Medical Emergencies: Life-Threatening Situations

Part of First Aid

When someone stops breathing, has a heart attack, goes into shock, or suffers a severe allergic reaction, you have minutes — sometimes seconds — to act. These protocols work without any medical equipment.

Triage: Who to Treat First

When multiple people are injured, you must prioritize. Spending 30 minutes on someone who cannot be saved while three others bleed out is a failure of triage.

Category	Signs	Action
Immediate (Red)	Not breathing but has a pulse, severe bleeding, shock	Treat first — life-saving interventions only
Delayed (Yellow)	Broken bones, moderate wounds, burns, conscious and stable	Treat second — painful but not immediately fatal
Minor (Green)	Walking, talking, minor injuries	Treat last — can wait or help themselves
Expectant (Black)	No pulse and not breathing, massive unsurvivable injury	Do not treat — direct resources to those you can save

This is harsh. It is also the only rational approach when resources are limited and multiple lives are at stake.

Cardiac Arrest and CPR

When the heart stops, the brain begins dying within 4-6 minutes. CPR buys time by mechanically pumping blood.

Recognition

• Person collapses or is found unresponsive
• No breathing or only gasping (agonal breathing — irregular, noisy gasps are NOT real breathing)
• No pulse at the carotid artery (side of neck) — check for 10 seconds maximum, then begin CPR

Hands-Only CPR Protocol

1. Place the person on a hard, flat surface. Soft ground or a bed absorbs your compressions. Use a floor, a table, a board across the chest if on soft ground.

2. Position your hands. Place the heel of one hand on the center of the chest, on the lower half of the breastbone (sternum). Place your other hand on top, fingers interlaced.

3. Lock your elbows straight. You will be pushing with your body weight, not arm strength. Position your shoulders directly above your hands.

4. Compress hard and fast:

   • Depth: 5-6 cm (2-2.5 inches) — this is deeper than people expect. You may feel ribs crack. This is normal and acceptable. Cracked ribs heal; a dead brain does not.
   • Rate: 100-120 compressions per minute. The rhythm of the song “Stayin’ Alive” is the correct tempo.
   • Allow full chest recoil between compressions. Do not lean on the chest.

5. Do not stop. Continuous compressions without interruption give the best survival chance. Stopping for even 10 seconds drops blood pressure to zero and restarts the clock.

6. Rotate rescuers every 2 minutes. Effective CPR is exhausting. Tired compressions are shallow and useless. Switch with minimal interruption — the incoming person places hands before the outgoing person lifts theirs.

Rescue Breathing

If you are trained and willing, add rescue breaths: 30 compressions then 2 breaths (tilt head back, lift chin, seal mouth, blow for 1 second until chest rises). If not trained or unwilling, hands-only CPR is still effective and far better than doing nothing.

How Long to Continue

• Continue CPR until the person starts breathing on their own, moves, or groans.
• In a survival situation without defibrillators, the realistic survival rate for cardiac arrest is very low. After 30-45 minutes of good CPR with no response, the decision to stop is a difficult but rational one.
• Exception: hypothermia victims — cold protects the brain. Continue CPR for hypothermic cardiac arrest until the person is warmed. People have survived after hours of cardiac arrest in cold conditions.

Choking (Airway Obstruction)

Conscious Adult

1. Ask: “Are you choking?” If they can cough forcefully, encourage them to keep coughing. Do not interfere with an effective cough.

2. If they cannot speak, cough, or breathe — perform abdominal thrusts (Heimlich maneuver):

   • Stand behind the person, wrap your arms around their waist.
   • Make a fist with one hand, place it thumb-side against the abdomen, just above the navel and well below the breastbone.
   • Grasp your fist with your other hand.
   • Pull sharply inward and upward in a J-shaped motion.
   • Repeat until the object is expelled or the person goes unconscious.

3. For a very large person or late-pregnancy: use chest thrusts instead. Same position but with your fist on the center of the breastbone, compress straight backward.

Unconscious Adult (or choking victim who collapses)

1. Lower them to the ground.
2. Open the mouth and look for the object. If visible, sweep it out with a finger. Do not blind finger sweep — you may push it deeper.
3. Attempt 2 rescue breaths. If air does not go in, reposition the head and try again.
4. Begin CPR — 30 compressions, check mouth, attempt 2 breaths. The compressions often dislodge the object.
5. Continue the cycle until the airway clears.

Anaphylaxis (Severe Allergic Reaction)

Without epinephrine auto-injectors, anaphylaxis in a post-collapse world is extremely dangerous. Recognition and supportive care are all you have.

Recognition

Anaphylaxis typically begins within minutes of exposure to an allergen (insect stings, food, plant contact):

• Swelling of face, lips, tongue, throat
• Difficulty breathing, wheezing, stridor (high-pitched breathing sound)
• Widespread hives or red, itchy skin
• Rapid pulse, dropping blood pressure
• Nausea, vomiting, abdominal cramps
• Feeling of impending doom (this is a real medical symptom, not anxiety)

Emergency Treatment Without Medication

1. Position: If breathing is difficult, sit them upright (easier to breathe). If blood pressure is dropping (pale, dizzy, faint), lay them flat with legs elevated 30 cm (12 inches).

2. Remove the trigger if possible — pull out a stinger (scrape sideways with a flat edge, do not squeeze with tweezers), move away from the allergen source.

3. Monitor the airway constantly. Throat swelling can close the airway within minutes. If the person cannot breathe at all, you may need to consider an emergency surgical airway (cricothyrotomy) — a last-resort procedure described in Surgery.

4. Keep them calm. Panic increases heart rate, which circulates the allergen faster and worsens the reaction.

5. Cold compress on the sting/exposure site may slow allergen absorption slightly.

Know Your Group's Allergies

In a survival community, catalog known severe allergies. People with a history of anaphylaxis to bee stings, certain foods, or other triggers should be identified and their risk managed — avoid known triggers, keep treatment supplies nearby, train others in emergency response.

Shock

Shock is the body’s circulatory system failing to deliver enough blood to vital organs. It follows severe bleeding, major burns, severe infection, allergic reactions, heart failure, or extreme dehydration.

Recognition

• Pale, cold, clammy skin
• Rapid, weak pulse (over 100 beats per minute)
• Rapid, shallow breathing
• Confusion, anxiety, agitation
• Thirst
• Decreased or absent urine output

Treatment

1. Treat the cause. Stop bleeding, cool burns, replace fluids — shock is a symptom, not a disease. Find and fix the underlying problem.

2. Position: Lay flat, elevate legs 20-30 cm (8-12 inches) above the heart. This shifts blood from the legs to the vital organs. Exception: do not elevate legs for head injuries, spinal injuries, or if it causes more pain.

3. Maintain body temperature. Shock victims lose the ability to thermoregulate. Cover with blankets, insulate from the ground. Do not overheat.

4. Give fluids if conscious and no abdominal injury — small sips of water with a pinch of salt and sugar (oral rehydration). If abdominal injury is suspected, give nothing by mouth.

5. Keep them calm and still. Talk to them. Reassure them. Anxiety worsens shock by increasing oxygen demand.

6. Monitor continuously. Check pulse, breathing, and consciousness every 5 minutes. Shock can deteriorate rapidly.

Recovery Position

For any unconscious person who is breathing:

1. Kneel beside them. Extend the arm nearest to you straight out at a right angle.
2. Bring their far arm across their chest, hold the back of their hand against their near cheek.
3. Bend their far knee up.
4. Roll them toward you by pulling on the bent knee. Their head should rest on their hand.
5. Adjust the top knee to a right angle to prevent them from rolling further.
6. Tilt the head back slightly to keep the airway open.
7. Check breathing every minute.

This position prevents vomit from entering the lungs (the number one cause of death in unconscious people who are otherwise stable) and keeps the airway open.

Seizures

During a Seizure

• Do not restrain the person. You cannot stop a seizure, and holding them down risks injury to both of you.
• Clear the area of hard or sharp objects they could hit.
• Do not put anything in their mouth. The “swallowing the tongue” myth is false. Objects in the mouth cause broken teeth and choking.
• Protect the head. Place something soft under it if possible.
• Time the seizure. Duration matters for assessing severity.

After a Seizure

• Place in the recovery position.
• They will be confused and exhausted (postictal state). Stay with them, speak calmly.
• If the seizure lasted more than 5 minutes, or if a second seizure follows without full recovery between them, this is a life-threatening emergency (status epilepticus) with very limited field treatment options.

Key Takeaways

• Triage saves the most lives when resources are limited — treat the saveable first, not the loudest or closest.
• CPR: push hard (5-6 cm), push fast (100-120/min), do not stop. Cracked ribs are acceptable. Rotate rescuers every 2 minutes.
• Choking: forceful abdominal thrusts for conscious adults; CPR cycle for unconscious with airway checks between rounds.
• Shock kills quietly — lay flat, elevate legs, treat the cause, maintain temperature, give fluids if safe.
• Place every unconscious breathing person in the recovery position to prevent aspiration.