This article on first aid for writers is part of the Science in Sci-fi, Fact in Fantasy blog series. Each week, we tackle one of the scientific or technological concepts pervasive in sci-fi (space travel, genetic engineering, artificial intelligence, etc.) with input from an expert. Please join the mailing list to be notified every time new content is posted.
The Expert: Stacey Berg
Stacey Berg is a pediatric oncologist who loves it when the medical details in speculative fiction are either technically accurate or really outrageous. She is the author of the science fiction novels Dissension and Regenera
First Aid and Field Dressings for Writers
If you’re writing science fiction or fantasy, it’s likely that you’re going to hurt your protagonist at some point, not just emotionally but physically as well. A common misconception, especially among those of us who watch TV and movies, is that whatever injury occurs, your character can get patched up and be back in action in no time at all. But if you’ve ever been injured yourself (even if it’s just a stubbed toe), you know it can be a lot more complicated than that.
In this post, we’ll take a look at what happens to the body when it’s injured and provide tips for adding realistic touches to your blood and guts scenes. (A disclaimer: none of this is intended as real world medical advice. However, everyone should learn basic first aid and CPR).
“Trauma” just means wound, though when we use it today in a physical sense we usually mean a major injury caused by some violent mechanism. When your hero gets shot, stabbed, pushed out a window, or hit over the head, that’s a trauma and the body responds. Tissue damage is occurring, even if it’s not obvious externally. The injured area bleeds and swells, releasing signals that cause a whole-body response aimed at controlling the damage. Bleeding and swelling can be external, as with those pesky sword cuts and broken bones. Internal bleeding and swelling can be even more dangerous, since it’s hard to stop bleeding in the chest or belly unless you have major healer points, and swelling inside your skull has nowhere to go, so it crushes your brain.
The whole-body response to trauma means that it’s never really just a flesh wound. At a minimum, you may notice that you just don’t feel quite right, beyond the throbbing in your stubbed toe; at the other end, your body can go into uncompensated shock, where multiple organs (including your brain) start failing. In real life, it takes advanced medical care and a long time to recover from severe injuries, and you’ll have to decide how much you want to gloss over this for the sake of your story. Meanwhile, let’s look at a few specific things your hero can do to help herself or others in the aftermath of the exciting battle you just put them through.
CPR: Go In Alphabetical Order
Before anything else, consider situational awareness: in the middle of the fight, it’s safety first for the rescuers, so that they don’t end up turning themselves into victims. We’ll leave techniques for securing an area for another contributor to Dan’s blog. Ongoing danger aside, then, here’s a handy approach to your traumatized hero. She can do some of these steps for herself if she’s physically and mentally able; others are things rescuers will need to help with. An important note: the steps below are NOT the steps for standard CPR. CPR emphasizes circulation first. Please learn it if you haven’t! Go here)
For purposes of this post, we’re not going to worry about making a spinal injury worse. Other than that, the airway step in a first-aid situation is undramatic: if your hero is unconscious, her rescuers can tilt her head back with a hand on the forehead and one under the chin.
That opens the airway. If the victim has been smashed in the face and you want to go full-on melodrama, you can have the rescuers do a cricothyroidotomy: poke a hole in the soft spot below the Adam’s apple and stick a convenient hollow reed in there to make a breathing tube (if you’re in a more modern setting you could use any stiff tube, including, as I saw once on “Trapper John, MD,” the hollow barrel of a ballpoint pen). Best to practice this on a minor character; if she’s this badly hurt, she’s probably not making it to the next chapter unless you get her to an advanced healer.
Pinch the nose, cover the mouth with yours, deliver a breath. Do this about ten times a minute. What you’re hoping for is that the victim will resume breathing on her own in a short time. It’s highly unlikely that you’ll suddenly notice her kissing you back; a more realistic outcome is that she’ll eventually puke from all the air going into her stomach. But you’re the writer; you get to decide.
If your hero is shot or stabbed in the chest, she’ll likely have a punctured lung. This will need to be taken care of at some point, but the real emergency is a “tension pneumothorax,” when air gets trapped inside the chest, collapsing the lung and putting pressure on the heart. To fix this you take a needle and insert it into the chest on the bad side, aiming just above the third rib, in line with the middle of the collarbone. For extra realism, your rescuer can listen for a little hiss as the trapped air escapes. Your injured hero should feel much better very quickly.
The heart’s a pump. It pushes blood around your body. Blood delivers oxygen (among other duties). If oxygen doesn’t get to organs, they die. Your brain is the organ that cares the soonest about being deprived of oxygen. Thus your hero and her rescuers should be highly motivated to stop the bleeding. The first thing to do is grab a cloth, relatively clean if possible, and press it onto the wound, hard. If it’s a big gaping wound, they should stuff it into the wound and press. (Note that in addition to being practical, this kind of first aid offers a great chance for fictional rescuers to rip their shirts off for purely altruistic reasons).
If direct pressure doesn’t work and the bleeding is from an arm or leg, the rescuers or the victim herself can make a tourniquet from whatever’s at hand. Something fairly wide and soft that won’t cut into the skin is best choice. For extra realism, have the rescuers loosen the tourniquet at least every hour to see if the bleeding has stopped. (These techniques, give or take the shirt-ripping, are real. Learn how to save someone with life-threatening bleeding here).
Once the bleeding is controlled, you can make all kinds of story choices about wound closure, ranging from ant mandibles to pinch skin closed (seriously) through laser tissue welding through whatever magical system your healers have handy.
If your hero has a broken bone, she’ll feel better with it immobilized, and it will heal better too. She can splint it with whatever’s handy, with the splint ideally extending across the joint above and below the break. If there’s a break creating an abnormal angle or a dislocated joint that’s obviously out of place, and there’s not skilled medical attention available, your hero or her rescuers might want to realign the deformed body part themselves, usually by a combination of pulling on the injured limb or digit and pushing the deformity into a more normal position. Consider that these sorts of injuries may evoke a visceral reaction in onlookers because they look so unnatural. You can write a lot of pain into these scenes and even some fainting, possibly by the rescuers as well as the victim.
Exposure has two meanings. First, it means exposing the victim’s body enough to be sure you’ve found all the serious injuries. It’s pretty darn embarrassing to get your injured hero’s arm all nicely bandaged, only to sit her up and discover that she’s bleeding to death from the stab wound in the kidney that you didn’t notice because her cloak or armor hid it. Your rescuer gets extra points for doing a thorough survey of the victim’s body as soon as possible.
Second, exposure means hypothermia. Even in mild weather, people who are seriously hurt tend to drop their body temperature below normal, and this causes problems with recovery. As soon as your wounded hero has been checked out, get her nice and warm.
Bonus Note: Head Injuries
In fiction, characters get knocked out cold (usually at the end of a chapter or right before a commercial break), wake up with a “where am I” moment, then immediately organize plans to outwit their attackers, escape their captors, etc. In real life, head injuries are more serious. Even a seemingly minor blow can leave you dazed, nauseated, unsteady on your feet, and suffering from headaches and memory problems that can last for days or weeks. Also, a second blow while you’re still recovering from the first can cause much worse problems. This is why you’re hearing so much about the “NFL Concussion Protocol,” which is designed to keep football players from returning to contact before they’re fully recovered from prior head injuries.
First Aid, In Closing
The great thing about medical emergencies in fiction is that they give you easy ways to show character and world-building through action. What your hero does when she’s hurt or helping someone else tells us about her personality, her life experiences, her training. The first-aid tools she has and the follow up care for the wounded tell us about the technology, knowledge, and social values of the world you’re drawing us into. I hope the tips in this blog help you create fantastic post-fight scenes.
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