If a person who has diabetes becomes confused, weak, or unconscious for no apparent reason, he may be suffering from insulin shock (low blood sugar) or diabetic ketoacidosis (high blood sugar).

INSULIN SHOCK (LOW BLOOD SUGAR)

If a person with diabetes takes too much insulin or fails to eat enough food to match his insulin level or his level of exercise, a rapid drop in blood sugar can occur. Symptoms may come on very rapidly and include an altered level of consciousness, ranging from slurred speech, bizarre behaviour, and loss of coordination, to seizures and unconsciousness.

Treatment
If still conscious, the victim should be given something containing sugar to drink or eat as rapidly as possible. This can be fruit juice, candy, or a non-diet soft drink. If the victim is unconscious, place sugar granules, cake icing, or Glutose® paste from your first aid kit under his tongue, where it will be rapidly absorbed.

  DIABETIC KETOACIDOSIS (HIGH BLOOD SUGAR)

Diabetic ketoacidosis (formerly called diabetic coma) comes on gradually and is the result of insufficient insulin. This eventually leads to a very high sugar level in the victim’s blood. Early symptoms include frequent urination and thirst. Later, the victim will become dehydrated, confused, or comatose, and will develop nausea, vomiting, abdominal pain, and a rapid breathing rate with a fruity odor to his breath.

Treatment
The victim needs immediate evacuation to a medical facility. If vomiting is not present and the victim is awake and alert, have him drink small, frequent sips of water. If you are unsure whether the victim is suffering from insulin shock (low blood sugar) or ketoacidosis (high blood sugar), it is always safer to assume it is low blood sugar and administer sugar.

Lightning kills more people every year in the United States than all other natural disasters combined. Carrying or wearing metal objects, such as an ice axe, umbrella, backpack frame, or even a hairpin, increases the chances of being hit.

To calculate the approximate distance in miles from a flash of lightning, count in seconds from the time you see the flash to when you hear the thunder, then divide by five.

Prevention

• When a thunderstorm threatens, seek shelter in a building or inside a vehicle (not a convertible).
• Occupants of tents should stay as far away from the poles and wet cloths as possible.
• Do not stand underneath a tall tree in an open area or on a hill top.
• Get out and away from open water.
• Get away from tractors and other metal farm equipment.
• Get off bicycles and golf carts.
• Stay away from wire fences, clotheslines, metal pipes, and other metallic paths which could carry lightning to you from some distance.
• Avoid standing in small, isolated sheds or other small structures in open areas.
• In a forest, seek shelter in a low area under a thick growth of saplings or small trees. In an open area, go to a low place such as a ravine or valley.
• If you are totally in the open, stay far away from single trees to avoid lightning splashes. Drop to your knees and bend forward, putting your hands on your knees. If available, place insulating material (e.g. sleeping pad, life jacket, rope) between you and the ground. Do not lie flat on the ground.

LIGHTNING CAN CAUSE INJURY BY FOUR
MECHANISMS:

1.DIRECT HIT
Lightning directly strikes a person in the open. It usually does not enter the body, but instead is conducted over the skin surface (“flashover”), producing a variety of injuries. The greatest damage may occur to skin beneath metal objects worn by the victim, such as jewelry, belt buckles, or zippers, which tend to disrupt the flashover and allow current to penetrate. Current may also penetrate the body through the eyes, ears, and mouth, causing deeper injuries to those parts. The victim is exposed to a tremendous elec-tromagnetic field, which can disrupt the workings of the brain, lungs and heart and lead to a cardiac and respiratory arrest. Finally, the instant vaporization of any moisture on the victim’s skin can blast apart his clothing and shoes.

2. SPLASH
A more common scenario is for the victim to be struck by lightning “splash,” which occurs when a bolt first hits an object, such as a tree or another person, and then “jumps” to the victim who may have found shelter nearby. Splashes may also occur from person to person who are standing close together.

3. STEP VOLTAGE
Lightning hits the ground or a nearby object and the current spreads like a wave in a pond to the victims. Step voltage is often to blame when several people are hurt by a single lightning bolt.

4. BLUNT TRAUMA
The explosive force of the pressure waves created by lightning can cause blunt trauma, such as spleen or liver injuries and ruptured ear drums.

TYPES OF INJURIES

1. HEART AND LUNG
Lightning can cause a cardiac arrest and paralyze the lungs. The heart will often restart on its own, but because the lungs are still not working, the heart will stop again from lack of oxygen.

2. NEUROLOGIC INJURIES
The victim may be knocked unconscious and suffer temporary paralysis, especially in the legs. Seizures, confusion, blindness, deafness, and inability to remember what happened may result.

3. TRAUMATIC INJURIES
Bruises, fractures, dislocations, spinal injury, chest and abdominal injuries from the shock wave may occur. Ruptured eardrums can result in hearing loss.

4. BURNS
Superficial first or second-degree burns are more common than severe burns after a lightning strike and form distinctive fern patterns on the skin.

Treatment
Lightning strike victims are not “charged” and thus pose no hazard to rescuers.

1. The immediate treatment of lightning strike victims differs from other situations in which you have multiple trauma victims. Rather than adhere to the standard rescue dogma of ignoring the victims who appear dead and giving priority to those who are still alive, after a lightning strike, treat those victims first who appear dead, because they may ultimately recover if quickly given mouth-to-mouth rescue breathing and CPR. If you’re successful in obtaining a pulse with CPR, continue rescue breathing until the victim begins to breathe on his own or you are no longer able to continue the resuscitation.
2. Stabilize and splint any fractures.
3. Initiate and maintain spinal precautions if indicated.

Head trauma and brain injury can result from direct impact or from the shearing forces produced by rapid deceleration. When your head hits a hard object such as a boulder, the impact can fracture the skull, bruise the brain, or cause severe bleeding inside the brain from damaged blood vessels. Shearing forces from sudden deceleration of the brain against the inside of the skull can also tear blood vessels on the surface of the brain, leading to an expanding blood clot and pressure on the brain (intracranial pressure).

Rising intracranial pressure is bad for several reasons. The increased pressure makes it difficult for the heart to pump enough blood to the head. This is a major catastrophe for the brain, which depends on a constant supply of blood to bring it oxygen and other nutrients. If the pressure within the skull rises high enough, it can force parts of the brain downward through the base of the skull (herniation), causing damage to the brain structures and, ultimately, death. Compression of one of the nerves as the brain swells produces dilatation of one or both pupils, an important sign of a severe head injury.

HEAD INJURIES CAN BE DIVIDED INTO THREE GROUPS:

1) Prolonged unconsciousness (more than five to 10 minutes).
2) Brief loss of consciousness.
3) No loss of consciousness.

PROLONGED UNCONSCIOUSNESS
Loss of consciousness for more than five to 10 minutes is a sign of significant brain injury. Assess the victim’s airway and perform rescue breathing if necessary. Because there is a potential for accompanying neck and spine injuries with severe head trauma, the victim’s spine should be immobilized. Immediately evacuate the victim to a medical facility. During transportation, maintain spine immobilization and keep the victim’s head pointed uphill on sloping terrain. Be prepared to log-roll the victim onto his side if he vomits. Continually monitor his airway for signs of obstruction (listen for noisy or labored breathing) and a decreasing respiratory rate.

BRIEF LOSS OF CONSCIOUSNESS
Short-term unconsciousness, in which the victim wakes after a minute or two and gradually regains normal mental status and physical abilities, is evidence of a concussion. A concussion does not usually produce permanent damage, although confusion or amnesia about the event and repetitive questioning by the victim are common.

To be safe, evacuate the victim to a medical facility for evaluation. At a minimum in the backcountry, you should keep the victim under close observation for at least 24 hours, and not allow him to perform potentially hazardous activities. Normal sleep should be interrupted every three to four hours to check briefly that the victim’s condition has not deteriorated and that he can be easily aroused. If the victim becomes increasingly lethargic, confused or combative, is just not acting his normal self, or if he develops any of the other signs on the head injury checklist (see below), he should be evacuated to a medical center immediately.

NO LOSS OF CONSCIOUSNESS
If an individual hits his head but never loses consciousness, it’s rarely serious. He may have a mild headache, may bleed from a scalp wound, or a have a large bump on his head, but evacuation isn’t necessary unless he develops any of the problems listed on the head injury checklist.

‘WHEN TO WORRY’ — HEAD INJURY CHECKLIST

Seek immediate medical attention if any of the following symptoms occur after a blow to the head:

• Headache that progressively worsens.
• Consciousness gradually deteriorates from alertness to drowsiness or disorientation; ask the victim if he knows his name, location, the date, and what happened. If he gets all four correct, he is oriented X 4.
• Persistent or projectile (shoots out under pressure) vomiting.
• One pupil becomes significantly larger than the other.
• Bleeding from an ear or nose without direct injury to those areas, or a clear watery fluid draining from the nose.
• Bruising behind the ears or around the eyes, when there is no direct injury to those areas.
• Seizures.

SKULL FRACTURES

Fracture of the skull is not life threatening unless associated with underlying brain injury or severe bleeding. Signs of a skull fracture include a sensation that the skull is uneven when touching the scalp, blood or clear fluid draining from the ears or nose without direct trauma to those areas, and black and blue discoloration around the eyes (raccoon eyes) or behind the ears (Battle’s sign).

Treatment:
Evacuate the victim to a medical facility as soon as possible.

SCALP WOUNDS

Scalp lacerations are common after head injuries, and tend to bleed a lot because of their rich blood supply. Fortunately, bleeding can usually be stopped by applying direct pressure to the wound with your gloved hand. It might be necessary to hold pressure for up to 30 minutes.

‘WEISS ADVICE’
Hair-tying a scalp wound closed

If you’re faced with a bleeding scalp wound and the injured person has a healthy head of hair, you can tie the wound closed using the victim’s own hair. Take a piece of heavy silk suture material (dental floss works well) and lay it on top of, and parallel to the wound. Twirl a few strands of hair on opposite sides of the wound and pull them together tightly, forcing the wound edges closed. Use the suture material to tie the opposing strands of hair together with a square knot.

Dr. Weiss Advice – Improvisational Technique – Wound Irrigation Using a Plastic Bag and Safety Pin

Fill a clean plastic sandwich or garbage bag with disinfected water and puncture the bottom of the bag with a safety pin or pointy knife. Hold the bag just above the wound and squeeze the top firmly to being irrigating.

Carry a first aid kit with wound irrigation supplies!

Learn more wilderness medicine, improvised techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Quick Relief of Dental Pain

Bleeding and pain from the mouth can often be relieved by placing a moistened tea bag onto the bleeding site or into the socket that is bleeding.

Carry a Dental Medic with you!

Learn more improvisational techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Making a Sling with Safety Pins

If the victim is wearing a long-sleeved shirt or jacket, pin the sleeved arm to the chest portion of the garment with two safety pins. If the victim is wearing a short-sleeved shirt, fold the bottom of the shirt up and over the arm to create a pouch. Pin this to the sleeve and chest section of the shirt to immobilize the arm.

Learn more improvisational techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Creating Ankle Support Using a SAM Splint

Wrap a SAM Splint around the foot and ankle, with the shoe in place and secure it with tape. This will help stabilize the joint while walking. You may need to stop periodically to tighten or re-wrap the splint.

You can buy a SAM splint here.

Learn more improvisational techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.

Dr. Weiss Advice – Improvisational Technique – Replacing a Lost Filling

Melt some candle wax and allow it to cool until it is just soft and pliable. Place the wax into the cavity or lost filling site and smooth it out with your finger. Have the victim bite down to seal the wax in place and remove any excess wax.

Check out our Dental Medic kit here.

Learn more improvised techniques and first aid tips – click here for Dr. Weiss’s Comprehensive Guide to Wilderness and Travel Medicine.