📘 Guides › 🩹 Health & medicine · 🆘 Emergency · 📇 Index A–Z

🩹 Injuries & Illness When No Help Is Coming

What to do when someone is hurt or sick and no ambulance, hospital or doctor is coming — from the first minutes through weeks of nursing. It follows the newest books on the drive: the US Army's 2026 first-aid manual (ATP 4-02.11), the Joint Trauma System (JTS) guidelines for care when evacuation is delayed, and WHO-ICRC Basic Emergency Care. Older books are used only where nothing has changed. The books are in Medical\Field-Care\ (Trauma-Bleeding, Wounds-Burns-Fractures, Nursing-Care, Dental, Childbirth-Newborn), Medical\Manuals-PDF, Medical\Where There Is No Doctor and Manuals\ArmyFieldManuals. Medicines and doses are in the companion guide, Medical — READ ME FIRST.

⚠️ Rules that prevent the worst outcomes

🚨 The first look: check in this order

Fix each problem before moving on. The Army calls it MARCH; WHO uses the same idea as ABCDE (ATP, p. 53; WHO-ICRC, p. 49).

Letter Check Do
M — Massive bleeding Spurting or pooling blood Tourniquet or packing (next section)
A — Airway Noisy, gurgling, unconscious Clear the mouth; recovery position or jaw thrust (ATP, p. 78)
R — Respiration Breathing? Hole in the chest? Tape plastic over a chest wound; lift it if breathing gets worse (ATP, p. 94; chest seals, p. 88; Occlusive dressing)
C — Circulation Pale, confused, weak wrist pulse (feeling it, WTND ch. 3, p. 4) Treat for shock (shock position, ATP p. 99)
H — Hypothermia, Head Cold, wet, knocked out Insulate; watch the head

Then pain, antibiotics, wounds and splints ("MARCH-PAWS").

Recovery position (unconscious but breathing, no injury suspected): roll them onto the left side, bend the top leg forward, and rest the head on the straight lower arm with the mouth pointing down so vomit drains out (WHO-ICRC, p. 190). If the neck might be hurt, push the jaw forward ("jaw thrust") instead of tilting the head back (p. 49; ATP drawing, p. 78; Jaw thrust), and turn the body as one unit — a "log-roll" (ICRC First Aid, p. 163; WHO-ICRC, p. 188). Recovery position; ATP drawing, p. 79.

Recovery position: a person lying on the left side, top leg bent forward, head resting on the straight lower arm, a helper kneeling behind On the side, top leg bent forward, head on the straight lower arm so the mouth drains; only when no injury is suspected (WHO-ICRC, p. 190).

CPR: push hard and fast in the center of the chest, at least 2 inches deep, 100–120 a minute, letting it come all the way back up — 30 pushes, then 2 breaths (ATP, p. 95; CPR). Know its limits:

📚 Go deeper: ATP 4-02.11 — the whole MARCH-PAWS sequence with drawings; WHO-ICRC Basic Emergency Care — the ABCDE check for any sick or hurt person.

🩸 Stopping life-threatening bleeding, then shock

Tourniquet — arm or leg, blood spurting or pooling (ATP, p. 62):

  1. Put it 2–3 inches above the wound, directly on the skin.
  2. Tighten until the bleeding stops and there's no pulse below it. It will hurt badly — that means it's tight enough.
  3. Still bleeding? Add a second tourniquet just above the first (often needed on the thigh).
  4. Write down the time it went on (p. 63).

No tourniquet? A band at least 2 inches wide twisted tight with a stick — never wire or a shoelace (FM 4-25.11, p. 48; this tip still holds; stick-and-knot steps, pp. 49–50). Tourniquet; Combat Application Tourniquet.

A leg with a thigh wound: the tourniquet goes on bare skin 2–3 in above the wound, toward the body, with a second one just above if needed; below, three steps to make one from a wide band and a stick "Above the wound" means between the wound and the body (a diagram drawn for this guide).

Where a tourniquet can't go (groin, armpit, neck — ATP, p. 69): pack the wound. Stuff gauze or clean cloth tightly in, right down to where the blood comes from, press hard at least 3 minutes — sometimes up to 10 — then wrap a pressure bandage over it (ATP, p. 64; JTS wound guideline, p. 5; direct pressure, WHO-ICRC p. 169; pressure dressing, FM 4-25.11 p. 45; Hemostatic agent). The hand or foot beyond should stay warm and pink (ATP, p. 65).

Tourniquet timing when no surgeon is coming (JTS Prolonged Casualty Care, p. 18):

Shock. An injured person who is confused (no head injury) with a weak or missing wrist pulse has lost a lot of blood and will die without fast action (ATP, p. 98). Stop the bleeding, lay them flat with feet raised (after any broken leg is splinted), loosen tight clothing, and insulate them above and below (p. 100; shock position, p. 99; Shock). Drinks: standard first aid says nothing by mouth (same page), because surgery may come soon. With no help coming, that changes: if they're awake and can swallow, give sips of electrolyte (rehydration) drink, not plain water, which can drop the body's salt dangerously (JTS, p. 18).

Shock position: a person lying flat on a pad with the feet raised on a rolled pack Flat on the back, feet raised a little above the heart, a pad between them and the ground (ATP, p. 99).

📚 Go deeper: ATP 4-02.11, ch. 4 — tourniquets, packing and pressure bandages step by step; JTS Prolonged Casualty Care — hour-by-hour care when evacuation is delayed.

🔥 Burns

First aid (ATP, pp. 131–132):

How big? Their own palm is about 1%. Rule of nines: head 9%, each arm 9%, each leg 18%, front of trunk 18%, back 18%. Don't count red skin without blisters (ATP, p. 130; adult chart in WHO-ICRC, p. 197, child chart on p. 198). Rule of nines; adult and child charts, JTS p. 53; photos of 1st-, 2nd- and 3rd-degree burns, JTS burn guideline p. 5; Burn.

Rule of nines, front and back of an adult: head 4.5 front and 4.5 back, each arm 4.5 front and 4.5 back, chest and belly 18, back 18, each leg 9 front and 9 back, groin 1 Add front and back: head 9%, each arm 9%, each leg 18%, front of the trunk 18%, back 18% (ATP, p. 130).

Fluids without an IV (JTS burn guideline, pp. 6–8):

Dressings (p. 9): leave unbroken blisters alone; cover with clean, dry gauze (wet dressings chill). For longer care, once a day wash gently with mild soap and clean water, remove loose dead skin, apply silver sulfadiazine cream (not on babies under 2 months, eyelids or lips) or a thin layer of honey (WTND, p. 96), re-cover (washing and covering a burn, ICRC First Aid p. 217). Give pain medicine first.

📚 Go deeper: JTS Burn Wound Management — sizing, drinking schedules, urine targets, daily care; WHO Surgical Care at the District Hospital — burns in a small hospital.

🧼 Wounds and infection when there's no hospital

Wash it out with lots of water (JTS wound guideline, pp. 4–5):

Close it or leave it open? (p. 10)

Bites (dog, cat, human): scrub at once with soap and water, let them heal open, think about rabies; most need antibiotics (p. 12). Tetanus: check vaccination with every wound (p. 10) — and get boosters now (general practice).

When infection spreads:

Sterilizing instruments — scrub off blood and dirt first (JTS, pp. 17–18):

Method How Result
Pressure cooker Tools on a rack above the water, 60 minutes once it vents Sterile
Oven 338 °F (170 °C) 1 hour, or 320 °F (160 °C) 2 hours Sterile
Plain bleach Soak undiluted 5 minutes, rinse Disinfected
Boiling Last resort Clean, NOT sterile (WHO, p. 115)

Autoclave; Pressure cooker.

📚 Go deeper: JTS Acute Traumatic Wound Management — washing, closing, bites, sterilizing; ICRC War Surgery Vol 1 — dirty wounds and delayed closure; WTND — skin infections — plain-language pictures.

🦴 Broken bones, sprains, spine and head

Splinting (WHO-ICRC, p. 191; arm slings: ATP pp. 141–143, Sling):

  1. Take off rings and jewelry.
  2. Before and after, check beyond the injury: pulse, color, feeling, movement.
  3. Pad the splint and bony points; reach past the joint above and the joint below (board and improvised splints, ATP pp. 146–148; the good leg as a splint, p. 149).
  4. Deformed, no pulse (cold, pale): gently straighten it. Deformed with a good pulse: don't force it.

Two boards splinted along a broken lower leg, from above the knee to past the foot, tied with cloth strips above and below the break The boards reach past the joint above (knee) and the joint below (ankle), with ties above and below the break (ATP, p. 147).

Cast too tight from swelling: split it and rewrap with an elastic bandage (Hospital Corpsman, p. 96; cutting a cast, WHO Surgical Care p. 393). Splint.

Sprains — treat like a break (WTND, p. 102): keep it still, wrap firmly from the toes up (loosen briefly every hour or two), keep it raised. Cold wet cloths 20–30 minutes every hour for a day or two, then warm soaks. Never rub or massage it. A bad sprain takes 3–4 weeks.

Dislocated shoulder — the longer you wait, the harder it gets (WTND, p. 101): lay them face down on a table, arm hanging over the edge. Pull steadily down 15–20 minutes, or hang 5–10 kg from the arm (start with 5). Then bind the arm to the body for a week to a month; no lifting with it for a month. Other methods: WHO Surgical Care, p. 403 (drawings, p. 404). Dislocated shoulder.

Spine: suspect it with numbness, weakness, or a head injury. Keep them flat; log-roll to check the back or let them vomit. A hard board is only for moving them — hours on one cause pressure sores (WHO-ICRC, pp. 55, 189; lifting without bending the spine, WTND p. 100; Spinal board).

Three helpers ready to log-roll a person lying on the back: one at the head holds the head and neck, two hold the shoulders, hips and legs Log-roll: the person at the head keeps it in line and calls "1–2–3"; everyone turns the body together as one unit (WHO-ICRC, p. 188).

Head injury danger signs: unequal pupils (WTND ch. 3, p. 5; Anisocoria), weakness on one side, seizures, vomiting, worsening confusion, clear fluid or blood from the nose or ears (ATP, p. 121). With no neck injury and no shock, raise the head of the bed about 30°. During a seizure, put nothing in the mouth (WHO-ICRC, p. 33).

📚 Go deeper: ATP 4-02.11, ch. 13 — splints from improvised materials; WHO Surgical Care — setting fractures, traction, plaster.

🐍 Rattlesnakes, spiders and stings

Rattlesnakes (the Northern Pacific rattlesnake; how to tell a pit viper, ATP p. 176), yellow jackets, ticks (western black-legged tick) and poison oak are normal hazards along the Rogue (BLM, p. 4).

Rattlesnake bite — DO (JTS snakebite guideline, p. 16; ATP, p. 179):

DON'T cut, suck, shock, burn, use chemicals, ice, or tie on a band or tourniquet, or use "venom extractor" kits — "outdated interventions that should not be performed" (p. 27; ice: ATP, p. 179). If a band is already on, don't rip it off: people can collapse when it comes off. Remove it with them lying down, ready to treat shock (p. 16).

Without antivenom, expect permanent damage or death, and weeks of nursing (p. 27).

Black widow (Western black widow; venomous spiders and other biters, ATP p. 180): shiny black or brown, usually a red or yellow mark. Lives in woodpiles and sheds; bites often happen in bed in fall and early winter. Painful cramps spread from the bite within 15–60 minutes; the belly can go board-hard. Death or lasting harm is extremely unlikely — pain medicine, wound care, tetanus check, no routine antibiotics (JTS spider guideline, pp. 4–5). Brown recluses don't live in western Oregon (general practice); "spider bite" sores are often abscesses (p. 5).

📚 Go deeper: JTS Snakebite Envenomation (2026) — first steps and what not to do (Appendix F: North America); JTS Spider and Scorpion Envenomation — widow and recluse bites.

🌡️ Heat and cold in the Valley

Heat. Grants Pass has hit 108 °F (Josephine soil survey, p. 5), — and summer is when wood gets cut and fires get fought.

Heat exhaustion Heat stroke — emergency
Looks like Heavy sweat, pale, faint, cramps Confused, odd behavior, collapse — may still sweat
Do Shade, lie down, legs up, sip electrolyte drink (ATP, p. 189) Cool first: into cold water (creek, tub), or wet sheets and hard fanning (ATP, p. 190)

Fast cooling cuts heat-stroke deaths from about 50% to 5%; stop at about 101 °F (38.3 °C) so they don't get too cold (Emergency War Surgery, p. 428). ATP lists "hot, dry skin," but people who collapse from hard work often still sweat — don't wait for dry skin (general practice). Too much plain water lowers blood salt and also causes confusion (ATP, p. 190). Heat stroke.

Cold. Cave Junction winters average 40 °F, nights near freezing, with about 85% of the rain October to March (soil survey, p. 5). Wet makes hypothermia possible even in mild weather (ATP, p. 103).

An improvised hypothermia wrap: a person on a sleeping pad inside an outer tarp, wrapped in a sleeping bag with a plastic vapor barrier inside it, and a cross-section showing the layers From the outside in: sleeping pad underneath, tarp or plastic, sleeping bag or blankets, plastic sheet; heat, if you have it, on the chest and never on bare skin (JTS, p. 7).

Hypothermia.

📚 Go deeper: Ship's Medicine Chest, p. 221 — mild to severe hypothermia; JTS Hypothermia Prevention — keeping hurt people warm; ATP, ch. 17 — heat illness.

🦷 Teeth: pain and emergencies

WHO's protocols for non-dentists (WHO Oral Health, p. 56):

Abscess signs: constant pain (even at night), the tooth feels "long" or loose, a gum boil, a swollen gum or face. Swelling pressing on the throat, or fever, is an emergency (p. 103; penicillin doses p. 104). Bring swelling down before pulling a tooth — the numbing shot won't work in a swollen jaw. Dental abscess.

📚 Go deeper: Where There Is No Dentist — abscesses, pulling teeth, fillings; WHO AFRO protocols — urgent-care flowcharts (images only).

🛏️ Nursing a bedridden person for days and weeks

From the JTS nursing guideline (CPG 70):

Diarrhea (WHO Treatment of Diarrhoea; signs of dehydration: the skin-pinch test, WTND ch. 13, p. 1):

Childbirth has its own books in Medical\Field-Care\Childbirth-Newborn. Heavy bleeding after birth: rub the womb until it's hard, baby to the breast, help her urinate, check the placenta came out whole (A Book for Midwives, ch. 13).

📚 Go deeper: JTS Nursing Interventions — turning, mouth care, bed baths, exercises; WHO Treatment of Diarrhoea — plans A, B and C; WHO Newborn Care — birth step by step.

⚖️ Knowing when someone can't be saved

Some people will die whatever you do. Seeing it early lets you save those who can, and comfort the dying instead of putting them through useless treatment.

Caring for the dying (Where Women Have No Doctor, ch. 17, p. 28): keep them comfortable and free of pain, have family sit with them, let them make their own decisions and talk about death if they want — pretending they aren't dying doesn't help. Then look after the carers (Community guide).

📚 Go deeper: ICRC First Aid in Armed Conflicts — triage; ICRC War Surgery — sorting casualties with few resources.

🧰 The kit to build now

The Army's first-aid kit (ATP, p. 231) — one per adult (rule of thumb): 2 tourniquets, 2 clotting (hemostatic) gauzes, 2 compressed gauzes, 2 gauze rolls, a triangular bandage, a vented chest seal (ATP, p. 88), 2 eye shields, 2 pairs of gloves, a safety cutter, tape and a marker. First aid kit.

For the household (rule of thumb unless a page is given):

Now, while you can: practice a one-handed tourniquet on yourself (ATP, p. 62), update everyone's tetanus shots, and take a first-aid or CERT class (general practice).

📚 Go deeper: ATP 4-02.11, Appendix A — kit lists; WTND — the medicine kit — home and village kits.

🔧 If this goes wrong

What you see What to do
Still bleeding with a tourniquet on Tighten; add a second one just above (ATP, p. 62)
Hand or foot cold, pale or numb beyond a bandage or cast Too tight — loosen or split it (ATP, pp. 64–65)
Redness spreading past your pen line Antibiotic failing — rethink the drug (MSF, p. 145)
Burned person passing little urine Raise the drinking rate by a quarter every 1–2 hours (JTS, p. 8)
Pulse over 90, fast breathing, confused Sepsis — treat now (JTS, p. 5)

📚 Go deeper: JTS Prolonged Casualty Care — what to recheck while you wait; WHO-ICRC Basic Emergency Care — the ABCDE check, to repeat often; JTS Nursing Interventions — day-to-day checks on a bedridden patient.

⚠️ Old advice in the library to ignore

Old book What it says Do this instead
FM 4-25.11 (2002), p. 48 Tourniquet only after a pressure dressing fails Tourniquet first for life-threatening limb bleeding (ATP, p. 62)
FM 21-76, p. 38 Snakebite: band, suction or squeezing, and small cuts if help is far No band, cuts or suction (JTS, p. 27)
FM 3-05.70, p. 56 Band, cuts, suction cup for 30 minutes Same: no band, cuts or suction
FM 4-25.11, p. 136 Constricting bands near the bite No bands of any kind (JTS, p. 16)
ST 31-91B (1982), p. 114 Incision and suction Never cut or suck
Hospital Corpsman (2000), p. 225 "Lymphatic constriction" band, suction extractors No bands, no extractors
WHO Surgical Care (2003), p. 90 Pressure bandage on snakebites; no walking For rattlesnakes: no constricting bandage; walking to antivenom is acceptable (JTS, p. 16)
Where There Is No Dentist, p. 97 30 minutes of boiling sterilizes Boiling only disinfects (WHO, p. 115) — use a pressure cooker or oven

Use the 2000 Hospital Corpsman course for nursing and casts, but ATP 4-02.11 for first aid and CPR.

📚 Go deeper: JTS Snakebite Envenomation, p. 27 — outdated snakebite treatments; ATP 4-02.11, p. 62 — current tourniquet rules.

🖼️ Pictures & diagrams

Look before you try it. 🖼️ = drawings in the books on this drive; 📷 = photos in the offline Wikipedia.

The first look: airway, pulse, CPR

Bleeding and shock

Burns and wounds

Bones, slings and spine

Bites, stings, heat and cold

Teeth and nursing

↑ Contents