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🏥

Discreet Clinical Support for Those Treating Protesters Inside Iran

A practical guide for emergency care, wound management, and operational security in high-risk environments

Encrypted • Offline-Capable • Evidence-Based
Immediate Care & Wound Management

🏥 Part 1: Immediate Care

Emergency protocols for life-threatening situations and wound management

⚠️ Security Reminder Access via VPN/Tor. Clear browser history after use. Share only through encrypted channels.

🚨 Life-Threatening Emergencies - ABC

  1. Airway: Check if person can speak or breathe. If unconscious, perform head-tilt chin-lift.
  2. Breathing: Look, listen, feel for 10 seconds. If no breathing or only gasping, begin CPR immediately.
  3. Circulation (CPR):
    • Chest Compressions:
      • Place heel of one hand on center of chest (between nipples), other hand on top
      • Lock elbows, shoulders directly over hands
      • Push HARD and FAST: 5-6cm deep, 100-120 per minute (rhythm of "Stayin' Alive")
      • Allow chest to fully recoil between compressions
    • Ratio: 30 compressions : 2 breaths if alone. 15 compressions : 2 breaths for children (or if 2 rescuers available).
    • Rescue Breaths: Tilt head back, lift chin, pinch nose, seal mouth over theirs, blow for 1 second until chest rises. If no chest rise, reposition head and try again.
    • Continue: Keep going until person breathes normally, help arrives, or you're too exhausted to continue.
If alone and can't/won't do rescue breaths: Compression-only CPR is better than nothing. Do continuous chest compressions at 100-120/min without stopping.
Severe Bleeding Control
  • Press HARD with clean cloth - don't remove, add more on top
  • Elevate limb above heart
  • Tourniquet LAST RESORT: 5-7cm band, note time

⏱️ When to Seek Help

URGENTChest/Abdomen Wounds

Cover with plastic taped on 3 sides (air out, not in)

URGENTHead Injuries

Confusion, vomiting, unequal pupils, fluid from ears/nose

MONITORInfection Signs

Fever >38°C, red streaks, pus, increasing pain after 48h

URGENTChemical Exposure

Flush eyes/skin with water for 15+ minutes continuously

🩹 Wound Care Protocol

  1. Hand hygiene: Wash 30 seconds. Use gloves or plastic bags.
  2. Stop bleeding: Direct pressure 10+ min without checking.
  3. Clean wound: Use boiled/cooled water or saline (1 tsp salt/liter). Pour from height. Pat dry.
  4. Dress: Cover with clean gauze. Change daily or when wet.
DO NOT use: Hydrogen peroxide, alcohol, iodine - damage tissue. Use only water/saline.

💊 Pain & Infection Management

Pain Relief:

DrugDoseNotes
Paracetamol500-1000mg q4-6hSafest. Max 4g/day
Ibuprofen400-600mg q6-8hWith food. Max 2.4g/day

Antibiotics (when needed):

DrugDoseUse
Amoxicillin500mg 3x/day, 7-10dGeneral wounds
Co-amoxiclav625mg 3x/day, 7-10dBites, contaminated
Doxycycline100mg 2x/day, 7dPenicillin allergy
CRITICAL: Complete FULL course. Stopping early causes resistance.

🔥 Burns & Chemical Exposure

Tear Gas Treatment:

  1. Move to fresh air upwind
  2. DON'T rub eyes
  3. Remove contacts immediately
  4. Flush eyes 15+ min (inner to outer corner)
DON'T USE: Milk, oil, baking soda. ONLY water/saline.

Burns:

  • Cool with water 10-20 min (not ice)
  • Remove jewelry before swelling
  • DON'T pop blisters
  • Cover loosely with clean dressing

🦴 Fractures & Sprains

RICE (First 48h):

  • Rest: Stop using injured area
  • Ice: 20 min q2-3h (wrap in cloth)
  • Compression: Elastic bandage (fit 2 fingers under)
  • Elevation: Above heart when resting
Splinting: Use rolled newspaper/cardboard/sticks. Pad with cloth. Immobilize joints above AND below injury. Check circulation daily.
Part 1 of 5: Immediate Care & Wound Management

See other parts: Delayed Complications, Psychological Support, Security, Resources

Delayed Complications

⏰ Part 2: Delayed Complications

Managing injuries that present days, weeks, or months after initial trauma

Critical: Even "old" injuries can become life-threatening. Delayed presentation doesn't mean it's too late to help.

🦠 Wound Infections (2-14 Days)

Timeline:

Days 2-3: Increasing pain, warmth, redness, swelling, minor fever 37.5-38°C

Days 3-7: Pus, red streaks, fever 38-39°C, swollen lymph nodes, foul smell

Days 7-14+ SEPSIS:
  • Fever >39°C or <36°C, confusion, rapid breathing >20/min
  • Extreme weakness, little urine, black tissue

Treatment:

  1. Reopen & clean wound: Remove dead tissue, irrigate with saline, pack lightly
  2. Antibiotics: Co-amoxiclav 625mg 3x/day OR Ciprofloxacin 500mg 2x/day + Metronidazole 400mg 3x/day for 10-14 days
  3. Supportive: Paracetamol 1g q6h, hydration 2-3L/day, high protein diet
Fever should reduce within 48-72h. If no improvement after 48h, may need different antibiotic.

💉 Abscess (Pus Pocket)

Firm painful lump, red/warm skin, may have white/yellow center, fever

Must be drained - antibiotics alone won't cure
  1. Pain relief: Ibuprofen 600mg + Paracetamol 1g, 30min before
  2. Incision: Clean area, make 1-2cm cut at lowest point, express all pus
  3. Pack: Loosely pack with gauze, leave tail out, remove after 24-48h
  4. Antibiotics: Co-amoxiclav 625mg 3x/day for 7 days

🦴 Bone Infection (2-6 Weeks)

Signs:

  • Deep constant bone pain, fever, chills, night sweats
  • Wound won't heal or keeps draining, new wound opens
SERIOUS: Can lead to chronic infection, sepsis, amputation, or death

Treatment:

  • Long-term antibiotics: Ciprofloxacin 500mg 2x/day MINIMUM 6 weeks
  • Remove dead bone/tissue if possible, keep wound draining
  • Immobilize bone completely, high protein/calorie diet

🫁 Delayed Chest Injuries

Collapsed Lung (Hours-Days):

  • Progressive shortness of breath, sharp chest pain worse with breathing
  • One side not moving normally, blue lips (severe)
Care: Position semi-sitting, oxygen if available, DON'T lie flat, reduce anxiety

Internal Bleeding (Hours-2 Weeks):

  • Progressive weakness, dizziness, increasing abdominal pain/swelling
  • Shoulder pain, fast heart >100bpm, pale cold skin, confusion
CRITICAL: Lie flat, legs elevated, keep warm, nothing by mouth, urgent surgical care needed

🧠 Delayed Brain Bleeding

Classic pattern: Person seems fine after head injury, then deteriorates hours/days later

ANY of these after head trauma:
  • Worsening headache, increasing confusion/drowsiness
  • Vomiting, unequal pupils, weakness one side, seizures

Care: Head elevated 30°, monitor consciousness q15-30min, prevent falls, facilitate neurosurgical care

👁️ Eye Complications

Persistent tear gas symptoms (>1 week):

  • Severe ongoing pain, blurred vision, extreme light sensitivity
  • Cloudy eye, white spot on cornea, pus/heavy discharge

Treatment: Continue eye irrigation 3-4x/day, artificial tears q2-4h, dark sunglasses, antibiotic drops if infected

Retinal detachment after trauma:

Emergency: Sudden floaters, flashes of light, shadow/curtain over vision - requires urgent surgical repair

🩺 General Principles

Key messages:
  • It's never too late to seek help - even old injuries can be treated
  • Don't minimize symptoms - small changes can signal serious complications
  • Infections are treatable - even severe ones can be cured with proper care

When to escalate care:

  • Life-threatening complications (sepsis, internal bleeding)
  • Conditions requiring surgery (abscess, fractures, organ injuries)
  • No improvement or worsening after 48-72h of treatment
Part 2 of 5: Delayed Complications

See other parts: Immediate Care, Psychological Support, Security, Resources

Psychological Support

🧠 Part 3: Psychological Support

Trauma responses and psychological first aid for protesters and caregivers

Important: Psychological injuries from violence are REAL and VALID. These are NORMAL reactions to ABNORMAL situations.

🧠 Trauma Responses

Emotional

Fear, anger, guilt, sadness, numbness, overwhelm

Physical

Fast heartbeat, sweating, shaking, headaches, fatigue, sleep problems

Cognitive

Confusion, poor focus, intrusive memories, nightmares

Behavioural

Withdrawal, irritability, hypervigilance, avoidance

These reactions typically decrease with proper support. Most people recover without chronic conditions.

🤝 Psychological First Aid (PFA)

PFA is evidence-based support anyone can provide. It's about connection and practical help, not therapy.

SAFETY - CALM - CONNECTION - HOPE

  1. Ensure Safety: Remove from threats, create secure space, address immediate needs (medical, food, shelter)
  2. Promote Calm: Speak slowly/clearly, normalize reactions ("this is normal"), teach simple breathing (in-4, hold-4, out-6)
  3. Foster Connection: Stay present, listen without judgment, don't force talking, validate feelings ("it makes sense you feel this way")
  4. Instill Hope: Remind intense feelings decrease with time, identify their strengths, support autonomy, provide practical info

⚓ Grounding Techniques

5-4-3-2-1 Method:

Guide person to slowly identify:

  • 5 things they SEE
  • 4 things they TOUCH/FEEL
  • 3 things they HEAR
  • 2 things they SMELL
  • 1 thing they TASTE

4-7-8 Breathing:

  1. Breathe in through nose for 4 counts
  2. Hold breath for 7 counts
  3. Exhale slowly through mouth for 8 counts
  4. Repeat 4-5 times

Physical Grounding:

  • Press feet firmly into ground, notice sensation
  • Hold ice/cold water in hands
  • Splash cold water on face

💔 Supporting Witnesses of Death/Severe Injury

What to do:

  • Be present - calm presence matters more than words
  • Don't force talking - some process silently
  • Validate without minimizing: "This is incredibly difficult" not "It will be okay"
  • Help with practical tasks - decision-making is hard during crisis
  • Monitor basic needs: eating, sleeping, hygiene
DON'T say:
  • "I know how you feel" - "Everything happens for a reason" - "Be strong/Don't cry"
  • Instead say: "I'm here" - "This is so hard" - "Take all the time you need"

Warning signs needing more support:

  • Talk of self-harm, complete inability to function >2-4 weeks, severe dissociation, dangerous behaviors

🔋 Caregiver Self-Care

Secondary trauma is REAL. You cannot pour from an empty cup.

Daily practices:

  • Boundaries: OK to say "I need a break" or "I can't right now"
  • Connection: Talk with trusted others about YOUR feelings
  • Physical care: Sleep, eat, move - non-negotiable basics
  • Meaning: Remind yourself why this work matters
  • Joy: Actively seek brief moments of beauty, humor, peace

Signs YOU need support:

  • Nightmares about others' trauma, emotional numbness/overwhelm, cynicism
  • Physical symptoms: headaches, stomach issues, exhaustion
  • Withdrawing from loved ones, using substances to cope
Remember: Taking care of yourself is NOT selfish - it's necessary for sustained helping. You deserve the same compassion you show others.

📱 When to Seek Professional Help

  • Suicidal thoughts or plans
  • Symptoms severely impacting daily function for 4+ weeks
  • Substance abuse as coping mechanism
  • Severe flashbacks or dissociation

Remote support options:

  • Encrypted telehealth platforms (research secure options)
  • Anonymous crisis text lines (available in many countries)
  • Peer support groups (can be done securely online)
Digital security: Use VPN/Tor for accessing mental health resources. Use encrypted messaging only.
Part 3 of 5: Psychological Support

See other parts: Immediate Care, Delayed Complications, Security, Resources

Security Guide

🔒 Part 4: Security

Operational security for caregivers

📱 Digital Security

Communication:

  • Use: Signal, WhatsApp, Telegram secret chats with disappearing messages
  • Avoid: SMS, unencrypted calls, social media DMs
  • Use code words for sensitive topics
  • Strong passwords, remote wipe, keep screen locked

Records:

  • Minimize - keep only essential notes
  • Use initials/numbers, not names
  • Encrypt all files with strong passwords
  • Destroy completely when done

Internet:

  • Always use VPN/Tor for medical resources
  • Clear history, cache, cookies after each session
  • Don't access from same location/time repeatedly

🏠 Physical Security

Locations:

  • Vary locations - don't repeat
  • Know exit routes before starting
  • Have lookout for threats
  • Look normal for neighborhood
  • Ability to cleanup quickly

Supplies:

  • Distribute - don't keep all in one place
  • Hide in everyday containers when transporting
  • Carry only what's immediately needed
  • Buy from different pharmacies
  • Use cash to avoid digital trails

Personal:

  • Work in pairs when possible
  • Check-in with trusted person regularly
  • Have emergency plan if compromised
  • Know local laws and your rights

🎒 Supply Kits

Basic (Portable):

  • Gauze pads & rolls, medical tape
  • Gloves, alcohol wipes
  • Scissors, tweezers
  • Paracetamol, ibuprofen
  • Antibiotic ointment
  • Emergency blanket, plastic bags

Enhanced:

  • Antibiotics (amoxicillin, doxycycline, metronidazole)
  • Sutures or steri-strips
  • Triangular bandages, irrigation syringe
  • Tourniquet, chest seal

Household Alternatives:

NeedUse
BandagesIroned cloth, sanitary pads
SplintNewspaper, cardboard, magazines
SlingScarf, belt
Saline1 tsp salt/L boiled water
GlovesClean plastic bags

⚖️ Ethics & Limits

Don't attempt without training:
  • Chest/abdomen internal injuries
  • Severe head injuries
  • Amputations, complex fractures
  • Gunshot wounds to torso

Focus on: Stop bleeding, support breathing, get to proper care

Consent:

  • Explain what and why
  • Respect refusal
  • Maintain dignity and privacy
  • Don't promise outcomes

Do No Harm:

  • ALWAYS: Wash hands, gloves, clean tools
  • Don't exceed your skill level
  • When unsure, prevent additional harm
Remember: Basic care (stop bleeding, prevent infection, manage pain, psychological support) saves lives.
Part 4 of 5: Security Guide

Stay safe while helping others

Resources & Training

📚 Part 5: Resources & Training

Evidence-based resources and free training opportunities

📖 Essential Medical Handbooks

All resources below are FREE and designed for low-resource settings:

Primary Resources:

  • Where There Is No Doctor - Hesperian Health Guides (Free PDF, designed for non-medical people)
  • Where There Is No Dentist - Hesperian (For dental emergencies)
  • WHO Basic Emergency Care - Free online manual for emergency situations
  • ICRC War Surgery - Comprehensive trauma care (Free PDF)

Mental Health Resources:

  • Psychological First Aid Guide - WHO (Free PDF)
  • Mental Health Gap Action Programme (mhGAP) - WHO evidence-based guidance
  • Self-Help Plus (SH+) - WHO stress management course
How to access: Use VPN/Tor to search for these resources. Download and save offline. Share via encrypted channels only.

🎓 Free Online Training

Medical Training Platforms:

  • WHO OpenWHO - Free online courses on emergency care, infection control, mental health
  • ICRC e-learning - Health care in danger, war surgery basics
  • MSF Resources - Médecins Sans Frontières training materials

Specific Skills:

  • Basic Life Support (BLS) - Search for free online videos
  • Wound management - Hesperian guides
  • Psychological First Aid - WHO course
  • Infection prevention - WHO guidelines
Remember: Even without formal training, basic first aid knowledge saves lives. Start with fundamentals: stop bleeding, prevent infection, manage pain, provide comfort.

💊 Medication References

  • WHO Essential Medicines List - Standard drug reference
  • British National Formulary (BNF) - Comprehensive drug guide (search for free online access)
  • Drugs.com - Drug interactions checker (use with VPN)
Key principle: When in doubt about dosing or interactions, use lower doses and monitor closely. Complete full antibiotic courses.

🔗 Building Support Networks

Connecting Safely:

  • Use encrypted channels to find trusted medical volunteers
  • Verify credentials carefully - misinformation can be dangerous
  • Share knowledge, not just supplies
  • Create redundancy - don't rely on single source
Trust but verify: Cross-check medical advice with multiple reputable sources. When possible, consult with trained medical professionals through secure channels.

⚖️ Legal & Rights Information

Medical Neutrality:

  • Geneva Conventions protect medical workers and wounded people
  • Providing medical care is a humanitarian right
  • Right to health care regardless of political affiliation

Documentation (When Safe):

  • Document injuries when it won't endanger person
  • Photos without identifying features can help accountability
  • Store securely with encryption
Balance: Documentation can support justice, but safety comes first. Never document if it puts the injured person at greater risk.

🌐 Accessing This Resource Offline

How to save these files:

  1. Right-click → Save Page As → Complete Webpage (for each of the 5 parts)
  2. Store on encrypted USB drive or secure cloud storage
  3. Works completely offline after download
  4. Share via encrypted messaging or USB only

The 5 Parts:

  • Part 1: Immediate Care & Wound Management
  • Part 2: Delayed Complications
  • Part 3: Psychological Support
  • Part 4: Security Guide
  • Part 5: Resources & Training (this file)
These files contain NO tracking, NO external dependencies (except fonts). Safe to use offline and share with trusted networks.

💚 Final Message

Your courage in providing care despite risks is profound. Remember:

  • Even basic care saves lives
  • Your wellbeing matters - take care of yourself
  • You're not alone - build trusted networks
  • Safety first - for you and those you help
  • This work is valuable and you are making a difference
Part 5 of 5: Resources & Training

Last Updated: January 2026 | Evidence-based humanitarian medical guidance

Not a substitute for professional medical care. For educational purposes supporting the right to health care.