Mechanical bowel problems
 
Mechanical bowel problems can include gallstones, bezoars, malrotation, ileus, foreign bodies, food impaction, stool impaction, tumors both cancerous and benign, and intussusception.  Then there is the mechanical problem we can actually do something about in a TEOTWAWKI environment:  constipation.  First, we will review the list and talk a little bit about prevention and conservative treatments of the list above; then we can spend some time reviewing the prevention, treatment, and management of constipation.  We will also talk a little about constipation's frequent sidekick:  hemorrhoids.  Fun topics, to be sure, but a little knowledge in these areas may one day really help your overall peace and comfort in a survival situation.
 
Gallstones form in the gall bladder and can obstruct the cystic duct, the common bile duct, or worse at the opening of the small intestine causing a painful and potentially deadly condition called pancreatitis.  Gallstones most often pass on their own without problems.  They can be encouraged to pass with a simple home remedy that Docswife herself has used successfully:  3 tablespoons of olive oil with 3 tablespoons of lemon juice.  This remedy encourages gall bladder spasm and emptying, and it seems to work for those stones that are "on the line" of being big enough to cause problems but just need a little shove.  It is worth a try if you have no surgical options in the future.  If you know that you have had gall bladder problems before and still do on occasion, now would be the time for an elective surgery to remove it.  Don't wait until it is not an option.
 
A bezoar is a collection of compacted indigestible material that accumulates in your digestive tract, and can sometimes block the intestine (large or small) and is synonymous with a food impaction.  Bezoars usually form in the stomach, though they may also occur in the intestines.  Bezoars can be made of fibrous vegetables (celery, etc.),  hair, fibers or medications that don't digest properly.  Usually it is the "rolling" feature of digestion that continues to "ball up" whatever is starting the bezoar into a larger problem.  Bezoars may cause lack of appetite, nausea, vomiting, weight loss and a feeling of fullness after eating small amounts.  Bezoars most often occur in people with certain risk factors; like those with delayed stomach emptying, people with diabetes, or end-stage kidney disease.  Without one of the risk factors for bezoars, you're not likely to develop them.  If you are high risk, reduce your intake of foods with higher indigestible cellulose to reduce your risk.
 
Malrotation, intussusception, and ileus are all mechanical bowel problems caused by the wave-like muscle contractions of the intestines.  Malrotation is just what it sounds like, the bowel "twists up" in the wrong way and pinches off the flow "downriver" and causes a backup.  This leads to pain, cramping, vomiting, and eventually death as the bowel will die of at the site of the twist.  Intussusception is a "tunneling" problem where the bowel slips inside another section of bowel and sometimes gets stuck.  It most often is a problem of children 3 to 5 months old and rarely it is a problem of older adults.  If an adult suffers from intussusception, it is nearly always from another cause (like cancer).  Intussusception is a very serious problem as the intestine will begin to swell and then the problem worsens and then can cause perforation which will lead to abdominal infection and death without surgery.  Ileus is the lack thereof of such contractions, almost always after a surgery.  Ileus is very common in hospitals now, as when a person wakes from surgery the bowels sometimes take longer to "wake up" and this is why nurses ask incessantly about passing gas and your bowels if you have ever had a surgery before.
 
Foreign bodies are self-explanatory.  Most often children and psychiatric patients will swallow things they should not and it can cause obvious bowel trouble.  Amazingly, coins smaller than a quarter will almost always pass through a child without problems.  Single coins, buttons, and other non-pointy objects will usually pass through the bowel without problem.  Lots of things that are eaten that you would think may cause problems like straight pins, needles, and other metal objects can often be digested by our stomach acid and are rendered fairly harmless.  Obviously, if you swallow something that cuts into your bowel or blocks it entirely, bad things will happen post-collapse.  Don't do that, and keep others in your group (like kids) from doing it too.
 
Tumors can cause many of the above secondary circumstances, due to the mass itself.  Malrotation and impaction are common due to tumors, both benign and cancerous.  Bleeding can occur with any larger tumor that is eroding the bowel wall.  If erosive or large enough, the tumor can cause perforation leading to unhappy non-survivor syndrome.  There is nothing you can do about a tumor once you have it post-grid, so make sure to get your colonoscopy if you are over 50 and see your doctor for any tumor concerns now.
 
Food impaction was discussed just a bit ago, because bezoars are sometimes food.  Other times, food gets far enough digested to become a fecal impaction.  Impaction is related to, but different from constipation itself.  Impaction is due to the "rolling" action of the bowels previously mentioned.  In some instances, this rolling can cause large "balls" or "rolls" of stool to harden into nearly rock-like stools.  These can get large enough to need to be removed surgically at times.  Children that often avoid bowel movements are at high risk.  Once, I helped coach a child suffering from impaction to birth an impaction ball that was literally the size of a baseball.  Amazing, and it must have hurt to be sure.  Impaction can cause severe pain, diarrhea as the stool blocks other stool behind it but lets liquid pass around it, and ultimately vomiting as the stool backs up all the way to the source.  Perforation of the bowel can occur, which again leads to bad outcomes at TEOTWAWKI.
 
Long before impaction comes constipation.  Constipation should and probably will have its own article in the future.  The short version of the story is prevention.  Prevent constipation before it starts, or treat it early to clear it before it worsens and bad things happen.  Prevention starts with being informed.  Regular bowel movements are important, bowel health is essential to survival long-term and comfort short-term.  Fluid and fiber, fluid and fiber, fluid and fiber.  Repeat.  No one should ever take fiber without thinking consciously about increasing their fluid intake.  It's that simple a rule.  Fiber goes with fluid, and visa verse.  Another that I stress for patients is regular exercise.  Moving around seems to help move around your bowels.  This is another reason nurses get you up and moving after surgery to encourage your bowels and prevent ileus.  Darn, those nurses are smart!  Laxatives should be used as a last resort for management of constipation, but again waiting too long can cause more of a problem to solve.  There is a fine line in using laxatives too much, but in TEOTWAWKI laxatives will be scarce and should be used sparingly.  After all these have failed to produce results, mineral oil enemas and disimpaction are the final options.
 
With constipation or with simple diet changes can come hemorrhoids.  Hemorrhoids are more common with protein-heavy diets, and with increased physical activity.  Hemorrhoids can be miserable, and sometimes internal hemorrhoidal bleeding can be severe, even life-threatening at times.  Prevention and early treatment are the best approaches.  Prevention of hemorrhoids is accomplished with the same general recommendations as constipation; but also witch hazel wipes, anti-hemorrhoidal medications and plain old ice used early can really help nip the bud in this situation.  Diet changes often will cause constipation and hemorrhoids, sometimes both, sometimes one then the other.  Weight control, regularity in diet, regular exercise, and sweat control can all help prevent or reverse hemorrhoids quicker.  All preppers should have a good supply of witch hazel wipes and hemorrhoid suppositories for treatment.  Ice may not be available, but if it is, ice is a much better treatment plan than topical gels or creams.  Good hygiene can also help treat hemorrhoids once they start, keeping everything nice and clean and dry down there is essential.

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: SurvivingHealthy.com.

I grew up in the low desert areas of Arizona:  Douglas, Wilcox, and Mesa.   Later, living near Flagstaff, I began keeping Aloe Vera (Aloe barbadensis) in my kitchen.  In the low desert, Aloe grows in medians and desert yards; almost weed - like.  It is a succulent so it does not need much water.  Most of its moisture comes from any available humidity.  It has a cactus look without thorns, and is a welcome green in a harsh country.  A bonus is the beautiful tiny orange-yellow lily flower that fits with the easy lifestyle of a desert landscape.   Pictures and further descriptions on the internet will help you identify this plant.  If you live in a warm climate you may even have it growing close by.

I do not remember when I first knew about the positive benefits of this plant.  It seems my family used it forever.  I know this is not true, but that is how I think of it.  Treating burns and wounds using aloe has been known for centuries.  Those who are concerned about future preparedness  and ”what if “ scenarios may gain some peace of mind if they have  at least one of the Aloe vera plants growing in a pot in their kitchens.  An offshoot makes an attractive Christmas gift for friends.
Aloe has a long positive history, also some controversy, some skeptics, and many true believers in its effectiveness.  A couple of my personal experiences put me into the true believer category:

1.    When my daughter was three and her big brothers were making model airplanes, the laws against using glue that contained oil of mustard had not been passed.  If a kid built model airplanes, that is what hobby shops sold at the time.  The boys knew to be careful with it, but baby sister Mary, didn’t want to be left out of the fun.  Unknown to her brothers, she grabbed the tube of glue and started playing.  Shortly after, she was screaming.  She had a bright red burn from the glue on her leg.  I grabbed a leaf of my Aloe plant, split it to get at the gel, and swabbed it on the burn area.  Next, I put her in the car and headed for the local hospital emergency room.  Mary screamed all the way.

I entered the emergency room with the crying child and she was rushed right in for treatment.  I was standing next to the doctor in charge and stated that I had just treated her leg with an Aloe vera plant.  He turned to me in anger and said, “You did what?”  I was made to feel that I had hurt my baby girl and must be a witch of some kind.  Then, still angry, the doctor asked me to spell it so his nurse could look up the plant.  I assumed this was to see what kind of poison, if any, I had put on my child.  I spelled it and then just stood by in silence.
 The nurse was busy going through her book and the doctor still had a stern look on his face as he waited.  No one noticed (except me) that Mary was no longer crying, and she was busy looking around and playing   under the table.  I breathed a sigh of relief.   The Aloe vera worked!
Finally the doctor and nurse noticed the same thing...the silence of a once screaming child.  The doctor checked the leg and gave her some minor care.   His countenance changed now, he casually stepped toward me to say, “Where can I get one of those plants?”  By this time I was the angry person.  He never apologized and he was rude and arrogant to me earlier.  Normally I give a person one of the aloe offshoots I generally have growing attached to the base of my Aloe vera plants, but in my anger I simply answered, “In a nursery.”  Aloe plants are easily obtainable in plant nurseries across the country so I forgave myself for my own just anger.  Mary healed with no scaring.

2. I use a pressure cooker.   One time I was impatient and wanted to open the cooker before it was completely free of steam.  When I opened the lid, the hot steam hit me and I felt it burn my entire inner arm.  I grabbed some aloe leaves, put a few in the refrigerator, and used the gel of another to spread over my arm.  I knew the effects would not be immediate, but also knew that the gel in the leaves in the refrigerator would be icy cold in seconds.   After the application of the first leaf,   I took another leaf from the refrigerator, sliced it, and applied more gel.  Now   the icy Aloe vera gel had burn stopping power, and the comfort of ice.    After several applications of the icy gel, the pain subsided.  With continued icy cold aloe treatment, my burn healed with no scaring.
Over the years I found that although not an instant cure for burns, it does work, but it usually takes about twenty minutes for pain to cease or at least become bearable.  Getting to an emergency room and obtaining “instant” treatment probably takes longer than that even if you live near a hospital.  I think the time saving application of aloe, plus a trip to the hospital is the best way to handle a burn.
Typing the words “Aloe vera plant” into web browsers will supply all sorts of information. One article I saw gave some details of its characteristics.    According to an article published by the University of Maryland Medical Center,  “Aloe vera gel is comprised of 99 percent water, and 1 per cent glycoproteins and polysaccharides”  Aloe's glycoproteins reduce pain and inflammation, while its polysaccharides stimulate skin growth and repair.   The article also mentions that for these reasons, “aloe can be effectively used to treat pain, itching and swelling caused by burns, insect bites or allergic skin reactions. It can also help small wounds and burns heal faster, and it can soothe and moisturize dry, irritated skin”.

I use aloe on chapped hands and lips, rough soles of my feet, sunburn and any minor burn, scratch, or rash.  A friend of mine uses aloe as her only face moisturizer.  Her face is beautiful and youthful looking.  Modern day beauty product manufacturers create all types of beauty products using Aloe vera as the prime ingredient.    Even Cleopatra knew about using it as a beauty treatment.  
Aloe is spoken of as a medicine perhaps as early as 4000 BC, when drawings of it were found on temple walls in the tombs of the Pharaohs.  The   Egyptians called it the "Plant of Immortality" suggesting that it might have been used in the embalming process. 
Greeks carried aloe plants into battle for wound treatment.  Alexander the Great knew about the power of aloe in healing wounds and sent an army to gather plants that were growing on an island so his enemies could not get them.  Aloe is one of the most frequently prescribed medicines in old herbal books which mention aloe’s use for a variety of ailments. 
 I like to have a small bottle of straight Aloe vera gel in my travel bag   to use on insect bites or scratches.  Having the “traveling aloe bottle” is like having a bottle of inexpensive soap along.   The gel has a soapy substance called saponin in it that is capable of cleansing, and, saponins have antiseptic and antibacterial properties   as well.     I cannot imagine a better product for a first aid kit.
Aloe is mentioned in the Bible including the following:
John 19: 39-40   Nicodemus (the man who had first come to Jesus at night) likewise came, bringing a mixture of myrrh and aloes which weighed about a hundred pounds. They took Jesus’ body, and in accordance with Jewish burial custom bound it up in wrappings of cloth with perfumed oils.
Psalms 45:8-9:  You love justice and hate wickedness; therefore God, your God, has anointed you with the oil of gladness above your fellow kings.  With myrrh and aloes and cassia your robes are fragrant; from ivory palaces string music brings you joy.
Proverbs 7:17:  I have sprinkled my bed with myrrh, with aloes, and with cinnamon.
One of the best things about Aloe vera is the ease in which it grows and the fact that it thrives in benign neglect.  In warm places it will grow outside.   Even then it is still a good idea to have a pot full inside.  Direct sunlight fades the plant but it is still good to use.
Inside, the plant thrives in a coarse potting mix similar to one for cactus.  Aloe is not a cactus,    it is a member of the lily family but the cactus mix drains readily.  About the only thing that kills an Aloe plant is over-watering.  Add some Perlite or something to lighten up the mix if using a regular potting mix.    Use a shallow but wide container because the plant is not deep rooted and it also produces offsets at the base which can be easily removed and repotted. 
I have only touched on some of the benefits of Aloe.  As with all survival skills, the plant can be researched, and knowledge can be gained about its use.  I have an Aloe vera plant growing in my kitchen and I always will.    I am in my “golden years” now, and think   people concerned about the future will do the same once they know about the benefits of this plant.   Do your homework, and then get an Aloe vera plant for your kitchen.

TEOTWAWKI IBD
Inflammatory Bowel Disease (IBD), is a poorly understood grouping of two separate diseases:  Ulcerative Colitis (UC) and Crohn’s Disease (CD).  Unlike other bowel diseases, both of these conditions have characteristics both in their presentation and pathology that make diagnosis fairly routine.  Both will be reviewed here with recommendations for ongoing management and treatment options in a post-collapse environment.
Ulcerative Colitis patients have recurrent episodes of inflammation of the mucosal layer of the colon.  There are different subtypes of UC based on the location of the inflammation.  Ulcerative Proctitis affects the rectum, or lowest portion of the colon.  If the inflammation is slightly more extensive, the terms Left-sided Colitis, Distal Colitis, or Proctosigmoiditis are often used to describe the disease.  Extensive Colitis involves nearly the entire colon but does not involve the cecum (closest to the small bowel junction) and Pancolitis involves the colon and the cecum.  Each subtype of UC is then characterized as mild, moderate or severe.  Mild disease is usually just the distal colon, with mild pain and sometimes bleeding, and four or fewer stools each day.  Moderate disease may involve more of the colon but it is not Pancolitis, and stools up to 10 daily.  Bleeding can be more severe and even cause anemia, but not transfusions.  Nutrition in both mild and moderate disease is normal.  In severe disease the bleeding can cause anemia which requires transfusions; along with severe abdominal pain, weight loss, malnutrition, low grade fevers, and can even lead to a deadly condition called toxic megacolon.

Treatment for mild and moderate disease is, of course, less involved and less intensive than the treatment for severe disease.  20% of those with Distal Colitis will have complete remission, and the later a patient has onset of their disease, the better their chances at longer and more complete remissions.  Mild and moderate late-onset disease responds better to courses of steroids too.  Often, medications like Azathioprine (Imuran) and salicylates like Sulfasalazine (Azulfidine) will help control symptoms and maintain remission.  Sometimes, more potent chemotherapy drugs are used to control moderate and severe disease, but these will be unavailable WTSHTF.  Steroid courses often help control specific exacerbations of UC, but long-term steroids have significant side effects and other medications like those mentioned above are often used for chronic suppression rather than steroids.

Crohn’s disease is the other IBD of the two.  Crohn’s Disease is usually disease of the small bowel, with only 20% having colon involvement only and the other 80% being small bowel alone or with some colon involvement.  CD is more variable in its presentation than is UC:  fatigue, long-term diarrhea, abdominal cramps, weight loss, low-grade fever, and bleeding are often ongoing and occur for months to years before diagnosis.  The hallmark sign of CD compared to UC is “skipping” or “cobblestoning” on scoping.  Crohn’s Disease has abnormal and normal mucosa right next to each other in patches, whereas Ulcerative Colitis is diffuse.  Otherwise, the two can often be very difficult to tell apart.  CD often causes small ulcerations that can lead to scarring and fistulas, sinus tracts and sometimes perianal skin tags.

Treatment choices for Crohn’s Disease include some of the same medications used to treat UC like salicylates like Sulfasalazine (Azulfidine), steroids and immunomodulators like Azathioprine (Imuran); but also antibiotics, non-systemic steroids like Budesonide (Entocort), and biologic therapies like Infliximab (Remicade) and Adalimumab (Humira).  Why some of these medications work better for CD than they do for UC will likely remain a mystery for many years, if not decades.  But, the fact remains that most of these medications will be unavailable WTSHTF and even now are ridiculously expensive and realistically not within the budget of most of us to even think of stockpiling.

Obviously, the diagnosis of these conditions is not going to be made in TEOTWAWKI.  If you already have or suspect that you may have Ulcerative Colitis or Crohn’s Disease, get your diagnosis and subtype confirmed now and do all you can to control your disease with the grid in place.  Learn about diet theories that help colon health, of which there are many.  Try these diets now and see if they work for you.  Then stick with them and plan your prepping foods accordingly.  If medication is needed to control your condition, you need to have it on hand.  If you currently are on one of the horribly expensive IV medications that controls your symptoms well, think about talking with your doctor about trying cheaper medications so that you can test the control and dosing to prepare for the worst-case scenarios. 

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: SurvivingHealthy.com.

Little shoots of green grass are peeking up in my part of the unnamed western state due to the unseasonably warm weather we've been having. Hope the sun is shining wherever you are today as well. My desire today is to share some knowledge and tidbits I've picked up at my job in the medical field. I hope these notes will be of benefit to you in the days ahead and that you can use them when I'm no longer coming in to work to help good folks like you because I'm at home guarding my food storage and family from the “unprepared and unprincipled”. The standard warnings apply, if you do this stuff at home pre-TEOTWAWKI, you may kill yourself or someone you love, but when there's no other choice when the SHTF, well, you'll have to decide for yourself. So, without further adieu...

Let's say that you find yourself in a situation like some character in JWR's "Patriots: A Novel of Survival in the Coming Collapse". Living in northern Idaho, you're a member of the resistance that is fighting back against the UN intrusion. As part of a three-member cell, you are often sent on missions for either reconnaissance or to show the opposing forces a little “Idaho welcome” with your heavily modified potato guns. Inevitably, one of your two companions suffers a fractured femur after falling from a lookout post. As they lay writhing on the ground, you instinctively know that by applying traction to the broken extremity, the muscle spasms will subside, giving your friend much relief. Take any piece of straight, rigid material you have with you, such as a branch from a tree, a walking stick, a ski pole, tent poles (doubled or tripled up and lashed together), etc., and lay them along the broken leg. Apply heavy padding to the inside of the groin and around the ankle in the form of folded t-shirts, etc. Now, use any form of rope or webbing available to tie two loops, one around the thigh high in the groin, and the other around the ankle, over the padding you just applied. Again, make sure they are well padded or you will cause more discomfort and risk interfering with circulation. They shouldn't be loose, but don't need to be overly tight, just enough to slip a finger or two under. Now with your remaining rope or webbing, attach the groin loop to the top tip of your straight, rigid pole. Do the same with the ankle loop, except make a simple pulley loop running from the bottom tip of the pole up through the ankle loop and back down to the tip again. In this way you can increase the amount of traction on the leg as necessary to relieve as much pain as possible. Furthermore, your rope/webbing/twine around the ankle, groin, and pole may relax with time, so you can simply unknot the pulley, pull tighter, and re-knot to keep the traction effective. When finished, lash the pole to the affected leg around the ankle and mid-calf for greater stability. One commercial option I've used is the Kendrick Traction Device (KTD) if you have the funds, but it is definitely not necessary. I would recommend watching a YouTube video of applying a KTD just in case you have questions about any of my instructions above, as obviously a video is worth 10,000 words.

Now that you have traction applied and your accomplice is happily enjoying a fentanyl lollypop for pain control, you need a litter to evacuate. Litters are made in all shapes and sizes. I'll give you a couple examples, but the guiding principle here is to use your imagination and whatever is available to create a gurney-like device that you and your non-injured friend can use to haul your injured ally back to home base. The simplest option is to lay a square tarp down (maybe your tent footprint) and tie a knot in one corner to create a pocket where the injured individual's feet will go. Then simply lay him diagonal on the tarp with his feet in the pocket, fold the tarp over top (he can even help hold it closed) and then drag him home from the head end of the tarp. In this way, one person can evacuate another without any help, but if you had some help they could lift the foot end so the injured didn't get such a jarring ride. Obviously, don't drag from just the foot end because it would be like being pulled down a flight of stairs by your feet. If he didn't have a brain injury before, then he surely would after bouncing his noggin down the trail being towed by you.

The next variation on the litter just takes it a step further by adding rigidity. Lay your tarp down and run two of those rigid poles (like the ones we talked about earlier, a straight branch, a walking stick, NOT your M1A because you're still under attack) down the center about two feet apart. Fold one straight side of the tarp over one pole, and then the opposite straight side over the other pole. Both sides are folded towards the center so they end up overlapping each other somewhere between the poles. Lay the injured between the poles on the tarp, and with one person at the head and one at the feet, lift and carry. If you don't have a tarp handy, lay down two coats, vests, or heavy shirts (zipped or buttoned up), top to bottom or bottom to bottom, turn the arms inside out (turned into the body of the garment), and run the poles through the inverted arm holes and out the bottoms. Load the injured between the poles on the coats and carry him to help.

There are endless variations of litters, and I'll wrap up this section with one of the most ingenious I've ever seen constructed. Take a long length of rope and lay it on the ground in a back and forth fashion like a snake (imagine a radio wave with high frequency and high amplitude) leaving yourself a coil of at least a third of the rope at one end. Each wave's “amplitude” should be about three feet wide from bend to bend and the “frequency” should be about a foot apart. Next, lay the tarp down on top of the rope, adding a blanket if it's cold out. Now you can add poles or an empty backpack for rigidity. Lay the injured on top and wrap him in the blanket and tarp like a burrito. Now with your leftover coils, start lacing the package together by “sewing” the amplitude waves over the tarp, back and forth, back and forth, until you get back to the other end. Go back through and pull out all the slack you can to really tighten it down, but save the tightening till you've laced all the way through or it may throw off your waves. You now have a very secure (and warm!) litter that many people can help carry, each grabbing a piece of the rope on opposite sides of the injured. Eight of us once used this litter to carry a rather heavy individual and it made the trip much easier. This also makes a great straight jacket for your friends experiencing TEOTWAWKI psychosis until they can calm down a bit.

While carrying your pal out of enemy territory, you're probably going to be shot at and possibly even take a bullet or two. Assuming you don't get shot anywhere really bad like the guts, heart, lungs, brain, spine, etc., you may live! Bring out those fish antibiotics and open wide, friends. I'm not going to cover the “sucking chest wound” or anything that would require a wound vac, a chest tube with suction, or any other heroic medical measures, because it is a very precarious situation to find yourself in a level one trauma hospital, let alone TEOTWAWKI. I'll just say that if you get shot in the arm or leg or whatever and you don't exsanguinate, then clean the wound very well with a mixture of half hydrogen peroxide and half normal saline, pack gently with iodoform gauze using a sterile cotton-tipped applicator (or anything sterile), and cover with sterile gauze and tape. Iodoform gauze comes in many widths, I personally like the ¼ or ½ inch varieties because they get in the crevices better. Take the dressing off every day, rinse with the ½ hydrogen peroxide ½ saline, and pack again with new iodoform gauze (using strict sterile technique!) and cover. Eventually (this may take a long time) the wound will begin to granulate and it will fill in. Keep feeding this person protein! I have personally taken care of people that either got shot or suffered some other penetrating injury through the legs, abdomen, flank, and arms who eventually recovered with this course of treatment. As far as antibiotics, I'll leave that to Dr. Bob, but basically just keep taking whatever you have and keep the wound as clean and sterile as possible. Since I know you really want me to say some names to satisfy your cravings, my favorite antibiotics for this type of wound seem to be trimethoprim/sulfamethoxazole (Bactrim) by mouth and of course cephazolin (Ancef) one or two grams every eight to twelve hours if you have IV capabilities.

On the topic of antibiotics, no one ever mentions the side effects. If you are on antibiotics for a few days or more, you may get a nasty little red rash in your privates and some super funky white growth in your mouth. That is fungus growing in your moist bits. There is a natural war happening all the time between your bacteria and your fungi (who knew you were such a “fun-guy”). When you load up on the antibiotics, it gives the fungi the go ahead to take over those moist, dark places of your body. You need an anti-fungal such as nystatin or miconazole, but in a serious pinch I would try some crushed garlic, citronella oil, coconut oil, iodine, tea tree oil, or some of the other alternatives you can find cruising the web. I am not an infectious disease expert! I have just always had nystatin and it has always worked. Keep as dry as you can with baby powder and clean those areas scrupulously and often.

When your team mate fell off that lookout and broke his femur, he may or may not think about his dislocated kneecap until a bit later. Dislocations can happen in all the joints- shoulders, knees, fingers, etc. Each is put back into place a bit differently, but the principle is always the same, slow steady traction. In some Hollywood movie, a character dislocates his shoulder, and to reduce it (the medical term for putting it back in place) he rams his shoulder full steam into a wall or something. That's Hollywood for you. In the real world, every time I've dislocated my shoulder, the doc applies slow steady traction until the muscles fatigue and stop their spasms and the joint will pop back in almost on it's own. Man, I can't tell you how good it feels when it does that. Don't be surprised by the sound, I promise it is a relief, but be prepared for weak-stomached onlookers to faint when they hear it.

The how-to of reducing dislocations is a topic in itself, but just in case you ever find yourself alone in TEOTWAWKI with a dislocated shoulder, here is what I would do. Find a flat place to lay face down where you can hang your arm over the side, a kitchen table is ideal. Place something heavy on the floor, a five or ten pound dumbbell or ammo can. Lay face down on the table with the affected arm hanging over the side and gently pick up the weight and hold it just off the floor, with your arm hanging straight down, then try and relax and think some happy thoughts. After a while, your shoulder muscles will tire from the traction of weight, and they will allow the head of the humerus to slip back into the labrum (the ball back into the socket). You'll know when it happens, I promise. Warning- do not dislocate your shoulder more than you have to, it will become so loose that it slips out in your sleep, quiet a weird experience to wake up to. After TEOTWAWKI, you won't be able to get your orthopedic surgeon neighbor to do the surgery you need quite as readily.

Knees and hips follow the same principle, but you need another person to help. For knees, lay the “patient” flat on the table with the affected knee bent at 90 degrees, wrap your elbow around the back of the lower leg at the top of the calf muscle, and apply traction away from the pelvis. You'll probably need someone holding the patient's shoulders so you don't pull them off the table while you're holding traction. The top of the tibia will eventually slip back into connection with the condyles of the femur. Hips are essentially the same positioning (person laying on back, knee bent at 90 degrees, the “doctor's” elbow wrapped under the knee to provide traction) except they require rotation (abduction) of the leg to the outside to get the trochanter (top of the femur) moved out of the way and back into the socket. Again, this is a topic that requires a little more than a paragraph. Your local paramedic or emergency room doctor can lead you aright, but YouTube is always a great place to start if you don't have time to volunteer on Friday nights at your local emergency department. All the standard warnings apply, if you do this at home pre-TEOTWAWKI, you risk nerve impingement or circulatory disruption and you could lose the function of your extremity at the least and eventually die from any number of possible sequelae.

Since we've covered dislocations, we should quickly cover ligaments. Ligaments are those awesome pieces of 550 paracord that God put in and around our joints to hold them together and keep them moving in the right fashion. If your friend who fell off his LP/OP is complaining of pain in the knee, you can examine the four knee ligaments to determine if he has a tear. With him laying on his back and the knee flexed at 90 degrees, gently attempt to move the tibia forwards and backwards at the joint. You can practice this right now where you're sitting if your knee is bent. With your hand resting over your kneecap, use your other arm to push and pull your lower leg (the top of your tibia) towards and away from your pelvis by pushing at the top of the calf muscle in the back and just below the kneecap in the front. You may feel slight movement, but more than slight movement or intense pain while doing this following an injury is indicative of a tear. The other two ligaments are tested by attempting to angle the lower leg inward and outward (adducting and abducting) while holding the thigh still. If you get movement or pain, your in trouble. Rest, ice, elevation, compression, ibuprofen, and a good knee brace will be the TEOTWAWKI prescription for healing, since you won't be getting any tendon repair surgery post-SHTF.

At this point I'm going to slip in a quick note about the spine. When your buddy hit the ground and commenced his injured state, there's a high likelihood he also suffered a spinal injury of one level or another. The most frequently injured portion is from the base of the skull down through the neck, the cervical or “c-spine” area. Think of those videos of motor vehicle crash test dummies. When they hit the wall, their neck flexes down till their chin touches their sternum and then extends back up in a whiplash movement. That's a c-spine injury. One of the first things paramedics do when they reach the scene of the crash is to immobilize the c-spine with a hard collar. At my facility we use the Aspen brand, but you can buy any number of hard cervical collars. After the wreck, people are so focused on their other injuries that they sometimes don't notice the aching neck, or they think it's just an ache and shrug it off. Unless you've squirreled away a CT scanner and neurosurgeon at your retreat (hey, it could happen), leave that collar on for six weeks! You've got a much better chance of decreasing the subsequent neurological impairment by keeping the neck immobilized, as well as decreasing further injury when the injury swells. You'll know you've got a problem when you can't move or feel an arm, but I've seen people walk in with three column vertebral fractures, not knowing that if they broke that fourth column they'd sever their spinal cord and become an instant quadriplegic. Under the current guidelines, we leave the collar on for three to four days till the other injuries subside, then get flexion/extension films of the c-spine before removing the collar. Post-TEOTWAWKI, six weeks of a hard collar is going to be a lot better than any amount of nerve impairment that reduces motor control or sensation. Lastly, the collar should be snug! Loose collars are as useless as not having one on at all.

To conduct a TEOTWAWKI neuro exam, have the “patient” flex, extend, abduct, and adduct his arms, hands, legs, and feet against resistance. Any focal weakness, numbness, tingling, or pain is indicative of nerve impairment. If any member of my group showed such signs, they'd likely be relegated to bed rest with bedside commode privileges for six weeks. Obviously they're going to get stiff and weak and grumpy, but better than losing the ability to walk because of a thoracic or lumbar fracture that got worse because of too much activity. The hardest part is learning to get out of bed correctly. Learning the log roll can really help. Flex the knee 90 degrees opposite the side of the bed you plan to get out of. Reach the ipsilateral (same side) arm across your chest and grab the side of the bed. Pull yourself onto your side with that arm and by pushing with your flexed leg. Focus on keeping your hips and shoulders square to each other to prevent twisting in your spine. You are now on your side close to the edge of the bed you'll be getting out on. As you drop your legs over the side of the bed, push yourself to a sitting position using the hand you pulled yourself over with and the elbow you rolled onto. That's the log roll, and it will save your back a ton of straining and stress if you have a fracture or some pulled muscles. Some Flexeril, Soma, or Valium will help those muscles relax and quit their spasms, but you're going to look like a druggie if you go ask your doc for them. Try alternating ice packs with heat packs, and stay on top of the pain meds.

Speaking of pain, I keep waiting to read a “how-to acupuncture” article on SurvivalBlog, but until then will just have to keep stockpiling the acetaminophen, aspirin, ibuprofen, and naproxen. Pain is a topic unto itself, but for the moment suffice it to say I would direct the reader to an excellent presentation called “Pain Management in the Wilderness” by Casey Turner and Patrick Zimmerman of Wilderness Medicine of Utah. It gives the topic of pain a thorough but easily understandable examination. For further reading I recommend “Wilderness Medicine” by Paul S. Auerbach, MD, and “Pain Management in the Wilderness and Operational Setting” by Col. Ian Wedmore, MD. Since reading up on wilderness medicine is basically the same as SHTF medicine, you cannot go wrong with the Wilderness Medical Society, the Wilderness Medicine Institute, or the Wilderness and Environmental Medicine Journal. I take no responsibility if you learn how to do a peripheral nerve block or employ herbs in any manner.

One final thought- if your friend doesn't die from the initial impact, the lack of modern medical care, or the innumerable complications that we haven't discussed, it sure would be pitiful for him to expire from a bowel blockage after he lays around for weeks and sucks down your narcotic supply like a kid in a candy store. Bowel movements are close to, if not the number one reason people spend an extra day in the hospital after surgery. All those pain pills put your bowels to sleep, and coupled with long hours in bed, you've got a recipe for constipation turned deadly. You better have some senna, docusate sodium (Colace), biscodyl suppositories, and Fleet enemas stockpiled. Give the senna and Colace one or two times a day starting immediately, and mandate a suppository or enema or both on day two or three post injury if no bowel movement.. They may not feel like eating or drinking, but fiber and liquids are a must and should be encouraged. If you have done all of the above but cannot produce a bowel movement and cannot hear bowel tones when listening to the abdomen with your stethoscope, the person will presumably be vomiting foul smelling bile and it's time to start digging if you don't have access to a nasogastric tube and intermittent suction.

Well friends, that's about all I have to say for now. Here's to us all being well versed and well prepared for a coming day in the future when the ER has been ransacked and the grocery stores are empty. Maybe we'll meet and trade some junk silver for some .22 LR, or you could trade some of your new-found medical knowledge to someone in desperate need in exchange for a mansion in our Father's Kingdom. May God's blessings rest upon you and yours.

It is very difficult for the average middle class American to prepare for the coming collapse; those that recognize the need still see it as maybe too late to do anything or there is too much to buy and prepare to be completely prepared.  Unless you are independently wealthy, that may be true, it is nearly impossible to be 100% completely prepared for all eventualities.

The first thing you need to do is to prepare your soul and your family, they have to understand and be on board.  Your family and yourself must first get right with God if you haven’t, and accept Christ as your savior and bend to God’s judgment, let his will guide your first and foremost.  After this you must begin your preparations, none of us know when the time will come, more than likely soon, but it may be a week away or years away, and every little bit will get you that much closer to survival and make your position far better.  I won’t go into deep detail on every facet of information as there are ample books and blogs explaining the “how to’s” and if you are on survivalblog already than you have a monstrous wealth of knowledge at your fingertips.  This is a quick once over to help the read understand the basics and get started, remember that knowledge is the best weapon you have, read, learn, try and repeat until you have it mastered.

Finances

More than likely you don’t have a lot of disposable income have had your hours cut back or have a hefty mortgage.  You have to look at all the expenses in your house, if renting is it reasonable, is there a way to find a more remote location to move to, or a cheaper place to rent that would save you monthly expenses?  Cell phone bills are an easy way to cut, if you have multiple phones consider cutting back to one main house phone, get a pen and paper and write down things to buy at the store instead of calling home from there to figure out what you need.  Cell phones are handy but are they worth the extra 60-100 dollars they are costing you a month?  Cable is not necessary, it is a convenience, if you have cable you probably have internet, have one house computer, sell the others, and get your news off the net.  Whatever disposable income you have, start to put it into tangible goods, things that you can use or sell in the coming TEOTWAWKI situation.  I invested a good portion of my net assets in precious metals in 2008 before the price went up, but even with the higher prices now you have to remember that when the time comes that everyone realizes that they should buy gold and silver it will be too late to get adequate amounts.  Buy “junk” silver, 90% dimes and quarters, they don’t have the numismatic value of silver Eagles or gold Krugerrands, but people won’t care about the collectibility of the coin in TEOTWAWKI only the content. Don't buy 1-ounce "trade dollars" or bars. What I mean by this is the 10 or 100 oz silver bars or 1 oz gold coins, those are worth a lot individually and you will need your metals to barter for things like food, ammo, clothes, etc.  day to day items not a new care, so buy small amounts, which is why junk silver is so nice, because about 1.30 in silver coin is worth a 1 oz silver piece and you can barter more accurately with the smaller denomination.  It’s okay if you can buy $10,000 worth of coin now, if it’s just a few hundred at a time, that’s more than fine, shop around get the best deal, but don’t not buy storage food and ammo to buy more coin, you can barter with silver but you can’t eat it, and at the beginning of the collapse people may only want “beans, bullets and Band Aids” as the military says.  In short, don’t eat out, buy bulk and buy cheap, learn to cook with simple ingredients that can be found in nature.  Cut out non-essentials, don’t take that vacations to Hawaii, instead go out camping and you can test the gear you buy and get your family used to living it rough, and relying on what they have and on God’s bounty in nature.  I know many people might disagree, but get out of your retirement accounts, cash them in take the hit, or at least don’t put your money into them anymore.  List out all your expenditures and future expenditures and figure out where you can cut out wants and boil it down to actual needs and go from there.

Food

Food isn’t hard to find and buy, with the proliferation of bulk food stores like Costco, Sam’s Club, etc.  On a tight budget you can see when there are deals on canned vegetables and other foods and when you go out buy a few cans per trip and it will add up.  This is a less efficient course, because when you buy in bulk you save much more per can than individually.  If you can’t afford a membership find a friend that does or find a few and pool your money and have the owner of the account shop for everyone. You can save up to a dollar a can in some circumstances.  Bulk Salt, Sugar, Molasses, Coffee and every other staple can be purchased there.  Buy in bulk store it in a garage or wherever you have room, and add to it over time as money allows, in a short while you will be amazed at what you can accumulated.  Read up on what is needed for an adult man, woman, and child to survive and buy accordingly.  You’ll need an ample source of carbohydrates, proteins and fats.  Hard Red wheat is a favorite of mine, you can (with a home grinder, recommend the Country living grain mill, it’s the best on the market) grind your wheat when needed into flour to make bread and it retains its nutrients much longer than buying flour itself.  You can also soak it in water overnight to make Wheat Berries and add some brown sugar and/or honey and it makes a nutritious breakfast that’s not too bad.  If you can’t find a cheap local seller of red wheat, check local bakeries many will sell it at wholesale or a buck a pound if you bring your own bucket.  For long term storage you need food storage grade buckets, and there are many techniques including Mylar bags with dry ice and “Gamma seal” lids, just a quick search on any survival site will give you more detailed information on how to pack and store this once you get your supplier lined up.  A quick tip is instead of buying the buckets online, is to call local bakery shops, or supermarkets, restaurants that buy bulk cooking foods and ask if they have empty buckets laying around.  Make sure that the buckets ARE food grade and haven’t had any chemicals stored in them.  Check for smells because if they held pickles and you don’t clean them out with bleach and baking soda then you might have pickled flavored wheat come TEOTWAWKI time. 

The other way to get your food storage situation in order is to look at bulk pre-packaged meals like those in the military MREs or the Mountain House meals you see at camping supply sections.  These meals are dehydrated, have long shelf lives and only usually need water to cook/heat up.  The downside is that they are much more expensive per calorie than say a bucket or hard red wheat and canned fruits/veggies.  The upside is that they are great emergency and Bug out (a term that denotes you needing to leave quickly) food, as they can be thrown in a backpack and left there for longer than your family dog will live.  If money is tight then I would only use this as a small portion of your total food storage. Definitely have some pre-staged in “Bug out bags” (will mention this later, but basically a backpack for each individual, easily available to grab and leave quickly if things get bad) so that you will have meal(s) to eat on the go and MREs can be rationed out to last a few days each.  Check Craigslist, local surplus stores and of course the internet, as they are sold everywhere and can range from $50-to-90 a case (of 12).  The last big item to mention for food is seeds and hunting.  Hunting will require weapons which will be discussed later and will be dictated by where you live and availability of game in the area.  Seeds on the other hand are very important for long term survival in a TEOTWAWKI situation.  The average seed store will sell you a pack of carrots or tomatoes that with a green thumb and good soil produce copious amounts of the fruit or vegetable wanted, but most people don’t save the seeds they produce to use the next year.  This is because of two reasons, one the packs are cheap and two most seeds are what are called “hybrid seeds”, meaning that they are made to produce good yields of each plants bounty, but the in a generation or two the seeds produced will not be viable.  What you want to buy are “heirloom” seeds, these seeds often don’t produce as big of yields of as their Frankenstein hybrid cousins, but year after year, the seeds they produce will grow true and can be used indefinitely.  Search out web sites that sell heirloom seeds and research the plants and crops that will grow best in your area, or areas near you will be moving to after the collapse.  Research heavily, I have a whole folder that has page upon page of information on every heirloom seed that I buy and that has helped tremendously when I did my own small experiments and tried my hand at home gardening, this information and experience helped me immensely to accumulate the knowledge needed to know how and when to plant, what plants to plant around or keep away from my “crops” as now the learning curve only means I lose a plant or two or none grow at all until I figure the tricks out.  In a TEOTWAWKI scenario when your life depends on this food, the learning curve will mean life or death.  You don’t want to OJT in a survival situation; you need to know the little tricks before.  Intent is good, knowledge is better and practical experience is golden.

Water

Water is one of the most important links in survival and a post indoor plumbing; TEOTWAWKI will amplify this for every man woman and child on this planet.  Most people take their ample water supply at home for granted, flip the faucet and water will run continuously.  When that water stops where will you get yours? Even if you have a house more than likely, as in 99% of the time your pump is electric with no manual backup. If you have your own well there are manual pumps that can be made and fitted to use before, or if you have the money to buy them, solar powered pumps are and option as well.  If you live in the city, or even the suburbs many times, you are dependent on city water and will be SOL in TEOTWAWKI.  First thing to do in any emergency is plugging the drains in sinks and tubs and fill it with water, you will need this to fill bottles, camelbacks, etc for your run from the city. 

Wherever you go one thing that it will need to have is water available, whether it’s a solar/hand pumped well, a neighboring creek or some other water source.  The closer the better because a five gallon bucket of water weighs around 41.7 pounds and hand carrying that long distances gets old real quick!  A water filer is a must especially if your water comes from a standing water lake or pond or even a stream.  I know and have drank from fast moving streams deep in the mountains, as they are often free from bacteria, but this was necessity and I know use a Steripen UV water purifier for when I fill my canteens.  The problems with streams is that you never know what is just upstream from you, a dead moose/deer or other animal could be lying dead or a friendly bear could be giving you the big finger by taking a dump in it.  Like I said I carry a candy bar size Steripen for my hiking trips with a solar recharger case for my mountain camping, but that takes 45 seconds to sterilize a quart of water, and only as long as the battery lasts.  The best plan is to buy a Big Berkey water filter with a 3.5 gallon per hour filter rate, and its filtration is second to none.  This baby runs about $250+, so it is out of the price range of some, but if you can make it work, it is well worth the investment.  This is a in-house filter and not good at all for on the go, in the same price range is the portable  Swiss made Katadyn pocket filter that you can use to fill up your canteens or Nalgene bottles from lakes and streams.  These are two examples of great filters for in house and on the go (bug out) use, but there are other ways to filter your water for cheaper.  The Common container of bleach (original non-fragrance) is an old standby for water purification.  Use ¼ teaspoon per gallon of water, or a full teaspoon per 4 gallons of water.  This is a cheap purifier and should leave avery slight bleach smell, this only means that it has done its job, but may not taste like it’s from the Brita.  Another more economical solution is to use “Pool Shock” a common ingredient to make pools safe to swim in and available from any pool care store, online or in your town depending on your environment.  Make sure that calcium hypochlorite is the only active ingredient in the product and at 65% with no added anti-fungal's, or clarifiers, if not you can seriously endanger you and your family.  You would use about ¼ ounce per two gallons of water, this will make bleach and with that you can use the bleach solution to treat water at 1 part per 100 parts water, roughly 2.5 tablespoons per gallon of water.  I got most of this info from J.W. Rawles on SurvivalBlog.com and the EPA site link, and using this I would definitely go with the EPA’s recommendation of aerating “The disinfected water by pouring it back and forth from one clean container to another” as this does get rid of the smell.  This was more because I had time and it wasn’t survival mode yet, but a bad smell is better than giardia (Beaver Fever) any day!   The last way is to just bring the water to boil for one minute, let it cool and drink it.  This is fine for the campsite but for a larger group of people in a more static location having the ability to treat large amounts of water is a real plus and your energies and time can go to more pressing matters.

Shelter

This list isn’t so much in order of importance, as food and water are important to survival but having a place to stay and survive while society collapses is a must.  If you live in an apartment there are books and manuals available on how to outfit it for “urban survival” but most of these recognize this as being just a "you have no other choice" type scenario and I would discourage it in every possible way.  The truth is yes if you have a fireplace you can burn furniture available throughout the city or construct a makeshift stove to heat and cook from.  You can barricade the doors; form a co-op with other residents, pool resources and all that.  That would be for a short term, month+ plus Katrina scenario where the caped federal crusader will be there to provide food and shelters eventually.  In a TEOTWAWKI world, this isn’t going to happen, currency and government will cease to function, and there will be no coast guard airdrops and FEMA trailers coming.  The best thing to do if you live in an apartment is move to a more remote home with land of your own.  If you can’t do that then, as previously stated, change your life habits, get something cheaper if possible and be ready to leave the city or suburbs as soon as things get bad, and before everyone else realizes it and loses their minds. A quick digression, if you are reading this you already recognize the need to know these things and have somewhat of an idea of how bad things will get.  But remember that 99% of the people in this country have no idea what do when the power goes out and the shelves at the supermarket are empty.  Many people will remain good hearted individuals, but many will not and turn to the darker side of humanity and steal, rape and pillage whatever they can.  Our commanding general in Iraq said that we Marines should “Be polite, be professional, but have a plan to kill everybody you meet.”  That is the mentality you need to have, that you should live the Christian virtues of charity and love of your fellow man, but have a plan to escape survive and defend you and your family’s life.  Okay Back to Shelter, if you can’t afford a place out in the woods away from the main cities, remote and self sustaining to the best of your ability, network.  Log into survival blog sites like Surivivalblog.com and others and find other like-minded Christian people like yourself that want to be prepared, form groups and pool your resources, more than likely you have skills that others don’t, and if you don’t have any practical survival skills begin to learn them, specialize in medicine, or hunting/trapping, solar power, mechanics so that you have something to offer the group that they need.  There is the rugged individual in every American (And I was of this mindset when I first started prepping) that wants to have a mountain top retreat, hunt, grow and trap all your food, and hold of waves of godless communists with nothing but your AR and brass balls.  Sorry to break this to you if you had the same thought as me, but you won’t survive long-term going solo, or just you and your family.  You could scrounge out an existence, but more than likely you will run out of food and/or gangs of looters before too long.  Your best chance of survival will be in groups, peppers who joined before and after the collapse to help each other and pool their resources and talents.  Your best chance will be to find a place off the beaten path, not near any major highways with freshwater, long growing seasons and plentiful game.  Even with all this life will be labor intensive and difficult.  You will want your retreat in an area where the population has some semblance of self reliance as a community virtue.  It should be within driving distance and if not you need to have pre-filled and rotated gas cans so you won’t rely on gas stations to get there.  There are extensive tomes written on this subject so I won’t try to touch on all the details that lie therein.  Basically you will want to get out of the cities and away from any major populations now, and if not do it before things get bad, read the signs and beat the crowd.  Survival in numbers, folks.

Weapons/Defense/Medical

Depending on whom you ask you’ll get many different opinions on what weapons someone should have to defend themselves in a TEOTWAWKI world.  I’m a firm believer that everyone should have a weapon for self defense even in the pre-TEOTWAWKI world we live in now.  I have the utmost respect for Police officers and have worked with many of them over the years, but Police rarely stop a crime before it is committed, more often they are a cleanup crew.  At the minimum someone should have a handgun, shotgun and rifle.  Handguns should not be your primary defensive weapon now or in TEOTWAWKI, they are great as a backup when your primary weapon runs out of ammo or you don’t have time to reload and need rounds on target quickly. Transitioning (which is what those in the military and plice world call it when you move from one weapon system to another) from your rifle to your pistol is much quicker often times than reaching for a new mag and reloading as your pistol should be already loaded and ready to go.  A .45 is my preferred choice for a sidearm for is stopping power, but there has been a lot of talk about the .40 S&W being of roughly equal stopping power, higher capacity and better ballistics when Special Forces was testing for a new sidearm over the hated M9 Beretta 9mm.  I personally use a Kimber Warrior, but any Colt manufacture .45 is excellent as well, with any weapon read up, shoot ones your friends may have, and many pistol ranges allow you to rent most common pistols, take lessons and use what is most comfortable with you.  I don’t like 9mm as its stopping power is at best problematic as I saw in Iraq and Afghanistan, even with hollow points a enemy can and has taken multiple rounds and been able to still keep fighting, albeit less efficiently.  If you have a 9mm now, consider selling it and getting a .45 if not, it’s still better than a knife or bat! 

For rifles well that’s where we run into a 1,000 different opinions and no matter what you say there’s always someone that says your wrong and this is why.  I don’t care much for armchair shooters' opinions and I rely on my own experience overseas, I did two tours in Iraq with the Marine Corps Infantry, the last was the Siege of Fallujah in 2004-2005 and then three years private contracting security for companies that have been unjustly maligned in recent years, anyway off my soapbox.  I prefer my M4 for main battle rifle due to its ability to do double duty as both an offensive/defensive weapon as well as hunt small to medium game.  The M4’s main attribute is it is basically a magnum .22 and has quite a bit of “oomph” behind it (the amount of depends on your barrel length and ammunition used).  There has been a lot of talk of it not being able to “stop” a enemy, and I have seen this in Iraq and Afghanistan, and it does sound hypocritical due to my diatribe on the 9mm previously, but the lack of one round stopping power is made of the other attributes the M4 (AR family) offers.  As a Drill instructor told me, the AK is great for uneducated, slow witted mud hut dwellers, they can point shoot and drop it in the dirt, and it will keep shooting, but the M4 is a professional’s weapon.  It can shoot accurately at distances far outrange of the AK (the barrel length will greatly affect this) or many other similar battle rifles, and in the hand of a well trained Marine it is deadly.   I love the AK as well and I own and use one as well as other rifles, but if push came to shove and there was an intruder in the perimeter, my M4 would be my primary.  With proper training and only Iron sights you can hit targets accurately at 500 yards or less.  With the right ammunition you can also hunt animals from rabbits to deer, which makes it a much more versatile weapon than the venerable AK. 

As for a Shotgun I would go with a 12 gauge Mossberg 500 or Remington 870, there are nice autoloader Benellis or other fine quality shotguns, but for the price that you can buy a Mossberg or Remington, you can’t beat them.  They are tough reliable and easy to use, and their close in stopping power is second to none.  I prefer 4 or 5 shot 00 Buck but pretty much any shotgun round at close range will do the trick.  There are also 3 shot+Sabot from Winchester called the PDX1 12 will destroy any intruder or enemy at close range, and even longer distances with the Sabot round.  For the uninitiated the 12 gauge shotgun can be a bit intimidating, so definitely get familiar with the weapon. 

Another quick point would be, if you are forming a group or have a large family, wishing to have a rifle for you, your wife, older sons/daughters, etc.  In any case where you are going to have multiple rifles in your family/group, come up with a group standard no matter which one you choose.  Any assortment of weapons is better than having nothing, but you do not want to be in a situation where you are running out of ammo and the people around you have different calibers and magazine styles, as you can’t interchange them.  So if you decide on the AR family then bulk up on magazines, at least six on each person, in a chest rig or some other type of practical magazine carrier.

Conclusion

To sum up, none of us regular chumps have a lot of extra cash to go and buy two years of food for a family of six an arsenal of weapons, a farm with animals and thousands of dollars in silver this minute.  But over time you can, but that time is rapidly growing shorter, as I believe things are coming to a head very soon.  So first and foremost pray, get right with God, get right with your family, become cohesive, find others you can rely on when things go bad, stock up on what you can when you can.  Every individuals situation is different so look at yours, look at your options, your network of friends and family, figure out who possibly has a place far away from the cities that you could fall back to, talk things over with them, even if they think you’re crazy if they agree, they will thank you later.  Pre-stock food, ammo and other essentials there, bring your family out and camp out in the elements with the, so they have a better understanding before it becomes real.  This is real camping, not Winnebago and a gas grill we are talking about, practice primitive survival methods (that are legal) practice trapping and hunting when the season permits, get everyone in decent shape.  Change your life, save your life and the lives of your loved ones.

James Wesley:
I often times read through the literature and blogs that speak of survival and the process of survival and one staggering issue is all too often neglected. The psychological and emotional aspects are all too often placed in the distant background or worst ignored altogether. I may not be a psychologist but I know from my own personal demons and experiences that stressful situations can slowly begin to affect the decision making process. In a survival situation a foolishly made decision can and most likely cost you dearly.

Any situation that requires that you begin to think about life in terms of life and death as such a survival situation a physiological and psychological response is made. This is the fight or flight response, while in most cases in survival it would not be usually seen as such; it would be view with “rose colored” glasses. In a survival situation fight or flight might be as simple as a decision to stay put (fight) or Bug out (flight). These and all seemingly small actions have a small guided effect from chemicals in the brain which will have been adjusted by the body due to a high stress situation.

In moments of extreme danger this response in magnified by a greater margin. Symptoms of this would include a rapid increase of heart rate and lung function, pupil dilation, and digestive tract upset. The major cause of this is the bodies’ release of biochemical known as adrenaline. Adrenaline is a special hormone that facilitate to body in performing rapid and violent muscle movements and aid the body in moments of danger (fight or flight).

Due to this you may suddenly freeze and be unable to react to the situation or you make a split second decision for the better or worse. In either case the reaction or lack of reaction may or may not directly affect you current goal of overall survival, but the hidden scars on your emotional well-being and psyche build. The lasting effects are what I’m trying to emphasize here. If in the split second decision you made, a life may have been cut short, you or another received a traumatic or crippling injury you could suffer from several different emotional and psychological traumas. The damage may manifest as survivors guilt, post-traumatic stress syndrome of any number of others, this can lead to depression and result in a greater number of issues as result.

Depression is a dangerous, emotional and psychological state to be in if even not in a survival situation. Depression can affect your ability to sleep properly leading to agitation and aggression, lethargy and even sleep deprivation. Any or all of these responses to improper rest can directly affect your chance of survival. Other reactions to depression can be a change in appetite, while not as quickly debilitating as sleep deprivation, a loss of appetite can slow your metabolism and cause health problems. On the flip side your appetite may increase which leads to a rapid depletion of food sources, a very dangerous problem in the fight for survival.
Depression can quickly turn deadly in facing seemingly insurmountable odds. When constantly faced with difficult situations as one would likely expect to find in a survival situation, suicide may seem to be the only solution. Suicide is never the answer. The state of an individual’s mental fortitude is limited and will become tested to the extreme in such tense and stressful situations. if in a group it is a good idea to just talk with everyone and get them to talk to help them and yourself cope. a simple pat on the back and a hug can go a long way to making a bleak situation better. Never try to escape the situation by using delusions such as daydreams, they may make you lose sight of the priorities.

The truth of the matter is there is no simple answer to the issue of psychological heath in such a situation. One would have to constantly keep themselves aware of their limits and allow them to cope in whatever method suits them. This is even more important to individual with clinical depression or individuals with bi-polar disorder as medications may not be readily available if at all. The moral of this article is keep a positive outlook and do what you can to assure yourself that the situation you find yourself in could always be worse. a good laugh or even a good crying session can be a very Therapeutic way to cope with your situation. support form others is another way of coping by sharing your thoughts and feelings. With a little hope and maybe a prayer, your emotional well-being as well as your chances of survival may take a sudden and unexpected turn for the better. - A.A. in the Northwoods

JWR,
Regarding the recent article Hypertension Prevention and Planning, by  Dr. Bob and Docswife, I recently learned about a Chinese herb called Jiaoguluan (Gynostemma pentaphyllum) .  Jiaoguluan is a vasodilator, and is reputed to have several beneficial properties.  An Internet search  turns up research that suggests that is reduces blood pressure and reduces cholesterol levels.  How much credence to give to a lot of what's on the net is hard to determine.  The plant can be grown in the US and brewed into a tea, which is the traditional Chinese way of taking it.

Perhaps some SurvivalBlog readers are knowledgeable about Jiaoguluan, and could provide additional information.  If it works as suggested it could provide an alternative to prescription meds, and you would have the additional advantage of being able to grow your own. - Rick S.

Along our continuing efforts to make prevention a big part of our push to inform, we need to now address hypertension.  High blood pressure is by far and away the most common condition experienced by the general population of the United States. Anti-hypertensive drugs are a multi-billion dollar business and for good reason.  High blood pressure, especially under or untreated, can lead to heart disease, stroke, memory problems, headaches, kidney failure, liver disease, bowel troubles, blindness, and can contribute to other serious disease states.  High blood pressure is a serious problem.  If you have high blood pressure; surely you have been told to eat right, lose weight, control your stress, cut down on your salt intake, get in shape, and take your medication.  With the right luck (genetically) and hard work, most people can reduce or eliminate their need for medication by following those lifestyle modifications.  But, we are Americans.  We don’t like being told what to do and most of us are too darn lazy to change our lifestyle and so instead, we take pills.  That time is past.  Prepping means doing everything you can to be ready to live a self-sufficient, independent life if there was a disaster of regional or national scale.
 
Sometimes, the best efforts lead to poor rewards here on Earth.  After you have mastered yoga, maintained your diet and exercise program, and become a model blood pressure control experiment–sometimes you still need to be on medication due to your genetics.  Stupid ancestors, left you hypertension and no trust fund.  The nerve.  There are major differences in medications for blood pressure control.  The first being the most important from a planning standpoint:  generic verses branded.  Brand-named medications are very expensive, and most-often completely unnecessary.  Generic hypertension medications include nearly all classes of medications and are usually very cheap.  Atenolol, for example, is about 15 dollars a year.  Brand-named Beta Blockers can run hundreds of dollars a month.  The same applies to almost every category of blood pressure medications:  ACE-inhibitors, Aldosterone Antagonists, ARBs, Antiadrenergic Agents, Beta-Blockers, Calcium-Channel Blockers, Diuretics (3 types), Nitrates, and “other”.  There were only seven types when medical school started for me, now there’s nine. What will it be in another 15 years?  Surely more types and lots more of these meds going generic.
 
One problem has popped up recently in regard to generics though:  drug companies sometimes won’t make generics because they don’t make enough money on them.  This is especially the case if the government is involved.  Recently, this happened across the US with the generic medication Triamterene/HCTZ (Maxzide and Dyazide).  Earlier this year many folks could not get this medication… sometimes for months, and had to switch to other medications altogether.  There have been many articles rearing up over the last months about possible medication shortages here in the US, from antibiotics to hypertension meds.

For the sake of scenario discussion, what happens when you run out of blood pressure meds and your pressure goes up?  The things that you would expect will happen:  pressure in your head, eyes, and neck; possibly headaches and neck pain; often swelling of the feet/legs and hands.  As blood pressures are high and stay high; the risk of stroke, heart attack, and kidney failure increases, as do eye problems from the hemorrhage risk.  Often small bleeds inside the head can cause spotty vision, nausea, vomiting, and confusion before death.  But, high blood pressure is labeled “the silent killer” for a reason; most of the time a person does not experience the symptoms of high blood pressure until it is too late.
 
So, what is a person with medication-controlled hypertension to do to prepare for TEOTWAWKI?  Mexico?  Canada?  The pet store?  Your doctor’s office?  My Surviving Healthy site?  Any, all, some is your answer.  The pet store is not likely to be a help to you, but other sources can prepare you for an uncertain future.  Make sure you do absolutely everything you can to adjust your lifestyle to drop your blood pressure, as mentioned above.  After that, work with your doctor to get on only generic medications if at all possible.  Then, if your doctor will not work with you to stockpile medications, you need to find another way.  You will need to investigate costs, border issues, travel, and storage before you will be able to put meds up on your storage shelves.  Stock bottles of 100 or 1000 will have a much longer expiration and will last longer on your shelves than standard 30-day prescriptions.  Try to get stock bottles whenever possible, many pharmacies will provide 100 count stock bottles instead of a 90 day supply, if asked.
 
With or without medications WTSHTF, if you suffer from high blood pressure, avoid heavy upper-body straining as this has been shown to increase sudden intercranial hemorrhages.  Avoid dead-lift type straining also as the same mechanism would apply.  Leave the heavy lifting to the normal blood pressure folks.  Control your stress and make your medications last as long as possible if facing a shortage by staggering doses over the timeperiod you expect to be unable to get your medication.  If you have 90 days left and expect to not see any more for a year for example, stagger the pills every 3-4 days to get them to last as close to that year as possible.  Being out for 6 months by taking them every other day will certainly be more dangerous than spacing them out over more time.  Neither is a great option, it is much better for you to be able to have some medication on your shelves to plan for disasters–short or long.

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: SurvivingHealthy.com.

Thanks to Jim Rawles and those who participate in SurvivalBlog--such a great source of material. It has been a real pleasure to review the material on this site and note the obvious amount of knowledge available as resources for others in proper disaster planning. When you see nation changing events happening around the world, it is nice to see a level of common people thinking about such things, preparing for such events, and sharing.
 
I have read other’s ideas on weapons related gear and I agree with many of their thoughts. My personal training comes from the Marine Corps as a Marine and NCO, federal, state, and local law enforcement agencies, civilian firearms trainers and others. This includes my own instruction of weapons and tactics training for SWAT and other tactical situations as well as the many decades of use of firearms and their related carry gear.
 
If you have an interest and are reading this material, at some point, you have probably gathered an array of personal protection pistols and long guns. Others have written about recommendations and the advantages of certain types and brands of weapons. Americans, depending where you live, may chose from many fine firearms. For those of us living in hoplophobic states, with legal restrictions on silly things like magazines and semiautomatic weapons, lawful choices become more difficult. I will point out that, even in these places, you can still gather fine weapons to meet an acceptable level of preparation. I have made and live with these choices.
 
Disclaimer: I am not advocating that anyone break the law. You must check your state and local laws regarding how you would utilize firearms and under what circumstances. I offer this information for consideration but the ultimate decision would rest upon the person possessing and using any firearm (and in some states, even the possession of types of semiautomatic weapons and the magazines used).
 
As long as we have law enforcement to respond to emergencies, within reason, we should use them. This material comes under the umbrella of, “what do you do when you call for a cop and there are none coming to your assistance?” In our culture, in almost any event where a citizen must use a firearm (pistol or long gun), ultimately law enforcement will probably review the circumstances regarding that use and come up with a judgment on that use. I am suggesting that we all must put forth thought and consideration as well as proper training now so that we may make better informed decisions on what we should do under the direst circumstances. I have personal experience in dealing with firearm incidents and I know they are frequently life changing events. That experience comes from four years as a Marine and 36 years in law enforcement.  
 
Many law enforcement personnel are trained and immediately think of people with firearms as threats. We need to continue to work on this issue so that covert carry and even open carry may not be seen as an immediate threat but a right of a citizen under the US Constitution. (I admit, we have a ways to go.) I recall a grade school friend bringing a .22 rifle to school for a project. He was not stopped, frisked and arrested either on the street or at the school. This was a better mindset for cops, and maybe, a goal for the future.
 
With such considerations in mind, my discussion is based upon the premise (or, in some cases, recommendation) that before you gather this weapon carry gear and related equipment, you have already decided or obtained the best quality firearms, related equipment, and training you can get or afford. Related to the topic, I hope that you have enough gun for any fight you need to be involved with. I like 7.62 because it is not understated in a fight. Neither is 12 gauge. An M4gery carbine is lighter but the extended effective range is nearer than the 7.62 NATO. (Since time and distance are your friends in a fight) . Iron back-up sights are required equipment on a serious weapon but I believe that a set of red dot type optics are quicker and easier for any grade of shooter. I also prefer handguns in calibers that start with a “point four.” Do not go cheap on weapons, magazines, or optics (“buy cheap twice or quality once”).
 
How will you carry your weapons and meet the necessary feeding requirements for your equipment? If your state requires a maximum of ten rounds in a pistol, you may find that a pistol with such a maximum mag count by design is a good size for your hand or, ultimately, if you cannot handle the situation with ten rounds in a secondary weapon, you need to add more thought to your primary weapon type. For that primary weapon, what kind of sling system will you need? A quiet way to carry a long gun is without a sling but, from experience, I can tell you that most will adapt a sling, piece of rope or something to help carry the weight of the piece.
 
A sling must work for you and it must work with your gear. I really prefer two-point adjustable padded slings, over one-point or three-point slings. Again, this is a personal preference from my experience. Military (“silent” or web) two-loop web slings can be used to carry a weapon over the right or left shoulder to the rear or front, butt up in the Rhodesian or African carry. These work if you practice with them. Try some out that belong to friends before you pick a sling you like and practice with it and with your gear so that you know that they work together. Use good training to assist in these decisions; see what works. For the taller people, if you find a sling you like is a bit short, have your rigger or shoe repair fit in an extension that works for you (this should apply for smaller people as well). Now is the time to pick a good sling.
 
Next, consider and study the circumstances of how you will deploy your weapons (again, training helps). All the equipment in the world may not be what we need in a serious social situation. The best way out of a gunfight is to not get in one in the first place. As you consider carry equipment, can you build up a set of gear that will allow you to carry a “combat minimum”? Can you wear a loose cover jacket or carry a covert “sports bag” that you can modify with the help of a para-rigger or shoe shop sewing machine (maybe adding some MOLLE strips inside to add loops or pouches) to carry loaded mags and not make you look like a GI Joe? If it is not raining, can you wear a serape like Clint Eastwood wore in his westerns so that you can wear or carry gear what will allow you to be seen but maybe not thought of as being an immediate threat? This is a topic for serious thought and consideration. You do not want to be shot on sight by someone a long way off who thinks that you are a bad guy? Can you have both a covert set of equipment to carry the minimal magazines and related gear you need to feed your weapons as well as an overt set of pouches and gear carried in manner we think of as load bearing gear? Why can’t you have both kinds? Remember, we should have a set of carry gear for each weapon available to us. Having a covert weapon and related equipment has merit – even if it is for someone that may be scouting ahead of others.    
 
Besides wearing many of these items, I have read a lot of material about vest’s and other load bearing gear. What is sometime missing is just how you put it together. We have a fresh crop of young military veterans. In the “Sandbox” and other “climbs and place,” they are wearing a lot of high speed gear and I am sure most of you can get some pointers from them about what works and what does not. Even if I am a generation older, I offer this material on things I find that work. 
 
During a certain age, the Marine Corps issued me 782 gear that included the hook type belt attachments. These swung to and fro against your body as you walked and canteens with these attachment points beat you when you ran. After wearing M1 cartridge belts, our individual M14 mag pouches slid onto the pistol type web belt and were more comfortable but four of them took quite a bit of space in front (most of us were pretty slim back then). Later we were issued the M16 and their mag pouches were the GI LC1 and later LC2 generations, both with the metal “ALICE” clips that dug into your midsection where they were attached on the inside of their very stiff web belts. We were not allowed to exchange out these clips like certain Army types using para-cord. After loading mags, in VietNam many of us carried most of our loaded 20-round M16 magazines in the pockets of OD green cotton bandoleers. (So save their safety pins). It is still a great way to grab additional full mags and walk away.
 
I did not like the hook type attachments that started, I believe, in WWI and continued until Vietnam or the ALICE clips (I do not use the word, “hate” but the feelings for those clips is pretty close). After my discharge, again wearing a green and tan uniform (for a Sheriff’s Office), I was again issued web gear as part of a riot unit and later a SWAT unit. With a wink and a nod, I was allowed to gather my own gear and modify it to be more comfortable (maintaining a “uniform” look). I took to using OD paracord in lieu of ALICE clips until I found that black nylon cable binders (zip ties) worked even better for me (put on, adjusted and then the ends are melted so that they did not come off). MOLLIE came later and I quickly learned how to adjust and wear it.
 
Today, drop down holsters are considered “Tact-a-cool”. I still have one that came with, again, ALICE clips. But I never felt encumbered with the GI leather holster for issued Model 1911 pistols. While stationed at a Marine Barracks, I learned to put a couple of stitches on the rear edge of the holster to hold it flat against the leg. I still have one modified this way (the hooks are on a leather slide-on carrier instead of going through a web belt). If this Marine were ever again put place to repel boarders, I might wear that holster (with some molding, you can holster a cocked and locked M1911). It protects the weapon and you can transition from your primary long gun to the pistol quickly. In the late 1960s, I also carried a C4 bag or Claymore Mine bag that I used as a “dump pouch.” More recently, Marines carry issue dump bags on their vest or belts (“adapt, improvise, and overcome”).
 
To carry my gear today, I still use a 2” nylon pistol belt with a plastic buckle or a padded MOLLE pistol belt with an Uncle Mike's nylon “Universal” holster (this holster allows me to fit a light/laser to the pistol) and I wear it strong side at waist level; a TUFF five mag holder; an old Cold Steel Tanto knife I carried during my SWAT years; a couple of hard plastic AR mag holders; and an “improved” Individual First Aid Kit (IFAK or “blow out”). Depending upon the need, I add a GI canteen and cup that is equipped with a sling or use a CamelBak. I prefer to wear my pistol on a belt rather than a load bearing harness or vest. Maybe I am old fashioned, but I may even wear the pistol holster on the trouser belt and wear the pistol equipment belt with the rest of my gear riding on top (and using nylon belt keepers to hold both belts together). This way, even if I have to drop most of my equipment, I still have some warfighting gear (a light but long cover jacket also covers this belt). Depending upon the situation, I can add a load bearing vest (LBV) with extra mags and other gear. 
 
If you choose to use a carry belt, former military web belts or the newer nylon pistol belts work fine. If you like the para-cord attachment method, after gathering the parts for the belt, I suggest you first position each piece of gear where you want it, then run the cord through the piece of equipment’s ALICE clip slot or MOLLE slots, under the belt, up the back, and over the top. Tie off the cord at the top of the piece of gear so that the knot does not sit inside the belt. Once you are sure of the placement and it is on tight, melt down the knot with a fireplace lighter. I usually use an OD green para-cord. Note: Since you remove the interior cords and use the “tube” for this task, you can heat the end of the “tube” to make it solid, thread the para-cord through the grommets or not and, depending on what the item is, sometimes I use the grommet and sometimes I do not.  
 
The cable binder (zip tie) method is slightly different. Position the gear, run the binder through that piece of gear (ALICE clip slot, etc.), then under the belt and over the top of the belt. Position the locking tab portion of the binder on the gear side so it will not move against the body as you put the running end of the binder through the locking portion. I sometimes use two or three binders for each piece of gear and may even run one diagonally from one corner to the other. As you adjust placement, do not over tighten and crush the belt. A triangular file is handy to make slight groves inside where the binder turns 90 degrees. This helps eliminate some of the tension curve in the tie. Again, once you are sure of your placement, ensuring the locking tab and end are away from the body, melt the running piece in the locking tab with the lighter. Since I do not find OD green ties, I use black.
 
An examination of my gear will show you that I may be using para-cord, cable binders, nylon snap belt keepers, and MOLLE at the same time to secure multi-generational gear items. The idea is to make your gear secure and available – oh, and quiet. By the way, don’t worry about the color of you gear (assuming it is not fire red) as mix-match makes good camo.   
 
The only thing I do not like about some LBVs is that, depending upon the vest and the placement of the gear, it makes me feel too high when I am trying to get flat on the ground (Okay, even the old style military buttons and thread is too thick when someone is shooting at you). When I see pictures of most troops and Marines wearing LBVs now, either they are spending less time on their belly or they are good a digging a deeper fighting positions – or they may be moving fast from an armored vehicle to the target building in built up areas. I adjust the LBV high so they clear the waist belt and I try to position the gear on the vest so that I can get the middle of my chest area down flat on the deck. The vest’s I use are the old 2-buckel woodland pattern that has enough room so that I can wear my gear this way. I also position a dump pouch on the left rear of the vest so I can drop mags in there if I have the time (or to carry a box of loose shotgun ammo). By the way, if you take the bottom belt out of these vests, they make a good MOLLE style gear belt.
 
I am pretty picky about the placement of my gear so I have different harness and vests setups for different weapons. [JWR Adds: It is indeed wise to have one set of web gear for each of your long guns. You never know when an absolute worst-case situation might occur where you suddenly want to hand out spare guns to relatives, neighbors, and friends. Any weapon without a set of web gear and a full complement of magazines won't be of much help.] There is a lot of new gear out there as well as military surplus and inexpensive enough that you can work up your gear as you want it. Also, it is worth finding a para-rigger or knowledgeable shoe repair person to modify or repair your gear to make it work as you want it to work.
 
Before I had LBVs (for SWAT), I wore a web belt, a nylon four-point shoulder harness (the three-point works almost as well), the Tanto knife, GI leather 1911 holster, a radio, twin pistol mag pouch, two AR mag pouches (six mags), the old USMC jungle first aid kit, and a canteen (before we purchased our first custom LBVs). I had a butt pack ready with food, dry socks, and other needed gear to add if needed. I have always liked this type of rig. You can improve it by adding a poncho and a butt pack (by the way, you can rig up two butt packs with the four-point shoulder harness). With this rig and a protective vest, I had great access and it allowed me to move and maneuver as necessary.
 
Like most cops, I have lots of pistol holsters and I find holsters are still an individual thing (for the person and the weapon). One kind of holster or carry method does not seem to be enough and, before you know it, you have a collection of them. Do not spend good money for a fine pistol and not on a good belt, holster and mag pouch. Check them out and get what you want. The traits you are looking for are; carry, access, and protection (your order may vary). If you want real comfort, you probably should not be carrying a pistol (or long gun). (By the way, start a chart of holsters and, as you get a new one, try all your pistols in the new one to see what else may fit. I have saved a fair amount of money using this chart for a new pistol or mag pouches.)
 
I also have a pretty fair collection of civilian and GI packs and war-bags. Again, depending on the situation you will be attending with this equipment, you may need to add a pack. I have worn most of the recent generations of military packs over the years and I still like a the US military issue ALICE medium ruck pack. But, if at all possible, I do not recommend this pack if you are using a long gun during a fight (drop the pack if you must maneuver). Proper maneuvering requires the ability to move smoothly and as fast or slow as you needed at the time and balance is important. You should be prioritizing as much weight off your body as possible (and still meet mission requirements). Besides your weapons, add one combat unit of fire in ammo (it varies with weapon and caliber), at least one additional unit of ammo loaded in mags or stripper clips in bandoleers (GI or home made), you will probably not have explosive weapons – frags, Claymores, etc. so use this for additional ammo in stripper clips/bandoleers, water, some energy food, IFAK, bug juice, a light, poncho, some kind of tool to improve a firing position, and something to carry all this as comfortably as you can (yes, I know a pack mule would be nice but no).  
 
At some point, you should have your weapons, gear, ammo, and carry equipment all together. Hopefully, you have already put it all on and made sure you have access to everything you need when your weapon’s bolt locks back with an empty chamber or another immediate action need arises. You can also jump up and down without making a lot of noise. Next, you need to try hiking, crawling and climbing over things to see if adjustments should be made. Once you have done this, tape down any loose ends, shiny spots, etc. with black or OD tape. I frequently see people show up at a range to begin long gun training. They are wearing the very minimum gear that they can. But, if you ask them to lay out the gear they think they need for a serious social situation, they have a lot more. Proper practice should be with the gear you need – not some lighter weight version to look “cool.”  
 
By the way, we have not spoken about protective vests yet. To wear a vest is another individual decision that needs to be made (your sling and gear will fit different with or without the vest). Both soft and hard protective vests are hot, somewhat restrictive, and not cheap. Besides deciding if you are going to use one, you need to figure out what level of protection you want to purchase. When in my SO uniform, when vests came along, besides the one issued to me, I bought a quality product and I wore it. The price of soft and plate armor has come down so the cost issues are easier but I suggest that as soon as someone shoots at you, you will ask yourself, “why am I here and why am I not wearing armor?” We should also bring up helmets. I recall that about 33% of all peace officers killed by firearms are shot in the head. Now, if cops are not around and you are in a gunfight, you might consider that the one-third of shooting incidents could include whoever is present.
 
As to the level of a vest protection, assess the potential aggressor. For most cops, a soft vest that will stop high end handgun ammo is the usual compromise. If you suspect your aggressor will have a rifle, hard armor is called for. It is always weight vs. threat. This applies to helmets to a lesser degree.
 
A note on individual first aid gear: 1) they are primarily for the individual carrying the kit; 2) they should have some basics like band aids, aspirin, etc.; 3) a small bottle of water purification tabs and; 4) basic treatment for gunshot wounds to include a tourniquet and gunshot bandages (1 or 2). 
 
We have also not discussed communications or night vision gear. You get to decide what you can use, what you can afford, and what you want to carry (remember the extra batteries). Once you make the decision, work with the equipment to make it work for you.
 
Once you have all your gear, put it in a bag (a bag for each set). I used to use a parachute bag but now I use a civilian style heavy cloth bag so it looks like luggage. Do not leave it out so that a “midnight shopper” sees it and takes it away when you are not present.  
 
Priority of Considerations:
Thought process – when and how can I protect myself and my family?
Training
Weapons and optics
Ammo
Sling
Carry gear
Other equipment
 
With all the parts available as surplus or new products, you get to pick your own rig for each weapon you may use, and high or low profile. You can start with a belt rig and then go heavier by adding or changing to a LBV. I know what works for me and I get to pick from gear going back awhile as well as new stuff.
 
Whatever you get, practice with it. You want to wear and use it enough that muscle memory builds so that when your mag goes dry, you automatically reach for replacements in known locations. Find places where you can wear and practice with your gear where you will not have the cops showing up due a hoplophobic reporting party calling in a “man with a gun” complaint (all part of your operational security mind set).

There are so many moving parts to being prepared. Juggling priorities, money, and time are part of it. I fit in recreation as it applies to firearms so I get to slide in some of these issues into that consideration. YMMV.
 
Keep your musket clean and your powder dry.

James:

I'd like to suggest one solution for grid-down insulin refrigeration: I have purchased a Dometic RC4000 3 way portable refrigerator for insulin.  It runs by 12 VDC,  120 VAC  and LP gas.  It is an absorption type ammonia system (as used in recreation vehicles) and appears to be a high build quality unit manufactured in Hungary.  It is the size and shape of a large wheeled ice type cooler but with only a small 1 cu ft cooled area.  It is perfectly suitable for long term insulin protection and uses 1 lb of propane a day  =  18 days from a typical barbeque-sized 20 lb tank.  With no moving parts it is expected to last a long time. [JWR Adds: These can also be plumbed to much larger domestic propane tanks. Or, if you have a large tank with a "wet leg", you can refill small tanks from it, repeatedly, if you buy the correct adapter fittings. Call you local propane distributor, for details. Be sure to consult your local fuel storage ordinances before doing do.]
 
Performance is as follows:
13.3 VDC @ 6.0 Amps  is  unregulated at 40F below ambient.
120 VAC has a 7 position thermostat and regulates from 22.5F at pos 7 to 42.5F at pos 1.
LP gas with regulator (supplied) has 3 settings providing 20, 30 or 40F below ambient.  The regulator required adjustment but was adjustable.
 
I purchased the unit for under $400 including shipping from PPL Motorhomes. Regards, - A-Man