Poisonous Plants

2-84. Isolated persons can benefit greatly from using plants as a food source, medical aid, and shelter building material; however, successful use of plants in a survival situation depends on positive identification. Knowing poisonous plants is as important as knowing edible plants. Knowing poisonous plants will help isolated personnel avoid sustaining injuries from them. Plants generally poison by—

• Contact. With a poisonous plant causes any type of skin irritation or dermatitis.
• Ingestion. This occurs when a person eats a part of a poisonous plant.
• Absorption or inhalation. This happens when a person either absorbs the poison through the skin or inhales it into the respiratory system.

2-85. Isolated persons must understand that poisoning from plants ranges from minor irritation to death. It is difficult to say how poisonous a plant is because—

• Some plants require a large amount of contact before any adverse reaction occurs, while others will cause death with only a small amount of contact.
• Every plant will vary for toxins it contains due to different growing conditions and slight variations in subspecies.
• Every person has a different level of resistance to toxic substances.
• Some persons may be more sensitive to a particular plant.

2-86. The following are some common misconceptions about poisonous plants:

• Watch the animals and eat what they eat. Most of the time this statement is true, but some animals can eat plants that are poisonous to humans.
• Boil the plant in water and any poisons will be removed. Boiling removes many poisons, but not all.
• Plants with a red color are poisonous. Some plants that are red are poisonous, but not all.
• Many poisonous plants look like their edible relatives or like other edible plants. For example, poison hemlock appears very similar to wild carrot.

2-87. Certain plants are safe to eat in certain seasons or stages of growth but poisonous in other stages. For example, the leaves of the pokeweed are edible when it first starts to grow, but they soon become poisonous. Some plants and their fruits are safe to eat only when they are ripe. For example, the ripe fruit of the May apple is edible, but all other parts and the green fruit are poisonous. Some plants contain both edible and poisonous parts; potatoes and tomatoes are common plant foods, but their green parts are poisonous. Some plants become toxic after wilting. For example, when the black cherry starts to wilt, hydrocyanic acid develops. Specific preparation methods make some plants edible that are poisonous raw. The thinly sliced and thoroughly dried (drying may take a year) corms of the jack-in-the-pulpit are safe to eat, but they are poisonous if not thoroughly dried. Learn to identify and use plants before a survival situation.

Rules for Avoiding Poisonous Plants

2-88. If isolated persons have little or no knowledge of the local vegetation, they should use the rules to select plants for the Universal Edibility Test. Remember to avoid all mushrooms. Mushrooms identification is very difficult and must be precise-even more so than with other plants. Some mushrooms cause death very quickly, and some mushrooms have no known antidote. Two general types of mushroom poisoning are gastrointestinal and central nervous system. Avoid contact with or touching unidentified plants unnecessarily.

Contact Dermatitis

2-89. Contact dermatitis from plants will usually cause the most trouble for an isolated person. The effects may be persistent, spread by scratching, and be particularly dangerous if there is contact in or around the eyes. The principal toxin of these plants is usually oil that gets on the skin upon contact with the plant. The oil can also get on equipment and then infect whoever touches the equipment. Never burn a contact poisonous plant, because the smoke may be as harmful as the plant. Isolated persons have a greater danger of being affected when they are overheated and sweating. The infection may be local or it may spread over the body. Symptoms may take from a few hours to several days to appear. Symptoms can include burning, reddening, itching, swelling, and blisters.

2-90. When isolated persons first have contact with the poisonous plants or when the first symptoms appear, they should try to remove the oil by washing with soap and cold water. If water is not available, they should wipe their skin repeatedly with dirt or sand. They should not use dirt if they have blisters. The dirt may break open the blisters and leave the body open to infection. After the removal of the oil, the area should be dried. The area can be washed with a tannic acid solution and jewelweed can be crushed and rubbed on the affected area to treat plant-caused rashes. Tannic acid can make from oak bark. Poisonous plants that cause contact dermatitis are—

• Cowhage.
• Poison ivy.
• Poison oak.
• Poison sumac.
• Rengas tree.
• Trumpet vine.

Ingestion Poisoning

2-91. Ingestion poisoning can be very serious and could lead to death very quickly. Isolated persons should not eat any plant unless they have positively identified it first. They should keep a log of all plants eaten and plants identified as inedible if tested.

2-92. Symptoms of ingestion poisoning can include nausea, vomiting, diarrhea, abdominal cramps, depressed heartbeat and respiration, headaches, hallucinations, dry mouth, unconsciousness, coma; which can lead to death. If plant poisoning is suspected, try to remove the poisonous material from the victim’s mouth and stomach as soon as possible. If the victim is conscious, induce vomiting by tickling the back of the victim’s throat or by giving the victim warm saltwater. If the victim is conscious, dilute the poison by administering large quantities of water or milk.

2-93. The following plants can cause ingestion poisoning if eaten:

• Castor bean.
• Chinaberry.
• Death camas.
• Lantana.
• Manchineel.
• Oleander.
• Pangi.
• Physic nut.
• Poison and water hemlocks.
• Rosary pea.
• Strychnine tree.

Soft Tissue Trauma

2-94. Soldiers face many threats in hostile fire environments. Whether conducting large-scale combat operations, low-intensity conflicts, or operations other than war; isolated personnel may wait for hours, days, weeks or longer before professional health-care is available. It is important to understand the implications over the long run, of trauma and the potential for infection if not treated and properly cared for.

Blisters

2-95. Blisters are caused by friction and occur in areas where the epidermis is thick and tough enough to resist abrasion. At first there is a red, sore area called a hotspot. If the friction continues, the epidermis separates and fluid enters the space, causing a blister. The best treatment for blisters is to prevent them: make sure shoes/boots are properly fitted, keep your feet dry, wear two pairs of socks, check feet periodically, and stop at the first sign of rubbing. Apply a small piece of moleskin or athletic tape to areas that are causing problems.

2-96. The primary goal with blister treatment is to optimize comfort and continued activity, maximize prevention of infection, and prevent further blister enlargement. If a blister is smaller than a nickel, do not puncture it. Cut a doughnut shaped piece of moleskin and center it over the blister. The doughnut hole prevents the adhesive from sticking to the tender blister and ripping it away when the moleskin is changed.

2-97. If the blister is larger than a nickel, it is best to drain it. Drain the blister by washing your hands and the area around the blister to decrease the chance of infection. Begin by puncturing the blister with a small sterile object, such as a needle or a pin, to drain the blister of built-up fluid. The best covering for a blister to heal is the skin itself. Clean and wash the blister and cover it with a sterile dressing.

Boils

2-98. A boil is a localized infection in the skin that begins as a reddened, tender area. Over time, the area becomes firm, hard, and increasingly tender. Eventually, the center of the boil softens and becomes filled with infection-fighting white blood cells from the bloodstream to eradicate the infection. This collection of white blood cells, bacteria, and proteins is known as pus. Finally, the pus forms a head which can be opened or may spontaneously drain out through the surface of the skin. Pus enclosed within tissue is referred to as an abscess. A boil is also referred to as a skin abscess. Boils can occur anywhere on the body, including the trunk, extremities, buttocks, groin, or other areas. The signs and symptoms of boils include the following:

• A firm, reddened bump.
• Tender, swollen skin surrounding the bump.
• A bump that may increase in size.
• Bump forms a pus-filled head which may spontaneously drain, weep, or ooze.

Treatment for boils includes the application of warm compresses to bring the boil to a head or use of the bottle suction method. Use the following process to perform 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 correctly.
• Open the boil using a sterile knife, wire, needle, or similar item.
• Thoroughly clean out the pus using soap and water.
• Cover the boil site, checking it periodically to ensure no further infection develops. Toothpaste and when available, iodine, were used to cover the boil site during the Vietnam War,

Fungal Infections

2-99. Keep the skin clean and dry, and expose the infected area to as much sunlight as possible. Do not scratch the affected area. Antifungal powders, lye soap, chlorine bleach, alcohol, vinegar, concentrated salt water, and iodine were used by Soldiers to treat fungal infections during the Vietnam War.

Facial Injury

2-100. Facial injuries are some of the most annoying and painful injuries—particularly injuries to the teeth and gums. Personnel should continue to clean and brush their teeth while isolated to prevent tooth decay and gingivitis. If a toothbrush is unavailable, make a chew stick by taking a small green stick, chewing the end, and using the fibers as a brush to clean the teeth. If tooth pain occurs, rinsing the mouth out with warm saltwater helps to soothe the pain. Personnel may also experience a painful mouth abscess. They can ease the pain and decrease the threat of infection by lancing the abscess and letting it drain. Other facial injuries may be soft tissue facial injuries such as abrasions, contusions, lacerations, and avulsions. Clean and cover the facial injury several times a day, which will help prevent infection and crusting over.

Eye Injury

2-101. If an injury to the eyes occurs, isolated personnel should know how to treat the injury to prevent loss of sight.

2-102. Snow blindness occurs when an isolated person spends time in an area where bright sunrays reflect off the ice crystals in the snow. The eyes will become red, scratchy, and watery. The casualty may have headaches and eye pain with light exposure. The treatment for snow blindness is to cover the eyes with a dark cloth until the symptoms disappear. To prevent snow blindness, ultraviolet (UV) protection rated sunglasses should be worn or improvise a pair of sunshades for the eyes. Putting soot under the eyes, helps reduce the shine and glare as well. This blinding affect can also occur when the sun’s rays reflect off water and other surfaces; the treatment and prevention methods remain the same.

2-103. Should the isolated person incur an eye impalement; never remove any object from the eye unless it is required to assist in their survival. Use an eye shield to cover the eye from further injury or if the eye shield is not available, make a protective cover from a cup, a bandage, or a similar item. This covering will protect the eye from further injury or movement. Cover both eyes because the eyes are sympathetic, and when one eye moves the other moves at the same time.

2-104. If chemicals or small objects get into the eye, flush the eyes with large amounts of water from inside the eye to the outside so the chemicals, etc. are not transferred from one eye and into the other.

Bone and Joint Trauma

2-105. The majority of isolated personnel will experience some form of bone or joint trauma during isolation. Broken bones are a serious survival emergency, removing the use of a limb and raising the risk of post-fracture infection. Additionally, the long term effects of detention and captivity highlight malnutrition and starvation’s adverse impacts on bone health, bone quality, bone regeneration and decreased cortical strength.

Sprains

2-106. A sprain is an injury to a tendon or ligament in the body. Signs and symptoms associated with sprains include pain, swelling, bruising, and loss of functional movement. There may be a pop or a tear associated with the injury when it occurs. The treatment for sprains and strains are similar. When treating sprains, you should follow the letters in RICE.

2-107. RICE as defined—

• R-Rest injured area.
• I-Ice for 24 to 48 hours. Use improvised ice packs and cold compresses intermittently for up to forty-eight hours following the injury.
• 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.

Strains

2-108. Strains are an injury to the muscle or the tendon, the tissue that connects the muscle to the bone. Signs and symptoms of a strain typically include pain, muscle spasms, and muscle weakness. There can be swelling, cramping, inflammation and, in severe cases, some loss of muscle functions. Severe strains that partially or completely tear the muscle or the tendon can be very painful and disabling. Treatment follows the RICE algorithm used to treat sprains.

Fractures and Dislocations

2-109. Combat, isolating events, and accidents produces broken bones and compression fractures affecting the back. Broken bones should be treated early, before swelling complicates treatment. Perform the MARCH algorithm conditions first. Immobilize before moving, if possible, and finish treatment later.

2-110. There are basically two types of fractures: open and closed.

2-111. With an open (or compound) fracture, the bone protrudes through the skin and complicates the actual fracture with an open wound. In open fractures, the soft tissue injury must be treated and properly dressed before splinting. 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.

2-112. The closed fracture has no open wounds. The signs and symptoms of a closed fracture are pain, tenderness, discoloration, swelling deformity, loss of function, and grating (a sound or feeling that occurs when broken bone ends rub together). Under normal conditions, the treatment of a fracture is beyond the abilities of normal first aid. However, in survival medicine, the risk of potential bone deformities is outweighed by the necessity to hasten the healing process and return the limb to function to enable the return of the isolated person.

2-113. Dangers associated with the treatment of a fracture include severing or 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 the area below the break becomes numb, swollen, cool to the touch, or turning pale, and the casualty showing signs of shock, a major vessel may have been severed and this internal bleeding must be controlled. Reset the fracture and treat the casualty for shock and replace lost fluids.

2-114. Often during the treatment of fractures, traction (i.e. a slow, strong pull — not a tug) must be applied during the splinting process to facilitate healing. Fractures of the smaller bones (finger or hand) can usually be performed using hand traction. For larger bones and muscled areas, traction is applied by wedging the fractured leg or arm in the V-notch of a tree and pulling until the overriding edges of fractured bone are brought into line. Check the alignment against the other limb. Then splint and immobilize, keeping up the traction to ensure it does not slip back. A splint can be made from sticks, branches, parts of wreckage, driftwood, rolls of paper, and other rigid items.

2-115. Use field expedient methods to immobilize a fracture. (See figure 2-5). Once an injury is immobilized, assess the pulse to ensure proper blood flow to the injury. Take your pulse multiple times at the farthest part of the injury. When immobilizing a fracture, it is crucial to splint the joints above and below the fracture site to prevent the bone ends from moving. If the mid forearm is fractured, the wrist and the elbow should be splinted to keep the bone ends from moving and achieve proper healing. Immobilize a joint in a fixed neutral functional position. This position is neither completely straight nor completely flexed, but in a position about midway between. Splint the finger, to about the same position that the finger would attain at rest. Use large straight strips of cloth material, vines, or braided plant material to secure the splints. To aid in controlling swelling, the limb should be elevated repeatedly throughout the day.

2-116. Improperly aligned bones and separation of bone joints are called a dislocation. These misalignments can be extremely painful and can cause impairment of nerve or circulatory function below the area affected. An isolated person must place these joints back into alignment as quickly as possible. Signs and symptoms of dislocations are joint pain, tenderness, swelling, discoloration, limited range of motion, and joint deformity. Manual traction or the use of weight (body weight) to pull the bones is the safest and easiest for “resetting” a dislocation and allows for normal function and circulation. Without an X-ray, judge the proper alignment by the look and feel of the joint and by comparing it to the joint on the opposite side. Immobilization is nothing more than splinting the dislocation after resetting. Figure 2-6 demonstrates the use of field expedient devices for an improvised sling.

Bites and Stings

2-117. Insects and related pests are hazards in a survival situation. They cause irritations and are often carriers of diseases that cause severe allergic reactions in some individuals. In many parts of the world, people can be exposed to serious, even fatal, diseases not encountered in the United States. Common insects and their hazards include the following:

2-118. Ticks. Ticks can carry and transmit diseases, such as Rocky Mountain spotted fever, common in many parts of the United States. They also transmit Lyme disease. Take care to remove the whole tick. Use tweezers if available. Grasp the tick where the mouthparts are attached to the skin and pull up with steady, even pressure. Do not twist or jerk the tick. Do not squeeze the tick’s body. Wash hands after touching the tick. Clean the tick wound daily until healed.

2-119. Mosquitoes. Mosquitoes may carry malaria, dengue, and many other diseases.

2-120. Flies. Flies can spread disease from contact with infectious sources. They are carriers of sleeping sickness, typhoid, cholera, and dysentery.

2-121. Fleas. Fleas can transmit plague.

2-122. Lice. Lice can transmit typhus and relapsing fever.

2-123. The best method of preventing bites and stings is to be aware of your environment and the insects in the area. If insects cannot be avoided, wrap your face with a bandana, use netting, roll down your sleeves, wear gloves, and repellant.

2-124. If bitten or stung, do not scratch the bite or sting; it might become infected. Personnel should inspect their body at least once a day to ensure there are no insects attached to them. It is impossible to list the treatment for all the different types of bites and stings. However, bites and stings can generally be treated as follows:

2-125. Become familiar with available antibiotics and how to use them before deployment.

2-126. Make sure immunizations are up-to-date before deployment; this can prevent most common diseases carried by mosquitoes and some carried by flies.

2-127. Be aware that common fly-borne diseases are usually treatable with penicillin or erythromycin.

2-128. Be aware that most tick, flea, louse, and mite-borne diseases are treatable with tetracycline.

2-129. Be aware that most antibiotics come in 250-milligram or 500-milligram tablets. If you cannot remember the exact dose rate to treat a disease, two tablets, four times a day for 10 to 14 days will usually kill any bacteria.

Snakebites

2-130. Deaths from snakebites are rare. More than one-half of snakebite victims have little or no poisoning, and only about one-quarter develop serious systemic poisoning. The primary concern in the treatment of snakebites is to limit the amount of eventual tissue destruction around the bite area. A bite wound, regardless of the type of animal that inflicted it, can become infected from bacteria in the animal’s mouth. With venomous and nonvenomous snakebites, this local infection is responsible for a large part of the residual damage that results.

2-131. Snake venoms contain poisons that attack the victim’s central nervous system (neurotoxins) and blood circulation (hemotoxins) as well as poisonous digestive enzymes (cytotoxins) that 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. Shock and panic in a snakebite victim can also affect the person’s recovery. Excitement, hysteria, and panic can speed up circulation, causing the body to absorb the toxin quickly. Signs of shock occur within the first 30 minutes after a bite.

2-132. Before isolated persons start treating a snakebite, they should determine whether the snake was venomous or nonvenomous. Bites from a nonvenomous snake will show rows of teeth marks. Bites from a venomous snake may have rows of teeth marks showing, but will have one or more distinctive puncture marks caused by fang penetration. Symptoms of a venomous 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. 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. If personnel determine that a venomous snake bit an individual, use the following procedures:

• Keep the victim still and reassured.
• Set up for shock and force fluids or give by intravenous (IV) means.
• Remove watches, rings, bracelets, or other constricting items.
• 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 cardio-pulmonary resuscitation (CPR).
• Use a constricting band between the wound and the heart.
• Immobilize the site.
• Get the person to medical treatment as soon as possible.
• Isolated persons should know four very important guidelines during the treatment of snakebites.
  Do not—
  • Give the victim or take alcoholic beverages or tobacco products, or administer atropine, morphine or other central nervous system 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.
  • Put the hands on the face or rub the eyes, as venom may be on hands. Venom may cause blindness.
  • Break open the large blisters that form around the bite site.
• After caring for the victim as described, take the following actions to minimize local effects:
  • If infection appears, keep the wound open and clean.
  • 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.
  • When treating a snakebite, be sure to keep the extremity lower than the heart.

Environmental Injury

2-133. The successful prevention and control of cold, heat and altitude injuries depend on vigorous command interest, the provision of adequate clothing, and a number of individual and group measures.

High altitude sickness

2-134. Isolated person’s not acclimated to high altitude may experience several illnesses that could affect their body and require treatment. Rapid change of altitude-for example, going from sea level to high altitudecan cause loss of consciousness followed shortly by death. The typical person working in a high-altitude environment will need to acclimatize in order to prepare their body for functioning at altitude. Acclimatization is the process of physiologic adjustments made by the body’s oxygen delivery system to the cells; this improves their hypoxic tolerance.

2-135. The first and maybe only sign of high-altitude illness is a headache. A high-altitude headache will have at least two of the following characteristics: bilateral, frontal, or frontal temporal; dull or pressing quality; mild or moderate in intensity; and aggravated by exertion, movement, straining coughing, or bending. Acute mountain sickness symptoms include headache plus one or more of the following: nausea, vomiting, fatigue, dizziness, and difficulty sleeping.

High-altitude Pulmonary Edema

2-136. High-altitude pulmonary edema is one of the most severe high-altitude illnesses. This illness can be so severe it can cause death. Treatment for high-altitude pulmonary edema involves limiting exertion, staying warm, and rapidly descending from altitude. Signs of high-altitude pulmonary edema onset involve loss of appetite, low energy level, coughing spasms, and a headache.

2-137. High-altitude cerebral edema is another risk at high altitudes that is serious. It is a severe high-altitude illness where the brain swells and stops functioning. This illness is so severe that it can cause death. Other than rest, hydration and descending to a lower altitude, further treatment is beyond the capabilities of nonmedical personnel.

Note. At high altitudes, the body will require more calories to counteract weight loss and acute loss of appetite.

Heat Injuries

2-138. In a very warm climate, personnel may experience heat injuries. Heat injuries can occur suddenly and, if not treated properly, can quickly incapacitate and prevent mission completion. Personnel should limit their time in the hot sun, cover exposed skin or wear sunscreen, remain hydrated, and take plenty of rest breaks. Follow this formula otherwise; heat cramps, heat exhaustion, and heatstroke may occur.

2-139. Heat cramps are muscle cramps in the arms, legs, and/or stomach. Other symptoms experienced may be wet skin and extreme thirst. The treatment for heat cramps involves resting in a cool, shaded area and loosening restrictive clothing. Personnel should slowly sip one quart of water per hour. Add one-fourth teaspoon salt to the water to help replace minerals lost through sweating.

2-140. If untreated, heat cramps can progress into heat exhaustion. With heat exhaustion, personnel may experience cool, moist, and clammy skin; a loss of appetite; a headache; excessive sweating; and weakness. They may also experience faintness, dizziness, nausea, and muscle cramps. The treatment for heat exhaustion involves resting in a cool, shaded area and loosening restrictive clothing. Personnel should pour cool water over the person and fan to increase the cooling effect of evaporation. They should also slowly sip at least one quart of water per hour to replace lost fluids. Elevating the legs will help.

2-141. Heatstroke is the most dangerous heat injury. The casualty will stop sweating and have hot, dry skin. They may experience a headache, dizziness, nausea, vomiting, and a rapid pulse and respiration. They may have seizures and mental confusion, and may collapse and lose consciousness. The treatment for heatstroke involves rapidly cooling victims by immersing them in cool water. If a water bath is unavailable, then douse victims clothing with water making sure to cool the groin, the armpit, and the back and neck areas. Use caution to avoid overcooling the victims. If victims are conscious, have them consume one quart of water.

Cold Injuries

2-142. In cold environments, personnel may succumb to different types of cold injuries that can cause incapacitation and permanent damage and make it difficult or impossible to reach mission success. To reduce the possibility of cold injuries-limit your time in the extreme cold, cover exposed skin, and use the buddy system to check for cold injuries. Proper layering of clothing along with staying dry and hydrated with warm fluids can reduce the risk of cold injuries. Heat transfers to and from the body through radiation, convection, conduction, evaporation, and respiration (see figure 2-7).

2-143. Radiation is the transfer of heat waves from the body to the environment or from the environment back to the body. It is the primary cause of heat loss. Radiation can contribute to heat loss of as 45 percent of body heat through exposed hands, feet, head, and neck, depending on the outside temperature. Use clothing to insulate exposed areas of the body. Convection is heat movement to or from an object by means of air or wind. The human body is always warming a thin layer of air next to the skin. When this warm layer of air is removed by convection, the body cools down.

2-144. A major function of clothing is to keep a warm layer of air close to the body. By removing or disturbing this warm air layer, wind can reduce body temperature. Conduction is the transfer of heat from one object to another. Extreme examples of rapid heat transfer include deep frostbite and third-degree burns. In hot conditions, sitting on a cool rock in the shade can conduct some excess heat away from the body. Evaporation is the process by which liquid changes into vapor. Heat within the liquid escapes to the environment. The body uses this method to regulate its core temperature (sweat) in hot, dry climates.

2-145. Clothing made of lightweight materials (cotton or linen) which have an open weave absorb sweat, allow air to circulate around the body, and help evaporation. Respiration works on the combined processes of convection, evaporation, and radiation. Air inhaled when breathing is rarely the same temperature as the air in lungs.

Chilblains and Frostbite

2-146. You can identify Chilblains or frost nip by red, swollen, hot, tender, itching skin. Continued exposure to the cold could lead to infected skin lesions. The affected area usually responds well to locally applied warming (body heat). Do not rub or massage the area.

2-147. Frostbite, superficial and deep, are the next stages of cold injuries personnel should be aware of and treat if signs appear. Superficial frostbite will produce redness and blistering within twenty four to thirty six hours and potential shedding of skin. Deep frostbite will be preceded by superficial frostbite, but the skin will be painless and pale yellowish in color. The spot will appear wooden, waxy, or solid to the touch and blisters may form within twenty four to thirty six hours.

2-148. To treat frostbite personnel should not attempt to thaw the affected areas by placing them too close to an open flame. The loss of feeling in the affected limb could lead to a severe destruction of tissue. Instead, thaw the affected area using water that is between 99 and 109° Fahrenheit (F) [(37 and 43° Celsius (C)]. Keep the tissue warm; decrease constricted clothing but increase exercise and insulation. Protect the affected area from further injury.

Immersion Foot

2-149. Immersion foot is caused by the foot being repeatedly exposed to wet, warm or cold conditions. A isolated person’s mobility can be affected in a severe case of immersion foot. The affected areas will be cold and numb. As the feet warm up, they may begin to feel hot with burning, shooting pains. In an advanced stage of immersion foot, the affected skin will be bluish and pale in color. The distal pulse will weaken, and blistering and swelling may occur. Casualties may also experience heat hemorrhaging and potential gangrene.

2-150. To treat immersion foot, gradually warm the affected area by exposing it to warm air. Do not massage or moisten the skin. Make sure to protect the affected area from trauma, dry the feet, and avoid walking. Personnel can prevent immersion foot by changing out of wet socks throughout the day. Washing and drying the feet daily also helps.

Hypothermia

2-151. Hypothermia is one of the most dangerous cold injuries personnel can experience. It can occur rapidly, and the temperatures do not have to be very cold to contract hypothermia. Personnel are predisposed to hypothermia because of lack of food, potential dehydration, and little rest. Symptoms of hypothermia are coldness, wetness, and uncontrollable shivering. The body’s core temperature will drop below 95° F (35° C).

2-152. The victim’s movements can become uncoordinated, and unconsciousness may occur. Shock and coma may occur as the body temperature drops. To treat hypothermia, get victims out of wet clothing and into dry clothing, and have them slowly consume warm fluids. Begin to warm the body evenly and immediately. Keep victims dry and protect them from the elements. For severe hypothermia, quickly stabilize the victim’s body temperature-this can include bare skin-on-skin contact inside a sleeping bag-and then prevent further heat loss.

Dehydration

2-153. The body continually loses water to supports its processes. A person typically loses 1.5 liters of water a day through urine. Rapid fluid loss may also come from vomiting and diarrhea (severe diarrhea can increase fluid loss at up to 25 quarts in a 24 hour period). Another large source of water loss in our bodies is through sweating, water is also lost from our body through breathing. Exposure to extreme hot and cold climate conditions and high altitudes expedite water loss. In extreme hot climates, the body can lose up to 3.5 quarts of water per hour when exposed to the elements. Additionally, intense activity burns, and illness, particularly the type that results in diarrhea, increases risk of dehydration.

2-154. To prevent dehydration, isolated persons should avoid or limit work during the hottest hours of the day. Sweat—not water—should be rationed when water is limited. If water is plentiful, drink enough water to ensure a steady urine output throughout the day. However, over-hydration can cause low serum sodium levels that can lead to death. Increase water intake in extreme climates. The body uses water more efficiently when small amounts of water is consumed at regular intervals. Isolated persons always drink water when eating. Personnel acclimated to the environment require less water to maintain hydration.

2-155. Do not use alcoholic beverages, urine, blood, and seawater as water substitutes. Alcohol causes dehydration and impairs physical and mental abilities. Urine contains harmful toxins the body is attempting to excrete. It is also comprised of about 2 percent salt. Blood is salty and contains proteins, and therefore requires water to digest. It is considered a food and may transmit disease is consumed without cooking it first. Seawater is comprised of about 4 percent salt and results in dehydration.

2-156. Common signs and symptoms of dehydration include—

• Dark urine with strong odor.
• Low urine output.
• Dark, sunken eyes.
• Fatigue.
• Emotional instability.
• Skin inelasticity.
• Capillary refill delayed under fingernails.
• Trench line down center of tongue.
• Thirst. Thirst is not an adequate indicator of the need to drink water. Once personnel are thirsty, they are already dehydrated.

2-157. Signs and symptoms can be assessed to approximate the degree of dehydration personnel are experiencing:

• The person feeling them can only describe symptoms. If you are having pain, no one knows unless you tell him or her. It is the same with dizziness, numbness, lightheadedness, fatigue, vision disturbances, ringing in your ears, and a whole host of other feelings. Anyone who is not in your body is only going to know about these experiences if you describe them.
• That does not mean other people do not notice when you are not feeling well. If your face is pale, you are unstable when you walk, or you are sweating, then you are showing signs. Signs have to be seen and read by someone (e.g., another Soldier or healthcare provider) rather than felt. Signs are just what they sound like: indicators of a problem.
• A 2% loss results in thirst.
• A 10% loss results in dizziness, headache, inability to walk, and a tingling sensation in the limbs.
• A 15% loss results in dim vision, painful urination, swollen tongue, deafness, and a numb feeling in the skin.
• Death can result from a loss of greater than 15%.
• Carry Alka-Seltzer tablets to add carbonation to water to help speed its use in the large intestine.

Ingestion Poisoning

2-158. Poisons can come from misidentified plants, animals, toxic water sources, toxic fungi, and chemicals. Poisons can enter the body through four means- eyes, nose, mouth and skin contact. The treatments for poison ingestion under field conditions include inducing vomiting and taking about 1 gram (0.04 ounce) of activated charcoal. Activated charcoal will attach and absorb the poison and carry it out of the gastrointestinal system. Activated can be made from a wide range of carbon rich materials like wood, coal, bones, coconut shells, nut shells and peat. The first step in making activated charcoal is to take the material and bring it to a temperature between 600-900 degrees Fahrenheit in a survival fire. Burn the material for about 4 ½ hours. Cool the burnt material, crush it into a fine powder, and use for survival medicine remedies, and water filtration.

2-159. In some cases, a laxative may be required to help the activated charcoal work to its full potential. If the poison is an acid, an alkali, or a petroleum product, vomiting should be avoided because the substance can burn the esophagus. These types of products can also be inhaled into the lungs during vomiting, causing pneumonia. Aggressively hydrate the body with clean, treated potable water to prevent renal failure and dilute the poison in the victim’s system.

Sanitation and Hygiene

2-160. Application of the following simple guidelines regarding personal health and hygiene will enable the isolated person to safeguard personal health and the health of others while detained or captive.

2-161. Stay clean (daily regimen) by—

• Minimizing infection by washing. (Use white ashes, sand, or loamy soil as soap substitutes.)
• Combing and cleaning debris from hair.
• Cleansing mouth and brushing teeth.
  • Use hardwood twig as toothbrush (fray it by chewing on one end then use as brush).
  • Use single strand of an inner core string from parachute cord for dental floss.
  • Use clean finger to stimulate gum tissues by rubbing.
  • Gargle with salt water to help prevent sore throat and aid in cleaning teeth and gums.
• Cleaning and protecting feet.
  • Change and wash socks
  • Wash, dry, and massage.
  • Check frequently for blisters and red areas.
  • Use adhesive tape/mole skin to prevent damage.
• Exercising daily.
• Preventing and controlling parasites.
  • Check body for lice, fleas, ticks.
  • Check body regularly.
  • Pick off insects and eggs (DO NOT crush).
  • Wash clothing and use repellents.
  • Use smoke to fumigate clothing and equipment.

Avoiding Illness

2-162. Isolated personnel can avoid many different kinds of illnesses and infections by practicing good sanitation and hygiene. Maintaining a clean body and living area will prevent the spread of germs and bacteria whether alone or in a group. It will also allow isolated persons to stay organized and protect items from animal contact.

2-163. Rules for avoiding illness:

• Purify all water obtained from natural sources by using iodine tablets, bleach, or boiling for 5 minutes.
• Locate latrines 200 feet from water and away from shelter.
• Wash hands before preparing food or water.
• Clean all eating utensils after each meal.
• Prevent insect bites by using repellent, netting, and clothing.
• Eat varied diet.
• Try to get 7-8 hours sleep per day.

Note. Purify all water obtained from natural sources before consumption, if possible.

2-164. Application of the following simple guidelines regarding personal hygiene will enable isolated persons to safeguard personal health and the health of others:

• Do not soil the ground in the camp area with urine or feces; use latrines. When no latrines are available, isolated persons should dig “cat holes” and cover their waste.
• Never put fingers and other contaminated objects into the mouth. Wash hands before handling any food or drinking water, before using the fingers in the care of the mouth and teeth, before and after caring for the sick and injured, and after handling any material likely to carry disease or germs.
• Clean and disinfect all eating utensils in boiling water after each meal.
• Thoroughly clean the mouth and teeth at least once each day.
• Avoid insect bites by keeping the body clean; wearing proper protective clothing; and using a head net, improvised bed nets, and insect repellants.
• Exchange wet clothing for dry clothing as soon as possible to avoid unnecessary body heat loss. Keep clothing clean and in good repair.
• Do not share personal items such as canteens, towels, toothbrushes, handkerchiefs, and shaving items.
• Aim for seven or eight hours of sleep each night.
• Keep hair clean because dirty hair can be a haven for bacteria, fleas, lice, and other parasites.
• Take care of feet; clean them and keep them dry.

Intestinal Parasites

2-165. Though seldom fatal, worms are significant as they can lower an individual’s general resistance to other illnesses. Common identifiers of worms include severe rectal itching, insomnia, and restlessness. Prevention can be a simple and readily obtainable goal. Undercooked or contaminated food, poor sanitation, and infected water sources are main causes of intestinal parasites and worms.

2-166. Eat hot peppers as treatment as they contain certain substances chemically similar to morphine. They are effective as a counterirritant for decreasing bowel activity. Grind pumpkin seeds and mix with water creating a “medicinal” porridge or make a cup of tea made from one to two grams (about ½ to 1 ounce) of thyme and drink several times a day.

2-167. Honey makes an ideal topical wound ointment to reduce infection and promote healing. Its hypertonicity, low pH, and inhibins provide antimicrobial activity against many types of bacteria and at least two types of fungi.