Ouch.

The next time you are watching television or a movie, start counting the shoulder wounds. If the hero is going to be wounded, he will be shot in the shoulder, and will end the movie with a little square of gauze taped to his shoulder. In reality, unless you are grazed by a bullet tearing up your deltoid muscle, there is no spot in your shoulder that will not suffer major and debilitating damage from a bullet impact. Feel the anatomy of your own shoulder. It is a complex joint, and a projectile is likely to cause permanent loss of use to at least some degree, if not loss of life.

Have you noticed in the survival fiction that hardly anyone ruptures a disc as they scavenge supplies? No one seems to suffer a compound fracture; it’s always a slight injury like a sprain, a flesh wound, or a survivable sniffle. It is never a condition that will disable the hero for a long time or even permanently.

We are conditioned by movies and books to think that many of the wounds and injuries portrayed are neither incapacitating nor fatal. Understandable, as watching an hour of the hero screaming in agony as he dies, or reading a hundred pages about the main character bleeding out makes for poor entertainment.

The reality is different. Major injuries or trauma will quickly become fatal without advanced medical aid. In the picture accompanying this article, the injury is from a boat propeller. Could you help that person? Reconstruct his leg, prevent infection? In fact, the ability of even medical professionals to render help is severely reduced if the usual suite of supplies, assistants and diagnostic tools are not available. With out modern medicine, the man in the picture will be at least crippled to an extent, if he doesn't die. So assuming you are not a medical professional, what does this mean for your preparations?

1. Your medical supplies are not enough. You may think you have a decent stockpile of medical goodies, but you are wrong. If you’ve ever observed a hospital emergency room, you will have noticed that the personnel burn through supplies at an astounding rate. It will take very few casualties to make a huge dent in what you think is an adequate amount of gear. Medications will go quickly as well. Who would deny pain killers to a friend or loved one, regardless of prognosis?

2. Your training is not enough. Unless you are a trained ER physician, it’s unlikely that you will have the skill and knowledge necessary to treat major trauma, even if there is a fully equipped ER at your disposal. Even most GPs will lack the knowledge that is needed to successfully treat major injuries, or even the surgical skill necessary to repair something like the ruptured disc mentioned above.

What’s the solution? In my opinion, there just isn’t one. In the event of a major collapse or extended crisis, people will die from injuries that are survivable when treated by competent doctors in a modern medical facility. We will all need to retreat from the idea that everyone can be saved by heroic measures and realize that certain injuries will sooner or later mean death to the person injured. That doesn’t mean there aren’t things you can and should do.

While your training will likely never be up to ER physician standards, DO get all the training you can to the highest level that you have the skill, time and money to obtain. Then get as much experience as possible. The greatest fault I see in the medical aspect of prepping is the lack of hands on experience. It is one thing to know to apply direct pressure to a wound, another thing entirely to do it while the blood is seeping through the compress and getting on your hands. You can know how to do CPR on a 20 pound training dummy, but it is something else entirely to do it on an unresponsive person that weighs 200 pounds who pukes on you. Get used to the sights and smells.

2. Equip to your level of training or a bit beyond, but don’t get stupid about it. To take it to the absurd, there is no point having an X-ray machine if you can’t read the X-rays. But it is useful to stock plenty of what you do know how to use, and more than you think you’ll need. Medical stock will make sought after barter goods.

Do equip past your skill level to some extent. While you likely shouldn’t try to have a fully equipped ER, it might be useful to have the tools that a more trained person could use. Additionally, if it comes to amputating a crushed finger or losing the person to infection, you may find yourself pushing the envelope more than you thought you ever would.

This brings me to my final point. The best way to treat a major injury is not to have one. In a crisis, you will be full of adrenaline, trying to get ten things done at once, and taking shortcuts. Counter-intuitive as it may be, take the time to work safely. You will do yourself and your family no good whatsoever if you are too injured to work, fight or flee.