SELCO: Trauma Assessment and Treatment in Adrenalized Situations

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Author of The Dark Secrets of SHTF Survival and the online course SHTF Survival Boot Camp

Would you know what to do if someone in your group was injured in the middle of a chaotic event, screaming for help?

It seems like a subject change but after many articles, assessments, and discussions about events that are happening around us during the last period of time, it makes sense to step away from looking at big events.  We need to step out of the big circle and step back into our small circle of survival. Our personal circle.

Or in other words, let’s go back to the basics of survival.

It does not make much sense to monitor big events or to participate in them, if you, for example, do not know how to start a fire, shoot a weapon, or treat the most common injuries.

No matter how large and complicated the event, look to yourself and your circle.  Most probably it is the simple things and situations that will kill you. A “small circle” personal particular event will cause trouble for you. Lack of food, lack of hygiene, or the lack of a particular skill will be the end, not something dramatic happening seven states away.

So we need to go back to basics, often.

Treatment in the field

Treating a wound in the field is much different than in your comfortable home with your handy supplies. I saw this video online and wanted to discuss it with you.

Watch the video and see if you think they’re treating the injury correctly.


Doing something like treating a wound in a real environment is a highly adrenalized situation, and when you under the effect of it you’ll make mistakes unless you have trained many times on what you have to do in that situation.

Without undermining those folks’ wish to help, it must be said that they overreacted in treating a wound that looked absolutely like a wound that does not require the use of a tourniquet.

In the survival movement (and not only there), a tourniquet is seen as a magical device that saves lives, and that almost should be used whenever blood occurs.

In reality, the explanation when you should use a tourniquet is very simple – whenever you can not stop the bleeding in any other way. The bleeding in the video looks like it could have been stopped by good old direct pressure without any problems. However cool the use of the tourniquet may look, there is (or there should be) common sense in using it.

Again, you use it when you can not stop massive bleeding in any other way because by using the tourniquet for example, on a leg like in the video, you are obstructing blood flow to the leg. From the point of application of the tourniquet, in other words, the leg is not getting blood and eventually, it will “die”.

That is the reason why you should use it only when other means are not stopping massive bleeding.  You use a tourniquet only in life-threatening situations.

Now, you as a prepper add to the fact that in the world without a running system (and hospitals) you should be extra careful when to use it, because “help is on the way” might not be an option. By applying an unneeded tourniquet on the leg, for example, you might turn a small wound into a situation when complicated surgical procedures might be needed.

That might be tricky in the collapsed world.

So, a tourniquet is a great device, it saves lives, but only if you learn how and when to use it.

Watching the video, there are a couple of more thoughts about basic trauma assessment and treatment in the field, so you need to think about this too.


Assess the situation and try to see what s happening. Try to assess if there is any possible danger to you if you want to treat the injured person, because otherwise, you might find yourself in a situation where you also get injured, and then there might be two of you injured with nobody to help.  If bullets are flying, you may have to wait to perform the treatment.


What’s going on? How many are injured? What kind of injuries do they have? Are there more serious injuries than those injuries that are visible…?

Trauma is an adrenalized event. You need to be sure what is happening, otherwise, you might easily find yourself in a situation where you treat the wound that looks horrible but it is not life-threatening and you forgot to check and see that there’s also a life-threatening wound.

In all that chaos, you need to find yourself in your “zone” if you already there and helping.

Expose the patient and check for other possible wounds more serious then the visible one.

Give orders, obey orders, or go away.

Again, trauma is a highly adrenalized event. It can be chaotic, and you can make a lot of mistakes with other people trying to help, too.

In all that wish to help, chaos will make you in the best case to do nothing, in the worst case, it will push you to make mistakes.

Learn to recognize who is who (in the matter of knowledge, skills, and guts) among people and find your place.

If there is a clear situation where you have the most and best knowledge among the people there, do not hesitate to take lead, and to give orders, People will usually listen to you. If there is a person with greater knowledge then you, do not hesitate to obey. If you are just blindly dancing around the victim, with other people you are not helping.

One important note here: know that there is a responsibility there, so in first place, decide carefully if you are gonna go there, and if you are gonna take responsibility.

Remember a bunch of people wanting to help blindly is not actually helpful. On the contrary, it can mean more harm to the injured man.

And this video kinda pushed me to mention one more thing.

You need to control the situation, and that also means you need to control the patient. If he is clearly overreacting, you need to help him get a hold of himself. Sometimes that means simply saying, “Shut the f**k up, you wimp. It is nothing.”

It works in those situations, trust me.

Picture of Selco


Selco survived the Balkan war of the 90s in a city under siege, without electricity, running water, or food distribution. In his online works, he gives an inside view of the reality of survival under the harshest conditions. He reviews what works and what doesn’t, tells you the hard lessons he learned, and shares how he prepares today. He never stopped learning about survival and preparedness since the war. Regardless what happens, chances are you will never experience extreme situations as Selco did. But you have the chance to learn from him and how he faced death for months. Read more of Selco's articles here. Buy his PDF books here. Take advantage of a deep and profound insight into his knowledge by signing up for his unrivaled online course. Real survival is not romantic or idealistic. It is brutal, hard and unfair. Let Selco take you into that world.

Leave a Reply

  • Good article.
    What I might add is that if you are going to be in a group, and there is a possibility of some one getting hurt, then you better know who is there to treat injuries and that they have the requisite skills.
    Now there are times when you can not do that.
    But in this case, a protest, where violence often occurs, then you need to know where to find proper medical aid, before you need it.
    It is part of being prepared or prepped.
    In a survival group it is having a dedicated medical person or persons and to vet them as to their actual knowledge and expertise in this field.
    Another aspect of this, is that during SHTF, they are unlikely to have all the current resources available to them, so they need to find alternatives and be prepared to use them instead. Even if they are not currently approved for medical use or in current usage.

    Herbs for instance might take the place of antibiotics or other medicines. Poultice’s and other home remedies might become the new way of dealing with infections.
    When you don’t have the modern products, they will be forced to rely on other methods, thing not taught in schools. So they need to be learning these things now while they can, rather than trial and error later on.

  • First thing is safety. If your in a shooting continue to fight until the issue is resolved. If your involved with a wreck you gotta get off the road or get the road shut down. No matter what get to safety first. Extra injured or dead do not help the situation and no one remembers your heroic deeds anyway.
    Panic and screaming do not help. Screaming when someone is hurt or dies seems to be a cultural thing. It helps no one and nothing. In fact it makes it impossible to communicate.
    Self aid should be first if possible. The recent video of a minor leg wound was comical where the “victim” who needed a band aid and a curse word to feel better laid there like the aforementioned crybaby whimp and the crowd lost their minds with makeshift tourniquets and yelling and things I’m still trying to figure out.
    Remain calm, if your going to lead then lead if your going to follow then follow but only after the establishment of a leader. In absence then lead and if you can’t then quit now before you kill someone else.
    Get trained, get experience and yeah I know if requires you to not be in your safe job to get experience so…..
    There are reserve programs in fire fighting, law enforcement, military and even things like CERT that will allow you to keep your safe job but touch the other side.

    • Let me elaborate on leadership since it’s a feels issue with some. Often scenes are chaotic and if you watch 3rd world country videos, the ongoings here and other things or have ever been involved in situations like we get into at work there is a lot of screaming, noise, panic, people who freeze. In order to provide timely care organization will assist in ensuring that. In order for it to be organized then someone must be in charge. Even in the authors words “Give orders, obey orders, or go away.”
      The military and other organizations have a dedicated COC allowing the skipping of this process which is why they are more effective after the first event or two.
      There will be bad leaders and I’ve encountered them. A couple of thanksgivings ago I stopped at a bad multiple vehicle fatality wreck. I responded with my car kit and the off duty radio equipped firefighter who had assumed control began literally screaming at the public because they had no medical supplies, which he didn’t either. I stated as much and he response was “I always have the truck” to which I stated “not today apparently and calm down and quit yelling”. We lost the battle, even with a med flight and all the gauze in the world wasn’t going to make the difference that day. His time spent screaming would have been better suited calming and comforting the patient who was obviously not going to make it and the last words she heard should not have been chaotic. Every time I’d get her calm he’d yell.
      I’ve no wish to “run you” “trample your freedoms” “be the oppressor” or any other feels you have. My desire is only to help in the most efficient way possible and if you are up in “tyranny” feels that deep then stay out of it altogether. We are there for one common goal. In preparedness it will be family or friends and until you’ve been there the emotions you feel will remain unknown.
      For others who are staying out of it and believe then PRAY. I’ll take any help I can get. If it’s not for healing then for no suffering.
      If there is apparent arterial spurting skip the pressure bandage and go straight to the tourniquet when possible. Pressure is a waste of time and training/knowledge has improved based on the decade + of war. If no arterial bleed then start with pressure.
      Again training and experience will give you the knowledge of which is which.

  • Get formal training, from a certified instructor or accredited course.
    Basic First Aid is good.
    Take it a step forward and look into a EMT-B course (I took mine at a adult education center, night class).
    An additional step would be the NOLS Wilderness EMT course. Lots of hands on training there. Week long course, and can be $$, but well worth the training.
    Then, if you can, volunteer at a local firefighting station. Your education will be highly valued.

  • Trouble is, when stuff happens in public, there will be self-important morons who force themselves into taking charge. I had one such experience while driving early morning near a hospital. The details still haunt me. I was second on scene of an unconscious woman lying next to a bicycle. The first person there was a distraught woman who didn’t know what to do. I did a quick assessment, and couldn’t see any serious injuries. Respiration seemed fine. So watchful waiting seemed to be in order until professional help arrived. I happened to have a cell phone (this was a long time ago, when this was uncommon) and called for an ambulance. I had blocked traffic from the victim with my car and flashing lights, and asked the other woman to do the same from the other direction on the road. Soon after, before the ambulance arrived, along came a tractor trailer. The driver stopped adjacent to us, totally blocking the road. He leaped out of the truck, rushed over, and reached out to move her. I politely attempted to get him to leave her where she was, explaining that we didn’t know what musculo-skeletal injuries she may have suffered in her fall, and we certainly didn’t want to exacerbate any such problems. He started swearing at me, insulting me, and assuring the other woman and me that he was very knowledgeable about first aid, something that was pretty obviously not the case since he was dragging her away without good cause and increasing the risk of harm. This would be consistent with the Dunning-Kruger effect I only recently learned about.
    I worry that in crises, similar events will unfold, just as the video suggests, and as I experienced. Well-meaning idiots can do far more harm than good even as they are convinced that they are being helpful.

    • I was going to add your observation to my comment. I’ve seen many situations where some under-qualified fool thinks they’re the smartest, most competent person in the area, and barks orders like everyone else is an idiot. It’s all due to a hyper-inflated ego from all their self-help courses, I guess…

    • That’s why they say “no good deed goes unpunished’ and more damage can be caused by good intentions than anything else?

  • I came to the same basic conclusions Selco did, before reading his commentary on the video. Military first aid taught us to apply the patient’s field dressing to the wound, then pressure, then elevate. If bleeding won’t stop, then tourniquet as a last resort – and mark ‘T’ on patient or notify medic.
    Other first aid training I’ve had addresses the “assess the macro situation” prior to dealing with an injured person – is it safe to approach, activating EMS, etc…. Military never discussed that in my era, nor anything to do with “taking charge” or delegating tasks to others. The assumption was that an injured soldier was going to be further treated by a medic or evacuated. The same could be applied to soys at rallies where society is still functioning and a hospital is just around the corner.

  • Great article, Selco! It’s good to have a 1st aid kit which contains a clotting sponge: My husband and kids hunt and I always send them with a couple of these. A friend used this when a dog was attacked and was bleeding out, so they have multiple uses! There are some good books that acquaint you with medical response, both traditional and alternative: When There is no Doctor:; Also Herbal Antivirals and Herbal Antibiotics by Buhner. There are lots of books on alternative practices, like the Nordic approach to heal injuries exposing the injured area to heat and then cold.

  • With 40 years in Health Care (10 as a Paramedic, 15 as Trauma RN), I absolutely agree with Selco’s assessment. This wound did not require a Tourniquet. Pressure Bandage would have been sufficient.

  • Watching that video, I was dumbfounded. The “caregivers” had no idea what they were doing. The victim too had freaked out.

    I don’t know what to say. Is this typical for the latest generation?

    • In a way R.O. it is. It’s a combination of tv, youtube and drama. They’ve seen shows or videos where things are done and they are combining it with “their cause”. They rush in full of drama but you have not only actors there an equal number of camera operators. Then comes the flood into social media where they are trying to “get the message out” and sadly I still end up watching it, and several others, because it’s on this type of forum to be picked apart as well as about every medical channel there is doing AARs.
      No matter the generation though there are cultures within that are always drama in situations. This one is just better at uploading.
      If anything it just shows the need for realistic training and practice.

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