Sovereignty Module: Heal the Wounded
Heal the Wounded
Complete Field Medicine, First Aid, and Emergency Surgery Guide
Complete Field Medicine, First Aid, and Emergency Surgery Guide
The Philosophy of Healing
The healer is the most valued person in any community. When injury or illness strikes, the difference between life and death is knowledge applied with calm hands. This campaign covers the complete spectrum of medical care achievable without modern hospitals: wound management, fracture treatment, infection control, childbirth assistance, dental emergencies, and the recognition of conditions that require intervention versus those that heal themselves. The guiding principle: do no harm, but do not fail to act when action saves life.
Chapter 1: Assessment and Triage
Primary Survey (first 60 seconds):
| Step | Check | Action if Problem Found |
|---|---|---|
| D - Danger | Is the scene safe for you? | Do NOT become a second casualty |
| R - Response | Is the patient conscious? Tap shoulders, shout. | If no response: proceed to A |
| A - Airway | Is the airway open? Look in mouth. Tilt head, lift chin. | Clear obstructions; head-tilt chin-lift |
| B - Breathing | Look, listen, feel for 10 seconds. | If not breathing: begin rescue breaths |
| C - Circulation | Check pulse (carotid, 10 seconds). Major bleeding? | If no pulse: CPR. If bleeding: direct pressure. |
| D - Disability | Conscious level (AVPU: Alert, Voice, Pain, Unresponsive) | Note and monitor |
| E - Exposure | Remove clothing to find hidden injuries | Cover to prevent hypothermia after exam |
Triage Categories (multiple casualties):
| Category | Color | Criteria | Action |
|---|---|---|---|
| Immediate | Red | Life-threatening but survivable with intervention | Treat first |
| Delayed | Yellow | Serious but can wait 1-4 hours | Treat second |
| Minor | Green | Walking wounded, minor injuries | Treat last (or self-care) |
| Expectant | Black | Unsurvivable with available resources | Comfort care only |
Chapter 2: Wound Management
Wound Classification:
| Type | Cause | Bleeding | Infection Risk | Treatment Priority |
|---|---|---|---|---|
| Incision (clean cut) | Knife, glass | Moderate-heavy | Low (if cleaned) | Control bleeding, close |
| Laceration (torn) | Blunt force, machinery | Variable | Moderate | Clean thoroughly, close if possible |
| Puncture | Nail, thorn, stab | Minimal external | HIGH (deep contamination) | Do NOT close; irrigate, leave open to drain |
| Avulsion (flap/tear) | Machinery, animal bite | Heavy | High | Reattach flap if possible, pressure |
| Abrasion (scrape) | Friction, road rash | Minimal | Moderate (ground-in debris) | Scrub clean, dress open |
| Crush | Heavy object | Internal (may be massive) | High | Elevate, watch for compartment syndrome |
| Burn | Heat, chemical, electrical | Weeping (plasma) | High (after 48 hours) | Cool, cover, do not pop blisters |
Wound Cleaning Protocol:
- Wash your hands (soap and water, or alcohol)
- Control bleeding first (direct pressure, 10-15 minutes)
- Irrigate wound with clean water under pressure (syringe or squeeze bottle, 250-500 mL minimum)
- Remove visible debris with clean tweezers
- Scrub gently around (not in) the wound with soap
- Irrigate again
- Pat dry with clean cloth
- Apply antiseptic if available (dilute iodine, honey, alcohol)
- Dress with clean, dry bandage
Wound Closure Decision:
| Close the wound (suture/tape) if: | Leave open if: |
|---|---|
| Clean cut, less than 6-8 hours old | Puncture wound (needs to drain) |
| Edges can be brought together without tension | Animal/human bite (high infection) |
| No signs of infection | Heavily contaminated (dirt, feces) |
| Adequate cleaning was performed | More than 12-24 hours old |
| Not over a joint (unless splinted) | Signs of infection already present |
Suturing (stitching):
| Aspect | Specification |
|---|---|
| Needle | Curved, cutting (or improvise: sewing needle bent with pliers) |
| Thread | Silk, nylon, or any clean, strong, thin thread |
| Technique | Simple interrupted: enter 3-5mm from edge, pass through both sides, tie square knot |
| Spacing | Stitches 5-8mm apart |
| Tension | Just enough to approximate edges (not tight, which causes necrosis) |
| Removal | 5-7 days (face), 7-10 days (body), 10-14 days (joints, high-tension areas) |
Alternative Closure Methods:
| Method | Best For | How |
|---|---|---|
| Butterfly strips (Steri-Strips) | Small, clean cuts | Tape across wound, pulling edges together |
| Super glue (cyanoacrylate) | Small, superficial cuts | Apply thin layer over closed edges (not IN wound) |
| Hair ties | Scalp lacerations | Twist hair from each side together, secure with tape/glue |
| Staples | Long, straight cuts in scalp/torso | Surgical stapler or improvised |
Chapter 3: Bleeding Control
Methods (in order of escalation):
| Method | When | How | Duration |
|---|---|---|---|
| Direct pressure | First response for all bleeding | Firm pressure with clean cloth directly on wound | 10-15 minutes continuous |
| Elevation | Extremity wounds | Raise injured limb above heart level | Continuous with pressure |
| Pressure dressing | When direct pressure controls bleeding | Tight bandage over wound packing | Leave in place |
| Wound packing | Deep wounds that cannot be compressed externally | Pack clean cloth INTO wound, then apply pressure on top | Leave in place |
| Tourniquet | Life-threatening limb hemorrhage not controlled by pressure | Tight band 2-3 inches above wound; tighten until bleeding stops | Note time; do not remove in field |
Tourniquet Construction:
Any strong, wide (1.5+ inch) material: belt, torn shirt strip, cravat. Wrap around limb, tie a half-knot, place a stick (windlass) on top, tie a full knot over the stick, twist the stick until bleeding stops, secure the stick in place. WRITE THE TIME on the patient's forehead or the tourniquet.
Internal Bleeding Signs:
| Sign | Meaning | Action |
|---|---|---|
| Rigid, distending abdomen | Abdominal hemorrhage | Position of comfort, keep warm, evacuate |
| Coughing blood | Lung/airway bleeding | Sit upright, lean forward, evacuate |
| Blood in urine | Kidney/bladder injury | Rest, hydrate, monitor |
| Increasing pain/swelling in limb | Compartment syndrome | Elevate, loosen all bandages/splints, evacuate |
| Shock signs (pale, fast pulse, confusion) | Significant blood loss anywhere | Lay flat, elevate legs, keep warm |
Chapter 4: Fracture Management
Fracture Recognition:
| Sign | Reliability | Notes |
|---|---|---|
| Deformity (abnormal angle/shape) | High | Compare to other side |
| Crepitus (grinding sensation) | High | Do not deliberately test for this |
| Loss of function | Moderate | Patient cannot use the limb |
| Swelling | Moderate | Rapid swelling suggests fracture |
| Point tenderness | Moderate | Pain at one specific spot |
| Pain with movement | Low (also present with sprains) | Splint if in doubt |
Splinting Principles:
| Principle | Application |
|---|---|
| Immobilize joint above AND below fracture | Forearm fracture: splint wrist AND elbow |
| Pad all bony prominences | Prevent pressure sores under splint |
| Check circulation after splinting | Fingers/toes should be pink, warm, with sensation |
| Splint in position found (if deformed) | Do NOT attempt to straighten unless no pulse below |
| Elevate after splinting | Reduces swelling |
Splint Materials:
| Material | Best For | Notes |
|---|---|---|
| Straight sticks (padded) | Any long bone | Most available in wilderness |
| SAM splint (moldable aluminum) | Any bone | Lightweight, reusable, versatile |
| Cardboard (folded) | Forearm, lower leg | Readily available |
| Pillow/blanket (wrapped) | Ankle, foot | Soft splint for stable fractures |
| Body splinting | Fingers (tape to adjacent), legs (tape together) | Uses body as the splint |
| Plaster of Paris | Long-term immobilization | Strips of cloth dipped in plaster, wrapped around limb |
Healing Times:
| Bone | Approximate Healing Time | Notes |
|---|---|---|
| Finger/toe | 3-4 weeks | Buddy-tape to adjacent finger |
| Wrist (Colles) | 6-8 weeks | Cast/splint |
| Forearm | 8-12 weeks | Must immobilize elbow and wrist |
| Upper arm (humerus) | 8-12 weeks | Sling and swathe |
| Collarbone (clavicle) | 6-8 weeks | Sling only (heals well without surgery) |
| Rib | 4-6 weeks | No splinting; deep breathing to prevent pneumonia |
| Femur (thigh) | 12-16 weeks | Traction splint required; life-threatening |
| Lower leg (tibia) | 10-16 weeks | Long leg cast/splint |
| Ankle | 6-8 weeks | Short leg cast/splint |
Chapter 5: Infection Recognition and Treatment
Signs of Wound Infection:
| Sign | Timing | Severity |
|---|---|---|
| Increasing redness around wound | 24-48 hours | Early (local) |
| Warmth and swelling | 24-48 hours | Early (local) |
| Pus (yellow/green discharge) | 48-72 hours | Moderate (local) |
| Red streaks extending from wound | 48-96 hours | SERIOUS (spreading, lymphangitis) |
| Fever | 48+ hours | SERIOUS (systemic infection) |
| Foul smell | 72+ hours | SERIOUS (possible anaerobic infection) |
| Rapid heart rate + confusion | Variable | CRITICAL (sepsis, life-threatening) |
Treatment of Wound Infection:
| Stage | Action |
|---|---|
| Early (redness, warmth only) | Open wound, irrigate thoroughly, apply honey or dilute iodine, leave open to drain, warm compresses 3x daily |
| Moderate (pus present) | Open wound fully, drain all pus, irrigate, pack open with wet-to-dry dressing, change twice daily |
| Spreading (red streaks, fever) | All above PLUS antibiotics if available; immobilize limb; mark edge of redness with pen to monitor spread |
| Abscess (walled-off pus pocket) | Incise and drain (cut into fluctuant area, express pus, irrigate cavity, pack open) |
| Sepsis (systemic) | Aggressive wound care + antibiotics + IV fluids if possible; this is life-threatening |
Natural Antiseptics (when modern medicine unavailable):
| Agent | Effectiveness | Application | Notes |
|---|---|---|---|
| Raw honey | Excellent | Apply directly to wound, cover | Osmotic + hydrogen peroxide production |
| Garlic (crushed) | Good | Apply to wound edges (not deep in wound) | Allicin is antibacterial; can irritate |
| Tea tree oil (diluted) | Good | 2-5% solution for wound wash | Broad-spectrum antimicrobial |
| Vinegar (5%) | Moderate | Wound wash, diluted | Effective against many bacteria |
| Salt water (saline) | Moderate | Wound irrigation (1 tsp per quart) | Mechanical cleaning + mild osmotic |
| Alcohol (60-70%) | Good (surface only) | Skin prep around wound (not IN wound) | Damages tissue if applied in wound |
| Iodine (diluted) | Excellent | 1-2% solution for wound irrigation | Gold standard field antiseptic |
| Charcoal (activated) | Moderate | Poultice over infected wound | Absorbs toxins and bacteria |
Chapter 6: Burns
Burn Classification:
| Degree | Depth | Appearance | Pain | Healing |
|---|---|---|---|---|
| First (superficial) | Epidermis only | Red, no blisters | Painful | 3-5 days, no scarring |
| Second (partial thickness) | Into dermis | Blisters, weeping, red/pink | Very painful | 2-4 weeks, minimal scarring |
| Third (full thickness) | Through entire skin | White, waxy, or charred | Painless (nerves destroyed) | Requires grafting; severe scarring |
Burn Treatment:
| Step | Action | Duration |
|---|---|---|
| 1 | Remove from heat source; remove clothing/jewelry from area | Immediate |
| 2 | Cool with clean running water (not ice) | 20 minutes |
| 3 | Cover with clean, non-adherent dressing (cling film works well) | After cooling |
| 4 | Do NOT pop blisters (they are sterile biological dressings) | Leave intact |
| 5 | Elevate burned limbs | Continuous |
| 6 | Pain management (ibuprofen, acetaminophen, or stronger if available) | As needed |
| 7 | Watch for infection (starts day 2-3) | Daily assessment |
Burn Size Estimation (Rule of Nines):
| Body Area | Percentage of Total Body Surface |
|---|---|
| Head and neck | 9% |
| Each arm | 9% |
| Chest (front) | 9% |
| Abdomen (front) | 9% |
| Upper back | 9% |
| Lower back | 9% |
| Each thigh (front) | 9% |
| Each lower leg (front) | 9% |
| Genitals | 1% |
Burns over 15-20% of body surface require IV fluid resuscitation (life-threatening without it).
Chapter 7: Childbirth
Normal Labor and Delivery:
| Stage | Duration (first birth) | What Happens | Action |
|---|---|---|---|
| First (dilation) | 8-14 hours | Contractions open cervix from 0 to 10 cm | Support, hydration, position changes, patience |
| Second (delivery) | 30 min - 2 hours | Pushing; baby delivered | Support perineum, guide head, check for cord around neck |
| Third (placenta) | 5-30 minutes | Placenta separates and delivers | Gentle traction on cord after separation signs; inspect placenta for completeness |
When to Intervene:
| Situation | Sign | Action |
|---|---|---|
| Cord around neck | Visible loop when head delivers | Slip over head; if too tight, clamp and cut between clamps |
| Shoulder dystocia | Head delivered but shoulders stuck | McRoberts maneuver (push knees to chest), suprapubic pressure |
| Breech (feet/buttocks first) | Abnormal presentation | Hands off until umbilicus visible; then assist delivery of arms and head |
| Hemorrhage (post-delivery) | Heavy bleeding after placenta | Uterine massage (firm pressure on lower abdomen), breastfeeding (releases oxytocin) |
| Retained placenta | Not delivered within 30 minutes | Do NOT pull; uterine massage, breastfeeding, position changes |
Newborn Immediate Care:
| Step | Action | Timing |
|---|---|---|
| 1 | Dry baby vigorously with clean cloth | Immediately |
| 2 | Clear airway if needed (suction mouth then nose) | First 30 seconds |
| 3 | Assess breathing (should cry/breathe within 60 seconds) | First minute |
| 4 | Skin-to-skin on mother's chest | After drying |
| 5 | Clamp and cut cord (after it stops pulsing, 1-3 minutes) | 1-3 minutes |
| 6 | Initiate breastfeeding | Within first hour |
| 7 | Keep warm (hat, blankets, skin-to-skin) | Continuous |
Chapter 8: Common Medical Emergencies
Choking (conscious adult):
- Encourage coughing (if able to cough, do not intervene)
- If unable to cough/speak/breathe: 5 back blows (heel of hand between shoulder blades)
- If unsuccessful: 5 abdominal thrusts (Heimlich maneuver: fist above navel, thrust inward and upward)
- Alternate back blows and abdominal thrusts until object expelled or patient becomes unconscious
- If unconscious: begin CPR (chest compressions may dislodge object)
Heart Attack Recognition:
| Symptom | Description |
|---|---|
| Chest pain/pressure | Crushing, squeezing, "elephant on chest" |
| Radiation | Pain spreading to left arm, jaw, back, or both arms |
| Shortness of breath | With or without chest pain |
| Sweating | Cold, clammy skin |
| Nausea/vomiting | Common, especially in women |
| Denial | "It's just indigestion" (classic) |
Action: Aspirin (325mg chewed) if available, rest in position of comfort (usually sitting up), prepare for CPR if cardiac arrest occurs.
Stroke Recognition (FAST):
| Letter | Test | Positive Sign |
|---|---|---|
| F - Face | Ask to smile | One side droops |
| A - Arms | Raise both arms | One drifts down |
| S - Speech | Repeat a sentence | Slurred or garbled |
| T - Time | Note time of onset | Critical for treatment decisions |
Chapter 9: Dental Emergencies
Toothache (infection/abscess):
| Treatment | Method | Purpose |
|---|---|---|
| Pain relief | Clove oil (eugenol) applied to tooth/gum | Natural anesthetic and antiseptic |
| Salt water rinse | 1 tsp salt in warm water, swish 30 seconds | Draws out infection, cleans |
| Drainage (if abscess visible) | Lance swollen area with sterile blade, allow pus to drain | Relieves pressure and pain |
| Extraction (last resort) | Grip tooth firmly with pliers/forceps, rock side to side, then pull | Removes source of infection |
Tooth Extraction Protocol:
- Pain control: clove oil, alcohol rinse, ice, or injectable anesthetic if available
- Loosen: rock tooth side to side with firm grip (dental forceps or strong pliers wrapped in cloth)
- Rotate slightly as you rock (breaks periodontal ligament)
- Pull outward with steady, firm pressure (do not jerk)
- After extraction: bite on gauze/cloth for 30 minutes
- Salt water rinses starting next day (not same day, to protect clot)
- Soft foods for 3-5 days
Chapter 10: Medical Kit and Supplies
Essential Medical Kit (for a community of 50):
| Category | Items | Quantity |
|---|---|---|
| Wound care | Gauze pads, roller bandage, tape, butterfly closures | 100+ of each |
| Instruments | Scissors, tweezers, hemostats, scalpel, needle holder, suture needles | 2-3 sets |
| Suture material | Silk or nylon thread (various sizes) | 50+ packets |
| Antiseptic | Iodine (povidone), alcohol, honey | 1 liter each |
| Splinting | SAM splints, plaster bandage, padding, slings | 10+ of each |
| Medications | Aspirin, ibuprofen, acetaminophen, diphenhydramine, oral rehydration salts | 500+ doses each |
| Antibiotics | Amoxicillin, ciprofloxacin, metronidazole, doxycycline | 100+ courses |
| Childbirth | Cord clamps, bulb syringe, clean towels, sterile gloves | 10+ kits |
| Dental | Clove oil, temporary filling material, extraction forceps | Basic kit |
| Reference | This guide (printed), anatomy charts | 1 set |
Medications and Their Uses:
| Medication | Use | Dose (adult) | Notes |
|---|---|---|---|
| Aspirin | Pain, fever, heart attack | 325-650mg every 4-6 hours | NOT for children under 16 |
| Ibuprofen | Pain, fever, inflammation | 400-600mg every 6-8 hours | Take with food |
| Acetaminophen | Pain, fever | 500-1000mg every 6 hours | Liver toxic in overdose |
| Amoxicillin | Bacterial infections (skin, ear, dental, respiratory) | 500mg three times daily, 7-10 days | Most common antibiotic |
| Ciprofloxacin | Urinary, GI, severe infections | 500mg twice daily, 7-14 days | Not for children/pregnant |
| Metronidazole | Anaerobic infections, dental, abdominal | 500mg three times daily, 7-10 days | No alcohol while taking |
| Diphenhydramine | Allergic reactions, sleep aid | 25-50mg every 6 hours | Causes drowsiness |
| Oral rehydration salts | Dehydration from diarrhea/vomiting | 1 packet per liter water, sip continuously | Life-saving for cholera/dysentery |
Reference Card
FIELD MEDICINE ESSENTIALS:
- Scene safety first (you cannot help if you become a casualty)
- Airway, Breathing, Circulation (ABC): check and fix in this order
- Direct pressure stops almost all external bleeding (10-15 minutes, do not peek)
- Irrigate wounds with clean water under pressure (most important step for infection prevention)
- Splint fractures in position found; immobilize joint above and below
- Do NOT close puncture wounds or bites (they need to drain)
- Honey is an excellent wound dressing (antibacterial, promotes healing)
- Most emergencies are managed by staying calm and doing simple things correctly
This campaign provides the complete knowledge to manage medical emergencies, treat wounds, set fractures, assist childbirth, and maintain community health without access to modern hospitals. A community with trained medical personnel has dramatically lower mortality from injury, infection, and childbirth complications. Knowledge and calm hands save more lives than any equipment.
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