Thoughts on Pre-Event Healthcare Preparations – Part 1 , by B.E.

…”An ounce of prevention is worth….”

I am fairly new to this blog but have found it immensely interesting and useful, and it prompted me to write down some thoughts I have been having for years. As a physician, I am particularly interested in how healthcare and basic needs will survive in a post-apocalyptic world. If this article is redundant for long-time users of the site, I apologize.

On June 5, 1976, at around 12:00 p.m., a catastrophic failure of an earth-built dam in southeastern Idaho occurred, resulting in the release of 250,000 acre-feet of water on an unsuspecting Snake River Plain. I was seven going on eight years old, living in the path of the water and subsequently living through a disaster scenario. Luckily, I had a father who was smart enough to listen to the warnings and evacuate us to higher ground and eventually to relatives out of state while the clean-up occurred. While my family was somewhat prepared, our food reserves and family mementos were stored in our basement, which ended up being filled with four feet of muddy, dead animal-infested water. In addition, our well was contaminated and remained so for many months after the event.

Despite my young age, I have many memories regarding houses floating by, dead animals, explosions from service station pumps and standing in line for food. However, my most vivid memory is cutting my toe on a nail at the house we were staying in and having to get a tetanus shot. Did I need a tetanus shot….NO! I was up to date on all my vaccines and was adequately covered, but because my shot record was… you guessed it… back in a flooded home, the medical community decided it wouldn’t hurt me to get an extra dose of tetanus toxoid (which it didn’t, but that isn’t the point when you are talking shots with a seven year old).

This memory of a shot I didn’t want or need, coupled with the ever-deteriorating society we live in, prompted me to write the following article: This is a brief overview of my thoughts on clean water, basic sanitation knowledge, personal health preparedness, and things I feel that should be in place prior to an event, whether it be a flood or something much more devastating.

Water and Waste

As evidenced by multiple boil orders across the nation recently in the news, clean water is not a guarantee, even in a first world country. It is interesting to note that an article from a war zone survivor listed the items that disappear first when society falls apart:

  1. Generators (quiet ones so as to not attract thieves),
  2. Water filters and purifiers, and
  3. Portable toilets.

I do own the Honda EU2000i and companion generators that work amazingly, use little fuel, and are super quiet, but that is for a separate article. In this article I would like to talk about basic health ideas and preparations that should be at least considered now, if you are truly prepping for a lack of basic services.

The importance of clean drinking water and the concept of not disposing of waste near the drinking water source was finally recognized as an issue in the late 1800s as diseases began to be linked to impure water. Prior to that, dysentery was rampant. In fact it is estimated that the disease that was the greatest killer during the civil war was dysentery from water borne illnesses, with typhoid being a major cause. The WHO (World Health Organization) estimates more than 1.1 billion people worldwide lack access to drinking water from a clean source and approximately 2.6 billion do not have basic sanitation.

Sanitation, along with purification of drinking water, are by far the most important advancement for prevention of disease in the history of mankind. While understanding of purification was not evident, everyone drank ale in the middle ages because it didn’t make you sick (pasteurization in the beer-making process), but no one tied the heating of liquid to the killing of pathogens until the late 1800’s.

So how does this translate into basic preps for today’s homeowner? Obviously the answer is where is your supply of freshwater going to come from and where is your waste disposal going to occur?

Ideally, you would have at least two or three sources of potential fresh water, but regardless of whether you have a well with a power source for the pump, have standing or flowing water on your property, are collecting rain water, or are storing your fresh water in containers, everyone should be aware of how to purify their water effectively.

Purification of water can be done through various means– heat, chemicals, UV light, distillation, or filtration.

Heat: Boiling water is a time-tested method for purification, but in reality it doesn’t eliminate everything. For instance, it doesn’t decrease

1. chemical toxins,

2. prions, which is a cause of spongiform encephalopathy or mad cow disease

3. fungus spores (This shouldn’t really be an issue, unless you are immune compromised.)

4. botulism spores (These aren’t a big deal if you are an adult, but they’re potentially fatal if you are an infant under one year of age.)

5. hea.vy metals

Unfortunately, these few potential threats are likely something you will just have to live with unless you build a slow sand filter, which would not be portable. However, the things that aren’t killed by heat are rare, especially if your water is not coming from an unknown source.

In all reality most parasitic causes of stomach troubles, like giardia and cryptosporidium, begin to be killed off at around 140 degrees Fahrenheit. The majority of bacteria, like campylobacter, e. coli, salmonella, shigella, and vibrio cholera, or viruses, like norovirus, rota virus, hepatitis A and enterovirus, are killed off after one minute of boiling at 212 degrees. So, the advice to boil water for 10 minutes is probably a little over kill, but to be certain you should have a rolling boil for at least one minute. The majority of gastrointestinal illness in this country are viral in nature, but each year we do see all of the above parasites and bacteria in our clinic population so even in this first world country that has not yet lost basic services, the water or food supply can be and frequently are contaminated.

On a side note, raw milk, unwashed vegetables, or vegetables washed with untreated water and undercooked ground meat are also reservoirs for potentially fatal pathogens.

Chemicals: Most chemical treatment for water is based on chlorine, iodine, or chlorine dioxide. These different chemicals work great on viruses and bacteria with mixed results with the parasites. In particular, cryptosporidium is an organism that survives chemical disinfectants particularly well. However, if chemicals were your only option, I would use the chlorine dioxide over the other methods of chemical purification, as it does have some efficacy against cryptosporidium. Chemicals suffer from the same limitations as heat in regards to:

1. chemical toxins

2. botulism spores

3. fungal spores

4. heavy metals

It should work on prions, as they are just fragments of proteins.

Filtration: The thing to know about filtration is that it is all about size. If the device you are using to block pathogens has holes that are bigger than the pathogen, then it is not going to be a very effective method of water purification. For example, most viruses are between .02 and 0.1 micron in size; most bacteria are between 0.5 and 5 micron in size; parasites are usually around 1-5 micron in size; and proteins are between 0.005 and 0.05 micron in size. (Again, prions are fragments of proteins.)

We own the1 Katadyn pocket filtration system. The reason we went with this system is that it has a filter for organisms down to 0.2 micron, making it an excellent choice for filtering bacteria and parasites. It is also very compact and portable for backpacking trips. We also have a large filtration net for bulky debris and hand-held life straws for individual use, all of which we have tried with excellent results.

Unfortunately, our Katadyn system will not filter viruses (between .02 and 0.1 micron in size), and as mentioned earlier the major causes of gastrointestinal illness in this country are viral in nature. Therefore, if I were filtering from an unknown water source, I would follow this up with a chemical treatment (iodine or bleach work great on killing viruses); heat; or UV light. Having said that, Life Straw does offer a filtration system that filters down to 0.02 microns (meaning it would filter bacteria, parasites, and viruses). It is not very backpacker-friendly as it is gravity fed (unless you want to hike with your arm in the air holding a bucket), but if you are stationary it would be an excellent choice for a single device water purifier.

Filtration suffers from the same limitations as heat in regards to

1. chemical toxins (that is where a charcoal filter comes in handy for most toxins; there are a few toxins where a charcoal filter doesn’t even work and sow sand filters are the only alternative)

2. botulism spores (because of size)

3. fungal spores (again because of size)

4. prions (because of size)

UV Light: UV light runs the spectrum from 400 nanometers to 10 nanometers, and it was discovered in the early 1900’s that the most accurate wavelength for killing pathogens is 254 nanometers. In my opinion this should be used in every hospital room and surgical suite in the country, and the number of hospital-acquired infections would almost disappear, -but I digress.

A number of products are on the market, including the steripen Ultra and the Camelbak All Clear with UV devices built in. These are supposed to kill all bacteria, protozoa, and viruses as long as there is limited turbidity to the water. In other words, the water should be filtered prior to using a UV device for optimal results. I own and have used the Camelbak without adverse effects, however, I have been unable to discover at this point at what level of intensity the bulb is set for as not all UV light is adequate for destruction of pathogens. If at the proper wavelength, it should kill molds, yeasts, fungi, viruses, prions, and bacteria, including tuberculosis. If not at the proper wavelength,A the product will only be partially effective on the destruction of pathogens. The limitation is similar to other methods in regards to chemical toxins but should kill spores and prions. Also this method is energy dependent, so extra batteries or a rechargeable version would be necessary for long-term use.

A combination of our UV source and filtration devices give us an adequate duel treatment system for any water we may have to consume in a long-term crisis. In a short-term crisis we have over 1000 gallons of water stored and relatives with a well for a long term solution.

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