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Letter Re: Triage in Emergency Mass Critical Care (EMCC) Event
Dear JWR:
I feel that there is a strong premonition in the article you flagged on Wednesday
(Who Should Doctors Let Die in a Pandemic?) This hit the Main Stream Media
(MSM) early this week and quickly fell off the news cycle. The topic is simply
too uncomfortable. The original
articles were published in the medical journal Chest (The
Journal of the American College of Chest Physicians and are very dry and
difficult reading even for a physician. This is unfortunate because it is a
salient topic
which needs to be vigorously publicly debated (instead of who got voted off – insert
various “reality TV” show). It has specific implications for those
of us reading your SurvivalBlog. Several recent postings in SurvivalBlog (specifically
two discussions initiated by questions
raised by DS in Wisconsin )
show this to be a paramount topic.
I would like to address some of these issues by means of an analogy to the
area I live and work. We have a typical, financially struggling, small (100
bed) non-profit hospital serving a population area of approximately 50,000.
Down the road is the “Medical Mecca” (actually more than one) with
total bed capacity in the thousands. Our small hospital has an 8-bed Intensive
Care Unit (ICU) which is always full, with the typical patient in one of the
various states of terminal disease processes. When a critical care patient
leaves the Operating Room (OR), there is the usual story of “Musical
Beds”, where a patient has to be transferred to “make room” in
the ICU. This usually involves transferring the least critical patient to the “Step
Down Unit” (SDU). ICU patient transfers to the “ Mecca ” typically
takes 24-48 hours because their beds are also constantly full. Our hospital
owns four ICU ventilators, and if the number of patients requiring ventilation
exceeds this, additional units have to be delivered from the “medical
supply house”, which also provides rental units to the “Medical
Mecca”. Due to financial constraints, there is no “surge capacity” in
the system. In the typical bureaucratic system, the “mirage” of
available space is accomplished by simply “redefining” a given
patient from “Intensive Care” to something less, either wholly
inside our hospital or by including the “Mecca” in the system (as
in a “larger” system). [JWR Adds: I briefly discussed
the chronic shortage of ventilators in my
static article on Asian Avian Influenza.
I agree wholeheartedly with your assessment
of the shortfalls in
medical delivery infrastructure!]
The issues addressed by the articles in Chest concerned Emergency
Mass Critical Care (EMCC) events, prototypically pandemic influenza. In such
a situation,
even the “mirage” of available space breaks down because you cannot “enlarge” the
system by including more “geographical” area since each additional
area is encompassed by the same problem. The currently circulating “bird
flu” H5N1 is a particularly nasty bug, more closely resembling the various “hemorrhagic
fevers” than typical influenza when infecting humans. The syndrome includes
pulmonary edema (fluid collecting in the lungs, i.e. drowning in own secretions),
disseminated intravascular coagulation (DIC) (internal bleeding) and multi-system
organ failure (kidney and/or heart failure, etc.). Treatment typically includes
intensive hemodynamic and ventilatory support until the body can clear the
infection and heal. Even in our relatively rural area, it would not be unreasonable
to expect to have tens, if not hundreds, of patients needing this level support
in order to survive. The “Mecca ” will see proportionately more
demand.
The recommendations of the authors of the Chest articles are well reasoned
and intelligent, but totally impractical in our financially strapped and egalitarian
healthcare system. These recommendations include providing for the ability
to surge to three times the ICU capacity and provide for 10 days of service
without resupply. Due to shortages of trained nurses, our ICU depends on locum
tenens (contract agency) nurses to staff the ICU and medical care is provided
by a single pulmonologist (physician specializing in lung diseases). It is
totally impractical from a staffing issue to provide 3x surge capacity. As
far as inventory, 10 days is an eternity. Where will the money come from to
stockpile these items and medications (our hospital only has about 30 days
of operating cash on hand)? Will the staff forego a paycheck in order for this
to occur? Additionally, the “medical supply house” typically only
has a couple of unissued ventilators at any given time, before having to “tap
into” their larger supply chain (i.e. maybe a dozen or so “extra” in
the entire State). Where do you expect these to be issued in such a crisis
(try not to be cynical, but I suspect it will be near the State capitol)?
The most difficult (albeit the most logical) recommendations concerns the rationing
of the scarce healthcare resources. They suggest that the effort should go
to those most likely to survive, instead of those likely to die (i.e. those
most likely to benefit from the therapy). This is described as making a medical
decision for the entire population, instead of an individual patient. The goal
is to maximize survival in the population (at the expense of individual survival).
The difficult question is: Who should get the resources and whom should be “redefined” into
the “expectant” (i.e. expected to die) category? Should the ventilator
go to the college student with severe pulmonary edema or the nursing home patient
with the stroke? Should the neonatal/pediatric ICU bed space go to the 20 week
premature infant or the previously healthy two year old? If only these decisions
would be this straightforward. Who is going to tell the family that grandmother
doesn’t meet criteria? Who is going to care for the other patients while
the situation is explained (repeatedly) to these families (typically hours
with each family)? Do you think that that family will quietly accept the decision
or will there be riots? Do you ever wonder why during a food riot, the first
thing destroyed is the bakery? Do you think healthcare providers will show
up for work at an armed camp with constant rioting or stay home and care for
their own family? Would you go to work in a similar situation?
As in most things health related, an ounce of prevention is worth a pound of
cure. With communicable diseases, isolation and personal hygiene are the most
important. These are issues which do not need to be described to the SurvivalBlog
family (look at the archives), but should be seriously discussed within your
own family/group. In regards to the questions raised concerning emergency medical
transport and personal/retreat medical stockpiling, it is an important consideration.
In such a crisis situation, transportation is likely to be futile, if not fatal.
While nobody should expect to have a personal ventilator in their medical kit,
a supply of IV fluids and electrolyte preparation should be standard for those
who know how to administer it. Antipyretics (fever reducers) and antispasmodics/antiemetics
(diarrhea and nausea medication) should also be standard fare as well as easily
digestible foods. A broad-spectrum antibiotic would also be warranted for bacterial
superinfection, although everyone should already know that antibiotics do not
treat viral infections. The data on antivirals (amantadine, rimantadine and
oseltamivir/Tamiflu) is inconclusive at best and contradictory at worst concerning
H5N1 [Asian Avian Influenza], but if they are available it may be prudent to
have some on hand.
It is unfortunate that the public discussion of this topic has died such an
untimely death. Perhaps a little more debate would spare a few hospitals from
the ultimate riots, but I am not enthusiastic, human nature being what it is.
In this era of “Hope and Change”, especially with regards to healthcare,
it will undoubtedly be continued deterioration. We will continue to spend the
majority of healthcare dollars in the last six months of life, instead of helping
the survival of those most likely to survive. In summary, logical evaluation
of such a crisis leads to an illogical result (riots and destruction of the
healthcare system). We will likely be left with taking care of ourselves and
our family. - NC Bluedog
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Four Letters Re: Advanced Medical Training and Facilities for Retreat Groups
James
In response to BES in Washington's comment on Paramedics and EMTs I must say
that I agree when it comes to workaday medics. A great benefit to having
the years of training as a paramedic is that it earns
you some credibility.
My advice to paramedics and long time EMTs is to speak to your training officers
and EMS directors and find out if your supervising physician or another doctor
would be willing to mentor you in surgery[, though observation]. I had the
opportunity starting with my paramedic internship to make relationships with
quality doctors
who wanted to mentor me in advanced surgical skills which were often outside
my scope of practice. It is important to somehow become a student under the
hospital so their insurance or that of your school will cover you or
this is a pointless exercise.
Getting advanced mentoring means establishing a bond of trust. You need to
convince the surgeons and doctors that you are reliable as well as being the
type of person that they want to have in their O.R. for hours. It doesn't hurt
to mention a desire to go to medical school in the future, I believe it was
my interest and reliability that opened many doors to advanced training that
might have otherwise would have remained closed.
The other thing that helped me was taking a part time job in the E.R. on my
off days, it was easy to have my beeper go off and run to the O.R. when there
was a surgical emergency. I got to see trauma calls come in and because of
my special training relationship with many of the doctors and departments I
was able to follow many cases from the door to the ICU. I made many career
decisions based on the opportunity to advance my skills.
In the end, once you are inside the system as a professional start asking for
extra training, remember that the title Doctor means teacher and if approached
with the proper attitude most good doctors are very happy to help you learn.
- David in Israel
Jim:
Just a quick note regarding medical training. While the combat medic courses
look okay, they are limited. EMT courses require a lot of advanced equipment.
A much better option would be a Wilderness First Responder (WFR) course.
It is an 80 hour course over about 10 days that teaches extended care and
injury
management. It is the gold standard in the outdoor industry. The "wilderness" designation
means that definitive medical care is more than an hour away--and then trains
you to deal long evacuations or extended care.
There are a number of places offering WFR courses throughout the United States.
You can contact the Wilderness
Medicine Institute of NOLS for a list of courses,
as well as others. What we like about the WMI courses is that they focus on
real world scenarios, as well as judgment. They are
not about memorizing lists, but about learning how to make good decisions under
stress. The courses and on-going recertification are more than worth it, as
they keep you sharp and up to date on what the latest issues and concerns are
in wilderness medicine.
Perhaps the best thing about WMI and related companies is that their instructors
are in the field teaching and doing wilderness medicine all the time--they
know what works and what doesn't work.- Mark R.
Dear Jim,
Thank you for sending us your autographed copy of the best of the blog and
the patriots. In response to the posting "Letter Re: Advanced Medical
Training and Facilities for Retreat Groups"
I commend the writer for addressing these important issues. Here are a few
thoughts to add: Over the years, the field of medicine has become very complex,
including training, equipment, and delivery. Lets look at each of these individually.
First, training. It used to be that every physician went through medical school,
then completed a general practitioner residency and then specialized in a particular
field if they were so inclined. About 10 years ago, that all changed. Now,
even before medical school is completed, the students decide which area
of medicine they would like to pursue and go directly into that residency program
without becoming a general practitioner first. What
this means is that physician's knowledge is highly specialized. Physicians
are good at what they do, but lack the knowledge/experience to perform tasks
outside their area of expertise. For example, if you were to suffer a bone
injury which
required an operation, the person you would need to see would be an orthopedic
surgeon. However, they
would most likely not feel comfortable putting you to sleep. For that,
you would need an anesthetist. And, if you also had and abdominal wound (e.g.
gunshot),
the orthopedic surgeon would most likely not feel
comfortable operating. For that, you would need a general or a trauma surgeon.
And if you happened to have burns associated with your injury, you are best
off with a plastic surgeon. Now throw a diabetic patient into the picture (for
which you need an internist), and you get the picture.
I am a physician, having recently graduated after 14 years of university, including
a biochemistry degree, a medical degree, and five years of residency specializing
in oncology. If you have cancer, I will
know what to do, but if you put me in an operating room, we're all in trouble!
The point is that if you have "one physician" in your survival group,
don't expect them to be able to do everything. Medicine is very multi-disciplinary:
General surgeons are best at abdominal wounds and trauma
Plastic surgeons are best at handling burns
Orthopedic surgeons are best at dealing with bone fractures
Internists deal with medical problems like diabetes and heart disease
Anesthetists provide anesthetic to put you to sleep for the operation
Oncologists deal with cancer
Pulmonologists deal with ventilators and such, et cetera.
All of these are highly specialized physicians, but physicians knowledge of
cross specialties is limited!
Second, equipment. In third world countries, physicians have wonderful diagnostic
skills based on physical examination of the patient. Most American physicians
don't have these skills. We rely very
heavily on tests including X-rays, ultrasounds, CT scans, MRI scans, PET scans,
angiography, blood work, laboratory tests with pathologic interpretation, etc,
just to name a few. All of these require expensive equipment, laboratories,
power to run them, and a radiologist or pathologist (specialized physician)
to interpret them. Asking a physician to diagnose your ailments without being
able to perform any of these tests is like asking your mechanic to tell you
what is wrong with
your car without allowing him to lift the hood. It is very difficult! Thus,
even
if you have a physician with appropriate knowledge in your survival group,
if they don't have access to their equipment, they will be very limited in
what they can do.
Third, delivery. Let's assume that a member of your group becomes ill and
that 1) you have a physician in your group with appropriate knowledge and 2)
the physician has access to equipment which allows them to diagnose your ailment.
Then, the physician would know how to treat you. However, there is a big jump
from knowing what you need to actually being able to deliver it.
For example, suppose a member of your group developed a bacterial pneumonia.
Lets say your physician was able to perform a chest xray to confirm this. Now
the physician knows how to treat you. You need an antibiotic. Now the problem
becomes access to appropriate medications/treatment.
What if your retreat does not have any antibiotics on hand? or insulin? or
nitroglycerin? or Fentanyl/Versed (anesthetic)? or IV fluids? or blood? or
chemotherapy? etc. Many of these are difficult to access and/or store.
In summary, the current healthcare system is highly complex in its training,
equipment, and delivery. Many of these issues need to be thought out beforehand
when planning your medical room at your retreat. - KLK
Dear JWR & SurvivalBlog Readers (especially DS in Wisconsin ):
I would like to respond to DS concerning his questions. I agree wholeheartedly
that nobody should try on-the-job training for medical care without a good
mentor. That is what nursing and medical training is for as JWR strongly suggests.
I also agree that the human body is complex and can be inadvertently damaged
with attempted care. However, the human body does have an amazing ability to
repair damage if allowed. This is why I strongly suggested learning techniques
to control and stop bleeding, replace lost intravascular fluids and limit infection.
In trauma, there is the concept known as the “Golden Hour”. During
the first hour after a near-fatal injury, the body can compensate for bleeding
by shutting down perfusion of not immediately critical tissues such as kidneys,
skin, muscles and extremities, thus permitting limited perfusion of heart,
lungs and brain. This is a state known as shock. If the patient can be stabilized
in the first hour, the likelihood of survival is dramatically increased. This
is accomplished by controlling bleeding and replacing lost fluids. Nearly everyone
can be trained to control bleeding, since holding pressure on a dressing is
not difficult. Starting an IV is slightly more complicated but is not beyond
the ability of most people. Even the most gruesome of wounds, such as a chainsaw
injury, will eventually heal if allowed to (although the cosmetics may be less
than desirable). If you can get over the “Golden Hour”, you are
blessed with what I refer to as “The Tincture of Time”.
My second suggestion was to do everything you are capable of doing, even with
the knowledge that survival is unlikely. This is where the concept of errors
of commission verses errors of omission comes into play. In my mind, it is
better to attempt something life-saving than omit the possibility because the
outcome may not be successful. As the quote goes: “Tis better to have
tried and failed, than never to have tried at all.” Our mindset has to
change from “First do no Harm” to one of “Do the Benefits
Outweigh the Risks?”. I don’t think anyone is suggesting reading
a guide while doing this, simply suggesting doing something you are capable
of doing. The key is not to destroy your psyche with remorse and self criticism
if the results are not optimal.
As far as our personal preparations, my wife and I are both experienced medical
people and long ago decided that that would be our biggest contribution in
TEOTWAWKI. As such, we have an elaborate and extensive setup, not unlike what
you describe, however our garage is reserved for other uses currently. We are
an extreme case and should not be viewed as a guide. Unfortunately, I feel
that JWR seriously overestimates the medical preparation
of the general population. Instead of 98%, I would suggest 99.99% of the population
is ill-prepared. The
biggest asset in a trauma situation would be a couple of cases of heavy duty
(I think they are called “heavy days”) feminine pads and some rolls
of tape. IV supplies and the skills to administer it would make you invaluable.
The “field surgical kit” would simply provide appropriately sized
sharp scissors and tweezers/clamps for cleaning out the wound after you have
administered the “Tincture of Time”. It is not something to carry
while also hauling around an enormous ego. - NC Bluedog
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Letter Re: Advanced Medical Training and Facilities for Retreat Groups
Jim,
I have been enjoying and appreciating the letters and replies throughout the
blog, and I am compelled to respond to “Advanced Medical Training and
Facilities for Retreat Groups”. The letter contained very accurate and
useful information, but I must comment on medical skills available to survivalists.
First of all, need to say that I am a professional Emergency Medical Technician – and
have been for 25 years. I have treated dozens of real-life gunshot wounds, hundreds
of knife wounds, and thousands of other cases of trauma that I would prefer to
not remember.
As a 911 responder, I appreciate the faith that the general public has in my
knowledge and skills. The word of an EMT or Paramedic is trusted – and
we don’t take that trust lightly. This is a part of the reason for this
letter. In our existing EMS system, EMTs are very good at arriving as
quickly as possible and providing life-saving treatment until definitive care
can be provided. In a TEOTWAWKI event, the shortcomings of EMT skills will be
readily apparent. My crew and I are as good or better than anyone at stopping
bleeding, splinting, providing IV support, protecting airways, and rapid transport.
However, final treatment of a gunshot (or fracture, or chainsaw laceration, or
what have you) is completely out of the realm of experience for any EMT or Paramedic.
A gunshot requires the cessation of bleeding – often requiring surgery.
Usually gunshots also involve bone fractures or organ damage – and require
surgery. An antibiotic regimen is also required – of which EMTs
have little to no experience. All of this is typical for the most simple of gunshots.
My fear is that in TEOTWAWKI, people too readily equate a physician’s knowledge
and skills with that of an EMT. To put a number on it, Physicians attend medical
training for 12 years or so. EMTs typically have two months of medical training.
Now – before I begin to get hate mail from other EMTs – let
me say this: For the treatment of traumatic injuries in the pre-hospital setting,
no one does our job better. I promise you I can do more effective CPR than most
any doctor. I can intubate in the field better than most any respiratory technician.
But my training and skills are limited to pre-hospital care. Of course, an EMT
will have basic useful skills in a hospital or clinic setting but they pale in
comparison to those of a physician. To state otherwise is foolish.
So, as a professional EMT for 25 years, the plan for my retreat is as follows:
1. Have a good relationship with a physician (preferably a surgeon) at the retreat
2. Have a RN, Veterinarian, or Physician’s Assistant at the retreat.
3. Know where other surrounding physicians are located
4. Have a method for transporting severely injured people to the physician,
5. Have adequate, in-depth barter stock to pay for surgery
6. Lastly – and I mean very last – would be to use a scalpel to open
up a family member.
Barter stock would be best that is applicable to the physician’s skills:
surgical tools, antibiotics, rubbing alcohol, sterile bandages, pain killers,
sutures, and so forth. Also beneficial for barter would be other high value items
from gold or silver coins, firearms, or even a fifth of whiskey.
The short of it is this: EMT skills are extremely valuable in the niche that
they are designed. However, they are not designed for long term care. For my
family, I will be providing life-sustaining care to include cessation of bleeding,
splinting, IV, treatment of shock, pain management, and antibiotics – and
they I will do whatever I can to get them to a surgeon. Anything else is second
best. Yes, I have several great books that provide great information, such as “Emergency
War Surgery” and “Where There Is No Doctor”. But to plan on
performing these techniques without adequately exploring all options to get my
wounded to a physician, is foolish. - BES in Washington
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Letter Re: Advanced Medical Training and Facilities for Retreat Groups
Mr. Rawles,
Last month I wrote to SurvivalBlog about what do one would do medically in
TEOTWAWKI, when
all systems are down. I had received three very good replies, and have
ben thinking about what was said. I want to thank those people for their valued
replies. Now, I have more questions and concerns.
From what I've read concerning medical advice leaves me wondering.
All of the advice given has stated to get a good quality Field Surgical Kit,
and two books: "Emergency War Surgery"; and, "Where there is no Doctor". Then
these articles went on to [imply that] when a medical emergency arises, grab
your surgical
kit and the Emergency War Surgery Manual, and handle the situation. This is
where I am concerned.
First: The human body is not like the family car. Both are made up of many
complex parts that must work together to provide transportation, in the sense
of a car, and life, in the sense of the human body. There are numerous maintenance
manuals for the car, and the repair of your auto can be learned in a short
time. However, This is not the case for the human body. The human body is composed
of many systems, that are inter-related. It takes a highly trained individual
to repair us, and sometimes, complex medical instruments to help him do his
job. The skills are not learned over night or in the quietness of your family
room. They must be used and practiced on a continual basis in order to do the
job properly. Anyone that says he can operate on a human being with a Field
Surgical Kit in one hand and an Emergency War Surgery Manual in the other,
in my humble opinion is wrong! This individual is about to break the Cardinal
Rule of Medicine: First, "Do Thy Patient No Harm!"
Second: For those either setting up a retreat or are already living with theirs,
I ask this question: Are you prepared for medical emergencies? I'm talking
about a specific area for treatment (i.e. disease and trauma)? If you do not,
then now is the time to prepare for that need. A treatment facility need not
be very large--about the size of a two-car garage. Inside this structure would
be an operating suite, intensive care unit for two patients, and a small laboratory.
You will need specialized training to utilize each area. You can add wind or
solar power systems, running water, or whatever you feel is necessary. It takes
a lot of work and effort to build something like this. It will also be expensive
to supply the right equipment.
Third: If you are a member of a group, you may be in a better position to set
up a treatment facility, and to find a General Practitioner Physician/Surgeon.
Finding such an individual is like having gold in hand. This individual would
be the most important member of your group. He would take care of all the aches,
pains, sniffles and sneezes.
Think about these things and give me your feedback. It will be valuable information
to all the readers. In advance I want to thank you for your replies. - DS in
Wisconsin
Not every retreat group is blessed with finding a doctor to be part of their
group. In the absence of a doctor, I recommend that at least one group member
get EMT training.
This is best accomplished by volunteering with your local Emergency Medical
Service. These are usually paid positions, so the pay offsets
the training expenses.
JWR Replies: Regardless of whether or not your group has
a medical professional,
I recommend that all adult group members get as much training as time
allows. Start out by taking the Red Cross basic and advanced courses and their CPR course.
Then take the field medic course offered by Medical
Corps. Several SurvivalBlog readers have taken this course, and they all
have all commented to me about how impressed with their training. In fact,
one of our readers from Hawaii flew all the way to Ohio to take this course,
and he reported that it was worth the expense. Their upcoming class
(May, 2008) is full, but get on the waiting list for the next one.
I also
recommend the Practical Medical Course taught by the Western
Rifle Shooters Association. (This course is subtitled: "Field Expedient
Medical Care for Outdoorsmen in Austere Environments.") Coincidentally, they
have one scheduled for May 16-17-18, 2008 in Brookings, Oregon.
Check their web site regularly, for announcements of other course dates and
locations. This modestly-priced training, led by an Emergency Room doctor with
35 years of experience,
will teach you many
things that the Red Cross doesn't teach you!
For example, their classes place an emphasis on treating gunshot wounds.
Only the largest and best-financed groups could afford to set up a surgery
suite and lab like you described. It is a worthy goal. But keep in mind that
even modest medical training, instruments, facilities, and logistics are better
than no preparation--which sadly is the state of 98% of American families.
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Letter Re: An Overlooked Aspect of Preparedness--Crutches and Canes
Mr. Rawles,
Hi again and thanks again for the wonderful blog! I wanted to address the
request for more information about splinting injuries and stretchers. Before
I begin
discussing methods of splinting we need
to first address the degree of injury. I once "sprained" my wrist
playing sports. It swelled, hurt, was sensitive, caused immense pain, and was
hot to the touch. Our sports
trainer pulled me out of the game, three hours after a "minor injury."
[X-rays showed that] I had two hairline fractures and went home with a cast.
The doctor
was shocked that
I waited
till halftime and said I was lucky not to further break my arm while I was
playing. In the original poster's story, he couldn't even move his knee
and it was a sprain versus my case, where I could move my arm and
yet it was broken. I could have easily fallen on my arm again and
seriously broken it! A real problem with trauma and any kind of illness is
that you have an
increased
chance
of falling
and re-breaking or breaking additional bones. You have to always consult qualified
medical advice on an injury that requires splinting, crutches, or any kind
of assistance.
In a post-TEOTWAWKI situation
that may be your medical person in the group, or "Where There Is No
Doctor" but unless you have a serious
fracture that is apparent (i.e. bone sticking out of flesh, deformity or immediate
inability
to move the extremity) you really can't tell and should make every effort to
go to a medical professional to get their help. Splinting [in order] to get
there is good and fine, but you really should have it looked at by a medical
professional
before splinting for a long time.
Splinting:
Generally speaking we splint to immobilize an extremity. This is
achieved by keeping the joint about and below the injury from moving. If its
a knee, splint the injury so the ankle can't move and the hip can move in a
forward backward motion while moving the entire leg but unable to bend the
knee. For wrist or elbow sprains simply bend the elbow 90 degrees and hold
it to
your chest. Splint in place. A critical assessment to make prior to
and after splinting is to see if you can feel a pulse, if they can feel sensation
and
their degree of mobility. This allows you to loosen, tighten, or change the
split as needed if they lose one of those three things during or after splinting.
By far, splinting is more about technique than the materials on hand. Before
x-rays and plaster were used, doctors used splints to treat fractures.
Anything hard, and straight
can be used. From tree branches to long wooden spoons, to a piece of stiff
plastic. I once watched a friend splint an arm for a wilderness class using
a soft paper
back book and magazines with a lot of tape. You can also buy commercial splinting
supplies. There are wire mesh types and card board cut outs and of course the
simple ACE [elastic cloth] bandage. Galls.com is
a great place to find splinting supplies! Look under medical supplies then
splinting. I do not recommend
the air splints,
they generally are fragile and can pop relatively easily. Once you buy your
items open them up and experiment with them, to try different things out and
different ways. I also highly recommend taking a basic first aid course that
will help you
with splinting and immobilizing. For treatment of sprains and twists use
the RICE acronym: Rest, Ice, Compress, and Elevate.
As far as stretchers go and hospital beds there are a few prominent brands
out there. Mostly in hospitals and in Emergency Medical Service we use Stryker
products or Ferno products. These offer a large variety of positions and features.
The
Stryker
ambulance stretchers I can say from first hand experience are extremely rugged
and durable! American Medical Response is the largest ambulance company in
the US uses Stryker gurneys across the nation! While these stretchers are durable,
and rugged they have some serious faults:
1. They are very heavy, around
100-120 pounds.
2. Due to their design, narrow wheel base and where
the patient sits, they are also very top heavy and tip over easily.
3. More
EMTs and Paramedics careers are ended due to back injury than any other reason.
All it takes is one improper lift, one time and one back injury to
do permanent damage! Proper body mechanics must be used at
all times!
4. They are very expensive--usually around $3,000
when purchased new. Typically they are just repaired until they can't function
at all, so its difficult to get a quality used one.
Back Boards and Garden Carts:
A better option [for prepared families] in my opinion is to simply buy
a back board and put the person on a cart or simply carry them. They run about
$100
dollars
and
the
straps
(spider straps) are about $50 dollars and are easy to use. As I recall, Mr.
Rawles recommends having a garden cart for hauling wood and other work related
materials around your retreat. Likely this cart would have big heavy duty wheels
and
could go just about anywhere on your retreat. Back boards have slots at the
top and sides for handling and you can easily secure the board via hooks, ropes,
or seat belts to the top and rear of the cart. Boards can be made out of wood,
but are largely made out of plastic. It would not be difficult to attach one
to the side of the cart at all times just in case you need it. In all of these
cases back boards should only be used to move the person and not to prevent
any head or neck injury which is their primary design in modern medicine unless
you are trained to that level of care. Another benefit to a back board is that
by strapping them down you are in effect splinting their arms and legs and
don't need to do that until after they have been moved or time allows. Another great option
is to secure all of your first response medical gear to the board! Get someone
to help you, and have all your emergency field
gear on top of the
board and simply carry it to your patient and have another set of hands to
help! So for about $150 to $200 and a cart used for other purposes, you
have a heavy duty stretcher to get the injured person back to your
retreat!
In my experience as an EMT, I have found that some great places to find emergency
gear are:
SaveLives.com
EmergencyStuff.com
Galls.com
The foregoing comments are purely suggestions and advice. I accept
no responsibility for your actions and consequences thereof.
Thanks again for the blog , James! - Michelle, "The 20-something EMT"
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Letter Re: An Overlooked Aspect of Preparedness--Crutches and Canes
Dear JWR;
A week ago, I did the first big spring mowing with a push mower "for the
exercise" (3 acres). The next morning, my knee was swollen, wouldn't
bend, and the pain was breathtaking.
I'm now down to limping around with a cane, and should be fine in a few more
days.
I discovered a weakness in my first-aid preparedness the hard way: I had no
crutches, canes, or aids to mobility for the injured.
I now own a fine set of crutches, two durable walking canes/livestock sticks,
and have a Cold Steel Heavy Duty Sword Cane on the way. I'll be looking for
a folding wheel chair at the spring flea market this month. I discovered that
both of pharmacies in my nearest town give away new cane tips to anyone that
asks. This may common, but surprised me.
Would you, or any of the Medicos in the forum have any recommendations on knee/elbow/shoulder
braces, stretchers, gurneys, etc? My search of the archives did not generate
specific brands or preferred features to shop for. Thanks in advance! - Mike
on the Reservation
JWR Replies: I have found that Craig's
List, garage sales, and estate sales
are the best sources of inexpensive (or even free) used "hard " medical
items. (Garage sales in retirement communities are wonderful.) If you have
the storage space available, buy plenty, since they are often available
for pennies on the dollars. Don't overlook items like walkers, wheelchairs,
toilet
seat extensions, bed pans, "potty"
chairs,
bed linens, and hospital
beds.
(For the
latter, look for the old-fashioned hand-crank variety.). You never know when
someone at your retreat or a neighbor will become, sick, injured,
or wounded,
and require
lengthy
rehabilitation or even long term (chronic) care.
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Letter Re: Advice on Emergency Dentistry
Dear Mr. Rawles,
I have read and been positively influenced by your novel ["Patriots"].
I am now making provisions for difficult times. Can you recommend any links
towards obtaining
dentistry kit and basic dental instruction? Mainly interested in being able
to perform extraction safely. With Thanks and Sincerity, - Dan-O
JWR Replies: This topic has been covered briefly in the blog,
but is important enough that it deserves additional discussion. The most important
resource is the book "Where There is No Dentist", available
for free download from the Hesperian
Foundation
(But
I
recommend
getting a bound
hardcopy. Ditto for their book "Where There is No Doctor".
Used copies can often be found on Amazon.com for little more than the cost
of postage.) Back in July of 2007, I posted letters from Tip
in Las Vegas and
from "J"
the Dentist, that describe low cost sources for dental instruments. It
would also be wise to stock up on other dentistry supplies such as gauze, oil
of cloves, and so forth. Unless you are stranded in the back country, I do
not recommend that you put in temporary fillings under present day circumstances.
If a filling
leaks, it could cause an infection. However, in a genuine TEOTWAWKI situation,
temporary fillings may be your only alternative to suffice for weeks or even
months until
you
can
get
to a
qualified dentist. For this reason, you should stock up on temporary
filling material such as Cimpat, Tempanol, or Cavit. There are also temporary
filling materials packaged for the consumer market that contain very small
quantities (under brand names such as Dentek and Temparin), but the per-unit
cost is relatively
high. With
those, you are mostly paying for the packaging. Nor do I recommend "do
it yourself" extraction, except again in extremis. Without the
support of a crown or bridge, the gap left by an extraction can cause a chain
reaction,
as other teeth shift, to compensate. This can lead to a series of complications.
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The Precepts of My Survivalist Philosophy
In the past week I've had three newcomers to SurvivalBlog.com write and ask
me to summarize my world view. One of them asked: "I could spend days
looking through [the] archives of your [many months of] blog posts. But there
are hundreds
of them. Can you tell me where you stand, in just a page? What distinguishes
the "Rawlesian" philosophy from other [schools of] survivalist thought?"
I'll likely add a few items to this list as time goes on, but here is a general
summary of my precepts:
Modern Society is Increasingly Complex, Interdependent, and Fragile. With
each passing year, technology progresses and chains of interdependency lengthen.
In the past 30 years, chains of retail supply have grown longer and longer.
The food on your supermarket shelf does not come from local farmers. It often
comes from hundreds or even thousands of miles away. This has created an alarming
vulnerability to disruption. Simultaneously, global population is still increasing
in a near geometrical progression. At some point that must end, most likely
with a sudden and sharp drop in population. The lynchpin is the grid. Without
functioning power grids, modern industrial societies will collapse within weeks.
Civilization is Just a Thin Veneer. In the absence of law
an order, men quickly revert to savagery. As was illustrated by the rioting
and looting that accompanied disasters in the past three decades, the transition
from tranquility to absolute barbarism can occur overnight. People expect tomorrow
to be just like today, and they act accordingly. But then comes a unpredictable
disaster that catches the vast majority unprepared. The average American family
has four days worth of food on hand. When that food is gone, we'll soon see
the thin veneer stripped away.
People Run in Herds and Packs, but Both Follow Natural Lines of
Drift. Most
people are sheep ("sheeple").
A few are wolves that prey on others. But just a few of us are more like sheepdogs--we
think independently, and instead of
predation,
we are
geared toward protecting and helping others. People naturally follow natural lines
of drift--the path of least resistance. When the Schumer hits
the fan, 99% of urbanites will try to leave the cities on freeways. The highways
and freeways will soon resemble parking lots. This means that you need to be
prepared to both get
out of town ahead of the rush and to use lightly-traveled back roads.
Plan,
study and practice.
Lightly Populated Areas are Safer than High Density Areas. With
a few exceptions, less population means fewer problems. WTSHTF, there will
be a mass exodus from the cities. Think of it as an army that is spreading
out across a battlefield: The wider that
they
are
spread,
the less effective that they are. The inverse
square law hasn't been repealed.
Show Restraint, But Always Have Recourse to Lethal Force. My
father often told me, "It
is better to have a gun and not need it, than need a gun, and not have it." I
urge readers to use less than lethal means when safe and practicable, but at
times there is not a satisfactory substitute for well-aimed lead going down
range at high velocity.
There is Strength in Numbers. Rugged individualism is all
well and good, but it takes ore than one man to defend a retreat. Effective
retreat defense necessitates having at least two families to provide 24/7 perimeter
security. But of course every individual added means having another mouth to
feed. Absent having an unlimited budget and an infinite larder, this necessitates
striking a balance when deciding the size of a retreat group.
There are Moral Absolutes. The foundational morality
of the civilized world is best summarized in the Ten
Commandments. Moral relativism and secular humanism are slippery slopes.
The terminal moraine at the base of these slopes is a rubble pile consisting
of either despotism and pillage, or anarchy and the depths of depravity. I
believe
that
it takes both faith and friends to survive perilous times. For more background
on that, see my Prayer
page.
Racism Ignores Reason. People should be judged as individuals.
Anyone that make blanket statements about other races is ignorant that there
are both good and bad individuals in all groups. I have accepted The
Great Commission with sincerity."Go forth into all nations" means
exactly that:
all nations. OBTW, I feel grateful that SurvivalBlog is now read
in more than 100 countries. I have been given a bully pulpit,
and I intend to use it for good and edifying purposes.
Skills Beat Gadgets and Practicality Beats Style. The modern
world is full of pundits, poseurs, and Mall
Ninjas. Preparedness is not just about
accumulating a pile of stuff. You need practical skills, and those
only come with study, training, and practice.
Any
armchair
survivalist
can
buy a set
of stylish camouflage fatigues and an M4gery Carbine
encrusted with umpteen accessories. Style points should not be mistaken
for genuine skills and
practicality.
Plentiful Water and Good Soil are Crucial. Modern mechanized
farming, electrically pumped irrigation, chemical fertilizers, and pesticides
can make deserts bloom. But when the grid goes down, deserts and marginal farmland
will revert to their natural states. In my estimation, the most viable places
to survive in the midst of a long term societal collapse will be those with
reliable summer rains
and rich
topsoil.
Tangibles Trump Conceptuals. Modern fiat currencies are generally
accepted, but have essentially no backing. Because they are largely a byproduct
of interest bearing debt, modern currencies are destined to inflation. In
the long run, inflation dooms fiat
currencies to collapse. The majority of
your assets should be invested in
productive farm land and other tangibles such as useful hand tools. Only after
you have your key logistics squared away, anything extra should
be invested in silver and gold.
Governments Tend to Expand their Power to the Point that They Do Harm. In
SurvivalBlog, I often warn of the insidious tyranny of the Nanny
State. If
the state where you live becomes oppressive, then don't hesitate to relocate.
Vote with your feet!
There is Value in Redundancy. A common saying of my
readers is: "Two
is one, and one is none." You must be prepared
to provide for your family in a protracted period of societal disruption. That
means storing up all of the essential "beans, bullets, and Band-Aids" in quantity.
If commerce is disrupted by a disaster, at least in the short term you will
only have your own logistics to fall back on. The more that you have stored,
the
more
that
you
will have
available for barter and charity.
A Deep Larder is Essential. Food storage is one of the key
preparations that I recommend. Even if you have a fantastic self-sufficient
garden and pasture ground, you must always have food storage that you can fall
back on in the event that your crops fail due to drought, disease, or infestation.
Tools Without Training Are Almost Useless. Owning a gun doesn't
make someone a "shooter" any more than owning a surfboard makes someone a surfer.
With proper training and practice, you will be miles ahead of the average citizen.
Get advanced medical
training. Get the best firearms
training that you can afford. Learn about amateur radio from your local
affiliated ARRL club.
Practice raising a vegetable garden each summer. Some skills are only perfected
over
a period
of years.
Old Technologies are Appropriate Technologies. In
the event of a societal collapse, 19th Century (or earlier) technologies such
as a the blacksmith's forge, the treadle sewing machine, and the horse-drawn
plow
will be
far easier
to re-construct than modern technologies.
Charity is a Moral Imperative. As a Christian, I feel morally
obligated to assist others that are less fortunate. Following the Old Testament
laws of Tzedakah (charity
and tithing), I believe that my responsibility begins with my immediate family
and expands in successive rings to supporting
my immediate
neighborhood
and
church, to my
community, and beyond, as resources allow. In short, my philosophy is to "give
until it hurts" in times of disaster.
Buy Life Assurance, not Life Insurance. Self-sufficiency
and self-reliance are many-faceted. You need to systematically provide for
Water, Food, Shelter, Fuel, First Aid,
Commo,
and, if need be, the tools to enforce Rule
308.
Live at Your Retreat Year-Round. If your financial and family
circumstances allow it, I strongly recommend that you relocate
to a safe area and live there year-round. This has several advantages,
most notably that will prevent burglary of your retreat logistics and
allow you to regularly
tend to gardens, orchards, and livestock. It will also remove the stress of
timing a "Get Out of Dodge" trip at the11th hour.
If circumstances dictate that you can't live at your retreat year round, then
at least have
a caretaker and stock the vast majority of your logistics in advance, since
you may only have one trip there before roads are impassable.
Exploit Force Multipliers. Night vision gear, intrusion
detection sensors, and radio communications equipment are key force
multipliers. Because
these use high technology they cannot be depended upon in a long term collapse,
but in the short term, they can provide a big advantage. Some low technologies
like barbed wire and defensive road cables also provide advantages and can
last for several decades.
Invest Your Sweat Equity. Even if some of
you have a millionaire's budget, you need to learn how to do things for yourself,
and
be willing to get your hands dirty. In a societal collapse, the division of
labor will be reduced tremendously. Odds are that the only "skilled craftsmen" available
to build a shed, mend a fence, shuck corn, repair an engine, or pitch manure
will be you.and
your family. A byproduct of sweat equity is muscle tone and proper body weight.
Hiring someone to deliver three cords of firewood is a far cry from
felling, cutting, hauling, splitting, and stacking it yourself.
Choose Your Friends Wisely. Associate yourself with skilled
doers, not "talkers." Seek out people that share your
outlook and morality. Living in close confines with other families is sure
to cause friction but that will be minimized if you share a common religion
and norms of behavior.You can't learn every skill yourself. Assemble a team
that
includes members with medical knowledge, tactical skills, electronics experience,
and traditional practical skills.
There is No Substitute for Mass. Mass stops bullets. Mass
stops gamma radiation. Mass stops (or at least slows down ) bad guys from entering
a home and depriving its residents of life and property. Sandbags are cheap,
so buy plenty of them. When planning your retreat house, think: medieval
castle.
(See the SurvivalBlog Archives for the many articles and letters on Retreat
Architecture.)
Always Have a Plan B and a Plan C. Regardless of your pet
scenario and your personal grand plan of survival, you need to be flexible
and adaptable. Situations and circumstances change. Always keep a G.O.O.D. kit
handy, even if you are fortunate enough to live at your retreat year-round.
Be Frugal. I grew up in a family that still remembered both
our pioneer history and the more recent lessons of the Great Depression. One
of our family mottos is: "Use
it up, wear it out, make do, or do without."
Some Things are Worth Fighting For. I encourage my readers
to avoid trouble, most importantly via relocation to safe areas where trouble
is unlikely to come to visit. But there may come an unavoidable day that you
have
to
make a stand to defend your own family or your neighbors. Further, if you value
your liberty, then be prepared to fight for it, both for yourself and for
the sake
of
your progeny.
« Letter Re: Don't Delay Dental Work and Elective Surgery! |Main| Note from JWR: »
Time For Retreat Logistics Stage Two--The Soft Items
If you are a regular SurvivalBlog reader, the odds are that you already have the majority of your key logistics squared
away, like food storage, tools, guns, communications gear. So
now it is time to stock up on "soft" and perishable items. These
include over the counter medications, vitamins, chemical light sticks, matches,
paper
products,
cleansers, spices, liquid fuels, and so forth.
You need to exercise caution when stockpiling soft items, for several reasons:
1.) Shelf Life and Deterioration. Some items like pharmaceuticals,
batteries, and chemical light sticks are best stored in a refrigerator. Keep
in mind that items like
matches
are
vulnerable to humidity. (BTW, do not store matches in Mason
type glass jars! Resist the urge, or else you'll inadvertently make a glass
shrapnel bomb! Instead, use a vacuum sealer,
such
as
the
Tilia FoodSaver sealers sold by Ready Made Resources. This is also a great
way to keep rubber bands (including elastrator
bands) from deteriorating. Exposure to sunlight, or heat, or moisture can
all be deleterious to soft goods.
2.) Bulkiness. Paper products like paper towels, toilet paper,
and paper napkins are extremely bulky, per dollar value. If you have limited
storage space then you will need to budget that space carefully.
3.) Flammability. You should think of your stored paper products
as house
fire tinder, and your stored liquid fuels as potential fire accelerants
and explosives. One mistake that that I've heard mentioned is storing numerous
gasoline cans at home, in an attached garage. Most garages have a hot water
heater, often
fired by natural gas or propane. Uh oh! Store gas cans, oil-based
paint cans, and bulk lubricants only in a well-ventilated outbuilding that
is well-removed
from your residence. Be sure to check your state and local fire code for permissible
limits.
4.) OPSEC risk. The aforementioned bulk of stored paper products
also makes them obtrusive to casual observers. This present s an OPSEC risk.
If you have 500 rolls of toilet paper and
paper towels in your garage, someone is likely to notice. OBTW, one item that
I've stored as a potential barter item is sheet plywood. Those extra plywood
sheets, if
properly positioned can keep prying eyes away from your stockpiles.
5.) Abundance-Inspired Waste. Human nature dictates that
when something is scarce, it is used frugally, but when it is abundant, it
tends to get used more wastefully. I've seen this happen with my children,
in target practice with .22 rimfire ammunition. If they know that they have
just 50 rounds apiece available for a shooting session, they make every shot
count. But if there
is a full "brick" of ammo sitting there, it soon starts to sound like a day at
Knob Creek.
In his book The
Alpha Strategy, John Pugsley mentioned some friends that "invested" in
stocking their own home wine cellar. They determined that it would be less
expensive to
buy wine by the case. But they soon had so much wine that they got in the
habit of having a bottle with dinner
almost
every evening. So even though the per-bottle cost decreased,
their monthly expense on wine actually doubled! OBTW Pugsley's The
Alpha Strategy is highly recommended. It
is
available for free download, but I recommend also
picking
up a used
copy,
for
reference. They are often available through Amazon.com for less than
$5.
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Letter Re: Sign of the Times--An Ambulance Service Shuts Down
Howdy;
My name is Ed and I am a paramedic in central Mississippi.
Last month a private ambulance service shut down with only eight hours notice
that they would stop operations, leaving 26 counties without 911 Emergency
Medical Service (EMS). Other
local providers and services were able to help provide coverage. But this
is difficult with increasing fuel cost, the ongoing War on Terror and overseas
deployments, shortages
of personnel and lack
of payments from medicare and medicaid and people without any coverage. These
are all are driving the remaining ambulance providers out of business. Be safe
out
there! - Ed
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Three Letters Re: Advanced Medical Care and Transport After TEOTWAWKI
James,
[Regarding
the letter from DS in Wisconsin:] Maybe and I mean maybe there
would be someone to care for a injured or sick member of your retreat group
or
a doctor
or nurse
to look
at
them, probably
not. If you have the gas to get them there. If you
can leave enough security at the retreat and enough security to take with
you. Remember, this is The
End of the World as we Know It (TEOTWAWKI).
There are several books that should be in a medical library you might already
have them: Where There
is No Doctor, Where
There is No Dentist,
and Emergency War Surgery. There
are more, but to me these
are the first books that I would choose. Your training would be one of the
best barter jobs I can think of. You can't call it practicing medicine without
a license.
You would be a Healer or Doctor for your area. Remember this is not
the world as it was. I don’t think enough people
put enough emphasis on medical [training and supplies] for there preparations.
I truly don’t
mean the foregoing to sound mean. - Lee (Once a Marine, always a Marine)
Dear JWR:
I felt (along with protracted pushing from my wife) that a response to the
honest and logical questions
raised by DS in Wisconsin was warranted. This
is coming from a long term preparer who is a practicing anesthesiologist
with internal medicine training and the husband of a “retired” ER/ICU RN. If we are talking about a scenario where transportation is problematic,
one needs to look in the mirror and determine if you are able and willing
to do what needs to be done. While training and experience are crucial, the
idea of limiting one’s actions based on whether or not it is within
an individual’s “licensed” scope of practice is problematic.
In a survival situation, one should do what he/she is capable of doing and
let the legal dust settle out later (i.e. Good
Samaritan Laws, etc.). I can
honestly say that in the absence of a fully stocked and staffed Operating
Room (OR), anybody with a little training, and preferably a little experience,
could perform 90+% of the “medical” interventions I could perform.
During the American Civil War, a good example of an era prior to “modern” medicine
with large displaced populations, the vast majority of deaths (including
military units) was from infections and communicable diseases. Actual combat
deaths were a significant minority. Above all else, sanitation alone, has
contributed the most to increasing the life expectancy of humans. This is
where I have a major problem with the idea promoted in the
article by Keith in Minnesota (The Home Chicken Flock for Self-Reliance) where he suggests
building immunity by constant exposure to pathogens. You do not need an MD
or RN license to practice good sanitation or isolation from communicable
diseases.
In the same vein as sanitation, preventive medicine is a strong contributor
to life expectancy, and is more crucial now before TEOTWAWKI.
If you have a gallbladder which is acting up or a problematic tooth, you
should
get those
things addressed now while “licensed” professionals have fully
stocked offices and ORs. Given the upcoming elections (and global
conditions such as food shortages), your time frame for addressing these
issues should likely be within 9-to-12 months.
Finally, let me address the core issue raised by DS in Wisconsin, namely
the occurrence of major injury or illness in bad times. This is where a crucial
paradigm shift in thought has to occur in people with medical/nursing training
and/or experience. Most people in the health care community see a major injury
and immediately think “ship it” to somebody or someplace else
to deal with the problem. In the OR (frequently the “final common pathway” for
these problems), for better or worse, we have a very fatalistic viewpoint
imposed on us. Some injuries and illnesses are simply not survivable and
we have accepted the fact that there will be some losses. This is a very
hard thing to come to grips with while maintaining stable mental health.
In my own personal case, I find comfort in the fact that I can (usually)
say that I did everything I was capable of doing in the situation. Hindsight
and after-action evaluation may find some deficiency, but this process should
be viewed as a learning tool rather than finger pointing. Pathologic depression
and protracted feelings of guilt take a major toll on healthcare providers
in “critical care” areas such as ER, ICU and OR. It is difficult
to explain, but there is a particular serenity in being able to accept that
despite the fact that mistakes were made, one did the best he could in the
heat of battle. This paradigm shift will be very difficult for many in the
healthcare field. I think it would be difficult to accept that my efforts
were not optimal because of some self imposed limitation such as “scope
of practice”, but others may find comfort in this view. I would simply
implore you to try and do everything you are capable of doing.
In the case of major injury or illness, the largest improvement in survivability
will come from stopping bleeding and replacing lost intravascular volume.
If major organ damage is done (such as liver, heart or brain), one has to
accept that death is a likely outcome, even in the best of times (with fully
stocked and staffed ORs). The problem is that there is nobody to “ship
it” to, and the implications that has on the mental health of the person
providing care. Apart from this, it is the rare injury, where bleeding has
been stopped and intravascular fluids replaced, where immediate survival
is not possible. In the case of a self limited illness like Salmonella poisoning,
continued supportive care with fluid replacement will likely be all that
is possible, and probably all that is necessary. For wounds and other injuries,
limiting infection and supportive care will again likely be all that is possible
(and likely all that is necessary). Keeping a wound clean and removing devitalized
tissue is something any person (healthcare provider or not) should be capable
of doing with training. One does not need to go digging for the bullet (as
in Hollywood lore). In the OR, bullet removal is usually incidental to following
the tract of the bullet to repair damage, not specifically to find it.
As far as material preparation, as a healthcare provider, I would suggest
a stock of items which will help with these two critical areas, namely stopping
bleeding and replacing lost intravascular fluid. Clean bandage material with
or without a pro-coagulant (such as Quick Clot) applied with pressure will
likely be all that is necessary (or possible) to stop most bleeding. An ability
to provide intravascular fluid resuscitation such as an IV catheter and tubing
with IV fluid (either prepackaged or home made) would put you in the top
tier of being able to provide emergency medical care in a crisis. A simple
battlefield surgical kit (although common household items such as scissors
and tweezers will suffice) will provide the ability to keep a wound clean.
If your neighbor knows that you have an RN or MD after your name, I promise
you that people will come seeking help in bad times. It will be up to you
to decide if you can provide it or turn them away. For your own mental health,
I suggest you think about this prior to a time of crisis. - NC Bluedog
Dear JWR,
If I am interpreting D. in Wisconsin's questions correctly, then they need
to be addressed separately:
The first question is being posed as a licensed healthcare provider. Are
you exempt from legal liability in TEOTWAWKI situations
for intervening in a person’s emergent situation to render healthcare
or aid and/or transporting them to a facility as the books that are referenced
suggest to do? The current
Good Samaritan laws, (see definition),
and their facts lie in which state of the US or Canadian province you are
practicing in. Notice that I said practicing
in. If you are visiting or vacationing another state or country, you had
best look up this law’s application for where you’re going. In
October/2000, the
Cardiac Arrest Survival Act (CASA) was added to the Federal Good Samaritan
Law.
It requires an Automated External Defibrillator (AED) to be located in all
Federal buildings. There is no comprehensive US Federal Good Samaritan Law
as of
yet which details a reciprocity for your
healthcare actions or coverage in your rendering licensed assistance to a
victim of injury or accident. See this
site for a detailed list of the US
States and their individual Good Samaritan Law. Study it carefully.
Each different state has its own standards, limitations and exceptions. One
consistent issue however, that is often confusing in it’s liability
of risk, is whether or not you have been a previous or ongoing provider of
this person’s healthcare. Meaning, if you are their routine Physician
Assistant, Nurse Practitioner or MD, that perhaps you best consider the diagnosis
of why you are intervening on an emergent basis and expecting the Good Samaritan
Law to provide you with protection? Is it for a different diagnosis? Like
an electrocution
or lake drowning or cardiac arrest or gunshot wound? Hopefully, however,
even if it is for the recurrent diagnoses but with a new emergent reason,
like a diabetic crisis, or a difficult child birthing, that you’ve
treated before in the past that you will still make the decision to intervene
and treat them for the condition, based on your scope of experience and practice
skills. Don’t rely on the Good Samaritan Law to be your decision basis
to help. Only you as an individual can make that difficult decision for yourself.
In the
TEOTWAWKI scenarios in some very rural areas or seasons, if you are the accessible
to transport to “medical person”, then you are it!
The second question that is asked is specifically about transport issues.
This has been a test case scenario for lawyers of Hurricane Katrina victims
requiring emergency intervention in Louisiana and Mississippi . Since that
lesson,
there
is still no proposed Federal intervention of the Good Samaritan Law.
I say that we do not need to federalize good moral practice. If more people
will just do what must be done in obvious emergencies or accidents and stop
looking
for the government or the lawyers to decide for them what is best, then we’ll
be able to truly practice what is best for them and for our medical professions.
Look up the bible’s definition of what it means of being a Good Samaritan.
Ask yourself, Why would you in a TEOTWAWKI situation, transport that emergent
someone who needs assistance immediately, and is the intervention needed
either not possible to do, or not wise to do, because it’s over your
head and experience and skill level. However, even after you consider all
of these answers, if you are the best or only one that is available, then
it’s you! You’re it. Do your honest best and pray and be willing
to accept some losses and your own human weaknesses.
In summary, get your medical certifications up to date, if you’re retired,
consider reallocating your license to volunteer practice status. You should
already know current CPR practices, which according to the AMA have recently
been revised to advocate no more mouth to mouth required for arrest cases
and know how to use an AED. But, the true moral to this whole story is, “Nosce
te ipsum!” Know Thyself! Know your limitations. Now,
not later is the time to acquire the skills and supplies and medications
you will need to
be the best you can be to offer medical assistance in a TEOTWAWKI situation
for your family, friends, community, or if you chose to hang that shingle
out of your retreat as the “Doctor is In”. And if you chose to
assist as a licensed medical person, it is your personal responsibility to
have
the qualifications to back your actions! I hope this information helps us
all when the time arises, and it will. - KBF
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Letter Re: Advanced Medical Care and Transport After TEOTWAWKI
Mr. Rawles,
I have been a reader of SurvivalBlog for at least a year now, and I feel it's
time to get involved. During this time I have been adding to my preps, building
a library, and re-certifying my medical credentials. I have also done a lot
of reading, getting many opinions concerning the future. I found one thing
that I am at a loss for, and that is the subject of this letter.
In all my medical re-certification courses and also in the medical library
that I have put together, I have these questions: If society does go down the
dumper and all social services and amenities cease, along with gasoline and
diesel fuel for transport, how to we get injured or seriously ill individuals
to proper medical facilities? Who would be there to receive them, and what
kind of treatment could we except once this patient arrives? None of my training
programs nor the books that I have in my library address these questions. They
all state: "Transport the patient to the nearest medical facility for
treatment." So, what do we do?
I have given much thought to this, and finally after reading material about
the situation in Africa and other countries, I started an Internet search for
answers. What I found was that several legitimate world-wide organizations
may have solutions to these questions. First, the World Health Organization
(WHO)
has published numerous books on medical care and treatment in Third World and
remote areas. I found them to be free of cost and can be downloaded.
Second,
The
Hesperian Foundation has a very good series of books concerning the same
subject. They can also be downloaded free on the Internet. I've managed to
download quite a bit of information concerning advanced medical care from these
two sources. I also have a found a copy of the book "Survival and Austere
Medicine: An Introduction." The 213 page book is in PDF format
and is available for free
download. These
books are a welcomed addition to my library. Now comes the job of reading and
taking them to heart.
I recommend that all
readers check out these sites.
I know this may rankle the professional some MDs out there, but it needs to
be addressed. You cannot be everywhere at once, or all things to all people.
I would appreciate hearing your comments and concerns in a constructive manner
on this Blog so that a proper understanding and direction for training can
be achieved. I also want you to understand that as a retired ER/ICU Nurse,
I know the legal side of things and I will
not practice medicine without a license.
As I said above, I am a retired Critical Care RN, a retired EMT and First Responder,
and a retired U.S. Army Reserve Combat Medic. I have over 30 years experience
in
the field, and I know my limitations. I ask that all who comment on this letter
do so in an intelligent manner so the information derived can be used for the
benefit of all of us. Sincerely and Honestly, - DS in Wisconsin
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Two Letters Re: Homemade Alcohol Stoves
Mr. Rawles,
The recent article on alcohol stoves made me think of these ultra-lightweight,
portable alcohol stoves made out of soda cans, See this
Wikipedia article.
I have successfully built the original Pepsi-can version using epoxy glue,
as well as the Heineken-can "penny" version. I have not tested them "in
the field" but both work very well indoors, and they have impressive performance,
boiling 2 cups of water in 5 minutes using only 2 tablespoons of alcohol. Those
who have actually used them outdoors say they outperform other small stoves
even in the most extreme of conditions. Even for indoor use, they are a compact,
easily stored backup for cooking.
The stoves are easy to build, but expect to build a few to get the hang of
it and make a well-burning version. Many web sites are available that cover
different versions of the stove and various accessories to go along with it.
For fuel, you should only use methyl or ethyl alcohol. Don't use isopropyl
alcohol in these stoves, as it will cover the bottom of your pots and pans
with soot. Methyl alcohol burns hot and clean, but it is poisonous.
It is available, among other places, as HEET brand engine fuel line de-icer
in auto parts stores
in the red
bottles. (Don't get ISO-HEET, since that is isopropyl alcohol). Denatured ethyl
alcohol is cheapest, and of course Everclear 190 proof grain alcohol works
as well,
but it is quite expensive. Sincerely, - Chris S.
JWR Adds: Denatured ethyl alcohol ("grain alcohol") is much less expensive if bought
in quarts or gallons. It is available at paint stores. Don't buy methyl alcohol (Methanol or "wood" alcohol"), because of its toxicity. Long term exposure to the fumes or just brief contact with the skin can be toxic and can cause irreversible liver damage.
James,
LeAnne's article today has some bad advice and some misstatements in
it - potentially dangerous.
First of all, alcohol will produce Carbon dioxide (CO2) and water vapor (not
carbon MONoxide, CO) only in a perfect (ideal) combustion, with exactly the
correct proportion of oxygen - called the stoichiometric ratio. Any deviation
from that will produce imperfect combustion and CO. Even a perfect combustion
will result in CO2 being produced, the carbon atoms in the alcohol have to
go somewhere. And perfect combustion only happens on chemistry examinations.
A buildup of CO2 can be just as deadly as CO.
Secondly, 70% alcohol is 30% water....and before you get any heat out of burning
the alcohol you need to heat up and boil off the water. Half of the energy
of the alcohol (by volume) is wasted getting rid of the water The water vapor
added to a shelter could be significant. A better choice would be 91% alcohol,
if you had to use isopropyl alcohol. A better choice IMO would be alcohol available from paint stores, boating shops, etc.
For people travelling (backpacking, etc) a higher energy density fuel (gasoline
versus alcohol, with roughly twice as much BTU value
per pound of fuel carried) makes more sense. Alcohol stoves have their niche
but LeAnne's reliance on them
can lead one to dangerous reliance on them in inappropriate conditions. - Flighter
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Letter Re: A Special Antibiotics-By-Mail Offer for SurvivalBlog Readers
Jim:
Many SurvivalBlog readers have expressed an interest in obtaining antibiotics
for emergency use, for example t be prepared for another 9/11-style anthrax
attack (for which ciprofloxacin has been recommended in the past by the FDA and
Centers
for Disease
Control) or a flu epidemic. The gentleman who owns a discount pharmacy has
agreed to a solution. From now until April 30, 2008, The Medical Center Pharmacy,
located in the lobby of The Hillman Medical Center
at 2116 Chestnut St, Philadelphia, PA 19103, will offer for sale sealed
stock bottles of 100 Ciprofloxacin 500 mg tablets in their original
packaging "to
SurvivalBlog readers who mention discount code SB1" for only $33. (If
your prescription is for less than 51 tablets of ciprofloxacin, the price will
be $25. [The cost per unit is higher because] if the quantity is less than
100 tablets the stock bottle will be opened by the pharmacist and pills counted.)
In addition,
10
capsules
of
Tamiflu
75
mg in their sealed original packaging for treatment and prevention of flu will
be available for $93. Any other prescription medicine available in
the USA will also be offered at a discount price if "discount
code SB-1" is
mentioned. This pharmacy has been owned by the same pharmacist for the past
15 years. Both of these medicines are recently manufactured and have distant
expiration dates. The pharmacy's toll free phone number is 888-653-9404 or
if busy, call 215-568-3858. FAX: 215.564.6065.
There are four straightforward conditions. Firstly, since these are prescription
products, you must have a health care provider phone, fax, or mail
in a prescription.
The pharmacy is only able to honor the "SB-1 discount" from 8:30
AM to 5 PM Monday-Friday EST. Second condition is that there will be no acceptance
of any prescriptions for any "controlled substances" (such as narcotics,
amphetamines, etc.) unless the original prescription is handed to the pharmacist
by the customer at the pharmacy's physical location [and provide proof of identity](provided
above). However, the good news is that any customer presenting a physical prescription
or picking
up prescription medication at the pharmacy will receive an additional $5 off
per prescription because the pharmacy is spared additional shipping, handling
and related costs. Third condition is that there is an additional charge for
mailing of $3 for the first prescription and $2 each for all other prescriptions
mailed out in the same package to the lower 48 states. This includes a charge
for delivery confirmation. The final condition is that the only acceptable
methods of payment are either major credit card, US postal money order (made
out to "Medical
Center Pharmacy"), or cash. No insurance accepted.
I researched prescription prices and urge your readers to do so. The Medical
Center Pharmacy is offering really great prices for genuine products. For the
price of roughly a half tank of gas or two AR or AK mags, you can choose to
have enough ciprofloxacin for anthrax exposure and not lose life-threatening
time if your doctor agrees that you need to start a medication immediately.
Based on the response, there may be other group-buy style discounts and programs
for other survival prescription medications available in the future. Why not
compare the prices of all your current prescriptions with those offered under
the "Discount Code SB-1". Given the rural isolation of many SurvivalBlog
readers and high gas prices, you have little to lose by prudent preparing,
asking question,
and price checks. The Medical Center Pharmacy reserves the right to increase
the prices stated above after April 30, 2008. - Yorie in PA (a retired physician)
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Family Learning for Preparedness, by T.D.
My husband and I are like minded, (he realized way before I did), and he and
I didn’t
meet until I was in my mid-thirties. I was considered weird, called a tomboy
and later, a gear head. Don’t get me wrong, I cook, sew, knit and crochet.
I had many interests though and wanted to learn.
What I have seen lately and in some people we met that are like minded, is the
lack of initiative on the part of some spouses. I have seen some women and men
that
will ridicule their spouses or will just roll their eyes and feign interest.
I have seen some that their spouses have prepared and bought supplies but their
other half has no clue even how to do the basics. If you are truly vested in
being prepared, your spouse and children need to brush up on the basics also.
This should give you some good ideas on how to learn where you are lacking.
Do you have a grain mill? Mortar and pestle? Does he/she know the basics? Can
all of you bake and cook from scratch? Are your children picky or will they eat
everything you put in front of them? Can they sew? Do they know the basics on
edible plants? Can they hunt or fish? Can your children do what is needed? Can
you do the repairs needed to your home/vehicle?
Our daughter is 16 and she is learning about cars, she can fish with the best
of them and she is a good shot. Our youngest is three years old and he will be
learning as we go. Both will be able to cook (one does now), sew, set traps,
care for
farm
animals, strip and clean weapons, basic survival, fix the family relic (car)
and hopefully get through anything that is thrown at them.
The first step is to start early – my husband is Creole and we eat a lot
most people don’t. Turtle soup, crawfish, head cheese and some even eat
tripe. My son will eat everything he is offered, he was eating crawfish when
he only had 2 teeth. So our routine was this; we fix it and tell you later what
it is. It works well with older kids; younger kids will eat what mom and dad
eat. It is a well known fact that most really young or really old will not eat
a “different” diet, unless they have been doing so all along.
When your child starts showing interest in guns, at about 6-7 years old, take
them hunting. Show them what guns do. My father did that I have always had respect
for what they can do. Children love doing what mom and dad do so they will take
to hunting with pride. We start ours fishing at 2-3 years old for small fish
and getting them used to being around the water supervised. They know how to
check nets and bait hooks by the time they’re 5, that’s when we teach
them how to clean the fish (mom or dad using the sharp knife).
With cars teach them as soon as they’re out of a booster seat. I have
seen too many men and women who can’t even check the oil in their own
cars. Your children should be a help in most situations not a hindrance, even
if it’s
just handing you the tools you need. Our three year old will do most simple
tasks
he is shown and he does them willingly, he is so happy to be a help.
If you are in the military they have a lot of classes on the base that can
help with some of this. Most bases have a repair shop and you can utilize their
mechanics
and tools to learn about repairing your car. They offer other
things so check
into at the base [or post] repair/craft shop.
Work out your plans to include the jobs you expect your children to do. When
things get bad, if we’re on the move our 16 year old is to keep her little
brother while we move and defend if necessary. When stationary she can shoot,
load and take care of first aid. She will be able to pull her own weight and
then some. Our littlest one will follow suit as he grows.
Use barter to attain the skills you don’t have, watch family, use the
Internet and community college. Take a vacation to Pennsylvania or Tennessee.
You can learn a lot in an Amish community, I learned how to make butter and
I am
going back so I can
learn to shear. Some teach and charge others will share what they know for
free. You
can also buy produce and goods from the Amish. Davy Crockett days are in August
and you can watch the craftsman work and it is for the whole family. All vendors
must have a "period" looking tent up and must dress in period clothing.
The on site cooking is also period.
Volunteer to gain skills; veterinarian office and humane society is a good
place to learn about wound care, antibiotic use and dosage, just go watch,
then you
will learn, most places will not turn down a volunteer. Zoos are a great place
to learn about husbandry, housing and more than basic wound care, as smaller
zoos take care of injuries themselves (after a vet is consulted), most of what
you learn at these places about wound care can be used on humans. Colleges
have book sales where you can get books on farming and some older trades/crafts
very
cheap (books are 1-5 dollars). Local small gun and knife shows are also a bountiful
source of information [and logistics], from hard to find books to hard to
find ammo.
Buy reference books! We recently went to a "Friends of the Library" book sale and spent just $12. We now have the McGraw-Hill's 20 volume set on technology ($5), doctor's desk references ("fill the box for $2"), a whole box. These included: beginner, intermediate and advanced practical chemistry, triage handbook, a nurse's reference guide, medical encyclopedias, and a diagnosis reference. We also got the EIR special report "Global Showdown Escalates", Practical Handyman from Greystone Press ($3). In many towns, you can join the Friends of the Library for $5 to $10 dollars annually, or just hit the book sales once per year. Our $12 investment filled the back seat of our car!
Even if you don’t live where your retreat is take the time to “visit” the
area. Go to the local library, stop at the local shops and grab the touristy
maps. In Amish communities the maps tell you about the local farms and what
produce and goods they sell. They have fliers that have information on classes
offered
locally. The department of education has listings for adult education classes
on things like welding. Introduce yourself to the locals, visit the farmers
and the farmers market. Attend the church while you are there, it is the quickest
way into the fold and into being welcomed by the locals. Whether you live there
permanent or you will someday, you will want to be on friendly terms right
away
then when it all goes down.
In Tennessee when we were there, we saw newcomers (less than one year there)
helping
and
being helped by the Amish. Neighbors coming together when they’re needed,
no questions asked other than when do you need me. They all pull together and
work well.
If your family isn’t ready, or is almost ready, taking these steps or some
of these steps will help you get there. If you’re not “together” as
a family in your preparedness then you need to find a way to be. Get the spouse
interested in this even during an outing or vacation. Find a way to get your
children involved. Preparing isn’t just for one person in the family, it’s
for everyone. - T.D.
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Letter Re: Surplus Ambulances as BOVs
Mr. Rawles
I am a long time lurker on your site and would first like to thank you for
all you do. I learn much from your site and finally read a topic I have some
knowledge of. I operate a large ambulance service (75 units) and read the
article about using ambulances as BOVs. I thought I might make a few observations.
It is true that the truck type ambulance have factory 4WD. However the majority
of van type units have good aftermarket conversions. Most are done by Quimby.
In fact I would only purchase a van type 4x4 from them. One down side to the
truck type unit is that rescue squads are notorious for building a unit well
above GVW. This causes all sorts of brake and suspension problems in the long
term.
As for durability you may be surprised but the van type units have a longer
service life as well as a lower cost of operation. They are usually lighter
and have far more payload than the truck type. One big concern of a truck type
ambulance is that the module is designed for remount. Now from a factory they
are built well but at remount time all bets are off. They can truly be done
by a shade tree mechanic and the electrical problems can be a nightmare. The
van units will almost always come with the factory wiring and since they are
all one unit the cabinets and structure seem to hold up better.
Excluding 4WD units, if I was getting one as a BOV, I would consider a van
type Ford E350 built between 1990 and 1994 with the non-direct inject, non
turbo engine. These
units can easily go 400,000 plus miles. Consider keeping [one or more]
glow plugs, a fuel pump, an extra set of injectors, and a crank position sensor
as
spare
parts.
These
units are small, durable and easy-to-maneuver vehicles that handle well get
acceptable mileage and are easy to obtain parts for.
One other thing to consider. How to paint the unit. In a true pre-TEOTWAWKI
Get Out of Dodge situation having a vehicle that can appear similar to an
emergency vehicle may not be a bad thing. With a van unit you could even have
a magnetic
sign
with some sort of logo that could be added and removed at will. I can tell
you an ambulance is rarely stopped or harassed. It is not unusual for them
to go long distances and both LEOs and
the public see out-of-area units all the time so it does not arouse a lot of
suspicion. Of course you would have
to
check state and local laws.
Hope this gives some insight into ambulances. It is true they can often be
found at low prices with low mileage and could make a great BOV, if selected
carefully. - RB
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Letter Re: A Reminder on the Terrorist Toxins Threat
Jim,
I bring this news story to your attention: Ricin
Found in Las Vegas Hotel Room; Man in Hospital
The Center
for Disease Control (CDC) protocols don't give one much hope if ricin is
inhaled or ingested. Unclothing and washing procedures for external contact
are not reassuring. Other sources indicate that skin contact is usually not
fatal unless accompanied by other agents that enhance absorption. [JWR
Adds: DMSO is
a well-known transdermal carrier.]
Other sources also indicate that ricin is 30 times more potent than VX nerve
gas. Full MOPP suit
and gas mask seem to be indicated to avoid aerosol exposure. Since the lapsed
time between exposure and onset of fatal symptoms can be hours and with no
existing antidote, this seems to be a particularly nasty agent to avoid.
It seems to me that for various reasons, one would be more likely to encounter
ricin in a terrorist event rather than the other CBR agents
that are usually mentioned. In any event, one might have to rely on the rain
gear and N95 particulate mask that should be in every BOB along
with the standard decontamination procedures that all should be thoroughly
familiar with.
Are there field detection resources and other related items that you might
recommend for an ai travel BOB which will be different from the vehicle BOB
left in the airport parking lot?
I think this has been covered before but it might be timely to reiterate it
again. Best Regards, - William D.
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The "Come as You Are" Collapse--Have the Right Tools and Skills
In the Second World War, the United States had nearly two full years to ramp
up military training and production before decisively confronting the Axis
powers. In the late 1970s, looking at the recent experience of the 1973 Arab-Israeli
War, the Pentagon's strategic planners came to the realization that the next
major war that the US military would wage would not be
like the Second World War. There would not be the luxury of time to train and
equip. They realized that we would have to fight with only what we had available
on Day One. They dubbed this the "Come as you are war" concept.
In my opinion, the same "come as you are" mindset should
be applied to family preparedness. We must recognize that in these
days of rapid news dissemination, it may take as little as 10 hours before
supermarket shelves are cleaned out. It make take just a few hours for queues
that are literally blocks-long to form at gas stations--or at bank branches
in the event of bank runs. Worse yet, it may take just a few hours before
the highways and freeways leading out of urban and suburban areas are clogged
with traffic--the dreaded "Golden
Horde" that I often write about. Do not make the false assumption
that you will have the chance to make "one last trip" to the big
box store, or even the chance to fill your Bug Out Vehicle's fuel tank. This
will be the "come as you are" collapse.
The concept also applies to your personal training. If you haven't learned
how to do things before the balloon goes, up, then don't expect to get anything
but marginal to mediocre on-the-job training after the fact. In essence, you
have the opportunity to take top quality training from the best trainers now,
but you won't once the Schumer hits
the fan. Take the time to get top-notch training! Train with the best--with
organizations like Medical
Corps, WEMSI, Front
Sight, the RWVA/Appleseed
Project, the WRSA,
and the ARRL.
Someday, you'll be very glad that you did.
The come as you are concept definitely applies to specialized manufactured
equipment.You are dreaming if you think that
you will have the chance to to purchase any items such as these, in a post-collapse
world:
razor
wire, body
armor, night
vision equipment,
advanced
first aid gear, tritium
scopes, dosimeters
and radiac meters, biological decontamination
equipment, Dakota
Alert or military surplus PEWS intrusion
detection sets, photovoltaics,
NBC
masks, and semi-auto
battle rifles.
Think about it: There
are very few if these items (per capita) presently in circulation. But the
demand for them during a societal collapse would be tremendous. How could
you compete in such a scant market? Anyone that conceivably has "spares" will
probably want to keep them for a member of their own family or group. So
even in the unlikely event that someone was even willing to sell
such scarce items, they would surely ask a king's ransom in barter
for them. I'm talking about quarter sections of land,
entire strings of
well-broken horses, or pounds of
gold. Offers of anything less would surely be scoffed at.
Don't overlook the "you" part of the "as
you are" premise.
Are you physically fit? Are you up to date on your dental work? Do you have
two pairs of sturdy eyeglasses with your current prescription? Do
you have at least a six month supply of vitamins and medications? Is your body
weight
reasonable?
If you answer to any of these is no, then get busy!
Even if you have a modest budget, you will have an advantage over the average
suburbanite. Your knowledge and training alone--what is between your ears--will
ensure that. And even with just a small budget for food storage, you will be
miles ahead of your neighbors. Odds are that they will have less than two week's
worth of food on hand. As I often say, you will need extra supplies on hand to
help out relatives, friends, and neighbors that were ill-prepared. I consider
charity my Christian duty!
I have repeatedly and strongly emphasized the importance of living
at your intended retreat year-round. But I realize that because
of personal finances, family obligations, and the constraints of making a
living at an hourly or
salaried job, that this is not realistic--except for a few of us, mainly retirees.
If you are stuck in the Big City and plan to Get Out of Dodge (G.O.O.D.)
at the eleventh hour, then by all means pre-position the vast majority of your
gear and supplies at your retreat. You will most likely only have one, I repeat, one G.O.O.D.
trip. If there is a major crisis there will probably be no chance to "go
back for a second load." So WTSHTF will
truly be a "come as you are" affair.
With all of this in mind, re-think your preparedness priorities. Stock
your retreat well. If there isn't someone living there year-round,
then hide what is there from burglars. (See the numerous SurvivalBlog posts
on caching and constructing hidden compartments and rooms.) Maintain balance
in your preparations. In a situation where you are truly hunkered-down at
your retreat in the midst of a societal collapse, there might not be any
opportunity to barter for any items that you overlooked. (At least not for
several months. ) What you have is what you got. You will have to make-do.
So be sure to develop your "lists
of lists" meticulously. If you have the fund
