Last Minute Medical Prepping, by Cynthia J. Koelker, MD

Soon enough we’ll know whether December 21, 2012 portends a cataclysmic event. One approach regarding how to prepare is to consider what might kill you in a day, in a week, in a month, or a year.  Your preparations will vary depending on your health now and how long you expect to live without the prospect of professional medical care.

The most common life-threatening conditions that can kill in a day include acute allergic reactions (anaphylaxis), heart arrhythmias, pulmonary embolism (blood clot to the lung), various severe traumas (gunshot wounds, excess blood loss, cervical fracture (broken neck), and of course, suicide.  Without sufficient fluid replacement, cholera victims will die within days.  Without insulin, Type 1 diabetics will soon be comatose.  Dehydration can kill in a week, as can many infections including untreated cellulitis, pneumonia, intestinal infections, sepsis, and several others.  By a month children may succumb to starvation, though adults generally take somewhat longer.  Shelter, water, and food are every bit as important as other medical needs.  At a year, all of the above scenarios remain a threat, but in addition, chronic diseases and nutritional deficiencies will begin to take their toll. 

With these considerations in mind, I suggest procuring the following:

  1. Asthmanephrin.  Released only a month ago, Asthmanephrin is the only currently available over-the-counter inhaler for asthma (and an alternative for anaphylactic allergic reactions).  It is similar enough to Primatene Mist to consider it a replacement, and an option when an Epi-Pen is unavailable.  At approximately $55 for the starter kit (10 doses, including EZ Breathe Atomizer inhalation device) and about $30 for the refill kit (30 doses) it should be in every prepper’s medical kit.  Before you say that you’re not asthmatic, consider that it could also be used for anaphylaxis in a bee-sting or other allergic patient, help a COPD patient in a pinch (with careful attention to side-effects discussed below), or in any patient with significant bronchospasm.  Doctors generally advise against using inhaled epinephrine, not because it is ineffective, but due to the greater likelihood of increased blood pressure and heart rate (as compared with current prescription beta-adrenergic agonists such as albuterol).  Not all pharmacies carry this yet, so call first for availability.  Locally, our CVS has it in stock.
  2. Antibiotics.  The antibiotics that are both readily available and most likely to save a life include amoxicillin-clavulanate (Augmentin), cephalexin, ciprofloxacin, trimethoprim-sulfamethoxazole, doxycycline, erythromycin, and metronidazole.  If you haven’t yet obtained them from your physician, or don’t believe doing so is possible, then consider the “fish antibiotic” route (which I have addressed in other articles on this site).  Should you or a loved one become ill, consider carefully before using your stock of antibiotics, which should be reserved for life-threatening infections. (Also see #14, below.)
  3. Wound cleansing and closure supplies.  A laceration isn’t likely to kill you, but a subsequent infection may well do so.  Clean water and any antibacterial soap are sufficient to clean a wound, though I am partial to Hibiclens (available OTC).  You may want to include a baby hair brush for gentle wound debridement and cleaning.  You will also need a needle holder and suture material (4-0 and/or 3-0 silk or nylon, such as Unify, available OTC).  Anesthetic is optional, but a good idea at least for children.  OTC tattoo cream contains lidocaine or similar medication and is pricey but somewhat effective.  Surgical staplers can be obtained online without a prescription.  A few staples can be placed more quickly than anesthetic can be administered and with no more discomfort than the anesthetic itself causes.  If you doubt this, purchase a surgical stapler a nd try it out on yourself, even without a laceration.
  4. Clean (non-sterile) medical gloves.  Useful to protect both patient and caregiver.  Sterile gloves should be used when the possibility of introducing a life-threatening infection into a wound from the outside environment is high, such as with an intra-abdominal wound.  However, clean (non-sterile) medical gloves can be rinsed in alcohol and worn when suturing superficial wounds, and are quite inexpensive, at under $10 per box of 100.
  5. Immunizations.  If you can’t get in to see your doctor, then visit your local health department or your local pharmacy for a flu shot, possibly a pneumonia vaccine, and to update your tetanus immunity with a Tdap injection.  These are the minimum.  You might also want to consider a Hepatitis A vaccine and an MMR (measles-mumps-rubella).  Even more important than updating your own immunizations is making sure all your children are up to date on theirs.  And don’t forget your pets.  At a minimum update their rabies and distemper vaccines.
  6. Pain medication.  Over-the-counter pain relievers are so inexpensive that you should buy them by the thousands.   If you doubt you’ll need them yourself, consider their value as barter items.  Tylenol is the primary pure pain reliever and the only one without the possibility of anti-inflammatory-related stomach distress.  On the other hand, the non-steroidal anti-inflammatory drugs (NSAIDS), which are somewhat likely to bother the stomach if used more than a few days, are often better at pain relief, especially when inflammation is present (gout, most other forms of arthritis, pleurisy, tendonitis, bursitis, etc.)  For many patients, the combination of Tylenol plus an NSAID can provide pain relief equal to that of a narcotic.  However, NSAIDs are not effective for stomach pain or intestinal pain (and sometimes worsen such problems).
  7. Stomach acid reducers: Proton pump inhibitors (OTC generics for Prilosec and Prevacid) and H2-blockers (generics for Zantac, Pepcid, Axid, and Tagamet).  For ulcer sufferers, these medications are worth their weight in gold.  If you don’t think they can be life-saving, you haven’t seen a person bleed out from a perforating ulcer, which is almost a disease of the past, thanks to these highly effective medications.  They are useful for any esophageal, gastric, or duodenal problem related to acid-irritation.  The H2-blockers are ridiculously cheap, and have the added benefit of an antihistamine effect, useful for treating hives.  The proton pump inhibitors are more effective in reducing stomach acid production, but also more expensive.  Again, if you don’t think you might need them yourself, they could be highly valuable for barter.  People have plenty of stomach problems now, in good times, and will have more when stress increases and food decreases.  Also, using an acid-reducing medication often makes it possible for patients to tolerate NSAID pain relievers (especially when narcotics are unavailable).
  8. Splinting and casting supplies.  Plaster is cheap and available online without a prescription.  Even if you don’t know how to work with plaster, someone else may.  It is easily adaptable to almost any fracture or sprain of both upper and lower extremities.  In addition to 3” or 4” rolls of plaster, stockinet and gauze rolls are helpful in producing professional results.  If you don’t know what you are doing, then do not apply a circumferential cast, which can act as a tourniquet and cut off blood supply, which could lead to amputation.  Plaster splints are generally safe for the layperson to apply, as they allow room for some swelling.
  9. Antihistamines.  Good for treating a variety of minor problems, antihistamines should also be used for life-threatening anaphylaxis, generally in combination with epinephrine (see #1 above).  People are most aware of their value for treating colds and allergies, but all the OTC antihistamines can be used for treating hives and itching of other causes.  The sedating antihistamines (diphenhydramine, doxylamine, and chlorpheniramine) are useful as sleep aids and are somewhat helpful for reducing anxiety.  The non-sedating antihistamines (Claritin, Allegra, Zyrtec) are best if alertness is essential.
  10. Meclizine.  This OTC medication is the same drug as prescription Antivert, and is the best OTC medicine for nausea and vomiting, as well as vertigo-type dizziness.
  11. Imodium.  Best OTC drug for diarrhea.  Also sometimes useful for stomach cramps.
  12. Long-term refills on your own prescriptions.  Most all doctors will give you at least a 3-month supply of medications for diabetes, high blood pressure, asthma, COPD, heart disease, and other chronic conditions.  Insurance will generally pay for a 3-month supply, but you could request an additional 3-month supply if you pay cash. 
  13. Protective clothing.  Depending on your climate, activity, and expectations, protective clothing can help prevent respiratory ailments, poison ivy, sunburn, frostbite, malaria, gunshot wounds, sprained ankles, blisters, calluses, lacerations, and amputations.  In addition to weather-appropriate clothing, you may want to consider steel-toed boots if you’ll be chopping wood, a Kevlar vest if you’ll be dodging bullets, high-topped boots to support ankles on rough terrain, well-fitting shoes for long marches, and anything else you can come up with to prevent a health problem.  My own bald father suffered second-degree sunburns from not wearing a hat on a sunny day, and with his diabetes, these took weeks to heal.
  14. Educational information.  Doctors and nurses consult books on a daily basis, and so should you.  While of course I’m partial to my own book, Armageddon Medicine, written with TEOTWAWKI in mind, there are other several others I recommend, listed at my web site.  If you haven’t started prepping yet, you likely don’t know how to recognize a life-threatening infection, or how to suture a wound, or apply a professional cast, but you can learn if you have print resources to help, should the need arise.  Evenå if you’re not a medical type and the sight of blood makes you faint, a nurse, or EMT, or even a mother may appreciate the resources you have on hand.
  15. A Bible.  Why are you prepping, anyway?  Some people believe preppers do so out of fear, but in my experience, this is not the case.  I have been so impressed with people who have attended my Survival Medicine classes.  While everyone wants to protect their family and loved ones, the majority of attendees have been caring people looking to help others as best they are able, striving to honor the “Great Commandments” (Love the Lord with all your heart, soul, and mind; and your neighbor as yourself.) I suggest thinking beyond your family’s needs to others you may be able to help (and who might benefit you in return).  In the medical arena, this might include procuring more supplies than you’re likely to use for your own needs.  If you have an extra thousand bucks to spend, why not consider what a clinic might require in the way of supplies?  Even if you’re not a health care provider, professionals will appreciate your foresight – I know I would.  In the event of a disaster, no man is an island. 

In a single shopping trip and one hour online, you can accomplish most of what I’ve outlined above.  If you do so, you’ll be ahead of 99% of the population.  And if every one of the hundreds of thousands of readers of SurvivalBlog is prepared, imagine how much good we could do for the world.

Editor’s Note: More of Dr. Koelker’s advice can be found at her web site: