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

Action:Cool the burn to stop the burning process. Flood the burn with water for at least 10 minutes, but watch the casualty’s body temperature. If they start to shiver, it will make the inevitable shock worse.

Remove clothing and jewellery around the burn. If anything is stuck to the burn, cut it down as small as possible and leave it there.

Do not burst any blisters. Do not use any type of cream, lotion or potion, even if it says ‘for burns’ on the packaging.

Take clean plastic, preferably something like cling film as that is sterile on the interior of the roll, and attach it to the burn to prevent infection. Use tape to stick it in place, but make sure it’s stuck to the plastic, not to the skin, as the burn may be bigger than it first appears. If the burn is on a foot or hand, you can encase it in a plastic bag, or even a condom if it is comfortable and doesn’t cut off blood circulation. If there is nothing you can use as a plastic dressing, take something non-sticky, such as a sterile dressing, and use that instead.

The casualty will need to replace lost liquid and salt, so dissolve about half a non-heaped teaspoonful of salt (and a tablespoonful of sugar too, if possible) per pint (500 ml) of water and keep giving it in small doses. However, if there is any chance they could be on an operating table in the next few hours, give them nothing but sips of this liquid.

Warning:A casualty with severe burns will almost definitely go into shock before long because of the fluid loss (see Shock). You need to get them to hospital as soon as possible.

See also Fire.

During Israel’s war against Hamas in Gaza in 2009, dozens of civilians were hit with white phosphorus. This chemical is meant to be used for creating a smokescreen during an attack and it is not supposed to be used directly as a weapon. It burns on contact with air and can be used to set areas on fire, but if it comes into contact with skin, it will set the skin on fire. Even if it doesn’t hurt anyone at first, it lies on the street and around homes, where children can play with it, and causes a lot of damage after the daily battles are done. There are very few doctors who have had to deal with the effects of white phosphorus on a daily basis. As the head of the burns unit in Al-Shifa hospital in Gaza, Dr Nafez Abo Shaban has the dubious honour of being an expert on it. He recommends the following treatment:

‘Cover the affected area with a piece of cloth soaked in water to cut off the supply of oxygen. The phosphorus will burn as long as it is exposed to the air, and the burn will go deep down to the bone. In an ideal situation, the patient should be taken into an operating theatre to remove all the phosphorus. This will stop the burning and also enable the medics to remove the dead tissue.

‘Some with massive burns develop systemic complications, such as an imbalance of salts in the blood. This can be fatal, so they should be admitted to an intensive care unit.

‘If there is no hospital nearby, scrape off the phosphorus with a piece of wood, not metal. This will be very painful as the chemical will be stuck to the patient. In some cases it will rip the flesh away. The patient needs to be aware and supported through the painful process. Once this is done, treat it as a normal burn.’

A penetrating injury to the chest can pierce the lung, which then starts dragging air inside (for this reason it’s called a sucking chest wound). This causes the lung to shrink and the cavity around it to fill with liquid. The result is known as a collapsed lung, and it can endanger the other lung as it gets worse.

First signs:Blood frothing out of the wound. Breathing shallow and laboured. Blood may be coughed up. If conscious, the patient will be panicky, and their skin will become grey-blue.

Action:Calm the patient and ask them to hold their hand over the wound to seal it. Place a sterile dressing over the wound and tape it on two sides. Next take a square of airtight material – a piece of foil or a plastic bag would work – and place over the dressing, taping it tightly on three sides of the square so that it doesn’t get sucked inside the wound. This will not allow air in through the wound, but it will allow air out.

People who smoke need to be particularly careful around infectious diseases. Smokers always catch cholera far more quickly than others because they are constantly bringing their hand to their mouth.

First signs:Inability to speak, noisy breathing, persistent cough, blue tinge to lips and nails because oxygen is depleted.

Action:If breathing is not obstructed just encourage them to keep coughing. If it is, first check the mouth for any obvious obstruction, such as vomit. Then, supporting the chest of the casualty with one hand and leaning them slightly forwards, give up to five hard hits between the shoulder blades with your other hand.

With children up to the age of about seven, tilt them downwards and pat rather than hit on the back, their head tipped down so they don’t choke again.

If the hitting or patting doesn’t work, move onto the Heimlich manoeuvre (see The Heimlich manoeuvre).

A bang to the head can lead to a mild brain injury.

First signs:Headache; balance problems; looking at the light is painful; vision may be affected; possible ringing noise in the ears; seizures may occur; confusion, forgetfulness and speech problems are common. The casualty might show an altered mood, particularly slowness and lack of energy.

Action:Seek urgent medical attention if you or anyone else experiences any of the symptoms above. Meanwhile, rest and monitor vital signs. Symptoms can last for weeks and lead to other brain problems if left untreated.

I used to help with the lambing at a farm near my granny’s place every year. It always amazed me how easily the sheep seemed to get up and carry on with their day immediately after giving birth, and how simple the process was in most cases. I have neither given birth nor helped any human give birth, but the following information, though basic, has been checked and double-checked by experts.

First signs:Lower back pain, regular muscle contractions, bloody discharge from the vagina are all signs of impending childbirth. When a woman’s waters break, it might look like she has wet herself, but the fluid comes from the amniotic sac inside the womb. Despite what you see in the movies, the waters breaking before labour begins happens in only 13 per cent of cases. It can also be just a tiny bit of unexpected fluid rather than a dramatic gush. By then the expectant mother is likely to know what is happening, and she will make sure that you do too.

Action:I am told that if the birth is sudden and unexpected, it is likely to happen naturally. You just need to offer support as the burden is all on the mother-to-be at this stage. The only things you have to do are to find a clean space, clean towels or clothing, a sterilized blade and a piece of sterile string (boil it if necessary, except if it is plastic, in which case you will have to soak it in a mild bleach or sterilizing solution).