EMERGENCY CARE OF THE SICK AND INJURED
A nuclear attack on the United States would cause great numbers of casualties, and there would be fewer doctors, nurses and hospitals available to care for them. Even in areas where no nuclear weapons exploded, radioactive fallout could prevent doctors and nurses from reaching injured or sick persons for a considerable period of time.
People would have to help each other during the emergency. Those in a stocked public fallout shelter would have available the basic medical kit stored there, and perhaps one or more shelter occupants might be a doctor, nurse, or trained first-aider. But persons in a home shelter would have only the medical supplies available at home, and would have to depend on their own knowledge of first aid and emergency medical care.
Both adults and teenagers can acquire these valuable skills now by taking free courses that are offered in many communities, such as the Medical Self-Help course or a First Aid course.
The following information is no substitute for one of these courses. This basic guidance may save lives during a nuclear emergency, however, by helping untrained persons take care of the sick and injured when professional medical assistance may not be immediately available.
General Rules For Any Medical Emergency
1. First of all, do no harm. Often, well-meaning but untrained persons worsen the injury or illness in their attempts to help. Get competent medical assistance, if possible. Do not assume responsibility for a patient if you can get the help of a doctor, nurse, or experienced first-aid worker. But if no one better qualified is available, take charge yourself.
2. Look for stoppage of breathing, and for serious bleeding. These are the two most life-threatening conditions you can do something about. They demand immediate treatment (see pages [58] and [61]).
8. Prevent shock, or treat it. Shock, a serious condition of acute circulatory failure, usually accompanies a severe or painful injury, a serious loss of blood, or a severe emotional upset. If you expect shock, and take prompt action, you can prevent it or lessen its severity. This may save the patient's life. (Treatment of shock is discussed on page [62]).
4. Don't move the patient immediately. Unless there is real danger of the patient receiving further injury where he is, he should not be moved until breathing is restored, bleeding is stopped, and suspected broken bones are splinted.
5. Keep calm, and reassure the patient. Keep him lying down and comfortably warm, but do not apply heat to his body, or make him sweat.
6. Never attempt to give liquids to an unconscious person. If he is not able to swallow, he may choke to death or drown. Also, don't give him any liquids to drink if he has an abdominal injury.
If the Patient Has Stopped Breathing
Quick action is required. You must get air into his lungs again immediately or he may die. The best and simplest way of doing this is to use mouth-to-mouth artificial respiration. Here is how to do it:
1. Place the patient on his back. Loosen his collar.
2. Open his mouth and use your fingers to remove any food or foreign matter. If he has false teeth or removable dental bridges, take them out.
3. Tilt the patient's head back so that his chin points upward. Lift his lower jaw from beneath and behind so that it juts out. This will move his tongue away from the back of his throat, so it does not block the air passage to his lungs. Placing a pillow or something else under his shoulders will help get his head into the right position. Some patients will start breathing as soon as you take these steps, and no further help is necessary.
4. Open your mouth as wide as possible, and place it tightly over the patient's mouth, so his mouth is completely covered by yours. With one hand, pinch his nostrils shut. With your other hand, hold his lower jaw in a thrust-forward position and keep his head tilted back. With a baby or small child, place your mouth over both his nose and mouth, making a tight seal.
5. Blow a good lungful of air into an adult patient's mouth, continuing to keep his head tilted back and his jaw jutting out so that the air passage is kept open. (Air can be blown through an unconscious person's teeth, even though they may be clenched tightly together.) Watch his chest as you blow. When you see his chest rise, you will know that you are getting air into his lungs.
6. Remove your mouth from the patient's mouth, and listen for him to breathe out the air you breathed into him. You also may feel his breath on your cheek and see his chest sink as he exhales.
7. Continue your breathing for the patient. If he is an adult, blow a good breath into his mouth every 5 seconds, or 12 times a minute, and listen for him to breathe it back out again. Caution: If the patient is an infant or small child, blow small puffs of air into him about 20 times a minute. You may rupture his lung if you blow in too much air at one time. Watch his chest rise to make sure you are giving him the right amount of air with each puff.
8. If you are not getting air into the patient's lungs, or if he is not breathing out the air you blew into him, first make sure that his head is tilted back and his jaw is jutting out in the proper position. Then use your fingers to make sure nothing in his mouth or throat is obstructing the air passage to his lungs. If this does not help, turn him on his side and strike him sharply with the palm of your hand several times between his shoulder blades. This should dislodge any obstruction in the air passage. Then place him again on his back, with his head tilted back and his jaw jutting out, and resume blowing air into his mouth. If this doesn't work, try closing his mouth and blowing air through his nose into his lungs.
9. If you wish to avoid placing your mouth directly on the patient's face, you may hold a cloth (handkerchief, gauze or other porous material) over his mouth and breathe through the cloth. But don't waste precious time looking for a cloth if you don't have one.
10. Important: Even if the patient does not respond, continue your efforts for 1 hour or longer, or until you are completely sure he is dead. If possible, have this confirmed by at least one other person.
1. Apply firm, even pressure to the wound with a dressing, clean cloth, or sanitary napkin. If you don't have any of these, use your bare hand until you can get something better. Remember, you must keep blood from running out of the patient's body. Loss of 1 or 2 quarts will seriously endanger his life.
2. Hold the dressing in place with your hand until you can bandage the dressing in place. In case of an arm or leg wound, make sure the bandage is not so tight as to cut off circulation; and raise the arm or leg above the level of the patient's heart. (But if the arm or leg appears broken, be sure to splint it first.)
3. Treat the patient for shock (see page [62]).
4. If blood soaks through the dressing, do not remove the dressing. Apply more dressings.
5. SPECIAL ADVICE ON TOURNIQUETS: Never use a tourniquet unless you cannot stop excessive, life-threatening bleeding by any other method. Using a tourniquet increases the chances that the arm or leg will have to be amputated later. If you are forced to use a tourniquet to keep the patient from bleeding to death (for example, when a hand or foot has been accidentally cut off), follow these instructions carefully:
--Place the tourniquet as close to the wound as possible, between the wound and the patient's heart.
--After the tourniquet has been applied, do not permit it to be loosened (even temporarily, or even though the bleeding has stopped) by anyone except a physician, who can control the bleeding by other methods and replace the blood that the patient has lost.
--Get a physician to treat the patient as soon as possible.
Preventing and Treating Shock
Being "in shock" means that a person's circulatory system is not working properly, and not enough blood is getting to the vital centers of his brain and spinal cord.
These are the symptoms of shock: The patient's pulse is weak or rapid, or he may have no pulse that you can find. His skin may be pale or blue, cold, or moist. His breathing may be shallow or irregular. He may have chills. He may be thirsty. He may get sick at his stomach and vomit.
A person can be "in shock" whether he is conscious or unconscious.
Important: All seriously-injured persons should be treated for shock, even though they appear normal and alert. Shock may cause death if not treated promptly, even though the injuries which brought on shock might not be serious enough to cause death. In fact, persons may go into shock without having any physical injuries.
Here is how to treat any person who may be in shock:
1. Keep him lying down and keep him from chilling, but do not apply a hot water bottle or other heat to his body. Also, loosen his clothing.
2. Keep his head a little lower than his legs and hips. But if he has a head or chest injury, or has difficulty in breathing, keep his head and shoulders slightly higher than the rest of his body.
3. Encourage him to drink fluids if he is conscious and not nauseated, and if he does not have abdominal injuries. Every 15 minutes give him a half-glass of this solution until he no longer wants it: One teaspoonful of salt and a half-teaspoonful of baking soda to one quart of water.
4. Do not give him alcohol.
Broken Bones
Any break in a bone is called a fracture. If you think a person may have a fracture, treat it as though it were one. Otherwise, you may cause further injury. For example, if an arm or leg is injured and bleeding, splint it as well as bandage it.
With any fracture, first look for bleeding and control it. Keep the patient comfortably warm and quiet, preferably lying down. If you have an ice bag, apply it to the fracture to ease the pain. Do not move the patient (unless his life is in danger where he is) without first applying a splint or otherwise immobilizing the bone that may be fractured. Treat the patient for shock.
A FRACTURED ARM OR LEG should be straightened out as much as possible, preferably by having 2 persons gently stretch it into a normal position. Then it should be "splinted"--that is, fastened to a board or something else to prevent motion and keep the ends of the broken bone together. As a splint, use a board, a trimmed branch from a tree, a broomstick, an umbrella, a roll of newspapers, or anything else rigid enough to keep the arm or leg straight. Fasten the arm or leg to the splint with bandages, strips of cloth, handkerchiefs, neckties, or belts. After splinting, keep the injured arm or leg a little higher than the rest of the patient's body. From time to time, make sure that the splint is not too tight, since the arm or leg may swell, and the blood circulation might be shut off. If the broken bone is sticking out through the skin but the exposed part of it is clean, allow it to slip back naturally under the skin (but don't push it in) when the limb is being straightened. However, if the exposed part of the bone is dirty, cover it with a clean cloth and bandage the wound to stop the bleeding. Then splint the arm or leg without trying to straighten it out, and try to find a doctor or nurse to treat the patient.
A FRACTURED COLLAR-BONE should also be prevented from moving, until the patient can get professional medical attention. It can be immobilized by placing the arm on that side in a sling and then binding the arm close to the body.
A FRACTURED RIB should be suspected if the patient has received a chest injury or if he has pain when he moves his chest, breathes, or coughs. Strap the injured side of his chest with 2-inch adhesive tape if available, or with a cloth bandage or towel wrapped around and around his entire chest.
Fractured bones in the NECK OR BACK are very serious, because they may injure the patient's spinal cord and paralyze him or even kill him. He should not be moved until a doctor comes (or a person trained in first aid), unless it is absolutely necessary to move him to prevent further injury. If a person with a back injury has to be moved, he should be placed gently on his back on a stiff board, door or stretcher. His head, back, and legs should be kept in a straight line at all times.
A person with a neck injury should be moved gently with his head, neck, and shoulders kept in the same position they were when he was found. His neck should not be allowed to bend when he is being moved.
Burns
Non-serious or superficial (first degree) burns should not be covered--in fact, nothing need be done for them. However, if a first degree burn covers a large area of the body, the patient should be given fluids to drink as mentioned in item 2 following.
The most important things to do about serious (second or third degree) burns are: (a) Treat the patient for shock, (b) Prevent infection, and (c) Relieve pain. These specific actions should be taken:
1. Keep the patient lying down, with his head a little lower than his legs and hips unless he has a head or chest wound, or has difficulty in breathing.
2. Have him drink a half-glass every 15 minutes of a salt-and-soda solution (one teaspoonful of salt and a half-teaspoonful of baking soda to a quart of water). Give him additional plain water to drink if he wants it.
3. Cover the burned area with a dry, sterile gauze dressing. If gauze is not available, use a clean cloth, towel or pad.
4. With soap and water, wash the area around the burn (not the burn itself) for a distance of several inches, wiping away from the burn. The dressing will help prevent surface washings from getting into the burned area.
5. Use a bandage to hold the dry dressing firmly in place against the burned area. This will keep moving air from reaching the burn, and will lessen the pain. Leave dressings and bandage in place as long as possible.
6. If adjoining surfaces of skin are burned, separate them with gauze or cloth to keep them from sticking together (such as between toes or fingers, ears and head, arms and chest).
7. If the burn was caused by a chemical--or by fallout particles sticking to the skin or hair--wash the chemical or the fallout particles away with generous amounts of plain water, then treat the burn as described above.
What NOT to do about burns:
--Don't pull clothing over the burned area (cut it away, if necessary).
--Don't try to remove any pieces of cloth, or bits of dirt or debris, that may be sticking to the burn.
--Don't try to clean the burn; don't use iodine or other antiseptics on it; and don't open any blisters that may form on it.
--Don't use grease, butter, ointment, salve, petroleum jelly, or any type of medication on severe burns. Keeping them dry is best.
--Don't breathe on a burn, and don't touch it with anything except a sterile or clean dressing.
--Don't change the dressings that were initially applied to the burn, until absolutely necessary. Dressings may be left in place for a week, if necessary.
Radiation Sickness
Radiation sickness is caused by the invisible rays given off by particles of radioactive fallout. If a person has received a large dose of radiation in a short period of time--generally, less than a week--he will become seriously ill and probably will die. But if he has received only a small or medium dose, his body will repair itself and he will get well. No special clothing can protect a person from gamma radiation, and no special medicines can protect him or cure him of radiation sickness.
Symptoms of radiation sickness may not be noticed for several days. The early symptoms are lack of appetite, nausea, vomiting, fatigue, weakness and headache. Later, the patient may have sore mouth, loss of hair, bleeding gums, bleeding under the skin, and diarrhea. But these same symptoms can be caused by other diseases, and not everyone who has radiation sickness shows all these symptoms, or shows them all at once.
If the patient has headache or general discomfort, give him one or two aspirin tablets every 3 or 4 hours (half a tablet, for a child under 12). If he is nauseous, give him "motion sickness tablets," if available. If his mouth is sore or his gums are bleeding, have him use a mouth wash made up of a half-teaspoonful of salt to 1 quart of water. If there is vomiting or diarrhea, he should drink slowly several glasses each day of a salt-and-soda solution (one teaspoonful of salt and one-half teaspoonful of baking soda to 1 quart of cool water), plus bouillon or fruit juices. If available, a mixture of kaolin and pectin should be given for diarrhea. Whatever his symptoms, the patient should be kept lying down, comfortably warm, and resting.
Remember that radiation sickness is not contagious or infectious, and one person cannot "catch it" from another person.