まだやっていたらちょっと恥ずかしい野外救急法-応急処置の迷信-

ばく

子供の頃からアウトドを楽しんできたみなさんは、野外での応急処置について、いろいろな本を読んだり、人から聞いたりしてきたと思います。私もサバイバル大百科などの子供向けの本で、「かっけー」っと思って、めちゃくちゃ読んでました。でも、その中にはなんの科学的根拠がないものもあったかもしれません。

WMTCでは、それらのハウ・トゥよりも、傷病の原理を理解した評価と処置を大切にします。今となって、原理原則を考えると、あれあれ、これっておかしくない？っていう応急処置が、これまでまことしやかに伝えられてきました。

現在では、医学的な正しい理解により、ほとんどが間違っていたと考えられるようになっていますので、今回はそんな「とんでも救急法」をみなさんと一緒に「やってた、やってた」と楽しみたいと思います。万が一、「えっまじで」って方がいたら、よかったですね。明日から恥をかかなくて済みました。

目次

野外毒編
皮膚の怪我編
四肢の怪我編
疾病編

野外毒編

ハチに刺されたらおしっこをかける

子供の頃やっていた気がします。尿に含まれるアンモニアに解毒作用があるという理屈でしょうけど。ハチの毒はアンモニアで中和できないことがわかっていますし、そもそもすでに毒は体内に入っています。皮膚に尿をかけても意味ありません。

推奨：水でキレイに洗う。冷やす。抗ヒスタミンもしくはステロイド軟膏。アレルギー反応に発展した場合どうしたら良いかは、WMTCコースで。

毒蛇に噛まれたら傷口をナイフで切って毒を吸い出す

ワイルドだろぅ。なんかかっこいいのですが、すでに毒は組織に入っており、吸い出せるのは関係ない綺麗な血液がほとんどです。さらに、傷口の感染リスクや、口内に傷があった場合、そちらへの毒の侵入の方が深刻です。

推奨：「マムシに噛まれたら走ってでも病院に行け」っていうのが花山（うちのキャンプ場のある田舎の地名です）の常識です。毒蛇の処置は血清を打つ以外にありません。（PS.走る必要がなければ走らない方がいいですが、それぐらい早く打てば打つほど軽度で済むということです）

ダニに噛まれたら熱を与えて出す

これ昔何回かやって失敗しました。全て、皮膚に食いつたまま焼け死んで結局、切開しました。熱さでダニがびっくりして、口を離してくれるという筋書きかと思いますが、そんな簡単な話ではありません。ダニはカやハチと違い、皮膚と口を膠着させる物質を注入するので、自分で抜けようと思っても、満腹になるまで抜けないのです。無理に体を摘んで抜こうとすると、ダニの体液を押し出し、感染のリスクをさらに高めます。

推奨：頭の部分をピンセットでつまみ、まっすぐ引き出す。傷が残るが、ハイリスクの創として処置する。噛まれたところは、感染を観察するため、処置後観察を継続する。ハイリスクの創の処置はWMTCで。

ハチやアブに刺されたらポイズンリムーバー

これは賛否両論分かれるところですね。ちなみにアメリカ心臓協会とアメリカ赤十字のガイドラインには明確に否定されています。また、推奨するところもできる限り早くと条件があり、刺されてそんなすぐにできませんよね。デメリットとして、吸いすぎて皮膚組織を痛めたり、痕を残してしまうこともあります。仮に少量吸い出せたとして、体に対するダメージを回避するほどではないようです。

正解：水でキレイに洗う。冷やす。抗ヒスタミンもしくはステロイド軟膏。

皮膚の怪我編

創口に唾を塗る

これは、間違いななくみなさんやってましたよね。「動物はそうやって創を治す。それが人間のあるべき姿だ」というワイルドな方もいると思います。確かに、唾液には殺菌作用もあり、動物にとってはそれしか方法がないのですが、実際には唾液には雑菌も含まれており、動物病院では止められます。人間なんて雑菌を創に入れるだけです。

推奨：水で洗浄して、あとは傷のリスクに応じてWMTCのプロトコに従ってください。

創口は乾かしてカサブタにする

やってた、やってた。カサブタできるように、口で吹いたりしていました。まず組織は湿潤状態の方が再生しやす事実があります。カサブタはいち早く細菌の侵入を防ぐ、人体の防衛反応ですが、同時に、創の中に細菌を閉じ込めることになります。結果として、治癒まで長く時間がかかったり、感染のリスクを高めます。

推奨：現在は創を清潔に保てる応急用品があるのだから、創を清潔な水でできる限りキレイにし、湿潤状態を保つようにましょう。その後の手順は、創に応じてWMTC参照。

創と言ったらすぐマキロン

罰ゲームですよね。創の消毒薬には塩素系のマキロンや、ヨウ素系のイソジンなどもあります。中でもマキロンは、創口にシュワーと泡が立って、同時に断末魔の叫びですよね。これはバイキンが死んでる証拠だと信じていたのですが、人体ではないバイキンが死んでなんで痛いのでしょうか？あれは人体の細胞までは死んでいる痛さです。創の消毒は確かにバイキンも死にますが、人体の組織も破壊してしまします。

正解：清潔な水でキレイにすればOKです。ただしWMTCでは状況に応じてヨウ素系のポピドン溶液を傷口に入れざるを得ない時があります。詳しくはWMTCコースで勉強してください。

火傷をしたらアロエ

子供の頃、実家にそのためにアロエの鉢がありました。アロエのネバネバにはアロインという成分があり、皮膚の炎症を抑えたり修復を助ける役割があります。ただ、植物のアロエを直接塗ってもその効果は極小で、逆に感染やかぶれのリスクもあります。これは昔薬がなかった頃の生活の知恵ですが、今は専用の薬があるので、そちらを使いましょう。つうか、アロエ自生していません。

正解：冷やす。一般的な保護はガーゼにワセリン。火傷の程度に応じた処置はここでは書ききれません。WMTCコースで。

鼻血が出たら上を向いてうなじを叩く

この理屈がどうしてもわかりません。ツボ？何故？っというとんでも救急法のナンバーワン かもしれません。頸動脈を絞めるならまだわかりますが、それじゃ鼻血止まる前に失神します。どう探しても理屈が見つからない上に、血液が喉に逆流し、嘔吐などのリスクもあります。

推奨：下を向いて鼻の付け根をしばらく押さえている。鼻にティッシュなどの詰め物をすることを推奨しない情報もありますが、WMTCでは、現実的に、粘膜を傷つけない程度の圧力で詰める方法をオプションとして示しています。

出血したら、心臓側を強くしばる

これは、理屈はわかりますがめちゃくちゃ難しい技術です。野外救急では、大出血や、四肢が切断されてしまったときにこの技術を使いますが、必ず2本の専用の止血帯を持ち、取り外しにも難しい手順があります。十分な知識や技術がないままやると、止血帯を締めた皮膚を痛めるたり、長時間の止血による抹消の障害などを起こします。外すときも、やり方を間違えると、一気に血流が再開し、また出血を起こすこともあります。

推奨：出血の止血の基本は圧迫止血です。止血帯の使い方を知りたい方はWMTCのWFRコースで。

四肢の怪我編

突き指をしたらポキッと音がなるまで引っ張る

やってたなあ。ポキッとなるとなんか気持ちいいし。傷んだ筋をまっすぐにして整えるといった変な感覚があったのでしょうかね？突き指も、四肢の怪我と同じ理屈で、幹部にさらにダメージを与えていいことがありません。また、突き指だからと言って、軽度の怪我ばかりではなく、靭帯断裂や骨折などその程度は様々です。基本的にはWMTCの四肢の怪我のプロトコルで対応しましょう。

推奨：RICE、バディスプリント、変形していたらTIP、TIPのトレーニングはWMTCコースで。

幹部の骨を叩いてひびく感じがしなければ骨折ではない

あ〜やっている野外指導者いましたねえ。「骨折していないから大丈夫」って、なんか自分に言い聞かせたかったのでしょうか？そもそも、骨折していなくても痛いものは痛いし。みなさんご存知の通り、明らかな変形、軋轢音などがなければ、骨折しているかどうかなんて、フィールドで医師だってわかりません。そもそも捻挫なら大丈夫で、骨折だとヤバイなんて概念自体がナンセンス。野外では、避難に必要な情報として、いくつかの基準をもとに、「安定した怪我」、「不安定な怪我」の２つに分類するだけです。

推奨：RICE、適切なスプリント、変形していたらTIP、四肢の怪我の評価はWMTCコースで。

捻挫をしたらマッサージやストレッチ

急性の四肢の怪我に対して、マッサージやストレッチをする人がいます。幹部を人の手でさすってもらう（まさに手当て）、心理的な効果はあるかもしれませんが、刺激により傷ついている組織をより傷つけてしまいます。また、強い指圧をすることで、筋が緊張し、さらにダメージを深刻にします。四肢の怪我は、肩こり、腰痛、オーバーユース症候群などのマッサージによる効果が期待できる慢性の障害と、痛みの質の区別がつかないために、このような対処をする人がいるのでしょう。急性の四肢の怪我はやっぱりRICEです。

推奨：MOIとSAMPLE評価、急性ならばRICE

疾病編

風邪は走って治す

なんか私思いっきりやってました。でもこれはあながち嘘ではありません。軽い運動は、NK細胞が活性化して、免疫力が高まるというデータがあります。一方、汗をできるだけかいて熱を下げるために、激しい運動をすると、当然免疫力は下り、さらに悪化します。私あえて激しい運動やってました。ただし、軽い運動も、あくまで風邪のひき始めだけに通用する話です。本格的に体調が悪い時は、しっかり休みましょう。

推奨：安静、水分、消化の良い食べ物

風邪をひいたら汗をかいて治す

私もたまーに熱を出すのですが、確かに寝汗をぐっしょりかいて、直った気になっていました。風邪ひいた時は、白血球が活発に活動する環境にするために、免疫反応で体温が上がります。「体温上昇」→「寒気」→「暖かい布団」→「寝汗」というだけで、汗をかくことに風邪を治す根本的なメカニズムはありません。寝汗をそのままにしてしまうと、逆に気化熱で体を冷やしてしまう可能性もありますし、脱水状態を促進します。汗をかくのは仕方がないので、それに気付いたらすぐ着替え、十分に水分を取りましょう。

推奨：積極的に汗をかかせる必要はありません。汗をかいたらすぐ着替え、水分をとりましょう。

風邪をひいたらお風呂に入っちゃダメ

っと言われてましたよね。熱が出ている時は、濡れたおるで体を拭くだけとか。上述した通り、体を温めることは、白血球の活動が活発になり、体の治癒力を高めます。よって、熱すぎないお風呂にさっと入って、体を清潔にすことになんら問題はありません。おそらく、昔の家は暖房もなく（特にお風呂や脱衣所は）、湯冷めしてしまうことの方が問題だったのでしょう。ただし、ガッツリ汗をかくために熱いお湯に長時間入るのは、エネルギーを消耗し、脱水を促進するため逆効果です。

推奨：お風呂は問題ない。その後湯冷めしないようにして、直ぐ休みましょう。

てんかん発作が起きたら何かを口の中に入れる

てんかん発作は舌を噛まないように口に手やタオルなどのものを入れると考えられていましたが、これは誤飲や気道閉塞のリスクがありますし、救助者の指や手を入れたら、すごい力で噛まれることもあります。下を噛みそうであれば、下顎を少し上げてあげましょう。また、抗てんかん剤も、発作を抑える目的ではないので、発作中に無理に飲ませると、やはり気道閉塞のリスクがあります。数分で治るので、傷病者の安全を確保ししつよく観察しましょう。

推奨：危険物から隔離（メガネ、ヘアピンなども外す）、呼吸の補助、頭部の保護、ベルトなどを緩める、回復体位、観察

留意：発作を繰り返す、発作が５分以上続く場合は、救急車を要請してください。

今回紹介した、これまで正しいと考えられてきた誤った処置はほんの一握りで、きっとまだまだあると思います。この原因は、おそらく応急処置をハウ・トゥで覚えてきたからでしょう。ハウ・トゥは、状況によって異なりますし、昔と今では環境が異なります。ハウ・トゥの記憶は人間の能力では限界があります。重要なことは原理を理解し、状況に応用する能力で、これこそ、AI時代に人間に求められる力です。

せっかくですから、みなさん個人、団体の、応急処置のプロトコルをもう一度レビューして、あやしいところがあったら、専門家に確認しておきましょう！

より詳しい傷病の原理、評価、処置はデジタルハンドブックを参照してくだい。また、それらの知識を正しく活用するためにはWFA/WFRコースに参加してトレーニングを受ける必要があります。

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  703. Карл Абрахам (1877–1925) – немецкий психоаналитик.

    В 1901 году получил докторскую степень по медицине.

    Работал в Берлинской психиатрической лечебнице,
    затем – в психиатрической клинике Бургельцли (Швейцария), где
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    В 1 907 году познакомился с Фрейдом и возвратился в Берлин.
    В 1910 году организовал и возглавил Берлинское психоаналитическое общество.
    В 1911 году впервые в Германии
    прочитал курс лекций по психоанализу.
    В 1914 году был избран президентом Международной
    психоаналитической организации.
    В 1920году– один из основателей
    Берлинского психоаналитического института и психоаналитической поликлиники.
    У него проходили учебный анализ X.
    Дойч, М. Кляйн, Ш. Радо, Т. Райк, К.

    Хорни и другие психоаналитики.
    Осуществил исследование
    отношений между сексуальностью и алкоголизмом, печалью и меланхолией, ранних догенитальныхстадий развития либидо.
    Одним из первых внес лепту в становление неклинического прикладного психоанализа.
    Автор работ «Сон и миф. Очерки по
    психологии народов» (1909), «Джованни Сегантини.

    Психоаналитический этюд» (1911), «Аменхотеп
    IV. Психоаналитический вклад в понимание его личности и монотеистического культа Атона» (1912) и других.
    как работают психоаналитики

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