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Sir:
The author of “Setting Up a Sickroom” provided much valuable information. One tip, however, is not supported by the last 30 years of medical evidence. Side rails on a bed are known to double the incidence of falls in health care facilities, and these falls result in greater injury. The evidence is so compelling that hospital accreditation agencies will ask for corrective action, if they find indiscriminate use of bed side rails. Delirious or demented people who are intent on exiting the bed unassisted will do so, and they have more to trip them up, turn them upside down, and farther to fall with side rails. One of the most common reasons for sick people to try to get up on their own is a full bladder. Offering a means of toileting every couple of hours reduces more falls than side rails on the bed.

I am a geriatric physician (either way you interpret the term), who has studied this issue and participated in countless root-cause analyses of hospital fall incidents. Regards, – Kris

Hugh Replies: It’s important to remember that much of the research that we see regarding this kind of thing is targeted towards institutions and the problems they tend to have with staffing. Side rails can be critical in keeping a patient from rolling out of bed. However, if you have a patient that wants out of bed and no one is there to help them, they will crawl over the side rail. That’s where the accidents happen. Is the siderail really the problem? Or is it the lack of attention to the patient. Institutions, like hospitals and nursing homes, tend to run staffing on the ragged edge of what’s acceptable, and they make decisions based upon lawsuits. As a firefighter, I am appalled that we are losing access to our backboards. When we suspect neck/back injury, we board the patient for extraction and transportation. Upon arrival at the ER, we transfer custody of the patient to the ER staff. I do not want to disparage the staffing at hospitals, but if the patient is receiving damage because they spend 10 hours strapped to the backboard, is that really the fault of the EMT/fire personnel? Yet, because patients have sued over such damage, we will soon lose the ability to use backboards. Yes, statistically, the backboards do damage, but it’s because of misuse rather than proper use. Sometimes I wonder if the suits who make the decisions have ever seen (let alone participated in) removing a patient from the bottom of a 20 foot deep ravine.

As we set up our own emergency/medical stations, we should make decisions based upon sound practice, good medicine, and common sense rather than lawsuits. It’s not enough just to set up a sickroom, but we need to have procedures in place that make sure those who must utilize those facilities receive adequate care. If your patient is receiving the care they need, there should be no need for them to climb out of bed over side rails by themselves. Likewise, if you are misusing a side rail to keep a lucid patient in bed, you really need to change your procedures.

Viruses are hitchhikers, and they love us. They love everything about us. We provide the perfect environment for them; we are warm, cozy, and moist, and we transport them exactly where they want to be. As my mother would say, we are the “Hostess with the Mostest”. Some viruses even like the same foods and drinks (water) that we like. They are sneaky little buggers. We hardly know they are there. However, with the right precautions and awareness, we can protect ourselves and others by preventing transmission and treating an infection properly. I would love to talk about how to treat and avoid every viral and bacterial infection to prepare you for when the SHTF, but to honor this flu season I will mainly talk about transmission and treatment of Influenza A, B, and C (also known as the flu). I am a Registered Nurse, and every other patient I currently treat has the flu. I will talk about the chain of events that lead to virus transmission, routes of transmission, how to treat viruses (such as the flu for when the “what if” happens without modern day medicine), and the use of herbal teas for SHTF medical care.

Transmission of a virus is a very simple yet vigorous cycle. To stop the transmission, you simply break a link in the chain of events. The transmission of a virus, such as the flu involves the following stages:

1. Escape from the host or reservoir of infection,
2. Transport to the new host,
3. Entry to the new host, and
4. Escape from the new host.

On a typical day, you head into work. You open the door to your building, wave at coworkers as you pass by, and make your way to your office, where you will sit and enjoy your coffee and quick breakfast before your busy day begins. Today, you will be interviewing a few new potential employees, and the first should be arriving shortly. (At this point, enough has been said. You have had no physical contact with a person yet, and no one has sneezed or coughed directly in your face. That would be way too obvious. Is the chain of events obvious yet? Let’s continue.) Not much time passes before your first interviewee shows up early and prudent. You shake hands and offer them a seat.

1. Escape from the host or reservoir of infection: The person who opened the door to your building right before you has mild cold/flu symptoms, a runny nose, and a sore throat. They will probably call in sick tomorrow.
2. Transport to the new host: You grabbed that door handle.
3. Entry to the new host: Without washing your hands, you ate your breakfast or maybe you simply rubbed your eyes, because you are still half asleep and let’s face it, it’s a Monday.
4. Escape from the new host: You shook hands with your interviewee and gave them an offer they were not quite expecting.

A person who is infected with the flu can spread it up to six feet away. This is a significant distance. A droplet from a sneeze or cough must simply be inhaled into the lungs or land in the mouth or nose of its new host. The flu is most commonly transmitted via a droplet route (we will discuss shortly) and is less commonly transmitted via a vector (door knob).

The flu is a highly contagious disease. It can be spread when you inhale infected droplets (from an infected person sneezing or coughing) or have direct contact with an infected person’s secretions (kissing, touching, sharing utensils, and cups). You can also collect the flu virus with your hands by touching smooth surfaces, such as doorknobs, handles, TV remotes, computers, phones, et cetera. When you then touch your hands to your nose, eyes, or mouth the virus is absorbed, and it gets right where it wants to be. The flu virus can live on a hard surface (such as those mentioned above) for 2-8 hours. This is a significant amount of time for a virus to live without a host! Just think of all those doorknobs and shopping carts! So, here is my number one rule: Stop touching your face and use hand sanitizer.

A common misunderstanding is that the winter weather brings on the flu. This is in fact not true. The flu season does commonly occur in the winter, but this is due to other factors and not weather related. The flu virus will survive suspended in air longer when there is less humidity. In the winter months, there tends to be less humidity to indoor air (compared to outdoor air) this gives the virus a longer opportunity to complete its mission. A simple humidifier and circulating the air in your home may help. Secondly, in the winter people spend more time indoors and have closer contact with others, therefore, increasing the likelihood of spreading a virus such as the flu.

For the sake of being thorough, I will briefly discuss what viruses cause the flu. The flu is different than a cold. A cold can be caused by hundreds of different viruses, whereas the flu is caused by Influenza A, B, or C. Influenza A and B are responsible for most of the flu epidemics, whereas influenza C is usually more mild and causes minor respiratory symptoms. The flu vaccine is created based off of Influenza A and B, while there is no vaccine for influenza C. Influenza A can be circulated between animals and humans, whereas influenza B usually circulates only among humans. You are probably thinking, “Wait, isn’t there a new flu each year?” Yes, your thoughts are right. Based on the viruses’ chemical structures, they are then categorized into influenza A, B, or C.

So, let’s just say that you are standing in a line at the grocery store, and the person behind you is coughing and has a poor attempt to completely cover their cough. Or, maybe you are sitting on a bus, and your bus-neighbor sneezes without warning. You think that you can hold your breath or turn away, but most likely it’s too late. Flu symptoms will usually appear within one to four days of infection. This is a pretty decent incubation period. By this time, you’ve completely forgotten about the grocery line or bus stranger, BUT most people infected with the flu are contagious one day before their symptoms even appear. Those sneaky little viruses! They have begun plotting their way into their new host before you even have a clue and means to stop them. (This is why hand and respiratory hygiene is key even when there is no sign of infection.) Now you are infected, and you are probably experiencing the classic flu symptoms:

• A fever 100 degrees or higher or simply feeling feverish (but NOT everyone with the flu gets a fever),
• Runny/stuffy nose,
• Sore throat,
• Body aches/chills/headache, and
• Nausea/vomiting/diarrhea. (These symptoms are most common in children and not a typical symptom of the flu among adults. Keep in mind that the flu is a respiratory disease, not a stomach or intestinal bug).

If you remember anything from reading this article, remember this: Once infected with the flu virus, you are contagious for up to seven days! It is a misconception that if you are no longer running a fever, then you must not be contagious. This is not true! So, forget what your mother, grandmother, or whoever told you about that. Children can be contagious with the flu for even longer than seven days. As a matter of fact, you can be contagious and carry the flu virus without any symptoms at all, and you can still transmit the virus to other people.

Those infected with the flu generally take 1-2 weeks to recover. Some people, such as the geriatric population, will develop complication such as pneumonia as a result of the flu. This could be a life-threatening condition. Pneumonia, bronchitis, and sinus and ear infections are examples of complications from flu. The flu can make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may experience a worsening of this condition that is triggered by the flu.

Influenza viruses can be destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodine-based antiseptics, and alcohols are effective against influenza viruses. For example, alcohol-based hand rubs can be used in the absence of soap and water for hand washing.

According to the CDC, between the years 2009-2010, the H1N1 (swine flu) virus hit the United States. The very first case was documented on April 15, 2009. Eleven days later it was declared a public health emergency, and vaccines were being created and then shortly distributed. Thereafter in the U.S., they estimated 8,000-18,000 deaths related to the H1N1. Imagine if they hadn’t created a vaccine? What if the “what if” happens, and there is no means of creating or distributing a vaccine for such a pandemic. We would be looking at a situation quite like the Spanish flu back in 1918, which was a worldwide pandemic that killed an estimated 50 million people. Our reliance on modern day medicine, vaccines, and antibiotics will be a pitfall once the SHTF and a worldwide pandemic strikes.

So how can we prevent and treat those infected with a flu virus, without hospitalization or vaccination? Simple, we resort back to the tried and true basic care– taking proper contact and airborne precautions to minimize exposure.

1. Keep the person with the flu in a separate room. This will help keep the other family members from getting the flu. Try to give the sick person their own room. If there are two sick people, they can share a room and share a bathroom. Do not let the sick person share cups, towels, linens, et cetera. Keep a good air flow in the room. Occasionally open the window for fresh air to circulate. Things that you should keep in the sick room and not remove are:
   1. Tissues,
   2. A trashcan with a lid and a plastic bag,
   3. Plenty of water (possibly a squeezable bottle or a cup with a straw for those too weak to sit up),
   4. Thermometer,
   5. Humidifier (the extra moisture will make it easier for the person to breathe),
   6. Facemasks (when the sick person leaves the room, they should be wearing a mask to protect others),
   7. If the “What if” happens:
      1. It is especially crucial to keep the sick person isolated and separate from your group.
      2. Protect the sick person from outside elements by placing them in a separate tent, if housing is not available. Keep them warm, dry, and off of the ground.
      3. Remove bodily waste, and bury it far away from the rest of the group.
      4. Boil any items, that the sick person has used, for at least 20 minutes.
      5. If the sick person remains in a tent, it is still important to circulate air, by occasionally opening a tent window to let fresh air in.
      6. Keep the sick person warm using hot heavy rocks placed on a fire. Place the rocks into a Dutch oven to heat the tent. Create a humidifier by pouring water over the hot rocks.
2. Treating symptoms of the sick person:
   1. Fever: If medications are available, such as Tylenol or Ibuprofen, or if using herbal remedies, keep a medication log for when doses were given. Always treat the fever. This will make the person feel better, and they may be able to get more rest. Bringing down a fever may also avoid febrile seizures, which are most common in children. Tylenol and Ibuprofen may not always bring a fever down, but should take effect within 30-45 minutes. In addition to using medications to treat a fever, there other steps to take:
      1. Put a cool damp washcloth over their forehead,
      2. Wash their arms and body with a cool damp cloth,
      3. Put the person in a slightly warm bath,
      4. Give them herbal tea– Lemon Balm tea and Yarrow tea promote sweating, which can break the fever,
      5. Give them Catnip and Ginger tea, which can relieve fever, and
      6. Treat chills that may be associated with a fever by:
         1. Providing the sick person with a light blanket,
         2. Bathing in warm water containing Epson salts (to sooth sore muscles),
         3. Providing willow bark, peppermint, ginger, and/or rosemary, which have pain-relieving properties,
         4. Serving Chamomile tea, which can help calm the body.
   2. A Sore throat:
      1. Tylenol or Ibuprofen for the pain,
      2. Ice chips or frozen popsicles,
      3. Salt water gargle then spit it out,
      4. Fennel tea will reduce fever and sooth a sore throat and upset stomach, and
      5. Ginger, Tilden flower, and sage teas will sooth sore throats. (Sage tea is also a natural antiseptic and antibacterial.)
   3. A cough: As a nurse I cannot stress enough that coughing will help break up mucus and congestion, and will make the sick person feel better. Encourage coughing. A dry cough (no mucus production, usually a hacking sound) will be irritating to the airway, throat, and chest. Treating a dry cough will make the person feel better, so provide the following:
      1. A humidifier,
      2. Hard candy to suck on, and
      3. Inhalation of chamomile, eucalyptus, or thyme, which will help loosen mucus and sooth the respiratory passageways.
   4. Congestion:
      1. A warm washcloth to the face for sinus pain,
      2. Peppermint tea can stimulate mucus flow,
      3. Cayenne pepper added to juices or soups can help break up mucus, and
      4. Licorice root is a natural expectorant and is also an anti-inflammatory.
   5. Upset stomach:
      1. Offer plain foods,
      2. Clear liquids,
      3. Valerian root tea and ginger tea, which will help sooth an upset stomach,
      4. Goldenseal tea, which boosts the immune system and treats diarrhea,
      5. Cinnamon tea, which may also stop vomiting and relieve nausea.
3. Cleaning up after the sick person:
   1. If means of doing laundry in a washer and dryer are available, then wash laundry with soap on a hot setting. Remember to hold linen away from yourself and wash your hands! It is alright to wash the sick person’s laundry with the laundry of other family members.
   2. Cleaning dishes: Dishes can be washed with normal soap and water. To sterilize, again you must boil for at least 20 minutes.
   3. As mentioned above, alcohol is a good disinfectant to kill the flu virus. I recommend keeping an abundant supply of rubbing alcohol for sterilizing the sick room.
4. It is crucial that the sick person remains hydrated. The person infected with the flu will be at an increased risk for fluid loss due to vomiting, diarrhea, sweating, fever, and mucus production. The individual must “push” more fluids than usual. In the case that the person becomes dehydrated, here is a simple electrolyte solution:
   1. 1 liter potable water
   2. ½ teaspoonp salt
   3. ¼ teaspoon salt substitute (KCL)
   4. ½ teaspoon baking soda, and
   5. 2-3 Tablespoon sugar or honey.
   6. Crushed vitamins can also be added.
   7. NOTE for treating kids: Cut the additives in half.
5. Protect yourself while caring for a person with the flu. Wear a mask and wash hands often. For immune boosting and antiviral herbs, try taking:
   1. Echinacea,
   2. Elderberry,
   3. Garlic,
   4. Asian Ginseng, and/or
   5. Wild Indigo.

Remember, the best treatment for the flu is prevention. Cut a link in the chain of transmission and show those bugs who is boss. Most of the time common colds and flus are taken lightly, especially by those healthy young individuals. In a “What if” situation, prevention could be the key between life and death of those who you love. Protect yourself and your family, and start this flu season.