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View Full Version : Broken bones in a survival situation (military and medical help appreciated)



Sera Trevor
09-11-2013, 02:49 AM
Hi!

The story I'm working on is technically military sci-fi, but I'm posting here because my characters are 1) on an earth-like planet, and 2) have no access to any sci-fi gear at the moment.

I've already done some research and feel pretty confident that my situation works, but I thought I'd see if anyone notices any glaring errors. (My husband is a veteran with survival training and has said this all sounds good; however, he's not a medical expert so I don't feel as confident about the injury part of the equation.)

THE CHARACTERS: a field medic and a member of Special Forces (or the equivalent), both corporals

THE SETTING: a base that serves as a field hospital/R&R facility on a small, otherwise uninhabited planet. The sole continent is covered in earth-like jungle.

WHAT THEY HAVE ON THEM: Special Forces dude: a machete; a canteen; a rucksack with the following items: a plastic poncho, a change of socks, a change of uniform, a length of parachute cord, a field shovel, a flashlight/fire-starting device (my only vaguely sci-fi tool)

The medic: a machete; a canteen; a camera; a specimen kit containing the following: small jars and plastic bags, a pair of scissors, a magnifying glass; a medical kit containing the following: butterfly bandages, a jar of aspirin, hydrogen peroxide, a couple ace bandages, iodine drops

THE SITUATION: my field medic and Special Forces guys are buddies who are feeling antsy. In spite of orders not to leave the base, they decide to sneak out for a couple of hours so that my field medic can look for strange and interesting new plants (he has an interest in exobotany.) (This is an extremely stupid thing to do, I know, and they will get in massive amounts of trouble for it.)

While they're tramping around, my medic tumbles into a drop-in cave. He falls about ten feet (3 meters). He lands on his right leg and breaks his tibia and fibula (closed fractures, fortunately.) A rock falls on his left foot, crushing it and also breaking that tibia. He also sustains a laceration to his head.

(QUESTION: Okay, so - do those injuries sound realistic for that kind of fall? I want him to be immobilized, but not in immediate life-threatening danger. He's going to be stuck in the jungle for a few days - I don't want him to die.)

My Special Forces guy repels down, checks to see if he has a concussion. He doesn't. He takes a sock from his rucksack and applies pressure to the head wound, which he binds to his head with an ace bandage. After that, he moves the rock off of the medic's crushed foot. They take the boot off. The foot is blackened and swollen. My medic doesn't have a lot of feeling in it.

(QUESTION: I want him to have to have this foot amputated later (so he can get a cool robot foot!), so I want it screwed up as much as possible: nerve damage, etc. I assume if the nerves were badly enough damage, the effect would be immediate? As in, he wouldn't be able to feel it? He's wearing thick boots - would that make much of a difference to his injuries?)

Special Forces wraps the foot with the remaining ace bandage. They take the boot off the other foot. Special Forces decides to cut some bamboo shoots to act as splints. He climbs out and returns with the shoots; they set the bones and tie the splints to his legs with either shoes laces or vines.

At that point, they decide they need help. They radio back to base - but oh no! There's a possible enemy incursion - the base is putting up its invisibility force field, which means no one gets in or out, and they have to maintain radio silence.

So at this point, Special Forces starts setting up camp - I feel pretty good about how he goes about it, so I won't go into here (if anyone wants to chat about it some, though, I'd love to hear it!) My main questions are about my medic: how long is he going to be able to last? Would five days be realistic? Could it be as much as seven? (Assume my Special Forces guy knows what he's doing - they have food and fresh water, reasonable shelter, etc.). I want his condition to deteriorate, but not too quickly, and not so badly that it would be unrealistic he would survive.

What I'm thinking: he does all right for the first four days (other than the terrible, terrible pain, of course), then develops gangrene, and maybe another infection. How long could he last after that happens? What could they do to treat it? I've already decided he loses a foot - would the loss of a leg be more realistic? Anything I'm forgetting?

ETA: Another thought - could I have my guys do a field amputation for maximum angst, or would that be stretching it too far?

robjvargas
09-11-2013, 02:54 AM
Maybe read up a bit on crush injuries, for the foot amputation.

I'm trying to locate a source, but I recall that if a portion of the body is compressed long enough, it starts to build up lactic acid. If enough builds up, then removing the compression can actually kill the patient. They have to amputate to stop the flood of lactic acid.

I think.

Sera Trevor
09-11-2013, 03:06 AM
Maybe read up a bit on crush injuries, for the foot amputation.

I'm trying to locate a source, but I recall that if a portion of the body is compressed long enough, it starts to build up lactic acid. If enough builds up, then removing the compression can actually kill the patient. They have to amputate to stop the flood of lactic acid.

I think.

Yes, there's a thing called compression syndrome that requires a lot more help than my guys have! However, from what I can tell, it only occurs when an entire limb is involved for a long period of time (a few hours or more). A crushed hand or foot isn't going to do it, especially since they free him right away. (Although I could be wrong, of course.)

Pallas Athene
09-11-2013, 04:08 AM
Hi!
While they're tramping around, my medic tumbles into a drop-in cave. He falls about ten feet (3 meters). He lands on his right leg and breaks his tibia and fibula (closed fractures, fortunately.) A rock falls on his left foot, crushing it and also breaking that tibia. He also sustains a laceration to his head.

(QUESTION: Okay, so - do those injuries sound realistic for that kind of fall? I want him to be immobilized, but not in immediate life-threatening danger. He's going to be stuck in the jungle for a few days - I don't want him to die.)

The injuries definitely sound realistic.


My Special Forces guy repels down, checks to see if he has a concussion. He doesn't. He takes a sock from his rucksack and applies pressure to the head wound, which he binds to his head with an ace bandage. After that, he moves the rock off of the medic's crushed foot. They take the boot off. The foot is blackened and swollen. My medic doesn't have a lot of feeling in it.

(QUESTION: I want him to have to have this foot amputated later (so he can get a cool robot foot!), so I want it screwed up as much as possible: nerve damage, etc. I assume if the nerves were badly enough damage, the effect would be immediate? As in, he wouldn't be able to feel it? He's wearing thick boots - would that make much of a difference to his injuries?)Nitpickiness here- once a concussion is ruled out, the head wound isn't nearly as worrying as the crushed foot and broken bones, and so would be treated last. The foot crush and the broken bones is kind of a tossup as to which would be treated first, so that could go either way. Also, there's no need to use an ace bandage to secure the sock to the medic's head. He can hold pressure on it manually without wasting resources.

As far as the boots go, it would protect the foot some from impact, due to the metal toe in military boots. If the impact point was on the midfoot or higher, the boot wouldn't do so much good. Any impact trauma is going to cause the tissue to swell, compressing nerves and blood vessels, and if you're really unlucky broken bone edges can sever them, leading to pain/numbness/tingling in the affected area. The foot wouldn't be blackened at that point, just badly bruised and badly swollen. It would only turn black later, as lack of blood flow causes the tissue to die.


Special Forces wraps the foot with the remaining ace bandage. They take the boot off the other foot. Special Forces decides to cut some bamboo shoots to act as splints. He climbs out and returns with the shoots; they set the bones and tie the splints to his legs with either shoes laces or vines.A first responder wouldn't be trained to set the bones, just to splint them in place.


At that point, they decide they need help. They radio back to base - but oh no! There's a possible enemy incursion - the base is putting up its invisibility force field, which means no one gets in or out, and they have to maintain radio silence.

So at this point, Special Forces starts setting up camp - I feel pretty good about how he goes about it, so I won't go into here (if anyone wants to chat about it some, though, I'd love to hear it!) My main questions are about my medic: how long is he going to be able to last? Would five days be realistic? Could it be as much as seven? (Assume my Special Forces guy knows what he's doing - they have food and fresh water, reasonable shelter, etc.). I want his condition to deteriorate, but not too quickly, and not so badly that it would be unrealistic he would survive.

What I'm thinking: he does all right for the first four days (other than the terrible, terrible pain, of course), then develops gangrene, and maybe another infection. How long could he last after that happens? What could they do to treat it? I've already decided he loses a foot - would the loss of a leg be more realistic? Anything I'm forgetting?The timing of onset of gangrene would depend on just how badly the flow of blood is impaired- total lack of blood flow I'd think within 24 hours it would be obvious something was seriously wrong, moderately impaired maybe another day. Gangrene would start at the toes, and work its way upwards from there. In the conditions in the cave, a bacterial infection on top of the gangrene would be almost a certainty. By day four both would be very worried, by day seven on the verge of panic as the bacterial infection progressed, considering an infection of that sort can kill.



ETA: Another thought - could I have my guys do a field amputation for maximum angst, or would that be stretching it too far?Too far, in my opinion. There's not enough equipment on hand to make sure the medic doesn't bleed to death, and the medic would know this.

James D. Macdonald
09-11-2013, 04:43 AM
He isn't going to tie splints in place with shoelaces or vines. Too narrow. Likely to cause more damage.

He's going to tie the splints on with strips cut from his buddy's clothing.

Make sure those bamboo shoots are wide, thick, and well padded.

After that, elevation of the injured parts.

I think some folks above are thinking of compartment syndrome.

These injuries, particularly when treatment is delayed, can indeed be life-threatening.

redfalcon
09-11-2013, 05:07 AM
The Special Forces medic would have a field dressing in his pack, not a big deal but no need to improvise with socks. I still had a few in my rucksack 15 years after I got out, and I was just a regular paratrooper.

+1 for what James said about width of splint ties.

FWIW most grunts carried bungee cords on their rucksacks. A poncho and 4-5 bungees was an almost instant shelter.

Special Forces medics know their stuff, so you can throw any medical info from him and be realistic.

just my.019873

Sera Trevor
09-11-2013, 05:12 AM
Nitpickiness here- once a concussion is ruled out, the head wound isn't nearly as worrying as the crushed foot and broken bones, and so would be treated last. The foot crush and the broken bones is kind of a tossup as to which would be treated first, so that could go either way. Also, there's no need to use an ace bandage to secure the sock to the medic's head. He can hold pressure on it manually without wasting resources.
This is exactly the kind of nitpickiness I wanted - thank you so much!


A first responder wouldn't be trained to set the bones, just to splint them in place. Did not know that - I knew I was going to get something obvious wrong.



As far as the boots go, it would protect the foot some from impact, due to the metal toe in military boots. If the impact point was on the midfoot or higher, the boot wouldn't do so much good. Any impact trauma is going to cause the tissue to swell, compressing nerves and blood vessels, and if you're really unlucky broken bone edges can sever them, leading to pain/numbness/tingling in the affected area. The foot wouldn't be blackened at that point, just badly bruised and badly swollen. It would only turn black later, as lack of blood flow causes the tissue to die.Good to know. Quick question - would massaging the foot help the blood flow? Or would that risk doing more damage and/or be too painful?




The timing of onset of gangrene would depend on just how badly the flow of blood is impaired- total lack of blood flow I'd think within 24 hours it would be obvious something was seriously wrong, moderately impaired maybe another day. Gangrene would start at the toes, and work its way upwards from there. In the conditions in the cave, a bacterial infection on top of the gangrene would be almost a certainty. By day four both would be very worried, by day seven on the verge of panic as the bacterial infection progressed, considering an infection of that sort can kill. That works really well for my purposes, then. *steeples hands* Excellent.

Sera Trevor
09-11-2013, 05:16 AM
The Special Forces medic would have a field dressing in his pack, not a big deal but no need to improvise with socks.

Aha! Yeah, that would make sense.


FWIW most grunts carried bungee cords on their rucksacks. A poncho and 4-5 bungees was an almost instant shelter.

*adds bungee cords* Yeah, I was planning on using the poncho for shelter - that makes it even easier.

Thanks for the info!

Sera Trevor
09-11-2013, 05:17 AM
He's going to tie the splints on with strips cut from his buddy's clothing.

Make sure those bamboo shoots are wide, thick, and well padded.

After that, elevation of the injured parts.

All good stuff - thank you!

Canotila
09-11-2013, 05:20 AM
If you want his foot amputated in the field the rock could be big enough to trap his foot. Then you give them a reason for the cave to be a life threatening place to stay. Flooding, poisonous gas, flammable gas that catches on fire, swarms of alien flesh eating cave bugs, really the sky is the limit here.

Edit: And given that this is science fiction, and your people are exploring a different planet, it seems entirely reasonable that your medic might have more advanced training in some areas than an army medic on earth.

Sera Trevor
09-11-2013, 05:39 AM
If you want his foot amputated in the field the rock could be big enough to trap his foot. Then you give them a reason for the cave to be a life threatening place to stay. Flooding, poisonous gas, flammable gas that catches on fire, swarms of alien flesh eating cave bugs, really the sky is the limit here.

Good point! Will take that into consideration. Thanks!

James D. Macdonald
09-11-2013, 06:15 AM
A wilderness EMT would be trained to straighten broken bones. In a city situation where the nearest hospital is five minutes away, no. In the backcountry you'll be doing more things, including reducing dislocations.

This guy is not going anywhere soon. The goal will be to stabilize him in place until he can be evacuated. To this end, after you've splinted the breaks, treat for shock.

A copy of Backcountry Medicine or Where There Is No Doctor will help out immensely.

Sera Trevor
09-11-2013, 06:23 AM
A wilderness EMT would be trained to straighten broken bones. In a city situation where the nearest hospital is five minutes away, no. In the backcountry you'll be doing more things, including reducing dislocations.

Ah, gotcha! Good news for my guy.

I'll check out the library for those books - they sound like great references. Thanks!

debirlfan
09-12-2013, 05:46 AM
As far as the steel toed boots - I used to work in a machine shop. Over the years I heard stories about cases where something sufficiently heavy fell on someone's foot and crushed in the steel, cutting off or crushing the individual's toes. No idea if the tales were true, but if so, it could work for you.

BTW, to do that much damage, I would think that the guys foot would have to be on rock when a second rock landed on him. It seems likely that if the floor was dirt/mud/debris, then there would be some "give" that would somewhat limit the damage.

Another thing to consider - if the crush injury leads to an open wound, there could be stuff in the cave that could get into it leading to further infection. (Bat poop, dead creatures, mud, an inch of filthy water...)

Nivarion
09-12-2013, 09:16 PM
If you are looking for amputation he could fall on his back when he breaks his leg and then the rock lands on his foot. It could smash bones to bits and put them where they don't belong. Would probably ruin his foot.

usuallycountingbats
09-12-2013, 09:30 PM
Can I point you in the direction of two true stories which I think will help your research? The first is Touching the Void by Joe Simpson. He is climbing and falls into a crevasse breaking both legs. The second is 127 Hours by Aron Ralston, where a climber cuts off his own arm. Both are also movies. I think they will surprise you in terms of human endurance and what it's possible to do to survive!

(It's rappel by the way, not repel).

Sera Trevor
09-13-2013, 01:28 AM
Thanks for the help, everyone! I think I'm going to change his injuries slightly - I think he lands on his left thigh and breaks his femur. I know that's more dangerous, but I'm worried having him land on his lower leg would be more likely to cause an open fracture, which I want to avoid. He manages to turn over slightly before the rock falls and crushes his foot.

debrilfan - Oooh, good thought about the steel tip boots! And also good point about the ground - I'll make sure he lands on something hard.

Nivarian - Yeah, he'll be on his back when the rock hits.

usuallycountingbats - awesome book recs - I will be sure to check them out! (And thanks for the spelling catch.)

NinjaFingers
09-13-2013, 01:33 AM
I don't know whether the "steel toe makes certain crush injuries" worse anecdote is true, but I do know a lot of people won't wear steel toes when working stock for exactly that reason...sooner or later, your foot WILL get stepped on by something that weighs 1,000 pounds or more and has hooves.

However, Mythbusters busted it some time ago. You might be able to get away with it, but...

Sera Trevor
09-13-2013, 02:13 AM
I don't know whether the "steel toe makes certain crush injuries" worse anecdote is true, but I do know a lot of people won't wear steel toes when working stock for exactly that reason...sooner or later, your foot WILL get stepped on by something that weighs 1,000 pounds or more and has hooves.

However, Mythbusters busted it some time ago. You might be able to get away with it, but...

Hmmm, if Mythbusters busted it, I might reconsider it. Thanks for the info!

GeorgeK
09-14-2013, 01:15 AM
A healthy guy breaks both legs on a 3 meter fall...he's not healthy. He has osteoporosis and the generic name is elastic wrap. Ace Bandage is a product name.

Sera Trevor
09-14-2013, 01:37 AM
A healthy guy breaks both legs on a 3 meter fall...he's not healthy. He has osteoporosis and the generic name is elastic wrap. Ace Bandage is a product name.

Good to know - I'll make the fall longer.