isn’t at all inclusive….think about what other little things you might wish you’d thought of that would make the next FTX a little more tolerable.