Document text
AF Handbook 10-644
Survival Evasion Resistance Escag
(SERE) Operations
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27 March 2017
DEPARTMENT OF THE AIR FORCE
BY ORDER OF THE AIR FORCE HANDBOOK 10-644
SECRETARY OF THE AIR FORCE 27 March 2017
Operations
SURVIVAL EVASION RESISTANCE ESCAPE
(SERE) OPERATIONS
COMPLIANCE WITH THIS PUBLICATION IS MANDATORY
ACCESSIBILITY: Publications and forms are available on e-Publishing website at
www.e-publishing.af.mil for downloading or ordering.
RELEASABILITY: There are no releasability restrictions on this publication.
OPR: HAF/A3XX (CMSst Filby) Certified by: HAF/A3 (Lt Gen MARK C. NOWLAND)
Supersedes: AFH10-644, 21 March 2017 Pages: 644
This handbook describes the various environmental conditions affecting human survival, and
describes isolated personnel (IP) activities necessary to survive during successful evasion or
isolating events leading to successful recovery. It is the fundamental reference document
providing guidance for any USAF service member who has the potential to become isolated;
deviations require sound judgment and careful consideration. This publication provides
considerations to be used in planning and execution for effective mission accomplishment of
formal USAF Survival, Evasion, Resistance, and Escape (SERE) training, environmentally
specific SERE training, and combat survival continuation training programs. The tactics,
techniques, and procedures in this publication are recognized best practices presenting a solid
foundation to assist USAF service members to maintain life and return with honor from isolating
events. This handbook also applies to US Air Force Reserve and Air National Guard units and
members. Refer recommended changes and questions about this publication to the office of
primary responsibility (OPR) using the AF Form 847, Recommendation for Change of Publication;
route the AF Form 847 from the field through major command (MAJCOM) publications/forms
managers. Ensure that all records created as a result of processes prescribed in this publication are
maintained IAW Air Force Manual (AFMAN) 33-363, Management of Records, and disposed of
IAW the Air Force Records Disposition Schedule (RDS) in the Air Force Records Information
Management System (AFRIMS). The use of the name or mark of any specific manufacturer,
commercial product, commodity, or service in this publication does not imply endorsement by the
Air Force. See Attachment 1 and Attachment 2 for glossary and acronyms.
ii
Table of Contents
Ti MISSION ssc cssscvceessavsvtivesseiusazescvelveavevvanave ce esoasteventiaevesssavesvendaveveasdaseUessaseveses svevbansauev bees sbeOeanssveveaveasesvensayevess 1
PD. D MISSION E E E E A E E E svebeancabenstedeveieaeedubueasesveedeasdsuvseedevbveseadvevesvesv¥vens 2
TEPA EOY 1 EA EE A E A T S 2
EAEE 0A D: 1 EAEE A S E E A N A E cacesens 3
a D SEE E ES E E A O EE AOE SE E O E E E AE E OTA 3
RSN AEE LEE A E AA EN E E 3
2. Conditions Affecting Survival eai ear EEEE EAER EEEa AAEE E EREET E a EE aE a eai aE in 4
2,1;;Environmental Conditions saren nsii a o EA a AE EAEE EE EENE costaectaeeietaseeln cst 5
PAA h ED EAS ala ELO) A A A 7
2:3. Duration-=The Time Condition sesso irteera arte th sv edebevesdacs e eE Piei E aR aar Aai o Dei i 10
2 A SOCiOpolitical: Condition s cssiernesni eisenii rnise irei ie iana iniaa E a 11
2.5. Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) Conditions............ eee 11
Be THEA? S: NC@CUS E E aiesstesat Slaven a E E noe ect Meditate? 12
3.1. Maintaining Lite cenione ccicceestanccetscanccedaluaceseeceaccusacescestecescctdal vaccdaassactduatanvccestaascedecaaestansiacsts 12
3.1.1. Personal Protection ices.cccccccscssetuacccdevasccdeesancckdecuadcvacaieccctecubscdenannscd denusdceucstacceseuanvadevaiascd cotannstacstneses 12
Sda SUSTEMAN CO ao sss 5 cases a A i AA be cebesh soetava N a a a i soettua boned e Gh eaeataa a 15
3.1.3. Health (Physical and Psychological)...........ccccesccssscesscesscsesceeseceseceneceneecssecseecsaecsaecesecesecesecseeeeeneeeneeees 15
DeleAe Dravell EEA E ly ccibe Sosa E E E E E E thea stbatedses 16
32. Maintaining HONOT .sccisssssscessosscccssssseccssoseseessvonyecesovececs A REVNES EE A EULATE iae VOETVEER SVAR VATE 17
Jar RETINE a a a EAEE E EAN E EEE EE 17
4. The Psychological Aspects of SERE .........sesesesessssseesessresseseesseserssesstsseesosstesseseresesorssesserseesosseessesorssessessee 18
ATs, Captivity ea eeir aaa aa a eaer ao oera t be io anaa ri a dns a eia i adak e eaaa r aiar ian ieena iiae 18
4:2. The Will to Survives eseese aeioeaio TAER ayaa e A deeded aa Ea EE eN a EA E eiS 19
A3 Overcoming SESS ¥. scseecceveiuedssecsuacssvsunvacs sosvccsposvnuacs sdsuaasyveuhea co sesunaspostvesessosuaasovevneacs sovecsposvneacssdeuaassoent 21
AAS Grisis Periodas tne ta eased estat E E saves AT N sea nae 21
4:5: The Coping PeriOd airccssccaccccssssacsescceaccvsacesccctecensccesteacsentcanccdeasencacesdaasceavbancssaeaacstanstbecctecancccassaaceskesuacess 22
4.6. Situation Awareness 3 saci svssace cs reee r EErEE IEEE EIERE T EEEE ONEA EEEE IEE TEE E URRE ETE TA 22
4t Atitude mininiai ii ein i e a aiei a i aaa i aii iea ESA oi e 23
4:8. Conmibuüting Factos riieteta etei aTa A van ein E E E G A EE EE A E E EATE 24
4:9.: Süryvival StreSSOS x: ea e a EEn E E E E E NE EE reas E E EE E AE a a a as N e T 25
a KO A o LOT aTe S E E E EE E 28
AE Vi aa 121o 1 ENE E RE A ox Osta E E OE A EEA S A A A EEE A E E A tee 29
4: TD Fath SUG nipae n a a a a a a a a i a a a AA doa beaet 30
4.13. Maintaining Group Morale and Efficiency .........eesseeseeeseeesssssessessssesessessssestestssssestenessssesresssseseesesessesee 31
4:14. Sleep Deprivation: 2. ¢.ccccvccssceshacsscecese neie eei Eie eE E EA E E aN E EOE N a Ea a iien 31
r Na Eo] Ke1 LO) a AEE A EEE 32
A TONEGO EE N Ba rie le ee as ie ay 32
AST /s IO PLeSSIOM, E E O E E E enue tes bates Slpvom E E E A E tes eadhs Sibests 33
4.18: Emotional: RE actions .c..ccclec.siecduas cckzcudevavyedehodscdecestdctvesecdsesdevevvaceastescaces¥veitesccddatéczeesates stecdus aiteives soidene 33
7. it ES 8b, EDA NNE aE OC OCT RT EA E OP ep 36
A 20 PAN A E E EE EEEE E EE 36
ADV Halsen Pavesi obtains cnte cn Eaa A EE E EE E A E E E AA Ea a A eir 36
DD RESCHLIMEN Es erena aarin NEE EI AEE EATE E EE EAEE EER 36
e E E E PA NA EE T AEA eves EATE A A AAE AEAT AE E 37
dadd opalen i EE E TE E EAE E E EAEAN a 37
AAE DO p= nla (E a CO 2k sivas A A E A A A E E 37
4:20; Loneliness sane cia Winks a A oes tetas wena eek ea en eae ee ae 38
ADT BROVOCOM EAEE siviveeeeca ee reser ee sec aues cones Whe cous E baaeee tesla ele cave E EES 38
4.28: Hopelessness uincere calecubccuenaaccd dendvscducslacceledansauevsngecd covdnedtacsTacsadeuabestevenbechceotbecvaestacext 38
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As 29. SUMMA Y 5 se sk a ceeds ye ctast aac eles sh Dasa walt ye ctessigs E N S Daaath wali testis eink ee 39
5 DERE Medicine « scccciscccaisaadesaciiaccsabtatccavatcccctaseacevaesuaccesdcvaccsaausiautedencecatsbaceeulceneceesabuacscaasadesedaccsubuanesd’ 40
5. Le Health Preservation ciccs.seceicasssecsstesvevesse veceanes scveda cess eaa daR shseediseuvicadssvecsdasveeeccdsvesvegabanssdacesbobste. vovades 40
5.2: Basic Health: Gare. rmes rnein eneee E aeir sure dead o ete ie andeo e E e cede Mesbateests 42
5:3; Clothing and Bedding seors eine roiie iisi E ari E E E EE E EAE EREET TE EE 45
BAL a E E E A E E E O 46
ss DUY aee e er E a a A aa aa ea e E a ee E a ais 49
5:6, Environmental. (jury seieren neari anisini ia iienaa eR E Ean a eraa iea ei e aar i iiaee iha 62
5:/.-Marine Animals that Bitessetae cnici nearne a a i a tess a a A e E 71
5:8: Marine Animals:that: Stin essers cecseesstesnctcctedesssccevwes aiei a E A ccesdedeabeuvees teases 73
5.9. Marine Animals that Puncture sassi eea EA EENE AEE E E i ina 75
5.10. Medical Plants for SERE Scenarios ossein ainni a E EE AE E a E a 79
Bil1, Eo) Tel LUTS 0) a EAA TAA AT T E 86
OP Wath Ot enion erare ae aea a a a eae a a i a e e a A E O a 87
6:1; Küowledge of Weather i. ccficcvscctctes tet scessdecvaes esaet ced duce E RATE E E E ESEE E E EE 87
6:2 AtMOSphere be ne ee ere 87
6.3. Elements Affecting Weather raesent EATE LEEA Era E EEE EC ERE Ea a ata a 87
0:4: StS enaena a a a a ra a r Ble antag onions SEESE 89
6.5. Weather Forecasting .............scssccssssssssssssenscsnscesscssccssccesccsscessnessncsensesnsesnsssusscnsscansceseseaesssceescennessnesens 92
G56. SUTMIMALY. asses scvsscesdesestas vovecue, sisvebe seevocdes ss E su svetesduvscdessboveded uvecads da ocebeavevocads dbobogedavescadssvovetesvovsess 97
7 EDVLONME Nte aan eer vce ta duatcoa dec segutecdantevede tae elke Sunteoden veg tha teatate doves ete bi utente a a a a eS 98
TAE K u Nh a PEE EEE EAE E cveand covets vusassvaaddecnteveussvenadeecessdoatieona? 98
T EO O y a e E E E E SE 100
Fede, H DT aa Ee E A A AE A 101
7A: Effects: of Climate on Terraine iri reiini iai iiiaae aa aaen anasa ea i secdes E iia ER ieie 102
79+ Effets of ‘Terrain, on: Climates amero naremn niai i a a E a E E E i a ria 103
7.6. Effects of Climate and Terrain on Life Forms ............:ccsccssccesscesscesecessceescesseceneeeneeeseecsnecsaecsaeceseeeseees 104
8. Global Climate Characteristics acorn anoei neirt rE A AE TE E E EEEN E EEEN eS 106
8:1- Tropical Climates es ea a ea EEE cave ines E EES EEE E a EEEa E a TES 107
8.2. Dry Climates si. s2ccccacseesiacstésnsiccssvsdacecdectnconsestacccteausceussadecceseobaccduavsvsccsstabscagnalascedeviaesavestacctévuabedsnesiacs 115
8:3. Warm. Temperate: Climates sssrinin nenei a i ea eea ia ear i aiae 120
8:4. Snow and Ice Climate Smear eeit ie e E E Eae E A E E A N a a ESNE EA 129
SRE ne e E E T E E EE A T E EAE E A ETE e E E 135
9.1. Seas are a Large Percentage of the Earth’s Surface ............sssesseeeessseesseseesseseessessrssressssressesressessessesee 135
9.2. Seas are Geographically Aligned along Distinct Boundaries ...............ccesccesscessceeseeeseeesceeeeeenteeseeesees 135
9.3. Ocean Climatic Conditions ..:...cccccecccsecsacccsscesccenscesccobetenccusassnccedecancccasaaaceesbeanssdastancsddessaccdhetanccedecancs 135
9.4. Procuring Drinking Water on the Open Sea5...........:scessesssecsecsseceseceseceseceseceseceeeeseseseneseneeeneeenseesaeenees 137
9;5. Shelter for Open: Seas ie. cavecsiccceecietcovec senetewedoyecededcsesiaueverdenteeateaecueteieiaasiiades senda vacousadbetetedesciearsueveutees 138
9-62 Life FOPMS rena eaei aeee aE E a a beclabes a E a ae a Ee NE e E ENE E REE 138
9:7: Trayeliñg On: Open: Sta Soren orena ia E E A a a Eria EAS Ara Ea E Ne E EEE E 139
9:8:-Physiċal Gomsiderations ss. .cccseccesscceaccsseseacccsadesccuseseviccestesccvantenccdsedasccedslansadeoseacsdastadcccdessecshtesnasedaastncs 144
9.9: Life Preserver USE scccsccsscscdes ods vetvas sutzebueyitecdas ccvvediesiesdes os dbet devisesdas ccvscsa,d¥ovibesesbistdevivestes otbeste deboabener tee 146
9:10, -Ratt Prócedüres snn nenta Bick. sias ee dileeta feelin Mewes ee sists eee Peace E iiaa 147
9.11, Making Landfall srera ir reei ia reen E E tints veb obec E ANERE te EE A ea EEEE NERE 155
9:12. Methods of Getting: AShOTe: mearra eare EEN EAE E EEE E E a S 157
10; Local People neern e EEEE AE EEE e ea EE E A A e E E Ea eves 159
10:1.:Contact with People seissioun resinosa aers EEaren Siaa aasi 159
10.2. TP Behavior coas i a a a a evs e A a A e e basen a e r a i a a eee 160
10:3. Political Alle gi ance eaves. ex ccsstel seashore csasdeiveas eet i eE E EA a EE EEO EEEE EEEE E dniweereees 161
10.4. Population in Built-Up Areas..........ccccssccssecesscesecesecessceesesesesenecenscensecssecssecsaecsaecaeceseceseeeseseneeeneeens 161
LOSS SUM ary’ ir aee rerea EAA AEE RAAE ESEE EEE E ae Ua EAER TEE ae PEE E E Ate eE 162
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11, Proper Body Temperature :...0...04ccccccdcarieceeuancchestancckdesuac aie iae eria leei airia onare iaa iaer 163
TEL Optimum: Core Temp Gr ature Seriene niae E EEEE NE TEENE NAE OES 163
11.2. Water as a an Effective Way to Transfer Body Heat ............:ccsccesscssssssseseeceseeeeeeensecsaeceecsneceseceseees 164
11.3. Factors Which Affect Survival Time ..........:cccccsccesscsssceesceeseseseceeecensecnsecseecsaecsaecesecesecesecseeseneseneeees 164
11.4. Factors that can Transfer Body Heat...........cccsccesscesscesscseseeeceeeneceeseeseeessecsaecsaecsaeceseceseceseeeeeseeeeeneeees 165
12- CLOCHIN p inn ae arer E E EEE E eutduns EEA EN E EE E E A mbes ene ens 168
TQ Ae Protecto vos! on eie r a a ae a tivesatesnas E eane EE E aE 168
12:2; Clothing Material sv. sesiet ereet iaoa a aaa oae a a Ee eae e der ar saen E E iiaeaa 168
123. Insulation Medsuürementin. snra n aa a A i a a a i a 170
12.4. Clothing Wear in Snow and Ice Are aS...........csccesscesscesscesseeeseeeseeenseeneecssecseecuaecsaecaeceseceseceeseeeneeeneeees 174
12.5,:Clothing:in: the Summer Arct esos veccvvsccacedaeescvevestisnnddeasechaccivaectdeenowaxtvelesuitcatesetevacsilages EE eSa 177
T26; Clothing at Séd inen niia rera aa a taie E devaeea esau ol E E AE dtd e ote E Eii 179
1227 -ANUHEXPpoSsure: GarMeMts eee etine cdvenleccdsaatbs Cobesbvccadazaye EOAR 179
1258. Warm OCCANS e050 Ainere ai nena iiA E E a E E eeeUsevivaatecea EE Aa S E ea ea 181
12:9; Tropical Climates resistere enisi arei et a EE E EATE EE EEO EREE E EE E E 181
12:10; Dry a Www | eee ee em E PE ET Ea E O E EES AEA EEE ECER 181
1211 G-no) the: E S EA E A AAE AEE couatouseWiewcrenses 182
TB eSh@lterscsccscccsdesvacscsesveccchetans chdsouvccduesSaccadanenccdentanscidsaleccdees dessa lavigeshestnns chiveateddecsdaceadeosbectaasnccRéasbscueindecs 186
13.1. Shelter Considerations .............cscsssscsssssescesscssesesccssccsscesscesscessncsenscsnsesnsssesscenscenscesssescssscescesneseneeees 186
13.2. Principles of Shelter Locations and Types..........s:ccsccesscsssseesseesecesecseeeeecseecsaecaeceseceseceseceeeeseeeeeneeees 187
1323. Types of Shelter Sesoni eee oaee eea te carpet e e e a E ae oie on EE suites evaded 190
13:4. Shelter for Tropical: Areas <i.icvvcccsts cctdcies covetcessevetv devscecsaseededesaedatatens ECER E A ENE EE e E 202
13.5. Shelters for Hot and Dry Climates ...........esesseeseoseseresseseesseseresessessresorstesseseresesotssesserstesorseesseserssessesee 203
13.6. Shelters for Snow and Ice Areas ..........sccesscesscessseeseeeseceeccessecseecsnecaecsecesecssecsseesseseneseneeeneeeauecseesseees 206
T3:7, Tree-Line ATeaS 35.5 .dscacevedvatascvvedesodtvcsuasesddatdessecsbusscvsateedt vetoes sediatéeyvtacdebocbssnaetivelbasestuadiesbenebtontbvaawere 208
13.8. General Construction TeChmiques .............:ccsscessssssseeseceseeeecseeceeceseceseceseceseceseeseeseneseneseneeeneecsaessaess 211
13.9. Arctic or Cold Weather Shelter Living Considerations ..............::ccsccesscessceesceesceesceeseeeneeeneeesseesnecnaes 212
13.10. Summer Considerations for Arctic and Arctic-Like Areds..........ccccecsseesssesseerseeseecseeceseceseceseenseenes 212
13.11. Maintenance and Improvements ............c:ccssccssseesseesceessecseecsseceseceseceseceeeeeseceneseneeenseesaecsaecaeceaeeeaeees 213
14; Firecraft cctscccsensccssestaccsscouaccoteauscccletuscesenadnscedecuadsceentacsedscbavcdeesiassddetaaessecstagsccevane EEEa E ARE E a 215
14.1- COmSideTatiOnss iernii n a a n ra e a e ea aao ee aiei 215
14:2. Elements of Fires coestebvcesestesvas ceakecdet cei cbestets Eae AE AE ENEE E E Ee ennai cad ott dni EEEE ATE 215
14:3: Fire: Sites Preparationnse aaee aeea asas e e AOAO EA ae E talon E EAS 218
pE RA A SL E a Da i o AA E N E 219
14.5. Fire Making with Matches (or Lighter) ............:ccccsssscssseesseeseecssecesecesecesecesecseeseeeseneeeneeeneeenseesaeeseees 219
14.6. Heat SOULCES siaisesesesccesoctn codes tun ccdeb cane ESEE O EE EEEE EEEE E EEr a 221
14.7. Other Methods of Fire Starting nieee riirii aeeie rE Earainn Re Ei n aR Seih 228
14.8. Burning Aircraft/Vehicle Fuel ...........cccceccesscesssseseceseceeeeessecseecsnecseeceaeceseceseceseeseeesecesenecenesensecsaessaees 228
LAOS SE Ta Lay A AORA E EEO E AE eevee cave tenet AEE E ce E A PE E ee eeeerees 229
To: Eguipment aana nee NEENA INVETE E EARE. NAEUN ONNEA TARANEE VEVEN ARANESE REAA ETSAN i 231
T5 21. Issued Equipment onsi nocnerisieinri tanii i e E A a aa arikiia iai iaa 231
A, 2c PAV a CHULC SR E PE AIEE EA AA AE A E E AA E A S 241
15.3. Other Improvised Eğuipment: serisinin eiie i i aa aan E aa es 247
15.4- Ropes and. Knot ce a eiei ero e i AEEA E a E EE N E E E E N a eE EK NEE Gate ben 250
15:5. Personal: Survival Kiteeseen a aE E EAN ES EEEN EEE EEE T EEEN C NiS 270
PDA: is sires Sebel E E E E A E E AEE 271
Ted Water S0 ES A esti A NA E E E E A N Aea 271
16.2. Locating and Procuring Watisser nicessarii nai i Aeree eiai iT 273
16.3. Water in Snow and Ice Areds...........cscssscesscssscssccssccesscssncesnsesnscsnsssnnscenscesscaceescesscensnesenesenaesnsesnaesnees 274
16:4.. Water in: Tropical Areas. cscs. ensei ir iederen e SEEE EEEE e REAN Eae Eo aa Eaa re iieis 276
16.5, Water in Dry Areas rees aaee recorreran Tenat Ae Eai AAE AE e RRE E Aae AEREE TOR Nae NiS EE ae EEEE oR Sa insa 280
Vv
16.6. Preparation of Water for CONSUMPTION .............c:cccsseesseessecssecssecesecesecesecesecesecsseseeseneseneeeneeeneeenaessaes 283
VFS HOOG asi cesses vesactes tadentieueshocey dotssias vacts cuss cvnoaih cusesapaceussoveesnsonhe ctessescautesesdevaedia duced dea censsoncedtastad sees sebveselorses 286
STAAN ELE TCA OND saeco E A EEEE A EEEE 286
172E OO sic ca bage acc e a a N a e o a ea tau ae e e E AEE ES 289
17:3 Animal. Food iienaa eree aean ea aee E EEEE iE aE EEEo TEESE NE Eear TEE e a 290
174; Plant Foodie orei r E REE TERE TE EE E E E E a i TNs 309
17-5. Food in Tropical Climates. seses scacevsacescccnecesccedetesccdscneacedatansccdetacscddesancsdasseacctassansccuosancetdees 320
[7 .6,FOOd:In: Dry Climates. irrien ienero aa inaari ana e asioi arare aaia a anarie ionin 330
17.7. Food in Snow and Ice Climatesieneanienan eiie ena ii ea i E A E a i 334
17:8, Food ón the Open Seasin enine ee ae i a aeaa a a i se 343
17:9. Preparing: Game Food rerorirsr nrn E EA a ae Ea AEN ees RENSE EENEN Te 346
17:10;-Prepàring Plant Foödsc. irn tennant eaae a eRe A eaa ated ae deat etd ir rE aA 353
17-11- COOKING tarnen aeia eE AE E a e a a a a a A r a a E a 356
1712; Preserving Food iineoae rnani n a e a a a aa aa a a a eean 359
18- Land: Navigatión eoin eteiseen a rare aCeee deans ATEC aip EEEE EE RE eS AATE OR EEE EEEE SEEK ERER 362
NBs M aS n tend et a ek RT, a ih fol E lal 362
18:2. Aeronautical Charts ac. ore ee ieee ss eaa te bises dak cauee esau ATA EA E Eae EEEa ERa E Ea Ea 365
18.3. Marginal Information s......c.ccccsceccsdessaccssesvecceseceascdenabnccdlensvacdectsaccesonnnvcdevesascd covdaestacbbacceceuabecteveancedteys 369
18.4. Topographic Map Symbols and Colors ..........:..csccesscesscessceeseeesecencesseecseecseecsaecaecsseceseceseeeeeseneeeneeens 374
18:5, Coordinate Systems kenra aaee Raa AEE E era Bek SEE ocabeleceecetvsbsvetasvetiiie. vicertesssbertes Ereni 375
18.6: Elevation and Relief aisicom aa a dan eet era eerie oria Teao P e rE a Ea Si 382
18.7. Representative Fraction (RF)..........:cssccssscesscssscssscssscseccsssessssssncsenseensesnsssnsscnsscanscesssseessceescensneseneeees 388
18:8... Graphic: (Bat) Scales tie. aetavicessecetes cchves Wasceckes via a cans EA E teaver E E e sedate A E E 388
18.9; -PYOUWACCONS senescere e a aae ne E e a E a a relat capes 390
18.10. Map Orientation socrii senen aae ea a aen p e tae a a a Ti a aE 392
18.11. Determining Cardinal Directions Using Field Expedients.............:..c:sccssecsseceseceseceeceseceeeeeeseeeneeens 394
18.12. Determining Specific POSition ..............:ccssssssscesscescssscssscssccssccessesssesenessecsensesnssseescnsecnssesesesesacones 398
18.13. Determining Specific Location without a COMPaSS...........::ccsccesscessceesceeeeeseeeeeeeseecseecneceaeceseceseeees 398
18:14; Dead RECKONING: 13. i ecca athe ede ale. cians tive cate Wie ees dnc E een aa 399
18.15. Position Determination. inesi cess cdevslaccccctuve cobevlavecsatbaccdeestnecduceusdcasevdeecdbesbasaaeeoteecdssvenveness 401
18:16: The: Compass and Tts USS ninesini ieie ie a iiae vibe a covers Veeessedees 411
18.17. Using a Map and Compass, and Expressing Direction .............ccccesscssscseseeeseceseeeeeceeceeceseceseeeseeees 414
19; Cand“Travel criniera a a a a e E e a ley eee a a a es os 418
19.1; Decisión tò Stay-or TAVE ea ea EE EEA a E EEE aE E ai eaaa] 418
19:2. Traveli ee a e a n a a a a aa r cide vl EEr ia ae ee Ei Goatees 420
19.3. Land Travel Techniques. ser ti.ccastiscccstecacctavsstcscsecnsccsnstanccostvancovaedvaccstecesccusncuncceuesebscdeassnccchetaasscaseaaess 421
194.:Glaciers and: GlacialTravells soreness rieo aar ia i ai eaa E aE a iE aini oet 427
19:5; Sjow and Ice Areas- neroet n a ve a E E E i a e E r t 432
19.6: Dry Climate Senseco nerea d ree a AE cet RE E snus E E E EE EE SEE TEE Ei 434
1927 Tropical lima tes ean E ae a ve aa tenes sud a a a EEN oE A E E AVEN Ea ERa 437
19.8. Forestéd ATeas? esi accccessacccsenascctdslassadseadaccsastoaccedesnnectdedancedeesabccvtaseaccctadesccdtabubbedhesonccusatonccehetaaccddsaaaess 438
19.9. Mountain Walking Techniques............ccccessscsssessseessecssecsnecssecesecesecesecsssesesecenecenseeaeecauecsaecaeceaeceseeees 438
19.10. Burden: Carrying raria Svectucd bis capse te vous vigiseatas vented vista speeded Woes estas i E a a Weiser i a 442
19.11. Rough Land Travel and Evacuation Techniques ...........:ccsccssscesscessceeseeeseeeseeeneeeseecaeecsaeceseceseeeseeees 446
19.12. Specialized Knots for Climbing and Evacuation ...........:ccccccsscessecsseeseecssecesecseeceseceseceseceeeeseeeeeneeens 446
19:13: Seat Harness’ ivi. c.esccss vives copseessaseviiedeswesspeaiviessssaevesaneieessssssuessbeables sstesueesssenubbastevets ETES EE Eai oi 450
19.14, Route: Seletti Nansenas ressar eers EA ENSSAT AVETS a EEKE SEa 451
19.15: Dangers-to Avoid sroine ani a a a e a A e e a ai e r a i a aa i 451
19.16; CUMDINP creier a a ee RE 452
19.17, Overland: Snow Travel iis iodinea e e eea E EN EA E aa ee Ea ara seeded 459
19.18. Snow and Ice Climbing Procedures and Techniques .............::ccsscsssesssecssecsseceseceseceseceeceeeceeseeeneeees 461
vi
19.19. Evacuation Principles and Techniques...........:ccsccssccssscesscesscessceesceeseseneceneceneeensecsaecsaecseeceaeceseeeseeees 464
20; River Travelics sccsntcscelescisscctisong ceezbuacsdussebscavasieccaten soaeuseescasnleunscuastad seen de ogosesten vadabaebucteesahcesseonssogastanses 468
20 T-River Travels, oiner ienet een oe eae iE R a a o Eaa eiee anta iiaia oieta io kaia 468
20.2. Using Safe Judgment and Rules for River Travel..........::cssccssccssscsssceseceseceseceeeceeseseeesececenseeneecsaeenaes 468
20:3; River: Hydraulics v treierat na treen eerk t i ea ESEE EE EAEE EE octets oes beter teaser a EEEE 478
20.4: Emergency SitüdtiðnS ceinen t e E EEREN E TE E a a T 488
20:5. Improvised Rafts 23. csccccaccedelacedescatcoutesancestacsaccetacessedescobccvsatescesdesoaccddalavsadesaassodestanesddavaacstdesnascdsesctaes 492
20.6. Fording Streams ssicesscs ccveske de vereesaceeetiosscestes ccedcke savadbeh osbeddeti-sccdasosecesa,sbovieesestielde¥iceites beste dieses ckees 495
21. Signaling and COMMUMICATION.............cccesccesecesscessceesceeseeeceeenecenseeseecsuecsaecaecesecesecsseeseseeeneseneeeneeesaeenaes 496
2161, GOMMUMICAL ONS: Eupe M fre cesveecebees AE E N A be aabvwntedbboeumtaeteass 496
21.2. EMergency Equip Ment oscri iat ane A EA EAA IN ANER ERN ENTERA TNE AATAS 496
21.3. Visualizing Emergency Development ........ssssesesssessesseseseessssssesestssesteressssestentsssststensssesesressssestesesess 497
21.4. Furnishing Information in Permissive Environments ............::ccssccssccsseceseceseceesceesceeeeeeseeeneeenteeseeenees 497
21.5. Furnishing Information in Non-Permissive Environments ...............:csccsccssecseeeeceeeceeeeeceeeeeseeeeeereeaes 497
22 RECOVOTY i aveivas cus sec veces Ea e AEA E T E E E A a a E A E a e a a a a a eeen 511
PPANS I EA ROG: A E E E A A E E E A E E 511
22.2. National Search and Rescue (SAR) Plan ........sssssssssssesesssesesesssesssesssesssesssesssessseessessseesseesseesseesseesseess 511
22:3. IP ResponsibilitieSn: mescina iins viia erar iai airs iriser ieies irese 512
22A RECOVETY. S Ea EE E T EE EEEE 513
22:5. Recovery Procedures atearen e eier ar an rideo E SRA Ea Eae eak Sair e aiaia P Aari ee Da a aS 513
22.6. Preparations for Open Seas RECOVETY.......:ccsccesscesssseseesseceseceseeessecseecaecesecesecesecseeseseseeeseneeeneeenaeenaes 520
22 7.5 Reintegration m ariere iriiria oet EEES EE ESEE r ETER EEEE ATE REE E Eaa} 520
PAS PA E ES O) a EAE E A T E E 522
23:1: Convert: SUPVIVAl aeree na aae A ae r ia an E e a aae a i Aeaaeai 522
23.2. Definitions. oiee iaaa er ioaea a o e eaei a a Ee aeaa ae earita iaie deiten S 522
2:3.3:-PiVe. Phases Of EVASON ceii eno i Aa i a aa a a vaste ett yada n i A 522
23 ALN alle. OF EVASION asneira ei a a ea e i a a e areae paee 524
23.5, Prepara ON or ear ra EENE TEE ERARE AN EEEE EARE IAA EEANN ENEAS TENNE EEE RAE Ts 527
23:6; Evasion Principles sieo eea aeea coved ces E AEE S a E Hones ELTE Ea TES 529
23:7, Camouflage ssnin ne Arse aS aCe VESE TE ESSES EE KESA EEE a risans 532
23:8; Types Of Observatið na.se rnea i a e aoa a dataset Oe ea Eana 532
23:9... Preventing Derech Oneri aaa E A EA E TNE E EA 534
23:10. Factors of Recognition s.es orrein ntaN e reei EE E S E Era ee e EEN ee A EE EE N oia 534
23.11. Principles and Methods of Camouflage .............ccssccssccessceseceseceescesseseseeeneeeneeeseecsuecsaecsaeceaeceseeeseeees 538
23.12. Concealment in Various Geographic Areas..........ccccccsseesseesseessecseeceseceseceseceseceseseeeseneeenecenseesaeenaes 546
23.13. Concealment Factors for Areas Other Than Temperate ..............ssccssccssscesscessceseceeseeeeeeeneeeneeeseeenaes 549
23.14. Camouflage and Concealment Techniques for Shelters .............ccsccssccsseceseceseceeeceeeeeeceeeneeeeeeeneeesees 551
23.15. Firecraft under Evasion Conditions ............ccccccesssessssssseeseeseeeeecnecneceseceseceseceeeseeeseneseneeeneeenaeenaes 554
23:16- Süstendnce fór EvasioNss sri eee art ea E EA teas coud E A E a A e ao Taai 556
23:1 7 SEGUNT oe horrei E E E EN E T E Aidan VE E E A E EA E E E 562
23:18, Evasion MOVEMENE screen ooreen ora aaa rea aas ae Ea reaa E aeaa iea aanas 564
23:19; Observing “Terrain san e ea a eie naera era i Rana esia aeaee biel deveceites srbeate gieibes cce39 565
23.20; Evasion Considerations stoam aa tie anes i a ie aaea aie iR 566
23.21. Movement Techniques Which Limit the Potential for Detection of an Evader (Single)............... 567
23.22. Movement Techniques Which Limit the Potential for Detection of Evaders (Group)...............4- 571
23:29 Rally POMS en ena oieta a ERE EE EAE bots E AE TE AEE SE Ea EE E e EE aa eCa eSEE Ea ETSY 576
23.24. Barriers to Evasion MOVEMENT ...........ceeeecesseecsseceessecesseeceseeeessecesssecessescsssesessecessascessescsseseeseesaeees 577
23,29: Evasion ATOS + 0.21 enrarir a i a a A a e a ee e a aA T a 586
2320 NON Permissive RECOVELY eiea e E AEE A EA NEE A I ARO 591
2327A Grond RESCUE nnet e n a ae a e eee e a E 593
23:28. Water ROCOVELY sereset reeuei tiie te ie ENE EAE A EEE cvsetverereauousesaiiveneaesgnes covitoerstenuneacousteeeurees 594
vii
DA WIEDEN ses fect Mecca lec tice Helse Me ed E at eh NE Re MNO ate Pe tl it 595
24.1: Key COMPONETS sj cos, sis eE EEE ERA seeenetes Geos lets oupetis ASTE ENEE EEEE 595
24.2. Five Phases of Urban Evasion ..........:cssssssscssscesscesscssscssccsscesssessncsensconsssnsssenscnsceaeceacesceescesnesenesenes 601
24.2.1. Immediate Action and Initial Movement ..............cccesscssscesseeeseeeeceescecseecsaecaecaeceseceseceteesereseneesnes 601
24.22 MOVE Mentir eseteire sie riita eiiiai EEE E ESEE ETE EES EE EEE EEE ta cuseteusoveasieneeteed 603
DADS ROCOVELY iai itoi EEEE EAE EENEN E RETE E EEEN E RET T EEO EEE 606
2A DA, BEIS Siina aeae aa aa ea a a iaai aaraa aiara 607
O DAS DTE AE TE PAE EE AE TEA N A EE E EAN ET 609
24.20: Urban Nayigationsumicciin naen i a ea E a Whiten E a deeds aae a beeen aa 614
24.2.7; Urban Barriers onres teeri te A ee sete faved ott veus EE E Ee EE E AEE SE E EEEE ENE tates 618
2428 e SUUCCUIES 85 iii r E EE AE E A E EAEE T EA E ER E A TOs 620
24:29. SUDSUTEACE erea r e ea E RE E EE cove ines E EESE aE E a EE TE aa 621
24.2.10; Groünd Vehicles noiiire area Ea rSn a risans 624
DAD VA, Urban: Foraging is ce vcvcersezevdatewdh edcakevscesvacsuvceoneesVietavea e a A a e a E AR EOS 631
Attachment -1 —Glossary of References and Supporting Information...........sssesssesessssesssseessesressessesseseessee 634
Attachment-2 = ATOY MS oeei eiei eoii EEEE eE seve cadeletodeacsaceteaessthacee Soveeeeviagses 639
viii
Air Force Handbook 10-644
Survival, Evasion, Resistance, and Escape Operations
THE ELEMENTS OF SURVIVING
Chapter 1
MISSION
1. Mission
An isolating event ends one mission-for the individual, but starts another-to successfully return
from the event. Are they prepared? Can they handle the new mission, not knowing what it entails?
Unfortunately, many Isolated Personnel (IP) are not fully aware of this new mission or are not
fully prepared to carry it out. All instructors teaching survival, evasion, resistance, and escape
(SERE) must prepare the IP to face and successfully complete this new mission (Figure 1-1).
HEALTH AND MORAL
HUNGER & THIRST _
i
DISTANCE
CLIMATE & TERRAIN
THE ENEMY
Figure 1-1 Elements of Surviving
1.1. IP Mission
The moment an individual or team encounters an isolating event, the assigned mission is to: "return
to friendly control without giving aid or comfort to the enemy, to return early and in good physical
and mental condition."
1.1.1. Friendly Doesn’t Always Mean Friendly
On first impressions, "Friendly Control" seems to relate to a combat situation. However, even in
peacetime, the environment may be quite hostile. Imagine a pilot parachuting into the arctic when
it is minus 40°F or an explosive ordnance disposal crew separated by the detonation of a roadside
bomb in the desert where temperatures may soar above 120°F; neither of these situations is
particularly agreeable. The possibilities for encountering hostile conditions affecting human
survival are endless. IP who egress an aircraft or are isolated from team mates on the ground may
confront situations difficult to endure.
1.1.2. Without Giving Aid or Comfort The second segment of the mission, "without giving aid
or comfort to the enemy," is directly related to a combat environment. This part of the mission
may be most effectively fulfilled by following the moral guide - the Code of Conduct. Remember,
however, that the Code of Conduct is useful to an IP at all times and in all situations. Moral
obligations apply to the peacetime situation as well as in wartime.
1.1.3. Return Early and in Good Physical and Mental Condition
The final phase of the mission is "to return early and in good physical and mental condition." A
key factor in successful completion of this part of the mission may be the will to survive. This
will is present, in varying degrees, in all human beings. Although successful survival is based on
many factors, those who maintain this important attribute will increase their chances of success.
1.2. Goals
Categorizing this mission into organizational components, the three goals of an IP are to maintain
life, maintain honor, and return. SERE training courses provide training in the skills, knowledge,
and attitudes necessary for an IP to successfully perform the fundamental survival goals shown in
Figure 1-2.
MAINTAIN LIFE
RETURN MAINTAIN HONOR
Figure 1-2 IP Goals
1.3. Survival
Surviving is extremely stressful and difficult. The IP may be constantly faced with hazardous and
difficult situations. The stresses, hardships, and hazards (typical of an isolating event) are caused
by the cumulative effects of existing conditions (see chapter 2 pertaining to conditions affecting
survival.) Maintaining life and honor and returning, regardless of the conditions, may make
surviving difficult or unpleasant. The IP mission forms the basis for identifying and organizing
the major needs of an IP, so the IP can reach their goals. (See IP needs in chapter 3).
1.4. Decisions
The decisions an IP makes and the actions taken in order to survive determine their prognosis for
surviving.
1.5. Elements
The three primary elements of the IP's mission are: the conditions affecting survival, IP needs, and
the means for surviving.
Chapter 2
CONDITIONS AFFECTING SURVIVAL
2. Conditions Affecting Survival
Five basic conditions affect every isolating event (Figure 2-1). These conditions may vary in
importance or degree of influence from one event to another and from individual to individual. At
the onset, these conditions can be considered to be neutral-being neither an advantage nor a
disadvantage for the IP. The IP may succumb to their effects-or use them to their best advantage.
These conditions exist in each isolating event, and they will have great bearing on the IP's every
need, decision and action.
SURVIVAL
SITUATION
Figure 2-1 Five Basic Conditions
2.1. Environmental Conditions
Climate, terrain, and life forms are the basic components of all environments. These components
can present special problems for the IP. Each component can be used to the IP's advantage.
Knowledge of these conditions will contribute to the success of the IP’s mission.
2.1.1. Climate
Temperature, moisture, and wind are the basic climatic elements. Extreme cold or hot
temperatures, complicated by moisture (rain, humidity, dew, snow, etc.) or lack of moisture, and
the possibility of wind, may have a life threatening impact on the IP's needs, decisions, and actions.
The primary concern, resulting from the effects of climate, is the need for personal protection
(consisting of clothing, shelter and fire). Climatic conditions also have a significant impact on
other aspects of survival (for example, the availability of water and food, the need and ability to
travel, recovery capabilities, physical and psychological problems, etc.) (Figure 2-2).
U.S. Army photo by Cpl. Rich Mattingly
Figure 2-2 Harsh Climates
2.1.2. Terrain
Mountains, prairies, hills, and lowlands, are only a few examples of the variety of land forms which
describe "terrain." Each of the land forms has a different effect on an IP's needs, decisions, and
actions. An IP may find a combination of several terrain forms in a given situation. The existing
terrain will affect the IP's needs and activities in such areas as travel, recovery, sustenance and to
a lesser extent, personal protection. Depending on its form, terrain may provide security and
concealment for an evader, cause travel to be easy or difficult, provide protection from cold, heat,
moisture, wind, or chemical, biological, radiological, nuclear and explosive (CBRNE) conditions,
or make surviving a seemingly impossible task (Figure 2-3).
Figure 2-3 Terrain
2.1.3. Life Forms
When considering an isolating event, there are two basic life forms other than human/plant life
and animal life. (NOTE: The special relationship and effects of people on the isolating event are
covered separately). Geographic areas are often identified in terms of the abundance of life (or
lack thereof). For example, the barren arctic or desert, primary (or secondary) forests, the tropical
rain forest, the polar ice cap, etc., all produce images regarding the quantities of life forms. These
examples can have special meaning not only in terms of the hazards or needs they create, but also
in how an IP can use available life forms (Figure 2-4).
Figure 2-4 Life Forms
2.1.3.1. Plant Life
There are hundreds of thousands of different types and species of plant life. In some instances,
geographic areas are identified by the dominant types of plant life within that area. Examples of
this are savannas, tundra and deciduous forests. Some species of plant life can be used
advantageously by an IP - if not for the food or the water, then for improvising camouflage, shelter
or providing for other needs.
2.1.3.2. Animal Life
Reptiles, amphibians, birds, fish, insects, and mammals are life forms which directly affect an IP.
These creatures affect the IP by posing hazards (which must be taken into consideration) or by
satisfying needs.
2.2. The IP's Condition
The IP's condition and the influence it has in each isolating event are often overlooked. The
primary factors which constitute the IP's condition can best be described by the four categories
shown in Figure 2-5. IP must prepare themselves in each of these areas before each mission, and
be in a state of "constant readiness" for the possibility of an isolating event. IP must be aware of
what role their condition plays both before and during the isolating event.
Figure 2-5 IP’s Condition
2.2.1. Physical
The physical condition and fitness level of the IP are major factors affecting survivability. IP who
are physically fit will be better prepared to face isolating events than those who are not. Further,
an IP's physical condition (injured or uninjured) during the initial phase of an isolating event will
be a direct result of circumstances surrounding the event. In short, high levels of physical fitness
and good post-event physical condition will enhance an IP's ability to cope with such diverse
variables as:
e Temperature extremes.
e Rest or lack of it.
e Water availability.
e Food availability.
e Long term isolating events.
2.2.1.1. Physical Weakness
During long term isolating event physical weakness may increase as a result of nutritional
deficiencies, disease, lack of adequate rest, etc.
2.2.2. Psychological
The IPs' psychological state greatly influences their ability to successfully return from an isolating
event.
2.2.2.1. Psychological Effectiveness
Psychological effectiveness in an isolating event (including captivity) results from effectively
coping with the following factors which may occur naturally or be induced by coercive
manipulation:
e Initial shock.
e Pain.
e Hunger.
e Thirst.
e Cold or Heat.
e Frustration.
e Fatigue (including Sleep Deprivation).
e Isolation - Includes forced (captivity) and the extended duration of any episode.
e Insecurity - Induced by anxiety and -self-doubts.
e Loss self-esteem - Most often induced by coercive manipulation.
e Loss of self-determination - Most often induced by coercive manipulation.
2.2.2.2. Depression - Mental "Lows"
An IP may experience emotional reactions during an isolating event due to the previously stated
factors, previous life experiences (including training) and the IP's psychological tendencies.
Emotional reactions commonly occurring in isolating (including captivity) events include:
e Boredom
e Loneliness
e Impatience
e Dependency
e Humiliation
e Resentment
e Anger
e Hate
e Anxiety
e Fear
e Panic
2.2.2.3. Crisis and Coping Phases
Psychologically isolating events may be divided into "crisis" phases and "coping" phases. The
initial crisis period will occur at the onset of the isolating event. During this initial period,
"thinking" as well as "emotional control" may be disorganized. Judgment is impaired and behavior
may be irrational (possibly to the point of panic). Once the initial crisis is under control, the coping
phase begins and the IP is able to respond positively to the event. Crisis periods may well recur,
especially during extended events (evasion or captivity). An IP must strive to control if avoidance
is impossible.
2.2.2.4. Will to Survive - The Most Important Tool
The most important psychological tool that will affect the outcome of an isolating event is the will
to survive. Without it, the IP is surely doomed to failure-a strong will is the best assurance of
survival.
2.2.3. Material
At the beginning of a isolating event, the IP’s clothing and the contents of available equipment,
survival kits, salvageable resources from the vehicle, parachute, — aircraft, or environment are the
sum total of the IP's material assets. Adequate equipment familiarity and pre-mission preparations
are required (and must be stressed during training). Although important all the time, once the
isolating event has started, special attention must be given to the care, use, and storage of all
materials to ensure they continue to be serviceable and available. Items of clothing and equipment
should be selectively augmented with improvised items.
2.2.3.1. Appropriate Clothing
Clothing appropriate to anticipated environmental conditions (on the ground) should be worn or
carried as space and mission permit.
2.2.3.2. Appropriate Equipment
The equipment available to an IP affects all decisions, needs, and actions. The IP's ability to
improvise may provide ways to meet some needs.
2.2.4. Legal and Moral Obligations
An IP has both legal and moral obligations and responsibilities. Members of the military service
will find their legal obligations expressly identified in the Geneva Conventions, Uniform Code of
Military Justice (UCMJ), Department of Defense (DOD) and Air Force directives and policies.
Before deploying to their operational environment, the potential IP should understand the rules of
engagement and their legal status in all likely types of isolating events. Moral obligations are
expressed in the Code of Conduct (Figure 2.6). Legal and moral obligations are addressed in
greater detail in Chapter 23.
SODE OF CONDUCT
I am an American, fighting in the forces which guard my country and
our way of life. I am prepared to give my life in their defense.
I will never surrender of my own free will. If in command, I will
never surrender the members of my command while they still have the
means to resist. Ill
If I am captured, I will continue to resist by all means available. |
will make every effort to escape and aid others to escape. I will accept
neither parole nor special favors from the enemy.
If I become a prisoner of oy, A keep faith with my fellow
prisoners. I will give no information or take part in any action which
might be harmful to my comrades. IfI am senior, I will take command.
If not, I will obey the lawful orders of those appointed over me and will
back them up in every way.
When questioned, should I become a prisoner of war, I am required
to give name, rank, service number, and date of birth. I will evade
answering further questions to the utmost of my ability. I will make no
oral or written statements disloyal to my country and its allies or
harmful to their cause. VI
I will never forget that I am an American, fighting for freedom,
responsible for my actions, and dedicated to the principles which made
my country free. I will trust in my God and in the United States of
America.
Figure 2-6 Code of Conduct
2.2.5. Other Responsibilities that Influence Behavior
Other responsibilities influence behavior during isolating events and influence the will to survive.
Examples include feelings of obligation or responsibilities to family, self, and spiritual beliefs.
2.2.5.1. Perception of Influence
An IP's individual perception of responsibilities influences survival needs and affects the
psychological state of the individual both during and after the isolating event. These perceptions
will be reconciled either consciously through rational thought or subconsciously through attitude
changes. Training specifically structured to foster and maintain positive attitudes provides a key
asset to survival.
2.3. Duration-The Time Condition
The duration of the isolating event has a major effect upon the IP's needs. Every decision and
action will be driven in part by an assessment of when recovery or return is probable. Air
10
superiority, rescue capabilities, the distances involved, climatic conditions, the ability to locate the
IP, or potential for or actual captivity are major factors which directly influence the duration (time
condition) of the isolating event. An IP can never be certain that rescue is imminent and must
prepare as though it is not.
2.4. Sociopolitical Condition
Sociopolitical conditions are the social, cultural, and behavioral factors characterizing the
relationships and activities of the population of a specific region or operational environment. The
local people, their social customs, cultural heritage, politics, and attitudes will affect the IP's status
within the spectrum of conflict. Due to these sociopolitical differences, the interpersonal
relationship between the IP and any people with whom contact is established is crucial to surviving.
To an IP, the attitude of the people contacted will be friendly, hostile, or unknown.
2.4.1. Friendly People
The IP who comes into contact with friendly people, or at least those willing (to some degree) to
provide aid, is indeed fortunate. Immediate return to home, family, or home station, however, may
be delayed. When in direct association with even the friendliest of people, it is essential to
maintain their friendship. These people may be of a completely different culture in which a
commonplace American habit may be a gross and serious insult. In other instances, the friendly
people may be active insurgents in their country and constantly in fear of discovery. Every IP
action, in these instances, must be appropriate and acceptable to ensure continued assistance.
2.4.2. Hostile People
A state of war need not exist for an IP to encounter hostility in people. Contact with hostile people
must be avoided. If captured, regardless of the political or social reasons and the IP’s legal status,
the IP must make all efforts to adhere to the Code of Conduct and the legal obligations of the
UCMJ, the Geneva Conventions, and DOD and USAF policy.
2.4.3. Unknown People
The IP should consider all factors before contacting unknown people. Some primitive cultures
and closed societies still exist in which outsiders are considered a threat. In other areas of the
world, differing political and social attitudes can place an IP "at risk" in contacting unknown
people.
2.5. Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE) Conditions
CBRNE conditions may occur during combat operations. CBRNE events create life-threatening
conditions from which an IP needs immediate protection. The longevity of CBRNE conditions
further complicates an IP's other needs, decisions, and actions.
11
Chapter 3
THE IP'S NEEDS
3. The IP’s Needs
The three fundamental goals of an IP are to 1) maintain life, 2) maintain honor, and 3) return. This
may be further divided into nine basic needs which include: 1) personal protection, 2) sustenance,
3) health, 4) travel, 5) communications, 6) recovery, 7) evasion, 8) resistance, and 9) escape.
Meeting the individual's needs during the isolating event is essential to achieving the IP's
fundamental goals (Figure 3-1).
Figure 3-1 IP Needs
3.1. Maintaining Life
Four elementary needs of an IP in any situation which are categorized as the integral components
of maintaining life are: 1) personal protection, 2) sustenance, 3) health and 4) travel.
3.1.1. Personal Protection
The human body is comparatively fragile. Without protection, the effects of environmental
conditions (climate, terrain and life forms) and CBRNE conditions may be fatal. The IP's primary
defenses against the effects of the environment are protective clothing, equipment, shelter, and fire
(Figure 3-2).
12
Figure 3-2 Personal Protection
3.1.1.1. Clothing
The need for adequate clothing and its proper care and use cannot be overemphasized. The human
body's tolerance for temperature extremes is very limited with clothing being the first line of
defense. However, its ability to regulate heating and cooling is extraordinary. The availability of
clothing and its proper use is extremely important to an IP, enhancing their body’s ability to
regulate temperature. Clothing also provides excellent protection against the external effects of
alpha and beta radiation, and may serve as a shield against the external effects of some chemical
or biological agents.
3.1.1.2. Equipment
Survival equipment is designed to aid IP throughout their event. It must be cared for to maintain
its effectiveness. Items found in a survival kit, ground/water vehicle, or aircraft can be used to
help satisfy the nine basic needs. Quite often, however, an IP must improvise to overcome an
equipment shortage, failure, or deficiency.
3.1.1.3. Shelter
The IP's need for shelter is threefold-as a place for protection from the conditions (environmental
and socio-political), safety from hazards, and is big enough for the IP and their equipment. The
duration and location of the isolating event will have some effect on shelter choice. In areas that
are warm and dry, the IP's need is easily satisfied using natural resting places. In cold climates,
the criticality of shelter can be measured in minutes, and rest is of little immediate concern.
Similarly, in areas of residual radiation, the criticality of shelter may also be measured in minutes
(Figure 3-3).
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Figure 3-3 Shelter
3.1.1.4. Fire
Fire serves many IP needs such as providing a source of heat to warm the body, dry clothing,
purifying water, preparing food, and signaling (Figure 3-4).
Figure 3-4 Fire
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3.1.2. Sustenance
Sustenance is the IP’s need for water and food to maintain normal body functions and to provide
strength, energy, and endurance to overcome the physical stresses of survival (Figure 3-5).
3.1.2.1. Water
The IP must be constantly aware of the body's primary and continuing need for water.
3.1.2.2. Food
Less important than water initially, the need for food receives little attention during the first hours
of an isolating event. Additionally, the human body must have adequate amounts of water to
process any food appropriately. The successful IP will need to overcome aversions to food before
physical or psychological deterioration sets in.
Figure 3-5 Evasion Sustenance
3.1.3. Health (Physical and Psychological)
The IP must be the doctor, nurse, medic, and psychologist. Self-aid and buddy care may be the
IP's sole recourse.
3.1.3.1. Physical Health
Attention to personal protection, sanitation, and personal hygiene are major factors in preventing
physical, morale, and attitudinal problems. Safety must be foremost in the mind of the IP. One
miscalculation with a knife or tool can result in self-inflicted injury or death. In the event of injury
or illness, the IP's existence may depend on the ability to perform self-aid or buddy care. In many
instances, common first aid procedures will suffice; in others, more primitive techniques will be
required (Figure 3-6). The need for cleanliness in the treatment of injuries and illness is self-
evident. Proper use of clothing and equipment can prevent serious medical or physical problems.
15
Figure 3-6 Self Aid
3.1.3.2. Psychological Health
Perhaps the IP's greatest strength is a positive and optimistic attitude. An individual's ability to
cope with psychological stresses will enhance successful survival. Optimism, determination,
dedication, and humor, as well as many other psychological attributes, are all helpful for an IP to
overcome psychological stresses. Refer to chapter 4 for more information on psychological health.
3.1.4. Travel
An IP may need to travel on land or water to meet any or all of their goals. In any isolating event,
the IP must weigh the need to travel against capabilities and/or safety (Figure 3-7).
Figure 3-7 Travel
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3.2. Maintaining Honor
The three needs associated with maintain honor are evasion, resistance, and escape.
3.2.1. Captivity- Worse than Evasion
Evasion will be one of the most difficult and hazardous situations an IP will face. However
difficult and hazardous evasion may be necessary. Captivity is always worse. Evasion needs are
specifically addressed in the Evasion chapter.
3.2.2. The Need to Resist Exploitation
The captive’s need to resist exploitation is self-evident. This need is both a moral and a legal
obligation. Resistance is much more than refusing to divulge information. Resistance is made up
of two distinctly separate behaviors expected of the captive:
e Complying with legal and authorized requirements.
e Preventing exploitation. This includes the captive doing such things as disrupting enemy
activity through resisting, refusing to divulge information, subtle harassment, and distracting
enemy guards who could be used on the front lines. For a captive, escape is the ultimate form
of resistance.
3.3. ReturningThe need to return involves communication, recovery, and/or traveling (on land or
water). Communication requires a hands-on knowledge of signaling procedures and devices to
report and locate the IP (Figure 3-8). The IP must be familiar with the various platforms, devices,
and methods that may be used during recovery. The IP must also be familiar with the various
methods and techniques for traveling overland and on the water to safely and accurately reach the
recovery location, if necessary.
Figure 3-8 Return
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Chapter 4
PSYCHOLOGICAL ASPECTS OF SERE
4. The Psychological Aspects of SEREThe psychological aspects of SERE involve the will to
survive, emotional reactions, and many other contributing factors. An IP’s attitude and mental
strength have a considerable influence on their ability to survive an isolating event. The will to
survive is defined as the desire to live despite seemingly insurmountable mental and/or physical
obstacles. The tools for survival are furnished by the military, the individual, and the environment.
The training for SERE comes from training publications, instruction, and the individual's own
efforts. But tools and training are not enough without a will to survive. In fact, the records prove
that will alone have been the deciding factor in many survival cases. While these accounts are not
classic examples of how to survive, they illustrate that a single-minded IP with a powerful will to
survive can overcome most hardships. There are cases where people have eaten their belts for
nourishment, boiled water in their boots to drink as broth, or have eaten human flesh - though this
certainly wasn't their cultural instinct.
4.1. Captivity
Captive environments may vary, but none are good. The will to survive has historically been a
very powerful motivator to overcome the worse captivity scenarios.
e Such was the case of Greg Williams, who was held hostage by an Al Qaeda linked terrorist in
the Philippines (Figure 4-1). Mr. Williams’ situation was unique. He had divested himself of
all worldly goods, going to the Philippines for missionary work, but had changed who he was
going to work with at the last minute, so no one in country really knew who he was or what he
was doing there. He was captured by terrorist who thought of him as a source of income.
Unfortunately, no one at “home” or at the mission knew where he was, as a result, there was
no one to pay any kind of ransom. The terrorist had killed other hostages. His treatment by
the terrorist just confirmed what he knew; his life expectancy was very short once they found
out he was of no monetary value to them. Chained by the ankle inside a coral rock cave, he
had tried to dig out the bolted chain from the cave’s wall by using his fingers and chicken
bones from his food, but had no luck. The use of the bones had led him to the only thing
available to him, his own teeth! Mr. Williams figured he could pull out a tooth with a crown
to dig into the wall; which is exactly what he did. His captors had beaten him knocking out
and loosening several teeth; he found a loose tooth in his mouth with a crown and pulled it out.
He used the yanked out tooth with a crown for approximately two days to dig around the bolt
securing him to the coral wall. Unfortunately, a few days later while using the tooth to dig, his
plan and “escape tool” were discovered by one of his captors. Just a little after his escape
attempt was discovered, one of the captors aided Mr. Williams to escape. Mr. Williams’ will
to survive and determination led him to take extraordinary means to escape.
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Figure 4-1 Al Qaeda Linked Terrorists
4.2. The Will to Survive
The will to survive is determination. It is a refusal to surrender.
e On April 18, 1995, Capt. Brian Udell, an F-15E fighter pilot and Capt. Dennis White, an F-
15E weapons systems officer, assigned to Seymour-Johnson AFB, NC, were flying a routine
training mission over the Atlantic (Figure 4-2). They lost control of their F-15E which
plummeted straight for the earth. Just above 10,000 feet and exceeding 600 knots (nearly 700
mph), Udell gave the order: 'Bail out! Bail out! Bail out!’ By the time the canopy blew off,
White ejected at 4,500 feet. With the aircraft still picking up speed (more than 780 mph) Udell
ejected at 3,000 feet.
19
Because of the high speed, Udell’s parachute opening shock felt like he had been hit
by a train. Udell felt some pain, but had no clue to the extent of his injuries. He began
going through his post-ejection checklist. During his checklist he attempted to inflate
his life preserver, but found it shredded. He figured he'd better reel in the life raft that
automatically deploys during ejection to ensure he had some kind of flotation device
when entering the water. That's when he discovered his left arm was injured. He hauled
in the raft with his right arm and his teeth. Just about the time he got his functional
hand on the raft, he hit the water, which is when his struggle both physically and
mentally began. Stranded in the middle of the Atlantic Ocean with 5-foot waves and
17 mph winds making the 60 degree water feel like a giant ice chest, he knew he was
in trouble. Udell had no life preserver, an injury rendered his left arm useless, and it
was a pitch-black night. It would have been easy to surrender to the environment, but
actually it was just the start of his struggle to survive. With his one good arm, he
desperately clung to the side of a partially inflated life raft trying to climb in. Salt water
made him painfully aware of open wounds - gashes, cuts, and scrapes - scattered over
his broken body. The thought of his blood pouring into the sea and inviting sharks to
surround him sent another kind of chill up his spine. Newly motivated, he kicked his
legs to assist his one good arm.
— Udell's lower limbs, from his left ankle and right knee down, felt as though they were
barely attached. Seemingly held loosely together only by the skin, they proved useless
as paddles - trailing lifelessly behind the upper portion of his legs. Kicking them
through the water was like trying to stir a glass of ice tea with a wet noodle. Thoughts
of death started to infiltrate his mind. Once in the life raft, Udell had immobilized his
legs and his left arm, Udell searched his 6-foot-1 frame for other injuries. Finding
nothing that appeared life-threatening, he went into prevent-shock mode. He drank
some water out of an emergency pack that automatically releases during ejection, then
tried to get warm. Udell spent four hours in the water before a Coast Guard helicopter
found him. Using an emergency radio, he directed them to his location where he was
rescued. Capt Udell’s determination and faith provided him the strength and presence
of mind to overcome his isolating event, use his training and equipment, and survive to
contact rescue forces.
LS =
Figure 4-2 F-15E
4.2.1. Desert Environment Tests the Will to Survive
The desert environment has long been one to test the will and determination of any IP. An event
showing a great deal of the will to survive was that of an Australian sergeant who bailed out of his
aircraft, and landed in the desert with both legs injured. He used his parachute to bind up his
wounded legs, but found he could not stand on his feet. Knowing his need for medical attention,
the unlikelihood of rescue forces finding him, and his lack of supplies, he crawled dragging his
legs for four days and nights, trying to affect his own recovery. The Sergeant found that at night
he couldn't sleep, due to a combination of anxiety and pain. The Sergeant kept crawling, using the
stars to aid him in navigation. During the day, he found himself partially shaded while crawling
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around the large rocks which blocked his path. He reached the point of total exhaustion on the
fifth day and found that his mind was beginning to wander, blacking in and out, and hallucinating.
On the fifth day he was found by a desert patrol. He had been without food or water for the entire
period (Figure 4-3).
Figure 4-3 Will to Survive
4.2.2. Loss of Hope
The exact opposite of the will to survive is the lack of will or loss of hope. For example, in the
Canadian wilderness, a pilot ran into engine trouble and chose to dead stick his plane onto a frozen
lake rather than punch out. The pilot did a beautiful job and slid to a stop in the middle of the lake.
He left the aircraft and examined it for damage. After surveying the area, he noticed a wooded
shoreline only 200 yards away where food and shelter could be provided. Approximately halfway
there, the pilot changed his mind and returned to the cockpit of his aircraft where he smoked a
cigar, took out his pistol, and blew his brains out. Less than 24 hours later, a rescue team found
him. Why did the pilot give up? Why was he unable to survive? Why did he take his own life?
4.3. Overcoming Stress
The ability of the mind to overcome stress and hardship becomes most apparent when there appears
to be little chance of a person surviving. When there seems to be no escape from a situation, the
will to survive enables a person to begin to win the battle of the mind. This mental attitude can
bridge the gap between the crisis period and the coping period.
4.4. Crisis Period
The crisis period is the point at which the person realizes the gravity of the situation and
understands that the problem will not go away. At this stage, action is needed. Most people will
experience shock in this stage as a result of not being ready to face this new challenge. Most will
recover control of their faculties, especially if they have been prepared through knowledge and
training. Shock during a crisis is normally a response to being overcome with anxiety. Thinking
will be disorganized. At this stage, direction will be required because the individual is being
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controlled by the environment. The person's center of control is external. In a group isolating
event, a natural leader may appear who will direct and reassure the others. The greater the group’s
cohesiveness and discipline, the easier the group will deal with the situation. But if the situation
continues to control the individual or the group, the response may be panic, behavior may be
irrational, and judgment is impaired. In a solitary IP episode, the individual must gain control of
the situation and respond constructively. In either case, IP must evaluate the situation and develop
a plan of action. During the evaluation, the IP must determine the most critical needs to improve
the chance of living and being rescued.
4.5. The Coping Period
The coping period begins after the IP recognizes the gravity of the situation and resolves to endure
it rather than succumb. The IP must tolerate the effects of physical and emotional stresses. These
stresses can cause anxiety which becomes the greatest obstacle to self-control and solving
problems. Coping with the situation requires considerable internal control. For example, the IP
must often subdue urgent desires to travel when that would be counterproductive and dangerous.
A person must have patience to sit in a protective shelter while confronted with an empty stomach,
aching muscles, numb toes, and suppressed feelings of depression and hopelessness. Those who
fail to think constructively may panic. This could begin a series of mistakes which result in further
exhaustion, injury, and sometimes death. Death comes not from hunger pains but from the inability
to manage or control emotions and thought processes.
4.6. Situation Awareness
When a potential IP is required to make critical choices — usually at a fast pace — the vast majority
of errors that occur are a direct result of failures in situation awareness (SA). SA can allow the IP
to see likely answers to complex situations. The loss of SA, in some cases, causes the isolating
event or at the very least, can complicate it.
4.6.1. Impact of Self Perception
SA is an IP’s continuous perception of self (and their team/crew) in relation to the dynamic
environment including their mission, vehicle (aircraft or ground vehicle), threats, resources, and
the ability to forecast future events, and then execute tasks based on that perception and
understanding.
4.6.2. Adaptation
SA, as we define it, is a specific brand of adaptation. This adaptation is the process by which an
IP channels their knowledge and behavior to attain goals, tempered by the conditions and
constraints imposed by the task environment. The continuous process of SA involves four actions:
1. Observe/Perceive: Observe, perceive, and recognize the available facts that comprise the
individuals, situation, event, or environment. Examine and note activities, people, objects,
and states. It includes using all of one’s senses to gather data. Observing and perceiving
can also include listening to one’s inner intuition. SA is all about perceiving the dynamic
state of the environment and making predictions from that perception. These predictions
form the basis for decisions to perform tasks that support your goals.
2. Analyze/Interpret: Assess the observed facts as they relate to the situation. Include what
was learned in past training, pre-deployment briefings, and study about the area or
situation. Answer the question, “What does this mean to me?” Keep an open mind and
22
remain flexible. Pre-conceived expectations can reduce the ability to analyze accurately.
Another skill is being able to choose which piece of information is important in any given
situation. The IP must focus on the right information from their observations. As a guide,
ask “What matters most for me now and in the future?”
3. Decide: Formulate a course of action based on sound judgment and the available
information. Judgment is a process where choices are weighed by considering their risks
verses their benefits and evaluation the possible consequences of acting on a given choice
over the others. Sound judgment equals a good decision which equals effective action.
4. Execute & Modify: As stated before, the individual should attempt to anticipate and predict
how the situation is likely to develop, understand their options and course(s) of action, and
be prepared to modify those actions if necessary. However, while evading or during
captivity, an IP often has to execute decisions under intense time pressure. Critical
incidents often force a decision, especially those that must be made under extreme time
pressure. If something has not gone according to plan, take corrective action following the
same steps outlined above.
4.6.3. Thinking Ahead
This understanding enables the IP to think ahead, project the future state of the isolating event, and
determine a course of action to meet, use, or mitigate the conditions affecting them. The more
the IP anticipates accurately, the more efficient they become at meeting their needs and goals.
4.6.4. Situational Awareness
SA represents the cumulative effects of everything an IP is and does as applied to successful
mission accomplishment to maintain life, maintain honor, and return.
4.7. Attitude
The IP's attitude is the most important element of the will to survive. With a positive mental
attitude, almost anything is possible. The desire to live is sometimes based upon the feelings
toward another person and/or thing. Love and hatred are two emotional extremes which have
moved people to do exceptional things physically and mentally. The lack of a will to survive can
sometimes be identified by the individual's lack of motivation to meet essential survival needs,
emotional lack of control resulting in reckless, panic-like behavior, and a lack of self-esteem.
4.7.1. Controlling Emotions
Controlling emotions is essential to strengthen the will to survive during an emergency. The first
step is to avoid a tendency to panic or lose self control. Sit down, relax, and analyze the situation
rationally. Once thoughts are collected and thinking is clear, the next step is to make decisions.
In normal living, people can avoid decisions and let others do their planning. But in an isolating
situation, this will seldom work. Failure to decide on a course of action is actually a decision for
inaction. This lack of decision making may result in capture or even death. However, decisiveness
must be tempered with flexibility and planning for unforeseen circumstances. As an example, an
aircrew member down in an arctic noncombat situation decides to construct a shelter for protection
from the elements. The planning and actions must allow sufficient flexibility so the aircrew can
monitor the area for indications of rescuers and be prepared to make contact - visually,
electronically, or by any other means - with potential rescuers.
4.7.2. Tolerance
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Tolerance will typically be a factor in isolating situations. An IP will have to deal with many
physical and psychological discomforts, such as unfamiliar animals, insects, loneliness, and
depression. IP are trained to tolerate uncomfortable situations. That training must be applied to
deal with the stress of environments.
4.7.3. Overcoming Fear
IP in both combat and noncombat situations must face and overcome fears to strengthen the will
to survive. These fears may be founded or unfounded, be generated by the IP's uncertainty or lack
of confidence or based on the proximity of enemy forces. Indeed, fear may be caused by a wide
variety of real and imagined dangers. Despite the source of the fear, IP must recognize fear and
make a conscious effort to overcome it.
4.7.4. Optimism
Optimism is one of an IP’s assets during an isolating event. IP must maintain a positive, optimistic
outlook on their circumstance and how well they are doing. Setting achievable goals (simple to
complex) and working toward them can help maintain optimism. Faith, hope, prayer, and
meditation can all be helpful.
4.8. Contributing Factors
IP must recognize that coping with the psychological aspects of SERE are at least as important as
handling the environmental factors. In virtually any isolating event, the IP will be in an
environment that can support human life. The IP’s problems will be compounded because they
never really expected to become isolated in the desert, over the ocean, urban, or anywhere else.
No matter how well prepared, the IP probably will never completely convince themselves that it
can happen to them. However, the USAF is filled with historic records that show it can and does
happen. Before an IP learns about the physical aspects of SERE, they must first understand that
psychological problems may occur and that solutions to those problems must be found if the
isolating event is to reach a successful conclusion (Figure 4-4).
Figure 4-4 Psychological Aspects
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4.9. Survival Stresses
The emotional aspects associated with isolation must be completely understood just as survival
conditions and equipment are understood. An important factor bearing on success or failure during
an isolating event is the individual's psychological state. Maintaining an even, positive
psychological state or outlook depends on the individual's ability to cope with or manage many
factors. Some include:
e Understanding how various physiological and emotional signs, feelings, and expressions affect
one's bodily needs and mental attitude.
e Managing physical and emotional reactions to stressful situations.
e Knowing individual tolerance limits, both psychological and physical.
e Exerting a positive influence on companions.
4.9.1. Adapting to Stress
Nature has endowed everyone with biological mechanisms which aid in adapting to stress. The
bodily changes as a result of fear and anger, for example, tend to increase alertness and provide
extra energy to either run away or fight. These and other mechanisms can hinder a person during
an isolating event. For instance, an IP in a raft could cast aside reason and drink sea water to
quench a thirst or IP in enemy territory, driven by hunger pangs, could expose themselves to
capture when searching for food. These examples illustrate how normal reactions to stress could
create problems for an IP.
4.9.2. Threats to Maintaining Life
Two of the gravest threats to maintaining life are concessions to comfort and apathy. Both threats
represent attitudes which must be avoided. To survive, an IP must focus planning and effort on
fundamental needs.
4.9.3. Comfort
Many people consider comfort their greatest need. Yet, comfort is not essential to human survival.
IP must value life more than comfort, and be willing to tolerate heat, hunger, dirt, itching, pain,
and any other discomfort. Recognizing discomfort as temporary will help IP concentrate on
effective action.
4.9.4. Apathy
As the will to keep trying to survive lessens, drowsiness, mental numbness, and indifference will
result in apathy. This apathy usually builds on slowly, but ultimately takes over and leaves an IP
helpless. Physical factors can contribute to apathy. Exhaustion due to prolonged exposure to the
elements, loss of body fluids (dehydration), fatigue, weakness, or injury are all conditions which
can contribute to apathy. Proper planning and sound decisions can help an IP avoid these
conditions. Finally, the IP must watch for signs of apathy in companions and help prevent it. The
first signs are resignation, quietness, lack of communication, loss of appetite, and withdrawal from
the group. Preventive measures could include maintaining group morale by planning, activity, and
getting the organized participation of all members.
4.9.5. Common Survival Stressors
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Many common stresses cause reactions which can be recognized and dealt with appropriately
during isolating events. An IP must understand that stresses and reactions often occur at the same
time. Although IP will face many stresses, the following common stresses will occur in virtually
all survival episodes: pain, thirst, cold, and heat, hunger, frustration, fatigue, sleep deprivation,
isolation, insecurity, loss of self-esteem, loss of self-determination, and depression.
4.9.6. Pain
Pain, like fever, is a warning signal calling attention to an injury or damage to some part of the
body. Pain is discomforting but is not in itself harmful or dangerous. Pain can be controlled, and
in an extremely grave situation, survival must take priority over giving in to pain.
e The biological function of pain is to protect an injured part by warning the individual to rest it
or avoid using it. During an isolating event, the normal pain warnings may have to be ignored
in order to meet more critical needs. People have been known to complete a fight with a
fractured hand, to run on a fractured or sprained ankle, to land an aircraft despite severely
burned hands, and to ignore pain during periods of intense concentration and determined effort.
Concentration and intense effort can actually stop or reduce feelings of pain. Sometimes this
concentration may be all that is needed to survive.
Despite pain, an IP can move in order to live. Pain can be reduced by understanding its source
and nature. Recognizing pain as a discomfort to be tolerated, concentrating on necessities such
as thinking, planning, and keeping busy. When personal goals are maintaining life, honor, and
returning, and these goals are valued highly enough, an IP can tolerate almost anything.
4.9.7. Thirst
The lack of water and its accompanying problems of thirst and dehydration are among the most
critical problems facing IP. Although thirst indicates the body's need for water, it does not indicate
how much water is needed. If a person drinks only enough to satisfy thirst, it is still possible to
slowly dehydrate. Prevention of thirst and the more debilitating dehydration is possible if IP drink
plenty of water any time it is available, and especially when eating (Figure 4-5). While prevention
is the best way to avoid dehydration, virtually any degree of dehydration is reversible simply by
drinking water. Thirst, like fear and pain, can be tolerated if the will to carry on, supported by
calm, purposeful activity, is strong.
Figure 4-5 Thirst
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4.9.8. Cold and Heat
The average normal body temperature for a person is 98.6°F. Individuals have survived body
temperatures well below and well above normal, but consciousness is clouded and thinking
numbed at a much smaller change. An increase/decrease just a few degrees above/below normal
for any prolonged period may prove fatal. Any deviation from normal temperature, even as little
as one or two degrees, reduces efficiency.
4.9.8.1. Cold
Cold is a serious stress since even in mild degrees it lowers efficiency. Extreme cold numbs the
mind and dulls the will to do anything except get warm again. Cold numbs the body by lowering
the flow of blood to the extremities, and results in sleepiness. IP have endured prolonged cold and
dampness through exercise, proper hygiene procedures, shelter, and food (Figure 4-6). Wearing
proper clothing and having the proper climatic survival equipment when in cold weather areas are
essential to enhance survivability.
Figure 4-6 Cold
4.9.8.2. Heat
Just as numbness is the principal symptom of cold, weakness is the principle symptom of heat.
Most people can adjust to high temperatures, whether in the heat of the desert during evasion or in
an isolation box during captivity. It may take from two days to a week before circulation,
breathing, heart action, and sweat glands are all adjusted to a hot climate. Heat stress also
accentuates dehydration, which was discussed earlier. In addition to the problem of water, there
are many other sources of discomfort and impaired efficiency, which are directly attributable to
heat or to the environmental conditions in hot climates. Extreme temperature changes, from
27
extremely hot days to very cold nights, occur in desert and plains areas. Proper use of clothing
and shelters can decrease the adverse effects of such extremes.
4.9.9. Effects of Wind
Blowing wind, in hot summer, has been reported to irritate some IP. Wind can constitute an
additional source of discomfort and difficulty in desert areas when it carries particles of sand and
dirt. Protection against sand and dirt can be provided by tying a cloth around the head after cutting
slits for vision.
4.9.9.1. Fear as a Result of Sandstorms Snowstorms
Acute fear has been experienced among IP in sandstorms and snowstorms. This fear results from
both the terrific impact of the storm itself and its obliteration of landmarks showing direction of
travel. Finding or improving shelter for protection from the storm itself is important.
4.9.10. Mirages and Illusions
Mirages and illusions distort visual perception but sometimes account for serious incidents. These
illusions are common in desert areas. In the desert, distances are usually greater than they appear
and, under certain conditions, mirages obstruct accurate vision. Inverted reflections are a common
occurrence.
4.10. Hunger
A considerable amount of edible material which IP may not initially regard as food may be
available during an isolating event. Early symptoms include impulsivity, irritability, hyperactivity,
and possibly passiveness or compliance. Research has revealed no evidence of permanent damage
or any decrease in mental efficiency from short periods of total fasting. Long term starvation
recovery depends on physical re-nourishment as well as possible psychological treatment.
4.10.1. Starvation
The prolonged and rigorous Minnesota semi-starvation studies during World War II observed in
detail the physical and psychological effects of prolonged, famine-like semi-starvation on healthy
men and their subsequent rehabilitation from this condition. However, even today, knowledge of
the biology of starvation in humans is still imperfect due to the great difficulty of obtaining reliable
data from subjects undergoing severe food deprivation. Famines do not generally lend themselves
to scientific investigation. A recent study done by the British Nutrition Foundation in 2006 has
examined the literature on starvation, using Body Mass Index (BMI) to define the limits of human
survival to starvation. Data included is based on normal weight subjects who died from starvation,
famine or anorexia nervosa. The following behavioral changes were revealed:
e Dominance of the hunger drive over other drives.
e Lack of spontaneous activity.
e Tired and weak feeling.
e Inability to do physical tasks.
e Dislike of being touched or caressed in any way.
e Quick susceptibility to cold.
e Dullness of all emotional responses (fear, shame, love, etc.).
28
e Lack of interest in others - apathy.
e Dullness and boredom.
e Limited patience and self-control.
e Lack of a sense of humor.
e Moodiness - reaction of resignation.
4.10.2. Food Procurement
Frequently, in the tension or distress of some SERE episodes, hunger is forgotten. IP have gone
for considerable lengths of time without food or awareness of hunger pains. An early effort should
be made to procure and consume food to reduce the stresses brought on by food deprivation. Both
the physical and psychological effects described are reversed when food and a protective
environment are restored. Return to normal is slow and the time necessary for the return increases
with the severity of starvation. If food deprivation is complete and only water is ingested, the
pangs of hunger disappear in a few days, but even then the mood changes of depression and
irritability occur. When the food supply is limited, even strong friendships are threatened. The
individual tendency is still to search for food to prevent starvation and such efforts might continue
as long as strength and self-control permit.
4.10.3. Aversions to Strange Foods
Food aversion may result in hunger. Adverse group opinion may discourage those who might try
foods unfamiliar to them. In some groups, the barrier would be broken by someone eating the
particular food rather than starving. The solitary individual has only personal predispositions to
overcome and will often try strange foods.
4.10.4. Controlling Food Aversions
Controlling food aversions during isolation or captivity can help mitigate hunger for the IP. Food
aversion is reflected in the excerpt from a survival account that follows: "It had consisted of a
small bowl of “soup” — really lukewarm water with a few pieces of leafy matter, some bitter-
tasting kohlrabi, and a moldy chunk of bread full of weevils and hair. Lt Rodney Knutson had not
been hungry, and the appearance and odor of the food had done nothing to awaken his appetite.
Even so, it was his duty now to keep up his strength...”
4.11. Frustration
Frustration occurs when one's efforts are stopped, either by obstacles blocking progress toward a
goal or by not having a realistic goal. It can also occur if the feeling of self-worth or self-respect
is lost.
4.11.1. Obstacles
A wide range of obstacles, both environmental and internal, can lead to frustration. Frustrating
conditions often create anger, accompanied by a tendency to attack and remove the obstacles to
goals.
4.11.2. Controlling Frustration
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Frustration must be controlled by channeling energies into a positive and worthwhile obtainable
goal. The IP should complete the easier tasks before attempting more challenging ones. This will
not only instill self-confidence, but also relieve frustration.
4.12. Fatigue
In an isolating event, an IP must continually cope with fatigue and avoid the accompanying strain
and loss of efficiency. An IP must be aware of the dangers of over-exertion. In many cases, an IP
may already be experiencing strain and reduced efficiency as a result of other stresses such as heat
or cold, dehydration, hunger, or fear. An IP must judge capacity to walk, carry, lift, or do necessary
work, and plan and act accordingly. During an emergency, considerable exertion may be necessary
to cope with the situation to ensure survival or escape. If an individual understands fatigue and
the attitudes and feelings generated by various kinds of effort, that individual should be able to call
on available reserves of energy when they are needed (Figure 4-7).
Figure 4-7 Fatigue
4.12.1. Avoiding Complete Exhaustion
An IP must avoid complete exhaustion which may lead to physical and psychological changes.
Although a person should avoid working to complete exhaustion, in emergencies certain tasks
must be done in spite of fatigue.
4.12.2. The Need for Rest
Rest is a basic factor for recovery from fatigue and is also important in resisting further fatigue. It
is essential that the rest following fatiguing effort be sufficient to permit complete recovery;
otherwise, the residual fatigue will accumulate and require longer periods of rest to recover from
subsequent effort. During the early stages of fatigue proper rest provides a rapid recovery. This
is true of muscular fatigue as well as mental fatigue. Sleep is the most complete form of rest
available and is basic to recovery from fatigue.
4.12.3. The Need for Short Rest Breaks to Improve Morale
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Short rest breaks during extended stress periods can improve total output and increase morale and
motivation. There are four ways in which rest breaks are beneficial: 1) by providing opportunities
for partial recovery from fatigue, 2) by helping to reduce energy expenditure, 3) by increasing
efficiency by enabling a person to take maximum advantage of planned rest, and 4) by relieving
boredom by breaking up the uniformity and monotony of the task.
4.12.4. Rest During Strenuous Activity
IP should rest before they show a definite decline in what they can do physically. When efforts
are highly strenuous or monotonous, rest breaks should be more frequent. Rest breaks providing
relaxation are the most effective. In mental work, mild exercise may be more relaxing. When
work is monotonous, changes of activity, conversation, and humor are effective relaxants. In
deciding on the amount and frequency of rest periods, the loss of efficiency resulting from longer
hours of effort must be weighed against the absolute requirements of the isolating event.
4.12.5. Reducing Fatigue
Fatigue can be reduced by working smarter. An IP can do this in two practical ways:
1. Adjusting the pace of the effort. Balance the load, the rate, and the time period. For
example, walking at a normal rate is a more economical effort than fast walking.
2. Adjusting the technique of work. The way in which work is done has a great bearing on
reducing fatigue. Economy of effort is most important. Rhythmic movements suited to
the task are best.
4.13. Maintaining Group Morale and Efficiency
A person should form an opinion of individual capacity based on actual experience. Likewise, a
group leader must form an opinion of the capacities of fellow IP. Group support, cooperation,
team work, and competent leadership are important factors in maintaining group morale and
efficiency, thereby reducing stress and fatigue. An IP usually feels tired and weary before the
physiological limit is reached. In addition, other stresses experienced at the same time - such as
cold, hunger, fear, or despair - can intensify fatigue. The feeling of fatigue involves not only the
physical reaction to effort, but also subtle changes in attitudes and motivation. Remember, a
person has reserves of energy to cope with an important emergency even when feeling very tired.
4.14. Sleep Deprivation
The effects of sleep loss are closely related to those of fatigue. Sleeping at unaccustomed times,
sleeping under strange circumstances (in a strange place, in noise, in light, or in other distractions),
or missing part or all of the accustomed amount of sleep will cause a person to react with feelings
of weariness, irritability, emotion tension, and some loss of efficiency. The extent of an
individual's reaction depends on the amount of disturbance and on other stress factors which may
be present at the same time.
4.14.1. Compensating for Sleep Loss
Strong motivation is one of the principal factors in helping to compensate for the impairing effects
of sleep loss. Superior physical and mental conditioning, opportunities to rest, consumption of
food and water, and companions has been shown to aid in the fight against the effects of sleep
deprivation. If a person is in reasonably good physical and mental condition, sleep deprivation
can be endured for five days or more without damage, although efficiency during the latter stages
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may be poor. A person must learn to get as much sleep and rest as possible. Restorative effects
of sleep are felt even after short naps. In some instances, IP may need to stay awake. Activity,
movement, conversation, eating, and drinking are some of the ways a person can stimulate the
body to stay awake.
4.14.2. Sleepiness Comes in Waves during Sleep Depravity
When one is deprived of sleep, sleepiness usually comes in waves. A person may suddenly be
sleepy immediately after a period of feeling wide awake. If this can be controlled, the feeling will
soon pass and the person will be wide awake again until the next wave appears. As the duration
of sleep deprivation increases, these periods between waves of sleepiness become shorter. The
need to sleep may be so strong in some people after a long period of deprivation that they become
desperate and do careless or dangerous things in order to escape this stress.
4.15. Isolation
Loneliness, helplessness, and despair which are experienced by IP when they are isolated are
among the most severe stresses. People often take their associations with family, friends, military
colleagues, and others for granted, but IP quickly begin to miss the daily interaction with other
people. However, these, like the other stresses already discussed, can be conquered. Isolation can
be controlled and overcome by knowledge, understanding, deliberate countermeasures, and a
determined will to resist it.
4.16. Insecurity
Insecurity is the feeling of helplessness or inadequacy resulting from varied stresses and anxieties.
These anxieties may be caused by uncertainty regarding individual goals, abilities, and the future
during an isolating event. Feelings of insecurity may have widely different effects on the IP's
behavior. An IP should establish challenging but attainable goals. The better an IP feels about
individual abilities to achieve goals and adequately meet personal needs, the less insecure the IP
will feel.
4.16.1. Loss of Self-Esteem
Self-esteem is the state or quality of having personal self-respect and pride. Lack or loss of self-
esteem in an IP may bring on depression and a change in perspective and goals. A loss of self-
esteem may occur in individuals in captivity. Humiliation and other factors brought on by the
captor may cause them to doubt their own worth. Humiliation comes from the feeling of losing
pride or self-respect by being disgraced or dishonored, and is associated with the loss of self-
esteem. Prisoners must maintain their pride and not become ashamed either because they are
Prisoners of War (POWs) or because of the things that happen to them as a result of being a POW.
The IP who loses respect (both personally and of the enemy) becomes more vulnerable to captor
exploitation attempts. To solve this problem, IP should try to maintain proper perspective about
both the situation and themselves. Their feelings of self-worth may be bolstered if they recall the
implied commitment in the Code of Conduct - POWs will not be forgotten.
4.16.2. Loss of Self-Determination
A self-determined person is relatively free from external controls or influences over his or her
actions. In everyday society, these controls and influences are the laws and customs of our society
and of the self-imposed elements of our personalities. During an isolating event, the controls and
influences can be very different. IP may feel as if events, circumstances, and (in some cases) other
32
people, are in control of the situation. Some factors which may cause IP to feel they have lost the
power of self-determination are a harsh captor, captivity, bad weather, or rescue forces that make
time or movement demands. IP must decide how unpleasant factors will be allowed to affect their
mental state. They must have the self-confidence, fostered by experience and training, to live with
their feelings and decisions, and to accept responsibility for both the way they feel and how they
let those feelings affect them.
4.17. Depression
As an IP, depression is the biggest psychological problem that has to be conquered. Everyone
experiences mental highs as well as mental lows. Feeling depressed is a normal reaction to many
situations including loss, disappointment, and loss of self-esteem. While most of these emotional
changes in mood are temporary and do not become chronic, these feelings may become
overwhelming and lead to a deep depression. Depressed IP may feel fearful, guilty, or helpless.
They may lose interest in the basic needs of life. Many cases of depression also involve pain,
fatigue, loss of appetite, or other physical ailments. Some depressed IP have tried to injure or kill
themselves.
4.17.1. Factors which Can Create A Continuous Cycle of Depression
The main reason depression is a difficult problem is that it can affect a wide range of psychological
responses. Factors can become mutually reinforcing, creating a continual cycle. For example,
fatigue may lead to a feeling of depression, and that depression may increase the loss of self-
esteem, and in turn, lead to deeper depression, and so on.
4.17.2. Onset of Depression in an Survival Situation
Depression usually begins after an IP has met the basic needs for sustaining life, such as water,
shelter, and food. Once the IP's basic needs are met, there is often too much time for that person
to dwell on the past, the present predicament, and on future problems. The IP must be aware of
the necessity to keep the mind and body active to eliminate the feeling of depression. One way to
keep busy is by checking and improving shelters, signals, and food supply on a daily basis.
4.18. Emotional Reactions
IP may depend more upon their emotional reactions to a situation than upon calm, careful analysis
of potential danger - the enemy, the weather, the terrain, the nature of the isolating event, etc.
Whether they will succumb to the fear, or use it as a stimulant for greater sharpness, is more
dependent on the IP's reactions to the situation than on the situation itself. Although there are
many reactions to stress, the following are the most common: fear, anxiety, panic, hate, resentment,
anger, impatience, dependence, loneliness, boredom, and hopelessness.
4.18.1. Fear
Fear can either save or cost one their life. Some people are at their best when they are scared.
Many IP faced with survival emergencies have been surprised at how well they remembered their
training, how quickly they could think and react, and what strength they had. The experience gave
them a new confidence in themselves. On the other hand, some people become physiologically
paralyzed when faced with a simple survival situation. Some of them have been able to recover
their senses before it was too late. In other cases, a fellow IP was on hand to assist them. However,
others have not been so fortunate and have either been captured or killed.
4.18.1.1. Different Reactions to Fear
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How a person will react to fear depends more upon the individual than it does upon the situation.
This has been demonstrated both in actual survival situations and in laboratory experiments. It
isn't always the physically strong or the happy-go-lucky people who handle fear most effectively.
Timid and anxious people have met emergencies with remarkable coolness and strength.
4.18.1.2. Fear is Common in Life Threatening Emergencies
Anyone who faces life-threatening emergencies experiences fear. Fear is conscious when it results
from a recognized situation (such as an immediate prospect of bailout) or when experienced as
apprehension of impending disaster. Fear also occurs at a subconscious level and creates feelings
of uneasiness, general discomfort, worry, or depression. Fear may vary widely in intensity,
duration, and frequency of occurrence, and affect behavior across the spectrum from mild
uneasiness to complete disorganization and panic. People have many fears; some are learned
through personal experiences, and others are deliberately taught to them. These fears may control
behavior, and an IP may react to feelings and imagination rather than to the problem causing fear.
4.18.1.3. Controlling the Fear
When a person’s imagination distorts a moderate danger into a major catastrophe, or vice versa,
behavior can become abnormal. There is a general tendency to underestimate and this leads to
reckless, foolhardy behavior in individuals and may affect the group. The principal means of
fighting fear (in an isolating situation) is to pretend that it does not exist. There are no sharp lines
between recklessness and bravery. It is necessary to check behavior constantly to maintain proper
control.
4.18.1.4. Physical Signs and Symptoms of Fear
One or more of the following signs or symptoms may occur in those who are afraid. However,
they may also appear in circumstances other than fear.
e Quickening of pulse; trembling.
e Dilation of pupils.
e Increased muscular tension and fatigue.
e Perspiration of the palms of hands soles of feet, and armpits.
e Dryness of mouth and throat; higher pitch of voice; stammering.
e Feeling of "butterflies in the stomach," emptiness of the stomach, faintness, and nausea.
4.18.1.5. Psychological Signs and Symptoms of Fear
The following common psychological symptoms typically accompany the physical symptoms
listed above:
e Irritability and/or increased hostility.
e Talkativeness in early stages, leading finally to speechlessness.
e Confusion, forgetfulness, and inability to concentrate.
e Feelings of unreality, flight, panic, or stupor.
4.18.1.6. Understanding, Admitting, and Accepting Fear
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IP cannot run away from fear and must take action to control it. Appropriate actions include:
e Understanding fear.
e Admitting that it exists.
e Accepting fear as reality.
4.18.2. Thinking Logically in the Face of Fear
Training can help IP recognize what individual reactions may be. Using prior training, IP should
learn to think, plan, and act logically, even when afraid.
4.18.3. Coping Effectively with Fear
To effectively cope with fear, an IP must:
e Develop confidence. Use training opportunities; increase capabilities by keeping physically
and mentally fit; know what equipment is available and how to use it; learn as much as possible
about all aspects of survival.
Be prepared. Accept the possibility that an isolating event can happen. Be properly equipped
and clothed at all times, and have a plan ready. Hope for the best, but be prepared to cope with
the worst.
e Keep informed. Listen carefully and pay attention to all briefings. Know when danger
threatens and be prepared if it comes; increase knowledge of survival environments to reduce
the unknown.
e Keep constructively busy at all times. Prevent hunger, thirst, fatigue, idleness, and ignorance
about the situation, since these increase fear.
Learn how fellow IP respond to fear. Work together in emergencies - to live, work, plan, and
help each other as a team.
Practice religion. Don't be ashamed of having spiritual faith.
Cultivate a survival attitude. Keep the mind focused on a goal and keep everything else in
perspective. Learn to tolerate discomfort. Don't exert energy to satisfy minor desires which
may conflict with the overall goals - to maintain life, maintain honor, and return.
Cultivate mutual support. The greatest support under severe stress may come from a tightly
knit group. Teamwork reduces fear while making the efforts of every person more effective.
Exercise leadership. The most important test of leadership and perhaps its greatest value lies
in the stress situation.
Practice discipline. Attitudes and habits of discipline developed in training carry over into
other situations. A disciplined group has a better chance of survival than an undisciplined
group.
Lead by example. Calm behavior and demonstration of control are contagious. Both reduce
fear and inspire courage.
4.18.4. Overcoming Fear
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Every person has goals and desires. The greatest values exercise the greatest influence. Because
of strong religious, moral, or patriotic values, people have been known to face torture and death
calmly rather than reveal information or compromise a principle. Fear can kill or it can save lives.
It is a normal reaction to danger. By understanding and controlling fear through training,
knowledge, and effective group action, fear can be overcome.
4.19. Anxiety
Anxiety is a universal human reaction. Its presence can be felt when changes occur which affect
an individual's safety, plans, or methods of living. It is generally felt when individuals perceive
something bad is about to happen. A common description of anxiety is "butterflies in the stomach."
Anxiety creates feelings of uneasiness, general discomfort, worry, or depression. Anxiety and fear
differ mainly in intensity. Anxiety is a milder reaction and the specific cause(s) may not be readily
apparent, whereas fear is a strong reaction to a specific, known cause. Common characteristics of
anxiety are: fear of the future, indecision, feelings of helplessness, resentment.
4.19.1. Overcoming Anxiety
To overcome anxiety, the IP must take positive action by adopting a simple plan. It is essential to
keep your mind off of your injuries, or the other stressors associated with the isolating event, and
do something constructive. For example, one hostage attempted to learn his captors’ language.
4.20. Panic
In the face of danger, a person may panic or freeze and cease to function in an organized manner.
A person experiencing panic may have no conscious control over individual actions.
Uncontrollable, irrational behavior is common in emergency situations. Panic is brought on by a
sudden overwhelming fear, and can often spread quickly through a group of people. Every effort
must be made to bolster morale and calm the panic with leadership and discipline. Panic has the
same signs as fear and should be controlled in the same manner as fear.
4.21. Hate
Feelings of intense dislike, extreme aversion, or hostility - is a powerful emotion which can have
both positive and negative effects on an IP. An understanding of the emotion and its causes is the
key to learning to control it. Hate is an acquired emotion rooted in a person's knowledge or
perceptions. The accuracy or inaccuracy of the information is irrelevant to learning to hate.
4.21.1. Emotional Feelings of Hate as a Motivator
Any person, any object, or anything that may be understood intellectually, such as political
concepts or religious dogma, can promote feelings of hate. Feelings of hate (usually accompanied
with a desire for vengeance, revenge, or retribution) have sustained former POWs through harsh
ordeals. If an individual loses perspective while under the influence of hate and reacts emotionally,
rational solutions to problems may be overlooked, and the IP may be put in jeopardy.
4.21.2. Examining Why Hate is Present
To effectively deal with this emotional reaction, the IP must first examine the reasons why the
feeling of hate is present. Once that has been determined, IP should then decide what to do about
those feelings. Whatever approach is selected, it should be as constructive as possible. IP must
not allow hate to control them.
4.22. Resentment
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Resentment is the experiencing of an emotional state of displeasure or indignation toward some
act, remark, or person that has been regarded as causing personal insult or injury. An IP must
always remember that factors beyond the IP’s control may play a role in any isolating event. A
hapless IP may feel jealous resentment toward a fellow IP, travel partner, etc., if that other person
is perceived to be enjoying a success or advantage not presently experienced by the observer. The
IP must understand that events cannot always go as expected. It is detrimental to morale and could
affect survival chances if feelings of resentment over another's attainments become too strong.
Imagined slights or insults are common. The IP should try to maintain a sense of humor and
perspective about ongoing events and realize that stress and lack of self-confidence play roles in
bringing on feelings of resentment.
4.23. Anger
Anger is a strong feeling of displeasure and hostility produced by a real or supposed wrong. People
become angry when they cannot fulfill a basic need or desire which seems important to them.
When anger is not relieved, it may turn into a more enduring attitude of hostility, characterized by
a desire to hurt or destroy the person or thing causing the frustration. When anger is intense, the
IP loses control over the situation, resulting in impulsive behavior which may be destructive in
nature. Anger is a normal response which can serve a useful purpose when carefully controlled.
If the situation warrants and there is no threat to survival, one could yell or scream, take a walk,
do some vigorous exercise, or just get away from the source of the anger, even if only for a few
minutes.
4.24. Impatience
The psychological stresses brought about by feelings of impatience can quickly manifest
themselves in physical ways and affect mental well-being. IP who allow impatience to control
their behavior may find that their efforts prove to be counterproductive and possibly dangerous.
For example, IP who do not have the ability or willingness to suppress annoyance when confronted
with delay may expose themselves to capture or injury.
4.24.1. Overcoming Impatience
Potential IP must understand they have to bear pain, misfortune, and annoyance without complaint.
In the past, many IP have displayed tremendous endurance, both mental and physical, in times of
distress or misfortune. Each potential IP should learn to recognize the things which may make
them impatient to avoid acting unwisely. One IP who couldn't wait stated: "I became very
impatient. I had planned to wait until night to travel but I just couldn't wait. I left the ditch about
noon and walked for about two hours until I was caught."
4.25. Dependence
An IP can become dependent on their equipment creating a lack of balance, interfering with
decisions, loss of situational awareness, and hindering the development of alternate
methods/solutions to problems. An IP may experience feelings of dependency in a captivity
environment. The captor will try to develop in POWs/hostages feelings of need, support, and trust
for the captor. By regulating the availability of basic needs like food, water, clothing, social
contact, and medical care, captors show their power and control over the prisoners' fate. Through
emphasis on the prisoners’ inability to meet their own basic needs, captors seek to establish strong
feelings of prisoner dependency, making prisoners extremely vulnerable to captor exploitation - a
major captor objective. IP’s recognition of this captor tactic is key to countering it.
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POWs/hostages must understand that, despite captor controls, they do control their own lives.
Meeting even one physical or mental need can provide an IP with a small victory and provide the
foundation for continued resistance against exploitation.
4.26. Loneliness
Loneliness can be very debilitating during a survival episode. Some people learn to control and
manipulate their environment and become more self-sufficient while adapting to changes. Others
rely on routines and familiarity of surroundings to function and obtain satisfaction.
4.26.1. Combating Feelings of Loneliness
A potential IP must develop the ability to combat feelings of loneliness during an isolating event
long before the event occurs. Self-confidence and self-sufficiency are key factors in coping with
loneliness. People develop these attributes by developing and demonstrating competence in
performing tasks. As the degree of competence increases, so does self-confidence and self-
sufficiency. Military training, more specifically SERE training, is designed to provide individuals
with the competence and self-sufficiency to cope with and adapt to survival living.
4.26.2. Being Active to Counter Loneliness
In an isolating event, the countermeasures to conquer loneliness are to be active, plan, and think
purposely. Development of self-sufficiency is the primary protection since all countermeasures in
isolation require the IP to have the ability to practice self-control.
4.27. Boredom
Boredom is accompanied by a lack of interest and may include feelings of strain, anxiety, or
depression, particularly when no relief is in sight and the person is frustrated. Relief from boredom
must be based on correction of the two basic sources: repetitiveness and monotony. Boredom can
be relieved by a variation of methods — solving problems, rotating duties, broadening the scope of
a particular task or job, taking rest breaks, or other diversification techniques. The under gratifying
nature of a task can be counteracted by clearing up its meaning, objectives, and, in some cases,
relation to the total plan. An IP should not be bored as there are always problems to be solved.
An IP should own the situation and not the other way.
4.27.1. Alleviating Boredom
Ray Rising was kidnapped by Colombian guerrillas on March 31, 1994. He spent 810 days as a
hostage in multiple jungle camps, in some cases spending weeks shackled to small tarp covered
shelter, only being allowed to move to relieve himself. Ray felt “like a dog on the end of a leash”.
During Ray Rising’s captivity to develop rapport with his captures and to alleviate his own
boredom he would offer to repair his guards electronic devises like their CD-players and hand-
held radios.
4.28. Hopelessness
Hopelessness is a state of feeling that success is impossible, regardless of actions taken, or the
certainty that future events will turn out for the worst no matter what a person tries to do. Feelings
of hopelessness can occur at virtually any time during an isolating event. IP have experienced
hopelessness when unable to maintain health due to an inability to care for sickness, broken bones,
or injuries; considering their chances of returning home alive, seeing their loved ones again, or
38
believing in their physical or mental ability to deal with the situation, for example, evading long
distances or withholding information from an interrogator.
4.28.1. Situations Where an IP Loses the Will to Survive
During situations where physical exhaustion or exposure to the elements affects the mind, a person
may begin to lose hope and give up. During some instances of captivity, deaths have occurred for
no apparent cause. These individuals actually appeared to will themselves to die. The premise in
the minds of these people is that they are going to die and the situation seems totally futile. People
who died in this manner withdrew themselves from the group, became despondent, then lay down
and gave up. In some cases, death followed rapidly.
4.28.2. Eliminating Stress to Treat Hopelessness
One way to treat hopelessness is to eliminate the cause of the stress. Rest, comfort, and morale
building activities can help eliminate this psychological problem.
4.28.3. Purposeful Attitude to Treat Hopelessness
Another method is to make the person so angry that they wanted to get up and attack the
tormentors. A purposeful attitude has a powerful influence on morale and combating the feeling
of hopelessness.
4.28.4. Compromise
Since many situations cannot be dealt with successfully by either withdrawal or direct attack, it
may be necessary to work out a compromise solution. The action may entail changing an IP's
method of operation or accepting substitute goals.
4.29. Summary
Psychological factors can be overcome by IP if they can recognize the problem, work out
alternative solutions, decide on an appropriate course of action, take action, and evaluate the
results. Perhaps the most difficult step in this sequence is deciding on an appropriate course of
action. IP may face either one or several psychological problems. These problems are quite
dangerous and must be effectively controlled or countered for survival to continue. IP do not
choose their situation and would escape it if they could. IP decide how they will deal with the
hand they are dealt and can determine their fate. The isolating event is not an easy one, but it is
one in which success can be achieved.
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Chapter 5
SERE Medicine
5. SERE Medicine
Among the many things which can compromise an IP's ability to return are medical problems
encountered during the isolating event. Although military members are provided with Self Aid-
Buddy Care (SABC) instruction, SERE medicine addresses the use of expedient techniques which
can aid survival in a field or captivity environment when more traditional methods are unavailable.
An IP’s situational awareness will help determine the appropriate treatment based on their
situation. The procedures in this chapter must be viewed in the reality of a true isolating event.
The results of treatment may be substandard when compared with present medical standards.
However, these procedures will not compromise professional medical care which becomes
available following recovery. Moreover, in the context of an isolating event, they may represent
the best available treatment to extend the individual's life expectancy.
Figure 5-1 POW Medicine
5.1. Health PreservationSERE medicine encompasses procedures and expedients that are
required and available for the preservation of health and the prevention, improvement, or treatment
of injuries and illnesses encountered during an isolating event. It must also be suitable for
application by nonmedical personnel to themselves or others in the circumstances of the isolating
event. SERE medicine is more than first aid in the conventional sense. It approaches final
40
definitive treatment in that it is not dependent upon the availability of technical medical assistance
within a reasonable period of time.
5.1.1. Triage in Group Survival
In a group survival situation, the methods of treating illnesses and injuries do not change but the
decisions and outcomes involved may change. It may become necessary to conduct a rudimentary
triage to determine if individuals have injuries that are incompatible with life. Treating these
individuals may waste critical supplies and time. This waste could endanger the remaining
personnel and jeopardize their chances for successful survival and evasion. Consideration should
be given to the potential of having to leave critically injured, unable to move, or deceased
individuals behind to insure the safety and freedom of the remaining IP (Figure 5-2). These
considerations should be thought of as part of IPs pre-mission preparation and discussion.
e During Operation Gothic Serpent, Warrant Officer Michael Durant was the pilot of Super Six
Four, the second MH-60L Black Hawk helicopter to crash during the Battle of Mogadishu on
October 3, 1993. The helicopter was hit by a rocket-propelled grenade in the tail, which led to
its crash about a mile southwest of the operation's target.
Durant and his crew of three (Bill Cleveland, Ray Frank, and Tommy Field), survived the
crash, though they were badly injured. Durant suffered a broken leg and a badly injured back.
Two snipers, Master Sergeant Gary Gordon and Sergeant First Class Randy Shughart, had been
providing suppressive fire from the air at hostile Somalis who were converging on the area.
Both volunteered for insertion and fought off the advancing Somalis, killing an undetermined
number, until they ran out of ammunition and were overwhelmed and killed, along with
Cleveland, Frank, and Field. Both Gordon and Shughart received the Medal of Honor
posthumously for this action.
e The Somalis captured Durant and held him for several days. Durant was the only one of his
crew to survive. During part of Durant's time in captivity, he was cared for by Somali General
Mohamed Farrah Aidid's propaganda minister Abdullahi "Firimbi" Hassan. After eleven days
in captivity, Durant was released, along with a captured Nigerian soldier, to the custody of the
International Committee of the Red Cross.
Figure 5-2 Survival Medicine
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5.1.2. Factors that Reduce Survival Expectancy
Injuries and illnesses peculiar to certain environments can reduce survival expectancy. In cold
climates, and often in an open sea survival situation, exposure to extreme cold can produce
serious tissue trauma, such as frostbite, or death from hypothermia. Exposure to heat in warm
climates, and in certain areas on the open seas, can produce heat cramps, heat exhaustion, or life-
threatening heatstroke.
5.1.3. Loss of Gender Boundaries in a Survival Situation
Gender boundaries and social customs may need to be crossed during an isolating event. This
may involve a female treating a male or male treating a female. The relationship will be of a
clinical nature and could entail wound tending, feeding, and personal hygiene.
e During Desert Storm, then Major Rhonda Cornum was on a Black Hawk helicopter which
was shot down on February 27, 1991. She suffered two broken arms, a broken finger, a
gunshot wound in the back, and other injuries. She and two other survivors of the crash were
captured by the Iraqis. After three days of being roughly shuttled from bunkers to primitive
prisons, Major Cornum received medical attention. During their captivity and until their
repatriation, Sergeant Troy Dunlap, a US Army Pathfinder, assisted Major Cornum, acting as
her nurse and tending to her personal needs due to her inability to use her arms.
5.1.4. How Illnesses Can Interfere with a Successful Survival Situation Illnesses contracted
during evasion or in a captivity environment can interfere with successful survival. Among these
are gastrointestinal disorders, respiratory diseases, skin infections and infestations, malaria,
typhus, cholera, etc. Captives are, in the physical sense at least, under the control of their
captors. Thus, the application of SERE medicine principles will depend on the amount of
medical service and supplies the captors can and are willing to give to their prisoners. An enemy
may both withhold supplies and confiscate IP's supplies. Some potential enemies (even if they
wanted to provide captive medical support) have such low standards of medical practice that
their best efforts could jeopardize the recovery of the patient.
5.1.5. Probable Medical Injury in an IP Situation
Looking at combat recovery missions for the past five years, all IP recovered had some type of
medical injury ranging from minor to major including fractures, lacerations, burns, and combat
trauma. Potential IP must understand, that even in the unlikely event of ending up un-injured
during the initial part of their isolating event, 10 percent of all IP have some type of injury by
the time they are rescued. It is important to emphasize that even minor injuries or ailments, when
ignored, become major problems in a survival situation. Thus, prompt attention to the most
minor medical problem is essential in a survival episode. Applying principles of survival
medicine should enable military members to maintain health and well-being until rescued and
returned to friendly control.
5.2. Basic Health Care
In a survival situation, cleanliness is essential to prevent infection. Adequate personal
cleanliness will not only protect against disease germs that are present in the individual's
surroundings, but will also protect the group by reducing the spread of these germs.
5.2.1.1. Washing
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Washing, particularly the face, hands, and feet, reduces the chances of infection from small
scratches and abrasions. A daily bath or shower with hot water and soap is ideal. If a tub or
shower is not available, the body should be cleaned with a cloth and soapy water, paying
particular attention to the body creases (armpits, groin, etc.), face, ears, hands, and feet. After
this type of "bath", the body should be rinsed thoroughly with clear water to remove all traces of
soap, which could cause irritation.
5.2.1.2. Substitute when Soap is Unavailable
Soap, although an aid, is not essential to keeping clean. Ashes, sand, loamy soil, and other
expedients may be used to clean the body as well as clean cooking utensils.
5.2.1.3. Air Baths When Water is in Short Supply When water is in short supply, the IP
should take an "air bath." All clothing should be removed and the body simply exposed to the
air. Exposure to sunshine is ideal, but even on an overcast day or indoors, a two-hour exposure
of the naked body to the air will refresh the body. Care should be taken to avoid sunburn when
bathing in this manner. Exposure in the shade, shelter, sleeping bag, etc., will help if the weather
conditions do not permit direct exposure.
5.2.1.4. Keeping Hair Trimmed
Hair should be kept trimmed; preferably two inches or less in length, and the face should be
clean-shaven. Hair provides a surface for the attachment of parasites and the growth of bacteria.
Keeping the hair short and the face clean-shaven will provide fewer habitats for these organisms.
At least once a week, the hair should be washed with soap and water. When water is in short
supply, the hair should be combed or brushed thoroughly and covered to keep it clean. It should
be inspected weekly for fleas, lice, and other parasites. When parasites are discovered, they
should be removed.
5.2.1.5. Infection and Open Wounds
The principal means of infecting food and open wounds is when they come in contact with
unclean hands. Hands should be washed with soap and water, if available, after handling any
material which is likely to carry germs. This is especially important after each visit to the latrine,
when caring for the sick and injured, and before handling food, food utensils, or drinking water.
The fingers should be kept out of the mouth and the fingernails kept closely trimmed and clean.
A scratch from a long fingernail could develop into a serious infection.
5.2.2. Care of the Mouth and Teeth
Application of the following fundamentals of oral hygiene will prevent tooth decay and gum
disease. The mouth and teeth should be cleansed thoroughly with a toothbrush and toothpaste at
least once each day. When a toothbrush is not available, a "chewing stick" can be fashioned
from a twig. The twig should be washed, and then chewed on one end until it is frayed and
brush-like. The teeth can then be brushed very thoroughly with the stick, taking care to clean all
tooth surfaces. If necessary, a clean strip of cloth can be wrapped around the finger and rubbed
on the teeth to wipe away food particles which may have collected. When neither toothpaste nor
toothpowders are available, salt, soap, or baking soda can be used as a substitute. Gargling with
Willow bark tea will help protect the teeth and relieve pain. Gum tissues should be stimulated by
rubbing them vigorously with a clean finger each day.
5.2.2.1. Removing Food Debris
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Food debris which has accumulated between the teeth should be removed by using dental floss
or toothpicks. The latter can be fashioned from small twigs. Parachute inner core can be used by
separating the filaments of the inner core and using this as a dental floss. Dental floss can also
be improvised from fishing line.
5.2.2.2. Cleaning Dentures and Removable Bridges
Use as much care cleaning dentures and other dental appliances, removable or fixed, as when
cleaning natural teeth. Dentures and removable bridges should be removed and cleaned with a
denture brush or "chew stick" at least once each day. The tissue under the dentures should be
brushed or rubbed regularly for proper stimulation. Removable dental appliances should be
removed at night or for a two- to three-hour period during the day.
5.2.2.3. Dental Problems
Dental Problems were a common issue among captives, not only during confinement, but also
before capture. Periodontitis (inflammation of tissue surrounding the tooth), pyorrhea (discharge
of pus), and damage to teeth consistent with poor hygiene and "wear and tear" were also present.
5.2.2.4. Toothaches
Specific complaints such as pain associated with the common toothache represented one of the
most distressing problems faced by past POWs. Along with toothaches, captives may have to
deal with facial injury during egress, or caused by physical abuse during interrogation
5.2.2.5. Maintaining a Well Maintained Cleaning Program
The basic principle of maintaining a well-planned cleaning program using fiber, brushes, or
branches certainly contributed to the relatively low incidence of cavities and infection among
POW’s. The lancing of an abscess using bamboo sticks, although not a professional maneuver
has merit insofar as the pressure is relieved and the tendency to develop into cellulitis
(widespread infection) decreased. The application of aspirin directly into the cavity should be
discouraged. The most effective tool against dental complications in captivity is proper
preventive dentistry. The present program, if adhered to, is adequate to ensure a high state of
dental hygiene while captive. Dental pain/problems were a major concern mentioned by POWs
after their return from captivity during the Vietnam War. Dental pain made eating what little
food they received difficult, disrupted times when they were left alone by their captors, and
could undermine all other activities.
5.2.3. Care of the Feet
Proper care of the feet is of utmost importance in a survival situation, especially if the IP has to
travel. Serious foot trouble can be prevented by observing the following simple rules.
5.2.3.1. Washing or Air Cleaning Feet
The feet should be washed, dried thoroughly, and massaged each day. If water is in short supply,
the feet should be "air cleaned" along with the rest of the body.
5.2.3.2. Trimming Toenails
Toenails should be trimmed straight across to prevent the development of ingrown toenails.
5.2.3.3. Proper Fitting and Breaking in Boots
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Boots should be broken in before wearing them on any mission. They should fit properly,
neither so tight that they bind and cause pressure spots nor so loose that they permit the foot to
slide forward and backward when walking. Insoles can be improvised to reduce any friction
spots inside the shoes.
5.2.3.4. Socks
Socks should be large enough to allow the toes to move freely but not so loose that they wrinkle.
Wool socks should be at least one size larger than cotton socks to allow for shrinkage. Socks
with holes should be properly darned before they are worn. Wearing socks with holes or socks
that are poorly repaired may cause blisters. Clots of wool on the inside and outside should be
removed from wool socks because they may cause blisters. Socks should be changed and
washed thoroughly with soap and water each day. Woolen socks should be washed in cool water
to lessen shrinkage and turned inside out when cleaned. In camp, freshly laundered socks should
be stretched to facilitate drying by hanging in the sun or in an air current. While traveling, a
damp pair of socks can be dried by placing them inside layers of clothing or securing them on the
outside of the pack. If socks become damp, they should be exchanged for dry ones at the first
opportunity.
5.2.3.9. Examining Feet Regularly When Traveling
When traveling, the feet should be examined regularly to see if there are any red spots or blisters.
If detected in the early stages of development, tender areas should be covered with adhesive tape
to prevent blister formation.
5.3. Clothing and Bedding
Clothing and bedding can become contaminated with any disease germs which may be present
on the skin, in the stool, in the urine, or in secretions of the nose and throat. Therefore, keeping
clothing and bedding as clean as possible will decrease the chances of skin infection and
decrease the possibility of parasite infestation. Outer clothing should be washed with soap and
water when it becomes soiled. Socks and under clothes should be changed daily. If water is in
short supply, clothing should be "air cleaned. "For air cleaning, the clothing is shaken outside,
then aired and sunned for two hours. Clothing cleaned in this manner should be worn in rotation.
Sleeping bags should be turned inside out, fluffed, and aired after each use. Bed linen should be
changed at least once a week, and the blankets, pillows, and mattresses should be aired and
sunned (Figure 5-3).
Figure 5-3 Bedding
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5.3.1. Rest
Rest is necessary for the IP because it not only restores physical and mental vigor, but also
promotes healing during an illness or after an injury.
5.3.1.1. Planning Session
In the initial stage of the survival episode, rest is particularly important. After those tasks requiring
immediate attention are done, the IP should inventory available resources, decide upon a plan of
action, and even have a meal. This "planning session" will provide a rest period without the IP
having a feeling of "doing nothing."
5.3.1.2. Planned Rest Periods
If possible, regular rest periods should be planned in each day's activities. The amount of time
allotted for rest will depend on a number of factors, including the IP's physical condition, the
number of IP, the presence of hostile forces, etc. Usually, 10 minutes each hour should be
sufficient. During these rest periods, the IP should change either from physical activity to complete
rest or from mental activity to physical activity as the case may be. The IP must learn to become
comfortable and to rest under less than ideal conditions.
5.4. Illness
Many illnesses which are minor in a normal medical environment become major in a survival
situation when the individual is alone without medications or medical care. IP should use standard
methods (treat symptoms) to prevent expected diseases since treatment in a survival situation is so
difficult. In an isolating event, whether short-term or long-term, the dangers of disease are
multiplied. Key preventive methods are to maintain a current immunization record, maintain a
proper diet, and exercise.
5.4.1. Personal Hygiene
Application of the following simple guidelines regarding personal hygiene will enable the IP to
safeguard personal health and the health of others:
e All water obtained from natural sources should be disinfected before consumption if possible.
e The ground in the camp area should not be soiled with urine or feces. Latrines should be used.
When no latrines are available, individuals should dig "cat holes" and cover their waste.
Fingers and other contaminated objects should never be put into the mouth. Hands should be
washed before handling any food or drinking water, before using the fingers in the care of the
mouth and teeth, before and after caring for the sick and injured, and after handling any
material likely to carry disease or germs.
After each meal, all eating utensils should be cleaned and disinfected in boiling water.
The mouth and teeth should be cleansed thoroughly at least once each day.
Bites and insects can be avoided by keeping the body clean, by wearing proper protective
clothing, and by using a head net, improvised bed nets, and insect repellants.
Wet clothing should be exchanged for dry clothing as soon as possible to avoid unnecessary
body heat loss. Refer to chapter 15 for more information on the care and use of clothing and
equipment.
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e Personal items such as canteens, pipes, towels, toothbrushes, handkerchiefs, and shaving items
should not be shared with others.
e All food scraps, cans, and refuse should be removed from the camp area and buried.
e If possible, an IP should get seven or eight hours of sleep each night.
5.4.2. Food Poisoning
Food poisoning is a significant threat to IP. Due to sporadic food availability, excess foods must
be preserved and saved for future consumption. Methods for food preservation vary with the
global area and situation. Bacterial contamination of food sources has historically caused much
more difficulty in survival situations than the ingestion of poisonous plants and animals. Similarly,
dysentery or water-borne diseases can be controlled by proper sanitation and personal hygiene. If
the food poisoning is due to toxins such as staphylococcus or botulism (acute symptoms of nausea,
vomiting, and diarrhea soon after ingestion of the contaminated food), supportive treatment is best.
Keep the patient quiet, lying down, and ensure the patient drinks substantial quantities of water.
If the poisoning is due to ingestion of bacteria which grow within the body, (delayed gradual onset
of same symptoms), take antibiotics (if available). In both cases, symptoms may be alleviated by
frequently eating small amounts of fine, clean charcoal. In POW situations, if chalk is available,
reduce it to powder, and eat to coat and soothe the intestines. Proper sanitation and personal
hygiene will help prevent spreading infection to others in the party or continuing re-infection of
the patient.
5.4.3. Gastrointestinal Problems
Gastrointestinal problems often occur while in captivity.
5.4.3.1. Diarrhea and Dysentery
Diarrhea and Dysentery are common ailments in captivity. Symptoms of diarrhea and dysentery
include violent explosive uncontrollable discharge with possible passage of mucous and blood.
They are commonly caused by ingesting contaminated food and water, poor sanitation and
hygiene, viral infections, and nutritional disturbances. Treatment can involve diet restrictions
(solid food denial and increased liquid intake). Restrict intake to nonirritating foods (avoid
vegetables and fruits), establish hygienic standards, increase fluid intake, and, when available, use
anti-diarrheal agents. Captives can use a more exotic therapeutic regimen consisting of eating
cooked green bananas, tea from specific tree bark, and drinking a quarter teaspoon of ground
charcoal or chalk mixed with a quart of disinfected water.
5.4.3.2. Worms and Intestinal Parasites
Worms were extremely common in captivity. Twenty-eight percent of the released prisoners in
the Vietnam War indicated worms as a significant medical problem during captivity.
e Danya Curry and Heather Mercer were held as prisoners by the Taliban, ultimately being
rescued by Special Forces after 9/11. After three months of captivity, Heather had been given
prescription medication to get rid of worms. Half way through the six pill treatment, one night
she felt a “string” resting on her tongue, when she pulled it out; it was identified as a 10” worm.
Later that night more worms attempted to crawl out, later diagnoses indicated that her
infestation was so severe that the worms crawled out not because of the medicine, but they had
“nowhere else to go”.
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5.4.3.2.1. Symptoms and Care of Worm Infestation
Seldom fatal, worms are significant, as they can lower the general resistance other illnesses of the
individual. Common identifiers of worms include severe rectal itching, insomnia, and restlessness.
Worms often cause gastrointestinal problems similar to those resulting from a variety of other
causes. Prevention can be a simple and readily obtainable goal. Worms and intestinal parasites
can be caused by undercooked or contaminated food, poor sanitation, and infected water sources.
Treatments can include the ingestion of peppers which contain certain substances chemically
similar to morphine. They are effective as a counter-irritant for decreasing bowel activity. Also,
pumpkin seeds can be ground up and mixed with water into a “medicinal” porridge or a cup of tea
made from one to two grams of thyme multiple times per day can be ingested. Lastly, shoes should
be worn when possible, hands should be washed after defecation, and fingernails should be
trimmed close and frequently.
5.4.4. Nutritional Deficiencies
Nutritional deficiencies are caused by a lack of a specific nutrient that the body requires.
Prevention for all nutritional disease include keeping the IP in good physical condition prior to the
isolating event, educate themselves on local food sources, and eating everything and anything
which is not harmful to themselves (balanced diet).
5.4.4.1. Vitamin B Deficiency (Beriberi)Beriberi is a nutritional disease resulting from a
deficiency of vitamin B (Thiamine). Early signs and symptoms of the disease include muscle
weakness and atrophy, loss of vibratory sensation over parts of the extremities, numbness, and
tingling in the feet. According to captives, Beriberi’s primary manifestation was pain in the feet
described as "a minor frostbite that turned to shooting pains”. It is difficult to formulate a diagnosis
for Beriberi. The treatment is to increase caloric intake by eating anything of value, especially
items high in vitamin B such as green peas, cereal grains, and unpolished rice.
5.4.4.2. Vitamin A Deficiency
There were several reported cases of decreased vision (primarily at night) attributed to vitamin A
deficiency. This problem usually occurred during periods of punishment or politically provoked
action when food was withheld as part of the discipline. The condition responded well to increased
caloric intake and deserves little special mention. An understanding of the transient nature of this
problem and its remedial response to therapy is important.
5.4.5. Skin Diseases
Boils, fungi, heat rash, and insect bites appeared frequently and typically remain a problem
throughout the captivity experience. Preventing different types of skin diseases can be simple.
Common preventions include practicing sterility when handling skin conditions, cleanliness,
exposure to sunlight, keeping skin dry, and getting adequate nutrition.
5.4.5.1. Lesions
Dermatological lesions are common to various prison experiences. Their importance lies not in
their lethality, but for their irritant quality and the debilitating and grating effect on morale and
mental health.
5.4.5.2. Fungal Infections
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Fungal infections were a common skin problem for those in tropical captivity settings. As with
other skin lesions, they are significant for their noxious characteristics and weakening effect on
morale and mental health. Superficial fungal infections of the skin are widespread throughout the
world. Their frequency among POWs reflects the favorable circumstances of captivity for
cultivating fungal infections. Treatment may consist of the removal of body hair (to prevent or
improve symptoms in the case of heat rash), exposure to sunlight to dry out fungal lesions, and
development of effective techniques to foster body cooling and to decrease heat generation.
Considerable effort should be directed at keeping the body clean.
5.4.5.3. Boils and Blisters
Boils and blisters are typically deep-seated infection that usually involves the hair follicles and
adjacent subcutaneous tissue, especially parts exposed to constant irritation. Boils and blisters are
typically caused by warm humid dark places, poor sanitation and hygiene, and will increase with
malnutrition and exhaustion. Boils seldom appear singularly. Once present, they are disseminated
by fingers, clothing, and discharges from the nose, throat, and groin. Throughout the history of
POW captivity, self-treatment was practiced primarily when there was distrust of captor
techniques. Prisoners would attempt to lance the boil with any sharp instrument such as a needle,
wire, splinters, etc., and exude their contents by applying pressure. The area was then covered
with toothpaste and when available, iodine. Modern therapy consists of hot compresses to hasten
localization, and then conservative incision and drainage. Topical antibiotics and systemic
antibiotics are then used. Boils increase in frequency with a decrease in resistance as seen in
malnutrition and exhaustion states in a tropical environment. The application of any material or
medication with a cleansing effect may be used (soaks in saline, soap, iodine, and topical
antibiotics).
5.5. Injury
Injuries are possible during any isolating event. In isolating events involving captivity, it is likely
that an IP will begin their captivity experience with pre-capture injuries such as burns, wounds,
fractures, and lacerations as well as the possibility of other injuries occurring from the captor’s
physical abuse. The practice of a few simple rules will generally lead to acceptable results in
wound treatment. Also, if necessary, much can be done after reintegration to correct cosmetic and
functional defects that may occur during an isolating event.
5.5.1. General Management of Injuries
5.5.1.1. Bleeding
Bleeding is the first and most important concern and must be controlled as soon as possible.
Controlling bleeding is important because in survival situations, replacement transfusions are not
possible. Immediate Self-Aid-Buddy-Care (SABC) steps should be taken to stop the flow of
blood, regardless of its source. The method used should be commensurate with the type and degree
of bleeding. Most bleeding can be controlled by direct pressure on the wound and that should be
the first treatment used. To control bleeding by direct pressure on the wound, sufficient pressure
must be exerted to stop the bleeding, and that pressure must be maintained long enough to "seal
off" the bleeding sources. It is best to apply the pressure and keep it in place for up to 20 minutes.
Alternate pressing and then releasing to see if the wound is still bleeding is not desirable. Oozing
blood from a wound of an extremity can be slowed or stopped by elevating the wound above the
level of the heart.
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5.5.1.1.1. Pressure Points to Stop Hemorrhaging
If direct pressure fails, the next line of defense would be the use of classic pressure points to stop
hemorrhaging.
5.5.1.1.2. Tourniquet
The last method for controlling hemorrhage would be the tourniquet. The tourniquet should only
be used as a last resort. Even in more favorable circumstances where the tourniquet can be applied
as a first aid measure and left in place until trained medical personnel remove it, the tourniquet
may result in the loss of a limb. The tourniquet should be used only when all other measures have
failed, and it is a life and death matter. A tourniquet, when required and properly used, will save
life. The basic characteristics of a tourniquet and the methods of its use are well covered in
standard first aid texts; however, certain points merit emphasis in survival medicine. A tourniquet
should be used only after every alternate method has been attempted. If unable to get to medical
aid, after 15 to 20 minutes, the IP should gradually loosen the tourniquet. If bleeding has stopped,
remove the tourniquet; if bleeding continues, reapply and leave in place. The tourniquet should
be applied as near the site of the bleeding as possible, between the wound and the heart, to reduce
the amount of tissue lost. NOTE: Use of a constricting band that reduces rather than stops blood
flow is NOT recommended. It does not allow for venous blood return.
5.5.1.2. Pain
The control of pain accompanying disease or injury under survival situations is both difficult and
essential. In addition to its morale-breaking discomfort, pain contributes to shock and makes the
IP more vulnerable to enemy influences. Ideally, pain should be eliminated by the removal of the
cause. However, this is not always immediately possible. Therefore, measures for the control of
pain are beneficial. Position, heat, and cold can be applied alone or in conjunction with each other.
5.5.1.2.1. Position
The part of the body that is hurting should be put at rest, or at least its activity restricted as much
as possible. The position selected should be the one giving the most comfort, and be the easiest to
maintain. Splints and bandages may be necessary to maintain immobilization of the affected area.
Elevation of the injured part, with immobilization, is particularly beneficial for throbbing type pain
such as is typical of the "mashed" finger. Open wounds should be cleansed, foreign bodies
removed, and a clean dressing applied to protect the wound from the air and chance contacts with
environmental objects to help reduce pain.
5.5.1.2.2. Heat and Cold
Generally, the application of warmth reduces pain such as toothache, bursitis, etc. However, in
some conditions, application of cold on injuries such as strains and sprains has the same effect.
Warmth or cold is best applied by using water soaked rags, materials, or water filled storage bags.
This works well due to water’s high specific heat. The IP can try both to determine which is most
beneficial. Caution should be used when placing hot or cold materials in direct contact with skin
to avoid additional injuries.
5.5.1.2.3. Pain Killers
Drugs are very effective in reducing pain. However, they are not likely to be available in the
survival situation unless the IP adds them to a personal survival kit. “Natural" procedures can be
an alternative to pain killers in a survival situation. If drugs are not available, there are some parts
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of vegetation which can be used. For example, parts of the Willow tree have been used for their
pain-relieving and fever-lowering properties for hundreds of years. The fresh bark contains salicin,
a substance that chemically resembles aspirin. It temporarily relieves headache, stomachache, and
other body pain. Salicin is metabolized in to salicylic acid in the human body, which is a precursor
of aspirin. Boiling eight to ten six-inch stalks in two cups of water until water turns into tea will
yield a pain relieving drink. Wintergreen was also traditionally used for body aches and pains as
well. Boil a half a cup of leaves into a tea and ingest the tea to reduce pains. Also, the boiled bark
of the magnolia tree helps relieve internal pains and fever, and has been known to stop dysentery.
To be effective controlling pain, stronger narcotic drugs such as codeine and morphine are
required.
5.5.1.3. Shock
In essence, shock is a circulatory reaction of the body (as a whole) to an injury (mechanical or
emotional). All IP should be familiar with the signs and symptoms of shock so that the condition
may be anticipated, recognized, and dealt with effectively. However, the best survival approach
is to treat all moderate and severe injuries for shock. No harm will be done, and such treatment
will speed recovery. Normally, fluids administered by mouth are generally prohibited in the
treatment of shock following severe injury. Such fluids are poorly absorbed when given by mouth,
and they may interfere with later administration of anesthesia for surgery. In survival medicine,
however, the situation is different in that the treatment being given is the final treatment. IP cannot
be deprived of water for long periods just because they have been injured; in fact, their recovery
depends upon adequate hydration. Small amounts of warm water, warm tea, or warm coffee given
frequently early in shock are beneficial if the patient is conscious, can swallow, and has no internal
injuries. In later shock, fluids by mouth are less effective as they are not absorbed from the
intestines. Burns, in particular, require large amounts of water to replace fluid lost from injured
areas. Alcohol should never be given to a person in shock or who may go into shock.
5.5.2. Infections
Infection is a serious threat to the IP. In survival medicine, one must place more emphasis on the
prevention and control of infection by applying techniques identified throughout this handbook.
In survival or captivity, consider all breaks in the skin due to mechanical trauma contaminated,
and treat appropriately. Even superficial scratches should be cleaned with soap and water and
treated with antiseptics, if available.
5.5.2.1. Basic Treatment
Water is the most universally available cleaning agent, and should be (preferably) sterile. At sea
level, sterilize water by placing it in a covered container and boiling it for 10 minutes. Above
3,000 feet, water should be boiled for one hour (in a covered container) to ensure adequate
sterilization. The water will remain sterile and can be stored indefinitely as long as it is covered.
When water is not available for cleaning wounds, the IP should consider the use of urine. Urine
may well be the most nearly sterile of all fluids available and, in some cultures, is preferred for
cleaning wounds. IP should use urine from the midstream of the urine flow. Antiseptics should
generally not be used in wounds which go beneath the skin's surface since they may produce tissue
damage which will delay healing. Open wounds must be thoroughly cleansed with disinfected
water. Irrigate wounds rather than scrubbing to minimize additional damage to the tissue. Bits of
debris such as clothing, plant materials, etc., should be rinsed out of wounds by pouring large
amounts of water into the wounds and ensuring that even the deepest parts are clean. In a fresh
51
wound where bleeding has been a problem, care must be taken not to irrigate so vigorously that
clots are washed away and the bleeding resumes. Allow a period of about an hour after the
bleeding has been stopped before beginning irrigation with the disinfected water. Begin gently at
first, removing unhealthy tissue, increasing the vigor of the irrigation over a period of time. If the
wound must be cleaned, use great care to avoid doing additional damage to the wound. The wound
should be left open to promote cleansing and drainage of infection.
5.5.2.2. The "Open Treatment" Method
This is the only safe way to manage survival wounds. Efforts to close open wounds by suturing
or by other procedure should not be made. In fact, it may be necessary to open the wound even
more to avoid entrapment or infection and to promote drainage. The term "open" does not mean
that dressings should not be used. Good surgery requires that although wounds are not "closed,"
nerves, bone, and blood vessels should be covered with tissue. Such judgment may be beyond the
capability of the IP, but protection of vital structures will aid in the recovery and ultimate function.
A notable exception to "open treatment" is the early closure of facial wounds which interfere with
breathing, eating, or drinking. Wounds, left open, heal by formation of infection resistant
granulation tissue (proud flesh). This tissue is easily recognized by its moist red granular
appearance, a good sign in any wound. Frequently, immobilization will hasten the healing of
major lacerations. While in captivity, deep open wounds will become infested with maggots
frequently. The natural tendency is to remove these maggots, but actually, they do a good job of
cleansing a wound by removing dead tissue. Maggots may, however, damage healthy tissue when
the dead tissue is removed. So the maggots should be removed if they start to affect healthy tissue.
5.5.2.3. Maggot Therapy
The scavenging activity of the maggots actually removes dead tissue. The maggots excrete a
digestive fluid which liquefies the tissue proteins, which the maggots then ingest. The maggots
exude calcium carbonate which alkalizes the wound and increases the destruction of bacteria and
dead tissue by the body’s white blood cells. The maggot’s excretion also contains two chemicals
which stimulate growth of healthy tissue and hasten wound healing. Excretions contain both
allantoin and urea which stimulate growth of healthy tissue and hasten wound healing.
5.5.2.4. Physiological "Logistics"
Despite all precautions, some degree of infection is almost universal in survival wounds. This is
the primary reason for the "open" treatment advocated above. The human body has a tremendous
capacity for combating infections if it is permitted to do so. The importance of proper rest and
nutrition to wound healing and infection control has been mentioned earlier. In addition, the
"logistics" of the injured body part should be improved. The injury should be immobilized in a
position to favor adequate circulation, both to and from the wound. Avoid constrictive clothing or
bandages. Applying heat to an infected wound will further aid in mobilizing local body defense
measures. Soaking the wound in lukewarm saltwater will help draw out infection and promote
oozing of fluids from the wound, thereby removing toxic products. Poultices, made of clean clay,
shredded tree bark with antiseptic qualities, ground grass seed, etc., will also draw out the infection.
e For bee stings and other common skin problems, use clay with disinfected water. Mix
together, using only enough water to form a thick paste, and apply it on the problem area.
Let the clay dry for about 20 minutes, and then rinse it off with cool disinfected water.
52
e Fora ground seed poultice, insert the ground seed between the third and fourth layers of
gauze or bandage material and close. Pour hot water over the gauze to release the flaxseed's
essential oils. Set the poultice aside to cool. Apply the poultice to the wound using medical
tape to secure it in place.
5.5.2.9. Drainage
Adequate natural drainage of infected areas promotes healing. Generally, wicks or drains are
unnecessary. On occasion, it may be better to remove an accumulation of pus (abscess) and insert
light, loose packing to ensure continuous drainage. The knife or other instrument used in making
the incision for drainage must be sterilized to avoid introducing other types of organisms. The
best way to sterilize in the field is with dry or moist heat.
5.5.2.6. Debridement
Debridement is the surgical removal of lacerated, devitalized, or contaminated tissue. The
debridement of severe wounds may be necessary to minimize infection (particularly of the gas
gangrene type) and to reduce septic (toxic) shock. In essence, debridement is the removal of
foreign material and dead or dying tissue. The procedure requires skill and should only be done
by nonmedical personnel in case of dire emergency. If required, follow these general rules. Dead
skin must be cut away. Muscle may be trimmed back to a point where bleeding starts and gross
discoloration ceases. Fat which is damaged tends to die and should be cut away. Bone and nerves
should be conserved where possible and protected from further damage. Provide ample natural
drainage for the potentially infected wound and delay final closure of the wound.
5.5.2.7. Sutures
On occasion, it may be necessary to suture the wound, despite the danger of infection, in order to
control bleeding or increase the mobility of the patient. If a needle is available, thread may be
procured from parachute lines, fabric, or clothing, and the wound closed by "suturing." If suturing
is required, place the stitches individually and far enough apart to permit drainage of underlying
parts. Do not worry about the cosmetic effect; just approximate the tissue. For scalp wounds, hair
may be used to close after the wound is cleansed. Infection is less a danger in this area due to the
rich blood supply. Remember that in most situations, it is imperative that the wound be left open
and allowed to drain.
5.5.2.8. Dressings and Bandages
After cleansing, some wounds should be covered with a clean dressing. The dressing should be
sterile. However, in the survival situation, any clean cloth will help to protect the wound from
further infection. A proper bandage will anchor the dressing to the wound and afford further
protection. Bandages should be snug enough to prevent slippage, yet not constrictive. Slight
pressure will reduce discomfort in most wounds and help stop bleeding. Once in place, dressings
should not be changed too frequently unless required. External soiling does not reduce the
effectiveness of a dressing, and pain and some tissue damage will accompany any removal. In
addition, changing dressings increases the danger of infection.
5.5.3. Lacerations
When soft tissue is split, torn, or cut, there are three primary concerns: 1) bleeding, 2) infection,
and 3) healing of the wound. See bleeding section under General Management of Injuries 5.5.1.1.
5.5.3.1. Infection
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Infection is the second concern when dealing with lacerations. It is extremely important that an
IP take proper precaution to prevent wounds from becoming infected.
5.5.3.2. Healing
An open wound will heal by a process known as granulation. During the healing phase, the wound
should be kept as clean and dry as possible. For protection, the wound may be covered with clean
dressings to absorb the drainage and to prevent additional trauma to the wound. These dressings
may be loosely held in place with bandages (clean material may be used for dressings and
bandages). The bandages should not be tight enough to close the wound or to impair circulation.
At the time of dressing change, disinfected water may be used to gently rinse the wound. The
wound may then be air dried and a clean dressing applied (the old dressing may be boiled, dried,
and reused). Nutritional status is interrelated with the healing process, and it is important to
consume all foods available to provide the best possible opportunity for healing.
5.5.4. Fractures and Sprains
Throughout history, captive therapy was primarily that of helping each other to exercise or
immobilize the injured area, and in severe cases, to provide nursing care. In survival medicine,
the initial immobilization is part of the ultimate treatment. In addition, immobilization in proper
position hastens healing of fractures and improves the ultimate functional result. In an isolating
event, the immobilization must suffice for a relatively long period of time and permit the patient
to maintain a fairly high degree of mobility. Materials for splinting and bandaging are available
in most survival situations, and proper techniques are detailed in SABC.
5.5.4.1. Fractures
Bone fractures are of two general types, open and closed. The open fracture is associated with a
break in the skin over the fracture site which may range all the way from a broken bone protruding
through the skin to a simple puncture from a bone splinter. The general goals of fracture
management are: restore the fracture to a functional alignment; immobilize the fracture to permit
healing of the bone and rehabilitation.
5.5.4.1.1. Reducing Fractures
The reduction of fractures is normally beyond the scope of first aid; however, in the prolonged
survival situation, the correction of bone deformities is necessary to hasten healing and obtain the
greatest functional result. The best time for manipulation of a fracture is in the period immediately
following the injury, before painful muscle spasms ensue (Figure 5-4). Restoring or reducing the
fracture simply means realigning the pieces of bones, putting the broken ends together as close to
the original position as possible. The natural ability of the body to heal a broken bone is
remarkable and it is not necessary that an extremity fracture be completely straight for satisfactory
healing to occur. However, in general, it is better if the broken bone ends are approximated so that
they do not override. Fractures are almost always associated with muscle spasms which become
stronger with time. The force of these muscle spasms tends to cause the ends of the broken bones
to override one another, so the fracture should be reduced as soon as possible. To overcome the
muscle spasm, force must be exerted to reestablish the length of the extremity. Traction is applied
by firmly and steadily pulling on the extremity until overriding fragments of bone are brought into
line (check by the other limb). If the IP is alone, the problem is complicated but not impossible.
Traction can still be applied by using gravity. The distal portion of the extremity is tied to (or
wedged) into the fork of a tree or similar point of fixation. The weight of the body is then allowed
54
to exert the necessary traction, with the joint being manipulated until the dislocation is reduced.
Frequently, it is advantageous to continue traction after reduction to ensure the proper alignment
of the bones. Once the ends of the bone are realigned, the force of the muscle spasm tends to hold
the bones together.
Figure 5-4 Fracture
5.5.4.1.2. Immobilizing Fractures
At this point, closed fractures are ready to be immobilized, but open fractures require treatment of
the soft tissue injury in the manner outlined earlier. In other words, the wound must be cleansed
and dressed, and then the extremity should be immobilized. The immobilization preserves the
alignment of the fracture and prevents movement of the fractured parts which would delay healing.
Once the extremity is immobilized the pulse should be repeatedly checked at the farthest part of
the immobilized limb to ensure circulation. For fractures of long bones of the body, it becomes
important to immobilize the joints above and below the fracture site to prevent movement of the
bone ends. For example, in a fracture of the mid forearm, both the wrist and the elbow should be
immobilized. In immobilizing a joint, it should be fixed in a "neutral" or functional position. That
is, neither completely straight nor completely flexed or bent, but in a position approximately
midway between. In splinting a finger, for example, the finger should be curved to about the same
position the finger would naturally assume at rest.
5.5.4.2. Sprains
An acute non-penetrating injury to a muscle or joint is best managed by applying cold as soon as
possible after the injury. Icepacks or cold compresses should be used intermittently for up to 48
hours following the injury. This will minimize hemorrhage and disability. Be careful not to use
snow or ice to the point where frostbite or cold injury occurs. As the injured part begins to become
numb, the ice should be removed to permit re-warming of the tissues. Then the ice can be
reapplied. Following a period of 48 to 72 hours, the cold treatment can be replaced by warm packs
to the affected area. A "sprain or strain" may involve a wide variety of damage ranging from a
55
simple bruise to deep hemorrhage or actual tearing of muscle fibers, ligaments, or tendons. While
it is difficult to establish specific guidelines for treatment in the absence of a specific diagnosis, in
general, injuries of this type require some period of rest (immobilization) to allow healing. The
period of rest is followed by a period of rehabilitation (massage and exercise) to restore function.
For what appears to be a simple superficial muscle problem, a period of five to 10 days rest
followed by a gradual progressive increase in exercise is desirable. Pain should be a limiting
factor. If exercise produces significant pain, the exercise program should be reduced or
discontinued. In captivity, it is probably safest to treat severe injuries to a major joint like a fracture
with immobilization (splint, cast) for a period of four to six weeks before beginning movement of
the joint.
5.5.4.3. Splints
A splint of any rigid material such as boards, branches, bamboo, metal boot insoles, or even tightly
rolled newspaper may be almost as effective as plaster or mud casts. In conditions such as
continuous exposure to wetness, the splint can be cared for more effectively than the plaster or
mud cast. Also, in cases where there is a soft tissue wound in close proximity to the fracture, the
splint method of immobilization is more desirable than a closed cast because it permits change of
dressing, cleaning, and monitoring of the soft tissue injury. Improvising a splint using available
materials may be done using the materials listed above or using several parallel, pliable branches,
woven together with vines, cords, or parachute lines. Use care so that the extremity is not
constricted when swelling follows the injury. The fracture site should be loosely wrapped with
parachute, other type of cloth, or soft plant fibers. The splints can then be tied in place extending
at least the entire length of the broken bone and preferably fashioned in such a way as to
immobilize the joint above and below the fracture site. Splinting or immobilizing materials should
be insulated to avoid heat/cold injuries as well as improve comfort (Figure 5-5). It may be
necessary to preserve the mobility of the IP after reduction of the fracture. This is difficult in
fractures of the lower extremities, although tree limbs may be improvised as crutches. With
companions, the use of improvised litters may be possible.
Figure 5-5 Splinting
5.5.4.4. Immobilization Duration
The time required for immobilization to ensure complete healing is very difficult to estimate. It
must be assumed that healing time will, in general, be prolonged. This means that for a fracture
56
of the upper extremity of a "non-weight bearing bone," immobilization might have to be
maintained for eight weeks or more to ensure complete healing. For a fracture of the lower
extremity or a "weight bearing bone," it might require 10 or more weeks of immobilization.
5.5.4.5. Swelling
While a limb is immobilized swelling is a common side effect that will need to be dealt with.
Keeping the limb elevated as much as possible throughout the day to aid in circulation will help.
5.5.4.6. Rehabilitation
Following the period of immobilization and fracture healing, a program of rehabilitation is
required to restore normal functioning. Muscle tone must be re-established and the range of motion
of immobilized joints must be restored. In cases where joints have been immobilized, the
rehabilitation program should be started with "passive range of motion exercises". This means
moving the joint through a range of motion without using the muscles which are normally used to
move that joint. For example, if the left wrist has been immobilized, a person would begin the
rehabilitation program by using the right hand to passively move the left wrist through a range of
motion which can be tolerated without pain. When some freedom of motion of the joint has been
achieved, the individual should begin actively increasing that range of motion using the muscles
of the joint involved. Do not be overly forceful in the exercise program. Using pain as a guideline,
the exercise should not produce more than minimal discomfort. Over a period of time, the joint
movement should get progressively greater until the full range of motion is restored. Also,
exercises should be started to restore the tone and strength of muscles which have been
immobilized. Again, pain should be the limiting point of the program and progression should not
be so rapid as to produce more than a minimal amount of discomfort.
5.5.5. Burns
Burns, encountered in isolating events, pose serious problems (Figure 5-6). Burns cause severe
pain, increase the probability of shock and infection, and offer an avenue for the loss of
considerable body heat, fluids, and salts. Initially, cooling a small area burn (10 percent of the
body or less than any single extremity) by immersing in cool water or using a cold, moist, compress
will provide relief from pain. Treating larger burns with cool water is risky due to the danger of
hypothermia. Covering the wound with a clean, dry, dressing of any type reduces the chance for
infection. Such protection enhances the mobility of the patient and the capability for performing
other vital survival functions. In burns about the face and neck, ensure the victim has an open
airway. Burns of the face and hands are particularly serious in a survival situation as they interfere
with the capability of IP to meet their own needs. Breaking an aloe vera leaf and spreading the
internal clear gel on burns will aid in the healing process. Additionally, soaking certain barks
(Willow, Oak, and Maple) in water soothes and protects burns by astringent action. This is a
function of the acid content of these barks.
57
Figure 5-6 Burns
5.5.5.1. Maintenance of Fluids to Recover From Burns
Maintenance of body fluids and salts is essential to recover from burns. Usually the only way to
administer fluids in a survival situation is by mouth; hence, the casualty should ingest sufficient
water early before the nausea and vomiting of toxicity intervenes. Consuming the eyes and blood
(both cooked) of animals can help restore electrolyte levels if salt tablets are not available. NOTE:
The IP may also pack salt in personal survival kits to replace electrolytes (one quarter (1/4)
teaspoon per quart of water).
5.5.6. Head Injuries
Injuries to the head pose additional problems related to brain damage as well as interfering with
breathing and eating. Bleeding is more profuse in the face and head area, but infections have more
difficulty in taking hold. This makes it somewhat safer to close such wounds earlier to maintain
function. Cricothyroidotomy may be necessary if breathing becomes difficult due to obstruction
of the upper airways. In the event of unconsciousness, watch the patient closely and keep him or
her still. Even in the face of mild or impending shock, keep the head level or even slightly elevated
if there is reason to expect brain damage. Do not give fluids or morphine to unconscious persons.
5.5.6.1. Performing a Cricothyroidotomy
Often, the safest and fastest method to establish a surgical airway is to perform a
cricothyroidotomy. In this procedure, the cricothyroid membrane is opened to allow air to pass
through into the trachea. The cricothyroid membrane is the soft spot just below the Adam's apple
(thyroid cartilage) and just above the cricoid cartilage. In men, this is easily identified by running
your finger down the center of the neck. Just beyond the Adam's apple the cricothyroid membrane
is asmall, soft indentation about the width of your finger.
5.5.6.2. Locating the Cricothyroid Membrane
The thyroid cartilage (Adam's apple) in women is not usually as prominent as it is in men. It is
easier to find their cricothyroid membrane by sliding your finger up the midline of the neck to the
58
first hard bump. That is the cricoid cartilage. Above the cartilage is the cricothyroid membrane
(your target), and above the membrane is the thyroid cartilage. Practice identifying the
cricothyroid membrane in your own neck, and in other personnel. Then, in an emergency, you will
have no difficulty finding it.
5.5.6.3. Tools Needed to Perform a Cricothyroidotomy
To perform an emergency cricothyroidotomy, a sharp instrument, is needed. The following
provides examples of instruments that can be used:
e Scalpel
e Pocket knife
e Scissors
e Razor blade
e Sharp edge of a tin can
e Broken glass
5.5.6.4. Speed is Necessary for Performing a Cricothyroidotomy
Ideally, this procedure is performed by well-trained and experienced medical personnel, using
sterile technique and instruments designed for this purpose. In other than ideal conditions, speed
is more important than sterile technique, special instruments or experience. In an operational
setting, if the casualty needs a surgical airway, go ahead and do it, and do it quickly. Some of the
most successful airway rescues have been performed by inexperienced, minimally-trained
personnel, who have never done this before. There typically won't be time for any anesthetic, but
that is not normally an issue since the people on whom you would be doing this procedure will be
unconscious. Bleeding usually is not a problem because there are no large blood vessels either in
the skin or beneath the skin in this area. Whatever device you use to keep the airway open, try to
find some adhesive tape to hold it in place, without obstructing air flow. An emergency
cricothyroidotomy can be left in place for up to 72 hours, but after that, it should be replaced by a
tracheotomy, placed lower in the trachea by trained surgeons.
5.9.6.4.1. Cricothyroidotomy Procedure
Here is the process for performing this procedure:
1. Identify the cricothyroid membrane with your index finger.
2. Make a transverse incision using any available sharp object, directly over the cricothyroid
membrane. The incision should be about an inch long.
3. Once through the skin, feel with your index finger for the soft, compressible cricothyroid
membrane.
4. Take your sharp object and push it straight down through the cricothyroid membrane.
There will be a distinct "pop" as you open the trachea. Don't worry about going too deep.
The far side of the trachea at this point is made of very tough cartilage and it's not too
easy to go all the way through it.
5. Once through the membrane, withdraw your sharp instrument and replace it with a hollow
tube to keep the airway open.
59
6. Ideally, this hollow tube would be an endotracheal tube, but any tube-like structure will
work fine. Examples include:
— Ball point pen barrel
— Nail clipper
— Two keys
— One key turned sideways
— Bent paper clip
5.5.7. Abdominal Wounds
Wounds of the abdomen are particularly serious in a survival situation and the IP must seek
immediate medical attention. Such wounds, without immediate and adequate surgery, have an
extremely high mortality rate and render patients totally unable to care for themselves. If intestines
are not extruded through the wound, a secure bandage should be applied to keep this from
occurring. If the intestine is extruded, do not replace it due to the almost certain threat of fatal
peritonitis. Cover the extruded bowel with a large dressing and keep the dressing wet with any
drinkable fluid or if drinkable fluid is unavailable, then urine may be used. The IP should lie on
their back and avoid any motions that increase intra-abdominal pressure which might extrude the
bowels even more. Keep the IP in an immobile state or move on a litter. "Nature" will eventually
take care of the problem either through death, or walling-off of the damaged area.
5.5.8. Chest Injuries
Injuries of the chest are common, painful, and disabling. In the case of a flail chest, ribs broken
away from the sternum, apply a bulky dressing and wrap to immobilize. Severe bruises of the
chest or fractures of the ribs may require that the chest be immobilized to prevent large painful
movements of the chest wall. If a bandage is required, apply it while the patient deeply exhales.
In an isolating event, it may be necessary for IP to wrap their own chest. This is more difficult but
can be done by attaching one end of the long bandage (parachute material) to a tree or other fixed
object, holding the other end in the hand, and slowly rolling body toward the tree, keeping enough
counter pressure on the bandage to ensure a tight fit.
5.9.8.1. Sucking Chest Wounds
These wounds are easily recognized by the sucking noise and appearance of foam or bubbles in
the wound. These wounds must be closed immediately before serious respiratory and circulatory
complications occur. Ideally, the patient should attempt to exhale while holding the mouth and
nose closed (Valsalva) as the wound is closed. This inflates the lungs and reduces the air trapped
in the pleural cavity. This procedure may need to be repeated if symptoms return or worsen.
Frequently, a taped, airtight dressing is all that is needed, but sometimes it is necessary to suture
the wound to make sure the wound is closed.
5.9.9. Eye Injuries
Eye injuries are quite serious in a survival situation due to pain and interference with other survival
functions. The techniques for removing foreign bodies and for treating snow blindness are covered
in SABC. With more serious eye injuries involving disruption of the contents of the orbit or
impaled objects additional steps may be required (note: Do not remove an object that is impaled
60
in the eye unless required for IP survival). A protective covering could be made from a bandage,
cup, or similar item to protect the eye from further injury and movement. This will require the
unaffected eye be covered and a vertical slit placed in the covering to reduce sympathetic eye
movement. As a last resort IP may consider removing the impaled object and risk losing the eye.
The IP may need to tape the lid of the affected eye closed to prevent infection (Figure 5-7).
Figure 5-7 Eye Injuries
5.5.10. Thorns and Splinters
Thorns and splinters are frequently encountered in survival situations. Reduce their danger by
wearing gloves and proper footgear. Their prompt removal is quite important to prevent infection.
Wounds made by these agents can be quite deep compared to their width which increases chances
of infection by those organisms (such as tetanus) which grow best in the absence of oxygen.
Removal of splinters is aided by the availability of a sharp instrument (needle or knife), needle
nose pliers, or tweezers. Take care to get all of the foreign body out; sometimes it is best to open
the wound sufficiently to properly cleanse it and to allow air to enter the wound. When cleaned,
treat as any other wound.
5.5.11. Blisters and Abrasions
Care for blisters and abrasions promptly. If redness or pain is noted, the IP should stop what they
are currently doing (if at all possible) to find and correct the cause. Frequently, a protective
dressing or bandage and/or adhesive will be sufficient to prevent a blister. If a blister occurs, do
not remove the top. Apply a sterile (or clean) dressing. Small abrasions should receive attention
to prevent infection. Using soap with a mild antiseptic will minimize the infection of small
abrasions which may not come to the attention of the IP.
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Figure 5-8 Blisters and Abrasions
5.5.12. Insect Bites
Bites from insects, leeches, ticks, chiggers, etc., pose several hazards. Many of these organisms
transmit diseases, and the bite itself is likely to become infected, especially if it itches and the IP
scratches it. The body should be inspected frequently for ticks, leeches, etc., and these should be
removed immediately. If appropriate and possible, the IP should avoid infested areas. These
parasites can best be removed by applying heat, irritants, or petroleum jelly to them or their
entrance hole to encourage a relaxation of their hold on the host. Then the entire organism may
be gently detached from the skin, without leaving parts of the head imbedded. Treat such wounds
as any other wound. Applying cold wet dressings will reduce itching, scratching, and swelling.
5.6. Environmental Injury
5.6.1. Dehydration
Dehydration is the lack of adequate body fluids for the body to carry on normal functions at an
optimal level (brought on by loss, inadequate intake, or a combination of both). Fluid losses up to
five percent are considered mild, up to ten percent are considered moderate, and up to fifteen
percent are considered severe. Severe dehydration can result in seizures, permanent brain damage,
cardiovascular collapse and death if not treated quickly. To prevent dehydration, drink water and
ration your sweat, not your water. Common causes and symptoms of dehydration include, but are
not limited to excessive loss of fluid through vomiting or excessive urine, stools or sweating, poor
intake of fluids, sunken eyes, dry or sticky mucus membrane in the mouth, lack of skins normal
elasticity, decreased or absent urine output, and decreased tears. If an IP shows signs of
dehydration, treatment includes oral rehydration which may be sufficient for mild dehydration.
Intravenous fluids and hospitalization may be necessary for moderate to severe dehydration.
5.6.2. Heat Related Injuries
5.6.2.1. Preventing Heat Related Injuries
By sweating, breathing, shivering, and shifting the flow of blood between the skin and internal
organs, the body can usually keep its temperature within a narrow range in hot or cold weather.
62
However, overexposure to high temperatures can result in heat disorders such as heat exhaustion,
heatstroke, and heat cramps. The risk of heat disorders is increased by high humidity, which
decreases the cooling effect of sweating, and by prolonged strenuous exertion, which increases the
amount of heat produced by the muscles. Sweat is the body's main system for getting rid of extra
heat. When an IP sweats, and the water evaporates from the skin, the heat that evaporates the
sweat comes mainly from the skin. As long as blood is flowing properly to the skin, extra heat
from the body’s core is "pumped" to the skin and removed by sweat evaporation. If a person does
not sweat enough, they cannot get rid of extra heat well, and you also can't get rid of heat as well
if blood is not flowing to the skin. Dehydration will make it harder for you to cool in two ways:
if you are dehydrated you won't sweat as much, and the body will try to keep blood away from the
skin in order to keep blood pressure at the right level in the core of your body. Since people lose
water when they sweat, they must make up that water to keep from becoming dehydrated. If the
air is humid, it is harder for sweat to evaporate -- this means that the body cannot get rid of extra
heat when it is muggy as it can when it is relatively dry. The best fluid to drink when a person is
sweating is water. Using common sense is the best way to prevent heat-related illnesses. Stay
well hydrated; to make sure that the body can get rid of extra heat, and be sensible about exertion.
It's also important to be sensible about how much a person exerts themselves in hot weather. The
hotter and more humid it is, the harder it will be for a person (IP) to get rid of excess heat. Clothing
also makes a difference. Use clothing to protect from the sun/heat and aid in keeping the body
cool. Many layers of clothing may hide heavy sweating, masking symptoms of heat disorders.
5.6.2.2. Heat Cramps
Heat cramps are severe muscle spasms resulting from heavy sweating during exertion in extreme
heat. Heat cramps are caused by the excessive loss of fluids and salts (electrolytes)--including
sodium, potassium, and magnesium--resulting from heavy sweating. Heat cramps often begin
suddenly in the hands, calves, or feet. They are often painful and disabling. The muscles become
hard, tense, and difficult to relax. Heat cramps can be prevented or treated by drinking beverages
or eating foods that contain sodium (salt), potassium, and magnesium such as fiddlehead ferns,
crickets nuts (acorn and pine work best), and fruits.
5.6.2.3. Heat Exhaustion
Heat exhaustion is a condition resulting from exposure to heat for many hours, in which excessive
loss of fluids from heavy sweating leads to fatigue, low blood pressure, and sometimes collapse.
Exposure to high temperatures can cause the loss of too much fluid through sweating, particularly
during hard physical labor or exercise. Salts (electrolytes) are lost with the fluids, disturbing the
circulation and the brain's functioning. As a result, heat exhaustion may develop. The major
symptoms of heat exhaustion are increased fatigue, weakness, anxiety, and drenching sweats. A
person may feel faint when standing still because blood collects (pools) in blood vessels of the
legs, which are dilated by the heat. Also, the heartbeat becomes slow and weak, the skin becomes
cold, pale, and clammy, and the IP may become confused. The loss of fluids reduces the volume
of blood, lowers blood pressure, and may cause the person to collapse or faint. Usually, heat
exhaustion can be diagnosed on the basis of the symptoms. The main treatment is replacing fluids
(rehydration) and salt. Lying flat or with the head lower than the rest of the body and sipping cool,
slightly salty beverages every few minutes are generally all that is needed. Moving to a cool
environment helps. After rehydration, a person often recovers rapidly and fully. If blood pressure
remains low and the pulse remains slow for more than an hour despite this treatment, another
condition should be suspected, diagnosed and treated.
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5.6.2.4. Heat Stroke
Heatstroke is a life-threatening condition resulting from long, extreme exposure to heat, in which
a person cannot sweat enough to lower body temperature. This condition often develops rapidly
and requires immediate intensive treatment. If a person reaches this state, body temperature may
rise to dangerously high levels, causing heatstroke. Heatstroke may develop rapidly and is not
always preceded by warning signs such as a headache, vertigo (a whirling sensation), or fatigue.
If a person has suffered a heat stroke, sweating usually but not always decreases. The skin is hot,
flushed, and unusually dry. The heart rate increases and may quickly reach 160 to 180 beats per
minute, in contrast to the normal rate of 60 to 100 beats per minute. The breathing rate usually
increases, but blood pressure rarely changes. Body temperature (which should be measured
rectally), rises rapidly to 104° F. to 106° F., causing a feeling of burning up. A person may become
disoriented and confused and can quickly lose consciousness or have convulsions. Heatstroke can
cause permanent damage or death if not treated immediately. A temperature of 106° F is very
serious; a temperature just one degree higher is often fatal. Permanent damage to internal organs,
such as the brain, can occur quickly, often resulting in death. Heatstroke is an emergency, and
lifesaving measures should be started immediately. A person who can't be taken to a hospital
quickly should be wrapped in wet bedding or clothing, immersed in a lake, stream, pond, or river.
Pay attention to their body temperature (through their signs and symptoms) to avoid overcooling.
After severe heatstroke, rest is advised for a few days to avoid other possible complications to
include heart failure. Body temperature may fluctuate abnormally for weeks causing the potential
for other environmental injuries.
5.6.3. Cold Related Injuries
5.6.3.1. Preventing Cold Related Injuries
The four main factors that make an IP more susceptible to localized cold injury are inadequate
insulation from cold or wind, restricted circulation, fatigue, and poor nutrition.
5.6.3.1.1. Inadequate Insulation from Cold or Wind
The easiest and most effective way to prevent the body from losing heat is the proper wear of
clothing. Keep the head and ears covered. IP will lose as much as 50 percent of their total body
heat from an unprotected head at 50°F. When exerting the body, prevent perspiration by clothing
at the neck and wrists and loosening it at the waist. If the body is still warm, comfort can be
obtained by removing the inner layers of clothing, one layer at a time. The outer protective layer
should be worn unless it is too bulky and a factor in causing the body to overheat. When work
stops, the individual should put the clothing on again to prevent chilling. Change and dry wet
clothing throughout the day.
5.6.3.1.2. Restricting Circulation
Avoid restricting the circulation. Clothing should not be worn so tight that it restricts the flow of
blood that distributes the body heat and helps prevent cold injuries.
5.6.3.1.3. Fatigue
When a person is severely fatigued his body generates less heat. This is why it is extremely
important that when in cold environment to take more rest breaks and drink plenty of water during
these breaks. Once the body is overworked it is very difficult to gain the strength back. IP should
take their time accomplishing tasks (like building shelters) and stay hydrated.
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5.6.3.1.4. Poor Nutrition
The amount and type of food IPs eat in cold environment directly affects the amount of heat
generated by the body. A large portion of an IPs diet should consist of fats. The energy contained
in fats is more slowly released that the energy in carbohydrates. Because of this, it is a longer
lasting form of energy.
5.6.3.2. Hypothermia
Literally, hypothermia means “low temperature” and is diagnosed when the inner (core)
temperature of the body falls below 95°F (35°C). Generalized, progressive cooling of the body
results in hypothermia. It can develop quickly. The body can usually tolerate a drop of a few
degrees of internal body temperature. Below 90°F, the body loses its ability to regulate its
temperature and to generate body heat. Progressive loss of body heat then begins. Hypothermia
occurs when the core temperature is between 90 and 95°F. Hypothermia is a silent killer of those
who are not prepared to face a cool, wet day. It happens when your body is not able to make
enough heat to replace the warmth you lose to the environment around you.
5.6.3.2.1. Mild Hypothermia
Even mild degrees of hypothermia can have serious consequences and complications. Involuntary
shivering begins in response to a drop in the body core temperature. The patient is usually alert
and shivering. Shivering is an attempt to generate more heat through muscular activity. Shivering
usually stops once the core temperature drops below 90° - 92°F (30° - 31°C). That is an indication
of extreme danger. Warming the skin of someone with hypothermia may stop the shivering, even
though the core temperature has not changed.
5.6.3.2.2. Additional Symptoms of Hypothermia
As the IP begins to sink farther into hypothermia they will have the additional symptoms of
clumsiness and mental confusion (i.e., slowing of thought and action). If left untreated they
become unconscious. Eventually all cardio-respiratory activity may cease and the patient may
appear dead. Never assume a patient that is cold and without a pulse is dead.
5.6.3.2.3. Proper Emergency Measures
Patients can survive even after severe hypothermia if you carry out proper emergency measures.
First, prevent further body heat loss, and then try to warm the victim. If outdoors, place the victim
out of the wind in the best shelter possible. Change the victim into dry clothes, if possible, and
place on top of as much insulation as possible to keep the victim off the ground. Placing a
hypothermic person in a cold sleeping bag is not sufficient. The bag should be pre-warmed by
another person, if possible, to transfer a maximum amount of body heat to the bag. If the bag is
large enough, it can be a lifesaving step to put both people in together (two non-hypothermic
people to one hypothermic person is the best ratio). If unconscious, place the victim on his/her
side to ensure an open air passage. If the victim is conscious, administer warm fluids such as tea
or broth. Sweets should be given if the victim is able to eat; they are quickly transformed into heat
and energy. Never use alcoholic beverages as a way to re-warm a hypothermic individual.
5.6.3.3. Frostbite
Frostbite is literally the freezing of body tissue; usually skin (Figure 5-9). Fingers, toes, ears, and
the nose are the area’s most vulnerable to frostbite. There are two degrees of frostbite which an
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IP should be concerned about. The first is Frostnip, which usually affects skin on the face, ears,
or fingertips. Frostnip may cause tingling, numbness, and/or blue-white skin color for a short time
(with normal feeling and color returning quickly when re-warmed). No permanent tissue damage
occurs. The second is deep frostbite, in which the skin and underlying tissue freezes, looking pale
or blue and feels cold, numb, and stiff or rubbery to the touch. Permanent damage is possible,
depending on how long and how deeply the tissue is frozen.
5.6.3.3.1. Symptoms of Frostbite
Frostbite is caused by either prolonged exposure to cold temperatures or shorter exposure to very
cold temperatures. Many people with frostnip or frostbite experience numbness. A "pins and
needles" sensation, severe pain, itching, and burning are all common when the affected area is
warmed and blood starts flowing again. Skin may look white, grayish-yellow, or even black with
severe frostbite, and it may feel hard, waxy, and numb. Blistering is also common.
5.6.3.3.2. Treating Frostbite
Keep the affected part elevated in order to reduce swelling. Move to a warm area to prevent further
heat loss. NOTE: Many people with frostbite may be experiencing hypothermia. Saving their
lives is more important than preserving a finger or foot. Remove all constrictive jewelry and
clothes because they may further block blood flow. Give the person warm, nonalcoholic, non-
caffeinated fluids to drink.
5.6.3.3.3. Frostnip
In cases of frostnip re-warm the IP by putting the injured area against warm areas of the body to
re-warm (i.e., frostnip fingers in the armpit). With frostbite, never re-warm an affected area if
there is any chance it may freeze again. This thaw-refreeze cycle is very harmful and leads to
disastrous results. Also, avoid a gradual thaw. The most effective method is to re-warm the area
quickly. Therefore, keep the injured part away from sources of heat until a proper re-warming can
take place.
5.6.3.3.4. What to do Once the Area is Re-Warmed
Once the area is re-warmed, apply a dry, sterile bandage, place cotton between any involved fingers
or toes (to prevent rubbing). Do not rub the frozen area with snow (or anything else, for that
matter). The friction created by this technique will only cause further tissue damage. Above all,
keep in mind that the final amount of tissue destruction is proportional to the time it remains frozen,
not to the absolute temperature to which it was exposed. Therefore, the act of re-warming and
avoiding refreezing are critical. After re-warming, treatment of the affected parts includes leaving
blisters intact, elevation of the affected parts, and using any Ibuprofen as indicated.
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Figure 5-9 Frostbite
5.6.3.4. Trench Foot or Immersion Foot
Trench foot (immersion foot) is a cold injury that occurs gradually over several days of exposure
to cold, but not freezing, temperatures. The name comes from World War I troops who developed
symptoms after standing in cold, wet trenches. Symptoms of trench foot include red wrinkling
skin that turns pale, swelling, numbness or burning pain, leg cramps, slow or absent pulse in the
foot, and the development of blisters or ulcers after two to seven days, but no actual freezing of
the skin. For immersion foot, remove wet shoes, boots, and socks. Re-warm the affected areas
(do not use heat from a fire to dry feet), relieving pain, protecting it from further cold exposure,
and preventing problems such as infection or dead skin (gangrene).
Ln
Figure 5-10 Trench Foot or Immersion Foot
5.6.4. Bites and Stings
5.6.4.1. Prevention
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Prevention is the key to treatment. Follow these simple rules to reduce the chance of accidental
bites and stings:
e Don’t put your hand into dark places such as rock crevices, heavy brush, or hollow logs
without first investigating. When crossing over debris, look to see what is on the other
side.
e Look where you are stepping (especially in heavy brush or tall grass).
e Use extra caution when walking at night.
e Don’t pick up any insect if you are not sure if it is venomous.
e Don’t pick up freshly killed snakes without severing the head (dead snakes can still bite).
e Check all clothing and bedding before using.
5.6.4.2. Snakebites
No single physical characteristic distinguishes a poisonous snake from a harmless one except the
presence of poison fangs and glands. A determination of the presence of fangs and glands safely
can only be made when the snake is dead. When in doubt, treat a snake bite as if it poisonous.
5.6.4.2.1. Hemotoxic Venom Types
Some examples of these types of snakes are the copperhead, common adder, puff adder, sand viper,
bushmaster, cottonmouth, and eastern/western diamondback rattlesnake. This type of venom
affects the circulatory system, destroying blood cells, damaging skin tissue and causing internal
hemorrhaging. Local effects include strong pain, swelling and necrosis at the site. Pai
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