These are the symptoms of shock: The patient's pulse is weak or rapid, or he may have no pulse that you can find. His skin may be pale or blue, cold, or moist. His breathing may be shallow or irregular. He may have chills. He may be thirsty. He may get sick at his stomach and vomit.

A person can be "in shock" whether he is conscious or unconscious.

_Important: All seriously-injured persons should be treated for shock, even though they appear normal and alert_. Shock may cause death if not treated promptly, even though the injuries which brought on shock might not be serious enough to cause death. In fact, persons may go into shock without having any physical injuries.

Here is how to treat any person who may be in shock:

1. Keep him lying down and keep him from chilling, but do _not_ apply a hot water bottle or other heat to his body. Also, loosen his clothing.

2. Keep his head a little lower than his legs and hips. But if he has a head or chest injury, or has difficulty in breathing, keep his head and shoulders slightly higher than the rest of his body.

3. Encourage him to drink fluids if he is conscious and not nauseated, and if he does not have abdominal injuries. Every 15 minutes give him a half-gla.s.s of this solution until he no longer wants it: One teaspoonful of salt and a half-teaspoonful of baking soda to one quart of water.

4. Do _not_ give him alcohol.

BROKEN BONES

Any break in a bone is called a fracture. If you think a person may have a fracture, treat it as though it were one. Otherwise, you may cause further injury. For example, if an arm or leg is injured and bleeding, splint it as well as bandage it.

With any fracture, first look for bleeding and control it. Keep the patient comfortably warm and quiet, preferably lying down. If you have an ice bag, apply it to the fracture to ease the pain. Do not move the patient (unless his life is in danger where he is) without first applying a splint or otherwise immobilizing the bone that may be fractured. Treat the patient for shock.

A FRACTURED ARM OR LEG should be straightened out as much as possible, preferably by having 2 persons gently stretch it into a normal position.

Then it should be "splinted"--that is, fastened to a board or something else to prevent motion and keep the ends of the broken bone together. As a splint, use a board, a trimmed branch from a tree, a broomstick, an umbrella, a roll of newspapers, or anything else rigid enough to keep the arm or leg straight. Fasten the arm or leg to the splint with bandages, strips of cloth, handkerchiefs, neckties, or belts. After splinting, keep the injured arm or leg a little higher than the rest of the patient's body. From time to time, make sure that the splint is not too tight, since the arm or leg may swell, and the blood circulation might be shut off. If the broken bone is sticking out through the skin but the exposed part of it is clean, allow it to slip back naturally under the skin (but don't push it in) when the limb is being straightened. However, if the exposed part of the bone is dirty, cover it with a clean cloth and bandage the wound to stop the bleeding. Then splint the arm or leg without trying to straighten it out, and try to find a doctor or nurse to treat the patient.

A FRACTURED COLLAR-BONE should also be prevented from moving, until the patient can get professional medical attention. It can be immobilized by placing the arm on that side in a sling and then binding the arm close to the body.

A FRACTURED RIB should be suspected if the patient has received a chest injury or if he has pain when he moves his chest, breathes, or coughs.

Strap the injured side of his chest with 2-inch adhesive tape if available, or with a cloth bandage or towel wrapped around and around his entire chest.

Fractured bones in the NECK OR BACK are very serious, because they may injure the patient's spinal cord and paralyze him or even kill him. He should not be moved until a doctor comes (or a person trained in first aid), unless it is absolutely necessary to move him to prevent further injury. If a person with a back injury has to be moved, he should be placed gently on his back on a stiff board, door or stretcher. His head, back, and legs should be kept in a straight line at all times.

A person with a neck injury should be moved gently with his head, neck, and shoulders kept in the same position they were when he was found. His neck should not be allowed to bend when he is being moved.

BURNS

Non-serious or superficial (first degree) burns should not be covered--in fact, nothing need be done for them. However, if a first degree burn covers a large area of the body, the patient should be given fluids to drink as mentioned in item 2 following.

The most important things to do about serious (second or third degree) burns are: _(a)_ Treat the patient for shock, _(b)_ Prevent infection, and _(c)_ Relieve pain. These specific actions should be taken:

1. Keep the patient lying down, with his head a little lower than his legs and hips unless he has a head or chest wound, or has difficulty in breathing.

2. Have him drink a half-gla.s.s every 15 minutes of a salt-and-soda solution (one teaspoonful of salt and a half-teaspoonful of baking soda to a quart of water). Give him additional plain water to drink if he wants it.

3. Cover the burned area with a _dry_, sterile gauze dressing. If gauze is not available, use a clean cloth, towel or pad.

4. With soap and water, wash the area _around_ the burn (not the burn itself) for a distance of several inches, wiping _away_ from the burn.

The dressing will help prevent surface washings from getting into the burned area.

5. Use a bandage to hold the dry dressing firmly in place against the burned area. This will keep moving air from reaching the burn, and will lessen the pain. Leave dressings and bandage in place as long as possible.

6. If adjoining surfaces of skin are burned, separate them with gauze or cloth to keep them from sticking together (such as between toes or fingers, ears and head, arms and chest).

7. If the burn was caused by a chemical--or by fallout particles sticking to the skin or hair--wash the chemical or the fallout particles away with generous amounts of plain water, then treat the burn as described above.

_What NOT to do about burns_:

--Don't pull clothing over the burned area (cut it away, if necessary).

--Don't try to remove any pieces of cloth, or bits of dirt or debris, that may be sticking to the burn.

--Don't try to clean the burn; don't use iodine or other antiseptics on it; and don't open any blisters that may form on it.

--Don't use grease, b.u.t.ter, ointment, salve, petroleum jelly, or any type of medication on severe burns. Keeping them dry is best.

--Don't breathe on a burn, and don't touch it with anything except a sterile or clean dressing.

--Don't change the dressings that were initially applied to the burn, until absolutely necessary. Dressings may be left in place for a week, if necessary.

RADIATION SICKNESS

Radiation sickness is caused by the invisible rays given off by particles of radioactive fallout. If a person has received a large dose of radiation in a short period of time--generally, less than a week--he will become seriously ill and probably will die. But if he has received only a small or medium dose, his body will repair itself and he will get well. No special clothing can protect a person from gamma radiation, and no special medicines can protect him or cure him of radiation sickness.

Symptoms of radiation sickness may not be noticed for several days. The early symptoms are lack of appet.i.te, nausea, vomiting, fatigue, weakness and headache. Later, the patient may have sore mouth, loss of hair, bleeding gums, bleeding under the skin, and diarrhea. But these same symptoms can be caused by other diseases, and not everyone who has radiation sickness shows all these symptoms, or shows them all at once.

If the patient has headache or general discomfort, give him one or two aspirin tablets every 3 or 4 hours (half a tablet, for a child under 12). If he is nauseous, give him "motion sickness tablets," if available. If his mouth is sore or his gums are bleeding, have him use a mouth wash made up of a half-teaspoonful of salt to 1 quart of water. If there is vomiting or diarrhea, he should drink slowly several gla.s.ses each day of a salt-and-soda solution (one teaspoonful of salt and one-half teaspoonful of baking soda to 1 quart of cool water), plus bouillon or fruit juices. If available, a mixture of kaolin and pectin should be given for diarrhea. Whatever his symptoms, the patient should be kept lying down, comfortably warm, and resting.

Remember that radiation sickness is _not_ contagious or infectious, and one person cannot "catch it" from another person.

PART TWO

MAJOR NATURAL DISASTERS

Many of the actions recommended in Part I of this handbook to help you prepare for and live through a nuclear attack--such as learning the warning signals, stocking emergency supplies, taking a course in emergency skills, and knowing how to fight fires at home--also would help you in case a major natural disaster occurs in your area. If you are prepared for nuclear attack, you are also prepared to cope with most peacetime disasters--disasters that kill hundreds of Americans every year, injure thousands, inflict widespread suffering and hardship, and cause great economic loss.

Part II of this handbook (pages 69-86) is intended to help you prepare for those natural disasters that may occur in your area, and tell you the right actions to take if they occur. Chapter 1 (pages 71-74) gives general guidance applicable to various types of natural disasters.

Succeeding chapters give special advice on floods, hurricanes, tornadoes, winter storms, and earthquakes.