The first ten minutes

The rule

If 911 still answers, call it. This chapter is for the stretch of road, the hollow, or the year when nobody is coming. You are not a hospital. Your job is to stop the thing that will kill them in the next hour, keep them warm and breathing, and not make it worse.

Warning. Do not cut, suck, or ‘bleed out’ a wound. Do not give alcohol. Do not put butter on a burn. Do not shake an unconscious person. If they might have a broken neck, you move them only to save them from fire, flood, or no air.

Scene, then the person

1. Stop. Look. Is the saw still running, the gun loaded, the stove dumping CO, the copperhead still there? You cannot help if you become the second patient.
2. Talk to them. ‘What is your name?’ A clear answer means air is moving and the brain is getting blood.
3. If they do not answer: tap the shoulders, shout. Look at the chest. Listen for breath for 10 seconds.
4. If they are face-down and not breathing well, roll them as one piece — head, neck, and back together — onto their back so you can work.

Airway and breathing

1. Head-tilt, chin-lift unless you suspect a neck break. Then jaw-thrust only: fingers behind the jaw angles, lift the jaw without nodding the head.
2. Look in the mouth. Sweep only what you can see. Do not fish blindly.
3. If they vomit, roll them onto their side (recovery position) so they do not drown in it.
4. If they are breathing and unconscious, recovery position: nearest arm out, far knee up, roll toward you, chin slightly up. Watch them. Do not leave.

Tip. Snoring in an unconscious person often means the tongue is blocking. Reposition the airway. If it quiets and the chest rises, you did the most important thing.

Choking

1. They can cough or talk: let them cough. Do not slap their back ‘to help.’
2. They cannot speak, cough, or breathe: 5 back blows between the shoulder blades, then 5 abdominal thrusts (fist above the navel, in and up). Repeat.
3. They go limp: lower them down. Start CPR. Each time you open the mouth, look for the object and hook it out only if you see it.
4. A pregnant person or someone you cannot get your arms around: chest thrusts, not abdominal.

Bleeding that will kill

1. Expose the wound. Cloth on it. Both hands. Lean your weight. Ten minutes by a clock, no peeking.
2. If it soaks through, more cloth on top. Do not take the first pad off.
3. A limb that is pumping bright blood or will not stop: a real tourniquet (CAT or SOF-T) 2–3 inches above the wound, not on a joint. Twist until the bleeding stops, not until it ‘feels tight.’ Write the time on their forehead. It will hurt. Leave it on.
4. A wound in the groin, armpit, or neck that a tourniquet cannot reach: pack the hole with clean gauze or the cleanest cloth you have, then press hard on top. Hold.
5. A belt as a last-ditch tourniquet often fails. A triangle bandage and a stick can work if you tighten until the bleeding actually stops.

Warning. A tourniquet left on for hours will cost the limb. In a true collapse that is still better than a grave. If help might come in under two hours, leave it. Do not loosen it ‘to check.’

Shock

Pale, sweaty, thirsty, anxious, fast weak pulse, getting sleepy — they are running out of blood volume or blood pressure. Lay them down. Legs up if there is no leg or pelvis break and they can breathe. Keep them warm. Silence and calm from you. Sips of water only if they are fully awake and not about to have surgery or a belly wound.

Do not pile coats on a person who is bleeding and then walk away. Recheck the wound.

No pulse, not breathing — CPR

1. They are unresponsive and not breathing normally (gasps do not count). Hard surface. Heel of one hand on the center of the chest, other hand on top.
2. Push 2 inches deep, 100–120 times a minute — the beat of ‘Stayin’ Alive’ or a fast march. Let the chest come all the way back up. Do not stop for more than a few seconds.
3. If you know rescue breaths and the mouth is clear: 30 compressions, 2 breaths that just make the chest rise. If you do not: hands only, without pause.
4. A child: same idea, one hand, about 2 inches. An infant: two fingers, about 1.5 inches, and you must give breaths if you can — their trouble is usually air, not a heart.

Warning. Without a defibrillator and a hospital, most adult hearts that have stopped will not restart. You do CPR because sometimes they do, and because the family needs to see that everything was tried. If the person is cold from the creek, keep going longer — cold people have come back. If they have been down more than 20–30 minutes warm, with no signs of life, it is reasonable to stop.

Do not move them — except

A fall from a stand, a wreck, or a blow to the head plus any numbness, can’t-move-a-limb, or a crooked neck: leave them where they lie if the ground is safe. Hold the head still with your hands. Pad around it.

Move them only for fire, rising water, or if they cannot breathe where they are. Then as one piece, many hands, a door or blanket as a litter.