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Six Letters Re: Oral Rehydration Solutions
Jim,
During my many travels in Asia and Central America I never brought along medications to stop diarrhea, only to prevent it. Diarrhea is natures way of getting rid of something your body doesn't want in it. Preventing that can lead to serious problems. Water and food born bugs (bacteria, not parasites) can be dealt with by taking Doxycycline Hyclate as a prophylactic.
Prior to the likely encountering of suspect food and water, such as a bug out situation, a pill a day will keep you reasonably safe. You should be able to talk your doctor into proscribing for emergency use only or you can pick them up over the counter in any Third World country.
I also take along Keflex in case of wound infections. Google has a wealth of info on these and other medications if you can't find a doctor willing to advise on TEOTWAWKI situations. - LRM in Perth, Western Australia
Sir:
My mother was recently hospitalized and learned the hard way. She had taken some antibiotics to fend off an infection. Antibiotics kill off the bacteria in our intestines (the good and bad kind). In her case, it killed off a larger portion of the good bacteria which led to an imbalance. The bad bacteria began to thrive. The diarrhea she had would've helped get rid of the build up of that bad bacteria. However, she took an anti- diarrhea
When the bad bacteria builds up like that and your body can't get rid of it, the bad bacteria begins to poison you (as it did her). She couldn't eat or drink anything without throwing up because her stomach was no longer in a condition to absorb any water or nutrients. She suffered from severe dehydration and malnutrition.
Her condition [Clostridium difficile] is commonly referred to as "C-Diff". She was in the hospital for a week and a half and is slowly recovering now.
So, if you get diarrhea after taking antibiotics, it may be best to just let nature "run" its course. Just be sure to drink lots of fluids. - Daron in San Diego, California
Jim,
You recently posted a letter from a reader inquiring about oral rehydration solution. I have chosen to stock up on oral rehydration salts instead of pre-mixed solutions such as Pedialyte.
The salts are packaged in little foil sachets. When mixed with water, each sachet produces one liter of oral rehydration solution. They can be purchased in bulk from a company called Jianis Brothers either by the carton (125 sachets) or by the case (5 cartons = 625 sachets). I don't recall how much I paid but I believe the unit price was around 50 or 60 cents per sachet - much less expensive than Pedialyte.
The sachets are convenient, compact and durable and I believe they would make a great little barter item if the need should ever arise.
The web site of The Rehydration Project contains a wealth of information on dehydration due to illness as well as treatment using oral rehydration therapy: Contact information for Jianis Brothers is also available on the same site. Sincerely, - Michael in California
Dear Mr. Rawles,
In reference to the recently-posted question/answer concerning anti-diarrheals, I have just a couple of comments from a pharmacist's perspective.
1. As the poster mentioned, loperamide (aka, Imodium) is available over-the-counter (without a prescription) in the same strength as the old prescription product. This effective anti-diarrheal is not considered an opioid, and does not appear on the DEA's Controlled Substance list, as does diphenoxylate/atropine (aka Lomotil - Schedule V). Be aware that individual states can add drugs to their own controlled substance list, but I don't know of any that have done so with loperamide. The dosing depends on recurrence of diarrhea episodes, but take no more than 8 tablets (16mg) per 24 hours period.
2. The bismuth subsalicylate-containing anti-diarrheals, such as Pepto-Bismol and Kaopectate and their generics, contain an active ingredient similar to aspirin, and in quantity, can have a similar effect on bleeding (inhibits platelet function). Therefore, be sure to stay under the daily maximum dosage of 8 30ml (1oz.) doses. Also, if you have any ongoing bleeding problem, such as active gastric ulcers, shy away from these products.
Thank you for all you do! Best Wishes, - S.H. in Georgia
Sir,
The most effective anti-diarrheal medications are usually sulfa drugs.
In my travels there have been times when I have lost 20 lbs. in a few days time due to the effects of diarrhea. I've had it so bad that the Air Force took a C-141 out of service to decontaminate it.
And my travels started when I was three years old (42 years ago now) so I have lots of practice in dealing with this issue. Outside of the US and Western Europe you have to assume that the water supply is contaminated and you will come down with something at some point. I've reached the point where I routinely add purification tablets to even bottled water in some countries.
First and foremost, if diarrhea is not caused by a virus then usually it is caused by a bacterial bloom in the body. When you travel from one area to another the normal flora and fauna in the body change to match what is local to the environment. As a result the balance of the flora and fauna in the body gets out of whack and you end up with the common traveler's diarrhea. If you have not drunk/eaten food in your home environment that was not processed/packaged/etc. etc. then you can get the same effect the first time you eat natural foods (farmer's market ...). A low dose of a sulfa drug usually is enough to take care of this problem. (Sulfa drugs are usually over the counter in most countries outside of the US.) In the US the doctor will normally prescribe Ciprofloxacin. Living and working in Turkey I learned to say "Streptomagma var mu?" or "Do you have Streptomagma (a sulfa drug)" -- and the same phrase will work across the near east (from Turkey through Afghanistan).
One of the tips/tricks that I have picked up over the years is to eat yogurt or other foods that contain live bacteria and/or drink a shot or two of hard alcohol. This helps stave off but does not 100% prevent diarrhea. But it is critical to continue to eat yogurts once you are treating the diarrhea symptoms with medicines as it helps to re-balance the flora in your body and prevent a second round of problems.
For viral infections (or protozoa) you just have to suffer unless you can get your hands on prescription only drugs. Nitroimidazoles seem to have the best effect on Giardia but when I've taken them in the past (seven Giardia infections to date) they are rough on the body. Hence oral rehydration is probably the best route unless you have a severe case of it. Amoebic dysentery is also common in many parts of the world -- and is almost untreatable and you have to suffer with it for years after your initial infection. Again oral rehydration (and having a wee bit more than 7% body fat) helps the most.
One of the better oral rehydration products out there is Ceralyte. Gatorade and other sports drinks usually are too much sugar and the wrong types of salts for long term oral rehydration (such as during an attack of Giardia which I have now had several times). You will also find Crystal Lite (and the store brand generic equivalents) makes a sugar free rehydration mix. My preference for these two routes comes down to portability and long storage life. (I mentioned that I carry several packets of rehydration powder with me in my travel kit.) I also lean towards using the Crystal Lite mix as I have a tendency at my age to pack on pounds even with a vigorous workout schedule.
The other tip to add? Always carry toilet paper with you. It is horrible to have dysentery in a country like Indonesia where the public toilets (even in office buildings) don't have toilet paper and you are using leaves and newspapers in a vain attempt to clean up afterwards. - Hugh
Hi,
I
read the recent post about dealing with diarrhea, and while I have made sure we have some OTC pills such as Imodium stored, I have also stocked up on dried Blackberry Leaf and made tinctures. It works extremely well in ending diarrhea, our family has had the chance to use it a few times over the years and it does indeed work. My darling husband says it tastes kinda 'woodsy', and I admit is is not the best flavor, but it certainly works. Just a teaspoon at first and maybe another teaspoon if there is another 'episode', but we have found that one teaspoon usually does the job the majority of the time, only a few times have we had to use a second dose. It can also be put in water or juice and taken that way.
I just wanted to pass this on. Dried blackberry leaf can be found at any online herbal store like www.MountainRoseHerbs.com [in Oregon] and a one pound bag is very inexpensive, around $8. Id suggest that interested people buy two bags and tincture them up right away with any 80 proof vodka to have it on hand when needed. Though it can be made into a tea or decoction, I prefer to tincture for long term storage.
All the best to you and yours and God Bless. - Karen F. in Colorado
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Letter Re: Oral Rehydration Solutions
Sir:
My recent trip to the library and skimming through a few books on diseases led me to the conclusion that some of the secondary or follow-on effects are often bigger killers that the diseases themselves. I'm talking about pneumonia and diarrhea. Respiratory bugs often develop co-infections like pneumonia. And stomach bugs often cause diarrhea, which can cause such severe dehydration, that the patient dies. Obviously, [some forms of] pneumonia can be avoided by getting a pneumovax innoculation. So how do we deal with diarrhea? It can be controlled with over the counter (OTC) medicines. According to FamiliyDoctor.org, some of the best available OTC meds include loperamide (such as Imodium) and bismuth subsalicylate (such as Kaopectate and Pepto-Bismol).
My questions to you are: what about prescription antidiarrheals? And what should I store for re-hydration? Thanks for your great blog and books. The number of lives that you will save, by encouraging people to get really and truly prepared will go beyond counting! Sincerely, - H.F.I. in St. Louis
JWR Replies: OTC antidiarrheals are usual sufficient in all but the most severe cases. Most of the prescription antidiarrheals are opium-based so they are on the controlled list. As my late wife learned in the last few weeks of her life, heavy opium-based pain medicines slow down the gastrointestinal tract dramatically. (And in fact, many pain patients have to take stool softeners like colase and laxatives like docusate and senna, to keep their bowels moving.) Because of their scheduled drug legal status, it would be almost impossible to get opium-based drugs by prescription from your friendly local doctor to keep on hand for contingencies. However, some of opium-derived meds to keep in mind for disaster situations include diphenoxylate (with atropine) and the industrial strength version loperamide (a synthetic opioid). Because of their side effects, and obviously because some of them are addicting, these meds are reserved for only the most severe cases of diarrhea
As you noted, and has been previously discussed in SurvivalBlog Oral Rehydration Solutions (ORSes) are very important to keep on hand. Every family should storing a few bottles of Pedialyte (or better yet, one of its many commercial equivalents, which are identically-formulated and often self for about 40% less). It is vitally important to know how to make your own ORSes. This is described in detail in the "Rawles Gets You Ready" family preparedness course.
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Two Letters Re: Wound Irrigation in Austere Environments
Hello James,
Regarding wound irrigation, wound preps, surgical site prep, etc., folks would do well to purchase a gallon each of Betadine, Povidone, or other generic tamed iodine, in both the scrub and solution formulations. These are not terribly expensive and one likely could talk his/her Veterinarian into getting some for them, as they are not controlled substances. [JWR Adds: They are also available in the vet supply department at some of the larger feed stores, and via mail order and Internet vet supply companies like Jeffers.] These are concentrates and can be diluted, and used on wounds if the patient has no iodine allergies. Sincerely, - Mike M., DVM
Jim,
The key to stopping a wound infection is to change the physical characteristics of the wound to make it hard for the bacteria to live. Most bacteria are very specialized and sometimes something as simple as oxygen will kill them dead. Irrigation is a great help too, it gets rid of a large numbers of bacteria and the pure water causes bacteria to swell up and pop. You can also change the pH of the wound, or the salinity.
Wound care in the Third World is almost always a problem. It seems that you never have all the supplies you need. Antibiotics and even antiseptics are scarce.
One of the key pieces of kit used by some NGOs in Africa is something called "sugardine". It's just plain old table sugar, mixed with a mild solution of iodine. Either one works pretty well, but for a raging infection, plain old table sugar (granulated sugar or sucrose), will cause bacteria to dehydrate. Your body will respond by oozing liquid into the wound, which also helps dislodge bacteria. The normal way of using it in Africa is to unwrap the wound, irrigate it with clean water and then pack it full of sugar and re-wrap it loosely. (Don't worry too much about dry dressings. It's going to ooze quite copiously.) After a couple of hours, you can open it back up and irrigate it again and let it air out with loose, cry bandages until the next sugar treatment.
Repack the wound with sugar twice a day and the results are amazing. - Jon
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Wound Irrigation in Austere Environments
TEOTWAWKI will result in a lot of wounds, including not just lacerations but scrapes and burns as well. These will happen regardless of if the injury is the result of a disaster or if post-crash efforts lead to injury. This is bad enough, but you could be in even more trouble if infection sets into one of these wounds.
A lot of preparedness/survival-types focus on suturing, including having access to suture material and instruments to allow for laceration repair. While this is all well and good, you shouldn't focus too much on actual wound repair without first being sure that you can provide wound closure with minimal risk for infection. Additionally, abrasions and burns are also at risk for infection and will benefit from good cleaning.
For any wound, infection prevention after injury consists of “irrigation” because as the poison control folks say: when it comes to pollution, dilution is the solution! Irrigation not only aids in prevention of infection, but also increases the chances of a wound healing without too much pain, functional impact or cosmetic disfigurement.
What should you use to irrigate wounds? In most health-care settings, sterile solutions such as saline are used. Under the best of circumstances, these are expensive. After the Schumer hits the fan, they will probably be in very short supply. If you have access to stored saline, you are in good shape, but what happens if it has run out or you don’t have any? Lucky for us, there are alternatives.
One “solution” is to make saline with water treated with bleach. Clean contact lens solution, bottled water or tap water can be treated with household bleach, resulting in a solution that is sterile and non-toxic. The residual bleach may actually have bacteria killing effects as well. Simply add a tablespoon of table salt to each gallon of clean water to make a suitable solution for wound irrigation.
There are even options if the grid is down and we can’t rely on delivery of clean water, either from a tap or in a bottle. Military doctors in one study took surface water from lakes, ponds and creeks. The water was “non-turbid”, so you may need to let it settle and/or filter it. Next, they treated it with 1 teaspoon (or 5 mL) of common household bleach in each liter of water. This killed 99% of the bacteria in the samples, and even the 1% left was thought to be contamination from the air picked up during testing. Their technique gives us a field-expedient method for obtaining water suitable for irrigation of wounds.
You can also purchase distilled water in advance, store it at room temperature, and make your own irrigation fluid later simply by adding salt (a tablespoon, again) to each gallon. When stored in a refrigerator at or below 48°, home-made solutions like this were sterile at least 3 weeks after they were made. Theoretically, using sterile (bleach-treated) water derived from the sources above could even be used in place of distilled water as well. Thus you can replace expensive or unavailable sterile saline without buying it from your pharmacy. Researchers used this fluid safely as peritoneal (abdominal) dialysis fluid as well.
You don’t need to worry about adding antibiotic to the irrigation solution either. A physician from the University of Missouri showed that patients with compound fractures of their legs did better if they were treated with irrigation solutions made from non-sterile tap water and Castile Soap
rather than water containing bacitracin, a common antibiotic. Researchers from SUNY-Buffalo also showed that straight tap water was just as effective as sterile saline irrigation in preventing infections in lacerations closed in their emergency room. [JWR Adds: Castile soap is multi-purpose, and a has a long shelf life. Stock up. watch for it a discount stores, or find discount Internet vendors. Dr. Bronner's Peppermint Castile soap is a standby, here ate the ranch.]
Once you have your solution prepared, you need to use it to wash the wound. In general, burns and abrasions should be washed until they're free of visible dirt. Lacerations, on the other hand, may need a little bit more work: It’s best to irrigate them through a syringe and intravenous catheter or needle such that you get good pressure, in order to the blast germs out of the wound. The textbook standard is 50 mL per centimeter of length; this converts to about 4 ounces for each inch long the wound is (not how deep it is.) Obviously, if the wound was grossly contaminated, you need to make sure to rinse it under pressure (ideally with pulsatile flow like from a WaterPik) until the wound is clean, with no foreign bodies left behind. Only then should you think about suturing a wound closed. [JWR Adds: Wound drainage is subject unto itself. My general advice, based on that reiterated by several experienced trauma doctors that have contributed to SurvivalBlog is to delay wound closure for an extended period, and even then a drainage tube should be left in place, even longer.]
If you don’t have a suitable syringe and catheter set-up for irrigation, one austere alternative is the ubiquitous 2 liter soda bottle; just be sure to clean it well beforehand, and don’t use one that held anything besides drinks! Next, drill two small (1/16th inch, for example) about 1/8th inch apart in the lid. Put your solution in the bottle and then cap it tightly with your modified. Now, simply squeeze the bottle while sweeping the stream across the wound. Keep in mind that if you don’t know the person is free of disease that you must use personal protective equipment to protect you from body fluids.
Finally, in a severe pinch, remember that we all have our own supply of sterile saline with us: yes, I am talking about urine. Dr. Gene Lam, then a Battalion Surgeon in the US Army, was held captive by North Korea. He describes many ingenious and heroic medical improvisations, including use of urine to rinse off burns and other wounds. Just be sure that the person “donating” the urine has no pain or burning on urination, cloudy or bloody urine, or other signs of bladder/kidney/urinary infection. Place it in your irrigation container and use it immediately as well.
All of the aforementioned techniques are only for a truly Schumeresque situation! If you have access to the usual care systems, that is the way to go. Otherwise, if you must provide your own wound care, the cornerstone of good care is meticulous wound preparation with copious irrigation. When you’re in the Schumer, making your own irrigation fluid will work in place of commercially made irrigation solutions and gives a lot of advantages in the fight against infected wounds.
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Letter Re: Open Enrollment for Many Medical Savings Plans
Dear Mr. Rawles,
Greetings! I saw a blog letter mentioning FSA (Flexible Spending Accounts)-one medical plan that helps the average person. Basically, one’s employer (private, public, etc.) has some amount taken out before taxes and this money is put into a plan with a pre-set amount that must be used by the end of the plan year.
Okay, what many people do not know is that IRS laws allow the following:
Once the plan is started, the full year's funds are present, even if you have not had that total amount saved up yet. Example: I set the plan to $1,000, and at the start of my plan $20 is taken each paycheck (50 weeks). But, I can start applying the plan immediately for the full $1,000. These funds are used to reimburse co-pays, over the counter drugs, reading glasses, or other prescription and generic [medication] costs.
Here are two important points I found out last summer:
First, the medical supplies reimbursed for by this plan include medical supplies, including Quik-Clot, Celox, (Yep! Even the Quik-clot for nose bleeds). Other first aid supplies (usually not found in the local drug store-but commonly found in survival catalogs) are covered (check with the FSA firm handling the reimbursements first!).
I got lots of Band-Aids, Celox, and Quik-clot this summer.
Oh yes, my former employer admitted (yes, I called both the FSA company and my employer at city hall to confirm), that due to IRS laws, a person can access the entire amount for that year, get reimbursed for all of it, and leave employment before the completion of employee payments are made-and no refund is required from the employee by either the former employer or the FSA company! This may prove useful for many people who have these plans and think that TEOTWAWKI is coming soon. [JWR Adds: But purchasing supplies without the intent to fully fund a FSA would be unconscionable.]
Also, real survival medical supplies can be obtained (again, check with the FSA first!) with the plan covering the expenses. (From your pre-tax dollars, of course!).
Food for thought. - L.F. R.
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Letter Re: Open Enrollment for Many U.S. Medical Savings Plans
Hi James,
First let me thank you for your wonderful blog, which I read every day. This is just a reminder that fall is typically Open Enrollment at many large and small companies for next year's benefits elections. My company's three week window to sign up for 2010 benefits opened yesterday. This is the time when a person can choose to participate in a ["before tax"] Flexible Spending Plan. While some people are justifiably nervous putting money away in a, "use it or lose it," program, the I.R.S. made the decision a lot easier a few years ago when it allowed Flexible Spending Plan funds to be used for over the counter medications. Even if you are blessed with perfect health and never see a doctor all year, the Flexible Spending Plan is great way to put some money away to stock up on your "Band-Aids," tax free!
My prayer for you and your family is that you have happy memories without pain in the shortest amount of time possible. - D.
JWR Replies: Thanks for that suggestion. One proviso for readers: Be sure to to mark your calendar for a date two weeks in advance of the spending deadline!
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Letter Re: Preparations for Eyesight & Hearing
JWR,
Regarding Eye Surgery: I am an optometrist. Unfortunately some of what was most recently posted is misleading if not flat-out wrong.
1. Laser Vision Correction (LVC) will not make you more prone to problems with your near vision. However, if (a) you are nearsighted before the surgery (and thus able to see up close without correction), and (b) you are over age 42 or so, then you will struggle with your near vision. Prior to the surgery, of course, you can see fine up close if you remove your glasses or if you have bifocals. But the LVC does nothing to make this problem worse; it simply corrects your distance vision. Of course all these points are moot if you are younger than age 42. But at around age 42 it will be a problem, so be aware of that.
2. Implantable Contact Lenses (ICLs) are very, very rarely an improvement over LVC. LVC sculpts the front portion of the eye, ICLs involve cutting the eye open and putting a synthetic lens into it. Contrary to the original poster, they are not “swapped out” at your whim, they can in fact correct farsightedness, and they do not have any different effect on your near vision than LVC. ICL’s are significantly more expensive and significantly more risk (of both post-operative infection and of cataract creation due to jostling of the natural lens in the eye) than LVC, which is why we do not recommend them often. Their greatest benefit is for those whose prescription is so high that LVC is not an option.
3. If you are really serious about refractive surgery, I strongly recommend PRK as opposed to Lasik. Both are forms of LVC, however the former is an operation that does not create a flap, while Lasik does create a flap. That flap can be dislodged in the future at any time.
4. Lastly, while I cannot fault many people for looking to the Internet for advice-—I do it too-—neither can I overemphasize the necessity of having an eye doctor who knows you go over the implications, benefits, and risks of refractive surgery with you. Last week I had a new patient who was 62 years old who had amblyopiia [commonly called "lazy eye"] in his right eye. No one had ever spoken with him about this condition or what caused it, even though he had it since he was a child. I explained it thoroughly to him, and he was impressed and thankful. I then smiled and said, “You’ve been going to the discount eye places, haven’t you?” He admitted he had been.
Fight the good fight, keep spreading the Gospel, - WPR
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Letter Re: Wood Stove Selection, Operation, and Safety
James,
You've had two good letters on woodstoves recently. I'd like to add a few thoughts based of heating and cooking with wood for a couple of decades in the Colorado mountains. I have never been more contented than when there's a blizzard raging outside and I'm inside next to a nice warm woodstove. That being said, woodstoves and chainsaws account for the vast majority of domestic emergencies in many rural areas and a constant source of amusement for EMTs.
As has been written, the importance of a properly installed chimney cannot overemphasized. Do get a quote for a good professionally installed chimney and then source the woodstove based on how much money you have left, not the other way around. A semi-okay chimney may not be a problem for years, but eventually that rafter up in the ceiling crawl space that's been getting too warm all those years will eventually cook off one cold winter night when the woodstove is nice and hot. Also get the chimney top nice and high and serviceable. Downdrafts will occur even if they are built to the 2'/10' rule if you have a higher addition near by and the wind is in the right direction. Smoke will also condense on the chimney top spark arrester and clog it up so figure out a way to brush that clean in a safe way. Best to do that as regular maintenance and not in the middle of the night when you find your chimney won't draw and the room is filling with smoke. Lightning will also find the chimney one day. Get a lightning rod installed before you're hit. Do attach a magnetic chimney pyrometer
to the chimney. It will tell you how the stove is doing by just glancing at the meter and will also alert you if things are getting too hot. My house did survive my youthful learning curve, but only just. Hopefully, some of your readers will profit from my experiences.
One thing that hasn't been mentioned is the area around the stove. I've seen red hot coals from resinous pine fly through a small slot in the air intake and all the way across the room. You'll never get a good night sleep if you just have a small fireproof pad around your stove. Woodstoves and carpet don't mix well. If nothing else the dirt tracked in from carrying wood will drive the wife crazy. If you do have carpet, pull it up and put down tile or stone flooring. If you have a modern springy framed plywood floor, a couple of layers of 1/4" plywood glued and screwed in alternating directions to the existing ply will stiffen it enough for tile.
Also, the wall behind the stove is equally important. Unless you're several feet away from a framed wall do something like this:
Cover the wall behind the stove with fire stop drywall a couple of feet above the top of the stove (or chimney if it exits through the wall). Install a steel lintel at floor level using large bolts screwed into the studs. Leave an inch air gap between the lintel and drywall using spacers. Lay up a brick wall on the lintel and tile over that. The air gap behind the brick wall allows a cooling draft. The brick also provides a good source of thermal mass which leads to a final point.
There's nothing much worse than getting out of a warm bed in the morning to start up a cold, dead woodstove. The stove that I owned when I lived in Colorado was made of Soapstone by a company in Woodstock, Vermont. They aren't cheap to buy but they are worth ever cent they cost. Once that stone gets warm, it stays warm for hours, even if the stove runs out of wood. I used to load my stove in the evening with whatever wood I had, generally pine, aspen or even hem/fir framing offcuts, not oak or hickory by any means and yet that great little stove heated the entire second floor of my house and the stove was still toasty warm well into the next day. Although I had been told this, I still was amazed at how a small properly built stove could heat such a large space and still not cook me out of the room it was in.
I cannot recommend highly enough the use of thermal mass over cast iron in a stove. There are other manufacturers of soapstone woodstoves
but if and when I move back to a cold climate, I'll be getting another Woodstock Soapstone Stove. Thanks again for the interesting blog. - LRM, Perth, Western Australia
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Lessons Learned from Hurricanes Ike, Rita, and Katrina, by TiredTubes
In September, 2008, Hurricane Ike--a Category 4 hurricane--pounded the Gulf Coast of the southern US. Some coastal communities like Crystal Beach no longer really exist. Inland, life was severely disrupted. For those of us on the South Coast hurricanes are a frequent reality. We were quite well prepared, but used the disruptions and dislocations as a test and opportunity to tune up our preparations.
1. Be ready to help others and to accept help We didn't need much during Ike, but the power went out before a neighbor finished boarding up his house. My 1 KW inverter, hooked up to his idling truck provide the juice for a Skilsaw and a few lights; allowing him to finish. Usually it is skills and not "stuff" that helps others and yourself. Besides strengthening a neighborly friendship, the number of damaged houses was probably reduced by one.
2. Keep your stuff squared away.. I repaired a few generators during and after Ike. I observed that every one suffering from lack of use; i.e. gasoline that resembled turpentine in the carburetor. People were at a complete loss to understand this. My daugher-in-law owned one of the generators that I repaired. She ignored my admonition to change the dirty oil ASAP and then once every 50 hours. Early in the next week it [ran out of oil and] threw a rod. She was in the dark for another week. Just a $2.99 quart of oil would have saved discomfort, ruined food, etc.
My portable genset, loaned to my daughter, was ready to go; fresh oil, filters, valves set, exercised, load tested. It started on the first try. I came to check it and change it's oil as soon as it was safe to travel. The first thing that I did was turn it so the exhaust faced away from the house! She had placed it so that the starter rope was in a convenient spot. At least she had, like I had asked, chained and locked it to a foundation pier.
After every hurricane Darwin gets a few through accidental carbon monoxide poisoning. Don't join them. If you have a generator, get a carbon monoxide detector in case the wind changes and wafts exhaust in your windows.
Our own [permanently-installed] genset uses natural gas (a tri-fuel generator)
which in the majority of cases is superior and much cheaper to operate. Over the 11 days that we didn't have power it consumed $100 worth of natural gas. I estimate that an equivalent amount of gasoline would have cost more than $300. I stopped it every 75 hours for oil and filter. If your genset doesn't have an hour meter, then add one. There are some inexpensive self contained hour meters made for lawn equipment that work very well and require no hard wiring. It's really the only practical way to keep track of operating time, without which, intelligent maintenance is impossible.
I noticed that many generators, some still in the box, on Craigslist following Hurricane Ike at bargain basement prices. I recommended to a friend he latch onto one of these and purchase a dual-fuel gasoline/natural gas carburetor] kit. Ants can profit from short-sighted grasshoppers.
It goes without saying have all your vehicles filled up and serviced so they can be depended upon with out much attention. Pay particular attention to cooling systems, oil changes, tire pressures, belts and battery terminals.
Develop a pre-event SOP: When we hear of a hurricane in the Gulf, we pick up loose items like branches that can be thrown by high winds and cause damage (aviators call this rubbish FOD), trim trees, check prescriptions, recharge everything rechargeable, treat the swimming pool with "shock" chlorine, get all the laundry and dishes done, get all the trash out for pickup, take “before” pictures, etc., etc., etc.
3. Have backups for your backups. The portable generator above was our backup to the natural gas-fueled genset. Then an inverter and ups. After that is a 100 Watt solar array I've been tinkering with to provide power for security lighting,etc.
My daughter spent up to two hours a day foraging gas, mostly waiting in lines. She found out that the problem with gasoline-fuel generators is gasoline! It's expensive, in short supply (when it is needed most), and it takes gas to go and get gas! Needless to say I rounded up the parts and the portable is now a dual fuel machine. Had it been able to use natural gas then she could have stayed home and been one less person waiting in line. And the machine still retains the capability to burn gasoline!
Since gasoline became hard to come by (it was impossible to get for a week after Rita) but diesel fuel was plentiful we did any necessary traveling in my old diesel Mercedes (which is EMP proof, BTW).
One important word on generators: Treat yours like it is the last one you'll ever get. Try and get a good one, I prefer either a Honda or Briggs Vangard engine. My Vangard portable is approx 10 years old and absolutely dependable. The difference is methodical maintenance. Keep the manuals, and read 'em ! Keep the oil changed, keep a fresh spark plug, keep spare [oil, air, and fuel] filters. Most importantly run it under load once a month. Unless it's new, pull off the cowling and clean all the dirt and dust from fins on the cylinder jug. Closely examine the starter rope, the fuel lines, et cetera. Replace 'em if they ain't perfect.
If you get a permanently installed generator carefully consider installing a manual transfer switch and other upgrades. With the exception of automatic "exercising" fully automatic generators these add a layer of complication and cost.
Don't store gasoline in the machine other than enough for one periodic test run. Develop a ritual on test runs: such as every other payday, or the last Saturday in the month, to reduce it to a ritual. I run mine monthly whilst cutting the back yard lawn. (The mower makes more noise.)
For storage between test runs: On portable gensets [with the ignition off, slowly ] pull the cord until you can feel that the engine is at the top of the compression stroke. This is where the engine feels like you are pulling it through a "detent". It puts the piston at the top of the bore and closes both valves. This protects the cylinder from moisture. If you store gasoline then use stabilizer, after six months burn it in your car and replace it. Few experiences are worse that trying to clean out a carburetor by a dim flashlight whilst being consumed alive by salt marsh mosquitoes. Trust me on this. BTW, I've had better results storing "winter" blended gas, since t has more light fractions and starts easier year round.
If you use gas cans; stick with metal, preferably safety cans. Plastics are slightly permeable and it will go bad much faster in a plastic can. On that note, [in humid climates] don’t keep spare spark plugs with the machine. This is because in outdoor storage the insulators can absorb moisture [and the metal parts can corrode]. Keep them inside or in a sealed can with some silica gel. An old one-quart paint can is ideal.
If you have a dual-fuel machine, then break the engine in on gasoline and make sure it operates properly on both fuels under load. Keep the necessary connectors for gas operation on the machine so that you don't have to go searching for that 3/8ths-inch pipe nipple with a flashlight.
Use high quality oils, and have enough. Don't forget to also store plenty of 2-stroke [fuel mixing] oil and chain oil if you intend to use a chainsaw. Maybe store some extra for your neighbors that are less prudent. I use Rotella brand synthetic oil and Wix brand filters, and have had good results with them.
Make sure you have enough oil, filters and plugs for at least two weeks (336 hours), or longer. Don't forget about your equipment after the crisis is over: There are valves to set, oil and plugs to change, etc. Even if you own two generators and have enough flashlights, automatic emergency lights, et cetera, things can, and may likely go wrong. Small children usually do not take kindly to being plunged into total darkness. Unless it is TEOTWAWKI, keep the candles in the cupboard, especially if there are small children about.
4. Double your plans for helping other people. Several relatives from coastal areas evacuated to our house (approximately 50 miles inland). I keep a 55 gallon drum of stabilized gasoline to fill up their cars to get them home. This was a lesson learned after the Rita evacuation cluster. How much food you will go through will surprise you. It finally dawned upon us that we almost always eat dinner (lunch to you Northerners) and sometimes breakfast away from home. So what we consumed whilst hunkered down seemed out of proportion.
We also sent some food home with people to hold them over. I was able to "lend" a retired neighbor enough generated power to keep his freezer, television, and fan going. He was genuinely happy. This also meant that he was one less person in line for ice, food, and so forth.
5. Keep a dial up phone line around, after 24 hours the cell phone tower generators started running out of propane, the cable modem (and the cable) went down with the power. Remember how to make that dial-up modem work.
If you're not a Ham radio operator, then find out where the local hams conduct their emergency nets, and listen on your shortwave radio (HF) or scanner (2-meter and 440 band) and you'll know a lot more that the local television news truck can find out.
If you have cable television, then keep a traditional antenna handy. If you live near a major market the local AM news station, then it is probably a good bet. Have a good UPS, plug the computer and the desk lamp into it. If you have a cordless phone, plug it into the UPS too. The UPS will take the "bumps" out of the generator's power; your computer will thank you. Make sure you test the UPS periodically by plugging in a 100 Watt lamp and pulling the plug on the UPS. I find I need to replace that UPS battery about every 2-to-3 years.
6. Plan for the guests. Have plenty of soap, have a small flashlight (preferably with rechargeable batteries) for each guest. Have things other than television to keep youngsters occupied. Try and get plenty of rest. You'll probably be plenty busy after you can poke your head out again. In this vein don't forget dishwashing supplies, laundry supplies, baby supplies, etc. If it's a predictable event such as a hurricane, have all the dishes and laundry done. before it hits.
A television in a room by itself will keep the racket contained from those who want to read, play games or just sleep. If you have the space, then a “quiet room” where people can just rest, read, be alone, have some privacy or get a fussy to baby to sleep cuts down on contagious stress.
7. Make sure you are medically prepared. Have a rather complete first aid kit that includes a backboard and splinting materials. There will be plenty of cuts,scrapes, bruises, sunburns and sore muscles in the aftermath. Have Band-Aids, 4x4s, neosporin, peroxide etc. Have plenty of acid reducer and immodium on hand (stress and unfamiliar cooking), have at least two weeks of prescription drugs on hand [and preferably much more for any chronic health issues]. Have a good assortment of Tylenol, cold and sinus preparations, BenGay [muscle ointment], good multivitamins, etc.
8.Be extra, extra, extra careful. You getting sick or more likely injured can really mess things up for everyone you have prepared for. Not to mention that the local fire/ambulance is probably already overtaxed. Be extremely careful handling fire and fuels. A lot of us are not entirely fluent in using chainsaws, small engines, fixing roofs, trimming trees and moving debris.[JWR Adds: safety equipment including heavy gloves, kevlar chainsaw safety chaps
, and a combination safety helmet with face shield and muffs
are absolute "musts"!] Don't get in a hurry unless there is a threat to life. Be hyper cautious, be very aware of your surroundings and things that can go wrong. Don’t toil alone. Make sure you have a clear path to beat a hasty retreat if things go wrong. Wear those gloves, safety glasses, boots and maybe a hard hat.
Don't overtax yourself. Getting a fallen the tree off of the roof today avails you little if it triggers a heart attack or heat stroke. Ask God's assistance and start over tomorrow.
Keep fire extinguishers near the gas generator, in the kitchen, and near the camp stove.
Avoid using candles at all costs, and absolutely prohibit smoking indoors for the duration. Have more than enough battery smoke detectors around.
9. Be ready to make temporary repairs.. The missing shingles, damaged windows, etc. Have some plywood, a few 2x4s, some Visqueen polyethylene sheeting, batting boards, duct tape, a tarp, some nails, and so forth around. If you happen to have a good cordless drill, then you'll find sheet rock and deck screws are very superior to nails. If you're squared away then you already have this stuff , but a neighbor might be in need, so buy extra.
Debris creates flat tires for quite some time after many events. Have a tire plug kit and a 12 VDC compressor in each vehicle. Repairs to structures, especially roof repairs guarantee nails in tires. Be ready for them..
Have everything rechargeable recharged. Make sure you have some traditional non-power tools, I have a handsaw that I've had for decades, a good bow saw, ax, maul, sledge and an old eggbeater style hand drill still get regular use.
10. If I had my choice of just one utility it would be running water. Fortunately where we reside is served by a well run rural utility district which has prepared well for hurricanes. Failing this, in addition to stored water I have a portable gas utility pump (Robin brand) that can pressurize our water system from our pool and has sufficient capacity for a fire line. The pool got a good jolt of shock a day before the storm hit.
11.Keep some cash money handy. For a few days [with no utility power] there were no functional ATMs, and no way to use credit or debit cards.
12. Keep a low profile. About a week after Ike a passerby indignantly asked "How'd you get your lights turned on?" This showed his ignorance on several levels. He seemed to think someone just had to flip a switch downtown and "shazam!" his lights are on. I couldn't make him understand there has to be an unbroken physical link between a power plant and consumer, this seemed to aggravate his obvious helplessness. Telling him that we had been making our own juice seemed to irritate him. I wonder who he voted for? People with this mindset (that the world owes them something) could be a genuine liability in a real catastrophe. (BTW on a news show during a piece about energy, I actually heard a lady refer to natural gas as “just another dirty fossil fuel”) and not be challenged on the facts. Little minds scare me. I think that the hyper-liberals would love to use the heavy hand of government to force the ants take care of the grasshoppers. Keep a low profile. The best advice I ever heard on the subject (I believe it was Howard J. Ruff
) was to "keep your principles public and your actions private".
13. Keep a notebook, keep a record of what happened, but especially keep a record of preps you overlooked or screwed up, or stuff you ran out of, or skills that need to be added or honed. That's where most of the preceding information came from! Also keep tabs on what's scarce after an event. Gas was scarce, but diesel plentiful after Rita. In contrast, after Ike there was plenty of fuel, but few operating stations due to lack of power. (There was a "mandatory evacuation" during Rita which turned out to be a fatal traffic jam for a few poor souls which quickly emptied the filling station tanks.) Out our way the local Wal-Mart made a heroic effort and opened up on locally-generated power, two days after Ike. The sheriff’s department was there to “maintain order”. (Let’s just say that they actually wear brown shirts here.). This event was a lifetime opportunity to study the varied behaviors of people under stress.
There were plenty of canned goods and auto supplies. But fresh fruits and veggies were a little thin, no meat due to lack of refrigeration for a few days, batteries, Coleman fuel, trash bags, paper plates, disposable diapers, formula, and nails evaporated. The pharmacy was closed.
Even with the numerous mistakes we made, we were able to stay safe, secure and comfortable and help others while "victims" were standing or idling their car engines in lines. It was an opportunity to try things out under more or less controlled conditions. WTSHTF there will not be controlled conditions!
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Two Letters Re: Preparations for Eyesight & Hearing
Jim,
I thought that I would respond to Jake G.'s letter on "Preparations for Eyesight & Hearing". I feel I can offer a little insight (no pun intended) on eyesight and Lasik.
I had Lasik a little less than two years ago. I had just turned 43 and, after 22 years of wearing glasses or contact lenses, I was ready to make the jump. I didn't take it lightly, as having any procedure contains some degree of risk, but having surgery on arguably the most important of your five senses is scary. I had been in love with the idea of ditching glasses for good, but I was not willing to have the procedure until it had been around for a while and was more comfortable with it. After many friends and relatives had Lasik, I researched eye surgeons in my area and found one with the facilities and qualifications that made me most comfortable. I wanted a physician who had done this before, many times before. The doctor I selected had done over 14,000 surgeries. I wanted someone who had seen almost anything before. I wasn't pressured to have it done, nor was I even encouraged to schedule a date while I was there.
I went in for the surgery, accompanied by my wife, who would be needed to drive home. While I was in his office for a good two and a half hours, the procedure itself took less than ten minutes and was relatively painless. It felt like someone was pressing on my eyeballs for a few seconds. I left the office feeling great and had little discomfort, although many people say they feel like they have sand in their eyes for up to 24 hours. I had a follow up appointment the next morning and went to work.
From a preparedness standpoint, it's the best thing I could have done. I am 20/20 in both eyes for the first time since I was 21 years old. I don't have to worry about contacts in a field situation, nor do I have to worry about losing or breaking my glasses. I can wake up in the middle of the night and can confront any situation without fumbling for eyeglasses. It is very comforting.
As Jake stated, the potential change in one's close up vision is an issue. I was gradually noticing that reading was a bit more difficult, particularly in low light situations, but I didn't require corrective lenses. After Lasik, I noticed that I was having more trouble reading and I found that I was unable to read comfortably without reading glasses. I picked up several cheap pairs of "cheaters" from the local drugstore. It is true that people begin to notice a decline in their vision when reading sometime after age 40. Lasik can make it more pronounced. It has now been almost two years and my near vision has not worsened any further. Wearing glasses while reading is a bit of a pain and a concession to the advancement of Father Time, but the freedom from glasses in everyday life has been fantastic. I would highly recommend Lasik for those interested with the caveat that they do their research and choose a well qualified physician who explains all the risks to their satisfaction. All the best, - Ken B. on Long Island
Sir,
The discussion about Lasik and contact lenses prompted me to write about an alternative: implantable contact lenses (ICLs). The surgery is more-or-less the same as cataract surgery, except that unlike cataract surgery (which replaces the natural lens of the eye with an artificial lens), ICL leaves the natural lens in place along with an artificial lens. Because it is essentially a variation on cataract surgery, which has been around since the 1940's, unknown negative long-term effects from ICL are unlikely.
The advantages of ICL over Lasik are several-fold. First, the result is significantly superior to Lasik surgery -- vision is far more clear (mine is now 20/15) and with fewer and less severe optical "halos" (mine disappeared entirely within a few months of surgery).
Because you're not changing the physical structure of the eye, you're less likely to wind up with poor results.In fact, if you're not happy with the results, the lens can be removed entirely and your vision returned to its pre-surgery condition. If your prescription changes, the implanted lens can be exchanged for a new one. If you develop cataracts, your natural lens can be removed and your artificial lens can be changed out if necessary.
During the surgery, local anesthesia is used along with a paralytic to prevent the eye from moving. This is a boon to those of us who have difficulty controlling our blink reflex. IV sedatives are also provided, making the surgery both pleasant and completely comfortable (as compared to Lasik, which is often described as "sucking my eyeball out of my head!").
ICL does not impact your ability to participate in extreme activities: since my surgery, I have been both scuba diving and sky diving with no negative effects.
Finally, people who have been turned down for Lasik -- such as those with corneas that are too thin for Lasik -- may be eligible for ICL.
ICL is more expensive than Lasik; I paid $3,000 per eye in 2005. It cannot correct farsightedness, and won't prevent the need to wear reading glasses (however, it will not increase the need for reading glasses like Lasik can).
I've had ICL for nearly four years now and I can't recommend it enough. The web site for the group I used is www.GoodEyes.com. - E.
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Prepping for the Worst Case: Becoming a Refugee, by Dr. L.D.
I am unable to make my home self-sustaining. So, unfortunately, my family will probably become refugees in a true SHTF scenario. My focus presently is in becoming desirable refugees rather than shunned refugees. The key is minimizing any negative impact (extra logistics of all sorts) and maximizing any positive impact (filling in weak spots) to someone that is geographically fortuitous. I was challenged to figure out how a small family could best become a wanted commodity when food is tight and security isn’t. I determined the key for us was that everything carried needed to be dense in value. Density equals mass divided by volume. In our case, mass would be the battered value of the item; volume was limited by the size of our packs. We can’t carry enough bulk food, but we can carry items that will have an excellent post-SHTF (bartered) value, an example would be trading batteries for an illuminated-reticle or starlight scope in exchange for food. Keeping our packs small (but danged heavy) will give us an additional advantage if we need to make a small camp.
Skill sets are valuable. I am fortunate to have become a physician. Talk about (trading) food for thought! I am trained in Internal Medicine, so much of my skill set depends on a working infrastructure, that is, availability of medications, imaging (X-rays, CT, MRIs and the like) which will be useless once the grid goes down. To make up for that, I have been certified in ATLS (Advanced Trauma Life Support) and ACLS (Advanced Cardiac Life Support), the former being far more useful in extended emergencies. Further, I have also trained in mass casualty scenarios. I have been stashing typically needed and well tolerated medications in a FIFO set-up in my home, from antibiotics to blood pressure pills. In a legally gray area, I have some potent narcotics (barter/ransom/medical use). I also have a good stock of scalpels, retractors, Celox and the like to maximize my worth. The first lives my first aid kit may save might be my family’s. My skill set will be in demand, and I hope with the other positives below, worth enough to take in extra mouths to feed. But I recognize, perhaps better than non-medical people, that the quality of medical care will quickly revert to the level practiced before the advent of antibiotics and other modern pharmaceuticals. Think Civil War or WWI where a gut-shot was a death-sentence. Garlic may have some ant- microbial properties, but it pales compared to a few doses of modern antibiotics. Being a doctor in a SHTF scenario may be like being a sailor in the middle of a desert: lots of knowledge but only able to apply a small fraction of it.
My wife is an educator and now teaches special needs kids. If the Collapse is a bad one, kids will still need to learn, and there is more to teaching than just putting material in front of kids, as anyone that homeschools will agree.
Those are our special skill sets. You can never have enough skill sets, and we plan to further develop our skills.
Our two children are too young to be useful for anything except giving us joy, . And dirty laundry.
We have been buying weapons in standard calibers – 45 ACP, 5.56, and 22LR. I have given myself the luxury of owning a PS90. I rationalized the purchase by the fact that it supports a 50 round magazine of 5.7 rounds and bridges the gap between a pistol and a longer rifle. In reality, it looks really cool. Four mags on my hip (and one in the rifle) gives me 250 rounds. In an urban/suburban location, which will be the most difficult part of our journey, I do not see a need to shoot over 100 m. Most action will likely be under that, and that is the niche for the PS90. Additionally, it’s bullpup design keeps it short and maneuverable in a vehicle without sacrificing accuracy (it has a 16 inch barrel). More importantly, we have packed way about 150 pounds worth of ammo in our G.O.O.D .bags and another 70 lbs in our BOB’s. We have so far two extra ARs and three Glocks for barter/trade. We don’t have a weapon for the 22LR, but either we will (Ruger’s 10/22) or it’s for barter. Our bags are meant to carry the lead at the sacrifice of food. It may be easier to barter rounds (heavy but small) for food (light but large). If we do make to the hinterlands, having our ammo added to the favorably situated ‘castle’ will be a bonus. My wife and I both shoot accurately to 200 m, and well enough at 300 - 400 m to keep the philistines away. We continue to practice our shooting skills by range time and class time. We will get far.
I’ve begun a ‘collection’ of survival knives and high quality folders by buying two at a time (again, two is one, and one is none). They will be needed en route and, like ammo, possess an excellent weight to bartered value. My guess is that knives will lost or broken and there will be a demand for them. In the same category, are redundant Katadyn water filters kits. Extras were purchased because they are small and will barter well. Bolt cutters were bought because they will be useful traveling and also in barter. Bic lighters, assorted tiny screws for spectacles with jeweler screwdrivers , rechargeable CR123 and AA batteries, extra Gerber multitools, quality compasses, 550 cord, several small but bright flashlights (Fenix brand – 1 or 2 CR123 batteries and they pump out over 180 lumen and fit on a keychain or a rifle), two Old Testaments, and 2 American flags fill the small spaces in the gear. We keep thinking on how to improve our “stock” and get more bang for the buck with ‘value dense ‘ items. I thought of the extra eye-glass screws after having my own come apart just as I got to work and spent a miserable day squinting. Someone missing their glasses won’t function at near capacity and the eye glass screw may be the equivalent of the nail that caused a horse to be lost, then a rider to be lost etc.
We also have our own gear and clothing, using the layer approach with an outer hardshell in camouflage. We both have packed two pair of extra boots, either for the long haul or barter.
These items get thrown into the trunk along with our Camelbaks, and our mountain bikes (with extra tubes and tires) go on top supporting a few jerry cans of gasoline lashed between them. If we can’t get to a refuge with available gas or the roads become impassable, then we load the bikes up and ride/walk until we are welcomed.
If we’re lucky, the Collapse will wait until we can move to a more geographically desirable location and all these purchases will remain useful while we focus on new needs (stored food, long term water and power and etc). If not, I have improvised a plan that adapts to our situation and hopefully will change our refugee status to a valued team-member.
This is written in part because there has been no view from the prepared refugees. There may be more preppers without a safe haven than those able to develop a safe haven, not because of any deficit or laziness on their part, but because of reality. In addition, all preppers cannot move to a sparsely populated area in the US for if they did (imagine merely 10% of NYC, LA, and DC doing so during by the end Obama’s administration), those areas would no longer be sparsely populated! So think of what you can carry that can be bartered for things you can’t carry and that will make you into a valuable team member.
I have worked hard to become a doctor (and perhaps even harder to remain a doctor is this crazed system) and to be able to give charity rather than receive it. If I am to receive the charity of shelter from someone who is able to do so, I will be sure that we do more than just pull on own weight. We will add security, in the short and long haul.
So if TEOTWAWKI happens, keep a lookout for strangers who may have much to offer. But for the grace of God, it might have been you unable to live in a geographically desirable area and looking to add to an established sanctuary.
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Letter Re: Preparations for Eyesight and Hearing
Mr. Editor:
Just a quick note to follow-up regarding preparations for Eyesight and Hearing. I checked into lasik and contacts long ago (I am slightly near-sighted – too many hours staring into cameras and computers I guess). Although Lasik advances have come a long way, please be sure you talk to your eye surgeon at length before you commit to this serious expense. If you are near-sighted, a successful lasik procedure will improve your long-distance vision, but may impede your “up close” vision. I talked with my eye doctor at length about this, and after many questions he acknowledged that in many cases, near-sighted people would require reading glasses in as little as 3-5 years.
Also, remember that as a person gets older, the eye muscles simply weaken, which is why many people need reading glasses by their mid-40s. For those of you who were genetically lucky enough to not need glasses, oh how I envy you! (Forgive me Lord!) For those of us who do need glasses, contacts are a nice thing. Remember that eye solutions do have expiration dates and never sleep with your contacts in because it can lead to eye infections. Make sure your hands are “hospital surgery clean” (HSC) when you place the contacts in your eyes. A post-TEOTWAWKI eye infection is not something you want to deal with.
If there are any ophthalmologists reading, I’d be interested in hearing from you about eye-related injuries and treatments, etc. For example, I imagine there will be a lot of people chopping wood without wearing safety glasses who end up with one of nature’s toothpicks embedded in their eye.
As a side note, I recommend going to Costco and picking up extra pairs of reading glasses. Buy several different strengths, including some that “stronger” than what you currently need. They are cheap, but somewhat durable. Even if you don’t need them now, someone else may. - Jake G.
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Letter Re: Preparations for Eyesight and Hearing
Hello Mr. Rawles,
This is just a quick note from a new reader. If what I mention to you has been covered on your site, I apologize; your site takes more than a few multi-hour reads to digest!
I see very little talk about contact lenses/solution and hearing aids/batteries post-TEOTWAWKI in most preparedness articles. I would think it would be most unfortunate to train, learn and prepare for any upcoming abnormalities and shortly thereafter not be able to see or hear.
It would seem to me that at least a couple year's supply of contact lenses on hand at all times would be wise, and perhaps an extra hearing aid or twenty for those that need? And I bet you saline solution for contacts and extra hearing aid batteries would be great barter items in the event of a major catastrophe. Those items will be worth their weight in gold (if not more valuable) to the unprepared masses.
Perhaps a wise suggestion would be Lasik surgery or something similar very soon for those who would benefit from it; those that depend on contacts would be wise to think about that procedure or something similar to eliminate their dependency on visual aids. And to say the least, several pairs of sturdy, mil-spec frame prescription glasses would be a great investment for the well-prepared.
One is reminded of the old "Twilight Zone" episode ["Time Enough, At Last", starring Burgess Meredith] where the bookworm comes out of the bank vault, sees the world in post-nuclear destruction....and drops his glasses, smashing them. A true nightmare scenario indeed! Thank you for your wonderful blog site and books. Sincerely, - Rick T.
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Is Prepping an Insurmountable Task?--The Beginner's Primer, by Gary T.
Once you realize the importance of being prepared for coming hard times, you may ask yourself, “How can I possibly prepare for any scenario? This is an insurmountable undertaking.” The more you ponder this, the more the reality of this seems to be confirmed. Let not your heart be troubled. As with almost any endeavor, the road to success begins with the first step and continues one step at a time. Consistent, prioritized, careful preparation over a period of time, preparation built around what your personal situation (budget, job, family, medical needs, etc.) will allow, can get you in a position in relatively short order to weather the scenarios that are most likely to occur. The mere fact that you have considered the possibilities of what may lay ahead can very quickly put you ahead of the vast majority of the population.
Consider the possible scenarios whereby preparedness would prove to be literally a lifesaver. These scenarios range from very geographically localized events, either natural or man-made, to the proverbial TEOTWAWKI. The likelihood any of these events occurring generally becomes decreasing likely in a given time frame as the geographical scope and severity of the event increases. Therefore the occurrence of a total multi-generational societal collapse, requiring the maximum amount of preparation is far less likely to occur over the next year or two or five than relatively local, relatively short term events such as tornados, hurricanes or floods, or even some major terrorist events, all requiring far less preparation than TEOTWAWKI situation previously mentioned. This should be considered in the early stages of preparation as priorities for investment are made.
Therefore, your preparation should follow a well planned, measured, prioritized process that enables you to be positioned to go through the most likely scenarios first followed by progressively increasing severe scenarios. Ongoing preparation will build on the past. No effort goes wasted. This should be encouraging to the beginning prepper.
How should you start? Start with a careful analysis of the most likely localized events that may occur in your area or region, or events from another region that may impact your local area (remember passenger air service after 9/11). Shutdown of transportation systems, especially trucking and rail should be of paramount concern. What is the probable time frame that these events may cause you to rely on your own resources? Make a list of all the items and quantities you will need to get through that period of time. This constitutes the Phase I physical resources preparation plan.
Prioritize the list and within the constraints of your budget begin to acquire the items you have listed. Keeping an Excel spreadsheet makes this task much easier and allows you to see at a glance exactly how much physical resource preparation you have achieved, how much you still need, the value of those resources, the cost to complete your initial Phase I purchases, etc. Your spreadsheet should include rows listing each item with columns for:
- Priority
- Category or subcategory
- Quantity Needed (for the given preparation Phase)
- Quantity on Hand
- Difference Needed vs. On-Hand (Calculated Value)
- Cost Each
- Acquisition Cost (Calculated Value)
- On Hand Value (Calculated Value)
- Total Value (Calculated Value)
- Percent Complete for the Item (Calculated Value) – you can color code this Red/Yellow/Green for and at a glance dashboard view
- Subtotals as you feel appropriate for each Category or Sub-Category
In the same way you used Excel to track your Phase I resources preparation status, use your spreadsheet to list categories, sub-categories, items and quantities that you wish to acquire for future Phases, up to and including a Phase for TEOTWAWKI. This allows you to systematically build your level of preparedness a Phase at a time. As you start with Phase I, you can also see how well you are gearing up for future Phases as well. Remember, on-hand quantities, pricing, etc, can carry from the Phase I sheet to the Phase II through Phase “n” sheets so redundant data entry isn’t required! Don’t forget to make hard copies of your files and save them in a three ring binder.
Additional Tips for getting started.
So you have determined what you need to acquire and have begun to do so. But prepping isn’t just about acquiring tangible goods.
It is also about skills. It is especially about skills. Even what I have called “Phase I” preparation should include training in the plan. A diversity of skills within your group (which may start out as just your family) is important. Take advantage of any relevant training available to you at low or no cost. Programs available in many communities include CERT, First Aid, CPR and similar. Use these opportunities to increase your skill base. These are great skills to have in normal times and are great skills to build upon. Even these basic courses could prove to literally be lifesavers in “normal” as well as tougher times.
Learn to garden. Even if you don’t have a retreat with the space, perfect soil, and water supply, you should garden on a smaller scale in your city or suburban back yard. This will give you a head start in knowledge and experience (i.e., harvesting and saving seeds for future years) when you are able to move to that retreat location. Plus, fresh garden vegetables are healthier and taste so much better than what you purchase from the store, especially if the store bought vegetables are poured from a can! Nothing beats enjoying a hand picked, vine ripe tomato fresh from the garden (and I confess, I take the salt shaker out back with me!).
Put away the foods you eat today. Nitrogen packed survival foods are expensive and likely should and may be a part of your plan. However, many foods that you eat today can be more immediately utilized to kick start your storage pantry at moderate cost while you save for other more expensive longer term options. You can buy or easily build out of plywood a FIFO rotation canned goods rack, set it in a pantry or closet and start loading it up today with the foods you already eat. This accumulation can be done for little perceived cost if done over time. Simply buy a little extra of what you already purchase each time you are at the store. You will be amazed at how quickly you can build up a 30, 60, 90 day supply of canned goods that will never go bad because they are what you currently eat so you rotate them via the FIFO system into your daily meals. Canned vegetables, meats, soups, fruits and sauces can all be stored in this simple way. All at very moderate expense.
Learn about your firearms. Practice with them as much as you can afford to. Get professional instruction. Basic courses for novices are available at moderate expense. There are NRA sanctioned courses for basic safety, handling and shooting skills. Work toward completion of an NRA course or equivalent in self defense in the home and self defense outside the home. If you are or once you get to be more advanced, get even more advanced training. If your budget doesn’t initially allow this, do the best you can but plan for more advanced tactical training in a future Phase. The key now is to get what you can afford and build on that. Practice, practice, practice.
Don’t think you must necessarily purchase a complete set of new firearms right out of the gate for your survival armory. Conventional wisdom suggests .45 ACP pistols for carry, .308/7.62 NATO semi-autos for your MBR (with expensive red-dot optics), a good .308 bolt action for long range and / or large game hunting, and perhaps a more expensive shotgun than you have budget for. If you already have 9mm pistols, that AR-15 you bought a few years ago “because you wanted one”, the scoped .303 you inherited from Dad and an old but functional Remington 870 Express in 12 gauge, you are good to go for now, as a beginner prepper. Make sure that adequate ammunition is part of your plan, but with this or a similar adequate set of calibers and shotgun you are set for your initial Phases of preparation. Early on, food, water, medical supplies and the like are likely a higher priority than new firearms. You can upgrade in a future Phase. Focus on firearms training at this stage. It’s about prioritization. Besides, later phases prepare for scenarios that will be more likely to require the capabilities of upgraded firearms.
A basic principle. Standardize. If you pick .45ACP for your personal carry weapon, it is advantages for all members of your group to do the same. The same principle applies for your MBR, self defense and hunting shotguns, etc. Ammunition and magazine plans will appreciate this. Try to standardize on 1 or 2 battery types for your battery operated devices. Or more correctly standardize by using devices requiring only 1 or 2 battery types. You don’t want to have to store and/or maintain charges on AA, AAA, CR123, C, D, N and CR2032 batteries, when you could be more efficient and effective with perhaps using only AA batteries. This principle applies to anything that you have more than one of. Radios, flashlights, etc. Remember the axiom, two is one and one is none. Standardization means simplicity, efficiency, spares. There may be exceptions, but take standardization into consideration when you develop or modify your plan. Initially, you may have to have a wider assortment of devices depending on the devices you currently have, but have a strategy to standardize.
Plan to read or more correctly, to learn by reading. Whenever you come across a useful article, print it out and save it in a three ring binder with other useful articles you have saved. Even if it is something you can’t purchase or do or use until a future Phase, save it now and add it to the plan now. There is an incredible amount of useful information in SurvivalBlog.com. Read and save (and purchase through Jim’s site when you decide to purchase goods from one of his advertisers). Jim helps us so we should help him where we can.
If you have relatives or friends in a rural location that you can get too and who are willing to take you in during appropriate events, have a G.O.O.D. plan. This includes hard copy maps with routes and alternate routes. Practice all routes before the big day. Practice your load out plan, again, prior to the big day. Search SurvivalBlog.com for loads of information on G.O.O.D. There are many concerns related to evacuation in certain scenarios. Educate yourself and make educated decisions.
This article is the tip of the iceberg with regards to beginning prepping, but hopefully it has a few pointers to get you thinking and to get you started and is an encouragement that this can be done, that you can successfully prepare for the future. You don’t have to purchase all nitrogen packed long shelf life survival foods or the perfect arsenal with one of every conceivable firearm type for every circumstance (in fact limiting (standardizing) models and calibers has some clear advantages) in order to successfully prepare for the likeliest of scenarios. Remember, methodical, prioritized preparing is the way to go for those of us on a budget. Start small, build your knowledge base, supplies and skills, and very soon you will be in the enviable position of weathering the most likely calamities to occur in the next few years. If you continue this methodical, ongoing process, you will continue to improve your situation and continue to put your self in a position to weather increasingly more severe and longer lasting scenarios. The important thing for those on a budget is not to wish you could do it all now by immediately trading cash for all the tangibles and training you need, but to start and to start now and to consistently build to our plan as we can afford to do so.
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Hypothermia Prevention and Treatment Part 1--Staying Warm, by Lumberjack
This two part series of articles is meant to address a basic physiological need that may be severely threatened both in a TEOTWAWKI situation and any time a lesser emergency takes us out of our bubble of comfort and preparedness. That issue is warmth: specifically how you stay warm and avoid hypothermia when your car slides off the road in a snow storm or you don’t get out of dodge fast enough and find yourself hoofing it overland with only what you can carry, through rain and wind. Part two deals with the possibility you or a loved one or team mate is succumbing to the cold, how you can best treat your patient to stabilize and revive them most effectively. Throughout this article I will not only lay out some basic concepts, examples, and treatments, but just as importantly I will debunk some of the myths about cold weather survival. My qualifications come from numerous years leading wilderness trips in the mountains, alpine search and rescue operations, and teaching wilderness medicine at the university level to doctors, nurses, EMTs and paramedics, and laymen alike.
To begin with, it is easier to stay warm than to get warm. The classic newbie mistake when traveling outdoors in cold weather is invariably some variation of the following: you get up in the morning, and it is cold. You layer up, putting on your puffy down jacket and hat and gloves, eat a bite, strike camp, and make ready to move. You are cold and not real excited about taking off your many warm layers to start hiking, so you hoist your pack and set out. 15 minutes later you are warm, 30 minutes later you are hot, and 60 minutes later you stop to take off your warm layers, drink some water, adjust your boots and consult the map. Now soaked in sweat you cool rapidly, and before you finish your snack break you are chilly, so you toss your coat on. When it is time to get moving again, you do so with your coat still on. Every subsequent break follows the same pattern, so start moving warm, get hot, stop, get cold, put jacket on again and get hot again. This is the exact opposite of what you should be doing. Instead follow the habits of every mountaineer: start cool, almost cold in the morning. When you stop to rest, even before you get cold, throw on a warm layer. When you are ready to move again, drop the layer. You will avoid sweating and avoid wasting valuable calories to thermo-regulate. Stay warm, don’t get warm.
Notice in that piece I kept referring to layers. This is how you need to dress outdoors. A t-shirt and parka doesn’t cut it. You want a base layer (think polypropylene or wool or silk long underwear) amid layer (fleece pull over, wool sweater) and a shell layer (windproof/waterproof) at a minimum, with an option for a puffy layer like a down jacket or vest. How heavy and warm these layers are depends largely on the environment you anticipate, colder equals heavier. But the concept of layering stays the same. Notice what I did not include here: cotton. The oft repeated adage of wilderness medicine is: cotton kills. The cell structure of the cotton fabric collapses when wet, destroying its ability to insulate (keep you warm). Wet cotton in a cold environment is worse than nothing. Excellent in a desert for its breathability and also the same habit of retaining moisture and evaporating to keep you cool, in a cold environment is an invitation to disaster. Fabrics should be wool, silk, or synthetic. Wool and synthetic do not collapse when wet and will keep you warm even soaking wet (albeit not quite as warm, but better than nothing and much better than cotton). So the white cotton long johns you find at Wal-Mart are out. Invest in polypro or wool for you layers (don’t forget socks).
Why do I keep hammering away at sweat and cotton? Because moisture is the enemy when it comes to keeping you warm. Water conducts heat away from the body 15 times faster than air. You can survive a lot longer in 32 degree air than 32 degree water, whether you are immersed in it or because your clothes are wet.
So how to stay warm in the field? First, fuel the machine. We are talking food, calories, fats and carbs. No time for a diet, eating foods with a high fat content will keep you warm longer. I have been on winter expeditions where before going to bed each night my hot drink consists of hot cocoa powder, milk powder, peanut butter, a handful of chocolate chips, and a spoonful of butter or margarine, with brown sugar and topped off with hot water. Sounds terrible in August in the flat lands, but on a winter’s night the body craves it when the temperatures drop. While we are on the topic, let’s talk about sleeping warm. Aside from fueling the machine, you need to think of your sleeping bag as a thermos: keeps hot things hot and cold things cold. So don’t go to bed cold. Do jumping jacks, walk around, get in and do push-ups and rub your feet to get the blood flowing and get them warm. Start out warm in your bag and you will stay warm. A mat or pad is essential to getting you off the cold hard ground, not because it is hard, but because it is cold! Conduction will draw heat out of you all night long. I like a closed cell foam pad from my shoulders to knees because it is cheap, light, and nearly indestructible. Thermarest air pads are great and comfy but have the potential to leak air with extreme use. Pine boughs, pine needles, coiled rope, empty backpacks, clothes you aren’t wearing; all help keep you off the ground and warm. Speaking of clothes, there is the old saw about sleeping naked in your bag. This is really only applicable if the clothes you would be wearing are either: 1) cotton 2) wet or 3) constricting blood flow. And I usually overlook #2 if they are only damp. Otherwise wear you layers to bed and you’ll be warmer than if you had slept naked. Other tips: empty your bladder. Yes, I know it is cold out there and warm in your bag, but do you know how many kCal it takes to keep that ½-1 liter of urine in your bladder at 98.6 degrees? Lots! And that is energy that could be keeping you warm, so empty your bladder, feel better, be warmer. If it is a snow camping situation, do as most mountaineers do and use a pee bottle (be sure it has a different tactile feel in the dark than your regular water bottle). Yes, there are female adapters out there. Speaking of bottles, taking a hot water bottle to bed with you insulted in a wool sock and stashed in your sleeping bag at the foot to keep your toes warm or on your chest to keep your core warm. Done properly it will still be warm in the morning. If I’m not in bear country I keep a high energy snack close at hand for a midnight warmer; peanut butter, cheese, or chocolate all work well. Wearing a wool or synthetic hat to bed, which covers the ears, and scarf around the neck if your upper layers don’t zip up that high are also big time heat retainers. Avoiding the temptation to roll over and cover your face with your sleeping bag will keep your breath from condensing into water, possibly freezing, and then melting and wetting your sleeping bag when you pack up in the morning. A final consideration for sleeping warm addresses this issue of a potentially wet sleeping bag: down is warmer on a per/weight basis than any other insulation but clumps and fails entirely when wet. Synthetic is almost as light and warm as down, but will still insulate when wet. Cotton or square shaped Coleman brand type bags should be used as dog house liners or for indoor kid’s sleep-overs.
Take home points for staying warm and preventing hypothermia:
1) Fuel the machine
2) Stay dry
3) Sleep warm
4) These concepts are not for winter snow expeditions alone; most hypothermia happens in the fall and spring in what are normally considered “moderate” temps because people aren’t prepared or don’t consider the possibility of rain, wind, or nighttime.
Next time I will address signs and symptoms of hypothermia and how to treat it effectively in the field. - Lumberjack
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Two Letters Re: Preparedness Information for Diabetics
Dear Mr. Rawles,
I have a few suggestions to add to the recent article about survival and preparedness for diabetics, particularly type 1 diabetics. I've had type 1 diabetes for 13 years and one of the few things I learned pretty quickly is that the power will go out and even if the bottle of insulin is unopened, temperatures higher than 40 degrees Fahrenheit for a long period of time will degrade the activity of the insulin. This will require a much higher dose than what would otherwise be necessary if the insulin is stored properly, if the insulin works at all. Some of the newer insulins will not survive more than a month at room temperature, and less if they're opened.
A few other suggestions on diabetes survival:
1. Be familiar with how to use all types of insulin, because there would not be any guarantee of a specific insulin type being available for use in an emergency situation. Nor would there likely be doctors and nurses familiar with anything other than humulin Regular and NPH (which are considered to be "old" insulins and are more familiar to those who went to medical school twenty years ago.) Be prepared to revert back to "feeding the insulin", meaning taking a rigid schedule of two or three injections daily and eating evenly spaced meals of specific amounts of carbohydrate, instead of eating various amounts at different times of day and using several injections of the newer, fast insulins to cover. Those insulins may not be available, and so a "normal" diet would be out of the question.
2. Know how much insulin you need, and how to measure this amount in any type of syringe. Like before, insulin syringes with .5 unit/1unit/2 unit measure may not be widely available.
3. If you do not immediately have insulin available, try to keep in mind what was done prior to its invention in the 1920s, starvation. They knew that carbohydrate seemed to make diabetes worse, and eating large amounts of carbohydrate increased the amount of sugar in the urine. So to prevent this, carbohydrates were restricted. It's much like a very strict form of the Atkins diet, but even protein is reduced to small amounts, because protein is eventually converted to glucose. There are books from the 1900s on recipes and menus to use to starve diabetic patients, as well as some of the "old-fashioned" methods of screening for glucose in the urine and blood, one good book is freely available on the gutenberg online library web site called The Starvation Treatment of Diabetes. Starvation would not be a viable long-term option because of the obvious end result, but would serve some for a short period of time until insulin becomes available to them. It would kill a diabetic faster, however, to continue to eat normally without insulin.
I have a 6 month stockpile of diabetes supplies, as well as translations of my current insulin regimen using different types of insulins and a plan on how to follow a starvation diet. For 1 month on a standard two injections per day of Regular and NPH insulin, testing urine glucose twice or three times per day and assuming blood glucose meters are unavailable, one would need:
2 bottles of Keto-Diastix strips (measures glucose and ketones in the urine; once opened, a bottle will last 3 months)
1 box of U100 insulin syringes (100 syringes - 60 syringes used in one month = 40 syringe surplus)
1 box of 100 alcohol swabs
1 or 2 bottles of Regular insulin
1 or 2 bottles of NPH insulin
4 bottles of 50ct glucose tablets (which would likely not be completely used)
2 16 oz bottles of light corn syrup (a very efficient method for reversing hypoglycemia/low blood sugar)
Diabetes has really only become complicated to manage in the years since the invention of blood glucose meters and excess information. Those of us with type 1 diabetes have been convinced that in order to "survive" we need so many little pieces of expensive technology, super fast "boutique" insulins and constant monitoring of our glucose levels, so that we are utterly lost if these things aren't available to us. There are type 1 diabetics alive today who "survived" very well on one or two injections of beef or pork insulin a day, testing their urine for glucose using Benedict's solution, and avoiding "sugary" foods. If they can do it and live to be 60, we all can. Thank you, -- Amber C.
James,
That was good info from Mr Fenwick. A great attitude for everyone to emulate.
As a type 2 diabetic I wonder if part of the Diabetics problem might be solved naturally in the worst case of TEOTWAWKI.
I lost 25 lbs and lowered my blood sugar by 50 to 75 points. The weight came from a period of inactivity after multiple surgeries. I rarely need insulin except when I fall off my diet. Oral meds take care of it normally and I am now able to exercise some. More weight loss is in my near future. My M.D. says Diet & exercise will take care of it when the weight stabilizes at my proper weight.
Considering my experience and from all I read, I'd guess many Diabetics will be helped by lowered food consumption and exercise brought on by TEOTWAWKI. Possibly to the point of needing no meds. I am hoping for that result. - E.H.
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Preparedness Information for Diabetics, by Chuck Fenwick
I ran across an article on survival and diabetics written by a nurse. It was what we call a basic brush and floss kind of article that quoted from some well-known medical books. I call it a brush and floss article because it contained mostly information which a diabetic already knows, much like the way a dentist tells you what your mom has told you a bazillion times about brushing your teeth.
However at the end of the article the nurse pretty much consigned type 1 diabetics to doom and even referenced Darwin and the "survival of the fittest". I know in the novel One
Second After, the diabetic daughter died because of lack of insulin, but the part in the book about it going bad because of temperature variations is not accurate.
Here’s some information which will be of help to those who use insulin, specifically Humulin. We've been helping with diabetic preparedness for several years and there are some important things which are not common knowledge. Humulin--unopened--has a shelf-life of at least one year at room temperature. And Humulin can be frozen without ill effects to the user. Lilly won't tell you this, but I know of a type 1 diabetic who froze a year's supply for Y2K.
Her name is Madeline and in 1999 she called me to ask if I knew if insulin could be safely frozen. I told her that I didn’t know, but I would find out. Several of us in the Medical Corps organization started making calls and found out it could. I relayed the good news to Madeline. I suggested that if she were going to freeze it that she keep a log of her blood sugar test values with un-frozen insulin and then with the frozen insulin. She did and her blood sugar did not vary. In fact, Madeline still practices that type of preparedness with her disease.
As for the Darwin and the natural selection mindset, EMP or not, this country is not the Titanic. There are lifeboats for everyone. As medical people, and for non medical as well, our job is not to pick who gets to live or die simply because we may not know the answer to the problem. Our job is to solve the problem and not bow down to Darwin or "selection" or ignorance. Diabetics, preemies, old people, retarded children and the like are not mass causalities and a matter of triage. They are just a people problem which can be solved. I do not have the moral right to pronounce doom on the sick or injured. I do have a moral obligation to at least try to solve a problem.
To say that a Type 1 diabetic wouldn’t have a tough time of it if the system collapsed would be untrue, but problems can be solved. People who are insulin dependent or dependent on any medications need to put away extra supplies for treatment and support of their condition. I would not solely count on electronic devices either. Telemetry has a bad habit of failing, so old fashioned ways of checking blood sugar might not be that old fashioned if we lose telemetry because of an EMP. Keep in mind that there are several other diabetic problems and that there are medications to treat them. Therefore, it is not just insulin which will be in short supply if the system fails.
These supplies will only be a cushion though if a disaster of the magnitude presented in, One Second After, happens. That cushion will give us some time to work on finding answers for a myriad of problems which would surface.
As for diabetics we will have to find a way to duplicate the work of Banting and Best and other researchers of the early 1920s. This isn’t a survival-of-the-fittest type of thing. It is a problem to be solved. Just recently some Canadian researchers injected capsaicin into the excess pain receptors of the pancreas of diabetic mice. Then a neuropeptide was used to soothe the inflammation. The pancreas immediately started producing insulin and 4 months later the previously diabetic mice were still “cured”.
Is the diabetic survival problem complex? Of course it is. All TEOTWAWKI problems tend to be complex. But they are still just problems to be solved. Keep in mind that if an EMP wiped out all type one diabetics, it would not be an end to type 1 diabetes. If it could be ended by some sort of natural selection then where did it come from in the first place?
Summary:
1) Humulin can be frozen without damaging the contents, bottle or seals and then used without ill effect to the patient.
2) Unopened Humulin has at least a one year shelf-life at room temperature (70 degrees F.)
3) Darwin wasn’t a diabetic or a survivalist so who cares what he said.
- Chuck Fenwick, Medical Corps
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Letter Re: Advice for a Post-Thyroidectomy -- Potassium Iodide?
Mr. Rawles,
I have read your blog for awhile, I would like to know if you about the following: I was diagnosed with Graves Disease over two years ago. They cured the Graves Disease and the way that was done was to completely remove my thyroid gland, If the main concern with radiation is thyroid cancer, without a thyroid what would radiation do are what organ would it damage the most. I would like to also know if there would be any need for myself to take Potassium Iodide (KI).
JWR Replies: There would be no need for you to take KI, since it only serves to "load" a thyroid gland with iodine and hence prevent the accumulation of radioactive isotopes that would otherwise accumulate there. Beyond that, in terms of "internal emitters", all that you should remember is to avoid fresh dairy products (since isotopes like Strontium-90 tend to accumulate in milk), and to drink a regular quantity of fluids, to keep your kidneys flushed.
Since you are post-operative, you can jokingly refer to yourself as partially "radiation proof." (At least you don't have to worry as much as the rest of us about radioactive iodine isotopes.)
From a preparedness standpoint, you should look into stocking up on your regular hypothyroid (glandular replacement) prescription, (assuming that you have one). Do so as much as possible, up to the maximum shelf life. And of course you should consistently rotate this supply, using the first-in, first-out (FIFO) method.
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Basic Survival Skills for Children, by M.L.
Children play a part in many of our lives. Protecting them becomes an important issue in daily life as well as in an end of the world as you know it moment. However, what happens when adults can’t be there to protect them? What happens when they may need to protect us?
Our government and even many schools across the country, as well as parents and other adults, often do not see the potential in children. I am not talking about the educated potential one might find in the youth of a suburban school, but the potential to rise to the occasion when it is necessary to help themselves or their families.
The key to survival is knowledge. What you do with that knowledge and how you apply it at the right moment determines if you survive or not. Why can’t our children have the same knowledge?
We have many threats facing our world. Swine Flu or even other pandemics have been brought to the fore front this year. The WHO. is telling the world to expect an explosion of H1N1 cases. What happens if you and your spouse get Swine Flu? Who will take care of your children? Your sick neighbors? Your aging grandparents whom live three states away? Give your children the knowledge to take care of themselves and their families.
The following are some ideas on how to engage your children in survival learning (please gauge these ideas on the maturity levels of your own children):
- Cooking ~ Sit down and plan out a list of easy foods to cook with the least amount of required steps. Make sure you include some easy recipes for items in your food storage pantry. Most children can begin to learn to cook around age 8, provided you explain the dangers in the kitchen and teach them how to properly use the range, oven, sharp knives, etc. Many libraries and booksellers, as well as the internet, offer cooking books or recipes geared towards children. Cook through the recipes with your child, but try to be as hands off as possible, while teaching them proper techniques.
- Chores ~ Again, start out slowly, but instill an understanding in your children they can and are able to do most any chores in the home. By age 5, most children can at least do the simplest of chores like folding laundry, dusting, and putting away silverware. Give your children a responsibility and work along side them at first. Add laundry and yard work for older children. Again, teaching the safety protocols for certain items. When it comes to cleaning with chemicals, use alternatives made from natural ingredients. Label bottles and provide instructions. However, even children should not use certain chemicals and you should exercise caution.
- Pets ~ Children always want pets. Make them responsible for those pets. Teach them how to bathe and groom Fido. Show them how to properly and safely remove ticks. Have your child learn the commands to control your dog as well. Let your child clean out the gerbil cage or feed the fish. All these things teach children how to be more responsible.
- Protection ~ Enroll your child into a Mixed Martial Arts program or a boxing class with the understanding this is not for beating up little brother but to protect his/her self from others whom might want to harm him/her. For older children, teach gun safety. Show them your weapons, take them to the firing range, and let them understand what it feels like to shoot your P22 or your 12 gauge. Let them practice at shooting targets as well as clays. Take them hunting if you can. And if you have a bow set-up teach them how to shoot arrows as well. By properly teaching gun safety, archery, and self defense your child would be well prepared to defend themselves or to hunt for food.
- Bartering ~ As odd as it may sound, take your child to garage sales or flea markets. Any age can do this. Make them use their good manners when approaching the seller to barter or haggle over prices. Teach them about good deals and help them to find things that may be useful at a later time.
- First Aid ~ Children as young as five years old can put a band aid on a wound. Get a first aid manual and teach your children the proper way to care for cuts, scrapes, and other wounds. Let them know what alcohol and peroxide are used for as well as other medical topicals. Show them the difference between when to use a large butterfly bandage or gauze and tape. Teach them the proper way to take someone’s temperature. Explain when professionals should be called in to help or if you are in a situation where there are no professionals available what should be done. If you have a child that gets woozy at the sight of blood help them to get over their fear as best as possible or make sure that particular child has a different responsibility.
While many of the aforementioned tasks may sound obvious for all parents or care-givers, it always helps to remember your children can accomplish many tasks as long as they are given the chance to try. There are a variety of adult survival activities that you can tailor towards your children. Teach your child about your own family op-sec and basic safety when it comes to dealing with strangers. Above all, always remember to stress safety when teaching your children.
Give them a chance to hone their skills by taking them camping. Allow them to start the campfire (with parental guidance), cook the camp dinner, pitch the tent, etc. Get “lost” in the woods and have them bring you back to camp using a compass and map. Then later, have them look for a cache using your GPS. Teach them about the animal tracks your family sees and what animal crossing look like. In the evening, teach them the major constellations and how they can use those for direction as well.
I personally recommend the book The Boy's Book of Outdoor Survival
by Chris McNab. Although it is titled "for boys" and has pictures of boys in the book, I think it is highly appropriate for girls as well. Every child should know how to take care of themselves in survival situations.
If you can help your children and give them the knowledge to help themselves and others, even at a young age, you will enable them to be more responsible for themselves for the rest of their lives. As a parent, you are responsible for teaching your children.
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Preparedness Beginnings, by "Two Dogs"
I am a retired Marine Corps officer and Naval Aviator (jets and helicopters), commercial airplane and helicopter pilot, and most recently, an aircraft operations manager for a Federal agency.
I graduated from numerous military schools, including the U.S. Army Airborne (“jump”) School, U.S. Navy Divers School, Army helicopter, and Navy advanced jet schools. In addition, I have attended military “survival” courses whose primary focus was generally short-term survival off the land, escape from capture, and recovery from remote areas. Like most Marine officers, I attended The Basic School, an 8-month school (only five during the Vietnam era – my case), which is still designed to produce a second lieutenant who is trained and motivated to lead a 35-40 man platoon of Marines in combat. This course covers everything from field sanitation to squad and platoon tactics, artillery and other ordnance delivery, communications, reconnaissance, intelligence, firearms training, and much more. Later, I attended the Marine Amphibious Warfare School and the Command and Staff College, both follow-on schools and centered upon the academic study of tactics and strategy as they applied to the missions of the Marine Corps. I flew helicopters offshore in the Gulf of Mexico and across the U.S. I found out first hand how thoroughly corrupted is the federal bureaucracy and the government, in general. Not a pleasant experience. I’d rather have been flying. I have bachelor's and master's degrees.
As a result, my wife of forty years and I seem to have been moving endlessly from place-to-place. Nevertheless, I have tried in each place to do what I could to maintain a level of self-sufficiency for my family that varied greatly with locations and personal finances. My intention here is to try to share some of the less-than-perfect ways that I have tried to accomplish that end.
Only in the last few years, primarily as a result of the political and fiscal situation in the U.S., have I begun reading some of the huge amounts of literature about how one can prepare for serious long-term off-the-grid survival. I have found that the preparation required to be ready for that contingency seems to be endless. I do not want to talk about all of those preparations. Others have done so very well, and besides, I’m not there, yet. What I would like to do is to talk to those, perhaps like me, who are not true survivalists in the commonly referred-to sense, but who are genuinely concerned about the future of this country, and might desire, like me, to begin to prepare. Perhaps my elementary and simplistic efforts might be of help to someone else who is beginning to think about the subject of preparedness. There are many scenarios that might require this, but the two that I am thinking most about are economic collapse and electromagnetic pulse (EMP) attack. I’m building small Faraday boxes, but not doing much else for EMP.
My thinking on begins with my own estimation of the basic problems: shelter, water, food, fuel, and security. I view these as the most critical needs, whether living in a tent or other outdoor shelter or here in our rural home in West Virginia. Here I have and often take for granted what I have -- shelter, well water, a small stream, a pond, a rain barrel; canned, dried, frozen, and freeze-dried foods; fuel for the generator and portable stoves, kerosene heater and lanterns; factory-made and reloaded ammunition for any one of several firearms. Edible plant books. Gardening books. Encyclopedia of Country Living-type books. Reloading books. Hunting books. Tracking books. A few novels devoted to the “what ifs” of the future, including Jim Rawles' excellent "Patriots:
A Novel of Survival in the Coming Collapse"
, for example. Books to fill an entire bookcase. The Boy Scout Field Book sits right there next to the military survival manuals, as do Tom Brown's Field Guides, the The Foxfire Book series, a canning book, field medical books, and quite a few others.
Those are the basic things about which I think. I have been thinking about them for quite a while, in fact, longer than I even realized. Perhaps I’ve been thinking about them ever since I was a young lad. For example, my very first “survival book” was the Boy Scout Field Book, the original of which I still have (circa late-1950s edition). It is still a great reference if one is looking for an all-in-one manual for starting fires, making simple shelters, recognizing game tracks, tying knots, and much more. I note that it is still available on Amazon.com. (It’s probably been scrubbed to favor the politically correct, but don’t know [JWR Adds: Yes, I can confirm that unfortunately it has been made politically correct--with the traditional woodcraft skills showing any injury to innocent and defenseless trees duly expunged. So I advise searching for pre-1970 editions!] ) One does not necessarily need the SAS
Survival Handbook
or the U.S. Army survival manual. I have them and have read them. They do cover security problems, but then don’t cover other topics. Alas, there appear to be no “perfect” manuals, and the Boy Scout Field Book is no exception. But it’s not a bad beginning. And so I was beginning the journey even before I knew that I was.
I think that my first education in “survival” came at about fourteen. That’s when I first shot a .30-06, an old [Model 19]03 Springfield. It pretty much rattled my cage. Mostly, my older brother and I used to track and shoot small animals in the deep woods of Missouri as youngsters. We were “issued” ten rounds of .22 LR ammo by our father, a retired USAF pilot, to be used in a bolt action, single shot, .22 rifle with open sights. One would be surprised what that meager handful of loose ammunition could do for one’s choice of shots, one’s ability to be patient in waiting for the shot, and for one’s great satisfaction at having brought home six or eight squirrels for the cooking pot, having used just those ten rounds – and sometimes, but not often, less. My point is that the knowledge of firearms is, in my view, basic to the notion of preparedness and in surviving in the wild. And it need not be exotic or overly complicated in nature. One can surely attend modern schools that will teach one to double-tap a cardboard target or silhouette at seven yards with a semi-auto pistol, as well as basic and advanced tactical rifle courses, but very basic survival skill with a rifle can be had without much cost if one is committed to learning the skill and if one disciplines oneself. Start with only one round, and work up from there. As Col. Jeff Cooper used to say, “Only hits count.” In a purely off-the-grid survival scenario, I can envision that .22 LR rounds would be very precious, indeed.
Consequently, and even though I own handguns and rifles that will shoot .45 ACP, .44 Magnum/.44 Special, .357 Magnum/.38 Special, .380 ACP, .223, .25-06, .270, 7mm-08, .308, .7.62x39, .30-30, .30-06, and .45-70/.457 WWG Magnum (a wildcat), I shoot a .22 rifle and pistol more than all of the others, combined, and normally at least twice a week. And I’m hoarding them, as well as shooting them. I have the capability to reload all the calibers (except .22 LR/Magnum, of course) above, as well as shotgun ammo in 12 and 20 gauge. I wasn’t really thinking of “survival” when deciding to do this about twenty years ago, but was interested only in having the capability to shoot more, and to do it more cheaply. Yet it appears that much of that ammo could be used for barter. I had never even considered this until reading some of the recent “survival novels.”
My apologies. I’ve wandered into the weeds here, as I could do forever on my favorite subject. Suffice it to say that whatever firearm one chooses – and make no mistake, one is necessary in my opinion -- there are all kinds of reasons to choose one over the other, depending on the situation and the person. One must endeavor to shoot it well. Owning a firearm is of almost no consequence, at all, unless it is properly employed. Personally, I prefer a M1911 .45 ACP pistol and a 7.62 M1A SOCOM, while my wife is comfortable with the milder .38 [S&W] revolver and 20 gauge. pump shotgun. I won’t even begin to get into the debate over .223 vs .308 and 9mm vs. .45 ACP. Suffice it to say that in Vietnam I had the opportunity to see the effects of all of these, and I chose for my own security the .308 and .45 ACP.
Having got my favorite subject out of the way, I’ll talk about one that is likely even more important. Water. It is amazing how complicated this can be, and how many choices one has to solve this problem. I have not yet solved it. I have put up a rain barrel, and plan to get a couple more. It’s amazing how rapidly a 55 gallon barrel will fill in even a moderate thunderstorm. I got mine from Aaron’s Rain Barrels. http://www.ne-design.net/. I’ve camo-painted the first one to make it recede into the bushes that surround it.
We have a very shallow stream down the hill that I need to dam so that it keeps only about a foot-or-two deep pool for gathering some water. It flows into a large pond, of which we own half (The owner of neighboring property owns the other half.). But that’s over a hundred-yard trek downhill with empty buckets, and the same distance uphill with full ones. Now, while that is okay for a backup, in my thinking, because I’m going on 63 years, I prefer to have something closer. So my next “big” purchase will be a Simple Pump that allows one to drop a pump and pipe though one’s existing well casing down to below water level and extract water by means of a hand pump or DC motor attached to a battery which, in turn, will connect to a solar panel. This is much, much cheaper than a Solar Jack. At $1,200 for the hand pump capability (I’ll add on the DC and solar later), it’s a bargain, for me. See: http://www.survivalunlimited.com/deepwellpump.htm.
I’m not recommending it for anyone, yet, as I haven’t got one. It has plenty of good reviews, and I’m willing to try it. My apologies, but I am just talking about how I, for one, intend to solve my “water problem.”
I’ve also started collecting clear plastic soda bottles for use in Solar Disinfection (SODIS), see; http://en.wikipedia.org/wiki/Solar_water_disinfection. I’ve set up a rack for putting out the bottles in a sunny place. Again, that’s a backup, but I’ll use it.
I have bought three different water filtering devices, the best of which is the Swiss-made, all-stainless Katadyn Pocket Microfilter. It works wonders in that shallow stream and pond down the hill.. [JWR Adds: The same Katadyn filter model is available from several SurvivalBlog advertisers. They deserve your patronage first, folks!]
With the exception of the Simple Pump, these solutions are relatively cheap and effective, if not producers of great volume. So far, they are what I’ve come up with.
I won’t go much into the food problem. It isn’t quite as complicated as the water problem. I’ve either got to have it [stored], grow it, or kill it. I’ve started storing all kinds of Mountain House freeze dried #10 cans (with expiration date dates in 2034), two-serving meals from Mountain House (expiration dates circa 2016), and numerous grocery store-type canned foods (expiration a couple years), in addition to dried beans, rice, Bisquick (sealed in plastic bags with desiccant inside), salt, sugar (Domino, which are sold in one-pound plastic tubs), olives, peanuts, wheat, etc. Basically hit-or-miss, so far. I need to get this “food problem” organized and do it right. But it’s a start. I think we’ve got only about a 60-day supply now, for two.
I’ve got two Coleman two-burner stoves. One is a butane stove, and the other a dual fuel (white gas or unleaded gas), as well as several small backpacking stoves, the best of which is a MSR Whisperlite International
, which uses virtually all fuel (unleaded, white gas, kerosene, diesel, and maybe even corn oil). I was heavily into backpacking when we were stationed in Hawaii in the late 1970s, and still have all the gear. After having one knee replacement and hedging doing another, I’ll not be backpacking if I can help it. Nevertheless, I have two bug-out bags with essentials in them, ready to hit the trail if need be. I’ve saved up and bought two good Wiggy's bags and a couple of his poncho liners.
Concerning backpacking stuff, I can recommend a book that I read back then called The Complete Walker, by Colin Fletcher. I haven’t read it in at least a decade, but its import is such that I remember much of it. He emphasizes simplicity in gear. That is to say, don’t pack a tent if you can get by with a tent fly – which you cannot in cold weather. I’ve still got my old three-season tent, but am saving up for a four-season. And he emphasizes: don’t worry about pounds – worry about ounces. That is to say, if one is packing tea bags, remove the labels from the bags. Ounces. Remove all packaging material unless it is absolutely necessary (usually never). Don’t carry a “mess kit,” nor a knife, fork and spoon set. A spoon will do (I’ve done it) along with a pocket knife. Now I have so many knives of so many types that I can’t remember them. Personally, I’d go for a multi-tool. But it’s heavy. I never used to carry a weapon while backpacking. Of course, it was (and is) illegal in Hawaii, but I think one would be remiss in not doing so today. There was so much good advice in that book that helped me in the USMC, if nothing more than when packing my helicopter before a mission, or a car, trailer, or truck to move across the country. “Think ounces, not pounds.” I always think about Mr. Fletcher’s advice when I pack.
Anyway, I think I’ve got the camping stove angle covered in spades. That is, until the fuel runs out. Same goes for kerosene heater and lanterns (5). My plan is to pull out our pellet stove and replace it with a free-standing wood stove. Pellets are nice, but they must be bought, and the price is getting exorbitant, according to my pocket book. They likely will be non-existent in a crunch.
I connected a 12,000 Watt/50amp gasoline generator when we moved into this house nine years ago, as I have with every house in which we’ve lived for the last two decades. I’ve got it wired through a transfer box to the circuit-breaker panel, a job that I did myself. It works, and it’s safe. The main reasons for having this were to run the 220V[olt AC] well water pump and to run the refrigerator and our free-standing freezer during power outages. But I’ve got it wired, anyway, to nearly every circuit in the house, except the other 220V appliances – water heater and heat pump. It is somewhat selectable. That is to say that I can choose which circuits I want to power by engaging or disengaging the switches on the transfer box. The problem is that it uses gasoline. So in a long-term outage it would soon become useless. I’ve had the propane gas company come out to estimate what it would cost to get a dedicated 100 gal propane tank for the generator. It would be about $500, but then, in addition to the 50+ gallons of gasoline, butane tanks, and white gas that I keep stored in a separate outbuilding, it would make a great explosion when hit with a tracer round.
Which brings me to the subject of security. We live in a split-level home on about ten acres of forest. The property is surrounded by other similar-sized properties of seemingly like-minded individuals. I gleamed this because everyone out here shoots. The sweet sound of gunfire can be heard at times in a full circle. West Virginia, at least, has still got its priorities straight in this regard. But I digress. This is a frame house with half of it below ground in front, but framed in back, which faces the forest. The forest, itself, is a maze of downed pine trees blown over by the wind, interspersed with small saplings, vines and low brush. Not a likely avenue of approach for anyone but the most determined. For those who are determined, the downed trees would make excellent cover and concealment. So I have a security problem to solve there, as well as at the front.
I’ve started buying rolls of barbed wire and baling wire. Unfortunately, I do not have access to dynamite, which we used to be able to buy in a hardware store in the 1960s. We used it back then to blow stumps while clearing the land for our house. I am thinking of buying a bunch of used railroad ties to build cover in the back; I’ve thought also of bricks and sandbags. Problem is we’re reaching the point in all of this where the house would begin to look like a fortress, of sorts, to all but the most ignorant observers. So there’s a line here concerning security versus “normalcy” that I must cross sooner or later. Inasmuch as my wife is a few years older than I and is on constant medications, I’m afraid that finding a retreat (if we could even afford one) would be out of the question, as access to doctors, hospital and pharmacy are a necessity. Nevertheless I’ve got the bags packed and gear ready to throw into the pickup (Toyota 4x4 – like to have one of those older model American trucks, but I think they are getting rare, at least around here. And what there are will likely go to the Cash for Clunkers Program….grumble, grumble. What will they think of next?).
So it looks to me as if we are here for the duration of the crisis, or sooner, if they try to take the guns from my cold, dead hands. Speaking of, I still have to build a cache or two for guns and ammo and a few other necessities.
And since I’ve more-or-less made that decision (here for the duration), I’ve thought of organizing the apparently gun-loving neighbors. I’ve begun to buy walkie-talkies, if not field phones and commo wire. I’ve got solar panels and several batteries (need to get a mega deep cell or two, however) to run the small battery chargers and the CB radio. My shortwave is up and running.
I will have to wait to talk to the neighbors, whom I rarely see, much less know. I can just imagine the words that would come out of their mouths if I were to mention to them the notion of forming a security “company” and establishing a perimeter. “That old retired Marine down the road is nuts!”
So that’s what I’ve got to say. I do hope it at least stimulates some thought for those who are starting out trying to prepare, as I am. All of this shows me that one “problem” in this “survival” business leads to several more, and they in turn lead to even more problems. Lots to do. So I’m glad I’m retired. I’ve got time to think about it. If I were rich, I could do a lot more and likely in a far away place, but as it is, we do with what we have. I have to use the lessons taught to every Marine: Improvise, Adapt, Overcome.
Long Live America. Keep the Faith. - “Two Dogs”, Col. USMCR (ret.) in West Virginia
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Letter Re: The Virtues of Fasting Experience for Well-Rounded Preparedness
Greetings!
I have an idea that I have been wanting the patriot survival community to consider. Here it is:
Basically we are able to go without food for much longer than most people know. This is not true with water to be sure. A normal, reasonably healthy human body is easily capable of going three to six weeks on very, very little nutrition and remain completely mentally alert and even physically active. During a prolonged fast you will not be able to pick up as much furniture as normal but you may easily be able to walk for 100 miles!
The biggest concern with fasting is that it not begin too abruptly. Most trouble comes from toxic reactions not lack of nutrients. Its better to reduce junk foods, sweets, red meat and unnecessary drugs & medications before embarking on a serious fast. A series of single-day or two and three day fasts are rejuvenating like nothing imaginable! Juice fasts and broth fasts and even solid, bland diet (rice & red lentils) are intermediate steps. Health food stores often have written material on fasting techniques.
Fasting is very healthy and has an unmistakable spiritual side to it as well. It increases mental health and will power. It is an excellent occasion to practice prayer, meditation and all sorts of mental work. Benjamin Franklin, for one, extolled the virtues of keeping the mind full and the bowels empty. This is all in the preparatory phase while you are teaching yourself how to fast, how your body reacts, how your mind reacts, what to make of any "hunger pains" and in general learning that you don't need to consume all you are accustomed to. Watch your will power grow!
Once you are "hardened off" and experienced in "coming closer to your own inner nature" (you now know how to consume your own substance without cutting off an arm or leg to try to keep the stomach full) you should wax serene in circumstances where others may easily fall prey to panic. In cases of stand off, siege, emergency or just plain prolonged lean rations you can totally, effortlessly and fearlessly rise above the circumstances.
I can tell you of how it has worked for me, in Hurricane Andrew for example, where people rioted or scuffled needlessly over ice. But I had not intended to write so much. I just wanted to get the idea across. Best Regards, - WL
JWR Replies: Those unaccustomed to fasting should first consult their doctor for a checkup. Your tolerance for fasting will vary greatly, depending on your diet, your body type (fat reserves), your blood sugar chemistry, and your activity level. Rather than water fasting--which can be debilitating and precipitate some acute health problems--I recommend occasional juice fasting, to maintain your electrolyte and blood sugar balance. My general advice is to build up to fasting gradually, while very carefully watching for adverse reactions, such as dizziness, confusion, or hallucinations. Even someone with regular fasting experience should never fast more than 36 hours while living alone. There must be someone there to watch for signs of distress or incipient syncope (fainting). Fasting can be beneficial, but as with anything else, when done to excess, it can be harmful.
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Gear Up -- Appropriate and Redundant Technologies for Prepared Families
I frequently stress the importance of well-balanced preparedness in my writings. All too often, I've seen people that go to extremes, to the point that these extremes actually detract from the ability to survive a disaster situation. These range from the "all the gear that I'll need to survive is in my backpack" mentality to the "a truckload of this or that" fixation. But genuine preparedness lies in comprehensive planning, strict budgeting, and moderation. Blowing your entire preparedness budget on just one category of gear is detrimental to your overall preparedness.
Another common mistake that I see among my consulting clients is an over-emphasis on either very old technologies or on the "latest and greatest" technologies. In the real world, preparedness necessitates having a bit of both. At the Rawles Ranch we have both 19th century technology (like hand-powered tools) and a few of the latest technologies like passive IR intrusion detection (Dakota Alerts), photovoltaics, and electronic night vision. My approach is to pick and choose the most appropriate technologies that I can maintain by myself, but to always have backups in the form of less exotic or earlier, albeit less-efficient technologies. For example, my main shortwave receiver is a Sony ICF-SW7600GR. But in the event of EMP, I also a have a pair of very inexpensive Kaito shortwaves
and a trusty old Zenith Trans-Oceanic radio that uses vacuum tubes. Like my other spare electronics, these are all stored in a grounded galvanized steel can when not in use.
Here is my approach to preparedness gear, in a nutshell
- Redundancy, squared. I jokingly call my basement Jim's Amazing Secret Bunker of Redundant Redundancy (JASBORR)
- Buy durable gear. Think of it as investing for your children and grandchildren. And keep in mind that there'll be no more "quick trips to the hardware store" after TSHTF.
- Vigilantly watch Craigslist, Freecycle, classified ads, and eBay for gear at bargain prices.
- Strive for balanced preparedness that "covers all bases"--all scenarios.
- Flexibility and Adaptability (Examples: shop to match a 12 VDC standard for most small electronics, truly multi-purpose equipment, multi-ball hitches, NATO slave cable connectors for 24 VDC vehicles, Anderson Power Pole connectors for small electronics--again, 12 VDC)
- Retain the ability to revert to older, more labor-intensive technology.
- Fuel flexibility (For example: Flex fuel vehicles (FFVs), Tri-fuel generators
, and biodiesel compatible vehicles)
- Purchase high-quality used (but not abused) gear, preferably when bargains can be found
- If in doubt, then buy mil-spec.
- If in doubt, then buy the larger size and the heavier thickness.
- If in doubt, then buy two. (Our motto: "Two is one and one is none.")
- Buy systematically, and only as your budget allows. (Avoid debt!)
- Invest your sweat equity. Not only will you save money, but you also will learn more valuable skills.
- Train with what you have, and learn from the experts. Tools without training are almost useless.
- Learn to maintain and repair your gear. (Always buy spare parts and full service manuals!)
- Buy guns in common calibers
- Buy with long service life in mind (such as low self-discharge NiMH rechargeable batteries.)
- Store extra for charity and barter
- Grow your own and buy the tooling to make your own--don't just store things.
- Rust is the enemy, and lubrication
and spot painting
are your allies.
- Avoid being an "early adopter" of new technology--or you'll pay more and get lower reliability.
- Select all of your gear with your local climate conditions in mind.
- Recognize that there are no "style" points in survival. Don't worry about appearances--concentrate on practicality and durability.
- As my old friend "Doug Carlton" is fond of saying: "Just cut to size, file to fit,, and paint to match."
- Don't skimp on tools. Buy quality tools (such as Snap-on and Craftsman brands), but buy them used, to save money.
- Skills beat gadgets and practicality beats style.
- Use group standardization for weapons and electronics. Strive for commonality of magazines, accessories and spare parts
- Gear up to raise livestock. It is an investment that breeds.
- Build your fences bull strong and sheep tight.
- Tools without the appropriate safety gear (like safety goggles, helmets, and chainsaw chaps) are just accidents waiting for a place to happen.
- Whenever you have the option, buy things in flat, earth tone colors
- Plan ahead for things breaking or wearing out.
- Always have a Plan B and a Plan C
If you are serious about preparedness, then I recommend that you take a similar approach.
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Controlling Pain Where There is No Doctor, by Bill R.
Some of you are probably asking yourself what this has to with Survivalism. Pain is our brain's way of letting us know that something is not right. You touch a hot stove and it warns you to pull away. With any number of things that can set off TEOTWAWKI, The result will be the same. Traumatic, stressful, pick your favorite term; it’s all the same. Increased stress levels in the body create tension. We have all heard the term ”your psychology affects your physiology”, nothing could be more true. I think it is an excellent idea to go through practice drills in as many what if scenarios as you can fathom. One of the things I have not seen accounted for however is the effect of stress and pain has on our daily routines .The moment the hammer drops we will probably get by on adrenaline for a short period. The first part is preparing our bodies for the culture shock that will probably happen overnight. I would say the majority of the people reading this have an ample food supply, guns, ammo maybe even a detailed plan on what to do. But how many of us have a way to reduce stress? If you do not have one during ”peaceful” times, how much less ready will your mind and body be prepped when the situation demands it of you? I am not here to tell you what method you should choose. One of mine is prayer. Whatever yours are, cultivate them now as you do everything else. This leads me to the title of the article.
Unless you are Amish or are like the few readers of SurvivalBlog that are already modern versions of Grizzly Adams, the overnight transition will be more mental and physical than you have been accustomed to. Mentally I have already explained the mind-body connection..What can we do in the physical? An ounce of prevention is worth a pound of cure. Here it comes: ”exercise”. This is much more than dropping a few here and there for the yearly family photo. A stronger, fitter body will not only reduce stress levels but will be able to handle a greater physiological demand. A stronger body will put you in a better position to defend yourself. When the last tick of the clock hits it’s point, you are where you are, and that’s it! That said, even the strongest bodies get sore and get injured. I have heard horror stories at the gym (where us city folk exercise). A man dropped some weights on his finger. The trainer urged him to stick his finger in the hot tub. That was a big mistake. This is an easy way to remember what to do INJURY = COLD (the area is already inflamed, heat will expand tissues more) SORENESS = HOT (heat soothes sore muscles, not injuries!) There are different ways to approach it. Without an MRI, you cannot know just how serious but you can start reducing the impact. After an injury, the area should be iced (if possible) 15 minutes on and 15 minutes off. This should be done [during waking hours] for several days. Anymore than 15-20 minutes of direct contact will have the same effect as heat, counterproductive. All that work on the Ponderosa will not only have you singing shoulda coulda woulda’s on being better prepared, it will also leave every muscle in your body begging for mercy. I have done massage on some of the strongest men around (the “Power Team”) and I assure you that pain is universal. Here is a non-medicinal pain survival equipment list for you:
- Two tennis balls
- A huge encyclopedia
- A low-back chair(like you used to have in school)
- Any good simple book on acupressure or trigger points
- A rolled-up towel
I could make a list a mile long but these five will do wonders for you.
Using tennis balls: this is good, no, great for the back. Laying on your back on the ground, place one tennis ball on either side of your spine (not on the spine). Start with the cervical, then move down to thoracic, then lumbar. Typically 10 minutes in each area should do the trick. Another way to stretch that lower back out is lying once again on your back. Place the large book or encyclopedia under your sacrum for 10 to 15 minutes. This technique uses your own body weight to release the muscles they surround, thereby relaxing them. Have you ever cooked a chicken? When you pull the skin off that milky white layer over the muscle is the fascia, it holds the muscle in place. Changing the angle of your lower back does wonders. The next thing is the low back chair. I like chairs that go about mid back. Sitting in the chair in the normal way, reach behind the chair grabbing the top of the legs (you can go lower as you stretch). Do not bounce! Pull for a few seconds at a time while leaning backwards over the chair edge, creating tension on your arms but stretching your back. At this point you probably wondering what in the world a rolled up towel can do for you. Hopefully by then you have already memorized all of your survival books , but chances are if you have not, you will be doing some serious reading. Sitting in a higher back chair or even a wall, place a rolled up towel east to west underneath your shoulder blades. This will help keep you in alignment and take pressure off your upper and middle back that develops from slouching as we read.
If these things seem too simple, well then I can assure you that they work. "Simple" is the key when your resources are limited. The American Indians used to have the children of the tribe walk on their backs for those with ailing backs, so I think you can adapt to these simple cures. Why not just pop an aspirin? Well, first off all if you have access to pain meds, they will be very valuable and the less you have to rely on them the better off you will be. Keep in mind that no pill will cure an injury or eliminate the cause of the pain. It will merely cover it up for awhile. Why not just treat the cause of the problem instead of the symptom? We have little control over the circumstances that come our way. We can either be more prepared or less prepared. Learn how to take care of your body if you want it to take care of you.
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Five Letters Re: How to Build a Deeper Supply of Prescription Medications
Dear Mr. Rawles,
Pat C.'s recent post regarding the acquisition of prescription drugs in quantity includes many good thoughts. As a pharmacist of more years than I like to admit, I feel compelled to add to a few of Pat's points.
Pat mentions FDA restrictions on quantities of several types of medications, including some "powerful antibiotics, pain drugs, and highly abused drugs". I'm unaware of FDA restrictions on dispense quantities of any drugs, except regarding a very small number of drugs with unusually high-risk of adverse reactions. These few drugs would rarely come into play in stocking for calamities. The point that I believe Pat is driving at involves the Drug Enforcement Administration (DEA) restrictions on "Controlled Substances", which, as a matter of definition include drugs with addictive potential, such as the opiate analgesics (pain relievers), many anti-anxiety agents (Valium, Xanax, etc.), and the amphetamines and related substances used for treatment of ADHD. The Federal list of these agents can be found at the DEA web site, for those who have time on their hands and are not easily bored. Many states have added a few agents to their very own 10th Amendment (my attempt at humor) replication of the Federal list, so check with your local pharmacist about specifics. You don't want to come off looking like a drug seeker! The methods suggested by Pat will attract a lot of attention if you innocently try to apply them to, say.... Tylenol #3 (acetaminophen with codeine - a Controlled Substance under Federal regs).
Also, Pat's statement, "some generics don't work as well as branded drugs" may breed confusion. Though there will be endless opinion-driven debates over this topic, the science, the FDA, and the overwhelming medical opinion at this point is that generic drugs rated as "therapeutically equivalent" to the innovator (brand name) product, can be used interchangeably without harm. Again, if you want specifics, you can Google (or, as I prefer, Scroogle) "FDA Orange Book", where you will find all of the products that are "AB rated", and thus approved (at least by the FDA) for interchange. Or, again, ask your pharmacist. Practically all commonly-available generic products are now listed as equivalent.
Okay...so I'm biased (I'm a pharmacist), but you may come off better asking your pharmacist about which tablets you can cut, than to ask your doctor. I think that I can safely say (without offending my friends that are medical doctors) that we pharmacists have a lot more time to study such things than most doctors!
Just my 2 cents worth! As always, thanks for all you do to help us live fuller live! - SH in GA
Dear Mr. Rawles:
Regarding yesterday's article "How to Build a Deeper Supply of Prescription Medications", I would like to suggest an alternative source for low cost prescriptions. When I was without medical insurance, I purchased prescription medications from AllDayChemist.com. This company is located in India. My experience was very good. My prescription cost $12/pill in the US, and $4/pill from India. The quality was fine, the service was great. They charged a flat fee of $25 to ship the package by air. Once I was comfortable with the quality and service, I started ordering larger quantities to amortize the shipping cost.
Best Regards, "+P+"
Hi Jim,
Just a note on how I got around this. I take a medication for GERD (a symptom of which is painful heartburn). I take one pill a day and my medical insurance will cover 100 pills at a time, and won't let me get any refills before the 100 days is almost up. Around here, all pharmacy computers are linked to insurance companies, so there's no way anyone could do what Pat C suggests in her article, unless it was ordinary OTC drugs. Anyway, I only pay $2 for prescription drugs, and a lot more otherwise, so I was heavily motivated to figure something out. So what I did was I told my doctor that 1 pill/day isn't always enough, depending on what I'm eating, and asked if she could raise it to two pills per day? (Sometimes this is true anyway). She did, and now every time I go I get twice as many pills. As long as I remember to go get refills every 100 days, I'll be able to build up a nice supply. This doesn't work for a lot of drugs, as dosage is critical in some things, but it worked in this case. GERD is one of those things where you just keep upping the dosage until it goes away (to a point, and I'm well below that point).
BTW, I cautiously asked my doctor about prescriptions for other types of medications, such as antibiotics, just to have on hand in a medical kit. In a word, she said "no". - RL in Ontario
James,
I can tell you as a retail pharmacist for a chain store that we do have linked data bases from state to state, but it is only within the chain itself.
A couple of thing you might want to considered when getting your physician to write that six month prescription is to have him write for a total quantity of ______# of tablets (fill in the blank with the total number of tablets you will need for that six months of medication). This will avoid problems with pharmacists who are limited by state law to dispensing only what the doctor writes for. In other words if your Dr, writes for 30 tablets they can only fill for that 30.
As far as tablet splitting, some good points were brought up. I'd just like to make sure every one understands that if a tablet is not scored do not try to split it. Pharmaceutical sales people have told me that manufacturers do not guarantee an "even mix" in unscored tablets.
Also don't forget to take advantage of any special transfer offers (such as $25.00 gift cards) that are being offered for transferring prescriptions between companies and the $4 prescriptions being offered by Wal-Mart, Krogers and Rite Aid. Many companies will also match these prices if you ask. (But you must ask.) - D. S. in Georgia
Mr. Rawles;
Many insurance companies allow you to purchase a 90-Day supply of prescriptions by mail at a cost that is normally much less then three individual 1-Month prescriptions. We have been participating in this program for years and have saved several thousands of dollars. - CaBuckeye
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Letter Re: The Latest Special Operations Forces Medical Handbook
Jim,
Among the books listed by the recent "favorite books" survey respondents was the US Army Special Forces Medical Handbook (ST31-91B). This book is obsolete and has been supplanted by the Special Operations Forces Medical Handbook.
The best summaries as to why the one is obsolete I've found are:
“That manual is a relic of sentimental and historical interest only, advocating treatments that, if used by today’s medics, would result in disciplinary measures,” wrote Dr. Warner Anderson, a U.S. Army Colonel (ret.) and former associate dean of the Special Warfare Medical Group.
“The manual you reference is of great historical importance in illustrating the advances made in SOF medicine in the past 25 years. But it no more reflects current SOF practice than a 25 year-old Merck Manual reflects current Family Practice. In 2007, it is merely a curiosity.”
“Readers who use some of the tips and remedies could potentially cause harm to themselves or their patients.”
JWR Adds: The new manual is a massive 680 pages. Here is the table of contents:
PART 1: OPERATIONAL ISSUES
PART 2: CLINICAL PROCESS
PART 3: GENERAL SYMPTOMS
PART 4: ORGAN SYSTEMS
Cardiac/Circulatory
Blood
Respiratory
Endocrine
Neurologic
Skin
Gastrointestinal
Genitourinary
PART 5: SPECIALTY AREAS
Podiatry
Dentistry
Sexually Transmitted Diseases
Zoonotic Diseases Chart
Infectious Diseases
Preventive Medicine
Veterinary Medicine
Nutritional Deficiencies
Toxicology
Mental Health
Anesthesia
PART 6: OPERATIONAL ENVIRONMENTS
Dive Medicine
Aerospace Medicine
High Altitude Illnesses
Cold Illnesses and Injuries
Heat-Related Illnesses
Chemical
Biological
Radiation
PART 7: TRAUMA
Trauma Assessment
Human and Animal Bites
Shock
Burns, Blast, Lightning, & Electrical Injuries
Non-Lethal Weapons Injuries
PART 8: PROCEDURES
Basic Medical Skills
Lab Procedures
APPENDICES
Thanks, - Frankie
JWR Replies: Thanks for mentioning the new manual! I have updated both the survey results post and the
SurvivalBlog Bookshelf
page, accordingly. OBTW, I have had difficulty finding an original copy of the new manual at a reasonable price. The copies that are presently listed on Amazon are "secondary market", at grossly inflated prices. But the good news is that the GPO also publishes a paperback edition
for $59. I would prefer the military 9.7" x 6.4" edition that is three-hole punched (and hence will lay flat when open--making it a better "working" reference), but the GPO paperback edition should suffice. There are also electronic editions available for PDAs and Windows for $73, and for Palm PDAs for $60. The Special Forces.com online store sells a smaller 7.5" x 4.75" format edition (a bit harder to read), but they do sell it in combination with a CD-ROM.
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How to Build a Deeper Supply of Prescription Medications, by Pat C.
Most well-prepared individuals with chronic health conditions want to keep a deep supply of medications on hand, in the event of disaster that would disrupt normal chains of supply. Medical insurance plans typically have a 30-day limit on the amount of medication that can be obtained at one time. There are various reasons for these limitations - medical complications, FDA regulations, and cost-containment by your insurance company. However, there are ways to get around these limits and build a deeper stock of meds as part of your survival
planning.
Multiple Scripts
Ask your physician to write several prescriptions, each of which authorizing six refills for each drug you need. You might have to explain why you need such a large supply so be ready with a non-political story - your rural location, concerns about getting snowed in, bridge or road washing out, extensive travel outside the US, etc. Then, go to different pharmacies to fill each script. Do not go to different locations of the same chain because the chain likely has a central computer that will flag multiple purchases of the same medication in a short period of time. Tell the pharmacist at each drug store that you want the whole batch filled at one time. You'll probably have to pay out of pocket for the drugs but you'll end up with a good supply of meds that you can start to rotate to keep your stock within the expiration dates. If you belong to a health plan and the pharmacy is a contracted provider of your plan, then you should get the discounted price for your order even though the plan won't cover more than a 30-day supply. Ask the pharmacist about that.
Multiple scripts that authorize several months of refills will work for most drugs but the FDA has strict dispensing controls on certain meds such as powerful antibiotics, pain drugs, and highly abused drugs like Vicodin,Xanax, and Adderall. It is unlikely that your doc will write a script beyond the FDA-approved limits - it's illegal. He'd lose his license to practice and could even go to jail. So don't push it - if he says something about FDA limits, respect the situation. Even if you did get such a script it's unlikely that you could find a pharmacy to fill it - it's illegal for them to do so.
Generics Versus Branded Drugs
To keep your costs down, ask your physician for a generic version of each med as opposed to a branded drug. Branded meds are protected by Federal patents which is why they are so expensive - no other pharmaceutical company can market a branded drug until the original patent expires. (It was the Reagan administration that extended drug patents.) Branded meds typically have cute names like Allegra, Celebrex, Lipitor, and Valium. Generic drugs are copies of branded drugs that are no longer under patent and usually have a chemical name such as Ampicillin or Hydrochlorothiazide. Wal-Mart now offers generics for $4 for a 30-day supply; I recently heard of a major drug chain that will fill a 90-day supply for $10. At these low prices, it's cheap enough to bypass your insurance company and pay out-of-pocket, which eliminates one level of control.
Some generics don't work as well as branded drugs and many meds are only available in branded form (the patent hasn't expired yet.) so you may have to stick with branded drugs even though they are more expensive. However, beware of "new and improved" branded drugs. Often, that means that the original patent has expired and the drug is now available as an inexpensive generic. Not wanting to lose its lucrative monopoly on the medication, the pharma company makes a slight change in the original formula and then files for a new patent. Several major branded drugs such as Lipitor will soon be off patent so do your research and ask your pharmacist.
Pill Splitting
Many drugs are available in different dosages, many of which come in tablet form that can be split in half. If you take a 20mg dose of a certain medication and a 40 mg pill is available, ask your physician if the pill can be split. [by cutting it in half at a grooved line--properly called a "score".] If so, then have the doc prescribe the 40mg dose which can be split in half, doubling your supply. Combined with the multiple script strategy outlined above, you'll have a nice stock of meds, each of which is double your actual dose. This works for both generic and branded meds but is of particular use if you need expensive branded drugs that you have to pay for yourself.
There are two important cautions about splitting your meds:
1) You must ask your physician about this since not all pills can be split. For example, some pills have time release coatings; if split, the dose is released into your body too quickly which could be dangerous or even result in death. Also, splitting doesn't work with capsules. Ask your doctor before splitting pills.
2) Do not split pills until just before you need them. Keep them sealed in their original containers or packets and store in a dark, cool place. Keep them from freezing. Pull only enough pills from your stock for the next 30 days or so. Split one pill at a time, as needed.
Canadian Pharmacies
You can also order meds through Canadian pharmacies which offer lower prices than US outlets due to strict governmental price controls up there. I am unsure how large a supply they will fill for each order but I suspect that you could obtain several months at one time. However, you have to make sure that you are ordering directly from a Canadian pharmacy. There are many Internet sites that claim to be Canadian pharmacies but it's impossible to know for sure whether you're working with a legit outlet or a crook in Nigeria or the Ukraine. Do not respond to e-mails about cheap drugs - most of those are fronts for identity theft rings - they want your credit card number. Others will send you meds beyond their expiration date or even fake pills that are perfect reproductions. Beware of scams, especially with anything you'll be putting in your body. If you are anywhere near the Canadian border, make the trip in person once or twice a year so you can personally visit the pharmacy and talk to the staff.
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Survey Results: Your Favorite Books on Preparedness, Self-Sufficiency, and Practical Skills
In descending order of frequency, the 78 readers that responded to my latest survey recommended the following non-fiction books on preparedness, self-sufficiency, and practical skills:
The
Encyclopedia of Country Living by Carla Emery (Far and away the most often-mentioned book. This book is an absolute "must" for every well-prepared family!)
The Foxfire Book
series (in 11 volumes, but IMHO, the first five are the best)
Holy Bible
Where
There Is No Dentist
by Murray Dickson
"Rawles
on Retreats and Relocation"
Making
the Best of Basics: Family Preparedness Handbook
by James Talmage
Stevens
The
"Rawles
Gets You Ready" preparedness course
Crisis Preparedness Handbook: A Comprehensive Guide to Home Storage and Physical Survival
by Jack A. Spigarelli
Gardening
When It Counts: Growing Food in Hard Times by Steve Solomon
Tappan
on Survival
by
Mel Tappan
Boston's
Gun Bible
by
Boston T. Party
Seed
to Seed: Seed Saving and Growing Techniques for Vegetable Gardeners
by Suzanne Ashworth
Survival
Guns
by
Mel Tappan
Boy
Scouts Handbook: The First Edition, 1911 (Most readers recommend getting pre-1970 editions.)
All
New Square Foot Gardening
by
Mel Bartholomew
When Technology Fails: A Manual for Self-Reliance, Sustainability, and Surviving the Long Emergency
by Matthew Stein
Back
to Basics: A Complete Guide to Traditional Skills, Third Edition
by
Abigail R. Gehring
Preparedness Now!: An Emergency Survival Guide (Expanded and Revised Edition)
by Aton Edwards
Putting
Food By
by Janet Greene
First
Aid (American Red Cross Handbook) Responding To Emergencies
Making
the Best of Basics: Family Preparedness Handbook by James Talmage
Stevens
Nuclear War Survival
Skills by Cresson H. Kearney (Available for free download.)
Cookin'
with Home Storage
by
Vicki Tate
SAS
Survival Handbookby
John "Lofty" Wiseman
Root
Cellaring: Natural Cold Storage of Fruits & Vegetables
by
Mike Bubel
Outdoor Survival Skills
by Larry Dean Olsen
Stocking Up: The Third Edition of America's Classic Preserving Guide
by Carol Hupping
The
American Boy's Handybook of Camp Lore and Woodcraft
Emergency
Food Storage & Survival Handbook by Peggy Layton
98.6 Degrees: The Art of Keeping Your Ass Alive
by Cody Lundin
Seed
to Seed: Seed Saving and Growing Techniques for Vegetable Gardeners by Suzanne Ashworth
Emergency: This Book Will Save Your Life by Neil Strauss
Five Acres and Independence: A Handbook for Small Farm Management
by Maurice G. Kains
Essential Bushcraft
by Ray Mears
The
Survivor book series by Kurt Saxon. Many are out of print in
hard copy, but they are all available on DVD. Here, I must issue a caveat
lector ("reader
beware"): Mr. Saxon has some very controversial views that I do not
agree with. Among other things he is a eugenicist.
How to Stay Alive in the Woods by Bradford Angier
The New Organic Grower by Eliot Coleman
Tom Brown Jr.'s series of books, especially:
Tom Brown's Field Guide to Wilderness Survival
Tom Brown's Field Guide to Nature Observation and Tracking
Tom Brown's Guide to Wild Edible and Medicinal Plants (Field Guide)
Total
Resistance
by
H. von Dach
Ditch Medicine: Advanced Field Procedures For Emergencies
by Hugh Coffee
Living Well on Practically Nothing
by Ed Romney
The Secure Home
by Joel Skousen
Outdoor Survival Skills
by Larry Dean Olsen
When All Hell Breaks Loose: Stuff You Need To Survive When Disaster Strikes
by Cody Lundin
The Last Hundred Yards: The NCO's Contribution to Warfare
by John Poole.
Camping & Wilderness Survival: The Ultimate Outdoors Book by Paul Tawrell
Engineer Field Data (US Army FM 5-34) --Available online free of charge, with registration, but I recommend getting a hard copy. preferably with the heavy-duty plastic binding.
Great Livin' in Grubby Times
by Don Paul
Just in Case
by Kathy Harrison
Nuclear War Survival
Skills by Cresson H. Kearney (Available for free download.)
How to Survive Anything, Anywhere: A Handbook of Survival Skills for Every Scenario and Environment
by Chris McNab
Storey's Basic Country Skills: A Practical Guide to Self-Reliance
by John & Martha Storey
Adventure Medical Kits A Comprehensive Guide to Wilderness & Travel Medicine
by Eric A. Weiss, M.D.
Rodale's Ultimate Encyclopedia of Organic Gardening: The Indispensable Green Resource for Every Gardener
Special Operations Forces Medical Handbook (superceded the very out-of-date ST 31-91B)
Wilderness Medicine, 5th Edition
by Paul S. Auerbach
Four-Season Harvest: Organic Vegetables from Your Home Garden All Year Long
by Elliot Coleman
Back to Basics: A Complete Guide to Traditional Skills, Third Edition
by Abigail R. Gehring
Government
By Emergency
by
Dr. Gary North
The Weed Cookbook: Naturally Nutritious - Yours Free for the Taking!
by Adrienne Crowhurst
The Modern Survival Retreat
by Ragnar Benson
Last of the Mountain Men
by Harold Peterson
Primitive Wilderness Living & Survival Skills: Naked into the Wilderness
by John McPherson
LDS Preparedness Manual, edited by Christopher M. Parrett
The
Long Emergency: Surviving the End of Oil, Climate Change, and Other Converging
Catastrophes of the Twenty-First Century
by James H. Kunstler
Principles of Personal Defense - Revised Edition
by Jeff Cooper.
Survival Poaching
by Ragnar Benson
The Winter Harvest Handbook: Year Round Vegetable Production Using Deep Organic Techniques and Unheated Greenhouses
by Eliot Coleman
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Letter Re: Avoiding Influenza When Traveling Overseas
James,
My work forces me to travel frequently – 80 to 90% of the time. And it’s not to fun places like Miami or Rio but rather third world locales (just coming back from a swing through the ‘stans – Afghanistan, Tajikistan, Turkmenistan, Uzbekistan, and Kazakhstan -- where I have a large telecommunications project). As such I get exposed to every imaginable sort of illness. I finally found a doctor I could work with when he started to ask where I had been lately rather than what the symptoms were.
As such I have a larger than normal medical kit I take with me on the road. (I also have a 1 quart water bottle sized survival kit I take with me, but more on that in another letter). So I have traveled for years and over the time the kit has grown based on the needs I could not meet in the locales I was in. It really took off when I spent one early December in Beijing and for three weeks the entire stock of western medicines in Beijing was sold out – no decongestants, no ibuprofen, and no sleep as a very bad cold kept me up.
Over the years I have found certain habits to be essential to keeping healthy overseas. First and foremost is a regular dosage of Vitamin C. As soon as I think I am coming down with something I start on a regime of Golden Seal mixed with Echinacea. Finally, I make sure that I have various OTC cold medicines with me at all times – such as Mucinex and 12-hour Sudafed. I also carry Ciprofloxacin, various sulfa drugs, and more recently Tamiflu, as well.
On top of this I am a hygiene nut – washing hands frequently, making quite sure that the water for tea is boiling before I get it, carrying hand wipes with me (Okay, since my youngest is finally out of diapers I am using up the last of the small diaper wipe packets), and the like.
Now while frequent close contact is the norm in many cultures and cannot be avoided without causing undue friction--I still can’t bring myself to do the nose rub with the Arabs--and although I do teach impromptu martial arts classes to all comers in hotel gyms, I do try to limit it.
But all my precautions were to no avail with the Swine Flu. I am just getting over it and have passed it on to my 17-year old son. I assume that the rest of the family will follow in short order (five kids means lots of germ breeding goes on). And if you were in the Frankfurt airport on Saturday – I probably gave it to you as well.
As such I would strongly recommend that folks, while preparing with masks and gloves and the like, concentrate on preparing for getting swine flu. I did everything “right” from a prevention stand point without turning myself into a hermit. And yet here we are with it spreading in my family.
What I have found in my personal case is that the three key medicines to have on hand were Mucinex
[expectorant], 12-hour Sudafed
[decongestant], and Albuterol Sulfate (found in most of the asthma inhalers and commonly used in nebulizer treatments for breathing disorders). Fortunately, with my travels I have a prescription for, and carry, one of the asthma inhalers for those times that I have come down with various forms of pneumonia while on the road. - Hugh D.
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Letter Re: Medical Corps Offering a Field Dentistry Class in August
Jim:
I thought that SurvivalBlog readers might be interested in a Dental class being conducted by Dr. Loomis (DDS) in Tennessee. Tom Loomis has been teaching at our classes for almost as long as we have had the school. On August 14-15 he will be teaching a Field Dentistry class near his office in Tennessee. The student will get the unheard of chance to fill cavities, replace broken or missing crowns, extract teeth and use a high speed dental drill. The drill is the same type used in any dental office. Several years ago I asked him if he could convert the air turbine drill to run off a simple [compressed] air tank which could be recharged with a bicycle air pump. He did and we now use EMP proof high speed dental drills. In fact some class members have even purchased these rigs for their survival retreats. If any of your readers are interested in completing their training with a good dental course, please contact:
Dr. Tom Loomis, DDS
423-337-9834
tandsloomis@bellsouth.net
Best Regards, - Chuck Fenwick, Director, Medical Corps
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The Jump Kit, by Skyrat
Inside the trunk of my vehicle is a near duplicate of the “jump kit” or “Green Bag” used in my days with the Detroit Fire Department's Emergency Medical Service Division. When I come across a roadside collision before the local medics, everything I need to start patient care is in the green canvas bag I sling over my shoulder. The supplies in my personal vehicle are very much like those I carried in my street medic days, and reflect a strong basic life support/trauma bias.
Basic life support includes those interventions that do not go past the skin, and generally do not require physician direction to implement. Advanced life support, on the other hand, includes therapies that do go past the skin, and include medications, intravenous fluids (IVs), electrical counter shock, and airway intubation.
I do not include intravenous fluids or medications in my green bag for a couple of reasons. First, these items have a limited storage life under the best of conditions, and the rear of a passenger vehicle in Northern Michigan is not calculated to prolong it. Second, the statutes under which paramedics practice here in Michigan requires systematic physician supervision of advanced patient care. Fundamentally, that means that if you are not functioning within an established paramedic system, you are out of bounds should you perform advanced procedures on the street. Third, advanced patient care procedures are occasions of peril even in the hospital, let alone in the rear of an ambulance. This is so, even within a system of continuing education, continuous quality assessment, supervision, and the backup of both your partner, and the physician and clinical staff on the other end of the telephone or radio. Soloing at the roadside provides neither you nor your patient with these safeguards.
Firearms owners are likely acquainted with the “gun shop commando”, classically braying about the bogus “shoot 'em and drag 'em inside” philosophy of home violence management. Likewise, you might consider the existence of the “parlor paramedic”, who seems to reason something like, ”wait until the Schumer hits the fan, and I'll come out of the closet, birthin' babies and saving lives!”
In order to entertain this fantasy, you will need the tools of the trade. Medications are not without risks, do not keep forever, and are expensive. Additionally, there is the issue of convincing a physician that he or she ought to prescribe for you and that you can differentiate your Barneyfrank (ass) from a hole in the ground. If the expense is no problem for you because you have money to burn, please see me after class! If you think that the utility of your medication stash outweighs the other concerns, please contemplate these points: 1) In the absence of a catastrophe the likes of which America has never seen, it is both illegal and immoral to withhold professional medical care required by an ill or injured person. 2) During Schumeresque times, it is unlikely that the infrastructure will be in service which allows the delivery of complex, highly skilled care to those in need. Particularly, you will not have access to that infrastructure, and (if you have your head screwed on straight) you will have no desire to perform skills you are not trained to do, in the midst of a disaster, upon your vulnerable, hurting and injured loved ones.
By way of example, I have 30 yeas of EMS and nursing experience (in ICU, CCU, and ER), as well as licensure as a Physician's Assistant. I have used Dopamine, along with other invasive therapies, innumerable times to support the blood pressure of critically ill or injured patients. Dopamine has potent effects upon the heart, among other systems, and these effects are monitored by a cardiac monitor. I found a Zoll Automatic Cardiac Defibrillator, after a brief internet search, for $3,000, which appears after a casual review to allow monitoring. The question, however, is whether you can make sense of the tracing the monitor displays, identify adverse changes in cardiac rhythm, and respond appropriately. Additionally, do you know the adverse effects Dopamine may have, and how they must be managed? If not, you have no business trifling with it. I have done all these things for years in my Nursing practice, and I do not have Dopamine in my personal stores. You need to assume the risks you both understand and are comfortable with. I am reluctant to assume this risk for myself and my family.
My bias toward trauma derives from the fact that the stabilization and management of the medical patient, in contrast to the trauma patient, calls for assessments and interventions that I generally do not find appropriate outside of the hospital or advanced life support ambulance. Determining the source of the patient's distress will identify what treatment is required. While there are a few medical conditions that are responsive to basic life support interventions, I am not about to pretend that a few thousand words will equip you to make such judgments. Find an American Red Cross first aid class and master it. Better yet, become an EMT.
Just the other day, I came upon a rollover as my girlfriend and I were en route to attend some family function. There were half-a-dozen civilians clustered about, and things seemed well in hand. The first firefighter arrived shortly after me, and I deferred to him. Offering him wound care supplies, I was surprised to discover I could not find any gloves in my kit! Returning home, I undertook an inventory. Here is the result of that tally, and some discussion of my view of why each item belongs in my kit.
Training comes first. There is a story told of the early days of the Israeli state, when the emergency response planners had the budget required to train their personnel to stabilize and transport spine injured patients, or buy the splints (called backboards), but not both. The story relates that the planners elected to train their personnel, and subsequently noted a spine injured kibbutznik transported to the hospital by his comrades, secured effectively to an entire barn door.
I place a priority on training for several reasons. First, neither vermin nor adverse storage conditions have ever ruined training and rendered it unusable. Secondly, “they can have my training when they can pry it from my cold, dead mind”. Third, I have never ever (in my disorganized life) failed to pack my training. Fourth, there is nothing that will be displaced from my supplies in order to make room for my training. Fifth, in contrast to supplies, ability improves with use, and becomes more abundant when you share it with others.
Begin with CPR training. Three or four hours of your time will equip you with the skill that may save a life in the here-and-now. You will gain an introduction to patient assessment, and learn some of he fundamentals of first aid, and whatever dilemma confronts you, your response cannot fail to be more effective with some training to guide you. Effectiveness saves lives.
Look into local outlets for first aid training. The American Red Cross, the National Safety Council, your local community college, as well as perhaps others offer credible training which may serve as an introduction to further studies. The justification for the further expenditure of additional hours may be found in the preceding paragraph. Additionally, if you are more acquainted with what the medical conversation is about, the health care decisions made with regard to yourself and your family will be less mysterious to you, and better informed decisions tend to be better decisions. The better your health, the better your chances of coming out the other side of Schumer times intact, and therefore the better chance of bringing your family with you, likewise unscathed.
Consider EMT schooling. You will learn more emergency care skills (a good thing), and an introduction to elementary anatomy and pathophysiology (how things go wrong in illness and injury). Such education gives you the opportunity to be a more informed participant in your health care decisions, and that is itself a good thing, as well.
SELECTING YOUR CASE
It really doesn't matte what sort of container you employ for your emergency supplies, so long as it meets your particular needs for security, identification, accessibility, protection and convenience.
Some fire departments use plastic “totes” to organize supplies required for specific types of calls. For example, haz-mat supplies are packed inside specific totes, and the top secured with a cable tie or some such device. An inventory is attached to the top (sealed in plastic) to identify what is inside, as well as out dates of time sensitive components. When properly closed, such bins are drip and dust resistant, resist crushing or jumbling of the contents, and can be convenient to carry when not overfilled. On the other hand, they will not conveniently fit beneath a vehicle seat, may be unwieldy to retrieve and place into action, and may get buried beneath other stuff in a trunk or truck box.
Others of my acquaintance use ammo cans, or plastic fishing tackle boxes. These are generally more convenient to shlep about (unless your tastes run along the lines of a 20 mm ammo can) and are more drip/dust/duh! resistant than the tubs mentioned above. On the other hand, they may overturn with disappointing ease, spilling your supplies into whatever noxious fluid is abundant on your particular scene.
I use a green canvas musette type bag. It is not water resistant, is not neatly compartmentalized, and does not have an IR glint Star of Life embroidered upon it. On the other hand, I know how my stuff inside is organized, it is convenient to sling over my shoulder when the scene requires that I do so, and the local military surplus store will sell me another for $10-20 when that becomes needful. It will fit beneath a van seat, or in a tub in my trunk, and I can work out of it when I have it slung.
IN THE TOP, OR IN AN OUTSIDE POCKET
Items that I am likely to require promptly are either in the outside pocket or immediately inside the top flap of the bag. These are things that I do not want to be fumbling for as I approach a scene. I will not list what might be considered “everyday carry” items like pocket knife, flashlight(s), CS spray, sidearm, and a cell phone. While these tools help keep the rescuer from becoming a victim of an ambush laid for a 'Good Samaritan” , particularly when employed in concert with a Condition Orange mindset. (I did mention I started out in Detroit, didn't I?) These items do not seem to me to be rescue/first aid/emergency medical tools.
First up is several pairs of gloves. (well, now, anyhow!) I am allergic to latex, so I have nitrile gloves. Current practice is to wear gloves anytime you might reasonably anticipate exposure to blood or other bodily fluids: tears, urine, stool, saliva, gastric contents, or any other moist, body-origin material you might imagine (and perhaps a few you might not!). I have so thoroughly incorporated this into my life that I get uneasy caring for my own children (or, at my advanced age, grandchildren!) without gloving first. These are in a zip-lock bag, safety pinned (now!) just inside the top flap of my green bag.
The upside to all this is that scrupulous gloving and thorough hand washing have so far proven highly effective at preventing the spread of the most common blood-borne infections. Diseases spread via airborne droplets (for example, Legionnaires disease), of course, require additional precautions. Others are spread by organisms coming to rest upon environmental surfaces and then accessing a vulnerable host (just like you and I are vulnerable hosts to “the common cold”) by means of unconsciously touching our faces after touching a contaminated surface. For myself, after 30 plus years of patient contact the worst I have brought home has been an occasional upper respiratory infection due to my conscientiously applying the glove/hand wash/hands away from my face regimen.
The next item I'll feel a burning need to have in my hands is a bag-valve-mask (BVM). This is a manually operated ventilation tool. It is employed by sealing the mask over the unbreathing patient's face, squeezing the self inflating bag, and thereby forcing air into your patient's lungs. Repeat at a rate of approximately 12-20 times a minute. Advantage: no kissing strangers, required for mouth-to-mouth resuscitation. You are able to maintain situational awareness of such things as evolving environmental hazards (like leaking gasoline), or indicators of your patient's improving condition (...he said, thinking positively!). On the downside, using a BVM is difficult in untutored hands. It is easier (compared to mouth-to-mouth) to force air into the patient's stomach, which will elicit vomiting. Aside from the aesthetic issues this presents, vomiting in a profoundly unconscious patient (such as one so unconscious as to have stopped breathing) presents the opportunity for aspiration into the lungs of that which has been vomited, which may be deadly.
Training in use of a BVM will be part of the EMT class I mentioned earlier. I'll wait here while you go find out when your local community college or rescue squad will be having their next class. Plan on being a part of that class. You will be making your community, and thereby your family, safer.
You can buy your own, and Gall's will ding your for around $15 for a disposable model. In the hospital, we use these once and discard them. You might choose to meticulously clean yours and re-use it. Your local rescue squad or ambulance may shop locally, and you might want to do likewise. Ya know, if you were to volunteer with your local rescue squad, you might be able to obtain things like this at your agency's cost. All this on top of the good karma from helping to provide a necessary community service. And,, besides, becoming known to the locals (police included) as one of “the good guys”. Your phone book likely will provide the contact information you require. I'll still be here when you get back.
One of the adjuncts to using a BVM is called an oral airway. Oral airways come in sizes, which may be selected according to the size of the patient. Their purpose is to hold the flaccid tongue of a profoundly unconscious patient forward, so that it does not sag against the rear of the throat and thereby block the passage of air into and out of the lungs. The problem it may trigger is, should your patient be other than profoundly unconscious, he or she will vomit. Among other disasters this may cause, the enzymes from the stomach, designed to digest proteins, will (unsurprisingly) begin to digest the proteins found in the delicate tissues of the air sacs (alveoli) of the lungs, with effects you are likely to be able to imagine on your own. Very Bad Thing. [JWR Adds: Plastic airways usually come in sets of six sizes, and usually color-coded these days, available for less than $5 per set on eBay. Buy a couple of sets. Someday you may be very glad that you did!]
Another way to fail when employing an oral airway is to bunch up the patient's tongue in the rear of the throat. This blocks air flow, strangling your patient. This device must be restricted to only profoundly unconscious patients, and only if you are schooled in its use. You can buy them individually, or in sets. Before shipping, they go for around $5.00/set. You might elect to buy them one at a time, but at $5 a pop, they aren't a particularly major investment.
When I'm confronted by an actively bleeding patient, I reach for a Carlyle dressing. Mine are the old style The Carlyle iteration includes muslin (cloth) ties to secure as any other tied bandage. The 21st century version is called an Israeli Dressing, and is available from various sources. (see my shopping list/spreadsheet for representative sources) It consists of a sterile dressing incorporating an elastic bandage to secure the dressing to the wound. Should you shop gun shows or surplus stores for your equipment, be wary of old dressings. They present potential issues of failed sterility as well as mustiness or mildew occasioned by improper storage or imperfect packaging. The contemporary Israeli Battle Dressings are available from Cheaper Than Dirt or from Gall's for $9.00 or $10.00 each.
Another wound care product is QuikClot . This is a mineral product, bound to a dressing, which enhances clotting, and thereby slows and limits blood loss in the bleeding patient (common in trauma, surprisingly enough!) One article (QuikClot Use in Trauma for Hemorrhage Control: Case Series of 103 Documented Uses. Journal of Trauma-Injury Infection & Critical Care. 64(4):1093-1099, April 2008.) reflected the occurrence of burns in several patients, but the manufacturer's web site reports that changes in packaging and delivery system have addressed this issue.
An alternative you might consider is Celox. It appears perhaps to be a reasonable alternative to QuikClot. It is derived from shrimp shells, although it seems to not produce allergic reactions in folks otherwise allergic to seafood. I have no personal experience with either product, but the reports are interesting. This goes on my “further research” list!
The preceding items are to be found in the outside pocket or very top of my jump kit. I don't want to be searching for them when I feel the need for them Right Freaking Now. Beneath the don't-wanna-wait-for-them items, I have supplies of somewhat lesser immediacy. These allow me to assess the situation in greater detail, or address issues that may come to light that are of less time sensitivity.
Triangular Bandages are useful for slings of injured arms, or may be folded into narrow strips and then used as a means to secure splints or dressings (as “cravat bandages”). If we were to consider them as a backpacker might, they may be used as expedient dust masks, bandannas, head coverings, or washcloths. I buy muslin by the yard at Wal-Mart, and cut it from one corner to the other, forming (surprise!) 2 triangles approximately a yard on a side. I keep 6 to 8 in my kit.
Bandage shears are the most obvious of the prehospital medic's tools. You can go with Lister style bandage scissors, often found as “nurse's scissors”, or the plastic and steel “super shears”. Prices range from $4.00 and up. Frequently employed to trim dressings to the proper size, cut away clothing from wounds, and to cut bandages.
Did you ever notice that a tongue blade/tongue depressor is almost exactly the width of a finger? And just a bit longer than your Mark 1, Mod 0 finger? Exactly like it were designed to be a finger splint, isn't it? In addition, should you tape three of them together one on top of the other, you have a dandy tool for tightening that “Spanish windlass” you are going to learn about, when your EMT class teaches you how to apply and improvise a traction splint for a fractured femur (thighbone). Finally, if you are unhappy at the thought of wiggling somebody's fractured femur (broken thighbone) so you may place ties (cravats: remember them?) for a splint, tongue blades are thin, stiff, and very helpful at limiting the wiggling as you place ties beneath the broken bone of your choice. I keep a handful handy.
You can pay a couple of bucks for them at the corner pharmacy, or you might be able to talk your way into several for free, like when you are volunteering at some public service event with your local volunteer fire department, emergency medical service, or amateur radio club.
Stethoscope/Blood Pressure Cuff. A stethoscope allows you to hear the sounds made as air moves into and out of the lungs, and note changes from normal. These changes might occur because your patient has a collapsed lung, or has pneumonia, or heart failure. When you get that far into your EMT class (hint, hint), you will learn how to evaluate these changes, and what sort of treatment decisions you ought to consider when you notice them. In addition, you will learn how to measure, and interpret, your patient's blood pressure.
I am certain you will know somebody who will go out and get the cardiology deluxe stethoscope, with the multi disc cd player, mag wheels, and gold trim. Do not join them in this folly. Spend $10-40 at the same place the local student nurses get their stethoscopes, and spend the difference on your spouse, whose enthusiastic support you will require, anyhow. If you can show your spouse how your expenditure of family money and time on supplies, education, and volunteering promote values that you both agree upon, the both of you will thereby make your family more crisis resistant. If your family is more crisis resistant, then you are not only NOT a drag on community emergency services during an emergency, you all might even be an affirmative community asset during bad times. That cannot fail to be a Good Thing when you get to explain yourself to The Jewish Carpenter. Me, I'm going to require all the help I can get. I'm volunteering!
Adhesive tape (1 inch, 2 inch) secures dressings, holds loose ends of bandages, and provides a single use notepad (tear off a length, tape it to your thigh, and jot notes. You will not lay it down somewhere to be forgotten). If you listen to some friendly and knowledgeable athletic trainer, you can learn how to use it to support sprained ankles or knees if the preferred treatment (rest, ice, elevation) is not possible. Before you employ these tricks, bear in mind that physicians frequently cannot differentiate a sprain from a fracture, even after an x-ray. In my view, except under the most dire possible circumstances, walking on a fractured (or sprained) extremity is a Very Bad Thing. Two rolls each are at hand when I open my green bag.
I keep 12 to 15 Gauze pad, sterile, 4x4 in my kit. I employ them as eye pads, padding beneath splints, or as (oddly enough) dressing for wounds. Occasionally I encounter a wound bleeding so enthusiastically that a couple of gauze pads will be overwhelmed. Fortunately, I haven't come across such a wound off duty, but in the hospital we use a “boat” of sterile gauze. This is a plastic tray of ten sponges in one pack. The tray also may be used as a clean basin for wound irrigation/cleansing solution. In the hospital we use sterile saline, you may elect to use the water from your retort pouch, or fresh from the bottle as you purchased it for storage. I would certainly give it some thought.
If you happen to be the purchasing agent for your entire survival community, ambulance service, or the entire Boy Scout Council, you might find the case price from Galls to be a useful bit of information. 1200 sterile 4x4 pads for $89.99 works out to around 7.5 cents each.
Triple padding/ABD padding, sterile, 5x9 inch. These multiple layer absorbent dressings are designed for wounds producing a lot of drainage of either blood or other fluid. They are my first choice for a bulky dressing or splint padding. I keep 6 in my kit. The frugally minded may note that “sanitary napkins” are designed to absorb drainage, are “medically aseptic”, and are available nearly everywhere.
And, on a related note, tampons from the “feminine hygiene” shelf at your local store are also constructed to absorb fluids, and contain them. Should you confront a penetrating wound, “tamponading” a wound is a widely known concept among inhabitants of the medical world. Packing such a wound with a tampon using sterile technique might prove to be life saving, and provide hemorrhage control options not otherwise available. (http://snopes.com/military/tampon.asp)
Roller Gauze, 4 inch is typically used to secure a dressing (see Gauze Sponge, above) to the wound. I pack 6 in my kit, and they have “found careers” as bandages to secure dressings, securing splints when I run out of triangular bandages, and upon occasion as packing/dressings for vigorously bleeding wounds. In fact, when one is employed as the dressing, and another as the bandage, I can not only dress the wound, but also (since the bulky roll provides a pressure point) apply direct pressure to the bleeding site. This provides an alternative to the Carlyle or Israeli Dressing, cited above
Vaseline Gauze (sterile, 3x9 inch) is intended to seal wounds penetrating the chest, in order to prevent collapse of your patient's lung(s). When you seal the defect in the chest wall, your patient will not draw in air through the wound when s/he inhales, and thereby not fill the space between the lung and the chest wall (the pleural space) with air. When you can avoid this, inhaling draws in air through the mouth, trachea and bronchi, and that inflates your lungs, and we think that is a good thing. Myself, I pitch the gauze and tape three sides of the foil package, sterile side towards the wound, forming a flutter valve sort of effect. In this way I allow excess pressure in the pleural space to vent to atmosphere (stopping further lung collapse, I hope), and seal the hole when the pressure inside the chest is less than atmospheric pressure (like when the patient inhales). The only way left to equalize that pressure is by inflating the lungs, already described with approval above.
The other use for Vaseline gauze is when my lips or hands are dry, in which case I use the Vaseline to remedy that little problem.
We all can think of uses for the common elastic bandage, 4 inch and 2 inch. Two inch is useful for sprains of your wrist or thumb, and the 4 inch is used for an ankle twist/sprain. In addition, I can use them to secure a splint (there is that rule of threes, seen in other posts on this blog, again!), as the “swathe” part of a sling-and-swathe to immobilize an injured shoulder, or as part of a pressure bandage over a dressed wound that does not want to stop bleeding.
Large Bulb Syringe (for which you can substitute a turkey baster) functions as an expedient means of removing fluids from the airway of someone who is not managing to do so effectively on their own. It will not work nearly as well as a battery powered or pump action suction, such as you might find on your local rescue squad rig, but it won't cost you $50-$60 (for the manually pumped version) either. Second best is superior to nothing.
Mylar “Space blankets” protect you or your patient from the hypothermia-inducing effects of the wind, slowing heat loss. Generally colored bright orange on one side and silver on the other, there are signaling opportunities as well. In a pinch, you can improvise shelter from one or two. Amazon sells the "Space Brand" blanket
inexpensively. Equip your jump kits, and each member of your family with one or two.
Any accident so severe as to convince suspicious old me (alumnus of Detroit's EMS) to stop and offer assistance will not be fixed with a couple of Adhesive Bandages (aka “Band Aids”). I have six in my jump kit, two entire boxes at home (and parceled out among my camper, car, and household kits).
I keep a couple of Ice Packs around, as assorted adventures may bring on modest orthopedic injuries. Ice is helpful for strains, sprains, or overuse of an over aged joint (...not that I would know anything, firsthand, about that...). Choices include “instant cold packs”, or that old picnicker's standby, a zip lock bag full of ice from the cooler.
Either option has drawbacks. I do not generally drive about with a cooler of ice at hand, although when camping I am likely to do so. Instant cold packs are kind of fragile, and you might find, when you go to place one in service, that you have a leaking mess on your hands. On the other hand, they are more likely to be there when you want one.
The foregoing lists the contents of my “jump kit”. I keep one kit in my vehicle, and another at home. In addition, there are Subordinate Kits, kept in camper, car and home, for lesser sorts of occasions. I have customized each by adding more dressings, triangular bandages, roller gauze, and gloves. In addition, I improved over the baseline “Wally World” $15 first aid kit, by adding zip lock bags of various household medications. I labeled each bag with the name of the med, the out date of that particular bottle, directions for use, and date of packing. I made my selections by inspecting my own medicine cabinet, and pondering which meds I had wished I had kept handy the last time I was out camping, for example. Most everything commonly needed is therefore in the Camper Kit, Car Kit, or House Kit.
The jump kits are reserved for “Holy Fertilizer!” sorts of events. They are not mere “boo-boo boxes”. Reserved in this way, I will not find myself hunting (and swearing) in crisis, as I need this or that widget, which some child (or adult) has used, and not restocked.
LONGER TERM CONSIDERATIONS
Some of us might contemplate longer term medical preparations. For those, I recommend Dr. Jane Orient's article. Once I get beyond the 20 year old pricing, the are only a couple of improvements I could suggest. One is in the arena of recently developed antibiotics (as in quinolones). Even in that light, it seems to me to be a very good basis for developing a longer term medical kit (and training plan) for your particular circumstances.
Another substitution I would make, is to delete surgical masks, and substitute NIOSH N-95 masks. I found a carton of MSA Safety Works No. 10005403, Pack of 20 Harmful Dust Respirator Model 10005043 for $18.97/each carton at Home Depot. You may find similar products locally.
Additionally, I would add loratidine (you may recognize the brand of Claritin) as a non-sedating antihistamine. (Personally, I would prefer my personnel pulling OP duty to be non-sedated.) I'd also add the most frugal of the following : ranitidine, famotidine, cimetidine, in lots of 1,000 tabs, as a superior stomach acid blocking medication, to supplement the antacid Dr. Orient suggested over 20 years ago. As the “big gun” for acid stomach problems or GERD, I'd lay in a supply of Prilosec OTC. This class of stomach medication is the yardstick against which all others are presently measured.
If you are planning establishing a longer term medical cache, it is imperative that you do so only in concert with a physician, or other personnel licensed to prescribe. The guidance you will receive will help you avoid causing more illness than you relieve. Medications are a double bitted axe, and may cut on the upstroke as well as on the downstroke. Be aware.
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Letter Re: Three Abstracts on Public Health in Ghettos During the WWII Holocaust
James,
In light of the recent shooting by a Nazi whacko in Washington at the Holocaust Museum, I think it is important that we remember the victims and impact of a totalitarian government deliberately starving, looting, and otherwise dehumanizing its citizens. (The articles were published in Hebrew but the following abstracts are in English) - Yorrie in Pennsylvania (a retired physician)
Clinical Manifestations of "Hunger Disease" Among Children in the Ghettos During the Holocaust
Hercshlag-Elkayam O, Even L, Shasha SM.
Western Galilee Hospital, Nahariya, Israel.
The harsh life in the ghettos were characterized by overcrowding, shortage of supplies (e.g. money, sanitation, medications), poor personal hygiene, inclement weather and exhaustion. Under these conditions, morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with a high mortality rate. The dominant feature was hunger. Daily caloric allowance was 300-800, and in extreme cases (i.e. Warsaw ghetto) it was only 200 calories. The food was lacking important nutrients (e.g. vitamins, trace elements) leading to protean clinical expression, starvation and death. The clinical manifestations of starvation were referred to as "the Hunger Disease", which became the subject of research by the medical doctors in the ghettos, mainly in the Warsaw ghetto in which a thorough documentation and research were performed. The first victims of hunger were children. First they failed to thrive physically and later mentally. Like their elders, they lost weight, but later growth stopped and their developmental milestones were lost with the loss of curiosity and motivation to play. The mortality rate among babies and infants was 100%, as was described by the ghetto doctors: "when the elder children got sick, the small ones were already dead...". In the last weeks of the ghettos there were no children seen in the streets. In this article the environmental conditions and daily life of children in the ghettos are reviewed, and the manifestations of "Hunger Disease" among them is scrutinized.
[Harefuah. 2003 May;142(5):345-9]
Morbidity in the Ghettos During the Holocaust
Shasha, SM.
Western Galilee Hospital, Nahariya.
The environmental conditions and daily life in the ghettos of Europe during the holocaust are reviewed, and their effect on morbidity in different ghettos is scrutinized in an attempt to construct a typical morbidity profile. The outstanding characteristics were: crowding, shortage of basic necessities (such as food, clothing and medications), harsh environmental and sanitary conditions, inclement weather, poor personal hygiene, chronic undernutrition and malnutrition, physical and mental exhaustion. Morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with high mortality, and high infestation rates of lice and other parasites. The dominant feature was "hunger disease" with its protean clinical expressions, endocine pathology, growth and development retardation in children, and amenorrhea and infertility among women of child-bearing age. Polyuria, nocturia and increased frequency of bowel movement were common. The typical presentation of a ghetto dweller was of extreme emaciation (a loss of up to 50% body weight); muscle weakness and skeletal abnormalities; pale, dry skin with excoriations; pedal edema; anxiety and nervousness; often goiter in children. Most of the inhabitants had some, or all, of those signs and symptoms (there were times when more than half the population was sick). This syndrome complex was termed "Ghetto Sickness" or "Ghetto Fatigue" (ghetto schwachkeit).
[Harefuah. 2002 Apr;141(4):364-8, 409, 408]
Medicine in the Ghettos During the Holocaust
Shasha, SM.
Western Galilee Hospital, Nahariya.
The Health systems in several ghettos in Europe during the holocaust were studied in an attempt to construct a typical structural profile. The medical system in a typical ghetto consisted of a department of public health (sanitation) that belonged to the Yudenrat, several hospitals, outpatient clinics, first aid stations and physicians in the labor groups. The structure of the system in several ghettos is discussed and the functions of the various units in the prevention of epidemics, and health education are reviewed. Also described is the medical research that was carried out in the ghettos, emphasizing the work on "Hunger Disease" in the Warsaw ghetto, as well as the heroic endeavor to establish a clandestine medical school in the Warsaw ghetto during the holocaust
[Harefuah. 2002 Apr;141(4):318-23, 412]
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Letter Re: Portable Oxygen Condensers
James,
I recently installed an AuraGen
system similar
to the current listing on eBay (#330329068735) onto a customer's Bug Out Vehicle
(BOV), a 1986 Chevrolet Suburban 1 ton (modified
with some parts that were originally incorporated in the M1008 CUCV).
This customer also is afflicted with COPD and
uses a 110 VAC Oxygen generator. The Auragen, being a military designed
system is far more durable, far more
rugged,
and most importantly, far more versatile than an inverter placed into any vehicle
electrical system. Being a mil-spec unit,.EMP is
also not an issue as it meets the military requirements for such use in medical
units for power generation.
At around $1,700 on eBay the end user can add about another
$500-to-$600 for install and miscellaneous parts. I personally have a PTO drive
system in my own
vehicle and have used it in several situations where, as some say "The
Schumer has
hit the rotating impellers", LOL,
powering some mission critical communications, networking, and telecom facilities
for other NGO customers. These are not cheap, but what price is reliable power when lives depend on it? Best Regards,
- Bob S.
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Letter Re: Advice For Older Preppers With Limited Mobility
Hi James,
Thanks for your many years of great work. While I was enjoying and learning
so much from your books and the web site, I was also growing older and have
physically "lost the edge". More accurately, I reaped the unintended
consequences of 55 years of smoking and now have a tough situation Chronic
Obstructive Pulmonary Disease (COPD).
This is [best described in layman's terms as] a combination of bronchitis
and emphysema. I have not smoked for
three years and my breathing
is now stable at 51% of normal. This ailment is not unusual in the senior community,
and COPD is the third largest killer in the USA. It severely restricts activity
and higher altitudes are deadly. Like most of us with COPD, I am on oxygen
20-to 24 hours a day, seven days a week, plus lots of varied and expensive
medications, to include my liquid oxygen, mostly supplied to me at low or zero
cost by the Veterans Administration.
Additionally, and this may apply to many of your readers, my wife and I are
the primary care givers, in our home, for her mentally disabled older brother.
He too is a vet, Korean War Era and age 79, and receiving 100% of his medical
care from the local Veterans Clinic, as I do. The Veterans Administration
(VA)
is a terrific source of excellent health care. All eligible vets should enroll
ASAP a the VA
web site. Go there and get in before the Obama National Health Carelessness
Agency gets to their house! I expect the VA will be forced to shut out all non
combat vets soon!
My wife and I, and a few friends, all sorta elderly fellow military vets, have been like minded about preparedness since well before the Y2K era. About 20 years of learning and prepping! We have the basic stocks of food, water, meds, clothing, and appropriate security items. We have learned to help one another and to be able to give to others in need. I have stocks of dvds to enjoy and to use to teach others. We have a 2,100 Watt solar system for power. We have devised a simple system to safely filter irrigation water for our local water needs, to include drinking, cooking, and laundry. We've worked together and planned together successfully. We are a team and care for each other as an extended family.
We live in small town in rural Utah. My wife and I are pleased to live in
a close knit town of about 500 good caring folks. This area is highly LDS,
about 50 - 60 %, and they are mostly "not very well-prepared" ....
surprise! surprise! The [majority of] Mormon people--and I can say this as
an active LDS--are not ready for any disaster. Less that 10% have a emergency
response
mindset.
The LDS Provident
Living web site is great, and while the LDS Church strongly
promotes and enables provident living, far too few members are prepared for
any emergency. Many have a little bit and very few have enough. As a people
we are not well prepared. [JWR Adds: But on average far better
prepared than most other Americans, and that is commendable.]
As a family, we've done all that preparation, and still I have a serious
problem with no answer. You see, I will be dependent on solar power to enable
my oxygen concentrator to produce O2, power the kitchen, and the computers,
and to recharge the batteries. I can't leave our home area for more than about
6-9 hours (maximum battery life for the portable concentrator). In an emergency
my darling wife of 43 years will not leave me. My Veterans Elderly "A" Team
/ Extended Family wants to "zip cuff, gag, and bag" me and take
me out of danger, but they too recognize the travel difficulty and are without
a solution. Moving the solar array and the necessary ancillary equipment is
a two day exercise.
We seniors are a large portion of the community and an even larger part of
the preparedness group. I have yet to see or hear any preparedness help for
folks like us. Many seniors are just like me; older, somewhat ""less abled
physically, somewhat less able to travel, and more dependent on local medical
services.
20% of us are raising our grand children... At the same time we are surely
more knowledgeable, more able to lead, more experienced, more secure financially,
more able to teach and to mentor, more equipped, and more likely to have lived
through hard times and to have serious military training. And very importantly,
many of us have real time combat experience. We have been to see the "Elephant
Country". The younger folks need what we have to offer because they will
die without it.
My problem is very simple. I have done all of the right preparedness chores and now I find that my family can not get in the truck and bug out. And I'll be 69, next birthday. What do I do now?
thanks again. - Old Bobbert in Utah
JWR Replies: My general recommendation for retirees is to
set yourself up as the retreat destination for the younger
members of your extended family. You can provide them with their bug-out location,
and storage for their supplies, and the benefits of your years of preparation.
They can provide you with the young and healthy hands, strong backs, sharp
eyes, and sensitive ears you will need after TEOTWAWKI.
I often stress the need to pre-position retreat logistics. By having your extended
family's supplies at your locale, it provides insurance that they
will be there to help out, when the balloon goes up.
OBTW, you mentioned oxygen. For anyone that heavily dependent on medical oxygen,
I strongly recommend buying a portable
oxygen concentrator. Many of the portable models are compatible with 12 VDC power.
This means that you can run them from your alternative power system battery
bank, without the need to run a DC-to-AC inverter. For much greater "range"
away from your retreat, you can keep a charged pair of deep cycle 6 VDC golf
cart
batteries in your vehicle.
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Letter Re: Anesthesia for Traumatic Times
Jim -
I've been reading your blog for a while now. Just thought I'd weigh in briefly
on the anesthesia issue. For background, I am a general pediatrician with
experience
in emergency pediatrics. Also, I am a fellow of the Academy of Wilderness Medicine.
Three quick points:
1. Under the vast majority of circumstances it is possible to work on mild
to moderate traumatic injuries in children without anything more than local
anesthesia. Papuses work
great and should be considered as part of an advanced medical kit that is intended
to treat children. If a papuse is too expensive or bulky, there
are all sorts of ways to immobilize children with sleeping bags, pillow cases,
sheets, etc. (one just has to use imagination - for example, try both arms
in a pillow case across the back). Obviously, the papuse idea only addresses
immobilization of the patient and does not assist with pain management. However,
even in an academic pediatric emergency department, we often concluded that
the risks of non-anesthesiologists administering anesthesia outweighed our
concerns about pain.
2. Dermabond is one of my favorite products. The screaming and struggling at
the University of Chicago pediatric emergency department dropped by 95% when
Dermabond was introduced to the market. It's a bit pricey but very simple to
use. I never had any "formal" training in dermabond use because it
was simply unnecessary. Carefully reading the instructions should suffice for
survival oriented self-training on the product. My biggest concern would be
to avoid gluing an eye shut. Even a glued eye is not a disaster as can slowly
be reopened with cooking oil and massage. People have suggested on your web
site, as well as at Wilderness Medical Society meetings, that super glue (same
active
ingredient - cyanoacrylate) could be used for the same purpose. However, I
have personally found it to take much longer to dry and to be far less reliable
at keeping the wound closed. Just last weekend I tried a new rubberized formulation
of super glue on a laceration of my own and was disappointed to find that it
peeled away the very next day - something I have never observed with Dermabond.
Lastly, Dermabond can successfully be used on joints as long as it they are
immobilized. This is less of a concern in children than it might be in adults
who might have to remain physically active.
3. I've personally experienced a hematoma block. Several years ago, I had a
broken rib that was so painful I couldn't breathe except in small gasps. Worried
about the possibility of a secondary pneumonia, my doctor injected hydrocortisone
and lidocaine directly into the fracture site. The block worked great and I
was able to breathe normally again.
On another note, I have noted a number of formulas on your blog for mixing
up wound cleansing solutions. The current research based consensus at the Wilderness
Medical Society
is that wounds may be cleansed with plain drinking water. So, simply treat
questionable water with a filter, by boiling, or with an appropriate chemical
agent and leave it at that. In fact, a Camelbak (or similar system) is an
ideal wound cleansing device. Just put the bladder under an armpit and squeeze
a large volume stream of drinking water from the tube directly into the wound.
The mouthpiece itself can either be carefully washed or simply removed prior
to use. - A.F., M.D.
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Three Letters Re: Anesthesia for Traumatic Times, by Scott N., EMT
Dear JWR:
As a practicing anesthesiologist, I felt it necessary to respond to Scott N.'s
article about TEOTWAWKI anesthesia. First, let me complement Scott N. for
the well written article as well as bringing up the issue in the first place.
Although it may be interpreted as self serving, I also have to strongly
agree with JWR's admonishment that this is not something to "try at home".
In a sense, we in the anesthesia field have somewhat become victims of our
own success. It wasn't that long ago that the risk of anesthesia (not the risk
of the surgery) was the main consideration in whether a surgical procedure
was even attempted. Today, you are probably more likely to die in a car accident
driving in to the hospital for your electively scheduled surgical procedure,
than from anesthesia. Anesthesia practitioners used to have one of the highest
rates for medical malpractice insurance, now it is one of the lowest. These
advances in patient safety are multi factorial. Anesthesia providers are some
of the most highly trained individuals in the medical field, advances in monitoring
(both invasive and non-invasive) has completely eclipsed what was available
even 20 years ago and medications, while becoming much more potent, have also
become much more precise in their effect. These three factors have led to the
risk of anesthesia becoming almost an afterthought.
In a TEOTWAWKI situation, all three of these factors would likely be unavailable.
One should be reminded that "lethal injection" is in effect an induction
of general anesthesia (the initial medications are the same), and the only
difference is the absence of an anesthesia provider at the patients head. It
has been stated (although a significant exaggeration), that sodium thiopental
(Pentothal) killed more Americans at Pearl Harbor than did the Japanese.
There are three main types of anesthesia. The first being General Anesthesia
(GA), which is a state of unconsciousness and is the normal public perception
of what anesthesia is. General anesthesia is described as a triad of states:
Analgesia (lack of response to painful stimuli), Amnesia (lack of memory of
the event) and Muscle Relaxation (a reduction or obliteration of muscle tone).
General anesthesia is accomplished by a combination of medications administered
by intravenous and/or inhalational routes. General anesthesia requires that
the anesthesia provider take responsibility for the patient's ABC's (Airway,
Breathing and Circulation). The second is Regional Anesthesia, which is accomplished
by injecting local anesthetics (numbing medicine) around a central or major
peripheral nerve, thus effecting anesthesia in a "region" of the
body, such as an arm or leg or "below the waist". Spinal, epidural
and brachial plexus blocks are routine examples. The third is local anesthesia,
which is accomplished by injecting local anesthetics into the soft tissues
around the area where a procedure is performed. Typical examples are dental
procedures and wound closure (stitches). Even though the latter two do not
necessarily include a state of unconsciousness, supplemental sedation, which
frequently causes amnesia, leads many people to believe that they "went
to sleep" (i.e. were under general anesthesia) when in fact they were
not.
In a survival situation, infiltration or local anesthesia would be the preferred
technique. An experienced surgeon can even perform an appendectomy under infiltration
anesthesia. While local anesthetic drugs (lidocaine, bupivicaine etc.) do have
toxic side effects, these can be mostly prevented by avoiding injecting directly
into an artery or vein (aspirating the syringe before injecting) and avoiding
a "toxic dose" by using no more than one bottle for an adult (this
is an oversimplification but is correct more times than not). Having an inexperienced
individual stick needles into major nerves or take responsibility for a patient's
ABC's raises the risk profile to astronomical proportions. - NC Bluedog
Sir
I feel compelled to say that as a subject matter expert--an MD Anesthesiologist,
in fact--on administering anesthesia, the publication of the article, " Anesthesia
for Traumatic Times, by Scott N., EMT" is fraught with peril. I wouldn't
have published it.Your web site lends an aura of credibility to whatever people
read there, at least it does to me. It can however encourage people to try
things that they
ought to think twice about. More to the point, it can make people believe they
are more medically trained than they actually are. As such, the article on
anesthesia shares in that aura which it simply does not merit!
Although the author begins to describe the classic "Stages" of General
Anesthesia, he should point out that while we in the business still do refer
to "Stage 2" under certain circumstances; proper use of these stages
is described only for ether anesthesia. Even though the author then goes on
in fact to describe the use of ether; I will describe why no one should.
The author then confuses these stages with the goals of an
anesthetic: Asleep (unconsciousness), Analgesia, Amnesia, Akinesia, and Autonomic
Stability- colloquially
known as the Five "A's" of Anesthesia. I guess that I am a purist,
but if the author is going to describe such a "make do with what you have" in
a SHTF scenario
on such a serious and potentially deadly topic, then the terms should be used
as they are professionally understood.
As a matter of background and to make a point, the most standard sedation scale
we use is the Ramsay Scale, which describes everything in six stages from mild
sedation (peaceful, tranquil, awake and aware) to deep anesthesia (stone-cold
out; complete with loss of airway, respiratory arrest, and
vital sign changes). The point is: As a rule, a practitioner
must be trained to manage an airway
of a patient one level deeper than the anesthesia you plan
to administer. In other words, at Ramsay score of 3 (what is commonly referred
to as "moderate
sedation", "conscious sedation" or "twilight anesthesia");
the patient still maintains their own airway; but at stage 4 can begin to lose
airway reflexes; even the practitioner of moderate sedation needs
to be able to manage a [compromised] airway. You are not only substandard;
you are dangerous if
you can't!
How does this relate to the original article: vinyl ether was never popular
since it induced deep anesthesia too quickly. Oops, that was fast- hope for
your patient's sake that you know how to manage the airway! The author, an
EMT, certainly can- what about your readership at large?
Also, ether doesn't just make you a little sick; it is (or was) notorious for
causing post-op nausea and vomiting. It caused intra-op nausea and vomiting!
Vomiting is one thing, but sucking the vomitus back into your lungs, called
aspiration, is a catastrophe. The mortality approaches 30% in young, healthy
patients, and leaves them with the lungs of a 70-year smoker if they survive.
Aspiration gets worse from there. Prevention of aspiration, for those who don't
know, is the main reason we ask people to fast before surgery- so their stomachs
are as empty as possible.
In addition, giving herbal extracts and whatnot by mouth increase the
amount of stuff in your stomach. Since adding ether to a stomach full of anything
is a recipe for aspiration. Do not be fooled by saying that its barely
a mouthful of total volume. The standard for having higher risk for aspiration
is a paltry
25cc's in your stomach. The average adult single "mouthful" ranges
from 80-150cc's.
Indeed, ether was almost abandoned in its infancy because of an aspiration
death. A historical anecdote for another time.
There are some other bad effects, both pharmaceutical and physical, of the
agents that need to be discussed. Ethers are associated with both acute and
delayed hepatic necrosis, and even hepatic failure; they are flammable as both
liquid and gas. The liquid is lighter
than water and the gas heavier than air, so they can flow and migrate long
distances to pick up a spark. And where diethyl ether is flammable (and explosive
in enclosed spaces/high concentrations), vinyl ether is explosive! In fact,
old operating rooms had extensive protections against heat, flame, sparks,
even static electricity (rubber mats and rubber soled shoes in place, after
a few demolished hospitals and personnel deaths! The fire potential of these
agents is no joke.
More, is the "survival source' of ether going to be pure? Common contaminants
include peroxides, formed spontaneously by exposure to air(oxygen) which are
explosive. Inhale that? not me.
Ultram, Toradol, etc- good drugs for their intended purposes- again if you
know how to use them. I haven't got too much to say on them at this time.
The herb that Mr. N spends a bit of time describing, Salvia divinorum, has
of course not yet made it into the mainstream medical practice. I remain open
to the idea, especially since I know Gamma-Hydroxybutyrate (GHB) would potentially
be a boon to anesthetic practice; but because of bad press [about its nefarious
and now notorious use as a "date rape" drug] will not be anytime soon. The "establishment" in
medicine is well-known for badmouthing things that they don't like (GHB, anabolic
steroids, etc) even when faced with much evidence that the drug has useful
medical purposes. So while I can't say how effective the salvia is, I also
can't say its safe. Also, while inhalation anesthesia is well established in
anesthetic practice, smoking is not. Especially smoking near
[explosive] ether!
I have long thought of how I can potentially contribute to your work. Even
though anesthesia is the skill I can most confidently share; I have resisted
writing on the subject for the reasons expressed and implied in this letter.
Sincerely, - Dr. Gaston Passer
James,
I pray all is well with you and your family.
Scott N.'s article on Anesthesia is a fine piece to which I would add but little:
Creative use of local anesthetics can preclude the need for a general anesthetic.
1.) Hematoma Blocks: This involves injecting the local anesthetic (no epinephrine)
directly into the blood collection at the site of the fracture, etc. This method
provides excellent relief for setting bones or otherwise dealing with the appropriate
trauma.
2.) Regional Blocks: This method combines a knowledge of anatomy with local anesthetics
to block sensation in a nerve bundle supplying a specific region. Although easy
in practice, it is best to use a textbook to guide you.
Look around for texts like Regional Anesthesia: An Illustrated Procedural Guide,
by Mulroy. There are many fine ones out there. {Remember latest edition is
not always greatest edition. Many times medical book edition changes are there
to
just add the newer drugs and many times they drop "older", but more
practical information.}
Hypnosis is a relatively easy to learn and very effective technique for pain
control and anesthesia. Most people are susceptible. I've seen it used in major
knee replacement surgery with success. I have personally used self-hypnosis it
for pain control at times.
One other note: Tramadol is an excellent painkiller. It has a fairly rapid
onset, relieves a high degree of pain effectively and is a non-schedule (not
subject to DEA scrutiny)
drug. On the down-side, it is addictive (although the
PDR denies
this). Having worked with numerous patients who began taking it according
to
recommendations,
I have seen that even those who never exceeded the proper dosage have a difficult
time withdrawing off of it. It appears to affect the serotonin system (same
system affected by newer antidepressants and ecstasy) in the brain to a degree
beyond
the measurable blood levels after taking it for even a short time. I have not
precluded use of it in my kit, however. Forewarned is forearmed. My recommendations
are to use it sparingly and infrequently. In those instances where a continuous
high degree of pain relief is necessary, expect the withdrawal to occur. It
can last up to two to four weeks. Thanks to Scott N. for his excellent article
and to you, James, for your efforts to assist all of us. - Doc Gary
JWR Replies: I must repeat the proviso to SurvivalBlog readers
that anesthesia is an art and science that should be left to professionals.
Don't
kid yourself
into thinking that reading a few textbooks somehow qualifies you for anything
beyond administering a light local anesthetic, if and when times get Schumeresque. A
little knowledge is a dangerous thing!
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Anesthesia for Traumatic Times, by Scott N., EMT
Introductory Proviso from JWR: The following article is
intended for educational purposes only. DO NOT attempt to
administer anesthesia without the proper training. There is a very fine line
between unconsciousness and death, and this path should be tread only by
a trained specialist. This is a very delicate art (and science) that requires advanced
training,
constant
practice, and some advanced monitoring equipment. All vital signs must be
closely monitored
closely.
Even for someone with
an "MD"
after
their
name, it
is EXCEEDINGLY
EASY to
mess up, and the consequences of doing so are tremendous. (In short: If you
are untrained and inexperienced and try to anesthetize a patient with diethyl
ether or chloroform, then the odds are high that you will be more
lethal to the patient than the trauma that you are attempting
to repair!
Survival medicine requires thought given to pain relief and anesthesia. It
is all well and good to have sutures and skin staplers in the SHTF kit, along
with instruments for debriding wounds sustained when the nearest doctor is
buried under 50 tons of rubble. But how can we do minor surgical procedures
without effective anesthesia? If a survival group member sustains a bad fracture,
how can we relieve their pain with only aspirin and head off stress ulcers?
We can just put on our hearing protection, give the patient a thick stick to
bite down on, and set that bone or debride that wound, while hardening our
heart to their cries of agony. This way we save some expense and eliminate
the need for several hours of extra intense study by the group's designated
medic, and maintain a very low profile. But few would forgo stocking tools
which can reduce the suffering of a wounded comrade.
We can, of course, talk our friendly family doctor into writing us prescriptions
for local anesthetics, morphine, and for ketamine. The local anesthetics will
probably be fairly easy to get obtain if we can show our doctor that we can
competently utilize the agents. But the DEA will probably want a word with
you and your doctor after you fill those prescriptions for morphine and ketamine
both of which are DEA Scheduled drugs.
But what if our doctor is scared of the DEA, and refuses to help your group
obtain any of the above agents? You can read this article and find alternative
anesthesia and pain relief medications
that are either “over the counter” (OTC)
or non-Scheduled drugs.
So what can we easily stock for pain control and basic anesthesia? I have some
ideas, based on my eighteen years as a chronic pain patient as well as some
training as a dental assistant and EMT, including some specialized anesthesia
training.
What follows is a simple “anesthesia module” for a group survival
medical kit that can be put together with minimal legal difficulties and for
modest cost. It will enable the user to deal with acute and chronic pain issues
such that the patient can be well cared for. It will also allow one to provide
good analgesia/anesthesia when perform basic minor surgery procedures such
as wound closure, wound debridement, or bone setting. Even, in extremis, used
to facilitate care for a gunshot wound as described in"Patriots" ..
This article will certainly not enable a layperson to become a skilled anesthesiologist.
What it will do is point out possible solutions, possible agents and references
to learn more about this subject. It will provide a list of agents which will
facilitate providing simple anesthetic care to injured group members who require
minor surgery or who have sustained significant, painful injuries.
This article will cover basic anesthesia definitions. “OTC” agents,
divided into chemicals/meds and herbs, will be covered for both oral and inhaled
use. Then a few relatively easy to obtain prescription agents will be described.
An annotated bibliography follows the article.
For the purposes of this article, anesthesia is defined as a state in which
the patient does not react to surgical activities in a significant physiological
way, has amnesia for the procedure, and feels no pain or “touch” sensations
during the procedure. Analgesia is defined as a state of reduced to no awareness
of the sensation of pain, though awareness of pressure and stretch may remain.
The state of anesthesia is traditionally divided into four Stages. The agents,
with few exceptions, described in this article enable putting our wounded comrade
into only Stages 1,2, and the 1st Plane of Stage 3. This is fine, as our concern
as survivalists will mainly be with performing minor surgery . The 1st level
of plane 3 equals light surgical anesthesia; deep enough to enable us to safely
and comfortably perform these minor procedures for our injured companion, light
enough to avoid significant respiratory or circulatory problems from the agents
used.
The first Stage is analgesia and amnesia; it lasts from the start of relative
pain relief and drowsiness to the loss of consciousness and loss of the eyelid
reflex. The second Stage is excitement, marked by delirium, breath holding,
and, likely, regurgitation. The third Stage is surgical anesthesia. It consists
of three Planes. We will only be working with the 1st Plane, light surgical
anesthesia. Note that at this Plane, our patient may move in response to surgical
manipulation and their heart/respiratory rate may change, though they will
not have any memory of the procedure. The 3rd Plane is the level needed for
major surgery, such as abdominal surgery. The fourth Stage is the time from
complete paralysis of the chest muscles until the time of shutdown of the circulation.
Anesthesia requires some basic tools and capabilities. Suction must be available
to keep the airway clear, especially if any of the ethers are used. Manual
powered units are widely available from such suppliers as Moore Medical. Oxygen
is very useful and should be considered along with the masks and tubing necessary.
Oxygen can make a great difference in the outcome for patients and is relatively
inexpensive, so consider adding an oxygen rig to your group kit.
Masks for administering inhaled agents and simple vaporizers must be bought
or locally fabricated. The absolute minimum for patient monitoring is: precordial
stethoscope and a BP cuff. Having a pulse oximeter is recommended though the
precordial
stethoscope will give more “advanced warning” of breathing issues.
The oximeter would be most useful when used with an oxygen rig to track improvement
in oxygen saturation.
One must be able to recognize developing severe allergic reactions, bronchospasm
and other medical emergencies and have the meds and skills necessary to save
the day. Study of respiratory and circulatory systems, coupled with a good
grasp of the basic principles of pain control and anesthesia will enable the
designated medic to use these drugs and equipment to improve the patient's
situation, and not generate additional medical problems. Only then can one
put together a useful anesthesia kit for Survivalist Field Hospital.
OTC Agents
We start with the classics here. Aspirin, , ibuprofen and naproxyn will see
us through most needs for pain control and reduction of inflammation from sprains,
tears, or arthritis. All are non-steroidal anti inflammatory drugs (NSAIDs)
and work very well. For pulled muscles or arthritis pain, we can also add in
such roll-on or “smear on” agents as Biofreeze, a very versatile,
herb-based agent which works surprisingly well for arthritis pain, or use such
venerable creams as Icy Hot or Ben Gay.
A few cautions with these. Avoid giving the patient multiple NSAIDs at the
same time as chance of side effects such as bleeding tendencies, slowed blood
clotting, and stomach damage increases greatly. Also, beware of using other
salicylate-containing meds, such as Ben Gay cream or Pepto-Bismol along with
an NSAID as overdose can result easily.
Other OTC pain relievers include Tylenol, which will lower fever and relieve
pain. But it will not reduce inflammation . Tylenol is very toxic to the liver
and kidneys so it is vital to not exceed the maximum 24 hour dosage. Menthol,
applied topically, is useful for relief of the pain . Biofreeze is a good menthol-based
product which can currently be obtained from physical therapists, sports medicine
clinics and the like.
What if our companion needs a dislocation reduced? How can we ease the process
by relaxing muscle spasm? We could use standardized, to 0.8% valerenic acids,
valerian root capsules or liquid extract. Valerenic acids are mild sedatives
and skeletal muscle relaxants. Valerenic acids will not be anywhere as effective
as giving the patient Valium or other benzodiazepines to facilitate the reduction.
But valerian root is OTC, while benzodiazepines are Scheduled drugs.
A quick note on alcohol for pain relief and anesthesia. Alcohol provides pain
relief in the same way a punch to the jaw can assist one in going to sleep,
by deranging the brain's functions. Only in Hollywood can a patient be anesthetized
with alcohol for the simple reason that alcohol is a very weak anesthetic such
that the anesthesia dose is functionally equivalent to the fatal dose.
All the agents below can cause some nausea so don't forget to include some
Benadryl or Dramamine in your medical kit. Either will help reduce the nausea
and also provide some sedation for the patient. Dramamine will also help reduce
the copious secretions that occur especially with usage of diethyl ethers.
We now get into our OTC anesthetic agents. All three are relatively common
chemicals which can be used in simple inhalers, such as drip masks or simple
vaporizers. All are general anesthetics which means they can be used to put
the patient “completely under”. Note that it is vital to do the
necessary study before using any of these agents as there is always the potential
for death or serious problems when using general anesthetics. In addition,
none of these three agents should be allowed to contact the skin as they can
cause bad dermatitis.
There are three “OTC” inhaled anesthetics available that fit our
needs; for safety, for efficacy, and for ease of use. Diethyl ether (DEE),
is the safest inhaled anesthetic for “lay usage” as it has a very
slow onset, with very clearly defined “descent” through the Stages
of anesthesia. Divinyl ether, DVE, has a shorter induction time and less incidence
of post-operative nausea and vomiting (PONV) than DEE. It is also less irritating
to the throat and lungs than diethyl ether. Trilene, TCE (trichloroethylene),
provides excellent analgesia at low doses, is non irritating to the airway,
and is non flammable . Careful monitoring of anesthesia depth for more extensive
procedures is critical with usage of trilene. All three of these agents were
widely used up until the 1950s, even the 1960s for trilene and diethyl ether.
These three agents are not equal in capability. Trilene can only be used for
such things as debriding wounds, suturing, or tooth extraction as it is a very
potent agent that sensitizes the heart to stress . This could result in heart
problems if Trilene was used for a long or extensive procedure or the patient
was given epinephrine. Trilene provides anesthesia only to Stage 3 Plane 1,
light surgical anesthesia, because it cannot be vaporized to a high enough
dose for extensive procedures. TCE must not be used with a closed circuit system
as it forms phosgene, a war gas, when it contacts soda lime.
It has the great advantage of quick recovery time when only used for short
procedures. One surgeon mentioned that his patient was [by observation only]
fully recovered 10 minutes after surgery. It was successfully used for wound
repair, bone setting (some reports), childbirth (the most common usage), and
dental procedures. It is “tailor made” for “self-administered” anesthesia
and is associated with less incidence of PONV than with the two ethers.
On the downside; it is a known teratogenic and carcinogenic chemical. It also
cannot be used in simple “drip masks” as it doesn't vaporize well
below body temperature. But a trilene vaporizer can be made by any handy person
with a basic grasp of how carburetors work.
Divinyl ether is only for short procedures, though it does provide good surgical
anesthesia (up to 2nd Plane of 3rd Stage), as it is toxic to the kidneys and
liver if used for long procedures. Induction doses and recovery time will be
a little less with DVE than with DEE.
On the downside; it requires very careful storage, away from light and moisture,
or else it will polymerize easily into [literally] a useless lump. DVE is fabulously
expensive, up to 30+ fold the cost of the other two agents.
Diethyl ether is usable for procedures of any length, provides excellent analgesia
at low doses, muscle relaxation, and anesthesia to 3rd Plane of Stage 3-and beyond
if you aren't paying attention! It also improves cardiac efficiency and stimulates
breathing so it is useful in the shocky patient. Theoretically it is the ideal
anesthetic for our use.
DEE administration does elicit heavy secretions and coughing so it is makes more
work for the “survivalist anesthesiologist” and her assistant than
Trilene does. It is highly flammable and can cause explosions, so all sources
of ignition must be far from the surgery. It must be stored in the dark, with
moisture absorbers, and preferably with oxygen absorbers. Recovery times for
the patient will be long, over 6 hours. Diethyl ether and Trilene are roughly
the same low cost (ca $34/500ml).
Chloroform is not even considered here even though it seems to be an ideal
agent for our use at first glance. Sure; it is not flammable, it doesn't induce
the
heavy secretions and coughing that the ethers above do, and it is a potent
agent. But it has serious disadvantages. First, it has a very narrow margin
of safety
and requires a true expert in anesthesia to use it safely. Second, it strongly
sensitizes the heart to stress, so if the anesthesia is too light and the operator
starts the incision, the patient could go into nearly instant cardiac arrest--something
we will not be able to treat.
Herbs
The herbs described below are widely available in most jurisdictions and can
be used for pain relief and the induction of light anesthesia in survival situations.
However, they are also “evil” in the eyes of the DEA and the like.
Some fools have used these herbs irresponsibly and ruined it for legitimate
researchers and survivalists. I strongly encourage those who use these to use
them responsibly,
otherwise we give our friends at the DEA more targets.
These herbs are psychedelics, some call them hallucinogens or even entheogens.
They provide pain relief and [very] light anesthesia by two mechanisms: making
all sensory input “equal” so that pain becomes no more important
than the fact that the sun is shining and these agents facilitate a disassociative
state in which the patient's interpretation of pain or pressure signals can
be radically altered by simple measures such as playing music, reading of Bible
verses or the like.
Extensive research in the 1950s and 1960s on LSD, for example, found that the
drug provided much better [for disassociative] pain relief than morphine, with
few, if any, side effects. The few formal studies done on salvia, the second
agent
below,
found
that it
also offered strong, albeit short-lived pain relief and has the potential to
be used as a general anesthetic.
In using these herbs, one must pay special attention to two vital factors; set
and setting. Set refers to the state and focus of the patient's mind; a relaxed
patient who is focused on positive thoughts will be unlikely to experience an
anxiety attack whether given one of these herbs, ketamine, or morphine. Setting
refers to how pleasant, or at least non-chaotic the treatment or convalescence
area is. Operating in a quiet, clean room will help allay patient anxiety and
thus reduce the need for additional meds during the procedure.
The first herb might be as available as your garden; morning glory seeds, preferably
Heavenly Blue or Flying Saucers. Yes, these are the real names. But the truth
is that the active agent in the seeds, lysergic acid amide, is a strong analgesic
that can provide six or more hours of pain relief with a single dose of roughly
150 seeds that are chewed thoroughly and swallowed. The downside is that tolerance,
of about three days duration, develops quickly. So that a second dose given
for pain control 10 hours after the initial dose must be roughly twice as large
and
so on. The total effects last for upwards of 12 hours. The seeds must either
be non-treated or must be washed free of the arsenical which is commonly used
on the seeds.
The taste is vile and tends to induce moderate nausea and vomiting, treatable
with mild anti emetics such as Benadryl, so the patient will probably never
want to repeat the psychedelic trip. This agent will
permit wound debridement or closure as long as the patient's attention is captured
by music, art, or a deep discussion about whatever interests
them at that millisecond. It would provide good relief of pain for bone setting
but careful monitoring of the patient's blood pressure and heart rate would
be required because this agent is a poor anesthetic and provides little, if
any
amelioration of the patient's body's response to the surgery. Used in conjunction
with one of the strong pain killers described in this article and/or one of
the inhaled agents, then bone setting becomes possible.
Salvia divinorum, a member of the sage family, is an herb which could be useful
in Survivalist Hospital for pain relief and in easing the pain and discomfort
associated with minor surgical procedures. In terms of the Stages of anesthesia,
salvia enables Stage 1 (analgesia). At very high doses, it produces a profound
disassociative state, coupled with a stormy Stage 2 of anesthesia that barely
reaches Plane 1 of Stage 3. It could be used when setting bones when combined
with an inhaled agent. Salvia frequently produces a calmness and “afterglow” for
up to a few days post-usage that will help greatly in reducing post-op pain
and anxiety.
It also produces a slowed reaction time and coordination side effects so the
patient should not operate the retreat's armored car or tractor for several
hours after salvia dosage. Since it acts on the kappa-opiod receptor in the
brain,
rather than the mu-receptor affected by morphine and the like, salvinorin A
is highly unlikely to turn the patient into a raving, addicted, member of the
Army
of Darkness. Euphoria is very uncommon with salvia use, indeed people do not
tend to ever take it for “kicks”. It also has potential for treatment
of addiction as the kappa-opiod receptor is key in addictive behavior.
Overdose will not kill per se, but it will result in a dangerous agitation of
the patient though of short, under 30 minutes, duration. The patient can leap
up and charge about, resulting in secondary injury. Salvia is usable for our
purposes only if the operator pays very close attention to dosage, using only
enough to enable the surgical procedure, but not so much that the operation suddenly
becomes catch-the-delirious-staggering-patient!
My personal experience with salvia has been with use for relief of chronic and
acute pain. It has reliably relieved pain of level 8 (roughly the pain from a
leg being shattered in a bike wreck) completely for 1.5 hours, and kept said
pain at endurable levels for three hours or more from a single salvia dose. Tolerance
does not develop so analgesic doses of salvia can be given consecutively.
A salvia researcher, Daniel Siebert, has published a good on line guide to
salvia which includes his model of “planes of the salvia experience”. As “survivalist
anesthesiologists”, we will be getting our patients to Siebert's “plane” 4
(vivid visionary state-with eyes closed, outside world is “gone”)
to 6 (amnesiac state, also high movement potential!).
Salvia can be purchased as a live plant which grows very well in the Northwest
USA as an indoor plant. It is also available as dried leaves. Dried leaves are
only marginally usable for our purposed though. It is also available as a crude
5x or 10x concentrate, or as a standardized extract. The standardized form is
obviously the best choice for our purposes.
It can be administered by mouth, by chewing 15-20 fresh leaves and holding
the chewed leaves in the cheek for 15 minutes. The effects then last about
45 minutes.
Ingesting the leaves or concentrate is useless as the agent is inactivated
by stomach acid. Or it can be "smoked", (inhaled as a vapor).
Vaporization allows the best titration
to effect, it also is associated with a high “failure rate” as
it is very technique sensitive. When vaporizing salvia concentrate, it is vital
that the concentrate be heated as much as possible, the smoke drawn deeply
into
the lungs, and held there as long as possible. Throat and lung irritation can
happen when using the vaporization method . I have asthma; salvia vapor does
not induce bronchospasm for me, but “your mileage may vary”.
The active agent, salvinorin A is extremely potent, being effective at 200-500mcg
for an inhaled/vaporized dose. Its effects begin in under 30 seconds which makes
titrating an analgesic dose fairly easy. It provides good analgesia, being about
as potent as morphine, though it only provides, at best, two hours of strong
pain relief. After inhalation, drug effects begin to fade within 3-5 minutes
of dosing.
At higher doses of 500-1,000mcg, it provides relative disassociative anesthesia
for about 5 to 7 minutes. However, at these doses the drug causes severe “motor
hyperactivity”. Think a PCP zombie who also drank three double espressos!
Titrating the dose to true disassociative effect, Siebert's “plane” 6,
without the patient lashing about and injuring herself can be tricky.
If used for just relieving the pain of simple wound debridement, having the
patient “smoke” small
amounts of concentrate until they report no sensation when the intact skin
is pricked with a sterile needle . If possible, capture the patient's attention
while the wound is cared for. Patient will probably still be somewhat aware
of
pressure and stretch sensation, thus the need to capture their attention elsewhere.
If a bone must be set or extensive wound debridement is required, then a higher
dose of salvia must be used, preferably along with one of the inhaled agents
listed above. This will mean a brief excursion back to pre-19th Century surgical
practice; the use of sturdy assistants to hold the patient in place. The purpose
here is to keep the patient from moving about and injuring themselves or facilitating
a horrible surgical disaster.
By Prescription:
There are some useful prescription pain killers that are not on DEA lists and
should be fairly easy to obtain. All have the potential for significant side
effects so thorough study is required before using these drugs.
Toradol (ketorolac) is the strongest drug in the NSAID class and is available
in pill , eye drops , and injectable forms. It provides excellent relief of
post-operative pain. It is also an anti coagulant so any bleeding must be under
good control
before giving Toradol. It also can cause serious liver or kidney problems.
Because of these “side properties”, Toradol cannot be used for
more than 2 days of continuous dosing for injection or 5 days of oral dosing
Tramadol is a pain killer which works well for moderate to moderately severe
pain. Or in layperson's terms, it will do for pain relief for most of the common
injuries the survivalist might deal with . It is available as both a pill and
in an injectable form. It does not elicit as much nausea as other opiods such
as morphine and unlike morphine, will not completely shut down the drive to
breathe at high doses. Another bright spot is that Tramadol is rarely associated
with
addiction as it relieves pain without euphoria. If needed, it can also be used
for your dogs or cats.
On the downside, it does lower the seizure threshold so it is a poor choice if
the patient has a history of seizures or is taking other drugs which lower the
seizure threshold.
Nubain® (nalbuphine) is a very strong pain reliever
that is only available in an injectable form. It is incompatible with ketorolac
and is an “opiod
effect reverser”. This means that giving Nubain to someone who is addicted
to opiods will result in withdrawal symptoms. I was told by an Army medic,
who had completed the US Army Field Anesthesia course, that Nubain is ineffective
for bad war wounds.
There are a few prescription “para anesthesia” drugs which should
be stocked. For reversal of overdoses of opiods, stock Narcan (naloxone). It
has significant side effects, be aware, be proactive.
Murphy's Law says that the group member who requires emergency surgical care
will have a full stomach, risking aspiration of vomitus, a serious complication.
Reglan (metoclopramide) is an anti-nausea/vomiting drug and it accelerates
stomach emptying. But do not rely solely on Reglan in the patient who ate or
drank
within a few hours pre-surgical need. Phenergan (promethazine) is a venerable
anti
emetic and sedative that also helps dry up secretions. It is available in both
pill and injectable forms. If injecting it, dilute and give slowly and carefully
as it can cause tissue damage and pain on injection.
Anesthesia and pain control must be factored into planning a survival medical
kit. I hope this article has helped point you in a useful direction. With the
items described in this article, you can provide better, more comfortable medical
care to your group members in a crisis environment. In a 96 hour crisis, you
will have the ability to perform exigent minor surgery. In a TEOTWAWKI scenario,
you will have a solid base for providing general anesthesia care to your group
members.
Bibliography:
Introduction
to Anesthesia
; 9th Edition; Longnecker, edited by: David E. and
Murphy, Frank L.; Saunders; 1997. Good coverage of the theory and practice
of anesthesia from the ground up.
[Textbook of Military Medicine] Anesthesia and Perioperative Care of the Combat
Casualty; edited by: Brigadier General Zajtchuk, Russ and Grande, Christopher
M., M.D.; GPO; 1995. Thorough coverage of the practice of anesthesia in a military
setting. If you need to know how to handle the anesthesia for a wounded comrade,
this is the book. Slanted toward more “high tech” care than usual
survivalist group can deliver but good for its explanations of procedures and
caveats. Also
available online, as free PDFs.
U.S.
Army Special Forces Medical Handbook
; Citadel Press; 1982. ISBN: 0806510455 A very
good general reference. Good, simple chapter on anesthesia using the inhaled
agents discussed in this article with excellent charts showing signs of anesthesia
depth.
Internet Resources:
New York
School of Regional Anesthesia. How to do regional blocks if you have local anesthetic
agents in your kit. Thorough, with very good illustrations.
Several Power Point
lectures on various basic anesthesia procedures as well as presentations on wound care,
orthopedics, and womens' issues.
All the volumes of Textbook
of Military Medicine are available online; for download as [free]
PDFs or as hardcover books for purchase. Lots of useful information for Survivalist
Hospital on anesthesia and wound care, care of environmental injuries, NBC issues, etc. A very informative site
that deals with psychoactive chemicals and herbs. It can be a good research
tool for the survival anesthesiologist. Use the site for research, and be responsible.
« Mexican Flu Update: |Main| Letter Re: The Top 200 Hunting, Fishing, and Low Cost of Living Towns »
Two Letters Re: Dealing with Uninvited Guests
Dear Mr. Rawles
I would like to add one last letter in response to “Uninvited Guests” and
to let your readers know that the only effective means to control head lice
is by “mechanical” removal. We were unfortunate to live, for a
time, in an area of the country where head lice had become resistant to the
OTC treatments.
This is because most people did not realize that in addition to the application
of something such as Rid, one must also clean one’s
living quarters, as well as systematically go through the lice sufferer’s
hair—strand, by strand, by strand…. Now this may seem very laborious,
but it is amazing how easy this becomes if you do this once a day for at least
a week along with the essential oil treatment that I have listed below. It
took my daughter having lice twice, and the school where my children attended
to tell me that they had, during certain times of the year a 45% infection
rate! Through several conversations with the local health department, and doctors,
the conclusion was reached that the lice had become resistant to the OTC preparations,
which are also not good for anyone—this stuff is poisonous!
Once I came up with my own treatment, my daughter never had lice again, and
thankfully
we moved back to Texas away from the lice infested area that we had lived in.
Here is the treatment that I recommend, and have given to several people I
know. For the most part, the supplies are readily available and plentiful—for
now and everything is non-toxic!
Supplies
-One very fined tooted comb—a metal one with a handle (like a rat-tailed
comb) if you can find it-plastic will not hold up as well
-One regular comb(don’t use this one for lice removal)
-A set of metal hair clips (about 4 or 5)—like the ones hair dressers
use to separate hair when they are cutting it
-Plastic wrap or a hair cap
-a coffee can with a lid-- with olive oil in it—so when you find a bug
or a nit, you can place it in the can to smother it
-a pair of pointed hair trimming scissors
-a pair of pointed tweezers to pick up individual hair strands
-a bright light to shine on your work
-a couple of bath towels
-Essential Oil Mixture- 1 oz of olive oil, 5 drops of tea tree oil, 5 drops
rosemary oil, 3 drops oregano oil
-Plain Olive Oil
When I was going through my daughter’s hair, I would have her sit on
the floor with her head resting on a pillow covered in plastic on the coffee
table. That was she was comfortable, and could read a book, or watch a video—we
are not connected to trash TV). I would sit on the couch with her body between
my legs
Step One: Infuse the hair with the Essential oil mixture, making sure to coat
the scalp, and all the hair strands. Place the plastic cap on the coated hair
and leave on the hair for 30 minutes. This has a two-fold purpose-the body-heat
helps the oil to soak into the strands of hair for ease of running the very
fined toothed comb through the hair, and the heat also helps to kill the bugs.
Step Two: Part hair down the middle and clip each side with the hair clips
Step Three: Beginning with one side of the head, separate and comb out a very
small section of hair from the clip (it is better to go through fewer strands
of hair at a time), and run the fined-toothed comb through each strand of hair
Step Four: As you inspect each strand of hair, look for nits at the base of
the hair near the scalp. Lice lay their eggs at the base of each hair strand—it
is important to get all of these since these are the viable ones and missing
one may start the lice-cycle all over again—any nit higher up is more
than liking not a viable one, but these should be removed as well.
Step Five-If you find a nit on a hair strand single it out with the tweezers
and cut it as close to the scalp with the scissors. Same for a bug( adult lice)
No you will not make your child bald—even if the infestation is severe!
Lice attach their nits with a glue that makes it almost impossible to remove
without losing the nit in the environment—it is best to clip the hair
strand with the nit attached and place it in the olive oil in the coffee can.
Step Six- After each small section of hair has been inspected, use another
clip to twist the hair and separate the now “clean” hair from the
rest of the hair that needs to be inspected. Depending on the amount of hair—my
daughter has very thick hair—you might need to use several hair clips
Step Seven-after finishing with the first half of the scalp, repeat steps four
through six on the other half of the head
When I got the hang of it, I could go through one half of my daughter’s
head in 20 minutes
Step Eight-when the process is complete wash hair a couple times to wash out
the essential oils. Then massage a few drops of plain olive oil into the hair
and comb from the scalp to the tips (Remember—don’t
use the nit picking comb—you do not want to accidentally re-infest) If
the child’s
hair is long enough braid very tightly! The one thing that I was told that
lice do not like oily hair, or hair that is tightly bound—they cannot
attach themselves as readily!
Step Nine-clean and vacuum your house. Any stuffed animals placed an airtight
plastic bag. Any nits that hatch have to have a human host soon, or they will
die. Keep non-washable items in a plastic bag for about three weeks. Wash bedding
daily, and if possible, hang out on the clothes line in the sun to drive.
Repeat this process daily for one week, and then do a preventative once a week.
It is better to catch an early infestation, than to have to deal with a full
out battle! The olive oil also makes hair very shiny!
Although lice infestation may seem like a curse, my daughter and I certainly
made the best of it, and enjoyed our “nit picking” time together!
Best Regards, - Susan M.
Dear Mr. Rawles,
As a Registered Nurse, during my tenure at a local hospital, a nurse practitioner
showed me a simple test to determine if scabies were present in a patient
showing
possible symptoms of an infestation.
Use a Sharpie marker to draw lines between a person's fingers. Allow this to
dry. Take an alcohol wipe and wipe off the dried ink. If dark, narrow lines
are left after the surface ink has been wiped away, it likely indicates the
presence of scabies. The reason is that the critters tunnel under the skin,
leaving a narrow track for the ink to penetrate.
All the best to you and yours, - Publius
« Mexican Flu Update: |Main| Letter Re: Keep Ammo in Original Boxes? »
Letter Re: FDA Restricts Over the Counter Sales of Bulk-Size Hemostatic Supplies
Sir;
I try to keep a gun shot trauma kit with my shooting range supplies; when I
was ordering some new medical supplies from North
American Rescue I was informed that the public can no longer purchase
Quikclot ACS+
or any other such hemostatic from them. The operator proceeded to tell me that
the [U.S.] Food and Drug Administration (FDA)
began regulating these products mid-May because "they go inside the human
body." I
was able to order some of my other products in the "scrape
and light cut" size" but none of the larger quantity hemostatics.
Perhaps some other SurvivalBlog readers might have some insight into this situation
and can offer some advice. Regards, - "Pop N Fresh"
JWR Replies: That is a most unfortunate development. Much
like last year, when Polar Pure iodine crystals were taken off the market, it
sounds like another window of opportunity is closing.
I strongly encourage readers to stock up on Celox and
QuikClot while
there is
still some
remaining inventory available from individual retailers. Several of our
loyal advertisers-- including Safecastle and
Ready
Made Resources--carry these products, and probably still have some left
on hand. I'm sure that they would appreciate your patronage. BTW, please mention
SurvivalBlog whenever you contact any of our advertisers. Thanks!
« Economics and Investing: |Main| Jim's Quote of the Day: »
Four Letters Re: Dealing with Uninvited Guests
Mr. Rawles,
I have read and enjoyed your blog for some time now and thank you
for it daily.
Regarding the recent post on control of head lice, I have found simple light
cooking oil to be startlingly effective. Massaged through the afflicted's
hair and scalp and left for a few hours the oil is meant to suffocate the lice and eggs.
I have used this several times, once I needed to repeat the processes to be
effective,
but in most previous infestations, once was enough.
This treatment can be made apparently more effective by including some Tea
Tree oil in the mix. Hope this helps, - Regards, JeMe.
Jim:
I keep getting such great info that I would not usually think of. Thank God
that your readers are thinkers as well. Regarding, the letter dealing with
uninvited guests I saw in my local Florida newspaper about using Listerine
for lice.
It reportedly
works the first time. SurvivalBlog readers should do Internet searches on
herbal or all natural
cures
for
dealing with these uninvited guests, for the pets as well. Thank you for
the web site. - Dawn
James,
With reference to "Dealing with Uninvited Guests", there is
an easy way to get rid of head lice. Using copious amounts of cheap hair conditioner
on hair, then leaving it in, stops the nits from being able to cling on to
the hair shaft. You must comb it through well to ensure every hair is coated.
Once they drop off they don't survive long without a host (a matter of hours).
You need to treat the whole family otherwise it just passes on the problem.
When my daughter was young, we spent a small fortune on head lice products
and nit combs, until my local hairdresser told me about the conditioner trick.
To help prevent infestations, add a couple of drops of tea tree oil to a final
hair rinse.
Blessings and prayers for your Memsahib, - Luddite Jean
JWR:
I have "been there, done that" with head lice and my daughter. Toxic concoctions
like “Rid,” “Kwell,” etc
are costly and worthless. When my daughter was 8 years old she would come home
from school scratching her head. We finally figured out it was head lice. I
went on internet and read up and decided that getting “Rid” or
some Permethrin based solution would be best so we tried it. The lice would
just swim around in the “killer” liquid on my daughter's scalp.
We tried another brand with Lindane and the same result. Be aware that many
of the “Lice Information” web sites are fronts for a particular
(useless) product. I went back to the internet where there were many “kook” solutions
like suffocating the lice in olive oil – what a waste of olive oil. There
were other “green” concoctions which were designed to suffocate
or poison (naturally) the head lice. I concluded that all the kook remedies
were worthless and were debunked on most of the mainstream web sites as worthless – good
luck trying to suffocate the nits and adult lice. It really drove me mad to
think of my beautiful daughter with her beautiful long hair having “bugs” crawling
around on her head. I wanted them dead and I wanted them dead now. I was desperate.
Then I read some where about merely using plain old hair conditioner – i.e.
putting it on after a shower in copious amounts and leaving it in – and
mechanically removing the noxious lice with a metal nit comb. I was tired of
poisoning my daughter (read the labels – it is poison) and from what
I read the prescription medication was way more toxic. So we tried it - we
bought two quality metal nit combs and slathered on the hair conditioner and
carefully followed the instructions that came with the nit combs. We mechanically
removed the nits and the live adult head lice. You get a cup of hot water and
dunk the nit comb and watch the “body count” of the adult lice
add up. It is satisfying to physically remove them one by one. After two days
there were no more adult lice to be found. The nits were another matter and
for the next couple days we went through my daughter’s hair strand by
strand and pulled out each nit with our finger nails as the nit combs were
ineffective in removing all the nits. It took a total of three to four hours
over the course of three or four days to remove the adult lice and all the
nits. Victory – free at last. A few months later when we found the early
stages of a new infestation we knocked it down quickly in just two days.
Another
aspect of this is the extensive instructions on the web sites and written instructions
about how to treat bedding etc. If you followed all the recommendations you
would spend hours on decontamination and spray toxic poisons around the bed
and house. Thankfully. head lice can only live in hair/scalp otherwise they
die fairly quickly. We found that merely washing the pillow case and sheets
was sufficient without spraying poison in the carpet and all over the place
another bad toxic idea. I shudder when I remember one of the coaches of my
daughter’s baseball team spraying lice “killer” in the batting
helmets and when I asked it was because of widespread lice in the local school.
Nice. My daughter had her own helmet and we told all the other kids it was
only for my daughter to use. Notes: Where we went wrong – we took our
daughter to her pediatrician early on to have her head checked out and we told
that the nits were old and there was no current problem. Wrongo bongo. The
full blown outbreak occurred days later. We called back to request the heavy
duty prescription medication and were told to try the over the counter stuff
as the prescription medication was really toxic and they only prescribe it
when absolutely necessary. Lice have adapted and have developed immunity
to the over the counter medication so aside from it being toxic it is worthless
and expensive – I saw this with my own eyes. I tried it over and over
- to the limits on the warning instructions. Also, when you go on the Internet
you read a bunch of politically correct nonsense about how kids who spread
head lice are not “dirty and unkempt” but some parent(s) at my
daughter’s school were sending a kid(s) to school with head lice – It’s
not the kid’s fault but I disagree, the parents were dirty,
inconsiderate slobs in my opinion.
So, bottom line – get two or more quality
nit combs, slather on the (non-toxic) hair conditioner, follow the combing
instructions
and remove the adult lice and as many nits as possible and then physically
remove all the remaining nits one by one with your finger nails as those nits
really glue themselves to the hair. Carefully dispose of the adult nits you
remove – I treat them as if they were black plague contagions – and
wash the bedding every day until you don’t find any more adult lice and
have removed all the nits. Mechanical removal has several advantages – it
is non-toxic, it uses common hair conditioner (easily stored), it is inexpensive,
and most importantly it works. It may be the only method that actually works.
In a true survival situation you could substitute olive oil or some other similar
substance in place of the hair conditioner. Hopefully we will never have to
deal with the problem again but all the dread is gone and we are equipped,
once and for all to deal with this problem because we have lots of hair conditioner
and three quality nit combs. Simple solution – the best solution - Keep
is simple.
On another note, I just finished reading "Patriots".
It was a great
read, and I could not put it down. Thank you - John M.in California
« Mexican Flu Update: |Main| Five Months Till Armageddon--A Dark View of the Future, by H.I.C. »
Letter Re: Dealing with Uninvited Guests
Mr. Rawles
I have been a faithful reader for about a year now and would like to take this
opportunity to thank you and your contributors for the wealth of information
found on this site. I would also like to thank Anon T. for his article on quarantine
procedures, though I'm wondering if it should be expanded to include "debugging".
I'm referring to head lice, body lice, crabs, bedbugs, mites, and fleas. Nobody
wants to believe
that it will happen to them. It doesn't even have to be a WTSHTF scenario.
In today's economic environment many people are loosing their homes and moving
in with family or friends. With more and more people and their belongings under
one roof, personal and residential cleanliness may begin to suffer. In a SHTF scenario,
add to this stressful situation, not being able to properly bathe, wash hair,
clothing, and bedding as often as they should, and the possibility
of "unwanted house guests" rises.
About 8 years ago, my then two-year-old brought head lice home from day care.
Before
I realized it, I was also beset by lice. My mom said "getting lice isn't
a
sin,
keeping
them is." But getting rid of these little bugs was just short of impossible.
As soon as you think they're gone a nit that you missed hatches, and it starts
all over.
Hopefully this won't be a problem for most of your readers, but they should be
prepared and informed.
|
Treatment products like "Rid" won't be easily rotated before they expire,
so it may be cost-prohibitive to stock it. are there any natural or more cost
affective alternatives? I'm wondering how we will deal with this in the future
when products like "Rid" might not be available. and maybe someone
out there could explain identification and treatment for those readers who have
never been through this. - J.C.M.
JWR
Replies: I agree that it is wise to stock up on anti-parasiticals (pediculicides
and scabicides ) The
active ingredients in Rid and Lindane ("Kwell") can be
effective
for several years. Most of the Rid variants are a 0.5% solution of Permethrin.
The Lindane
solutions
(typically
1%) are
sold
under trade names such as BBH, Bio-Well, G-well, Kildane, Kwell,
Kwildane, Scabene, and Thionex. Some
traditional
treatments for lice that were used in the 19th Century and early 20th Century
might still be viable, but most of them are harsh an potentially toxic, so they
should be considered only in
absolute worst case disasters,
when
modern anti-parasiticals are unavailable. The 1996 article titled Control
of
Human
Lice
Infestations: Past and Present (in
PDF)
from
American
Entomologist provides some interesting history on lice control, including
some lousy methods from the 19th Century. It might sound severe, but when modern
anti-parisiticals can't be found, head shaving is a good starting
point. (But it will give you the Sinead
O'Connor "I'll never be accused
of
being
infested"
look.)
« Letter Re: Any Widespread Flu Will Overwhelm America's Emergency Medical Services |Main| Notes from JWR: »
Biological Threat Assessment and Containment, by Anon.T
When either you or your group is confronted with a biological threat [such
as a pandemic or biological warfare], you must determine the following before
making decisions either for yourself or
for your group.
1) What is the threat?
2) What is the incubation period prior to showing symptoms?
3) How contagious is the threat?
4) By what means is the threat contagious?
5) What is the morbidity rate?
6) What is the mortality rate?
Once you have determined these things, you can make sound decisions that can
get you and your group through a trying time.
Quarantine:
In the event that you are forced to deal with new members joining your group,
[during a pandemic] you will need to quarantine them for a set period of time.
This will assure you and your group that the new-comer's presence does not
cause harm
within
your group.
To set up quarantine you will need the following items which will be detailed
below:
Shelter
Food & Water
Disinfectant
Communication equipment -or- Another pre-determined way of communicating with
the quarantined.
Medicine
Symptom measuring devices and charts.
Rules that the quarantined must follow if they wish to become part of your
group.
A plan should the quarantined not follow those rules.
A plan should the quarantined show symptoms and/or become sick.
A way for the quarantined to expel waste that does not pose a risk of infection
to other members of the group.
There is not a single point above that can be neglected for any reason. Having
to survive a biological threat has nothing to do with niceties or with comfort.
Shelter:
A place [that is downwind,] away from all group activity for the person(s)
in question to be quarantined. How far away is far enough? Miles would be great
but it
is
probably
not economical
so do with what you have to ensure that your group never gets within a 1,000
feet of the quarantined.
Food & Water:
Whatever the food and water that you supply or that your possible guests bring,
they must have means of making it safe for human consumption.
Disinfectant:
You and the quarantined must be able to protect yourselves from the environment
and the biological threat. A strong bleach solution, a rag and a bucket
would be fine for disinfecting everything. Alcohol sanitizer and anti-bacterial
soap
are
luxuries
if you can
afford them.
Communication:
The group and the quarantined must be able to communicate for numerous reasons.
Humans get pent up if they are left in a confined place to their own devices
for long and to limit the risk of the quarantined coming too close to the group,
they must be able to communicate with the group from a safe distance.
Two-way radios with rechargeable batteries and a way to recharge them at the
quarantine site make the best answer to the communication problem, the only
problem is that they are expensive to have spares around and impossible to
outlast the quarantine if power isn’t available to recharge them.
In the absence of two way radios, your group should have a pre-determined plan
for communication should anyone be at risk for the threat, including any quarantined
individuals.
The group should never risk entering a place of possible contamination if it
can be avoided in any way, so a group should have a Communication Center set
up some distance away from the quarantined and a further distance away from
the group.
To allow the best ventilation, Communication Centers should never be indoors
so a tree, a table or a large rock, all make adequate places.
Each member (the group and the quarantined) should have a pen and multiple
sheets of paper (A dry erase board for each group would do fine) of their own
to write on and leave at the communication center. Each member should understand
the nature of the quarantine and the time at which the papers will be picked
up, read and possibly replied to that is consistent with the length of time
that the biological threat is thought to stay active on paper.
(e.g: Every 3 hours from __ a.m. - __ p.m.)
Medicine:
Your group should have medicine that can be used to treat common pains and
injuries so that the quarantined can be comfortable and it will be easier to
gauge their symptoms if they should have any.
Symptom Measuring Devises:
You should include devises that allow the measuring of all symptoms familiar
to the threat. Some adequate symptoms measuring devices include a Thermometer,
a watch for checking pulse and blood pressure and so on.
Rules:
Your group should have rules that everyone in the group must follow and separate
rules that the quarantined must follow if they wish to eventually enter your
group. These rules must include items like; Staying at least _00(0) feet away
from every member of the group at all times, keeping the quarantine area clean
and free of infection, following proper communication procedures, washing all
contaminated clothing upon entering the quarantine area and being honest with
the progression of any and all symptoms including minor symptoms that may or
may not be related to the threat.
Contingency plan for symptoms within the quarantined:
This plan needs special consideration because the quarantined may be members
of one’s own family or close friends and particular thought must be given
to how they will handle the onset of symptoms and how the group must handle
the quarantined should they become less than complacent including delivery
of proper medication to treat the threat.
Contingency plan if the quarantined does not follow the rules:
This plan should be relatively simple. Anyone who puts your group’s health
and safety at risk by not following the rules is not a valued member of any
group and should be avoided like the threat itself.
Waste Expulsion:
Human waste is possibly a carrier of the threat and since it cannot be avoided
it should be taken into consideration.
If there is a working toilet and sink at the quarantine site, by all means
use it.
In place of a working toilet and sink, the quarantined will have to take special
measures to not endanger the group. In an outdoor environment, the group will
have to dig a hole at the quarantine site (Prior to the visitor’s arrival)
at least 5-6 feet deep and mark that area with a flag easily visible to both
the quarantined and the group. The quarantined will then need to expel all
human waste in that hole and only in that hole (to limit the exposure of contaminants
to the quarantine site) and then kick a little bit of the pre-dug dirt back
into the hole covering the excrements.
This is the time where a little lime would go a long way. If at all possible
to acquire, get some lime prior to the threat to have on storage for just such
a need.
Quarantine Items:
2 - 5 Gallon bucket(s) or the equivalent.
Bleach
Rag(s)
Anti-Bacterial soap
Food that does not need cooking (Min. of incubation period worth of food if
able to spare) and additional food left at communication center every day.
Water or a clean water source
2 way radios with rechargeable batteries and a battery charger
Paper and Pens should the 2-way radios give out
Gloves
Mask(s)
Flag(s) for marking human waste site
Watch for keeping time for communication and symptoms
Thermometer
Toilet Paper (If available)
Quarantine Item Set Up:
All should be able to fit within the 5 gallon bucket with the exception of
food and water (Though a little will be placed in there in advance) including
the following items placed on the top:
Rules of the group
Expected quarantine Time
Rules of quarantine
Rules of communication
Rules:
This will be a pre-printed or pre-written page that will be given to
the prospective guests to read and decide whether they are willing to do the
things necessary to join the group.
Hello,
We are very glad to see you healthy and well and are taking the health and
wellness of our group extremely serious. In doing so, we have implemented rules
that you must adhere to without exception if you wish to join our group.
These rules may seem tedious but we are not taking chances when human life
is at stake just as we will not take chances in protecting your health or the
health of any new members to our group.
Firstly, we will not be having any face to face communication. In place of
this, we will provide, among other things, a 2 way radio, rechargeable batteries
and a battery charger so that we may communicate with each other at all times
(or another way of communicating as described later).
The current known incubation period of the threat that we face together is
____ hours or __ days. If you wish to join our group, you will be forced to
quarantine yourself in a location that we provide or set for ____ hours or
__ days to ensure your safety and the safety of our group. If you are not willing
to follow these rules including duration of quarantine, kindly set down this
sheet of paper now and walk away.
At no time will a group member come within 500 – 1,000 feet of you during
your time in quarantine. This is for the protection of all members of the group
and yourself. Do not violate this rule – Use the radio or the aforementioned
way of communicating in it’s place.
Once you enter your quarantine location, you will be required to stay within
_00(0) feet of your quarantine location until the time of quarantine is over.
If you breach this _00(0) feet marker which we will set or determine, you will
no longer be eligible for joining our group. Please follow this rule.
If you do not have food and water with you, food and water will be provided
for you at a drop point that we will disclose later.
Human Waste:
There will be a pre-dug designated latrine that will be used for the disposal
of all human waste. Human waste, which already poses a health safety hazard
is not to be expelled into any container but dropped directly from your body
into the designated latrine as you “go to the bathroom” after
which you are required to kick dirt or shovel lime back into the latrine
to cover
the waste.
Food disposal:
Only prepare as much food to eat and you are going to eat. Any food that is
not consumed is to be buried with the waste as noted above.
Self evaluation and symptom reporting:
We will provide you with the tools necessary to evaluate yourself. You will
be required to evaluate yourself twice a day, once in the morning and once
before bed. You must answer all items honestly. You are to report the following
items to the group:
Appetite: None, Normal or Excessive
Vision: Clear, Blurry or Normal
Fluid Consumption: Normal, Heavy or Low
Temperature:
Physical Well-Being: Tired, Energetic or Normal
Medications taken within the last 24 hours:
Pain: None or on a level of 1 – 10 with 10 being the worst pain you’ve
ever felt.
Stress Level: Low, Moderate or High
Symptoms: ________
Urine Excretion: Yellow, Cloudy or Clear (Was there a hot or burning sensation
when urinating?)
Waste Excretion: How many times a day and; Loose, firm, normal or painful.
Staying Healthy:
We expect that you came to us healthy and we want to see you remain that way.
Please eat 3 meals every day, drink plenty of liquids, busy yourself with items
you brought or by writing a story (not involving the current situation but
rather one that is purely fictional) and following the listed daily exercise
recommendations:
Walking: Even in a confined area, walking moves the blood through your system
and will provide a healthier you.
Arm and leg stretches: Stretching your arms and legs is a fundamental need
that every body has.
Not staying in one spot or position for an extended period of time.
Brushing your teeth daily with or without toothpaste and brushing your body
down (dry shower) with a rag are two essential ways of staying healthy.
Please do not perform any muscle building or muscle retaining exercises during
this time. Muscle building exercises break down your current muscle to rebuild
more and releases toxins into your system. Refrain from any such activity during
this time so as not to confuse the symptoms of muscle breakdown with symptoms
of the threat.
Positive Thought:
Negative thought will not be tolerated in our group. You are a strong person
and you will get through this. Please do not let the dire nature of this threat
overwhelm your sense of self worth or the free will that God gave to you. If
the threat seems overwhelming, know that you are strong and pray for the endurance
to see this through.
Carried Item Quarantine:
Please understand that the items that you brought with you may carry the threat
on them for an unknown amount of time. The group will decide which items can
be cleaned, used or disposed of without hesitation or regard to personal feelings.
You may at no time keep an item that the group feels is dangerous.
That is it. Those are the rules required by anyone who wishes to join our group
and anyone who leaves our group for any amount of time.
If you are not 100% sure that this move is right for you and 100% sure that
you will abide by these rules, there will be no hard feelings between us. Please
put this paper down on the ground, wave a goodbye and walk away now.
We thank you for your patience and understanding during these difficult times
that we all must face.
If you are positive beyond doubt that you will abide by these rules and any
rules that the group may impose in addition to these, please fold this paper
up and place it in either your shirt or pants pocket. At this time we will
disclose the location of items that we will be providing you and further our
communication together.
Go on to Document #2
Document #2 – On a separate sheet of paper
Hi,
We are very glad that you have chosen to quarantine yourself from our group
before joining it. This shows that you care as much about our well being
as we do yours and proves your willingness to put the group’s needs
ahead of your own. In no way does quarantine mean isolation, we look forward
to communicating
with you using the two way radios that we will provide or the use of a communication
center that we will set up.
We know that this can be an emotional time. Please do not let your emotions
run your self control, will for life or care for others. We are here to communicate
with you throughout this entire time and we look forward to spending time with
you once you join our group.
The location that you will be staying in during your quarantine is:
________________________________________________
We will provide the following items for you if you do not already have them
on hand.
2 - 5 Gallon bucket(s) or the equivalent (for the cleaning of clothes and items.)
Bleach
Rag(s)
Anti-Bacterial soap
Food that does not need cooking (Min. of incubation period worth of food if
able to spare) and additional food left at communication center every day.
Water or a clean water source
2 way radios with rechargeable batteries and a battery charger
Paper and Pens (In case the 2-way radios give out or for story writing)
Gloves
Mask(s)
Watch (for keeping time for communication and daily health evaluations.)
Thermometer
Toilet Paper (If available)
Radio Operation:
Provide instruction for radios here
Communication Center:
The communication center will be at the following location.
________________________________________________
We will be using the communication center for the supply or re-supply of
all goods including the items that you will get once entering quarantine.
We will
also use it for communication if the radios fail to work properly. We will
be checking for communication every ___ hours (1 hour beyond the time that
the threat is thought to survive on paper) from ____ a.m. to ____ p.m. daily.
Please flag a
new communication by placing __________ over the paper or dry erase board
for the group to see.
Proper Communication Etiquette:
As you can probably tell, we are limited by the items that we have on hand
including paper. Please write legibly and please tear off the paper at the
bottom of your communication so that the rest of the paper may be saved for
later use.
To limit the risk of exposure, we will not be touching any communication items
at the communication center. It will be your job to dispose of all paper used
for communication by placing it in the latrine.
Emergency Communication:
A true emergency is something that is life threatening and that cannot wait
until our next communication. We will never cry wolf to you so please express
the same care and respect for us.
If the need should arise for emergency communication, the universal distress
code that we will use is 3 of anything, 3 seconds apart.
That means 3 loud whistles 3 seconds apart, 3 bangs on the bottom of a bucket,
3 shouts using
the word “Emergency” or 3 blows on an air horn.
We will continue to use this code every 3 minutes until visual confirmation
can be made of the person issuing the emergency code and the group.
Example use of the Emergency Distress Code: Whistle Whistle Whistle – Wait
3 seconds - Whistle Whistle Whistle – Wait 3 seconds and then finally
Whistle Whistle Whistle now wait 3 minutes and repeat.
That covers it. We are so glad to see you well. Please fold this paper up,
place it in your pocket and follow the schedule below:
Schedule:
Now:
Gather your items and bring them with you to the quarantine site.
Leave all items well outside of the quarantine site until proper decontamination
can be fulfilled.
Before entering the Quarantine Site: Remove any outer clothing which may be
contaminated and place all items inside the bleach/water solution that is in
the bucket provided for you at the site.
Next, take a rag and rinse your body over with the bleach and water solution
from head to toes. Bleach will not hurt you at the strength it is diluted to.
Please wash well your hair, face, hands and all exposed body parts.
Dry off with clean rag provided.
Enter Quarantine site
« Mexican Flu Update: |Main| Letter Re: Diverters and Pre-Filters for Roof Rainwater Catchment »
Three Letters Re: Stocking Up on Prescription Medicines
Jim-
I want to publicly commend “SH from Georgia” on his excellent
and concise article on stocking prescription drugs for a TEOTWAWKI
scenario. I agree with just about every point that he has made. Adding metronidazole
to the list is a great addition, and his comment about having medications on
hand so that a physician might use them to your benefit is a point that I was
contemplating, as well. Of course, the list of “med-prep” logistics
that one could store is lengthy, and will be limited by 1.
budget; 2. knowledge
base, and 3. storage ability. SH’s list is very doable
from all of these angles. If I were to make my own list, my only point of departure
would be to emphasize again that these drugs will be quite precious. Most of
the
upper respiratory infections that are currently treated with antibiotics would
resolve spontaneously without them, e.g., acute sinus infections, mild ear
infections and a sore throat not accompanied by fever. I purposely left out
amoxicillin
because it is a wimpy antibiotic that is currently rarely effective for the
sort of infections that will unequivocally require antibiotic therapy in an
austere environment. A final recommendation: for anyone stockpiling prescription
meds, having a current copy of the Physicians
Drug Handbook
(Not to be confused with the
Physician's Desk Reference (PDR)) would be indispensable. - RangerDoc,
MD, FACS
JWR:
A quick note on one of the medications that SH from Georgia mentioned:
Metformin does not usually work until you reach 1000-to-1500 MG dose. Also,
it is important to note that the tablets [of this particular medication]
should not be
cut. Everyone should always double check everything
concerning
medications.
All the drugs [in this family] are also now going to have black
box warnings soon for possible heart problems! - Russell M.
Hello,
I am a retail pharmacist in Philadelphia. The letters with regard to stocking
up on medication and medical supplies were great. I'm glad to see other Pharmacists
into preparedness. There are
a few other things I thought I would mention.
A good topical anti-fungal cream could prevent a lot of unpleasantness. Generic
Lotrimin (clotrimazole) applied twice daily for a week or two can treat ringworm
(a fungal skin infection), athlete's foot and jock itch. Lamisil and Lotrimin
Ultra are a bit more potent but probably aren't worth the additional cost.
SH's letter was great and he really knows his stuff. Another antibiotic that
might be useful in people who are allergic to amoxicillin/penicillin, etc (those
same people can also be cross-sensitive to cephalosporins (keflex, etc)) is
azithromycin (z-pak) or erythromycin (ery-tab). They are broad-spectrum and
are usually tolerated well (some G.I.side effects like cramping and diarrhea).
If someone is unable to find a like-minded prescriber there are plenty of veterinary
medicines that can be used by people available at pet supply/agricultural stores.
I have seen tetracycline, amoxicillin, and sulfa drugs which were to be used
on everything from fish to horses. These would be fine to use in post-SHTF circumstances. They go by different brand names but are the same medicine.
One would just have to take care to use appropriate dosing as they are usually
in different strengths than human dosage forms. Ragnar
Benson has some books
on these topics.
Another thing is to have a good supply of natural medicines available(grow
echinacea as an antibiotic and elderberry as an antiviral (flu prevention/treatment).
There are many others.
Staying in good health and thinking "preventative" is a good way
of decreasing the effects of some of the major killers. It seems as though
the American way of life conditions many people to wait until a problem occurs
to start thinking about their health, but you wouldn't wait until your engine
locks up to change your oil. Diabetes, heart disease and cancer risk can be
reduced by proper diet, exercise, stopping smoking, etc. This will allow you
to be free of any "maintenance medications", insulin, etc. that might
be difficult or expensive to stockpile.
I just finished reading "Patriots" , it is awesome work!
Take care, - S.T. in Philly
« Letter Re: Prince of Wales Island, Alaska as a Retreat Locale? |Main| Note from JWR: »
Three Letters Re: Stocking Up on Prescription Medicines
Jim,
In regards to stocking up on prescription medicine your readers may want to
use the book "Wilderness
Medicine"
by
William Forgey, M.D. as a good starting point. A couple of other "beginner
books" are "Where
There Is No Doctor"
by
David Werner and "Where
There Is No Dentist" by
Murray Dickson. Amazon.com is running a special on all three books for $42. [JWR
Adds: The latter two books are available for free download, but
I recommend getting hard copies for your survival reference library.]
I took the book "Wilderness Medicine", to my doctor's office
and discussed the list of medicines Dr. Forgey recommends and my doctor advised
it was a very good reference. Our doctor advised a lot of the medicines listed
were included in his supplies that he keeps at home.
Included in the book is some information on multiple uses of the medicines
as well as alternatives if you run out of one of them.
My doctor also recommended the following prescriptions: Cipro, Tamiflu, and
Relenza.
We had to search for a preparedness minded doctor but they are out there if
you seek them out. Thanks, - Art
Mr. Rawles,
In response to Bryan’s request for a list of medications that may be
worth adding to your preps, the following is my humble reply. I am a pharmacist,
of the clinical variety (the kind that works in hospitals and clinics helping
docs manage acute drug therapy, as opposed to the community pharmacists, who
dispense drugs and valuable information to the public) with 27 years of hospital
pharmacy experience. Please don’t think that my recommendations are the “gospel
truth”. This e-mail is off the top of my head, and I’m sure many
others will add to, or detract from, my suggestions. If there’s one thing
I’ve learned over the course of my career, it’s that there are
very few definitive answers to medical questions.
Now, it should go without saying (but I’ll say it anyway) that these
recommendations are in no way meant to suggest that you should self-medicate
under normal circumstances. The safe and effective use of medications is a
risk:benefit game, best assessed by your doctor. No drug is absolutely safe,
and the proper diagnosis of illness and treatment with medications is an endeavor
that consumes lifetimes of study. Having said that, in a TEOTWAWKI situation,
the risk:benefit equation shifts, and sometimes the risk of doing nothing will
exceed the risk of using some drugs without the oversight of a physician.
To get started, as my good buddy and I always say, “you must define
your goal before you can hope to decide on the appropriate action”. So
here’s the goal: suggest some commonly available drugs (prescription
and over-the-counter (OTC))
which could be stored in preparation for foreseeable calamities in an extended SHTF or
TEOTWAWKI situation – either for self-medication, or for selection by
a “country doctor” who has the knowledge, but not the drugs. I
will focus on drugs that may have a chance of making a difference in acute
situations without heroic measure beyond the ken of most non-medical folks;
that is, no designer drugs for the syndrome of the week will be included. Also,
I will stick to generically-available drugs in order to seek cost feasibility.
I will avoid “controlled substances” (those federally regulated
by the DEA) – a
difficult obstacle when it comes to pain management, because we must exclude
all of the opiates. Also, though I use mostly intravenous medications in the
hospital, this list focuses on oral medications, for obvious reasons. Finally,
in TEOTWAWKI, we will simply have to accept that certain conditions lead to
shorter life spans, so drugs for the treatment of chronic diseases are not
included. Nutrition, trauma, infection are about all we can hope to impact – and
surgery is more important than drugs in trauma. Those with diabetes, severe
hypertension, heart disease, and other all-too-common chronic maladies will
have to wing it….not to say that it isn’t a good idea to have several
months of your specific medications on hand to get through a temporary interruption
in our normal flow of life.
I will resist the urge to get into details about bacterial resistance patterns,
differential diagnosis, viral vs. bacterial infection, dosing, duration of
therapy, etc. It would be much better to chat with your local medical person
about the specifics. These are just the very basics – I’m sure
a rational argument could be made for almost any drug.
ANTIBIOTICS – the breakthrough that promoted chronic diseases and cars
to the top of the mortality list
Ciprofloxacin (common brand name: Cipro) – usually dosed 500 mg twice
daily, this wonder drug covers a broad spectrum of pathogens, and is reasonably
effective in treatment of urinary tract infections, pulmonary infections, skin
infections, and gut infections. Bonus: can treat or prevent pulmonary anthrax
infection, prophylaxis against bacterial meningitis, and has a fighting chance
against gonorrhea. Sold by prescription only.
Cephalexin (common brand name: Keflex) –usually dosed 250-500 mg every
six hours. A reasonable choice for upper respiratory (ear, nose, throat) infections
and skin infections, including prevention of infections secondary to lacerations.
Small risk of problems in folks with severe penicillin allergy. Sold by prescription
only.
Metronidazole (common brand name: Flagyl) – usually dosed 250-500 mg
every six hours – This oft-overlooked drug has good activity against
the class of bacteria called “anaerobes”, and is useful in treatment
of diverticulitis, some gynecological infections, and would be a welcome addition
to cephalexin in the event that a “home appendectomy” is to be
tried on the kitchen table (just kidding…sort of). This drug can also
treat (or cause…go figure) a severe, and oft-fatal type of diarrhea,
called Clostridium difficile colitis (aka, pseudomembranous colitis). Don’t
mix alcohol with this one! But then, who will have booze in TEOTWAWKI anyway?
(no offense to the home distillers out there!). Sold by prescription only.
Amoxicillin (common brand name: Amoxil) – usually dosed 500 mg every
eight hours – Good for ear, throat, urinary tract, and some soft tissue
infections. If started immediately, may prevent bad infections secondary to
animal bites, including humans, but if the infection has already begun, bigger
guns are usually needed (different bacteria are problematic with various species,
but we’re talking generalities here). Bacterial resistance has cut into
the effectiveness of amoxicillin over the last 20 years, but it would sure
be better than nothing, especially in a more rural setting (the nastiest bugs
always hang out in crowds!). Sold by prescription only.
Other possible generically-available antibiotic candidates include good ole
penicillin (G or VK), ampicillin, amoxicillin/clavulanate (common brand name:
Augmentin), sulfamethoxazole/trimethoprim (common brand name: Bactrim or Septra – a “sulfa
drug”), and doxycycline (common BN: Vibramycin)
ANTIFUNGALS – just one
Fluconazole (common brand name: Diflucan) – About the only reason to
have this on hand is for vaginal candidiasis. (Ladies, you can probably diagnose
that one as well as your doc!). Other uses would be difficult to diagnose at
home. A single 150 mg tablet shows very good efficacy in this indication – but
I suspect that the 200 mg tabs would be cheaper to obtain in quantity, since
the 150 mg tablet is individually packaged for the indication. In this scenario,
an extra 50 mg won’t hurt. Perhaps one of my community pharmacist colleagues
could confirm or deny my suspicion. Sold by prescription only.
VITAMINS – much more important when on survival rations!
Multiple Vitamins – get several of the biggest bottles of a generic multi-vitamin
that you can find at the warehouse club. If you’re eating white rice
three times a day, a vitamin a day (or even three times a week) may dramatically
extend your chances of survival. OTC
Vitamin C (ascorbic acid) – Very good to have around when citrus and
greens are not available…remember scurvy? (Though I hear you could eat
a pine tree). A couple of big bottles of Vitamin C 500 mg could stave off scurvy
for your family for quite a while. A quarter of a tab a day would be sufficient,
probably less (Dietitians should fill in the details here). OTC
Vitamin D – If you’re expecting a nuclear winter, you’ll
need this in the absence of sun…but then again, after reading [Cormac
McCarthy's novel] “The Road”, I’m not sure I would
want to stick around for that one! OTC
ALLERGY DRUGS
Antihistamines – Of course, seasonal allergies will have to be tolerated,
but it wouldn’t hurt to have some diphenhydramine (common brand name:
Benadryl) on hand for particularly bad cases of poison oak and bad (but not
anaphylactic) bee stings, etc. Available OTC
Corticosteroids – Along the same lines as above, perhaps a few methyprednisolone
dose packs (common brand name: Medrol Dospak) would be good for more serious
allergic reactions. Sold by prescription only.
Epinephrine – Though I promised to “stay oral”, I must mention
Epi, because it is probably the only thing that may save someone experiencing
a bona fide anaphylactic allergic reaction (tongue swells, throat closes down…can’t
breathe). The injectable form in ampoules (1mg/ml) is much cheaper, but the
Epi-Pen product is a pre-filled syringe that is ready to go. Sold by prescription
only.
ANALGESICS (pain control)
Ibuprofen (common brand names: Motrin, Advil) – Pretty good for what
ails you, since we’re not talking about narcotics. Strengths are headache,
bone pain, tooth pain, and general sprains/strains. It’s a good anti-inflammatory
(unlike acetaminophen) and will bring a high fever down. Available OTC
Aspirin – Still good for headaches and fever (except in children--do
a web search on Reyes Syndrome), but beware the enhanced risk of bleeding if
used for pain secondary to traumatic injury. Though ibuprofen theoretically
can cause a similar problem, it’s much rarer than with aspirin. Bonus:
Though heart attack mortality will undoubtedly go back up to early 20th century
levels in TEOTWAWKI, a chewed aspirin tablet (325mg) at onset of chest pain
may improve your odds in the absence of any other medical intervention. If
an old bottle of aspirin smells strongly of vinegar, it is probably kaput…but
it wouldn’t hurt you to try it.
Hydrocodone/Acetaminophen (Common brand names: Vicodin, Lortab, Lorcet, etc.) – I
said I wouldn’t include controlled substances, so this one is not included….but
just so you know, this combination of an opiate and acetaminophen (Tylenol)
is probably the minimum analgesic intervention that would help much with traumatic
visceral pain. But the laws involved and the risk of misuse complicate the
issue greatly. Be sure you’re not putting yourself at legal risk before
deciding to get prescriptions for this, or the more strictly controlled analgesics
such as oxycodone/acetaminophen (Percocet), morphine, meperidine (Demerol),
and others.
GASTROINTESTINAL MEDS – “Keep it movin’ – slow it down”
Soluble Fiber (common brand names: Metamucil, Citrucel, Fibercon) – May
be essential to keep things moving in the early days of survival rations (though,
as it is oft pointed out on this blog, eat what you store and the transition
will be much smoother). Available OTC
Docusate Sodium (common brand name: Colace) – stool softener…’nuff
said
Loperamide (common brand name: Imodium) – this antidiarrheal could save
a life, but be sure to study up on when, and when not, to use it. In bacterial
enteritis it may do more harm than good. Available OTC, though if you have
a pharmacist friend, they may be able to order a bottle of the caps much cheaper
than the OTC boxes.
TOPICALS – Cuts, burns, and scrapes
Antibiotic Ointment (“triple” bacitracin/neomycin/polymyxin or “double” bacitracin/polymyxin)
Good to reduce the risk of infection in minor cuts and scrapes. Many folks
suffer a contact dermatitis when exposed to neomycin, so many docs are recommending
the double formula these days (common brand name: Polysporin).
Silver Sulfadiazine cream (common brand names: Silvadene, Thermazine) – A
lifesaver in severe burns, but you’ll need a big jar of it.
Eye Wash – It’s basically just sterile salt water, but good to
have when you need it!
Obviously, this is a starter list. I will apologize in advance for the glaring
omissions that I’m sure friends and colleagues will point out.
A word on stability – as we’ve discussed on this blog before, the
manufacturer’s expiration date has been found to have quite a bit of
wiggle room by our Department of Defense, that has, commendably, conducted
their own degradation studies in order to extend the shelf life of the military
drug stockpile, and thus save us poor taxpayers a buck or two. For obvious
reasons, this [Shelf Life Extension System (SLES)] data is closely guarded,
so we don’t know the specifics. A few details have leaked out, and it
seems that most drugs are “good” (meaning within a reasonable range
of their original potency – usually 90%) for years beyond the
labeled expiration date when stored appropriately. For most tablets and capsules,
cooler, darker, and dryer is better (low oxygen is also good). I would suggest
that you ask your pharmacist to add the manufacturer’s expiration date
to your pill bottle for a frame of reference. Many pharmacy computer
systems default to one year from the fill date on the prescription label, irrespective
of the actual date on the stock bottle. The bottom line is this: the
drugs on this list (with the possible exception of doxycycline) do not degrade
to a toxic compound; they only loose potency over time. If you refer to Mr.
Rawles’ excellent novel, "Patriots" ,
you will note how the characters titrated the dose up to allow for potency
loss post-expiration date. When to do this, and by how much is a crap shoot,
but in TEOTWAWKI it is better to have tried and lost, than never to have tried
at all!
Here’s hoping and praying that we all die in our beds at 101 years of
age, with our wives (or husbands) lilting voice in our ear, saying, “I
told you that you were wasting money on all that survival stuff!!!” Regards,
- SH in Georgia
Mr Rawles,
I'm a retail pharmacist working in Louisiana and am new to prepping. Many of
my patients come to me asking for advice on low cost medications that will
still yield positive outcomes. As a result I've gained valuable insight into
the potential for stockpiling medications on a budget. I hope this helps:
Stockpiling mediations for WTSHTF can
be a daunting task, even for those with an idea of their current medicinal
needs. For those currently taking prescription medication, the question is
usually affordability and accessibility. Most insurance plans will not pay
for supplies larger than 90 days, and paying cash for prescriptions is usually
cost prohibitive. While greater accessibility exists in countries such as Mexico
or Canada, crossing the border with large quantities of medication is usually
asking for trouble, thus requiring multiple trips. And while the lower costs
of medications outside of the US has been frequently touted, quality can be
suspect. Internet pharmacies in places such as India or even China will ship
to your front door, but only after paying a "doctor" for your required
by law "consultation", usually costing anywhere from 75 to 125 dollars.
So what are the options?
There is a two fold strategy regarding lowering your drug cost to allow for
cost efficient stockpiling. First, talk with your doctor or pharmacist about
generic medications. Generics save as much as 80% over their brand name equivalent,
are covered on every insurance plan, and because of the cost will allow for
bulk purchases. A prescription is good for one year from the date it is written,
so unless the medication is a controlled substance, you may purchase as much
as a years worth of medication at a time(provided your doctor has authorized
that many refills). Second, for those taking multiple medications, talk to
your doctor and pharmacist about decreasing the number of medications you are
taking by increasing the dose of others or changing the medications altogether.
This strategy can best be illustrated in the following example:
Patient "X" is a 55 year old Type II (non-insulin dependent) diabetic
with a history of coronary artery disease. His current medications are as follows:
Drug Condition Cost/month
Actos 30 mg diabetes $240
Zetia 10 mg cholesterol $110
Plavix blood thinner $170
Cardizem LA 240 blood pressure $125
Total medication cost/ month= $645
After consulting with his doctor and pharmacist, the following changes were
made:
Drug Condition Cost/month
Metformin 500 mg diabetes $4-$10
Simvastatin 20 mg cholesterol $4-$20
Warfarin 5 mg blood thinner $4-$10
Atenolol 50 mg blood pressure $4-$10
Total medication cost/month= $16-$50
These are cash prices, not insurance co-pays. Insurance plans would not allow
you to purchase medication for stockpiling purposes.
Also, in the same manner that firearms and ammunition should be purchased in "common
calibers" to allow for ease in buying or bartering, so should medications.
Even if you do not take maintenance medications it might make sense in the
long run to build up a supply. In much the same way as we seek out kindred
survival spirits in firearms,food storage, etc, it is possible to find doctors
that may write prescriptions for conditions that you could potentially (wink,wink)
develop. Medications used to treat blood pressure or diabetes will be in short
supply post-TEOTWAWKI,
and it will take several growing seasons for herbal remedies to make their
way through the production pipeline. Also, family members, friends and other "guests" will
undoubtedly forget their medications in their attempt to G.O.O.D..
Of the top 20 drugs prescribed in the US in 2007, four were for blood pressure,
three were for cholesterol, three for GERD (heartburn/ulcer), three for depression,
three for asthma/allergy, and one each for thyroid,osteoporosis, sleep and
blood thinning. For the sake of brevity, let's focus on the three conditions
typically undeserved by over the counter medications:
1) Atenolol: A common beta blocker medication used to treat blood pressure.
Common dosages begin at 25 mg daily to twice daily. Purchase the 100 mg strength
and cut them in fourths.
2) Metformin: Sulfonylurea class medication used to treat non insulin dependent
diabetes. While other drugs such as glipizide or glyburide are less expensive
they can also lead to hypoglycemia (low blood sugar) if dosed incorrectly.
Metformin does not have that problem. Can also help lower LDL (cholesterol)
and tryglycerides- but so will the average post-TEOTWAWKI diet. Dosages begin
at 500 mg, twice daily. Where possible, buy the 1,000 mg strength and cut them
in half.
3) Tramadol: Non-narcotic pain reliever. Does not have many of the sedating
side effects of Lortab, Vicodin, Norco, etc and is not a controlled substance.
Tramadol also does not cause the stomach problems (reflux, ulcerations) commonly
seen with ibuprofen, aspirin, and naproxen (non-steroidal anti-inflammatory
drugs (NSAIDS)). This will make them easier to obtain as most physicians are
more comfortable writing prescriptions for non narcotic pain relievers. Typical
dosage is 50 mg up to four times daily as needed.
There are thousands of over-the-counter medications used to treat an unlimited
variety of ailments. This can make stockpiling medications difficult. Every
health care professional has their personal recommendations, but the following
are the five OTC items that should be bought in bulk. They are cheap, effective,
and each covers a wide range of potential maladies:
1) Aspirin
Can be used to relieve pain, relieve inflammation, thin the blood and lower
fever (do not take on an empty stomach)
2) Benadryl (diphenhydramine)
Can be used to treat itching, rash, allergic reactions, and is the most common
ingredient in over the counter sleep aids (will cause drowsiness)
3) Pepto-Bismol
Can be used to treat indigestion, nausea, heartburn and diarrhea.
4) Neosporin
Antibiotic ointment for cuts, scrapes and burns
5) Primatene Mist
The only over the counter inhaler capable of minimizing the symptoms of or
stopping an acute asthma attack.
No first aid kit is complete without those five. - LA, R.Ph .
JWR Adds: In several places, "LA" mentioned cutting
pills in halves or quarters. This is best accomplished a with a tray-type pill
cutter, since cutting pills with a knife --especially those that are not pre-scored
for cutting--tends to be messy and inaccurate. Note that many drug companies
give away plastic pill cutters marked with their corporate logos as promotional
items, so the chances are good that your local retail pharmacist will have
some available,
free for
the
asking.
« Two Letters Re: That Post Die-Off Fragrance |Main| Letter Re: Year-Round Gardening »
Letter Re: Stocking Up on Prescription Medicines
James,
I have just visited with our family physicians about a stockpile of
prescriptions medications. Seems that two of them are "preppers" and are
putting a plan together for their families.
They physicians are more than willing to write scripts for meds, they really
are supportive of the plan and like the Wal-Mart list. For some reason, they
will not recommend specific drugs, they will prescribe but not recommend.
I wonder if a pharmacist and Ranger Doc might be willing to put together
a specific list of recommended prescription items and you could put it in the
blog. This would be a great help.
Thanks. Your blog is my #1 read every day. - Bryan W.
JWR Replies: You are fortunate to be associated with like-minded
doctors. Just keep in mind that legally they can only prescribe drugs that
are within "the scope of practice" of their respective speciailties.
« Two Letters Re: Which Form of Precious Metals? |Main| Letter Re: Stocking Up on Prescription Medicines »
Two Letters Re: That Post Die-Off Fragrance
Mr. Editor:
In regards to EM Joe's post regarding "That Post Die-Off Fragrance," I
too spent 30 years in Public Service as a Forensic Investigator attending and
investigating numerous death scenes and autopsies involving decomposing bodies.
I used to use copious amounts of Vicks Vapor-Rub, both on my upper lip and
even stuffed up the nose. One day, while attending an autopsy on a real "stinker",
the pathologist conducting the post mortem exam observed me and my faithful
jar of Vicks and informed me that if I used enough of the stuff I would eventually
erode away the mucus membranes in the sinus cavity. Just Dandy I thought to
myself, soooo I asked what would be a good alternative? He responded by saying
that a good activated
charcoal filter mask would do the trick for a short time. However, for
long term the mask and a
small single drop of Oil of Clove on the exterior front portion of the mask,
between the nose and mouth would work wonders. I employed this method for approximately
25 years with no side effects. A caution when using this method is to use only
a single drop of oil and not make direct skin contact with the Oil of Clove.
It has a tendency to burn the skin. Regards, - Surfin' Cowboy
Jim:
I worked in around Gulfport,
Mississippi after Hurricane Katrina as an insurance adjuster. Most of the
deaths occurred next to the ocean where the storm surge killed people and animals.
You could
drive
down
the interstate
6 to 8 miles north from the kill zone and still smell decaying flesh. This
came from all the dead pets, wildlife, sea life, and a few dead people. (a
warehouse full of frozen chicken didn't help either)
If it is summertime, the problem takes care of itself in about 2 weeks. We
pulled out of the worst area for a week or so to let nature take its course.
Obviously the duration depends of the time of year. In the summertime in the
deep south we have 100 degree weather and near 100% humidity. Bodies quickly
decompose to little more than bones in a very short period of time.
Like anything, you quit smelling it and will not notice it unless you leave
the area and come back - J.
« Letter Re: Food Storage--Will People Ever Learn? |Main| Note from JWR: »
Letter Re: That Post Die-Off Fragrance
I have read many [preparedness-oriented] web pages and other scenarios of
the impending collapse as they see it. A common theme in most of them is there
will be a
sudden and
short
lived phase of total chaos. In your novel "Patriots" I
remember the couple who took to a storm drain while the blood ran in the streets
overhead.
So let's say we are unfortunate enough that this really does happen, and at
least half the people on the planet get wiped out in short order. Meanwhile,
the other half can do nothing more than fight, run, and hunker down. And those
survivors of the great collapse are all very careful about cooking odors, no
perfumes, plain soap only, etc. The survivors are just dang busy setting up
their means to survive, because its a new, tough world. But just weeks earlier,
it was a much more sanitized
world. In my 30 years as a Paramedic I was called out many times to check out "that
foul odor" coming from somebody's house or apartment.
I can't even begin to imagine what its going to smell like with about three
billion fresh corpses scattered around rotting without a single funeral
home open for business.
I can tell you its probably not going to smell too good! Heaven help us who
are down wind of a major city!
Sure, in time the problem will fade away. But let's face facts, most people
don't have any real exposure to the possible stench "The Big Die Off" will
conjure up. So, what are some recommendations to get through "The Big
Stink" while you are trying to survive the post social chaos event? Vicks
Vapo-Rub under the Nose? I can tell you from first hand experience that it
offers only minimal relief. I became quite good at putting on a Fire Fighters
Self Contained Breathing Pack. Some of our Tactical Team Medics who went to
New Orleans in the days following Hurricane Katrina can tell you a little about
how its going to smell. Most of them ordered new uniforms after their deployment,
since the old uniforms had taken on a new fragrance. - EM Joe
« Mexican Flu Update: |Main| Letter Re: A Practical Tip on Using Roof Catchment Rainwater »
Three Letters Re: Deer Ticks - The Threat Within Your Perimeter
Jim,
Good post about Lyme Disease today. I live in Connecticut and caught Lyme in
1995. Took me years of antibiotics to get it into remission. Also, please
note that on 50% of people get the classic "bulls eye" rash. I
didn't, and as a result I was misdiagnosed for five months while it established
itself
in my neurological system.
I recently purchased some special undergarments from Rynoskin which
the ticks and other bugs can't get though. Maybe some of your readers would
be interested. Cabela's sells their own version, called Bugskins but I'm not as familiar with it.
Keep up the great work. I enjoy the blog out here in Blue country!
All the best, - Joe from Connecticut
James:
I found your post on deer ticks and Lyme Disease of much benefit. I would
like to share with you a brief account of a man I knew who contracted
a
very peculiar illness. He suffered from severe malaise (general
weakness) which was misdiagnosed by the local doctors a number of times.He
was diagnosed with anything ranging from influenza to Rocky Mountain Spotted
Fever and even cancer. As it turned out, he had Lyme disease contracted via
a deer tick
His symptoms were not much different from what Bill S. described in his letter
but apparently at the time, it was not recognized for what it was. there was
as
much early
suspicion of Lyme disease as there is now.
My point is that we cannot be too cautious when it comes to our health. even
with competent doctors, things can get missed.
This gentlemen endured quite a long recovery, partly due to lack of early
recognition and partly because Lyme disease is a nasty one. It was years before
he was "right" again. - M.D.T.
Hello Mr. Rawles,
The definitive studies on ticks were concluded in Oklahoma some 30 years ago,
in detailed deer habitat/population studies. (See the reference below.) The
results of the studies indicated that 90% of the ticks occur only in a small
portion of the outdoor habitat. Perhaps as little as 5% of the habitat.
That particular habitat is the area where deer bed down regularly.
I live on five acres and in contact with the vegetation outside daily, in waist
high shrubs, knee high grass and under some heavy growth of trees. Rarely do
I find a tick on me, here in western Oklahoma.
Generally the potential occurrence for ticks on humans is overstated. Because
people simply do not regularly pass through, work in or visit the bedding areas
of deer.
This does not however belittle the fact that just one tick can pass to a human
a disease condition that can impact health negatively. Fear of ticks from outside
activities is generated when warnings are described to the public. If you stay
away from deer bedding areas your chances of having a tick transfer to you
are very low.
The other environmental condition for ticks to gravitate to is a yard with
outside penned dogs. Watering tanks serviced by windmills or solar pumps for
livestock will also be used by deer, bobcats, coyotes and many small mammals.
Watering places frequently will have over runs of water leaving behind pools
of water
on the ground.
These areas may have higher concentrations of ticks.
Beat the odds:
- Always inspect yourself for ticks after being outside.
- If you have an outside
dog in a fenced yard treat the dog's sleeping area with insecticides.
- Stay
out of deer bedding habitat.
But for the first time in more than a year yesterday I picked a crawling
tick off of my neck heading for the hairline.
If in a bugout situation stay away from deer bedding areas for sleeping or
rest stops. You can spot these areas. The deer will leave behind a mashed
down area of vegetation [usually] in brush and/or under low trees. You can
also see the imprint of where deer rest and sleep under trees where there is
less
vegetation.
Distinctive well-used trails will lead to these areas.
Type of habitat that is based on ecological descriptions of a community of
plants have a significant effect on the ability of ticks to maintain a population
of individuals.
Reference: White-Tailed Deer
Utilization of Three Different Habitats and Its Influence on Lone Star Tick
Populations, by Carl D. Patrick and Jakie A. Hair, The
Journal of Parasitology, Vol. 64, No. 6 (Dec., 1978), pp. 1100-1106. Published
by: The American Society of Parasitologists
Understanding ticks is more complex than just understanding the potential
for disease transmission. Cordially,-
JWC in Oklahoma
« Economics and Investing: |Main| Three Letters Re: Deer Ticks - The Threat Within Your Perimeter »
Mexican Flu Update:
WHO Says Up to Two Billion Will Get Swine Flu
Swine Flu: A Survivor's Tale
Swine Flu Kills
30-Something Woman in Texas (First US Citizen Casualty)
« Economics and Investing: |Main| Jim's Quote of the Day: »
Letter Re: Deer Ticks - The Threat Within Your Perimeter
People who venture into the woods or fields should be aware of a very serious,
but underreported, threat to their health, the deer tick. Deer ticks carry
and transmit Lyme disease and a half dozen other serious diseases. Deer ticks
can be found in most parts of the world. They are very common in Central
Wisconsin which has a large population of deer, their preferred host. Thanks
to the anti-hunting nuts and poor government management practices deer can
found in residential neighborhoods, including large cities.
Most people are familiar with the dog or wood tick, a large, easy-to-spot tick
that feeds on human blood and is very ugly when engorged. It is however, relatively
benign. The deer tick is especially dangerous because it is very small, smaller
than a match head. Their size makes it very difficult to detect on clothing
or on your body.
Two years ago I was bitten a number of times while clearing land for our retreat.
It was prime deer tick habitat; heavily wooded, high grasses and lots of deer.
You may not know that you have been bitten by a deer tick (unless the tick
is still embedded). It will however sting like a bald face hornet – and
for a good 24 hours.
After I started developing the symptoms I put two and two together and did
some Internet research. I suspected that I had Lyme disease. I had the classic
bulls-eye rash on my hip; it looks like the Target logo. The primary symptoms
were extreme fatigue and body aches. After years of outdoor work and practicing
yoga I could barely get out of a chair.
I went to the local clinic. The NP took one look and said, “You’ve
got Lyme”. She said she had got it earlier in the year, her husband the
year before. I was given antibiotics. The symptoms went away within three days.
I thought I was cured.
The following year I was not the same, better, but still lacking energy. Over
the last year I have experienced the same deep fatigue as well as many other
symptoms. I had previously been very healthy. The symptoms come and go and
express themselves in a variety of ways. Reported symptoms include heart, lung,
visual and mental problems – it can be fatal. It is one bad bug.
I cannot say for sure what the cause of my problems is or recommend a treatment.
Lyme disease is poorly understood and often misdiagnosed or not diagnosed at
all. It is a complex issue and requires much research into the subject. Most
physicians are Lyme illiterate; they don’t have a clue about the disease.
One place to start is with a Google search for Joseph J. Burrascano, Jr., M.D.
for information from one of the foremost Lyme experts. Also see http://www.turnthecorner.org/lyme-disease-quick-facts.htm
for more information.
Prevention is the best medicine. When we have been in tick territory we do
a complete body check in the evening – head to toe. Ticks prefer the
torso; I have been bitten in the center of the back, hip and groin. I was recently
bitten under my arm, my wife under her breast. Ticks live in tall grass, especially
along human or deer paths. They are most active during the spring and early
summer. A powerful tick repellent should be used around the ankles, wrists
and neck. I wrap my socks with wide duct tape – sticky side out, to trap
ticks; it works, but is no substitute for a full body check.
It is reported that if you remove the tick within 24 hours of being bitten
the disease will not be transmitted and not all ticks carry the disease, this
may be wishful thinking. If you do get a tick follow these instructions for
removal: http://www.lyme.org/ticks/removal.html
Note that dogs can get Lyme. There is a dog vaccination available.
I urge everyone who visits or lives in areas with a deer population to exercise
constant vigilance for deer ticks. If you are bitten you should consult a physician
familiar with Lyme disease. Failure to do so can lead to serious long term
consequences.- Bill S.
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Letter: Re: Long Term Health Care Needs in TEOTWAWKI
Good Morning,
You may have addressed this previously, but I could use your
help on this issue. Our six year old daughter has significant medical needs
(none requiring
electricity thankfully) requiring us to shelter in place. We live outside a major
metro area and probably wouldn’t want to be on the roads anyway. Any comments
for those of us who fit this bill? Thanks - Jeremy
JWR Replies: Yes, this has been addressed. See this
letter in the archives, from 2007.
OBTW, be sure to follow the back-links there for the previous SurvivalBlog article
on
mid-size photovoltaic systems for medical needs such as sleep apnea CPAP machines
and small refrigerators
for insulin storage.
« Letter Re: Concerns About Toxicity in Water From Roof Catchment Rainwater |Main| Notes from JWR: »
Health, Hygiene, Fitness and Medical Care in a Coming Collapse, by RangerDoc
Spiritual Fitness
Let us start this discussion by confronting a stark fact of life: very few
of us, living the life of North American citizens, are fit to survive for a
generation in an austere, off the grid, world. First of all, few of us have
the philosophical orientation to be survivors. I know in my bones that without
God’s help, my family’s ability to survive in a prolonged state
of austerity is worse than questionable. As an evangelical Christian, I understand
that my own commitment to preparedness is a function of my ongoing submission
to God’s will. It could have been otherwise. He could have willed me
to pursue other ventures: sacrificing my own survival for the benefit of others
as I helped them “escape the storm”. Is this not the philosophical
basis of soldiering and of the missionary? Self-sacrifice, even to the point
of death. That was Jesus’ example of discipleship. So I diverge from
that example only by virtue of an ongoing conversation with my Lord and Master,
and He urges me to prepare for the worst, so that my family and my “retreat
posse” will survive. I know not His particular purpose in this endeavor,
but I trust His will implicitly. It is my personal belief that the Lord calls
all family leaders to provide deeply for the sustenance and well being of their
families. But unless you have had this conversation with the Author of life,
you may not be philosophically and spiritually “fit” for the challenging
times to come. And God may have a different path for you to pursue, in the
service of His Kingdom. Remember that Jesus has called us all to Himself and
He wants you to trust Him today! Preparedness is not a hobby- it is a calling.
In this vein also, I do not condone the “secret squirrel” approach
to preparedness. Being discreet about the specifics of our preparedness plans
is a wise tactic in these dangerous times, but failing to share our wisdom,
insight and knowledge with others who could effectively use this information
for good is, in my estimation, downright sinful. So much for my personal philosophical
bias.
Physical Fitness
Second of all, few of us have the physical fitness level required to be 19th
century farmer-builder-warriors, which is what we may be called to become.
Example: Thirty five years ago, I was a carpenter and gardener: climbing, lifting,
sawing, digging, hammering. I joined the US Army to become a Ranger. And, boy,
did I find out how poor my aerobic fitness was. Fast forward ten years: I was
then a medical student and an avid, competitive triathlete. I visited my buddy’s
place (Yeah, he’s in the “posse”) and helped him cut, stack
and split firewood for a day. Well, my “designer body” ala swim-bike-run
was exquisitely fit aerobically, but that episode of real labor left my body
an aching mess for the next three days! Now I am a 60 year old surgeon who
mixes aerobic exercise with gardening, light carpentry, resistance training,
hiking
with the Boy Scouts, woodcutting, et cetera, so that I can be at least minimally
fit for the challenging lifestyle that would be required in a TEOTWAWKI world.
If you are overweight, smoking and sedentary, you are engaged in a futile fantasy
to think that you will survive in a post-apocalyptic world, surrounded by your
storage food, guns and ammo. These are mere possessions that will swiftly be
taken from you by the ravenously hungry horde of healthy young men who have
heard about your stash. Start your physical preparedness plan with physical
fitness.
Preventative Medicine
Next issue: public health measures. For many years I taught and practiced medical
and surgical care in austere environments. In the late 1990s I was the chief
of the medical special response teams for the US Army, Pacific, and taught
disaster planning and medical care in austere environments around the world
as a Department of Defense consultant. If I had to choose between having access
to modern medical care and having a sound public sanitation system and clean
water,
it
would
be a no-brainer. The clean water and hygienic handling of human waste as first
perfected in the twentieth century have saved many more lives than have antibiotics
and modern surgery. Hepatitis, polio, typhoid fever, dysentery and other waste
and waterborne diseases have defeated far more armies throughout history than
have poor tactics and strategy. Witness [German General Erwin] Rommel’s
own struggle with hepatitis during the North Africa campaign of WWII, which
he
roundly lost,
in spite of
his brilliance as a military tactician. If you have a retreat, please remember
this simple principle: keep you food and water supply as far as possible from
latrine sites. Controlling mosquitoes may be important in some areas, to avoid
epidemics of West Nile Virus, malaria and yellow fever. The current H1N1 flu
pandemic should remind us all that we need to protect ourselves from infectious
disease. There is much more to learn about field sanitation and hygiene, so
please consider reviewing this
comprehensive resource.
Now you have arrived at the next step. You are right with God and your body
has been worked into a lean, mean, diggin’, buildin’ and fightin’ machine.
You have an ample and reliable source of potable water and your latrines are
at least 100 yards downhill from your water supply. You have a half ton of
lime ($30-40 worth) to sprinkle in the latrine. Your food is stored securely
and safely away from vermin, fungus and other pests. After 2-3 years of experimenting,
your food growing skills and garden are adequate. You have established sound
and reliable defense and OPSEC measures, to include perimeter defense, adequate
weapons capability, mastering of small unit operations and tactics and adequate
familiarization with improvised weapons and tactics and redundant communications
systems. Whew!! That was a lot of work! Now, and only now, should you plan
your strategy for medical, dental and surgical care.
Medical Care in Austere Environments
Number one principle: avoid injuries and illness. In practical terms that means
maintaining sound health and hygiene, as above noted. It includes scrupulous
avoidance of horseplay, as well. What a tragedy to break your ankle playing Ultimate
Frisbee during planting season, when every able body will be needed to secure
your frugal harvest for the year. Without the availability of operative orthopedic
care, many of our ancestors became lifelong cripples from simple injuries such
as this. Skiing and mountain biking will be absolute no-no’s unless truly
necessary for operational reasons. Sorry, but fun activities are way low on the
list of gotta-do’s in a survival environment.
Next: eat to survive, not for fun. No one will care what you prefer in your diet,
least of all your retreat cook, who is tasked with cobbling together a nutritious
meal from whatever is on hand. (As an aside, when my very wise wife and I developed
the list of friends that we would invite into our “retreat posse”,
the overarching selection criteria, following a Judeo-Christian moral orientation,
could be characterized as “high skill, low maintenance” personality
traits). Multivitamins will be most helpful, but probably can be stretched to
one every other day or even two per week, if there is a shortage. Include adequate
fiber in your diet. In our stores, we have large containers of Metamucil, for
instance, to avoid constipation. When encountering this problem, the French Maquis
(WWII resistance fighters) would ask a local farmer for some butter or lard and
eat 2-3 tablespoons…like grease through a goose! We also have a simple
formula for an oral rehydration solution to treat dehydration following diarrheal
illnesses, heat injury, or trauma- induced hypovolemia. Please copy the data
on this site of the Rehydration Project (http://rehydrate.org/solutions/homemade.htm)
for an excellent and simple description of homemade rehydration remedies.
Take scrupulous care of your teeth! Floss at least three times per week and brush
at least twice daily. Toothpaste is nice, but not necessary. Baking soda works
almost as well and it is not only cheap, but has many other uses. Buy 20 pounds
of baking soda.
I strongly urge all to get a copy of Where
There Is No Dentist by
Murray Dickson.
It is available from Ready Made Resources. This is an excellent and authoritative
manual that is easy to put to use by someone with at least a modicum of medical
training, for example an EMT.
Now the fun part you were all waiting for: interventional health care, i.e.,
the practice of medicine and surgery in an austere environment. To start with,
I strongly recommend getting a copy of the list of $4 prescription medications
available at Wal-Mart pharmacies. The array of inexpensive medications is astounding.
Antibiotics, antihypertensives, hormone replacements, topical medications, eye
and ear preparations- they are all on this list. Ten to fifteen years ago, most
of these items were very expensive “designer drugs”. If you need
antihypertensives, see if your doctor will prescribe drugs off this list and
then get him to write you a 6-12 month prescription. Also ask him to write you
prescriptions for the antibiotics that I recommend below. You should also get
several bottles of eye and ear antibiotic drops. Admittedly, this may be an uphill
battle. Hopefully you can educate your physician about the importance of preparedness
and make him an ally. Tell the Wal-Mart pharmacist that you are going on a mission
trip to a distant land without access to pharmaceuticals. This would not really
be a lie, would it?! Don’t worry about your cholesterol- it will drop on
your new diet…but then, my guess is that the survival lifestyle will also “cure” most
hypertension and non-insulin dependent diabetes. But, please, try to get to that
level of lean fitness prior to encountering the “SHTF” dilemma. I
recommend a stockpile of four antibiotics that will treat most conditions that
will really require them: pneumonia, anthrax, urinary tract infections, skin
infections, and wound infections: Cephalexin 500 mg, Ciprofloxacin 500 mg, Doxycycline
100 mg, and Septra DS (SMZ/TMP DS). These can all be taken by folks with penicillin
allergies, with the possible exception of the cephalexin. The number of tablets
that you need will be based on the size of your group. All of these are dosed
for adults but can be split or crushed for children. Echoing the advice of Jim
Rawles, having a retreat member with significant medical experience, e.g., an
advance practice RN, a PA or, ideally a practicing physician, will enable you
to utilize
these medications optimally. In my humble estimation, about 30-40% of antibiotic
prescriptions currently doled out by my colleagues are unnecessary, and often
done to placate demanding “health care consumers” because it is often
too frustrating and time consuming to educate folks in the office. Although these
medications are inexpensive now, when you have a limited supply that must last
months or years, they will become precious allies in your fight for survival
that must only be used when life or limb are at risk. The expiration dates on
the bottles of meds that you receive at the pharmacy are really made up, since
no pharmaceutical company really studies the time-related efficacy and safety
of these drugs carefully. The expiration dates are always much earlier
than the true degradation dates, except for liquid and injectable medications.
Almost
all medications are probably still safe and effective for at least 1-2 years
after the printed expiration date. Almost every doctor friend of mine gives his/her
family expired medications from their sample shelves! If you live within 200
miles of a nuclear power plant, a large military base or a major urban center,
it is prudent to stockpile a 1 month supply of iodine supplements for each member
of you family, to avoid the long term carcinogenic effects of a nuclear fallout
emergency. These are really cheap, have long shelf lives, and can be purchased
from several of the advertisers on this web site.
Wound and Trauma Care
Let’s start by making life simple: any soap with water works as an adequate
antiseptic for scratches and scrapes, and good ol’ Vaseline works nearly
as well as a wound dressing as the expensive antibiotic ointments. Large second
or third degree burns are another story, however. Having worked in the developing
world as both a military doc and as a medical missionary, I have observed for
myself the well known fact that flame injuries are a major cause of death and
disability in primitive cultures. Open fires are often used for heating and cooking,
resulting in frequent flame injuries, especially to children. Children are neither
wise nor well coordinated, and they fall into fires. Get several large jars of
Silvadene cream for extensive burn use only. Keep it refrigerated, or even frozen
as long as possible to extend its shelf life. This stuff is somewhat expensive,
but not easily replaced. OTC topical antibiotics like bacitracin ointment could
be substituted in a pinch. Extensive burns (larger than the palm of your hand)
should be cleaned with soap and water and dressed with antibiotic ointment and
sterile gauze reapplied daily until fully healed. When you run out of Silvadene,
use Vaseline (get 50 lbs of it- it has many, many practical uses).
I currently teach advanced tactical medics for the US Army, SWAT teams and
the
U.S. Border Patrol. We teach them suturing techniques. But, unless you can
really clean a wound within 12-24 hours of its occurrence and close it surgically
with a truly aseptic technique- sterile gloves, drapes, sutures and instruments-
it should be left open to heal by itself. Otherwise it will likely get grossly
infected, pus out, and require you to take out your precious suture material
and use your precious antibiotics to treat the now deep wound infection. Soap
and Water will take care of this wound better, along with copious irrigation
with previously boiled water (allowed to cool, of course). “The solution
to pollution is dilution!” Clean the wound with a 50/50 mix of hydrogen
peroxide and sterile water if it gets crusty or develops a thick discharge and
change the dressing daily. If large vessels, tendons, nerves or bones are exposed,
the wound will require suturing, but only after extensive cleaning and irrigation,
followed by several days of sterile dressing changes and the administration of
oral cephalexin three times each day, and then only with the cleanest, sterile
technique.
Orthopedic Injuries
Basic first aid techniques are most important to acquire for all preppers. This
is especially true for injuries to bone, joint and spine. The first aid techniques
that I learned as a Boy Scout almost 50 years ago are still relevant today. Taking
a Red Cross First Aid course is really important as the minimum medical training
for anyone seriously facing a survival situation. However, when there is no doctor
available, you will be required to go several steps further. Fractures must be
set into their normal , functional positions and then casted or splinted effectively
when you are the final medical authority. Additionally, if the fracture is open,
i.e., there is a break in the skin where the bone had poked through, this wound
must be thoroughly washed and irrigated, dressed with a sterile dressing and
antibiotic ointment, and broad spectrum antibiotics given for a week. Serious
spinal injuries may be a death sentence in this situation, invoking the principle
of expectant care (see “Triage principles” below).
Pain Relief and Anesthesia
Okay, so this part comes easy to me. Not only is my wife a former marathon runner,
triathlete, and cross country cyclist, she is also a total Christian babe. And
an anesthesiologist. She has taught me how to perform total IV anesthesia, using
relatively inexpensive drugs given by injection, thereby not requiring the use
of inhalational agents. Most of the procedures that can be done outside of the
hospital are short- under one hour in duration. In the austere environment, the
group surgeon would ideally be prepared and equipped to perform the following
major surgical procedures: Debridement of dirty wounds; open ligation of major
bleeding vessels; appendectomy; cholecystectomy (removal of a diseased gall bladder);
cesarean section. Although endotracheal intubation may be required, the presence
of a ventilator and oxygen can be circumvented. A bag-valve device will be necessary
for manual ventilation. Intravenous equipment and fluids are required. Again,
the amounts of each will depend upon your situation, but I would recommend having
at least four liters of normal saline IV solution for each member of your group.
Ignore the expiration dates: salt water does not degrade. Avoid using this precious
resource for routine causes of dehydration. Use the rehydration solutions instead.
Put up an ample supply of Tylenol, Motrin and Aleve. If possible, store a supply
of stronger narcotic pain medications, such as Vicodin.
Triage Principles
Triage is the function of rationing medical care in the context
of limited availability. This may mean a limitation in supplies, time, facilities,
transportation or professional medical providers. In a TEOTWAWKI scenario, all
of these factors may be in short supply.
The four triage categories are as follows:
1. IMMEDIATE: These victims have life threatening conditions that will a) result
in death if not promptly addressed and b) can be remediated with the judicious
use of assets on hand. An example would be a deep laceration to the groin with
arterial bleeding from the femoral artery. The immediate application of pressure
or, if necessary, a tourniquet, will save a life. This could then be treated
with definitive surgery later.
2. DELAYED: This describes serious conditions that are not immediately life
threatening, but that will require medical attention in hours to days to avoid
serious disability
or even death. An appropriate example would be a humerus fracture sustained
while having piggy back chicken fights in the back yard (you’ve already
forgotten: no horseplay!)
3. MINIMAL: This category includes illnesses and injuries that are self limiting:
small lacerations, a non-displaced finger fracture, a short episode of diarrheal
illness, etc. These folks need to keep working!
4. EXPECTANT: When medical resources are severely limited, they must be used
to derive the greatest survival benefit for the community. That means that
using a lot of medications, supplies and manpower in attempts to resuscitate
profoundly
ill or injured patients is unethical. These unfortunate folks will be unlikely
to survive regardless of your best efforts. They are triaged as expectant,
meaning that they are likely to die. Examples include severe shock, quadriplegic
injuries,
or multiple gunshot wounds to vital organs. They should be treated for pain
if possible, and given comfort and affection until their demise. This will
save
resources for those who are salvageable and can continue to contribute to the
group’s survival.
Medicolegal disclaimer: Please do not use
any
of the above advised techniques or methods unless you have no possible access
to professional medical care. This advice is not at all applicable,
and may in some instances be harmful, if you have access to professional medical
care. - RangerDoc, MD, FACS
« Mexican Flu Update: |Main| Note from JWR: »
Responding to a CBRNE Event, by J. Paramedic
CBRNE is an acronym for Chemical-Biological-Radiological-Nuclear-Explosive
events. [It is most commonly spoken "Sea-Burn"] This article gives
a general guideline for responding to such incidents, geared toward the
individual
or small group with basic medical/trauma care abilities and
little to no rescue capability. Some details about each type of event are
also included. Note that I am a paramedic; my training is geared toward that
venue, and this essay reflects that. However, many of the same principles
are relevant to anyone forced by circumstances to respond to such incidents,
not just public safety personnel.
Deliberate Attacks Versus Accidents
Most CBRNE events will be accidents or natural occurrences - chemical spills,
pandemics, etc. Some, however, may be deliberate attacks. The most likely candidates
are explosive devices, which are relatively cheap, do-it-yourself, low-risk
endeavors. Chemical, biological, radiological and especially true nuclear attacks
are
expensive and high-risk. For example, creating a nuclear device requires obtaining
plans, a large team of scientists in multiple specialties, esoteric materials,
and so on. And that is just to build the device - a delivery system is still
needed. Bringing these elements together is expensive, difficult and time-consuming,
and likely to attract unwanted attention. Overall, the cost and risk-to-body-count
ratio is much better with conventional arms and explosives; accordingly, these
are the most likely forms of deliberate attack.
Safety
The first priority must always be making sure that you and yours do not become
victims. If you become injured, you cannot help others; furthermore, you require
assistance, which draws resources away from other victims. Consider the following:
Scene Safety: Look for fires, unstable structures, weapons or dangerous persons.
Look up, down, and all around - remember that not all threats come from ground
level. If you do not have the training or equipment to help safely, then wait
for those who do. Leave the area if necessary. Do not try to provide aid in
an unsafe area - move victims if necessary. In some cases, you may even have
to leave them behind. Remember, you cannot help others if you become
a casualty.
Contamination:
CBRNE events pose a high risk of contamination. Do not expose
yourself to chemical or infectious agents or to radiation. If you do not have
appropriate personal protection equipment (PPE) - do not approach the incident
site. PPE is discussed in more detail later. Keep in mind the "Rule of
Thumb" - get far enough away from the scene that you can completely cover
it with your outstretched thumb. Remember to go uphill and upwind of
the affected area.
Secondary Devices: In the case of a deliberate CBRNE attack, be aware that
there could be additional threats or devices waiting for responders. While
these are generally directed at police, fire, EMS or other official agencies,
if you are trying to help, or have the bad luck to be at the scene, you share
the danger.
Organization
In the case of CBRNE event, public safety agencies – police, fire and
EMS – will have initial responsibility for scene management. Whatever
you believe the long-term consequences will be, initially these agencies will
be functioning. What follows is a description of their organizational model.
If they are on the scene, you will be expected to function within that structure,
if you are permitted to assist at all (for safety and liability reasons, you
may not be). However, even if a CBRNE event occurs where public safety agencies
cannot respond, the principles of this structure are still appropriate for
your own use.
Overall responsibility for managing a given event will, at least initially,
fall to a single person, designated as Incident Command. If the event can be
managed with less than 7 or so responders, this person (and perhaps a Safety
Officer) may be the only command personnel needed. However, a CBRNE event is
likely to require a considerably larger response. It has been found that a
single individual cannot effectively direct more than 3-7 people; 3-5 is an
even better number. This is referred to as an effective span of control.
Accordingly, for an event of large size, additional levels of organization
will be introduced
in order to maintain an appropriate span. Regional or functional divisions
are used as necessary. For example, the Incident Commander may appoint a Rescue
Chief, a Medical Chief, and a Fire Suppression Chief for a large-scale response.
(Note that regional or functional elements and leaders are appointed by Incident
Command. Some are standardized across the nation, while others will vary geographically
depending on local organization, preference and tradition.) Each of these individuals
will in turn direct about 3-5 subordinates. Depending on the number of responders,
each of those subordinates could in turn direct a team of 3-5 responder, et
cetera. The keys are that (1) each responder reports to one and only one supervisor,
chief, or other leadership element; (2) each leader directs no more than 3-5
subordinates directly; and (3) overall responsibility for the scene falls to
a single Incident Command. It is essential that there is no freelancing – a
disorganized response can lead to inefficiency, an unsafe scene, oversights
or mistakes resulting in poor outcomes, additional injuries [, needless contamination]
or even deaths.
Zones
Geographically, a scene will be divided into three zones: a central hot zone,
a surrounding warm zone, and a safe cold zone.
The hot zone is the immediate site of the incident, and may
expand based on wind, spill or rainwater runoff, etc. Only trained responders
with appropriate
equipment should be in the hot zone. Depending on the incident type, this could
mean fire department, HazMat or other type teams.
The warm zone surrounds the hot zone. Operating in the warm zone may also call
for specialized training and equipment, but not always and not as much. Decontamination,
which is discussed below, is usually performed in the warm zone.
Finally, the cold zone is the [ostensibly] safe area surrounding
the warm zone. Basically this is the rest of the world. Additional resources
and
treatment
centers will
normally be located in the cold zone.
Decontamination
Decontamination will be necessary when it is likely that victims or responders
have been exposed to chemicals, biological agents or radiation. The most common
method of mass decon is gross decon. Essentially, victims are instructed to
disrobe (it is estimated that in many cases this can remove up to 90% of contaminants)
and are run through a large “shower” area, then given clean garments.
On a smaller scale, you or your family members can self-decontaminate by disrobing
and showering. It is recommended that garments that must normally be pulled
over the head be cut off, instead. In some cases more detailed decon may need
to
be performed,
for example a wound contaminated with radiological material. In this case,
wash the specific site with soap and water, making sure not to contaminate
others or other areas of the body while doing so (wear appropriate PPE). Note
that victims should in most cases be decontaminated before receiving medical
care or first aid. The exception is an immediate life-threatening condition,
such as a severe hemorrhage, which may receive preliminary treatment prior
to decon.
Personal Protective Equipment (PPE)
This discussion will deal with two forms of PPE: medical PPE and chemical protective
gear. It is essential to wear appropriate PPE in any CBRNE event to avoid becoming
contaminated or spreading contamination to others.
Medical PPE includes gloves, masks, gowns and eye protection. Follow the Universal
Precautions philosophy – assume that everyone is a potential
carrier of dangerous infections, and behave accordingly. Wear gloves whenever providing
treatment, and change them between patients. Also be aware of the following “special” situations:
Splash protection – when “splashes” are anticipated (for
example with childbirth, massive hemorrhage or vomiting) wear eye protection,
a mask and a gown
Contact precautions – some infections, such as certain MRSA varieties,
can be passed skin-to-skin, and call for contact precautions; wear gloves and
a gown
Droplet precautions – infections spread in mucus or respiratory secretions
may be transmitted over short distances by coughs and the like; wear a surgical
mask when in close proximity. (The CDC says within three feet [but coughs can
project droplets 10 feet or more.])
Airborne precautions – infections with airborne spread, such as tuberculosis,
call for an N95 mask; ideally, the patient should be in a negative pressure
room
Chemical Protective Equipment comes in four levels:
Level A calls for a Self-Contained Breathing Apparatus (SCBA) and a sealed
chemical protective suit. Note that no single suit type protects against all
forms of exposure. Generally, Level A protection is used only by trained HazMat
Technicians.
Level B calls for an SCBA and a non-encapsulated (non-sealed) chemical protective
suit, such as a Tyvek suit.
Level C consists of a filter-type respirator and chemical protective clothing,
gloves and boots (same as type B).
Level D includes standard work clothes – uniforms, surgical scrubs, turnout
gear – which give some skin/splash protection, and no respiratory protection.
Triage
Once proper PPE is in place, the response has been organized, and the scene
has been rendered safe, care for victims can begin. After safety, preventing
or minimizing the loss of life is the highest priority. A CBRNE event is likely
to produce a large number of victims, and could easily exceed response capabilities.
When this happens, the goal must be to do the greatest good for the greatest
number.
Haphazardly rendering aid to random victims will result in chaos and poor treatment
priorities, which will in turn lead to unnecessary loss of life or poor outcomes
for victims. It is important to apply triage procedures. “Triage” simply
means “to sort,” and refers to sorting victims into groups based
on severity. The first competent care-giver to arrive at the scene of a mass
casualty event should begin triaging – sorting – victims. The following
categories are pretty much universally recognized:
Red or Immediate – These persons have severe injuries, but are likely
to be able to be saved. The are “salvageable.” Given the seriousness
of their condition, they receive treatment (and transport to the hospital,
if available) first.
Yellow or Delayed – These are the people with serious but not life-threatening
injuries. They are the second group to receive treatment, after the Reds/Immediates.
Green or Minimal – These are folks with only minor injuries. After
all the reds and yellows are taken care of, they can be taken care of.
Black or Expectant – These victims are dead or expected
to die. Any victim who cannot breathe on their own should be triaged into
this category.
If manpower
or resources are limited, they should not be expended on these victims, who
will
probably not survive anyway.
Once triage is completed, treatment can begin.
Treatment
Some comments specific to incident type will be included later. For now, consider
the following general assessment and treatment priorities (note that this is
a mere overview; detailed first aid skills should be sought elsewhere):
Mental Status – Assess whether the patient is awake, unresponsive, confused
or lethargic, etc. An unresponsive patient should be considered Red/Immediate.
A confused patient will probably be Yellow/Delayed, assuming no additional
problems are found. Next check the ABCs:
Airway and Breathing – Check to see whether the victim is breathing.
If not, open their airway by tilting the head or (if injury is suspected) by
lifting the jaw forward. If the patient does not breath on their own at this
point, consider them Black/Expectant. If they do, ask whether they are having
difficulty breathing and listen to their breath. Difficulty breathing, rapid
breathing or strange breathing sounds indicate at least a Yellow/Delayed patient.
Severe or progressive difficulty breathing indicates a Red/Immediate patient.
Circulation – First, if a patient has no pulse, they are dead, and are
Black/Expectant. Second, check for bleeding. If bleeding is found, it should
be controlled. Place direct pressure on the site; this should control the bleeding.
You may have to maintain pressure for several minutes, then place a dressing
and bandage. If the bleeding does not stop, and is from an arm or leg, apply
a tourniquet. In the past tourniquets were viewed with great caution, but it
has been found that they can be safely used for up to several hours without
long-term negative effects. At any rate, one cannot worry too much about an
arm or leg when a victim – possibly a loved one – is bleeding to
death. Finally, keep a bleeding patient warm (cover them with a blanket) and
elevate their feet; this will help combat shock.
Those of you with CPR training will notice that I’ve omitted rescue breaths
and chest compressions from this discussion. That’s because (1) in a
mass casualty situation victims needing these interventions will be Black/Expectant,
and will not be treated; and (2) unless high-level follow-on care – paramedic,
ER and/or ICU – is available, CPR alone is unlikely to save a cardiac
arrest victim. And I simply don’t
have space to include such details here. I do, however, recommend that everyone
seek out first aid and CPR training, at a minimum.
Finally, remember that scene safety comes before treatment. If necessary, move
the victim. In general it is good to leave trauma victims in place, in case
there is some spinal damage. However, when the scene is unsafe, you have to
move.
Specific Incident Types
Explosives Events
Remember that explosive devices can also include some biological, chemical
or radiological (“dirty bomb”) contaminant; and that there could
be secondary devices waiting for responders. (Note that explosives will usually
destroy any included biological or chemical material, making explosive dispersal
of such agents unlikely to succeed.)
Explosives create blast-type injuries, which are classified as follows:
Primary Blast Injuries: pressure-related injuries from the blast wave, these
can affect internal organs such as the intestines, lungs or inner ear without
visible external injuries
Secondary Blast Injuries: these are injuries from objects (shrapnel, debris,
etc.) striking the victim
Tertiary Blast Injuries: if a blast is powerful enough to throw a victim into
the air, they will sustain injuries from striking the ground or other objects
Quaternary Blast Injuries: all other injuries, including burns and the like
Here are some basic treatment ideas:
Bleeding should be controlled by direct pressure and, if necessary, tourniquet.
Broken bones, sprains, etc., can be splinted
Burns should be covered with clean – preferably sterile – sheets
or dressings; do not put any salves or chemicals on any but minor burns, as
they will have to be washed out later – very painful for the victim
Victims with neck or back pain or tenderness, or loss of sensation or movement,
should not be moved unless absolutely necessary, as they may have suffered
spinal injury, which may be worsened by movement. However, this is much less
likely than television and first aid instructors would have you believe.
Chemical Events
Chemical events require proper PPE; otherwise, follow the “Rule of Thumb.” Remember
that wind and water run-off can spread contaminants. Also remember that chemical
events may not be immediately apparent. Multiple victims with quickly-developing
symptoms, as well as dead flora or fauna in the area, are the most likely signs.
A special note should be made for organophosphates. These produce a condition
commonly called SLUDGE (salivation, lacrimation, urination,
diarrhea, gastrointestinal distress, and emesis), which in layman's terms is
the sudden onset of soiling yourself, peeing on yourself, crying and vomiting
everywhere.
They
merit special mention because these are the type of exposures for which Mark
I kits and other atropine/2-PAM kits are indicated, as well as valium for possible
seizures.
Biological Events
Biological events can be difficult to detect, and to protect against, because
often there is no scene. Generally, multiple victims will present with “flu-like
symptoms” or other complaints to multiple health care providers. The
main signs are multiple patients with similar complaints, especially when the
symptoms, the demographics, or the season are unusual. For example, large numbers
of healthy young people complaining of flu symptoms in the middle of summer,
clustered in certain areas, is a sign of an exposure or pandemic. Isolating
the source is a matter of finding “common ground” between the victims – think
of lots of people suffering from nausea, vomiting and diarrhea after eating
at the same restaurant.
Speaking of flu-like symptoms, I thought it might be timely to share with you
the following guidance that I’ve received from my EMS agency regarding
the current “Swine flu” –
1. Suspect swine flu in a person who:
- has a cough, runny nose or sore throat; and
- has a fever more than 101.4F; and
- has been to an “endemic area” in the last 7 days
Endemic areas currently include Mexico and affected areas of the USA.
2. Distance is considered adequate protection; however, if one must approach
a suspected swine flu patient, a surgical mask is recommended.
3. Only if one must be in a confined space with a suspected swine flu patient
is an N95 respirator recommended.
These recommendations come from our medical director based on CDC and other
agencies’ information and advice.
Victims of a biological agent (i.e., an illness) can often be treated, depending
on the agent; preventing further spread within a population can usually only
be accomplished by isolation or – on large scales – by quarantine.
Nuclear or Radiological Event
As noted previously, deliberate nuclear attacks are relatively unlikely, due
to their expense and risk when compared with conventional methods. “Accidents” are
also rare, as modern-day reactors and the like are designed with multiple redundancies
and dead-man’s-switches. We are many years removed from the technologies
of Chernobyl and Three Mile Island, or so experts say. Smaller radiological
events are more likely. Of course the first thought in most minds is the “dirty
bomb,” a conventional explosive with radioactive material.
Radioactive materials are usually divided according to the following types:
Alpha particles cannot penetrate clothing or often even skin; however, they
are very dangerous if somehow introduced into the body
Beta particles can be absorbed by protective clothing
Gamma rays are stopped only by several inches of lead [or
several feet of earth or concrete], and easily penetrate human beings, damaging
organs along their
paths.
The severity of radiation exposure will depend on time, distance and shielding – a
shorter exposure, over a greater distance, with more shielding in between,
will be less severe than the opposite. Radiation effects various bodily systems.
Inhaled radioactive material can damage the lungs. Radiation can also produce
severe burns; these will present as severe itching, but over time will reveal
significant damage.
In evaluating the severity of radiation exposure, the easiest reliable measure
is time to onset of vomiting. If a victim starts vomiting within one hour of
exposure, their exposure is severe. Beyond two hours, exposure is probably
mild to moderate.
You may find it useful to stock geiger counters, personal dosimeters, or potassium
iodide (KI)
for your family. Information on all of these topics is already archived
on SurvivalBlog, so I will not go into them here.
Otherwise, without specialized facilities, the best you can do for a victim
of radiation poisoning is to decontaminate and treat symptoms as they arise.
Remember that with a sufficient dose of radiation the victim can themselves
become a source of radiation, and pose a contamination risk.
Summary
In the case of a CBRNE event, essential include a scrupulous eye to safety,
an organized response, careful use of personal protective equipment (PPE)
and decontamination to prevent spread of contamination, triage of victims,
and
the best treatment
available.
Remember
that you will probably not be able to do as much as you would like. You must
do the greatest good for the greatest number. Finally, remember your priorities:
after safety, preventing the loss of life comes first. Then you can worry about
protecting property and/or the environment, and long-term recovery. These topics,
however, are beyond the scope of this essay. I hope you find the information
contained here useful in your preparations, though I hope you never have to
use it in a true CBRNE event.
« Mexican Flu Update: |Main| Letter Re: The Rush Has Begun for Flu Prep Logistics »
Six Letters Re: Adapting Family Food Storage for Gluten Intolerance
James,
I found out last year I am gluten intolerant, and my little girl was
symptomatic with me. In our case, we found we can't tolerate any grains--not
even corn
or rice. Below are some ideas for those with either condition or who are on
lower-carbohydrate diets for health reasons.
* In addition to beans, other carbohydrate-rich foods that you can store include
potatoes, yams, peas, beets and tapioca. To avoid the additives found in some
dehydrated foods, I have freeze-dried potatoes, yams, and peas. I also have
some home-canned yams and plan to grow more. Beets are only available in regular
cans. I have those, plus regular canned peas and potatoes. Tapioca isn't as
nutritionally rich as some of these others, but it's nice to be able to have
a treat and it stores well. (Most prepared puddings have problematic thickeners.)
In terms of rice, I did some research when I was eating grains. White rice
is
the least nutritious grain--eating it actually depletes your body's nutritional
reserves, which isn't a good idea in a stressful SHTF situation
(where the stress alone will deplete you of B complex). Brown rice is much better
for you, but
doesn't store well. So I would suggest storing more corn than rice, and using
rice as a treat or as a break from monotony.
* Don't forget lentils. They aren't used nearly enough in American cuisine (mainly
soups). I have found some fabulous Middle Eastern and Indian recipes for them.
They store well, and are a wonderfully nutrient dense food. The brown ones don't
always look that appetizing, so I often opt for the red ones. You can add these
to tomato sauce or spaghetti sauce dishes to boost protein and not even realize
they're there. And like most anything else, they taste even better with cheese
on top.
* To avoid the corn syrup present in nearly all canned fruits, I looked until
I found a local store brand that uses only pear juice. (I can't have sugar either,
and won't use artificial sweeteners.) I pay extra for a couple of other fruits
at Whole Foods that are also canned in pear juice. I have also canned a variety
of fruit. And I store some freeze-dried fruit instead of the dehydrated, which
sometimes have some unfriendly additives and aren't necessarily cheaper. Nice
fruit is important when you can't have a traditional breakfast. Canned or freeze-dried
can be heated and turned into a compote, or put into a smoothie for a nice breakfast
shake--one of my daughter's favorites.
* Finding MREs
for a bug-out bag was very difficult. One
company makes gluten-free
MREs, but they don't run batches every year--so the MREs
may last only a year or two. I finally found one Mountain House pouch entree
that looked okay (chicken with potatoes), and opted for that, plus canned meat
and pouch sides of veggies (potatoes, peas, etc.).
* Coconut flour has a shelf life of 1 year at room temperature, possibly longer
if you have a cold basement. I have been experimenting with recipes and found
it yields a result similar to wheat flour. Coconut pancakes are similar to buttermilk
pancakes. It is not cheap ($7 / lb.) but you use a lot less of it per recipe
than regular flour. Bob's Red Mill makes some, and you can buy it in larger bulk
quantities on the web. Due to the expense, for us it is a treat on weekends,
birthdays, holidays, etc. But the results so far have been good, and the taste
is scrumptious. It also works as a substitute for flour if you're making oven-fried
chicken or breaded things. Coconut flour is a carb[ohydrate], but it has a high
fiber content (6 g/serving),
which
helps with blood sugar stabilization. Those watching carbs could top coconut
pancakes with peanut butter (and a dash of honey or syrup), or heat up some frozen
or canned fruit to make a simple compote that's lower in carbs than maple syrup.
* Almond flour is a fabulous substitute for wheat flour, and yields results that
are more similar to flour-based breads (rice and corn products tend to be dry).
There are also two great books with wonderful recipes for the Specific Carbohydrate
Diet (Grainfree Gourmet). However, it is twice the price of coconut flour, and
is not suitable for using in a SHTF situation because it can easily go rancid
if it's kept out of of a freezer or a refrigerated environment. It is also not
calorie-free.
But it is really nice to work with if you're watching carbs because
it counts
as a protein. For this reason, it's my choice for "bread" for holiday
meals.
* I have also had to change a lot of my condiments and sauces. Soy sauce, for
example, is wheat-based. So I use Bragg's Liquid Aminos. Most ketchups, barbecue
sauces, and relishes include corn syrup. I found a barbecue sauce and ketchup
that don't, and now make my own ketchup with a recipe I found on the web. I also
make up my own Worcestershire sauce. It doesn't take long, and I know it's safe
to consume.
* Since I can't use cornstarch to thicken, I use arrowroot--and have a lot of
it on hand. I also use mashed potato flakes (the kind without preservatives that
lasts about a year) to thicken soups and in place of cracker crumbs in recipes.
* Where I have been put on a lower carb diet, I have had to pay more attention
to protein than many folks do in their preparations. I need protein, and can't
produce it myself. So I try to have an extra deep larder of it: dehydrated eggs
(for scrambled eggs), canned cheese, freeze-dried cheese, freeze-dried cottage
cheese (good with canned fruit on top), lots of salmon (for salmon breakfast
patties), and lots of canned meat from Best
Prices Storable Foods. After Hurricane
Ike, we used some of our canned meat. It was great, and I didn't get sick (unlike
a friend who at store-bought meat with lots of additives). I can't buy canned
beef or pork in the stores--too many additives I can't have.
* One critical change has been to play to what we can eat and truly enjoy. My
husband loves pineapple. So I used the internet to find several recipes we can
eat that use pineapple. They're now family favorites--and safe for me and my
little girl to eat. This really helps with the sense of deprivation, which can
be an issue in sticking to any diet. Focusing on these new delicious finds has
helped ease the pains of missing pasta, oatmeal, etc. So for morale purposes
if nothing else, I've made sure our larder includes the ingredients for the "family
faves" that we can eat.
* For snacks, we usually eat dried fruit and nuts. I have a good stock of both,
especially the nuts, since I can't grow them here (not enough room for a pecan
tree). While they won't keep long-term, they will keep a good year and I rotate
my stock. Buying in bulk from www.nutsonline.com and www.bulkfoods.com has saved
me a ton of money and yet let me make sure I'm getting fruit without syrups or
sugar added.
* Another snack is fresh bananas with peanut butter on them, honey optional.
I have also been stocking up on banana chips--these make a great substitute for
crackers. Since I plan to nurse a new baby this summer and won't be able to eat
peanuts while nursing, I have also been stocking up on almond butter.
* Instead of granola bars, we eat fruit strips (100% real fruit) or Lara bars.
Since these are rather pricey, I'm learning how to dry fruit and looking into
recipes to make my own bars. But in the meantime it works, and they would be
great in a bug-out bag. I always keep some in my purse and in the diaper bag.
(Finding snacks I can eat while "out" is very difficult.)
* For "junk" or convenience foods, we often use potatoes and sweet
potatoes. We make oven-baked fries, and buy the occasional bag of chips for garnishing
stir-frys or giving crunch to a soup or salad (instead of croutons or crackers).
* When sick or overheated, I can't rehydrate with Gatorade (sugar, etc.). So
I either make my own Gatorade, or drink fruit juice and eat a fresh banana. We
also store fruit juice in various forms (100% juice pouches for my daughter,
bottles for when we're sick or going through a heat wave).
* I also can't start eating again after the flu or morning sickness with crackers
or noodle soups. So I make my own Gatorade and use baked potatoes, mashed potatoes,
or yams. My toddler preferred oven-baked fries the last time she was recovering
from the flu.
* I have also had to change our shampoo, lotions, and even over-the-counter (OTC)
medicines to avoid grain products and sugar. For OTC medicines, I usually look
for the dye-free packages, and these usually have fewer troublesome ingredients.
Since my 3-year-old daughter was symptomatic with me, and the doctor indicated
my soon-to-be-born son will most likely inherit the genetic tendency, our whole
family has switched to my diet. (My husband is a saint! He does get bread and
normal food when he eats out with his clients.) With my daughter, it is much
easier to simply not have "off-limit" foods in the house.
As a postscript, I found out I was gluten intolerant because I was eating what
I was storing. I was subclinical--did not exhibit any of the traditional symptoms
despite eating a "healthy" whole-grain diet for years--until I tried
a homemade bread recipe that called for extra gluten. In my case, the results
were catastrophic. However, I am so grateful to found out before I needed to
rely on my supplies (and good medical care might be unavailable). Needless to
say, I am a big advocate of using what you store. - CL in Houston
Sir,
After reading your post today Letter Re: Adapting Family Food Storage for Gluten
Intolerance I remembered reading recently about Kamut a possible low gluten
wheat substitute for individuals what are gluten intolerant. I did a quick
search on your blog and could not find a previous article about Kamut so
I thought I would drop you a note to let you know about it.
You can read more about
Kamut at the Walton Feed web site.
Regards, - Eric in The Desert
Sir,
My youngest daughter and I are sensitive to gluten. We have discovered
that "alternative" grains
like millet, quinoa, and amaranth are quite good. All three can be cooked as
is as a side for supper or as a "porridge" for breakfast. Also, all
three can be ground into flour or purchased bulk as flour from different sources.
Sorghum and buckwheat are also good alternative flours. Millet would be good
for anyone to investigate storing. It stores for a long time with little preparation
-- one to two years. It can be stored longer with better preparation -- oxygen
absorbers, etc. You cook millet like rice. You rinse then boil or you can rinse,
toast, then boil. But, you use less millet than rice per cup of water. So the
millet goes a lot farther. Generally, you cook 1 cup of millet per 2-1/2 cups
of water. I cook brown rice at 1 cup of rice per 1-3/4 cups water. However,
because of this, when grinding and baking with it, your baked item may be a
bit dry from the millet absorbing so much liquid. With a touch of practice,
you can remedy that.
As you mentioned, there are many good sources for cooking gluten-free. Blogs
are wonderful resources. You can find a lot of practical advice from people
who are dealing with it on a day to day basis.
And here is an
excellent blog on going gluten-free. - Emma
Mr. Rawles,
Another place to get gluten free recipes is Frugalabundance.com.
I hope that this proves helpful to any SurvivalBlog readers that are gluten
intolerant.
Regards, - Gloria
Hi Jim:
I read Tim's post yesterday about his wife being diagnosed with Celiac disease.
As you may recall, I was the one who posted one year ago about my daughter
being diagnosed with type 1 diabetes and a month later, learning she and
my other ladies having Celiac disease. I can certainly sympathize with Tim
as it is daunting and overwhelming when a loved one is initially diagnosed.
From our year long experience with this, here is what I can offer.
The blessing and curse of these times is Celiac. While so many foods include
wheat and gluten as part of their overall production, many more foods are now
Gluten Free. This is driven in part by a growing awareness of the Celiac disease,
gluten intolerance in general, links of gluten and Autism and simple dietary
issues. More foods than ever are gluten free. We began by eliminating all sources
of gluten and wheat from the house. Any wheat or gluten in our house would
cause my diabetic daughter to begin to violently throw up, causing dehydration
and ketone spikes. So it all went away. What was usually a two or three grocery
store ensemble has now grown to seven (7) different stores in our region in
order to find the various things. One store carries some things, another store
different things and so on. Our best sources for gluten free foods has been
the local Fred Meyer (owned by Kroeger) and Whole Foods. Some products are
now clearly marked as "gluten free" so spotting them has been easier.
For instance, instead of a loaf of wheat bread, we now use rice flour bread
made at Whole foods (about 65% more expensive that regular whole wheat bread).
Instead of the usual wheat flour waffles on the waffle maker, it's now waffles
made with rice or tapioca flour from the local health food store (Manna Mills).
The treat of freezer cookies are accomplished with a brand of gluten free freezer
cookies from Whole Foods. Cereals are rice or corn based. All chips are either
corn tortilla or pure potato and we eat far more rice eaten as a staple.
One of the things we have encountered is that the carb load on these are typically
higher, leading us to better watch our weight and how much we eat. As I indicated
before, our grocery bill went up over 50% in one night when we switched. Many
of these foods have a significantly shorter shelf life, especially when processed.
As an example, a loaf of rice bread in my cool, dry house will spoil within
36-48 hours. But we found many, many on-line and local resources to help us
in making the correct food decisions. My girls religiously reading the labels,
looking for any signs of gluten, wheat or wheat family products that could
contaminate. There is a very good magazine called Living Without which addresses
foods without certain items such as gluten or wheat. Amazingly enough, our
local Kroeger owned store was found to have a sizeable gluten free section
in the natural foods section. And of course, we eat less processed foods, more
fresh fruit and vegetables.
Naturally, the shift from a wheat based survival foods platform to a rice based
platform was expensive. Many survival, dehydrated and MRE based foods were
given away as they all contained either wheat or gluten. I bulked up on more
rice and shelf stable wheat free survival foods (very little out there, I must
admit).
Last November, our family took a much needed vacation to Disneyland. It was
one of our most positive eating experiences as we learned that Disney (and
other major theme park enterprises) takes Celiac disease seriously. They had
gluten/wheat free alternatives based upon breads made in our area by Energee
Foods. My girls were able to enjoy pizzas made with tapioca flour crust. We
were even able to communicate with the head chef for Disneyland food service
for information. That made for a more enjoyable trip. A visit to a local Von's
and Trader Joe's and we had a great gluten free vacation.
For Seattle, Washinton area SurvivalBlog readers, here is
a list of local stores we have been successful
in finding wheat free or gluten free foods at:
Costco - Rice chips, corn tortilla chips, beans (bulk and canned refried),
rice, Robert's gourmet foods like Smart Puffs
PCC (Puget Consumers Co-Op) - Commercially produced gluten/wheat free foods
Whole Foods - Wheat free bread, rolls, pizza crusts, Angeline's
Manna Mills - Bulk rice and tapioca flours
Fred Meyer - Crackers, Bob's Red Mill gluten free flours, cereal, rice cakes,
soy crackers, etc.
Ener-gee foods - Local commercial based gluten free foods (products used
exclusively at Walt Disney resorts)
Trader Joe's - Wheat and gluten free frozen waffles, pancakes, chips, crackers
I wish Tim and the other Celica readers great success! - MP in Seattle ( a
Ten
Cent Challenge subscriber)
Hi There,
In response to your reader post about food storage and gluten intolerance,
I would like to add that if you plan to mill your own grains, and plan to
store wheat for those that can eat it, you will need to get two grain mills
and never mill grains containing gluten on your gluten free mill. Mills are
too difficult to fully clean and there will be traces
of gluten left from milling grains such as wheat or barley.
Every coeliac has a different level of intolerance, but it is not worth risking
problems. Gluten free grains suitable for beer making are probably also suitable
for substituting for wheat and barley in other foods too. Some of these are
millet, buckwheat, corn, rice, quinoa and sorghum. Just remember to only use
your gluten free mill to mill gluten free grains
and store both the whole grains and flour in separate dedicated containers.-
The Anonymous Economist
« Economics and Investing: |Main| Six Letters Re: Adapting Family Food Storage for Gluten Intolerance »
Mexican Flu Update:
The first really good news on the flu outbreak came yesterday: Scientists
See this Flu Strain as Relatively Mild. I am hopeful that the current strain
won't mutate into something more inimical. But be sure to be
well prepared, and get in the habit of frequent
hand washing, regardless.OBTW, if I were in a position of influence, I'd recommend
that the custom of handshaking be temporarily replaced with saluting, as was
done
during the 1918 Spanish
Flu Pandemic. (But alas, these days some segments of society might see that
as
overly militaristic
and politically incorrect.)
Reader Pat M. suggested an
interesting article in Science Daily on social isolation to prevent
the spread of influenza.
OBTW, to minimize "casual
contact",
I recommend curtailing social events, and shifting to family wilderness activities
such
as hiking
and rock hounding.
If
you are
a
target
shooter, instead of going to public ranges do your shooting on
remote BLM land, or on private land (with permission.)
The latest flu headlines:
The Binder sent us a link to a Newsweek article that suggests that
the number of flu cases may be under-reported in Mexico: City
of Fear; How the swine flu is terrorizing Mexico's capital. An on-scene report.
Queensland
residents told to stockpile food amid flu fear
WHO
to Stop Using Term "Swine Flu" to Protect Pigs
Vaccine Promised as US Cases Passes 100
More than 40 Probable Cases in Illinois
48 Confirmed Cases in New York State
Three New Cases Confirmed in Britain
Swine Flu Spreads to 11 States, 100 Schools Closed
Pandemic of Panic
E-mail From Trucker to Steve Quayle
Government Issues Guidance on Facility Closure: School Dismissal and Childcare
More
Than 300 Schools Now Closed in US "Closing a school alone won't stop
community spread. "If a school is
closed, it's not closed so kids can go out to the mall or go out to the community
at
large," Homeland Security Secretary Janet Napolitano said. "Keep
your young ones at home."
Hong Kong Confirms Asia's First Case of Swine Flu (now known as H1N1) Detected
in Mexican man who had come from Shanghai.
Security Agent Likely Caught Swine Flu on Trip with Obama
NYC Mayor Says Many Sick People Not Tested, Number of Cases Probably Higher
Doctor in Washington State Saw 22 Patients Before Falling Ill
Ft. Worth: Mayfest, Other Events Cancelled Over Flu Concerns
Harvard Medical School Cancels Classes Over Possible Swine Flu
« SurvivalBlog Reader Survey Results: Conveniently Bypassed Areas |Main| Note from JWR: »
Mexican Flu Update
I recommend that SurvivalBlog readers seriously think through the implications
of successive waves of Mexican Flu sweeping around the globe for the next three
years. From
what we've already seen of its virulence after the normal "cold
and flu season", then the next couple of winters could bring very high
rates of infection
and overwhelm the healthcare system. Please take the time to watch Dr.
Henry Niman of
Recombinomics discussing"Swine" flu. His projections
are disturbing, to say the least! Think this through folks, on a macro scale:
How would a pandemic impact your work? Commuting? Grocery shopping? Church activities?
School? (If you are not yet homeschooling, then you should plan on it!) Your
vacation
plans? Summer camp? Family holiday get-togethers? Sports and cultural
events? These
implications
are enormous. As SurvivalBlog readers, you are already
accustomed
to contemplating
abstractions
at this level and getting "ahead of the power curve." You also likely
have
the
benefit
of
superior
training
and
a deep
larder.
And, hopefully,
many
of you took my advice three years ago, and began to develop home-based businesses.
(Mail order businesses will undoubtedly flourish, as people shun face-to-face
sales.)
There are no guarantees, but you have a better chance
of getting through this
unscathed than most of your neighbors. Hopefully, all of you read the backgrounder
on family flu preparedness, that I've had posted here are SurvivalBlog
for more
than
three
years.
But
if
not... Now is
time
to make the requisite adjustments to your daily routine and to top
off
your
logistics:
- Now is the time to order several boxes of N95
masks
and
rolls of bandage tape (for sealing any mask edge gaps )
- Now is the time to buy a steam
vaporizer
(new,
or used -- Try Craig's
List for used ones)
- Now is
the
time to approach
your family doctor, and
ask for a scrip for Tamiflu.
- Now is
the time to
lay in a supply of Sambucol (Elderberry
extract.)
- Now is the time to lay in supplies
of hand sanitizer (with aloe) and latex gloves--or nitrile gloves for
those with latex allergies
- Now is the time to stock up on Vitamin C, Vitamin D, and Guaifenesin expectorant
- Now is the time to buy a couple of Bag Valve Masks
- And
lastly, for
this and umpteen other contingencies, now is
the time to acquire an honest one year supply of storage food (or more) for
your family. Buy some extra, for charity.
If
you
wait
too long,
then those
supplies
will
either be
non-existent,
or exorbitantly priced. By the time most of the sheeple think
this through (or have it explained to them by the talking heads on the
Idiot Box),
you will have long since "topped off" your
preps. But
not if you
hesitate. As my friend Bob in Tennessee is fond of saying: "Panic
now, and avoid the rush." [The Memsahib adds: If you've been consistently
panicking since 1999 with no ill effects on your spouse's mental health,
then give yourself a pat on the back.]
Mark my words: A true pandemic will disrupt supply chains,
starting with relatively exotic items (such as antivirals), but eventually
working down to basic commodities. Be ready.
Today's flu headlines:
Panic buying and government distrust in Mexico
1st
US Swine Flu Death: Toddler in Texas (visiting from Mexico) Flu also
now in Austria and Germany
"Patient Zero" may have been found. A 5-yr-old who lives near a pig
farm.
Access to Safe, Reliable Food Essential in Pandemic
Swine Flu Tracking On-Line
Ron Paul: Putting Swine Flu in Perspective
Dr. Len Horowitz: Mexican Flu Outbreak 2009 Special Report
Swine Flu Worries Shut Down Three Private California Schools
US Swine Flu Cases Now Officially at 68
Schwarzenegger, Obama Boosts Efforts Against Swine Flu
WHO Warns Swine Flu Threatening to Become Pandemic
World Takes Drastic Steps to Contain Swine Flu
Biden Tells Family to Stay Off Planes, Subways
Mexico Shuts Nonessential Services Amid Swine Flu
Asia Suspected Swine Flu Cases Rise
All Ft. Worth, Texas, Schools Closed Over Flu Fears
49 Confirmed Cases in NYC
CDC Latest Facts and Figures Re Swine Flu
Obama: US May Close Schools to Battle Swine Flu
Swine Flu Could Threaten Millions with Other Diseases
« Letter Re: Adapting Family Food Storage for Gluten Intolerance |Main| Jim's Quote of the Day: »
Mexican Flu Update
Cheryl wrote to mention an article that described using Vitamin
D to prevent a cytokine storm The dose is 2,000
units of Vitamin D per kilogram (1 kg = 2.2046 pounds), once per day. Thus,
for an average 150 lb. adult, the dose would be would
be
136,060 units of Vitamin D. This is to be taken for three days. (I.U. Equivalence:
50,000
units = 1.25 mg) My Strong Proviso: The usual fat soluble vitamin (KADE)
warnings apply. Don't over-do a good thing. You should discuss vitamin D testing and replacement with your physician before acting on that doctor's recommendations! Vitamin D supplement limits vary depending on body weight, diet, and exposure to the sun.
Today's flu headlines:
WHO
pandemic threat level raised to 5 out of 6
New Flu Strain is a Genetic Mix
First
US Swine Flu Death, Cases Now in 10 States
France urges Mexican flight ban
Cuba Halts Mexico Travel (First Country to Do So)
Pandemic Risk Grows as New Cases Emerge US cases now at 64, Mexico 152 dead,
over 2,000 infected
US Flu Deaths Seem Likely as Outbreak Spreads
Scary Advertisements From 1976 Flu Outbreak Today they tell us to stay calm
Mexico
City Mayor: One more death, toll stabilizing
« Letter Re: Home and Ranch Methane Gas Generators |Main| Mexican Flu Update »
Letter Re: Adapting Family Food Storage for Gluten Intolerance
Hi Jim,
I wonder how many other preppers out there have the same issue we just discovered.
My wife has always had trouble with her digestive tract. Recently we discovered
that she is has Coeliac's disease which means she is gluten intolerant. She
can no longer eat gluten which it seems is in just about every type of prepared
food. It comes from Wheat and is obviously in anything that has wheat i
