Drawing: Cobra helicopter Drawing: Cobra helicopter
Chapter 4 - Page 1



Foremost among the many problems that can compromise a survivor's ability to return to safety are medical problems resulting from parachute descent and landing, extreme climates, ground combat, evasion, and illnesses contracted in captivity.
Many evaders and survivors have reported difficulty in treating injuries and illness due to the lack of training and medical supplies. For some, this led to capture or surrender.
Survivors have related feeling of apathy and helplessness because they could not treat themselves in this environment. The ability to treat themselves increased their morale and cohesion and aided in their survival and eventual return to friendly forces.
One man with a fair amount of basic medical knowledge can make a difference in the lives of many. Without qualified medical personnel available, it is you who must know what to do to stay alive.


To survive, you need water and food. You must also have and apply high personal hygiene standards.


Your body loses water through normal body processes (sweating, urinating, and defecating). During average daily exertion when the atmospheric temperature is 20 degrees Celsius (C) (68 degrees Fahrenheit), the average adult loses and therefore requires 2 to 3 liters of water daily. Other factors, such as heat exposure, cold exposure, intense activity, high altitude, burns, or illness, can cause your body to lose more water. You must replace this water.

Dehydration results from inadequate replacement of lost body fluids. It decreases your efficiency and, if injured, increases your susceptibility to severe shock. Consider the following results of body fluid loss:

The most common signs and symptoms of dehydration are —

You replace the water as you lose it. Trying to make up a deficit is difficult in a survival situation, and thirst is not a sign of how much water you need.

Most people cannot comfortably drink more than 1 liter of water at a time. So, even when not thirsty, drink small amounts of water at regular intervals each hour to prevent dehydration.

If you are under physical and mental stress or subject to severe conditions, increase your water intake. Drink enough liquids to maintain a urine output of at least 0.5 liter every 24 hours.

In any situation where food intake is low, drink 6 to 8 liters of water per day. In an extreme climate, especially an arid one, the average person can lose 2.5 to 3.5 liters of water per hour. In this type of climate, you should drink 14 to 30 liters of water per day.

With the loss of water there is also a loss of electrolytes (body salts). The average diet can usually keep up with these losses but in an extreme situation or illness, additional sources need to be provided. A mixture of 0.25 teaspoon of salt to 1 liter of water will provide a concentration that the body tissues can readily absorb.

Of all the physical problems encountered in a survival situation, the loss of water is the most preventable. The following are basic guidelines for the prevention of dehydration:

You can estimate fluid loss by several means. A standard field dressing holds about 0.25 liter (one-fourth canteen) of blood. A soaked T-shirt holds 0.5 to 0.75 liter.

You can also use the pulse and breathing rate to estimate fluid loss. Use the following as a guide:


Although you can live several weeks without food, you need an adequate amount to stay healthy. Without food your mental and physical capabilities will deteriorate rapidly, and you will become weak. Food replenishes the substances that your body burns and provides energy. It provides vitamins, minerals, salts, and other elements essential to good health. Possibly more important, it helps morale.

The two basic sources of food are plants and animals (including fish). In varying degrees both provide the calories, carbohydrates, fats, and proteins needed for normal daily body functions.

Calories are a measure of heat and potential energy. The average person needs 2,000 calories per day to function at a minimum level. An adequate amount of carbohydrates, fats, and proteins without an adequate caloric intake will lead to starvation and cannibalism of the body's own tissue for energy.

Plant Foods

These foods provide carbohydrates—the main source of energy. Many plants provide enough protein to keep the body at normal efficiency. Although plants may not provide a balanced diet, they will sustain you even in the arctic, where meat's heat-producing qualities are normally essential. Many plant foods such as nuts and seeds will give you enough protein and oils for normal efficiency. Roots, green vegetables, and plant food containing natural sugar will provide calories and carbohydrates that give the body natural energy.

The food value of plants becomes more and more important if you are eluding the enemy or if you are in an area where wildlife is scarce. For instance —

Animal Foods

Meat is more nourishing than plant food. In fact, it may even be more readily available in some places. However, to get meat, you need to know the habits of, and how to capture, the various wildlife.

To satisfy your immediate food needs, first seek the more abundant and more easily obtained wildlife, such as insects, crustaceans, mollusks, fish, and reptiles. These can satisfy your immediate hunger while you are preparing traps and snares for larger game.

Personal Hygiene

In any situation, cleanliness is an important factor in preventing infection and disease. It becomes even more important in a survival situation. Poor hygiene can reduce your chances of survival.

A daily shower with hot water and soap is ideal, but you can stay clean without this luxury. Use a cloth and soapy water to wash yourself. Pay special attention to the feet, armpits, crotch, hands, and hair as these are prime areas for infestation and infection. If water is scarce, take an "air" bath. Remove as much of your clothing as practical and expose your body to the sun and air for at least 1 hour. Be careful not to sunburn.

If you don't have soap, use ashes or sand, or make soap from animal fat and wood ashes, if your situation allows. To make soap —

After the mixture—the soap—cools, you can use it in the semiliquid state directly from the pot. You can also pour it into a pan, allow it to harden, and cut it into bars for later use.

Keep Your Hands Clean

Germs on your hands can infect food and wounds. Wash your hands after handling any material that is likely to carry germs, after visiting the latrine, after caring for the sick, and before handling any food, food utensils, or drinking water. Keep your fingernails closely trimmed and clean, and keep your fingers out of your mouth.

Keep Your Hair Clean

Your hair can become a haven for bacteria or fleas, lice, and other parasites. Keeping your hair clean, combed, and trimmed helps you avoid this danger.

Keep Your Clothing Clean

Keep your clothing and bedding as clean as possible to reduce the chance of skin infection as well as to decrease the danger of parasitic infestation. Clean your outer clothing whenever it becomes soiled. Wear clean underclothing and socks each day. If water is scarce, "air" clean your clothing by shaking, airing, and sunning it for 2 hours. If you are using a sleeping bag, turn it inside out after each use, fluff it, and air it.

Keep Your Teeth Clean

Thoroughly clean your mouth and teeth with a toothbrush at least once each day. If you don't have a toothbrush, make a chewing stick. Find a twig about 20 centimeters long and 1 centimeter wide. Chew one end of the stick to separate the fibers. Now brush your teeth thoroughly. Another way is to wrap a clean strip of cloth around your fingers and rub your teeth with it to wipe away food particles. You can also brush your teeth with small amounts of sand, baking soda, salt, or soap. Then rinse your mouth with water, salt water, or willow bark tea. Also, flossing your teeth with string or fiber helps oral hygiene.

If you have cavities, you can make temporary fillings by placing candle wax, tobacco, aspirin, hot pepper, tooth paste or powder, or portions of a ginger root into the cavity. Make sure you clean the cavity by rinsing or picking the particles out of the cavity before placing a filling in the cavity.

Take Care of Your Feet

To prevent serious foot problems, break in your shoes before wearing them on any mission. Wash and massage your feet daily. Trim your toenails straight across. Wear an insole and the proper size of dry socks. Powder and check your feet daily for blisters.

If you get a small blister, do not open it. An intact blister is safe from infection. Apply a padding material around the blister to relieve pressure and reduce friction. If the blister bursts, treat it as an open wound. Clean and dress it daily and pad around it. Leave large blisters intact. To avoid having the blister burst or tear under pressure and cause a painful and open sore, do the following:

Get Sufficient Rest

You need a certain amount of rest to keep going. Plan for regular rest periods of at least 10 minutes per hour during your daily activities. Learn to make yourself comfortable under less than ideal conditions. A change from mental to physical activity or vice versa can be refreshing when time or situation does not permit total relaxation.

Keep Camp Site Clean

Do not soil the ground in the camp site area with urine or feces. Use latrines, if available. When latrines are not available, dig "cat holes" and cover the waste. Collect drinking water upstream from the camp site. Purify all water.


Medical problems and emergencies you may be faced with include breathing problems, severe bleeding, and shock.

Breathing Problems

Any one of the following can cause airway obstruction, resulting in stopped breathing:

Severe Bleeding

Severe bleeding from any major blood vessel in the body is extremely dangerous. The loss of 1 liter of blood will produce moderate symptoms of shock. The loss of 2 liters will produce a severe state of shock that places the body in extreme danger. The loss of 3 liters is usually fatal.


Shock (acute stress reaction) is not a disease in itself. It is a clinical condition characterized by symptoms that arise when cardiac output is insufficient to fill the arteries with blood under enough pressure to provide an adequate blood supply to the organs and tissues.


Control panic, both your own and the victim's. Reassure him and try to keep him quiet.

Perform a rapid physical exam. Look for the cause of the injury and follow the ABCs of first aid, starting with the airway and breathing, but be discerning. A person may die from arterial bleeding more quickly than from an airway obstruction in some cases.

Open Airway and Maintain

You can open an airway and maintain it by using the following steps.

Step 1. Check if the victim has a partial or complete airway obstruction. If he can cough or speak, allow him to clear the obstruction naturally. Stand by, reassure the victim, and be ready to clear his airway and perform mouth-to-mouth resuscitation should he become unconscious. If his airway is completely obstructed, administer abdominal thrusts until the obstruction is cleared.

Step 2. Using a finger, quickly sweep the victim's mouth clear of any foreign objects, broken teeth, dentures, sand.

Step 3. Using the jaw thrust method, grasp the angles of the victim's lower jaw and lift with both hands, one on each side, moving the jaw forward. For stability, rest your elbows on the surface on which the victim is lying. If his lips are closed, gently open the lower lip with your thumb (Figure 4-1).

Drawing: jaw thrust method

Step 4. With the victim's airway open, pinch his nose closed with your thumb and forefinger and blow two complete breaths into his lungs. Allow the lungs to deflate after the second inflation and perform the following:

Step 5. If the forced breaths do not stimulate spontaneous breathing, maintain the victim's breathing by performing mouth-to-mouth resuscitation.

Step 6. There is danger of the victim vomiting during mouth-to-mouth resuscitation. Check the victim's mouth periodically for vomit and clear as needed.

Note: Cardiopulmonary resuscitation (CPR) may be necessary after cleaning the airway, but only after major bleeding is under control. See FM 21-20, the American Heart Association manual, the Red Cross manual, or most other first aid books for detailed instructions on CPR.
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Updated: 12 January 2008
Born on 25 October 1999