FM 3-05.70 Field Manual Survival (17 May 2002)

• Food—knife, snare wire, fishhooks, fish and snare line,

bouillon cubes or soup packets, high-energy food bars,

granola bars, gill or yeti net, aluminum foil, freezer bags.

• Medical—oxytetracycline tablets

(to treat diarrhea or

infection), surgical blades or surgical preparation knife,

butterfly sutures, lip balm, safety pins, sutures,

antidiarrheal

medication

(imodium), antimalarial

medication

(doxycycline), broad-spectrum antibiotics

(rocephin and zithromax) and broad spectrum topical

ophthalmic (eye) antibiotic, antifungal, anti-inflammatory

(ibuprofen), petrolatum gauze, and soap. Medical items

may make up approximately 50 percent of your survival

kit.

• Signal—signaling mirror, strobe, pen flares, whistle, U.S.

flag, pilot scarf or other bright orange silk scarf, glint tape,

flashlight, laser pointer, solar blanket.

• Miscellaneous—wrist compass, needle and thread, money,

extra eyeglasses, knife sharpener, cork, camouflage stick,

and survival manual.

3-10. Include a weapon only if the situation so dictates.

Ambassadors and theater commanders may prohibit weapons even

in extreme circumstances. Read and practice the survival

techniques in this manual and apply these basic concepts to those

you read about in other civilian publications. Consider your

mission and the environment in which you will operate. Then

prepare your survival kit with items that are durable,

multipurpose, and lightweight. Imagination may be the largest

part of your kit. It can replace many of the items in a kit.

Combined with the will to live, it can mean the difference between

surviving to return home with honor or not returning at all.

3-5

Chapter 4

Basic Survival Medicine

Foremost among the many problems that can

compromise your survival ability are medical

problems resulting from unplanned events, such

as a forced landing or crash, 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 feelings of apathy and

helplessness because they could not treat

themselves in this environment. The ability to

treat yourself increases your morale and aids in

your 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.

REQUIREMENTS FOR

MAINTENANCE OF HEALTH

4-1. To survive, you need water and food. You must also have

and apply high personal hygiene standards.

WATER

4-2. 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 [F]), the average adult loses and

therefore requires 2 to 3 liters of water daily. Other factors, such

4-1

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.

4-3. Dehydration results from inadequate replacement of lost

body fluids. It decreases your efficiency and, if you are injured, it

increases your susceptibility to severe shock. Consider the

following results of body fluid loss:

• A 5-percent loss results in thirst, irritability, nausea, and

weakness.

• A 10-percent loss results in dizziness, headache, inability

to walk, and a tingling sensation in the limbs.

• A 15-percent loss results in dim vision, painful urination,

swollen tongue, deafness, and a numb feeling in the skin.

• A loss greater than 15 percent may result in death.

4-4. The most common signs and symptoms of dehydration are—

• Dark urine with a very strong odor.

• Low urine output.

• Dark, sunken eyes.

• Fatigue.

• Emotional instability.

• Loss of skin elasticity.

• Delayed capillary refill in fingernail beds.

• Trench line down center of tongue.

• Thirst. (Last on the list because you are already 2-percent

dehydrated by the time you crave fluids.)

4-5. You should 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.

4-6. 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.

4-7. 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 liters every 24

hours.

4-2

4-8. 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 8 to 12 ounces of water

every 30 minutes. It is better to regulate water loss through work

or rest cycles because overhydration can occur if water intake

exceed 1 1/2 quarts per hour. Overhydration can cause low serum

sodium levels resulting in cerebral and pulmonary edema, which

can lead to death.

4-9. 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. You should maintain an intake of

carbohydrates and other necessary electrolytes.

4-10. 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:

• Always drink water when eating. Water is used and

consumed as a part of the digestion process and can lead to

dehydration.

• Acclimatize. The body performs more efficiently in extreme

conditions when acclimatized.

• Conserve sweat, not water. Limit sweat-producing activities

but drink water.

• Ration water. Until you find a suitable source, ration your

sweat, not your water. Limit activity and heat gain or loss.

4-11. You can estimate fluid loss by several means. A field

dressing holds about 0.25 liters (1/4 canteen) of fluid. A soaked

T-shirt holds 0.5 to 0.75 liters.

4-12. You can also use the pulse and breathing rate to estimate

fluid loss. Use the following as a guide:

• With a 0.75-liter loss the wrist pulse rate will be under 100

beats per minute and the breathing rate 12 to 20 breaths

per minute.

• With a 0.75- to 1.5-liter loss the pulse rate will be 100 to

120 beats per minute and 20 to 30 breaths per minute.

4-3

• With a 1.5- to 2-liter loss the pulse rate will be 120 to 140

beats per minute and 30 to 40 breaths per minute. Vital

signs above these rates require more advanced care.

FOOD

4-13. 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 provides energy and replenishes the

substances that your body burns. Food provides vitamins,

minerals, salts, and other elements essential to good health.

Possibly more important, it helps morale.

4-14. The three basic sources of food are plants, animals

(including fish), and issued rations. In varying degrees, both

provide the calories, carbohydrates, fats, and proteins needed for

normal daily body functions. You should use rations to augment

plant and animal foods, which will extend and help maintain a

balanced diet.

4-15. 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.

Plants

4-16. Plant 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 foods containing

natural sugar will provide calories and carbohydrates that give

the body natural energy.

4-17. 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—

• You can dry plants by wind, air, sun, or fire. This retards

spoilage so that you can store or carry the plant food with

you to use when needed.

4-4

• You can obtain plants more easily and more quietly than

meat. This is extremely important when the enemy is near.

Animals

4-18. 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.

4-19. 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

4-20. 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.

4-21. 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.

4-22. 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—

• Extract grease from animal fat by cutting the fat into

small pieces and cooking it in a pot.

• Add enough water to the pot to keep the fat from sticking

as it cooks.

• Cook the fat slowly, stirring frequently.

• After the fat is rendered, pour the grease into a container

to harden.

• Place ashes in a container with a spout near the bottom.

4-5

• Pour water over the ashes and collect the liquid that drips

out of the spout in a separate container. This liquid is the

potash or lye.

4-23. Another way to get the lye is to pour the slurry (the mixture

of ashes and water) through a straining cloth.

• In a cooking pot, mix two parts grease to one part lye.

• Place this mixture over a fire and boil it until it thickens.

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

4-24. Germs on your hands can infect food and wounds. Wash

your hands after handling any material that is likely to carry

germs, after urinating or defecating, 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

4-25. 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

4-26. Keep your clothing and bedding as clean as possible to

reduce the chances of skin infection or 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

4-27. 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 (cm) (8 inches)

long and 1 centimeter (1/3 inch) wide. Chew one end of the stick

4-6

to separate the fibers. Then 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.

Rinse your mouth with water, salt water, or willow bark tea. Also,

flossing your teeth with string or fiber helps oral hygiene.

4-28. If you have cavities, you can make temporary fillings by

placing candle wax, tobacco, hot pepper, toothpaste or powder, or

portions of a gingerroot 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

4-29. 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.

4-30. 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:

• Obtain a sewing-type needle and a clean or sterilized

thread.

• Run the needle and thread through the blister after

cleaning the blister.

• Detach the needle and leave both ends of the thread

hanging out of the blister. The thread will absorb the

liquid inside. This reduces the size of the hole and ensures

that the hole does not close up.

• Pad around the blister.

Get Sufficient Rest

4-31. 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

4-7

or vice versa can be refreshing when time or situation does not

permit total relaxation.

Keep Campsite Clean

4-32. Do not soil the ground in the campsite 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 campsite. Purify all water.

MEDICAL EMERGENCIES

4-33. Medical problems and emergencies you may face include

breathing problems, severe bleeding, and shock. The following

paragraphs explain each of these problems and what you can

expect if they occur.

BREATHING PROBLEMS

4-34. Any one of the following can cause airway obstruction,

resulting in stopped breathing:

• Foreign matter in mouth of throat that obstructs the

opening to the trachea.

• Face or neck injuries.

• Inflammation and swelling of mouth and throat caused by

inhaling smoke, flames, and irritating vapors or by an

allergic reaction.

•

“Kink” in the throat (caused by the neck bent forward so

that the chin rests upon the chest).

• Tongue blocks passage of air to the lungs upon

unconsciousness. When an individual is unconscious, the

muscles of the lower jaw and tongue relax as the neck

drops forward, causing the lower jaw to sag and the tongue

to drop back and block the passage of air.

SEVERE BLEEDING

4-35. 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.

4-8

SHOCK

4-36. 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.

LIFESAVING STEPS

4-37. 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.

Start with the airway and breathing, but be discerning. In some

cases, a person may die from arterial bleeding more quickly than

from an airway obstruction. The following paragraphs describe

how to treat airway, bleeding, and shock emergencies.

OPEN AIRWAY AND MAINTAIN

4-38. You can open an airway and maintain it by using the

following steps:

• Step 1. You should check to see 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, and

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, page 4-10).

4-9

Figure 4-1. 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:

Look for his chest to rise and fall.

Listen for escaping air during exhalation.

Feel for flow of air on your cheek.

• 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, Physical Fitness Training, the American

Heart Association manual, the Red Cross manual, or most other

first aid books for detailed instructions on CPR.

CONTROL BLEEDING

4-39. In a survival situation, you must control serious bleeding

immediately because replacement fluids normally are not

available and the victim can die within a matter of minutes.

4-10

External bleeding falls into the following classifications

(according to its source):

• Arterial. Blood vessels called arteries carry blood away

from the heart and through the body. A cut artery issues

bright red blood from the wound in distinct spurts or pulses

that correspond to the rhythm of the heartbeat. Because

the blood in the arteries is under high pressure, an

individual can lose a large volume of blood in a short

period when damage to an artery of significant size occurs.

Therefore, arterial bleeding is the most serious type of

bleeding. If not controlled promptly, it can be fatal.

• Venous. Venous blood is blood that is returning to the

heart through blood vessels called veins. A steady flow of

dark red, maroon, or bluish blood characterizes bleeding

from a vein. You can usually control venous bleeding more

easily than arterial bleeding.

• Capillary. The capillaries are the extremely small vessels

that connect the arteries with the veins. Capillary bleeding

most commonly occurs in minor cuts and scrapes. This

type of bleeding is not difficult to control.

4-40. You can control external bleeding by direct pressure,

indirect (pressure points) pressure, elevation, digital ligation, or

tourniquet. Each method is explained below.

Direct Pressure

4-41. The most effective way to control external bleeding is by

applying pressure directly over the wound. This pressure must

not only be firm enough to stop the bleeding, but it must also be

maintained long enough to “seal off” the damaged surface.

4-42. If bleeding continues after having applied direct pressure

for 30 minutes, apply a pressure dressing. This dressing consists

of a thick dressing of gauze or other suitable material applied

directly over the wound and held in place with a tightly wrapped

bandage (Figure 4-2, page 4-12). It should be tighter than an

ordinary compression bandage but not so tight that it impairs

circulation to the rest of the limb. Once you apply the dressing,

do not remove it, even when the dressing becomes blood soaked.

4-11

Elevation

4-44. Raising an injured extremity as high as possible above the

heart’s level slows blood loss by aiding the return of blood to the

heart and lowering the blood pressure at the wound. However,

elevation alone will not control bleeding entirely; you must also

apply direct pressure over the wound. When treating a snakebite,

be sure to keep the extremity lower than the heart.

Pressure Points

4-45. A pressure point is a location where the main artery to the

wound lies near the surface of the skin or where the artery passes

directly over a bony prominence (Figure 4-3). You can use digital

pressure on a pressure point to slow arterial bleeding until the

application of a pressure dressing. Pressure point control is not as

effective for controlling bleeding as direct pressure exerted on the

wound. It is rare when a single major compressible artery

supplies a damaged vessel.

Figure 4-3. Pressure Points

4-13

4-46. If you cannot remember the exact location of the pressure

points, follow this rule: Apply pressure at the end of the joint just

above the injured area. On hands, feet, and head, this will be the

wrist, ankle, and neck, respectively.

WARNING

Use caution when applying pressure to the neck.

Too much pressure for too long may cause

unconsciousness or death. Never place a

tourniquet around the neck.

4-47. Maintain pressure points by placing a round stick in the

joint, bending the joint over the stick, and then keeping it tightly

bent by lashing. By using this method to maintain pressure, it

frees your hands to work in other areas.

Digital Ligation

4-48. You can stop major bleeding immediately or slow it down by

applying pressure with a finger or two on the bleeding end of the

vein or artery. Maintain the pressure until the bleeding stops or

slows down enough to apply a pressure bandage, elevation, and so

forth.

Tourniquet

4-49. Use a tourniquet only when direct pressure over the

bleeding point and all other methods did not control the bleeding.

If you leave a tourniquet in place too long, the damage to the

tissues can progress to gangrene, with a loss of the limb later. An

improperly applied tourniquet can also cause permanent damage

to nerves and other tissues at the site of the constriction. If you

must use a tourniquet, place it around the extremity, between the

wound and the heart, 5 to 10 centimeters (2 to 4 inches) above the

wound site. Never place it directly over the wound or a fracture.

Figure 4-4, page 4-15, explains how to apply a tourniquet.

4-50. After you secure the tourniquet, clean and bandage the

wound. A lone survivor does not remove or release an applied

tourniquet. However, in a buddy system, the buddy can release

the tourniquet pressure every 10 to 15 minutes for 1 or 2 minutes

to let blood flow to the rest of the extremity to prevent limb loss.

4-14

PREVENT AND TREAT SHOCK

4-51. Anticipate shock in all injured personnel. Treat all injured

persons as follows, regardless of what symptoms appear (Figure

4-5, page 4-17):

•

If the victim is conscious, place him on a level surface with

the lower extremities elevated 15 to 20 centimeters (6 to 8

inches).

•

If the victim is unconscious, place him on his side or

abdomen with his head turned to one side to prevent

choking on vomit, blood, or other fluids.

•

If you are unsure of the best position, place the victim

perfectly flat. Once the victim is in a shock position, do not

move him.

•

Maintain body heat by insulating the victim from the

surroundings and, in some instances, applying external

heat.

•

If wet, remove all the victim’s wet clothing as soon as

possible and replace with dry clothing.

•

Improvise a shelter to insulate the victim from the

weather.

•

Use warm liquids or foods, a prewarmed sleeping bag,

another person, warmed water in canteens, hot rocks

wrapped in clothing, or fires on either side of the victim to

provide external warmth.

•

If the victim is conscious, slowly administer small doses of

a warm salt or sugar solution, if available.

•

If the victim is unconscious or has abdominal wounds, do

not give fluids by mouth.

•

Have the victim rest for at least 24 hours.

•

If you are a lone survivor, lie in a depression in the ground,

behind a tree, or any other place out of the weather, with

your head lower than your feet.

•

If you are with a buddy, reassess your patient constantly.

4-16

BONE AND JOINT INJURY

4-52. You could face bone and joint injuries that include

fractures, dislocations, and sprains. Follow the steps explained

below for each injury.

FRACTURES

4-53. There are basically two types of fractures: open and closed.

With an open (or compound) fracture, the bone protrudes through

the skin and complicates the actual fracture with an open wound.

Any bone protruding from the wound should be cleaned with an

antiseptic and kept moist. You should splint the injured area and

continually monitor blood flow past the injury. Only reposition the

break if there is no blood flow.

4-54. The closed fracture has no open wounds. Follow the

guidelines for immobilization and splint the fracture.

4-55. The signs and symptoms of a fracture are pain, tenderness,

discoloration, swelling deformity, loss of function, and grating (a

sound or feeling that occurs when broken bone ends rub together).

4-56. The dangers with a fracture are the severing or the

compression of a nerve or blood vessel at the site of fracture. For

this reason minimum manipulation should be done, and only very

cautiously. If you notice the area below the break becoming numb,

swollen, cool to the touch, or turning pale, and the victim showing

signs of shock, a major vessel may have been severed. You must

control this internal bleeding. Reset the fracture and treat the

victim for shock and replace lost fluids.

4-57. Often you must maintain traction during the splinting and

healing process. You can effectively pull smaller bones such as the

arm or lower leg by hand. You can create traction by wedging a

hand or foot in the V-notch of a tree and pushing against the tree

with the other extremity. You can then splint the break.

4-58. Very strong muscles hold a broken thighbone (femur) in

place making it difficult to maintain traction during healing. You

can make an improvised traction splint using natural material

(Figure 4-6, page 4-19) as explained below.

4-18

Figure 4-6. Improvised Traction Splint

• Get two forked branches or saplings at least 5 centimeters

(2 inches) in diameter. Measure one from the patient’s

armpit to 20 to 30 centimeters (8 to 12 inches) past his

unbroken leg. Measure the other from the groin to 20 to 30

centimeters (8 to 12 inches) past the unbroken leg. Ensure

that both extend an equal distance beyond the end of the

leg.

• Pad the two splints. Notch the ends without forks and lash a

20- to 30-centimeter (8- to 12-inch) cross member made from

a 5-centimeter (2-inch) diameter branch between them.

• Using available material (vines, cloth, rawhide), tie the

splint around the upper portion of the body and down the

length of the broken leg. Follow the splinting guidelines.

• With available material, fashion a wrap that will extend

around the ankle, with the two free ends tied to the cross

member.

4-19

• Place a 10- by 2.5-centimeter (4- by 1-inch) stick in the

middle of the free ends of the ankle wrap between the cross

member and the foot. Using the stick, twist the material to

make the traction easier.

• Continue twisting until the broken leg is as long or slightly

longer than the unbroken leg.

• Lash the stick to maintain traction.

NOTE: Over time, you may lose traction because the material

weakened. Check the traction periodically. If you must change or

repair the splint, maintain the traction manually for a short time.

DISLOCATIONS

4-59. Dislocations are the separations of bone joints causing the

bones to go out of proper alignment. These misalignments can be

extremely painful and can cause an impairment of nerve or

circulatory function below the area affected. You must place these

joints back into alignment as quickly as possible.

4-60. Signs and symptoms of dislocations are joint pain,

tenderness, swelling, discoloration, limited range of motion, and

deformity of the joint. You treat dislocations by reduction,

immobilization, and rehabilitation.

4-61. Reduction or “setting” is placing the bones back into their

proper alignment. You can use several methods, but manual

traction or the use of weights to pull the bones are the safest and

easiest. Once performed, reduction decreases the victim’s pain

and allows for normal function and circulation. Without an X ray,

you can judge proper alignment by the look and feel of the joint

and by comparing it to the joint on the opposite side.

4-62. Immobilization is nothing more than splinting the

dislocation after reduction. You can use any field-expedient

material for a splint or you can splint an extremity to the body.

The basic guidelines for splinting are as follows:

• Splint above and below the fracture site.

• Pad splints to reduce discomfort.

• Check circulation below the fracture after making each tie

on the splint.

4-20

4-63. To rehabilitate the dislocation, remove the splints after 7 to

14 days. Gradually use the injured joint until fully healed.

SPRAINS

4-64. The accidental overstretching of a tendon or ligament

causes sprains. The signs and symptoms are pain, swelling,

tenderness, and discoloration (black and blue).

4-65. When treating sprains, you should follow the letters in

RICE as defined below:

• R-Rest injured area.

• I-Ice for 24 to 48 hours.

• C-Compression-wrap or splint to help stabilize. If possible,

leave the boot on a sprained ankle unless circulation is

compromised.

• E-Elevate the affected area.

NOTE: Ice is preferred for a sprain but cold spring water may be

more easily obtained in a survival situation.

BITES AND STINGS

4-66. Insects and related pests are hazards in a survival

situation. They not only cause irritations, but they are often

carriers of diseases that cause severe allergic reactions in some

individuals. In many parts of the world you will be exposed to

serious, even fatal, diseases not encountered in the United States.

• Ticks can carry and transmit diseases, such as Rocky

Mountain spotted fever common in many parts of the

United States. Ticks also transmit Lyme disease.

• Mosquitoes may carry malaria, dengue, and many other

diseases.

• Flies can spread disease from contact with infectious

sources. They are causes of sleeping sickness, typhoid,

cholera, and dysentery.

• Fleas can transmit plague.

• Lice can transmit typhus and relapsing fever.

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4-67. The best way to avoid the complications of insect bites and

stings is to keep immunizations (including booster shots) up-to-

date, avoid insect-infested areas, use netting and insect repellent,

and wear all clothing properly.

4-68. If you are bitten or stung, do not scratch the bite or sting; it

might become infected. Inspect your body at least once a day to

ensure there are no insects attached to you. If you find ticks

attached to your body, cover them with a substance (such as

petroleum jelly, heavy oil, or tree sap) that will cut off their air

supply. Without air, the tick releases its hold, and you can remove

it. Take care to remove the whole tick. Use tweezers if you have

them. Grasp the tick where the mouthparts are attached to the

skin. Do not squeeze the tick’s body. Wash your hands after

touching the tick. Clean the tick wound daily until healed.

TREATMENT

4-69. It is impossible to list the treatment of all the different

types of bites and stings. However, you can generally treat bites

and stings as follows:

• If antibiotics are available for your use, become familiar

with them before deployment and use them.

• Predeployment immunizations can prevent most of the

common diseases carried by mosquitoes and some carried

by flies.

• The common fly-borne diseases are usually treatable with

penicillins or erythromycin.

• Most tick-, flea-, louse-, and mite-borne diseases are

treatable with tetracycline.

• Most antibiotics come in 250 milligram (mg) or 500 mg

tablets. If you cannot remember the exact dose rate to

treat a disease, 2 tablets, 4 times a day, for 10 to 14 days

will usually kill any bacteria.

BEE AND WASP STINGS

4-70. If stung by a bee, immediately remove the stinger and

venom sac, if attached, by scraping with a fingernail or a knife

blade. Do not squeeze or grasp the stinger or venom sac, as

squeezing will force more venom into the wound. Wash the sting

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site thoroughly with soap and water to lessen the chance of a

secondary infection.

4-71. If you know or suspect that you are allergic to insect stings,

always carry an insect sting kit with you.

4-72. Relieve the itching and discomfort caused by insect bites by

applying—

• Cold compresses.

• A cooling paste of mud and ashes.

• Sap from dandelions.

• Coconut meat.

• Crushed cloves of garlic.

• Onion.

SPIDER BITES AND SCORPION STINGS

4-73. The black widow spider is identified by a red hourglass on

its abdomen. Only the female bites, and it has a neurotoxic

venom. The initial pain is not severe, but severe local pain rapidly

develops. The pain gradually spreads over the entire body and

settles in the abdomen and legs. Abdominal cramps and

progressive nausea, vomiting, and a rash may occur. Weakness,

tremors, sweating, and salivation may occur. Anaphylactic

reactions can occur. Symptoms may worsen for the next three

days and then begin to subside for the next week. Treat for shock.

Be ready to perform CPR. Clean and dress the bite area to reduce

the risk of infection. An antivenin is available.

4-74. The funnelweb spider is a large brown or gray spider found

in Australia. The symptoms and the treatment for its bite are as

for the black widow spider.

4-75. The brown house spider or brown recluse spider is a small,

light brown spider identified by a dark brown violin on its back.

There is no pain, or so little pain, that usually a victim is not

aware of the bite. Within a few hours a painful red area with a

mottled cyanotic center appears. Necrosis does not occur in all

bites, but usually in 3 to 4 days, a star-shaped, firm area of deep

purple discoloration appears at the bite site. The area turns dark

and mummified in a week or two. The margins separate and the

scab falls off, leaving an open ulcer. Secondary infection and

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regional swollen lymph glands usually become visible at this

stage. The outstanding characteristic of the brown recluse bite is

an ulcer that does not heal but persists for weeks or months. In

addition to the ulcer, there is often a systemic reaction that is

serious and may lead to death. Reactions (fever, chills, joint pain,

vomiting, and a generalized rash) occur chiefly in children or

debilitated persons.

4-76. Tarantulas are large, hairy spiders found mainly in the

tropics. Most do not inject venom, but some South American

species do. They have large fangs. If bitten, pain and bleeding are

certain, and infection is likely. Treat a tarantula bite as for any

open wound, and try to prevent infection. If symptoms of

poisoning appear, treat as for the bite of the black widow spider.

4-77. Scorpions are all poisonous to a greater or lesser degree.

There are two different reactions, depending on the species:

• Severe local reaction only, with pain and swelling around

the area of the sting. Possible prickly sensation around the

mouth and a thick-feeling tongue.

• Severe systemic reaction, with little or no visible local

reaction. Local pain may be present. Systemic reaction

includes respiratory difficulties, thick-feeling tongue, body

spasms, drooling, gastric distention, double vision,

blindness, involuntary rapid movement of the eyeballs,

involuntary urination and defecation, and heart failure.

Death is rare, occurring mainly in children and adults with

high blood pressure or illnesses.

4-78. Treat scorpion stings as you would a black widow bite.

SNAKEBITES

4-79. The chance of a snakebite in a survival situation is rather

small, if you are familiar with the various types of snakes and

their habitats. However, it could happen and you should know

how to treat a snakebite. Deaths from snakebites are rare. More

than one-half of the snakebite victims have little or no poisoning,

and only about one-quarter develop serious systemic poisoning.

However, the chance of a snakebite in a survival situation can

affect morale, and failure to take preventive measures or failure

to treat a snakebite properly can result in needless tragedy.

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4-80. The primary concern in the treatment of snakebite is to

limit the amount of eventual tissue destruction around the bite

area.

4-81. A bite wound, regardless of the type of animal that inflicted

it, can become infected from bacteria in the animal’s mouth. With

nonpoisonous as well as poisonous snakebites, this local infection

is responsible for a large part of the residual damage that results.

4-82. Snake venoms not only contain poisons that attack the

victim’s central nervous system

(neurotoxins) and blood

circulation (hemotoxins), but also digestive enzymes (cytotoxins)

to aid in digesting their prey. These poisons can cause a very

large area of tissue death, leaving a large open wound. This

condition could lead to the need for eventual amputation if not

treated.

4-83. Shock and panic in a person bitten by a snake can also affect

the person’s recovery. Excitement, hysteria, and panic can speed up

the circulation, causing the body to absorb the toxin quickly. Signs

of shock occur within the first 30 minutes after the bite.

4-84. Before you start treating a snakebite, determine whether

the snake was poisonous or nonpoisonous. Bites from a

nonpoisonous snake will show rows of teeth. Bites from a

poisonous snake may have rows of teeth showing, but will have

one or more distinctive puncture marks caused by fang

penetration. Symptoms of a poisonous bite may be spontaneous

bleeding from the nose and anus, blood in the urine, pain at the

site of the bite, and swelling at the site of the bite within a few

minutes or up to 2 hours later.

4-85. Breathing difficulty, paralysis, weakness, twitching, and

numbness are also signs of neurotoxic venoms. These signs

usually appear 1.5 to 2 hours after the bite.

4-86. If you determine that a poisonous snake bit an individual,

take the following steps:

• Reassure the victim and keep him still.

• Set up for shock and force fluids or give by intravenous

(IV) means.

• Remove watches, rings, bracelets, or other constricting

items.

4-25

• Clean the bite area.

• Maintain an airway (especially if bitten near the face or

neck) and be prepared to administer mouth-to-mouth

resuscitation or CPR.

• Use a constricting band between the wound and the heart.

• Immobilize the site.

• Remove the poison as soon as possible by using a

mechanical suction device. Do not squeeze the site of

the bite.

4-87. You should also remember four very important guidelines

during the treatment of snakebites. Do not—

• Give the victim alcoholic beverages or tobacco products.

Never give atropine! Give morphine or other central

nervous system (CNS) depressors.

• Make any deep cuts at the bite site. Cutting opens

capillaries that in turn open a direct route into the blood

stream for venom and infection.

NOTE: If medical treatment is over 1 hour away, make an

incision (no longer than 6 millimeters [1/4 inch] and no deeper

than 3 millimeters [1/8 inch]) over each puncture, cutting just

deep enough to enlarge the fang opening, but only through the

first or second layer of skin. Place a suction cup over the bite so

that you have a good vacuum seal. Suction the bite site 3 to 4

times. Suction for a MINIMUM of 30 MINUTES. Use mouth

suction only as a last resort and only if you do not have open

sores in your mouth. Spit the envenomed blood out and rinse your

mouth with water. This method will draw out 25 to 30 percent of

the venom.

• Put your hands on your face or rub your eyes, as venom

may be on your hands. Venom may cause blindness.

• Break open the large blisters that form around the bite

site.

4-88. After caring for the victim as described above, take the

following actions to minimize local effects:

• If infection appears, keep the wound open and clean.

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• Use heat after 24 to 48 hours to help prevent the spread of

local infection. Heat also helps to draw out an infection.

• Keep the wound covered with a dry, sterile dressing.

• Have the victim drink large amounts of fluids until the

infection is gone.

WOUNDS

4-89. An interruption of the skin’s integrity characterizes

wounds. These wounds could be open wounds, skin diseases,

frostbite, trench foot, or burns.

OPEN WOUNDS

4-90. Open wounds are serious in a survival situation, not only

because of tissue damage and blood loss, but also because they

may become infected. Bacteria on the object that made the

wound, on the individual’s skin and clothing, or on other foreign

material or dirt that touches the wound may cause infection.

4-91. By taking proper care of the wound you can reduce further

contamination and promote healing. Clean the wound as soon as

possible after it occurs by—

• Removing or cutting clothing away from the wound.

• Always looking for an exit wound if a sharp object,

gunshot, or projectile caused a wound.

• Thoroughly cleaning the skin around the wound.

• Rinsing (not scrubbing) the wound with large amounts of

water under pressure. You can use fresh urine if water is

not available.

4-92. The “open treatment” method is the safest way to manage

wounds in survival situations. Do not try to close any wound by

suturing or similar procedures. Leave the wound open to allow

the drainage of any pus resulting from infection. As long as the

wound can drain, it generally will not become life-threatening,

regardless of how unpleasant it looks or smells.

4-93. Cover the wound with a clean dressing. Place a bandage on

the dressing to hold it in place. Change the dressing daily to

check for infection.

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4-94. If a wound is gaping, you can bring the edges together with

adhesive tape cut in the form of a “butterfly” or

“dumbbell”

(Figure 4-7). Use this method with extreme caution in the absence

of antibiotics. You must always allow for proper drainage of the

wound to avoid infection.

Figure 4-7. Butterfly Closure

4-95. In a survival situation, some degree of wound infection is

almost inevitable. Pain, swelling, and redness around the wound,

increased temperature, and pus in the wound or on the dressing

indicate infection is present.

4-96. If the wound becomes infected, you should treat as follows:

• Place a warm, moist compress directly on the infected

wound. Change the compress when it cools, keeping a

warm compress on the wound for a total of 30 minutes.

Apply the compresses three or four times daily.

• Drain the wound. Open and gently probe the infected

wound with a sterile instrument.

• Dress and bandage the wound.

• Drink a lot of water.

• In the event of gunshot or other serious wounds, it may be

better to rinse the wound out vigorously every day with the

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cleanest water available. If drinking water or methods to

purify drinking water are limited, do not use your drinking

water. Flush the wound forcefully daily until the wound is

healed over. Your scar may be larger but your chances of

infection are greatly reduced.

• Continue this treatment daily until all signs of infection

have disappeared.

4-97. If you do not have antibiotics and the wound has become

severely infected, does not heal, and ordinary debridement is

impossible, consider maggot therapy as stated below, despite its

hazards:

• Expose the wound to flies for one day and then cover it.

• Check daily for maggots.

• Once maggots develop, keep wound covered but check

daily.

• Remove all maggots when they have cleaned out all dead

tissue and before they start on healthy tissue. Increased

pain and bright red blood in the wound indicate that the

maggots have reached healthy tissue.

• Flush the wound repeatedly with sterile water or fresh

urine to remove the maggots.

• Check the wound every 4 hours for several days to ensure

all maggots have been removed.

• Bandage the wound and treat it as any other wound. It

should heal normally.

SKIN DISEASES AND AILMENTS

4-98. Boils, fungal infections, and rashes rarely develop into a

serious health problem. They cause discomfort and you should

treat them as follows:

Boils

4-99. Apply warm compresses to bring the boil to a head. Another

method that can be used to bring a boil to a head is the bottle

suction method. Use an empty bottle that has been boiled in

water. Place the opening of the bottle over the boil and seal the

skin forming an airtight environment that will create a vacuum.

This method will draw the pus to the skin surface when applied

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FM 3-05.70 Field Manual Survival (17 May 2002) - page 2