CONTACT WITH LOCAL PEOPLE
You must give serious consideration to dealing with the local people. Do they have a primitive culture? Are they farmers, fishermen, friendly people, or enemy? As a survivor, "cross-cultural communication" can vary radically from area to area and from people to people. It may mean interaction with people of an extremely primitive culture or contact with people who have a relatively modem culture. A culture is identified by standards of behavior that its members consider proper and acceptable but may or may not conform to your idea of what is proper. No matter who these people are, you can expect they will have laws, social and economic values, and political and religious beliefs that may be radically different from yours. Before deploying into your area of operations, study these different cultural aspects. Prior study and preparation will help you make or avoid contact if you have to deal with the local population.
People will be friendly, unfriendly, or they will choose to ignore you. Their attitude may be unknown. If the people are known to be friendly, try to keep them friendly through your courtesy and respect for their religion, politics, social customs, habits, and all other aspects of their culture. If the people are known to be enemies or are unknowns, make every effort to avoid any contact and leave no sign of your presence. A basic knowledge of the daily habits of the local people will be essential in this attempt. If after careful observation you determine that an unknown people are friendly, you may contact them if you absolutely need their help.
Usually, you have little to fear and much to gain from cautious and respectful contact with local people of friendly or neutral countries. If you become familiar with the local customs, display common decency, and most important, show respect for their customs, you should be able to avoid trouble and possibly gain needed help. To make contact, wait until only one person is near and, if possible, let that person make the initial approach. Most people will be willing to help a survivor who appears to be in need. However, local political attitudes, instruction, or propaganda efforts may change the attitudes of otherwise friendly people. Conversely, in unfriendly countries, many people, especially in remote areas, may feel animosity toward their politicians and may be more friendly toward a survivor.
The key to successful contact with local peoples is to be friendly, courteous, and patient. Displaying fear, showing weapons, and making sudden or threatening movements can cause a local person to fear you. Such actions can prompt a hostile response. When attempting a contact, smile as often as you can. Many local peoples are shy and seem unapproachable, or they may ignore you. Approach them slowly and do not rush your contact.
THE SURVIVOR'S BEHAVIOR
Use salt, tobacco, silver money, and similar items discreetly when trading with local people. Paper money is well-known worldwide. Do not overpay; it may lead to embarrassment and even danger. Always treat people with respect. Do not bully them or laugh at them.
Using sign language or acting out needs or questions can be very effective. Many people are used to such language and communicate using nonverbal sign language. Try to learn a few words and phrases of the local language in and around your potential area of operations. Trying to speak someone's language is one of the best ways to show respect for his culture. Since English is widely used, some of the local people may understand a few words of English.
Some areas may be taboo. They range from religious or sacred places to diseased or danger areas. In some areas, certain animals must not be killed. Learn the rules and follow them. Watch and learn as much as possible. Such actions will help to strengthen relations and provide new knowledge and skills that may be very important later. Seek advice on local hazards and find out from friendly people where the hostile people are. Always remember that people frequently insist that other peoples are hostile, simply because they do not understand different cultures and distant peoples. The people they can usually trust are their immediate neighbors--much the same as in our own neighborhood.
Frequently, local people, like ourselves, will suffer from contagious diseases. Build a separate shelter, if possible, and avoid physical contact without giving the impression of doing so. Personally prepare your food and drink, if you can do so without giving offense. Frequently, the local people will accept the use of "personal or religious custom" as an explanation for isolationist behavior.
Barter, or trading, is common in more primitive societies. Hard coin is usually good, whether for its exchange value or as jewelry or trinkets. In isolated areas, matches, tobacco, salt, razor blades, empty containers, or cloth may be worth more than any form of money.
Be very cautious when touching people. Many people consider "touching" taboo and such actions may be dangerous. Avoid sexual contact.
Hospitality among some people is such a strong cultural trait that they may seriously reduce their own supplies to feed a stranger. Accept what they offer and share it equally with all present. Eat in the same way they eat and, most important, try to eat all they offer.
If you make any promises, keep them. Respect personal property and local customs and manners, even if they seem odd. Make some kind of payment for food, supplies, and so forth. Respect privacy. Do not enter a house unless invited.
CHANGES TO POLITICAL ALLEGIANCE
In today's world of fast-paced international politics, political attitudes and commitments within nations are subject to rapid change. The population of many countries, especially politically hostile countries, must not be considered friendly just because they do not demonstrate open hostility. Unless briefed to the contrary; avoid all contact with such people.
BASIC FIRE PRINCIPLES
To build a fire, it helps to understand the basic principles of a fire. Fuel (in a nongaseous state) does not burn directly. When you apply heat to a fuel, it produces a gas. This gas, combined with oxygen in the air, burns.
Understanding the concept of the fire triangle is very important in correctly constructing and maintaining a fire. The three sides of the triangle represent air, heat, and fuel. If you remove any of these, the fire will go out. The correct ratio of these components is very important for a fire to burn at its greatest capability. The only way to learn this ratio is to practice.
SITE SELECTION AND PREPARATION
You will have to decide what site and arrangement to use. Before building a fire consider--
•The area (terrain and climate) in which you are operating.
•The materials and tools available.
•Time: how much time you have?
•Need: why you need a fire?
•Security: how close is the enemy?
Look for a dry spot that--
•Is protected from the wind.
•Is suitably placed in relation to your shelter (if any).
•Will concentrate the heat in the direction you desire.
•Has a supply of wood or other fuel available. (See Figure 7-4 for types of material you can use.)
If you are in a wooded or brush-covered area, clear the brush and scrape the surface soil from the spot you have selected. Clear a circle at least 1 meter in diameter so there is little chance of the fire spreading.
If time allows, construct a fire wall using logs or rocks. This wall will help to reflector direct the heat where you want it (Figure 7-1). It will also reduce flying sparks and cut down on the amount of wind blowing into the fire. However, you will need enough wind to keep the fire burning.
CAUTION
Do not use wet or porous rocks as they may explode when heated.
In some situations, you may find that an underground fireplace will best meet your needs. It conceals the fire and serves well for cooking food. To make an underground fireplace or Dakota fire hole (Figure 7-2)--
•Dig a hole in the ground.
•On the upwind side of this hole, poke or dig a large connecting hole for ventilation.
•Build your fire in the hole as illustrated.
If you are in a snow-covered area, use green logs to make a dry base for your fire (Figure 7-3). Trees with wrist-sized trunks are easily broken in extreme cold. Cut or break several green logs and lay them side by side on top of the snow. Add one or two more layers. Lay the top layer of logs opposite those below it.
FIRE MATERIAL SELECTION
You need three types of materials (Figure 7-4) to build a fire--tinder, kindling, and fuel.
Tinder is dry material that ignites with little heat--a spark starts a fire. The tinder must be absolutely dry to be sure just a spark will ignite it. If you only have a device that generates sparks, charred cloth will be almost essential. It holds a spark for long periods, allowing you to put tinder on the hot area to generate a small flame. You can make charred cloth by heating cotton cloth until it turns black, but does not burn. Once it is black, you must keep it in an airtight container to keep it dry. Prepare this cloth well in advance of any survival situation. Add it to your individual survival kit.
Kindling is readily combustible material that you add to the burning tinder. Again, this material should be absolutely dry to ensure rapid burning. Kindling increases the fire's temperature so that it will ignite less combustible material.
Fuel is less combustible material that burns slowly and steadily once ignited.
HOW TO BUILD A FIRE
There are several methods for laying a fire, each of which has advantages. The situation you find yourself in will determine which fire to use.
Tepee
To make this fire (Figure 7-5), arrange the tinder and a few sticks of kindling in the shape of a tepee or cone. Light the center. As the tepee burns, the outside logs will fall inward, feeding the fire. This type of fire burns well even with wet wood.
Lean-To
To lay this fire (Figure 7-5), push a green stick into the ground at a 30-degree angle. Point the end of the stick in the direction of the wind. Place some tinder deep under this lean-to stick. Lean pieces of kindling against the lean-to stick. Light the tinder. As the kindling catches fire from the tinder, add more kindling.
Cross-Ditch
To use this method (Figure 7-5), scratch a cross about 30 centimeters in size in the ground. Dig the cross 7.5 centimeters deep. Put a large wad of tinder in the middle of the cross. Build a kindling pyramid above the tinder. The shallow ditch allows air to sweep under the tinder to provide a draft.
Pyramid
To lay this fire (Figure 7-5), place two small logs or branches parallel on the ground. Place a solid layer of small logs across the parallel logs. Add three or four more layers of logs or branches, each layer smaller than and at a right angle to the layer below it. Make a starter fire on top of the pyramid. As the starter fire burns, it will ignite the logs below it. This gives you a fire that burns downward, requiring no attention during the night.
There are several other ways to lay a fire that are quite effective. Your situation and the material available in the area may make another method more suitable.
Bump: HOW TO LIGHT A FIRE
Always light your fire from the upwind side. Make sure to lay your tinder, kindling, and fuel so that your fire will burn as long as you need it. Igniters provide the initial heat required to start the tinder burning. They fall into two categories: modern methods and primitive methods.
Modern Methods
Modem igniters use modem devices--items we normally think of to start a fire.
Matches
Make sure these matches are waterproof. Also, store them in a waterproof container along with a dependable striker pad.
Convex Lens
Use this method (Figure 7-6) only on bright, sunny days. The lens can come from binoculars, camera, telescopic sights, or magnifying glasses. Angle the lens to concentrate the sun's rays on the tinder. Hold the lens over the same spot until the tinder begins to smolder. Gently blow or fan the tinder into flame, and apply it to the fire lay.
Metal Match
Place a flat, dry leaf under your tinder with a portion exposed. Place the tip of the metal match on the dry leaf, holding the metal match in one hand and a knife in the other. Scrape your knife against the metal match to produce sparks. The sparks will hit the tinder. When the tinder starts to smolder, proceed as above.
Battery
Use a battery to generate a spark. Use of this method depends on the type of battery available. Attach a wire to each terminal. Touch the ends of the bare wires together next to the tinder so the sparks will ignite it.
Gunpowder
Often, you will have ammunition with your equipment. If so, carefully extract the bullet from the shell casing, and use the gunpowder as tinder. A spark will ignite the powder. Be extremely careful when extracting the bullet from the case.
Primitive Methods
Primitive igniters are those attributed to our early ancestors.
Flint and Steel
The direct spark method is the easiest of the primitive methods to use. The flint and steel method is the most reliable of the direct spark methods. Strike a flint or other hard, sharp-edged rock edge with a piece of carbon steel (stainless steel will not produce a good spark). This method requires a loose-jointed wrist and practice. When a spark has caught in the tinder, blow on it. The spark will spread and burst into flames.
Fire-Plow
The fire-plow (Figure 7-7) is a friction method of ignition. You rub a hardwood shaft against a softer wood base. To use this method, cut a straight groove in the base and plow the blunt tip of the shaft up and down the groove. The plowing action of the shaft pushes out small particles of wood fibers. Then, as you apply more pressure on each stroke, the friction ignites the wood particles.
Bow and Drill
The technique of starting a fire with a bow and drill (Figure 7-8) is simple, but you must exert much effort and be persistent to produce a fire. You need the following items to use this method:
•Socket. The socket is an easily grasped stone or piece of hardwood or bone with a slight depression in one side. Use it to hold the drill in place and to apply downward pressure.
•Drill. The drill should be a straight, seasoned hardwood stick about 2 centimeters in diameter and 25 centimeters long. The top end is round and the low end blunt (to produce more friction).
•Fire board. Its size is up to you. A seasoned softwood board about 2.5 centimeters thick and 10 centimeters wide is preferable. Cut a depression about 2 centimeters from the edge on one side of the board. On the underside, make a V-shaped cut from the edge of the board to the depression.
•Bow. The bow is a resilient, green stick about 2.5 centimeters in diameter and a string. The type of wood is not important. The bowstring can be any type of cordage. You tie the bowstring from one end of the bow to the other, without any slack.
To use the bow and drill, first prepare the fire lay. Then place a bundle of tinder under the V-shaped cut in the fire board. Place one foot on the fire board. Loop the bowstring over the drill and place the drill in the precut depression on the fire board. Place the socket, held in one hand, on the top of the drill to hold it in position. Press down on the drill and saw the bow back and forth to twirl the drill (Figure 7-8). Once you have established a smooth motion, apply more downward pressure and work the bow faster. This action will grind hot black powder into the tinder, causing a spark to catch. Blow on the tinder until it ignites.
Note: Primitive fire-building methods are exhaustive and require practice to ensure success.
HELPFUL HINTS
Use nonaromatic seasoned hardwood for fuel, if possible.
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Collect kindling and tinder along the trail.
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Add insect repellent to the tinder.
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Keep the firewood dry.
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Dry damp firewood near the fire.
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Bank the fire to keep the coals alive overnight.
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Carry lighted punk, when possible.
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Be sure the fire is out before leaving camp.
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Do not select wood lying on the ground. It may appear to be dry but generally doesn't provide enough friction.
REQUIREMENTS FOR MAINTENANCE OF HEALTH
To survive, you need water and food. You must also have and apply high personal hygiene standards.
Water
Your body loses water through normal body processes (sweating, urinating, and defecating). During average daily exertion when the atmospheric temperature is 20 degrees Celsius (C) (68 degrees Fahrenheit), the average adult loses and therefore requires 2 to 3 liters of water daily. Other factors, such as heat exposure, cold exposure, intense activity, high altitude, burns, or illness, can cause your body to lose more water. You must replace this water.
Dehydration results from inadequate replacement of lost body fluids. It decreases your efficiency and, if injured, increases your susceptibility to severe shock. Consider the following results of body fluid loss:
•A 5 percent loss of body fluids results in thirst, irritability, nausea, and weakness.
•A 10 percent loss results in dizziness, headache, inability to walk, and a tingling sensation in the limbs.
•A 15 percent loss results in dim vision, painful urination, swollen tongue, deafness, and a numb feeling in the skin.
•A loss greater than 15 percent of body fluids may result in death.
The most common signs and symptoms of dehydration are--
•Dark urine with a very strong odor.
•Low urine output.
•Dark, sunken eyes.
•Fatigue.
•Emotional instability.
•Loss of skin elasticity.
•Delayed capillary refill in fingernail beds.
•Trench line down center of tongue.
•Thirst. Last on the list because you are already 2 percent dehydrated by the time you crave fluids.
You replace the water as you lose it. Trying to make up a deficit is difficult in a survival situation, and thirst is not a sign of how much water you need.
Most people cannot comfortably drink more than 1 liter of water at a time. So, even when not thirsty, drink small amounts of water at regular intervals each hour to prevent dehydration.
If you are under physical and mental stress or subject to severe conditions, increase your water intake. Drink enough liquids to maintain a urine output of at least 0.5 liter every 24 hours.
In any situation where food intake is low, drink 6 to 8 liters of water per day. In an extreme climate, especially an arid one, the average person can lose 2.5 to 3.5 liters of water per hour. In this type of climate, you should drink 14 to 30 liters of water per day.
With the loss of water there is also a loss of electrolytes (body salts). The average diet can usually keep up with these losses but in an extreme situation or illness, additional sources need to be provided. A mixture of 0.25 teaspoon of salt to 1 liter of water will provide a concentration that the body tissues can readily absorb.
Of all the physical problems encountered in a survival situation, the loss of water is the most preventable. The following are basic guidelines for the prevention of dehydration:
•Always drink water when eating. Water is used and consumed as a part of the digestion process and can lead to dehydration.
•Acclimatize. The body performs more efficiently in extreme conditions when acclimatized.
•Conserve sweat not water. Limit sweat-producing activities but drink water.
•Ration water. Until you find a suitable source, ration your water sensibly. A daily intake of 500 cubic centimeter (0.5 liter) of a sugar-water mixture (2 teaspoons per liter) will suffice to prevent severe dehydration for at least a week, provided you keep water losses to a minimum by limiting activity and heat gain or loss.
You can estimate fluid loss by several means. A standard field dressing holds about 0.25 liter (one-fourth canteen) of blood. A soaked T-shirt holds 0.5 to 0.75 liter.
You can also use the pulse and breathing rate to estimate fluid loss. Use the following as a guide:
•With a 0.75 liter loss the wrist pulse rate will be under 100 beats per minute and the breathing rate 12 to 20 breaths per minute.
•With a 0.75 to 1.5 liter loss the pulse rate will be 100 to 120 beats per minute and 20 to 30 breaths per minute.
•With a 1.5 to 2 liter loss the pulse rate will be 120 to 140 beats per minute and 30 to 40 breaths per minute. Vital signs above these rates require more advanced care.
Food
Although you can live several weeks without food, you need an adequate amount to stay healthy. Without food your mental and physical capabilities will deteriorate rapidly, and you will become weak. Food replenishes the substances that your body burns and provides energy. It provides vitamins, minerals, salts, and other elements essential to good health. Possibly more important, it helps morale.
The two basic sources of food are plants and animals (including fish). In varying degrees both provide the calories, carbohydrates, fats, and proteins needed for normal daily body functions.
Calories are a measure of heat and potential energy. The average person needs 2,000 calories per day to function at a minimum level. An adequate amount of carbohydrates, fats, and proteins without an adequate caloric intake will lead to starvation and cannibalism of the body's own tissue for energy.
Plant Foods
These foods provide carbohydrates--the main source of energy. Many plants provide enough protein to keep the body at normal efficiency. Although plants may not provide a balanced diet, they will sustain you even in the arctic, where meat's heat-producing qualities are normally essential. Many plant foods such as nuts and seeds will give you enough protein and oils for normal efficiency. Roots, green vegetables, and plant food containing natural sugar will provide calories and carbohydrates that give the body natural energy.
The food value of plants becomes more and more important if you are eluding the enemy or if you are in an area where wildlife is scarce. For instance--
•You can dry plants by wind, air, sun, or fire. This retards spoilage so that you can store or carry the plant food with you to use when needed.
•You can obtain plants more easily and more quietly than meat. This is extremely important when the enemy is near.
Animal Foods
Meat is more nourishing than plant food. In fact, it may even be more readily available in some places. However, to get meat, you need to know the habits of, and how to capture, the various wildlife.
To satisfy your immediate food needs, first seek the more abundant and more easily obtained wildlife, such as insects, crustaceans, mollusks, fish, and reptiles. These can satisfy your immediate hunger while you are preparing traps and snares for larger game.
Personal Hygiene
In any situation, cleanliness is an important factor in preventing infection and disease. It becomes even more important in a survival situation. Poor hygiene can reduce your chances of survival.
A daily shower with hot water and soap is ideal, but you can stay clean without this luxury. Use a cloth and soapy water to wash yourself. Pay special attention to the feet, armpits, crotch, hands, and hair as these are prime areas for infestation and infection. If water is scarce, take an "air" bath. Remove as much of your clothing as practical and expose your body to the sun and air for at least 1 hour. Be careful not to sunburn.
If you don't have soap, use ashes or sand, or make soap from animal fat and wood ashes, if your situation allows. To make soap--
•Extract grease from animal fat by cutting the fat into small pieces and cooking them in a pot.
•Add enough water to the pot to keep the fat from sticking as it cooks.
•Cook the fat slowly, stirring frequently.
•After the fat is rendered, pour the grease into a container to harden.
•Place ashes in a container with a spout near the bottom.
•Pour water over the ashes and collect the liquid that drips out of the spout in a separate container. This liquid is the potash or lye. Another way to get the lye is to pour the slurry (the mixture of ashes and water) through a straining cloth.
•In a cooking pot, mix two parts grease to one part potash.
•Place this mixture over a fire and boil it until it thickens.
After the mixture--the soap--cools, you can use it in the semiliquid state directly from the pot. You can also pour it into a pan, allow it to harden, and cut it into bars for later use.
Keep Your Hands Clean
Germs on your hands can infect food and wounds. Wash your hands after handling any material that is likely to carry germs, after visiting the latrine, after caring for the sick, and before handling any food, food utensils, or drinking water. Keep your fingernails closely trimmed and clean, and keep your fingers out of your mouth.
Keep Your Hair Clean
Your hair can become a haven for bacteria or fleas, lice, and other parasites. Keeping your hair clean, combed, and trimmed helps you avoid this danger.
Keep Your Clothing Clean
Keep your clothing and bedding as clean as possible to reduce the chance of skin infection as well as to decrease the danger of parasitic infestation. Clean your outer clothing whenever it becomes soiled. Wear clean underclothing and socks each day. If water is scarce, "air" clean your clothing by shaking, airing, and sunning it for 2 hours. If you are using a sleeping bag, turn it inside out after each use, fluff it, and air it.
Keep Your Teeth Clean
Thoroughly clean your mouth and teeth with a toothbrush at least once each day. If you don't have a toothbrush, make a chewing stick. Find a twig about 20 centimeters long and 1 centimeter wide. Chew one end of the stick to separate the fibers. Now brush your teeth thoroughly. Another way is to wrap a clean strip of cloth around your fingers and rub your teeth with it to wipe away food particles. You can also brush your teeth with small amounts of sand, baking soda, salt, or soap. Then rinse your mouth with water, salt water, or willow bark tea. Also, flossing your teeth with string or fiber helps oral hygiene.
If you have cavities, you can make temporary fillings by placing candle wax, tobacco, aspirin, hot pepper, tooth paste or powder, or portions of a ginger root into the cavity. Make sure you clean the cavity by rinsing or picking the particles out of the cavity before placing a filling in the cavity.
Take Care of Your Feet
To prevent serious foot problems, break in your shoes before wearing them on any mission. Wash and massage your feet daily. Trim your toenails straight across. Wear an insole and the proper size of dry socks. Powder and check your feet daily for blisters.
If you get a small blister, do not open it. An intact blister is safe from infection. Apply a padding material around the blister to relieve pressure and reduce friction. If the blister bursts, treat it as an open wound. Clean and dress it daily and pad around it. Leave large blisters intact. To avoid having the blister burst or tear under pressure and cause a painful and open sore, do the following:
•Obtain a sewing-type needle and a clean or sterilized thread.
•Run the needle and thread through the blister after cleaning the blister.
•Detach the needle and leave both ends of the thread hanging out of the blister. The thread will absorb the liquid inside. This reduces the size of the hole and ensures that the hole does not close up.
•Pad around the blister.
Get Sufficient Rest
You need a certain amount of rest to keep going. Plan for regular rest periods of at least 10 minutes per hour during your daily activities. Learn to make yourself comfortable under less than ideal conditions. A change from mental to physical activity or vice versa can be refreshing when time or situation does not permit total relaxation.
Keep Camp Site Clean
Do not soil the ground in the camp site area with urine or feces. Use latrines, if available. When latrines are not available, dig "cat holes" and cover the waste. Collect drinking water upstream from the camp site. Purify all water.
MEDICAL EMERGENCIES
Medical problems and emergencies you may be faced with include breathing problems, severe bleeding, and shock.
Breathing Problems
Any one of the following can cause airway obstruction, resulting in stopped breathing:
•Foreign matter in mouth of throat that obstructs the opening to the trachea.
•Face or neck injuries.
•Inflammation and swelling of mouth and throat caused by inhaling smoke, flames, and irritating vapors or by an allergic reaction.
•"Kink" in the throat (caused by the neck bent forward so that the chin rests upon the chest) may block the passage of air.
•Tongue blocks passage of air to the lungs upon unconsciousness. When an individual is unconscious, the muscles of the lower jaw and tongue relax as the neck drops forward, causing the lower jaw to sag and the tongue to drop back and block the passage of air.
Severe Bleeding
Severe bleeding from any major blood vessel in the body is extremely dangerous. The loss of 1 liter of blood will produce moderate symptoms of shock. The loss of 2 liters will produce a severe state of shock that places the body in extreme danger. The loss of 3 liters is usually fatal.
Shock
Shock (acute stress reaction) is not a disease in itself. It is a clinical condition characterized by symptoms that arise when cardiac output is insufficient to fill the arteries with blood under enough pressure to provide an adequate blood supply to the organs and tissues.
LIFESAVING STEPS
Control panic, both your own and the victim's. Reassure him and try to keep him quiet.
Perform a rapid physical exam. Look for the cause of the injury and follow the ABCs of first aid, starting with the airway and breathing, but be discerning. A person may die from arterial bleeding more quickly than from an airway obstruction in some cases.
Open Airway and Maintain
You can open an airway and maintain it by using the following steps.
Step 1. Check if the victim has a partial or complete airway obstruction. If he can cough or speak, allow him to clear the obstruction naturally. Stand by, reassure the victim, and be ready to clear his airway and perform mouth-to-mouth resuscitation should he become unconscious. If his airway is completely obstructed, administer abdominal thrusts until the obstruction is cleared.
Step 2. Using a finger, quickly sweep the victim's mouth clear of any foreign objects, broken teeth, dentures, sand.
Step 3. Using the jaw thrust method, grasp the angles of the victim's lower jaw and lift with both hands, one on each side, moving the jaw forward. For stability, rest your elbows on the surface on which the victim is lying. If his lips are closed, gently open the lower lip with your thumb (Figure 4-1).
Step 4. With the victim's airway open, pinch his nose closed with your thumb and forefinger and blow two complete breaths into his lungs. Allow the lungs to deflate after the second inflation and perform the following:
•Look for his chest to rise and fall.
•Listen for escaping air during exhalation.
•Feel for flow of air on your cheek.
Step 5. If the forced breaths do not stimulate spontaneous breathing, maintain the victim's breathing by performing mouth-to-mouth resuscitation.
Step 6. There is danger of the victim vomiting during mouth-to-mouth resuscitation. Check the victim's mouth periodically for vomit and clear as needed.
Note: Cardiopulmonary resuscitation (CPR) may be necessary after cleaning the airway, but only after major bleeding is under control. See FM 21-20, the American Heart Association manual, the Red Cross manual, or most other first aid books for detailed instructions on CPR.
Control Bleeding
In a survival situation, you must control serious bleeding immediately because replacement fluids normally are not available and the victim can die within a matter of minutes. External bleeding falls into the following classifications (according to its source):
•Arterial. Blood vessels called arteries carry blood away from the heart and through the body. A cut artery issues bright red blood from the wound in distinct spurts or pulses that correspond to the rhythm of the heartbeat. Because the blood in the arteries is under high pressure, an individual can lose a large volume of blood in a short period when damage to an artery of significant size occurs. Therefore, arterial bleeding is the most serious type of bleeding. If not controlled promptly, it can be fatal.
•Venous. Venous blood is blood that is returning to the heart through blood vessels called veins. A steady flow of dark red, maroon, or bluish blood characterizes bleeding from a vein. You can usually control venous bleeding more easily than arterial bleeding.
•Capillary. The capillaries are the extremely small vessels that connect the arteries with the veins. Capillary bleeding most commonly occurs in minor cuts and scrapes. This type of bleeding is not difficult to control.
You can control external bleeding by direct pressure, indirect (pressure points) pressure, elevation, digital ligation, or tourniquet.
Direct Pressure
The most effective way to control external bleeding is by applying pressure directly over the wound. This pressure must not only be firm enough to stop the bleeding, but it must also be maintained long enough to "seal off" the damaged surface.
If bleeding continues after having applied direct pressure for 30 minutes, apply a pressure dressing. This dressing consists of a thick dressing of gauze or other suitable material applied directly over the wound and held in place with a tightly wrapped bandage (Figure 4-2). It should be tighter than an ordinary compression bandage but not so tight that it impairs circulation to the rest of the limb. Once you apply the dressing, do not remove it, even when the dressing becomes blood soaked.
Leave the pressure dressing in place for 1 or 2 days, after which you can remove and replace it with a smaller dressing.
In the long-term survival environment, make fresh, daily dressing changes and inspect for signs of infection.
Elevation
Raising an injured extremity as high as possible above the heart's level slows blood loss by aiding the return of blood to the heart and lowering the blood pressure at the wound. However, elevation alone will not control bleeding entirely; you must also apply direct pressure over the wound. When treating a snakebite, however, keep the extremity lower than the heart.
Pressure Points
A pressure point is a location where the main artery to the wound lies near the surface of the skin or where the artery passes directly over a bony prominence (Figure 4-3). You can use digital pressure on a pressure point to slow arterial bleeding until the application of a pressure dressing. Pressure point control is not as effective for controlling bleeding as direct pressure exerted on the wound. It is rare when a single major compressible artery supplies a damaged vessel.
If you cannot remember the exact location of the pressure points, follow this rule: Apply pressure at the end of the joint just above the injured area. On hands, feet, and head, this will be the wrist, ankle, and neck, respectively.
WARNING
Use caution when applying pressure to the neck. Too much pressure for too long may cause unconsciousness or death. Never place a tourniquet around the neck.
Maintain pressure points by placing a round stick in the joint, bending the joint over the stick, and then keeping it tightly bent by lashing. By using this method to maintain pressure, it frees your hands to work in other areas.
Digital Ligation
You can stop major bleeding immediately or slow it down by applying pressure with a finger or two on the bleeding end of the vein or artery. Maintain the pressure until the bleeding stops or slows down enough to apply a pressure bandage, elevation, and so forth.
Tourniquet
Use a tourniquet only when direct pressure over the bleeding point and all other methods did not control the bleeding. If you leave a tourniquet in place too long, the damage to the tissues can progress to gangrene, with a loss of the limb later. An improperly applied tourniquet can also cause permanent damage to nerves and other tissues at the site of the constriction.
If you must use a tourniquet, place it around the extremity, between the wound and the heart, 5 to 10 centimeters above the wound site (Figure 4-4). Never place it directly over the wound or a fracture. Use a stick as a handle to tighten the tourniquet and tighten it only enough to stop blood flow. When you have tightened the tourniquet, bind the free end of the stick to the limb to prevent unwinding.
After you secure the tourniquet, clean and bandage the wound. A lone survivor does not remove or release an applied tourniquet. In a buddy system, however, the buddy can release the tourniquet pressure every 10 to 15 minutes for 1 or 2 minutes to let blood flow to the rest of the extremity to prevent limb loss.
Prevent and Treat Shock
Anticipate shock in all injured personnel. Treat all injured persons as follows, regardless of what symptoms appear (Figure 4-5):
•If the victim is conscious, place him on a level surface with the lower extremities elevated 15 to 20 centimeters.
•If the victim is unconscious, place him on his side or abdomen with his head turned to one side to prevent choking on vomit, blood, or other fluids.
•If you are unsure of the best position, place the victim perfectly flat. Once the victim is in a shock position, do not move him.
•Maintain body heat by insulating the victim from the surroundings and, in some instances, applying external heat.
•If wet, remove all the victim's wet clothing as soon as possible and replace with dry clothing.
•Improvise a shelter to insulate the victim from the weather.
•Use warm liquids or foods, a prewarmed sleeping bag, another person, warmed water in canteens, hot rocks wrapped in clothing, or fires on either side of the victim to provide external warmth.
•If the victim is conscious, slowly administer small doses of a warm salt or sugar solution, if available.
•If the victim is unconscious or has abdominal wounds, do not give fluids by mouth.
•Have the victim rest for at least 24 hours.
•If you are a lone survivor, lie in a depression in the ground, behind a tree, or any other place out of the weather, with your head lower than your feet.
•If you are with a buddy, reassess your patient constantly.
Bump: to morrow i will add
•Bone and Joint Injury
•Bites and Strings
•Wounds
•Environmental Injuries
•Herbal Medicines