Know when to go for real help

Learn the signs that home care is not enough and reaching a doctor matters more than anything else in this book.

easy⏳ an hourtradition — not yet hand-tested

Everything in this book about caring for the sick and hurt has one limit: some troubles cannot be fixed at home, by anyone, with any skill. For those, the single most life-saving act is recognising them early and moving toward real medical care — a doctor, a nurse, a clinic, a hospital — without delay. People die not because help did not exist, but because they waited one more night to see if things improved.

So learn this short list by heart, and teach it to everyone in your household, including children. It is one hour of learning that outweighs every other page here.

You need

• This list, known by heart — danger signs are useless written down somewhere if no one remembers them at 3 a.m.
• A plan made in advance — where is the nearest real medical care? How long does it take to get there by day and by night? Who goes, who stays? Decide now, while everyone is well.
• A way to carry a person — a strong blanket, a board, or two poles and a coat can become a stretcher.
• The story of what happened — when it started, what changed, what the person ate, drank, or was doing. Helpers treat faster when they know the story; send it along even if the sick person cannot speak.

Steps

1. Learn the go-now signs. If you see any one of these, stop home care and start moving toward help immediately — day or night:
   • Breathing trouble — fighting for air, breathing very fast, grey or blue lips, or noisy strained breathing. (One exception, and only one: a newborn that will not breathe in its first minutes cannot wait for a journey — it has about four minutes, and the person standing there has to breathe for it. The help-a-birth guide shows how.)
   • Not truly awake — unconscious, impossible to keep awake, confused about who or where they are, or having a fit (shaking they cannot control).
   • Bleeding that will not stop after ten full minutes of firm, direct pressure on the wound.
   • Fever with a stiff neck, or fever with a rash, or a fit with fever, or any fever in a baby under three months.
   • Severe dehydration — no urine for eight hours or more, sunken eyes, drowsiness, skin pinch that stays tented.
   • Blood in vomit, stool, or urine, or coughing up blood.
   • Belly pain that is severe and constant, a belly hard as a board, or pain that settles low on the right side.
   • Deep or gaping wounds, a bone bent the wrong way or poking through skin, or burns bigger than the person's hand or on the face, hands, or groin.
   • Any bite from a snake, or an animal bite that breaks the skin, however small — some animal bites carry sickness that is unbeatable once it starts, and only prompt medical care prevents it.
   • A head injury followed by vomiting, worsening sleepiness, or confusion.
   • Trouble in pregnancy or birth — heavy bleeding at any point; a fit, or the warning that comes before one (a bad headache that will not lift, blurred or spotty vision, swelling of face and hands, pain high in the belly), at any time from pregnancy until six weeks after the birth; long labour that is not progressing; anything but the head coming first; the afterbirth still not out after an hour, or coming away torn and incomplete; fever in the days after, foul-smelling discharge, or a belly sore to touch; a tear that keeps bleeding through firm pressure; or a newborn who is floppy, feeds poorly, feels hot or cold to hold, or whose cord stump turns red and angry. The help-a-birth guide has what to do while someone goes — including the two things there that will not wait for a journey: a baby that will not breathe, and a shoulder that will not come.
   • Sudden crushing chest pain, or one side of the face or body going weak or droopy.
2. Learn the getting-worse rule. Most ordinary illness turns the corner within two or three days. Anything that gets worse day after day, a fever past three days, a wound growing more red, swollen, and painful instead of less, or red streaks spreading from a wound — go for help. You do not need a name for the problem; "worse each day" is reason enough.
3. When a sign appears, move at once. Send the fastest person ahead to alert help or find transport, while others prepare the sick person. Do not wait for morning, for the rain to stop, or "one more hour to see."
4. Keep care going on the way. Pressure on bleeding, sips of fluid if the person is awake and can swallow, warmth, shade, calm words. Going for help and giving care are not either-or.
5. Tell the story straight. When you reach help: what happened, when it started, what changed, what you did. Short and honest, including anything you gave the person.

Watch out

• Pride and hope are the killers here. "I can handle this" and "it will pass" delay the trip that mattered. Everything in this book is care until help — never instead of it.
• The quiet patient can be the worst. A person who was moaning and is now silent and drowsy may be fading, not improving. Wake them and check: alert is safe, hard-to-wake is an emergency.
• Children fall fast. A small body has small reserves; a child can go from unwell to critical in hours. Use the danger list more strictly, not less, for children — and for the very old and for pregnant women.
• Do not send the sick person alone. They may worsen on the road. Always a companion who knows the story.
• If you truly cannot reach help, keep giving the best home care in this book, keep the person hydrated and warm, and try again for help at every chance — a passing traveller, a radio, a neighbour with transport. Do not give up on reaching care just because the first road failed.