H7N9: What should I do?

As of the recent date of writing this article, the CDC does not have any new or special recommendations for the U.S. public at this time regarding H7N9. There is currently no vaccine to prevent H7N9. CDC will keep you updated. If you live outside of the U.S., search the WHO web site often. Stay informed.

Since H7N9 is not spreading easily from person to person at this time, CDC does not recommend that people delay or cancel trips to China. The World Health Organization also is watching this situation closely and does not recommend any travel restrictions.

CDC advises travelers to China to take some common sense precautions, like not touching birds or other animals and washing hands
often. Poultry and poultry products should be fully update its advice for travelers if the situation in guidance is available at Avian Flu (H7N9) in China.
cooked. CDC will China changes. This

The foregoing content is provided and maintained by the Centers for Disease Control and Prevention (CDC).
Okay, I'm on notice, but What should I be doing now to get prepared?

Here are some Helpful thoughts and actions to consider being taken now, to assist your families in being prepared for this next epidemic in the making.
In our home, we are preparing for this H7N9 virus, and getting a two month jumpstart on our normal farm and home routines schedule. One of those ramped up to today instead of waiting until July, is making my family's annual batch of Sambucus nigra Elderberry Tincture, now.
But what is that, and why use that? So glad you asked!

We use it routinely as a supplement, because consuming Elderberry Tincture made with Sambucus nigra elderberries, is an effective alternative to Western pharmaco-medicine. This supplement has shown very positive results in preventing virus's from clinging to the body's healthy cells and aiding the passage of the virus out of the body, all naturally! The commercially made product, marketed as Sambucol, blunts the haemaglutinin spikes on the outside of viruses and stops them from entering cells where they reproduce, causing the cell to explode and allows the virus to continue invading the body. Also, in vitro study, its results has also shown Sambucol to be effective in increasing the production of four inflammatory cytokines, which are effective in boasting your body's immunity, suggesting that the intake of this supplement may have an immuno-stimulatory effect and therefore be worth taking all year round to prevent flu and other viral disease.

Besides, with all this research findings to prove its effectiveness, my maternal Yugoslavian Great-Great Grandmother made Elderberry Tincture for her family and passed on these recipes for us to use and bless US Centers for others with good health for future generations. There are many clinical research trials on the product called Sambucus available on the web for you to additionally search and read more for yourself. Here are a couple: Read what the Israeli research says! 99% EFFECTIVE!

"Retroscreen Virology, a leading British medical research institute associated to Queen Mary College, University of London, announced that Sambucol was at least 99% effective against the avian flu virus, H5N1, and in cell cultures significantly neutralized the infectivity of the virus."

Great! So Can I make my own? and, if so, How do I make my own? Again, glad you asked! YES!

How to make Homemade Sambucus nigra, Elderberry Tincture

Note: Not recommended for administration to Children or alcoholics, due to the high alcohol content.
Materials and Ingredients needed:
6 pint mason jars with lids and ring bands 1 1/2 lbs. of Sambucus nigra, Elderberries 2 fifth bottles of any inexpensive brand, unflavored 80 proof vodka
Order or buy the dried elderberries from a reliable health food store, or from an online source. Herbalcom.com is an inexpensive
source to consider. Amazon.com also has several suppliers available.

Fill a large stainless steel stock pot 1/2 full of potable water, and bring the water to a boil. Carefully submerge all 6 pint sized mason jars, lids, and ring bands, and one stainless steel serving spoon in the boiling water, and set your timer to boil for 15 minutes. Turn off your heat source. Carefully remove the jars with clean tongs, pour off any water in them and lightly shake off
the lids and band rings of water, and allow these to cool to room temperature on a fresh clean towel, with all flat surfaces facing up, to dry.

Using the sterilized spoon, scoop straight into the mylar bag they are packaged in and fill each of the cooled sterilized jars with elderberries up to the 1/3rd full mark. Set the berry filled jars aside.
Now pour the 80 proof vodka into the jars to fill up the jars remaining 2/3rd space, to near totally full. Leave a sparse 1/8th inch head space at the top of the jar unfilled.
Then seal up the jars, by placing on the clean lids and apply the band rings snugly. Place them gently in a cabinet or, on a shelf that is out of any source of direct light and also away from any heat source. They will stay here for 14 days. You can keep the berries in the jars for longer, but 14 days will be the minimum adequate time for the berries to finish soaking in the vodka. Take the jars in hand and once a day shake up the jars contents very well. During this osmotic process that is taking place over the 14 days, the elderberries will be taking up the alcohol and successively extracting off the berries medicinal anti-viral properties into the liquid, to give you a quality finished product of tincture of the berries.

After 14 or more days, (but never longer than 21 days), use a sieve strainer to separate the berries from the juice caught into a clean bowl. Press down on the berries in the sieve strainer with your spoon, to get all of the juice from them into the bowl of tincture.

Finally, pour your filtered elderberry tincture back into the jars and place the rinsed clean lids back on and tighten the ring bands well. Label the jars with contents and date. There is no need to heat or pressure seal the jars like you would in canning. In fact, a heating process used on this tincture would kill the anti-viral properties of it. Your tincture should keep for storage and use for a few years, as long as it is stored in a cool, dry location. The vodka is also the long term preservative medium in this recipe. You now have your own homemade Elderberry tincture to begin using.
Okay, now while that recipe is being turned into usable tincture, you may want to also create this temporary use syrup, which has a "no wait time", to consume it for some protection of boasting your immunity with a ready-made homemade supplement. It will get you through an unexpected "viral flu attack" season, or again, through the period of time while waiting for the more anti-viral potent tincture to age for use.

Homemade Elderberry Syrup
Note: can be considered for use of children over 24 months of age. Raw Honey should never be administered to children under the age of 2 years.

2 cups dried Sambucus nigra elderberries 1 quart of boiling water 1/4 cup raw honey 1/4 lemon juice
Put the elderberries in a non-reactive metal or glass saucepan, add the boiling water and cover the pan and leave it out on the stove or counter to soak overnight. The next day, low simmer the berries for 30 minutes, set aside to cool a little, then put the mixture in a food processor or blend them.
Once blended well, add the honey and lemon juice. Cool, then pour into a clean mason jar or dark glass bottle. Store this in the refrigerator and use the syrup daily.
Here, I offer other important considerations to take to help boost and prepare the human body's immune system in protecting it from viruses, and other physical and logistical preparations to make and consider for your family to do now, don't dawdle!

1. Adults, and teens, start taking 2000 UI per day (one pill) of Vitamin D3, and extra Vit C. consumption.
Note: The Fat soluble vitamins, which are vitamins A,D,E & K can be toxic to your body organs if you take dosages past the recommended daily allowances.

2. Begin to increase that dosage US, to 4000 UI per day (two pills) of Vitamin D3, only for the duration of the epidemic.

3. Also start taking one tablespoon of Elderberry Tincture, per day and continue to do so, or make the Elderberry syrup and begin using it now, and until the viral epidemic is cleared by the CDC or becomes non-life threatening in the your region.

4. Note: There is a non-alcoholic version of Sambcus available for small children, Nature's Answer Sambucus nigra Black Elder Berry Extract Kids Formula, just look for Sambucus nigra at your local health store, or order some online now. Don't wait until the virus is reported in the US, because it will become scarce or totally unavailable when the virus starts spreading to our country's geographical direction.

5. Prepare to not leave your home once the virus has entered into your geographical region. Consider enforcing a rule in your own homes, of no outside human contact, other than with those staying quarantined inside of your own household or property gate. Consider options for your work outside of the home. Consider having any normal prescheduled farm or home need deliveries of animal feed, fuel, hay, or supplies done now, instead of later.
A self imposed protective quarantine or closing off your property to others is strongly advised if this virus becomes epidemic and deadly. Bookmark and Check your state dept. of health and the CDC web sites daily to see where the virus is being transmitted from and moving to, so you will know to effectuate this protective quarantine of your family.

6. Do not handle mail or packages delivered by the mail carriers or from delivery carriers during this self imposed quarantine.

7. Dehydration is caused due to loss of body fluids by high fever and sweating, in loss of respiratory secretions associated with respiratory infections, with nausea, which causes vomiting and with diarrhea, which are all showing to be significant symptoms of this virus, that can quickly become life threatening if you are not prepared to immediately counter their effects of the body and actively treat them. Children and infants have much less body mass, and if they develop any of these symptoms and continue having them excessively for prolonged periods, over 4 hours, you should seek emergent medical help.

For the whole family's use, have extra potable water stored for use, store Pedialyte, Extra Formula, Gatorade powders, Tylenol,(acetaminophen), Aspirin and otc anti-diarrheals and remember to get on hand extra of any medications you are already prescribed to take if the Virus jumps from Asia to the routinely. Procure and store several boxes of disposable nitrile gloves, kleenex tissues, extra toilet paper, disposable towels, disposable eating utensils and plates and large garbage type plastic bags for trash disposal use.

8. Stay Home and away from crowds of people. If you must absolutely go out into the general public due to emergency needs which cannot be met at home during this epidemic, you will need to wear N95 masks and gloves at all times, with long sleeves and long pants, cover your body up as much as possible, as this flu is transmitted by human contact on any surface contact made by carriers of this virus. Don't hug, kiss, or shake hands. Disrobe immediately upon returning to your home from the outside world, disrobe in the garage or carport, and then bag up your soiled clothes. Discard the disposable mask and then take off and dispose of the gloves, into a bag lined lidded bucket placed outside of your home. Wash your clothing separately from others in your household, in hot soapy water and wash your face and hands, better yet, go take a hot shower, wash your hair, and add the towels you use to the washing machine with your dirty clothing. Don't forget to disinfect your car wheel, and mobile phone, and seats and floor board and mats.

Again, make sure you have ample supplies that you will need to use, on hand in your home, your vehicles, at your work place, as well as ample food stocks and water set aside in every number of the locations you may decide you need to move from or go to.

9. Make provisions for bagging up or burning your household trash. Do not handle your curb-side waste containers that have been handled by contracted disposal companies.

10. Take special precautions to wash your hands often during the day with soap and water, before and after going shopping for your food at the grocery, wipe off cans and packaging before you bring them into your home from your vehicle. Wash up after handling any produce or food imported from other outside countries, and after handling any food preparation tools. Especially be cautious after touching any live animals. Do not let your pets have free run outside of your property gates. Use meticulous washing after using public restrooms. Use a paper towel to touch a public restroom door to exit it. Wash surface areas with diluted bleach water mixed at a 10:1 ratio in a spray bottle. Don't forget to wipe down your phone receiver often and computer mouse and keyboard.

I am a holistic medicine-practicing RN, and wife to a MD. I have No affiliations with any companies mentioned in this article other than purchasing some of their quality products for our home use, nor have I merited by any free products or compensation for the recommendations of their products. Also, you are responsible for what you consume into your own body, thus I am not advocating intake of any substance to which you have not thoroughly researched for yourself. As with any human consumption, allergies to substances need to be heeded and avoided in the ingredients noted in any of these recipes, if you are known to have allergic food reactions. Dosages of alternative products made yourself need to be titrated individually and according to the
products used and to your body weight and age.

I pray that this information will be fruitful to you and will assist you and your family, in being prepared for the next coming epidemic.
GodSpeed to your Health Preparations and May HE Bless you and Shelter your family with Protections from this Deadly Disease!

A thoughtful EMT wrote me to ask:

Dr. Koelker:
What effect could you have on blood sugar for a diabetic (type 1) through blood transfusions? I am a paramedic, and our field treatment for high blood sugar is IV fluids until the hospital can give them insulin to lower the blood sugar. In a SHTF scenario, there is no hospital. The thought process got me thinking though....My questions are these:

1) What, if any effect could you have on lowering blood sugar through transfusions? i.e., basically finding a non-diabetic donor match, and swapping a couple pints of blood...the non-diabetic can process any sugar, and the diabetic gets blood sugar lowered by dilution.

2) Could you time a high sugar meal for the non-diabetic to manipulate the blood you were donating? Could you get enough glucose and insulin transfused to affect the diabetic’s intracellular glucose?

3) If the science and idea are valid, would it be able to have any appreciable effects or would you be re-arranging deck chairs on the Titanic?

The idea intrigues me, because blood transfusion gear can store a lot longer than insulin.

Thank you- Eli
 
Here is my reply:
Excellent questions, Eli.  I’ve pondered the possibility myself and will offer my preliminary conclusions.
First, theoretically, the answer is yes, it could work. 
For example, in a scenario where, say, identical twins would essentially share the same pancreas, IV lines could be connected in a continuous system, allowing the diabetic’s blood to enter the non-diabetic’s system, with the “treated” blood being returned in equal amounts from the non-diabetic to the diabetic. 
This is not quite the same as swapping a couple pints of blood, as I’ll address below.
Eli’s preliminary questions raise several more:
1.      Who is a suitably-matched donor?
2.      Would a non-diabetic be the best donor? 
3.      How much blood would need to be transfused?
4.      How long would this arrangement work?
5.      Should the non-diabetic receive blood back in return?
6.      Should serum be used instead of blood?
7.      Could the blood be administered via a different route?
8.      Could non-human blood be used?
9.      Could God have left us a simpler answer for treating diabetes Type 1 than we’ve discovered to date?
To begin with the end, I believe #9 above could well be true.  Though science has investigated pancreatic transplantation, islet cell transplants, stem cell manipulation, and other high-tech options, no simple solutions have been found, but they yet may be out there.
And so, at TEOTWAWKI, what to do? 

(Before I go on, let me say don’t miss the March 13, 2013 SurvivalBlog article by AERC regarding Insulin Dependent Diabetics.  The author offers many excellent suggestions along with personal experience as a diabetic.)

But the question remains: what to do if no insulin is available?  Would transfusion work?
A few calculations will help explain:  In the non-diabetic, serum insulin levels average <30 microUnits/ml (that’s 0.000030 Units/ml), or 0.003 Units per liter of blood or serum.  (In a type 2 diabetic with insulin resistance, the serum insulin level may actually be higher than normal.)  If a type 1 diabetic requires 24 units of insulin/per day, that’s 1 unit/hour, or 0.0427 Units per minute, if my number-crunching is correct (and let me know if it’s not).    The calculations are actually quite complex, in part due to the half-life of insulin, along with multiple other factors. 
To simplify the computation enormously, if it takes a serum insulin level of around 10 microU/ml to metabolize a serum glucose level of 100 mg/dL, it would take about 5 times that much insulin (or non-diabetic blood) to regulate a serum glucose level of 500.  To treat a diabetic’s blood sugar of 1000 could require all the insulin within a non-diabetic’s circulatory system – and clearly you can’t donate all your blood multiple times a day (except in the shared-pancreas arrangement described above).
If a diabetic’s blood glucose level of 900 were suddenly diluted 50:50 with a non-diabetic’s blood (which isn’t really possible), this would decrease the level to around 400 mg/dL to start, then perhaps 50 points further due to transfused insulin . . . but only for a very short time, on the order of hours at best.  And in order to administer this much blood, an equal amount would have to be removed via blood-letting.

Given an unlimited blood supply and ICU-level nursing, perhaps this could be accomplished, but considering factors likely to be present at TEOTWAWKI, the challenges appear to be insurmountable.

Additionally, to answer a few more of my own questions above:
1.      In the identical twins shared-pancreas scenario, with blood going in and out of each person, blood typing is not a problem.  However, for others to share blood back and forth, both the diabetic and non-diabetic would need to be compatible to both donate and receive blood.  Simple ABO/Rh typing does not prevent all transfusion reactions, and of course even correct typing does not eliminate the possibility of infection or fluid overload.  Still, in a life-or-death situation, with a supply of insulin expected to be available shortly, it could be considered.  (Make sure to obtain a blood donation compatibility chart if you would consider transfusion for any reason.  You’ll either need to know everyone’s blood type ahead of time, or learn how to crossmatch it yourself.)
2.      Theoretically a normal weight or an overweight person, even a mild Type 2 diabetic with insulin resistance, could serve as the donor.
3.      Serum alone is not likely to work because transfusion alone is not really feasible.  The only way I see transfusion working is the shared-pancreas scenario already described. 
Next, what about non-human blood?
Animal-to-human blood transfusions have been tried hundreds of years ago, but were often fatal, and assuredly would be fatal using large volumes of blood.
But could the insulin within, say, a gallon of cow blood be put to use some other way?  
Theoretically, maybe so.  The blood would need to be centrifuged promptly to remove the cells, since the blood cells themselves remain metabolically active until they begin to break down.  The serum could be further concentrated by evaporation at room temperatures (with careful attention to sterile technique).  The resulting insulin-containing liquid should not be given intravenously but might be effective via a rectal infusion, high in the anus (see Oral Insulin (Swallowed) and Rectal Insulin Suppository for Diabetics by T.R. Shantha, MD, PhD, FACA).
Although insulin does not degrade when given rectally as it does when given orally, absorption is a potential problem.  Although some insulin is absorbed rectally, I can find no answer to whether bovine insulin would be – but it might work.

Another possibility would be an enema of blenderized bovine (cow) pancreas, though the pancreatic enzymes might irritate or even perforate the colon – perhaps a reader would like to try this experiment on rats or rabbits before trying it on themselves.  Allergic reactions are also a concern.

The earliest treatment of hypothyroid patients involved implanting (not transplanting) sheep thyroid tissue into a patient.  Surprisingly, it worked.  So could the same idea work with insulin-dependent diabetes?  Again, I don’t know, and again the pancreatic enzymes could be a problem.  But it might work, to a degree.  Perhaps a curious reader would be interested in trying this experiment on their diabetic pet.  Answers simply cannot be obtained without experiments (some of which end badly for the subject). 

Transdermal insulin use has also been studied, but requires ultrasound or iontophoresis for transport through the skin.  Could a slurry of pancreas be used on the skin?  We just don’t know – I doubt it’s been tried.  The pancreatic enzymes may irritate the skin.  Alternatively, the same enzymes may aid insulin absorption.  Insulin itself has some deleterious effects when applied topically.  But if the choice is death or experimentation, necessity becomes the mother of invention. 

In summary, the analogy of re-arranging deck chairs on the Titanic is probably valid regarding using transfusion to lower blood sugar, but if I had a child with Type 1 diabetes, I’d be motivated enough to start experimenting, maybe even learn how to follow Banting’s recipe for insulin.  And I’d do some hard praying about stem cells – the answer to a new pancreas lies within our bodies; how to unleash it is the only question. 

About the Author: Dr. Cynthia Koelker is SurvivalBlog's Medical Editor. her web site is www.ArmageddonMedicine.net.

In One Second After, William Forstchen describes a cataclysmic scenario, a widespread EMP effect that is only slightly less devastating than nuclear near-annihilation. The protagonists in JWR's novel Patriots fare better temporarily because the physical infrastructure remains relatively intact for a few weeks after the nation’s economic collapse. In either scenario the five epidemics that are already under way in the United States give new relevance to TEOTWAWKI.

Epidemic (from the Greek: among the people): prevalent and spreading rapidly among many individuals within a community at the same time; widespread.

The five epidemics:
            Obesity
            Type 2 diabetes
            Osteoporosis
            Dementia
            End-stage renal disease (kidney failure)

Although it is the leading cause of death in the United States, heart disease resulting from coronary atherosclerosis is not an epidemic according to the above definition. It is not spreading rapidly but is well established and mortality
is actually decreasing slightly because of modern treatment.

Epidemic #1: Obesity
Obesity is the linchpin for the other four epidemics.
From 2000 to 2010 obesity increased by 80 percent or more in 39 states. The Centers for Disease Control and Prevention estimate that by 2030 42 percent of Americans will be obese, nearly half again as many as currently bear that burden. A study from Duke University indicates that morbid obesity, a weight 80 pounds or more above standard weight, will affect 11 percent of the U.S. population. Obesity is clearly “prevalent and spreading rapidly among many individuals” as defined above.

Inactivity is a major factor in the obesity epidemic. A century ago only about 5 percent of Americans were obese but labor-saving devices and automobiles have reduced the need for physical activity for the average person by nearly 75 percent. The typical American adult or child spends 8.5 hours a day watching television and using a computer or similar devices.
Diet is the other major factor that leads to obesity. Over the past 4 or 5 generations we have replaced whole-grain products with those made from refined flour and we have increased our consumption of sugar several-fold. The average American consumes 40 pounds of sugar in soft drinks alone in a single year. When the SHTF, whatever the cause, our food supply will be severely compromised.            

One might think that the one-third of our population that is obese will be able to live off stored energy and will survive longer but they will not. The reason is that very few of them are free of medical problems. Obesity is simply not compatible with good health. There are no exceptions. To think otherwise is delusion.

Epidemic #2: Type 2 diabetes
Type 2 diabetes is the fastest-growing chronic disease in the world. It affects more than 25 million Americans and 57 million more have prediabetes (defined as a fasting blood sugar between 100 and 125), half of whom are not yet aware of their condition. The CDC projects that one-third of the population will have type 2 diabetes by 2050. Among Hispanic females that number will reach 53 percent.

Type 1, early onset or juvenile diabetes, is a disease in which an autoimmune process completely destroys the insulin-producing cells of the pancreas. A severe reduction in carbohydrate intake will postpone the inevitable in some persons with type 1 diabetes but not for long. They need insulin daily in order to survive. Reduced supplies of all forms of insulin and the lack of effective refrigeration mean that their days are numbered, as described so tragically in One Second After.

Type 2 diabetes was once known as adult-onset diabetes but it has become common in adolescence and it occurs with some frequency among pre-adolescent children. Persistently high levels of blood sugar cause cells to be come unresponsive to the action of insulin. After a period of such insulin resistance the cells that produce this hormone eventually fail.

A lifetime of moderately intense physical activity almost eliminates the risk of developing type 2 diabetes. Experts refer to it as an exercise-deficiency disease. Sometimes it results from a genetic disorder or from prescription medications but these are in the minority. In reality, more than 90 percent of persons with type 2 diabetes are inactive and overweight or obese. Among those who appear to be of normal weight, some fall into the category of normal-weight obese, persons who have gained fat but lost muscle. Although their weight is normal, their waist size reveals the truth because a pound of fat takes up more space than a pound of muscle.

Diabetes is a disease of blood vessels. That’s why its worst complications, heart disease, stroke, kidney failure, blindness and limb amputation are so common. These complications appear faster and earlier among children because those growing bodies are constantly forming and re-forming new blood vessels as they increase in size.

When the SHTF death rates will rise dramatically among those with both types of diabetes. Type 2 diabetics who have mild disease will fare better but most of them have
complications that will worsen without prescription drugs. Lifestyle changes can postpone the need for insulin but when metformin and other drugs become unavailable, complications of the disease and mortality will rise rapidly. 

Survivalists with type 2 diabetes should double down on their efforts to lose weight and to become physically fit. Those who can afford to stock up on medications should do so. Pharmacies will be depleted of stock as rapidly as grocery stores when the SHTF.

Epidemic #3: Osteoporosis
The incidence of this bone-thinning disorder will reach epidemic proportions by mid-century. Like type 2 diabetes, osteoporosis is an exercise-deficiency disease. It is not due to an inadequate calcium intake. Lack of calcium makes bones soft, not brittle. Two examples are childhood rickets and adult osteomalacia. The first is due to a lack of vitamin D that inhibits the absorption of calcium; the second has several causes, including chronic kidney disease. These calcium-deficient bones do not break; they bend, causing extreme bowlegs, for example.

There is a bone-building window between the ages of about 5 and 25 years during which the body completes the formation of almost all of its bone mass. Once closed, that window never reopens. The process requires two elements: moderately intense physical activity and proper nutrition. Today’s young people fail on both counts and will face an epidemic of broken hips and collapsed vertebrae when they are eligible for Medicare (if it still exists then).

Only a couple of generations ago most kids walked a lot, rode bikes, climbed trees, participated in pick-up games of various sports, frolicked on monkey bars and roughhoused. Safety concerns, urbanization, organization of sports, cancellation of Physical Education classes in school and other factors limit those activities now. Computer games and television occupy about half of their waking hours today.

Calcium is important during these bone-building years but children now drink twice as much soft drinks as milk. In the 1970s it was just the opposite. Other nutrients for making strong bones include several vitamins, magnesium and omega-3 fats but children who don’t get many vegetables but eat plenty of junk food get few of them. Nearly half of today’s adolescents are deficient in vitamin D because they spend so much time indoors.

Few people, including those in the medical field, are aware that pregnancy factors will affect the skeleton of the fetus when that infant reaches middle age. A pregnant young woman who exercises little, smokes and has poor nutrition will herself have an inadequate bone mass. Her baby will too, the evidence of that being that the rate of forearm fractures among school-age children has doubled since the 1970s.

Most adults lose bone mass year by year because of their sedentary lifestyle. Without regular, moderately intense physical activity bones become less dense and break easily in a fall. Exercise, especially resistance training, helps to restore some of the bone mass that has been lost during years of inadequate physical activity.

Why is osteoporosis a problem in TEOTWAWKI? A hip fracture almost always requires hospitalization, perhaps surgery. Even with modern medical care about 25 percent of persons with a hip fracture die within a year. Picture the scenario when the SHTF.

Epidemic #4: Dementia.

Dementia consists of two different conditions, Alzheimer’s disease and vascular dementia. Alzheimer’s disease is a disorder whose cause is uncertain. Genetic factors play a major role in about half of its victims. As our population ages it is estimated that Alzheimer’s disease will affect about 25 percent of the population by the age of 85.

Vascular dementia is the result of narrowing of the blood vessels of the brain. Diminished blood flow prevents brain cells from being properly nourished and removing waste products. The result is poor mental function, memory loss and shrinkage of brain tissue. Type 2 diabetes has become the most important cause of vascular dementia.

Persons with dementia require attentive personal care for their nourishment and hygiene requirements. I cannot predict what will happen to them in a TEOTWAWKI scenario but many of them have one or more chronic illnesses that require prescription medications that are likely to be in short supply. In a worst-case scenario they will have a low priority for treatment.

Epidemic #5: Kidney failure (End-Stage Renal Disease)

The kidney is little more than a collection of tiny blood vessels in close contact with equally tiny tubular structures, the combination forming a filtering system that removes waste products in the form of urine. When normal blood vessels within the kidney are replaced by those that have become deformed and scarred because of diabetes or other disease, toxic by-products accumulate within the body. A dialysis machine – what some persons still refer to as an artificial kidney – cleanses the blood in 3 or 4 treatments per week.

When the nation’s power grids fail because of an EMP or a devastating cyber attack it will take the lives of hundreds of thousands of dialysis patients with it. In 1972 there were 10,000 persons on dialysis; in 2010 that number reached 350,000, even as dialysis centers were struggling to keep up with the demand. If the CDC’s projection for type 2 diabetes, the primary cause of kidney failure, is correct that number could soar to more than a million in a couple more decades. The yearly cost of dialysis ranges from $15,000 to $50,000 per year and it will make kidney failure one of our most expensive epidemics.

There is no alternative treatment for kidney failure. Kidney transplantation, which may require a year or two on a waiting list, is not an option for millions of diabetics and it certainly will not be at TEOTWAWKI.

Dialysis units will stop working when the lights go out. Patients with end-stage renal disease will be among the grid failure’s first casualties.

Finding solutions: Genes load the gun; lifestyle pulls the trigger.

All these chronic conditions are lifestyle-related and are not due to genetics or to aging. They were either rare or nonexistent barely a century ago and not because people are living longer and have more time to acquire these diseases. Centenarians in places as diverse as Okinawa and Sardinia are slender and fit and can name their great-grandchildren. They have almost no heart disease and type 2 diabetes is virtually non-existent. Elderly hunter-gatherers don’t develop these diseases either – until they become civilized.

To be sure, if the pharmaceutical industry were to collapse in a SHTF scenario we would again face new threats from old infectious diseases but the thin and the fit would fare best. Obesity and diabetes weaken the immune system but exercise strengthens it.

Scores of posts on SurvivalBlog urge us to maintain a high level of fitness and to keep our weight, i.e., body fat, at normal levels. No one is too old to exercise and eating sensibly (quantity and quality) is not rocket science. It’s not too late to begin a healthy lifestyle. It may be the key that will help you to survive in TEOTWAWKI.

About The Author: Philip J. Goscienski, M.D. is a retired pediatric infectious diseases specialist, CPR instructor, columnist and author. His book, Health Secrets of the Stone Age, Second Edition, Better Life Publishers, 2005 has won three book awards. He has archived more than 400 weekly newspaper columns at www.stoneagedoc.com.

Dear Editor,
I am an emergency physician practicing in Southern Californistan. I share TXNurse's concern about influenza in general, and especially new variants of Avian Influenza, like H7N9.   Her information is current and valuable.  I would urge standard OPSEC on this information if you are a nurse or physician or other health worker.

Many of my colleagues pooh-pooh my concerns about Influenza.  They just don't believe it.  And these are educated physicians!  Given many of them are liberal and believe FEMA will protect them and all that, but even so you would expect a nod from other physicians about the threat, given the history of the Great Pandemic of 1916-1918.   

Our family knows the value of OPSEC.  We just don't discuss our preparations, especially as to Influenza.  My wife, a Nurse by the way, and I already monitor world influenza cases, and have email alerts regarding influenza.  

One thing we have done that others may find helpful is to have pre-determined sentinel events for keeping our children home from school and implementing quarantine.  Our quarantine triggers involve cases in adjoining states, a pattern of progressive number of cases, and so on.  Our triggers may not fit yours, so research the data as to your local situation and prayerfully make a decision.

One more note regarding OPSEC.  Two months ago our doorbell rang about 9PM.  Odd.  While I went to the door, our son stood by at the ready.  It was a previous ER patient who wanted me to loan him money for rent.  I expressed my concern, but told him I couldn't loan him money and suggested some alternatives.  I don't know how he made my address, but nowadays your address is all over the Web.   This rattled me, and I told one of my few Prepper ER doc friends about it.  He reminded me to drive home by different routes when I get off shift.  

FWIW, I am not an epidemiologist.  I'm just an ER Doc.  - Doc C.J.

Influenza A viruses originate from various avian species, and almost exclusively begin in China. Influenza A viruses have always infected many different species of birds. Often initially seen in one species, they frequently cross over and cause illness in another species, this is called mixing, mutation or antigenic drift. This is how new subtypes of viruses are created. Eventually these viruses progress until they mutate enough to become infective to mammalian hosts (us). These viruses can be highly infective, easily transmissible and very lethal in humans. Most of us have probably heard of the H1N1 virus that took a substantial toll on the world’s population in 2009, and continues to be a threat during flu season. Many still may be familiar with H5N1. This subtype appeared around 1997 in China and has made slow progress to become more adaptable with human to human transmission (H2H). In the last 10 days China has made announcements (almost daily) of cases of severe influenza that has been subtyped as H7N9. This particular strain has been known to infect birds, but up until this point not humans. The number of cases daily, including deaths has been alarming. The World Health Organization (WHO) and the Centers for Disease Control (CDC) are taking this new development very seriously. What the 3 subtypes mentioned above have in common is that when they first appeared they are what scientists and virologists call Novel subtypes (meaning new to humans). Depending on the way they have mutated and adapted to become infective to humans has a lot to do with how lethal they are to us. The unique genetic sequences of these viruses also give virologists insight into how lethal they may be, and what their “case fatality rate” (CFR), may be on the general population.

My intent on writing this article is to make it as easy as possible for everyone to understand the importance of how serious a novel pandemic can be to us without getting bogged down with the scientific terms, and how important it is for us as prepared individuals to know how to handle and stockpile for a pandemic with a high CFR. My background is in critical care. For the past 24 years I’ve worked in an Intensive Care Unit, and have taken care of numerous influenza patients. We had quite a few patients on ventilators in 2009, and we lost some young people with serious pneumonias and multi organ failure. I have always been interested in epidemiology and in the mid-1990s began researching influenzas extensively. What has me particularly worried about H7N9 is the rapid development of this novel subtype, and the possibility that there is already human to human transmission. As of 4/12/13 China has reported 49 cases, 11 deaths, many remaining critical and only two recoveries. This may not sound worrisome to most people, but if you knew how difficult it is to get accurate information and numbers out of China, it is quite astounding that they are admitting to these cases so quickly! This leads me to believe that there are many more still unreported. We do not have a complete picture yet, with possible “mild” cases factored into the numbers, but the numbers we do have show an extremely high CFR (probably greater than 50%). In comparison the last great pandemic in our recent history was the Spanish Flu of 1918, it had a CFR of 2% and it killed approximately 50 – 100 million people world wide. The World Heath Organization, CDC, and much of the scientific community believe it is only a matter of time before another novel pandemic virus hits the world again. Normally in each century the world has approximately three flu pandemics, this was the case in the last century, we had two mild pandemics in 1957 and 1968, which increased the overall mortality rates throughout the world, but not significantly, and still had the elderly and infirm as its primary victims. The Spanish Flu in 1918 was quite different in the fact that its primary victims were young and healthy people in their prime. Scientists believe this was primarily due to something called a “cytokine storm”, which occurs most frequently in the young healthy population, allowing a person’s own immune system to over react and attack vital organs, especially the lungs. This is also what we saw to some extent with the H1N1 virus in 2009. Currently with H7N9 victims the reports have stated that most became very hypoxic (short of breath) fairly soon, and most progressed rapidly to multi organ failure.

Effects of Past Pandemics on the United States
Pandemic    Estimated U.S. Deaths      Influenza A Strain     Populations at Greatest Risk

1918-1919       500,000                            H1N1                      young, healthy adults
1957-1958         70,000                            H2N2                      infants, elderly
1968-1969         34,000                            H3N2                      infants, elderly
2009-2010         18,300                            H1N1 (swine)         young, healthy adults

Please note that all these recent pandemics had a CFR of 2% or less. World wide the current CFR for the slow adapting H5N1 virus is greater than 60%, which means that every 6 out of 10 people who have caught the H5N1 virus have died! I shutter to think what the CFR will be for the H7N9 virus that appears to be adapting to humans at a much faster pace.

Seasonal Flu vs. Pandemic Flu what is the difference?

The seasonal flu is the normal flu we see arrive every year usually starting sometime in the fall and lasting until sometime in the spring. Each year we see slightly different variations of influenza virus subtypes that have been around for awhile, and most of us have some antibodies and immunity to some of these subtypes. So when it comes time to look at making the next season’s flu vaccine our influenza specialists usually look at the three most prevalent subtypes we just had and begin to culture these viruses in fertilized eggs (scientists are working on cell based vaccines now for faster deployment of vaccines, soon to be common place I hope) and then combine them to come up with our new vaccine for the coming flu season (this is the simple version). The process to make a new vaccine usually takes about 6 months. The seasonal flu can target 5 – 30% of the population, and usually makes you feel horrible for about a week or so. Complications arise in people with compromised immune systems and in the very young and elderly. Deaths occur usually from a secondary pneumonia infection. Getting your flu vaccine every year greatly reduces your chances of getting the flu. The experts who just made the new vaccine are hoping the new subtype out for the season will at least be partly covered by the vaccine. I’ve heard many people say they “got the flu” from the shot. That really is not possible as the vaccine is made from a “killed” virus, your arm may hurt and some people may have a slight fever, with minimal other discomforts, but I believe you are better off being vaccinated.

A pandemic flu occurs when we have an avian species coming up with a new subtype that we have no antibodies or immunity to. The virus goes through several stages until it mixes and mutates to become easily transmissible to humans. This novel strain can possibly be very lethal. “Pandemic” simply means it will become a global problem (because of the newness). A global pandemic flu will likely target greater than 50% of the world’s population due to the fact that none of us has any immunity.

Consequences of a Global Flu Pandemic

In a typical disaster which usually happens to a localized area or country, resources are mobilized to help with the recovery. In a global flu pandemic there are no resources from unaffected regions to mobilize, it will be every region, every country, every family fending for themselves. In a global pandemic the disaster is unrelenting (up to 12 – 18 months), which will thwart any effort to recover. Hospitals will be overwhelmed in days to 1 – 2 weeks. Because of our “just in time delivery systems” that every corporation now uses, medical supplies will become nonexistent in days. The hospital I work in usually has a pharmacy delivery twice a day. As an example of the systemic system weakness people will walk off their jobs and go home due to the fear of catching the flu and bringing it home to their loved ones. This will greatly affect our supply chains for all our resources; groceries, medicines, fuel, etc. Hospitals are not just made up of Doctors and nurses, we have ancillary departments that are fundamental in the care and operation of our hospitals. Suppose just one department, like Nutritional Services is affected first, either by fear of coming to work, or by people who have caught the flu, how do our patients get fed? Within days many departments in the hospital will be depleted of personnel, again either by not coming into work, or becoming victims of the flu. Emergency Room departments will be completely over run very quickly, and unfortunately in most cases there is not a whole lot we can do medically for people with a viral infection. Flu usually has to run its course, and if we do not have IV fluids for hydration and any antivirals left, how do we care for these people? People requiring a ventilator for lung support will be out of luck, as this number could be in the thousands, or worse, millions. Our hospital has 5 ventilators at any given time, in times of extra need we can rent maybe 1 or 2 more in our area. It is my firm belief that if we had a global pandemic occur with a high CFR we will be taking care of our own sick, at home. The smartest way is to prepare ahead of time with supplies at home, and be prepared to quarantine your family during the event.

What are the Symptoms of the Flu?

Pretty much what we are already familiar with: sore throat, cold, fever, chills, nausea, vomiting and muscle aches. Warning signs for an immediate Doctor or ER visit would include severe acute shortness of breath, bluish skin (fingers, lips, etc.), seizures and dehydration.

What is the incubation period for catching the flu?

The time between human exposure and onset of illness (incubation period) is usually 2 – 4 days, sometimes up to 7 days. (If I had my family in isolation/lock down for a pandemic and another family member came, I would quarantine them for up to 14 days).

How long does a Pandemic last?

Generally flu pandemics come in three waves, with the second wave usually being the worst. For a global pandemic you are usually looking at up to possibly eighteen months for the three waves to have made their rounds and begin to subside. Currently the CDC has stated that in the recent past they have tried to make a H7 vaccine “just in case” and have had difficultly with it conveying immunity. This may be a big problem for us, as it could take up to a year or more to have a vaccine available to vaccinate our total population.

How contagious is the flu?

The influenza virus can live on an inanimate surface for up to 48 hours; it can live on your clothes for up to 8 hours.

How is the flu spread?

The flu can be spread by droplet infection: coughing, sneezing, bodily fluids. It can be spread by direct contact: shaking hands, door knobs, computer keyboards, shopping carts, etc. The flu can also be airborne, and many influenza experts call for social distancing during a pandemic while out in public or at work (6-10 feet), and if you are out in public during a pandemic you should be wearing personal protective equipment  (PPEs).

What can I do to prepare my family for a pandemic?

Make sure your family members are up to date on their vaccines, such as the annual flu vaccine (this could possibly convey some immunity to a new virus, not really sure if it would or not). The pneumovax vaccine is also very important, this protects against 23 types of bacterial pneumonia. Hepatitis A is not a bad idea if our utilities are not working and we are forced to drink or eat questionable water or food. A tetanus vaccine is also important, as everyone should have one every 10 years. Be sure to contact your own Physician and discuss these maters with her/him.

The single most important thing we can do during a flu pandemic while at home, work or in public is practice good hand washing skills. This means using plenty of soap with warm to hot water and scrubbing 30 – 40 seconds, remember to get the back of your hands and in between your fingers, under your nails and up your arms. Rinse thoroughly and dry with a paper towel and then turn off the water with the paper towel, so as not to contaminate your hands on the dirty faucet handle. Using a alcohol based hand sanitizer is also recommended (not a antibacterial soap that is not alcohol based). To use this thoroughly wet your hands with the sanitizer and let air dry, do not towel dry. If you are sneezing or coughing be sure to use Kleenex, and properly dispose of them, if Kleenex is not available sneeze into the fabric of your shirt sleeve. I think sneezes have been clocked at 200 miles/hour, that can really travel some distance! Frequently clean your work surfaces at home and at work with either germicidal wipes or a weakened bleach solution (one part bleach to 4 parts water), don’t forget your telephones and computers!

Medicines and Personal Protective Equipment (PPEs)

Lets talk about antivirals first: Neuraminidase Inhibitors have been proven to be effective for some people during normal flu seasons and also with the 2009 H1N1 pandemic, and for some of the unfortunate people who contracted the H5N1 subtype, these antivirals may not prevent the flu, but they can lessen the severity and duration of the flu. Some of these antivirals are Tamiflu, and Relenza and the M2 inhibitors Amantadine and Rimantadine. If you have an understanding physician try talking to them now and see if you can get some prescriptions for these drugs. The first two listed have proven to be the most effective, but depending on the specific subtype, some of the viruses have become resistant to the antivirals. Please be sure your home is stocked with plenty of pain and fever reducers. Also be sure you have working thermometers on hand. Have a blood pressure cuff at home and learn how to use it properly; low BP can be one of the first signs of complications.

Particulate Respirator Masks – these ideally should be “fit tested” to be worn properly, you could try going by your local hospital and see if they could show you the proper way to wear the mask. If that is not possible be sure the mask fits snuggly around your face covering your nose and mouth without leak areas (guys….this means no mustaches or beards). These masks must be NIOSH approved N95 rating or higher. A surgical mask is a second (although poor) alternative if respirators are unavailable. One mask can usually be worn for approximately 8 hours, if it has not become soiled, contaminated (taking off and on), or becomes too moist. Nitrile, latex, or vinyl (if you have a latex allergy) single use exam gloves. These come in boxes of 100, you can find them cheap at Sam’s or Costco. The masks can be ordered from places like medical supply companies. You need to have a lot of these on hand, try to get appropriate sizes for your kids if you can. You also need eye protection, wear goggles or a face shield. Goggles should have the side protectors, these can be found at medical supply companies and stores like Lowe’s or Home Depot. Often I have seen pictures of people in the world wearing only masks and not goggles during a pandemic, this was especially evident during the SARS out break. With droplet infections you are contaminated by coughing and sneezes into your mucous membranes…..that includes your eyes! Don’t forget your alcohol based hand sanitizers, and germicidal wipes.

Gowns – a long sleeved cuffed disposable gown may be needed for direct care for an infected person.
 If you are caring for an infected person at home in the case of a severe pandemic and hospitals are closed or full be sure to isolate and quarantine this person to a separate part of the house if at all possible, and have only one primary care person who always wears their PPEs. Keep all materials to care for the infected also separate. Be sure to dispose of  any items that may be soiled or contain bodily fluids very carefully, and away from other family members.

Hydration of the person with flu is extremely important, especially if a hospital is not available. This can prove daunting for someone with nausea and vomiting, but it is imperative if you are the care giver to keep trying to push fluids.

Electrolyte drink
½ tsp. baking soda
½ tsp. table salt
3-4 tbsp. sugar
1 quart water
Mix well, flavor with lemon or sugar free Kool Aid.

Keep a daily record of the person who is ill, include temp, blood pressure, and respirations. Also take daily temps of other members of your family (with a separate thermometer), and be prepared to separate and isolate any additional family members who you believe may be becoming ill. Make sure the infected person is urinating regularly, and in good amounts, if they aren’t this is the first sign of dehydration, or worse, possible kidney failure.

As preppers we all strive to protect our families and loved ones as best we can, a pandemic with a severe CFR would be devastating to the world. Personally this would be one of my tipping points in calling all family members home and staying home, no one in or out for the duration. I would be praying that they come up with a vaccine within a year.

I sincerely hope none of us has to deal with a pandemic with a high CFR in our future, but if we do please prepare now with the items you may need. I will never forget watching scenes from Toronto, during the SARS epidemic, of people selling simple surgical masks on street corners for $10 each! Like with everything else we prepare for now, this is just another possibility in the crazy, crowded world we live in.

Please stay healthy and God Bless.

Disclaimer: This information is not intended to replace the advice of a doctor. The author and web site disclaim any liability for the decision you make based on this information.

I know this blog is primarily aimed at folks preparing for a long-term crisis, but I have a unique perspective on living without electricity after a regional disaster that I thought some might find informative. I live in the hills of northwestern New Jersey, and I have lived through three sustained (my definition: 4 or more days each) power outages caused by extreme weather events during the last two years. These power outages were caused, respectively, by Hurricane Irene, 19 inches of wet, heavy snow in October before the trees had lost their leaves, and Hurricane Sandy. I have learned important lessons from each power outage that I would like to share.
 
A wood stove and lots of firewood are necessities. I live in a county with tens of thousands of acres of forest. Today, however, most folks are too lazy to cut and process firewood. As each generation passes, fewer and fewer know how. Fortunately, I grew up on a farm and my dad always heated our home with firewood so I learned the joy of hard work and more about trees than I could begin to write here. As the temperatures plunged in the wake of Hurricane Sandy, the inside temperature of homes in my neighborhood dropped to near freezing and those of us with woodstoves became havens of comfort each day for friends, children, the elderly and neighbors in need of warmth. I think anyone who doesn’t have a wood stove and 10 cords of split, stacked and dried firewood in the backyard by October is unprepared. It’s a low-technology essential that works on simple principles, it warms your home, cooks your food and dries your clothes. Get a wood stove. Trust me when I say your wife won’t complain about the mess that comes with one when it is warming your house. Get a bigger wood stove than you think you need, it will make it easier to load and you won’t have to work as hard cutting small pieces of firewood. The side benefit is that a wood stove will save you thousands in heating costs each winter and will pay for itself in short order.
 
Water. It seems so obvious, but even most country folk today are dependent on electricity to run their well to provide them with water. Having a generator is much more useful if it powers your well. For starters, this means you can flush your toilet, wash your hands and take a shower, things we take for granted when the electricity is running. I learned after our first extended power outage that I wanted to get a generator and a lot of gas cans to protect the venison in my freezer. After the second one I realized that I wanted a Reliance transfer switch to hook up my generator in a safe way to my electrical box so that I could provide power to my well pump. As a bonus, I could also run my freezers, a refrigerator, a few lights and outlets. But I needed water. For a longer-term crisis, I am looking into a hand pump such as the Simple Pump that has the capability to pump water by hand from my existing well. Because I believe in redundancy when it comes to water, I also picked up some high-quality water containers that hold 7 gallons of fresh potable water. You can use it for drinking, cooking, washing and filling up the toilet. There’s a stream about a mile from my house that I could drink from if I had to (I strongly discourage this unless it is a true survival situation because of water-borne illnesses found in most surface streams), and I would be glad to haul the water back home in a wheelbarrow each day if it came down to it.
 
A generator coupled with a transfer switch. I made this a separate category because I think it deserves special attention. I personally bought a 5,000 Watt generator that can surge to 6,250 Watts, made by Briggs and Stratton. There are myriad choices in this area so do your research, evaluate your budget, and get the most appropriate generator for your circumstance. It has performed admirably for over 100 hours and has only required minimal maintenance. For starters, it is recommended that you change the oil every 40 hours or so. You should also drain the gas out when you are done using it. No problem here, but if you don’t use the generator for six months you ought to run it for half an hour or so. This means you are bi-annually putting a little gas in, running the generator, and draining the fuel out. A model which lets you easily detach the fuel line to drain the leftover fuel out makes this chore much less of a hassle.
 
I suggest having a two-week supply of fuel on hand, because it is amazing how quick it runs out during a crisis. I never would I have believed that I would live to witness gas lines, gas rationing, people driving to other states to get fuel, etc. until I actually experienced it. It can happen. That being said, I believe that within two weeks after a regional disaster, supply chains will develop to get things moving around again. If they don’t, then we are talking about a situation that is truly dire and you’d better think about how to live without electricity from any source for the long haul. My generator burns a little less than 4 gallons of gas in twelve hours (I turn mine off each night), so 10 gas cans gets me there if I conserve a bit. I could get by on eight hours, but my wife immeasurably appreciates being able to open and close the refrigerator with four kids. If I have learned only one thing in thirteen years of marriage, it is that having an appreciative wife is invaluable.
 
I had a neighbor with very large whole-house generator that was burning over 10 gallons of gas a day, and he ran out of fuel within a few days. So bigger is not always better. I also learned that diesel fuel is more available than gasoline during these situations, so if I were to do it again, and money were not an issue, I would consider a diesel, natural gas or propane generator. I found out the hard way that having a can of carburetor cleaner and a small piece of wire is invaluable because carburetors get gummed up easily if a little gas sits in there for a few months. If this happens, you have to clean it (which is easy once you have done it once) or run your generator on partial choke all the time (which is less than ideal and may not work). Drain your gas completely when you put it away and this shouldn’t be a problem.
 
Food. This was actually the least of our worries. We had plenty of food on our shelves to last for months if necessary, and we didn’t really even plan it that way. I guess with four kids and one income we are just used to buying in bulk when sales hit at the local grocery store. There has been a lot written already on this subject, so I will defer to other essays on this topic.
 
Medical Supplies. Everyone has different needs here, but it is just good sense to keep a few extra of whatever you need around in case the pharmacy isn’t open (which it won’t be if the store doesn’t have a back-up generator).
 
Feminine hygiene products. Keep a few extra boxes around.
 
Lighting. Because we had plenty of firewood and a fireplace, we lit the fireplace each night and everyone in the family loved it, but it didn’t light up the bathrooms or the other rooms in the house. And when I went out in the dark each night to turn off the generator and bring it in the garage, a lantern came in really handy. LED lanterns that can run over 100 hours on one set of batteries are great, and are easily available on Amazon.com. Get two of them because you need one in the bathroom and the rest of the family doesn’t have to sit in the dark while they wait for your return if you have two. I also purchased two old-fashioned kerosene lanterns and a gallon of kerosene after the last power outage. The more flashlights and batteries you have around the better when the power goes out. Those little LED book lights are nice luxuries as well when you want to settle down and read a book in the evening.
 
A hand crank radio. This is one item I used every day during lunch. We sat around and listened to the local AM radio station as people would call in with all sorts of useful information, such as which gas stations had gas to sell and a generator to power their pumps, which stores were open, where one could get potable water (some buildings have emergency generators), what roads were cleared of trees and now passable, and where the electrical crews were working. On top of this, listening to a radio lifts your spirits when you have no other contact with the outside world.
 
Relationships with your neighbors are vital. No one knows everything, and a plumber, electrician, farmer, mechanic, doctor, dentist, police officer, etc. each possess unique and valuable skills and knowledge. You can only access those skills and knowledge if they trust you before the crisis and are regularly communicating with you during the crisis. Build friendships now with your neighbors. Find out what their strengths are. Forgive those whom you have had past disagreements with, as those arguments will seem truly unimportant if the SHTF. One of the unexpected benefits of Hurricane Sandy was that I built several long-lasting friendships with neighbors as we spent two weeks cutting trees, dragging branches, splitting wood and stacking firewood. We worked together to get warm, make food, get gasoline and other supplies, take showers and watch children. And everyone in my area has give a lot of thought about surviving when the government and the utility companies cannot help you. I can honestly say it was, in some ways, a blessing.  
 
Cash. Try buying something when nobody in town has power and you find out real quick that cash is still better than a credit card or a debit card.  A few hundred bucks was more than enough for the short-term outages I have experienced, but a longer-term situation would require more. In a truly long-term disaster situation, actual goods that you could barter with would have the most value.
 
Intangibles. I would like to conclude by suggesting that maintaining a positive attitude in spite of adversity is of immense value. Being a person who smiles while working to meet daily challenges lifts the spirit of everyone you come into contact with, and your attitude will have a marked impact on children. My children actually think that power outages are something to be celebrated (no school and you get to pretend like you are living Little House on the Prairie)! Having faith helps us see the good that comes with difficulty, and gives us strength to forge ahead, no matter what.
 
Our world is becoming more like a Rube Goldberg machine every day. Our infrastructure and supply lines become more fragile as they become more dependent on new layers of technology. My advice to everyone is to build redundancy into every system you control, and pass on practical knowledge to the next generation. A co-worker who was not prepared for any of these circumstances suggested to me that preparing for them was wrong, that it amounted to cynically saving yourself at the expense of your neighbor. I replied that quite the opposite was true: those who are prepared are far more able to help their neighbors than those who are not, and my real-life observations actually back up this assertion. Thank you for taking the time to read this essay and God Bless!

Jim:
I enjoyed the Become Your Own Herbal Doctor article very much as herbal medicine is my current interest and latest preparation.  Because I did not learn this type of information from my grandmothers or mother, I have opted to take a class to speed up the learning curve.  The author is correct; the home remedies our families knew just a hundred years ago have already been lost to most of us.  Taking this class has been a fun and educational process.  We have learned so many herbs and their uses; we’ve even crafted our first (sprain/strain) salve.  There is a lot to learn in this field, but the process has been rewarding.  The class I take is also offered as an online course for those of you like me who need some structure to make any real progress or just want a fast track to learning herbal medicine.  One day soon, I hope to begin teaching my kids these valuable skills.  For me, the choice to learn herbal medicine now makes great sense and I appreciate how the author provides information to help others get started.
 
The school (The Human Path) I am referring to is lead by Sam Coffman, whose medical background started as a U.S. Special Forces (a.k.a. “Green Beret”) medic.  He started becoming very interested in plant medicine while in the field as a medic on teams.  At the time his interest was based on the need for a backup if there was no pharmaceutical medicine available.  However, over the past 20+ years, Sam has devoted his time to integrating plant medicine (“herbalism”) into every day acute illness and injury care.  His goal has been to work with plant medicine as a first alternative rather than a last resort, for injuries and illnesses that people normally go to the Emergency Room for (non-surgical care).  He runs the previously mentioned school that focuses primarily on post-disaster and remote medicine using medicinal herbs both from the area as well as worldwide.  He also runs a non-profit organization (Herbal Medics) that takes students into remote areas to create off-grid solutions for health care, clean water and self-sustainable food solutions.
 
People located in the central Texas region ought to give this school a look, as there are many types of classes offered. These classes have been a fun way to learn skills and meet people. - Laura in Texas

Hi James,
I was very concerned about some of the things C.C. recommended in her letter to you for a woman giving birth, post-collapse.  I am a strong believer in natural childbirth.  After my first birth at a hospital with a doctor I swore never again!  I had my next three babies with midwives, two of the births being at home.  I read every book out there over the years on natural childbirth, including several of the ones the above writer listed.  I even trained to be a doula (woman who aids a labouring and post birth woman).  Two things the writer advised are not just foolish but down right dangerous in a home-birth and post collapse situation.  

First is her suggestion that a woman should "catch"  her own baby. Anyone who has attended a number of natural births will tell you that many women who are in the last stages of birth and actually pushing go into an almost trance like state, only really noisy!   Often times they are concentrating so hard on just getting that baby out that they cant even really hear what people are saying around them.  To then expect the woman to reach down and help guide the baby out is ridiculous.  I did in fact help to "catch" my third baby, but with the midwife helping guide my hands, and only after she had checked to see that my daughter didn't have a cord wrapped around her neck and that her mouth and nose were already clear.  Also a birthing woman cannot ascertain if the baby has a cord wrapped around its neck or is in distress.  That is what a midwife, or birth attendant would do.  Not only is the labouring woman a little busy at the moment, she also is in a very bad position to see the baby clearly.  And last but not least if a woman does have the wherewithal to grab the slippery baby and pull it up to her chest she could accidentally tear the umbilical cord if it is short or wrapped around the baby causing blood loss to both mother and child.

Also most babies need to have their mouth and nose cleared and checked before the mother immediately starts nursing as the writer suggested.  There is obviously lots of fluids happening during birth and if a mother were to try nursing before the babies nose and mouth were cleared really bad things can happen.

The second suggestions of allowing the placenta to stay attached to the baby via the umbilical cord is downright dangerous to a newborn and totally unnecessary.  Those who practice it probably feel that they are being more back to nature or something.  Where they ever got that idea is beyond me.  I have had goats, rabbits, and dairy cows and watched births more times than I can count.   Every mother animal who gives birth rapidly severs the umbilical cord from the birth leftovers by urgent licking and gentle biting until it is detached.  If the mother animal doesn't eat the placenta herself then she will move her newborn(s) as far from it as possible for two reasons.  One is that the smell of the placenta draws predators, but second and most important in our case is that the placenta is the perfect place for breeding bacteria.  To keep such a thing close to a newborn with a weak or non-existent immune system is begging for infection.  And considering that post collapse we will not have access to neo-natal units, antibiotics, or doctors the risk is too great to chance.  The first and foremost goal of anyone helping a woman to give birth is to reduce the chance of infection to mother and child.  People need to remember that childbirth was the number one killer of women due to post birth infections!   The cord should be cut and clamped as soon as it stops pulsating and then when the placenta is delivered it should be checked over carefully by the birth attendant to make sure some is still not in the womb.  Then is should be disposed of as hygienically as possible. Preferably by burying it by a tree or some other large plant that could use it for good. - C.W.

JWR Replies: Thanks for those comments. I should add that one of the books that C.C. recommended, Spiritual Midwifery, while entertaining to read, has some dated information. It was written by a hippie from The Farm in the 1970s. In this book contractions are euphemistically called "rushes."

Jim:
I saw J.A.N.'s letter about MSDS information for chemicals.  A comment J.A.N. made indicated the lengthiness of some MSDSs – very true with amazingly confusing info.  Another source is the international chemical safety card (ICSC) and can be located here.
 
These are typically only two pages in length, have standardized format, and are available in numerous other languages.  As an FYI – the “MSDS” is quickly becoming archaic as the U.S. is finally catching up with the international concept of SDSs  (no “M”)– with mandated format, international symbology, and definitive info for personal protective clothing/equipment (PPE).  Too many MSDS indicate simply to wear “gloves” as PPE – well, is that nitrile, or latex, or neoprene, or what? - Bill C.

Common ailments can really keep you down in the best of times, but when the SHTF you won’t have the luxury of staying in bed and taking a sick day when a bad cold or diarrhea strikes.  In a TEOTWAWKI scenario, there will be no doctor to call and no over-the-counter medicines to treat your symptoms.  If that sounds at all scary to you...it should. But fear not!

Luckily, we all have the ability to become our own doctor, as plant medicine is all around us.  But it takes more than a reference book or cursory knowledge of herbal medicine to be prepared to use it.  To be really prepared to cure yourself when TEOTWAWKI strikes, you must start now, just as you have with your other preps. 

Before we embark on the path to natural healing, let me offer this disclaimer. I am not a doctor...at least, not in the sense that most people use the word. Rather, I am a self-reliant homesteader. I grow my own meat, vegetables fruits and medicinal herbs. Like many of you (hopefully), I make my own soaps/lotions/shampoos and have long sworn off chemicals and fancy pharmaceutical products. From my gardens and land, I make specialized medicines and use them to prevent or cure many family ailments, from arthritis relief to the common cold. But all of the information presented here is from my own experience and intended for informational purposes only.

With that disclaimer out of the way, let's begin our journey to self-reliant health.

The first hurdle to over come may be the toughest – to realize that you can be your own doctor.  In a way, we've all been on life support our whole lives, having been trained that the doctors are experts and that they have the magic answer to whatever problem we present.  As a result, we have lost our own intuition and confidence in our ability to heal ourselves.  While a trained doctor may be what you need for surgery or severe medical trauma, there is no reason why you can’t heal (and even prevent) your own common ailments. 

Thanks to relentless advertisements and lobbying of doctors by the pharmaceutical industry, we have also been brainwashed into believing that a little pill made in a lab is safer to take than a naturally grown herbal tea of weeds we can find in our own backyard.  Medicine from nature has become a foreign concept, one we now look at as unsanitary or potentially toxic.  In retrospect, it’s amazing to consider how quickly we allowed this to happen.  Just a few generations ago our ancestors had knowledge of basic home remedies that included things like horehound cough drops and chamomile tea.  When the doctor wasn’t so easy to get to, families took care of their own during times of fever and flu.  So the first thing you have to realize is that people have used plants for medicine far longer than they have used pharmaceuticals, and without all the side effects. The knowledge is in our history and our confidence must come from our experience.  You can start preparing now by resisting the urge to call to a doctor when you feel a twinge of illness coming on, if at all possible.  Instead, begin experimenting with being your own healer and making your own medicine. This will prepare you for a time when it may be your only option. 

The second thing to do is to change your mindset of illness and medicine.  Start by knowing that being a little bit sick is actually a good thing.  When your body encounters invading bacteria it has natural defenses to combat them.  For example, one purpose of a fever is to raise the body temperature to a point in which it is inhospitable for the bacteria to live.  A bit of a fever can be a good thing!  Our reaction however is to quickly take a fever reducer at the first sign thereby limiting our body from doing its job.  Those fast acting chemical medicines have also trained us into thinking that medicine must work quickly in order to be effective. The medicine is also so concentrated and potent that it can alleviate symptoms often with just one dose.  In addition to introducing chemicals with potentially harmful side effects to your body, you are also treating your illness with a crutch rather than allowing your immune system to strengthen and do its job.  This means that the next time you encounter the bacteria, you will need more medicine rather than relying on your immune system’s memory, which could have built up a natural resistance, had you not taken the medicine.  The only one who benefits from this approach is the shareholders of the pharma giant that hooked you on the medicine!

Using plant-based medicine helps you to realize that tolerating a little bit of sickness will just make you stronger in the long run.  It also teaches you to listen to your body and feel the instant that something is out of balance. Plant-based medicine is also far gentler. This is good on your bodily systems, but also means you often have to take it at the first signs and in low doses over the course of a few days in order to keep symptoms at bay.  Much of what herbal medicine does is to boost your immune system so that your body can defend itself.  This, paired with the natural properties of the plant, can alleviate pain, reduce swelling, or increase circulation in order to help your body function at it’s most effective level.  Changing the way you think about being sick NOW will make an easier adjustment to herbal medicine.  Also, not reaching for an over-the-counter aid at the first cough or sneeze will help you to become more in tune with your body and allow you to focus on what it’s natural reaction is.  Practice listening to and trusting what your body is telling you and find natural remedies that will complement your own defenses rather than taking over the fight.  Most of all, don’t be skeptical when one dose doesn’t bring you back to 100%. Instead, realize that fully experiencing the illness is much like exercising your muscles.  Giving your body and your immune system this workout will make you that much stronger over time. 

One of the best things that experience will teach you is what you can treat on your own and what you need expert help with.  We will most likely each draw the line at a different point, but as your confidence grows you will feel able to treat more serious conditions.  This is why starting now is so important.  You do not want to wait until the doctors and medicine are unavailable before you turn to herbal medicine.  The best way to truly be prepared for TEOTWAWKI is to make it a commonplace every day thing that you are already accustomed to. 

To ease into it and start off simply, begin with herbs and plants that you are already used to consuming.  Culinary herbs and spices are easily identified and considered safe to everyone as we use them in cooking almost every day.  What we have overlooked is that they are also medicinal.  Learning to make basic medicines from kitchen herbs is a great way to feel comfortable and build your confidence. 

Now, let’s explore some basic medicine making techniques and apply them to some common every day herbs. 

Infusions and Decoctions
Simply put, this is making tea.  Tea used for medicine is much like regular tea that you drink, but it is just a bit stronger.  Having a mesh tea ball that can hold lose herbs is handy, but you can always just strain the herbs out through a clean piece of cloth, such as a bandana or T-shirt, if necessary.  Teas can be made from either fresh or dried herbs. 

Infusions are made from softer plant material such as leaves and flowers and decoctions are made from harder plant parts like bark and roots.  For either process, begin by boiling water and gathering clean, washed herbs.  To make an infusion, simply pour boiling water over the herb and then leave it to steep for 15-20 minutes.  You will want to cover it loosely so as to not let steam escape. Rather, the aim is to direct the essential oils of the plant back into the cup for consuming.  After steeping, strain out the herbs and press them to get the last bits of medicine out, and then drink the tea.  If the herb you are using holds it’s medicinal properties in the roots or bark (or something harder), then you will make a decoction.  Just add the herb to the boiling water, cover, and simmer for 15-20 minutes.  The continued heat will help to draw the medicine out of the tougher material.  After steeping, just strain, press, and drink the tea. 

Infusions and decoctions are great ways to take medicine if you have fresh or recently dried plant material and access to boiling water.  Once you harvest a plant, the medicinal value begins to deteriorate.  Fresh plant material is the most potent.  You can dry the material and preserve much of its power, but the longer it sits the less potent it will be. Therefore, if you require a certain plant that is only available for a short time, relying on tea to consume it may not be the most effective option and you should look to other ways of preserving it. However, teas are sometimes the best ways to take medicine due to the other properties that hot tea can provide.  A cup of hot tea can warm the body, soothe a harsh throat, and the steam can loosen congestion. Children easily consume teas and teas do not require previous preparation. Rather, they can be made in just a few minutes when symptoms first appear.  They are highly perishable, though, and will not last longer than a day or two before growing mold and bacteria.  

Try a simple infusion:
Mint is an herb that is easily grown.  It tolerates neglect and will spread like crazy in just about any environment.  Although starting from seed is more difficult, buying a transplant or taking a division of a plant from a friend is an easy way to start growing your own mint.  Try peppermint to help with stomach and intestinal complaints.  In many climates, mint is available year round, but in colder areas it may die back in the winter and then re-grow when the temperatures warm up.  The leaves hold the medicine and can be harvested whenever the plant is growing and dried for later use.  When a stomachache comes with gas and bloating, make a cup of mint tea following the infusion directions above.  Drink a cup every few hours until relief is felt. 

Try a simple decoction:
Ginger is an plant that everyone is familiar with.  The root is the part that holds the most medicinal value.  You can buy ginger root from the store and then sprout it yourself by submerging half of it in a cup of water.  It will take a few weeks, but will eventually grow roots and green shoots.  Then you can plant your sprouted ginger in a pot and it will grow into a beautiful plant.  Each year it will grow offspring roots that can be harvested.  Ginger plants like warm weather and will need to be brought indoors for protection during cold periods.  Chop or grate your cleaned ginger root and dry it for future use.  Make a decoction using the directions above with a piece of ginger root to ease a nauseous stomach.  Whether it is due to motion sickness or illness, a cup of hot ginger tea will soothe and relax the stomach muscles taking away the nausea.  Try a cup every few hours until relief is felt. 

Tinctures
A tincture is made by soaking the plant material in a strong substance such as alcohol or vinegar over a period of time, with the aim being to draw out the medicinal qualities.  The substance you choose to use serves two purposes.  First, it will attack the plant’s cell walls and release the medicine. Second, it will preserve the extracted liquid by creating an environment that is inhospitable for bacteria and mold growth. The stronger the alcohol or acidity content of your substance, the longer the medicine will last. This means that grain alcohol will preserve your medicine the best and substances with less alcohol content such as wine or brandy will not last as long. However, some may find them more enjoyable to consume. 

When stocking your pantry with food storage, be sure to include grain alcohol in abundance not only for bartering, but also for medicine making.  Otherwise, learning to make your own alcohol and vinegar will provide you with an endless supply of ingredients with which you can preserve your herbal medicine.  Once you have your extracting substance, then you must gather clean, washed fresh or dried herbs. 

Place the plant material in a sealable container, then pour the extracting liquid over it until all material is completely submerged.  If you are using dried plant material, then you may need to top it off in a day or two as the plant matter rehydrates and absorbs some of the liquid.  As long as all material is covered, it will not mold.  Put the lid on the container and leave it in a protected area that you can easily get to, as it will need daily maintenance.  Each day you will shake the container at least once, but more often will only help and not hinder the process.  By shaking the container you are helping to break apart the plant cells and forcing the extracting liquid deeper into the plant matter to extract more medicine.  You are also making sure that all parts of the plant matter are coated with the liquid that will preserve it.  In 14 days your tincture will be finished.  Strain out the plant material and press it to push out all of the last bits of medicine.  The liquid that remains is a concentrated form of the herb’s medicine.  Storing it in an opaque glass bottle out of direct light and protecting it from temperature changes will help it to last the longest.   

Tinctures are a great way to take medicine because they are preserved so well that they can last months to years depending on the extracting liquid used and how they are stored.  They are also easy to store and transport because they are concentrated, so only a little bit is needed.  Tinctures are usually taken by dropperfuls or teaspoon sized doses.  The drawbacks of tinctures are that they usually contain alcohol and might not be the best way for some people, especially children, to take medicine.  They also do not offer any other medicinal properties the way hot tea does.

Try a simple tincture:
Garlic is well known for its antibacterial and immune boosting properties.  It is also easy to grow.  You can buy a head of garlic from the store, pull off the individual cloves without peeling them and plant them in your garden.  Garlic is planted at different times of the year depending on your zone so refer to a planting guide for your area.  Each clove that is planted will grow into a new head of garlic.  Be sure to save some cloves from your year’s harvest to plant for your next year’s garlic crop.  Make a tincture by chopping a few cloves of garlic into very small pieces and then follow the directions above.  Your garlic tincture can be used for many purposes including lowering blood pressure and cholesterol, speeding the healing process of an infection, and serving as an antiseptic.  The next time you feel a common cold coming on, reach for your garlic tincture and take 20 drops three times a day to boost your immune system and help fight off invading bacteria.  To make the medicine more palatable, mix the dosage in a cup of water to dilute the taste. 

Medicinal Oils and Salves
Medicinal oils are made in a similar way as a tincture, but in this case it is the oil that extracts the medicinal qualities of the herb. The first rule to remember is that oil and water don’t mix and if you have water in your medicinal oil, you will get mildew and mold.  Fresh plant material contains water and therefore is unsuitable for making medicinal oils. 

In order to make medicinal oil, harvest and clean your plant material and then dry it until all of the water has evaporated.  A dehydrator works fine if you have electricity or a solar one, but you can just as easily dry leafy plant material by hanging it up in your house or laying a single layer of plant material in a dry spot outside.  If drying outside, cover the plant material with a screen or cheesecloth to keep bugs and birds off of it, and do not dry it in direct sunlight.  Also, be sure to take it inside if morning dew is expected.  Leaves, stems, and flowers can be dried whole and will crumble easily once brittle, but roots and bark should be chopped before drying to speed the drying process and also because they may become too hard to break up once dried.  You will also need oil and this is a good item to stock up on in your food storage. If you do not have oil, medicinal oil can also be made from animal fat or pressed from seeds if necessary.  Learning how to harvest animal fat and render it into lard and tallow is as valuable skill as is learning to grow things like sunflowers for seed. If you do grow your own seed for oil, having a simple hand cranked oil press will be a very valuable addition to your preps.   

Once your material is dried, put it in a sealable container and cover with oil.  You may need to top it off after the plant material rehydrates and absorbs some of the oil.  Make sure that all material stays covered with oil in order to keep it preserved. Seal the container and put it in a warm location, such as a sunny window.  The heat will help the oil to penetrate the plant material.  You will also need to shake it at least once a day to force the oil deeper into the plant material and to ensure that all parts are covered.  The ideal temperature for extracting the medicinal qualities of the herb is around 100 degrees.  Too cool and it will either take a much longer time to extract the medicinal values, or else will be unable to extract the plant’s properties.  Too hot and the heat could kill some of the valuable properties of the plant’s medicine.  In a TEOTWAWKI situation where mechanically creating a constant temperature via appliances such as a crock-pot or stovetop is more difficult, the sunny window is a perfect solution.  While constant temps at exactly 100 degrees would be sufficient to extract medicine in as little as 24 hours, a sunny window is less precise and therefore leaving your jar there for around 14 days is a better idea.  After this time, strain out the plant material and press it to extract the last bit of medicine.  Your medicinal oil should be stored in an opaque airtight container out of direct sunlight and protected from extreme temperature changes. 

Medicinal oils are best used for topical applications.  While you could soak a cloth in some freshly brewed tea and apply it to the skin, this would require fresh or recently dried plant material and is highly perishable.  Also, you could apply a few drops of tincture to the skin, but this could sting if it was an open wound.  Medicinal oils work great because they are preserved for a long time and can be applied in any circumstance.  Rub them into muscles, cover wounds and bruises with them, or even apply to a cotton ball and place in the ear for ear infections. 

Medicinal oils can be messy to transport and use though.  Turning your oil into a salve is easy with just one additional ingredient.  If you have access to wax, possibly by keeping your own beehives, all you have to do is to put the oil in a pot over a heat source or water bath and grate some wax into it.  The wax will melt into the oil and, once cooled, will harden in to a solid and more easily transportable salve.  The amount of wax you add depends on how hard you want the salve to be and will take some experimentation.  For a muscle rub you may want a looser salve that easily melts into the skin.  For soothing chapped lips you may want a stiffer salve that will sit on top of the skin without being rubbed away as quickly.  Try making your salve with only a portion of your medicinal oil. That way, if the texture is not what you want initially, you can re-melt your salve and add more wax to harden it or more oil to soften it as needed.   

Try a simple medicinal oil or salve:
Thyme is a very common culinary herb used to flavor meats and salad dressings.  It is also one of the most useful and powerful medicinal herbs.  Among its many properties, thyme is highly antiseptic and can be use to disinfect anything from kitchen counters to bed linens to infected wounds.  There are many varieties of thyme so you can choose the one that is best suited to your gardening needs.  Thyme is a perennial that can withstand cold temperatures, so in most climates you can have access to thyme year round.  During an extremely harsh cold spell the most care it may need is a blanket to give some protection from a freeze. Thyme can be started from seed or you can buy a transplant or get a division from a friend.  To make oil infused with thyme simply cut a few of the small branches and lay them out to dry.  Once dried you can follow the directions above to make an oil or salve.  Immediately rub the oil or salve onto any cuts or scrapes to kill bacteria and avoid infection.  If you already have an infected cut, blister, or incision, apply the oil or salve 3-4 times a day directly to the wound.  The thyme oil will draw out the infection and kill the bacteria promoting healing. 

Poultices
A poultice can be thought of as an herbal bandage.  To make a poultice, you can use either fresh or dried plant material.  Gather and wash your plant material and then use a mortar and pestle to break up the plant pieces.  If you do not have a mortar and pestle, just smash the material between two clean rocks. Even chewing it will accomplish the same goal.  Fresh material may release enough water to make a paste, but dried material will need a few drops of water or saliva to rehydrate it enough to make a paste.  By smashing the material you release the medicine, and by adding just a bit of liquid you are able to create a substance that binds together. Shape a piece of thin cloth into a pouch and wrap the mass of plant material in it.  Cheesecloth or gauze work great, but you could also use a bandana or piece of T-shirt.  You want the material thin enough that the plant juices can seep through to the skin.  To use the poultice, hold it over the affected area or tie it on in place and leave it to do its work.

Poultices are great ways to apply medicine to the skin and will be most potent if you use fresh plant material.  They are very perishable, however. Therefore, they are only useful if you have fresh or recently dried material.  They are best to use if you have an ailment that will benefit from constant medicine.  For example, if you have an infected wound, then a tincture will sting and medicinal oil may wear off, but a poultice tied on the area will apply medicine all day long.  They are also very effective if you require something to be drawn out of the skin, such as venom or splinters.  One of the best things about poultices is that they can be easily made and used on the go.  For example, if you get a bee sting while out in the woods, you can quickly grab a leaf, chew it up, and hold it on the skin to draw out the venom. 

Try a simple poultice:
Oregano is a popular herb used in many Italian style dishes.  It’s also very easy to grow either from seed, transplant, or a division of a friend’s plant.  It is a perennial in most climates, but may need cover in extremely cold areas.  Oregano also grows very well indoors in containers if you live in an area where it is too cold to survive the winter.  The medicine is held in the leaves of the oregano plant.  To make a poultice, strip the leaves off of a few stems then follow the directions above.  Oregano has strong anti-inflammatory properties.  The next time you have a bruise or swelling, try adding an oregano poultice to the area.  Leave the poultice on all day or change the poultice a couple of times a day to a fresh one if the material becomes dry. 

By starting with some common herbs and spices that you already know and probably have on hand to treat minor conditions, you can familiarize yourself with medicine making and build your confidence.  Soon you will be researching the medicinal properties of other herbs and learning to identify native plants in your area that can serve as medicine.  Also, by starting now, you will begin to build up a natural medicine cabinet of medicinal oils and tinctures that will supplement your preps of stored bandages and gauze. 

The most important benefit of becoming an herbal medicine maker before you really need it is that you can develop a garden of plants from which you can always rely.  Once you have perennial herbs all around your home or bug-out location, you will learn to save seeds and cuttings from annual herbs that will provide you with medicine from year to year, no matter what happens in the world around you. Indeed, you may become one of the most valuable members of your community, a new-age doctor with skills so valuable that others will help trade their resources/skills to ensure your survival and allow you to prosper.

This article isn’t designed to cover all aspects of childbirth, of course, but it is meant to reassure people who are unsure of their abilities to do prenatal care and their own or a neighbor’s birth, if the stuff hits the fan. I am a Certified Professional Midwife, and have assisted people in birth as a childbirth educator, doula, and now midwife since 1984. (My North American Registry of Midwives certification, however, is fairly recent, since I have concurrently raised three children alone, and earned a BS in Computer Information Systems.)

One of the first things to remember when the stuff hits the fan, is that most births, if not tinkered with, are straightforward.  Most women are quite capable of birthing at home just fine. I would recommend having several good books on hand, such as Spiritual Midwifery by Ina May Gaskin (the only midwife who has had a procedure named after her), Heart and Hands by Elizabeth Davis, and either Varney’s Midwifery, or Myles Midwifery. Varney’s is for the American audience, Myles is British, but easy to read and understand.  Laura Shanley’s Unassisted Childbirth, and Dr. Gregory White’s Emergency Childbirth are two others. There is also the book Where There Is No Doctor; it has a good section on childbirth, but doesn’t go into the details that one might need in a post-collapse situation.

I am not calling this article Emergency Childbirth for a reason, because most home births are not! They are normal physiological functions that only require good nutrition, watchfulness and cleanliness to have a good outcome. One should study, to know what normal is. If you have time before the birth (months, I hope), try to find your nearest CPM. They are trained in out-of-hospital birth, and are trained to know how to help the mom birth twins, breeches (a variation of normal) and Vaginal Birth after Cesarean Section (VBAC).  In a post collapse scenario, there won’t be access to the hospital for pregnant women in labor, as was discovered during Hurricane Katrina. (Laboring women were turned away from the hospitals, and either birthed alone, with family, or with the two CPMs that were available to help until more help arrived).

If there is no one that can assist you, then concentrate on the best nutrition you can do, specifically plenty of protein (50 mg daily, minimum) and green leafy veggies (at least 3 servings daily, but more is better). The protein helps maximize fetal development, and the green leafies provide B Complex, Iron and other necessary nutrients. Nutrition is covered more thoroughly in the books mentioned. Better nutrition means a healthier mom and baby, often an easier labor and breastfeeding and better ability to withstand blood loss. Avoiding caffeine, illegal drugs, pesticides, chemicals, and tobacco goes a long way to a healthy pregnancy.  Some people follow a vegan diet successfully, and as long as you get enough protein, it should be okay. In the first three months, the following herbs should be avoided (see Herbal for the Childbearing Year, by Susun S. Weed); Basil, Caraway Seeds, Celery Seed, Ginger(except in small doses for morning sickness and/or heartburn), fresh horseradish, Savory, Marjoram, Nutmeg, Rosemary, Saffron, Sage, Parsley, Taragon, Thyme, and Watercress, Aloe Vera, Angelica, barberry, Buchu, Buckthorn, Cascara Sagrada, Coffee, Comfrey, Ephedra, Goldenseal, Juniper, Lovage, Male Fern, Mistletoe, Mugwort, Wormwood, Pennyroayal, Rhubarb root, Rue, Shepherds purse, Tansy, Yarrow, Senna, and Mandrake. Seems like a long list, but most people won’t encounter these herbs.

Red Raspberry Leaf tea, however, is a great uterine strengthener and just tastes good! If you have access to prenatal vitamins, those should be taken as well. Folic acid is very important to help prevent neural tube defects and any vitamin regimen should have at least 4 mcg daily.

Exercise is very important, for both physical and mental health. Just getting outside and walking in the yard if weather is inclement is a great stress reducer and helps blood flow to the baby. Yoga, tai chi, and other relaxing stretching types of exercise can help the mom’s body adjust to the changes that are occurring over the course of the pregnancy, and prepare for the birth. Massage is a wonderful relaxing tool and can be used during the birth as well. Learning simple massage, and reflex points can help tremendously during birth. Whatever it takes to get mom loose, can help. Talking to the baby in utero helps the baby learn your voice (Dad’s too!) and helps establish a bond that will make breastfeeding easier. Reading good books, thinking good thoughts (I bet that won’t be easy during post collapse, but it can be done), prayer, meditation, visualizing an easy birth, saying birth affirmations,  and examining your birth beliefs (overcoming negative ones) is calming to the spirit. You have to come to a place within yourself where you recognize that birth is normal, and your body can do this, that it was designed for this. Mind has a lot to do with how easy or difficult a birth may be. Not everything, but negative emotions and unspoken fears can inhibit labor pretty significantly. Mothers who learn to draw on their inner strengths can often know when a situation during labor needs correcting. They learn to get in “touch with the baby”, so to speak.

Rest each day if possible, especially in the last trimester. The baby is getting bigger and it takes more energy just to keep up with daily demands of the family. Napping helps recharge mom’s batteries. If that isn’t possible, getting off your feet for 15 minutes twice a day, can both give some rest, and help avoid varicose veins. Especially with a multiple gestation, getting your feet elevated helps blood circulation to the babies.

You can do your own prenatal care, writing down your blood pressure, taking temperature and pulse, and your weight. You or whoever is helping you might be able to learn to feel baby’s position in the uterus (palpation), to better prepare for labor. A baby that is posterior (his spine is laying near mom’s spine, feet kicking outwards) can often be turned around before labor, avoiding much backache and a long labor. Spending 15 minutes twice a day on hands and knees can frequently turn a baby anterior (spine facing out, away from mom). There are other tricks for turning a posterior baby on SpinningBabies.com.  Optimal Fetal Positioning by Jean Sutton  and Pauline Scott is an excellent resource for this. Paying close attention to nutrition in the earlier parts of pregnancy can pay off by helping avoid Metabolic Toxemia of Late Pregnancy, otherwise known as preeclampsia, and noting weight gain in the last trimester, along with any swelling (edema) of the hands, face, or legs (some in the legs/feet is normal especially during the summer months, but should not maintain a depression if pressed with a finger (pitting edema). Facial swelling is not normal, and may indicate a need for medical help.  This is one of the reasons  blood pressure is checked so often. Dr. Tom Brewer developed a nutritional system for nearly eliminating preeclampsia in a low-income population in Denver Colorado. (see www.blueribbonbaby.org)

List of items to have on hand for the birth:
Scissors,
Cotton shoe lace (preferably unused, or you could make a “friendship bracelet” out of embroidery floss) (both can be placed in a pan of water during labor, boiled for 20 min, then heat turned off and covered until after the birth)
Bulb syringe,
Chux underpads or black and white newspapers(they can be rolled up to make a bowl of sorts),
4 receiving blankets warmed on a heating pad or near a wood stove (not on it! Or you can heat some water, fill 2 or three mason jars with hot water, put on lids and rings and wrap the blankets around them)
Maxi pads, or cloth menstrual pads
Bath towels, at least 6 if planning a water birth
2 Shower curtains or plastic drop cloths (to protect the mattress and/or floor)
Sheets that are clean, for after the birth, and a set of older sheets for labor/birth that you don’t mind if they get stained.

Herbs: Shepherd’s purse, Ladies Mantle, or Motherwort tinctures or commercial ones like HemHalt or Wombstringe (in case of bleeding),
Superglue (for vaginal tears(small ones, less than an inch long-although those very small ones will heal just fine by themselves as long as the moms stay in bed for the first few days and keep legs together! No tailor sitting or climbing stairs)). For longer tears, you might have to know someone who knows how to suture. Most home births occur without any tears at all, since mom is more relaxed, and water births help too!(we’ve seen 12 lb  babies born with no tear to mom at all) If no suturing available, have mom keep legs together, only moving to get up to potty for the first few days. Nori seaweed is also used as a binding agent on mom’s bottom to help hold a tear together until it heals.
Large bowl or pan (or newspaper bowl) for placenta
Pen and paper to write times or notes on labor/birth
Baby diapers and clothes
Stethoscope, if possible
Tape measure and hanging fish scale(for newborn)
Sling for weighing baby(or you could use a receiving blanket. Just remember to weigh the cloth and subtract that to get the weight of baby.
St. Johnswort tea or capsules (for after pains)

To make the bed for birth, put a plastic shower curtain or drop cloth on mattress, place the clean, “after the birth” sheets on bed, then put plastic drop cloth or shower curtain over them, then the birth sheets. After the mom is cleaned up, all you have to do is take the dirty sheets and first plastic off and voila! Fresh bedding.

For the actual labor and birth, just let mom do what she wants to do. Most women will walk some, rest, dance or sway, eat, sleep, shower, etc, till the contractions become so close together and long (usually 1-2 minutes apart and long) that she cannot move much during them. She will probably vocalize, oohing, singing, or making noise, which is perfectly fine and normal (women are not beached whales, and should not be silenced!) As Ina May says, “an open mouth makes an open bottom”. At some point, the mom will start pushing, and she can reach down and catch her own baby. She can bring the baby to her breast and baby can start nursing right away. Nursing will help the uterus contract, and help the placenta separate more easily. There is no need to cut the cord at this time. One third of the baby’s blood volume is present in the placenta and cord, and it should be allowed to enter the baby (although the term “polycythemia” is used, to my knowledge it hasn’t caused any problems to the baby. He absorbs the extra blood, the unneeded cells break down and they are excreted).

If there is a tight cord around the neck, there is a technique called “somersaulting the baby out”, whereby the attendant holds the baby’s head near mom’s thigh and allows the body to be born over the cord. Unwrap the cord, and baby gets the rest of his blood supply. (I have seen wraps 4 times done this way). Baby should be moving, if not, you can rub baby gently on the back, or flick the bottoms of his feet, and mom can talk to him. He is still getting oxygen from the cord, and it will assist transition to breathing well. If it’s a Water birth, the baby is brought up out of the water right away, and placed on mom’s chest, with a warm towel placed over both mom and baby. The baby usually starts breathing and looking around, connecting faces with the voices he’s heard for the past 9 months. After this point (usually within an hour, but a little longer might still be okay), the placenta separates, there is a small gush of blood from mom’s vagina and she feels a need to push. Once the placenta is birthed, make sure the uterus remains firm(it’s about the size of a grapefruit and easy to feel) and mom breastfeeds baby, if not done earlier. Even if she isn’t planning on nursing baby, (but in a post-collapse, it may be the only source of pure nutrition for baby) breastfeeding helps shrink the uterus to pre-pregnancy levels (over the next few days) helps mom lose any extra weight gained, and minimizes bleeding. The cord can be cut, if desired, when it is limp and white. That shows the baby no longer needs it. Some people don’t cut it, just leave it wrapped in a diaper and carry it around with the baby for a few days until it dries naturally and falls off  (Lotus birth), but unless herbs are used on the placenta, it has a tendency to get a little stinky.

Mom should get up and see if she can urinate (this helps uterus clamp down) and if she wants a shower, someone should be there to help her. In the meantime the bed can be changed of its dirty linen and fresh put down, with plastic underneath. Someone should get mom something to eat and drink, high in protein, and some sugar(mom has done a tremendous amount of work!)  and let her rest and recuperate. Keeping an eye on mom for bleeding (blood pressure checks, color of her face, firmness of uterus) should be ongoing for the next few days.  She and baby should be kept together, to establish bonding and nursing. Wearing the baby in a sling, Mei Tei, or other wrap, helps the baby stay warm, regulate his heartbeat and respirations and establish other rhythms. Within 24 hours, he will probably have his first bowel movement (meconium) and will have peed. Milk will probably come in around the 2nd-to-4th day postpartum. Until then, the breasts produce colostrum, which helps clean out baby’s gut, add good flora to baby, and is anti-bacterial.

I hope this wasn’t too long, but birth is an amazing function, that is awe-inspiring to participate in. It can be a little scary sometimes, too, but the more you know, like any preparedness subject, the better you can be to deal with the unexpected.

Regarding the discussion about appendicitis - While it is definitely not something you want to try at home, in 1961, Soviet physician Leonid Rogozov, removed his own appendix. He was the only physician in a Soviet Antarctic expedition station. In the words of a Russian account:

"At night, on the 30th of April, 1961, the surgeon was being helped by a mechanical engineer and a meteorologist who were giving him the medical instruments and holding a small mirror at his belly. Laying half bent on the left side, the doctor made a local anesthesia with novocaine solution and made a 12cm incision in the right iliac region with a scalpel. Either watching in the mirror or by touch he removed an inflamed appendix and injected antibiotic in the abdominal cavity. In 30 or 40 minutes from the beginning of the operation there developed a faint and giddiness and the surgeon had to make pauses for some rest. Nevertheless, by midnight the operation lasting 1 hour and 45 minutes was over. In five days the temperature normalized, in two days more – the stitches were taken out."

There are few survival stories that can top that one. - Stephen in Florida

Sir,
Like so many others, I thank you for all that you and your family do with SurvivalBlog. It is immensely helpful. I just caught up on a bunch of recent posts related to diabetic preps and thought I'd toss in my 2 cents' worth.

For the record: I am a (female) type 1 diabetic, diagnosed at age 13 and currently in my mid-thirties. The info below is based entirely on my own 20+ years of personal experience; I am not in any way a medical or pharmaceutical professional. As always, consult a medical professional if you need advice regarding diabetes management - YMMV.

I am currently taking Lantus once daily (basal dose) and Humalog with every meal (bolus dose, thrice daily). I am personally still a little freaked out by needles (can apply them to myself, but prefer to do so as minimally as possible), thus the idea of having an insulin pump semi-permanently attached is not appealing. I am still old-school, with syringes & vials (this becomes important later). I test my blood sugars before every meal, and keep a written record to help spot patterns of highs or lows, so that I can adjust my dosages accordingly.

When I started contemplating diabetes management and long-term preparedness, two problems stood out: the ability to acquire a stash of meds, and the ability to store them. I'll address these in that order.

How does one acquire even a minimal store of vital meds when severely constrained by both budget and insurance bureaucracy? A sympathetic doctor is very helpful if you can find one (mine is only a phone call away; I usually address him as "Dad," and he's on board with the whole prepping thing), but there's not much he can do if my insurance won't play along. The thing that helped me the most in building up a supply of insulin is the fact that one vial of insulin lasts me more than one month, but less than two. Ditto test strips for the glucose meter. The idea is to refill like clockwork every month, whether you need to or not. Over time your stash will accumulate ahead of your actual usage. You may be able to refill every three or four weeks, instead of monthly (gives you at least one extra month's supply every year) - ask your pharmacist, or just go up to the counter and try it. If it's too soon for your insurance to pay out again, they will tell you when to come back. Note that this probably won't work for pills - they know exactly how many of those you will use in a given time frame. I use this strategy for test strips, too - they are just a little cheaper on prescription with a copay than OTC (over the counter), although if you have the budget for it you can just walk up and ask for them. Store brands work just as well as the big names, as long as you have the meter to match.

Other supplies (syringes, alcohol swabs, lancets, extra/replacement meters) are readily available OTC, and should be part of your regular prepping budget just like water, food, and other goods. Do the math on how many you use in a day/week/month, multiply by how long your prepping time frame is (i.e. 3 weeks/3 months/3 years), and build up to your goal. Extra alcohol swabs are good to have in the first aid stores anyway; I keep my spare meter(s) in a Faraday cage, with the rest of the last-ditch electronics.

Once you have it, how do you store it? FYI, I personally break a LOT of rules. See disclaimer above re: medical advice. The micro-print on the insert tells you to keep insulin at 36-46 F if unopened, below 86 or refrigerated after opening, and that you must discard the stuff 28 days after you open it, regardless of whether the vial is empty. And don't freeze it, either. Expiration dates on my refills are nearly two years from date of purchase.

I have NEVER discarded a drop of insulin just because it was 28 days old. My vials last about 40 days, and I have never had a problem. The vial currently in use rides around in my purse, at room temperature, the entire time. Still no problems. Last year, I started to carry spares of each type, in addition to the ones currently in use, with me at all times. This means that by the time I finish one, rotate the spare into use, then use it up, it has spent 80-100 days out of refrigeration, at room temp. STILL no problems.

A word about grid-down: you really can't let this stuff freeze, and it will denature (become completely inert and useless) above 80-86. If you are caught out in winter weather, remember to keep your insulin warmish but not clear up to body temperature. Try a pocket; in the BOB/GHB is probably a bad idea. If you are dealing with summer temperatures and need to keep it cool, IT JUST HAS TO STAY BELOW 80. Do a web search on "Frio case" for a nifty little portable evaporative cooling pouch (I am not affiliated or compensated in any way, just a satisfied customer). There are other companies with similar products. For medium-term grid-down, I have a cooler-sized propane-powered fridge; a root cellar would be a more permanent, less fuel-dependent option. I would not care to test both expiration dates AND temperature tolerances with my entire store of meds. I have yet to push past an expiration date, but I figure that slightly expired insulin has to be better than no
insulin at all. I appreciate the input from an earlier poster on the subject.

A word about BOB/GHB: don't forget the extra syringes! You may be able to get away without finger sticks for a couple of days, but don't try skipping the shots. And for crying out loud, throw alcohol swabs in so you can keep the whole process clean. You should carry enough to match the quantity of insulin you carry around every day. For me, that's about 50-90 days.

A word about syringes and lancets: I break the rules, big time. I reuse both of these items, and have for more than a decade with no ill effects (no infection, no noticeable difference in site irritation). Lantus does not play well with others (I can't mix it in the syringe with another type of insulin), so I use one Lantus needle every two days. I keep that vial and syringe tucked in same interior pocket of my purse, next to my spare vials. I use one other needle for all three of my daily Humalog injections, and one lancet for all three (or more) daily blood tests. So I go through three syringes and two lancets in two days, plus six test strips and alcohol swabs. I originally did this on a purely economic basis - I couldn't afford to blow through four syringes and three of everything else, every single day. Now I'm just used to it, and why spend more than I have to? You may not want to take measures this extreme (and if you are prone to infections or irritation at your injection sites, DO NOT ATTEMPT this). It may come in handy if you need to stretch your supplies.

A word about insulin pumps: I don't use one, so don't take only my word for it. But I have heard from those who do that the cartridges must be discarded every three days, empty or not, due to risk of infection. This would make it difficult or impossible to sneak your supply ahead of your usage. And my dad (who has spent his career in emergency medicine, and is an EMS medical director) has confided that he is glad I've never gotten one, because they seem to be associated with a higher risk of hypoglycemic reactions. I know there are a lot of people out there who love their pumps and wouldn't go back to vials/syringes for anything, but IMHO insulin pumps are not the best choice for preparedness.

One more thing. Diabetes management is a three-way balancing act with medication, food, and exercise. We all know we'd be better off eating right, exercising, yada yada blah blah blah. I did not realize what a dramatic difference that last one would make until I started self-defense classes last summer. My insulin requirements started to drop almost immediately; at this point, my dose is down twenty percent across the board! And still falling! (I'm getting ready for a belt test this month.) And I've lost two clothing sizes! And I know how to put fingers, fists, feet, elbows, knees, heel palms, head butts, and shins into an attacker's soft tissue, from a crazy number of vantage points! (Yes, it's krav maga. "We do bad things to bad people.") Bottom line, getting in shape is part of both diabetes management and emergency preparedness. Find something you like, that is useful and fun, that you will stick with.

Thanks for reading; hope it comes in handy.
Keep your powder dry and your insulin cool! - Sarah in Missouri

Sir,
Thank you for your service and for your tremendous witness and testimony shown through your blog!
I am not an expert on poison, but a recent event made me realize this is probably an important topic to cover on this forum. My forum searches did not produce anything on this subject.

About a month ago, my daughters small dog wondered into the garage while I was taking out the trash. When I went back into the living room I found him eating something green... which turned out to be an old rat poison bait he found in the corner of the garage. Knowing these can kill in a single feeding (he's very small) I rushed him to the all night emergency animal clinic with the remains of the poison cube in a small Ziploc. They asked me what type of poison he ate and I produced the green cube. They said they are all green and that there were no tests available to determine what kind it contained. One type was treatable and the others weren't. Fortunately they were able to make him throw up and basically empty everything from his stomach. I have been treating him with supplements (just in case) for a month and he is doing great.
Here are the key lessons that I learned… If you are storing food and decide to place poison with the storage and on the approaches:
1.      know the exact poison you are using
2.      keep the original boxes just in case
3.      know the treatments and be prepared to administer
4.      place them in a way protected from children and pets
5.      monitor them regularly
There are many different kinds of poisons available for rats/mice/etc. It is my recommendation to only use a type that IS treatable. These may not be as fast working, but at least you have a chance to save a child or pet.
A common type of poison I found that is treatable is called Brodifacoum - which should be listed as the primary active ingredient. There are many brands that offer this product. This type is highly lethal (4 to 5 days) and attacks the body’s production of vitamin K causing the blood to lose its ability to clot. As with my daughters dog, you may be able to treat an exposed animal by forcing them to throw up and giving them vitamin K supplements twice a day. I purchased some beef flavored vitamin K tablets from my vet to ensure he would eat them and that he received the proper dose. Note that this poison is 2nd generation.. so it lasts much longer in the body (from 20 to 130 days) than older similar types. My vet felt we successfully emptied his stomach and that I had caught him before he ingested much at all, so she recommend I treat him with supplements twice a day for 30 days just to be safe.
I'm sure there are many readers who have more knowledge on this subject and particularly the medical aspects of human ingestion. I look forward to their comments.

If someone decides to use poison and has any doubt at all about the type you have... I recommend that you throw it all away. Start over with something you know is treatable and obtain the treatment. - J.W.M.

Having a baby under normal circumstances is a great and beautiful thing, but when disaster strikes there’s going to be some issues.  Obviously in dark times one might not be able to deliver at a clean, safe hospital, or run to Walgreens in the middle of the night to get formula and diapers, or to Target to get extra pajamas for baby.   As a mom (and EMT 3 years, 8 years as a First Responder before that) I feel a certain responsibility to help others and to encourage preparedness in others.  Here are some helpful shopping tips, knowledge, and other items that are always good to have on hand for moms and babies in times of emergency. 

I live in a state where we have disasters and evacuations every year, so the concept of getting out of Dodge quick is something that we are familiar with.  As an EMT and as a Venturing Scout I have responded to and given aid to those struck by disaster many times, and in between I teach others how to be better prepared.  I know that sometimes response to emergencies can be delayed, resources get stretched thin at big disasters and you may not get help at all if your problem isn’t immediately life threatening.  This is why everyone should have a bag ready with supplies and waiting by the door readily accessible and more importantly a place to go to that is safe.  As a parent and wife I have a responsibility to protect and care for my son and husband and vice verse, this should be your priority too.   
 
If you have a member of your group who is pregnant and or has small children you’ll need to take extra care for them.  While pregnant women can do a lot of things, they will need help and, for certain duties, partnering up for safety.  Some light duty jobs you could consider are working the ops desk, the communications desk, KP, or watching the groups other children.  Jobs that you might have a partner for could be laundry, gardening, milking cows or goats (no horse riding if it can be avoided), feeding livestock, water hauling (with cart, don’t push to hard) or other not too strenuous work.  There are going to be some exceptions to this list as pregnancy progresses and morning sickness gets better or worsens.  For instance I couldn’t handle the smell of raw meat when I was pregnant, so I couldn’t cook certain things. 

There are also some comfort items that you can keep at the retreat for anyone who is or becomes pregnant.  Candied ginger and ginger ale are always great to help with nausea.  Saltine crackers are also good for this purpose.  Pregnant women will also need a good multivitamin with folate in it to ensure good gestational health and neural tube development in the baby.  A good stool softener (such as Colace) and extra fiber in the diet are both highly recommended and pregnant women will also need and extra 300 -350 calories a day.  Some pregnant women might become anemic and requite an Iron supplement.  There are also some things that pregnant women should avoid like cleaning the litter box, over exertion/lifting, and excessive stress.  Taking care with your words and actions can go a long way (like not saying that the pregnant woman is a burden or implying it).  Stress can adversely affect not only the mom, but also the baby.  When you are stressed your body secretes a lot of hormones that then affect the baby and put it under stress which can then affect fetal health.  All pregnant women should have regular Blood pressure and blood sugar tests throughout the pregnancy.  You will especially want to monitor for preeclampsia and diabetes.  Make sure you get a thorough medical history prior to delivery especially important are has the mother had a ultrasound and if so what was the placement of the placenta, medical issues like diabetes or preeclampsia, past pregnancies and any complications with those, and finally any signs of possible health issues with the baby.  

In times of disaster there is a great likelihood that the mortality rate will rise when it comes to deliveries and pregnancies.  So it is here that I shall list a little about miscarriage.  According to The Everything you need to know about pregnancy book, “up to 20% of all detected pregnancies miscarry before week 20.”  After week 20 your chances of miscarriage greatly decrease, but are not totally eliminated.  Sometimes miscarriages happen because of trauma to the baby and mother, but other times the baby could have genetic abnormalities.  Some bleeding does occur after implantation and is normal, but all bleeding should still be taken seriously.  If it’s bright red blood then this would be the time to seek out a professional.  If there is a doctor or midwife in the area then get the mother to them quickly.  A paramedic from the local fire department would have some training in child birth and complications and could also assist.  Signs and symptoms of a miscarriage are: Bright red bleeding in copious amounts, severe abdominal cramping, low back pain (contractions), high fever, extreme nausea and vomiting beyond morning sickness with quick onset, amniotic fluid leakage, and severe headache.  One of the first things that you can check for, before advanced help arrives, is a fetal heart rate by using a stethoscope. If it’s a good scope you should be able to hear the heart rate post week 10.

If the mother does miscarry or lose the baby after the delivery this will affect her not only physically, but mentally as well.  It doesn’t take long to fall in love with your baby, and when a woman miscarries or the baby dies post delivery she’ll go through the full spectrum of mourning plus additional guilt, doubt, and depression.  Again other members of the group should support, offer help, prayer, and counsel the mother.  Allow her and the father time for grieving.  It is also advisable to let her rest and recover so that she can deal with her loss.  Don’t let her rush off to work to avoid grief as this may compound the problem.  Grieving is a very individual thing and only that person will know how they need to deal.  Most importantly watch for depression and suicidal symptoms and get the mother professional help and medications if at all possible.
 
I won’t comment on the actual birthing process itself as this was well covered in Mr. Rawles' book.  Some additional helpful reading if you are interested thought, would be any Recent EMT Manual published within the last 3 to 5 years as these have a detailed chapter on field childbirth and complications.  You can find used copies on Amazon.com or BN.com.  I would also advise taking a Emergency Medical Responder (previously First Responder) level aid course and few ambulance ride-alongs or hospital clinicals.  These will give you a lot of valuable training and experience and can make all of the difference in a bad situation.  Volunteering at your local hospital in the birth center can also provide you some valuable experience and you can gain helpful knowledge from the experienced RNs.  Above all else keep your head cool and mind calm, your most important tool is the one on your shoulders.               

Now let’s talk a bit about some supplies for baby.  As a parent you learn to budget (money, time, sanity), and prepping for an emergency is no different.  You must have a budget and plan in mind well before you head to the store.  When it comes to baby clothes a great, frugal place to buy is the second hand store.  From 25 cents to a dollar an item secondhand stores are a great place to stock up.  You can find all seasons of clothing, shoes and toys there for a fraction of the cost new.  Just use your head and watch for the quality of the items you buy.  Usually for a baby all through the toddler stages you want 6 outfits, 3 PJs, 6 pair of socks, 2 pair shoes, a light and heavy jacket, and a few hats and mittens per size (Remember little babies grow at a very exponential rate through years one and two,& go by months).  You will also want a stuffed animal or two, some pacifiers, extra sheets, and at least 5-7 warm blankets with 3-4 light ones.  Look into a decent port a crib (either foldable mesh or collapsible fixed material) a new one can cost as little as $20 new.  It is not advisable to co sleep with infants as there is a high risk of smothering.  The only time you might consider co sleeping is if you are on the run and sharing a sleeping bag, even then much caution must be taken.     

Let’s talk bathing and medication for baby.  Go to your local big box store (Costco/ Sam's Club) and get the double pack of baby body & hair soap.  This will last you two years if used conservatively.  You might also want to buy extra of this for wound cleaning, trade or charity.  As far as babies go there are some basic must haves for your kit: baby acetaminophen (Tylenol), baby Vic’s vapor rub, nasal saline, Pedialyte, band aids, Neosporin, and Baby Ora-gel for teething.  Children’s Benadryl would also be prudent to have, but check with a doctor on dosages for children under 4 years of age.  When babies are sick, these are the top fall backs, a humidifier would be nice but if the power is down you can use a few tea pots and a towel or bed sheet to make a steam tent.   

Making sure that babies stay hydrated and fed is a must.  Here are some good things to have:  lanolin ointment, a manual breast pump or if there is power a portable pump (I like Madela), in case of latching difficulties a nipple shield, nursing and sleeping bras, feeding and storage bottles, and a firm pillow for nursing.  A note on the shields, these are very handy for women who have odd shape nipples (flat tops or inverted) when babies have a hard time nursing, if you don’t use them you can always trade them.  If there is a problem nursing don’t be afraid to employ the pump and bottle feed off and on, get that sustenance and hydration in the baby.  Long term storage of liquid formula may be difficult and costly, but having even a little on hand can be handy in case something happens and mom can’t nurse (the powdered formula stores longer, but you will need a clean water source).  When babies get bigger you can use a hand grinder to make fresh baby food. 

Diapering can be a difficult topic to broach when it comes to emergencies, do we use cloth or buy bulk disposable.  I say do a bit of both.  During the first week or so while you’re waiting for the umbilical stump to fall off and getting through those first very dark and sticky poops my recommendation is disposable.  This will save you a bit of time while mom is healing up and decrease the risk of infection.  After this time I would go with cloth (disposable diapers might become hard to come by in a long term scenario), but the eventual decision will be up to you.  A note on the cleaning of cloth diapers, boil to rinse and then dry in direct sunlight if you can.  Between the sterilization in the water and the UV rays the bacteria should be killed.  You will also want to stock up on the big box store wipes, if not for baby then they work well for general hygiene needs.  My husband was deployed to Afghanistan for a year while I was pregnant with our son and one of the top 3 things he would ask for was baby wipes.  His unit was often assigned to FOBs (Forward Operating Bases for those who don’t speak Army) that were little more than flattened earth and concertina wire so he used the wipes to bathe. Disposable diapers also make for very absorbent abdominal wound pads so keep a few in your field first aid kit.  I would recommend getting the big box store double pack of diaper cream, at least 2 of them (it lasts forever & it’s good for trading). 

Let’s talk about some things we can do for Mom post partum.  Good things to have for sore mommies are tucks pads (or witch hazel and gauze), sanitary napkins, pain killers (Ibuprofen [Advil] or Acetaminophen [Tylenol] are generally considered safe but check with a doctor first; aspirin should be avoided), Epsom salts, stool softener, disposable ice packs, seat cushions, and a back brace or girdle.  Buy in bulk and you can always trade later.  When it comes to post partum pads the bulkier, cheap variety work best for this purpose (burn after use).  For moms who have had to get sewn up a sitz bath at night, ice packs, and the tucks pads/ witch hazel go a long way for relief.  The girdle will help shore up a new mom while her abdominal muscles repair acting as a back support.  Moms should ideally take a good 4-6 weeks off minimum to heal, but can perform light duty tasks during that time.  Don’t let the mom over do it and hurt herself (Been there, done that, Got the PT bill to prove it).  If you need to have a new mom up and on duty put her at a watch desk for short watches and make sure she takes a nap in between, eats, and nurses or pumps. 

Lastly I wanted to mention a few things about children and getting out of Dodge.  Kids don’t like big sudden changes, so keeping them apprised of any plans would be prudent.  If they know the plan it’s easier on them mentally and they know what’s going to happen.  You may have to leave in a hurry and leave many things behind, but don’t forget their lovie (security object, toy never seen without).  It may be the only thing they have to play with and their only comforting object if you have to leave during an emergency, so don’t forget it.  Have copies of birth certificates, updated family pictures that show you all together as a family, and any other important papers in your go bag (preferably in a waterproof box like Otterbox or Pelican).   If you become separated from your children you may need proof that they really are your kids when you find them again (as seen in the aftermath of Hurricane Katrina).  You might consider sending copies of your papers to the family members you will be staying with if you trust them implicitly (if not then a bank safety deposit box near them could work also).  When leaving town one of the better options is to go at night and right away, don’t hesitate and don’t wait.  If possible take those back roads and avoid the highways as these will not only clog up but become targets for looters and banditos.  When driving out have an adult in the back seat with the kids ready to help them bail if it comes to that.  Above all else remember operational security and do what you have to do to protect your family.  Hopefully this knowledge will be helpful and informative for any preparedness savvy parents out there.

When considering the question of appendicitis at TEOTWAWKI the most important questions are these:
1.     What is the cause?
2.     How can it be recognized?
3.     Who is most at risk?
4.     Is it always fatal?
5.     Can it be treated non-surgically?
6.     Should it be removed before TEOTWAWKI?
Appendicitis is caused by a blockage of the appendix, which varies according to age.  In children and young adults this is usually due to infection.  In the elderly it is usually due to hardened feces.  In developing countries appendicitis may be caused by parasites.  In people with an inflamed bowel it can be due to swollen lymphoid tissue, which can also occur with stomach flu, viral respiratory infections, measles, or mononucleosis.
Once the blockage has occurred, the appendix swells due to continued production and trapping of secretions, causing the appendix to enlarge like a water balloon until it bursts, spewing the contents into the abdomen (peritoneal cavity), leading to sepsis (overwhelming infection), and death.  The inflammation also draws white blood cells to the area, which produces pus and additional pressure.
Also, once the pressure within the appendix rises too high, this acts like a tourniquet, cutting off the circulation to the appendix.  This injures the lining of the appendix, which allows infection to invade the wall of the appendix, and may lead to gangrene of the appendix and/or perforation (a hole in, or bursting of, the appendix). 

What symptoms does this lead to?  As S.M.G. describes, the classic history is one of loss of appetite associated with pain around the navel, followed by nausea and right lower abdominal pain.  Unfortunately, no single symptom or test is completely accurate in diagnosing appendicitis.  Only 50% of patients have vomiting.  Because the location of the appendix varies, the location of the pain may vary.  Even with modern medicine, 20% of cases of appendicitis are misdiagnosed as something else.  Though surgeons hope to be 100% accurate, even now up to 40% of patients who undergo emergency appendectomy are found to have a normal appendix.  When someone claims that they have cured appendicitis at the painful and nauseous state by administering a purgative, I question the accuracy of the diagnosis.

The classic signs described above occur only half the time in true appendicitis (diagnosed with surgery and pathological examination of the appendix).  Nausea and loss of appetite occur most but not all the time, and at the same rate that occur with other causes of abdominal pain. Vomiting that follows onset of pain is more typical of appendicitis than vomiting that precedes abdominal pain.  Diarrhea or constipation may occur with appendicitis, and the diagnosis of either as a cause for abdominal pain does not rule out appendicitis.

Abdominal pain is the most consistent symptom of appendicitis.  The migration of the pain from one location to another increases the likelihood of a correct diagnosis of appendicitis.  Fever is not usually present early on.  Appendicitis can be confused with bladder infection, kidney stones, endometriosis, ovarian cysts, diverticulitis, gallbladder disease, intestinal virus or other infection, or duodenal ulcers.   
If this is the case now, what will it be at TEOTWAWKI?  Will diagnostic accuracy improve in a scenario without blood testing or internal imaging (CAT scans, MRI, ultrasounds).  Not likely.   No doubt cases of appendicitis will not be diagnosed as such, possibly leading to fatality.  Other causes of abdominal pain will be mistaken as appendicitis, sometimes leading to treatments being mistaken as cures.

Since a person can live a completely normal life without an appendix, should it then be removed to prevent a life-threatening emergency at TEOTWAWKI?  The current incidence of appendicitis in the U.S. is about 1 per 1,000 people per year, with a 7% lifetime risk.  (This is less than the incidence of breast cancer.  Should women have prophylactic mastectomies before TEOTWAWKI as well?  Just a thought.)  No doctor is likely to perform such a surgery unless you have a documented genetic predisposition to appendicitis (and insurance is not likely to pay either). 
The incidence of appendicitis is less in undeveloped countries where the intake of dietary fiber is much higher, and is actually decreasing in developed countries where dietary intake of fiber has increased.  Dietary fiber draws water into the stool, making feces softer and less likely to form fecaliths (stone-like feces) which may obstruct the bowel or appendix.

The best answer for prevention of appendicitis is a high fiber diet, high enough to keep the stools on the softer side.  A bowel movement that has the consistency of a soft banana is about right.      

Without treatment is appendicitis always fatal?  The standard answer is “yes,” though the truth is “not always.”  If an obstruction is relieved, the inflammation may resolve without treatment.  I have seen a few cases of recurrent appendicitis which were not recognized as such until the appendix was eventually removed.  At times the body will wall off the infection resulting in a local abscess which prevents bacteria from entering the blood stream.    
Can antibiotics help?  An interesting study by Eriksson (BR J Surg. 1995; 82(2):166-9) compared antibiotic therapy alone to surgery.  Their conclusion was that IV antibiotic treatment (followed by oral antibiotics) was as effective for acute appendicitis as was surgery, though 7 of 20 patients who took antibiotic therapy alone had recurrent symptoms within a year (and underwent subsequent appendectomy).

Can appendicitis be treated with oral antibiotics alone?  While I have never tried this, if surgery were not an option, I would treat acute appendicitis much as I have treated acute diverticulitis, a fairly common illness in the middle-aged and elderly.  For diverticulitis I commonly prescribe either ciprofloxacin plus metronidazole, or Levaquin plus metronidazole.  Other possibilities might be amoxicillin-clavulanate plus metronidazole or trimethoprim-sulfamethoxazole plus metronidazole.  It generally takes two antibiotics used in combination to kill intestinal bacteria (aerobic and anaerobic bacteria).   
If you believe you or your loved one is suffering from appendicitis, go to the nearest emergency room.  However, at TEOTWAWKI, if no surgeon is available, administering the above antibiotics may be life-saving.  It will not cure everyone, and the likelihood of recurrence is high.  Still, it is a much better answer than doing nothing at all, and gives the patient at least a fighting chance of survival. 

About the Author: Dr. Cynthia J. Koelker is SurvivalBlog's Medical Editor. Her web site is: www.ArmageddonMedicine.net 

Sir:
I am an Emergency Room physician in Arizona and a preparist.  When I treat people with Type 1 diabetes I routinely mention the need to stockpile and safeguard insulin and diabetes supplies.  When the patient is agreeable I write prescriptions for extra supplies on the spot.  One of my patients told me about Wal-Mart's ReliOn brand of regular insulin, which is about half the price of other U-100s.  Those SB readers who are physicians and other healthcare providers have an obligation to their patients to inform them and help them obtain the medication and supplies they will need when TSHTF. - Dr. John in in Arizona

JWR:
First, many thanks to AERC for a very well-written article on Type 1 diabetics in SHTF situations. It was greatly appreciated and well written.

My youngest son (now 7) was diagnosed as a Type 1 diabetic about 2 months after I read [the novel] One Second After by William R. Forstchen (the daughter of the main character is a Type 1 diabetic), and along with getting used to our "new normal" lifestyle, I have also been trying to get prepped over the past 18 months in case SHTF. We are stocking up on insulin, test strips and other supplies, but I felt more was needed. My biggest concerns are 1) refrigeration for medications, and 2) protecting vital equipment from EMP/solar flare bursts.

My solution to refrigeration has been to begin testing a small "six-pack" refrigerator with a battery connection, which my father-in-law found at a swap meet. (I've also seen "battery powered coolers" for sale elsewhere.) This refrigerator is big enough to hold a few dozen vials of insulin and requires much less power than any other refrigerator. To keep it going long-term, I plan to rotate several car/deep cell batteries with a solar trickle charger for the duration of the emergency. Based on AERC's article, I'll also be looking at other alternatives as well. [JWR Adds: With a couple of 40 watt photovoltaic panels and a charge controller, you should be able to keep a refrigerator running for up to eight years. (The limiting factor is the sulfation of lead-acid batteries.]

For protection against EMP and solar flares, I intend to build a Faraday cage for extra diabetes electronic equipment such as an extra blood glucose test kit (along with radios, laptop, etc.). One possibility I will be trying is a 2-drawer filing cabinet conversion; the instructions are at Instructables. There are other possibilities I'm researching now for small, easy-to-build Faraday cages.

Even with a prepper mentality, along with a parent's acquired nerves of steel....I still haven't been able to pick up and read One Second After again since my son's diagnosis. Just can't do it. But articles like this one give me hope that, with proper planning, we can weather almost anything as a family. Thanks again. - Z. from Arizona

Dear JWR:
Another option not mentioned in the article is a DC refrigerator, batteries, charge controller, and a few solar panels.  There are other uses for this setup as well. One brand of compact refrigerators to consider is Sundanzer. - S.B., MD

About five years ago, my husband started worrying about many things happening to our country and the world in general.  Bird flu, inflation, resource grabbing, bank bail outs, government policies, Peak Oil… and more provided fuel for his concern.  As I listened to him talk about what was happening in the world, I began to think about what to do in a situation that would dramatically alter our “way of life”.  We already had goats, sheep, pigs, rabbits and chickens.  We already had a nice sized garden and I already canned what we didn’t eat fresh, but it wasn’t done with a plan to store anything for more than a few months.    We started working on our food storage and stockpiling animal feed until we hit a huge wall:  How would I deal with having diabetes if I couldn’t get my monthly insulin and blood checking strip refills? 

I have been a diabetic since the age of 6 – so about 40 years.  I became diabetic when all insulin was derived from pork or beef pancreases.  Blood checking machines weren’t even available until I turned 14.  Back then, I had to collect urine and use an eye dropper to put a certain number of drops of urine and add a reagent to see if I was spilling sugar in my urine.  Unfortunately this is one of the least accurate methods of checking how the body is processing food and if the person needs more insulin which is why I would need to go into the hospital for a finger prick and blood test once a week.  As a child, my blood sugars would vary from 200mg/dl to 350mg/dl and higher (normal is around 70).  Control was very difficult to achieve, particularly in a young person who is growing and going through hormone changes. 

Today, we are fortunate in that we can buy blood checking machines in several different brands and blood checking strips to go with them.  These wonderful devices give a result in 5 seconds and tell the person what is going on in their body right now (taking blood from a finger actually shows what happened 10-15 minutes prior, but it is the most accurate result that is available at home).  We also have different kinds of insulin available, from insulin that will react within a couple minutes to insulin that will last 24 hours.  All insulin available in the US right now is human insulin (it is human derived insulin which is grown in the laboratory using e-coli bacteria that is genetically modified to make insulin that is virtually identical to the insulin made by human pancreases) We also have insulin pumps that can include a device to give up to date blood sugar readings.  A diabetic has so many options that they can have extremely tight control and can live very normal lives with few complications. 

Unfortunately, all of the supplies needed to keep a diabetic under control would soon run out if anything interrupts the system needed to run the laboratory that makes this lifesaving hormone and all of the paraphernalia a person with diabetes needs to keep good control.  Sure, pharmacies keep a supply of insulin on hand, but it needs to be refrigerated and even then, has a relatively short shelf life.  So what can a diabetic do if they are confronted with a widespread grid down situation or even a long term break down of “normal” operations? 

The following is not to be used as medical advice.  I am not a doctor and even if I were, what you take from this article is meant to give you some suggestions based on my experiences.  Make sure that you talk to your regular medical professional and take their advice and make informed decisions.

The diabetic confronts some serious issues in a SHTF situation.  They may not be able to obtain insulin.  They may not be able to keep the insulin they have cool.  They may not be able to check their blood sugar.  They may be able to obtain one kind of insulin but not their usual insulin.  They may be on more than one kind of insulin but only be able to obtain one of them.  They may not have enough blood checking strips.  Their blood checking machines may no longer work (in an EMP situation).  They may not have batteries for their machines.  Their pumps may no longer work.  They may not be able to get the pump components.  Diabetics on Ace inhibitors may not be able to get their pills.  Diabetics who are experiencing complications from their disease may not be able to obtain dialysis or other vital treatments.  The problems facing a person with diabetes seem almost endless.

As a diabetic, I had to take a hard look at what I could be facing if I were not able to get my supplies.  I pondered the problem for a long time.  I did lots of research and came up with all kinds of conflicting information on storing diabetic supplies.  All of the official sites talked about how open vials of insulin should be thrown away on day 28 (because it degrades at room temperature). Syringes were to be used once and tossed.   Insulin was no good after the expiration date.  So, I decided to use myself as a guinea pig.  First I began reusing syringes.  I would keep my bottle of insulin on the refrigerator shelf and put the syringe beside it. Amazingly, I did not get any infections.  I also continued using both kinds of insulin after the 28 day mark.  Here again, I didn’t experience any issues with the insulin degrading past the 28 day mark.  I decided to talk to my doctor about what I had found.  My doctor was not the “prepper” type and was a bit dismayed at my using my insulin differently than before, but knew that not only was I stubborn, but I was also extremely well controlled (HA1C of 6.5).  She told me that if she noticed a spike in my HA1C readings she would take issue with my new way of doing things.  Of course, I check my blood sugars a minimum of 10 times a day before meals, after meals, before bed and during the night so if I had a spike or drop in blood sugar I could immediately correct it.  A little background to explain what an HA1C is; Hemoglobin A1C (HA1C) is a component of hemoglobin that glucose binds to.  Doctors use this measurement to give a broader picture of diabetic control.  This means that it is an average of the blood sugars for the previous three or four months.  A “normal” person’s HA1C should be between 4.5 and 6. 

See:

What Is What Is A1C And What Does It Measure?

and,

The Hemoglobin A1c (HbA1c) Test for Diabetes (at WebMD)

Prior to my experimenting, I had been using the insulin pump but had stopped for a period of time.  I didn’t like the pump because I was prone to getting infections at the injection site.  I talked to my doctor and came up with a Lantus/Humalog combination that worked for me and kept my blood sugars under control.  I then decided I would start stockpiling insulin, but how was I going to overcome the expiration date issue?  I talked to my doctor and mentioned that I was concerned about issues that would cause problems with being able to get diabetes supplies and she gave me a prescription for double my monthly prescriptions. So every month, I used a bottle and saved a bottle.  Of course I rotated my stock but occasionally, a bottle would get overlooked and near its expiration date.  I decided to perform an experiment and leave a couple bottles and use them past the expiration date.  The first bottle I used was 6 months past the expiration date and it worked like one that was brand new so I let another bottle go a year past the expiration date and again, no problems.  Right now, I am using insulin a couple years past its expiration date and it still works.  Of course, my bottles of insulin are kept very cold in a very good refrigerator which might be a reason they haven’t degraded, but they still work as normal.  I think we can conclude that if insulin is kept at optimal temperature, which is around 40 degrees Fahrenheit it doesn’t degrade like insulin kept at improper temperatures which might shorten its storage ability.  As an aside, pork and beef derived insulin is available internationally and might be able to be stored longer due to it being pure insulin and not chemically manufactured.  Keep in mind that using any other kind of insulin other than what your doctor prescribes carries with it a risk.  You need to make sure you are discussing this with your doctor and getting his or her suggestions as far as boluses and times.   If you do decide to go back to using animal derived insulin you are in good company.  I know many diabetics who feel that the genetically modified insulin has made them feel “unhealthy”.  Do your research and decide for yourself with the help of your doctor.

The first concern a person with diabetes should have is how to ensure their insulin is kept cold in a grid down situation.  There are several ways to keep things cool.  The first is a root cellar.  Root cellars which are dug deeply enough and insulated well can maintain a year round temperature of about 40F.  The most important thing to remember is that a thermometer needs to be kept inside the cellar to keep track of the temperature.  If the goal is to create an environment to keep insulin at a constant temperature this needs to be a priority.  A second method of refrigeration could be a “Servel” LP Gas refrigerator.  Unfortunately, long term LP might be a bit iffy, but it is definitely an option which should be considered.  [JWR Adds: There are still a number of brands of LP refrigerators being made. Most of these are made for the RV market and hence are fairly small and thrifty to use. A couple of SurvivalBlog advertisers sell them. Also keep in mind that almost any LP freezer can be run at its lowest flame setting to have it work as a refrigerator, with an interior temperature in the low 40s.] I have heard that this refrigerator is no longer being manufactured in the US due to issues with leakage, but I have used them and as long as they are kept in an outbuilding, and they are monitored for malfunction, they should work just fine.  I have seen them on CraigsList as well.  

Another method that can keep insulin cold is a “pot-in-pot” which uses a large earthenware pot with a smaller pot set inside of it.  Wet sand is put in between the two pots.  The moisture in the sand evaporates and cools the contents of the smaller pot.  The sand needs to be kept wet, but this could be an emergency way of keeping insulin cold. The fourth is to put the insulin in a waterproof container and an insulated cooler (the cooler is to add an extra layer of protection against fluctuating temperatures) and immerse the entire contraption into cold water such as a lake or a stream.  Before doing so however, the temperature of the water must be measured over a period of time to determine if it is an appropriate temperature for the insulin.  However, even if it isn’t, as long as the temperature is not at or below freezing, and it is cooler than ambient temperature, it can help to prolong the life of insulin.  I have heard some medical professionals mention that an additive has been put in human insulin to make it “shelf stable”.  Regardless of this, I still keep my insulin refrigerated.  If only to ensure that I can store it for the longest period of time possible.

The second concern for the diabetic is to find ways to check blood sugars and ketones.   A dangerous problem that diabetics who have prolonged high blood sugar can experience is ketoacidosis.  This is when the body doesn’t have enough insulin to digest food that is ingested and instead starts to break down fat and muscle for fuel.  The waste product created is called ketones.   Now everybody has heard of protein diets and how they cause ketones which in turn cause weight loss.  In a diabetic who is experiencing ketoacidosis, they not only have ketones but they also have high blood sugar.  The biggest problem is that the body has no way to deal with high blood sugar other than insulin and if a person is diabetic, their pancreas does not make any, so a vicious cycle is entered into.   Both ketones and sugar are excreted by the kidneys and can cause kidney damage as well as further complications due to dehydration.  If a person has high blood sugar and ketones for more than 24 hours and this situation is not corrected with insulin, the diabetic will enter into diabetic coma and ultimately die.   

Because of this, diabetics should stockpile Ketostix which is a urine test that can show if the diabetic is spilling ketones.  If they are, checking blood sugars would be the first thing to do.  The easiest way to check blood sugars is to use a blood checking machine.  There are many excellent brands on the market.  I have purchased several of the same brand and keep many months of blood checking strips and batteries.  Blood checking strips can be purchased over the counter but many insurance companies will cover them.  I have a very good relationship with my doctor and routinely ask for about 100 strips more than I use a month.  Of course strips also have an expiration date but I vac pac them to keep moisture out which is the biggest no-no for the reagent strip.  But, what if there is something that causes a problem for the machine?  The best thing to do is to have back up strips that can give a visual reading.  Unfortunately these are not available in the US but BetaChek.com will ship them worldwide.   The key to avoiding ketoacidosis is to make sure to check blood sugars regularly and correct high blood sugar.  This issue needs to be discussed thoroughly with your doctor and a sliding scale of bolus insulin should be charted.  This is vital. 

Many diabetics today use one of the insulin pump models available on the market today.  These devices have helped many people with diabetes achieve very tight control.  Unfortunately the pump components may not be available if we experience an interruption in modern services.  Make sure to store extra batteries for the pump, extra pump sets and reservoirs, extra sterile pads, extra glucose monitoring supplies if you use “continuous glucose monitoring” and/or any other things needed to keep the pump operational.  Additionally, make sure to store plenty of extra insulin.  Not only the fast acting insulin used in the pump, but also long acting insulin for a pump failure.  Prepare for a SHTF situation by having a discussion about what injectable insulin to use with your doctor. 

Many doctors will put their patients on several different medications that will lower blood pressure, protect kidneys or lower cholesterol.  It goes without saying that the most important thing a prepper can do is to make lifestyle changes that will protect the circulatory system, but it is vital that a diabetic who is on these medications stockpile them as well.  It is crucial that the diabetic speak with his or her doctor and ask for double prescriptions.  This is easier to do than most people think.  If the diabetic is on a 50mg pill once a day, ask for a prescription that is 50mg twice a day or 100mg once a day and split the pills.  This way the person can put the extra away every month.  It might be a good idea to look outside of the US to purchase additional stock of these medications.  These meds can often prolong a person’s health and are an important addition to a diabetic’s medical stockpile.    Again, discuss this with your doctor.  Some pills can’t be split without it affecting the medication delivery.  These choices should not be attempted without thorough research and medical advice.

Unfortunately there are diabetics that have had additional complications that have compromised their eyesight or kidneys (or other organs).  It can’t be stressed enough that the person with these complications be completely forthright with their doctor with concerns about the future.  Discuss options that can be done at home.  A good way to get your medical professional on your side is to talk to them about the aftermath of Katrina, Sandy and the weather issues that have caused blackouts and power failures.  Talk to them about how you can deal with this.  This is particularly important if you are on dialysis or suffer from infections that aren’t healing.  Talk to them about how to manage these problems if you can’t go into the clinic.  Ask them what medications to use and ask them for additional supplies “just in case”.  Talk to your medical professional about alternative dialysis procedures, and if you are a candidate for these.  If you have already had transplant surgery, make sure you discuss what you should be doing for your immune system and how you can get additional anti-rejection medication as well as the shelf life of these necessary drugs. 

Something that needs to be discussed is pregnancy in diabetics.  In a long term SHTF situation, pregnancy must be avoided.  A diabetic pregnancy is very high risk now when we have modern conveniences available.  If they are interrupted long term, the repercussions could be terrible for a diabetic.  I have had three children and my last was the most difficult.  My blood sugars were perfect throughout my pregnancy but diabetes affects the entire system.  My daughter was born 6 weeks early because of placental insufficiency.  In a SHTF situation both she and I would have died.  Make sure to store condoms, birth control pills, and/or anything else to prevent pregnancy. 

The last part of this is dealing with reality.  I know that if systems are interrupted long term that I most likely won’t survive.  Yes, I feel as if I can stockpile my medications for years, but ultimately they will lose their effectiveness over time.  If I am unable to get more, I need to prepare for the inevitable.  I don’t want to think that way, but just because I don’t like it doesn’t mean I shouldn’t prepare for it.  We do the best we can for as long we can but a diabetic has an organ that no longer works.  If insulin is no longer available it won’t take long before the diabetic goes into ketoacidosis, coma and death.  This conversation should be had with all family members so all can prepare for this eventuality.  I hope and pray that if we do experience a SHTF scenario that we can rebuild before my stockpiles run out, but if not, I want my heart, soul and family to be ready for the end.

There are 25.8 million diabetics in the US and about 371 million worldwide. Most of these are Type II diabetes but for those of us who are Type I, we need to think ahead.  Most Type II diabetics can control their disease with diet and exercise, but not all.  For those of us who need insulin and other medication, we need to plan.  I hope that this will help a person who has diabetes as well as their family prepare for a SHTF situation.  Do your research.  Decide what the best approach is for you and talk to your medical professional.  Find a doctor that is willing to work with you and help you prepare.  I have included some links at the bottom of this article that can help give some suggestions about the different types of insulin available.  Look at the links that are included in the article as well as those at the bottom.  Learn as much as you can about your condition and prepare, prepare, prepare. 

Further Reading:

http://care.diabetesjournals.org/content/25/suppl_1/s112.full
http://www.iddt.org/wp-content/uploads/2011/05/JDN15-1pg32-6.pdf
http://www.iddtindia.org/whichinsulin.asp
https://secure.pharmacytimes.com/lessons/200510-03.asp
http://www.diabeticconnect.com/discussions/5892-pork-insulin-what-i-have-learned
http://www.idf.org/about-insulin-0
http://care.diabetesjournals.org/content/4/2/180

It was quite a shocker when I couldn’t get my husband’s heart medication prescriptions filled in January.  After numerous phone calls to our pharmaceutical insurer, I finally found someone who assessed and fixed the problem, but it took over 6 weeks to get his prescriptions filled.  (Fortunately, I had stocked up last year, so he wasn’t completely out of his medications.  Stocking up was not intentional.  The insurer accidentally sent twice the amount requested and when I called to let them know, they said not to worry about it and they would stop the auto-refill feature).  As to why my husband’s prescriptions could not be filled, the customer care representative said something about a “glitch” in the system.  At least, that is how it was explained to me.  How one customer care representative described it – “…all Medicare eligible persons are being switched over to a Medicare type plan and your husband’s record did not make it into the new database”.  The net effect was that it appeared he didn’t have any drug insurance coverage.  The problem was “fixed”, but the costs skyrocketed.  

Hey, wait a minute, we have private drug insurance through my husband’s previous employer – he is now retired.  We didn’t sign up for Medicare Part D because we didn’t need it.  We already had good insurance.  How can they switch you over like that without your knowledge or permission?  ObamaCare, that’s how.  The out of pocket costs for his prescriptions is now more than 10 times what they were the last year (i.e., $10 co-pay versus a $100 co-pay per prescription + a deductible that quadrupled and an out of pocket cap that doubled).  And this happened with no warning.  Our budget is fairly tight each month, so it was a budget shocker too.  I scrambled to rob Peter to pay Paul to get the medications he needed, but I was angry.  I thought of all the seniors who are less fortunate than ourselves.  How would they pay for their medications?  And how in the world can anyone stock up on medications for TEOTWAWKI?

This article provided some information about skyrocketing drug costs and the changes being made in Medicare right now under ObamaCare.  (Listen up people, the sequester and the Republicans have nothing to do with this, as Mr. O declares.  These changes are a direct result of ObamaCare.)  The title, Medicare drug costs to fall in 2014, but donut hole widens, is a bit misleading.  Costs are up for 2013, so don’t believe they are going down in 2014.  Here’s a quote from the article:

“Seniors fall into the "donut hole" when spending on drugs (the combination of what the individual and the insurance company spend) reaches a predetermined threshold.  This year, the number is $2,970; after that point, the senior pays 50 percent (a new change this year from the Affordable Care Act) of brand-name drug costs, until individual spending exceeds $4,750...

But for 2014, the CMS has proposed that beneficiaries enter the hole when combined spending reaches $2,850 - $120 less than in 2013.  That means seniors would start paying more out-of-pocket at a lower level of spending.  That will surprise seniors, since one of the key touted benefits of President Barack Obama's healthcare reform law is the gradual closing of the donut hole entirely between now and 2020.”

Can you make it until 2020 for things to improve?  There’s a lot of double talk put out by the federal government on how costs are going to be lowered for seniors.  I’m not seeing it.  Neither are my friends and family.  Our cost spike was a result of being forced from a private plan into a Medicare plan.  However, my parents have both Medicare and a private plan and experienced huge increases when they went to refill their prescriptions in January this year.  Something’s fishy, right?
I shared my story with a few friends, and they had also experienced the “sticker shock” and this includes people who are not Medicare eligible.  I don’t know what’s going on, but I’m not going to put up with it.  I have choice (ah, so American of me, right?).  I started my quest to find an alternative source for medications.  Something I had never thought of before.  I recall my sister mentioning to me that her doctor at a major medical university had prescribed her a drug that was not FDA approved and gave her the link to a Canadian pharmacy.  I researched Canadian pharmacies and there appears to be a lot of confusion about them.  Is it legal for a US citizen to purchase medications from a Canadian pharmacy?  Some say yes, some say no.  I went to the source, the FDA, and read their policies.  It appears that for personal use and in small quantities (30-90 days), the FDA may “look the other way” when US citizens “import” Canadian pharmaceuticals.  The trick is finding a legitimate online pharmacy and protecting yourself against identity theft by purchasing from an legitimate source.  There exists policy only and I have not found a federal law on the books that prohibits US citizens from purchasing pharmaceuticals for personal use from Canada.  (Maybe that will be made a law as the vast ObamaCare bill is slowly morphing into legislation.)

Just a quick note:  If you travel overseas and are able to purchase your drugs there, make sure you dump the pills into existing pill containers (that you have taken with you) that are labeled by a US pharmacy; trash your receipts and new pill bottles prior to traveling home, just in case a customs agent decides to hassle you upon re-entry.  You never know how far the federal government will go in forcing people into paying into the ObamaCare system.  Without your dollars, the system will fail and they know that.

There is an organization, RxRights.org, which is fighting to retain the right to purchase prescription drugs from overseas.  God bless them.  They wrote an article that described the FDA’s new campaign to warn citizens away from purchasing drugs from outside the United States.  The FDA’s web site for the campaign (BeSafeRx: Know Your Online Pharmacy) can be found here. Key points from the FDA: Know the Risks, Know the Signs, and Know your Online Pharmacy.  (The very fact that the FDA is counseling citizens about safely buying outside the US, is permission enough for me.)  However, RxRights.org depicts the FDA’s campaign as being misleading by scaring people away from online pharmacies. RxRights.org stated that “…a recent Consumer Reports survey indicated that nearly half of those under age 65 without prescription drug coverage neglected to fill a prescription due to cost in 2012.  As Americans struggling to survive in this economy seek ways to save money, scare tactics are not what they need”.  And yes, there are many rogue Internet pharmacies out there, so BE CAREFUL, but don’t be deterred.  I am going to use the pharmacy that my sister’s doctor recommended.  

We have a close relationship with our family doctor.  Something I didn’t really care about a few years ago, but major health changes in our family forced us into regular doctor visits.  Now, I see this relationship as critical as we all work our way through what ObamaCare has done to destroy healthcare in America.  Our family doctor also practices what I call “Chinese medicine” in addition to traditional medicine, which is an indication to me that she is open minded.  She also listens and she cares.  When my husband’s insurance changed to Medicare primary, she continued to see him.  Many doctors are stating that they are “not taking new patients”, but that’s a response you will most likely get after you answer the question, “What is your insurance?”  It’s the first question asked, when you call to make an appointment now.  My next step is to call her for a new prescription and I will ask her for a couple of copies and explain that I am going to “shop pharmacies” due to the increase in drug costs.  I don’t think she will complain, but we’ll see.  This where your relationship with your doctor counts.  

I called my sister and she explained that getting her drugs from the Canadian pharmacy was fairly straightforward.  First, she had to call them.  Secondly, she had to fax her prescriptions to them.  Once she paid (they take Visa and Mastercard), her medications were shipped to her with no problems.  I have high confidence that her recent positive experience will be the same for us.  We are forced in this direction because the Affordable HealthCare Act is not affordable and the government takeover of private insurance plans is an outrage.  Once accomplished, I am hoping to be able use several online reputable pharmacies for stocking up purposes.  Expensive as it may be, I can still refill his prescriptions through our insurer, (and oh by the way – your insurer has become Big Brother too.  If you don’t refill your prescriptions in a timely manner, they not only will send you a letter or call you on the phone, they will alert your doctor as well.  Maybe they instituted that practice under the guise of “we care”, but I think more likely it’s about “we want your money”.)  My plan is to use the insurer despite the cost, and also use the online pharmacies for stocking up.  I can do this because I can.  If you can’t, get what you need any way you can.

2013 started out with increased taxes, higher healthcare premiums, higher food prices, higher gas prices, higher utility bills, and a huge increase in drug costs.  Inflation is here as forecasted.  Family budgets were slaughtered.  Not a good start.  I hope this helps others in finding a reputable online pharmacy, understanding the process, and understanding the risks in preparing for TEOTWAWKI.  

Mr. Rawles:
I am writing to address some of the questions in the letter on The Human Appendix. I am a physician who works at a large academic center.

Regarding The letter writer's questions, an inflamed appendix is not uncommon (This is know as appendicitis), and removal of the appendix is one of the simplest surgery's we perform in modern medicine. It is unclear why the inflammation occurs, but if untreated it can be fatal. The appendix was historically thought to be a vestigial organ (useless), or an immune presenting organ ( i.e.: helps the immune system fight off infections). It is thought to have no role in the digestions of foods, and people can live a normal life span without it. The symptoms that go with appendicitis are mid belly pain (pain around the belly button) which moves to the lower right corner of our abdomen over time, and the inability/lack of desire to eat. Recent evidence in the scientific literature points to the fact that the appendix may actually be more important then once thought (see the recent Wired Science article which points to the original science) though this is still under debate . There is nothing you can independently do to keep the appendix healthy (other then try to eat a healthy diet and not take unneeded antibiotics), and we no longer remove appendixes prophetically, that is we do not take them out unless they are infected. There is nothing you can do to keep your babies appendix healthy beyond possibly breastfeeding to make sure he/she develops a healthy immune system.

The Gallbladder is a different story. Most gallbladder problems are caused by gallstones, which are stones made of bile and cholesterol (two substances which the gallbladder stores in order to aid with digestion). When we think about people who get gallstones, the classic med school mnemonic is "fat, female, fertile and forty". Woman, of reproductive/middle age who are fat get gallstones. So the only preventative measure is to stay fit and skinny, as you can't really control your age or gender.

I hope this helps, - S.M.G. MD
 

Jim,
 Regarding Letter Re: The Human Appendix, I am not a medical professional but I've had reason to learn about some of what was asked regarding the appendix and gall bladder as I had both of mine removed when I had a gastric bypass.  First, there is evidence the appendix actually has a purpose by storing good bacteria.  It's not critical, but it is helpful.  Without an appendix, the some antibiotics can cause you GI distress.
 
Next, the gall bladder helps you digest, among other things, fatty food.  Without a gall bladder, you will likely regret eating too much fat for dinner as you will tend to need the bathroom more urgently the next day.  Without the gall bladder, tracking what you eat is important to maintain good GI comfort.
 
As a GB patient, fat rushes through me and I don't have a very big stomach which can not easily process certain foods (especially proteins) thus causing discomfort.  Further, as a person over 50, my body naturally does not grow the helpful bacteria or enzymes as well.
 
I've read various medical sites talking about probiotics and there are certain probiotics that create a very good mix of the suggested helpful bacteria.  However, they need to be encapsulated properly to bypass your stomach and get into the intestines lest they be destroyed by the stomach acids.  Probiotics can help you maintain a comfortable life and help you draw in the nutrition from the foods you eat.
 
I use a product that I found on the internet and researched their claims.  After some consideration I decided to try them and have been happily using their products for over a year.  I found that after a few weeks, I can back off of the probiotic pill to every other day or so.  Can I live without them?  You bet!  But my overall GI comfort level is harder to maintain without them.  
 
I have not had much luck finding medical information regarding enzymes beyond the fact that as you get older, your body does not produce as many.  What I have learned is that certain freshly picked greens make my digestive system very happy and, for everything else, the enzyme pills help me digest protein and other foods with greater comfort.
 
I have no ties with this company and am simply an avid user of their products. I personally use them and swear by their effectiveness.
 
IMHO, their web site leaves much to be desired, but their products perform quite well. - J.W. from Virginia

James,
I've benefited from so many tips from survivalblog that I'd be gratified if you could pass this preventive measure on to your readers.  I have on several occasions cured a case of appendicitis at the painful and nauseous stage by administering a purgative.  Appendicitis is caused by a blockage in the bowel, a hard piece of stool that is blocking the secretions of the appendix.  A purge that leads to full elimination can remove the blockage and give immediate relief.  Aloe vera or gum of aloes is excellent for this purpose.  (Do not use senna or epsom salts if ulcers or hemorrhoids are present.  Purgatives should be used with caution during the first trimester of pregnancy.)
 
In an environment where people have no choice but to eat high fiber foods, appendicitis would be a rare problem.  There are many other "modern" diseases that would disappear if our diet were not so "modern".  For example, diabetes is only a problem because of the high percentage of refined starches and sugars in most people's diet.  The natural human diet is one of the many things that God set and humans tampered with, to their own detriment. - Suzan G.

JWR:
There was an article from the Institute for Creation Research just yesterday on this topic, highlighting recent research showing that the appendix harbors a "cache" of bacteria that are used to re-colonize the gut following a major illness or condition that disrupts the digestive system. Evidently there are no vestigial organs. - Tip H. in Washington

Sir:
I have a medical question that I thought that maybe you could forward to Dr. Cynthia Koelker, your Medical Editor, on perhaps she could write an article.
 
My appendix was enflamed recently and they performed emergency surgery to remove it before it burst. My doctor said that his granddad, also a doctor, performed preventative surgery to remove his daughter's (my doctor's mom's) appendix. He said that there is really no purpose for the appendix except to get infected and inflamed and burst. I agree that he is probably correct in this day and age, but when I asked the same question of my surgeon, he said that pandas have the largest appendix, and they live entirely on raw plant materials, that the appendix is to make it easier to digest plant materials.
 
So here are my questions:
1. What IS the purpose of the appendix in the human body?
2. In a survival setting, how would you insure keeping the appendix healthy, especially in climates where there is a long winter and thus, difficulty in obtaining fresh food? In hot climates? In asking this question, I am assuming that TEOTWAWKI has occurred, like 10 years ago, maybe I had a baby somewhere in there, there is no food save what I have grown, no modern devices, etc. So for people that are alive now, we can go get the surgery before it gets bad, to prevent the appendix getting sick. But how would I prevent the inflammation of the appendix of a future baby?
3. I haven't experienced problems with the gall bladder, but how do you keep it healthy?
 
Thanks so much, - Anita L.

JWR Replies: Dr. Koelker is now writing a reply. That should be posted tonight.

JWR,
In my military life I can relate the reason for the expiration date on the bag is due to the bag not the fluid.  Plastic is not impermeable.  The rationale is after the date of expiration enough time has passed to question the integrity of the fluid.  The purity of the fluid can be compromised.  If you started a line and pushed the fluid you have a increased risk of infection.  The fluid is perfectly good for oral use.  It doesn't taste very good but in a pinch it works. - Ken L.

JWR:
I know you are not a medical doctor, but I had a question about Sodium Chloride .9% IV bags.  They have an Expiration date on them.  Is this information valid.  It is sterile water and salt so could something like that go bad?  Is it because the plastic might leech something out over time?   We just had a lovely “stick” class with my group where we each learned how to put in an IV on each other.  We determined who was good at it, and who should never, ever approach people with a needle.    

Each person was out of pocket for only about $11 for IV bag, butterfly infusion set, and tubing.  Already had alcohol wipes and latex gloves, so it was pretty cheap, but invaluable knowledge.  One of our group is an RN so we did have some medical assistance. 
 
Thanks in advance for the answer on the IV bags.  Really appreciate what you do. - A.J.

JWR Replies: The makers' expiry dates are absurdly short. The NaCl isn't going to magically drop out of solution on that date.  I wouldn't hesitate to use a bag that has been stored properly (in the dark) that is several years "out of date", as long as the solution looks clear. (No visible floaters or discoloration.)

James:
While the article Nursing an Infectious/Infected Patient Post-Collapse, by P.C., RN, shares some common methods of treatment for general conceptual care of some common childhood diseases of infectious patients, it does not consider that in the treatment of diseases without available treatment of antibiotics, of diseases that are airborne and highly contagious, like Tuberculosis, SARS, Pertussis, or the Blood borne pathogens like Ebola, Active Hepatitis B, C or D, HIV PCP (Pneumocystis Pneumonia) or Ebola.

In these cases you do not want an open window to be allowing any escaping infectious droplets. Use of an airflow HEPA filtration system is optimum. It is also preferable to not provide care for the person in your home dwelling if others are residing there, if possible. Set up a non-porous washable surface tent for the patient with only a metal framed bed or cot, an overbed table and a bedside commode, 30 ft. away from your home or any animals. Anything that was in that room that is porous, like fabrics or even binds with cording that opens and closes them, must be either removed before the patient is placed in the room, or disposed of if left in it. Only Non-porous metal furniture or bed frames are recommended to be used in that room after the infectious droplets or bloodborne pathogens have come in contact with them. They will need to be heavily scoured and disinfected with bleach on all surfaces and baked in the sunshine before reuse. 

What to do with waste: Use disposables whenever possible, not re-usables. Store up ample supplies of paper towel rolls, tissue, toilet paper, plates, spoons, forks, cups, gowns, disposable nitrile gloves in at least two sizes, face masks, incontinent pads, for the patient, add those and also head covering, and shoe covering, for each of the caretakers use, and when once used, double bag them, and bury them or burn them downwind from the homestead, in a designated metal 55 gallon drum. 

Urine and stool should not be flushed untreated into a septic system if the field line runoff is connected to a gray water system or for leach watering your lawn or garden. 

For additional specific information on Infection Control Practices used in Present Third World countries, refer to the PDF available at the WHO web site or search the Doctors Without Borders/Médecins Sans Frontières web site for useful infection control practice information. Here is an interesting and informative article dealing with care of infections with the absence of antibiotics. Are you ready for a world without antibiotics?  - K.A.F.

Sir:
Regarding your recent link to the US News article: “Doctors Struggling to Fight 'Totally Drug-Resistant' Tuberculosis in South Africa”, I would like to comment.  

As an infectious diseases research scientist with a specialty in tuberculosis (TB) the term “Totally Drug Resistant” peaked my interest, considering the World Health Organization (WHO) does not recognize this term.  To express the resistance to anti-TB drugs, we use very precise terms, where multidrug resistance (MDR-) represents resistance to two specific drugs, isoniazid and rifampin, and extensively-drug resistance (XDR-) is resistance to any of the second line drugs and one of the injectable drugs in addition to meeting the MDR qualifications. These terms have very explicit meanings and nomenclature criteria. 

The US News article cites a recent report published in the journal Emerging Infectious Diseases (EID).  I have few disagreements with the findings of this journal and Koebler’s report. In the original study DNA typing methods identified certain mutations in the bacteria. It assumed correlations between mutations and antibiotic resistance patterns. Although for few anti-TB drugs the relationship between a specific mutation and resistance to that particular drugs hold reasonably true, it is not necessarily always the case and there are instances where these methods do not always correlate actually clinical experiences. The best methods to predict resistance to a drug is antibiotic susceptibility testing, but again for many of anti-TB drugs there is no standard or reproducible method. Furthermore, the susceptibility testing, when available, involves each drug individually, whereas therapy is always administered as a combination of anti-TB drugs. Therefore, even if the laboratory data suggest presence of drug resistance to one drug, other drugs in the combination therapy may still be active, effectively controlling the disease and suppressing the selective pressures leading to resistance emergence.

In my opinion WHO does a great job by discouraging the use of term “totally drug resistance”, as these studied cases fit very well within the present terminology. In fact the EID paper uses this sensational term “Totally Drug-Resistant Tuberculosis” only in its title and abstract, truly only mentioning “this virtually untreatable form of TB” in reference XDR-TB. In the conclusion the authors acknowledge the lack of clinical evidence to support the gene-based assumptions. My ultimate concern as a researcher in this field is not the EID study, but rather propagating the wrong hysterical message to people who may not be able to tease out the actually scientific data.  It appears to me that telling half truths is not doing any social service. If one reads the other reports using this very specific term, evidence is present that even this form of tuberculosis is curable, although treatment approach might be different. To take quotes out of context, only skimming the title and concluding paragraph, is an injustice to the public at large who rely heavily on secondary sources for scientific information.  Although the emergence of resistance is a problem with tuberculosis, as with many other bacteria, attaching such a label sends a certain message and triggers frantic stigma to a real problem. There is effective treatment available for drug sensitive tuberculosis and individualized treatment for drug resistant tuberculosis with continuous efforts to develop better drug, doses and regimens. 

Regards, - C.S. and S.S. in Texas

Nursing today is a complicated, technological process involving multiple disciplines, technology and advanced fourth generation antibiotics, none of which will be available in a TEOTWAWKI situation.  It stands to reason that we have to prepare ourselves mentally for the fact that none of the equipment or drugs that are such an integral part of medicine and nursing today, will be available for our use.  There will be no antibiotics for chest infections, no IV fluids for dehydration, no advanced medical treatments for wound infections; It will be a return to nursing at the level of the 19th century.  Now that in itself is not necessarily a bad thing.  Nursing during Florence Nightingale's day was exciting and cutting edge.  There were advances being made in hygiene and sanitation and the general logistics of caring for multiple illnesses and infections of whole groups of people being cared for in enclosed spaces.  Florence Nightingale focused on hygiene and organization of the ward.  These were essential areas that needed close attention.  For our purposes these will also be the focus of this article; to prepare ordinary folk with the skills to nurse a sick relative or loved one in their own home without benefit of advanced medical care or treatment.  It can be done.

The Sick Room
The first thing to concentrate on is the area in which a sick person is to be nursed.  If possible, the room should be separate from the remainder of the general living quarters; a separate bedroom or a ground floor family room or recreation room with a dedicated use of separate bathroom would be ideal.  These areas would be off limits to general household use and only those directly involved in nursing care would have access.  This prevents the cross-contamination of surfaces and materials through multiple use by many people.  It is probable that there will be limited or no running water so the bathroom, per se will be of limited use.  However, it can be used as a depository of soiled linens, body wastes etc, until they can be contained in buckets and carried out doors for disposal or decontamination. (To be discussed later in this article) 

The room should be light and airy with access to a functioning window.  Cold air returns and heat vents, though not in use should be sealed off with heavy duty plastic and duct tape to prevent the spread of germs throughout the rest of the house.  The window will supply fresh air as needed.  Furniture can be functional and minimal.  There should be no surfaces that are cloth covered or not easily cleaned. Eliminate all soft furnishings, rugs and wooden tables.  If possible, use a metal table or one with a wipeable surface.  The bed mattress should be covered, if possible, in a waterproof barrier. Several sets of sheets should be dedicated for the use of the patient only and not mixed in with regular washing.  A shelf located just outside the sick room could provide linen storage for this purpose, covered with a cloth to keep clean. 

Any equipment brought into the sick room should be dedicated solely for the use of the sick room.  A bucket with a small amount of sodium hypochlorite or bleach in clean water can be kept in the bathroom to sterilize or clean utensils or other washable items used by the patient once the general soil has been cleaned off them. Mugs, spoons, plates and dishes can soak in this solution overnight and then be drained dry on a clean counter. A second 'dirty' bucket can be used for toileting articles once they have been cleaned out. Tea towels to dry dishes etc can be used but these items also need to be washed and disinfected every 24 hours at a minimum.  The door to the sick room should be kept closed if the patient is suffering from a respiratory tract infection as this will keep the spread of germs throughout the rest of the house to a minimum.  A window can be opened an inch or two, even in cold weather to provide fresh air to the room as long as the patient is not in direct line of airflow. Window coverings in the sick room should also be washable, or preferably wipeable such as blinds. Curtains can be used but would have to be washed and disinfected between patients as these can become grossly contaminated with airborne droplets through coughing or spray contaminants from wounds, human waste, blood etc. The floor surface of the room should be disinfected daily with a mild soap solution in hot water and air-dried quickly. Shoes worn outdoors or in other areas of the house should be left outside the sick room door on a dedicated mat and dedicated shoes for the nurse/attendant  can be put on a clean mat just inside the doorway for use in the room . 

Disposable coveralls or gowns that protect the caregivers clothing whilst in direct contact with the patient can be hung up in this area (back of the door) when exiting the sick room. These should be changed /washed daily and changed if moving from patient A to patient B. Again this prevents the spread of contaminants between patients and throughout the rest of the house.  If the patient is suffering from an upper respiratory infection it would be ideal to hand a thick, preferably 30mil plastic sheeting over the doorway.  This would help to contain airflow when moving in and out of the room. 

A small table outside the room should be set up which contains an anti-bacterial solution for cleansing hands upon leaving or entering the room.  If these are not available, plain soap and a bowl of fresh water for thoroughly washing the hands can be used.  Again, the towels need to be changed every 24 hours or even more frequently to prevent the spread of germs.  Hands should be washed for 20 seconds including the webbing between the fingers and  thumbs, over the back of the hand and up the forearms to the elbow.  Towels should be nurse specific and identifiable as such for each person, again to prevent cross-contamination.  No nurse or attendant should wear clothing that can touch surfaces, i.e. loose or baggy clothing, Arms should be bare to the elbows to prevent contamination with body fluids.  

Urine and stool collected from the patient could be flushed down the toilet if the sewer system is not compromised.  A bucket of clean water can provide the 'flush' mechanism to evacuate the toilet bowl. If this is not possible, the waste products should be taken outside and buried in a deep pit at least l00 feet away from any source of water, water collection system or vegetable patch.  The pit should be at least 4 feet deep and a layer of lime (if available ) sprinkled over each deposit.  The pit should be covered  and separate from regular household waste dumping. The bucket should be kept clean and covered outside the house and dedicated solely for this purpose.  Soiled linens should be washed separately from regular household laundry.  A separate bucket or washtub should be set aside for this purpose. 

Once bed linen is washed it should be hung out to dry on a clothesline so a good supply of laundry soap and clothespins may be necessary if bed linens need to be changed more than once a day. If the patient is incontinent a plastic 'draw sheet' and runner sheet can be placed directly under the patient at hip level.  It is easier to clean/disinfect a small sheet and wipe down a rubber mat than to handle full sheets. The plastic sheeting will keep the bottom sheet clean and minimize full bed changes; a lifesaver when the washing machine doesn't work! Sunlight will not only sanitize linen it will also bleach any residual staining that may occur. In warmer weather it may be easier to wash contaminated sheets outside on a porch or patio.

The Patient with a Respiratory Illness
Turning our attention now to the sick patient.  I am going to talk about care based on the assumption that there are little if any, medications available and certainly no antibiotics. The method of nursing will depend upon the illness but of course, universally, a clean room and a clean patient is to be  understood for all situations!   For upper respiratory tract infections there will be possibly fever, congested cough, shortness of breath, malaise and restlessness and insomnia (due to cough etc.) If the patient exhibits a fever, and it is to be hoped that you have prepared your emergency medical supplies with a least one thermometer!, take the patients temperature routinely in the morning, afternoon and evening.  Fevers tend to rise in the afternoon and peak in the evening/overnight.  If you do not have anti-pyretics available in your medical stores you will need to alleviate the core temperature by removing excess bed clothes, pajamas etc and using tepid sponging techniques across forehead, forearms and upper chest.  Small cloths wrung out and placed/replaced every 5-10 minutes will help.  Cotton wool, soaked in methylated spirits (denatured alcohol) and applied to the inner wrists and temples can also help.  If the patient is short of breath, nurse him/her in an upright position with the arms elevated above waist level, resting on a table or several pillows will help.  This helps to raise the diaphragm and relieve pressure encouraging better air entry into lungs. 

If the patient is congested with a dry hacking cough that is non-productive, a poultice can be made with linseed.  Boil 2 cups of water and put in a half cup to one cup of linseed, cook it until it becomes a porridge consistency and then pour into a double thick towel and wrap up. If  you have a piece of waxed paper or plastic this can help to prevent leakage through the towel by placing the 'porridge' onto the plastic/waxed paper first.  Once the poultice is wrapped securely  apply gently across the patient's uncovered chest.  You may want to check that the heat from the poultice is not too hot or it may scald the patient. Check by placing poultice across your own forearm first .  If it's too hot for you, it's too hot for the patient.  These poultices can be changed as they cool and they can help to loosen secretions and assist the patient to expectorate the phlegm.  Remember that milky foods, products can increase the tenacity and viscosity of secretions so it is best to give thin broths and clear fluids until the patient is breathing easier.  On this point, it is worth mentioning that the ubiquitous chicken broth is the number 1 oral fluid for helping to loosen secretions. 

If the infection is affecting the upper airways of the nasal/pharyngeal/laryngeal area then a soothing inhalation can be prepared using a large bowl of steaming hot water and a few drops of eucalyptus oil. The patient can then inhale the vapors from the bowl while a towel is draped over his head to concentrate the vapors towards the patient and prevents them dissipating into the air. There are other natural remedies such as turmeric which may promote healing of congestion but as I am not entirely familiar with this area of herbology I will only recommend that you acquire a book which deals with this subject as an adjunct to practical nursing. 

Another area of discussion, that, while distasteful, has to be dealt with; what to do with the secretions.  Initially, the infection will not produce much in the way of phlegm but during the recovery stage there may be copious secretions that the patient will need to expectorate.  In a post collapse situation the luxury of boxes of clean white tissues in unending supply will not be available.  What you can do is provide a cup with a lid.  It is best to stockpile a few of these plastic denture-type cups with lids now, to store away when needed.  These sputum cups will contain the secretions and can be cleaned out as often as needed.  Phlegm, by its nature is a very sticky, tenacious substance and it will be difficult to pour out of the container.  I suggest lining the container with a small amount of newspaper or other paper. It need not be sterile but it will help prevent 'cling-ons' and make a distasteful job easier.  These secretions will be highly infective and need to be disposed of as carefully as other human waste. If you  have disposable gloves or even several sets of dishwashing gloves that can be cleaned in between patient use, it would be wise to stockpile some of these for this type of care. To help the patient during this period, frequent oral care, rinsing of the mouth with bicarbonate of soda in warm water, or salt water rinses (1 tsp of salt or soda bicarb in 1 cup of warm water) will keep oral hygiene tolerable and prevent build up of materials in the mouth and keep the patient more comfortable.  Plenty of fluids offered frequently will keep them hydrated and while they may not be hungry for several days, beef broths and other light foods will help to keep their strength up. 

If electrolyte balance is an issue, and this may not be easy to detect, due to dehydration, a solution of salt/sugar in water ( 1/2 tsp salt and 2 tbsp sugar in 1 quart water) with a little honey to taste and glycerin to sooth, will help with rehydration.    While it is not possible to always stockpile a supply of antibiotics due to prescription restrictions and/or due to the perishable nature of the drug, or it being in short supply due to high demand or lack of availability, there is one treatment that you must have in your medicine cabinet; silver solutions.  There are several good companies online that deal in the production or sale of silver ion solutions. Silver is a super antibacterial, antifungal that can be used in the topical treatment of wounds, abrasions, ulcers and can even be inhaled.  I have found that though ionic silver may not cure a chest infection, it may help reduce the bacterial load that the patient has to deal with and may shorten the infective process.  The shorter the illness, the less likely complications from bed rest will affect the patient.  On this note, it is important to remember to keep the patient moving passively whilst on bed rest.   Frequent turning, side to side and passive movement of ankles and legs will prevent the development of blood clots in the legs which can occur due to stasis of blood in the veins from inactivity.  Frequent turning can also prevent the development of pressure sores which are prevalent in undernourished or malnourished patients, those who are elderly or who have pre-existing skin conditions. In a post-collapse situation you can be sure that undernourished people will be the first to succumb to infection and disease. If the primary cause of disease can be addressed with proper nutrition then many of these conditions can be ameliorated. 

Infected Wounds
Whilst this area of nursing is complex and extensive, I will only cover the general nursing care of bed rest acquired sores and the more superficial wounds and abrasions. I leave trauma management for other more qualified persons to elaborate on. The primary principle to remember in treating any wound or sore is to keep it clean and to support wound healing.  The body can do a great job with minimal assistance if the right techniques are used.  As mentioned previously, pressure sores arising on the boney prominences from unrelieved pressure due to bed rest can become tricky to treat and chronic if left uncared for.  The primary method of preventing these is by movement, one-two hourly turning and relieve of pressure on the affected area.  Pressure sores can develop in as little as a few hours if they conditions are right; the patient is malnourished, the skin is friable, the patient is not moving (i.e. may be unconscious).  Once a pressure sore has developed the skin is broken there may be sloughing material that needs to be removed from the area.  The wound can be irrigated with a solution of boiled salt water that has cooled to tepid (in the absence of sterile saline solutions for irrigation) If the underlying skin is pink and looks healthy it is enough to cover it with a clean, wet saline dressing and then apply a dry dressing on top. These wet to dry dressings need to be changed daily after cleansing/irrigating the sore.  A wet dressing soaked in a silver solution may also be used to clean the affected area. These dressings create an environment that encourages healing as long as dirt and infection are cleaned out regularly, daily at the very least. There may occur an area of necrosis around the healing pressure sore, a blackened area that will need to be cut away using a sharp scalpel.  This necrotic material will have to be removed in order for the tissue to granulate properly from the base of the wound upwards and thus close the wound. A sharp, small pair of scissors (pre-cleaned) will do as good a job if the area is small. 

Dealing with daily dressing changes can eat up supplies very quickly and in a TEOTWAWKI situation you may want to conserve supplies.  You can use materials found around the house to make bandages and absorbent pads for wound coverings.  They should be non-dyed, white cotton, with no added lycra/nylon or foreign materials in them.  Anyone who sews or is handy with a needle can sew several thicknesses of these materials cut to size for dressing materials. The usual sizes for wound dressings are 2"x2" and 4"x4" pads and 2" and 3" bandages. Thicker absorbent pads can be made out of the same cotton materials folded over and over and sewn together. It is important that no loose threads or debris  from these dressings get lodged in wounds as they can become a focus for infection and set up an inflammatory response in the area.  If the wound is suppurating or draining a large amount of fluid a wick can be made from the same materials, just longer and narrower.  Wicks of 1" thickness can be dipped in a solutions of saline (salt water) or iodine and then carefully packed loosely into the wound bed.  The wound can then be covered as usual with a dry dressing.  The wick will literally wick away the drainage and promote healing of the wound better.  These wicks can be discarded (ideally) or thoroughly washed and soaked in a weak bleach solution over night and then rinsed again thoroughly and hung to dry on an outside clothesline.  Sunlight and air are great antiseptics.  All bandages and dressings that are clean and dry should be packed away in a sealed plastic bag to keep as clean as possible for future use.

Although I have only touched on a couple of issues that are of concern in caring for the sick I believe that they are the most prevalent and the principles of caring are generally the same for most conditions; dedicated use of space and materials, good hygiene both for the patient and the caregiver and supportive measures to help the person heal and overcome their illness with minimal complications and shortest duration.

I was reviewing some back issues of the Journal of Wilderness and Environmental Medicine, published by the Wilderness Medical Society, and came across an article that I realized may be of use to preppers.  The article deals with the effects of food deprivation vs. the effect of sleep deprivation, on cognitive ability, decision making, and risk taking behaviors.  Here I will attempt to summarize the relevant findings and examine how these realities might inform our choices in prepping and responding to emergency survival situations. 

We have all been taught the easy to remember device for setting priorities for survival, right? You can't live more than 3 minutes without air, 3 hours without shelter, 3 days without water, 3 weeks without food.  While this list has been examined and tweaked over the years to suit the uses and particulars of various groups, it remains essentially a fair, if imprecise rubric of priorities.  Except the food.  Studies have shown what reality has long known: when things get tough, people do not starve to death; they are killed or injured as a result of poor decision making (often related to trying to obtain food).  From a strictly starvation stand point, it takes far more than 3 weeks to die, but the poor decisions you make, whether in a moment of hunger or a prolonged calorie deficit, are much deadlier much faster.

Hunger isn't the only stressor facing the would be survivor (doesn't matter what the disaster--could be TEOTWAWKI, could be a wildfire/hurricane/tornado/ice storm/train derailment/etc.).  Lack of sleep,  whether caused by a need to remain vigilant (security threats, long haul driving) or insomnia related to mental stress or environmental stimuli, is a very real and very common reality in the days and even weeks immediately following disasters.  Back when I was a wild land firefighter, the feds would not let a crew work more than 18 hours in a stretch, no matter what the fire was doing, because after so many hours of constant wakeful work, reaction time was dulled to the point of being legally drunk (so I was told).  A crew must be taken “off the clock” and given a safe place to sleep, even if that place was 3 feet back of the fire line they had just been working on.  Better to let a crew sleep and loose a few steps on the fire, than push a crew past the point of fatigue and have to deal with the inevitable costs and casualties that come with high risk work and dulled perception, reaction time, and impaired decision making.    

Even if zombie squirrels ate every last protein bar and bit of hardtack in your BOB, you will not die of starvation on your 3 day (or 3 week) journey to safe haven.  What is much more likely to get you into trouble is making bad choices.  In light of this fact, the authors of this study wanted to determine which had the greater negative impact on decision making and cognition in civilian survival situations, lack of food, or a lack of sleep.  To do this, they examined the effect of food deprivation for 18, 42, and 66 hours and of sleep deprivation for 26 and 50 hours on blood glucose levels, simple and choice reaction time, memory/recall, risk taking, and navigating a computerized maze. 

Results
The tests found that while food deprivation had the effect of increasing symptoms of low blood sugar (hypoglycemia), these symptoms where increased even more when deprived of sleep.  Reaction time was slower for both groups (food deprivation and sleep deprivation) in both simple reaction time (how quick you can perceive a change and react) and in choice reaction, which forces a choice between three actions when prompted.  Sleep deprivation of 26 and 50 hours was found to have a more deleterious effect that either 18, 42, or 66 hours of food deprivation.  Memory and recall tasks were both negatively affected to nearly the same extend for both groups, with the exception of delayed recall, which suffered a much larger (almost 50%) decrease after 50 hours of sleep deprivation.  Visual/spatial learning was also negatively affected by both treatments, again with sleep deprivation causing a more dramatic worsening of ability to navigate a computer generated maze.  Finally risk taking behavior was affected very little by food or sleep deprivation, with the exception that 50 hours of sleep deprivation decreased subjects risk tolerance, and both food and sleep deprivation cause subjects to make risk taking decisions faster. 

Discussion:
So what does all this mean?  Essentially given the choice between expending energy to procure food or toward procuring sleep, we should prioritize the sleep.  This of course is easier said than done.  In fact the authors even acknowledged that even small amounts of food may make sleeping easier.  “Sleep hygiene”, as it is known among those who counsel people with insomnia, includes things like avoiding caffeine after noon, not watching TV while lying in bed, keeping a consistent pre-bedtime routine, having a quiet, dark, cool place to sleep, and going to bed at the same time each night.  Good luck finding any of those things in the hectic days immediately following a major disaster.  So what to do?  For starters, be aware of what environmental factors are affecting our mood and decision making process.  By being aware that perhaps it is not only the stupid knot on your tarp shelter you can't untie in the freezing rain at night that is causing your disproportionately angry feelings, but also the lack of sleep, you can compartmentalize the things that you can control and the things that you can't, fix or improve what can be fixed, and prioritize what is important in the long run (sleep!) over the task at hand (untying that knot).  Finally, it may be worth considering some supplements to your emergency sleep hygiene plan.

Pharmacology:
Chamomile has been used for centuries as an herb that calms and promotes sleep, and is available in tea form at the supermarket right now.  Melatonin is also available over the counter, and used on an occasional basis by many night shift ER nurses, among others.  Benadryl (diphenhydramine) is the most common histamine blocker used to treat allergies, but its' number one side effect is drowsiness.  In fact, the exact same drug in the exact some dose (diphenhydramine 25mg) is sold as an over the counter sleep aid, often cheaper than the same drug in a different bottle sold as an allergy blocker!  A brief warning, there is a very small percentage of people who have an opposite reaction to Benadryl and get a stimulant effect from the drug.  My mother is one such, who refuses to take it because she'll be up all night cleaning the house and unable to sleep.  Of course there are also prescription drugs available to promote sleep, and while their action is different than those listed above, they share the warning that they are NOT for long term use, as they can cause a dependency that makes is difficult to fall asleep without them.  But as a useful addition to a disaster medical kit, I would certainly give them strong consideration.  Among these, the benzodiazepines such as Ativan, Xanax, and Valium are common, useful, and powerful, and have the added benefit from a survival medicine chest perspective of being anti-seizure and anti-anxiety drugs.  The down side is that they are also commonly abused and are controlled substances, which makes it less likely that even a sympathetic doctor will prescribe them “just in case”.  You may have better luck with the non-benzo hypnotics such as Sonata, Lunesta, and Ambien, which have less potential for abuse and are meant for short term treatment of insomnia.  In any case, never mix these drugs with alcohol (even the over the counter drugs), use the lowest effective dose possible to avoid over sedation and grogginess the next morning, and use only after consultation with a doctor (Disclaimer: nothing in this article should be construed as specific medical advice).

This is not to discount the value of food, as negative effects with food deprivation on performance were noted in the study; it is just that they were not as dramatically negative as the effect of sleep deprivation.  This study also cites other, prior published works that illustrate the negative effects of combined food and sleep deprivation, which of course is a real possibility in a survival situation, This study however was attempting to discern the relative contribution of each to the noted reduction in capability.  The study also cites prior literature dealing with the effect of hypoglycemia on cognition and decision making, and found it to have a greatly deleterious effect.  Even though in this study sleep deprivation was found to increase hypoglycemia symptoms, this study intentionally excluded those with diabetes or other confounding health problems.  For that reason, food would certainly be a bigger priority for those with diabetes, hypoglycemia, or other metabolic conditions.  Finally, the study authors also acknowledged that even small amounts of food may improve endurance and be critically important to preventing hypothermia in cold conditions.  All of these are valuable considerations for preppers.  Better to know why we do the things we do, rather than blindly following by rote the prescriptions of a variety of experts. 

Through better understanding we can be better prepared for unanticipated circumstances.  In particular it is an easy temptation for the strong (well prepared) member of a group to shoulder a bit more of the burden, to take that longer shift on watch, to hike through the night, thinking after all that it is only a little sleep you are missing out on.  But bear in mind it is not just sleep and comfort you sacrifice, but rather it is your keen edge in decision making, reaction time, and spatial reasoning that you give up.  Knowing this, you may be better prepared to appropriately weigh all priorities should you ever be faced with such a situation.

For those with an interest in reading the entire article, it is available to the public in the WEM archive here.  In addition to this article there are a variety of others on all kinds of topics related to emergency, wilderness, remote, expedition, combat, and improvised medicine.  Be aware, the details of some of these articles may be difficult for those who don't speak “medical”, but the abstracts are generally very comprehensible.   The Wilderness Medical Society also holds several conferences each year, with expert speakers in many disciplines of medicine and hands on workshops on subjects like improvised splinting, litters, and orthopedic care, avalanche awareness and rescue, snow shelters and hypothermia prevention and treatment, and many others.  While these conferences are geared for medical professionals, there is no reason interested lay-persons (preppers) can't attend and learn alongside the pros. 

Finally, a very reasonable standard of medical training for peppers would be Wilderness First Responder, an approximately 80 hour program that goes much deeper into prevention, assessment, treatment, and ongoing management of the sick and injured with an emphasis on austere environments, limited resources, and improvisation.  Numerous schools with some excellent instructors include Wilderness Medicine Institute, Aerie, SOLO, WMA, and others.  A quick search online will locate a school near you.  Given that fracture/laceration/heart attack type “disasters” are much more common than EMP/hurricane/asteroid type disasters, the wide spread dissemination of a useful level of medical training makes all of us safer. 

I have tried to think about things that you may not have thought of, in regards to The End of the World as We Know It (TEOTWAWKI.) And maybe not just fresh ideas for readers, but even for those that write about these things. And, it's possible that you may even think that I am going waaaay out there to bring you fresh ideas. But I'm not. I bet you haven't thought of how silly and secret addictions can really hurt you. Have you? While the effects of hard drugs, even seemingly minor alcoholism, have their own withdrawal symptoms that are easy to point at and identify. It's the ones that you haven't thought of that may be your undoing. Let me share a story.

Last week, I traveled by commercial airliner for some on behalf of NASA. My flight left at 6:08 am. So, I didn't really have time to fix a pot of coffee. I figured I would grab a cup when I got the the airport and enjoyed a fabulous $10 re-warmed biscuit. And, verily, that's exactly what I did. I enjoyed said biscuit with a small coffee, then boarded the flight from Huntsville to Houston.

Knowing that this would be a long day, judging by post experience on United, I drifted off to sleep on the flight. When I woke up, I found out that we had been diverted to Alexandria, Louisiana due to fog. We sat on the plane an hour, then deplaned into this tiny executive airport. Alas, it has no restaurants and only one kiosk that sold bottle drinks. Since 7 other planes arrived before me, the kiosk was drained. No big deal. After all, I have sworn off soft drinks in an attempt to lose weight.

Boarded, once again, and we finally made the flight to Houston.

That's where it began.

I had a splitting headache. I was sick to my stomach. I had ZERO energy. When I called my wife, she immediately could tell something was wrong. I could barely speak, I was trying to figure out what I needed to do to make it to Salt Lake City with all the delays. But I couldn't think. At all. My brain simply wouldn't work. I told her I didn't know what it was and that I felt I was dying. Being ever so intuitive to her loving spoonful, she knew what had happened. I had 1 cup of coffee. All day.

Sounds stupid, doesn't it? Because I had only 1 cup of Java that day, I couldn't mentally function. And this isn't the product of just a long day. It's happened over. And over. And over.

In fact, I can't start my day without having a pot of coffee. Not because I am spoiled, but because I can't mentally function. See, my every morning revolves around dressing my kids, packing snacks and diaper bags, and getting them to school. There have been days that I have gotten to work and had to seriously think about if I actually took them.

Laugh now. But consider. Are you in the same boat? Do you have a long term tradition of stopping at Starbucks? Do you have to have a pot of coffee at your desk while you read the news, before you start your work day? Do you have to have that Mountain Dew at 2 pm? How about that Redbull or 5 Hour Energy Drink?

You do. Don't you? Don't lie to yourself. It's ok.

And if you don't? Do we dare go down that path? Well, I've already told you about my inability to function. As a NASA engineer, I recognize many of the stereotypes in myself, and one of those is the need to "mainline" caffeine directly into my blood stream. And if I don't....I cannot function.

Okay. So, I think we have beaten that dead horse enough.

What does this mean for our survival? Do you realize just how dangerous this is to your TEOTWAWKI plan? We have had many talks about being on top of your mental game. Having a plan and enacting it, having thought of solutions to conceivable future issues. Making. Critical. Decisions. At. Critical. Times.  This takes clarity of thought. And if you don't have this, you have a problem.

I couldn't wrap my mind around how to change a flight to make it to my destination. How would I ever be able to make a split second decision on how to save my and my families life? I wouldn't. That doesn't even get into the physical ailment I felt. I am willing to bet that I would have been throwing up had I not downed a 34 ounce Dr. Pepper.

Now, I am much better off with my coffee consumption that I have been at other times in my life. I drink about 10 fluid cups a day. That's the only caffeine in which I partake. Let's look at some facts.

According to CoffeeFAQ, a standard 8oz coffee has UP TO 200 mg, but usually around 110mg.
According to Mountain Dew, a standard 12 oz can has 55 mg
According to 5 Hour Energy Drink, a standard shot has 208 mg
According to Red Bull, a standard 8.4oz can has 50 mg

So, while many people may laugh at the amount of coffee I drink, many of those drink multiple 20 oz bottles of Mountain Dew everyday. Or multiple Redbull. According to this, I consume a gram of caffeine a day. A GRAM!

Where do you fit? Have you ever gone without? If so, what were your experiences? I honestly would like to know.

What this past weekend showed me was that I have a severe addiction to coffee which can completely inhibit my physical and mental cohesiveness. It is something that I MUST consider in my survival plan. But, I will be honest. I enjoy coffee, so weaning myself off of it is improbable. So, what's my solution? Well, it's silly and simple.

I had been thinking about this topic and just how dangerous it really is, for something as stupid as a daily habit. I mean, honestly, I don't rank my addiction up there with heroine...and yet, I can now identify what Kurt Cobain must have felt (though I identify that I didn't have Courtney Love to deal with). When I got to my hotel that evening, the first thing I saw was the prepackaged Coffee on the sink. I thought to myself....hey. That's at least a Band-Aid solution. After all, in TEOTWAWKI, our plan all along is that we will have scavenge at least some. But until it's safe, just a few packets of prepackaged brown goodness would get me by. So, I snagged it. And now it's in the pack.

While this may sound stupid and you may not even believe me, others have considered it. In the "Outlanders" series of books by James Axler, coffee is a regular staple of commodities that are held in high regard in the Post-Apocalypse. In "Pitch Black", Cole Hauser's character Johns, has an addiction that is never specified, yet it renders him physically and mentally incompetent after their space ship crashes on a hostile planet.

So you don't care about media? Consider this: Coffee is a staple in military Meals Ready to Eat (MREs). Why? Maybe not for addicted souls like me, but certainly for some of the reasons that I am addicted to it. It's a stimulant. It keeps you alert. It's comforting.

The fact is, the TEOTWAWKI is a scary and harsh place where survival is already walking a razor thin edge. Just to survive and prosper, you already will require a great amount of luck, not to mention the planning and sharper-than-razor mental capacity to make even the smallest decisions that mean life or death. You cannot have anything keep you from making the right call at the right time. Loosing your mental capacity over something stupid, such as missing a days worth of coffee, is a silly way to go out.

And, again, we aren't even considering the more serious addictions that you may have. Doing a quick search, I learned that 30% of Americans have a drinking problem. That sound about right to you? It does to me. The effects of alcohol withdrawals are just as dire, and even more so. I have seen it first hand. So, 1 out of every 3 of you that read this now know that your alcohol addiction should be something to consider.

I'm not telling you that you must kill off your secret addictions. It's not my place. And, considering how unlikely an earth-shattering TEOTWAWKI would be, it's probably not worth quitting. Shoot, I know I can't quit coffee. But, it's certainly worth planning for, even if it means raiding the hotel's freebee coffee stash.

This past week I had a pharmacy call me about a multi-year prescription I had written for a fellow prepper.  The pharmacy would not fill the prescription, and didn’t even know if was legal.  At first they told the patient I would have to write a note regarding the purpose of so much medication, and that the drug might not even be good beyond a year.  On further consideration, they informed him that he would have to get a new prescription written for a smaller amount.  It seemed they did not even want to keep the written prescription in their records (which are periodically reviewed).

It so happened that the state board of pharmacy was visiting that day and the pharmacist inquired as to what the law actually states.  I’m told the pharmacist was advised that they could not fill any prescription for more than one year into the future, even if the physician writes a note saying the patient is aware the medication will be considered out of date beyond a year.
This demonstrates just one of the obstacles to obtaining long-term medication for TEOTWAWKI that I’d like to address.  There are other barriers as well – perhaps you’ve encountered a few.

To begin, here’s my short list of reasons your doctor won’t help you prep:

• He or she believes all is well – From your doctor’s point of view, tomorrow will be much like today, and on and on, indefinitely.  All this doomsday stuff is mere malarkey. 

• Your doctor may be an employee – Even if he’s a hard-core survivalist, your doctor is obligated to comply with his employer’s policies.

• Your physician is afraid of getting in trouble – How many people are looking over your doctor’s shoulders?  To name a few, your physician may be answerable to partners or peers, a practice manager, a hospital or other employer, pharmacies, drug boards, the DEA, insurers, Medicare, Medicaid, the state medical board, and no doubt the IRS.  Would you risk losing your license and livelihood under these conditions?

• Your doctor thinks you’re a nut – Perhaps your questions are perceived as paranoia rather than preparedness.

• Depending on your condition, your doctor may fear you’ll hurt yourself – Medical concerns include overdosing, under-dosing, not recognizing certain side-effects, drug interactions, necessary lab tests, and many others.

• Your doctor does not want to be responsible for someone he or she is not seeing regularly – Current law requires a doctor to oversee a patient’s care on a regular basis, and to document this in a legal medical record.  Physicians are required to document every prescription written or dispensed, as are pharmacies.  Doctors are responsible for treatment regimens we prescribe.

• Your physician may fear lost income – Doctors still have to make a living, which is becoming increasingly difficult, particularly for primary care physicians.

• Society as a whole and medical providers as well believe the field of medicine should be left to professionals – The person who learns enough to care for himself may be more feared than respected, a loose cannon beyond societal norms.

The point of this list isn’t to make you give up, but rather to recognize and quantify the challenge.  There is much you can do, depending on your motivation.  You, too, can make a difference.   
So here’s a list of suggestions to overcome the above obstacles:

• Convince your doctor that all is NOT well – When you see your doctor, take a brief moment to ask a question about the economy, or where our medications come from, or what you should have on hand if a tornado strikes, or how your community is set to handle a disaster like Hurricane Katrina.  

• Learn whether your physician is an employee – If so, don’t expect much cooperation in the prepping department.  You may want to seek out a second, independent medical professional.  Solo practitioners are becoming a rare breed, but are much more likely to be independent thinkers.

• Don’t put your doctor at risk – Ask only for small favors, perhaps an extra month of medication at each visit. 

• Don’t act like a nut – Doctors appreciate patients who act responsibly, who know the names and doses of their medications, and who follow-through on agreed-upon treatment plans.  There could come a time when your doctor comes to you for advice on a preparedness issue.

• Educated yourself thoroughly about your own medical condition, medications, and other treatments – There is nothing that prevents you from studying up on your own disease.  Your doctor likely has more clinical experience, which is an enormous advantage, but otherwise you can learn an great amount about any medical condition.  A good place to start is with the American Academy of Family Physicians journal which is online free at www.aafp.org.  You should know the common side-effects, potential for poisoning, and common drug interactions for all your medications.  Although doctors are aware of many of these, they cannot memorize them all.  A free online Interaction Checker is available at www.drugs.com.

• If you have a chronic medical condition (such as diabetes, hypertension, etc.) see your doctor regularly – I cannot emphasize this enough.  The point is not only your current care, but your future health as well.  If you demonstrate trustworthiness in small things (such as keeping appointments), your doctor is more likely to trust you with bigger things (such as extra medication or a prescription for antibiotics for a future need). 

• And now for the fine print – I recognize the above will only get you so far.  I strongly advise taking advantage of your current freedoms.  Currently you are allowed to seek medical care from more than one physician, perhaps one within your insurance network and one out-of-network, or even in a different city.  Currently you are free to obtain prescriptions from more than one pharmacy.  Currently you have access to a vast and amazing array of effective over-the-counter medications, about which I’ve written previously.  Currently you are permitted to acquire a wide variety of A-B rated USP generic antibiotics intended for aquarium use.  Currently you have access to as much medical information as physicians enjoy.  Currently you have the freedom to acquire medical items for potential future barter.  Currently there is no restriction regarding obtaining medical skills for personal use, such as suturing and casting, as taught in my classes and elsewhere.   Currently you can acquire insulin over-the-counter.  Currently desiccated thyroid replacement may be obtained without a prescription.  Currently herbal medications are available in abundance.  Currently you can purchase new or used books on physical therapy, massage, and chiropractic.  Currently you have the freedom to attend EMT or nursing school, even if you don’t intend to pursue a career in the field.

Fortunately there is much you can do to build your self-reliance in the medical arena, but it cannot be accomplished overnight.  An abundance of free information to get you started is available at my ArmageddonMedicine.net web site, and I suggest reading my other articles in the SurvivalBlog archives. (Put "Koelker" in the Search box.)

Note: This article is adapted from my book When Disaster Strikes: A Comprehensive Guide for Emergency Planning and Crisis Survival

Tips for Surviving Outside in Extreme Weather and Subfreezing Temperatures

Every year people get lost in the backcountry near where I live in the High Sierras, and end up spending one or more unplanned nights outside in the snow and extreme cold. Some of those folks live to tell the tale, and some of them don’t. Hopefully you will never need to spend unexpectedly long hours outside in extreme weather, but in case you do, here are a few tips:

• Stay Dry: If at all possible, keep your clothing dry, including hat, gloves, and boots. It takes a huge amount of energy to dry clothing using just body heat, and wet clothes will not insulate nearly as well as dry clothing. If you must lay down to sleep, break fresh green pine boughs off evergreen trees to make a somewhat insulated “bough bed” that will help you stay drier and warmer than lying directly on the snow.
• Check for numb hands and feet: The extremities of your body will tend to cool and freeze first, so keep a watchful eye on your hands and feet. At the first signs of numbness, you should stop what you are doing and get the blood circulating again, or you will risk frostbite and potentially permanent damage due to freezing your flesh. For the feet, brace your arms against something, stand on one leg, and vigorously swing the other leg back and forth, like a ringing bell in a bell tower. The centrifugal force of the swinging motion will usually restore blood circulation and warm your toes, unless they are already truly frozen and not just cold. If they burn and hurt, that is okay and the painful condition should only last a few minutes, unless the feet had actually suffered frostbite. The easiest technique for restoring feeling and circulation to the hands is similar to the previous technique for the feet. Swing your arms in wide rapid circles to help drive blood into the fingertips. Alternately, take your gloves or mittens off and stick your bare hands under your jacket and into your arm pits until your hands are warm.
• Check each other for signs of hypothermia and frostbite: A few years back a father and son skied out of bounds into the Granite Chief Wilderness and survived several nights out until they were rescued. The father kept the son moving most of each night to keep his feet and hands from freezing, and to help prevent him from succumbing to hypothermia. A couple winters back, a female snow boarder descended out of bounds into the Granite Chief Wilderness. She perished from exposure while trying to hike her way out of the wilderness, not realizing that in the direction she chose, it is about a 50 mile snow covered backcountry trek to reach the nearest all-season road. If you have no companion to help each other check for frostbite and/or hypothermia, you must be vigilant and do this for yourself. Frostbite on the skin shows up as a bright white patch of skin, usually surrounded by pinkish colored flesh. It is caused by freezing of the flesh, and actual frost crystals start forming on the skin’s surface. See below for more details on both frostbite and hypothermia.
• When in doubt, backtrack: Surprisingly few folks who get lost in the wilderness try to backtrack. Downhill skiers and snowboarders who travel out of bounds inherently dislike the idea of hiking back up the mountain the same way they came down, but this course of action would have saved many a life. However, when snows are incredibly deep, like they can be in the high mountains, backtracking may not be a viable option.
• Seek Shelter: Tree wells and snow caves can provide shelter from storms and extreme cold. Snow is an excellent insulator, but try to keep yourself from getting wet both while building your snow shelter and when staying inside the shelter. If you must sit or lie down in the snow, a layer of fresh green pine boughs can provide insulation and help minimize getting wet from melting snow with body heat
• Build a Fire: Your chances of starting a fire in extreme weather, using primitive methods, like a fire drill, or flint and steel, are pretty slim, but if you happen to have matches or a cigarette lighter on hand, by all means build a fire! Look for standing dead wood, or drier branches sheltered underneath fallen logs that may be drier than the rest of the available wood. For kindling, look for branches on trees that have a bunch of dead brown pine needles. The dead pine needles on these branches will usually burn even if they are fairly wet. Make sure you knock the snow off any overhead branches before you start your fire, so they won’t dump snow on your fire as it heats up. You can build a fire directly on top of the snow. Just lay down a bunch of branches to keep your drier wood separated from direct contact with the snow.

An aside:

On a solo trans-Sierra backcountry ski trip, while I was setting up my camp for the night, I made the mistake of not bothering to stop what I was doing in order to swing my feet and regain the circulation in my toes. My route had taken me to lower elevations in the warmth of the midday, and the snow had been quite wet, soaking through my old leather ski mountaineering boots. It was a clear night as I was pitching my tent, and the temperature had dropped to well below zero. Figuring I would soon be inside my sleeping bag, boiling a hot pot of tea on my camp stove, I did not pay attention to my numb toes. Turns out I froze the last half inch of my big toe. It blistered up, became quite sore, and turned black. I eventually lost my toenail and a large hunk of blackened flesh peeled off the tip of my big toe, but I did not need any surgery or have to deal with infection problems, so I consider myself lucky, having learned a valuable lesson that could have been a lot worse.

Hypothermia, and its evil twin, hyperthermia, are both very dangerous life-threatening conditions. The human body is designed to function within a relatively narrow core body temperature within a few degrees of 98.6°F (37°C). When the body’s core temperature rises a few degrees above this, hyperthermia (overheating) occurs, and when it drops a few degrees lower, this condition is described as hypothermia (overcooling). When left uncorrected, either case can rapidly lead to impaired mental and physical performance followed by death. When people die in the wilderness due to either overheating (hyperthermia) or overcooling (hypothermia), their cause of death is usually referred to as “exposure”.
Recognizing the signs and symptoms of hypothermia is extremely important. Most people who died of exposure probably had ample time to recognize the situation, and may have been able to do something about it had they realized what was going on. The following are warning signs of hypothermia:

• Shivering
• Decreased awareness and inability to think clearly
• Numbness, especially in the extremities
• Pale skin color and skin cold to the touch
• Poor dexterity

As hypothermia advances, and the body core temperature approaches the “death zone”, the following symptoms may occur:

• Apathy
• Feelings of blissful warmth
• Sleepiness and the desire to lie down and take a nap
• The victim may start to feel hot and start shedding clothes
• Difficulty or inability to walk
• Slurred speech followed by inability to speak, or speech not making any sense whatsoever
• Ashen cold skin, looking like a corpse that can still move a little
• May or may not have waves of uncontrollable shivering

Treatment for hypothermia:

• It is absolutely critical that core temperature be raised as soon as possible.
• Monitor pulse and breathing. Give victim artificial respiration, or CPR, if necessary.
• Get the victim out of wet or frozen clothes and immerse in a warm bath (not hot, optimum is from 102°F-105°F/39°C-40.5°C), if available. Change victim into dry warm clothes. Alternatively, wrap victim in pre-warmed blankets.
• Drink plenty of hot liquids, such as tea, coffee, or simply just hot water.
• If prior options are not available, have a warm person crawl into a single sleeping bag alongside the hypothermic victim for body heat transfer from the warm body to the hypothermic body. NOTE: Simply placing a hypothermic victim inside a sleeping bag by themselves is usually not good enough, since their body will at that point be pretty much shut down and not generating enough body heat on its own to rapidly restore correct body temperature.
• Seek medical attention— hypothermia is life threatening, so time is of the essence!

Jim:
I'd like to recommend the best chigger bite treatment:
Put some rubbing alcohol on tissue paper and lightly rub this on the chigger bite as soon as possible. Hold in place for at least half a minute to kill germs. Then immediately rub a piece of ice on the bite for a few minutes to reduce swelling. This will eliminate pain and swelling by 99%.  After getting hundreds of chigger bites over the years, this is the best method I've found. - Paul O.

James,
One thing to add about chiggers, or red bugs. I got these on my legs when I worked outside in Louisiana back in the early 1980s. I was told to sit for a half-hour in a hot bath, to which was added 1 cup of Pine-Sol. It did the trick, but I smelled like a pine tree for about three weeks. - Jim A.
 

Hi,
In reference to the recent bugs article, I wanted to share another defense against chiggers. We live in Texas and frequent areas that seem to be loved by chiggers. We've found that sulfur dust is a great chigger deterrent.

We put the sulfur dust in a sock and the tie a loose overhand knot in the sock. Before we go into a chigger infested area, like a dewberry patch or tall grass near a body of water, we'll take the sock and pat it on our shoes, socks and pants (or legs if wearing shorts) up to the knee.

It's not a foolproof method as we'll get an occasion chigger bite, but I've gone into the previously mentioned areas in shorts and yellow tinged legs without being bothered by chiggers. We also try to stay out of these areas during the morning, or at least until the heat has burned the moisture off of the plants. It seems that there are fewer chiggers on the dried vegetation.

Best Regards, - Jeff B.

Being “bugged” by insects is a problem we will likely face in TEOTWAWKI. Americans will spend more time outdoors in an effort to gather food and fuel as well as hunt and guard their retreat and resources. Exposure to insects will increase exponentially. Our defenses against pests will diminish significantly as our homes and retreats have their windows and doors left open more often. Also, the commonly available pesticides will probably not be available as supplies (of all kinds) decrease when TSHTF. We all know that insects have the potential to spread disease as well as lower our quality of life.  
While some insects have many beneficial roles in nature, this article will focus on those that are considered biting or stinging pests, e.g., ants, mosquitoes, flies, chiggers, fleas, ticks, lice, bees, wasps, and bedbugs.  Certainly, there are many more insects that can be considered pests. The brief descriptions here are intended to familiarize the preparing reader with insects that may be a nuisance when TEOTWAWKI comes and give some information on the dangers they pose and some suggestions for their control when supplies may be limited. Each of the listed insects below has a brief description, their likely locations, the effect and treatment of their bite or sting, as well as suggestions for their control when supplies may be limited.
ANTS
Ants are found on nearly every inhabited land mass of the planet. Most ants serve beneficial roles in our ecosystem, but occasionally conflict with humans. Examples of such conflict include, invading retreat larders and foodstuffs, damage done to equipment by ant hills, and of course, ant bites. There are many species of ants: the Black Ant is the most common while the Fire Ant is the most feared. Ants may be nomadic but most build nests that are made up of chewed vegetation and soil. Their nests may be located on or underground, under stones or logs, inside logs, hollow stems, or even acorns, in and on buildings in walls, windows, and even electric appliances. Ants enter a home to forage or seek shelter or both. Most ant bites cause brief pain, but scratching at them can lead to skin infections. Fire Ants are the only ant species that both bite and sting. The sting can be painful for several hours. Multiple stings can cause anaphylaxis and death to individuals that are highly allergic to insect stings.  Treatment for ant bite/sting consist of topical cortisone cream and oral antihistamines such as Benadryl. Control of ants is difficult. For ants found in the home, a bait that the ants carry back to their nest is the most effective. Many commercial products are on the market and a supply should be included in your preparations. Other control methods are to be sure your home and retreat are tightly sealed with caulking, screens, etc before TSHTF. There are many folk remedies for repelling ants, many more than can be discussed here, but I’ll include citrus oil.  Save any citrus peels, boil them gently in a small amount of water for 10 minutes, strain, and spray areas that need ant control. Boric Acid powder placed where ants will walk through it clings to their exoskeleton and dehydrates them or is ingested when they groom and kills them. Boric acid can be effective for up to a year if kept dry.  Please investigate other remedies to determine what will store well, be affordable, and perform to your satisfaction.
MOSQUITOES
Mosquitoes have been called by some “the most dangerous animal on Earth”.  Mosquitoes are found everywhere, except Antarctica. Stagnant pools of water are required for most mosquitoes to lay their eggs. The water can be fresh or salty depending on the species of mosquito. Both male and female mosquitoes feed on nectar and other plant juices, however, only the female of some mosquito species requires blood protein for egg production. Besides the irritation of their bite and possible allergic reactions, mosquitoes are known to transmit West Nile virus, St. Louis Encephalitis and Eastern Equine Encephalitis to humans. Use insect repellent containing DEET, citrus oils, or diluted Skin So Soft (Avon) on exposed skin and/or clothing. Products containing 100% DEET have been shown to provide up to 12 hours of protection while those with concentrations of 20% - 30% DEET offer 3 – 6 hours of defense. DEET is very stable and is effective indefinitely as a mosquito repellent.  The repellent/insecticide permethrin can be used on clothing to protect through several washes. Always follow the directions on the package. Avon Skin-So-Soft (diluted 1:1 with water) sprayed on skin and clothing is an excellent, economical repellent. Wear long sleeves and pants when weather permits. Have secure screens on windows and doors to keep mosquitoes out. Limit outdoor activity during peak mosquito feeding times such as early morning and evening hours. Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets, open barrels and other containers. Make small holes in tire swings so water will drain out. Children’s wading pools should be kept empty and on their sides when they aren't being used, as should similar containers.  

FLIES
The Housefly comprises about 90% of the common flies. Not only is the Housefly a nuisance, it spreads diseases as well. Houseflies lay their eggs in decaying, organic material from which larvae (maggots) emerge and develop into the adult. Houseflies serve as vectors of diseases such as Amebiasis (amoebic dysentery), Giardiasis, Typhoid, Cholera, bacterial dysentery, and intestinal viruses to name only a few. Flyswatters may keep kids busy and provide temporary relief from these pests, but other control measures are needed. Several commercial fly sprays are available, use the one you are familiar with which provides the control, price and availability you desire. In a TEOTWAWKI situation, a DIY fly trap may be useful. Re-purposing a 2 Liter (or similar) bottle with a funnel taped to the mouth (small opening in the bottle). Use a little waste organic material or waste sweet substance as bait. When full, remove the funnel, place the cap on the bottle and pour on the compost pile. Start over again.. Remove organic trash daily (or more frequently) to the compost pile, which should be located well away from the residence and water source.  If Houseflies (or other flies) are a problem, look for the source of decaying organic material and remove it. Wipe out waste receptacles, rinse, and bleach weekly or as needed. Sanitation is the key to Housefly control. Horsefly females inflict a painful bite. They are present in nearly all of the United States. Control is difficult relying on long sleeves and pants with DEET  insect repellent. Horseflies are known to transmit many blood borne pathogens between humans and Tularemia from rabbits to humans in the western US. They also transmit Equine Encephalomyelitis to horses. 

CHIGGERS
Chiggers (aka Red Bugs) are found worldwide and are present in the United States. They are common in the Southeast and Midwest but rare in the northern areas, deserts, and mountain terrain. A Chigger is a mite that lives in forests, grasslands, low, damp, marshy areas and appears to be more active in early summer. They seem to thrive in hot humid climes. Chigger larvae attach to human (and several other animal) skin. These larvae form a hole in the skin (not a bite) and inject digestive enzymes through this hole. The Chigger larvae then ingest the cellular contents and after 3-5 days on its host they drop off. The redness, itching, and irritation of a Chigger “bite” are not usually noticed until more than 24 hours after their digestive juices are injected.  Chiggers are not known for transmitting serious disease in the U.S., however serious cellulitis and secondary bacterial infections are common. Over the counter topical corticosteroids and/or topical/oral antihistamines are often used to treat Chigger “bites”. Cool or warm baths have both been described as bringing relief for Trombiculiasis (Chigger “bite”s). Fingernail polish applied to the “bite” does not suffocate the Chigger as is commonly believed. Control methods include wearing long pants/long sleeved shirts when possibly entering an area Chiggers are known to infest. Use a DEET or permethrin  pesticide before engaging in activity near Chigger infested areas. Wash clothes in hot water or leave them out in the hot sun for an extended period will clear the Chigger larvae from the clothes. Widespread or spot/area pesticide treatment of areas known to have chigger infestations is probably not practical in a TEOTWAWKI scenario.

LICE
Lice (singular is Louse) are small insects that are very species specific. Human lice affect only humans, while different animal lice affect only their host specie, i.e. cattle louse for cattle, dog louse for dog, etc. Lice are spread by direct contact and there are three types of human lice. These are head lice, body lice and pubic lice. Head lice are spread by direct head to head contact, sharing combs and hair adornments (hats, caps, etc.). They are very common among children, but also spread by child-parent contact. Body lice are also spread by direct contact as well as by sharing clothing and like articles from an infested person. Pubic lice are spread by direct contact, sexual contact, and/or shared towels, bedding, and clothes. All three types of human lice feed on blood, but do not burrow under the skin. The body louse has been known to spread diseases such as typhus.  All lice cause itching, redness and the possibility of secondary bacterial skin infections due to the intense itching. Head lice are treated most effectively with  a combination of lice combs to remove the nits (louse eggs attached to hairs) and wet combing every 3-7 days until the infestation is cleared. Hot air blow drying until the nits are dehydrated is effective, but not against newly hatched larvae.  Several other treatments are described, but may not be available when TSHTF.  Prevention is directed at preventing contact with affected persons and scrupulous hygiene when an infestation of head lice is occurring. Body lice are more easily treated by improving personal hygiene and washing clothing, towels, and bedding in hot water greater than 130 degrees F. Leaving clothes unwashed, but unworn for greater than a week will also kill the lice and prevent lice eggs from hatching.  Pubic Lice (aka Crabs) require clothing and bedding to be laundered and topical treatment by a physician using a permethrin or lindane product. Sexual or other direct (or indirect) contact should be avoided until the infestation is cleared. The take home message about lice is not to let an infestation get started in a TEOTWAWKI situation. There’s enough to worry about. Be careful of sexual, direct, or indirect contact (by group or family members) with new additions to your group until sure they are healthy to prevent pediculosis (louse infestation) as well as other health problems.

BED BUGS
Bed bugs are parasitic insects that feed exclusively on blood. The name "bed bug" comes from its preferred habitat: inside of or near beds or bedding in warm houses. Bed bugs are mainly active at night. They usually feed on their hosts without being noticed.  Many adverse health effects may result from bed bug bites, including skin rashes, psychological effects, and allergic symptoms. Diagnosis involves both finding bed bugs and the occurrence of compatible symptoms. Bed bugs are bloodsucking insects. They are attracted to humans mainly by carbon dioxide and body heat. Their bites are not usually noticed at the time. Itchy welts develop slowly and may take weeks to go away. Bed bugs prefer to bite exposed skin, especially the face, neck and arms of a sleeping individual. It takes between five to ten minutes for a bed bug to become completely engorged with blood and then it returns to its hiding place. Bed bugs can live for a year without feeding; they normally try to feed every five to ten days. When it’s cold, bed bugs live for about a year while at warmer temperatures they survive about five months. Bedbugs are carried to new locations on clothing, luggage, visiting pets, and transfer of furniture and/or on the human body. They may also travel between connected dwellings through duct work or false ceilings. Elimination of bed bugs is difficult. They are beginning to enjoy resistance to many pesticides. The active ingredient Lambda-Cyhalothrin found in Hot Shot Spider Killer has been found to be effective, but not appealing to use around human sleeping areas. Vacuuming, heat treating mattresses and bedding as well as wrapping mattresses must be included in any attempt to exterminate bed bugs, here again, be careful what you bring into your home or retreat. Bed bugs are hard to find and usually move only at night. They usually stay unnoticed in dark crevices, and their eggs can be found in fabric seams. Aside from bite symptoms, signs include fecal spots, blood smears on sheets, and molts. Bed bugs can be seen alone, but often congregate once established. They usually remain close to hosts, commonly in or near beds or couches. Bed bugs can also be detected by a unique smell described as that of rotting raspberries.

FLEAS
Fleas are small pests that cause discomfort and disease. They are laterally compressed, wingless insects that are found worldwide. Both male and female fleas bite and feed on the skin cells and blood of their host which may be human or domestic animals such as dogs or cats and rabbits, squirrels, etc.  For every adult flea found on a host, there are many more in the environment. Fleas cause discomfort by biting and crawling on the hosts’ skin. Their bites cause itchiness and redness. Some people may be highly allergic to these bites. Fleas also spread diseases such as plague, flea-born typhus, and cat-scratch fever. Treat flea bites with topical steroid or antihistamine creams, and/or calamine preparations. Flea control is difficult, especially if you have canine security or feline rodent control as part of your preparations. Modern flea control for pets is very effective; however the best topical or oral flea control products may not be available long when the grid is down. There are many, many flea control suggestions. Some are effective and others are hopeful. The following suggestions are offered for use when better flea control products may not be available. Salt, boric acid (borate), or baking soda can be applied liberally to bed linens and laundry mixed well in a closed container and left for 24 hours, then washed thoroughly. This will dehydrate and kill the fleas. These same compounds can be liberally sprinkled on floors and other places fleas may hide. Luckily, these are non-toxic and have many other uses so they may be too precious to use for flea control. Stock up! On the pet, most shampoos and diluted dishwashing detergents will kill fleas if lathered well for 10-20 minutes and rinsed well, however, this offers no long lasting control. Another suggestion is to use as much discarded citrus peelings or rinds as you can, boil in a small amount of water for 10 minutes and allow to steep overnight. The resulting fluid may be used as a non-toxic flea spray on humans, pets, and the environment, if you are lucky enough to have citrus fruits available. Have a container to accumulate citrus rinds and peelings to make as much of this fluid as you need.

TICKS
Ticks are not insects, but are included in this discussion as they are biting pests that cause discomfort and transmit disease. Ticks are present worldwide and are known to transmit diseases such as Rocky Mountain Spotted Fever, Lyme Disease, Colorado Tick Fever, as well as several other blood borne disease like babesiosis. They can also cause tick paralysis in humans and animals. The treatment of these diseases is not in the scope of this discussion, but is important for any outdoors person to be familiar with. If a tick is discovered on a human or pet, it must be removed with care not to force more of the fluid in the tick into the bite wound. Tweezers are recommended to remove the tick by grasping the attached mouth parts and head and gently rocking them out of the skin, being sure to remove the mouthparts and head. If these parts remain attached to the victim, gently scrape to remove these parts much like a splinter. Of course, wash and treat the bite as a wound. Tick control can be accomplished with regular inspection of your body especially after walking through tick infested areas. Also, many of the commercial mosquito control products containing DEET work well for tick control. An interesting approach for tick control in the environment, especially in a survival situation, is the use of guinea fowl. An article in the New York Times reports that 2 guineas can clear 2 acres of ticks in a year. As a bonus, guineas and their eggs can be cooked and eaten, plus they may add to security by setting up a ruckus if a predator or stranger comes near.

BEES AND WASPS
Bees and Wasps are truly venomous insects that are common throughout the United States. There are several types including the Paper Wasp, Yellow Jacket, Hornet, Mud (or Dirt) Dauber, and Cicada Killer as well as Honey Bee, Bumble Bee and Carpenter Bee. The Honey Bee may be the most beneficial insect to humans. All these venomous insects contribute to agriculture by honey production, pollination, and pest control, but may pose a threat to humans when their nests are disturbed. These insects feed on nectar, sugary plant juices, ripe or rotting fruit, and attractive, sugary human foodstuffs. Many of them prey on spiders, caterpillars, and other insects to feed their developing larvae.  Wasps and bees make their nests in many different fashions. Honey bees build colonies of combs or cells made of beeswax in tiers or layers located in tree cavities, rocks, spaces in buildings and commercial hives. Honey bees swarm when a newly produced queen leaves the colony with workers looking for a new place to establish a colony. A swarm is typically not aggressive and will usually settle in 2 – 4 days.  Bumble bees are larger, more hairy relatives of the honey bee. They burrow in the ground and use old rodent dens. Carpenter bees have little hair and are very similar in appearance to the Bumble bee. Their abdomens are typically slick. The female deposits its larvae in a tunnel with ½ inch diameter holes that extend several inches into wood. Male Carpenter bees cannot sting but will “bluff” when protecting the tunnel. Yellow Jackets make their nests in the ground, attics, crawl spaces and wall spaces. Hornets are bigger relatives of the wasps and make their paper, upside-down, pear shaped nests in trees, attics, and eaves of structures located in or near forests. Mud Daubers and Cicada Killers make their nests out of dirt on the sides of structures or burrow in the ground.  Only the female bees and wasps have stingers, which are adaptations of the ovipositor.  Honey, Bumble and female Carpenter bees typically are not aggressive unless provoked. Honey bees rarely sting when away from the colony however, but will actively defend the colony. Africanized Honey bees are more aggressive and attack in greater numbers when threatened. Paper Wasps build nests under eaves of buildings, trees, or other structures that they feel are out of the way and not likely to be disturbed. They will aggressively defend their nest if provoked. 

Yellow Jackets cause more stings than any other bee or wasp. They are notoriously belligerent. Yellow Jackets are attracted to sweets, and like the paper wasps, they feed on nectar and plant juices but prey on insects, spiders, and caterpillars to feed their larvae. Hornets behave like the wasps, but are slightly larger. Mud Daubers and Cicada Killers are wasps but are very passive and only sting when handled roughly. Their nests are the familiar dirt tubes found on walls or in the ground. Honey Bees stingers are strongly barbed compared to other bees or wasps. As such, when the Honey bee stings, the stinger is lodged in the skin and torn out of and along with other parts of its abdomen. Therefore, Honey Bees can only sting once and die shortly after stinging.  Honey Bee Queens stinger has no barb and can sting repeatedly, but rarely do. Other bees and wasps can sting repeatedly, and do not necessarily die from the act of stinging alone.  Bees, wasps, and hornets may release an aggression pheromone when killed, threatened, or stinging to identify a threat and raise an alarm to the rest of its colony. This pheromone goes away slowly and may stay on even after being rinsed with water. Therefore, these venomous insects may attack again after the perceived threat has gone under water and re-emerged.  

Bee, wasp, or hornet stings (venoms) vary in intensity by the type of insect. Usually they only cause brief pain, swelling, and redness which may last a few hours to a day or so. Some people are highly allergic to bee or wasp stings such that one sting can be fatal. Treatment for a bee or wasp sting is to rapidly remove the stinger, either by scraping the stinger out or removing it with fingers being careful not to stick yourself again. No difference has been proven between scraping or plucking the stinger from the skin, the more important factor seems to be removing the stinger quickly so that less venom is injected. Several home remedies such as applying tobacco, toothpaste, pennies, clay, urine, onion, baking soda and other similar applications circulate in folklore, but are not proven to be of benefit other than that from rubbing the area and the placebo effect. Ice applied to the area has the best result as for reducing the pain and swelling. People known to be highly allergic to bee and wasp stings should have an EpiPen or other source of epinephrine readily available. These people should be monitored closely and treated for anaphylactic shock if necessary. Destroying the nest of bees and wasps that are likely to conflict with humans is the most important part of bee and wasp control. Aerosol wasp and hornet sprays are available, and a significant supply should be available in your home or retreat. Sometimes destroying a nest becomes more of a threat than if the nest is simply left alone.

Honey Bees are the only one of the flying venomous insects that survive the winter. The others produce a queen to start over again and usually do not re-use a nest after freezing weather. Other control techniques involve good sanitation where foods are stored, prepared, eaten, and discarded. Also, using trash receptacles that have a tight lid and are cleaned as needed and regularly is important.  Control is not easy given that these insects usually nest in places that may be secluded and not frequently used. It is tempting to save gasoline or diesel fuel that is no longer useful, to kill ants, wasps, or bees with, but be aware of the risk these fuels may have if there is accidental skin or eye contact or inhalation. The flammable or explosive nature of old fuels may present more of a hazard than the insects you need to manage. Wasp and Hornet sprays can be used as a personal defense spray when directed at the face of an unwanted attacker - which may qualify it as a force multiplier.  

In conclusion, be prepared. Have your home and retreat pest proof. Seal cracks in walls and floors, use window screens and screen doors where appropriate and have a way to mend them. Include first aid items for insect bites and stings in your medical supply. Research and stock up on pesticides and repellents with an emphasis on those pests common to the area your home and retreat are in. Realistically guesstimate the quantities you may need or wish to have for barter or charity. Be cautious of who and what you allow into your home or retreat as they may bring insect pests. Always use good hygiene and sanitation. As preparations are made for TEOTWAWKI, please remember that it will be a long haul. My hope is that we will all thrive, not merely survive. If your arrangements have progressed past the Beans, Bullets, and Band-Aids stage, remember that you will have some company in the form of insects. Given the information above you can make some educated preparation. Now, of course, this information is not exhaustive and you should do more due diligence on this topic, just as you should with any other preparation. Where pesticides are used, it is the applicator’s legal responsibility to read and follow directions on the product label. None of the commercial products listed here are endorsed nor do I have any commercial interest by mentioning them. A physician, veterinarian, entomologist, nurse or pest control technician should be consulted if possible for more information, ideally before it is needed.

References:
Centers for Disease Control and Prevention – Fact sheets
How to Manage Ants – University of California Agriculture and Natural Resources
Iowa State University Extension Department web site
DEETonline - web site
University of Wisconsin Extension Department web site
University of Florida – Medical Entomology Laboratory web site
US Environmental Protection Agency web site
US Department of Agriculture web site
Wikipedia

Author's Personal Experience: Twenty years of Scouting: Scoutmaster, District Chairman, Board Member. More than 300 days and nights of camping (front country and back country). Firsthand experience with all of these pests while camping – except the bedbugs.

This is the time for all of us to learn something abut “Building a community”. We have done our best to be prepared to survive and to continue to enjoy an acceptable good life, and provide for the present and for the future. Time surely appears to be getting very short. Now is the very best time we will ever have to ready ourselves to rebuild our community and provide the services and protection that we will need.

We sincerely believe that our post-SHTF life must be more than simple survivalism, more that just having enough basic food to survive at a lower calorie count, more than simple security from the Golden Horde. Life must continue to be about improving one’s self. Life must be about enlarging God’s kingdom here on earth. Life must be about creating strong love for families. Life must continue to be about helping those who truly cannot help themselves.

We have envisioned being able to help our very small town of about 500 population, to be a tight knit community of survival oriented family units working together to provide for our selves and others as may be needed.  Our small town consists of about 125 homes with a terrific grouping of skill sets plus a 153-year history of working together on common interest projects. The nearest larger town is about six miles in one direction with another even smaller town about fourteen miles further up the road. A large segment of our town already strives to set aside a 1-2 years supply of basic food, fuel, and medicine.

Yes, about 60% of our little country town is Mormon and about half of them actually go to church with us. That is not the important thing. What really counts is that the folks around here are personally experienced in droughts, flash floods, forest fires, landslides, economic downturns, and just plain bad luck on occasion. In actuality we have experienced all of these disasters in just the immediate past 12 years. All of them!  And FEMA  and the Red Cross didn’t show up until the third day after the flood!

As for my family, we are actually two retired couples,, ages 72-72-61-62, plus four  small dogs  and two large cats, residing in a spacious shared home. . We have agreed that we are going to stay here when the SHTF.  We are long-term (20 years) close friends and have learned to trust one another. We have compatible skills and experiences. Yes! two women can share a kitchen and stay friends. Actually sisters in every sense of the word.

Our location is in rural southwest Utah and is centered on a very wide valley mouth (about 4 miles), and next to and above a usable small river. There is an all year creek feeding the river right in the center of town. There is plenty of drinkable irrigation water. We have a two lane state road passing through and only two other roads coming into town. We can be very security oriented immediately! We have a goodly number of retired military and police individuals who are ready and committed to help as needed.

Many of our folks have large gardens and grow wholesome food. There are very large pastures in the immediate area currently used to graze horses and cattle. Many of the ladies here in town raise chickens and are bartering eggs already.

We, as a community, already know mostly who will need medical help, as well as who can probably help to “pull the wagons “when needed.

As for our combined four retirees family, we are fortunate to share a very large well situated home with ample auxiliary power, good water, and a large septic system. A twelve panel solar array (2.3 KW) and a thirty-foot wind turbine  (1.6KW) will provide plenty of power as needed during the “hard times”. A Taller pole would be much preferred. We can heat the entire house with wood easily.

Our alt electricity system is a grid tied 48-volt system with 16 gel deep cycle 6-volt batteries. The batteries are situated in the garage and we are safe from battery fumes because of their gel configuration.

The turbine is good  for our situation and our location. It is a FALCON MACH 5 from Missouri Wind and Solar.  Good people to work with!  They carry all of the miscellaneous parts needed to make the power system perform to our specs.

Our electric power situation is not the only one in town. Two other families also have solar power arrays. However, we do have the only wind turbine. We will be able to provide recharging for the many kindles, notepads, laptops and battery powered small appliances we all seem to need so badly.

Our home is now plumbed to filter the local irrigation water to the kitchen for drinking and cooking. In addition to watering the garden, we can use that water for showers and to flush the toilets. We have a roof mounted solar water heating panel. The small twelve-volt glycol fluid pump at the water heater tank in the garage is powered by a roof top tiny ten-watt solar panel.

I have spent nearly twenty years building an excellent library of specific topic books and videos so that what ever breaks down, disappears, wears out, or proves to be inadequate to our needs, will be rebuilt, repaired, replaced, or expanded. We will do whatever it takes to make it work! We have the specific knowledge needed to do the job. And we can teach others as well.

We have recently made a small investment in Kindles and an exterior hard drive for data storage. Nearly every day one of us downloads and/or copies data from another source into the kindle. Amazon.com has a huge list of EBooks available for free and a great many for just 99c.

Additionally there are 40,000 free eBook’s available from Project Gutenberg. No fee or registration is required. It is fabulous.

Another good site for free EBooks may well be your favorite university. Here is a search result from Google looking for “free university EBooks”.

A great place to find very good quality new and used books and videos is Half Price Books stores. We paid $9.99 for a box of CDs covering 1890 to 1995 National Geographic magazines. Every word, every photograph, every map. 

Our personal main physical library has roughly five types of books. We work on expanding these regularly.  Where do we find books and videos?

Everywhere! Yard sales, consignments, public libraries, Craigslist, etc.

Our favorite topics are mainly these:

History - American

Medical  - “how to do it “

 Drugs -  Essential oils, homeopathic health care

 Food  - storage and usage

 Farming - anything we can find about non-electric farming
 
 Military – Army-USMC infantry low to mid level skills and leadership

Biographies - great men and women who built this nation

 PLUS … K-12 BASIC LITERARY AND MATH SKILLS!!!

These information jewels are of tremendous value now,  and even more when we start to rebuild our lives after the onset of chaos resulting from the loss of power, or the loss of financial systems, or the loss of regular food deliveries to our stores.

How will we use these data banks? Simply put, they are our DIY “how to” tools. We will build up a community known locally for good individual and town security, good medical care, good solutions to problems, great barter items, education for the children, gunsmiths, charged 12 volt batteries, protected trading fairs, barber and beauty shops, and nothing for free.

We will start with the community we already live in and know well. We will work with people we know and have learned to trust !

I am a 72-year-old diabetic with COPD and I need a regular supply of meds and a supply of oxygen 24/7.  We were able to get a used Oxygen Concentrator from the local company that provides my bi-weekly liquid oxygen restock. A patient had passed away and that person’s concentrator was then considered unusable. The delivery tech cut off the power cable and gave the used concentrator to me.  They wrote it off as destroyed.

I replaced the power cable and put the unit in the garage stores room as my backup. Further, I was able to obtain a supply of reserve air filters for the unit and extra tubing parts in order to be prepared when the O2 deliveries stop.

COPD is now the #4 killer in the nation. These oxygen usage situations are everywhere and are very serious.  Many persons with various serious medical situations keep that knowledge to themselves.  Finding them is important. Helping them to help themselves and others is critical.

A simple web search for “ Used Oxygen Concentrator” will produce more information that anyone may want or need. Three things are important.  #1. Free to low cost shipping costs, #2. 30 plus days of warranty, and #3. a 5 liter per minute flow. Do not buy under 5 liter flow.  Here is a link from the web search I did for these facts. There are many others available. http://www.dotmed.com/ The companies selling new ones all have good used stock as well. These same factors apply to obtaining other diagnostic and treatment equipment.

You can do a web search for companies selling new units and just make a list of their names and phone numbers. Do about 10 of them. I suggest that you make a list of questions with ample space between them to write the answers. Make enough copies so as to have a page for every company you are going to call. Now work the phone and make good notes about the answers to your questions. Always note the name of the person you are talking to. This is always a good research method for just about any important inquiries you might have.

As a diabetic I am concerned about safeguarding my insulin and keeping it cool. There was an article published in this blog site on 12-19-12 about a non-electric “zeer pot”. It is simple and it works. Look it up for yourself.

 In our town we have at least 4 elderly widows who now live alone. Surly there are others. When the SHTF we will try very hard to enable them to move in with a “compatible” family who has room for them. Every family needs a grandma, especially one who brings food, blankets, books, smiles, and experience with her. This will reduce the levels of community needs for winter firewood, summer cooling, childcare, etc. And we will all be happier!

Why do we believe this type of community care is important? Experience and history both teach us that if we do not care for those who “can not take care” of themselves, then no one will be cared for. We will succeed, or fail, together. If we do not take care of each other, no one will be taken care of.

Another element that we should keep in mind is, how should a community deal with strangers wanting help coming to one’s door, especially if they have children? We all know that we must make difficult decisions well in advance before the situation occurs. So be smart! Make these types of decisions before you are stressed.  Should you have to turn someone away, I suggest that you provide to them a small amount of food. One simple meal of beans and rice in amounts as needed. Send them on their way With a stern warning to not return.

A simple solution to future problems is to decide how you will respond to a situation in advance. And then perhaps agree in advance that the only new folks who will be accepted into your community are the family members of current residents. But first, I would require the current residents to commit to sheltering and feeding their newly arrived family member.

The newbies will need to be “thoroughly interrogated” as individuals, one at a time, and questioned separately as to skills and education and especially their background. Then the resident family will need to be questioned to assure that all of the family’s answers are the same. Do not be reluctant to say no!

Perhaps these suggestions are not exactly what you need. Talk about and make the decisions the decisions in advance. Be very careful whom you invite into your town, your secrets, your homes, and your hearts. Your worst enemy will be someone who will turn on you out of envy!

What about non-family exceptions? Keep in mind that your community will surely need some specific skills. Perhaps you need a plumber or a carpenter or a nurse or a teacher. Ask questions about skills and experience. Just what are the skills you will need almost immediately?  Most likely it will be Military and Police. These two are fully separate responsibilities. They should work together, each within the parameters of their specific tasks. 

Who is in charge? Perhaps an administrator, or mayor, or chairman. The actual title of the community leader really is not important. It just needs to be one that everyone understands who is the boss.

Your community leader will most likely perform best if he/she has two associates who work with him/her as counselors and surrogates with specific areas of authority and responsibility. One should be responsible for everything concerning medical and health. The other should be responsible for everything concerning food and supplies. Both will most likely have other areas of responsibility.  Before management decisions are final they would need to be very sure that they are both ready to support the leader.

Your military commander should be, if possible a combat veteran, responsible for every thing concerning security outside of your local area boundaries. Your police commander should be an experienced lead officer, and be responsible for the community security inside your boundaries. Both should report directly to the leader. Neither should be a counselor. You will have enough to worry about without a mutiny.

These tasks are going to be much the same in every sized group and in every type of location. Yes! There will be differences, just be flexible and understand that not everyone will immediately agree with you. Be patient and teach through honest dialogue and skilled questioning. The best leader is usually the best listener.

Now back to our basics, books and videos. We do not want to reinvent the wheel. This wonderful web site has a terrific suggested book list of lists readily available to you. Use it first!  SurvivalBlog.com blog.

Below we have a list for you of some of the books on our shelves. Some of the choices we have made for ourselves may well be nothing like what you feel that you need. No matter! You’re in charge. Smile anyway! Just do a list and get to work before the SHTF.

Our single expensive knowledge tool to date is the “Appropriate Technology Library” on four CD’s. The cost about six years ago was huge, $400. The four CDs contain 1,050 books. That’s about 49 cents per book! They cover everything anyone would ever need to know to start or to restart civilization, or just to build or repair a community infrastructure. The pricing has increased a little and the material is now available on two DVDs. Their web site is
http://villageearth.org/appropriate-technology/appropriate-technology-library

REMEMBER THAT ONLY CORRECTLY APPLIED KNOWLEDGE IS REAL POWER!

Here we go. Already on our book shelves as I write this, from among the suggested titles on the Rawles gigantic list of lists: -

When there is no doctor * When there is no dentist
The encyclopedia of country living * Nuclear War Survival Skills
Ball Blue Book of Preserving * Boston’s Gun Bible  * Tappan on Survival
Physicians desk Reference * The Merck Manual * LDS Preparedness Manual
Alas Babylon * Lucifer’s Hammer * One second After * Earth Abides
Molon Labe * The Postman ( book & video) * Out of the Ashes (1 thru 12)
Unintended Consequences (see warning) * Tunnel in the sky * Footfall
Atlas Shrugged * Jim Rawles Books ( All of them)*
Plus twenty-one more from the Jim's lists.

I am only including a selection of our other books that we have actually read, and there are many more just waiting to be picked up and gently used. As a rule, strictly reference books are stored in place, to be used as needed by someone to successfully complete a task or to teach a topic. Our total count in the library is in excess of six hundred plus the 1,050 on the CDs.

Farming 1918 Edition / Four Volumes Set - Sears & Roebuck
Farm Knowledge – Illustrated – pre-electricity -2,000 pages
American Survival Guide – 120 issues ( 10 years )

Medical  / drugs Essential Oils by Bowles / Barron’s
The PDR Family Guide by Three Rivers Press
Acupressure’s Potent Points by Michael R. Gach
AMA Family Medical Guide by Random House
The Green Pharmacy by James A. Duke
Everyday Health Tips by Prevention Magazine
The Botanical Atlas by Daniel McAlpine
Prescription for Nutritional Healing by P. A. Balch
Armageddon Medicine by C. J. Koelker, MD

History Rights of Man by Thomas Paine
Original Intent  book  *  Wall Builders DVDs by David Barton
Patriots of the American Revolution by Richard Dorson

Military Expertise: Company Commander by Charles McDonald
Company Command   by John G. Meyer
Army Officers Guide by L.P. Crocker
On War by Clausewitz
Command in War by Van Creveld
West Point by Bruce Galloway
Citizen Soldier by Robert Bradley
Total Resistance by H. Von Dach

Biography Roosevelt F.D.R.  & Teddy
Franklin  *  Churchill  *  Washington
Adams     *  Jefferson   *  Monroe

Food My wife has more than 40 books on everything imaginable
Concerning buying, storing, preserving, canning all types of Food. And that’s not counting her cookbooks & videos.

One more thing, no one should rely on the Internet for information because when the power fails, the Internet will die! It will be too late to get the information you will need.

It is our sincere hope that our readers will give serious thought concerning the timing and extent of your preparations in the areas of helping others and building a good life after we have survived the major disaster we are all facing. We are sure that Almighty God does answer our prayers for direction and decisions. Please refer to James 1:5 for this assurance.

We are passionate in teaching others the concept of making difficult decisions well in advance.

Remember Winston Churchill’s advice to the graduation collage class during the worst moments of WW2   “ Never Give Up."

Disclaimer: I have to say that I am not a physician and nothing I tell you is a substitute for good medical care. I am an RN with many years of experience in Emergency Room care, but that does not qualify me to advise you in medicine when there are Emergency Rooms all over the USA with qualified physicians on duty to take care of your health problem. The things I’m going to tell you only apply in a TEOTWAWKI situation. Use any information I am going to give you at your own risk.

That being said, what do you do if you’re bitten by a striped bark scorpion? First of all, let’s make sure that’s what bit you. A striped bark scorpion (or Centruriodes vattatus) is native to Northern Mexico and the Central United States, but I’ve heard it can be found all over this great nation of ours. It’s certainly the most common scorpion encountered in the US. Now, in South West United States, there is such a creature as the Arizona Bark Scorpion. It’s the most venomous scorpion in the US, but the fatality numbers are so low, it’s probably more likely that you’ll die choking on asparagus. However, knowing the difference between the two types can save your life, or your dog or your goat or whatever you have. I recommend that you look at some pictures of them right now. It’s okay, I’ll be here when you get back. I could describe them all day long, but a picture is worth a thousand words. You’ll notice that the Striped Bark Scorpion is about two to three inches long and has two broad, black stripes running down the length of its back (it’s striped, who knew). The Arizona Bark Scorpion is similar in build, but it’s more of a uniform light brown. While the striped one is venomous and its sting is highly painful; I’ve never seen anyone have a reaction more than that of a typical wasp, bee or fire ant sting. That being said, most of the tips I’m going to give you are treatments for wasp, bee or fire ant stings too. Just remember, this article is not about the Arizona bark scorpion, just the striped variety.

An ounce of prevention is worth a ton of cure. It certainly beats a mouthful of colorful expletives that you might have to explain to your small kids later on if you get stung. Striped bark scorpions tend to be nocturnal. That means they do most of their business at night. But, they sleep in cozy little places and tend be upset if you wake them; so don’t let your guard down because the sun is out. They really like dark and damp places, so if you have dark and damp places, take extra precautions. Be careful when lifting up old tree bark or wood that has been on the ground for more than a few hours. That also goes for rocks, bricks, tools, helicopters or anything that you might have laying around in the yard. When you bring firewood in, give it a good once over if you’re not putting it immediately on the fire. Keep your yard mowed and trim tree limbs so that they don’t touch your home. Invest in a cat, invest in two cats! Over the counter sprays and pesticides do very little if anything at all to kill scorpions, but cats will eat those little dudes up! If you live in the country, get some Guinea Fowl. Guineas are veracious little insectivores (omnivores, actually) and they’ll mostly leave your garden alone. You dog will be thankful for all the yummy ticks they take care of, also. As an added bonus, they lay eggs that taste like chicken eggs and cook up nicely with dumplings. Just be careful with your guineas because they’re very susceptible to predators, like cats.

Now that we know how to keep scorpions away from yourself, let’s talk about some other things we can do before TEOTWAWKI to minimize bad outcomes. After all, the very nature of prepping is having things ready before things go south. Get a tetanus shot. You should have one anyway. If you haven’t had one in the last ten years, make an appointment to get one first thing in the morning. Tetanus is a much more painful death than a scorpion sting. A tetanus shot is good for ten years, unless you have a scratch, then it’s five years. Getting one today will help you when there’s no doctor or ER to go to.  Have lots of soap on hand. Also, know the difference between soap and detergent. Most soaps you buy today are just detergent that will cut grease and make you smell nice, but they really don’t disinfect. Look for antibacterial soaps. Just in the regular world, I don’t recommend them; but for TEOTWAWKI, they’ll become essential. Lye soap can disinfect. Learn how to make it, it’s not too difficult. Make sure you have access to clean water. It’s always a good idea to not only have clean water to drink, but for first aid, also. Always know how much you weigh and how much your children weigh. It’s terrible important. There are three medications I recommend having on hand. Benadryl and Ibuprofen or Aspirin are the two most useful. The third is an EpiPen, which is available by prescription only. We’ll talk about that one later. First, let’s cover immediate first aid.

If you get stung by a striped bark scorpion, the first thing you do is scream like a little girl and dance around because it hurts like a mad bastard. You’ll know it because it almost feels like a bee sting but worse. When you calm down and regain some self control, look at where it bit you. Is the insect still in a place where it can sting you again or sting one of your children as they run towards you to find out why you’re expressing your filthy mouth? Is it still on your pants leg? Go ahead and kill it. Don’t worry, they’re not endangered. God will make more. Smash it with a shoe, scoop a little dirt and then bury it so it won’t sting you or your kids again. Wash it with clean water and soap. If it’s today and the lights are on, regular soap is okay. If it’s post TEOTWAWKI, then you want to use an antibacterial soap or lye soap. The risk and incidence of infection will be so much higher. If you have ice, put ice on it, but for no more than twenty-four hours. Be careful with ice, too. Placing it directly on your skin can cause frost burn. Elevate your offended body part and keep it still for about twenty-four hours. Expect to have pain and some numbness in your entire extremity for up to forty-eight hours. Never be afraid to seek medical help. If you have a reliable family doctor or an Emergency Room within a day’s drive, go see them.

Warning! Math content ahead! Before we go any further, let’s take a minute to learn how to convert pounds to kilograms. It’ll be important later if you want to save your children’s life. You take a weight in pounds and either divide it by 2.2 or multiply it times 0.45. So, if you weigh 123 pounds, 123 X 0.45=55.35 kilograms (just round it off to 55). Okay, moving on.
Benadryl is useful as an antihistamine. Basically, when you have an insect sting, your body releases chemical called histamine.  Histamine, in turn, triggers and inflammatory response. That is what makes a bite so red and itchy. Also, if you are prone to allergic reactions to insect stings, this can be helpful in saving your life. Any medications I tell you about are best taken as soon as possible. Let me repeat that, it’ll be on the test. In the event of a scorpion sting, take these meds as soon as you can get them in your body! In a true anaphylactic (allergic) emergency, seconds count! Benadryl works by blocking histamine, therefore blocking some inflammation. If you are an adult weighing over 100 pounds, take 50 milligrams. If you have pills, you’ve wasted your money, but we’ll talk about that later. If you have twenty-five milligram pills and that’s all you have, take two of them (twenty-five plus twenty-five equals fifty, see how that works?). The reason I say that the pills are a waste of money is that the liquid works much faster. It tastes horrible, it costs more and it’s hard to store, but the faster absorption can be the difference between life and death when seconds count. Remember seconds? If you are an adult weighing over one-hundred pounds and you have Benadryl liquid that is 12.5 milligrams in a teaspoon, then take four teaspoons. If one of your children gets stung, give them Benadryl at 1 to 2 milligrams per kilogram. So, if your kid weighs 50 pounds, that’s 22.5 kilograms. 2 milligrams per kilogram turns out to be 45 milligrams of medicine (2X22.5=45). 45 milligrams divided by 12.5 milligrams = 3.6 teaspoons. Since there’s 5 milliliters in a teaspoon, we will give 18 milliliters (3.6 X 5=18).

Wow, have a headache yet?

Now, let’s talk about Ibuprofen. Ibuprofen, Motrin and Advil are all the same thing. Ibuprofen is an anti-inflammatory. So, after the histamine makes inflammation, the Ibuprofen will kick in. Still, don’t waste any time taking it. It’s okay to mix Benadryl and Ibuprofen. For grownups weighing more than 100 pounds, take 400 milligrams. Again, take a liquid. If your Ibuprofen is mixed 100 milligrams to one teaspoon for the kids give 5 milligrams per kilogram. So, if your child weighs 50 pounds, that’s 22.5 kilograms. 5 milligrams per kilogram turns out to be 112.5 milligrams of medicine (5 X 22.5=112.5). 112.5 milligrams divided by 100 milligrams = 1.125 teaspoons. We’ll just give one teaspoon.
Burns your eyes, don’t it?

Okay, next let’s talk about EpiPens. No more math, I promise. An EpiPen is available by prescription only. It’s a shot that you give to yourself if you’re having an allergic reaction to anything, insect bites included. If you need one, make sure you see your family physician, get a prescription, get it filled and carry it with you at all times. It contains a prescribed dose of adrenaline to get you to the ER so that doctors and nurses can take it from there. If you can’t get to an ER, say a little prayer. If you know you’re allergic to insect bites and you get one in a TEOTWAWKI situation, always use your EpiPen, because it’s the best chance you have. If you use one or not, go ahead and pray. It’s never too late to get yourself right with God.
What are the symptoms you might experience when stung by a striped bark scorpion? Let’s see.  The site will be red. It’ll be painful if you mash on it.  Check and make sure there’s not a stinger left in there. A scorpion won’t leave a stinger, but a bee will and sometimes it’s hard to tell the difference. If you see a stinger, scrape it out with a clean fingernail. Numbness and tingling.  Those are the local signs. You might sweat, vomit or feel palpitations (heart fluttering). That’s less common, but it’s a sign of a more serious reaction. If you get dizzy, feel your throat and lips swelling, get restless or irritable, that’s even more serious.

The most important rule of all is to stay calm. Running around in circles and acting like a chicken with its head cut off gets you nowhere. People make mistakes when they panic and panic is much more dangerous than any insect known to man. No matter what, if you’re not sure what to do, always ask somebody who knows. Again, this information is for use only in TEOTWAWKI. Otherwise, use it at your own risk.

Ever since Primatene Mist was taken off the market a year ago, SurvivalBlog readers have asked about a replacement for this potentially life-saving over-the-counter drug.    Now there is one, in the form of Asthmanefrin.
If you don’t have asthma, should you care?  Definitely so.
Although the drug is officially only indicated for asthma, in the event of societal collapse, it may be the only effective and available treatment for:

• Serious allergic reactions to foods, drugs, stinging/biting insects, or other substances
• Widespread hives
• Anaphylactic swelling of the face, lips, or throat (or angioedema)
• Dropping blood pressure
• Narrowed airways due to infection, inflammation, COPD, or exposure

If you don’t have any of these problems, you surely know someone who does. Or maybe you have a young child who may one day suffer from croup.  Or perhaps you occasionally contract acute bronchitis.  Or possibly you’ll be around a campfire where you accidentally inhale poison ivy smoke.  Any of these conditions may require an (adrenergic) bronchodilator, and the only available such medicine over-the-counter is Asthmanefrin.  Anyone who has struggled with asthma in the middle of the night can tell you why a rescue inhaler is worth its weight in gold. 
When the FDA banned the manufacture of Primatene Mist as of December 31, 2011 (due to the CFC propellant and concerns about the ozone layer) asthmatics were left with no OTC alternative to prescription rescue inhalers.  Although Armstrong Pharmaceuticals does hope to release a new version of Primatene Mist using an approved hydrofluoroalkane (HFA) propellant, no date has yet been set. 

The new product, Asthmanefrin, contains 11.25 mg of racepinephrine per 0.5 ml vial, in a solution equivalent to 1% epinephrine.  Epinephrine is the same medication contained in the Epi-Pen, the well-known injection for bee sting and other allergic reactions.  Although inhaled epinephrine is most active in the airways, some of it enters the bloodstream, which delivers it to the rest of the body, hence its ability to raise blood pressure, accelerate the heart rate, and relieve the vascular-related swelling common to hives and allergic reactions. 
These potential benefits are also sometimes considered side-effects, which may be dangerous to patients with heart disease, hyperthyroidism, high blood pressure, tremor, and other nervous conditions.  Doctors don’t like over-the-counter epinephrine products due to 1) the potential harm they may cause in susceptible individuals, and 2) the potential delay they may cause in seeking needed professional care.  However, in a young, otherwise healthy population epinephrine is generally safe.

The product insert includes dosing recommendations for adults and children down to the age of 4 years old.  For adults, one 0.5 ml vial of solution is placed in the EZ Breathe Atomizer, with a recommendation of not more than 12 inhalations in 24 hours.  By comparison, Primatene Mist inhaler delivers 0.22 mg of epinephrine per inhalation, also with a limit of 12 inhalations per day. 

The Starter Kit contains 10 vials plus one Atomizer and costs approximately $50, with the 30-vial Refill Kit priced at about $25, a small price to save a life. 

About the Author: Cynthia J. Koelker, MD is SurvivalBlog's Medical Editor. Some in-depth additional information on using over-the-counter medications like prescription drugs is available free on her web site at ArmageddonMedicine.net. 

A little about me: I am 27 years old, I have been married to my wife for 7 years. We have two boys, ages six and 22 months. Both my wife and I are school teachers; I also coach football and power lifting. So, we are the epitome of the American middle class. I have always enjoyed hunting, camping and the outdoors. So I have developed some basic “outdoorsman” skills throughout my youth and early adult hood.
As a young child and early teen, I was very interested in survival, homesteading, and living off the land. I remember reading Foxfire books with my grandfather and dreaming of becoming a true mountain man. I wanted to be a real Jeremiah Johnson. My grandfather passed away when I was thirteen and I subsequently lost interest because it was something we talked about together. It was just too upsetting to think about without him. Shortly after his passing, I began high school and eventually college and “got caught up in life”.
In the last several months, I have become very interested in emergency preparedness for my family. I was truly overwhelmed with the amount of information I discovered; some of it very good, some so-so, and some just plain off-the-wall. I am writing this in hopes that it will save others in the same situation I was in some time. Just like in any other survival or preparedness situation, time is of the essence.
This article is meant as an introduction for someone who has little to no background information on the subject. This article could also be useful to the serious prepper who never thought about how they would get back to their shelter if a disaster struck while they were “out and about.” This is a “primer” to get people thinking about survival situations. Are there some better choices out there? Possibly. Did I say my suggestions were the cold, hard, fast rules?  No. Take this article as it was meant.
I have run across several three tier survival models in my searching. I have also discovered several good sources for emergency preparedness for bugging out and sheltering in place. I have combined the information in what I am calling 4-Tier Survival. The tiers are as follows:

• TIER ONE: This is your everyday carry (EDC) on person. You should have this with you 24/7 or as close to 24/7 seven as possible. Basically, if you have pants on, you should have these items with you.
• TIER TWO: This is your EDC bag. You should have this with you or within reach 24/7. Take it with you to work, the grocery store, running to the gas station, etc. If you walk out the door of your house, it should be with you.
• TIER THREE: This is your 72 hour kit, bug out bag, SHTF bag, or any of those other catchy names for them. At a minimum you need one. If you only have the funds for one, so be it. But, eventually I would suggest having one for the house, the vehicle and possibly at work if you have the space to store one.
• TIER FOUR: This is for long term preparedness. This is long-term food and water storage and procurement methods. Always prepare your home to shelter-in-place first. Then, if you have a secondary bug out location, prepare it. Depending on the disaster or emergency you may or may not be able to bug out. On the other hand, you may be forced to evacuate or bug out.

Before I go any farther in this article I want to give you a great piece of advice: Develop and hone your knowledge, ability and skills over the knives, tools and kits. A vast amount of knowledge and skills with a minimum amount of tools will keep you and your family alive a lot longer than a vast amount of tools and minimum amount knowledge and skills will. This may seem contradictory to what this article is about. But, do not lose sight of this advice. Everyone knows someone who has the newest, best whatever it is but no clue how to use it. This makes them look like a fool. Don’t be a fool.
When creating the tiers, I kept in mind the basic needs of a survival situation, shelter, water, fire, food and I am going to add protection. In a the end of the world as we know it (TEOTWAWKI) situation, protecting yourself, your family, home, supplies and gear could be a paramount priority. The first three tiers will enable you to get to your fourth tier. We all find ourselves away from
Now, let’s discuss the tools and supplies I feel are needed for each tier. This is by no means the end all, be all list of what is needed. This is what I have come up with for my kits. Feel free to add or take away as you feel necessary. This is based off of my skill set and my family needs. I wanted to condense a lot of information into a single article and basically get you thinking about what you will need. I want you to come up with your own kits. I also wanted to show you that all of the tiers are possible. They will take some time, energy and money, but anyone can do this.
Note: I will not get very technical in the types/brands of items to carry. Use your own judgment; remember, most times you get what you pay for. Also, I go by the mantra, “Two is one, one is none.”
TIER ONE: On-person EDC

• Blades/Tools
• Quality folding knife of your choice. Make sure it is sharp. You are more likely to injure yourself trying to cut something with a dull knife than you are using a sharp knife.
• Quality multi-tool. There are many options available. Look at the type of environment you spend the majority of time in, consider your skills, and use this to decide the brand/style of tool you want to carry.
• Lock picks/Bogota – I choose NOT to carry these as of now. Remember what I said about skills earlier. I know I don’t have the skills needed to use these. Now, once I develop the skills, they will be added to my EDC.
• Small compass. Just to get a general direction if needed.
• Pen and small notepad. I personally like the waterproof kind. Nothing like getting caught in the rain and losing everything you have made notes of.
• Small survival whistle.
• Cotton bandana.
• P-38 can opener. I carry one on my key ring. I forget it is even there, until I need it.
• Cell Phone
• Pretty self-explanatory. Pretty much everyone has a cell phone that they carry anyway. [JWR Adds: It is important to also keep a 12 VDC cell phone "car charger" handy.]
• Cordage
• 550 Cord. There are lots of different, creative ways to carry. There are bracelets, key fobs, zipper pulls, belts, even lacing your boots/shoes with it. Learn how to braid your own items.
• Fire
• Small brand name lighter. Cheap and easy to carry way to start a fire.
• Small firesteel. Another cheap, easy to carry way to start a fire.
• Tinder. Could be a magnesium rod, dryer lint, or any brand of quick tinder that is out on the market now, you should know what works. I prefer magnesium rods; they take up less room and are light.
• Firearm
• I am not going to start the never-ending conversation of discussing brands and calibers.
• Find a gun that you can comfortably carry and shoot.
• Shoot, a lot.
• Shoot from behind cover, kneeling, sitting, lying down, standing, off hand, from one yard to 25 yards.
• Shoot some more.
• Practice reloading, practice reloading behind cover, practice reloading standing, kneeling, lying down, off hand.
• Practice some more.
• Light
• Small flashlight. I personally look for an LED version that runs off of AA or AAA batteries. Look for one that is waterproof or at the very least water resistant.
• Keychain LED light. Look for one that has a locking on/off switch. These are easier to use in the fact that they do not have to have constant pressure on the switch to illuminate.
• USB Drive
• I use my USB drive to store all types of important documents and other information I run across and want to save. I have encrypted my USB drive in case it falls into the wrong hands. (I strongly suggest doing this.) Also, save the information under nondescript names. In other words, don’t save the file as: “Insurance Papers” or “Social Security Cards”, etc.
• Birth/Marriage Certificates
• Social Security Cards
• Driver’s License
• Insurance Policies/Cards
• Vehicle Registrations/Insurance
• Medical/Shot Record
• Recent Check Stubs/Bank Statements
• Stocks/Bonds
• Property Description
• Another option/addition to this is online file storage. There are many places available on the internet to store files on a remote server and be able to access from any computer or cell phone with internet access.

Some people I have seen carry as much as possible on their keychain. The only thing with that is if you lose your keys, you have lost a lot of your gear. I carry some stuff on my belt, some in pockets and some on a keychain. I have even seen and thought about carrying some items around my neck. Whatever you feel comfortable with and what works for you is best.

TIER TWO: EDC Bag
Tier two is going to contain pretty much everything from tier one except bigger and better.

• Blades/Tools
• Quality fixed blade knife of your choice. Again make sure it is sharp.
• Sharpening stone.
• Quality multi-tool. I would look at one to complement the one from tier one. A little larger and possibly features that the other does not have. I personally wouldn’t want the exact same model from tier one. Look at the ones that have the screwdriver possibilities.
• Small entry bar or pry bar.
• Larger more reliable compass. Possibly a GPS system if you are so inclined. If you are in a large urban environment, I would have a city map in my EDC bag.
• Pens and notepad again. Plenty of pens and permanent markers.
• P-51 can opener.(A scaled-up version of the P-38.)
• Cell Phone/Communications
• This is where I would keep a wall charger for my cell phone.
• I would also think about one of the emergency chargers that run off of batteries at this point.
• I also carry a pay-as-you go phone in my EDC bag. On some occasions when one service is down, others are still up and running. It’s a cheap insurance policy.
• Radio of some sort. Depends on your location and abilities.
• Cordage
• I would carry no less than 25 feet of 550 cord in my EDC bag. The more the better. Again, options here, braid it to take up less space, key fobs, I’ve seen some braided water bottle carriers. Use your imagination
• I have run across Kevlar cord, no personal experience with it. But, something I will check out.
• I would toss in some duct tape and electrical tape here. You can take it off of the cardboard roll and roll it onto itself and it takes up very little room.
• Possibly some wire, picture hanging wire works well.
• Possibly some zip ties. Various sizes as you see fit.
• I also have a couple of carabiners clipped to my bag.
• Fire
• Another cheap lighter.
• Larger firesteel.
• More tinder. Personally I prefer the magnesium, but whatever you are comfortable with.
• Firearm
• I personally don’t see the need to carry a second firearm.
• I would however warrant the carrying of at least two spare magazines for the handgun in tier one.
• First-Aid
• Basic first aid kit.
• Package of quick slotting agent.
• Basic EMT shears.
• Basic pain relievers, fever reducers, upset stomach tablets etc.
• Small bottle of hand sanitizer.
• Baby wipes.
• Food
• I always carry a couple of energy or meal replacement bars in my bag. If nothing else, I may have to work through lunch and need a snack.
• Some people will toss a freeze-dried meal or MRE if they have room. Personally, I don’t.
• A small pack of hard candy.
• Light
• I personally prefer a headlamp at this stage. You can use a headlamp as a flashlight; you can’t use a flashlight as a headlamp.
• If you don’t go the headlamp route, choose a higher quality flashlight than tier one.
• Extra batteries. On the subject of batteries, do your best to acquire electronic items that use the same size of battery.
• Another keychain light. I have one attached to the inside of my bag to aid in finding items inside in low-light situations.
• Some people carry chemical light sticks in their EDC bag. I have found battery operated light sticks that also have a small flashlight in one end I prefer to carry.
• Shelter
• I keep a packable rain jacket at all times and depending on the weather a packable pair of rain pants. Remember, your clothing is your first form of shelter.
• I also keep a couple of “survival” blankets in my bag.
• I keep a couple of contractor style garbage bags as well.
• Water
• I have a stainless steel water bottle that stays in my pack at all times. If I am traveling longer than my normal commute, I will toss in a small collapsible water container.
• Ziploc bags.
• Two-part chemical water purifier.
• Filtering drinking straw.
• Toss in a couple of standard coffee filters to filter sediment if needed.

Now, bear in mind, my EDC bag is not for long-term survival. I feel like I could sustain myself for several days if I needed to with the contents of my pack. However, that is not its intended use. All of the tiers are designed to sustain you until you can “make it” to the next tier.

My EDC bag is the same bag I use for school every day. Granted I cannot carry a weapon or ammunition into the school building. My point is you don’t want all of your Tier Two items to be so big and bulky that you can’t comfortably carry them. All of this stuff is in addition to my school books and papers and tablet. For those of you that are curious, I prefer a messenger style bag. But, again, whatever works for you and is the most comfortable.

TIER THREE: Larger rucksack or backpack

A lot of people would call this the 72 hour kit. I feel that this is a bit of a misnomer. Granted, 72 hours is a good figure for most people to shoot for. However, I feel that in this stage of the game, you should be able to carry enough to survive indefinitely. 

• Blades/Tools
• Quality fixed blade knife. If you want you can double up from tier two. Depends on your requirements. Remember, two is one, one is none.
• Small quality folding shovel.
• Quality hatchet.
• Small machete. If you feel that your knife is up to the task of clearing brush, no need for one. Also, if you are in a true bug out situation where people could be looking for you, you don’t want to clear a highway through the brush.
• Some type of saw or saw blades. There are some nice pocket chain saws on the market now. Or you could carry blades and fashion your own handle or frame.
• Tools for forced entry if warranted. Pry bars, bolt cutters, etc.
• Tool kit. Depends on your location and environment. At the bare minimum carry enough tools to repair anything that you are depending on in a survival situation.
• Cell Phone/Communications
• Depending on the level of the disaster cell phones may or may or may not be working.
• Again, depending on your location and abilities, depends on the type of communications you should carry.
• One thing I have not seen widely talked about is two way radios. Obviously this would be if more than one person is in your party. However, now you start talking about batteries and chargers.

• Cordage
• At least 100 feet of 550 cord.
• Depending on your environment, climbing rope, harness and gear may be warranted.
• Tape, electrical and duct.
• Zip ties, various sizes
• Wire, picture wire.
• Carabiners, various sizes.
• Fire
• Cheap lighter.
• Firesteel.
• Tinder.
• Camp stove. Small, lightweight, portable. A lot of good information about this out there. Pay special attention to the type of fuel that the stove you select uses.
• Firearm

This depends on the type of situation you are in. I will list the types of firearms I would have, not necessarily carry, and reasons why. If this is a true bug out situation obviously the adults in your party could carry at least one, more than likely two, long guns.

• We have already discussed a handgun.
• “Modern Sporting Rifle”. Be it an AR based platform, an AK-47, Mini-14 etc. I personally like the AR platform. However, A’s can be a bit finicky if not properly cleaned and maintained. Something you may not be able to do well in a TEOTWAWKI situation. So, I would grab an AK-47. Whatever your budget and preference lead you to.
• .22 caliber rifle. There are many options, I personally recommend the Ruger 10-22. There are several collapsible stocks available. This is for hunting small game.
• Home defense shotgun. I would suggest a 12 gauge. The options and setups are endless. You can go as mild or as wild as your budget and imagination allow. This is not something I would necessarily always grab. However, this is something I feel that no home should be without. The sound of a shell racking into the chamber of a pump shotgun is a sound that will deter most people without even firing a shot.
• Extra magazines and ammunition.
• First-Aid
• More advanced first aid kit. There are pre-made ones on the market or come up with your own.
• Quick clotting agent.
• EMT Shears.
• Pain relievers, fever reducers, upset stomach pills, etc.
• A week’s supply of any prescription medications.
• Any supply of antibiotics or narcotics that you can procure.
• Knowledge of natural/herbal remedies. Here is a great area where knowledge can help you a lot longer than supplies can.

• Food
• If you want to put in a three day supply of freeze-dried meals or MRE’s. Go for it. But here is where procuring your own food will come in handy.
• I would suggest some type of mess style kit for cooking. Again, your choice.
• Fishing kit. Fishing line, assortment of hooks, sinkers and artificial bait if desired.
• Fishing “yo-yo” traps. Can be set and left alone to catch fish while you are doing some other task. I feel these are a necessity. They are light and take up little room.
• Snare kit. I would suggest several pre-made snares and supplies to create more.
• Traps. Connibear style traps, an assortment of sizes. 4-6 is all you should need.
• Frog gigs. Could also be used for spearing fish, depending on your location.
• You also have a firearm for taking small or large game.
• Knowledge of wild edibles in your area or bug out location.
• Light
• Again, I would suggest a headlamp and extra batteries.
• Use your discretion for what else you may want/need.
• Shelter
• Two changes of clothes. One for warm weather and one for cool/cold weather. Again depending on your environment.
• I would suggest at least 3 pair of underwear and 6 pair of socks.
• Packable rain gear.
• Quality bivy style shelter or tarp.
• Quality sleeping bag. Again, do some research. See what fits your needs and budget.
• Sleeping pad if wanted.
• Possibly a pocket style hammock.
• Water
• Stainless steel water bottle.
• Chemical water treatment.
• Water filter/purifier. Again, look at your budget and needs. There are several nice options out there.
• Coffee filters for straining out sediment.
• Collapsible water storage.

TIER FOUR: Long term preparedness.
Even though this is the largest of all the tiers, I will probably go into the least amount of detail. There are many great sources of information concerning long term preparedness, SurvivalBlog.com being one of the best, if not the best, in my opinion.

• Blades/Tools
• Obviously any blade or tool previously discussed. Except full size versions.
• An ax, saws, shovels, garden hoes, rakes, etc.
• Possibly a plow, seeder, etc, for planting a garden.
• Variety of hand tools.
• Automotive tools, carpentry tools, etc.
• Sewing machine, needles, thread, clothing patterns, etc.
• Begin thinking of ways you can use your tools and knowledge to develop a skill that can be used for trade or barter.
• Communication
• Short wave radios, ham radios, etc.
• Two way radios.
• Cordage
• Large amounts of any cordage or supplies under cordage already discussed.
• Fire
• Cast iron stove.
• Fireplace.
• Begin thinking now about how you will be heating your home in the winter. Think about how you will be cooking your meals. Also, think about how you will get fuel for your fire.
• Firearms
• We discussed in tier three the types of firearms I felt were needed.
• Begin thinking about amount of ammo you can and are willing to stockpile.
• Begin thinking about reloading your own ammunition. Begin thinking about stockpiling supplies. This can be turned into great bartering items.
• First Aid
• Begin developing a large first aid supply. Think about what you will need to do without a doctor present. Suture kits, surgical kit, trauma kit, etc. There will be no running to the emergency room.
• Begin thinking about dental supplies. Again, there will possibly be no dentists to go to.
• Again, knowledge is key in this situation. There are some good books about this type of thing. Take a first aid class, learn CPR. Learn as much as you possibly can.
• Study about and begin stockpiling medications.
• Food
• There are many more articles to be written and read on this subject alone.
• Start developing a small reserve of foods that you eat on a regular basis that have a long shelf life. Start with a week; go to a month, then three months, then a year, then longer.
• Begin thinking now about storage. A year’s supply of food for your family will take up a considerable amount of space.
• Expand on the amount of items you have from tier three. Increase the number of traps and snares you have.
• Think about obtaining a variety of seeds to plant in your garden.
• Again, there is a vast amount of information to be found on this subject alone. The main thing I want you to understand is this is doable, on any income. Start small and work your way up to larger quantities.
• Do not get yourself into a financial burden by going out and buying a year’s supply of food at one time.
• Light
• Begin obtaining lanterns, fuel, mantles, etc.
• Begin thinking about candles and candle making.
• If you are so inclined, begin thinking about solar panels for your home or shelter location.
• Shelter
• Begin making those small repairs to your home. Things that may be fairly quickly and easily fixed now may not be so easily fixed later. I’m not talking kitchen remodeling; I’m talking leaky faucets, broken windows, drafty doors, etc.
• Think about having a metal roof installed if you don’t have one already.
• This is the time to think about a secondary survival location. A remote, rural location. Think of this as an investment. It could be used now as a vacation spot. Use it later as a retirement home.
• Water
• Begin storing water. Think not only about drinking, but also cooking and cleaning.
• Again, start small. Begin with a few days worth; then weeks and months.
• Start thinking about long-term procurement and storage. Gutters that empty into water storage, etc. Think also about purification on a large scale.
• Miscellaneous Things to Thing About
• Sit down and make a list of normal, everyday things that you do around your house, cleaning, washing, “personal” business, entertainment, etc.
• These are activities that require items that you will not be able to run down to the store to get.
• Toiletries. Soap, shampoo, toothpaste, toilet paper, razors, shaving cream, feminine hygiene, etc.
• Cleaning. Bleach, disinfectant, dish soap, laundry detergent, etc.
• Entertainment. Cards, board games, puzzles, books, etc.
• Think about large quantity storage of fuel; for cooking, heating, anything with an internal combustion engine, etc.

Again, I have very briefly touched on long term preparedness. There are numerous articles and books on long term preparedness. Read them. This is meant merely as a primer to get you thinking about long term survival.

Conclusion:
I hope you use this article as it was meant; to give you some basic information on survival and get you thinking about survival situations. Remember to develop your skills, knowledge and abilities over the amount of tools and supplies you have. I cannot stress this enough. Read, listen to others, take classes, and always be open to new ideas and opinions. You will find things that will work for you; and just as importantly, you will find things that will not work for you.

Take the time to use the skills and tools you acquire. Go camping, use primitive methods to start a fire, gather food and water, cook over an open flame. Once you think you are ready to test your preparedness, turn the breaker off to your house, and turn off the gas main and water main. Do this for a weekend. You will quickly find your shortcomings and deficiencies. You will also find the things that you have done well on.

Hi Mr. Rawles,
It is a bit embarrassing to share this account with you, but maybe, just maybe someone will learn from my errors.
I guess we’ve always been ‘preppers’’ of some sort.  We’ve always had a fruit-cellar and extra personal hygiene items along with bandages etc. on the shelf.  When I found this site about 4 years ago, my husband and I took a long, hard look at where we were and where we needed to be.  The two of us are not just looking at helping ourselves, but my sister and her family.  So we dug in and got serious.  We read the information shared, check out the links provided, copy and print information I know will be a benefit to my family.  Every article has its proper place in the proper binder with proper labels.  Even the dog has his own binder with the necessary information and even alternative diets etc. 

Anyone who visits SurvivalBlog has been reminded many times over not to assume you have all of the needed supplies.  Let alone remember everything you’ve read and should have been practicing for.  Well---I thought I had things under control and could remember what I needed to do and do it flawlessly (such arrogance on my part).  God in his wisdom taught me a huge lesson this past Wednesday, and I am thankful for the wake up call from Him.

This past Wednesday we were experiencing a snow storm, expecting about 6-8 inches of snow with blowing winds. Yes the storm arrived as predicted.  I work part time and the dog and I usually have a play time mid afternoon.  While playing fetch somehow my dog tore an entire toenail off.  Blood went flying all over the carpeting.  I got him into the kitchen, grabbed a huge wad of paper towel and applied pressure to stop the bleeding.  The bleeding didn’t stop, so I grabbed the corn starch and drenched the toe.  All along I’m thinking, what in the world am I going to do?  I’m home alone, the dogs bleeding like crazy, can’t get it to stop!  Well silly girl, where’s the dogs medical kit, was it close by?  Of course not.  Accidents don’t occur at the perfect spot.  Now what I have available to me was not available since I didn’t have a runner.  More corn starch and pressure, yes the bleeding stopped.  My husband was due home from work shortly.  There I sat on the kitchen floor holding my German Shepherd's foot just waiting for help.  When hubby did arrive home I allowed our dog to stand up so we could see if the corn starch worked.  Of course not, the bleeding started all over again.  I re-bandaged his foot, put his foot into a plastic bag, hubby, dog and I headed off to the Emergency vet.  No one in their right mind should have been out on the road, driving was dangerous—uncontrolled bleeding is also.

But what would have happened if the Vet weren’t available and help wasn’t just a short time off?  Truth is I wasn’t as ready or prepared as I thought. So many writers have reminded us that you can never have too much gauze, 4x4’s, self adhesive bandaging—the list goes on and on.  I proved that point Wednesday. Everything I had upstairs was used.  The sanitary pads I’d purchased to use in an emergency situation was downstairs in one of my several marked bins.  Way out of quick reach. 

I am now working on an emergency kit (not just the supplies we had on hand on the first floor, but an actual emergency kit).  One for us and one for the dog, one on the first floor and one in the master box. A massive amount of supplies will be purchased.   With the emergency kit preparedness not being up to par, it’s made me review everything else.  (I did find a Vet link that someone might find useful.  I found it when I was looking up the pain medication our German Shepherd came home with.)

Again, I am so thankful for this ‘test’ God had given me.  He’s given me time to do some honing on skills and supplies.  And too, I am so thankful for this Site what I've gathered, learned and continue to learn from. - OldKimberGirl

Dear Mr. Rawles,

I was recently treated for an abscess in my foot and was reminded of the importance of stockpiling large amounts of everything, gauze in particular. The good news is that a nasty staph infection is treatable in a TEOTWAWKI situation. The bad news is that you need to have antibiotics and gauze, and lots of it.

A few weeks ago I went to see my doctor after developing a large and painful abscess that didn't look like pimples I've experienced before. It was deep under the skin, large and painful, so I thought it should be checked out by a professional. My doctor diagnosed it as a potential MRSA infection because of its appearance and the speed with which it had developed (it went from zero to the size and consistency of a cherry pit in 48 hours). Normally MRSA is diagnosed in the laboratory, but the doctor recommended treating it immediately because it could have gotten worse while waiting for the lab results.

Do a web search for "abscess," "MRSA," and "staphylococcus aureus" to get more information about what I was dealing with.

The treatment program was first, the doctor wiped down the area with hydrogen peroxide, injected the area with novocaine and then punctured and drained the abscess using a sterile knife. He then packed the wound with iodoform packing gauze (basically a string with powdered iodine embedded in it), covered the wound with ordinary gauze and taped it down with medical tape.

I came back to his office the next day to have the gauze replaced, and the day after that to have the second piece of gauze removed from the wound.

The program of treatment with antibiotics was as follows: injections of rifampicin once a day for 3 days, plus cephalexin and trimethoprim/sulfamethoxazole taken orally twice a day for 10 days. In addition, I had to replace the gauze twice a day for 2 weeks and apply topical mupirocin every time.

Disclaimer: This treatment program worked for me, but I am not a doctor and I am not claiming that this is the best course of treatment for you. Your doctor may disagree with mine, or may prescribe a different course of treatment for the type of abscess you might have, or to work around any allergies or other individual issues you might have. If the world has not ended yet, please see a professional for any semi-serious condition you have and do not rely on what some guy (in this case, me) writes on the internet.

Now, let's do some math: 3 injections of rifampicin, 20 trimehoprim/sulfamethoxazole pills, 20 cephalexin pills, and about half a tube of mupirocin ointment. In addition, every time I changed the gauze, I needed to use one piece of gauze soaked in hydrogen peroxide to clean the skin around the wound and then another fresh piece of gauze to apply to the wound. That was twice a day for 14 days, so I went through a total of 56 medium-sized (2" x 2") gauze pads. Most boxes of gauze you might buy at the drug store contain 10 or 12 pads.

All of that for a single wound that was smaller than a dime. Imagine what you'd need if you had a larger injury, say a big gash in your thigh from sawing wood.

Now, I have to ask the other readers out there, how much gauze do you have in your first-aid kit? How much do you have stockpiled? I'll admit that before I developed the abscess, each of my 3 first aid kits (home, car and BOB) only had 3-4 medium-sized (2" x 2") gauze pads and 1 large (5" x 9") gauze pad. After this experience, I went out and bought 100 medium-sized gauze pads for home, another 100 for the car, and a dozen large gauze pads for each. Because of space limitations, I only added 10 medium-sized gauze pads and two large ones to my BOB. I'm not fully squared away yet, but it's a start.

I'm going to acquire more sterile gauze in the future, and I'm also going to think about ways to stockpile recyclable gauze, i.e. sterilize and store cloth rags, which seems to be the only long-term solution.

The general rule for prepping is to figure out how much you need and then double it. In this case, what I found out I actually needed was more than I thought I needed by at least a factor of ten. I hope my experience is useful to some of your readers. Many thanks for maintaining this great blog!

Best, - Ted from Maine

Thank you for your wonderful service,  and Merry Christmas!

On the subject of Hemorrhoids, my favored,and very effective,  treatment for this problem is tincture of witch-hazel (Hamamelis  Virginiana)

It grows plentifully in damp woods in central Appalachians---maybe elsewhere,

I simply cut a bunch of the small twigs, stuff them in a jar, and add alcohol. I prefer drinking-grade ethanol, as it is the least toxic of the alcohols.

After a couple of days steeping, I begin using it by soaking a small pad of toilet paper or cotton , and pressing it to the affected area a couple of times a day.  IT BURNS (from the alcohol)!  But the burning sensation last only a minute or so. Relief (for me) in two days or so.

If alcohol were unavailable,  I would try a decoction in water (boil the twigs in water)  I think I would add a lot of salt to help preserve the decoction and discourage the growth of bacteria in it, and I would make a fresh batch every few days. The alcohol tincture lasts nearly indefinitely.   Alcohol has the added advantage of dissolving (extracting) both water-soluble and oleoresinous substances in the plant, and carrying them into the tissues.  The modern reductionist tendency is to decide that an herb has ONE "active principle" responsible for its beneficial effects, and that should be extracted and purified, but I prefer to assume that many of the herb's constituents are there, together,  for a reason, and the closer I can get to using the whole herb, the better.  I would also consider using a ground- or smashed-up pulp of the whole twigs, moistened with clean water or brine.

I would like to emphasize that I believe this condition usually is caused by a long period of bad "bowel habits", that is, straining, which usually means you are not eating enough fiber.

Start eating more fiber NOW.  Lose the white flour! Do not wait until you have damaged yourself.

Thanks again for SurvivalBlog. - From Darkest West Virginia

Dear Editor:
Hemorrhoids are, in some cases, related to caffeine intake.

Reducing one's coffee consumption is a good step, but changing one's brand of coffee is better.

Switching to something like jasmine tea helps, too. Regards, - Richard C.

Mr. Rawles,
I would like to comment on the recent article by P.S. in Virginia on the sensitive (pun intended) subject of hemorrhoids.  I would suggest the use of arnica montana or just Arnica.  It comes in gel, cream, and sublingual tablets and acts as a very powerful anti-inflammatory agent.  Don't use the topicals on open wounds.  I am not in the medical field, but my chiropractor/nutritionist recommends it and I have used it for this very purpose and for others.  I purchase mine from Puritan.com, but it is available at many local health food stores, amazon.com, etc.  I have a good supply of the tablets and they are currently inexpensive.  I generally take a couple under the tongue and if it hasn't helped within 30 minutes, I can take more.  Obviously one must not take my word for it - do your own research -, but it's an inexpensive and powerful method to reduce many kinds of inflammation.  Hope that helps someone else. - Kevin K.

One of the best ways to learn something is by doing for yourself or if it's a painful learning experience then the best way to learn is from someone going through it so you hopefully won't have to. A couple of days before Thanksgiving (Tuesday) I managed to end up with the wonderful surprise of a hemorrhoid. I would like to think I have a high tolerance to pain but let me tell you, this puppy took me down for the count. When these first start there is just no comfortable position you can get into, sitting, standing or laying down. Fortunately I happen to keep in my supplies some Preparation H suppositories and ointment. Neither of these are fast acting but it was a start towards the healing process.

I have had hemorrhoids before and remembered it was just going to be a long uncomfortable time. I quickly fired up the internet and looked up several sites on what to do, what to expect and when to contact a Dr. One of the things I read was too make sure I increase my fiber intake. I also keep in my supplies a healthy stock of orange flavored Metamucil.

If anyone has had one of these happen to them you know how uncomfortable sitting can be. That evening my wife called me on her way home from work and when she finally was able to stop laughing she listened long enough to go into Wal-Mart on her way and pick me up an inflatable donut to sit on. I now have spares of these in my emergency supplies. I preceded with the suppositories and ointment and on the Friday after Thanksgiving I noticed bleeding. The best thing I can think of that may have caused it was using the combination of the suppositories and ointment at the same time. I'm sure any Dr. reading this is laughing and thinking "What an idiot" I immediately stopped using both items (it actually says that on the box). For the time being I padded up some toilet paper and placed it as a barrier to absorb the blood. My wife called me on her way home from work and when she finally was able to stop laughing she listened long enough to go into Wal-Mart on her way and pick me up a package of Depends [adult diapers] for men. These are now also part of my emergency stock.

To add insult to injury, when my wife was in Wal-Mart she called me and asked where in Wal-Mart they would be, I guided her over to the medical area and told her to look along the wall where they keep woman's supplies for similar situations. My wife is from Peru and her English is still improving so we were having a communication problem. I kept telling her my waist size and she was insistent I needed a large when my size is actually in a small / medium for Depends diapers. The next thing I know I was talking to a female employee of Wal-Mart explaining my situation and what I needed them for. Moral of this part is buy ahead of time, it's less embarrassing.

Sitting on my donut I was able to get back on the internet and look up more information on what to do. To tell you the truth, the bleeding was a new one for me and it had me a little worried. Being a Friday night and Dr. offices being closed I knew if I needed to do anything it would be a trip to the emergency room. Fortunately I found out that the bleeding can be normal and not to panic. One of the things it mentioned was to take a sitz bath. This is nothing more than sitting in a tub of warm water just high enough to cover the affected area. You can add salt or vinegar to the water to aid in reliving the pain of the bleeding area. I chose to use salt which I have plenty of in my emergency supplies. You do not need a lot, just enough to give the water a salty taste. I highly recommend that if you choose to taste the water you do it before you sit in it. Just to add as a note here, I didn't taste the water before or after, I just kept pouring in the salt until I figured I had enough. I did however spend about 15 minutes cleaning the tub prior to getting in hoping to get it as sanitary as I could. I wasn't sure to what extent the bleeding was and how much was open to any further infection from a dirty tub.

After about 20 minutes of sitting you should be able to get out and dry yourself off. A note I would like to inject here is it would have been much more comfortable sitting in the tub if I had brought my donut with me. Lesson learned! To dry off use something soft and just pat it gently, do not use a towel and dry like you normally would. After it was dry, I did not wish to use the ointment anymore but I felt I needed some lubrication to relieve the dryness and chafing. For this I used Petroleum Jelly (Vaseline) which I also have plenty of in my emergency stock.

With my diaper on, my wife laughing and my dog wanting to sniff everything, I finally went to bed and hoped for the best. I kept the diaper on until after my morning rituals, starting coffee, letting the dog out to use her restroom, feeding the dog, drinking my coffee, watching the news, getting upset from all the idiots in Washington and eventually my morning time in the bathroom. The fiber really helped and as bad as it sounds once done the last thing I wanted to do was wipe with toilet paper. Before I got into the shower I had remembered a conversation I had long ago with a retired Navy Captain who was an MD.

We were at a CERT sponsored search and rescue exercise and I had time to sit down with him and go over several questions. One of the things that came up was, what would he put into an emergency pack if he needed to bug out into the wild. This man was so brilliant and such a pleasure to listen to, he mentioned that some of the most important things to make sure you have are, bottles of water, clean white wash cloths, Ivory soap (the plain unscented), a soft bristle brush and plenty of gauze pads. He mentioned you can have plenty of food, but if you get a cut or abrasion and it gets infected its game over. These items would be very necessary to make sure you properly cleaned any wound.
           
Not feeling the need to use a soft bristle brush on my situation, I went to my stock and picked out a bottle of Ivory dish washing liquid and a white wash cloth to clean the area. Once dry I again used Vaseline and put on a fresh diaper. Sitting was still very uncomfortable but I have to admit, the diaper offered a lot of additional padding. Every time I felt the need to change the diaper I opted for the shower and Ivory soap. Come Monday there was just a small amount of bleeding and still a little swelling but it was getting more comfortable to deal with.
I felt the bleeding was more from irritation on the outside then from internal bleeding so I stopped using the Vaseline and started using Neosporin which is also a part of my emergency stock. The Neosporin seemed to work like magic in stopping the bleeding and reliving any irritation.

This whole thing started on Tuesday afternoon before Thanksgiving and come the Thursday after Thanksgiving I was no longer needing the Depends and things were much more comfortable. I know this may sound like a strange topic to tell people about, but what if we were in a TEOTWAWKI situation and could not make it to a Dr. Anyone who has had one knows just how painful and uncomfortable these can be. If you ever end up with one, plan on being down for about a good week. The sooner you can get rid of it the quicker you can get back to working around the house or on your survival. If you don't nip this in the bud quickly and you end up making it worse you can truly end up with a medical emergency. I can't help but think if the time comes when the SHTF and peoples diets change, this may become more common than any of us would like to imagine. I came out of this realizing there were a few new items to add to my emergency storage. I now have added spare inflatable donuts to sit on and also packages of Depends diapers. Good luck prepping and God Bless.

Modern neonatal care in a fully equipped and staffed hospital connected to a power grid will be all but a memory in TEOTWAWKI. In the event of SHTF where professional medical services are no longer available it is completely up to the parent(s) to assist the newborn in the traumatic transition from womb to world. Knowledge of basic neonatal field care will increase the chances of survival for a newborn. This article is divided into three sections: Pregnancy, Transition, and First 48 Hours.

Pregnancy

The first section of this article deals with pregnancy. To begin our discussion of field care for your newborn, it is prudent to address women’s lifestyle choices today that will directly impact the success rate of their pregnancies and infant health tomorrow. In anticipation of potential TEOTWAWKI, we maximize our survival chances through diligent stockpiling, training and construction. In the same spirit, women should maximize their future children’s survival chances through healthy lifestyle choices that could contribute to a more robust pregnancy.
Women who have medical conditions such as diabetes, asthma and/or high blood pressure are at increased risk of having infants with difficult transitions. In addition, women who smoke, drink and/or use controlled substances during pregnancy are also increasing the risks for their future children. I thereby urge women to adopt and maintain healthy diets, exercise regularly, and break any addictions to nicotine and/or alcohol ASAP. Healthy lifestyle choices apply just as strongly for men, of course. Pursued jointly as a couple, healthy lifestyles can be more easily achieved and maintained. When SHTF, we must be in prime condition because there will be nobody and nowhere to run to for help.
It is estimated that approximately 15-30% of pregnancies end in miscarriage regardless of access to professional medical care. Of the uncomplicated, full-term pregnancies that result in delivery, 90% of infants transition without need for any intervention. 10% of infants will need some form of help, and of those, 1% will need intensive intervention. It is crucial to be prepared to assist the 10% with the acknowledgement that there is little that can be done for the 1% with intensive needs. Simply put, out of 100 babies born, 9 will need your help to survive the transition.

Transition

The second section of this article covers transition. The “transition” for a newborn is generally the first six hours of life. A newborn needs to be immediately evaluated to determine its initial state of health. Doctors have developed a simple system to do this called APGAR, which stands for APPEARANCE, PULSE, GRIMACE, ACTIVITY, and RESPIRATION. Each criteria are given a score from 0–2 based on the appearance and behavior of the baby. All scores are added up to determine whether your newborn is healthy or needs immediate help. The scores are calculated as follows:
APPEARANCE: blue=0; pink with blue extremities=1; pink=2
PULSE: no pulse=0; pulse<100=1; pulse>100=2
GRIMACE: (response to rubbing/scratching) no response=0; weak cry=1; loud cry/pulling away=2
ACTIVITY: floppy limbs=0; some flexing of limbs=1; flexing of limbs against resistance=2
RESPIRATION: absent=0; weak and irregular=1; strong, crying=2
The sum of these scores gauges the initial health of the baby as follows:
NORMAL: 7–10
LOW: 4–6
CRITICALLY LOW: 0–3.
APGAR can be administered by anybody. But in the heat of the moment, rational behavior and memory can be impaired. I suggest that you write down the basic APGAR scorecard on an index card and pack it in your BOB. If the APGAR guidelines are lost or forgotten, remember these basic guidelines: a baby born at term, crying or breathing with pink color and good tone can stay with the mother; a baby born floppy, silent or bluish must immediately be resuscitated.
Basic resuscitation is begun by briskly rubbing down the baby with a clean towel or cloth. This stimulates crying and reduces the risk of hypothermia. Infants who are not in severe danger should respond fairly quickly to physical stimulation. If they do not, they need advanced neonatal resuscitation. Infant CPR, unfortunately, is far beyond the scope of this article. While many individuals might have training or have cursory knowledge of basic adult CPR, all of it goes out of the window when it comes to infants. Infants are extremely delicate and can be fatally injured with even the most delicate efforts and loving intentions. This is why as a professional physician I direct parents and young couples to attend Infant CPR and/or Neonatal Resuscitation classes that are offered by the American Red Cross and American Heart Association as well as numerous institutions recommended. Go to www.redcross.org or www.heart.org to learn more.
Keep in mind that it is well within your abilities to rescue an infant in jeopardy. Nearly one half of all newborn deaths occur within the first 24 hours after birth. Many of these deaths are caused by asphyxia (inability to breathe). This means that with proper training, you could be equipped to effectively deal with a common complication among newborns. If you expect to become a parent within the next ten years, equip yourself with this valuable training and knowledge while it is still available.

First 48 Hours

The final section of this article covers general newborn field care topics including delayed cord clamping, umbilical stump care, skin-to-skin, breastfeeding, and nutrition.
The average newborn has about 300mL of blood (one can of soda) with a portion of the blood still in the placenta after delivery. If you were to place your hands on the umbilical cord before the placenta was delivered, you could feel the cord pulsating; this signifies that blood is being transfused back into the baby from the placenta. People pay thousands of dollars to collect and store the umbilical cord blood, with the hope that in the future the stem cells in the cord blood can be used if needed. There are OBGYNs who encourage the use of delayed cord clamping to auto-transfuse the baby with its own stem cells. The process is simple: do not clamp and cut the cord until you feel the cord stop pulsating. If there is concern for fetal compromise and resuscitation must be performed quickly , milk the cord several times towards the baby before clamping and cutting. Make sure to use sterilized instruments for cord clamping and cutting. In a survival scenario, submerge all knives, instruments and towels in a pot of boiling water for five minutes or more. Note that the tool or implement with which you retrieve the sterilized items from the pot must itself be sterilized first. A simple workaround is to pour the boiling water out of the pot and handle the knives and instruments upon actual intended usage.
There is no evidence that there needs to be any further care of the umbilical cord stump if the umbilical cord was clamped/cut in an aseptic (free from disease-causing bacteria) manner. In a sterile environment, dry cord care (keeping the stump clean and dry) is effective. Take care that the infant’s diaper is folded down below the umbilical stump. Dry cord care is recommended when sterile instruments have been used during delivery but this cannot be guaranteed without an autoclave machine. Therefore umbilical stump care may be necessary. Studies have shown that cleaning the umbilical stump with chlorhexidine reduced the rate of infection and newborn mortality. In the absence of chlorhexidine, use an antiseptic ointment or rubbing alcohol. The umbilical stump will separate after one week.
Skin-to-skin care – also called “Kangaroo Care” – describes a way of holding a newborn so that there are no clothing barriers between the infant and the mother. This form of mother-infant interaction has been shown in multiple studies to be beneficial. The benefits include assisting the baby to sleep better, breastfeed sooner, breastfeed better and increase weight gain faster. Research shows that this form of contact helps regulate the baby’s physiologic processes including pain responses, temperature, breathing, and heart rate. Preterm and low-birth weight infants who are born in resource-poor settings particularly benefit from kangaroo care. In a typical labor and delivery floor, stable infants are immediately placed on the mother’s abdomen in this manner to ease the stressful transition they undergo in childbirth. In a resource-poor setting, kangaroo care should be initiated immediately after childbirth for at least 30 minutes, but can last as long as the mother is able to tolerate. There are no guidelines for how long skin-to-skin care should continue, but many proponents encourage multiple daily episodes (short or long) for up to six weeks postpartum. Fathers may also contribute to this process and perform skin-to-skin care.
Breastfeeding is the recommended form of infant feeding by multiple medical associations because of the numerous benefits to the infant as well as to the mother. Breast milk promotes intestinal growth/motility, protects against infections or certain chronic diseases, and provides optimal nutrition. This process can be frightening and frustrating for some parents. Adequate positioning and latch are important for successful breastfeeding.
For good positioning, place a pillow on the mother’s lap for support, and then place the infant on the pillow. Using the arm opposite the breast that is being used to breastfeed, cradle the infant so that his/her head is supported by a “C” formed with the hand around the base of the skull. An effective latch is characterized by the infant’s mouth covering the entire nipple and much of the areola. The baby should not be sucking the nipple only.
Newborns in a hospital receive a regimen of standard care: eye ointment for the prevention of gonococcal infection, vitamin K to prevent bleeding, hepatitis B vaccine, and blood sugar and bilirubin monitoring. This battery of care will of course not administered in TEOTWAWKI. Certain steps can be taken, though, to evaluate and improve the health of the baby with the means at hand.
Infants are born with nutritional stores that will supplement them during the first few days after birth. Weight loss is normal in infants in the first week of life. However, weight loss greater than 10% is cause for concern. Signs of infant dehydration include: lethargy, loose skin, decreased urine output, and delayed capillary refill time. Capillary refill can be assessed by applying pressure on the infant’s sternum for 5 seconds; if the color fails to return in less than 3 seconds, this suggests dehydration. Monitoring of input and output ought to be done as well. Newborn babies feed every 2-3 hours during the first month of life. Also, urination and defection should occur within the first 24 hours of infant life. Consider supplementing with formula if available.
In summary, this article has attempted to promote awareness about TEOTWAWKI field care for your newborn. Hopefully it has provided numerous touch points from which you can launch your own study, training, and preparation. While all our means of shelter, sustenance, and defense will ensure our personal survival in a WROL, only our children ensure our collective survival.

Disclaimer: This article for educational purposes. It is not a substitute for medical care under the direct supervision of a physician or in a hospital.

James,

In a recent TCCC class, more info was covered on why hemostatic infused gauze is preferred over Hemostatic granules.
 
The concept for Hemostatic agents was first explored with the use of instant mashed potatoes dumped into a wound. The blood soaked the potatoes thickening them up and helping aid the blood in clotting. This was efficient, until it was realized that the potato “granules” were being carried into the blood stream and causing blood clots. Obviously, this is a very bad thing. When the hemostatic agent was first created in a granule form, it did the same thing as the mashed potatoes did, only faster. However there was a small chance of the granules once again escaping into the blood stream causing blood clots.
 
In a combat zone where helicopters were used for evacuation of wounded – same as in most rural areas of America, the rotor wash would blow the granules out of the wound (bad) and sometimes blow them into the eyes of the medics or others present causing eye issues.
 
After application of the granules, Gauze of some sort as well as a trauma bandage had to be applied.
 
Next up in the evolution of progress was Hemostatic Infused Gauze. This has avoided the issue that the granules had, and helped speed up the blood clotting due to the Gauze being applied as the Hemostatic is. In a situation where a Hemostatic agent is being applied, clearly time is life. So removing one step out of the blood stopping and bandaging equation is a good thing.

Just something to be aware of. - Bluelinesheepdog

Hi James, 
Sometimes the easy solution to a serious medical supply problem is hidden right in front of us. I am and adult-onset Type 2 insulin-dependent diabetic prepper. My life depends on a regular and continuous supply of medicines.

What will I do when all of the available test strips for my "Accu-chek" Aviva blood tester strips are out of date and will not function in my Veterans Administration-supplied tester?

In the military we were taught that the winners  learn to adapt, overcome, and improvise. After the military, as a self- employed father of four, I learned another  basic rule of success in difficult times, for dealing with dangerous events, and for most important activities. When I see that I have a serious problem, and I am not winning, I change the rules! This is not all that complicated.

When my glucose test strips are out of date for my Veterans Administration (VA) supplied tester, I simply change the date in the tester itself. 12-12-2012 becomes 12-12-2011, or what ever past date will allow the tester to only see a test strip that is not out of date. 

I lie to my tester about the date. My tester  knows that I am a nice guy, and it always believes me, and uses the out of date strips.

An additional small piece of knowledge, which can be extremely valuable to  folks like myself, is the real time facts about refrigeration of insulin. Most refrigerators cool the contents to 37-38 degrees F and that is  below the recommended safe temperature range of 60 - 86 for insulin. Our home is well insulated and I keep the current usage insulin bottles on top of my desk with full confidence that it is safe to use because our inside house temperature stays at about 65 - 70 F all year. One bottle of insulin lasts me about 9 days.  from the Internet concerning insulin temperature safety:

  It is usually okay to keep a bottle of insulin you are using at room temperature for up to 28 days provided  the room temperature is 59º to 86º F. 

We live in the high desert in the southwest and of course there are seasonal summer days of 100 plus degree outdoor temperatures. For cooling in the event of a serious power outage,  we have pre-positioned the materials for our Zeer Pot Fridge, in our garage.  For full written and picture instructions on construction and usage just doe web search on the phrase "zeer pot fridge" and you will be in the cooling stuff business. Just don't wait until the power goes out to search for instructions. Although we have not yet needed it, we have tested it. We  feel very safe knowing it does work and  having the required materials needed on hand. 

A Zeer Pot is is a zero electrical power evaporative cooler that will take most items from 95 degrees down to 35 degrees in about 12 hours. Fresh vegetables will actually stay fresh for about 7 - 10 days.  It is simply two inexpensive large clay pots with a smaller one inside a larger pot. They are separated by a thick, about 2 inches, layer of very fine ground sand. Just pour water slowly into the sand until the sand is fully saturated with the water, then put your item to be cooled into the smaller pot and cover the 2 pots with a damp cloth . The evaporation process will cool the contents very nicely. Just keep the sand and the cover wet!

Now let us talk about paying for our preparedness stuff. We have been able to partially fund our prepper medical supplies thru my status as a VA-enrolled veteran. I took my private non VA doctors medicine prescriptions into my VA primary care doctor.  

The VA doctor then wrote new VA scrips for the meds and filled them for me at little or no cost to us. There's a maximum $8 co-pay for "some" higher income  vets. This co-pay varies with the specific county a vet lives in. Google VA.gov and search the site for co-pay information.

I do not get our less-expensive OTC medical items from the VA because the congressional funding for VA is never enough. Lets not even think about politics and funding for our vets health care. Forget what the military recruiters said about lifetime free health care. They actually believed that line themselves. They are not getting free care either. Additionally when we can afford to get both the VA meds and the non-VA meds, I have been able to buy some extras to build up a medicine reserve supply. 

I also have to deal with chronic obstructive pulmonary disease (COPD), which is very serious and often very dangerous. For respiratory emergency quick relief, which is usually 3-4 times daily, I use an albuteral inhaler. The VA  sends them to me monthly at no cost to me. And we do appreciate the VA care I get!

For the all important reserve supply, I use an (S)albuteral puffer.  These inhalers are inexpensive and area available from India. Before I made my first overseas purchase, I did my regular safety research and  talked to my non-VA doctor about the Indian supplied medicines.  He did not have a problem in any way.  I do try to remember to rotate my medical supplies so as to use the oldest first. I tested their service with a single stand-by box of 15 inhalers I purchased from an Indian pharmacy that were manufactured in Australia by Smith-Glaxo-Kline, a huge company. My cost, to include their standard $25 shipping, for 15 inhalers,  was $77.50. The inhalers themselves cost were $3.50 each. That bought me a full one year supply

About ten years ago at Costco my inhalers cost about $4.50 each.  With the federally required new propellants, these inhalers locally now cost about $45 each without insurance, and about $10 each with insurance, provided you have a written prescription. There is no requirement for a prescription by  the overseas vendors. There are many Indian pharmacies available and I have had good results doing business with AllDayChemist.com. This Indian company supplied inhalers use the same  FDA-required type propellants as do the American-supplied inhalers. 

The small shipping box was plainly marked as a personal health product not for resale. Nothing was hidden and everything about the medicine contents was completely honest and open. It came through our Customs cleanly with no import costs and then passed through our U.S. Postal system with zero complications or delays. 

I now have an ample 2++ years reserve inhaler supply on hand.  We also have great peace of mind and enough meds to be able to share with others if it should become necessary. We believe that we do not have enough for ourselves unless we have enough to give some to the needy, those who are truly not able to help themselves.

We have been taught many important lessons of preparedness and frugality by the many entries published in your blog site and by the many friends with who we have spent countless  hours talking about current event and how best to be ready for whatever may come our way. We are very fortunate to have a terrific relationship with our close neighbor the world’s best veterinarian who smiled and handed me a thick catalog of everything that might ever be used in his clinic. To this very day I have an icon of that web site on my Mac computer startup screen.  There are a great many good veterinary supply sources available through the Internet. Google is a great way to search, but it really doesn’t matter which search engine someone uses. 

We have used the Internet to obtain most of our preparedness supplies and my sweet wife even bought some medical scrubs to do her gardening chores. They were on close out sale at 99 cents per item.

Another great buy was FISH MOX FORTE (Amoxicillin 500 mg ) @ 100 tablets for $27.96.

It is very important to maintain a low profile in situations where a person is planning to acquire animal medications for possible disaster times usage. Try to be sure before you bring up these topics that the person you are going to ask for help in your buying activities will not be likely to say no and never forget that you asked.  It may be best to wait until you are at the veterinarian for a regular pet care visit and ask about backup pet meds in cause there is another serious power outage. Just start the topic and then wait for the veterinarian's response .

You will be able to gauge the veterinarian's prepper status easily. You will benefit greatly from a diligent web search of information concerning the use and availability of pet medications and vet clinic supplies that are readily available through the internet.

Support the troops coming home from these very difficult multiple deployments. They are usually in bad shape emotionally. The stats are frightening. The Post-Traumatic Stress Disorder (PTSD) rate is 41%. The marriage breakup rate is 80%. And 15% of our "combat" returnees are female. These fabulous women fly our planes and drive our trucks and live in harm's way every day. We have the finest military force this nation has ever fielded. Better educated. Better motivated. Better trained. They are our best. I am proud to be a veteran of our military. I am proud of my American Legion brothers and sisters. I am proud to be the grandfather of a infantry grandson.

I've come to the conclusion that our worst imaginings of Canadian timber wolves (purposefully introduced to the Lower 48 by do-gooder bureaucrats in 1995) might have been insufficient. To those of us who live in the rural west, these land sharks are well known for their fanged depredations on sheep, cattle, deer, elk, and moose. But their greater menace--at least to humans--might actually be in the form of a tiny tapeworm that they carry: Echinococcus granulosus. This tapeworm was endemic with these wolves, long before they were introduced. Tapeworm cysts have been identified in both Idaho and Montana in recent years, and wolves have been confirmed as definitive hosts and the primary vectors.

Take a few minutes to read this: Two-Thirds of Idaho Wolf Carcasses Examined Have Thousands of Hydatid Disease Tapeworms. Also read this summary and a few of its many linked references.

It bears particular mention that this variety of tapeworm is incurable, except by invasive surgery. (Antiparasitical drugs are ineffective.) And even worse, there is no simple test for infection. Only chest-abdomen scans or whole body scans show "hot spots" where the worms have triggered the formation of cysts. Echinococcosis is not pretty. The Echinococcus granulosus tapeworm cysts are mainly found in the lungs and liver. The tapeworms themselves are just a half inch long, but their cysts are large, ugly, and eventually life threatening, especially in mammals with the longest life spans. (Read: humans.) In some cases they can grow in the heart, the thyroid gland, and although rare, even inside bones and in the brain. I would not like them to start breeding inside my skull. Not good.

The life-cycle Echinococcus eggs and worms is insidious and incremental. The eggs can be viably dormant in the soil for up to 41 months. They can potentially become endemic in a wide variety of mammal populations. Here is just one example: In areas where wolf packs travel, the scat they leave in random locations can be handled by mice and rats that are attracted to the hair that makes up as much as 40% of the scat pellets, by volume. (Rodents actively gather hair, for nesting material.) So they bring the tapeworm eggs home, and are infected. Then the infected rodents get eaten by the local foxes, coyotes, wolves, bobcats, lynx, and mountain lions. And, oh yes, your house cat. Then your sweet little kitty leaves moist deposits in your garden raised beds, or in your child's play sand box. Charming. This is sort of like watching the movie Prometheus, albeit with the critter life cycles in extreme slow motion, and on smaller scale.

I am particularly troubled by the fact that wildlife biologists knew that Canadian timber wolves carried the hydatid tapeworms. (It has been well documented since the 1930s, and was studied in detail in the 1950s.) But because of their enthusiasm, the biologist-activists were silent about it and went ahead and supported the wolf introduction plan. There are some sick puppies out there, and not all of them are canids.

The bottom line: Encourage your state legislators to allow wolf hunting and trapping, to reduce the number of wolf packs. And if you live in wolf country, then DO NOT handle the scat of any predators without wearing gloves and a good quality dust respirator. That includes handling feces from your house cat.

One final parenthetical note: Be on guard for anyone who uses the term "reintroduction" for the introduction Canadian timber wolves in the Lower 48. These wolves were not reintroduced. They are in fact an invasive subspecies. The Canadian timber wolf is a larger subspecies of wolf: Canis lupus occidentalis. The Canadian Timber Wolf (aka Mackenzie River Wolf) can weigh up to 170 pounds and travel up to 70 miles per day. Most of the wolves that originally inhabited the Lower 48 that were extirpated a century ago were the 80 to 110-pound Great Plains Wolf subspecies. (Canis lupus nubilus.) This disparity in part explains the rapid decline of the deer, elk, and moose herds in Idaho and Montana since 2000.

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: ArmageddonMedicine.net

Caring for a chronically ill family member takes an emotional and physical toll on the caregiver. Compound this in a time of disaster, civil unrest, social and economic collapse and you might feel there is no chance for survival. I cannot say that. There might be insurmountable odds against a seriously ill family member living in harsh conditions for very long, but it is my goal as a caregiver to ensure I have the tools and knowledge to keep that family member as comfortable; physically, emotionally and spiritually as I can.

As the wife of a recent kidney transplant recipient, I am familiar with all aspects of his care, before transplant while he was on dialysis and now, with a severe regimen of anti- rejection drugs. I have researched and found very little information on varied “prepping” sites as to what to do for those family members that may require medical devices that require electricity, medications that prolong life, such as anti-rejection, anti- viral, chemo, asthma to name a few. These medications are usually very expensive, and generics are few. No doctor will allow you to stockpile these. I have tried. You may only be able to obtain a 3 month supply at best. So you might have a generator to run the dialysis machine, but when the supply chain that brings the boxes of dialysis fluid breaks down, you won’t be able to make it in your kitchen. What do you do when the medications run out, or the nebulizer canisters stop coming in the mail?

How do you prepare yourself and your loved one for the inevitable outcome? Depending on the condition your loved one suffers from, I surmise most people will try to stretch out certain medications in a disaster scenario, such as blood pressure meds, if the ill family member is not exerting themselves. My plan for my husband is to keep him comfortable and hydrated, occupied with low impact activities to keep his blood pressure down when we run out of his meds. There is not much I can do for his anti-rejection drugs other than halve the dose so they last longer. The key is to keep normalcy and good attitude combined with communication. Speaking with your ill loved one and making the care plan together. They might not want to alter the medication schedule, and may just want to abandon it all together. They might not want to be a burden, or might want to face the inevitable head on. They might want to survive at all cost. It is crucial to your survival that you face all outcomes and discuss these with your loved one in detail. Having a Medical Power of Attorney, with a Healthcare Directive in place makes sure that your decisions, directives, and care plan will be followed if the loved one is cared for outside the home in this type of scenario.

It is beyond the scope of many people’s thoughts of having to watch a family member deteriorate in the absence of medical care or medications. In a SHTF scenario, many will be experiencing the same anguish. Many will lose family members quickly, some will watch over a protracted time frame, a loved one wasting away. What you can do in that time frame, is mentally prepare yourself and your loved one for a dignified and comfortable passing.

What my husband and I have decided on, is to allow the meds to run out, treat the symptoms of kidney failure as they come, and live as normally as we can, given the variables that we are faced with. I have come to terms as has he that he will not survive without the drugs. I have always been the stronger, optimistic one, he is my beloved pessimist. Knowing each other’s strengths and weaknesses helps you realistically view your action plan and implement it together. I have stocked up on several of his favorite foods, a warm and inviting bedroom with books and a view of our yard and chickens, a photo album, and will surround him with the best attitude I can.

“But who cares for the caregiver?” That is a crucial point. You may be blessed with a large family that can offer help and respite. You may find yourself in a small group banded together to increase your chances of survival, or you may find yourselves isolated with the ill family member. It is your responsibility to maintain the wishes and directives of the ill person to the rest of the group or family. It is up to you as the caregiver to eat, sleep, hydrate, and keep healthy before you can even begin to take care of a chronically ill family member on a daily basis let alone in a disaster. The stresses are numerous, as is the often precarious mental state you can find yourself in if you allow yourself to be run ragged. I always make a feasible list of the daily tasks I need to accomplish. In a SHTF scenario, daily life will most likely end up with an abbreviated list. Food, shelter, water, protection. Daily life in a SHTF world will make that small list 100% harder. Imagine having to start a fire to bake bread, removing waste from your living area, skinning game, chopping wood, pumping water, and bathing your ill family member, all before a cup of coffee in the morning. Imagine having to guard your perimeter from looters, day and night, and making sure your ill loved one eats, or has help with the most basic tasks. I would have to do all of this myself, as my husband is also severely sight impaired.  I am prepared to ask, or barter for help when I need it. I would not be serving myself or my husband if I tried to do everything myself.

I have a vast supply of medical and first aid items from the years of dialysis that I intend to donate or barter should the occasion arise. I also have skills in herbal remedies. My skill set as a caregiver insures my worth in a group. What skill sets do you have that may help you survive in such a scenario? If you haven’t thought about what you’d need to do in this type of situation, or might end up being the one to care for a chronically ill person, it would be of great benefit to take a CPR and First Aid class, or invest in an EMT used textbook. Learn as much as you can about the condition your loved one has, so you are better equipped to handle it. Read about hospice, and yes, read about dying. Elizabeth Kubler-Ross wrote a wonderful book titled On Death and Dying. I suggest it to anyone caring for the chronically ill. Having some foundation to act on will make the journey you and your loved one face together less of a surprise. Ask your health provider about your condition, in the instance of a disaster much like Hurricane Sandy, what will happen. What is the worst case scenario? What kind of symptoms can I expect as my condition worsens? What can I discuss with my spouse or family to make it easier to care for me? Of course, you will be reassured that nothing like that will happen, but at the risk of sounding like a tin foil hat-wearing Doomsday Prepper, a few innocent questions soon after an extremely damaging natural disaster would not seem that out of place.

I cannot place enough emphasis on having a positive mental outlook in the face of illness. In a SHTF world things will look bleak, and you might not want to go on. As a chronically ill person, you might not want to be a burden. You might even think about taking your own life in this type of situation, fearful of succumbing to your condition. This is a time to talk to your family or spouse, or group. Everyone deserves to enter and depart this world with dignity. It is up to the individual, family, spouse and the faith they hold to sustain them in survival. I have no doubt that somewhere there will be drugs that can be bartered or stockpiled that in a large enough dose could end a loved one’s suffering. Although I don’t condone that as a solution, I know that that could and would happen possibly on a larger scale than would be spoken about. I don’t think anyone who has not experienced a loved one’s death can truly say what they would do. It is a deep and personal choice that must be made with compassion, communication and love. It is our duty as families, spouses, communities to make sure that the chronically ill in our homes and neighborhoods are cared for to the best of our abilities, and offered safe and comfortable departures when they pass.

JWR,
Thank you for all your efforts. I pray they are never needed but fear otherwise. We run a safety training and supply company specializing in custom first aid/survival kits for various customers. We agree that Coban is wonderful stuff. A hint for the budget minded preppers use a vet supply house or feed store and buy "vet wrap"-- same stuff at lower price. - A.K.S.

Jim:
Coban is not a panacea for your wound dressing needs.  While it does offer self-adherence,  ease of use, durability, availability, selection of sizes and colors, etc.  There are a few flaws with this material.  The first and most dangerous is while this material is self adhering, it is also progressive in nature, e.g. it will continue to tighten over the first few minutes on it's own.  This means there is a learning curve to the proper application of Coban and serially (several times) monitoring to ensure the extremity distal (further from the heart) has not been subject to neuro-vascular compromise, this is easily done by determining light touch sensation, capillary refill, pulse and movement.  Second, it is not typically re-usable nor as durable as a simple Ace bandage.  

I have used both daily as a Physician Assistant in both Orthopedics and Emergency Medicine and both have their advantages/disadvantages, but if I had to chose, I would pack a few aces. - Charles T.

Hi,
I love Coban! We use it at Appleseed [rifle marksmanship training] weekends to hold pipe insulation to rifle stocks to build up cheek rests. It is great to bind anything you don't want to mar with duct tape. We purchase it by the case from veterinarian supply houses, it is much cheaper and comes in MANY fun colors. Look for it as vet wrap. - Elizabeth B. in Colorado

Mr. Rawles,
I just wanted to echo Frank L.'s enthusiasm for the class of medical products generally known as self-adhering bandages.  In 2010 I earned my EMT certification for prep skills and I work in the EMS world on the side.  We use the self-adhering bandages for many applications.  They not only perform compression, but will also adhere when wet.  They are excellent for holding a dressing in place and are superior to medical tape for such applications.  I helped provide medical coverage for a church youth camp at a beach with 2700+ students and another 700+ adults.  We used a case of this stuff for sprains, lacerations, abrasions, and holding ice packs in place.  I keep several rolls in my personal medical gear at all times.  Avoid storing in high heat as prolonged exposure to hot temps will degrade the adhesive.  Thanks. - Old School

Dear James:
I'm a long time reader and love the SurvivalBlog site. I really wanted to point out one little thing that  I think is a very important item in any kit: Coban Wrap. (Sold under several brand names.)
 
I'm a former medic and now live in the northeast on the water. I have young kids and we do some of boating and spend a fair amount of time on the remote rocky beaches of the area. When we got here earlier in the year I put together a little first aid kit focused on multi-use items and scalability and try to keep it with me especially when we're far from emergency services. I broke into the kit a lot this summer and the one thing that stood out was how glad I was to have Coban.
 
Coban's a self adhering wrap and I've been impressed its versatility for a while. This last summer I used it many times.
Here's what it came out of the kit for this summer (these are off duty situations):

• Foot laceration. Happened in the ocean, nasty cut. Coban kept pressure on and sand out. It really helped with the long walk out.
  
  
• Compression wrap on a metal door to forearm collision. Was told it helped a lot.
  
  
• Ankle sprain.
  
  
• As [the equivalent of] an Ace bandage on my own sprained knee while wade fishing. This got me through the half mile walk home over a very rocky shoreline.
  
  
• Stabilization of a large fishhook in a young girl's foot. Seemed to calm her down and let her parents get her to the Emergency Room.
   
  

That's what I actually used it for in just one 2-month period as a civilian... In more dire trauma situations it's an extra hand when there are multiple wounds and holds things together a lot faster than tape. Many problems big and small can be addressed with a roll of Coban and a trauma pad and I keep both of them even in my smallest kit.
 
Suffice to say that I think the versatility of Coban is worth noting especially since it is rarely supplied in stock first aid kit lists. I'd urge folks to consider adding it to their kits.
 
Best Wishes, - Frank L.

This all fits in a one gallon Ziploc baggie (except for laptop and fleece)
 
19 hour Emergency Room and Hospital Survival Kit
 
·       Stocking cap (to shut out light and things you don’t want to see)
·       Ear Plugs (to shut out things you don’t want to hear)
·       Zip-able fleece outer wear (Wear. To control Temperature)
·       Cell phone/Smart phone/I-pad/Laptop(Obvious reasons plus recreation/distraction for self and kid(s).  Typically something you already carry)
·       Way to charge cell phone etc. (It will see much use and you will be making many calls.  The phone will gobble up charge hunting for signal if signal is weak.)
·       Card with lists of contact numbers (To save digging them out of cell phone.  You will be asked for this information several times.)
·       Lists with kid’s meds or those in family with chronic illness (Names, dosages, frequency of taking.  You will be asked at least twice a shift for this information and it is easy to screw up)
·       24 hour supply of your meds (so you don’t get goofy)
·       Aspirin/Ibuprofen/Tylenol (Whatever works for you.  ER furniture designed to torture and maim the people who sit on it.)
·       Tooth brush (obvious)
·       Change for vending machines
·       Clean pair of socks (Emotional pick-me-up)
·       Empty Ziploc bag to stow dirty socks. (The ER staff will appreciate it)
 
Note that if you are in an ER for more than 8 hours it is probably because there is not a regular room to transfer you to in the immediate area.  So your 19 hour ER stay may have a 6 hour (round trip) drive and a 2-or-3 hour admission tacked onto the end of it.

- Joe H.

It’s no secret the majority of survivalists are males.  If your better half is just as prepared for emergencies as you, or you are a female survivalist who is reading this article, then congratulations!  But what about others who have a wife or significant other who goes about their daily life in ignorant bliss; unaware of the dangers surrounding us in today’s world, and how to prepare for and handle them?  I am sure you all love your spouses, and when disaster strikes, you’re going to look after them.  However, wouldn’t they (and you) be better off if they were assets during an emergency rather than dead weight?

All the preparations you’ve made to keep your family and home safe isn’t going to amount to squat if your wife is clueless and you are away on a business trip, or trapped in your office, with no way to get home (transportation suspended) and no way to get in touch with your loved one (phone lines down).

Preparing your better half is the most important thing you can do.  Do you have a gun at home?  It might as well be an expensive paperweight if she doesn’t know how to use it; or worse, if she doesn’t know the combination of the safe where it is stored.  I know women who don’t even know where the circuit breaker is in their home, much less what it does.  If they cannot handle that, how are they going to defend and provide for themselves and your children in the hours, days, or weeks it takes you to get home from wherever you may be?

I’m currently in Afghanistan and my wife and our infant son are in a third-world country in Southeast Asia.  Were something to happen, such as the civil unrest that occurred there two years ago, she will have to take care of herself, as well as our infant son, on her own.  The chance of me getting to her anytime soon is slim.  At best, I am a convoy, a helicopter flight, and two plane flights away.  I tell you this so you realize this problem is real and you need to take it seriously, just as you would your other preparations.

How many hours a day are you away from home?  If you have a full time job, then it’s at least 25% of every weekday.  Now, I have friends who are willing to wager hard earned money at casinos where they don’t have nearly that high of a percentage to win.  Yet, many survivalists are willing to take much lower odds, and wager something more important that money, that an emergency will always occur when they and all their family members are sitting in their house, which is just nonsense.  Add in the time it takes you to commute to and from work, as well as the time you spend away from home doing other things (shopping, visiting friends, going to sporting events, et cetera), and the percentage is significantly increased.  A disaster waits for nobody, and the chance of one occurring when you’re away from your home is quite high.

Now that you recognize the importance of your better half becoming an active part of your survival plan, you need to start bringing her into the fold.  This is a task not to be taken lightly.  If I approached my wife and told her the world, as we know it, is going to end, she would look at me like I’ve lost my marbles and would cease listening to anything I subsequently say.  Therefore, you need to broach this topic with your better half gradually.

The majority of you all reading this did not attain all your survival equipment, rations, skills, and knowledge in a single day.  And while time is of the essence, it’s best if you don’t expect your better half to acquire everything in a single day either.  For me, I started small.

My first order of business was instilling in her the desire to be prepared for the unexpected.  Remember; start small.  For example, I purchased rain ponchos when it was sunny.  Sure, this isn’t exactly a must-have item, but it’s one I like because it serves the dual purpose of keeping me dry during a rain storm, as well as a first aid item for a sucking chest wound.  Purchasing the ponchos when they weren’t needed gave me a chance to talk with her about the ease of buying them now rather than after it starts raining.  This way I was able to gradually accustom her to the strategy as opposed to starting out by purchasing a bomb shelter.

When my wife and I went out one night a few days later it looked as though rain was forth coming, so I slipped the ponchos I’d previously purchased into my cargo pocket.  Sure enough, later that night it started pouring down rain, as it is prone to do in tropical climates.  Everyone around us, including my wife, immediately ducked into a convenience store to purchase ponchos.  Thankfully, they were sold out.  Reaching into my cargo pocket, smiling, I presented her with a poncho, which allowed me to demonstrate to her why it’s a good idea to stock up on handy items when they’re not necessarily needed right at that moment.

Gradually, my wife began to see the importance of such acts, and I’m afraid I’ve created a monster.  Now it’s her who is in charge of our supplies.  She took over that job without giving me a choice in the matter.  And why not?  She loves to shop, so it’s an enjoyable activity for her.  We have since reached our goal of having 2 months worth of necessities (diapers, food, water, you name it).  When I was in charge of our stash, we only had 2 weeks worth.  Who’s better at that job?  I know when to bow to superiority.  She still has room for improvement when it comes to rotating the stashed items to ensure they stay as fresh as possible, but she’ll get there.

Moving on, let’s hit on self-defense in the home.  Have you taught your wife to handle a firearm?  I have not because it is extremely difficult to obtain one in the country we live in, not to mention tremendously expensive.  However, she can recognize daily household items can be used as weapons.  I know this because every once in a while she will pick up a common item around the house and threaten me with it.  For example, she’ll grab scissors and declare, “I cut you!”  Sometimes I believe she’ll do it.  Of course, she’s only mimicking what I’ve taught her gradually over time.  It has turned into a fun game of finding the most non-threatening item in the home and using it as a weapon.

What about surviving natural disasters?  Where we live, flooding is a regular occurrence.  Therefore, my wife has learned how to fill sandbags, and can do so with the best of ‘em.  Does she like doing it?  No.  But she knows the chances of her having to fill sandbags when I’m not there is high.  In addition, when we move to the east coast of the U.S. next year, you can bet your generator my wife will know how to install plywood over our windows in case I’m away during a hurricane.  She’ll have help from my relatives because it’s a two-person job, but that’s not the point.  She will understand the letter and number code I mark each pre-cut piece of plywood with, so she’ll know which piece goes on which window.  Time is of the essence in an emergency, and neither she, nor my other family members, can afford to waste time trying to figure out which piece goes where.

What would your wife or significant other do during an emergency during an emergency?  No, I’ve not mis-spoken.  What I’m referring to is if your child stopped breathing during a natural disaster when medical personnel weren’t readily available.  Does your wife know first aid?  Is she CPR certified?  With a one-year-old son at home, you can rest assured one of the first things I did was have my wife take a CPR course.  I have extensive training in first aid.  In addition, I am CPR, AED, and First Responder certified.  However, none of that is going to do me a bit of good if I’m unconscious with only a non-trained wife to take care of me.  My wife immediately recognized the importance of such training and has since learned a vast amount of information on the subject.  It’s another area she excels at and I am confident in her abilities.

I’m not saying your better half needs to be equally as good as you are in every aspect of survival, as different people bring different skill sets to the table.  However, she should be proficient.  And you might as well get off your macho high horse now because believe it or not, she will excel in areas you don’t.  My wife and I are a team…not a survival expert and the beneficiary of a survival expert.  I cannot begin to tell you all how comforting it is to know my wife can handle whatever is thrown her way to keep herself and our son safe when I’m not there.  And when I am there, I know I’m not in it alone.  Taking care of every aspect of three people’s lives (me, my wife, and our son) would be stressful during the best of times.  Doing so during an emergency would likely turn me into a two-pack-a-day smoker.

It’s my hope you all will take heed in what I’ve written, bring your wife or significant other into the fold, and become a team to be reckoned with when things go bad.  After all, your better half will most likely turn out to be the best piece of survival gear you’ve ever invested in.

Hello Jim,
I wanted to pass on an after action report (AAR) of our experience at Doc Cindy's Armageddon Medicine "102" class, this past weekend.

This class differed from classes we had taken from other Doctors/trainers in the past as it dealt with what to do with sick people rather than a class that focused on trauma treatment. I assume that Cindy's 101 class dealt with those issues.

The mix of the students contained a dentist, a doctor, 2 nurses, a civil engineer, a biochemist, several business people, a gal from Canada, a Federal Emergency Responder, a very bright, well-trained 17 year old and the rest were made up of citizens such as Abigail and myself. The class mix was extremely fun and interesting as we shared various and numerous stories, experiences, thought processes and ideas.

Cindy did a most excellent job on getting the critical information to us that would be needed in a grid down situation. She weeded out all the cosmetic from the practical. However it was still a fire hose of information. We learned which of the current medications could be used on a particular disease and what was perhaps more important what to use if those medicines were no longer available.

One of the areas of discussion was how warts on our feet could affect our ability to travel and keep up with our group. This lead to proper wart removal, and we were given prepared plastic feet to practice on. Before this session was done Abigail surgically removed a wart from my finger. It won't be missed!

I will not go into detail on all that was covered in our three-day course. You can view the syllabus online if you would like a more in depth look.
The long and short of it is this class is highly recommended, for anyone that is concerned about their and their loved ones health in these troubling times.
This class is also Grandma recommended, as it will enable you to be a reliable resource to your children as they combat childhood illness when they enter the parenting field.
We are so glad we took this course and are hoping that there will be a 103 class offered. Our thanks to Doc Cindy.

Yours in Christ, - John and Abigail Adams

Dear Mr. Rawles,
As a pharmacist of more years than I like to admit, I would like to make a few comments and additions regarding Jason J.'s recent excellent post on "The Core Kit - First Aid and Beyond". First, I must thank Jason for his time, knowledge, and insight, as well as for his service to our country. His sense of humor was well-received as well! My comments are minor, but may clarify/enhance an issue or two.

First, as Jason suggests, it is wise to follow "Universal Precautions" whenever you are dealing with the blood or bodily fluids of someone else. In the health care field, these precautions simply mean to protect yourself as if the unknown person has a blood-borne disease, whether you know it to be true or not. However, thankfully, Jason's statement: "Realize that every person has unique blood. This includes pathogens. We all have something in our blood we should not pass around" is a bit of an overstatement. The blood of a healthy person is sterile, except for the living blood cells that are a natural component of human blood.

With regard to the analgesic (pain med) section, I fear that a few typos may result in a misunderstanding of the intended points. First, ibuprofen should not be the long term choice of analgesic if you have stomach problems (especially if you're prone to ulcers). As a side-effect of it's pharmacological action, it inhibits the formation of the essential mucous layer which protects the lining of the stomach from the extreme acidity of the gastric juices. Using ibuprofen regularly, and long-term, is a sure recipe for ulcers and the inevitable G.I. bleed. Perhaps acetaminophen would be a better choice in people with stomach problems. While on the subject of ibuprofen (including its longer-acting sister, naproxen), it must be noted that it does indeed possess anti-inflammatory properties which are very useful in suppression of pain involving inflammation, such as rheumatoid arthritis (an auto-immune, inflammatory disease). In contrast, osteoarthritis (the general "wearing out" of joints which eventually manifests in most of us old geezers) is not considered an inflammatory condition (though acute flare-ups happen!). In this case, acetaminophen may relieve the pain without the stomach and kidney side-effects of ibuprofen.

Speaking of acetaminophen, though it is excellent for reducing fevers and helping to relieve some non-inflammatory pain, I would be remiss in not reminding everyone that it is the second most common cause of liver failure in the U.S. (anyone care to guess the first most common cause?...I'll drink to that!). To dramatically reduce the risk of this toxic phenomenon, many experts are now recommending that acetaminophen should be restricted to no more than 3 grams daily. Since a regular strength acetaminophen (i.e., Tylenol) tablet contains 325 mg, the maximum would be 9 tablets per day. Beware that "extra strength" tabs contain 500mg, and some sustained release products contain 650mg per tab. Also, be alert to other combination analgesics, often containing acetaminophen in a dose of 300-500mg per tab (e.g., Norco, Vicodin, Lortab, Lorcet, Percocet, etc.). If you're taking any of these drugs, this acetaminophen should be figured into your total daily dose count.

Finally, many medical folks (especially dermatologists) recommend the routine use of "double antibiotic ointment" (bacitracin and polymyxin) in the place of "triple antibiotic ointment" (bacitracin, polymyxin, neomycin) because many people develop a sensitivity (allergy) to neomycin - usually resulting in a local skin reaction which may confound assessment of the severity and healing progress of the wound. I haven't studied the data on this phenomenon, but many hospitals have changed to the double antibiotic ointment as the standard. Having said that, whichever you can get is far better than having none! Also, with regard to antibiotics and their appropriate uses, I would recommend a copy of "The Sanford Guide to Antimicrobial Therapy" to keep handy with whatever antibiotics you can store. This is a small paperback "pocket reference" published annually which summarizes the clinical use of antibiotics. Much of it is more detailed than most non-medical folks would need, but the first chapter addresses common infections by affected body system, and recommends empiric (i.e., "best guess without cultures") antibiotic choices based on the most likely involved pathogen. If you know a doctor, nurse practitioner, or hospital pharmacist, ask them if you can have their last year's edition. We usually throw them away when we get the new one, and the bulk of the recommendations rarely changes. You may also need to get a good magnifying glass. If the information is condensed much more, we're going to need a microscope to read it!

Thanks again, Jason, for your post, and, as always, thank you to Mr. Rawles for all that you do!

Best Regards, - S.H. in Texas

As of today, many families are still suffering from the effects of Superstorm Sandy.  Are you prepared, should such a disaster strike your area?
The following is offered as an outline for medical prepping, should you someday find yourself without access to professional medical care.  (Part 1 of this series covered weeks 1 through 6.)
Please note the following abbreviations:
ORG = organizational concerns
OTC = over-the-counter products
Rx = prescription products
ED = education and skills
The supplies listed under OTC can all be purchased without a prescription, though some are only available online.  For prescription items, assess what your group has and what each member is likely to be able to acquire. 
The three-month period is divided into 13 weekly tasks, divided according to topic, making the project more readily manageable.  The outline could also be divided into months, rather than weeks, to cover a year instead.
For more detailed information on medical prepping, please visit www.armageddonmedicine.net. 

Beans, bullets, and Band-Aids are the basics of prepping. Each has its own place, and they each lean on each other. Beans are pretty easy, but expensive. You spend the money, organize yourself and learn to use the food. There are more sources to learn about this than you could ever read, we all know about eating, and you are certain to need food in almost any situation you can imagine! Bullets are really not that complicated. We make it complicated, but as an Army Ranger that has been shot at countless times, I promise you will not question if that was a 5.56 or a 7.62 fired your way. I have hidden from a .22, because they all can kill you! The counter to being shot at has been addressed, mass. Have some weapons you can use, know how to use them, and then be prepared to use them. It is about that simple. About the only things I can think to say from my experience is that rookies practice shooting while pros practice correcting malfunctions and reloading and that two decent guns in two different pairs of hands are usually better than a great gun in one pair of hands. Band-Aids are where I think things get more difficult. We all eat, all can buy guns and practice basic marksmanship, but we do not all get a chance to learn professional medicine or practice the skills we have learned about in books! I suppose if you can find someone to let you practice suturing on them or practice a teach then you have a more committed prep group than I do and you need read no further!

I switched from Infantry to nursing when I realized that no one pays you [in the civilian world] to be infantry. While in the Infantry I did get a chance to learn some great emergency/trauma management. In fact, when I went to medic school there really wasn’t much new to me. Your typical American Infantryman has the skills to stabilize most pre-hospital trauma injuries. Basically, stop the blood, keep the wind going.

I want to address the typical person reading this. I bet the typical reader is most likely to start by going to Wal-Mart and buying a first aid kit, a few over the counter drugs, and learning CPR. This is great! If more Americans would do this it would provide quite a stable situation for us as a community. I also want to talk about the more advanced prepper and the things I bet I’d find in his stores.

I started by buying a typical kit for around $15. I chose it because it said “outdoor” on it (a marketing tool that appeals to preppers) and because is useful before the world ends. I plan to toss it in the wife’s car for the normal bumps and bruises my kids and I receive.

I chose a “Be Smart Get Prepared Outdoor First Aid Kit”. It caught my eye because of the eco-friendly packaging! Who brings a paper bag to the outdoors? The first thing I noticed when I opened it was that it had an anti-theft zip-tie on the zipper! That would have been a real pain for my wife to deal with while my son was screaming about his bleeding thumb on the tailgate. Upon opening it I did notice the sort of compartments I am used to in the emergency packaging I carry as a medic. The kit did not come separated into any real logical order. It looked like someone that had no idea what was what had put things shaped similarly together. This would be a pain.

The kit included:
    12 antiseptic towelettes
    12 alcohol prep pads
    3 antibiotic ointment packets
    2 lip ointment packets
    3 sunscreen lotion packets, SPF 30
    3 burn cream packets
    3 sting relief pads
    1 poison ivy cleanser towelette
    3 insect repellent packets
    4 aspirin tablets
    4 non-aspirin tablets
    2 electrolyte tablets
    15 adhesive bandages: 3/4" x 3" (1.91cm x 7.62cm)
    15 adhesive bandages 3/8" x 1-1/2" (0.95cm x 3.81cm)
    5 waterproof bandages: 1" x 3" (2.54cm x 7.62cm)
    5 butterfly closures
    2 moleskins: 2" x 2" (5.08cm x 5.08cm)
    1 waterproof adhesive tape: 1/2" x 2.5 yd (1.27cm x 2.29m)
    4 sterile gauze pads: 2" x 2" (5.08cm x 5.08cm)
    2 sterile gauze pads: 4" x 4" (10.16cm x 10.16cm)
    1 sterile gauze trauma pad: 5" x 9" (12.7cm x 22.9cm)
    10 cotton tip applicators
    1 instant cold pack: 5" x 6" (12.70cm x 15.24cm)
    2 examination gloves
    1 First Aid Guide
    1 pair of tweezers
    2 finger splints
    2 safety pins
    1 Brightstick: 12-hr
    1 outdoor emergency blanket

This looks like a bunch of really good stuff, and it is. There is a reason most kits include some combination of these things. Lets look at each one that is worth looking at. You may be surprised some additional and actual uses for each item and some considerations you should have before you use them:

Antiseptic wipes. These are not sterile! They are real good for cleaning. I find I use this sort of thing to clean my own hands when I work on another person. Realize that every person has unique blood. This includes pathogens. We all have something in our blood we should not pass around. Also, dirt has many, many pathogens in it you should either remove mechanically or deal with chemically. Think of antiseptic as killing most pathogens, not all.

Alcohol pads. Know that there is a segment of our population that is allergic to these. Typically, it is not a huge issue, some redness, swelling, irritation, and minor pain. However, if you find yourself using them there is a reason and an allergic reaction may not help. You need to have another solution. Iodine is one, but the allergy is an even bigger concern. Consider chlorhexidine if you can afford or find it (additional use, extremely flammable, fire starter!).

Antibiotic ointment. This is Neosporin to most of us. I suspect this simple, cheap, and easy intervention can prevent a huge portion of the preventable discomfort many of us may experience. Use it! As I said before, dirt is full of bad stuff. To make my point, bacteria spores can live for decades. Small wounds can and do kill. Even if this were not the case, wounds healing faster and with less pain is a good thing. Buy more.

Lip ointment. I chuckled when I saw this on the Ranger packing list. Weeks later I was borrowing this from other guys. It was mostly a comfort issue. But, as my first Squad leader said, “When in the field; comfort, comfort, comfort!”
Sun screen. See above.

Burn cream. The rule of thumb for a burn is to not get infected! This ointment is not for that sort of burn. Really, if you have a burn that does not break the skin, don’t put ointment on it. Let the heat that has entered you leave. When you take a pot off the stove it is still hot for a while. Putting a cream on it will insulate it. The ointment is useful a bit later. A good way to think about it is how long does your steak take to cool down? In fact, it continues cooking for up to 10 minutes after taking it off the grill. If you have broken the skin barrier, dry sterile dressings are the best first response. Your body is going to be sending fluids to the area. The dry dressings allow the fluid, and the possible invectives, a place to go, away from your body. This prevents secondary complications. For burns that do not cause a breakdown of skin, the cream is really for comfort. Last, don’t pop a blister, that is Nature’s bandage. It is way better for protection and provides a better healing environment than anything you can buy.
Sting relief pad. Comfort issue.

Poison Ivy relief. I have had poison ivy. It is possible to do whatever you need to do with poison ivy. However, it is not fun. Extreme comfort!
Insect repellent. Comfort and prevention. Note that this stuff has an odor you can smell from farther away than you might think. I have noticed it on other people before from quite a distance after a while in the field. People have had infection from insect bites.  Ounce of prevention… Malaria has killed more humans than anything else in the history of humanity. There are seldom perfect answers for every problem.

Aspirin tablets. If the FDA were to consider Aspirin (ASA)[as a new drug] today, you would not find it available over the counter. Be aware that, by order, soldiers are not allowed to use ASA in theater unless there is a very good reason pre-approved by a provider. ASA does help with pain, but it is better understood as an anticoagulant. It does not thin your blood, but keeps you from forming or building clots (a clot on the outside of your skin is a scab). If you have ASA in your blood and suffer a wound, you will not stop bleeding very fast. Additionally, Aspirin has a very real chance to cause gastrointestinal bleeding if you take it often. Your guts will start bleeding! On a positive note, ASA can help reduce the damage from a heart attack and save a life. Aspirin should be kept around, but perhaps not in the field.

Non-Aspirin tablets.  Acetaminophen is the active ingredient you are after when you buy Tylenol. Note, print out or write down the doses for adults and children for all of your medicines. The active drug in all the different packages and forms of most drugs are the same, name brands are not important. The reason the drug looks different in children’s packages is that it is difficult to convince children of certain ages eat a tablet. Mortar and pestle will help here. Liquid medicine and capsules do not store long. Tablets are great. Look into survivalblog.com or any of the numerous sources concerning medication storage. Acetaminophen is not only a pain reliever, but also an antipyretic (fever reducer). Fever = acetaminophen. It will reduce pain, but is processed in the liver. Something to consider for that hangover since your liver is already stressed from the alcohol. Motrin, ibuprofen, is a good alternative. If you have any stomach issue ibuprofen should be the choice in the long term. Alternating is an even better idea. Acetaminophen will not address inflammation, a common reason discomfort is noted. If arthritis is the complaint, ibuprofen will do nothing.

Electrolyte tablets. These are like protein supplements in some ways. If you eat the right foods, they are useless. Drink water, eat food. *-- The kit I purchased came with a note inside asking me to request the tablets!! I plan to complain, it is unreasonable to sell an emergency kit and not indicate on the outside that everything on the list is already in the package. Another reason to put your hand on your equipment and know it. -- Your body needs electrolytes, you get them in food! Variety of diet prevents most nutrient deficiencies. I would say to eat variety, but I hate when people are redundant, because I do not like that people say the same thing they just said for the sake of saying things again, after saying what they just said, because they just mentioned it and it was already explained earlier... You need all your macro and micro nutrients. 8,000 pounds of wheat might feel good in the basement, but no teeth from scurvy bites better than you will, inability to stop bleeding is a real drain, muscle cramps and twitches turn you into a jerk!

Adhesive bandages. Band-Aids do a few things. One, they keep blood off your shirts and whatever you may brush against! Two, they help stop bleeding. Three, they keep pathogens out of the wound. The biggest thing, they keep stuff out of your wound. Your body will continue to bleed for a little while; this is how your body cleans an injury. The bandage keeps it clean. For my family, I use a bandage after I clean an injury and then put triple antibiotics on it. Usually it is a perfect answer to put the cream on the bandage. Practical point, joints bend. Flex or bend the joint so that movement does not create a limit to range of motion or large gap in coverage. A bandage is an artificial barrier. If you fail to create a clean wound you are creating a dirty, warm, wet, and isolated environment for any pathogen to proliferate.
Waterproof bandages. Want a bandage and be active? Try a waterproof bandage. Don’t jump into Staph creek and think you are good to hook. This is an active bandage. It is a little better. Think about it, do you trust this thing to keep every environmental factor out of your wound? I don’t, but it is better. I would buy more, they are cheap.

Butterfly closures. These are cheap, DIY, limited solutions to a wound an adhesive will not address. It can replace stitches in a few limited situations, but are not complete replacements. These serve to connect tissue. Have a cut on your skin a bandage won’t fix, use a butterfly. However, if the wound is deep enough to see muscle or anything under the skin you may not be fixing anything. You might be holding pathogens in the wound. If it is very deep you may want to consider a wet to dry dressing. This gets into a place where average people can understand and perform, but need to take time to really inform themselves and think about it a lot. I wish there was a class to take to learn these sorts of nursing things without going to nursing school. Many parents and family members get to learn this sort of thing when a family member has a particular need and hospitalization is not really cost effective. A nurse can teach you, at his/her level of comfort in doing so. Maybe volunteering at a hospital or nursing home would expose you to a few of these sorts of skills. At the very least, you would be familiar with more medical issues.

Sterile gauze pads,  2" x 2". Small sterile gauze pads are good for covering a small wound that is in a difficult position. Also, they can come into play with the wet to dry dressings. Bottom line, if you keep it so, it is a sterile cloth for putting on a wound. You can also use them to clean a wound; the only trouble is a sterile liquid for mobilizing dirt and debris in the wound. You only get two, use carefully!

Sterile gauze pads, 4" x 4". See above, only bigger.

Cotton tip applicators. Q-tips. These are good for cleaning difficult places. Be very careful you are not pushing things deeper in your attempt to clean. Your ears are a perfect example.

Instant cold pack. If you hurt a joint, RICE is a good thing to remember; Rest, Ice, Compression, and Elevation. In the first hours your body is sending fluids to the injury to help it heal. This fluid causes some discomfort. Cold decreases the fluid coming to the area. To let you know how well it works, Ice is the first thing they toss between a woman’s legs after giving birth. People often pass this sort of thing over because it is simple, and they are of course advanced!

Examination gloves. These protect the injured and the person helping. If there is any possibility of fluids getting on you then you should use the gloves. Remember, if I help you, the small cut on my hand could pass something to you while I dress your wound.

First Aid Guide. I always keep these references. I have not used one yet, but I figure it has two good uses. First, I know I am not perfect. If I have time, I look things up. Second, I imagine if I was working on my son while my wife was there, it could be useful to give her something to do. This is not patronizing. It is practical! She may remind me of something and she feels involved. Helplessness is a huge issue for parents.

Finger splints. The big thing to remember is ensuring you do not limit circulation. To keep a digit from moving does not require much. It is really a bit more of a reminder and protector from bumping it against things than keeping the patient from moving it. If the end of the finger feels cold, it may be too tight. Additional note, the finger next to the injured finger provides a decent splint. This leaves your wood splint for additional uses like examination and manipulation.

Brightstick. Chem lights work. It is hard to see things with the light they emit. Practice with the light. It is a great signal device. Make a “buzz saw” by tying the light to the end of two feet of string. Spin it around, very easy to see at night. Remember, once it is on, you cannot turn it off. Bury it, if you must. I can vouch that these are visible while in your pocket.

Outdoor emergency blanket. This is another of those things people do not realize is very useful. You can carry a person with one of these, as long as you do not brush against anything! This thing is a good reflective surface for heat! This is the final step in packaging a person for transport. Do what you can, and then put this on the patient, you just cut all their clothes off! If they say they don’t need it, I bet they don’t.

This sums up what I thought about the kit. Next, I want to talk about other items that the advanced prepper has:

Tourniquet. This is a lifesaver. It is the number one intervention for soldiers! Modern medicine can preserve a limb longer than we used to think. You do not need the expensive ones available for purchase. I have them because I got them for free. For the general public they are expensive. The things to really know is that string will not do. If you have a 550 survival bracelet and that is your plan, you are planning on having no tourniquet and additional injury! You need a wide strap, one inch at least, that compresses the tissue around the vessel. Keep it off the joint. The fast rule, if you are not sure where to put it, put it as high as you can. Make it as tight as possible. The first one I ever put on was interesting. I placed it on an Iraqi soldier. My training had not mentioned that a conscious person may really dislike the tourniquet! It was something of an argument I am amused with now. This was an easy situation where I was able to see when the blood was spilling from his leg, and when it was not. He was in pain from the gunshot. Despite the language barrier, I can tell you the tourniquet seemed worse to him. I kept it on because that is the way to save his life. I have one question for the grid-down prepper; if there is no “next level” of care, what next? Some things are just beyond what we can do without years of school. This is a reality to deal with. I would rather die from hemorrhage than sepsis. This is only an honest consideration to have if you claim any integrity. A book and a surgical kit will not work 99 out of 100 times if you have no real training.

Israeli Dressing/Trauma Bandage. These are great options for dressing a wound fast and tight. They are clean, wrap hard and tight, secure well, and cost a lot. If you got a line on some, go for it, great. If not, there are better things to spend your money on. Cheap gauze and tape can do fine with some practice. The goal with this thing is pressure. We all know pressure helps stop bleeding. The Trauma Bandage keeps the pressure on. If you bleed through it, add more. Do not remove the original material, you may be ripping some of the clot off and starting over again.

Combat gauze/Quik-clot. This falls into the tourniquet area. Great, you stopped the bleeding. If the grid is down and you do not have a medical professional, what next, sepsis? There is also an allergy issue. Shellfish allergy indicates an allergy to many of these options.

SAM splint. These are a bit costly. There are cheaper ways to secure and splint an injury, but these things are awesome! You can immobilize almost any body part, even the neck! Do not play around with them too much. They are just thin aluminum covered in thin foam. Playing with it will create sharp edges and exposed metal. If you have a choice, go for the thin packed ones. They are much easier to stow away than the rolled up sort.

Surgical kit. When you buy these things at a surplus store, know they usually are not sterile. Options to make them sterile can be found on the internet. My wife had the idea to find a tattoo shop willing to help us out. For those not sure of the sort of people working in a tattoo shop realize that they are very regulated and physics works pretty much the same everywhere! Many of these places have an autoclave for their instruments. These machines are very user friendly. I used one in a hospital after a 10 minute class. The wrapper has an ink in it that indicates the correct conditions were met to be considered sterile. Additionally, many of the people that include themselves as preppers have tattoos!

I would also say that surgery is a risk in the best of conditions! This is certainly a time where there can be too many cooks in the kitchen because each cook has his/her own ability to infect the patient. Forget your Rambo illusions and think about being clean. Think stitches, object removal, wound healing, and cleaning. It has been said the reason to have a surgical kit is to have something to put into capable hands. Very true!

Prescription Drugs. I figure there are two main things here, sedation/anesthesia and antibiotics.
I have read about all manner of anesthesia. They all look dangerous. Drinking yourself into a state may have worked a few times in the past, but carries some real consequences. I would love someone to offer a real solution. I doubt there is one because if there was it would be logical to assume that solution would be used today. Playing with consciences is always dangerous. Anesthesiologist/Nurse Anesthetist are very highly trained and have years of school. Do you really think you can mimic this after reading an article online and mixing some solvents from the auto shop? Even if you could do this correctly, you need a very clean room, a plan, a correct diagnosis, good assistance, and many other things. And, you still need to remember antibiotics!

Antibiotics are a more reasonable pursuit. Preppers go for antibiotics sold for fish, find doctors that are ok with their license being on the line with your preps, and some try to keep their past drugs after they feel better, figuring it will help them later. The latter is a very bad idea. First, using only a portion of a prescription leaves the bacteria in your system. You could get sick again, or pass is on as stronger bug for the next person. This means that over time you get super-bugs that are very difficult to treat. The antibiotics we are using for some people now have huge problems and side effects. According to many sources antibiotics for animals are good to hook. However, this is only when you apply the correct antibiotic for a given situation. Penicillin is not going to work for all bacteria. Doctors know which drugs to give based on the location of the infection and the current trends in their area and experience. Your animal drugs are not as specific or broad. I am not saying this is necessarily a bad idea, but that you certainly need to have a hard copy explanation of what you have, when to use it and how to recognize it in simple and reasonable ways. Know how to dose your drug and what a common dose for a child or adult is. Go to the book store and get a nursing drug guide. This will tell you what to look out for while using the antibiotic, possible negative effects, common dose, and when not to use the drug. For the most part, an older used book is fine. The drugs you get from a vet do not change so rapidly that a drug guide from 2005 will be out of date. I strongly suggest a drug guide if you do or do not have prescription drugs.

Some things people don’t think about that are worth having are ways to transport patients, palliative measures/pillows, N95 masks, gloves, sterile blades, Netti-pot, and vitamins. Transporting people correctly limits additional injury and stress.  Pillows can help limit pressure sores after being in the same position for a long time. Palliative measures make people more comfortable, reduces stress, and even help those not injured feel better. If the world ended and you were going to die, being comfortable would be nice. Rotate people’s position every few hours. Just a bit to place pressure on a different spot, this reduces skin breakdown. N95 masks and gloves protect everyone! Sterile blades to cut the umbilical cord are the number one intervention to reduce infection and death after a “normal” birth. A shard of obsidian is not a good answer! A Netti-pot keeps a sinus infection from becoming a bigger problem. Vitamins can help the body heal its self. If you have variety in your diet you should not normally need supplements. If your body has an increased need from injury or illness vitamins can play a big part.

Herbs are an interesting topic and very worth investigating. Mid-level providers are increasingly turning to this old wisdom. However, like any drug there can be consequences and contraindications. You need to know what you are doing before you use your friend or family as an experiment.
Training and knowledge are the biggest part of the puzzle. All the cool, expensive equipment in the world is useless and dangerous in the wrong hands. In some cases, it may even be useless in the right hands. A well-stocked bookshelf is certainly indicated for the prepper, but you actually have to read and consider the information. You will not rise to a medical emergency! You need to have a plan first. Seek out people with the knowledge you want. My experience is that people are happy to share what they know and are interested in.

Some closing food for thought: I attended the survival/preparedness expo in Spokane, WA a few weeks ago. There were many people there spending large amounts of money on preps. In truth, many of them would be better off spending that money on a gym membership to be prepared for TEOTWAWKI! What is the logic of $1,000 worth of gear when you are 50 pounds overweight, pre-diabetic, have decreased cardiac output, decreased mobility, reduced cardiovascular potential, and any host of other problems that come with the sedentary American lifestyle?. Sometimes the answer you have heard all along is the best answer. There are few short-cuts to health and fitness. I question the motivation of a person worried about TEOTWAWKI when they do nothing to prep for the world as we do know.

Dear Jim,
I am board certified in family medicine. I believe D.A. gave sound advice, but  I would suggest staying away from clindamycin as about 20 percent of people who take it get C. Diff. collitis.

I have several patients who have been successful in purchasing medications through AlldayChemist.com. Typically, at 75 to 90 percent savings of the U.S. price. Keep up the good work. - J.W.

First let me advise you that I am not an MD, nor am I qualified or authorized to give medical advice to humans.  Keep in mind, however, that we are all animals.  The information herein is for reference only, and I bear no liability for misuse or adverse effects (allergy) by using any of these antibiotics.  Essentially all of the antibiotics used in veterinary medicine are from human medicine, and most were tested on animals before being used in humans.  Although you may have used a particular antibiotic in the past, your body may have developed a sensitivity or allergy to the very same product since then, and you should discontinue any medication if you are exhibiting negative signs (usually a rash).

Everybody gets sick sooner or later.  It can be a mild “cold” or upper respiratory infection, or blood poisoning from an infected scratch.  In a post-disaster situation, the risk of infection likely will go way up, due to lack of medical care, contamination, stress, poor nutrition, exposure, and reduced hygiene.  Even gunshot wounds are possible, or lacerations and broken bones.  Having a stock assortment of common antibiotics ready now is a good idea.

Antibiotics don’t change to poison the day after they expire.  It has been proven that antibiotics are safe to use for at least five (5) years beyond their expiration date.  Don't throw away expired antibiotics or other medications for that matter.  They may not be as effective as when they were “fresh,” but they are probably 90+% still active.  In a disaster situation they may not be available again for a long time, and you’ll be longing for the Amoxicillin you flushed down the toilet. [JWR Adds: The only exception might be cycline family antibiotics, which have been reported to cause Fanconi Syndrome when they break down. This has been previously discussed in SurvivalBlog.]

Try the “First Choice” medicines; if they aren’t working, try another First Choice, or go to the “Resistant/2nd Choice” column.  You won’t have the luxury of doing a culture and sensitivity test to see what is causing your infection and what the best antibiotic is to eliminate it.  This will all be trial and error.  You have to give an antibiotic at least a three-day try before deciding it’s not working, and even slight improvement is a sign to continue what you’re on.  Don’t jump from one antibiotic to another unless symptoms are worsening.  Checking body temperature is a good way to judge.  If your former fever of 103°F is coming down, it’s a good indicator that things are improving.  (Add a digital or “old fashioned” thermometer to your list.)

An abscess generally needs to be drained before it will heal.  That means lancing it at some point to “let the corruption out” of the body.  Your immune system is trying to throw out the bacteria by killing and consuming it, creating pus, but sometimes the bacteria reproduces faster than the white blood cells can work.  That’s where antibiotics help out by interfering with the bacteria’s reproduction or by actually killing the bugs.  Often the abscess will rupture by itself, when the skin over the infection breaks down, but you can also get pretty sick before that happens.  (Add a half-dozen scalpel blades to that list, too; #10 curved edge for slicing, #11 sharp point for lancing.)

There are various categories of antibiotics, such as the penicillins (-cillins), sulfas (sulfa-), tetracyclines (-cyclines), and fluoroquinolones (-oxacins).  If you have Ciprofloxacin and it isn’t working, then the other “-oxacins” probably won’t be any better.  This isn’t always a hard/fast rule.  Amoxicillin may not knock down a cat bite abscess, but amoxicillin-clavulinic acid combination usually will.  Survival medicine is a situation where you do what you can with what you have.  And add lots of prayer.

An antibiotic doesn’t do the job of wiping out infection all by itself; it basically gives your own immune system a “backup.”  You can optimize the effect of an antibiotic by keeping yourself well hydrated, warm, comfortable, well-fed, and by reducing stress as much as possible. 

If you are stocking up, it would be good to have something from each category, such as Amoxicillin, Cephalexin, Ciprofloxacin, Doxycycline, and Trimethoprim-sulfa.  Or substitute Amoxi-Clavulinic acid for plain Amoxi.  It’s a “bigger gun” for treating infection.  Also, you want to use the first line of antibiotics in nearly all cases (exception might be a bullet wound or deep laceration).  If you continually use the strongest/newest antibiotic, you risk developing resistance to that antibiotic.  And use the antibiotic until you are certain the infection is over, and add a few days treatment to be sure.  A wound would usually take two weeks’ treatment or more.

Cost can be an issue with some antibiotics.  I traveled to a very remote atoll in 1997, and I knew the place was a virtual cesspool.  I asked my doc for a prescription for a week’s worth of Ciprofloxacin, and the 14 tablets cost me $100.  Today you can get 30 for $4.  Generics in nearly all cases are just as effective as the original trade-named product.  Some in-store pharmacies (Wal-Mart, Sam’s Club, Giant Eagle) offer a 30-day supply or 30 doses of common antibiotics and other medicines for just $4, or sometimes free. 

Viral infections, such as flu, are not affected by antibiotics.  But my opinion always has been that if a virus is causing damage, there are secondary bacterial “opportunists” that are also present, and an antibiotic can’t hurt.  It may reduce the overall recovery time.

I’m not including injectable antibiotics for several reasons.  First, they require syringes and needles, which in today’s world are used only once and replaced.  Before plastic came along, syringes were made of metal and glass and were reused until worn out.  Needles were re-sharpened, sterilized, and reused as well.  Not nearly as sharp as today’s disposables.  Second, many injectable antibiotics require refrigeration and may have a shorter shelf-life overall.  Third, once you put it in, you can’t take it back out, but you can stop giving tablets if there is a reaction.  Lastly, injectable antibiotics are nearly always in glass vials or bottles, and subject to breakage.

Infection Site
Urinary Tract                        First Choice                                                            Resistant/2nd Choice
           
                                    Amoxicillin                                                            Ciprofloxacin
                                    Amoxi/Clavulinic acid (Augmentin®)           
                                    Ampicillin                                                           
                                    Cefadroxil                                                               Cephalexin (Keflex®)                                   
                                    Trimethoprim-sulfonamide

Upper Respiratory (sinus, throat)

                                    Amoxicillin                                                            Azithromycin
                                    Amoxi/Clav                                                           Ciprofloxacin
                                    Ampicillin                                                           
                                    Cephadroxil/Cephalexin                                       Tetracycline/Doxycycline                                   
                                    Trimethoprim-sulfonamide

Lower Respiratory (bronchitis, pneumonia)

                                    Amoxi/Clav                                                          Azithromycin
                                    Cefadroxil                                                            Cephalosporin 2nd/3d gen.                                               
                                    Cephalexin                                                            Tetracycline/Doxycycline
                                    Ciprofloxacin                                                       Combinations
                                    Trimethoprim-Sulfonamide

Skin/Soft Tissue (wounds, abscesses)

                                    Amoxi/Clav                                                          Clindamycin
                                    Cefadroxil                                                            Dicloxacillin
                                    Cephalexin                                                            Ciprofloxacin                                   
                                    Trimethoprim-Sulfonamide                                 Oxacillin
                                                                                                           

External Otitis (ear canal to the eardrum)

                                    Topical therapy:  Clotrimazole, Tresaderm, Ciprodex Otic
                                    (You want to use a liquid that will flow into the ear canal all the way to the ear drum.)

Internal Otitis (middle ear)

                                    Same as first-choice Lower Respiratory

Oral Infections

                                    Amoxi/Clav                                                            Metronidazole plus
                                    Clindamycin                                                            Amoxi/Clav

Bones
                                    Amoxi/Clav                                                            Clindamycin
                                    Cefadroxil                                                               Ciprofloxacin
                                    Cephalexin                                                              Metronidazole                                               
                                    Tetracycline/Doxycycline                                   

Human Dosages

     Amoxicillin:  500mg every 12 hours (severe 500mg every 8 hrs)
     Amoxicillin/Clavulinic acid:  500mg every 12 hours
     Ampicillin:  500mg every 12 hours
     Azithromycin:  500mg first day, then 250mg per day for 4 more days
     Cefadroxil:  500mg every 12 hours
     Cephalexin:  500mg every 12 hours
     Ciprofloxacin:  500, 750, or 1000mg once a day
     Clindamycin:  450mg every 6 hours
     Doxycycline:  100mg every 12 hours for 7-10 days
     Metronidazole:  500mg every 12 hours for 7 days
     Oxacillin/Cloxacillin/Dicloxacillin:  500mg every 6 hrs for 7-21 days
     Tetracycline:  500mg every 6 hours for 14-30 days
     Trimethoprim/Sulfonamide (Sulfamethoxazole/Trimethoprim):  800mg every 12 hrs
           
Notes:  The two most important things you can do to prevent infection are wash your hands with soap and clean water often, and dental care: both brush and floss your teeth daily or three times a day

There is a “Guide to Veterinary Drugs for Human Consumption, Post-SHTF” that covers readily-available veterinary medicines that we can use [in true disasters].

However, it is just as easy (and probably less expensive) to buy from All-Day Chemist at https://www.alldaychemist.com/.  These are generics that are very affordable.

            If you are on your own, I would recommend having a couple weeks’ or a month’s worth of the following in the largest sizes (mg):

            Amoxi/Clavulinic acid (Augmentin®)
            Azithromycin (Z-Pack®)
            Cephalexin (Keflex®)
            Ciprofloxacin
            Doxycycline
            Trimethoprim/Sulfamethoxazole

If you need a prescription, you might confide with your family doctor and tell him/her your concerns about preparing for all possibilities.  There are legal ramifications in the good old litigious USA, but if you’re lucky you’ll have a doc with common sense.  It would also be wise to read the antibiotic inserts (also available online at www.drugs.com ) and familiarize yourself with what they’re used for, side effects, and dosages for various problems.  The dosages listed above are “shotgun” amounts, or highest levels.

About The Author: D.A. has had a veterinary career in mixed practice (large and small animals)

It is human nature to approach preparedness according to gaps that we see in our plans.  Most of us make checklists (see List of Lists), have 72 hour bags (BOB), and cover the three B’s (Beans, Bullets, and Band-Aids).  We rotate food and water, learn new skills, and do anything we can to bridge the gap between our perceived lack of preparedness and what we consider as “sufficiently prepared”.  We may get so caught up in building bunkers and buying bullets that we operate in an “out of sight, out of mind” mode.  Sure, we should prepare for four-legged and two-legged predators, but what about our unseen enemies?  I’m not talking conspiracy theories here, but about microbes.  These microscopic enemies can penetrate your defenses and strike your entire group before you have time to formulate a response. 

We’ve had several wonderful articles about bacteria, fungi, viruses, and parasites, but I thought it would be helpful to condense some of the information I have gathered and offer some advice on how to create a defensive strategy against our smallest enemies- a Pathogen Protection Plan (PPP), if you will.  I will do my best to keep this basic.  I usually have to scroll up and down on articles with lots of terms and acronyms, so I’ll try to keep it short and memorable.  Get a pencil, just in case.

To help break up some of the cloud surrounding the microscopic world, let me give a little more background.  We will get to the interesting part soon, I promise.  Scientists use a classification system to identify organisms, using what’s called binomial nomenclature to assign them a two-part name.  Humans are Homo sapiens, and the horrible antibiotic-resistant bacteria we call MRSA is actually Staphylococcus aureus.  If these names are used at all in common parlance, they are often shortened.  Staphylococcus becomes Staph or just S.  Due to advances in genetic research, sometimes the names change as scientists discover that something they thought was similar to something else actually wasn’t.  Enterobacter sakazakii (E. sak), a dangerous microbe in the infant formula industry, was recently renamed Chronobacter sakazakii.  Different name, same bacteria.  It’s confusing, but you won’t need to worry too much about that.

For the purposes of this article, let’s refer to all of the above named disease-causing organisms as Pathogens (Greek- producers of suffering).  They all have their differences, but we can group them together as Pathogens because they have one big thing in common- you.  The earth is filled with an unbelievable number of microscopic organisms, but most of them don’t thrive inside the human body.  You’d be shocked to know how many viruses are in a milliliter of seawater, yet it’s unlikely you would get sick from any of them.  Our focus in creating a Pathogen Protection Plan (PPP) is not to create a living space devoid of microbes, but to reduce the chances of exposing ourselves to the dangerous microbes.  Some pathogens are easier to kill than others.  Most things are killed with an alcohol or bleach solution, but spore-forming microbes must be treated more harshly, typically with high heat methods.

Let’s start our PPP with the most basic of needs - water.  We know that a water filter is necessary to prevent gastroenteritis caused by Giardia lamblia or Cryptosporidium cysts.  Ceramic filters (the best on the market) have pore sizes down to 0.3 micrometers (or microns), but they are ineffective against Hepatitis A virus (often found in tainted water), with a size of 0.028 microns (approximately 1/10th of the pore size).  I don’t know offhand if silver impregnated filters are rated to “kill” viruses (viruses aren’t technically alive)-most filters say that they prevent growth of microbes when not in use.  Using unscented bleach to treat water takes the guesswork out of it.

The next item would be food.  Most of us are familiar with using a pressure canner to kill C. botulinum spores.  In the food industry, a concept known as HACCP is used to identify and minimize risks associated with ingredients that are likely to be contaminated.  HACCP stands for Hazard Analysis and Critical Control Point, and is a system originally developed for NASA’s space food.  In the home, we are taught to cook food according to a dumbed-down version of HACCP.  No mixing vegetables and raw chicken, wash your veggies, wash your hands- things like that.  HACCP gives us a more organized approach to preparing hazardous food (raw chicken, etc) that is easy to teach through SOP’s (you do have SOP’s for your group, right?).   Let’s go through the seven principles of HACCP:
1.       Conduct a Hazard Analysis- What is in the area that can contaminate the food? Raw meat, engine coolant, and metal shavings are all possible hazards.  Identify anything that could harm you if it made it into your meal.
2.       Identify Critical Control Points- What can be done to reduce/eliminate the hazard, and at what step should you do it?  Is all of your meat fresh?  Do you refrigerate it?  Do you cook meat all the way through?
3.       Establish limits for CCPs- How bad does the hazard have to be before you give up and start over?  Is that chicken fresh?  If not, does it smell “off”?  If the dog won’t eat it, it might not be safe, even after you cook it.  How long can the fridge be above normal temp before you consider the food inside “no good”?
4.       Monitoring CCPs-  How can you tell that the CCP is working?  Do you have a thermometer in the fridge?  You should!  If you like meat pink, do you check the temperature?  Temperature is the easiest way to monitor after TEOTWAWKI.  Glass thermometers are plentiful online.  Some laboratories change them yearly to maintain calibrations.  That’s how I get mine.
5.       Corrective Actions- What will you do if your CCP limits are not met?
6.       Verify- Check that the system is working properly.  The best way to do this is to have someone else prepare a hazardous meal following your SOP word for word.  If you are skeptical of the result, you have some work to do!
7.       Establish record-keeping procedures- You should have records like garden logs, weather events, and vehicle maintenance already.  When you use an ingredient that smells or looks odd, you should write it down somewhere.  If someone gets sick, write it down!  Tracking what you ate will help you identify latent food allergies (some people get migraines from certain foods) as well as problems associated with the food (was your home-grown chicken diseased?).  You don’t need to keep industrial logs- 100 kilos of x ingredient and 200 kilos of x product.  You might have something like that for inventory maintenance, but it’s not going to do much good for a Pathogen Protection Plan.

Not everything about a HACCP plan is tied to chickens.  Potato salad is often the cause of a bad day.  Potatoes contain Bacillus cereus spores, which activate upon cooking and grow if the salad is not kept cool.  The toxins they emit can cause nausea, vomiting, and diarrhea.

In a situation without medical assistance, we can convert a pressure canner to act as a sterilizer for medical equipment.  There are sterilizers for sale that are designed for use on a stovetop.  Quality examples can be had at AllAmericanCanner.com.  If TEOTWAWKI comes and you don’t have a sterilizer, adding an anti-siphon tube to the vent stack will allow you to use it to sterilize surgical equipment and dressings if you’re really in a pinch.  An anti-siphon tube is a tube typically installed on pressurized gas tanks (most often CO2) that are stored horizontally.  The tube prevents liquid from coming out of the pressurized tank when we want the gas.  A quick image search will give you a diagram of what I am talking about.  We want the tube opening just above the surface of the water.  The reason for a siphon tube is that hot, dry air is a poor sterilizer, while hot steam is a great sterilizer.  Because steam is lighter than air it will move to the top of the pressure canner and exhaust out, leaving the air untouched.  The tube forces the air to move out of the canner first, leaving the steam behind to effectively sterilize items.  To remove the guesswork of a DIY system, buy a stovetop sterilizer .

A standard sterilizer cycle is 121*C (which translates to approximately 18 psi on the gauge) for 15 minutes. Pressure canners typically have a max safe operating pressure of 15psi, so it would be wise to process items for at least 30 minutes.  Because the stovetop varieties lack the special purge cycles of larger, modern steam sterilization equipment (autoclave), processing time is lengthened beyond the standard 15 minute cycle.  Follow the directions.   A supply of sterilizing pouches will allow you to sterilize medical equipment and bulk surgical dressings for storage and emergency use.  This way you won’t have to run a 30 minute cycle while someone is waiting for you to pull a bullet out.  Typical prices I have seen for the larger pouches are $15 for a pack of 200.  That’s 200 sterile cotton bandages you could make and store, just with a bolt of cotton or muslin cloth and a pack of pouches.  Put a date on these and rotate them every other year or so (again, follow the directions).  If you lay in a couple hundred dollars worth of supplies, you could have a booming SHTF business bartering sterile dressings and the like.  I would not advise bartering your bandages if you are using a DIY sterilizer.  You’re responsible for the product you market, even after a collapse.  Repackage and re-sterilize if the pouch is damaged in any way.

Another great thing about sterilizing pouches is that they have chemical indicators to let you know if sterilizing conditions were met when processed.  Keep in mind when sterilizing to not crowd your equipment.  You need ample room in the pouches and around loose items to allow the steam to circulate and contact the items.  You can’t cram the pouch full of metal instruments and expect them to come out sterile!  Do not put soiled items into the sterilizer!  Clean and disinfect them first with soap and water, then a soak in a bleach solution.  Sterilize after rinsing with clean water.  I must reiterate that this is only for a worst-case scenario.  Don’t practice medicine without a license.  Having said that, it is not illegal to prepare for an emergency in which you are unlikely to have access to professional medical care.  As always, something is better than nothing.

So you have clean water, safe food, and sterile medical equipment after the collapse, but you still have to worry about communicable (contagious) diseases.  Once you’re in your permanent location, your PPP must include methods for isolating, controlling, and removing pathogens carried by people or objects.  This may mean a “sick room” for a person who has diarrhea (you don’t know what’s causing it), with a plan for sanitizing the living quarters afterwards.  How will you handle the waste?  How will you sanitize the bedding, clothing, and other items that won’t fit or you don’t want to put in the sterilizer?  A simple way to sanitize the room would be to use a hand-pump garden sprayer with a bleach solution.  We use these at work to sanitize floors.  It’s 20 to 30 times faster than mopping with a sanitizer.  Make sure what you’re spraying won’t eat the floor if you spray it and let it dry.  Some quaternary ammonia solutions dissolve floor wax and make it gummy.  Epoxy floors are about the best I have found for chemical resistance.

You must have a plan to deal with all possible contaminants.  How will you treat someone in your group that has contracted a blood-borne pathogen (Hepatitis B,C) just before the collapse?  What will you do with surgical instruments that get covered in their blood?  What will you do with your clothes that are now covered in their blood?  How will you clean the room to prevent other patients from contracting the disease?  How will you prevent yourself from contracting the disease? You must create a method for dealing with these scenarios.  Although disposable items are not ideal, they are a quick and easy solution.  Gloves are almost entirely necessary.  Although more expensive, nitrile gloves are hypoallergenic and more resistant to puncture.  Don’t buy these from big-box stores.  Nitrile gloves made for medical or laboratory applications are thick, while consumer-grade nitrile gloves are very thin and tear easily.  Surgical masks are also a must if your group plans to conduct surgery post-collapse (I’m assuming you have someone who is trained and competent).  One word of wisdom on surgical masks- the blue masks you see on television shows will not protect you from a sick person.  Look at who is wearing them in the OR.  Not the patient.  They are designed to catch aerosols created from talking, coughing, and sneezing.  They will only protect you if the infected person is wearing them, not the other way around.  The easy rule of thumb is that if it doesn’t form an airtight seal, it doesn’t protect you from the environment. 

Another angle to consider is combat.  What happens if an enemy punches through the perimeter, is killed, and now you have to dispose of the body?  What precautions will you take to be sure you don’t catch something he may have?  Although it seems paranoid, I feel the best course of action for a group in a fortified location is to treat all outsiders as though they are contagious.  That means full coveralls, respirators, dedicated shoes, and dedicated shovels and equipment, all of which will either be kept in a designated area outside the main living quarters and away from food storage and preparation areas, or sanitized/destroyed by flame or other sufficient, non-destructive processes.  If your group adopts this method, it would be wise to designate only two people to do the disposing in order to limit the quantity of disposable/dedicated items required.  More than two people would make things faster, but the waste of protective materials increases.  It is easier (and cheaper) to use only two sets for the entire excursion, then dispose of them.

In order for a PPP to work effectively, all of your group members must have a general understanding of aseptic technique.  Let’s skip the classical definition.  This means, generally, that there is a hierarchy of cleanliness.  I would set it up as follows:
1-      Sterile – Item contains no pathogens or other foreign materials that can cause illness.  Example use -extensive surgery, dressings for 3rd degree burns.
2-      Sanitary – Item has been treated with a chemical or other process that makes it unlikely to carry pathogens. Example use- minor wounds (stitching, minor burns)
3-      Clean – Item has been cleaned to remove soil and possibly sanitized at some point.  It has been stored in a place where it is unlikely to come in contact with pathogens.  Example use- food preparation (no raw meat or eggs) and consumption.
4-      Unsanitary- Item is stored in an area thought to contain pathogens, or is used in handling objects that may contain pathogens.  Example use – gardening, preparing raw meat/eggs.  NOTE:  Although a garden shovel and an egg whisk are on two opposite ends of a traditional “dirty” spectrum and would not be used for the opposite task, we are only focusing on microbes that will certainly cause illness.  A compost-laden garden is unlikely to make you sick, even if you eat some of the dirt (I don’t advise it).
5-      Contaminated- Item is known to be used for cleaning or removing infected materials, and/or is stored in a place with other contaminated items.  Example use – burying dead outsiders, digging cat holes, sanitizing a quarantine area.

The general purpose of aseptic technique, for our discussion, is to prevent transferring a pathogen from a known or possibly contaminated object or area to an area that is unlikely to be contaminated.  This means that items higher on the list cannot be used for a task lower on the list and then re-used for an item above the first task.  If you were to use a Class 1 (sterile) item to perform a Class 3 task, you could not use the same Class 1 item for a Class 1 or 2 task without proper treatment of the item (sterilization in this case).  I find it easier to change the classes to colors, a la, white, yellow, blue, green, black, respectively.  This way, you can turn it into a game of “tag”, where when an item of one color “tags” an item of another color, the item higher on the list changes to the other color.  Whatever system works for you is best.
Hopefully this article has given you some tools to develop a plan for minimizing your risks associated with disease-causing microbes.  Stay safe, stay healthy!!

Disclaimer:  Do not perform medical procedures on yourself or others while you have access to professional medical care!  It is illegal in the US to practice medicine without a license.  The views expressed are not those of a medical professional.  You are solely responsible for the consequences of using any information contained herein.

About The Author: J.R.M. has Bachelor’s Degree in Biology/Microbiology, and several years of experience working with microbes in a laboratory environment.

Today I offer part 1 of a 3-month medical prepping guide for your family, group, or community.

Please note the following abbreviations:
ORG = organizational concerns
OTC = over-the-counter products
Rx = prescription products
ED = education and skills

The supplies listed under OTC can all be purchased without a prescription, though some are only available online.  For prescription items, assess what your group has and what each member is likely to be able to acquire. 

The three-month period is divided into 13 weekly tasks, divided according to topic, making the project more readily manageable. 
For more detailed information on medical prepping, please visit www.armageddonmedicine.net. 

(Part 2 of this series, covering Weeks 7–13, will be published in the near future.)

About the Author: Cynthia J. Koelker, MD is SurvivalBlog's Medical Editor. Her web site is www.ArmageddonMedicine.net

Dear JWR:
I want to make just a quick comment on C.T.M.’s recent article titled Guarding Your Mental and Emotional Health.  There is an excellent essay that Dr. Song, Director of the Northeast School of Botanical Medicine in New York has made available. He notes that perhaps 1 in 20 folks have an opposite reaction to Valerian. I know, that is only 5% - but what if you are one of those in that 5%?  My suggestion is to give it a try before you stock up.  Practice now, so you know what works. - Linda Z.

I started prepping a few years back when I was in paramedic school.  I had no educated goal when prepping initially.  Then I met a good friend of mine that changed the way I look at prepping, and helped me make my prepping intentional.  I read Patriots and I started prepping all the more; now with motivation and intelligence.  When my friend reads this he will probably view this is as some form of Narcissism even though he falls into this category.  But I digress.

I have been a full time firefighter for 5-1/2 years  I am currently a Paramedic, and have been so for 2.5 years, before that I was an EMT-I.  Most of you had no idea there was a difference, but after reading this you may look further into it.  Prior to my time with the fire department I spent time in the Marine Corps as a non-grunt, working on aircraft.    

Firefighters are also some of the best preppers for several reasons and the first is because of our medical experience.  Our medical training is some of the most critical that will be required no matter the disaster scenario.  Paramedics deal with disasters and high stress, high stakes environments daily, and operate at a high level of reasoning (there are exceptions)-often more so than Nurses.  After I just pissed off every nurse that is reading this, let me explain.

Paramedics have a unique advantage over Nurses, even some Doctors, for one major reason.  We have to think on our feet with no one of higher authority or knowledge base in the Medical field is around.  Nurses look to doctors, doctors look to specialists and so on.  Paramedics often have to make split second decisions that can mean life or death.  We may have to call on a doctor for orders, but the major recognition and decisions have already been made.  Our reasoning skills, in high stress environments, operates at a high level; if you are in high stress environments on a regular basis.  To achieve this as a Paramedic you need to be working full time at a high volume department.  Not saying those boys and girls in the rural areas don’t know what they are doing, they are usually some of the best, but an inner city or busy suburban paramedic/firefighter is worth their weight in gold.

Unfortunately when TEOTWAWKI comes to fruition I will have already seen death, major trauma, and gunshot wounds.  With this gruesome experience I can come into situations that for most will be unnatural, and will not have previous experience to draw on.  We have a tendency as humans to stare at disastrous circumstances and just watch.  Experience gets people from inaction-watching a disaster unfold, to action, to move or help out where you can.  In same way it will help your brain more quickly realize when and how to escape or run the other way from a disaster. 

I know from my little Marine Corps experience and my firefighting experience that knowing how you are going to perform under high stress, high stakes environments, is only achieved through doing it every day.  This translates very well to the use of fire arms, particularly deadly force.  There’s a guy I work with that has a saying, “Never mess with a fireman’s family, he sees bad things on a regular basis, and the only thing he is worried about when killing someone that is trying to harm his family is cleaning up the mess afterwards.”  I couldn’t agree more with this statement.  When someone is placed inside of a burning structure or when someone is dying, a cool head that is used to utilizing reasoning skills is essential to see it through. 

Now as a professional firefighter I do not see fire every day.  But I do see it a lot more than the average person, and most likely more than the volunteer fire fighter.  Firefighting as an essential skill has been talked about extensively, but I won’t be going into tactics or the fact that it is darn useful to have some one that has actually fought fire when your house is burning post schumer hitting the fan.  Knowing and recognizing fire behavior, particularly at critical points, are essential to all preppers.  I suggest that everyone has a fire extinguisher.  But not just an ABC-really these are best for electrical fires.  A pressurized water extinguisher, otherwise known as a water can is probably the most versatile and complete fire protection you may need post apocalypse.  These types usually can be filled with a water hose, and re-pressurized with an air compressor attachment you probably already use to fill up the air in your personal vehicles, or bike tire.  I have seen a room in contents fire nearly put out by a ONE water can, saving the structure.  Ideally you want at least one per floor, two if there are living quarters or high fire hazards on that floor.  They need to be some place you look every day and are used to seeing, or you will not remember them.  Many a kitchen fire has been put out by a water can, precious life and property.  They do not go out of date; As well another useful trick that I do with my water cans is put dish soap in them.  Soap breaks the surface tension of water and makes it more readily able to soak into materials, very helpful for small brush fires and mattress/couch fires especially.  A couple table spoons should do a normal water can.   These are easy to use, easy to refill, or re use items.  They average about $60 apiece. 

Emergency Medical training is not hard to come by.  Real world practical experience is invaluable and not readily available.  Paramedics and EMTs usually have access to sources of medical supplies, and medical training, from CPR (not useful post-Schumer, if they are dead, leave them dead), to basic would care.  Medical training is the one skill that may save your life or one of your family members life one day, and it is portable anywhere.  Nurses provide long term care, known as palliative care.  Although this is very useful in a survival situation, often critical care at critical times is what saves lives.  A good combination of both would be ideal.

Another point on why firefighters are the best preppers is our schedule.  Full time firefighters usually work 24 hours on and 48 hours off.  Those 48 hours are usually filled with part time jobs in other fields.  Due to the emotional toll of being a first responder, Paramedic or firefighter, a lot of us choose not to work in our part time in this field.  Some do and gain further experience in the medical field.  I work in an ER, so I have the best of both worlds, I believe.  Where most firefighters work part time is in construction.  Handy man type service, if not an all-out trade that they use to make good money on the side.  These skills are essential at maintaining your bug out property in a variety of ways that I am sure are easily recognizable. 

The schedule brings up my next point.  Firefighters often have the time to not only work part time to make more money, but have time to plan, prep, and to train, three things that can be difficult if you work 9-5 Monday through Friday.  This includes helping you prep and build up your bug out property.  All you got to do is ask.  They are also used to working late at night, and waking up at the first signal of trouble, and operate at a high efficiency, even at 0300 in the morning.

Another essential part that firefighters already have is the mindset.  We have to prepare ourselves and our equipment to go into perilous environments on a daily basis.  We are always planning for the worst, expecting the worst, and we are rarely disappointed.  So when it comes to prepping most firefighters already have the skills of trying to fore see what can, or could happen.  We also know human behavior all too well and know the traps that complacency and lack of training and experience will get you in to.  Many firefighters are already preppers, they just don’t know it.

Further, firefighters are usually in pretty good shape.  We need to be for our job; as well most departments require annual physicals, and physical fitness test.  This makes the transition to a TEOTWAWKI a lot easier.  We are used to a regimented schedule and train regularly for our job.  The minimum training for our job (ISO requirements for major departments) is around 280 verifiable hours every year.  I can guarantee that most jobs do not require this amount of training. 

Operational Readiness is a buzz term a lot of people in security, defense, and public safety use.  It is most easily broken down to a spectrums of events and required training that are: high frequency and low risk (requires little training), high frequency and high risk (requires regular training), Low frequency low risk (little to no training), and finally Low frequency high risk events (need to be drilled regularly to minimize risk).  This is a good start when looking at training for you and your family.  Firefighters are well acquainted to this as stated above, and very familiar with risk assessments and needs.
So if you are looking to add a good group of folks to your prepping group then I suggest you look at your nearest full time fire department.  You may already know some.  They will be a great asset in any end of times, disaster, or apocalyptic scenario. 

There is one downfall to firefighters and paramedics when the Schumer hits the fan.  They will be running into the burning buildings, and running to the aid of others, which may lead them from taking care of their own family.  This was a trait we saw all too clearly on 9/11.  When disaster strikes though, most know the protection and care for their own family takes priority.  With that knowledge firefighters that are married or in a long term relationship, with or without children, are the best choice for addition to groups.

As a side note, many firefighters end up dating/marrying, or becoming nurses themselves, and nurse practitioners.  Ultimately their service to their community will provide some of the best intangible assets.    There is only one group of people that I think could be more appropriate for a good addition to any group of preppers: former or active Special Forces/Infantry soldiers, and and emergency room physicians or surgeons.

Recently I attended a three day class on medical response in hostile environments presented by Medical Corps in Caldwell, Ohio.  The presenters were terrific, the topics important, and the hands on lab sessions made the whole thing come together very well.  I have already had considerable medical training but I left with a better understanding of what may be required in the future. I gained additional confidence in my ability to perform many of the basic and lifesaving medical functions.  After talking to a number of people I realized a few things about medical preparedness could be presented to this blog for thought and discussion.  The everyday American seems poorly equipped for medical emergencies, basic medical or dental care requirements for a grid down situation.  The majority of our individual healthcare needs are provided by the giant US healthcare system. We have become a population with limited medical skills, knowledge, and have no definitive plan to carry us through a serious societal breakdown.

Medical professionals possess a high level of training that may or may not be available to you or your group.  There are tens of thousands of doctors and nurses living in this country but I rarely hear or read where any prep groups are including or recruiting medical professionals.  I have been deeply involved in surgical and medical procedures for over 25 years and consider myself well educated on a wide variety of medical products and their use, but find myself nearly overwhelmed with the various aspects of medical prepping. The information that is available on an assortment of medical procedures and conditions is scattered around the internet and is difficult to understand.  Any numbers of sites praise the use of herbal remedies that they say will be growing in a roadside ditch while many others sell battle bandages and magic powder guaranteed to stop an arterial blood shower when your child gets shot by a band of ruthless marauders. People are wondering should we buy bird antibiotics in pills, capsules, can we freeze it, is it enough, will it last, what exact one should we buy, how much do we give someone, will it expire, what about other drugs, and suture, or dental instruments, and IV fluids, or what about shock treatment, or this , or that, or the other? Many people don’t know what information to look for or what they may actually need to do to provide for future medical needs.  Countless people are not even sure what they may be facing in the event someone falls ill or a grave injury occurs to a family or group member.  The choices and availability of medical provisions are, quite simply, dizzying and far too expansive for the average person to begin to make the right purchasing and stockpiling decisions regarding critical items.  Medical textbooks and manuals are readily available to the public but many describe techniques and procedures that call for far more knowledge and proficiency than average people genuinely possess.  In reality, people can’t expect to open a medical text book during an emergency and follow the directions.   In all seriousness, legitimate layperson medical skills training classes and study need to be a part of every preparedness plan.   All of these questions have answers but we must have a little help.         

While attending the Medical Corps training class I had the opportunity to talk openly to other people that made the decision to invest in essential formal medical and dental training.  Each person that attended the class shared some common beliefs.  The universal feeling was that the economic conditions in the US are near a catastrophic end point and that someday we would no longer enjoy our current way of life.  That ‘we the people’ will be required to take care of ourselves and our medical needs or people we care about may end up in a FEMA camp or worse.  They made the conscious decision to serve as at least one of the primary caregivers for their family or group.  Many of them felt like the proverbial deer in the headlights when it came to medical care in a hostile or grid down environment.  Like most of us they have entered the vast maze and had the online medical industry staring back at them from their computer screen.  These people realized they needed some help.  Attending the Medical Corps program was a big step in the right direction for many of those folks.  After a lot of searching I have come to the conclusion that medical and dental training for civilians is not readily available just down the road.  Organizations like the Medical Corps are few in number and seem to be located a long away from everywhere. Fortunately the cottage industry is growing and several quality organizations that offer authentic civilian medical training do exist.  I hope the following can help:

Trained Medical Personnel
A group, large or small, should designate a member as the medical director.  This person must be a responsible and intelligent member of the group.  A doctor, dentist, veterinarian, corpsman, nurse, chiropractor, pharmacist, surgical technologist, or respiratory therapist would all be good choices. Many of these people would be a great addition to a group and a few have access to things that will be difficult to obtain. In lieu of an experienced person, pick someone that will be able to keep a cool head and be prepared to make life and death decisions.  In reality it may be the father or mother of a family. Someone has to take the lead.  Ideally, the group should invest in the education of this person. A single 3 day class is only a start.  Someone must make a real effort to find and attend multiple training courses and become a student of medical skills.    Medical training classes, courses, workshops, and the ancillary materials are expensive.  The airline travel and lodging for multiple day programs and time off from work can definitely add up so the reliability and dedication of this person to the group must be without question. If financial restraints only allow one person to attend, then this person can start immediately sharing the information with others.  One fundamental for learning medical skills is: watch one, do one, teach one.  The long term health of the group or even your own family may depend on it.  Once your group is active and living in a hostile situation, it is vital to protect your doctor from harm.  There is a reason that the military avoids sending doctors into battle.  Doctors cost a small fortune to train and without them a lot more people die. Do not designate your primary, battle ready, gung ho group leader to this position.  Don’t exempt your medical personnel from tactical training and leave them vulnerable, but do not send them into dangerous situations. Military surgeons are generally armed at all times in hostile areas. Not a bad practice. The hopeful reality of a post crash society is that surviving groups of good and decent people will come together and form communities.  These communities will almost surely have doctors and nurses that will rebuild along with everyone else.  Our responsibility is to get our people to that point alive, in as good a condition as possible and provide a relatively functional medical support system.
Take a hard look at medical care and keep some things in mind about what will be needed.  We could all give some thought to a few categories:

Acute Trauma
 Acute trauma may be something as simple as a severe ankle sprain, bone fracture, laceration, or as bad as a gunshot wound to the head.  The most important job in a grid down acute trauma situation is to stabilize the person and get them to a location (your home or retreat) for more definitive care.  This may mean stopping the bleeding from a laceration or correctly taping an ankle.  It may mean more advanced care like stabilizing a fracture with plaster or a SAM splint.  Under almost all conditions it is far better to have the person walk out on their own, or at least walk out with assistance.  Proficiency in splinting and taping can make this possible some of the time.  In a hostile, hot, or rugged environment carrying a full size adult for anything other than a short distance may well create other causalities.  Carrying someone, even with a well designed liter it is an enormous, backbreaking ordeal.  You may be tasked with making an airway for someone that has a severe reaction to an insect sting or poison.  You may be forced to stop your best friend from bleeding out after a severe wound.  The key to successful, and potentially lifesaving intervention is to get some training before anything happens.  At a minimum every group member should do what it takes to learn the skills to stabilize bones and joints, open airways, stop bleeding, and get fluids into the patient. (There are some interesting ways to hydrate a person)  If you can perform these procedures and carry a carefully crafted medical kit you may keep someone alive.

Acute Care
This is care that should be able to be provided at your base location after a patient presents from the field or down the street.  People will come in here with all types of injuries. The “oh I cut myself” patient to the people that are going to die. This location will for all practical purposes be your hospital. The types of care will include cleaning, suturing and bandaging wounds.  It may also include setting, splinting, and casting fractures and joint dislocations.  Minor and perhaps not so minor, surgical procedures will ultimately be performed by qualified people with the right supplies and equipment. Burns are a common hostile setting injury and will be initially treated in this location.  Sucking chest wounds, head wounds, and foot blisters may all show up on a given day. This area must be kept exceptionally clean, ordered, well lit, and standing by for use at anytime.  If there is anywhere that clean water will be available in quantity it needs to be here.  Infection must be stopped here and copious washing of wounds and hands is vital.    If your group has stored medications and antibiotics, this is the place for those.  A stove top pressure cooker can be used as a sterilizer, but you must learn how to do it.  Many people are visual learners and there could be large human anatomy posters (commercially available) and step by step diagrams of common procedures on the walls in here. This location (in a separate but attached room) will be where the largest percentage of your stored medical supplies will be housed and used. In a grid down situation a well prepared community may want to limit foot traffic and keep this spot guarded at all times.  Some of the available civilian medical courses can help us with setting up and stocking this type of area.  

Dental Care
The Medical Corps training program provides a very good foundation for field dentistry.  The lectures were down to earth and the hands on lab sessions were a popular part of the class.  Basic techniques and procedures like extractions, fillings, and cleanings will be absolutely necessary for your group.  The class literally stripped away the mystery surrounding the basics of extractions and fillings.  A lot of people are of the mindset that a tooth can just be grabbed with a set of pliers and pulled.  I guess it could, and the tooth will come out eventually, but every physician lives by the oath “first, do no harm”. After attending this class I would never attempt to remove a tooth without the proper preparation and tools.  But now that I have completed the class and gotten the necessary tools I will never be in that situation. The point is that with a basic education and the proper instruments field dentistry can be added to your group medical care plans.  For those who are dedicated to providing group care and are committed to furthering their field dental education, the Dentist/instructor offers an additional 3 day advanced dental class.  My own preparation plans include attendance at the next scheduled class.  An untreated abscessed tooth can turn into a life threatening emergency.

Medical Supplies
This is one area of medical preparedness where a lot of money is being spent.  This is also a prime area of confusion for a lot of people.  There appears to be somewhat of a feeding frenzy going on. A lot of people are not sure what to buy so they just start ordering. Medical product and first aid companies have tens of thousands of product line items to choose from.  Many sites appear to list a single type of bandage ten or more times, with slight variations in the product, making it difficult to actually order what you wanted. This process is repeated over and over on thousands of products. Even a very savvy medical supply shopper remains hopelessly confused and many times will exit the site without buying anything.  There are literally thousands of all inclusive first aid kits being sold on the internet.  Be careful what you buy for there may be some kits that fall more in the realm of marketing and not medicine.  Please understand, there are great first aid kits out there and they can be an excellent start to medical prepping but purchase from a reputable company and really understand exactly what you are getting. This is not a blanket denigration of first aid kits that are sold on the internet.  However, it is a gentle word of warning to be careful what you buy.  Medical products are much like any other consumable manufactured goods.  There are a lot of choices of similar products from various companies.  Some products are great and some not so great.  Some store well long term while others degrade rather quickly. I have learned a lot about first aid kits and supplies by doing my own research, attending medical training, and trial and error. Trial and error gets expensive. Many people’s preference is to assemble their own kits with products and supplies that they have the knowledge, or plan on obtaining the knowledge, to use. Educating yourself before you buy is important.  With proper guidance we can get our hands on most of the medical and dental supplies needed for our group or family.  Organizations like the Medical Corps help you make the right decisions and steer you in the right direction. They honestly tell you “buy this exact one because we use it in battle and it works”.  Finally!  As you or your designated medical officer press forward in your education you can add supplies to support your skills. Many of the exact same products used in hospitals, dental clinics, and operating rooms can be purchased by the average citizen.

In closing I hope that I have not added to the confusion of medical preparedness.  If you seek out and ultimately take advantage of the training opportunities that are available I sincerely hope you will get the feeling of empowerment that can only come from knowledge and preparation.  Finally, THE PRACTICE OF MEDICINE OR DENTISTRY WITHOUT A LICENSE IS ILLEGAL IN THE USA.  Thankfully, education is not.

Imagine a scenario where there are no more hospitals, no more drugs, no more pharmacies, no more walk in clinics. No more ER’s or Acute Care Clinics. The OTC medicine’s shelves have been cleaned bare by looters. All the nurses and orderlies and support staff have fled the ruins of the healthcare edifices to be with their families. The modern healthcare system is no more.

Now imagine someone you are depending on for your security and perhaps even survival wrenching their back while hopping out of the back of a pick up. Their back muscles seizing up so tight and the pain that they are experiencing, so excruciating that they can barely walk, let alone perform the tasks necessary for survival in a post TSHTF world. With modern healthcare now non-existent, what are you going to do?

Now, given the fact that our American healthcare system is highly dependant on high cost, high tech interventions, the idea that our current healthcare system would very quickly suffer a horrible degradation should TSHTF is a very real probability.

Given that high tech complexity and the subsequent hole that will be left should our healthcare system ever collapse, it makes sense to prepare by learning a low cost, easy to use, scientifically proven, versatile form of medical care not dependant on electrical power, knowledge of advanced applied organic chemistry or even nuclear science (all of which modern medicine is based on). With this single article, you have the tools to offer your loved ones the benefit of the 2500 years of proven effectiveness acupuncture provides.

Should one find themselves in a TEOTWAWKI situation, acupuncture could be very useful in a wide range of medical situations when medications are hard to come by (or increasingly expensive). Acupuncture is free when you know how to do it. Since most clinical studies show that acupuncture has a long lasting pain relieving effect, it could be very useful in post-pharmaceutical America.

I believe that knowing a little bit of acupuncture could not only prove potentially lifesaving for ones own inner-circle of family members, but also would be a skill that would quickly become a valuable tradable service in a post pharmaceutical healthcare landscape.

Acupuncture. Really???
Dating back thousands of years, the practice of acupuncture has held the distinction of being one of the worlds most commonly used and scientifically tested and verified forms of medical care. While it is common in China to utilize acupuncture as routinely as an aspirin, here in America, acupuncture is still relatively portrayed as an exotic, mystical or mysterious voodoo medicine by popular media. That is unfortunate because with a little bit of instruction (as in this article) anyone could learn to perform a simple yet effective acupuncture treatment with great results.

Acupuncture has shown itself over the centuries to be one of the most versatile medical therapies out there (being utilized for just about any dysfunction in the body, from digestive health issues to urinary issues to allergies). I often say that it’s easier to list the things acupuncture cannot treat than to go down the much longer list of the things it can be successfully used for.

For brevity, this article will focus ONLY on low back pain. Perhaps subsequent articles will give condition specific treatments for other health issues such as knee, shoulder or neck pain, PTSD, asthma, anxiety & depression, headaches, nausea, etc.

Acupuncture has recently become well regarded by the mainstream western medicine establishment in recent years. It has been endorsed by the National Institutes of Health (NIH), The World Health Organization (WHO), The American Medical Association (AMA), Mayo Clinic & Harvard, the socialized medical plans of France, Germany, Italy, England and several others, as well as the US military who provides “battlefield acupuncture” as part of the rehab to active duty personal as well as returning vets returning with wounds from overseas. Based on results from a comprehensive study they conducted, even the Israeli government now recommends and utilizes acupuncture for PTSD in soldiers and civilians alike.

While acupuncture is starting to be found more and more in hospitals her in the US; in Europe, acupuncture is much more integrated into their medical systems. In Britain for instance, acupuncture is considered a “first-line therapy” for lower back pain as it also is in Germany, where 1/3 of their MDs report routinely using acupuncture as a treatment for their patients.

Please note that in most states, acupuncture is a regulated profession and one must be licensed by the state to practice. So utilizing the information in this article in normal day-to-day society could likely be flirting with “practicing medicine without a license” in your state. Because of that, I suggest printing this article and keeping it stored away until a TEOTWAWKI situation develops, when such legal implications would likely be overlooked by state & local government officials.

Yet, doing a course of 12 treatments on a loved one by yourself in today’s environment would theoretically save you $900 in medical bills (based on the national average of $75 per treatment). Should you have had the acupuncture done at a typical hospital that charges $220 a treatment, the hypothetical savings would be $2,640 or more.

Please keep in mind that properly trained acupuncturists receive 6-8 years of higher level college education in acupuncture and herbal medicine from one of the TCM (Traditional Chinese Medicine) schools here in the US or overseas. The “how-to” information is this article is a very cursory overview with a few “down and dirty” protocols, so should you not get the results you are looking for when performing “TEOTWAWKI Acupuncture”, please remember that this article is just a few pages while a practicing acupuncturist studied 10,000’s of pages of information just to begin practicing. This article is a very cursory “how-to” for the simplest of cases, so as they say; “individual results may vary”. Should this article pique your interest in learning more; there are millions of pages online and books available to gain further information on the practice of acupuncture.

So let us begin…

Acupuncture is the practice of inserting fine, thin sterilized metal needles (or threads / slivers / pins / etc) into specific spots on the body to elicit specific physiological responses, such as triggering the body to produce a surge of natural anti-inflammatory, natural endorphins (natural pain-relieving morphine-like chemicals), or muscle relaxants. One would say that acupuncture triggers the body to “make its own medicine” or “rekindle the body’s natural healing response”.

Although acupuncture has undergone more scientific scrutiny than any other medical procedure in the world, modern science does not fully understand how it works (This is not truly a concern since neither do they fully understand or explain the effects of aspirin or any other medication for that matter). Regardless; acupuncture can be used for muscle skeletal pain relief, hormonal and menstrual issues, stress, anxiety, depression and numerous other mental health conditions, digestive conditions such as irritable bowels and acid reflux. But since this article must only focus on back pain for brevity sake; again, I suggest you find supplementary information on the web with info on how to treat conditions readily treatable.

Let’s have an example; for simplicity sake, let’s say one of your family members strained their back chopping firewood or laying sandbags or jumping off the back of a truck bed wearing a backpack. In my practice, I see people like this all the time.

Often, after wrenching their back, they take OTC pain relievers for a week, anticipating that the pain will go away on its own in due time. When that doesn’t happen they next go to their doctor and get an x-ray or MRI and get prescribed a combination of narcotics and muscle relaxants. After several more weeks of waiting for the medications to “kick in”, they come see me at the acupuncture office. After doing a quick intake exam, I typically place 5 half-inch long (.16mm thick) acupuncture needles into the cartilage of each ear (the floppy outer part of the ear; just deep enough for them to stay there) as well as three one inch needles of the same gauge on each hand at a depth of about ½ in. Finally I place a needle on the back of each ankle in the hollow formed by the Achilles tendon. I then tell them to sit there for half an hour quietly at which point I come back to remove the needles and they leave. Done.

Unbelievably this cuts pain in 85% of the people that get acupuncture. For some people (about 15%), they experience what could be considered a miraculous, instantaneous alleviation of the pain.

Unfortunately; for 15% on the other end of the spectrum, no amount of acupuncture seems to give any relief. Everyone else is somewhere along that relief gradient. So like all medicine; it is a percentage game. Even aspirin does not work in 100% of all cases. Keep in mind that acupuncture works best as a short series of treatments. A single session is almost never enough (no matter what you see in the movies), but 6-12 sessions are often enough to alleviate and eliminate someone’s long term chronic pain. On average, in my office, I typically see a back pain patient 6 visits before they consider themselves pain free. If they do not see any change or even the slightest improvement after 3 sessions, I make the assumption that they are in that 15% category which will not respond. I typically release them from care after the three sessions instead of continuing and wasting their money.

Preparing Your Kit
The amazing thing about using acupuncture as a medical treatment is that you need so little equipment. A single needle is often enough. In a typical modern acupuncturist office, you will have some pre-sterilized needles, maybe some disinfecting alcohol swabs to swipe the puncture points beforehand (although this is arguably not necessary) and perhaps a cotton ball, Q-tip or tissue to apply pressure to the puncture site after removing the needles to “close the hole”.

Procuring Needles Today
Acupuncture needles are very affordable. You can find them for around 2¢ or less per needle if you shop around. The more expensive Seirin brand, which is considered “top of the line” will put you back only about $12 for a box of 100. Since acupuncture needles are considered “medical instruments” in most states, some suppliers may ask for some sort of proof of licensure from your state when you try to purchase them online. Don’t worry; the fortunate thing is that most suppliers online do not bother asking for your credentials. So if you go to purchase needles online and they ask for you to fax them a copy of your acupuncture license, simply go to another site. Since there are 100’s of manufacturers and brands to choose from, I would simply mention that I favor the DBC brand. I almost exclusively use the DBC brand 0.16mm size.  For body acupuncture I use the one inch needles (30mm) and for ear acupuncture, I use half inch (15mm) needles.

The thing to keep in mind is that some practitioners suggest that the patient needs to get a strong sensation from the needles, so “bigger is better”. These practitioners typically would use .30mm thick needles, which is something I have found that patients DON’T usually enjoy. If you want a patient to come back for enough acupuncture to get the job done, I suggest sticking to the thinner needles. From my observations, you can use thinner needles and get just as good of results. The only caveat is that you should perhaps pick up at least one box of the thicker needles for elderly patients who need a little more “oompf” or for the nut who thinks “I have to feel it for it to work”.

Another avenue of procuring acupuncture needles is to go to your nearest acupuncture college book store which often has them available for purchase by alumni right on the shelf, no questions asked. Needles are sold in boxes of either 100 needles or 1000. Either pre-wrapped and sterilized as individual needles or in bulk packs of 5 and 10’s. When you are doing the math to determine how many to buy and cache, consider that most acupuncturists will use 10 needles per patient per treatment.

Use The “Guide Tube” When You Can
Most manufacturers supply their needles with disposable “tubes” or “pipes” which make acupuncture even more pain free. To do acupuncture using a guide tube, you simply place the acupuncture needle into the guide tube, gently apply a bit of pressure downward onto the skin and tap the protruding top of the needle down. The tip of the needle slips into the flesh painlessly. The purpose of the guide tube is to gently pull the area of the skin about to be punctured a bit more taut, so that the tip of the needle goes in easier.

DIY Acupuncture Needles, Sterility and Reusing Needles When TSHTF
While it would be wisest to procure an ample supply of acupuncture needles before TSHTF, there really isn’t anything magical about the needles acupuncturists use. They are simply threads of metal wire, usually stainless steel. Under dire circumstances, you could make acupuncture needles easily. If need be, you literally could use sewing needles from your sewing kit or a spool of thin wire from the machine shop.

I have personally made and used acupuncture needles (on non-litigious leaning family members) out of steel wire I found in the garage, and leftover electrical copper wire I had. Should you find yourself in such a situation requiring you to make your own, look for thin, springy, flexible wire. Wire will typically have the diameter printed on the spool. You’ll want to use something in the ballpark of .15mm to .30mm. Using anything larger than that will not make you any new friends but can be used in a pinch. Snip the wire to the length of about 1 ½” and use needle nose pliers to create a small loop on one end to prevent the needle from getting lost by slipping too deep into the muscle. You can also use a piece of tape wrapped around the top ½ inch to give it a more comfortable handle for yourself. Otherwise, you can give it a more sturdy handle by soldering a few additional treads of wire around the center main wire needle. Once you have the handle on, you will want to buff the tip with some emery cloth to give it a bit of a sharper tip. What I have done is simply draw the emery cloth in single strokes away from myself towards the tip of the needle. I doubt that I could ever get the tip as surgically sharp as the manufactured ones, but its somewhat close.

Once the needle is honed, you’ll want to sterilize them before use. One option is to bake them in an oven for 30 minutes at 356° F (180°C). I’m pretty “old school”, so I have even used the “direct flame” method of sterilizing, which is holding the needle over an open flame until the metal glows red. Once it cools off, it is ready for use. [JWR Adds This Warning: DO NOT use the flame from matches or a wood fire for sterilizing needles. This will coat them with carbon and you will then be inadvertently permanently tattooing your patient!!! Use only a clean gas flame from a propane or natural gas burner, or from a disposable butane lighter.] Obviously, this method has major disadvantages (such as weakening the integrity of the wire and potentially leads to breakage) which I won’t otherwise get into here for brevity. Another back woods disinfection technique is soaking in bleach or alcohol or by boiling the needles in water for 20 minutes. Of the three options, boiling is considered the most effective way to disinfect. Just keep in mind that the greatest danger to a patient would be person-to-person blood-borne pathogens from reusing needles amongst several people. So never do that.

A word about the risk of infections with acupuncture. Statistically, acupuncture is THE most commonly performed invasive medical procedure in the world; Yet is considered the therapy with the lowest incidence of adverse medical events. Approaching the range of one in a million insertions causing a problem requiring further medical care. Problems that arise may be a local infection (0.01% rate of incidence), short term nerve injury (0.01% chance), systemic infection (0.001%), punctured lung (0.001%) or a broken needle (0.001%).

Those odds are pretty good statistics compared to our modern western medical model which is so powerful that we all run a lifetime risk of one in four of spending some time in the hospital due to an issue caused by that standard medical care such as pharmaceuticals or doctor error (at least that’s what the CDC says). Even if you have a very ample supply of ibuprofen in your medical cache, keep in mind that daily use of ibuprofen doubles ones chance of having a stroke. Having a stroke is not a good thing, especially after TSHTF.

In my practice, the most common adverse reaction is a bruise that develops when I don’t “close the acupuncture point” after removing the needle. You “close the point” by momentarily pressing the point with a cotton ball, Q-tip or finger immediately after removing the needle while the body quickly closes the microscopic wound through its clotting process. Acupuncture is safe enough for routine use for a lifetime (as was typically done by members of the Chinese Imperial court for millennia and by millions to westerners today).

It is also possible to clean, re-sterilize and re-use needles. Although I have never seen any special “reusable” acupuncture needles sold here in the US, In China, even today, you can find hospitals and individual practitioners alike, reusing acupuncture needles. They simply, wipe off the needles, wash them, buff and hone them with a sharpening cloth and then re-sterilize them, much the same way a dentist re-sterilize and reuses his tools. But I do admit that I have a very deep hesitation to reuse needles between people, regardless of how sterile they come out of the autoclave (And never would in my current professional practice… with needles costing just two cents each, there is absolutely no reason to in this modern day and age). There is the “ick” factor, regardless of blood-borne pathogen concerns.

So the moral of the story is that using fresh, unused, disposable single use needles made in a factory under strict sterile conditions is best. By picking up a few boxes of needles before TSHTF and throwing them into your medical kit, you will be set for years to come.

The DIY Low Back Pain Protocol
There are several approaches to effectively address lower back pain. The most obvious would seem to be inserting the needle into the painful area. You simply find the “knot” and insert a needle half an inch deep. You just slip it in. Easy. Simple. Let the person rest quietly for 20-40 minutes and then remove the needle. From this pure scenario comes a million variations of possible treatment protocols from a trained acupuncturist.

In general, you will want to use several needles in tandem for best result. Let’s use a scenario where a compatriot strains his back while chopping and stacking wood for the winter. If you are familiar with back sprains, you’ll know that they can be quite debilitating… sometimes for weeks. To perform acupuncture, you would have your patient lay face down or on his side (if laying face down is too uncomfortable) and locate the problem area. Most often, lower back pain involves the muscles around the second to the fifth vertebras (right around the belt line). The approach I find most effective is to simply insert 6 needles into the muscle two finger widths away from the spine on either side. For simplicities sake, I would suggest that you put 3 needles on both sides of the spine, regardless of which side the pain is on. So ideally, if the person has pain at the level of the third lumbar vertebra, you would want to put a needle two fingers width away from the 2nd, 3rd and 4th lumbar vertebras on both sides. You just slip them right in. Really; they insert so easy if they are good needles. Once you try it, you’ll be amazed at how easy they are to insert.

Once they are inserted, you’ll want to “wiggle” or “shimmy” them deeper to a depth of about a half inch to a full inch. Don’t worry; on a healthy sized male, there is at least 3-4 inches of muscle you would have to go through before getting to the organs inside (if you have ever seen a whole pork loin at the grocery store, you’d get some idea of how beefy the back muscles are). So that is 6 needles total.

With muscle pain, the locations don’t have to be exact. Some practitioners just feel around in the local area and look for the most tender or tightest spots. And that is where they place the needles. But for some degree of organization, here are the main three “official” acupuncture points most commonly used;

1. “Shen Shu” (Bladder 23) Located two fingers lateral from the spinal process of the 2nd  lumbar vertebra (which is the second vertebra not connected to a rib). Typically located at the highest point on the paraspinal muscle. This point can also be easily found by feeling for the natural thinnest part of the waistline (if you go feeling along the sides of the torso; at the level typically below the bottom ribs and above the iliac crest of the hip bones). The point is at that level but close to the spine. This point can also be acupunctured for urinary issues, fatigue, lung issues such as asthma and menstrual issues.

2. “Qi Hai Shu” (Bladder 24) Located two fingers width away from the 3rd lumbar vertebra. Typically located at the highest point on the paraspinal muscle.

3. “Da Chang Shu” (Bladder 25) Located two fingers width away from the 4th Lumbar vertebra. Typically located at the highest point on the paraspinal muscle.

Here is a link to photo of these points to aid in locating them.

Additionally; For even better effect, you should also place a needle a half inch to a whole inch deep into the middle of the popliteal crease located in the depression at the back of the knees midway between the tendons. This point is called “Bladder 40”. A final, very effective point is “Kidney 3” which is located in the spaces between the ankle bone and the Achilles tendon. The flesh there really isn’t all that thick, so the needle only needles to be placed ¼” or so.

These “distal points” many not make sense to most readers, but just please temporarily suspend your disbelieve that an acupuncture point on the back of the knee or on the ankle could help back pain. They do. Many of the most effective points in an acupuncturist’s repertoire are located away from the area of complaint.

The Million Dollar Points
Another effective approach in treating low back pain is utilizing the 3 “million dollar points” for back pain on the hands. “Ling Ku, Da Bai and Zhong Bai”, when used together can be all one needs for instant improvement in cases of back pain. I have literally seen patients who come into the office bent over in pain and holding onto furniture and walls to keep from falling over, walk out of the office 80% better after using just these three acupuncture points on the back of the hand for a half hour. The locations are easy to find, but again, I encourage you to look at the picture online should there be any confusion as to their location. I recommend applying these points on both hands.

1. “Ling Ku”; Located on the hand in the depression just distal to the junction of the first and second metacarpal bones. If you feel the meaty webbing which is between your thumb and index finger, you’ll simply feel for the spot where the two metacarpal bones meet. This spot alone is commonly used for sciatic pain, back pain, headaches or just pain throughout the body. It is a very commonly used point in most acupuncture practices. Insert the needle 1/3 to ½ inch.

2. “Da Bai”; is located close by. It is located just a bit more distally (towards the finger tip) of ling ku, in the depression just before the head of the second metacarpal bone which is the index fingers knuckle. Insert the needle ¼ inch or so.

3. “Zhong Bai”; is located in the depression on the back of the hand just distal to the fourth and fifth metacarpal joints. So if you feel for the short trench on the back of the hand between the bones of the pinky and ring finger, slide up to where the longer bones meet. The needle goes into the fleshy soft spot about a half inch deep but not completely through.

Below is a link to an image showing these acupuncture point locations.
http://i1150.photobucket.com/albums/o616/098123acupuncture/LingKuDaiBaiZhongBai001_zps447283a8.jpg

You can either do a “back treatment” or a “front treatment” since it’s hard to hit all the points mentioned simultaneously. If your treatment is just the three hand points and the ankle points, you can have the patient sit in a chair or lay on their back. I know it’s hard to believe, but you really do NOT have to do acupuncture in the local area to get great results. Once all the needles are in place, the patient should be allowed some quiet time for about a half hour before taking the needles out. Since the needles are now considered “bio-hazardous waste”, be sure to dispose of them properly. While state regulations vary, in my state here, sharps can be disposed of into municipal garbage as long as they are disposed of in a hard sided container such as an empty laundry detergent jug. If you have questions about your state regs, just ask a diabetic who takes insulin. They will be able to tell you what they do with their used needle sharps containers once they are full.
           
Good Luck
With acupuncture being so affordable (free) and easy to use, gaining a basic understanding of its use could be quite valuable in a post SHTF world either for yourself or as a tradable service. I hope this is the first of many articles showing how easy acupuncture can be to learn and apply for very common medical conditions. What you take away from this article could potentially be a lifesaver for someone otherwise debilitated with pain.

A Few Reminders to Keep In Mind When Providing Acupuncture;

1. Acupuncture shouldn’t hurt. If it does, you may have landed on one of the billion thread-thin nerve ending or an artery, so simply remove the needle and replace it 1/10th of an inch away.
2. Sterility of the needles is priority number one. Most practitioners will disinfect the puncture site before insertion of the needles with 70% alcohol.
3. Once the needles are in place, you can either leave them be or feel free to “wiggle and jiggle and thrust up and down” until the patient experiences a mild sensation in that area. For some this “arrival of the qi” feels like pressure (either bearing down or pushing up), a warmth or mild tingling, etc. Some practitioners disagree over how important or not getting this sensation is for patients. Some argue that this “DeQi” sensation confirms that the needles will be effective. Other acupuncturists will argue that too much stimulation is counterproductive. To be honest; even after 10+ years and seeing thousands of patients, I still can’t make a determination on this. I typically do NOT try to produce this “DeQi” sensation in patients unless they are elderly or the acupuncture is not producing quick enough results after several sessions. Try to find the answer on your own with experience.
4. Leave the needles in place for ½ hour to 45 minutes while the patient rests quietly. Chatting and “visiting” decreases effectiveness. Just relax for God’s sake.
5. The first session is the least effective. Just like taking that first antibiotic pill. Subsequent sessions build off of the prior sessions.
6. Acupuncture typically does not give instantaneous relief. For some patients, it does, but they are the exception. It usually takes hours for patients to begin to see improvement. It seems to take about three days for the full effect of a single treatment to kick in. Because of that, doing acupuncture every day or every other day is ideal. Three times a day is possible in the most extreme situations.
7. Acupuncture is a medical therapy. Don’t expect Hollywood miracles. A single session is almost never enough. Like going to the gym or doing a course of antibiotics, the effects are accumulative over the course of treatment. It is not uncommon to treat a chronic pain patient 12 sessions.
8. Remember; approximately 15% of people will not respond to acupuncture no matter what the practitioner does. In my practice, I encourage new patients to do at least three sessions to get an idea of how well they may respond. What I have found is that if they show no signs of improvement after 3 sessions, they fall into that category. On the other hand; 15% of people respond remarkably well to this form of therapy. These are the ones you hear about who get a single session of acupuncture and the bad back they had for 10 years goes away instantly. Since acupuncture is free, if a patient doesn’t see results after 3 sessions, you can still encourage them to do 3 more. They may be just a “late bloomer”.
9. Have the patient also look for secondary areas of improvement. Since acupuncture is improving function and circulation throughout the body, most patients see improvement is other areas of health. A patient may come in for rotator cuff pain but report that they also saw a marked improvement in sleep, digestion, allergies or other ailment.
10. The exact biological explanation of how acupuncture works is still out, but it may simply be explained that acupuncture kick-starts the healing response and triggers various natural chemical responses from within the body. It triggers the body to produce natural pain relievers, endorphins, muscle relaxants and anti-inflamatories, among other chemicals and hormones.

Rose R. owns and operates a Midwestern acupuncture clinic currently treating 20 patients each day. Rose has operated this sole proprietorship for 14 years.

JWR Adds: Be forewarned that you should not experiment with do-it-yourself acupuncture without proper training. Train only under a fully-qualified practitioner. Even with sub-millimeter diameter needles, things can go wrong if you are clumsy or if you don't pay attention to hygiene--including subdermal bleeds, nerve damage, inadvertent tattooing, or inadvertent infections.

Dear Editor:
I am a practitioner of fasting. Having learned how it feels to go without food I feel it necessary to let others know. Hunger is a good thing, but letting hunger go too long is very bad. Let me explain how this works. Hunger and starvation are totally different. Hunger is the state that tells you that your body is not receiving food. Starvation is when your body is destroying itself to stay alive. As a geologist in the jungles of South America I had the not so pleasant experience of typhoid. Most of my time there (15 years) I was well supplied by the companies who hired me to explore. This one time the logistics failed. I went through one month of typhoid, and for anyone who wants to know the details I can provide, but the end result was starvation. I had no muscle mass, only gray skin and bone. The recovery period without exercise was two years. Internal damage remains.

You do not need typhoid to get to starvation. This letter is not to instruct you on starvation, it is how to handle hunger. As a fit man I have about liberally 15% body fat. Using fasting to clean my cells of toxins and accumulated vitamins I would need minimum three weeks of water fasting to achieve the goal. Juice fasting can do the same but failure is more likely since it takes longer.

Here's how it goes: For the first four to five days I drink only water (bottled or well-filtered water is fine) and I have fierce hunger. At the fifth day hunger stops and the body realizes that it must draw upon stored energy. So, the body enters ketosis, which is the breakdown of fat to produce energy. The process will continue without any hunger pains until a very distinct signal, that is desire for food from the mouth and throat not the stomach. If you feel hunger from the stomach you have cheated and confused your body, keep going. When you feel that mouth and throat sensation it the time to eat, but eat sparingly. There is the urge to gorge, but resist and develop your food intake that equals the time spent off food. Fruit, juices, then more solid soft foods, then hard foods. Of course this will not be possible in a scarcity environment.

I drink only water for the full three weeks or until the signal arrives. The fasting initially may be a logical decision, the end of it is is not, it is very biological. During that time I experience the full range of effects from illness to euphoria, to true hunger.

Pushing beyond the signal is the beginning of starvation. You will know at that point, all your body fat has gone, it's very visible.That body to dream of is not your friend here. As a survivalist your body fat, in moderation, is your friend and you must keep a decent store of it just in case.

Long periods of accumulation of toxins and fat soluble vitamins stored within the body will have a detrimental effect upon people during periods of stress and food shortage. When the body is pushed to fat storage utilization the toxins come out and you are sick. Under stable societal conditions this is ok. Under scarcity conditions you have a period of problem. Hang back for a bit and let the hunger pass then move forward.

Fasting is one more form of training not often discussed in SurvivalBlog. With fasting the body becomes accustomed to the initial cleaning, This cleaning is the removal of toxins the body has stored for so long. You will be ill for the first week, you will look horrible but it is okay. After that you will feel great and a wave of energy will come across you. This is the body supplying energy to your endeavors. This will only last as long as you have fat reserves to spend. Fasting removes the toxins and vitamins, but restores the vitamins as long as the toxins (smoking the most readily available toxin) is not restored. Smoking is not the only one. There are so many others. The cleansing is worth the effort if the body restores the fat and accumulates the vitamins. How do you know? You feel so much better than before.

In some cases the weight loss is permanent and some not. No matter, since the replenishment of fat to the cells is what you want prior to any crisis but without the accumulation of stored chemicals. Fasting is a short period where the body endures hunger. Experiencing hunger before a crisis is a valuable lesson. Hunger, going without food, for four days is difficult. Most people fail. But, to endure the hunger and let the body adapt has beneficial and some say enlightening effects. Hunger is not starvation. When a person feels hunger they are not starving. Starvation occurs when the body has no energy reserves.

Repeated training in fasting allows your body to learn that the current food stress is okay. The period of hunger is shortened. Again, once the feeling of throat hunger appears, eat, eat sparingly and you will come out of the hunger period cleaner, faster thinking and happier. - Wesley F.

By the way, for those who are currently experiencing addictions, this is another good way to kick the habit before the crisis, but only one habit at a time please. - Ex-Addict Faster

JWR Adds: Some words of warning: Always consult your doctor before fasting. Never fast if you suspect that you are pregnant. Never fast when you are living alone. Beware that you could have dizziness or fainting after just a few days of fasting, so never drive or operate machinery when fasting.

Dear James,
I'm a long time SurvivalBlog reader, first time responder, and serious prepper.    This article by J.F. has some excellent information but there is a glaring omission.  In most auto immune diseases, there is an assault on your body that invokes a response by your immune system. At times, such as the case of the Spanish Flu Pandemic of 1918, your body gets confused by various threats and “brings out the big guns, namely a cytokine storm that effectively neutralizes the threat.  Unfortunately, this also does “collateral damage” in the form of severe oxidative stress to surrounding tissue.  
 
Vitamin D3 is well known to be an immuno-regulator, meaning it prevents a harmful over reaction of the killer T-cells sent in to take care of the problem.  Vitamin D makes your immune system work smarter, not harder.  How much dosage does a person need to properly regulate their immune system?  The key is to get your blood level of Vitamin D between 50 and 100 nanograms per milliliter based on a 25(OH)D blood test.  For most people this means taking 5,000 international units a day.  (Your typical multi vitamin has 400 units.)  Some who spend a lot of time outdoors and have certain dietary habits might need a little less than 5,000, but the blood test is the ultimate arbiter.  
 
Optimizing your vitamin D to this level has many other benefits, so we’re not talking about introducing an unnecessary risk.  It’s good for you whether or not you’re concerned about pandemics or your immune system.  And it’s quite inexpensive, normally 5 to 10 cents a day (US). 
 
For those who don’t want to take my word for it, Dr. John Cannell is arguably the leading authority on Vitamin D’s role in regulating the auto-immune system, so a google search of his name and “auto immune” will lead you to all the authoritative sources you could possibly want. (I just did it and got 668,000 articles.)  Best of luck to everyone in the coming times. - Big Blue

JWR Replies: Readers must be warned that Vitamin D is fat soluble. Unlike the water soluble vitamins, excess fat soluble vitamins are not easily excreted by the human body, and can build up to toxic levels. Consult your physician before mega-dosing any fat soluble vitamins for more than just brief periods. (Two or three days.) The acronym KADE should be memorized: Vitamins K A,D, and E are fat soluble, and special care must be used in their dosing. In contrast, the water soluble vitamins are rarely a problem, since the body can easily get rid of any more of them than are needed for complete nutrition and a sufficient immune response.

Many preppers are carefully strategizing the health care needs of themselves and their families. They are doing a great job of planning for a lack of conventional medicine, by stocking up on prescription medication where possible, finding alternate sources for antibiotics, collecting over-the-counter supplies and supplements and stockpiling the necessary items for inevitable wounds, rashes, skin infections and the like.

But what about those folks with chronic illnesses, who rely upon daily medications and/or the newer injectable biologic answers to auto-immune disorders such as Rheumatoid Arthritis or Lupus? What solutions, hopefully temporary, can be offered to those with diabetes, hypertension, hyperlipidemia, or thyroid disorders?

This material is offered as a stop-gap for people suffering from auto-immune disorders. And people with auto-immune disorders often have secondary conditions of Type II diabetes, high blood pressure, high cholesterol, and thyroid disorders. I should know: I am a Registered Nurse and I also have Rheumatoid Arthritis.  That said, I want also to add the disclaimer that I’m NOT a physician but I’ve done my best research on how to manage these chronic conditions in the event that traditional health care is unavailable. I’ve tried some of them now - and found I’ve been able to reduce my prescription medications in half! Let me share with you what I’ve tried myself.

Rheumatoid Arthritis: We know this isn’t the wear-and-tear joint destruction of normal aging, but instead the body makes too much of an immune system response so that it attacks its own joints, vessels, and organs. An easy description appears on the Arthritis Foundation web site:

“Rheumatoid arthritis, or RA, is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system – which is designed to protect our health by attacking foreign cells such as viruses and bacteria – instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that’s systemic – meaning it can occur throughout the body.”

But here’s the good news: People with ‘ramped up’ immune systems are better able to fight infections, which will be a favorable condition in a collapse situation! Before learning about prepping, I was already concerned with the amount of ‘chemicals’ I was putting into my body to treat this condition, so began researching alternative treatments. First of all, I went on a Gluten Free, Low Glycemic Index, Anti Inflammatory Diet. (Sometimes, I cheat…) Diet modification might be difficult to do in a collapse situation and I plan to eat gluten/wheat if need be until such a time as I can return to my usual diet.  Gluten Free and Anti Inflammatory Diets have been in the news for a few years now as solutions for auto-immune diet therapy. So stocking up on Gluten Free pastas, flours and mixes, and steel-cut oats was self explanatory. But in putting aside food stores for a Low-Glycemic Index diet for a collapse situation, I have included dried sweet potatoes instead of white potatoes, along with other ‘slow burning carbs’ such as brown rice instead of white rice, steel cut oats instead of flaked oats, quinoa (a grain with a low-glycemic index as well as high protein), and rice pasta, along with dried black beans as opposed to other dried beans due to the low-glycemic index of black beans.

The Low-Glycemic index diet resulted from research conducted at the New Balance Foundation Obesity Prevention Center at Harvard-affiliated Boston Children’s Hospital in which obesity prevention was the primary focus but study outcomes determined not every calorie is an equivalent calorie. This study found that the Low-Glycemic index diet had similar metabolic benefits to the very low-carb diet without negative effects of stress and inflammation as seen by participants consuming the very low-carb diet. As inflammation is part and parcel of auto-immune disorders, it stands to reason a Low-Glycemic index diet will (1) reduce inflammation, and (2) achieve improved metabolic use of calories in a stressful situation such as a collapse situation. Low-Glycemic index diets are beneficial for diabetics as well, and results of this study can be viewed at the Journal of American Medical Association’s journal site.

Another aspect of the Anti Inflammatory Diet includes adding ¼ teaspoon of Tumeric twice daily in your diet. Tumeric is expensive; start buying it now. You can add it to powdered eggs for a scramble or on rice/grains/beans and some people have been known to put it in a cup of warm water and drink it (though, I find it is better on foods.)  Saffron, also very expensive but get it if you can, when added to rice has been known to reduce inflammation and adds a buttery flavor to rice. Cardamom seeds, 1 teaspoon of crushed seeds per cup of water taken one to four times daily, have been shown to reduce inflammation (and has antibacterial properties.)  According to Dr. Sharol Marie Tilgner in her book, “Herbal Medicine: From the Heart of the Earth,” California Poppy infusion is used for its anti-inflammatory properties, anti-spasmodic properties, and has been used as a substitute for its cousin the Opium Poppy. California Poppy infusion ratio is one heaping fresh tablespoon per cup of water, or 1:1 fresh liquid extract 1-4 times daily. Arnica tablets, taken under the tongue, have been used as an adjunct for pain in hospice patients. All of these remedies are available in herbal specialty stores or online and do not require prescription.  If you happen to live in the Pacific Northwest there is an abundance of wild Feverfew - it’s bitter, no doubt about it, but chew a little leaf for a headache or make an infusion of 1 teaspoon dried leaves per cup of water up to four times daily for its anti-inflammatory properties. Of course, as with all herbal remedies, don’t use if you’re pregnant or might be pregnant. 

Don’t forget to put aside Sea Salt for your diet rather than regular table salt - it contains less sodium so reduces the ‘water retention’ properties of inflammatory conditions as well as fluid retention in high blood pressure conditions. Vitamin C, 1000mg daily, has been shown to reduce inflammation in blood vessels - something that occurs in auto-immune disorders and cardiovascular disease. Put some good, old Ibuprofen in your kit: My rheumatologist has me taking 600mg up to three times daily, which is a safe ‘prescription dose’ if you do not have abnormal liver lab values or liver disease. Of course, 325mg of aspirin daily helps prevent blood clotting that can cause heart attack but use caution if you are taking a prescription blood thinner or using herbal alternatives that thin the blood (such as Feverfew.)  I wish I had a distinct reference for this but this is just knowledge I’ve acquired in my career over the past 20 years and carry the knowledge with me!

People with auto-immune disorders often have secondary endocrine conditions. I have not acquired these secondary conditions yet, but my home apothecary for use in a collapse situation contains herbal medicines, and I’ve initiated some of them to stave off developing high blood pressure or Type II diabetes as described in the next paragraph.

First off: Exercise. I mean it! Keep moving, it helps level blood sugar, lower blood pressure, forestall cardiovascular disease and keeps you fit for unfortunate situations. Secondly, a cup of Green Tea steeped at least three minutes, taken at least twice a day has been shown to reduce blood sugar levels up by up to 40 points. Cinnamon, either in capsules made from the bark or in liquid extract form, has been shown to stave off Type II Diabetes. I use the capsules made of bark as my reading on Cinnamon tells me to use caution with infusions as it is easy to overdose. My herbalist friends insist it’s an alternative treatment, but my endocrinologist friends tell me it won’t work, so my philosophy on this particular item is to give it a try because in a collapse situation you may not have an alternative.

According to my herbalist friends, Hibiscus Tea, one cup steeped three to five minutes twice daily has been shown to reduce blood pressure. According to the Mayo Clinic, Niacin or Flush-Free Niacin or Niacinamide, available over the counter, has been shown to increase High Density Lipids (good cholesterol) and may help reduce cholesterol, along with a low fat diet. I suggest also taking Omega-3 Fish Oil capsules to further assist in lowering cholesterol. Many of the medications prescribed for Rheumatoid Arthritis can cause high cholesterol (it’s all about homocysteine converting to cholesterol in the liver, a pathophysiology lesson best given another day) but what we don’t know is this: If you stop taking your Rheumatoid Arthritis medication because of a collapse situation, will your cholesterol come back down? Because this isn’t known and I can’t find it in my research anywhere, I’ve stocked up on Hibiscus Tea and Omega-3 Fish Oil in the event I can no longer get my Pravastatin!

This leaves the topic of thyroid disease, typically low thyroid. It leaves you with a slowed metabolism, weight gain, fatigue, and you feel like a blob.  I don’t have thyroid disease and can’t speak to actual alternative therapies, but in my local herbal supplement/infusion shop I find infusions and capsules that are said to increase thyroid function. From a pathophysiologic standpoint, I do not understand how you resurrect a nonfunctioning gland, but I plan to add the herbal remedy to my current apothecary as I am the household medic and you never know - it can’t hurt, and it might help. If you have a thyroid disorder, do your best to stock up on prescription medication.

As with traditional, currently available medicine, people with auto-immune disorders need to balance rest with activity, and avoid stress. I do not need to remind you a collapse situation will be a stressful situation and in order to take care of others you must take care of yourself.  It is my hope these suggestions help you find ways to take care of yourself - and others -  in an unfortunate situation. Until then, take your prescription medications as directed and save the alternatives for such a time as prescription medication is unavailable. God bless!

References:

1. What is Rheumatoid Arthritis? Accessed August 23, 2012.

2. Ebbeling, C., Swain, J., Feldman, H., Wong, W., Hatchey, D., Garcia-Lago, E., and Ludwig, D. Effects of Dietary Composition on Energy Expenditure During Weight Loss Maintenance. JAMA 2012; 307(24)2627-2634. Retrieved August 23, 2012 from JAMA.

4.  Tilgner, S., Herbal Medicine: From the Heart of the Earth, Second Edition; Wise Acres, Copyright 2009.

In the introduction to this series I gave a brief outline of the medical skills that a layman should acquire when preparing for TEOTWAWKI. Injuries will be common among people required to be more active than they are accustomed to.   Lacerations have already been addressed in Parts 1 and 2 of this series.  Next we will turn to injuries that required immobilization for optimal healing including sprains, strains, and fractures.

To begin, what’s the difference between a strain and a sprain?  To strain means to overstretch a muscle or tendon beyond its capacity to resist without tearing.  A sprain means essentially the same thing but applies to ligament injury.  A tendon is the fibrous termination of a muscle that attaches the muscle to a bone.  The next time you eat a chicken leg, note that the rubbery part of the meat near the end of the bone is the tendon, which often maintains its bony attachment. In contrast, a ligament connects two bones but without a muscle, much like a strong semi-elastic band. Neither tendons nor ligaments have a good blood supply, which accounts for their slow healing.  Knees are usually sprained, that is, the supporting ligaments are damaged.  Ankles are commonly sprained as well, but since the leg muscles terminate near the ankle, it is sometimes difficult to tell a sprain from a strain.  An Achilles tendon injury would be called a strain, but a twisted ankle is usually a sprain.  In a sense, a sprain is a subset of strain-type injuries, and knowing the difference is not essential.

Next, what’s the difference between a break and a fracture?  There is none, though many patients seem to believe that one or the other is worse.  Medically speaking, they are equivalent terminology. 

With any muscle or bone injury, the damage may be mild, moderate, or severe.  Regarding strains and sprains, mild injuries generally resolve within minutes to hours, and involve only microscopic tears at most.  They do not swell, cause bruising or persistent pain.  The classic example is a twisted ankle, which limits walking for a brief time, but reverts to normal after a short rest.  Patients rarely seek medical care for this degree of injury.  These mild injuries are often termed first-degree.  Third-degree injuries involve complete disruption of the muscle, tendon, or ligament, where the tissue is “torn in two.”   The second-degree classification covers everything in between, from injuries that require days to heal to injuries that may cause permanent impairment.  Without surgery as an option, third-degree injuries will rarely heal.  Second-degree injuries are what patients typically seek medical help for and where you can become an excellent resource.
As for bones, a good mental image is that of Styrofoam, which can be crushed, slightly bent, or broken.  A stress fracture is analogous to crushing; a greenstick fracture is similar to bending; a complete fracture is like breaking the foam in two; a comminuted fracture is like breaking the foam into multiple pieces.

Strains, sprains, and bones heal by gradually filling in the gap.  To do so efficiently, the gap needs to be minimized and stabilized in good position until sufficient healing occurs.  Immobilization prevents further injury and facilitates quicker healing.

Immobilization may be accomplished by any means that achieves the above requirements.  One significant advance in recent decades is the recognition that prolonged bed rest leads to blood clots which may kill.  Therefore, it is best to immobilize only the affected area and encourage movement otherwise.

Traditionally plaster splints and casts have been employed, but they are not the only option.  In my classes I teach both techniques and principles.  After learning how to apply plaster correctly, I encourage students to improvise with materials on hand.  Adequate splints may be manufactured from cardboard, Styrofoam, wood, plastic, duct tape, magazines, etc.
However, the benefit of plaster is versatility and durability.  A 3 or 4” roll of plaster can be adapted for use on essentially any body part.  The material is easily cut to smaller dimensions if needed.  A properly constructed splint or cast can last for the required duration, whereas other materials will likely need to be removed and replaced periodically. 
It behooves anyone prone to injury – which is all of us – to learn to apply a plaster cast or splint.  The technique of working with plaster is fairly simple, though mastery of diagnosis, positioning, timing, and adequacy of healing takes longer to acquire.  Even if you don’t plan on being the sole medical provider for your group, a doctor would appreciate the assistance of someone with knowledge of casting.

Any injury that is suspicious for a sprain or break should be immobilized with a splint and re-evaluated regularly.  A doctor may be confident that an injury could be re-checked in a week or two, but for the layman, I’d advise checking daily until the situation is clarified.  A cast may be applied later if needed.  Accurate diagnosis is not always possible, so immobilizing until pain, swelling, and bruising are resolved is indicated.  Full weight-bearing should be avoided until walking can be accomplished with little if any discomfort.  Don’t forget to stock crutches or a walker for potential leg injuries.

Anyone can purchase Gypsona plaster bandages online without a prescription, as well as cast padding and stockinette.  Even if you don’t plan to cast or splint yourself, having the equipment on hand is advisable for emergency use.  I recommend investing in the following:
1 case each 3” and 4” Gypsona plaster bandages
1 box each 3” and 4” stockinette
1 case each 3” and 4” cast padding (synthetic is least expensive)

Additionally, you will need a bowl, bucket, or basin for wetting the plaster, a tarp or other floor covering to protect against plaster drippage, and a source of water, preferably warm.  Using cold water will take longer for the plaster to set; using hot water will shorten the period and may cause burns, since plaster heats as it sets.  Gloves are not mandatory but they do minimize the mess.  Protective clothing is rarely necessary. 
If you cannot afford both 3” and 4” supplies, I’d advise only 4” plaster which can be trimmed as needed along with 3” cast padding.  Applying stockinette underneath the cast padding yields professional results, but a thin sock could be substituted, or simply use cast padding alone.

For arm splints and casting, the plaster width should equal the width of the palm; for leg splints the plaster width should be a little wider than the widest part of the foot; for leg casts, 3” or 4” plaster works well applied from the foot to the ankle, then 4” or 6” plaster from the ankle to below the knee.  

One important point that I stress repeatedly is to NOT apply a cast unless you are sure no further swelling will occur.  Splints are fine and are secured with elastic wraps or gauze, which has some give to them and can be easily loosened.  A circular/circumferential cast may compromise the blood or nerve supply to the injured part if it becomes too tight due to increased swelling.  A fracture is rarely an emergency, and a splint may be applied for a few days until it is clear that further swelling is unlikely.  Before applying any cast check the circulation, sensation, and movement in the affected limb, then check again after application.  If there’s any question that the cast is too tight, remove it immediately.  Pressure sores beneath a cast can take months to heal or yield permanent problems, even infection and death.

Never apply a cast over an open wound, unless you are able to cut a window in the cast for frequent inspection.  Even then, applying a cast may be a problem if swelling occurs and bulges through the opening.  It’s best to use only a strong splint until the skin is completely healed.
Nowadays cast removal is typically accomplished using an oscillating cast saw, but any plaster cast can be removed by wetting the cast thoroughly and gradually unraveling or cutting it off, layer by layer, especially when electricity is not available.

Numerous YouTube videos demonstrate plaster splinting and casting, so I’ll not go into detail here.  The most useful are short arm casts and splints, and short leg casts and splints.  (Short means below the elbow or below the knee.)  For those who prefer live instruction, see my web site at www.ArmageddonMedicine.net for upcoming hands-on training opportunities.

Hello Mr. Rawles,
In response to the Dr. S.V.’s article, which I thought was fantastic, I would like to take a moment to describe my experience with Effexor, which as the Doctor points is in a different class of medication than Prozac, Zoloft, Paxil, Celexa, Lexapro. That being said, the withdrawal symptoms are just as devastating and in my case began within 24 hours. My fiancé and I were on a short weekend trip to see her folks and in our rush to get on the road, I forgot to pack my Effexor. At the time I was currently taking 150mg once per day. The next morning when I woke I realized I had forgotten my Effexor and rather than make a call to my doctor or pharmacy I decided I would just tough it out. Before noon I started to experience the Neurological, phenomena called “paraesthesias”, which The Doc said feels like “electric shocks”. I and others, who have experienced this, call it “The Zaps”. Over the course of the next 12 hours I experienced the full gamut of everything from headaches, to sweating, nausea, insomnia, tremors, confusion, nightmares, vertigo agitation, anxiety, irritability, decreased concentration, slowed thinking, confusion, and memory/concentration difficulties. It was a nightmare.
 
It was at that moment I decided I was getting off Effexor. I got on-line and found that my experience was far from unique. My story of withdrawal was very common. I blame two people for my situation. First, myself; although I had taken this drug successfully for 3 years I had no knowledge of its side-effects. I was completely ignorant of what I could be looking at during withdrawal. Second my doctor. My doctor never explained the down-side of coming off the drug or warned of what an abrupt stoppage could be like. Furthermore, I’m not even sure I was a good candidate for the medication. It was prescribed to me after I had a bad week at work and was feeling down. There isn’t a person on the planet that hasn’t experienced that.
 
I can only imagine would happen in a TEOTWAWKI survival situation where stress is high and you are trying to make good, sound decisions for you and your loved ones and on-top of that dealing with the harsh withdrawal of these medications.

I am no doctor and I know everyone’s situation is different, but a word of caution. If a doctor wants to put you on any of these medications, push him for both the good and the bad. With my doctor's guidance I successfully stepped down off Effexor and have been free of it for almost six months, however, it was months before I regained full motor skills and clarity of thought. These drugs can be helpful to many, but they would be a nightmare for all if they became unavailable overnight. - West Texas Prepper

Worldwide, Prozac is the most prescribed antidepressant.  It is also prescribed for obsessive-compulsive disorder (OCD) and co-morbid anxiety. By inhibiting serotonin re-uptake, more serotonin is available at the synapse, which is anti-depressant.  There are many SSRIs prescribed for depression: Prozac, Zoloft, Paxil,  Celexa, Lexapro, etc.  There are antidepressant medications which target serotonin and other neurotransmitters, such as norepinephrine (Effexor), but they lie outside the scope of this article.

When raw ingredient availability is interrupted these medications will become abruptly unavailable.  There are recent examples of this phenomenon in the United States:  in 2003 tetanus toxoid became very scarce for some months due to a “pharmaco-political” issue, private clinics and urgent care centers ran out of tetanus toxoid for a period of some months, and it was available only in hospital emergency rooms.   In 2004 Ciprofloxacin became temporarily unavailable from any source for largely unknown reasons.  It is used for many common infections and it was nowhere to be found.

Current conditions will evolve to produce critical shortages in vital medications as is happening now in Greece:  "Pharmaceutical companies are no longer interested in selling to Greece where hospitals and pharmacies are in debt," said Kostas Lourantos, head of the pharmacies' association in the Attica region that includes the capital Athens.   Rampant inflation is making lifesaving drugs unaffordable even if available.  This is especially true for cancer drugs, antibiotics, antidepressants, and insulin (emphasis mine).

Abrupt cessation of SSRI’s creates both prompt and delayed withdrawal symptoms.  This is well recognized and variously called “SSRI withdrawal syndrome,” “SSRI cessation syndrome,” “Discontinuation syndrome,” etc.  Neurologically, phenomena called “paraesthesias” occur, feeling like  “electric shocks” in the head. Other symptoms include: sweating, nausea, insomnia, tremor, confusion, nightmares, and vertigo agitation, anxiety, akathesia, panic attacks, irritability, hostility, aggressiveness, worsening of mood, dysphoria (unhappiness), crying spells, mood instability, hyperactivity, depersonalization, decreased concentration, slowed thinking, confusion, and memory/concentration difficulties.

The current standards of medical practice advise a slow, gradual, well controlled withdrawal of SSRI’s in cases where discontinuation is advisable.  In the event of drug shortages and hyperinflation, discontinuations will be abrupt, and acute withdrawal syndromes will be frequent.

As with other TEOTWAWKI survival strategies, those who take SSRI anti-depressants must plan for their unavailability.  In general, naturally occurring substances and adjunct therapies are not enough by themselves to treat depression completely, although there is much disagreement on this issue. Naturally occurring substances often do not produce the pronounced pharmacological effects like manufactured medications do.  For this reason, when SSRI’s are available, one must  not discontinue the SSRI’s in favor of taking “natural” substances whose anti-depressant effects may not be as pronounced. One could endanger one’s health, have recurrent depression which resists treatment, become suicidal, etc. (“Available” is a relative term: congress just passed a bill to prohibit and destroy any medications bought online from foreign pharmacies, thereby eliminating access to affordable pharmaceuticals for those on a budget).

However, in this informational article, we discuss the situation where the American economy, society and infrastructure are collapsing and SSRI’s are no longer available.  In that case, it will be necessary to substitute available substances and strategies to replace the SSRI’s and continue to treat depression.  If the U.S. ends up like Greece, one may have to seek and use natural substances, plants, foods to treat depression.

Serotonin is involved in mood, appetite, sleep and impulse control. Serotonin taken orally cannot easily cross the blood brain barrier. However, serotonin levels can be increased by ingesting a precursor amino acid: tryptophan. L-tryptophan is an essential amino acid necessary for the production of serotonin. Some people find that boosting their L-tryptophan levels helps alleviate the symptoms of depression or insomnia. The figure below shows l-tryptophan converting into 5-HTP, which then readily converts into serotonin. Once serotonin is made, the pineal gland is able to convert it at night into melatonin, the sleep-inducing hormone.
L-Tryptophan --> 5-Hydroxytryptophan 5-HTP --> Serotonin --> N-Acetyl-serotonin --> Melatonin

Either tryptophan or 5-hydroxy-trytophan are good natural options since they convert into serotonin after going into the brain.  If supplemental tryptophan and 5-HTP are available, they can be stockpiled.  But, supplements too are manufactured and may become unavailable.

L-tryptophan dietary supplements were available for use in the 1980s.  Consumers were using tryptophan for sleep and as an antidepressant. It was available without a prescription until 1989 when the FDA prohibited its over-the-counter sale because a manufacturer in Japan shipped a contaminated batch to the U.S. causing a serious illness called eosinophilia myalgia syndrome (EMS) in about 1,000 individuals. Around 1995, tryptophan gradually became available by prescription through compounding pharmacies, and since the year 2000 it slowly and cautiously resurfaced on the over-the-counter market through a few vitamin companies.

Tryptophan side effects, caution, safety, toxicity
A common tryptophan side effect from high dose use is drowsiness.  Therefore, it should be taken in the evening and not while driving or operating heavy machinery. Dry mouth is a less common side effect. Other less common l-tryptophan side effects include nausea, dizziness, and loss of appetite.  A beneficial l-tryptophan side effect is drowsiness since that is the desired effect of many users who take this supplement for sleep. Confusion or disorientation is rare.  L-tryptophan occurs naturally in food and there is no danger of EMS from eating foods which contain tryptophan.  Poultry and some vegetables supply tryptophan (remember turkey sandwich bedtime snack helps you sleep?). So, the approach should include adequate intake of tryptophan containing foods: 

• Meats – turkey, red meat, fish, shellfish, poultry, pork chops.
• Dairy - Milk, egg whites and cheese are all good source of tryptophan
• Soy products, nuts and seeds are high in tryptophan. Fruits and vegetables containing tryptophan are bananas, spinach and beans.
• Pumpkin seeds are a natural source of L-tryptophan, with a tryptophan content of 0.576 grams per 100 grams of dried pumpkin seeds. Roasted pumpkin seeds, with or without added salt, have a slightly lower tryptophan content

Description 5-hydroxy-tryptophan (5-HTP) is an amino acid that is the immediate precursor of serotonin.  It is produced in the body and is used to make the neurotransmitter serotonin. Although taking 5-HTP in supplement form may boost the body's serotonin levels, some experts feel there is not enough evidence to determine the safety of 5-HTP. There is general agreement that 5-HTP should not be combined with other pharmacologic anti-depressants.

Efficacy Since 95% of depressed individuals also have one or more anxiety symptoms, anxiety will be mentioned often as accompanying depression.  One RCT (retrospective controlled trial, the “sine qua non” for many doctors) examined 5-HTP for anxiety disorders. A total of 45 patients with agoraphobia, panic attacks, generalized anxiety disorder, panic disorder, or obsessive–compulsive disorder, were randomized to clomipramine (a tricyclic antidepressant), 5-HTP or placebo for 8 weeks.  Patients treated with 5-HTP showed a reduction in anxiety which was similar to that of clomipramine. Five out of 15 treated with 5-HTP improved more than 50%, compared with only one out of 15 on placebo.

Safety Issues: A study by Kahn, et.al. showed an initial and transient worsening of anxiety symptoms in those treated with 5-HTP before improvement.  Overdosing on 5-HTP can cause: fever, nausea, dizziness, confusion, hallucinations, and restlessness; severe cases can result in fever and death. These symptoms can progress very quickly and can prove to be fatal within 24 hours of the first symptom. 
Those on other serotonin-targeting chemicals such as SSRI’s, tryptophan, SAM-e, or St. John's wort should not take 5-HTP supplements. 5-HTP should not be taken with anti-depression or anti-anxiety medication because this can cause serotonin levels to increase to a dangerous level, causing “Serotonin Syndrome.” Supplements of 5-HTP can also raise blood pressure and increase heart rate, so it is not recommended for those with high blood pressure unless approved by their physician. Pregnant and nursing women should also avoid 5-HTP, as well as anyone with cardiovascular disease or who is at risk for cardiovascular disease. The increased blood pressure brought on by 5-HTP may also increase tumor growth rate: those with carcinoid tumors should avoid 5-HTP.

Conclusion 5-HTP shows promise for anxiety disorders which often accompany depression. Many physicians feel insufficient research has been done to recommend 5-HTP (Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459).
Because of its chemical/biochemical relationship to L-Tryptophan, 5-HTP has been under scrutiny by consumers, industry, academia and government for its safety. However,  extensive analyses of several sources of 5-HTP have shown no toxic contaminants similar to those associated with L-Tryptophan. References: “Safety of 5-hydroxy-L-tryptophan,” Toxicol Lett. 2004;  Expert Rev Pharmaco- economics Outcomes Res. 2009;9(5):445-459).

B Vitamins  
Vitamin B6 is involved in the metabolism of tryptophan to serotonin. Vitamin B-12 and other B vitamins play a role in producing brain chemicals that affect mood and other brain functions. Low levels of B-12 and other B vitamins such as vitamin B-6 and folate may be linked to depression and can result from eating a poor diet or not being able to absorb the vitamins consumed. Older adults, vegetarians and people with digestive disorders such as celiac disease or Crohn's disease may have trouble getting enough B-12. Sometimes a vitamin B-12 deficiency occurs for unknown reasons.
The best way to make sure one is getting enough B-12 and other vitamins is to eat a healthy diet including sources of essential nutrients. Vitamin B-12 is found in animal products such as fish, meat, poultry, eggs and milk. Fortified breakfast cereals also are a good source of B-12 and other B vitamins.

| Taking a daily supplement that includes vitamin B-12 may help the body get the nutrients it needs, especially if one is older than 50 and/or a vegetarian. However, B-12 and other vitamin supplements can interact with some medications, especially in high doses and one should consult with a doctor before taking a vitamin supplement.
The precise role of B vitamins in depression not clear.  In the case of a vitamin deficiency, taking a supplement may help. But no supplement can replace proven depression treatments such as antidepressants and psychological counseling (see below for more on B vitamins).

Reference: Skarupski KA. “Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time,” American Journal of Clinical Nutrition. 2010;92:330. Mayo Clinic, Daniel K. Hall-Flavin, M.D.

Ginkgo Biloba

Extracts of the leaves of the Ginkgo biloba tree are used therapeutically. EGb 761® is a Ginkgo biloba extract registered in a number of countries for the treatment of dementia disorders. According to mayoclinic.com, studies show possible benefits of using ginkgo for depression in elderly patients. Investigation is ongoing.

The mechanism of action in improving depression and anxiety is not precisely known. Ginkgo may inhibit serotonin reuptake at serotonin receptor sites.  According to the University of Maryland Medical Center, clinical studies suggest that ginkgo provides improvement in the areas of cognition, daily living, social behaviors and feelings of depression in the elderly. Persons with depression may need to take ginkgo consistently for 12 weeks before seeing benefits; others have reported positive effects as soon as two to three weeks after starting ginko.

The Mayo Clinic information on ginko suggests dosages between 80 and 240 mg taken daily by mouth in two to three divided doses.  A dosage of 3 to 6 mL of 40 mg per mL extract may be taken in three divided doses, or the herb is available as a tea. These dosages are for adults over the age of 18 years; there have been no clinical studies of ginkgo use in children. The recommended dosage is 80 mg twice a day, once in the morning and again after lunch.

Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459;  Mayo Clinic “Ginko Evidence;” National Institutes of Mental Health “Depression.”

Kava
Kava is a plant native to the South Pacific.  The root is used for medicine. Kava affects the brain and other parts of the central nervous system. The kava-lactones in kava are believed to be responsible for its sedative effects.

There are substantial safety concerns about kava. Many cases of liver damage and even some deaths have been traced to kava use. As a result, kava has been banned from the market in Switzerland, Germany, and Canada, and several other countries are considering similar action.  The National Institutes of Health firmly recommends against using Kava at this time, citing the histories of deaths, and serious interactions with other medications and herbs.

Passionflower (Passiflora incarnata)
 Passionflower is a plant native to the Americas used as a folk remedy for anxiety and insomnia, and can be used to treat anxiety symptoms that may occur with an agitated depression, or generalized anxiety disorder with depression.  The therapeutic mechanism is not understood, but may be related to activation of benzodiazepine receptors.

Passion Flower and anxiety
Roots and leaves of the passion flower species, Maypop, were used by Native Americans and later by the American colonists. The leaves were used fresh or dried out to make a tea that was useful in treating epilepsy, “hysteria” and insomnia. A tincture even proved to be analgesic.  The roots and leaves contain most of the active  compounds:  flavonoids, maltol, cyanogenic glycosides, harman indole alkaloids, etc. A double-blind randomized trial compared the efficacy of passion flower extract with oxazepam ( a benzodiazepine in the same family as Valium®) in the treatment of generalized anxiety disorder. The study was performed on patients diagnosed with anxiety:  18 people received passion flower extract 45 drops/day (plus placebo group receiving sham drops), and 18 people received 30 mg/day (plus placebo group receiving placebo tablets) for a 4-week trial. Passion flower extract and oxazepam were effective in the treatment of generalized anxiety disorder, which can often accompany depression. More problems relating to impaired job performance were associated with oxazepam. The results suggest that passion flower extract is an effective herb for the management of generalized anxiety disorder, with low incidence of impairment of job performance. 

Safety Issues  A case has been reported in which self-administration led to severe nausea, vomiting, drowsiness, prolonged QTc (a dangerous cardiac electrical effect seen on EKG)  and episodes of nonsustained ventricular tachycardia (which can progress to fatality).

Conclusion Anecdotal and traditional historical use of passion flower suggest it is helpful for treatment of anxiety, from whatever cause. There is a lack of well controlled scientific studies for the medical community to reach a consensus.

Passion flower should not be relied on to treat panic disorder or other severe anxiety disorders.  Very often, several conditions will co-exist, e.g. depression, anxiety and obsessive compulsive disorder. Along with an anti-depressant there may be a need for an anti-anxiety agent .However, note that the use of anti-anxiety medications and/or herbal supplements/substances may worsen depression.  Exercise caution using passion flower use for anxiety in the setting of concomitant depression. Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459; Rehwald A, Meier B, Sticher O. “Qualitative and quantitative reversed-phase high-performance liquid chromatography of flavonoids in Passiflora incarnata L.”, Pharm Acta Helv . 1994;69:153-158.

St. John's Wort
St John's wort is a flowering plant used as a traditional remedy for sadness, worry, nervousness, and insomnia. The most common modern-day use of St. John's wort is the treatment of depression. Today, the results of over 20 clinical trials suggest that St. John's wort works better than a placebo and is as effective as antidepressants for mild to moderate depression, with fewer side effects.

Numerous studies report St. John's wort to be equally effective as tricyclic antidepressant drugs in the short-term treatment of mild-to-moderate depression (1-3 months). It is not clear if St. John's wort is as effective as selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline (Zoloft®). In Germany, St. John’s Wort is indicated for clinical use in mild to moderate depression, nervous disturbances, fear, somatoform disturbances, anxiety and insomnia. Some 66 million annual doses of this plant are consumed in Germany and three million prescriptions are given to patients. In Germany use of hypericum extract is supported by many clinical studies and doctors’ prescriptions, and is extensively listed in the German Commission E Monographs (you can purchase the German Commission E Monograph on Amazon).*

Scientific evidence supports the effectiveness of St. John's wort in mild-to-moderate depression. It may also be helpful in treatment of Seasonal Affective Disorder (S.A.D.) The efficacy of St John’s wort in severe major depression is unclear and it should not be used to treat severe depression. St. John's wort may take 4 to 6 weeks to produce full effects.

Therapeutic Mechanism
Evidence suggests serotonergic, dopaminergic and GABA-ergic activity, but the exact mechanism is not known.  St. John's Wort is available from herbalists, health food stores, drug stores and online in the form of capsules, tablets, liquid extracts, or brewed as a tea.  St. John’s wort is easy to grow, and although it is an annual, it readily reseeds itself coming back year after year.
The daily dose of St. John’s Wort for capsules standardized at 0.3% hypericin, is 300mg, 3 times per day. For non-commercial preparation, the flowering and leafy parts of hypericum plant should be obtained from dried above ground part of the plant just before or after the flowering period. The lower part of stem has lower concentration and fewer active ingredients. For tea one would place 2 teaspoons of herb in 1 cup of boiling water, and take 3 times per day.

Safety issues
Side effects may include dizziness, dry mouth, indigestion, and fatigue. St. John's wort increases photosensitivity. Also, recent disturbing information from the University of Alabama suggests that St. John’s wort is related to development of cataracts and macular degeneration. Apparently, the hypericin in St John’s wort reacts with ultraviolet light producing free radicals which can damage the lens and/or retina.  These are serious and irreversible side effects of using St. John’s wort, and anyone beginning therapy with this herb must weigh these risks of its use against the benefits of its use. It is not known if polarized UV protection with sunglasses can prevent these complications or not.One must take frequent breaks from the use of this natural antidepressant and substitute other dietary supplements that elevate mood. Reference: “St John's Wort (Hypericum perforatum),”, Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459.

Overall, St John's wort causes fewer side effects compared with the use of antidepressants. However, it may have clinically dangerous interactions with a range of prescribed medications, including anticancer agents, anti-HIV agents, anti-inflammatory agents, antimicrobial agents, cardiovascular drugs, CNS agents, hypoglycemic agents (oral diabetes medication), immune suppressants , oral contraceptives, proton pump inhibitors (for stomach acid), asthma medications and statins (for lipids) . St. John's wort is not recommended for pregnant or nursing women, children, or people with bipolar disorder, liver or kidney disease.  St. John’s Wort can cancel out the effects of oral contraceptives, making one more likely to become pregnant. People using this or any other medication/herbal remedies should consult their healthcare providers prior to starting therapy.  Reference:  Mayo Clinic St. John's wort (Hypericum perforatum L.)  Natural Standard Patient Monograph, 2012.

Omega-3 fatty acids
Omega-3 fatty acids are a type of good fat needed for normal brain function. Our bodies can't make omega-3s on their own, so we must obtain them through our diet. Studies have linked depression with low dietary intake of omega-3 fatty acids. In countries with higher fish consumption, such as Japan and Taiwan, the depression rate is 10 times lower than in North America. Postpartum depression is also less common.  Studies strongly suggest that omega-3's together with antidepressants may be more effective than antidepressants alone.
Cold water fish such as salmon, sardines, and anchovies are the richest food source of omega-3 fatty acids. But instead of eating more fish which contain mercury, PCBs, and other chemicals, fish oil capsules are a “cleaner” source of omega-3 fatty acids. Many companies filter their fish oil so that these chemicals are removed.
Fish oil capsules are sold in health food stores, drug stores, and online.  When comparing brands, the key active components for depression are EPA (eicosapentaenoic acid)  and DHA  (docosahexaenoic acid). Fish oil capsules may interact with blood-thinning drugs such as warfarin and aspirin. Side effects may include indigestion (To prevent the “fishy aftertaste” one may take the fish oil just before meals). Fish oil should not be taken 2 weeks before or after surgery to avoid bleeding. 
Controlled studies have examined omega-3 fatty acids and placebo in depression. One clinical study found that four months of treatment with 9.6 g of omega-3 fatty acids (6.2 g EPA/3.4 g DHA) showed a highly significant effect in treating depression (p < 0.001). In another trial, the addition of 2 g of pure EPA to standard antidepressant medication enhanced the effectiveness of that medication vs. medication and placebo. These particular patients had treatment-resistant depression, and EPA had a beneficial effect on insomnia, depressed mood, and feelings of guilt and worthlessness.

SAM-e
SAM-e, pronounced "sammy", is short for S-adenosyl-L-methionine, a chemical found naturally in the human body and believed to increase levels of neurotransmitters serotonin and dopamine. Several studies have found SAM-e is more effective in treating depression than placebo. A study found it was helpful even in depressed patients who did not respond well to Prozac and other SSRIs.  SAM-e works best for  depression associated with low energy and low motivation. High doses can cause restlessness and anxiety. For depression associated with anxiety, 5-HTP is a better option. There is a risk for overstimulation with SAM-e use, hence dosage should be kept low and it is a good idea to take a day or two off when one notices overstimulation. Side effects can include nausea and constipation.  SAM-e is not advised for those who have manic depression (bipolar disease).  If a patient has been diagnosed with any type of manic or anxiety disorder, use with extreme caution only under a physician's monitoring. Severe manic episodes can occur with the use of SAM-e.
In North America, SAM-e is available as an over-the-counter supplement in health food stores, drug stores, and online. It should be enteric-coated for maximum absorption.  

Acetyl L-carnitine
Acetyl L-carnitine can lift mood and enhance mental activity. This nutrient can begin working within hours, providing lifted mood, mental clarity and stamina. However, acetyl-L-carnitine must be avoided by breast cancer patients as it may induce or exacerbate a chemotherapy induced peripheral neuropathy. Reference: 2012 Annual Meeting of the American Society of Clinical Oncology,. “Duloxetine Useful in Chemo Neuropathy, But Avoid ALC”, Zosia Chustecka.

Diet
Reduce intake of sweets
Sweets temporarily make one feel good as blood sugar levels soar, but may worsen mood later on when they plummet.

Avoid caffeine and alcohol
Caffeine and alcohol both dampen mood. Alcohol temporarily relaxes  and caffeine boosts energy, but the effects of both are short-lived. Both can worsen mood swings, anxiety, depression, and insomnia.  Conversely, caffeine withdrawal can also cause depression.

It is unknown whether  B-vitamin deficiency is the cause or the result of depression. Given that the chemical reasons for depression are largely unknown, it is difficult for scientists to pinpoint any association, says the NIMH. However, it is known that a B-vitamin deficiency strongly correlates with depression. Patients with high levels of vitamin B12 respond better to antidepressant treatment of depression. B vitamins seem to play an important role in relieving depression by alleviating the anxiety and restlessness that often accompanies this illness.  Dietary vitamin B12 can help fight anemia which can also cause depressed moods.

Folic Acid
Folic acid (or “folate”) is a B vitamin often deficient in people who are depressed.  Folate is found in green leafy vegetables, other vegetables, fruit, beans, and fortified grains. It is one of the most common vitamin deficiencies because of poor diet. Chronic conditions and various medications such as aspirin and contraceptive pills can also lead to deficiency. Besides food, folic acid is also available as a supplement or as part of a B-complex vitamin.
Researchers at Harvard University have found that depressed people with low folate levels don't respond as well to antidepressants, and taking folic acid in supplement form can improve the effectiveness of antidepressants.

Vitamin B6 
Vitamin B6 is needed to produce the mood-enhancing neurotransmitters serotonin and dopamine. Although deficiency of vitamin B6 is rare, a borderline deficiency may occur in people taking oral contraceptives, hormone replacement therapy, and drugs for tuberculosis.   B6 may help with the depression of the pre-menstrual syndrome.
B vitamins, including pantothenic acid (B5), have a mild but discernable influence on mood.  Low blood levels of B vitamins  increase the risk of depression. Older adults with relatively low intakes of vitamins B6 and B12 may have a higher risk of developing depression than those who get more of the nutrients. A B complex supplement containing all the B vitamins is advisable.  Reference:National Institutes of Mental Health: “Depression.”

Magnesium
Most people do not get enough magnesium in their diets. Good sources of magnesium are legumes, nuts, whole grains and green vegetables. Like vitamin B6, magnesium is needed for serotonin production. Stress depletes magnesium. According to review published in "Medical Hypotheses" in 2006 and 2010, magnesium deficiency is a major cause of depression. Magnesium supplementation may thus function as an effective treatment for depression. A 2008 clinical trial referenced in the review showed that magnesium was as effective as a tricyclic antidepressant in treating depression in diabetics. Additionally, case histories indicate rapid recovery from major depression using a magnesium dosage of 125 to 310 mg with each meal and at bedtime. It is important to note, however, that these experimental dosages for depression treatment are higher than those considered safe by health authorities, and one should not attempt to self-treat depression by taking such high doses of magnesium.

Risks
Magnesium doses of less than 350 mg/day are considered safe for most adults. However, taking large doses may cause magnesium levels to build up in the body, resulting in serious side effects such as low blood pressure, confusion, irregular heartbeat, coma and death. Taking magnesium supplements is very dangerous if one has kidney problems or kidney failure because magnesium can only be excreted by the kidneys. Magnesium may also cause moderate drug interactions with the following types of medications: antibiotics, bisphosphonates, calcium channel blockers, muscle relaxants and diuretics. Magnesium supplements may interact with other dietary supplements including calcium, boron, vitamin D, malic acid and zinc.

According to the National Institutes of Health, the best and safest way to get extra magnesium is to eat a variety of whole grains, legumes, and dark, leafy vegetables. Certain types of fish and nuts also provide magnesium. According to the NIH, a 3-oz. serving of cooked halibut provides 90 mg of magnesium, or 20 percent of the Daily Value for magnesium set by the U.S. Food and Drug Administration. Other foods that are especially high in magnesium, each providing 20 percent of the DV, include a 1-oz. serving of dry roasted almonds, cashews, or mixed nuts; a 1/2-cup serving of cooked soybeans; and 1/2 cup of cooked spinach. Baked potatoes, peanut butter, fortified oatmeal, yogurt, and brown, long-grained rice are some other common foods that are good dietary sources of magnesium and it would be wise to stockpile these foods if one suffers from depression.

Caffeine Reduction
Caffeine is a CNS stimulant that can be found in coffee, tea, cola and chocolate.  It is thought that caffeine can induce anxiety by binding to adenosine receptors and blocking the anxiolytic effects of adenosine. Caffeine intoxication presents with similar symptoms to anxiety (e.g., restlessness and nervousness) and some anxiety disorders may be caffeine-induced. For these reasons, reducing or abstaining from caffeine could be helpful for those with anxiety disorders accompanying depression.
Symptoms of rapid caffeine withdrawal include headache, fatigue, decreased energy/activeness, decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty concentrating, irritability and foggy/not clearheaded. These symptoms may last for 2–9 days.  Even for those without depression, caffeine withdrawal will be an unpleasant exercise for many when coffee/tea/chocolate become unavailable. Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459.

Exercise
Regular exercise is one of the most effective and inexpensive ways to improve mood.  Exercise, particularly aerobic exercise, releases mood-elevating chemicals in the brain and decreases stress hormones, though the precise mechanism is unknown. Preliminary evidence suggests downregulation of 5-HT2C receptors or GABAA receptors, enhancement of slow-wave sleep, enhancement of perceived coping ability, and change in focus from ruminations and worries
One of the best options to combat depression is taking a brisk walk outside each morning for at least 30 minutes five days a week. Non-aerobic weight training has also been shown to improve depression.  What's important is that one chooses something either enjoyable or practical in a TEOTWAWKI environment.

Safety Issues There is a risk of injury when exercising for those who are overweight, have a chronic health condition, or have not exercised regularly for a long time. There is no way to predict who will benefit from exercise to improve depression, and if there are no contraindications to exercise, the approach should be tried.  References: Journal of Clinical Psychiatry; Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459

Light Therapy  
Getting enough sunlight has been shown to be effective for seasonal mood changes that happen in the darker winter months.  Recent studies indicate that bright light also helps depression that is not seasonal:  Three weeks of daily, bright light therapy improved depression symptoms compared with placebo. Three weeks after treatment, symptoms continued to improve in the light treated group, but there was no improvement in the placebo group. Reference: Evid Based Ment Health. The British Psychological Society and the Royal College of Psychiatrists, 2011;14(3)
Exposure to light in the morning helps the body's sleep/wake cycle work properly. Production of serotonin is activated in the morning upon exposure to light. During the winter when there is less sunlight, serotonin levels can drop, causing one to feel tired and prone to seasonal affective disorder (SAD).
The simplest way to increase one’s exposure to light is to walk outdoors in the morning. It is recommended to wear sunscreen.  Another option is to use special lights that simulate natural daylight. Studies have found they are effective.

Suitable lights can be found online. There are different types available, from light boxes to visors. Look for lights with a minimum of 3,000 lux (used for about 45 minutes a day), though many experts suggest 10,000 lux ( used for 30 minutes a day).

Vitamin D 
Recently, several studies show correlation between low vitamin D (vit D) and depressive symptoms. Although the medical community is reluctant to say that very low vit D levels cause depression, in reality, physicians are testing everyone for vitamin D deficiency, especially if they are depressed, and recommending enthusiastic replacement of the deficient vitamin.   There are widespread anecdotal reports of vit D replacement dramatically improving depressive symptoms.  Many have suggested that Vitamin D associated improvement in symptoms mirrors the improvement in depressive symptoms with sun exposure.  However, it is unlikely to be the only reason sunlight exposure helps depression.   Keep in mind that normal exposure to sunlight for 15 or more minutes can produce transient blood vitamin D levels of 20,000 IU or more, which is quite high, and seems to suggest a direct link.  With these recent findings in mind, the recommended daily dose of vitamin D for adults has gone from 400 IU to 2000 IU per day.  In a very deficient person (<10ng/ml), there is an accepted regimen for more robust replacement of 50,000 IU a week for 4 weeks, then daily dosing of around 2000 IU a day.  Some physicians have a bit different regimen of 7,000 to 8,000 IU of vit D a day for 3-4 weeks, then resumption of recommended daily doses. 

Ashwagandha (Withania somnifera)

Withania somnifera is a plant that has been used for centuries in India to treat a variety of ailments, including stress,anxiety, and depression. Ashwagandha is easy to grow as a shrub and the roots are the main part of the plant used for therapeutic purposes.  The therapeutic mechanism is thought to involve its beneficial effects on GABA neurotransmission.
A review of one double-blind, placebo-controlled study of Withania somnifera in 39 patients with anxiety disorders found Withania superior to placebo after 6 weeks, and it caused no more adverse effects than placebo.

A study done in 1991 at the Department of Pharmacology, University of Texas Health Science Center indicated that extracts of ashwagandha had GABA-like activity. This may account for this herb’s anti-anxiety effects.  A 2000 study with rodents showed it to have anti-anxiety and anti-depression effects.
Extensive studies in animals indicate that it is nontoxic in a wide range of reasonable doses. Anecdotal reports suggest that Withania somnifera may potentiate the effects of barbiturates causing sedation. Large doses have been shown to cause gastrointestinal upset and may possess abortifacient properties, so it should not be taken during pregnancy. Reference: Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(5):445-459.

Rhodiola
Rhodiola rosea is a succulent herb which grows in the Arctic regions of eastern Siberia. It is a popular plant in traditional medical systems in Eastern Europe and Asia. Russians have drunk rhodiola tea for centuries as an energy booster. The root has a reputation for stimulating the nervous system, fighting depression, enhancing work performance, decreasing fatigue, and reducing high altitude sickness. This herb has been categorized as an adaptogen by researchers due to its ability to increase resistance to a variety of chemical, biological, and physical stressors. The adaptogenic activities have been attributed  to its ability to influence levels and activity of monoamines and opioid peptides such as beta-endorphins.
The botanical Rhodiola rosea, has been studied in the U.S.  for anti-depressive efficacy using 340mg versus 680 mg versus placebo for 6 weeks in mild-to-moderate depression. A significant reduction in depression inthe Rhodiola groups was found, but no improvement with placebo. 
Reference: Expert Rev Neurother. “Complementary and Alternative Medicine Therapies in Mood Disorders”,Aleeze S Moss; Daniel A Monti; Andrew B Newberg, 2011;11(7):1049-1056.

Another study found that overall depression, together with insomnia, emotional instability and somatization improved significantly following medication with Rhodiola while the placebo group did not show such improvements. No serious side-effects were reported in any of the groups. Reference: Nord J Psychiatry, “Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression,” Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A., 2007;61(5):343-8.                                                             

Safety Issues
Due to its energy boosting properties, too high a rhodiola rosea dose can cause side effects including restlessness, irritability, and insomnia. A possible adverse reaction on high doses is increased heart rate while very high doses could produce heart palpitations or development of atrial fibrillation. It is also possible that high doses could increase blood pressure.  Reference:  “Experimental analysis of therapeutic properties of Rhodiola rosea and its possible application in medicine”, Medicina, 2004.

Dosage

Rhodiola extracts are standardized to their content of salidroside. A typical dosage of 170 to 185 mg daily supplies 4.5 mg of salidroside.
If growing your own Rhodiola, order the seeds online and plant according to package directions. It is hardy down below zero. Dry the herb without affecting potency by hanging it in bunches in a dry, shady location. Make Rhodiola tea by pouring 1 cup of hot or boiling water over 1 teaspoon of dried Rhodiola, steep for five to 10 minutes, strain and drink once per day.
References: Darbinyan V, Kteyan A, Panossian A, et al. “Rhodiola rosea in stress induced fatigue—a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty”, Phytomedicine. 2000;7:365-371; Shevtsov VA, Zholus BI, Shervarly VI, et al. “A randomized trial of two different doses of a SHR-5 Rhodiolarosea extract versus placebo and control of capacity for mental work”, Phytomedicine. 2003;10:95-105; Spasov AA, Wikman GK, Mandrikov VB, et al. “A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen”; Phytomedicine. 2000;7:85-89;  Fintelmann V, Gruenwald J., “Efficacy and tolerability of a rhodiola rosea extract in adults with physical and cognitive deficiencies,” Adv Ther. 2007;24:929-939;  Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malmström C, Panossian A., “Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression,” Nord J Psychiatry. 2007;61(5):343-348.

According to a study published in the September 2008 issue of the "Nepal Medical College Journal," 500 mg of holy basil capsules taken two times a day after meals  significantly lowered the intensity of generalized anxiety disorder. Some studies have  indicated that holy basil extracts have the ability to attenuate depression and anxiety in laboratory animals. Managing anxiety and depression may, in turn, help treat insomnia. Reference: Nepal Medical College Journal; “Controlled Programmed Trial of Ocimum sanctum Leaf on Generalized Anxiety Disorders”, D. Bhattacharyya et al., September 2008.

Holy Basil can be direct-seeded in the spring after the last frost with germination rates at temperatures between 65-70 F.  Cover with a thin layer of soil as seeds require light for germination.  Holy Basil will grow to a height of approximately 20" and produce green and red leaves and delicate purple flower bracts from mid summer on.  Ocimum teniflorum is the variety used for medicinal purposes, and all the cultivars are in the mint family, and related to sweet basil.

Though holy basil is still being examined for potential risks and side effects, some negative side effects have been reported. According to the University of Michigan Health System, use of holy basil has been linked to fertility problems. No drug interactions are known as of yet.

Ketogenic diet

A ketogenic diet results from restriction of carbohydrate intake, and often calories, relying on fat metabolism to produce ketones to meet metabolic needs. Ketones can be produced by using “MCT’s” (medium chain triglycerides, from e.g. coconut oil) for up to 50% of fat intake. Under these circumstances, the body produces ketone bodies from fat (your own fat, ingested fat and MCT’s) which the brain and body can use for fuel. A ketogenic diet reduces seizure frequency, and medical doctors have observed it to benefit depression.  The ketogenic state changes the metabolism of the amino acid glutamate to be preferentially made into GABA, an inhibitory neurotransmitter, associated with calm and relaxation.  Physicians widely note that excessive carbohydrates and low fat intake correlate strongly with depression.  This could result from several mechanisms: excessive glucose directly causing depression, the hyperinsulinemia response to excessive carbohydrates may cause depression, insulin resistance could cause depression, obesity, and diabetes, lack of dietary fat could lead to depression, and the lack of vitamin D could cause or exacerbate depression.

Although there have been no rigorous studies to statistically demonstrate that ketogenesis benefits depression, the observation is so widespread and consistent that it is more than anecdotal, and impossible to deny.  In the TEOTWAWKI scenario we are considering, much like present day Greece, medications including antidepressants can and will become scarce or nonexistent.  Millions of people will suddenly withdraw from anti-depressants causing crises of depression and suicide rarely seen nowadays.  The time for collapse may be near, and one must gather available information including anecdotal and historical experience to prepare to treat depression without medications if the situation arises.

Medications represent top tier, sophisticated manufactured goods which will be among the first to disappear as the infrastructure collapses.  Recent history is rife with examples of this phenomenon.  In the “stable” pre-collapse society we live in now, many physicians demand rigorous, repetitive, consistently reproducible data to decide that a particular therapy may be helpful.  We will not have money, time or personnel to employ this process on non-medication forms of therapy if the SHTF very soon, as we believe it will. 

A smart survivalist who either has depression or family members with depression will examine this information and do the obvious: stockpile fish oils, St. John’s Wort seeds, canned salmon,sardines, anchovies, coconut oil, a bright light source (e.g. LED, get them online while you still can), SAM-e and/or other supplements and adaptogens, consider growing other adaptogens and acquire their seeds, consider growing chamomile/lemon balm/skullcap/valerian to use for anxiety, stockpile vitamin D, B vitamins, multivitamins, and start preparing physically for the increased physical activity. I guarantee in Greece today, people with depression desperately wish they had done these things. Because when the Prozac runs out, a stockpile of non-medication treatment modalities may prevent a miserable reversion to immobile depression, and will literally be worth more than gold for trade value.  ?

This article is not intended to offer professional medical advice. It is written for informational purposes only.  It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL CONDITION OR EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition or treatment. Any other use of this information if at the reader’s risk, and the author will not be held responsible for the outcome.

This information does not apply to manic depression, or bipolar affective disorder. Although all of the afore mentioned help depressive symptoms, you should neither self - diagnose nor use herbal or nutritional remedies to self-treat your symptoms. Consult your doctor or a qualified medical professional if you think you may be suffering from depression. Depression can become worse if not properly treated and may result in suicide/death.

* Germany's Commission E is the scientific committee of Federal Department of Health. This committee is active since 1978 and it has a panel of multidisciplinary experts in the field of medicine, pharmacology, botanist, toxicologists and others.

This panel came out with 312 monographs of clinically supported herbal use with 286 individual herbs and herbal formulations. The main criteria of this panel is that the herb should be absolutely proven to be safe and and should show reasonable efficacy. These monographs represent the most comprehensive and supported information about herbs In 1978 the German government established an expert committee, the Commission E, to evaluate the safety and efficacy of over 300 herbs and herb combinations sold in Germany. The results were published as official monographs that give the approved uses, contraindications, side effects, dosage, drug interactions and other therapeutic information essential for the responsible use of herbs and phyto-medicines. For the first time, the complete set of all Commission E monographs has been complied, translated into English and edited for use by physicians, pharmacists, health professionals, researchers, regulatory agencies, consumers and the herb industry.

You can purchase a copy of the The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines on Amazon.  A pre-owned copy is fine and much less expensive.

I hope that what I have to say will help someone that is just getting started with their survival preparedness situation, SurvivalBlog has helped me in streamlining our preparations, and I believe in giving back some of what I have received.  I have read many different blogs and forums, and come away with the impression that most of the blogs are for the arm chair survivalist that do not try anything for themselves, but only go on what they have read or heard.  SurvivalBlog.com is one of the few that have individuals that seem to have tried what they say they have done and shared their experiences.

My experience with a survival mind set started almost a decade ago, but only limited for a few weeks or month at most.  That all changed several years ago when I started really looking at the way our country was headed.   I will admit that I still have a long ways to go, but with God’s help, and if the world will hold together long enough, I will get to where I desire to be.  If not, then my family and I will survive with what we have on hand for a long time.

FOOD

We do have enough for me and my family for at least a year, longer if we just go to two meals a day.  My youngest daughter is almost 17, and I have 4 boys that range in ages from 19 to 33, then two older daughters and their families.  You can imagine the appetite of young men so I have taken that into account.  Only one son is married and has two small children.  I have endeavored to teach my children to always be prepared for as much as possible, if only for a short time.  Again, that has changed over the last couple of years.  We live in a hurricane prone area, so it is imperative that we always have plenty of food on hand that can be eaten with little or no cooking.  I am not talking about MRE’s.  I do have two cases of MRE’s that I obtained during the last hurricane that was not eaten, but I like to store what we usually eat daily, and eat what we store. I read that on a blog and it made sense to me.

It was very difficult to get my wife onboard, but during the last hurricane a few years ago, she and my daughter went to my sister’s house because it was further away from the coast than our old house (built in 1925).  My sister and her husband had nothing to eat but a few bags of chips and some crackers, and two bottles of soda.  They did not even have matches to light the one decorative candle that was in their house.  My brother-in-law had unplugged the refrigerator before the hurricane hit so it would not be damaged from power surges.  Hence, all the food that was in the refrigerator and their freezer was ruined before it was truly needed.  When communications was restored about two days later, my wife called and talked to one of our sons.  He told her that we still had cold milk, and were eating fine.  At the time, we only kept about two months’ worth of food on hand.  It was two days later before she and my daughter were able to come home, and a month before we had electricity restored.

It was at that point that my wife fully came on board with storing extra food.  There are times that she will say “I think we have enough”, but we are still building our “lauder” as she sometimes calls it.

There have been times that we were only able to add one or two cans or a bag of rice and beans every two weeks or so, but every little bit helps.  There have even been a few times that we could not add anything, but had to use what we had stored just to make it for the week or two before we could buy something.  In those cases, we were very glad we had something to fall back on.

It doesn’t matter if you have very little at this point.  The time to start is now.  Even if you have to do as we did during our lean times with just a few cans of something or a bag of rice and/or beans.  You need to get something to hold you over during a natural disaster or the eventual TEOTWAWKI.

FIREARMS

I have been an avid hunter all my life until the last decade or so.  Hunting leases just became too expensive for my budget.  I did try hunting the National Forest for a few years, but they are a dangerous place.  You think you are alone, and then a bullet hits a tree just above your head.  I decided that was enough of the National Forest for me.  My sons’ still hunt the National Forest on occasion, but they too are not having very good success.

Because of where we live, I had built a range in my pasture years ago.  I have taught all my children how to shoot firearms from the time they were about 4 years old.  At that age, they do not have the concept of how to aim, but they enjoyed shooting with their dad.  In my opinion, you can never be too young to learn gun safety.  As they grew, their marksmanship also improved, and the enjoyment of just shooting.  I still have the Chipmunk and the youth .22lr rifles that they learned with.  My granddaughter that is now 3 years old has been shooting with her mom, dad, and papa using that same Chipmunk.  That is the first thing she wants to do when they come to visit.

All my children now have their own .45 ACP Glock or XD .45 handguns, a 12ga. Mossberg pump shotgun, a .22 lever action rifle, and a main larger caliber rifle (MBR).  My wife can handle the .45 ACP, but prefers her 9mm Glock, and a 20 gauge youth 870 pump shotgun.  She is not into rifles yet, but I am still hoping that one day she will ask me for one.  I do have a few extra rifles that have been in the family for a long time that she might be able to handle, but I would like to get her something she will enjoy and not be afraid to shoot.  We also have several .22 LR handguns that we use for just plinking on occasion.  We try to train with the handguns and rifles at least once a month depending on the funds available for ammunition.  Ammunition can get expensive with that many shooters at one time.  I do reload all our handgun ammunition only, and replace all that we use during our practices. 

I was striving for everyone to shoot the same make/caliber/ga. to cut down on the different types of ammunition that I would have to have on hand.  I would interject here that it doesn’t matter what you decide for your family.  It is what you and your family are comfortable with.  My daughter, who is almost 17 likes the Glock, but the XD45 fits her hands better.  It is all in your size, training, desire, finances, and ability.  Do not buy cheap, since cheap will get you hurt, or killed, or will break down when you need it the most.  If you do not have the funds to get everyone their own firearm, buy quality, and each learn to use that quality firearm until you are able to purchase another.

At this point, I would like to say that you cannot go wrong by storing factory ammo for all your firearms.  I trust my reloads but do not count it as part of my stored ammunition.  I have not had a malfunction with any of the reloads that I have made, but that is not to say it will never happen.  I am only human, and could make a mistake.  I have read about various amounts of ammunition that should be stored for each firearm, but your comfort level may be different from mine.  Personally, I am trying to store at least a thousand rounds of factory ammo for each firearm that we have.  I am not quite there yet, but getting closer.  At this time I have switched my priorities again.  I am trying to build our food supply to a much larger level.  That is my number one priority so the ammunition storing will be a little less for now.  I am comfortable with what I have on hand, but not so much with our food supply.  I believe that it could be over a year to years before everything settles down again, if ever.  We also have lots of seeds for the garden.

MEDICAL/PERSONAL HYGIENE

My family has been truly blessed in that none of us have to take any type of medications.  Therefore, it has been relative easy to stock what we think we might need.  We have stocked Band-Aids and bandages of various sizes.  Antibiotic creams and anti-itch creams, and large quantities of various types of aspirin are in our stores.  I just recently purchased a blood pressure kit and a stethoscope.  You just never know when you might need this.  Along with the various salves and creams, we have items for stomach problems and for dry eyes.  We are not as far along in this area as I would like, but we need so little (right now) in this area.  We have lots of tooth brushes and tooth paste, dental floss, oral jell, emergency dental repair kits, and some mouth wash.  Not to be left out, a lot of TP, and personal things for my wife, daughter, and daughter-in-law.  Also we have some preventives.  That is all I will say about that.  Soap and shampoo will be at a premium, so we have quite a bit of that along with alcohol, peroxide, and disinfectant washes.  We have also saved any prescription antibiotics and pain killers from the past.  Most of these were for tooth ailments, and from my daughter-in-law.  Babies are always taking medications for something, so she has saved them for me.

All my family’s teeth have been taken care of, and kept up with regular cleanings and any minor dental decays have been fixed.

We also have some medications and things for small children, including dozens of cloth diapers.  The cloth diapers can be used for almost anything. 

Needless to say, we do have other things for medical and personal hygiene, but this is just to give you a rough estimate to what we have on hand for a healthy large family.  We didn’t collect all of these preparations overnight.  Everything takes time.  Just remember that you can only take one step at a time.

There are other areas that we could talk about having on hand, such as alternate power sources, heat sources, clothing, tools, retreats, children’s games, bug or ant solutions, or etc., but you may be able to only concentrate on one specific area at this time.  Start there.  Start where you are now, and do not get frustrated that it is going so slow, and you feel that you may only have a short time.  Something now for your family is better than nothing while waiting for a government that doesn’t have the resources to take care of the millions that depend on it now as proven by the Hurricane Katrina.   Your family is depending on you.

There is a certain amount of “snowball effect” when someone decides to invest in survivalist, TEOTWAWKI, or prepper knowledge.  The initial decision is not a light one, nor is a “set it and forget it” for the type that bounces from one fad to the next.  There are many different types of survivalists.  But all survivalists have one thing in common – a beginning.  Whether it is your views on the ever changing political arenas or natural disasters that have piqued your interest or even steered your choice to the survivalist lifestyle, the initial influx of information can be a bit overwhelming.

First off, TEOTWAWKI?  The End Of The World As We Know It.  It sounds simple, but your everyday life is filled to the brim with simple things you normally take for granted.  If your power goes out, you usually can count on it being restored before your freezer defrosts.  But what if it doesn’t?  Sure, candles around the house are great, but if a widespread, long-term power outage occurred, you’d be stuck trying to get anything you could just to warm up a can of beans.  That is, if you can get into your can of beans because your electric opener isn’t working either.  And your car is low on gas trying to find any kind of supplies, so you can’t get yourself to the hospital because you impaled your thumb trying to open the “stupid” can of beans.  Even if it was a TEOTWAWKI on a smaller scale, like a corrupted water system, you need to be prepared to provide for yourself and your family as others scramble around trying to find even a 12 ounce bottle.

You know your own personality and know how far down the rabbit hole this decision will take you.  Prepare in moderation.  You already have responsibilities in your life, albeit work, children, and maybe hobbies.  If you are thinking that becoming a survivalist is going to be a new “hobby” along the lines of hunting or snow skiing or scuba diving, there is some truth.  The truth to that statement is that you will spend a decent chunk of change committing to this.  If you choose to devote your time and effort to learning a new way of thinking, you will learn that survivalist gear is like good hobby equipment; some will buy the cheap stuff and come to find out later that cheap doesn’t equal good.  Along with this decision to survivalist, you’ll need to learn a lot and then disregard what you don’t need, want or will use. As stated above, you know yourself best and will need to weed out the useless-to-you information.

Prepare for situations that would be likely, but keep the worst-case scenario in mind.  Natural disasters happen frequently, whether it is a hurricane, tsunami wave, earthquakes or fires.  Hurricane Katrina and the recent droughts show how hundreds of thousands, even millions, can be brought to their knees.  Man-made disasters also occur along the lines of a bombing, terrorists or political corruption that can shut down governments that trickle down to public sector jobs and then to private sectors.  The tsunami triggered nuclear reactor meltdown in Japan was mostly glossed over in the United States of America, with the exception of the chance of sensationalism.  The natural disaster occurred in the dead of winter.  If you were in a similar situation and survived the initial onslaught, would you be able to survive the repercussions? If the weather conditions were survivable, would you be able to protect yourself from looters?

You will never see me, nor know my real name.  To me, my survivalist choices are best kept to my family and a few other families that we are close with.  Each family is responsible for their own level of skills, supplies and knowledge, but we encourage each other and pass on useful knowledge and places to buy or barter for good supplies.  Being involved with a group may not be for you.  I take pleasure in knowing that I will have friends to be with should we have to leave most everything behind.  However, we all take great pains in not being the ones to discuss it openly with others.  It’s not that we hoard our skills or knowledge.  I’d rather not have 15 friends knowing that I have a cache of ammo or a supply of food, because if my 15 friends know and TEOTWAWKI happens, I’ll have 15 people asking me to help them out.  My first responsibility is my family.  Lack of planning on their part doesn’t constitute an emergency on my part.  So, gather your supplies, skills and knowledge quietly.  Don’t sign up for a reality show unless you want trouble. 

There are as many different camps on where and how to start as there are name brands for toilet paper.  Being practical has to play into your launching point.  My personal preference is basic necessity.  You cannot build a sturdy house without a good foundation (although I’m sure some would argue that point) and the same is true for beginning preppers and survivalists.  Water is essential for life.  You can buy cases of small bottles, one gallon jugs, or water containers from canteen size to 5 gallons to 50 gallons.  If you are leaning towards “bugging out” or “heading for the hills,” then a 50 gallon drum probably wouldn’t be the wisest choice.  But quality should play a role in your decision.  A cheap 5 gallon jug with a flimsy handle could break and any loss of water in a TEOTWAWKI could be a point of life or death.  There are water purification tablets, water hydration packs, knowledge on how to find water in the wilderness, the list is practically endless.  Never forget, though, that your body will fail without water.

Food follows a second close to water.  Being able to feed your family during a prolonged disaster is essential.  Not one of you reading this would care to see a child or loved one die of starvation, but it is a real possibility in a TEOTWAWKI situation.  Again, the choices on food storage are plentiful.  There are the classic MRE’s (meals ready to eat), which could be useful in a “bug out” situation.   If the scenario calls for staying put in your own home, however, food storage could be a lot more feasible and, to be frank, a lot more tasty.  There are many articles on life expectancy of home canned food, store bought cans and storage of dry ingredients to make meals.  Be sure to figure in how your storage is affected by weather, i.e. if you live where the summers are regularly over 90 degrees and how it influences the stored food.  Garden seeds could be useful for long term crops.

It may sound contradictory, but cash will speak in a broken society.  If you have studied, stored and mastered skills, there may be something you missed.  It is the one tiny thing that will pop up and send your “plan” sideways.  This is where cash comes in.  If there is a lack of electricity, banks won’t have computers to tell them how much is in your account and they certainly won’t let you “borrow” it.  Bartering could also prove useful in this type of circumstance, but cash is king with most people.  The amount you decide to keep on hand will be something that you find reasonable, but a good jump off point is $500, in bills that are 20’s and smaller.  Why so much to start out with?  If you think gasoline prices are unreasonable now, just wait until there is no electricity to automate the pumps. 

Lastly, for a brand new survivalist, consider your own medical needs.  Are you one daily, weekly or monthly medications?  If you are, you may need to consider getting a month more and then rotating it so that you have at least a month’s supply.  Do you have allergies that need an over the counter or even a prescription for?  Buying a box or two and rotating the stock is wise and easy.  Women need supplies for their “lady days,” and that may include special medications.  You can take a basic first aid kit and expand it with more supplies to start out with.  If you have any unused elastic bandage wraps, arm slings or splits, make sure that you include them with the medical supplies.  You will be able to gauge what you need for your family in your own medical kit.  Consider keeping your supplies in a red storage tote or bin to signify that it is for medical supplies.  In a panic, it is a lot easier to yell to someone to “Grab the red bin!” than it would be for someone to read the labels. 

For a beginner, sometimes you just want someone to spell out exactly what you need and which order to buy it in.  Unfortunately, it just doesn’t work that way.  What is good for my family may or may not be good for you, but it can give you a general idea of which direction to go.  Checklists are abundant on the internet, but can either be missing something you need or want or the list can be bogged down with advanced supplies to be collected once the essentials are there.  As you advance past the beginning stages and gather your basic needs, you will branch out into a plethora of different areas.  But the basics will have you covered in case TEOTWAWKI happens much sooner than you expect.

In Part 1 of Suturing I discussed several aspects of wound closure, including goals of treatment, common lacerations, alternate wound closure techniques, types of suture to purchase, wound cleansing, sterile field, needle size, proper instruments, correct suture placement, and aftercare.

In Part 2 of Suturing I will address common mistakes to avoid.

Wound closure is not rocket science, and any adult of average intelligence can learn the basic techniques.  Anyone who has sutured has learned from their own mistakes and those of others.  The following advice will help you skip a few errors and should make you look like a professional.

Common Suturing Mistakes to Avoid

Diagonal sutures yield misalignment, often with “dog ears” or leftover skin remaining on one side, which will cause a puckered appearance or open area at one end.  Make sure to align the edges well and place your sutures exactly perpendicular to the wound edge, aligning each stitch as you go.

Over-tightening yields inversion of sutures, that is, the edges dip into the wound, which prevents proper healing.  The sutured wound may look great, but what you really have is intact skin butting against intact skin, which of course isn’t going to grow together.  You need to have raw edge against raw edge, preferably with these edges everted a little (tented outward a bit).  As the wound heals they will flatten out.  Eversion is best accomplished by making sure you suture to the full depth of the wound with stitches as far from the edge of the wound as the wound is deep.  If the wound is a quarter-inch deep, sutures should be placed a quarter-inch away from the wound on each side, yielding a distance twice that (or one half inch) from side to side.

Likewise, suturing uneven thicknesses together often yields overlapping skin edges, which also will not heal together.  In this case the raw skin edge overlaps onto intact skin.  Take care to check each suture as you go for tension adequate to close the wound but not enough to overlap tissue edges.

Under-tightening yields loose sutures with a gaping suture line.  Be sure to use the surgeon’s knot (a double loop) on the first throw (half knot) of each suture.  This prevents knot slippage, which is especially helpful with nylon suture.  Raw tissue must touch raw tissue for the body to bridge the gap quickly.  It’s not that a gaping wound won’t heal, it will just take longer and cause a wider scar.  Everting the edges a bit, a millimeter or two, helps prevent this problem.  

Superficial sutures result in poor healing.  Your stitches may look great on the outside, but if the deep layers do not touch each other, they cannot grow together.  Make sure to close the laceration to the full depth of the wound.

Using large needles and/or suture material on fine skin yields needle-hole scars.  On tender or facial skin, better to use multiple fine sutures (5-0 or 6-0) placed closely together than try to bridge the wound using fewer, larger sutures.

Using too fine of suture on areas of greater thickness or tension may yield stitches that pull through.  Only use 5-0 on fine skin such as the face, fingers, or children’s skin.  Use 4-0 for most standard lacerations where the wound is just through the skin and/or where tension across the wound is minimal.  Use 3-0 for deeper lacerations into the subcutaneous tissue and/or where tension across the wound is greater, especially over large joints.

Leaving sutures in too long also results in needle/suture hole scars.  On fine skin which is not under tension 3—5 days is sufficient.  Average lacerations not under tension require 5—7 days before removal.  Deeper wounds or skin under tension require 7—10 days, though up to 14 days is recommended if healing is in doubt.  In patients whose sutures are left in longer they typically become embedded in the healing skin, which makes them difficult to find and remove.  If you suture someone up, examine your work daily to get an idea of the rate of healing. This only takes a minute or two, and also helps diagnose infection early.  If in doubt whether it’s too soon to remove stitches, take out only one or two in a non-critical area and see if the suture line holds.  Sometimes doctors take out alternating stitches one day, then the rest a few days later if wound strength is in question.

Leaving infected sutures in results in needle/suture hole scars and delayed healing.  Once a wound has pus coming out or begins to look red and swollen, all sutures should be removed.  The wound will heal better once the pus is rinsed out, though may well require oral antibiotics (cephalexin, trimethoprim-sulfamethoxazole, or amoxicillin-clavulanate are all good choices).  If the infection is caught very early, removing the stitches and applying a topical antibiotic such as bacitracin, Bactroban, or possibly Triple Antibiotic Ointment may be sufficient.  (Doctors seldom recommend the latter due to increased likelihood of allergic reaction, but if it’s all you have I’d use it.)  I have not used honey for this purpose, but it may work as well.

Sutures placed too close to the wound edge may pull through.  Placing your sutures about an eighth to a fourth inch from the wound edge is about right – the deeper the stitch is, the wider it should be.  Better a bit too wide than too narrow.

Just as women can learn to make a dress by reading a book, you can learn to suture on your own.  However, most people feel more comfortable if they’ve had professional supervision, at least to begin.  To this end I offer workshops several times per year where students can perfect their skills and receive professional instruction.  (See my web site for upcoming classes.)

In the next article I will discuss Splinting and Casting. 

About the Author: Cynthia J. Koelker, MD is SurvivalBlog's Medical Editor, the author of the book Armageddon Medicine, and the editor of ArmageddonMedicine.net   

Part of preparing for any emergency, including TEOTWAWKI, is making plans for those who cannot take care of themselves. Yet, there is very information out there about what to do about Grandma and Grandpa in a crisis situation, or those who just may not be the “fittest.”   Having elders who have been struggling with dementia or who are in cancer treatment, having seen so many of our soldiers come home with PTSD, having loved ones who are chronically ill or permanently disabled, I think about prepping in perhaps a different way than others. After seeking out the information I needed myself from doctors, mental health professionals and fellow preppers, I am now sharing some of the practical advice I’ve found for helping those we love who do not appear to be the best candidates for survival. Why?

For some, caring and preparing for those with less than optimal survival chances may seem like a foolish, even dangerous, goal. Certainly, some soul-searching is required when thinking about who you are willing to “carry” (figuratively and perhaps literally), and just how far you are willing to put yourself and other members of your group in jeopardy to care for someone who may not make it in even a best-case scenario.  You will have to make your own decisions about who to help and who to abandon. But I could not leave my parents, in-laws and grandparents any more than I could leave my children to weather the chaos on their own. I also cannot justify leaving other relatives or friends where they could be victimized by those who prey on the weak. The Biblical commandment to “honor thy father and mother” means not just that I honor them, but that I must also care for them in a crisis. I cannot bear the consequences of writing them off, or leaving them to the unkindness of strangers or the bureaucracy of FEMA. The same goes for all of those I am responsible for, by virtue of my being able, even if they are not.

In the case of illness or dementia, even if it meant that moving them might hasten their deaths, I would choose to care for my own family and friends. Perhaps it is my own rationalization, but I would prefer that if they do indeed die, they do so in the company of people who love them and who will treat them with dignity, not at the hands of mobs or criminals.

If my loved ones were currently in a hospital, nursing home or assisted living situation, I would know the facility’s emergency plan and contingency plans. In case of an emergency, would my people be evacuated, by what means, by whom, and to where? (And I would make my own plans to take custody of them instead).  I would try to be as low-key as possible to avoid alarming the powers that be about any specific disaster or emergency, but I would get the information that could protect them, and make it possible for me to intercept them as quickly as possible in a crisis.

MEDICAL ISSUES - DRUGS
For those who require daily prescription medications, such as cardiac patients, diabetics, epileptics and other chronic illness patients (including those recovering from cancer treatment), some logistical planning now will save anxiety and life-threatening repercussions later.

You will need to know (and have written down) all medications, what they’re for, dosing schedules, and danger signs to watch for. At first, the problem will be in stockpiling enough medication when most insurance covers only minimal monthly quantities. Many times though, a sympathetic physician can prescribe a twice-daily med instead of a once-daily, for example. Explain you’d like to keep a back-up supply for the patient in case of loss, misplacing or forgetting when traveling.

As your supply grows, be especially diligent about rotating meds, using the oldest for current needs and storing the newest in a cool, non-humid environment, and including desiccant packets whenever possible.  (Ask your pharmacy, as they throw these out by the hundreds). 

One of my doctor friends tells me that more than 80% of his geriatric patients are on mood-altering drugs. A similarly large percentage of handicapped and cancer patients are routinely put on these drugs as well. For those who are on antidepressants, antipsychotics or anti-anxiety meds, benzodiazepines or steroids, special cautions apply. These drugs can cause terrible effects if stopped suddenly, and most require a very gradual weaning off the drug if one wishes or is forced to discontinue use. Check with your patient’s physician, and do your own research on ALL of the drugs your patient is taking (www.rxlist.com is an excellent resource), and plan accordingly.

MEDICAL ISSUES – ELDERS
While health can vary widely among seniors, there are specific concerns that are common to most. Circulation issues such as edema, bruising and bleeding, dehydration, and constipation can all be more serious in the aged, no matter what the fitness level. Falls and resulting injuries should always be avoided and prevented, as the consequences for elders can be much more serious than normal.
Simple observation and precaution about everyday conditions is necessary. We lose the ability to adapt rapidly to temperature variations as we age—most elderly people feel “cold” faster than younger companions and are at special risk of hypothermia. Your preparations will have to include supplies that ensure more warmth, such as extra clothes, hats, socks & gloves, and you will have to be vigilant in caring for elders who get wet or chilled.

Response to heat or exercise can also be a problem. Fluid intake of seniors must be monitored closely at all times. Dehydration during exertion or other stress may occur rapidly and without warning, causing diarrhea, vomiting, delirium and ultimately, death.

Many seniors will have dietary deficits, due to waning appetite, poor digestion, or self-sacrifice for others’ needs. Without adequate fiber-rich foods (or supplements) and liquids, constipation can become a life-threatening situation for an elder, not merely a painful inconvenience. Stool softener and laxatives should have a starring place in your senior’s medical kit. Lack of vital nutrients may also affect sight, hearing and balance. Keep an eye on their diets and make sure they get the nutrition they need.

Seniors are subject to painful and dramatic bruising when injured, especially if they have been on blood-thinning medications, commonly prescribed to prevent arterial plaques and stroke. Excessive bleeding and inability to clot are also effects of these drugs. Avoid injury first, and if unsuccessful, treat bruises and bleeding quickly to forestall further complication. Every cut or abrasion is also a potential site for infection, which can overwhelm one who is already weak, so be particularly aware of your charges’ skin condition.
Swelling of the extremities due to poor vascular circulation can incapacitate your older loved one. Compression socks, or in a pinch, elastic bandages, are a good addition to the clothing or first aid kit.

COMMUNICATE
Preparation for your loved ones begins with talking to them. You may be surprised to find out that oldsters are more prepared than you thought. After all, many have lived through tough economic depressions and wartime shortages, and they know a thing or two about living well with less convenience. Someone whose breathing depends on oxygen may have already prepared for a power failure or disruption of supply. If not, you can help that person get prepared.  Someone who is overweight or in poor physical condition can benefit from a daily walk or strength training, even without the threat of an emergency. You might be the motivator or the companion to help improve the quality of that person’s life, now and in case of future crises.
Approach with a sincere offer of help, but be sure to ask what general and specific help they would need from you in case of an emergency. You do not know what the unique needs are until you ask.
For those that still don’t accept the idea that all sorts of manmade disaster and mayhem can happen here, and can happen at any time, the conversation can take place in the context of preparing for a natural calamity, such as a tornado, earthquake or fire.

Be aware that some of the sick, disabled and elderly may need to be convinced that their survival is possible, even probable, if they prepare themselves mentally and physically. You may hear this type of defeatism in statements such as “Don’t worry about me, I wouldn’t want to live in that world anyway…” Your people need to know that that a can-do, positive attitude combined with practical planning and preparation can up their chances. They need to know you’ll be there to help them. Most importantly, they need to know that their survival is of paramount importance to you.

MENTAL TOUGHNESS vs. PHYSICAL FITNESS
You should not assume that because your parent is sick, your grandparent is old, your friend is diabetic, your relative is obese, or your neighbor is blind, that these people are helpless or even less than capable of survival.  Emotional strength, mental tenacity, technical skill sets or ethical leadership can quickly trump any physical challenges, depending on the situation. Lack of emotional resiliency or deteriorating mental stability can quickly turn a strong athlete into a greater liability to the group than Granny who needs a cane.
For example, I have a physically-fit friend who stocks an “earthquake kit,” a 72-hour stopgap to see her through a brief disruption of water and food supplies “until help arrives.” She refuses to consider anything more than that, because it would mean that she would be on her own for longer than she is willing to be. She refuses to own a firearm, because that would mean that she might have to use it. This head-in-the-sand attitude is not preparedness, in spite of her pride in running 10Ks on the weekends, having a few gallons of water and a three-day supply of food in the garage.
On the other hand, my 85-year old mother bought a retreat back in the 1970s, stocked it with supplies and learned to shoot. She has a stay-put plan, several bug-out escape routes, keeps her stock rotated, tests her equipment regularly and maintains situational awareness, even when she’s just going to the bank or grocery store. She has a mental toughness that belies the physical weaknesses of a woman her age.

THE NEED TO BE NEEDED
All of the people you care about have combinations of physical and mental challenges. What we all have in common is our need to be useful, no matter what our abilities or lack of abilities. A person without functioning legs can still wield a weapon or man a security cam. Someone who is blind can still direct audio comms. Everyone has skills and talents that the family and community need, and the survival of the whole group dictates finding appropriate jobs for everyone.
Those who are critically ill or in the advanced stages of dementia may need to have round-the-clock caregivers, which could put a strain on community labor resources. The whole group would ideally have the same reverence and respect for all the members’ quality of life, even the infirm and ill.

GET YOURSELF READY FIRST
Much of the information about surviving natural disasters or man-made insanities assumes that we will prepare not only our environment, but ourselves as well. In order to deal with a crisis, realize that while we are teaching ourselves new skills, setting aside food stores, preparing security and energy options and planning for those who are weaker than ourselves, we must diligently prep our own minds and bodies to withstand the multiple demands that will be required.

Knowing that stresses of panic, physical exertion, mental exhaustion, and lack of sleep will pile up and collapse you if you are not ready, is not enough. Add in caring for others who are young, old, chronically ill, obese, disabled or just darn difficult, and your preparedness becomes even more critical.
Part of the process requires that we must be physically fit ourselves before we can take care of others. So put down that list and go exercise, at least some part of every day! Do not allow yourself to become out of shape, while you’re stockpiling supplies and securing your environment. There are people depending on you. Make sure you are the fittest you can be, physically and mentally. Then you can expend energy on building a community that includes everyone you care about, even the unfit.

Goal:  To help organize medical supplies into easily accessible modules of like items within your medical kit(s).

Two years ago I was looking at pre-packaged medical kits on-line and noticed one with various items organized in colored bags.  For example the red pouch had everything a person needed for simple wound care.  Some ambulances carry trauma and pediatric bags with contents organized by color.  The kit on the internet was over my budget, but I was intrigued by the idea.  On my next trip to town, I was looking for office supplies and noticed zippered pencil pouches, which are intended to help organize loose school supplies (like pencils and pens) and the pouch is inserted onto the metal rings of a binder, with three metal grommets.  These are the roughly 7.5”x10” nylon cases with a zipper and a clear plastic front to view the contents.  They are available in many different colors.  They can be purchased in the school supply section of many stores and cost about $1 each.  I use these pouches to help consolidate similar medical items together, allowing me to sort and protect the valuable medical supplies.  In times of stress it may be easier to grab the needed packet of items or tell a companion which color pouch you need for the task at hand.  A permanent marker or medical tape can be used to label the outside of each packaged module.  This allows for personalization of a kit and eases the addition or subtraction of items quickly, depending on the situation.  Also, with a duplicate set of each pouch, resupply could be enhanced, removing the used pouch and replacing it with a full one.  This method can help organize an existing medical kit or be a good starting point for assembling a new kit.

BLUE:  Airway.  This would include simple devices to help keep an airway open or more advanced items, depending on your level of comfort / training. 
Consists of: CPR mask, Airway adjuncts (Oral and Nasal Pharyngeal sets.), King Airway with lube and syringe.

RED:  Bleeding Control / Shock Management.  The basics for controlling bleeding and treating small wounds.
Consists of: Trauma dressings, supplies to make a tourniquet (triangular bandage and a windlass made of 8 tongue depressors taped together), a space blanket to control heat loss, various sized band-aids, gauze, dressings, etc. 
Homemade Trauma Dressing:  As mentioned in several articles a maxi-pad could also be used to help control external hemorrhage.   I take it a step further and make a simple set with two pads, plus two sterile 4x4 dressings and a roll of gauze to hold the dressing in place on a wound.  This is packaged in a quart sized sealable plastic bag.  The bag could also contain a pair of gloves and other small wound management items.  With the addition of tape, the bag itself could cover an open chest wound to make an occlusive (air-tight) dressing. 

GREEN: BSI - Body Substance Isolation.  Items needed to reduce spreading germs. (protects both you and the patient)
Consists of: Nitrile gloves, surgical mask, goggles etc. 

PURPLE:  Splinting.  Used to immobilize joints or bones that are injured. 
Consists of:   36” formable aluminum splint.  Cohesive flexible bandage (the duct tape of the medical world) or reusable athletic wrap, triangular bandages, popsicle sticks to splint fingers, tape, etc. 

TEAL:  IV Set Ups:  This includes everything needed to establish intravenous access in an emergency, if you have the training / medical direction.  If you do not have the background, these materials could be passed on to a qualified person, if needed.  There is not enough space for bags of fluids, but you could use a saline lock to have the IV catheter in place and sealed until needed to infuse medicine or fluids.    
Consists of:  IV Catheters.  Two each 24 gauge through 18 gauge, alcohol prep pads, IV dressing, saline locks, flushes, tape, etc.

CLEAR:  Topical / Medication:  This could include various over-the-counter creams or small bottles of pills.  
Consist of: antibiotic cream, anti-itch cream, liquid bandage, ibuprofen, ASA, diphenhydramine, burn cream, surgical super glue, etc.  

ORANGE: Medical Instruments.  
Consists of: tweezers, various scissors, scalpel, hemostats, syringe and needle combos, sutures, etc. 

PINK:  Vitals.  These devices can help you recognize changes in your patient's condition.  Depending on how big the kit or extensive your training this may not all fit into one pouch.  The smaller items could go in a zipper pouch, but the larger items may be better in a zippered mesh bag, as intended for protecting delicate items put in a washing machine.  
Consists of: stethoscope, thermometer, blood pressure cuff, glucometer, pulse-ox, etc. 

BLACK:  Dental.
Consists of:  temporary fillings, oral pain gel, gauze, dental picks.

YELLOW:  Documentation.  To write down vital signs, treatment given, etc. 
Consists of pad of paper, pencil, pen, triage tags, small medical reference book.

In conclusion, organizing these ten pouches of medical gear and supplies can help you become more prepared to treat basic medical emergencies, as well as enhance the general health and well-being of your family or survival group.  These pouches make great gifts, building good-will, and could help lesser prepared friends or neighbors.  The colors and contents are based on how I have organized my supplies and would obviously be tailored to the individual.  Instead of just filling a bag with supplies and then digging through it or dumping it out to find the item you need, this gives a basic format to help find the needed items more easily.  This can cut down on frustration, like knowing that you have a pair of tweezers, but not being able to locate them when you have a splinter.  The main advantage of these kits is that you can start very simply and inexpensively, letting your supplies grow as your training and budget allow.  By carefully shopping at discount stores and on-line you may even save money by putting this kit together yourself or buy in bulk and share the cost of multiple kits within a group.  Also farm supply stores often have less expensive materials, like scalpels, hemostats, etc. without having to pay the shipping when buying them on-line, although incredible deals are available on auction web sites.  Compare costs per unit to be sure.  A few dollars spent each week on supplies will slowly build into a nice cache of useful items for both everyday living and could be vital in a worst-case-scenario.  Also, by building the kit yourself or organizing the items in your prepackaged medical kit, you will be totally familiar with all of the contents.  Any of the pouches could be used as stand-alone medical kits, for example one pouch would easily fit in a cargo pocket or a backpack, or even your vehicle’s glove compartment.  In this way, you can keep your medical supplies close at hand and organized in an easily recognizable manner. - Jeff F.

I spent a number of years doing trauma surgery in several Level 1 NYC hospitals, and I'd like to share some thoughts. I don't usually like to give advice - it's not my custom to tell another man or woman what to do. So please take this for what it's worth - my experience and thoughts - and do with it whatever seems best to you.

DISCLAIMER: I am a licensed physician. However, this is not medical advice. For any Johnny-Rambo's out there, if you need medical assistance, please pick up the phone. This is for when there is no dial tone.

Let me say first that I appreciate the wealth of information on this site. It's very interesting to read, and humbling to implement, a lot of the solid advice offered here. I'm less of a talker, and more of a do-er, and the reality is, there is a lot to get done. Some would be tempted to think that with several Ivy-league degrees and an M.D., something like gardening would be easy. Of course, you know what the reality is: starting something new is hard. And smart people are notoriously dumb.

I mention this because trauma is like any other discipline, and there's nothing magical about it.

If you go to the range and shoot flat-footed at paper targets, you'll fail when your AR double-feeds on the run, with your heart pumping, sweat in your eyes, and the world swirling around you. Medicine is the same way. You might have a trauma bag, you might have read a lot, but when your wife, or best friend, or child is bleeding out and looking at you, your mind will go blank. Don't be ashamed. That's reality. The question is, how can we handle it?

My first piece of advice is:

You need to do some limited amount of training that involves moving your hands and feet.

Muscle memory is an incredible thing. I've spent most my life in martial arts. I have no idea exactly what I would do if someone grabbed me by surprise. Be certain, though, that I would do something decisive and unfriendly. You don't need to become a paramedic, or make this a big time commitment, but you do need walk through handling a trauma. Your hands need to know. The more stressed you are while you practice, the better.

Spouses will generally support this. Taking a CPR course is a good start. Then, during dinner, or hanging out with like-minded friends, role-play it: "John just got shot in the neck/the propane tank exploded. What do we do?" Then have John lie down on the ground. Walk through what you would do, and do it. Do it every few months if you can. It takes 5 minutes. John will thank you one day.

The second thing is:

Keep things simple.

When your pistol malfunctions, it's tap-rack-bang. It's not complex. Don't go for a Ph.D. Don't rely on thinking. When it counts - and I've been covered in blood more nights than I care to count - you won't be thinking. You'll be reacting. So train to react. Here's how:

Step 1: A-B-C. Airway. Breathing. Circulation.

Say it again and again and again. I can promise you no matter how many other tidbits you pick up, you will forget everything else but A-B-C when you get caught off-guard by a serious trauma.

Here's my (humbling) anecdote: Years ago, as a first year medical student, I was in Costa Rica, hitch-hiking down some road. The car in front of us didn't make the turn and went under a tractor-trailer. Immediate carnage. The young woman in the passenger seat was on the pavement and she wasn't breathing.

Pause for a moment. If you're honest, what flashed into your head? An image? A similar experience? But what didn't occur to you? Did you immediately think: tilt back her head?

At that time I had already taken BLS (basic life-saving) which covers CPR, etc. I had all the book smarts in the world for this, but I didn't react. I hesitated. Some random guy on the side of the road tried to pick her up and her airway opened. She started breathing. She lived.

My point is this: don't concern yourself with complex trauma decision trees. Don't worry about whether it's Adenosine or Amiodarone. If you've got the meds, you've likely got the medical professionals to use them. The key in trauma management is to buy yourself (and the patient) enough time to get to the next step. That's it.

How do you do that? Concentrate on ABC. Do each one, in order, and then move onto the next:

Airway: Make sure the airway is open. If they are awake and talking, they are breathing. If not, tilt the head back. If there's blood or vomit in the mouth, get it out of there with your fingers. Get the airway clear. Textbooks will tell you to use a "jaw-thrust" maneuver if there is head or spinal trauma because of the theoretical risk you might dislodge a bone fragment and sever the spinal cord. This is nonsense. If you've got a broken neck, you're not breathing, and there's no medical help, you're dead. Don't screw around. Tilt the head back.

Breathing: If the airway is open and they're not breathing, there is a reason for it. At this point, you don't need to worry about what the reason is. You just need to start breathing for them, or they'll be dead in less than two minutes. With their head tilted back, pinch the nose, open the mouth and blow in two huge breaths. Bonus points: look at their chest. Make sure it's rising. Once air is moving in and out, take a closer look at the chest. Here's what to look for:

• Is the chest open?
• Is there a wound/hole?
• Is it collapsed/caved in?
• Are there Rice-Krispies (air) under the skin?
• An unusual hollow sound when you tap with your fingers?
• Is the wind-pipe (in their neck) shifted away to the other side?

These would suggest a pneumothorax (air outside the lung, but inside the chest). What to do:

• The patient needs a chest tube. If that's outside your ability, and the patient is having a lot of difficulty breathing, you need to find another way to get the air out of the chest cavity, because it's putting pressure on the lungs. Keep in mind, if you have to do this, the patient is in trouble:


• Use a big needle to suck it out. Here's how: Get some gloves on. Splash the chest with betadine and spread it around with some gauze. Get a big, long needle (at least 1 1/4" inch long) preferably with a catheter, and stick it in through the top of your chest muscle. Go straight in about 1.5 inches on a normal person. Keep the syringe on the needle and keep sucking out air while they breathe.
• If that isn't working, here's your last option: make a small incision between the ribs. Here's how: find a space between the ribs just under the armpit in front of the lat muscle. Cut a one-inch incision parallel to the ribs, and using a clamp (or needle-nose pliers), push in, spread and repeat. Stay on the top side of the rib (instead of underneath where the blood vessels are). Don't be afraid to use your fingers. When you enter the chest, you'll feel a small pop and see air bubbles through the blood. Allow the pressurized air to come out and cover it with some vaseline gauze. Pray.

Circulation: If your own pulse is pounding, it's hard to feel the patient's pulse. Next time you go for a run (you do work out regularly, right?) practice feeling your pulse while you're running. That's about what it's like in a trauma. Check the neck. Check the wrist. Really simple: Is there a pulse? This is harder than it sounds. If the patient is cold, low on blood, wet, or thrashing around, and you're flooding adrenaline through your own veins, one of the harder things to do is say with confidence that something isn't there. Be sure. Remember: fast is slow, slow is fast. Relax. It's only life and death. If there is no pulse, start doing chest-compressions. Here's how:

• Get the patient onto something solid - the ground, the kitchen table - not the bed, not the sofa. Something hard.
• Find where their belly meets their ribs. In the middle, on the ribs, push down hard with the heels of your hands twice per second. Fast.
• How hard? On an old person, you may be breaking ribs. On a young person, they'll feel like they got the ever-living crap kicked out of them. Don't try to hurt them, but do it fast. Push down hard. You will be sweating like a fat man in a cake shop.
• Recent AHA guidelines recommend that you do 30 chest compressions, then two breaths. I agree. 30 fast compressions, 2 huge breaths, and repeat. You're breathing and pumping their heart for them. Don't skimp.

The other part of "C" - circulation - is checking for hemorrhage (bleeding). I talk about bleeding below, but here's the point: there's bleeding you see (dribbling out some hole), and bleeding you don't (internal). You want to keep both in mind and look for the signs of each (visible blood, fast/weak pulse, low blood pressure, a thigh or belly that's fuller than it should be, etc.).

What's next? Before we move on. Remember: ABC. Say it out loud. When your mind goes blank, A-B-C should enter it. If you remember nothing else, ABC.

There are two more letters after ABC. Not surprisingly, they are D and E. I separated them out because in my opinion, they are less applicable in a survival situation.

D is for Disability. Specifically, a neurologic evaluation. There is limited value to this (who is doing brain surgery on the back porch?) with one exception: triage. If a patient is flexing or extending their arms in a strange fashion, has no anal sphincter tone, doesn't respond to painful stimuli (pinch their finger/toe), or their pupils are very dilated (or one is), these are signs of serious neurologic injury. It may be useful in a survival situation to know that this patient is unlikely to recover.

E is for Environment. If possible, cut off the patient's clothes, and keep them warm in preparation for the secondary survey. Again, trauma patients get cold easily. Cover them with blankets and keep them warm.

A-B-C-D-E is the primary survey. It's quick and dirty and designed to address issues that might immediately kill the patient. Each step needs to be completed before moving onto the next. There's no point trying to work on breathing if the airway is blocked. After all five steps are competed, it's time to do a secondary survey.

The point of the secondary survey is to look for things that were missed, and to gather more information that might aid treatment. Examine the patient head-to-toe, front and back. Look under the arms, and between the legs. Many times on a patient (covered in blood) I've found another bullet or knife hole on secondary survey. Patients generally won't know where they are injured. When you roll the patient, do a "log-roll" where their head is rolled at the same time as their body. This should provide some protection in case they have a spinal fracture. Check their spine by pressing on each vertebrae for unusual tenderness. If they yelp, keep them on their back and don't let them sit up.

If at any time, the patient's condition deteriorates, abandon your secondary survey and restart your primary survey - A-B-C. Again, no matter what happens, no matter where you are, if something unexpected happens, don't think - just start doing ABC.

There are several common types of injury, and I will walk you through them:

Penetrating Trauma: Translation: you're bleeding. Bullet, knife, chainsaw - it doesn't matter. Nothing, and I mean nothing, stops bleeding like direct pressure. It's not fancy, but if you see blood, particularly on an extremity (arms, legs, head), lean on it, push your weight onto it with the heels of your hands or your fingers. If you're pressing hard enough, it should cut off the blood to your own fingers. You can stop any bleeding - including major arterial bleeds - with enough pressure. If it can't be stopped with pressure, it can't be stopped without operating.

No tourniquet, or other device - even a suture - is going to do the job in the first 3 minutes like you pushing down with everything you've got. The only reason you should ever even consider using a tourniquet is if you're in a firefight and need both hands for your rifle. Quikclot and other similar hemostatic powders are useless in a real trauma with brisk bleeding. We use them all the time in the O.R., but they have no place in a trauma. Use direct pressure every day of the week and twice on Sunday. Remember that a hard surface underneath makes everything easier.

When the bleeding slows, get lots of gauze (or your t-shirt) onto the wound and keep pressing down hard. You may need to hold it up to half an hour if you're all alone. If the patient stays awake and you've stopped the blood from flowing - you're doing it right.

Blunt Trauma: Without an ability to do imaging, or blood work, or a long experience doing physical exams, it's hard to know what's going on with blunt trauma. If there is a blast injury (explosion) all bets are off. Don't underestimate a blast injury. In many blunt traumas, but particularly blast injuries, there are lung injuries you can't see initially. This will cause the lungs to fill up with fluid and the patient will drown. If you have oxygen, some ability to use an airway, or diuretics (like ferosemide / lasix), this is the time. Otherwise, don't over-hydrate the patient if you suspect a lung injury (big chest bruising / gurgling / coughing up fluid).

For abdominal blunt trauma, here's what to consider: is the spleen or liver bleeding? What to look for:

• Is there a big welt on the skin below the ribs?
• Does the patient look pale and waxy?
• Pulse stays over 110, or rises?
• Blood pressure 100 or lower?
• More pain in their belly than you think they should have?
• Do they feel faint and thirsty?

These are signs of internal bleeding. The very best thing you can do for internal bleeding (assuming you don't have blood on hand) is to give IV fluids. Run in a couple of liters of normal saline or lactated ringers to start. Anybody who's not already in heart failure can tolerate 2 liters - don't be shy.

Keep the patient still. No moving or shifting around. You want the bleeding to clot off, and every time you move around, you risk starting it up again. Keep the patient warm. Cold patients have more trouble clotting.

If the patient gets worse, and passes out, and their pulse is weak, and their blood pressure drops to 80, they are bleeding to death.

Unless you're in the mood to operate with a butter-knife, you have to hope the bleeding stops on its own. That may sound like a negligible hope, but as their blood pressure drops, it makes it easier for the body to clot off the bleeding. It may be enough for them to survive.

If you have medical training and feel able, and the patient is hemodynamically unstable (is bleeding to death internally), you can take a shot at operating. Here's how: Take a deep breath. Never start surgery with a full bladder or a full trash can. Make a midline incision top to bottom and go around the belly-button. Go straight down through the fat to the fascia (that's the white, tough membrane that keeps your guts in). Stay in the midline. Pick up the fascia with some clamps, and ever so carefully make a little nick in it. Get your fingers in, lift it up, and cut between them. Don't hit the bowel. Only cut what you can see. There will be blood everywhere. Don't try to clean it up. Quickly reach way up high under the ribs on both sides and start packing the abdomen with towels. Pack up high all around, behind, and underneath the spleen and liver. Pack until you can't fit any more. You'll probably need 25-50 facecloth sized towels. If you can, count them as they are going in. I can't see a scenario where a non-medical person would do this and improve the outcome.

Fractures: This is too big a topic to handle in any depth. Here is what to keep in mind:

Hip (pelvic) fractures are a big deal because you can bleed internally from them. You can check the pelvis by pushing down from the front and feeling for instability.

Rib fractures are only a big deal if there is a big section of the chest wall that is moving independently from the rest, or if they have punctured the lung.

Extremity (arm and leg) fractures can compromise the blood flow to that limb. Make sure the broken limb has a pulse. On the arms, check the radial (thumb-side) of the wrist. On the legs, check both feet behind the medial malleolus (the bony-bump on the inside of the ankle), and on top of the foot (check your wrists and feet now to find the pulses if you like). Not everyone will have both foot pulses. But if there is a difference between left and right limbs on your patient, particularly if the limbs look different (color, swelling, temperature, etc.) you need to reduce the fracture quickly.

To reduce the fracture, you'll need to:

• Pull it straight (away from the body) to line up the bone fragments, then
• Have some type of support to keep it there (a splint)

Make sure you get your splint ready before you reduce the fracture. Depending on where the break is, you may need a lot of force. Do it once and do it right. Pull slowly and steadily - leaning back with your weight if necessary, but don't jerk. If you can wait until a second person is available to help you, that's better.

Keep in mind that in addition to being broken, the limb might be dislocated. If it's dislocated, you need to put in back in place (reduce it). Here's how:

• For hips, they're usually a posterior dislocation. That means the foot and knee will be turned inwards. With the patient on his or her back, flex the hip then pull the knee forward (skyward). Have a second person hold the patient's hip down on the table - you need a lot of force to relocate a hip.
• For knees, it's the kneecap that slides laterally (away from the midline). Bend the knee, push the kneecap up and back towards the midline and straighten the leg.
• For shoulders, the key is to get the patient to relax the shoulder muscles. There are lots of ways to do this. Generally, the Kocher method has the highest success: with the arm bent at 90 degrees, gently rotate it outward until you feel a bit of resistance. Then bring the whole arm forward as far as possible and rotate it back inward.
• For elbows, have one person hold the biceps, and the other pull the wrist while the arm is slightly bent.
• For fingers, slide your thumb up the side of the finger that is sticking out, and push the digit away from the body. Pulling on it doesn't work very well because you make the tendons tighten around the bone.

Once you reduce a fracture, keep the traction (pull) on it, and stabilize it with a splint. Make sure the splint isn't cutting off the circulation by slipping your finger between the patient's skin and the split to check the tension. Then check the pulses again.

In some unusual cases, but particularly when there is a fracture, or a crush injury, you can get what's known as a "compartment syndrome." This means that pressure inside your calf or forearm is building up (from swelling or bleeding). The limb may go numb, pulses can disappear, get pale, and almost always you'll have a lot of pain when you move the ankle or wrist even a bit.

If this occurs in the context of a trauma, you may need to surgically cut open the limb to release the pressure. This sounds extreme, but if you don't, the pressure can kill the nerves and you'll lose function of the limb permanently.

To do it on the leg, you want to open 4-5 inches on the outside of the shin. For the forearm, do it on the inside of the forearm for most of its length. Keep in mind that it's not the skin you need to open - it's the white-gray, tough tissue called "fascia" that's under the skin, and under the fat. There are different compartments and it's theoretically advisable to open each. In practice, however, it's usually unnecessary. Don't go any deeper than the fascia, and don't do this unless you're sure - you're creating a large new wound with its own issues.

Burns: Burns are probably one of the more likely injuries in a survival situation. They are very common in the third-world. Open cooking fires, burning refuse, combustion-based illumination and heating, and improvised equipment all increase the chance that you'll get burned. I will not go into general burn-care here but rather I'll focus on addressing burns in the context of trauma. This usually involves a flash fire or explosion.

First, drag the person away from the fire and make sure the fire is under control. Take a close look at the patient. Go through your ABCs! Remember that they may have other injuries besides the burn. Here's the reality: for serious burns, there's often little you can do to help outside of having access to real medical care.

If there are burns around the head, mouth and airway, you should worry. Even if the patient is talking, the clock may be ticking. Any questions you have to ask, should be asked now. Don't wait. Not even an hour. Their airway or lungs may be burned, and without intubation and oxygen, death may be unavoidable.

If the burns are wide-spread, you're at risk early-on for fluid loss and electrolyte imbalances (dehydration). Keep burn patients warm and very well hydrated. If they aren't urinating, they need more fluid. Remember to use rehydration salts, not just water. IV fluids are best, but drink some pedialyte/gatorade if that's all you can do.

Infection risk comes later. At the first sign of infection, start some broad spectrum antibiotics (that have gram-negative coverage, such as ciprofloxacin or erythromycin). Give a tetanus vaccine if you have it. (You have your tetanus vaccine up to date, right? Dying from tetanus is horrible and ranks next to peeing on an electric fence for preventable ways to die).

For the wounds, initially just put some dry dressings on the wounds. They will ooze. Later, topical silver (e.g. silvadene) and vaseline gauze or xeroform are a good place to start for deep wounds that need debridement. Don't let them get too soupy. Give pain meds if you have them.

If the patient survives, handle the wound care (and contractures) the best you can. Pay close attention to circumferential burns (fingers, limbs, or chest). These may cut off the flow of blood, or make it difficult to breathe. If that's the case, you need to cut just enough through the burn scar to allow the tissues to move. You usually will not need to do this.

Initial wound care is covered well in the SurvivalBlog article "Wound Care: An Emergency Room Doctor's Perspective, by E.C.W., MD" . Burn wound care after the immediate trauma is a little different and would require a good deal of discussion, outside the scope of what I can cover here.

If you'd like to prepare to handle a trauma, here (in order of priority) is what you have on-hand that will make the most difference in changing the outcome:

1. Bandages . Lots and lots of gauze and bandages. During a trauma, we use boxes and boxes of gauze. They don't need to be fancy - just have a lot of them. I'll add in here things like betadine (to clean) and saline (to irrigate), as well as gloves, tape, and linens.
2. IVs and IV fluids. There are really only two reasons why life-expectancy in the developed world has doubled in the last century: Intravenous fluids and antibiotics. If you have the ability to keep (and rotate) some IV fluids and some large (18-20 gauge) IVs and lines, you are two steps ahead of anyone else. Whether it's a trauma or a viral pandemic, the most important thing (sometimes the only thing) you can do is give IV fluids.
3. Oxygen. A small home oxygen tank with a bag-mask buys you a lot. Any type of respiratory problem gets better with oxygen. If you add an LMA (laryngeal mask airway - a device that anybody can use to secure an airway) you are really cooking. Speaking of cooking - keep it away from combustion sources.
4. Splints. Plaster, fiberglass, aluminum finger splints, slings, crutches are all great to have. You need to splint or cast most broken bones.
5. A blood pressure cuff. You can figure out someone's pulse or respiratory rate with your hands and eyes, but you need a blood pressure cuff and a stethoscope to know what their pressure is. Throw in a thermometer and you're half-way to being a hospital.

In summary, if there's a trauma, follow your A-B-Cs. Put pressure on bleeding, don't move blunt traumas, reduce fractures and make sure the limb is getting blood, and pay close attention to burn patients. Walk through a trauma with your family and put each other on the spot to see how you'd actually react. One day you may need it. And remember, when your brain goes empty - A. B. C.

Many Americans have never experienced the death of someone close to them, and our current system of dealing with death makes sure that family and loved ones have as little contact as possible with the dead, and often very little with the dying.  Our culture reacts to the topic of death much like the Victorians reacted to the topic of sex.  We avoid even using the word “died” or “dead”, preferring euphemisms such as “passed”.   With the more widely spread use of hospice and palliative care teams, families are learning that helping their loved ones through the dying process can be a rich and healing time.  However, the dying process is still rather reminiscent of childbirth 30-40 years ago, when fathers and other family members were shut out, and the mothers in labor were left to labor alone and in pain, or drugged.  Too often the dying find themselves in similar situations, isolated from family and away from home.

Contrast the process of dying in our not so distant past, and in current non-westernized cultures, with that of many American families today.   In the past, the family would be responsible for caring for their loved one through the dying process, preparing the body for burial, sitting in vigil with the body as everyone told stories and remembered the person, and finally committing the body to the ground with prayer and other important rituals.   Now, often due to anxiety about the whole process, the family often chooses to have the person die in the hospital, be whisked away by funeral home personnel to be attended to.  Cremation avoids the uncomfortable issue of being in the presence of a dead body, and if cremation isn’t done, the body certainly must not be seen as that might be too “creepy”.

Those readers who saw the movie Places in the Heart may remember Sally Field’s character tenderly washing and preparing the body of her husband for burial.  Indeed, this was the norm not so long ago and continues to be the norm in non-westernized cultures, where caring for the dying and the dead is a way for the family to perform the final actions of kindness and respect for their loved ones.

What happens when it all comes down and we must, of necessity, figure out what to do with the dying and the dead?  In the past, there was a process which was taught elder to younger.  Now we are cut off from that wisdom and must sort out how to manage a painful and devastating situation.  We must learn again about the dying process, how to help our loved ones and ourselves through this final transition, and what to do afterward.  Caveat- none of this is offered as medical advice, and trained medical persons should be consulted when they are available.

Preparing to care for the dying:

As hard and sad as the topic of dying is, we must prepare for managing these situations in a collapse situation, and help our loved ones, and ourselves through.   There may be no option to simply call the doctor, funeral home, our pastor or priest, or the ambulance.  Preparing emotionally and spiritually is the vital first step.  Then, we can make the practical preparations.  You’ll want to assemble a comfort in dying kit, much as you would assemble a childbirth or first aid kit.  Here are some steps:

1. If possible, collect medications ahead to assist with pain and anxiety such as liquid morphine and ativan, and learn how to use them safely.
2. Constipation can increase pain and overall discomfort. Make sure you have laxatives, stool softeners and enema supplies.
3. Adult diapers or continence supplies can be comforting to both the dying person and caretakers.
4. Lotions for skin dryness, and lip balms
5. Small mouth sponges for comfort during dehydration
6. Include pads for beds such as Chux
7. Sometimes in the dying process the body’s ability to clot blood is impaired, leading to bleeding through the mouth, nose, rectum and skin.  This can be very distressing to both patient and caretakers.  Having dark colored sheets and towels set aside in your kit can help.
8. Nitrile gloves, N95 masks and eye protection in the event that the illness is contagious.

Preparing to care for the caretaker

Walking with someone through the dying process, as hard as it is, can also be a powerful, deep, and rewarding experience.  It is truly a privilege to help someone through the passage of death and into their new lives, free from their weary physical bodies.   Grief can be like a tsunami, running us over and we feel as though we will drown in our sorrows.  Helping someone we love in practical ways, praying with them, and holding their hands gives us strength as well.  How do we try to get ready for this experience and get through it?

1. Grow strong in your faith.  Pray, read scripture, recall God’s promises
2. Take breaks. You cannot help someone else over the long haul if you exhaust yourself.  Arrange for practical care in shifts.
3. Don’t forget to eat
4. If you can’t sleep, try to rest
5. Share your own sorrow with others and reach out for help
6. Gather your own resources in terms of Bibles, prayer books, and other things which comfort you.
7. Don’t keep children away, but do explain to them what is happening at a level of their understanding.  Children are comforted by being included and made useful, such as fetching things.  Children become anxious when they are not told anything and often their worries about what is going on are worse than the truth. 

What Happens in the Dying Process and How to Support the Dying

A very wise teacher once told me that the dying need two things, comfort and company.  They also need honesty.  It will become obvious to them and to you that they will die from their illness or injury.  Pretending is easier, but it also denies them the dignity of acknowledging their time is short.  It keeps the dying from being able to talk about their own fears, make their own plans, talk openly with their loved ones, and reconcile with God and old enemies.  Follow their lead as they come to their own recognition of mortality, but try to be brave and allow the hard conversations to happen.

In the natural process of dying by illness or disease, there are some consistent signs and symptoms which can be recognized.  To use a natural pregnancy as our example, the mother and her doctor or midwife may be aware that labor is going to start soon even if they don’t know exactly when.  They may note symptoms such as increased Braxton Hicks contractions, an extra burst of energy, loss of the cervical mucus plug, change in the position of the baby etc.  Likewise, there are signs and symptoms that someone is in the process of dying, even if it’s not known exactly how long that will take or how soon it will happen. 

Early Stage Changes and Symptoms

Decreased appetite or no appetite.  This is the body’s way of gradually shutting down systems.  In certain cancers, blockages of the stomach or intestines can cause pain and discomfort during eating and avoiding intake helps with comfort.
What to Do
Don’t force food, but allow the person to choose their own intake
Experiment with textures, sometimes liquid or very soft food is more easily tolerated

Even if the person refuses food and water, they may welcome a small sponge soaked in water to moisten their mouth and a balm to keep lips from becoming uncomfortably dry.

Increased fatigue and weakness and increased in sleeping.  Some of this may be connected with decreasing intake, but some may be related to decreasing oxygenation and failing organ systems.
What to Do
Allow the person to rest and sleep as they need to. Don’t attempt to wake them up or stimulate them to stay awake.

Assume the person can still hear you, even if they appear to be sleeping.  Speak gently and softly to let them know you are there and what you are doing e.g. changing bed linens.

Withdrawal from others and from usual activities and interests.  It is normal for the dying to begin a process of being more internally focused.  This does not mean they don’t care for you or necessarily want you to go away.
What To Do
Follow the lead of the person in determining whom they want to have around.

Decrease the stimulation in the room e.g. keep the noise down and avoid too many persons in the room at once.

Loss of bowel and bladder control.  As the muscles begin to loosen and relax, a person may not be able to avoid accidents.  The decreased appetite experienced by many may decrease bowel and urine output. 

What To Do
Keep the person as comfortable as possible, changing out soiled or wet garments and bedding.

A pad under the person may keep the bedding cleaner.

Try to take a matter-of-fact attitude with the person, who may be embarrassed or feel humiliated by this loss of function and independence.

Itching.  This may happen as a result of kidney failure, or with dehydration

What To Do
Lotions may relieve itching briefly
Benadryl may offer some relief.

Increased pain.  As some disease processes progress, pain will increase at the same time as the person’s capacity to manage may decrease.

What To Do
You’ll want to try to anticipate ways to help with pain ahead of time by stockpiling medications if possible.

Explore methods such as gentle massage, warm and cold compresses, and position changes.

Late Stage Changes and Symptoms

Mental confusion.  This may be related to decreased oxygenation of the brain, or to changes in the brain itself e.g. with metastases of cancers to the brain.  Fevers with infections may lead to delirium and hallucinations.  People who are confined to one room may become confused when they lose track of routines to mark times/days.  This symptom, known as “sundowning” can become worse in the evening.

What To Do

Keep the shades or curtains open so that the person can tell if it is day or night.  This helps keep them oriented.

Gently orient the person when you enter the room, telling them who you are and where they are.

Some may talk of seeing and hearing long departed loved ones, or angels, or may see things you aren’t able to see.  Don’t try to argue with them or convince them they’re wrong.  Simply listen.

Even if they seem asleep, assume they can hear you.  They may enjoy hearing scripture read or passages from favorite books..  Pray with them.

If the person becomes agitated, don’t restrain them or try to reason with them.  Simply continue to quietly and gently respond with reassurance.

Towards the end of the dying process, some individuals seem to have a burst of clarity, become brighter and engaged with others, are able to say goodbyes.  This period may last a short time or for a day or two.

Swelling of extremities such as feet and ankles.  This may be caused by the kidneys failing or lack of circulation.  There is little to do and this is generally not uncomfortable.

Labored breathing and gurgling sounds during breathing. Breathing may become very fast or shallow.  Breathing may stop for a few seconds to minutes, only to have the person suddenly take a large gasping breath. This may be very distressing to others but usually does not mean that the person is in distress or is uncomfortable.

What to Do
Allow secretions to come out of the mouth, wiping them gently.

Suctioning secretions (assuming this would be available) can sometimes increase the secretions and isn’t recommended.

Coolness in fingers and toes, mottled bluish coloration.  This means the circulatory and respiratory systems are shutting down.

How Do You Know When A Person Has Died:

1. No breath or pulse able to be detected
2. Pupils dilated
3. Jaw may be relaxed and mouth slightly open
4. Bowel and bladder release
5. Skin is cool to the touch and pale to bluish in color.

Before burial (if this is possible for you in a TEOTWAWKI situation), wash and dress or wrap the body.  Coffins will be a luxury in many situations but bodies may be buried without one.  The public health implications of where you locate your cemetery is a whole other article, but obviously beware of contaminating water sources and bury the dead deep enough to discourage animals from digging.

May God give us the strength to manage these hard and sad tasks with His grace and love. 

As a formerly disabled person I would like to share some ideas to help make survival more likely or at least less treacherous:

 * Keep a heavy duty luggage cart for bug out bags. They are versatile and can be used for many other things like hauling water. Wheeled backpacks with roller blade wheels will not be as durable and versatile.

*  Adult tricycle bikes are quite stable can help many get around easier and quicker while carrying some supplies too. These can be used by others as well to carry water and heavier supplies.
   
*  Foot-care should be top priority. If you are caring for someone who is elderly or diabetic check there feet often and make sure to keep moleskin, extra soft socks and that they own a pair of quality sneakers that are comfortable.

*  Meal replacement shakes That have a minimum of 19 grams of protein per serving, contain a minimum 25% of RDA on Vitamins and minerals per serving. Higher calories are better and low in sugar. Ideally you want something that only needs to be mixed with water or you can also add powdered milk.

   These can be used by everyone but will be especially handy for the elderly & sick.

*  For those dealing with incontinence it will not always be practical to stock up on or carry the required amount of supplies needed but the following items can help:

        Male external catheters (available online)
        Female urination devices like GOGIRL
        Plastic moisture barrier underwear
        Reusable (washable) incontinence pads & briefs for both men & women       
        Gentle laxatives
        Baby wipes & washcloths

 *   USB memory stick containing medical records

 *  10 parameter reagent test strips- an easy urine strip test that tests glucose, bilirubin, ketone, specific gravity, blood, pH, protein, urobilinogen nitrite, and leukocytes. They are inexpensive--only about $13 for 100  test strips and should be included in everyone's emergency kits.

*  Back pain- Mueller adjustable lumbar back brace, Biofreeze or Salonpas, extra Ibuprofen or Aleve
    Knee pain- Patella tendon strap or full knee brace, Biofreeze or Salonpas , extra Ibuprofen or Aleve
   Neck pain- Inflatable neck pillow, Caldera relief neck rest, Biofreeze or Salonpas , extra Ibuprofen or Aleve

    You can also learn acupressure using your fingers or a knob like device
    Robin Mckenzie has written two very popular books on the subject titled Treat Your Own Back and Treat Your Own Neck

*  Book Recommendation: Where There Is No Doctor: A Village Health Care Handbook by David Werner

*  Heart rate monitors for exercise. These can be used to monitor those with heart conditions and make sure that they
   take a break or practice calming exercises when needed. Some of these have custom alarms that will beep when your heart rate
   goes to high or too low.

*  Diabetic supplies may run out Cinnamon bark capsules, Fenugreek seeds or tea, and chromium polynicotinate
   can be used as a last resort. Cinnamon will also be pretty easy to come by and can be easily put into foods, drinks or
   emptied capsules.

Regards, - Tricia, Illinois

In the introduction to this series of article I gave a brief outline of the medical skills that a layman should acquire when preparing for TEOTWAWKI.  One of the most needed skills is suturing and other forms of wound closure. 

Lacerations are frightening, especially to young children.  One’s sense of wholeness is violated, often out of proportion to the actual injury.  Even adults view minor cuts as emergencies, when the truth is, most would heal (though perhaps with more scarring) with little intervention beyond cleansing and bandaging.  Pain and fear may cause as much discomfort as the actual wound.
The primary goal of intervention is to speed healing with a good cosmetic outcome.  Healing is accelerated when the wound edges are in contact with each other and infection is prevented.  That’s just about all that suturing does.  The God-given wound repair mechanism is what really heals the body.  The secondary goal of treatment, which is often equally important, is instilling confidence in the patient that he or she will be fine.  The ability to provide gentle, professional wound closure earns the skilled caregiver a great deal of respect in the injured party’s eyes.

The most common lacerations patients experience are relatively superficial.  In my work in urgent care I rarely encountered an injury that required complex closure techniques, though deep lacerations certainly do occur.  The incidence of minor to major lacerations is at least 100:1, likely much higher.  By minor, I mean no deeper than through the skin and subcutaneous tissue, not penetrating to muscle, tendon, or internal organs, and not involving the eyes or other special organs.  Therefore, learning how to suture a standard laceration is the place to start. 

Before discussing suturing I’d like to stress that other wound closure techniques are often quicker and may give equally good results.  When the edges of the wound are practically touching each other, with no tension to stretch them apart, taping is an excellent choice.  When speed is of the essence, taping or stapling is often the best option.  Several staples can be placed in the time it takes to numb a wound – and hurt little if any more than an injection of anesthetic.  Anyone who doubts this should purchase a surgical stapler and try it out personally (I have). 

Both surgical staplers and suture material are available online without a prescription, though the quality is often not equal to professional equipment.  Don’t bother with the super-cheap stuff except perhaps to practice – it will certainly be inferior for human use.  Outdated veterinary sutures are fine for knot-tying or practice on a chicken breast, but at least the ones I’ve purchased have dull needles.  (More on this in the next article.)  If you are going to practice suturing, needle choice is paramount.  Sewing needles have tapering points, which actually do not penetrate the skin well.  Surgical needles have tiny knife points, labeled cutting or reverse cutting.  A tapered point is fine for practice on foam, fabric, or perhaps a chicken breast, but requires too much pressure for penetration when used on actual skin.  Practicing on a pig’s foot will yield a simulation more comparable to suturing human skin than does chicken skin or foam.  They don’t stay fresh long, though, so be sure to refrigerate your practice pig’s feet and use them within a few days of purchase. They also freeze well, and after practice you can cook them up for your dogs if desired (but beware of the distinctive smell). 

To date the best sutures I find online available to the layman are the brand Unify.  The 4-0 size is appropriate for most lacerations; 3-0 works well for larger or deeper injuries, whereas the 5-0 is good for facial lacerations or the tender skin of children.  A suture length of 18” is generally sufficient, and easier to work with than the 30” material.  The silk suture is easier to tie so that knots slip less easily, but nylon slides through the skin easier, causing less trauma when positioning knots or removing stitches.  As a single filament, nylon also produces less wicking action and therefore less likelihood of infection.
If you do not or cannot obtain surgical suture, purchase nylon or silk thread from your local sewing supply store.  Prior to use you can dip it in alcohol to sterilize. 
Before suturing a wound you must make sure it is clean.  Clean is a relative term – no wound is completely clean, and some are assumed contaminated whether they look clean or not, especially human and animal bites.  Human bites and cat bites will get infected nearly 100% of the time and so should not be sutured.  Dog bites generally should not be sutured, either.  Closing a dirty wound provides a cesspool for bacterial growth – i.e., a warm, moist, dark environment with foreign bodies (sutures) that bacteria can cling to.  Cuts inflicted by sharp objects (knives, razors, wire) can usually be rinsed clean with soapy water and sutured (as long as no rust is present).  Any wound where infection is suspected should not be sutured.

After the wound is cleaned, establish a sterile field for your sterile instruments, or at least a clean field so your suture is not dragging over dirty clothes or adjacent skin.  If you don’t have a sterile field, at least use a clean towel to cover any contaminated areas.  I’ve never used aluminum foil, but I think it would be a good option, or possibly plastic wrap or even wax paper.  Paper that tears when moistened would be less than ideal. 
The topic of anesthesia for suturing will be covered in a separate article, but for now I’ll just mention that it certainly is possible to suture without numbing, especially an adult patient.
Once the patient is prepared, establish a work area so that you can work in a relaxed, comfortable position at a comfortable angle.  You may need to move your chair or the patient’s orientation.  If you try to suture while leaning over the patient you will certainly regret it part-way through as your neck or back begin to ache or your hands begin to tremble (as most doctors know from experience.  Please learn from our mistakes.)
The goal of suturing is to bring the edges of the wound together clear down to the depth of the wound, with no gaps in between where the wound can separate.  The depth of the wound determines proper needle size as well as suture width and spacing.  Specifically, the radius (R) of the curved needle should equal the depth of the wound, which is also the distance the suture should be placed from each edge, as well as how far apart the sutures should be spaced.  Half this distance (R/2) is a good spacing to place the first stitch from the end of the laceration.  As you’ve cleaned the wound you’ve estimated the depth and decided on the proper size needle and suture.

When suturing, it is best to use a needle holder with smooth edges rather than a hemostat with small teeth or ridges.  The flat edge holds the needle more securely.  When inserting the needle into the skin, grasp the needle holder in your palm (not with your fingers in the finger holes), making sure the needle is directly perpendicular to the skin to enable it to reach the full depth of the wound.  (Beginners usually direct the needle in at an angle rather than directly perpendicular.  Palming the needle holder assures much better control.) 
Each suture should be placed half at a time, that is, start from the right side and have the needle come up in the middle of the wound; then reposition the needle and insert inside the laceration, directing your needle up and out to the opposite side of the wound.  (Left-hand dominant individuals often sew from the opposite direction.)  Proceed from one end of the laceration to the other; usually it is best to start at the point furthest away from the operator and work toward the operator for best visibility.  When the laceration lies well-closed, make sure the knots are positioned all on one side for easier removal and less crusting.  Apply Bacitracin antibiotic ointment (optional) to a sterile (or clean) dressing and cover the wound (as opposed to applying the Bacitracin directly to the wound, which risks contamination of your tube of medication and also may cause discomfort for the patient). 
 
As I write this I realize that a picture is worth a thousand words, and not everyone learns well from text alone.  Doctors don’t suture their first laceration without an experienced physician supervising their work, and preferably neither would you.  If at all possible it would be ideal to receive hands-on training from a medical professional in your area.  Alternatively, I offer this at my own SURVIVAL MEDICINE workshops, as mentioned previously (see www.ArmageddonMedicine.net for upcoming classes). 

In the next article I will expand on the above with SUTURING, PART 2. 

About the Author: Cynthia J. Koelker, MD is SurvivalBlog's Medical Editor, the author of the book Armageddon Medicine, and the editor of www.ArmageddonMedicine.net   

Sir:
A few  years ago I found I had cataracts in both eyes.  Not too bad -- I could still see to drive and shoot -- but enough that open sights became more difficult and oncoming headlights a bit of a problem at night.  Slowly they got worse, until I was 20/80 in my left eye and not much better on the right (shooting!) side.  Like many folks I am reluctant to get treatment until it's absolutely necessary.  I put it off, in part because getting the new flexible lenses cost $2,500 more per eye than insurance would pay.  Finally I realized that sophisticated procedures like this might not always be available.  I decided to get it over with.

I had my left eye done in December.  Within a week I was 20/15 in that eye.  I still use readers for fine work up close, but from arm's length to forever, I have better vision than I have had in years.  The first thing I noticed was how bright the world is.  I had my right eye done yesterday.  I am already seeing better than before the operation, although it will be a few days before we know how much better.  The doctor says there is every reason to expect comparable results, 20/20 or better.

The bottom line is that many of us are probably putting off operations that would improve our quality of life immediately because they are not yet 100% essential.  I suggest that you bite the bullet and take care of them while you still can.  TEOTWAWKI is not the only thing that could soon put these treatments out of reach. - Randy in Maine

The two procedures that make up Field Dentistry are fillings and extractions. Field Dentistry is defined as providing your own dental care when there is no other way; probably due to collapse of our health care system along with the rest of our fragile economy and civilization due to the disastrous economic policies of our “leaders”, a terrorist attack, or some other reason.

Fillings can be easy or complicated depending on the size of the cavity and the surfaces of the tooth that are involved.  Starting with the simplest- a one surface cavity in the chewing surface of the tooth, here is how it can be fixed.  A dental instrument called an excavator is used to remove decayed tooth and any debris that is in the tooth.  The instrument has small spoon shaped ends that have an edge and will remove decay easily, but sound tooth structure is harder and the difference is easily detected after a little experience.  Once the decay is removed, a filling is placed.  This is where the difference in Field Dentistry and office dentistry is pronounced.  In an office under a controlled environment, a composite filling that will last many years can be placed.  This requires the ability to etch, dry the surfaces, place bonding agent, light cure it, place composite, light cure it, and finish it down using the drill to shape it to match the bite of the patient.  These steps are close to impossible to accomplish in the field without electricity.  There are battery powered devices for part of the procedures mentioned, but not for all.  If the cavity is not kept dry during most of the steps, the composite won’t bond and the filling will either come out or leak and get decay around it very soon.

Here is what can be done in Field Dentistry.  The cavity is dried with a cotton pellet.  A Temporary Filling Material (TFM) such as Cavit is placed in the cavity using a Plastic Filling Instrument.  The instrument is made of stainless steel.  It got its name when the first white fillings were called plastic fillings.  The instrument has a paddle shaped end which is used to carry the TFM to the cavity and placed by putting the TFM in by pushing it into the cavity with a simultaneous wiping motion against the edge of the cavity.  The TFM has a consistency before setting similar to toothpaste but a little more viscous.  It is sticky and will stick to the instrument instead of the tooth without the above mentioned technique.  The other end of the Plastic Filling Instrument has a flat condensing end and is used to make sure there are no voids in the material by condensing it into the cavity.  It is also used to shape the TFM to match the original anatomy of the tooth surface.  The margins where TFM and tooth come together are important and should be well adapted because any gaps here will reduce the quality of the filling and shorten its life.  Gaps increase the possibility of recurrent decay.  After the filling is placed, the patient bites and grinds shaping the filling to the patient’s bite so there won’t be any high spots.  After this is accomplished the TFM can be smooth by wetting your gloved finger in the patient’s salvia and rubbing it across the filling.  If you have a cotton swab, it can be wet and used the same way.  The patient should then wait at least an hour before chewing to allow the TFM to harden.  It hardens on exposure to moisture, so drinking liquids is OK, just no chewing.

Though TFM is not made to last nearly as long as composite fillings, its ease of placement and forgiveness of mistakes in placement make it a very good material for Field Dentistry fillings.  It could last about six months, and if small sometimes longer.  Cavities between the teeth are treated in a similar manner in Field Dentistry, but placement of the TFM will be more difficult.  TFM sticks to teeth well when soft, but it doesn’t have much adherence when set, so the shape of the cavity needs to help in retention of the cavity.

The best material for Field Dentistry fillings is a zinc oxide powder eugenol liquid material that sets much harder than TFM.  Directions that come with the kit are followed in measuring and mixing, then the material is placed like TFM.  It sets in a few minutes after mixing, so adjustment to the patient’s bite needs to be accomplished before it sets as much as possible.  Once it sets, if it is high and interferes with the patient’s bite, it must be shaped with an instrument called an Amalgam Carver.  This has a disc shaped end and a sharp pointed spade-shaped end and can be used to carve off any part of the filling that interferes with the patient’s bite.  If the filling is high, it can created worse problems than a cavity, causing excess pressure on the tooth, and also tooth grinding or clenching that creates pain in the TMJs (Temporomandibular Joints) both of which are worse that having a cavity.  THE TMJs are the joints right in front of the ears on both sides.  The zinc oxide-eugenol mix is a little more technique sensitive, so the best Field Dentistry kit will include both it and TFM along with the necessary instruments.

Having the correct materials and instruments and knowing how to use them are critical in effective Field Dentistry.  Dental School takes four years after college, but learning some of the basics is much better than having no idea of what to do when dental care is needed. The instruments mentioned above are stainless steel, the same as I use in my office, and can be autoclaved repeatedly.  A pressure cooker-canner makes a good autoclave. The excavator and amalgam carver can be periodically sharpened using a stone that is used to put a final edge on a knife blade, because like a knife they get dull with use and should be fairly sharp.  An excavator is sharp enough when it will carve off a little bit of fingernail when scraped across the flattest part.

Long after all filling materials are gone, teeth can be extracted when necessary.  We will be back to the level of dentistry of the nineteenth century when teeth were extracted because there was no alternative.  Extracting teeth should not be done with anything except forceps that are made for that purpose.  The shapes of the beaks may look like pliers, but they are different, and the difference is critical.  The forceps are made to grip the tooth as far down on the root as possible to give the best leverage.  Pliers and vise-grips will crush the tooth and break it off most of the time and should not be used unless they are all you have; but be aware of their limitations.

I have been in dental practice for 31 years.  I will have at a minimum for Field Dentistry in my kit the following:  1) Basic Kit for fillings, re-cementing crowns and bridges, and treating some toothaches, 2)Extraction Kit with three forceps, a curette, and an elevator, and 3) a Zinc oxide-eugenol kit for fillings.  These are compact in their roll-up nylon holders and even in a mobile situation on foot they won’t take up much room in my pack or weigh too much to carry with me.

If you have ever had a toothache, you know how important it is to have it treated.  The pain is so intense it interferes with camp security and even regular camp chores.  Don’t neglect Field Dentistry in your preparations.

Instruction on extracting teeth is planned for a future article.

James:
The Problem
Sleep Apnea has been a recent topic in the blog.  My wife and I both use one of “the machines”.  And although it is true many people just simply cannot get use to using them, others like us can no longer get a good nap or full night’s sleep without one.

So, what do we do if some yahoo hits the pole in route to his (with your permission Mr. Rawles) “hid-e-hole in Idaho”. Our choices were to stay up all night waiting for the power to come back on or …. Nothing!  Sleeping without “the machine” is difficult and can be downright dangerous, stroke or heart attack being top on the list of things that can beset you.  

A Solution
We have found a work-around, a way to prepare for the eventuality of a power outage by purchasing a couple of Duracell DPP-600HD Powerpack 600 Jump Starter & Emergency Power Source units. Each unit will supply a couple nights’ sleep with our CPAP machines.  Our decision to buy two units instead of one “humongous” 100 + amp battery was twofold:  1. Portability - the 100 + amp batteries weigh a ton; the Duracell jump packs are very portable giving me the ability to move them around without help and 2. Redundancy - if one of the jump pack units goes south, we still have one unit left. 

The Product
The jump packs are equipped with an AM/FM radio, flashlight, jumper cables, and charge meter, 480 watt power inverter - all supported by a 28ah AGM battery. These mini power stations run both CPAP machines which represent our most important emergency power needs.

Most sleep apnea machines today are DC-powered and are sold with the required AC adapter for normal household use.  Plug in the CPAP manufacturer's [DC-to-DC] car adapter cable -- one end into the jump pack and the other into the CPAP machine -- and you’re in business for the night.  

Charging Scenarios
When the power comes back on, we plug our jump packs into the wall outlet to trickle charge – always read for the next power outage.  The built in charger will not overcharge the battery.  With the built-in jumper cable sockets, it is a simple task to plug in the cables and quickly recharge the batteries from an automobile or truck.

And in consideration of a TEOTWAWKI event we chose to construct a simple, portable solar charging station.  This solar solution includes a couple of good quality 50 watt solar panels, charger/regulator and the necessary wiring and connectors for off the grid charging capabilities.

One last suggestion:  More books Mr. Rawles.  Waiting for your next book is akin to subjecting fans to literary water boarding.  You must write faster!
Regards, - R. in Oregon  

The topic of obstructive sleep apnea and CPAP machines has been mentioned regularly in SurvivalBlog. These references were mostly related to how an alternate power supply could be used to keep CPAP machines functioning. In a TEOTWAWKI situation or lengthy grid down scenario persons suffering from sleep apnea, especially severe sleep apnea would worsen and probably die without an alternative power source or alternative type of treatment.

As a dentist who is a member of the American Academy of Dental Sleep Medicine and treating snoring and sleep apnea for almost 15 years I thought I would give the members some insight into the condition, its possible treatments and implications for long-term survival particularly in TEOTWAWKI. One of the recent blogs referred to a web site. If anything I say sounds similar to information on that site is because the developer is my dear friend, personal mentor and one of the foremost experts in the country.

Snoring
Snoring is the focus of humor in countless movies, jokes, videos and family stories. There are people whose snoring has decibel levels as loud as a steam locomotive. My own father could bring down the house, not just with his singing or jokes, but unfortunately with his snoring. Over the years he had developed severe obstructive sleep apnea. He was also the first sleep apnea patient that I treated.
All joking aside, snoring is no laughing matter. It’s the reason for many lost hours of sleep for bed partners, husbands and wives having separate bedrooms and sometimes even divorce.

What is Snoring?
Snoring is the sign of a breathing problem, in other words a blockage in your airway. The sound is typically caused by the tongue falling toward the back of your palate and throat. As your airway constricts it creates a negative pressure or pulling on your soft palate. This creates a vibration and sound like a reeded instrument, although much more annoying! If you snore loudly and often, you know the social implications of your problem. It’s bad enough when your spouse can’t sleep in the same room with you, but when your travel companions schedule a separate room because they can’t get a decent night’s sleep, it may be time for you to do something about it.

Even if you have become accustomed to sharp pain in your ribs at night (your spouse’s elbow), a lot of bad jokes, snoring is as serious as a heart attack or even worse a stroke. It is a signal that something is wrong with your breathing during sleep. It means that the airway is not fully open and the bad tunes you are playing could kill you. According to recent sleep studies, approximately 45% of the general population, 30% of men and women over age 30, 40% of the middle-aged population, and 6% of children snore on a regular basis. Studies show that 45% of normal adults snore at least occasionally, and 25 percent are habitual snorers. Sadly, these statistics are on the rise with rising obesity approaching epidemic proportions.

Problem snoring is more frequent in males and overweight persons. It usually grows worse with age. Although obesity is a major factor for snoring and sleep apnea people that are “as thin as a rail" can have these issues. Generally these are people that have narrow jaws, tall (high) palates and or deep bites and are more prone to having or developing airway issues.

Is Snoring Dangerous?
During the days of the Wild West a famous gunslinger shot a man in the same hotel for snoring too loudly. Ouch! It has also been shown that of males over the age of 45 almost 50% have some form of sleep apnea.  An Australian study found that the prevalence of blockage of the carotid artery (which can lead to strokes) was 20% for mild, 32% for moderate and 64% for heavy snorers. According to the Journal of American Medical Association (JAMA), snorers have three times as many motor vehicle accidents as non-snorers..

 According to the experts at www.ihatecpap.com, snoring can be a strong indicator of the condition known as sleep apnea. Sleep apnea patients that snore are actually lucky that the condition manifests vocally, so the condition can be treated early, before it becomes life threatening. Partners with concerns are often the ones to bring this problem to light and ask the snorer to seek sleep disorder/sleep apnea treatment. Because of the intermittent periods of stopped breathing, patients do not get the amount of oxygen needed and health risks are increased. Recent studies have led many leading clinicians to state that they believe that snoring will lead to sleep apnea 100% of the time. Sleep apnea has been linked to cases of heart attack, stroke, hypertension, high blood pressure and other dangerous conditions. If you notice heavy snoring in your loved one, ask him or her to see a sleep apnea professional.

According to a Mayo Clinic sleep study, it is estimated that snorers cause their partners to lose an average of about an hour of sleep each night. For the average American that is almost 20% of your night’s sleep. Even if sleep apnea is not indicated, the disruption of the sleep cycles of family members can create a hazard. Bed partners of snorers also reports high levels of fatigue, sleepiness and possibly even hearing loss. Recent studies have indicated that repeated disruption of sleep patterns can cause sufferers to perform motor skills at or below the levels of individuals who are legally intoxicated! So even if your snoring is not a sign of sleep apnea, it is likely that your snoring could be a real threat to your loved ones because impaired reaction behind the wheel of an automobile can lead to disaster regardless of the cause. The whole family can suffer when any family member has a sleep problem.

What is Sleep Apnea?
Apnea is a Greek word that means shortness of breath. An apnea episode is the absence of breath for 10 seconds or more repeatedly during the normal seven hour sleep cycle. During an apnea event, the oxygen level in a person's blood drops(while the carbon dioxide increases), the blood becomes" thicker" and more difficult for the heart to pump throughout the body. This puts a strain on the heart (which can show signs of enlargement) as well as the entire cardiovascular system. Coughing or choking sensations, which force you to wake up or get elbowed by your partner, are also common signs. Untreated sleep apnea (OSA) increases the risk of heart attack and stroke, shortens life, and diminishes your quality of life.
What are the common signs of Snoring and Apnea?
Sleep apnea can reveal its presence in a number of ways, and each patient may have a unique combination of symptoms. If you or a loved one experiences any of the following recurring symptoms, please speak with your family physician or a dentist that has experience with treating OSA.

• Excessive daytime sleepiness
• Morning headaches/migraines (may also signify a jaw joint problem known as TMJ/TMD).
• Short term memory problems
• Altered human growth hormone secretion at night contributes to decreased metabolism leading to weight gain and difficulty in weight loss
• Tiredness
• Dosing off in front of the television
• Gastric reflux(GERD)
• Dry mouth
• Sore throat
• Slow metabolism
• Inability to lose weight
• High blood pressure
• Diabetes
• Depression
• Severe Anxiety
• Memory and concentration difficulties
• ADD and ADHD symptoms
• Intellectual deterioration
• Mood swings/temperamental behavior
• Poor job performance or problems in school
• Mouth breathing
• Restlessness and tossing and turning during sleep
• Impotence
• Decreased sex drive
• Difficult nose breathing
• Sudden shortness of breath, choking or gasping sensation that wakes you up
• Insomnia
• Inability to sleep through the night
• Heavy snoring (more common in patients with obstructive sleep apnea, rather than central sleep apnea)

Pediatric Apnea

Chronic breathing problems during a child’s sleep have been shown to affect children’s physical, intellectual and emotional growth. Heavy snoring in children may be a sign of pediatric apnea. Pediatric apnea causes children to have paused breathing events during sleep and can be dangerous if left untreated. Children with untreated apnea may experience daytime sleepiness, or signs of ADD/ADHD such as lack of concentration and mental capacity, trouble in school, and hyperactivity. A thorough ear, nose, and throat exam are a priority. Any asthma and allergy concerns need to be diagnosed and controlled. Often a tonsillectomy and adenoidectomy may be needed to eliminate airflow obstructions.

Apnea and Childhood Development
Visit the web pages from sleep apnea dentist Dr. Brian Palmer. He has given international, national and state presentations on the importance of breastfeeding for the proper development of the oral cavity, airway and facial form; infant caries; why tight frenulums need to be addressed; the signs and symptoms, cause and prevention, and treatment of snoring and obstructive sleep apnea; and basics of dentistry not taught in dental schools.

Sleep Apnea & Snoring Treatment

I will briefly list some of the treatments for sleep apnea, but will focus mainly on the most TEOTWAWKI pertinent answers.
First and foremost, your physician or dentist will examine your living habits and make recommendations for behavioral therapy, such as avoidance of alcohol or sedatives, or sleep positioning devices. Use of pillows to alter your nighttime breathing habits may also be suggested. Your sleep physician and dentist with appropriate training in sleep apnea will help you decide which dental sleep medicine treatment or combination of treatments will work best for you.

Depending on each patient's diagnosis, sleep apnea treatment may be as simple as a lifestyle change such as weight loss or change in diet. Other patients may benefit from the help of a specially designed oral appliance, which prevents airway blockage. Some more severe cases of apnea may require surgical intervention to prevent upper airway obstruction. Jaw surgery, tongue surgery, palatal implants and removal of the soft palate (UPPP, LAUPP,) are among these techniques. Some work well (jaw surgery) and others not well at all (UPPP, LAUPP). 

Nasal Vents
ProVents are a new as a treatment option. The results from the initial studies are promising. They do have a significant impact on lowering the number of apnea events a patient experiences, but they are not adjustable. Any one that is prescribed these by the doctor should insist on a full night sleep study while wearing them to verify that they are working sufficiently. Just because you feel better after sleeping with them doesn’t mean you are getting the best results possible.

CPAP
Mechanical therapy in the form of a mechanical device called a CPAP, or Continuous Positive Airway Pressure, uses a mask with an air blower to force air through the patient's upper airway, assuring constant inhalation of adequate amounts of oxygen. are positive air pressure machines with various types of masks and hoses designed to force air past the main obstruction in the airway which in the vast majority of patients is the tongue. It inflates the airway like a balloon and hose.

CPAP has been considered " the gold standard" of OSA treatment for many years and is incredibly effective for alleviating symptoms, avoiding the health risks discussed earlier and achieving a restful sleep. These benefits can only be realized when the CPAP is actually worn and worn for the fully prescribed amount of time. Sadly, study shows that 2/3 to 3/4 of people given a CPAP cannot tolerate full compliance. The list of problems encountered by CPAP users is lengthy. Many of these can be overcome, but the ones most pertinent to us on this blog are loss of power and portability.

Alternate power sources can definitely be one solution when these are available and when OSA patients want to use them. The majority of OSA patients who cannot tolerate the CPAP or want a non-powered solution and oral appliance should be considered.

As Seen on TV
You’ve probably seen dental appliances advertised on television that claim to handle your snoring problem. These have a few problems. If you snore but have not been tested for apnea and you wear one of these devices you may not snore, but if you have sleep apnea it is still killing you. If you have been diagnosed with OSA these devices are not being adjusted (titrated) for optimal effect and they are not FDA approved to treat OSA. The principle is the same, but as they say: " the devil is in the details".

Dental Appliances
There are dozens of these devices with varying designs, patents and trade names, but they all work on the same principle, basically they move the lower jaw forward in order to open your airway. Since your tongue is attached to your lower jaw basically behind your chin, moving the jaw forward (mandibular advancement) moves his tongue forward, opens the airway front to back, as well as side to side and prevents the tongue from falling to the back of the throat.

The best devices are custom fit and extremely adjustable so that your airway is opened enough to drastically reduce the number of apneic events and ideally eliminate snoring. This adjustment or titration is done in close collaboration between you, the dentist and the sleep physician. When looking for a dentist, be sure they are a member of the American Academy of Dental Sleep Medicine and ideally one who is a diplomate of that academy. Unfortunately, over the years I have seen dentists treat patients for snoring without knowing whether the patients have obstructive sleep apnea and use devices that are not approved to treat OSA. I've also seen lack of knowledge and follow-up with patients both of which are extremely important for optimizing treatment and avoiding unwanted side effects.

Some physicians shy away from this treatment, but quite honestly in my opinion this is due to what they are taught or not taught in medical school. There is a great deal of research that shows the effectiveness of these" low-tech" devices in treating mild, moderate and even severe sleep apnea. As preppers and survivalists you should appreciate that they are generally very durable, relatively inexpensive and could be repaired without a lot of sophisticated equipment. They are easily cared for and stowable in a tac bag, glove compartment, briefcase and purse or bug out bag. I would suggest speaking to your dentist about making several appliances . . . for a discount (or barter) of course. Remember: one is none and two is one.

One point that I would like to emphasize is that it is extremely important for you or your loved ones to be evaluated and treated regardless of whether a TEOTWAWKI situation ever occurs. This is a life-threatening condition is often ignored or minimized. It is a silent or not so silent killer. For those of you that are trying to maximize your health and your families health as a part of preparedness is crucial to consider seeking treatment. Everyone will sleep and function much better.

For more information on snoring, obstructive sleep apnea and treatment you can visit www.ihateCPAP.com and www.aadsm.org.

JWR,
In his recent SurvivalBlog article, Don H. incorrectly stated that alcohol will not kill MRSA or Staph.  I want to set the record straight on this, as working with bacteria is my career.  Any bacteria that does not form spores will be contact-killed by a 70% Isopropanol (or other alcohol) treatment.  This includes MRSA (and other staph bacteria, as MRSA is Methycillin Resistant Staphylococcus Aureus). 

The only commonly encountered bacteria that will certainly not be killed with alcohol are Clostridium species (the source of botulism [C. botulinum] and gas gangrene [C. perfringens] and Mycobacterium species [M. tuberculosis].  C. difficile is another Clostridium species that infects humans, but in a situation where antibiotics are unavailable, C difficile (C. diff) will most likely never appear.  Being an opportunistic pathogen, it can only infect patients that have had their intestinal flora (gut bacteria) wiped out by rounds of antibiotics.  

Until a collapse occurs, I suggest hospital patients and their family members rip into staff that use only the alcohol foam instead of washing their hands before working with a patient.  Most of these infections are spread by lazy hospital workers who don't wash up between patients. - J.R.M.

We are now entering what I call the Red Zone. Society as we know it is like a high performance race car. It  has many moving parts and some of them are very delicate. Right now that race car is in the red. The RPMs are being pushed to their max and it's just a matter of time before something has to give or break. The greedy are the ones that are pushing the pedal and they show no signs of slowing down. The incident that just happened in Greece is like the check engine light coming on. Instead of stopping and fixing the problem, the greedy just keep going.

Every society since the start of mankind has collapsed, ours is no different. It's not a matter of if just a matter of when. From the looks of things, that when is not too far off. We are in a downward spiral and it is getting faster and deeper. Some say that we are past the point of no return, I hope they are wrong. If we are past the point of no return you better have your Three Bs ready: Bullets, Beans, and Band-Aids. In this essay I'm just going to address a few things about those three. I'm not going to elaborate in detail, as there are plenty of articles on the given subject,  but merely my 2 cents worth.

Bullets

Mr. Rawles has stated that guns are like tools, there is no one perfect gun. Just like there is no one perfect tool. You need a specific tool for each given task.So I'm not going to use a folding ruler to hammer a nail down and I'm not going to use a hammer to screw in a flat head. Guns are the same way, I'm not going to use a .50 BMG to go rabbit hunting, just like I'm not going to use a .22 to go moose hunting.

This question has been asked many times, if you had to pick one and only one gun in a bug out situation what would it be? My answer would be the AK-47. In a WTSHTF situation the primary purpose of the gun is to protect yourself and your loved ones. The secondary purpose is to kill game to provide food. You can have all the resources in the world but if you have no means of protection then sooner or later someone will come and take them by force, both your resources and your loved ones. Don't let that happen!

So why the AK-47? A buddy of mine, Jason H., said it best: "The d%*n thing is nearly indestructible. It's good for 200-300 yards out and how many people can even make that shot under stress? There is a reason that over 75 million of them have been made and there is a reason that they have been used in every war since they were made."

The AK-47 has a reputation of being "the bad guys gun." The gun itself is not bad it's the person behind the trigger. Most westerners have been brainwashed with this concept via Hollywood. The bottom line is that it works. In most other countries the AK is a symbol of freedom. When your life is on the line, would you trust a gun that has been around for over 60 years and is tried and true or some concept gun that has been around for a few years?

So, once, again why the AK? It is low maintenance, reliable, affordable,  can be field stripped and reassembled quickly with no tools and you can literally put, a thousand rounds through it before cleaning. Though, I don't recommend this, it can be done. Some other guns jam after 100 rounds in dirty field conditions. You can drown it, drag it through mud, bury it in sand and even run it over and it will still work.

If for some reason, one can not obtain an AK-47. Your next best bet would be an SKS (Simonov carbine.) There are many similarities between the two-the main one is ruggedness. The SKS has two main shortcomings. First, they come stock with a fixed magazine, this can be remedied by TAPCO's semi-detachable [20 round] magazines. Secondly, they have been know to slam fire. Inherently any automatic or semi-auto has the potential to slam fire. However, the SKS is known for this. Why? Because the firing pin stops itself on the cartridge base itself [and the firing pin is free-floating, without a spring]. The ammo with "soft" primers that is most commonly used today is sensitive to light strikes from the firing pin. The most common cause for the slam fire is not cleaning the cosmoline off the rifle. If you fire several hundred rounds through an SKS without cleaning it could also cause a slam fire. A simple remedy for this would be to install a Murray Firing Pin (spring loaded to prevent slam fire).

Mr. Rawles has often said, that just because someone owns a surf board doesn't mean they know how to surf. So where would one look for training on the AK-47? There are tons of books and videos on marksmanship, however, if you can't get yourself in position to take the shot then they are useless. Most tactical guns such as the AK are shot on the move in a combat situation. BTW, I don't like the term, "assault rifle." The AK-47 as well as the SKS were not meant to "assault". Nobody in their right mind ever bought a gun and said, "Man, I can't wait to assault someone with this!" So what would be good material for this particular gun? I would recommend the DVD titled Beyond The Firearm Part II by Sonny Puzikas [, a former Spetsnaz trooper.] It has lots of useful information.

"Anything that is complex is not useful and anything that is useful is simple. This has been my whole life's motto." - Mikhail Kalashnikov

These are words to live by in a WTSHTF situation. There will be times when you do not have time to think only react, such as when the bad guys are almost on your doorstep.

Beans

There are three macronutrients that the human body needs, protein, fat, and carbohydrates.

All are important, but, of these three, in a survival situation the carbohydrates would probably be the most important. The reason being is that the human body is made of between 60-70% water. The word itself carbohydrate has the word hydrate in it. The main fuel of the human brain is sugar (simple carbs). Therefore it only makes sense to stock up on carbohydrates while you still can. They will be hard to come by in harsh cold environments. My personal advice would be rice and plenty of it. It is cheap and you can buy them by the pounds at Costco. Buy the bags and put them in 5 gal. buckets along with dry packets of silica (this will absorb the moisture). Another good item for carbs that last long is oats. For the simple carbs. I would recommend honey, honey in its purest form will last hundreds of years.

The protein and fat you can get from meat. Because the power grid will be down, there will be very few ways to store the meat during summer months. This is where salt and a dehydrator come into play. The old school philosophy was if you don't hunt and kill the game, you don't eat that night. In a WTSHTF situation to hunt would be a waste of time, energy, and effort. You are better off baiting and trapping the game.

There are several methods to trapping-dead falls, snares, cage traps, etc. Of them all the snare takes the least amount of time, energy, and effort, best of all it is cheap and light weight to carry. To set a snare near your bait (such as your garden) can be done quickly. This will eliminate both pests and provide food, you are killing two birds with one stone. They are light weight and quick to set up. Some people argue that a snare is inhumane and in our current society I will agree with that. However, WTSHTF it is more inhumane to let your family starve to death. You bait the game, set up the snare, and check it once a day. If you catch anything you have your protein and fat to feed your family.

Your MREs will only last you a short period of time. The basic premise for humans is that if it crawls flies, walks, swims, or slithers it probably can be eaten.

Remember this Latin proverb: "Aut Agere Aut Mori." ( Either Learn or Die.)

Band-Aids

There are many aspects of this concept that can be perceived, what I'm trying to focus on here is something that a lot of people may have overlooked: antibiotics

Most people have their basic First Aid kit and what not, but what about virus and bacteria?

The first thing that one needs is alcohol...this kills 99% of all bacteria-however, it does not kill staph and MRSA. For this, one needs to stock up on antibacterial soap. I recommend hand soap and dish washing liquid if it does not say antibacterial on it, it's garbage. Right now it's estimated that 30% of the north American population has MRSA and does not even know it, because it can lay dormant in your system for X amount of time.

Of everything since the beginning of human existence, virus and bacteria have killed more of the human population than all other unnatural reasons combined...

The Black Plague is estimated to have killed between 30-60% of Europe's population in the mid-1300s.

Small pox is estimated to have killed 300-500 million between 1914-1977...

The first thing is where to get them without a prescription...the answer is at your local feed store or online. But your not getting human antibiotics you are getting fish antibiotics. Fish and human antibiotics are the same thing. There is no difference. But please note the warning that it is not for human use, it is for your fish.

Obviously, if you don't know what your doing you are going to kill someone. Some good books to get would be:

"The Handbook of Antibiotics"

"Antibiotics Simplified"

"Do-It-Yourself-Medicine: How to Find and Use the Most Effective Antibiotics, Painkillers, Anesthetics and Other Miracle Drugs...Without Costly Doctors Prescriptions or Hospitals"

Which antibiotics should one get? Cephalexin (Keflex) would be the number one-this antibiotic can usually handle the vast majority of infections out there. The next two would be Amoxicillin and Erythromycin, then Sulfamethoxazole. Some others to think about are:

Ampicillin
Ketoconazole
Penicillin
Metronidazole
Tetracycline
Doxycycline

Needless to say the antibiotics should be stored in a cool, dry, dark place. Except for tetracycline, the expiration date that is marked is not the real date but the recommended date. Bear in mind that when they do the testing they are subjecting the drugs to the worst conditions possible, heat, humidity, and direct light. Most drugs are good for 6 months to 1-1/2 years after the expiration date. Some say longer-check out "A Doctor's Thoughts on Antibiotics, Expiration Dates, and TEOTWAWKI, by Dr. Bones in the search bar.

There are many viruses that can easily kill the human race, the Black Plague and Small Pox almost did. In a WTSHTF situation where there are no hospitals and medicine, it quickly becomes a YOYO situation. These are of the viruses that we know of. There are many viruses out there that we haven't even identified much less found a cure for. The nature of any virus is like that of a human-to survive. They do this through mutation and building tolerances to certain drugs and antibiotics. This is how MRSA evolved from the common staph infection.

The current pop culture has adopted the whole zombie apocalypse theme. It is somewhat of an amusing theme. The dead are walking, which of course will never happen. However, consider this for a minute. Some people believe that the demise of the human race will come from a "Doomsday Virus." Biological warfare has been used since before the time of Christ. Do a web search for yourself.  In the movies Quarantine 1 and Quarantine 2 the "zombies" were really living people that contracted a virus that caused aggressive behavior and insanity, that was transmitted through saliva. Much like the rabies virus.

How far-fetched would it be that a biologist somewhere has been working on splicing the rabies virus with say a 24 hour stomach bug to make it fast acting? Don't get me wrong I'm not saying that when society collapses that zombies will be coming after you. What I'm getting at is that there are many viruses out there and some are worse than others.

The rabies virus does exist and in a WTSHTF situation, there will be no hospital to go to if you are bitten by an animal that has rabies. There will be no series of shots to be administered. You will be on your own. That would be a very painful way to die.

To anyone reading this, I love my family and I love my fish. Stock up while you still can on the three Bs.

Sir,
I've found another possible non-power-using answer to CPAP.

Check out this oral device to simulate the chin-lift method of opening the airway used during CPR.

I have no affiliation with the above web site and I currently use CPAP. I just thought the above web site looked like an okay starting point for information and research into the subject.

I recently witnessed an accident that gave me great insight into what it means to be prepared for an emergency situation and what it will mean post-TEOTWAWKI, when you cannot dial 9-1-1.  It was important for me to evaluate the situation afterwards and to share the lessons I learned with others.  I have numbered the main lessons that can be learned from my situation and I hope you will find a thing or two that might be helpful to you in the future.  

I was driving from Denver to Vail after work on a Friday this past May.  Less than 10 miles from my destination, in Vail Pass, the weather quickly turned to a damp snow which collected on the highway.  As you drive through Vail Pass you gain thousands of feet in elevation over only several miles and the difference in climate can be drastic.  

I slowed my front-wheel drive 2009 Honda Civic to around 45 mph since I had already put on my summer tires (Lesson #1- Have adequate tires for the terrain or be prepared to drive SLOWLY) .  A white Jeep Grand Cherokee passed me and lost control as we crested a hill which was nearly glare ice.  The driver managed to slow it down a bit so I anticipated they would go into the ditch in the median and come to a stop. But as the vehicle went into the ditch the car did a quick, full roll and I saw a body fly out of the driver’s door (Lesson#2- Always wear a seatbelt and drive with your doors locked!  If a vehicle rolls over, the doors can easily open).  I brought my vehicle to a stop, put on my hazard lights, dialed 9-1-1 and safely crossed the highway.  As I was approaching the Jeep, while giving the 9-1-1 Dispatcher the information, I could see the driver (heavy-set woman, early to mid 30’s) crawling on the ground about 20 feet from where her vehicle landed.  I told her “Ma’am you’re okay, help is coming, please sit down right there.”  She was sobbing, shocked, and hurt but she did as I asked.  

I then looked up to see the back driver’s side door open and a young boy (who I later learned was 8) stepped out.  There were two gashes on his face that were a least 5” long; one laterally across his forehead and another vertically down his left cheek.  You could see pretty far inside the one on the cheek and blood was dripping from both wounds pretty badly.  I have minimal emergency training but a good amount of time spent with young ones so I knew I didn’t want to freak him out any more than he already was.  I bent my knees and got to eye level with him, gave him a smile and a thumbs up and said “Buddy, you’re gonna be ok, everything is going to be fine.  Can you go sit beside your mom there?  I’m gonna get help, everything is okay.”  He immediately stopped crying, stared directly into my eyes like he was hypnotized, and sat down by his mom. I could tell he wanted her to go back to the vehicle.  She stayed there, in hysterics.   (Lesson #3- Don’t freak out the kids.  They’re already scared to death and you might be too, but your face  can’t show it.  That kid probably thought I was some kind of idiot, grinning and giving him a thumbs up, but it worked.)

I walked past the two of them to look in the vehicle and could see through the open door that there were two very small children in the backseat.  Having seen the injuries to the older boy, I had a natural aversion to walking up and looking at the two tiny children still in the vehicle but the Dispatcher asked me to describe the condition of all parties involved in the accident.  (Lesson #4-You might have to see some stuff that you aren’t prepared for.

Some people with military or emergency response backgrounds will already have experience with these types of situation.  I don’t really have much advice to give other than be ready for it and don’t freak out. )
As I looked inside the vehicle I saw two little girls under the age of 4, one still in her car seat, one on a booster seat, both still buckled in.  They were crying but physically unharmed.  At that point I felt truly blessed.  Seeing those two babies moving around, trying to get out of their seatbelts was the best possible scenario, and I had been mentally preparing myself to see the worst.  The injuries to the boy seemed most serious, but not life threatening.  At this point I had given 9-1-1 all the info she needed and she said help was on the way.  I also reached in and shut off the vehicle, which was now lightly smoking/steaming from under the hood.  
My priority was to tend to the boy’s wounds and stop that bleeding.  I had a small First Aid kit in my car that I knew contained some latex gloves and gauze.  I ran back across the highway to retrieve the kit from my trunk. (Lesson #5 - I probably should have brought that kit from my car in the first place, huh?  I had never trained for this situation and had to learn this lesson the hard way.  Unless you are in a profession where you do it on a regular basis, you probably don’t spend much time thinking about having to run into an emergency situation and care for others.  Any one of us might have to be a First Responder in a given situation, so be prepared for it.)

As I returned to the accident with my First Aid kit, other people had started to gather.  One couple had pulled over just as I did but didn’t have much means to help.  At this point, we received some more good fortune.  As I went to unzip my First Aid kit and apply gauze and pressure to the young boy’s wounds, I hear a man behind me say “I’m an EMT, is anyone hurt?”  I was really grateful for this because my training is limited to a First Aid course I took back in college that has since expired.  I then gave him my first aid kit and told him that the boy was the most seriously injured.     

Myself and another young lady at that point told the mother that all of her kids were going to be fine.  I now understand why she had not run back to the vehicle while she was still moving around as I first got there.  You could tell that she had it in her mind that her kids were seriously injured or worse.  (Lesson # 6 - Don’t assume the worst.  I understand this woman was traumatized and injured from being tossed from her vehicle, but her kids were okay.  Despite how awful the situation was, it was a wonderful thing to be able to give her that news.)
Another man arrived on the scene who clearly had some training and he began to take care of the boy with a medical kit he brought with him.  The EMT, myself, and a few others took the two girls from the backseat, wrapped them in whatever clothes we could take off our backs, and moved them into another car to keep them warm.  

As the first ambulance pulled up, I breathed a sigh of relief until it did a U-turn at the median and drove the other direction down the highway.  It stopped less than 300 yards up the road where another accident had occurred. Apparently someone else had called 9-1-1 before I did.  Several more minutes passed until the Vail Fire Department showed up with all of their medical supplies.  I wanted to wait there until help arrived but at this point I was ready to get out of there.  I had done all I could for them and they were now in much more capable hands.  Only after all the action had taken place and I was returning to my vehicle did I get a bit emotional.  

The main lesson (#7) that I took from the situation was to get some training.  Ideally, anyone who is serious about survival should get EMT training, but that requires a good amount of time which most of us do not have.  At the bare minimum, everyone should have First Aid/CPR training and keep it current.  These classes are widely available and inexpensive.  Your local Fire Dept or college will offer these first aid  several times a year.  
If you are part of a survival group, all of your members should have basic First Aid training and someone should be trained as an EMT or better with some serious research into field/survival medicine.  SurvivalBlog has a large section of First Aid/Medical related articles and JWR has several recommendations on survival and field medicine books.  Be sure to pick some up and share them with your group’s Medic. (You do have a group Medic, right?).

Another lesson (#8) to be learned is to always have some sort of emergency kit in your vehicle.  The EMT was helpful, but more helpful because I was able to provide him with some of the tools he needed to care for someone who was injured.  The trunk of my car contains:

• Basic First Aid kit (gauze, bandages, rubbing alcohol, Neosporin, a few small splints, etc...)
• Wool Blanket
• Space Blanket
• Fleece coat
• Gloves
• Road Flares
• Zip ties
• Small tool kit (screwdriver, wrench, sockets, etc.)
• Strike anywhere matches
• Small bag of food (granola bars and a few cans of tuna)

All of these items take up less than 2’x2’ of space in my trunk.  Keep in mind that my kit is tailored to my needs.  Someone who lives in coastal Texas or a desert in Arizona will have different items than someone who travels through the Rocky Mountains of Colorado.

Now last but not least, it is important to put my experience into context.  What I described was how we were able to handle an emergency situation until the cavalry arrived, so to speak.  What if there was no 9-1-1 to call?  What if someone is seriously injured and the buck stops with you?  For most people in the United States, help is only minutes away and we live our lives with a notion of security because of that.  If you are reading this site, you are already acquainted with the notion that someday there may be no emergency services to rely on.  This will require us to have a greater level of training and to take much greater precaution in our day to day lives.  A minor injury today could be life threatening post-TEOTWAWKI.  Please evaluate your level of preparedness and take the steps to get the training and supplies that you need.  I hope my situation serves as an example that anyone could be in any situation at any time.  You don’t need to be a Doctor or an EMT to help someone, but you do need to be prepared. 

Dear Editor:
I suffer sleep disruption and was prescribed apnea treatment. First a CPAP then a BIPAP machine. Neither of those were right for me, so my doctor put me on ProVent nose plugs. These are little disposable stickers with one-way valves, which seal up your nostrils; you can breathe in but are forced to breathe out through your mouth, so you don't get throat blockage.

Not only did they work better for me, but I realized that since they don't use electricity they're great for grid-down situations. Score!

Their downsides are ongoing availability in a TEOTWAWKI situation, dry throat (so I keep water by the bed) and they're not covered by my insurance, so they're very expensive. $60 per month for some stickers!

I discovered that I could re-use them if I washed my nose well (got rid of oils) and dried my nose before applying. I was able to get 2-4 nights per set. But then I wondered what else I could do. I tried taping my nostrils shut with Band-Aids, and it worked! Not as well -- dry throat got slightly worse, and it's not as comfortable -- but I'm still sleeping well through the night.

I clean my whole nose with soap and dry it. Then I gently tape both nostrils shut with one Band-Aid, leaving just a small gap for a little bit of air to pass. I use real Band-Aids, which stick very well; not cheap knock-offs. I use a second Band-Aid across the top of the nose to hold the sides of the first Band-Aid, to keep it from falling off. Then I drink a big glass of water and off to bed.

I'm glad I started with ProVents just to get accustomed to mouth breathing. The starter kit was $20. I can imagine that going cold turkey to Band-Aids would have been too difficult, so I'm glad I started with ProVent. But now I don't need them.

My next change will be to a high-quality swimmer's nose plug. Speedo plugs get good reviews on Amazon, and they're less than $10. I'll get two of them, for two is one and one is none :-)

Maybe your readers with apnea will consider asking their doctor about ProVents. They're not for everyone; my doctor told me if you have congestion you'll find them difficult to tolerate. On the other hand my Band-Aid solution is like having permanent congestion, so maybe they are still an option.

Thanks for what you do, and God bless! - V.C.D.

If society collapses and you’re on your own, what medical skills seem the most essential?  The answer likely depends on your age, health status, and stage in life.  For those of child-bearing years, midwifery skills may be paramount.  For those advanced in age, diagnosis and treatment of chronic disease becomes primary.  For the otherwise young and healthy, treatment of injuries and infection tops the list.
Our current compartmentalized society has deemed that doctors should perform these tasks, though turf wars abound over what nurses, physician assistants, pharmacist, paramedics, and others should legally be permitted to do.  Recent decades have also seen the trend toward home care for I.V. therapy, nebulizer treatments, dialysis, and much more.  The take home lesson is this:  the layman can acquire many skills once considered the purview of health professionals alone.  Thus, the first step in acquiring these skills is believing that you can do so.

The next question is to identify what skills you’d like to acquire.  Though an unknown future presents unknown threats, common injuries and diseases will no doubt persist.  Patients suffering lacerations, infections, sprains, and broken bones fill the ERs.  Infections, diabetes, asthma, pneumonia, chest pain, arthritis, GI disturbances, urinary problems, STDs, and assorted rashes comprise the majority of medical problems.  Learning how to diagnose and treat these problems is a good place to start.

To be more specific, needed skills include the ability to suture, to apply a splint or a cast, to administer an aerosol or needed fluids, to check urine for infection, to identify common rashes, to have a working knowledge of antibiotic usage, and much more.  Such a list is daunting and may dissuade a person from attempting anything – but remember:  doctors take a lifetime learning the practice of medicine.

So pick your favorite topic and start somewhere.  Medical apprenticeships have been the time-honored mode of learning for thousands of years.  Even now a great deal of medical training is accomplished in this fashion, from medical school through specialty fellowships.  “See one, do one, teach one” is the tongue-in-cheek but very real motto among physicians.  An apprenticeship need not be formal.  Find someone who knows more than you do and ask them to teach you.

For those who learn well from books, nearly every resource available to doctors is available to you.  The Internet provides a medical education in itself – just be careful to visit legitimate sites.  YouTube videos are effective tools for learning the basics of many medical procedures.

The Internet is also an excellent starting point to find live training/workshops to expand your medical skills.  I have personally attended Chuck Fenwick’s and Dave Turner’s Operational Medicine Course, and would recommend it to both the layman and allied health professional.  Also, in response to requests from my readers, I offer several live workshops throughout the year as well (see ArmageddonMedicine.net for current learning opportunities), where we cover suturing, splinting, casting, and basic labs, as well as treatment of infection and disease.  For those interested in all aspects of survival training, the July Total Survival Weekend at Stone Garden Farm and Village offers another option, and features one full day of hands-on medical teaching (primarily splinting and casting), one day of outdoor survival skills training with Tom Laskowski of SurvivalSchool.com, and one day of homesteading skills learning with farm owners Jim and Laura Fry.

In future articles in this series I will cover essential skills in detail one at a time, beginning with suturing.

My wife, our children and I live on our family's farm. Our lives are quite unburdened by the daily cares of most folks. We live debt free, have never owned a new car and have never taken a vacation. There's just simply no other place we'd rather be than home.
 
We do have quite a few visitors here, with people stopping by to tour the 19th Century era museum and village we have created, or folks coming to the homesteading classes we teach, or neighbors coming for eggs and honey. But, even with the daily company and the rarity of a dinner eaten alone, our lives are basically stress free, and rather enjoyable.
 
Lately the two of us have been talking about world events and the need for folks to organize in like-minded communities or to acquire 'survival' retreats. But there is something that has puzzled us. As long time readers of SB, we have of course taken notice of the many letters and articles about bug-out-bags and getting out of the cities 'when the time comes'. 
 
Many people seem to think they need to get the just right gear and vehicle in order to leave the cities and go someplace else in the collapse because the cities won't be livable. It seems to us that kind of thinking is a bit backwards. If someone who has spent a life in the city suddenly tries to move to the country in the time of turmoil and confusion, it's the country that will be unlivable. 'Country liv'n' is just so vastly different from city life, that few city folks are likely to be able to make it.
 
The environment is just so 'other'. The sounds, smells, plants, landscapes, the amount and kinds of work, the climate, the skills needed, the challenges, the available foods, types of required clothing, kinds of tools, the things you notice and things you don't notice, the way you use time, your emotional outlook on daily events, are all vastly different. --And that's just a partial list of the things you'll need to adjust, acquire and change in order to be successful in a completely new and different environment. Your B.O.B. may be just right enough to get you through the first few days or even week. But after that, fields are simply not the same as cement. And looking up in a tree is not the same as looking down from a high rise apartment.
 
In talking about this question of 'getting to the country', my wife and I have discovered we actually have somewhat different reasons for moving 'to the country' now, rather that waiting until 5 minutes before the crunch when it may actually already be too late. My thinking runs more to the material side of why move sooner than later. Laura's has much more spiritual reasons to move now.
 
...So, together, we write two letters.
 
During WW2 in the Pacific Theater, Allied troops were island hopping. Very few of the young men had ever been in a tropical environment. The palm trees were different than anything they had ever seen. The weather and wetness was foreign to anything they had experienced. It was just so much hotter and more humid than Brooklyn or Buffalo.
 
The Japanese developed the "trick" of hiding in tree tops and picking off the troops as they walked by, knowing the city boys would never see them. But, the Americans fairly quickly learned to send the country boys through an area first because the country-raised guys knew what to look for. They could spot when a tree, even though a completely new to them species, just didn't look right. Many of them couldn't exactly explain how they were different. Just something about the thickness of the branches, or the color being off slightly, or the shadows were "wrong". City raised boys couldn't see it, but men raised in the woods and fields all their lives just, ...knew. And so they could deal with the enemy snipers before the enemy could deal with them.
 
I had something a little like that happen to me a few years ago. I was driving through a park one day. As I drove I was scanning side to side as I always do. (There have been studies done of how most folks mostly just stare straight ahead as they drive, and never see what is to either side.) I was driving normally, not fast, not slow, just driving and looking. I noticed something wrong about a tree, so I stopped and backed up to take a look. I walked quite far into the woods and discovered a deer head set in a crotch of a maple tree. Someone had been poaching.
 
Later the police asked me how I had spotted the head. I think they were suspicious that I might have put it there while illegally hunting. I tried to explain that from a distance it just wasn't "right". But they just didn't get what I meant. It was outside their experience.
 
A year ago the past winter I was disposing of a pile of papers for one reason or another. I asked a couple of friends if they would burn them on the outdoor burn pile. They dumped the paper, then tried to light it up. They couldn't do it. Too much wind, or something. ....They called me over to relate the problem. I bent down, struck a match, and off and going the fire went. They told me later that I had put my back to the wind to make a wind shelter so the match could take. I didn't even know I had done that. It was just something that a person does naturally without thinking. (At least naturally when you had been building fires all your life.)
 
So what does this have to do with survivalblog? Well, I'm often struck by how many folks spend so much time on collecting bug out bags, but seemingly spend little time in the woods they imagine they'll bug to.
 
Some time ago a writer on SurvivalBlog wrote about the cart and the horse. He suggested that it may very well be more useful to collect now what you need, rather than collecting trade goods in order to be able to try to acquire the needed items later. To me, he was absolutely right. If you are already living your TEOTWAWKI existence as you believe it will be, you won't much need trade goods for getting what you may need. You'll have already gathered the tools of self-sufficiency.
 
The problem is, if you haven't already been living in 'the country' and acquiring the knowledge, skills and goods you'll need, you will be just like those fish out of water soldiers in the Pacific. You'll have a very hard time functioning in a strange environment. You won't know what you need (except by reading someone else's barter list. Viagra! Really?) Simply put, you won't know how to live if you only know a pre-crunch 'walking on cement' life.
 
These are all very practical issues for me. It takes years to be able to unconsciously know where the wind is, to know what it means when birds roost differently than usual, or how old a deer track is. Or just the knowing of, when does a tree look wrong. I want to know the how of things. I want to have, in hand, the things I need to do the job. I want to be fully prepared for TEOTWAWKI before it happens. Not play catch up when it's too late. Prepping a bag is only skin deep to what you'll need. Living the life now, 24 hours, will serve you much better.
 
But my wife goes much deeper than that. She's more,"horse first" than even me. She wants to know the the why of, 'why do you want to know or do'? In her words she writes, ....
 
Why do you want to survive TEOTWAWKI?
 
Why do you want to live as long as you can? What makes living as long as you can seem important to you, so important that you are spending your free time after work, or in the mornings, or in between activities, reading this web site? Do you feel that with more length of time on Earth, you may have a greater opportunity to teach others? Maybe learn more yourself, or perhaps prove to yourself or your God(s) that you can conquer this world, or can take whatever "they" can dish out? Perhaps that will make you feel valued? Certainly most of us will feel that being around to take care of our families is of utmost importance..
 
Or maybe you are just afraid to die?
 
In times as hard and unbelievable as these, we can all get caught up in such questions. Some of them are good ones, the best kind there are. But we ought to be careful to not walk the path of simply how to 'get there". We really need to think beyond the need to survive and really get to the why we want to live.

 
My husband, our two daughters and I are blessed with a decent amount of land on which to live. Many other people also have land somewhere they can go to in need. But the difference between this land and so much of the land of those other people is that we have used our hands, minds, efforts, and desires to manifest an existence as close to perfect as we can imagine. Even, in a lot of ways, greater than we can imagine. We have found and brought home many buildings in order to create a place of self-sufficiency and sustainability (including a sawmill, blacksmith shop, weaving mill, smokehouse, windmills and many more.).
 
We have spent many hours and days hauling in mulches and manure to perfect our many gardens. We dedicate many an hour to perfecting and teaching dozens of classes on indefensible skills such as soap making (including rendering storable lard from fats and making lye from wood ash), cheese making from our goat's milk and creating rugs from scrap fabrics. We grow most of our vegetables, save the seeds and preserve as much as we can through canning, pickling, fermenting, dehydrating and freezing. Most meals include at least one wild edible, and when itches or irritations occur, we reach for our homemade salves.
 
We do all of this, live this life from sleep to waking, until sleep again. But why? Is it because we want to be ready when the time comes? Is it out of fear of being 'cut off ' from outside help?
 
Well, that is certainly in our minds. But none of those reasons are why we dedicate our lives to this. We do it because at any point in existence, whether before the Coming of Christ, or now in the spring of 2012 or after TEOTWAWKI, living sustainably and consciously is the way to create the same peace and common sense in our physical world that is abundant in our mind. Because NOT living in a way that we create everything we need, living in a way where the average man consumes more than he creates, is what got us in this mess in the first place.
 
 For many people there seems to be this big reality 'gap' of what people want to do and how the world has turned out. Because of this many almost SEEK this big apocalyptic event that will perhaps 'jolt' us into living the way that we SHOULD be living right now. But I ask you all, friends, ...what is stopping you from living your dream now?
 
For us, we see the virtues of the old ways of living before technologies and computers took hold. We don't need to wait until the electricity is gone to live as if it doesn't exist now. We choose to relearn that which is now all but lost, but was once so common. We seek to remember all of the lost Prophecy, lost tradition, lost music, lost way of life. And in doing this, "the end of the world as YOU know it", will mean little to us as we know it. That is what our farm and community are about, what the classes are about, and what our gardens are about. Living now, as we know you survivors will try living later. The same path can open for you as well.
 
An important but mostly forgotten Native American Prophecy states that until the average man learns to live with less, Earth will never know peace. Make the simple transition to change.  Do it happily and get excited about it. What better time than 2012? If you don't want a government who feels compelled to wipe the behinds of every citizen, then learn how to make toilet paper and wipe properly.

 
Owning a good plant identification book isn't enough. Cleverly keeping it in your BOB isn't enough. You need to know where to find this precious food and medicine, how to use it, at what time of the year it is available, and if necessary, how to cultivate it.
 
 Living in a self-sufficient mind is not what you do after a disaster. It's what you can do now in everyday life. It's what you can do to respect our planet. And to respect the people and creatures on it, and honor the Creator of such an amazing world. It doesn't take many days of having your hands covered in fertile soil, sitting in a garden and planting individual peas, gathered from vines planted by your hands last season, created from nothing more than soil water and sun to learn the important unchanging cycle of creation. And as a homebirthing mother I will say that nothing can teach the lesson of creation and life as can loving another person so much that you join together in the Holiest of ways to then find yourself heavy with life, and then unburdened one day to see another life, two new eyes never before opened laying next to you in your bed. No government, no hospital, and no medications are necessary to experience these things. 
 
And that, friends, is worth surviving for.
 
This continual circle of creation and destruction, rising, falling, birthing, aging, dying, and birthing again.. This is what we live for. This is why we choose to survive. For the opportunity to witness it, learn from it, and be a part of this mysterious beautiful thing we call life.

Well, obviously my wife's words grow more corn than mine. But I will close by saying, forget the bugging out bags. There's a world waiting for you to discover. You can live in it now. You can learn it now. If you don't, well, it may soon be too late. Because, just like for those 'boys' in the Pacific, it's a whole different world when crunch time comes. And you better have learned what those differences are while you still have time.
 
Jim & Laura Fry in Ohio
 
Note: Jim & Laura are co-teaching a series of three day survival courses with Dr. Cindy Koelker (SurvivalBlog's medical editor) and Tom Laskowski beginning this June and July. Visit www.ArmageddonMedicine.net for more information.

I read the article by “American Dad” titled “Prepping and Unassisted Childbirth”, and I must comment on some of his points.  As a “senior” practicing Physician, and an avid closet “Prepper” since the early 1980s, I have often considered the health consequences of a true SHTF scenario.  Only recently has my Family suddenly decided my preparations are not so “far out there” after all, but it has been a lonely quest these many years.  I long ago gave up trying to convince people to look past and through the media hype and actually “see” what is running the world view.  Either they do or they do not, but all you can really do is try to prepare for your Family, plan to join other like minded persons who may not be your Family, and bring along as many souls as you possibly can manage.  

You may also want to read www.shtfschool.com, where Selco (not his real name) will tell you in graphic detail of what happened to him in a year of SHTF in the Bosnia/Serbia arena concerning “basic” health related issues.  Selco is a Medical Professional, and he will explain how a “scratch” in that setting can kill you, leaving your children orphans.  I have corresponded with him, and what happened during that time left him a markedly “changed man”.  Nothing and I mean nothing can be taken for granted.

Having worked in third world countries, I have experienced first hand the effects of not having the best in medicines and medical expertise.  Certainly people do survive in these circumstances, some quite nicely, but that is often the result of “luck” more than it is anything else.  “Routine” maladies can and do quickly kill a human under these conditions.  It is horrifying and unnerving to witness these deaths and life threatening events knowing with simply the basic rudimentary elements of “modern medicine” available, most could have been prevented.  “Simple” pneumonias, small cuts and abrasions, minor fractures leading to disfigurement, the stench of gangrene, amputations (without decent anesthesia), and death become commonplace.  Remember this mental picture as I continue.

I am fortunate to have attended many hundreds of human births in my long career. Birthing is always a happy, joyous time…until it isn’t.   During my career my professional path has crossed the paths of Obstetricians, Family Practitioners, Mid-wives, Certified Nurse Practitioners, Obstetrical Nurses, Doulas, and “experienced” birthing Mothers.  I will state openly the following belief I hold dear:  It is every individual’s basic right to choose whatever type or degree of care they wish. It is also your obligation to assume the responsibilities associated with those choices.

American Dad laments, “The impersonal way hospital staff treated us; the overactive use of clinical equipment, terms, and technology; the fact that I had to keep briefing incoming personnel on our birth plan (since apparently they didn’t take the time to actually talk to read the copies I had provided, or talk to one another); the fact that they ordered my wife to lay on her back, which made the process excruciatingly slow and painful; the fact that the first thing my baby saw was a doctor dressed in a haz-mat suit; the way they whisked the baby away from mom as if the child were public property; the way they treated me like a useless observer and not the head, protector”. 

This interpretation of the birthing event in “modern” times is certainly different than anything I have experienced.  I shall refrain from lengthy comment concerning exactly “what” a newborn is capable of visually perceiving immediately at birth, but I do know most hospital settings allow one to practice anything the Mother desires as long as the modern techniques of frequent non-invasive fetal monitoring are allowed to proceed unencumbered.  Without a doubt, “fetal continuous monitoring” of the non-invasive variety has lead to a marked decrease in fetal morbidity during the birthing process in the last 20+ years.  Even with these data, most hospitals will forgo continuous fetal monitoring if the Parents insist.  They might, however, ask them to sign a liability waiver and an “against medical advice” waiver.  Those are very reasonable requests.

American Dad’s view of “Vaginal Birth After Caesarian Section” (VBAC) mirrors his obvious disdain of hospitals and their staff.  His comment, “The hospitals sure make a lot of money off of parents’ love for their babies, but they do treat all of the parties as ignorant, blundering, or unwelcome troublemaker” certainly is inflammatory, but neglects the simple fact most “Community Hospitals” are actively closing down their birthing centers.  The reasons are simple and straightforward:  they are losing money keeping them open, and the “liability” costs are too great.

Vaginal Birth After Caesarean (VBAC) deserves a special commentary.  The possible catastrophic events associated with VBAC, although correctly stated as “rare” by “American Dad”, are impossible to predict with certainty, and occur so suddenly, the mother and neonate can easily both be dead in a matter of ten (10) minutes or less.  This requires an entire Operating Team (Obstetrician, Anesthesiologist,OR Nurse, OR Technician, Assistant Surgery Member, and a Large amount of dedicated surgical supplies) be continuously present in the Labor Suite throughout the entire Labor Event of possibly many hours.  This is why VBAC is usually limited to large “University Training Centers” where all this is available.  They are costly and consume an inordinately large number of resources that most VBAC patients do not understand and cannot assume.  Just whom does “American Dad” expect to “cover” these costs?

I doubt “American Dad” would agree to the “costs” of providing all this service on a “just in case” basis at a Community Hospital.  My guess is “American Dad” assumes the “worst case scenario” would never happen to his wife, and if it did, then he would consent to the C-section (“Worst case, we’d have to get another C-section.  Fine.”)  The problem is, in anything other than the scene described above, it is quite probable he would be facing a considerable risk of morbidity and mortality for both his Spouse and his unborn child.  It is doubtful the Surgical Team could be assembled in less than 30 minutes in a Community Hospital.  In “American Dad’s” case add to that time the trip from his home to the hospital.  “American Dad” is, however, willing to assume that risk, which is his and his wife’s choice.  Let us be clear, these are serious considerations.

American Dad agrees an “unassisted childbirth” (UC) would take some “serious training”.  Actually he is over-stating this.  Face it; for many thousands of years, Mothers have given birth quite “naturally” over 90% of the time without much assistance at all.  Simply brace them against a tree in the squatting position, give them a green twig to gnaw on for the pain, stand back, and let “nature” take its course.  It’s that pesky 10% that quickly made it clear “things” could be vastly improved by knowledgeable persons helping with the process.  After all, each new life is a priceless asset to the group, and the magnitude of the loss of a working Mother cannot be quantified in simple terms.

For those of you fellow Preppers kind enough to have stayed the course of this, here are my observations and simple steps to follow in a SHTF situation.

1. Find the best of what you can find to suit the situation you are in concerning Birthing.  If you are in a position and are fortunate enough to have the availability of a trained Obstetric Physician, by all means, use that person.  If not, then find the best “Family” Physician (GP in the old parlance).  Next would be a Nurse Midwife or an Obstetrical Nurse.  Finally, an experienced Mother who has survived several successful births would be better than going it alone.
2. Without the availability of #1, EXPECT SERIOUS LOSSES and morbidity.
3. Do what you can to have a person with “advanced medical training” and experience in your group, or at least have access to that person.
4. In a SHTF scenario, pregnancy cannot be considered “lightly”. Know the risks.
5. Since order is usually eventually restored, plan your pregnancy wisely.

Events happen suddenly and swiftly in the birthing arena.  I seriously doubt “American Dad” or any lay person with no experience could act decisively and quickly enough with most of the common complications.  As “American Dad” correctly states, “Again, this isn’t rocket science.  The techniques aren’t mystical or complicated”, but it isn’t calming and relaxing either.  These situations are tense, messy (blood, amniotic fluid, bodily fluids), and emotionally charged.  It is a “pressure cooker” situation and “time is of the essence”.  You had best know exactly what you are doing.  A mistake here will be costly and unforgettable.

Each year we attend to people in our large western city who have a Home Birthing experience complication.  The people have similar qualities:  They are usually quite intelligent like “American Dad”.  They are well read.  Many are “professionals”, frequently Nurses.  Their “hearts” are in the right “place”.  Common to all I have seen and attended is the fact none thought anything would go wrong, or that they were really at risk of death.  By the time they present to us, their condition is frequently quite critical, costing several days in the hospital. 

As adults, each of these individuals has the capacity to make these choices to take these increased risks.  Shall we even broach the capacity of the unborn child to make the decision to not take these increased risks that are unnecessary without a SHTF event?  When we elect to “go it alone” when going it alone is not necessary, is that a fair choice to make for the unborn child.  It becomes far more serious with these thoughts considered.

“American Dad” has much useful information in his article, but the cavalier attitude he takes toward this subject will not well serve his readers.  There are reasons for how and why Professional Medical Practitioners do the things they do.  It’s not always a remuneration issue.  Frequently it is about common sense and giving you the best available chance to make it through a potentially very dangerous event alive and well.

JWR Replies: Home birth is gaining popularity (United States Home Births Increased 20 Percent from 2004 to 2008), but it is still a relatively low 0.67 percent of United States births. The statistics for planned home births show a very high success rate with "No significant differences were found between planned home and planned hospital birth." But it is important to note that that this data is skewed, because expectant mothers who show any sign of pre-natal difficulties almost always opt for a planned hospital births. Thus, hospitals get all of tough cases, and it is mostly those that expect a "low risk" easy delivery opt for home birth.

One key metric is the transfer rate--the rate at which planned home births transition to emergency hospital births. These are usually precipitated by any signs of fetal distress, such as bleeding, umbilical cord issues, extended labor, or stained waters. (Meconium in the amniotic fluid.) Early transfer is a wise course of action. In the U.S., the transfer rate averages around 16%. In Sweden, the transfer rate is only between 6 and 12%. In some First World countries, midwives are required by law to order a transfer if labor goes beyond a set number of hours. But it is noteworthy that some of these transfers are not due to fetal distress, but simply because a midwife was called too early and becomes exhausted. (Midwives often work alone, and they cannot be expected to function well after 12 hours at a delivery home.)

For what it's worth, three of our children were born at home, with plenty of prior planning.

I do recommend home birth for most moms. If nothing else, this experience provides crucial knowledge and experience for the potentially dark days ahead, when home birth might be their only option.

Sir:
Becca makes a great deal of sense with regard to muscle recovery.  It is also my humble opinion, that massage is an essential component in physical therapy for major injuries and for those preppers, such as myself, who suffer from partial disabilities involving muscle issues that are resultant from nerve damage, neuropathy,  and other deep tissue injuries.  As an example, I have had everything from vertebra L3 down to vertebra S1 surgically fused.  While such a fusion, in and of itself, is not considered completely disabling; if you take into account the resulting damage of lesser nerves by the surgery, the eventual deterioration of the neighboring discs, and the resulting loss of the ability to coordinate the muscles involved after the nerves get damaged, the combination is very much considered a structural disability of a permanent nature.  This is to say, using myself as the example, I can still do a good number of things I used to; however, as we all are painfully aware, can and should are two entirely different critters.  Thus someone with my type of disability can help cut firewood, manipulate bales, and other such things, though they may not be able to actually lift much, but will pay for such activity with secondary effects, such as mass muscle spasm, which will have them bed bound for several days afterward depending on the severity of the individual's condition, and whether or not they still have meds for it. (Assuming, of course, that said person is not already standing security watch or radio watch for the more physically capable) 

The standard heat and cold wrap treatments will not help an iota with deep muscle spasm, though they're great for the swelling.  Heat and massage, however, will.  Another thought, strange as it will no doubt sound, is acupressure combined with massage.  This will, in turn, help that person to be able to get back on with business quicker than they otherwise might, in a world without the usual meds like Flexeril (cyclobenzaprine) and other relaxants.  I cannot count the number of times a proper therapeutic massage would have had me on my feet in a day, after pushing too hard, as opposed to several days spent medicated and essentially immobile because the lower back was locked up with spasms.  In a world where the heavy meds are scarce or gone, therapeutic massage could very well end up being the only means of dealing with such things effectively.

Just my two cents on the idea of therapeutic massage as part of one's medical arsenal, and food for thought from the perspective of a prepper intimately acquainted with the need for such treatments.

Semper Fi, - J.H.

This article isn’t your normal food and ammo stockpiling type of article.  I believe those things are extremely important or I wouldn’t be reading this blog on a regular basis.  I do, however, believe that this subject matter is as important as stockpiling food, ammo, medical supplies.  Stockpiling our knowledge base may be even more important than stockpiling these other items, because no matter how prepared you are you never know where you will be when the SHTF.  One aspect of your knowledge base that I would like to suggest you increase your stockpile is in the areas of therapeutic massage. 

Most people will read this article and scoff at the suggestion that I just made, but I assure you that the idea of adding a solid working knowledge of therapeutic massage techniques to your TEOTWAWKI knowledge base could be the difference between surviving and thriving.  Massage has been a healing therapy for as long as man has walked this earth.  Think about it, when we were children, before we knew about Band-Aids to heal boo-boos, we would instinctively rub the part of our body that hurt.  Even now as adults, if you have a head ache you will most likely take off your glasses and rub the areas around your eyes (temples, jaw, even your neck).   Massage therapy is a part of our make-up.  We use it to heal ourselves and comfort those around us.   It is my belief that understanding massage techniques and how to properly apply them will make my survival much easier for many reasons. 
These are the main reasons I am thankful that I have training as a massage therapist and why I believe you should include a working knowledge of massage therapy techniques into your SHTF knowledge bank.

1. Muscle recovery is a process that our bodies go through anytime we work it beyond its normal level of activity.  The metabolic processes that take place to allow your muscles to move create waste products that can settle in the muscle tissues and cause stiffness and soreness. When you push your body’s limits it doesn’t have time to remove these waste products on its own.  This is part of the reason we are a little sore after we increase our work out in the gym or try that next level hiking trail.  Basic massage techniques can be used with a basic stretching routine to increase muscle recovering.   These techniques will help manually break down these metabolic waste products that settle in the tissue as well as increase blood flow to the area helping to remove the waste products to be cleaned out of your system. Most TEOTWAWKI scenarios include situations where our daily activity levels will be increased exponentially.  How much work will it be to carry your BOB to your next site,  set camp, prepare the area to ensure safety, gather water and food, try to get a few hours of sleep only to break camp at sunrise and do it all over again the next day?  This will be your day to day existence until you reach your retreat area or find a suitable location to make an extended stay.  Relying on your knowledge of basic massage techniques will give your body an extra boost on its way to recovery that will increase your chances of reaching your retreat.
2. It is this humble massage therapist’s opinion that human touch is essential for maintaining a healthy physical and mental state of being.  During a time of great stress we may be less likely or unable to seek out the simple touches that give us a sense of being connected to those around us. In a SHTF scenario there will be little semblance to our everyday life, we will be under physical stress, mental stress and most likely emotional stress. We will most likely feel more disconnected from the world around us than at any other time in our life [except for maybe puberty ;)].  The twenty to thirty minutes that you and your retreat group set aside each night to go through a basic massage routine with each other will not only help with the muscle recovery but it will serve as a daily reminder that there are other people working towards the same goal as you: surviving.  This reminder will serve as a method to increase trust and connectedness to those around you.  This sense of connectedness and trust will literally make it easier for you to sleep at night.  It is important to understand that massage therapy is in no way, shape or form sexual in nature.  As a professional massage therapist, this is a misconception that I need to educate people about on a daily basis. 
3. At some point in time you will need something that you don’t have and a system of bartering may be in place in many communities that you come across.  Massage therapy is an important healing skill that will cost you nothing other than your time and knowledge.  You may not have to trade precious life necessary equipment, food, or ammunition.  Instead, offer your healing hands for trade of the item.  Keep in mind that most people may not understand how important massage is to increasing their well-being, so an important part of your barter will be educating those you will be trading with.  Also, keep in mind that your trade of massage may not hold as much value in a TEOTWAWKI situation, as evidenced by the fact that most people are not willing to pay for a massage when money is tight.  But, if your knowledge of massage techniques is strong enough, you may be able to start a working relationship with another small community. This could be the start of bartering relationship between you and other people you come across, the same way a doctor might barter his or her services for fresh meat or produce.  Please keep in mind that during a massage the person giving the massage is just as vulnerable as the person receiving the massage, so in a TEOTWAWKI situation never work on someone alone, unless you absolutely trust them with your life.  Also, there are plenty of techniques that can be completed without removing clothing.
4. The techniques that you learn are not just applicable to humans.  The animals that you may be using to help carry your gear will also benefit from your knowledge of these techniques.  For the same reasons that your body will benefit from them.  An over worked animal will not perform to a suitable standard if their musculature has not had enough time to recover. 
5. Self Defense.  What?  That’s right; I am suggesting that my knowledge base of massage techniques can help me defend myself and my retreat group.  How?  Well, to have a solid foundation for performing massage you must have a solid understanding of the structure and function of the human body.  That means that I know where all the major arteries are located and approximately how deep they sit in the person approaching me.  Also, because of my training in functional assessment of the human body I can point out the site of muscle or joint weakness in the possible threat coming my way.  Because I know how the body works, I can tell you by watching the way a person moves if the limp they are displaying is affected, or caused by a weakness to the left or right side of the body.  This knowledge will help me determine my defense long before I am even within an arm’s reach of the person.

With a working knowledge and understanding of massage therapy you will also have a working knowledge of the human anatomy and physiology.  You will know about the muscles and how they work, the tendons and ligaments that keep the muscles attached to the bones, as well as the blood vessels that keep the muscles supplied with oxygen and energy necessary to work.  Once you understand how the body is meant to work then you can understand how to heal it.  A major plus to  having this knowledge is that even without any traditional medical training you will be able to assess some injuries and know how treat them as well as understand if the cut you or a person in your retreat group just received is an immediate threat to life or not.

Before I go any further, please, let me point out that I am not suggesting that a massage therapist has the knowledge base to diagnose and treat medical conditions.  However, as a massage therapist, I am better able to understand an injury to the body and how to correct the negative effects said injury will have on the function of the body as a whole.   This is why I suggest that understanding massage techniques is an extremely important skill set to add to your knowledge base.  Also, it is important to note that there are some medical conditions for which massage is contraindicated.  So, please, keep in mind that this article is only meant to convince you that these techniques are worth your time in learning.  Most of us do not have the time or money to go to medical school, but in order to become a certified massage therapist you only need to invest minimal amounts of money and your time.  But, unless you have an interest in being a massage therapist when you grow up I wouldn’t worry about becoming certified or licensed (though in most states you cannot practice or advertise your services as a massage therapist without being certified or licensed). 

When choosing the level of massage training you wish to add to your knowledge base please keep these things in mind: financial investment, time investment, and desired outcome.
If you have all the time and money in the world then I would suggest attending a massage program that will teach you the following areas of massage: basic anatomy and physiology, basic massage techniques and functional assessment.  This last part, functional assessment is the most important aspect of the training I received as far as I am concerned.  In this segment of training, you should be taught how to assess the human body for injuries by watching someone move as well as through various muscle testing techniques.  The muscle testing techniques help you to determine if therapeutic massage is indicated for the injury as well as which massage techniques to employ to treat the injury.  The aspect of assessment that teaches you to read the movements of the body will help you not only in treatment of injuries but also in a self-defense aspect as well.  In understanding the way everything is connected in human anatomy, you will be able to determine which side of the body is actually injured as well as where the weak point is located. 

If you have time but not a great deal of money, I would suggest that you seek out a therapist who is like minded and knowledgeable in their field and willing to trade their knowledge for skills you may possess.  This way you get the skill set without investing anything more than your time and own personal knowledge in return.  These knowledge base/skills set trades will not only give you what you want but it will give you important experience in bartering based on the value of knowledge. Check your state laws because this could be considered and internship, in which case you may be able to sit for the licensure exam should you choose to become a licensed therapist.   If you choose to go this route and the person making the knowledge trade with you does not seem to have a strong set of functional assessment skills I would strongly suggest obtaining a copy of Functional Assessment in Massage Therapy by Whitney W. Lowe.  This is the book rom which I was taught functional assessment and I still find it to be extremely helpful when dealing with issues I do not see on a regular basis.  If this book does not seem to help you understand functional assessment then find another, the important part of functional assessment is that you understand what you are looking for if you can’t get it from a book find a practitioner or DVD that will help you understand what you are trying to learn.

If time and money are issues then I would suggest that you find a few good books on therapeutic massage and functional assessment.  I have already mentioned the book by Lowe for functional assessment, so my favorite book to teach you the basics of therapeutic massage is Theory and Practice of Therapeutic Massage.  This book gives you a basic foundation for anatomy and physiology as well as massage history and techniques.  If you are going to get all of your massage knowledge base form books I ask you to also consider the following books to add to your library: Trail Guide to the Body Student Handbook (4th Edition) by Andrew Biel, Mosby's Pathology for Massage Therapists, 2nd Edition by Susan G. Salvo BEd LMT NTS CI NCTMB.

Once you have a foundation for therapeutic massage I would encourage you to seek out additional training and information concerning three specific areas of massage. Sports Massage, Lymphatic drainage massage, and essential oils and herbs for massage.  Sports massage techniques prepare the body for strenuous activity as well as promote muscle recovery after strenuous activity.  Lymphatic drainage helps the body to remove lymphatic fluid from areas of the body where lymph vessels may have been damaged.  Improper lymphatic drainage can lead to painful and debilitating swelling of extremities.  A strong knowledge base in essential oils and herbs used to enhance the benefits of therapeutic massage can increase the benefits while possibly reducing the number of treatments necessary to reach the same goal.  Also, once the SHTF, there may be limited access to the medical care we are used to receiving and a working knowledge of essential oils and herbs could benefit more people than just those who choose to receive massage.

Please remember that practicing massage therapy with proper training can be dangerous if you are not paying attention to what you are doing.  This means that practicing without proper training can be even more dangerous.  For your safety and for the safety of those around you I encourage you to seek proper training of some sort before you begin using massage as a treatment for any ailment.

It could evolve as systems are stressed after a natural disaster.  It could be caused by a terrorist attack.  It could even be the result of a societal or economic collapse.  Have you ever thought about what might happen if our current health care system (EMS, Doctors, Hospitals, and Pharmacies) ceased to function normally?

What would you do if you couldn't go to your doctor, all of the hospitals were shut down, all of the pharmacies closed, and no one answered the phone when you called 911?  You would be on your own.  You would have to take care of yourself and your family members with the knowledge and supplies you currently have.  Could you do it?

Many people have been forced to care for themselves due to partial or full system collapses in recent history.  Think about these events:
- Hurricane Katrina in 2005
- The 2006 Tsunami in Thailand
- The 2010 Haitian Earthquake
- The 2011Earthquake, Tsunami, and Fukushima Nuclear Disaster in Japan

Those were just the big ones.  There have been countless other natural disasters on a slightly smaller scale.  Besides the natural events, think about what happened in New York City when the Twin Towers were brought down.  Think about the economic collapse that affected Argentina for several years.  Think about the societal collapse in the Balkans in the early 1990s.

In each of these events, medical care was limited or non-existent.  All of the residents affected had to take care of themselves.  I ask again: could you do it?

In order to be successful, you have to have knowledge.  With the right medical knowledge, you can acquire, create, or improvise many of the supplies you may need.  Fortunately in this digital age, there is a lot of knowledge freely available on the Internet.  The difficulty lies in sorting through all the rubbish and trying to discern good information from bad.

Well, I've done the work for you.  Below are links to the best available free videos and publications on the internet.  These resources are designed primarily for the person who is not a medical professional.  Most speak in relatively clear language without too much technical jargon.  With a little work, anyone reading these books should be able to understand the concepts.  Almost all of these references address the issue of austere medical care...what to do when you have relatively untrained practitioners, limited equipment, and no one coming to help.  These are the facts and skills you will need to learn if you want to take care of yourself in a system-collapse medical emergency.

Where There is No Doctor
The most widely-used health care manual for health workers, educators, and others involved in primary health care delivery and health promotion programs around the world.  While you are visiting this site, make sure you also download "Where There is No Dentist", "Where Women Have No Doctor" and "A Book For Midwives".  All are excellent resources. Print versions are also available as well. 

These books are a great introduction to primary care in an austere environment, offering useful information for handling everyday medical problems by unskilled caregivers with minimal access to resources. but the advice often ends with “and transport patient to definitive medical care”.  That may not be enough when there is no definitive care available.

US Army Tactical Combat Casualty Care (TCCC) Correspondence Course
“When you have casualties on the battlefield, you must determine the sequence in which the casualties are to be treated and how to treat their injuries. This subcourse discusses the procedures for performing tactical combat casualty care; treating injuries to the extremities, chest, abdominal, and head; and controlling shock.”
This course was developed by the United States Army, but the lessons contained within are the battlefield medical protocols utilized by all branches of the US Military.  These are the absolute best practices for handling traumatic injuries without professional medical intervention.

Combat Lifesaver Home Study Course
This is the "advanced" version of the basic TCCC protocols course above.  It is a self- guided home study course that is academically equivalent to the class that many soldiers going into combat receive.