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Tetanus (sometimes called lockjaw because it causes spasms of the jaw) is a very serious infection that can be fatal. It is caused by organisms that live in the large intestines of most domestic animals. These organisms pass out with the excreta of such animals and go on living for a long time in dirt, soil, or street dust. If a wound is contaminated by such dirt or soil, some of these organisms may get into the body. Particularly hazardous are so-called puncture wounds, from, say, a rusty nail or a dog bite, which may cause little bleeding but go deep under the skin. Because children are so likely to suffer minor cuts and scrapes while playing, it is standard practice to immunize children against tetanus during their first year and every few years thereafter. If, however, your child suffers a puncture wound, or any other wound from a object that has been lying in the dirt or out of doors, you should ask your doctor to give the child a booster injection if he has not had a shot for one year. If the victim is an adult, ask a doctor whether an anti-tetanus inoculation is necessary.

While it is important to prevent harmful bacteria from entering a cut where they may cause infection, most doctors agree that ordinary soap and water are sufficient to remove these bacteria from the skin, and any germs that do enter a small wound will probably be killed more effectively by the body s natural defenses than by an antiseptic. If you do wish to use an antiseptic, doctors say, choose isopropyl (rubbing) alcohol—it is just as effective as any other antiseptic and is less likely to cause an allergic reaction. Be sure to apply it to the skin around the wound, rather than on the wound itself. The body naturally sheds dirt and germs to the surface of a wound, and any antiseptic applied directly to a wound may seal germs in rather than keeping them out. In the case of a large or deep wound there is, of course, a much greater risk of infection, and such wounds should always be treated by a doctor.

Wash the cut under cold running water, and cleanse the surrounding skin with soap and water, remembering to wipe away from the wound edges. Pat it dry with a sterile gauze pad, and cover it with a small bandage to prevent infection.

Internal bleeding may occur in the chest, abdomen, or skull, following a fall, blow, crash, or injury from a stab or bullet. It can also happen in. certain chest or abdominal illnesses. The bleeding may remain unseen, or blood may escape from the body sometime after the injury. Symptoms of internal bleeding may include shock, dizziness, loss of consciousness, pallor, rapid breathing, severe pain or swelling, and anxiety. If you suspect internal bleeding, do not move the patient. Keep him lying down, warmly covered, with his head low, and send for urgent medical help.

A bullet wound may be superficial or involve internal bleeding and serious damage. Stop heavy bleeding by direct pressure until help arrives. Cover a surface wound with sterile gauze, but don’t try to clean it until you have received medical advice. If the wound is internal, check for breathing and give mouth-to-mouth resuscitation if necessary. Keep the patient lying down, with his head low if possible, to aid the supply of blood to the brain. Wrap coats or blankets under and over his body, and call an ambulance urgently.

Even the most severe and profuse bleeding can almost always be stopped by direct, continued pressure. If the bleeding does not abate, you are probably not pressing in the right place, so shift your pressing fingers until you hit or. the right spot. Several minutes of this firm pressure should be enough to control the bleeding sufficiently for a thick, firm dressing (a makeshift one if need be) to be applied. If bleeding still continues as profusely as even when you take your fingers away, you must just keep on pressing until you can get the casualty to the hospital.

Shouldn’t I use a tourniquet?

No. A tourniquet, if wrongly applied, can be extremely dangerous and cause more harm than the injury itself. A tourniquet, or constrictive bandage, stops bleeding by cutting off the blood supply to an injured arm or leg, but if it is put on too tightly and not loosened often enough, it may cause the entire limb to die. A tourniquet should therefore never be used except by a trained person, and even then, is rarely necessary. Applying direct pressure on to the wound by fingers or hand is usually just as effective and far safer.

1. Above all, do not pull people out of the car, unless it is already on fire. This could further seriously injure or kill them.

2. Send someone to flag down traffic far enough away from the scene of the accident for safety, or do this yourself. The first cars to come along should be sent in opposite directions to telephone for help. The drivers of any other cars can then act as flagmen to block traffic from both directions.

3. Switch off the ignition and lights in the crashed car to prevent fire.

4. If there is more than one victim, see who needs help most urgently. Give attention first to anyone who is not breathing or who is unconscious, and deal with any severe bleeding. Treat everyone involved for shock (even those who protest that they are “perfectly okay”).

5. Even if the crash victims do not appear to  be seriously hurt,  leave them until help arrives. Anyone thrown on the road should be covered with a coat and guarded from the traffic.