Although I'm not a RN, PA or MD I can give some info from the perspective of a former USAF medic / civilian emergency medical technician. First of all, even if you choose not to undergo the training necessary to become an EMT or Paramedic the national association of emts (
www.naemt.org) offers a class that is invaluable in providing some of the training necessary to manage trauma in the pre-hospital setting. The course is PHTLS (Pre-Hospital Trauma Life Support) and more information can be found at:
http://www.naemt.org/PHTLS Even if your not a certified EMT, Nurse or other medical professional you can take the course, you just won't receive the certificate.
Much of this training is stuff you would want to know in a SHTF scenario and will give you the basic training (or a refresher in the training) to start iv's, manage traumatic injuries, perform cricothyrotomies, needle decompressions, etc.. It also goes into more detail regarding specific traumatic injuries such as abdominal injuries, head injuries, etc..
If your squeamish and needle-shy you may want to consider calling the local training center or college that handles EMS training in your area. Most of them are always looking for "patients" to use in class as IV stick dummies or to be used as patients for the student's practical exams. Being stuck a few times tends to get people more used to needles and in turn tends to make you calmer when it comes to performing the skill on someone else. Of course it's no substitute for training.
As far as the scenario that was posted goes the first course of action before the patient is moved any substantial distance would be to control the bleeding and ensure patency of the airway. If the S really has HTF and I'm going to be caring for the victim for 5-7 days before proper medical attention then I must assume that I am going to end up being the victim's primary care.
You have to consider that in normal times a patient with a gut wound if uncomplicated with minimal damage to GI tract and vital organs could 2/3's of the time be discharged from the hospital and well on his way to recovery within that 5-7 day period.
If the victim has a patent airway which is self-maintained then the next course of action would be inspection of the wound site and the surrounding area. Is the abdomen unusually firm or soft? Is there extensive bleeding as if from a major vein, an artery or the liver? If the wound site is substantial and there is free-flowing blood is there foreign matter in the blood that I'd really prefer not to be present? Such as stomach contents, bile, excrement, etc.. Is there an exit wound? Visually retracing the path in my mind between entrance and exit if it's a straight path, soft tissue shot what major organs may have been affected?
Alot of the above information would dictate what the overall course of action would be. As harsh as it sounds, pain management would fairly low on the priorities list. The next steps I would take would be starting 2 IV's, one large bore 14ga or 16ga and a second that although it may never be used I would at least keep as a saline lock and mantain a scheduled flush. Hang a bag of normal saline on the primary IV line and if bleeding is slight to moderate and uncontrolled run it open, if bleeding is heavy and uncontrolled hang a second bag on the second line and run it open also.
Now comes the hard part, If the bleeding is moderate to heavy after attempts to control it then I'd need someone to assist me in rudimentary battlefield surgery. Even with fluid replacement if the bleeding is left uncontrolled the victim will eventually come to a point where the blood circulating is so dilute that it can no longer carry oxygen and death will be forthcoming.
Uncontrolled bleeding in this context includes internal bleeding. The placement of pressure bandages or clotting agents such as the powders of miscellaneous brands that are available do a good job of controlling bleeding in the near term but in a gut shot type wound the bleeding may continue unabated internally.
Scalpels, betadine surgical scrub, sutures, suction and basic surgical equipment should be in every group's inventory of medical supplies. It doesn't necessarily have to be in a person's kit that they carry in the field unless that person is comfortable using it in the field. If something like this were to occur in the field I'd pray for a couple of litter bearers, a litter and that my camp is close.
I'd proceed with very minimal pain management, the administration of narcotic analgesics such as nubain or hypnotic sedatives such as versed would depend greatly on vital signs and patient condition. Field surgery would be focused on finding bleeders and either tying them off or suturing larger bleeders back to restore bloodflow. Once bleeding is controlled then I'd make a survey for lacerations / ruptures to the GI tract and organs and suture the affected areas if I felt comfortable with it and there were an actual need. The thing to keep in mind is that this surgery is not meant to be a long drawn out exploratory surgery but an expedient bleeding control exercise. I'd end the surgery by suturing up the incision except for a 1/2"-3/4" section left as a drain.
Once the bleeding was controlled I'd convert the second IV line to a saline lock, consider placement of a foley cath, and begin administration of IV antibiotics until such time that the patient was capable of receiving oral antibiotics. My choice of antibiotics would probably be doxycycline & pcn by IV if available to cover both anaerobic & aerobic bacteria, IV Cipro could also be considered.
At this point I'd be searching for a physician in the local area that could do a consult and possibly perform a more complete and competent surgery to repair any other damage.
If during the initial treatment it had been a slight to moderate bleed that could be at least partially controlled I would opt for continual fluid replacement and basic medical care to maintain the patient until a more advanced level of provider were available. IV antibiotics would of course still be called for as well as pain management dependent upon pt condition. I really don't consider field surgery to be a minor affair, in fact when you consider the time that it ties up the healthcare provider, the people assisting him / her and the continued need for guards to maintain security in the area it's a huge resource hog.
Everyone should consider getting to know a couple of professional healthcare providers (MD's, RN's, PA's, etc.) in your local area or at the very least keeping a list of healthcare providers that reside in the immediate area of your home or the area you plan to bug out to in a SHTF scenario.
The old standard red cross on white background arm band does still have it's uses. Keep it out of sight in your inventory somewhere but if you end up going to medical professional's homes in an attempt to get aid put it on prior to approaching the house, if their hiding inside glancing out curtain slits it will make them more likely to answer the door. :wink:
What do you think? Am I completely flippin psycho?
DigitalNY
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