Rosie Garthwaite - How to Avoid Being Killed in a War Zone

Find out what happened and look for signs of injury head to toe whether the person is conscious or not (see Head-To-Toe Check). Ask the following questions, if possible, about the patient’s recent and longer medical history:

• What medication they are taking (e.g. asthma inhaler, blood pressure pills)?

• When did they last eat or drink?

• Do they have a condition such as epilepsy, diabetes or anaphylaxis?

Such conditions will affect the way you approach treatment. If the casualty is unable to answer, look for a medical warning bracelet or pendant. These items can look very fancy, so check and double-check.

• Where is their usual medication, such as their insulin injector pen? Take a look at it.

• Do they have any allergies?

• What is their recent medical history, e.g. illnesses, operations and treatment they are already receiving, and what drugs have they taken that day? Write it down.

This applies to an unconscious but otherwise unhurt person (not a baby) and should be done only after you have established the following:

• The casualty’s airway, breathing and circulation are stable.

• The head-to-toe check (see Head-To-Toe Check) has not revealed a back or neck injury.

The recovery position is designed to keep the airway open if the casualty is having trouble breathing, and will prevent them choking if they vomit.

With the casualty lying on the floor, kneel at their side. Place their nearest arm out to the side. If they are wearing glasses, remove them.

Take the arm furthest away from you over to their nearest cheek, palm out.

Lift up the furthest knee to a bend. Hold that with one hand and their head and palm with the other, and gently roll them over into a foetal position. Their head should now be resting on their hand.

Make sure the airway is open by tilting the head back slightly. And for stable support, ensure the straight thigh and bent knee are at right angles to each other.

Hold the baby in your arms as shown in the diagram below. Their head should be tilted slightly downwards to stop them choking on their tongue or vomit.

As it can be very dangerous to move someone with a suspected spinal injury, approach with extreme caution, as follows.

If the casualty is stable, leave them as they are on the ground.One person should be assigned to make sure they do not move their head. That person needs to get comfortable as they could be there for some time. Extra support, such as towels or clothing, can be put around their hands to relieve the strain.

If the casualty is having trouble breathing, you might be forced to move them into a recovery position. This should be done as a last resort. It is the same process as the normal recovery position (see Recovery position for babies), except that somebody holds the head while the turning process happens. They must continue to hold the head stable after the turn has happened, so, as before, they need to get comfortable.

With adults and children over the age of around seven, stand behind your choking patient, who should be leaning forward. Wrap your arms tight around them, creating a fist with your closed hands between their stomach and the bottom of the breastbone. It is where you hiccup from – the diaphragm. Give yourself plenty of room to move your hands, then pull sharply back and up, lifting them if necessary with the force. Carry that out five times. Stop, give five more hits between the shoulder blades, then repeat the Heimlich manoeuvre. Continue alternating the procedures until the obstruction is coughed up. Do not give up – keep trying.

With young children under the age of around seven, the Heimlich manoeuvre is very different. Lay them on their back and use the force of just two fingers in an upward thrust movement.

The best way to stop a broken limb moving is to splint it. You can use anything – a fence post, a ski pole, a walking stick, a windscreen wiper, a roll of newspaper… even a magazine wrapped around a break works well. Splinting is a matter of logic and listening to the patient.

If a limb is broken, you need to make sure that the areas above and below the injured area are immobilized. For example, if you’re dealing with a broken shin bone, you would immobilize the knee and the ankle. Use splints either side of the limb if possible, and put padding between them and the body to avoid bruising. Tie any knots on the uninjured side.

If there is nothing you can use as a splint, tie the injured limb to the body: one leg to another, for example. Put padding in any natural gaps and tie with wide pieces of cloth above and below the injury. Tie any knots on the uninjured side.

Be prepared to adapt. If you cannot move the broken limb straight, or if the break is at a joint such as the knee or elbow, splint as they are – bent. You can splint one bent leg to another, or put a bent arm inside a sling.

If the neck is broken, wrap a large scarf around it as tightly as you can without affecting the person’s ability to breathe. Alternatively, wrap a folded newspaper around it. If the person is lying down, put something heavy at either side of the head.

If the back is broken, minimize all movement. Put something heavy at either side of the head and all around the body to prevent movement.

If a sling is needed, use material that isn’t too stretchy. Fold it into a triangle and slide it under the broken arm, keeping the shorter pointed end towards the elbow. Tie the long ends behind the neck. There are in fact several ways to put on a sling, so experiment with folds and knots until the patient is comfortable.

A full sling should be used for any injury to the lower part of the arm, or to immobilize a limb if the collarbone has been broken or a shoulder dislocated.

If there is a splint on the upper arm or elbow, it might only be necessary to tie the sling around the wrist.

There are several places on the body where arteries flow near the surface and pressure can be applied to stop bleeding elsewhere. The idea is to press on a point between the casualty’s heart and their wound to stem the flow. You will need to move your finger around a bit to find the right spot.