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Letter Re: Avoiding Influenza When Traveling Overseas
James,
My work forces me to travel frequently – 80 to 90% of the time. And it’s not to fun places like Miami or Rio but rather third world locales (just coming back from a swing through the ‘stans – Afghanistan, Tajikistan, Turkmenistan, Uzbekistan, and Kazakhstan -- where I have a large telecommunications project). As such I get exposed to every imaginable sort of illness. I finally found a doctor I could work with when he started to ask where I had been lately rather than what the symptoms were.
As such I have a larger than normal medical kit I take with me on the road. (I also have a 1 quart water bottle sized survival kit I take with me, but more on that in another letter). So I have traveled for years and over the time the kit has grown based on the needs I could not meet in the locales I was in. It really took off when I spent one early December in Beijing and for three weeks the entire stock of western medicines in Beijing was sold out – no decongestants, no ibuprofen, and no sleep as a very bad cold kept me up.
Over the years I have found certain habits to be essential to keeping healthy overseas. First and foremost is a regular dosage of Vitamin C. As soon as I think I am coming down with something I start on a regime of Golden Seal mixed with Echinacea. Finally, I make sure that I have various OTC cold medicines with me at all times – such as Mucinex and 12-hour Sudafed. I also carry Ciprofloxacin, various sulfa drugs, and more recently Tamiflu, as well.
On top of this I am a hygiene nut – washing hands frequently, making quite sure that the water for tea is boiling before I get it, carrying hand wipes with me (Okay, since my youngest is finally out of diapers I am using up the last of the small diaper wipe packets), and the like.
Now while frequent close contact is the norm in many cultures and cannot be avoided without causing undue friction--I still can’t bring myself to do the nose rub with the Arabs--and although I do teach impromptu martial arts classes to all comers in hotel gyms, I do try to limit it.
But all my precautions were to no avail with the Swine Flu. I am just getting over it and have passed it on to my 17-year old son. I assume that the rest of the family will follow in short order (five kids means lots of germ breeding goes on). And if you were in the Frankfurt airport on Saturday – I probably gave it to you as well.
As such I would strongly recommend that folks, while preparing with masks and gloves and the like, concentrate on preparing for getting swine flu. I did everything “right” from a prevention stand point without turning myself into a hermit. And yet here we are with it spreading in my family.
What I have found in my personal case is that the three key medicines to have on hand were Mucinex
[expectorant], 12-hour Sudafed
[decongestant], and Albuterol Sulfate (found in most of the asthma inhalers and commonly used in nebulizer treatments for breathing disorders). Fortunately, with my travels I have a prescription for, and carry, one of the asthma inhalers for those times that I have come down with various forms of pneumonia while on the road. - Hugh D.
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Letter Re: Medical Corps Offering a Field Dentistry Class in August
Jim:
I thought that SurvivalBlog readers might be interested in a Dental class being conducted by Dr. Loomis (DDS) in Tennessee. Tom Loomis has been teaching at our classes for almost as long as we have had the school. On August 14-15 he will be teaching a Field Dentistry class near his office in Tennessee. The student will get the unheard of chance to fill cavities, replace broken or missing crowns, extract teeth and use a high speed dental drill. The drill is the same type used in any dental office. Several years ago I asked him if he could convert the air turbine drill to run off a simple [compressed] air tank which could be recharged with a bicycle air pump. He did and we now use EMP proof high speed dental drills. In fact some class members have even purchased these rigs for their survival retreats. If any of your readers are interested in completing their training with a good dental course, please contact:
Dr. Tom Loomis, DDS
423-337-9834
tandsloomis@bellsouth.net
Best Regards, - Chuck Fenwick, Director, Medical Corps
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The Jump Kit, by Skyrat
Inside the trunk of my vehicle is a near duplicate of the “jump kit” or “Green Bag” used in my days with the Detroit Fire Department's Emergency Medical Service Division. When I come across a roadside collision before the local medics, everything I need to start patient care is in the green canvas bag I sling over my shoulder. The supplies in my personal vehicle are very much like those I carried in my street medic days, and reflect a strong basic life support/trauma bias.
Basic life support includes those interventions that do not go past the skin, and generally do not require physician direction to implement. Advanced life support, on the other hand, includes therapies that do go past the skin, and include medications, intravenous fluids (IVs), electrical counter shock, and airway intubation.
I do not include intravenous fluids or medications in my green bag for a couple of reasons. First, these items have a limited storage life under the best of conditions, and the rear of a passenger vehicle in Northern Michigan is not calculated to prolong it. Second, the statutes under which paramedics practice here in Michigan requires systematic physician supervision of advanced patient care. Fundamentally, that means that if you are not functioning within an established paramedic system, you are out of bounds should you perform advanced procedures on the street. Third, advanced patient care procedures are occasions of peril even in the hospital, let alone in the rear of an ambulance. This is so, even within a system of continuing education, continuous quality assessment, supervision, and the backup of both your partner, and the physician and clinical staff on the other end of the telephone or radio. Soloing at the roadside provides neither you nor your patient with these safeguards.
Firearms owners are likely acquainted with the “gun shop commando”, classically braying about the bogus “shoot 'em and drag 'em inside” philosophy of home violence management. Likewise, you might consider the existence of the “parlor paramedic”, who seems to reason something like, ”wait until the Schumer hits the fan, and I'll come out of the closet, birthin' babies and saving lives!”
In order to entertain this fantasy, you will need the tools of the trade. Medications are not without risks, do not keep forever, and are expensive. Additionally, there is the issue of convincing a physician that he or she ought to prescribe for you and that you can differentiate your Barneyfrank (ass) from a hole in the ground. If the expense is no problem for you because you have money to burn, please see me after class! If you think that the utility of your medication stash outweighs the other concerns, please contemplate these points: 1) In the absence of a catastrophe the likes of which America has never seen, it is both illegal and immoral to withhold professional medical care required by an ill or injured person. 2) During Schumeresque times, it is unlikely that the infrastructure will be in service which allows the delivery of complex, highly skilled care to those in need. Particularly, you will not have access to that infrastructure, and (if you have your head screwed on straight) you will have no desire to perform skills you are not trained to do, in the midst of a disaster, upon your vulnerable, hurting and injured loved ones.
By way of example, I have 30 yeas of EMS and nursing experience (in ICU, CCU, and ER), as well as licensure as a Physician's Assistant. I have used Dopamine, along with other invasive therapies, innumerable times to support the blood pressure of critically ill or injured patients. Dopamine has potent effects upon the heart, among other systems, and these effects are monitored by a cardiac monitor. I found a Zoll Automatic Cardiac Defibrillator, after a brief internet search, for $3,000, which appears after a casual review to allow monitoring. The question, however, is whether you can make sense of the tracing the monitor displays, identify adverse changes in cardiac rhythm, and respond appropriately. Additionally, do you know the adverse effects Dopamine may have, and how they must be managed? If not, you have no business trifling with it. I have done all these things for years in my Nursing practice, and I do not have Dopamine in my personal stores. You need to assume the risks you both understand and are comfortable with. I am reluctant to assume this risk for myself and my family.
My bias toward trauma derives from the fact that the stabilization and management of the medical patient, in contrast to the trauma patient, calls for assessments and interventions that I generally do not find appropriate outside of the hospital or advanced life support ambulance. Determining the source of the patient's distress will identify what treatment is required. While there are a few medical conditions that are responsive to basic life support interventions, I am not about to pretend that a few thousand words will equip you to make such judgments. Find an American Red Cross first aid class and master it. Better yet, become an EMT.
Just the other day, I came upon a rollover as my girlfriend and I were en route to attend some family function. There were half-a-dozen civilians clustered about, and things seemed well in hand. The first firefighter arrived shortly after me, and I deferred to him. Offering him wound care supplies, I was surprised to discover I could not find any gloves in my kit! Returning home, I undertook an inventory. Here is the result of that tally, and some discussion of my view of why each item belongs in my kit.
Training comes first. There is a story told of the early days of the Israeli state, when the emergency response planners had the budget required to train their personnel to stabilize and transport spine injured patients, or buy the splints (called backboards), but not both. The story relates that the planners elected to train their personnel, and subsequently noted a spine injured kibbutznik transported to the hospital by his comrades, secured effectively to an entire barn door.
I place a priority on training for several reasons. First, neither vermin nor adverse storage conditions have ever ruined training and rendered it unusable. Secondly, “they can have my training when they can pry it from my cold, dead mind”. Third, I have never ever (in my disorganized life) failed to pack my training. Fourth, there is nothing that will be displaced from my supplies in order to make room for my training. Fifth, in contrast to supplies, ability improves with use, and becomes more abundant when you share it with others.
Begin with CPR training. Three or four hours of your time will equip you with the skill that may save a life in the here-and-now. You will gain an introduction to patient assessment, and learn some of he fundamentals of first aid, and whatever dilemma confronts you, your response cannot fail to be more effective with some training to guide you. Effectiveness saves lives.
Look into local outlets for first aid training. The American Red Cross, the National Safety Council, your local community college, as well as perhaps others offer credible training which may serve as an introduction to further studies. The justification for the further expenditure of additional hours may be found in the preceding paragraph. Additionally, if you are more acquainted with what the medical conversation is about, the health care decisions made with regard to yourself and your family will be less mysterious to you, and better informed decisions tend to be better decisions. The better your health, the better your chances of coming out the other side of Schumer times intact, and therefore the better chance of bringing your family with you, likewise unscathed.
Consider EMT schooling. You will learn more emergency care skills (a good thing), and an introduction to elementary anatomy and pathophysiology (how things go wrong in illness and injury). Such education gives you the opportunity to be a more informed participant in your health care decisions, and that is itself a good thing, as well.
SELECTING YOUR CASE
It really doesn't matte what sort of container you employ for your emergency supplies, so long as it meets your particular needs for security, identification, accessibility, protection and convenience.
Some fire departments use plastic “totes” to organize supplies required for specific types of calls. For example, haz-mat supplies are packed inside specific totes, and the top secured with a cable tie or some such device. An inventory is attached to the top (sealed in plastic) to identify what is inside, as well as out dates of time sensitive components. When properly closed, such bins are drip and dust resistant, resist crushing or jumbling of the contents, and can be convenient to carry when not overfilled. On the other hand, they will not conveniently fit beneath a vehicle seat, may be unwieldy to retrieve and place into action, and may get buried beneath other stuff in a trunk or truck box.
Others of my acquaintance use ammo cans, or plastic fishing tackle boxes. These are generally more convenient to shlep about (unless your tastes run along the lines of a 20 mm ammo can) and are more drip/dust/duh! resistant than the tubs mentioned above. On the other hand, they may overturn with disappointing ease, spilling your supplies into whatever noxious fluid is abundant on your particular scene.
I use a green canvas musette type bag. It is not water resistant, is not neatly compartmentalized, and does not have an IR glint Star of Life embroidered upon it. On the other hand, I know how my stuff inside is organized, it is convenient to sling over my shoulder when the scene requires that I do so, and the local military surplus store will sell me another for $10-20 when that becomes needful. It will fit beneath a van seat, or in a tub in my trunk, and I can work out of it when I have it slung.
IN THE TOP, OR IN AN OUTSIDE POCKET
Items that I am likely to require promptly are either in the outside pocket or immediately inside the top flap of the bag. These are things that I do not want to be fumbling for as I approach a scene. I will not list what might be considered “everyday carry” items like pocket knife, flashlight(s), CS spray, sidearm, and a cell phone. While these tools help keep the rescuer from becoming a victim of an ambush laid for a 'Good Samaritan” , particularly when employed in concert with a Condition Orange mindset. (I did mention I started out in Detroit, didn't I?) These items do not seem to me to be rescue/first aid/emergency medical tools.
First up is several pairs of gloves. (well, now, anyhow!) I am allergic to latex, so I have nitrile gloves. Current practice is to wear gloves anytime you might reasonably anticipate exposure to blood or other bodily fluids: tears, urine, stool, saliva, gastric contents, or any other moist, body-origin material you might imagine (and perhaps a few you might not!). I have so thoroughly incorporated this into my life that I get uneasy caring for my own children (or, at my advanced age, grandchildren!) without gloving first. These are in a zip-lock bag, safety pinned (now!) just inside the top flap of my green bag.
The upside to all this is that scrupulous gloving and thorough hand washing have so far proven highly effective at preventing the spread of the most common blood-borne infections. Diseases spread via airborne droplets (for example, Legionnaires disease), of course, require additional precautions. Others are spread by organisms coming to rest upon environmental surfaces and then accessing a vulnerable host (just like you and I are vulnerable hosts to “the common cold”) by means of unconsciously touching our faces after touching a contaminated surface. For myself, after 30 plus years of patient contact the worst I have brought home has been an occasional upper respiratory infection due to my conscientiously applying the glove/hand wash/hands away from my face regimen.
The next item I'll feel a burning need to have in my hands is a bag-valve-mask (BVM). This is a manually operated ventilation tool. It is employed by sealing the mask over the unbreathing patient's face, squeezing the self inflating bag, and thereby forcing air into your patient's lungs. Repeat at a rate of approximately 12-20 times a minute. Advantage: no kissing strangers, required for mouth-to-mouth resuscitation. You are able to maintain situational awareness of such things as evolving environmental hazards (like leaking gasoline), or indicators of your patient's improving condition (...he said, thinking positively!). On the downside, using a BVM is difficult in untutored hands. It is easier (compared to mouth-to-mouth) to force air into the patient's stomach, which will elicit vomiting. Aside from the aesthetic issues this presents, vomiting in a profoundly unconscious patient (such as one so unconscious as to have stopped breathing) presents the opportunity for aspiration into the lungs of that which has been vomited, which may be deadly.
Training in use of a BVM will be part of the EMT class I mentioned earlier. I'll wait here while you go find out when your local community college or rescue squad will be having their next class. Plan on being a part of that class. You will be making your community, and thereby your family, safer.
You can buy your own, and Gall's will ding your for around $15 for a disposable model. In the hospital, we use these once and discard them. You might choose to meticulously clean yours and re-use it. Your local rescue squad or ambulance may shop locally, and you might want to do likewise. Ya know, if you were to volunteer with your local rescue squad, you might be able to obtain things like this at your agency's cost. All this on top of the good karma from helping to provide a necessary community service. And,, besides, becoming known to the locals (police included) as one of “the good guys”. Your phone book likely will provide the contact information you require. I'll still be here when you get back.
One of the adjuncts to using a BVM is called an oral airway. Oral airways come in sizes, which may be selected according to the size of the patient. Their purpose is to hold the flaccid tongue of a profoundly unconscious patient forward, so that it does not sag against the rear of the throat and thereby block the passage of air into and out of the lungs. The problem it may trigger is, should your patient be other than profoundly unconscious, he or she will vomit. Among other disasters this may cause, the enzymes from the stomach, designed to digest proteins, will (unsurprisingly) begin to digest the proteins found in the delicate tissues of the air sacs (alveoli) of the lungs, with effects you are likely to be able to imagine on your own. Very Bad Thing. [JWR Adds: Plastic airways usually come in sets of six sizes, and usually color-coded these days, available for less than $5 per set on eBay. Buy a couple of sets. Someday you may be very glad that you did!]
Another way to fail when employing an oral airway is to bunch up the patient's tongue in the rear of the throat. This blocks air flow, strangling your patient. This device must be restricted to only profoundly unconscious patients, and only if you are schooled in its use. You can buy them individually, or in sets. Before shipping, they go for around $5.00/set. You might elect to buy them one at a time, but at $5 a pop, they aren't a particularly major investment.
When I'm confronted by an actively bleeding patient, I reach for a Carlyle dressing. Mine are the old style The Carlyle iteration includes muslin (cloth) ties to secure as any other tied bandage. The 21st century version is called an Israeli Dressing, and is available from various sources. (see my shopping list/spreadsheet for representative sources) It consists of a sterile dressing incorporating an elastic bandage to secure the dressing to the wound. Should you shop gun shows or surplus stores for your equipment, be wary of old dressings. They present potential issues of failed sterility as well as mustiness or mildew occasioned by improper storage or imperfect packaging. The contemporary Israeli Battle Dressings are available from Cheaper Than Dirt or from Gall's for $9.00 or $10.00 each.
Another wound care product is QuikClot . This is a mineral product, bound to a dressing, which enhances clotting, and thereby slows and limits blood loss in the bleeding patient (common in trauma, surprisingly enough!) One article (QuikClot Use in Trauma for Hemorrhage Control: Case Series of 103 Documented Uses. Journal of Trauma-Injury Infection & Critical Care. 64(4):1093-1099, April 2008.) reflected the occurrence of burns in several patients, but the manufacturer's web site reports that changes in packaging and delivery system have addressed this issue.
An alternative you might consider is Celox. It appears perhaps to be a reasonable alternative to QuikClot. It is derived from shrimp shells, although it seems to not produce allergic reactions in folks otherwise allergic to seafood. I have no personal experience with either product, but the reports are interesting. This goes on my “further research” list!
The preceding items are to be found in the outside pocket or very top of my jump kit. I don't want to be searching for them when I feel the need for them Right Freaking Now. Beneath the don't-wanna-wait-for-them items, I have supplies of somewhat lesser immediacy. These allow me to assess the situation in greater detail, or address issues that may come to light that are of less time sensitivity.
Triangular Bandages are useful for slings of injured arms, or may be folded into narrow strips and then used as a means to secure splints or dressings (as “cravat bandages”). If we were to consider them as a backpacker might, they may be used as expedient dust masks, bandannas, head coverings, or washcloths. I buy muslin by the yard at Wal-Mart, and cut it from one corner to the other, forming (surprise!) 2 triangles approximately a yard on a side. I keep 6 to 8 in my kit.
Bandage shears are the most obvious of the prehospital medic's tools. You can go with Lister style bandage scissors, often found as “nurse's scissors”, or the plastic and steel “super shears”. Prices range from $4.00 and up. Frequently employed to trim dressings to the proper size, cut away clothing from wounds, and to cut bandages.
Did you ever notice that a tongue blade/tongue depressor is almost exactly the width of a finger? And just a bit longer than your Mark 1, Mod 0 finger? Exactly like it were designed to be a finger splint, isn't it? In addition, should you tape three of them together one on top of the other, you have a dandy tool for tightening that “Spanish windlass” you are going to learn about, when your EMT class teaches you how to apply and improvise a traction splint for a fractured femur (thighbone). Finally, if you are unhappy at the thought of wiggling somebody's fractured femur (broken thighbone) so you may place ties (cravats: remember them?) for a splint, tongue blades are thin, stiff, and very helpful at limiting the wiggling as you place ties beneath the broken bone of your choice. I keep a handful handy.
You can pay a couple of bucks for them at the corner pharmacy, or you might be able to talk your way into several for free, like when you are volunteering at some public service event with your local volunteer fire department, emergency medical service, or amateur radio club.
Stethoscope/Blood Pressure Cuff. A stethoscope allows you to hear the sounds made as air moves into and out of the lungs, and note changes from normal. These changes might occur because your patient has a collapsed lung, or has pneumonia, or heart failure. When you get that far into your EMT class (hint, hint), you will learn how to evaluate these changes, and what sort of treatment decisions you ought to consider when you notice them. In addition, you will learn how to measure, and interpret, your patient's blood pressure.
I am certain you will know somebody who will go out and get the cardiology deluxe stethoscope, with the multi disc cd player, mag wheels, and gold trim. Do not join them in this folly. Spend $10-40 at the same place the local student nurses get their stethoscopes, and spend the difference on your spouse, whose enthusiastic support you will require, anyhow. If you can show your spouse how your expenditure of family money and time on supplies, education, and volunteering promote values that you both agree upon, the both of you will thereby make your family more crisis resistant. If your family is more crisis resistant, then you are not only NOT a drag on community emergency services during an emergency, you all might even be an affirmative community asset during bad times. That cannot fail to be a Good Thing when you get to explain yourself to The Jewish Carpenter. Me, I'm going to require all the help I can get. I'm volunteering!
Adhesive tape (1 inch, 2 inch) secures dressings, holds loose ends of bandages, and provides a single use notepad (tear off a length, tape it to your thigh, and jot notes. You will not lay it down somewhere to be forgotten). If you listen to some friendly and knowledgeable athletic trainer, you can learn how to use it to support sprained ankles or knees if the preferred treatment (rest, ice, elevation) is not possible. Before you employ these tricks, bear in mind that physicians frequently cannot differentiate a sprain from a fracture, even after an x-ray. In my view, except under the most dire possible circumstances, walking on a fractured (or sprained) extremity is a Very Bad Thing. Two rolls each are at hand when I open my green bag.
I keep 12 to 15 Gauze pad, sterile, 4x4 in my kit. I employ them as eye pads, padding beneath splints, or as (oddly enough) dressing for wounds. Occasionally I encounter a wound bleeding so enthusiastically that a couple of gauze pads will be overwhelmed. Fortunately, I haven't come across such a wound off duty, but in the hospital we use a “boat” of sterile gauze. This is a plastic tray of ten sponges in one pack. The tray also may be used as a clean basin for wound irrigation/cleansing solution. In the hospital we use sterile saline, you may elect to use the water from your retort pouch, or fresh from the bottle as you purchased it for storage. I would certainly give it some thought.
If you happen to be the purchasing agent for your entire survival community, ambulance service, or the entire Boy Scout Council, you might find the case price from Galls to be a useful bit of information. 1200 sterile 4x4 pads for $89.99 works out to around 7.5 cents each.
Triple padding/ABD padding, sterile, 5x9 inch. These multiple layer absorbent dressings are designed for wounds producing a lot of drainage of either blood or other fluid. They are my first choice for a bulky dressing or splint padding. I keep 6 in my kit. The frugally minded may note that “sanitary napkins” are designed to absorb drainage, are “medically aseptic”, and are available nearly everywhere.
And, on a related note, tampons from the “feminine hygiene” shelf at your local store are also constructed to absorb fluids, and contain them. Should you confront a penetrating wound, “tamponading” a wound is a widely known concept among inhabitants of the medical world. Packing such a wound with a tampon using sterile technique might prove to be life saving, and provide hemorrhage control options not otherwise available. (http://snopes.com/military/tampon.asp)
Roller Gauze, 4 inch is typically used to secure a dressing (see Gauze Sponge, above) to the wound. I pack 6 in my kit, and they have “found careers” as bandages to secure dressings, securing splints when I run out of triangular bandages, and upon occasion as packing/dressings for vigorously bleeding wounds. In fact, when one is employed as the dressing, and another as the bandage, I can not only dress the wound, but also (since the bulky roll provides a pressure point) apply direct pressure to the bleeding site. This provides an alternative to the Carlyle or Israeli Dressing, cited above
Vaseline Gauze (sterile, 3x9 inch) is intended to seal wounds penetrating the chest, in order to prevent collapse of your patient's lung(s). When you seal the defect in the chest wall, your patient will not draw in air through the wound when s/he inhales, and thereby not fill the space between the lung and the chest wall (the pleural space) with air. When you can avoid this, inhaling draws in air through the mouth, trachea and bronchi, and that inflates your lungs, and we think that is a good thing. Myself, I pitch the gauze and tape three sides of the foil package, sterile side towards the wound, forming a flutter valve sort of effect. In this way I allow excess pressure in the pleural space to vent to atmosphere (stopping further lung collapse, I hope), and seal the hole when the pressure inside the chest is less than atmospheric pressure (like when the patient inhales). The only way left to equalize that pressure is by inflating the lungs, already described with approval above.
The other use for Vaseline gauze is when my lips or hands are dry, in which case I use the Vaseline to remedy that little problem.
We all can think of uses for the common elastic bandage, 4 inch and 2 inch. Two inch is useful for sprains of your wrist or thumb, and the 4 inch is used for an ankle twist/sprain. In addition, I can use them to secure a splint (there is that rule of threes, seen in other posts on this blog, again!), as the “swathe” part of a sling-and-swathe to immobilize an injured shoulder, or as part of a pressure bandage over a dressed wound that does not want to stop bleeding.
Large Bulb Syringe (for which you can substitute a turkey baster) functions as an expedient means of removing fluids from the airway of someone who is not managing to do so effectively on their own. It will not work nearly as well as a battery powered or pump action suction, such as you might find on your local rescue squad rig, but it won't cost you $50-$60 (for the manually pumped version) either. Second best is superior to nothing.
Mylar “Space blankets” protect you or your patient from the hypothermia-inducing effects of the wind, slowing heat loss. Generally colored bright orange on one side and silver on the other, there are signaling opportunities as well. In a pinch, you can improvise shelter from one or two. Amazon sells the "Space Brand" blanket
inexpensively. Equip your jump kits, and each member of your family with one or two.
Any accident so severe as to convince suspicious old me (alumnus of Detroit's EMS) to stop and offer assistance will not be fixed with a couple of Adhesive Bandages (aka “Band Aids”). I have six in my jump kit, two entire boxes at home (and parceled out among my camper, car, and household kits).
I keep a couple of Ice Packs around, as assorted adventures may bring on modest orthopedic injuries. Ice is helpful for strains, sprains, or overuse of an over aged joint (...not that I would know anything, firsthand, about that...). Choices include “instant cold packs”, or that old picnicker's standby, a zip lock bag full of ice from the cooler.
Either option has drawbacks. I do not generally drive about with a cooler of ice at hand, although when camping I am likely to do so. Instant cold packs are kind of fragile, and you might find, when you go to place one in service, that you have a leaking mess on your hands. On the other hand, they are more likely to be there when you want one.
The foregoing lists the contents of my “jump kit”. I keep one kit in my vehicle, and another at home. In addition, there are Subordinate Kits, kept in camper, car and home, for lesser sorts of occasions. I have customized each by adding more dressings, triangular bandages, roller gauze, and gloves. In addition, I improved over the baseline “Wally World” $15 first aid kit, by adding zip lock bags of various household medications. I labeled each bag with the name of the med, the out date of that particular bottle, directions for use, and date of packing. I made my selections by inspecting my own medicine cabinet, and pondering which meds I had wished I had kept handy the last time I was out camping, for example. Most everything commonly needed is therefore in the Camper Kit, Car Kit, or House Kit.
The jump kits are reserved for “Holy Fertilizer!” sorts of events. They are not mere “boo-boo boxes”. Reserved in this way, I will not find myself hunting (and swearing) in crisis, as I need this or that widget, which some child (or adult) has used, and not restocked.
LONGER TERM CONSIDERATIONS
Some of us might contemplate longer term medical preparations. For those, I recommend Dr. Jane Orient's article. Once I get beyond the 20 year old pricing, the are only a couple of improvements I could suggest. One is in the arena of recently developed antibiotics (as in quinolones). Even in that light, it seems to me to be a very good basis for developing a longer term medical kit (and training plan) for your particular circumstances.
Another substitution I would make, is to delete surgical masks, and substitute NIOSH N-95 masks. I found a carton of MSA Safety Works No. 10005403, Pack of 20 Harmful Dust Respirator Model 10005043 for $18.97/each carton at Home Depot. You may find similar products locally.
Additionally, I would add loratidine (you may recognize the brand of Claritin) as a non-sedating antihistamine. (Personally, I would prefer my personnel pulling OP duty to be non-sedated.) I'd also add the most frugal of the following : ranitidine, famotidine, cimetidine, in lots of 1,000 tabs, as a superior stomach acid blocking medication, to supplement the antacid Dr. Orient suggested over 20 years ago. As the “big gun” for acid stomach problems or GERD, I'd lay in a supply of Prilosec OTC. This class of stomach medication is the yardstick against which all others are presently measured.
If you are planning establishing a longer term medical cache, it is imperative that you do so only in concert with a physician, or other personnel licensed to prescribe. The guidance you will receive will help you avoid causing more illness than you relieve. Medications are a double bitted axe, and may cut on the upstroke as well as on the downstroke. Be aware.
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Letter Re: Three Abstracts on Public Health in Ghettos During the WWII Holocaust
James,
In light of the recent shooting by a Nazi whacko in Washington at the Holocaust Museum, I think it is important that we remember the victims and impact of a totalitarian government deliberately starving, looting, and otherwise dehumanizing its citizens. (The articles were published in Hebrew but the following abstracts are in English) - Yorrie in Pennsylvania (a retired physician)
Clinical Manifestations of "Hunger Disease" Among Children in the Ghettos During the Holocaust
Hercshlag-Elkayam O, Even L, Shasha SM.
Western Galilee Hospital, Nahariya, Israel.
The harsh life in the ghettos were characterized by overcrowding, shortage of supplies (e.g. money, sanitation, medications), poor personal hygiene, inclement weather and exhaustion. Under these conditions, morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with a high mortality rate. The dominant feature was hunger. Daily caloric allowance was 300-800, and in extreme cases (i.e. Warsaw ghetto) it was only 200 calories. The food was lacking important nutrients (e.g. vitamins, trace elements) leading to protean clinical expression, starvation and death. The clinical manifestations of starvation were referred to as "the Hunger Disease", which became the subject of research by the medical doctors in the ghettos, mainly in the Warsaw ghetto in which a thorough documentation and research were performed. The first victims of hunger were children. First they failed to thrive physically and later mentally. Like their elders, they lost weight, but later growth stopped and their developmental milestones were lost with the loss of curiosity and motivation to play. The mortality rate among babies and infants was 100%, as was described by the ghetto doctors: "when the elder children got sick, the small ones were already dead...". In the last weeks of the ghettos there were no children seen in the streets. In this article the environmental conditions and daily life of children in the ghettos are reviewed, and the manifestations of "Hunger Disease" among them is scrutinized.
[Harefuah. 2003 May;142(5):345-9]
Morbidity in the Ghettos During the Holocaust
Shasha, SM.
Western Galilee Hospital, Nahariya.
The environmental conditions and daily life in the ghettos of Europe during the holocaust are reviewed, and their effect on morbidity in different ghettos is scrutinized in an attempt to construct a typical morbidity profile. The outstanding characteristics were: crowding, shortage of basic necessities (such as food, clothing and medications), harsh environmental and sanitary conditions, inclement weather, poor personal hygiene, chronic undernutrition and malnutrition, physical and mental exhaustion. Morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with high mortality, and high infestation rates of lice and other parasites. The dominant feature was "hunger disease" with its protean clinical expressions, endocine pathology, growth and development retardation in children, and amenorrhea and infertility among women of child-bearing age. Polyuria, nocturia and increased frequency of bowel movement were common. The typical presentation of a ghetto dweller was of extreme emaciation (a loss of up to 50% body weight); muscle weakness and skeletal abnormalities; pale, dry skin with excoriations; pedal edema; anxiety and nervousness; often goiter in children. Most of the inhabitants had some, or all, of those signs and symptoms (there were times when more than half the population was sick). This syndrome complex was termed "Ghetto Sickness" or "Ghetto Fatigue" (ghetto schwachkeit).
[Harefuah. 2002 Apr;141(4):364-8, 409, 408]
Medicine in the Ghettos During the Holocaust
Shasha, SM.
Western Galilee Hospital, Nahariya.
The Health systems in several ghettos in Europe during the holocaust were studied in an attempt to construct a typical structural profile. The medical system in a typical ghetto consisted of a department of public health (sanitation) that belonged to the Yudenrat, several hospitals, outpatient clinics, first aid stations and physicians in the labor groups. The structure of the system in several ghettos is discussed and the functions of the various units in the prevention of epidemics, and health education are reviewed. Also described is the medical research that was carried out in the ghettos, emphasizing the work on "Hunger Disease" in the Warsaw ghetto, as well as the heroic endeavor to establish a clandestine medical school in the Warsaw ghetto during the holocaust
[Harefuah. 2002 Apr;141(4):318-23, 412]
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Letter Re: Portable Oxygen Condensers
James,
I recently installed an AuraGen
system similar
to the current listing on eBay (#330329068735) onto a customer's Bug Out Vehicle
(BOV), a 1986 Chevrolet Suburban 1 ton (modified
with some parts that were originally incorporated in the M1008 CUCV).
This customer also is afflicted with COPD and
uses a 110 VAC Oxygen generator. The Auragen, being a military designed
system is far more durable, far more
rugged,
and most importantly, far more versatile than an inverter placed into any vehicle
electrical system. Being a mil-spec unit,.EMP is
also not an issue as it meets the military requirements for such use in medical
units for power generation.
At around $1,700 on eBay the end user can add about another
$500-to-$600 for install and miscellaneous parts. I personally have a PTO drive
system in my own
vehicle and have used it in several situations where, as some say "The
Schumer has
hit the rotating impellers", LOL,
powering some mission critical communications, networking, and telecom facilities
for other NGO customers. These are not cheap, but what price is reliable power when lives depend on it? Best Regards,
- Bob S.
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Letter Re: Advice For Older Preppers With Limited Mobility
Hi James,
Thanks for your many years of great work. While I was enjoying and learning
so much from your books and the web site, I was also growing older and have
physically "lost the edge". More accurately, I reaped the unintended
consequences of 55 years of smoking and now have a tough situation Chronic
Obstructive Pulmonary Disease (COPD).
This is [best described in layman's terms as] a combination of bronchitis
and emphysema. I have not smoked for
three years and my breathing
is now stable at 51% of normal. This ailment is not unusual in the senior community,
and COPD is the third largest killer in the USA. It severely restricts activity
and higher altitudes are deadly. Like most of us with COPD, I am on oxygen
20-to 24 hours a day, seven days a week, plus lots of varied and expensive
medications, to include my liquid oxygen, mostly supplied to me at low or zero
cost by the Veterans Administration.
Additionally, and this may apply to many of your readers, my wife and I are
the primary care givers, in our home, for her mentally disabled older brother.
He too is a vet, Korean War Era and age 79, and receiving 100% of his medical
care from the local Veterans Clinic, as I do. The Veterans Administration
(VA)
is a terrific source of excellent health care. All eligible vets should enroll
ASAP a the VA
web site. Go there and get in before the Obama National Health Carelessness
Agency gets to their house! I expect the VA will be forced to shut out all non
combat vets soon!
My wife and I, and a few friends, all sorta elderly fellow military vets, have been like minded about preparedness since well before the Y2K era. About 20 years of learning and prepping! We have the basic stocks of food, water, meds, clothing, and appropriate security items. We have learned to help one another and to be able to give to others in need. I have stocks of dvds to enjoy and to use to teach others. We have a 2,100 Watt solar system for power. We have devised a simple system to safely filter irrigation water for our local water needs, to include drinking, cooking, and laundry. We've worked together and planned together successfully. We are a team and care for each other as an extended family.
We live in small town in rural Utah. My wife and I are pleased to live in
a close knit town of about 500 good caring folks. This area is highly LDS,
about 50 - 60 %, and they are mostly "not very well-prepared" ....
surprise! surprise! The [majority of] Mormon people--and I can say this as
an active LDS--are not ready for any disaster. Less that 10% have a emergency
response
mindset.
The LDS Provident
Living web site is great, and while the LDS Church strongly
promotes and enables provident living, far too few members are prepared for
any emergency. Many have a little bit and very few have enough. As a people
we are not well prepared. [JWR Adds: But on average far better
prepared than most other Americans, and that is commendable.]
As a family, we've done all that preparation, and still I have a serious
problem with no answer. You see, I will be dependent on solar power to enable
my oxygen concentrator to produce O2, power the kitchen, and the computers,
and to recharge the batteries. I can't leave our home area for more than about
6-9 hours (maximum battery life for the portable concentrator). In an emergency
my darling wife of 43 years will not leave me. My Veterans Elderly "A" Team
/ Extended Family wants to "zip cuff, gag, and bag" me and take
me out of danger, but they too recognize the travel difficulty and are without
a solution. Moving the solar array and the necessary ancillary equipment is
a two day exercise.
We seniors are a large portion of the community and an even larger part of
the preparedness group. I have yet to see or hear any preparedness help for
folks like us. Many seniors are just like me; older, somewhat ""less abled
physically, somewhat less able to travel, and more dependent on local medical
services.
20% of us are raising our grand children... At the same time we are surely
more knowledgeable, more able to lead, more experienced, more secure financially,
more able to teach and to mentor, more equipped, and more likely to have lived
through hard times and to have serious military training. And very importantly,
many of us have real time combat experience. We have been to see the "Elephant
Country". The younger folks need what we have to offer because they will
die without it.
My problem is very simple. I have done all of the right preparedness chores and now I find that my family can not get in the truck and bug out. And I'll be 69, next birthday. What do I do now?
thanks again. - Old Bobbert in Utah
JWR Replies: My general recommendation for retirees is to
set yourself up as the retreat destination for the younger
members of your extended family. You can provide them with their bug-out location,
and storage for their supplies, and the benefits of your years of preparation.
They can provide you with the young and healthy hands, strong backs, sharp
eyes, and sensitive ears you will need after TEOTWAWKI.
I often stress the need to pre-position retreat logistics. By having your extended
family's supplies at your locale, it provides insurance that they
will be there to help out, when the balloon goes up.
OBTW, you mentioned oxygen. For anyone that heavily dependent on medical oxygen,
I strongly recommend buying a portable
oxygen concentrator. Many of the portable models are compatible with 12 VDC power.
This means that you can run them from your alternative power system battery
bank, without the need to run a DC-to-AC inverter. For much greater "range"
away from your retreat, you can keep a charged pair of deep cycle 6 VDC golf
cart
batteries in your vehicle.
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Letter Re: Anesthesia for Traumatic Times
Jim -
I've been reading your blog for a while now. Just thought I'd weigh in briefly
on the anesthesia issue. For background, I am a general pediatrician with
experience
in emergency pediatrics. Also, I am a fellow of the Academy of Wilderness Medicine.
Three quick points:
1. Under the vast majority of circumstances it is possible to work on mild
to moderate traumatic injuries in children without anything more than local
anesthesia. Papuses work
great and should be considered as part of an advanced medical kit that is intended
to treat children. If a papuse is too expensive or bulky, there
are all sorts of ways to immobilize children with sleeping bags, pillow cases,
sheets, etc. (one just has to use imagination - for example, try both arms
in a pillow case across the back). Obviously, the papuse idea only addresses
immobilization of the patient and does not assist with pain management. However,
even in an academic pediatric emergency department, we often concluded that
the risks of non-anesthesiologists administering anesthesia outweighed our
concerns about pain.
2. Dermabond is one of my favorite products. The screaming and struggling at
the University of Chicago pediatric emergency department dropped by 95% when
Dermabond was introduced to the market. It's a bit pricey but very simple to
use. I never had any "formal" training in dermabond use because it
was simply unnecessary. Carefully reading the instructions should suffice for
survival oriented self-training on the product. My biggest concern would be
to avoid gluing an eye shut. Even a glued eye is not a disaster as can slowly
be reopened with cooking oil and massage. People have suggested on your web
site, as well as at Wilderness Medical Society meetings, that super glue (same
active
ingredient - cyanoacrylate) could be used for the same purpose. However, I
have personally found it to take much longer to dry and to be far less reliable
at keeping the wound closed. Just last weekend I tried a new rubberized formulation
of super glue on a laceration of my own and was disappointed to find that it
peeled away the very next day - something I have never observed with Dermabond.
Lastly, Dermabond can successfully be used on joints as long as it they are
immobilized. This is less of a concern in children than it might be in adults
who might have to remain physically active.
3. I've personally experienced a hematoma block. Several years ago, I had a
broken rib that was so painful I couldn't breathe except in small gasps. Worried
about the possibility of a secondary pneumonia, my doctor injected hydrocortisone
and lidocaine directly into the fracture site. The block worked great and I
was able to breathe normally again.
On another note, I have noted a number of formulas on your blog for mixing
up wound cleansing solutions. The current research based consensus at the Wilderness
Medical Society
is that wounds may be cleansed with plain drinking water. So, simply treat
questionable water with a filter, by boiling, or with an appropriate chemical
agent and leave it at that. In fact, a Camelbak (or similar system) is an
ideal wound cleansing device. Just put the bladder under an armpit and squeeze
a large volume stream of drinking water from the tube directly into the wound.
The mouthpiece itself can either be carefully washed or simply removed prior
to use. - A.F., M.D.
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Three Letters Re: Anesthesia for Traumatic Times, by Scott N., EMT
Dear JWR:
As a practicing anesthesiologist, I felt it necessary to respond to Scott N.'s
article about TEOTWAWKI anesthesia. First, let me complement Scott N. for
the well written article as well as bringing up the issue in the first place.
Although it may be interpreted as self serving, I also have to strongly
agree with JWR's admonishment that this is not something to "try at home".
In a sense, we in the anesthesia field have somewhat become victims of our
own success. It wasn't that long ago that the risk of anesthesia (not the risk
of the surgery) was the main consideration in whether a surgical procedure
was even attempted. Today, you are probably more likely to die in a car accident
driving in to the hospital for your electively scheduled surgical procedure,
than from anesthesia. Anesthesia practitioners used to have one of the highest
rates for medical malpractice insurance, now it is one of the lowest. These
advances in patient safety are multi factorial. Anesthesia providers are some
of the most highly trained individuals in the medical field, advances in monitoring
(both invasive and non-invasive) has completely eclipsed what was available
even 20 years ago and medications, while becoming much more potent, have also
become much more precise in their effect. These three factors have led to the
risk of anesthesia becoming almost an afterthought.
In a TEOTWAWKI situation, all three of these factors would likely be unavailable.
One should be reminded that "lethal injection" is in effect an induction
of general anesthesia (the initial medications are the same), and the only
difference is the absence of an anesthesia provider at the patients head. It
has been stated (although a significant exaggeration), that sodium thiopental
(Pentothal) killed more Americans at Pearl Harbor than did the Japanese.
There are three main types of anesthesia. The first being General Anesthesia
(GA), which is a state of unconsciousness and is the normal public perception
of what anesthesia is. General anesthesia is described as a triad of states:
Analgesia (lack of response to painful stimuli), Amnesia (lack of memory of
the event) and Muscle Relaxation (a reduction or obliteration of muscle tone).
General anesthesia is accomplished by a combination of medications administered
by intravenous and/or inhalational routes. General anesthesia requires that
the anesthesia provider take responsibility for the patient's ABC's (Airway,
Breathing and Circulation). The second is Regional Anesthesia, which is accomplished
by injecting local anesthetics (numbing medicine) around a central or major
peripheral nerve, thus effecting anesthesia in a "region" of the
body, such as an arm or leg or "below the waist". Spinal, epidural
and brachial plexus blocks are routine examples. The third is local anesthesia,
which is accomplished by injecting local anesthetics into the soft tissues
around the area where a procedure is performed. Typical examples are dental
procedures and wound closure (stitches). Even though the latter two do not
necessarily include a state of unconsciousness, supplemental sedation, which
frequently causes amnesia, leads many people to believe that they "went
to sleep" (i.e. were under general anesthesia) when in fact they were
not.
In a survival situation, infiltration or local anesthesia would be the preferred
technique. An experienced surgeon can even perform an appendectomy under infiltration
anesthesia. While local anesthetic drugs (lidocaine, bupivicaine etc.) do have
toxic side effects, these can be mostly prevented by avoiding injecting directly
into an artery or vein (aspirating the syringe before injecting) and avoiding
a "toxic dose" by using no more than one bottle for an adult (this
is an oversimplification but is correct more times than not). Having an inexperienced
individual stick needles into major nerves or take responsibility for a patient's
ABC's raises the risk profile to astronomical proportions. - NC Bluedog
Sir
I feel compelled to say that as a subject matter expert--an MD Anesthesiologist,
in fact--on administering anesthesia, the publication of the article, " Anesthesia
for Traumatic Times, by Scott N., EMT" is fraught with peril. I wouldn't
have published it.Your web site lends an aura of credibility to whatever people
read there, at least it does to me. It can however encourage people to try
things that they
ought to think twice about. More to the point, it can make people believe they
are more medically trained than they actually are. As such, the article on
anesthesia shares in that aura which it simply does not merit!
Although the author begins to describe the classic "Stages" of General
Anesthesia, he should point out that while we in the business still do refer
to "Stage 2" under certain circumstances; proper use of these stages
is described only for ether anesthesia. Even though the author then goes on
in fact to describe the use of ether; I will describe why no one should.
The author then confuses these stages with the goals of an
anesthetic: Asleep (unconsciousness), Analgesia, Amnesia, Akinesia, and Autonomic
Stability- colloquially
known as the Five "A's" of Anesthesia. I guess that I am a purist,
but if the author is going to describe such a "make do with what you have" in
a SHTF scenario
on such a serious and potentially deadly topic, then the terms should be used
as they are professionally understood.
As a matter of background and to make a point, the most standard sedation scale
we use is the Ramsay Scale, which describes everything in six stages from mild
sedation (peaceful, tranquil, awake and aware) to deep anesthesia (stone-cold
out; complete with loss of airway, respiratory arrest, and
vital sign changes). The point is: As a rule, a practitioner
must be trained to manage an airway
of a patient one level deeper than the anesthesia you plan
to administer. In other words, at Ramsay score of 3 (what is commonly referred
to as "moderate
sedation", "conscious sedation" or "twilight anesthesia");
the patient still maintains their own airway; but at stage 4 can begin to lose
airway reflexes; even the practitioner of moderate sedation needs
to be able to manage a [compromised] airway. You are not only substandard;
you are dangerous if
you can't!
How does this relate to the original article: vinyl ether was never popular
since it induced deep anesthesia too quickly. Oops, that was fast- hope for
your patient's sake that you know how to manage the airway! The author, an
EMT, certainly can- what about your readership at large?
Also, ether doesn't just make you a little sick; it is (or was) notorious for
causing post-op nausea and vomiting. It caused intra-op nausea and vomiting!
Vomiting is one thing, but sucking the vomitus back into your lungs, called
aspiration, is a catastrophe. The mortality approaches 30% in young, healthy
patients, and leaves them with the lungs of a 70-year smoker if they survive.
Aspiration gets worse from there. Prevention of aspiration, for those who don't
know, is the main reason we ask people to fast before surgery- so their stomachs
are as empty as possible.
In addition, giving herbal extracts and whatnot by mouth increase the
amount of stuff in your stomach. Since adding ether to a stomach full of anything
is a recipe for aspiration. Do not be fooled by saying that its barely
a mouthful of total volume. The standard for having higher risk for aspiration
is a paltry
25cc's in your stomach. The average adult single "mouthful" ranges
from 80-150cc's.
Indeed, ether was almost abandoned in its infancy because of an aspiration
death. A historical anecdote for another time.
There are some other bad effects, both pharmaceutical and physical, of the
agents that need to be discussed. Ethers are associated with both acute and
delayed hepatic necrosis, and even hepatic failure; they are flammable as both
liquid and gas. The liquid is lighter
than water and the gas heavier than air, so they can flow and migrate long
distances to pick up a spark. And where diethyl ether is flammable (and explosive
in enclosed spaces/high concentrations), vinyl ether is explosive! In fact,
old operating rooms had extensive protections against heat, flame, sparks,
even static electricity (rubber mats and rubber soled shoes in place, after
a few demolished hospitals and personnel deaths! The fire potential of these
agents is no joke.
More, is the "survival source' of ether going to be pure? Common contaminants
include peroxides, formed spontaneously by exposure to air(oxygen) which are
explosive. Inhale that? not me.
Ultram, Toradol, etc- good drugs for their intended purposes- again if you
know how to use them. I haven't got too much to say on them at this time.
The herb that Mr. N spends a bit of time describing, Salvia divinorum, has
of course not yet made it into the mainstream medical practice. I remain open
to the idea, especially since I know Gamma-Hydroxybutyrate (GHB) would potentially
be a boon to anesthetic practice; but because of bad press [about its nefarious
and now notorious use as a "date rape" drug] will not be anytime soon. The "establishment" in
medicine is well-known for badmouthing things that they don't like (GHB, anabolic
steroids, etc) even when faced with much evidence that the drug has useful
medical purposes. So while I can't say how effective the salvia is, I also
can't say its safe. Also, while inhalation anesthesia is well established in
anesthetic practice, smoking is not. Especially smoking near
[explosive] ether!
I have long thought of how I can potentially contribute to your work. Even
though anesthesia is the skill I can most confidently share; I have resisted
writing on the subject for the reasons expressed and implied in this letter.
Sincerely, - Dr. Gaston Passer
James,
I pray all is well with you and your family.
Scott N.'s article on Anesthesia is a fine piece to which I would add but little:
Creative use of local anesthetics can preclude the need for a general anesthetic.
1.) Hematoma Blocks: This involves injecting the local anesthetic (no epinephrine)
directly into the blood collection at the site of the fracture, etc. This method
provides excellent relief for setting bones or otherwise dealing with the appropriate
trauma.
2.) Regional Blocks: This method combines a knowledge of anatomy with local anesthetics
to block sensation in a nerve bundle supplying a specific region. Although easy
in practice, it is best to use a textbook to guide you.
Look around for texts like Regional Anesthesia: An Illustrated Procedural Guide,
by Mulroy. There are many fine ones out there. {Remember latest edition is
not always greatest edition. Many times medical book edition changes are there
to
just add the newer drugs and many times they drop "older", but more
practical information.}
Hypnosis is a relatively easy to learn and very effective technique for pain
control and anesthesia. Most people are susceptible. I've seen it used in major
knee replacement surgery with success. I have personally used self-hypnosis it
for pain control at times.
One other note: Tramadol is an excellent painkiller. It has a fairly rapid
onset, relieves a high degree of pain effectively and is a non-schedule (not
subject to DEA scrutiny)
drug. On the down-side, it is addictive (although the
PDR denies
this). Having worked with numerous patients who began taking it according
to
recommendations,
I have seen that even those who never exceeded the proper dosage have a difficult
time withdrawing off of it. It appears to affect the serotonin system (same
system affected by newer antidepressants and ecstasy) in the brain to a degree
beyond
the measurable blood levels after taking it for even a short time. I have not
precluded use of it in my kit, however. Forewarned is forearmed. My recommendations
are to use it sparingly and infrequently. In those instances where a continuous
high degree of pain relief is necessary, expect the withdrawal to occur. It
can last up to two to four weeks. Thanks to Scott N. for his excellent article
and to you, James, for your efforts to assist all of us. - Doc Gary
JWR Replies: I must repeat the proviso to SurvivalBlog readers
that anesthesia is an art and science that should be left to professionals.
Don't
kid yourself
into thinking that reading a few textbooks somehow qualifies you for anything
beyond administering a light local anesthetic, if and when times get Schumeresque. A
little knowledge is a dangerous thing!
« Economics and Investing: |Main| Notes from JWR: »
Anesthesia for Traumatic Times, by Scott N., EMT
Introductory Proviso from JWR: The following article is
intended for educational purposes only. DO NOT attempt to
administer anesthesia without the proper training. There is a very fine line
between unconsciousness and death, and this path should be tread only by
a trained specialist. This is a very delicate art (and science) that requires advanced
training,
constant
practice, and some advanced monitoring equipment. All vital signs must be
closely monitored
closely.
Even for someone with
an "MD"
after
their
name, it
is EXCEEDINGLY
EASY to
mess up, and the consequences of doing so are tremendous. (In short: If you
are untrained and inexperienced and try to anesthetize a patient with diethyl
ether or chloroform, then the odds are high that you will be more
lethal to the patient than the trauma that you are attempting
to repair!
Survival medicine requires thought given to pain relief and anesthesia. It
is all well and good to have sutures and skin staplers in the SHTF kit, along
with instruments for debriding wounds sustained when the nearest doctor is
buried under 50 tons of rubble. But how can we do minor surgical procedures
without effective anesthesia? If a survival group member sustains a bad fracture,
how can we relieve their pain with only aspirin and head off stress ulcers?
We can just put on our hearing protection, give the patient a thick stick to
bite down on, and set that bone or debride that wound, while hardening our
heart to their cries of agony. This way we save some expense and eliminate
the need for several hours of extra intense study by the group's designated
medic, and maintain a very low profile. But few would forgo stocking tools
which can reduce the suffering of a wounded comrade.
We can, of course, talk our friendly family doctor into writing us prescriptions
for local anesthetics, morphine, and for ketamine. The local anesthetics will
probably be fairly easy to get obtain if we can show our doctor that we can
competently utilize the agents. But the DEA will probably want a word with
you and your doctor after you fill those prescriptions for morphine and ketamine
both of which are DEA Scheduled drugs.
But what if our doctor is scared of the DEA, and refuses to help your group
obtain any of the above agents? You can read this article and find alternative
anesthesia and pain relief medications
that are either “over the counter” (OTC)
or non-Scheduled drugs.
So what can we easily stock for pain control and basic anesthesia? I have some
ideas, based on my eighteen years as a chronic pain patient as well as some
training as a dental assistant and EMT, including some specialized anesthesia
training.
What follows is a simple “anesthesia module” for a group survival
medical kit that can be put together with minimal legal difficulties and for
modest cost. It will enable the user to deal with acute and chronic pain issues
such that the patient can be well cared for. It will also allow one to provide
good analgesia/anesthesia when perform basic minor surgery procedures such
as wound closure, wound debridement, or bone setting. Even, in extremis, used
to facilitate care for a gunshot wound as described in"Patriots"
..
This article will certainly not enable a layperson to become a skilled anesthesiologist.
What it will do is point out possible solutions, possible agents and references
to learn more about this subject. It will provide a list of agents which will
facilitate providing simple anesthetic care to injured group members who require
minor surgery or who have sustained significant, painful injuries.
This article will cover basic anesthesia definitions. “OTC” agents,
divided into chemicals/meds and herbs, will be covered for both oral and inhaled
use. Then a few relatively easy to obtain prescription agents will be described.
An annotated bibliography follows the article.
For the purposes of this article, anesthesia is defined as a state in which
the patient does not react to surgical activities in a significant physiological
way, has amnesia for the procedure, and feels no pain or “touch” sensations
during the procedure. Analgesia is defined as a state of reduced to no awareness
of the sensation of pain, though awareness of pressure and stretch may remain.
The state of anesthesia is traditionally divided into four Stages. The agents,
with few exceptions, described in this article enable putting our wounded comrade
into only Stages 1,2, and the 1st Plane of Stage 3. This is fine, as our concern
as survivalists will mainly be with performing minor surgery . The 1st level
of plane 3 equals light surgical anesthesia; deep enough to enable us to safely
and comfortably perform these minor procedures for our injured companion, light
enough to avoid significant respiratory or circulatory problems from the agents
used.
The first Stage is analgesia and amnesia; it lasts from the start of relative
pain relief and drowsiness to the loss of consciousness and loss of the eyelid
reflex. The second Stage is excitement, marked by delirium, breath holding,
and, likely, regurgitation. The third Stage is surgical anesthesia. It consists
of three Planes. We will only be working with the 1st Plane, light surgical
anesthesia. Note that at this Plane, our patient may move in response to surgical
manipulation and their heart/respiratory rate may change, though they will
not have any memory of the procedure. The 3rd Plane is the level needed for
major surgery, such as abdominal surgery. The fourth Stage is the time from
complete paralysis of the chest muscles until the time of shutdown of the circulation.
Anesthesia requires some basic tools and capabilities. Suction must be available
to keep the airway clear, especially if any of the ethers are used. Manual
powered units are widely available from such suppliers as Moore Medical. Oxygen
is very useful and should be considered along with the masks and tubing necessary.
Oxygen can make a great difference in the outcome for patients and is relatively
inexpensive, so consider adding an oxygen rig to your group kit.
Masks for administering inhaled agents and simple vaporizers must be bought
or locally fabricated. The absolute minimum for patient monitoring is: precordial
stethoscope and a BP cuff. Having a pulse oximeter is recommended though the
precordial
stethoscope will give more “advanced warning” of breathing issues.
The oximeter would be most useful when used with an oxygen rig to track improvement
in oxygen saturation.
One must be able to recognize developing severe allergic reactions, bronchospasm
and other medical emergencies and have the meds and skills necessary to save
the day. Study of respiratory and circulatory systems, coupled with a good
grasp of the basic principles of pain control and anesthesia will enable the
designated medic to use these drugs and equipment to improve the patient's
situation, and not generate additional medical problems. Only then can one
put together a useful anesthesia kit for Survivalist Field Hospital.
OTC Agents
We start with the classics here. Aspirin, , ibuprofen and naproxyn will see
us through most needs for pain control and reduction of inflammation from sprains,
tears, or arthritis. All are non-steroidal anti inflammatory drugs (NSAIDs)
and work very well. For pulled muscles or arthritis pain, we can also add in
such roll-on or “smear on” agents as Biofreeze, a very versatile,
herb-based agent which works surprisingly well for arthritis pain, or use such
venerable creams as Icy Hot or Ben Gay.
A few cautions with these. Avoid giving the patient multiple NSAIDs at the
same time as chance of side effects such as bleeding tendencies, slowed blood
clotting, and stomach damage increases greatly. Also, beware of using other
salicylate-containing meds, such as Ben Gay cream or Pepto-Bismol along with
an NSAID as overdose can result easily.
Other OTC pain relievers include Tylenol, which will lower fever and relieve
pain. But it will not reduce inflammation . Tylenol is very toxic to the liver
and kidneys so it is vital to not exceed the maximum 24 hour dosage. Menthol,
applied topically, is useful for relief of the pain . Biofreeze is a good menthol-based
product which can currently be obtained from physical therapists, sports medicine
clinics and the like.
What if our companion needs a dislocation reduced? How can we ease the process
by relaxing muscle spasm? We could use standardized, to 0.8% valerenic acids,
valerian root capsules or liquid extract. Valerenic acids are mild sedatives
and skeletal muscle relaxants. Valerenic acids will not be anywhere as effective
as giving the patient Valium or other benzodiazepines to facilitate the reduction.
But valerian root is OTC, while benzodiazepines are Scheduled drugs.
A quick note on alcohol for pain relief and anesthesia. Alcohol provides pain
relief in the same way a punch to the jaw can assist one in going to sleep,
by deranging the brain's functions. Only in Hollywood can a patient be anesthetized
with alcohol for the simple reason that alcohol is a very weak anesthetic such
that the anesthesia dose is functionally equivalent to the fatal dose.
All the agents below can cause some nausea so don't forget to include some
Benadryl or Dramamine in your medical kit. Either will help reduce the nausea
and also provide some sedation for the patient. Dramamine will also help reduce
the copious secretions that occur especially with usage of diethyl ethers.
We now get into our OTC anesthetic agents. All three are relatively common
chemicals which can be used in simple inhalers, such as drip masks or simple
vaporizers. All are general anesthetics which means they can be used to put
the patient “completely under”. Note that it is vital to do the
necessary study before using any of these agents as there is always the potential
for death or serious problems when using general anesthetics. In addition,
none of these three agents should be allowed to contact the skin as they can
cause bad dermatitis.
There are three “OTC” inhaled anesthetics available that fit our
needs; for safety, for efficacy, and for ease of use. Diethyl ether (DEE),
is the safest inhaled anesthetic for “lay usage” as it has a very
slow onset, with very clearly defined “descent” through the Stages
of anesthesia. Divinyl ether, DVE, has a shorter induction time and less incidence
of post-operative nausea and vomiting (PONV) than DEE. It is also less irritating
to the throat and lungs than diethyl ether. Trilene, TCE (trichloroethylene),
provides excellent analgesia at low doses, is non irritating to the airway,
and is non flammable . Careful monitoring of anesthesia depth for more extensive
procedures is critical with usage of trilene. All three of these agents were
widely used up until the 1950s, even the 1960s for trilene and diethyl ether.
These three agents are not equal in capability. Trilene can only be used for
such things as debriding wounds, suturing, or tooth extraction as it is a very
potent agent that sensitizes the heart to stress . This could result in heart
problems if Trilene was used for a long or extensive procedure or the patient
was given epinephrine. Trilene provides anesthesia only to Stage 3 Plane 1,
light surgical anesthesia, because it cannot be vaporized to a high enough
dose for extensive procedures. TCE must not be used with a closed circuit system
as it forms phosgene, a war gas, when it contacts soda lime.
It has the great advantage of quick recovery time when only used for short
procedures. One surgeon mentioned that his patient was [by observation only]
fully recovered 10 minutes after surgery. It was successfully used for wound
repair, bone setting (some reports), childbirth (the most common usage), and
dental procedures. It is “tailor made” for “self-administered” anesthesia
and is associated with less incidence of PONV than with the two ethers.
On the downside; it is a known teratogenic and carcinogenic chemical. It also
cannot be used in simple “drip masks” as it doesn't vaporize well
below body temperature. But a trilene vaporizer can be made by any handy person
with a basic grasp of how carburetors work.
Divinyl ether is only for short procedures, though it does provide good surgical
anesthesia (up to 2nd Plane of 3rd Stage), as it is toxic to the kidneys and
liver if used for long procedures. Induction doses and recovery time will be
a little less with DVE than with DEE.
On the downside; it requires very careful storage, away from light and moisture,
or else it will polymerize easily into [literally] a useless lump. DVE is fabulously
expensive, up to 30+ fold the cost of the other two agents.
Diethyl ether is usable for procedures of any length, provides excellent analgesia
at low doses, muscle relaxation, and anesthesia to 3rd Plane of Stage 3-and beyond
if you aren't paying attention! It also improves cardiac efficiency and stimulates
breathing so it is useful in the shocky patient. Theoretically it is the ideal
anesthetic for our use.
DEE administration does elicit heavy secretions and coughing so it is makes more
work for the “survivalist anesthesiologist” and her assistant than
Trilene does. It is highly flammable and can cause explosions, so all sources
of ignition must be far from the surgery. It must be stored in the dark, with
moisture absorbers, and preferably with oxygen absorbers. Recovery times for
the patient will be long, over 6 hours. Diethyl ether and Trilene are roughly
the same low cost (ca $34/500ml).
Chloroform is not even considered here even though it seems to be an ideal
agent for our use at first glance. Sure; it is not flammable, it doesn't induce
the
heavy secretions and coughing that the ethers above do, and it is a potent
agent. But it has serious disadvantages. First, it has a very narrow margin
of safety
and requires a true expert in anesthesia to use it safely. Second, it strongly
sensitizes the heart to stress, so if the anesthesia is too light and the operator
starts the incision, the patient could go into nearly instant cardiac arrest--something
we will not be able to treat.
Herbs
The herbs described below are widely available in most jurisdictions and can
be used for pain relief and the induction of light anesthesia in survival situations.
However, they are also “evil” in the eyes of the DEA and the like.
Some fools have used these herbs irresponsibly and ruined it for legitimate
researchers and survivalists. I strongly encourage those who use these to use
them responsibly,
otherwise we give our friends at the DEA more targets.
These herbs are psychedelics, some call them hallucinogens or even entheogens.
They provide pain relief and [very] light anesthesia by two mechanisms: making
all sensory input “equal” so that pain becomes no more important
than the fact that the sun is shining and these agents facilitate a disassociative
state in which the patient's interpretation of pain or pressure signals can
be radically altered by simple measures such as playing music, reading of Bible
verses or the like.
Extensive research in the 1950s and 1960s on LSD, for example, found that the
drug provided much better [for disassociative] pain relief than morphine, with
few, if any, side effects. The few formal studies done on salvia, the second
agent
below,
found
that it
also offered strong, albeit short-lived pain relief and has the potential to
be used as a general anesthetic.
In using these herbs, one must pay special attention to two vital factors; set
and setting. Set refers to the state and focus of the patient's mind; a relaxed
patient who is focused on positive thoughts will be unlikely to experience an
anxiety attack whether given one of these herbs, ketamine, or morphine. Setting
refers to how pleasant, or at least non-chaotic the treatment or convalescence
area is. Operating in a quiet, clean room will help allay patient anxiety and
thus reduce the need for additional meds during the procedure.
The first herb might be as available as your garden; morning glory seeds, preferably
Heavenly Blue or Flying Saucers. Yes, these are the real names. But the truth
is that the active agent in the seeds, lysergic acid amide, is a strong analgesic
that can provide six or more hours of pain relief with a single dose of roughly
150 seeds that are chewed thoroughly and swallowed. The downside is that tolerance,
of about three days duration, develops quickly. So that a second dose given
for pain control 10 hours after the initial dose must be roughly twice as large
and
so on. The total effects last for upwards of 12 hours. The seeds must either
be non-treated or must be washed free of the arsenical which is commonly used
on the seeds.
The taste is vile and tends to induce moderate nausea and vomiting, treatable
with mild anti emetics such as Benadryl, so the patient will probably never
want to repeat the psychedelic trip. This agent will
permit wound debridement or closure as long as the patient's attention is captured
by music, art, or a deep discussion about whatever interests
them at that millisecond. It would provide good relief of pain for bone setting
but careful monitoring of the patient's blood pressure and heart rate would
be required because this agent is a poor anesthetic and provides little, if
any
amelioration of the patient's body's response to the surgery. Used in conjunction
with one of the strong pain killers described in this article and/or one of
the inhaled agents, then bone setting becomes possible.
Salvia divinorum, a member of the sage family, is an herb which could be useful
in Survivalist Hospital for pain relief and in easing the pain and discomfort
associated with minor surgical procedures. In terms of the Stages of anesthesia,
salvia enables Stage 1 (analgesia). At very high doses, it produces a profound
disassociative state, coupled with a stormy Stage 2 of anesthesia that barely
reaches Plane 1 of Stage 3. It could be used when setting bones when combined
with an inhaled agent. Salvia frequently produces a calmness and “afterglow” for
up to a few days post-usage that will help greatly in reducing post-op pain
and anxiety.
It also produces a slowed reaction time and coordination side effects so the
patient should not operate the retreat's armored car or tractor for several
hours after salvia dosage. Since it acts on the kappa-opiod receptor in the
brain,
rather than the mu-receptor affected by morphine and the like, salvinorin A
is highly unlikely to turn the patient into a raving, addicted, member of the
Army
of Darkness. Euphoria is very uncommon with salvia use, indeed people do not
tend to ever take it for “kicks”. It also has potential for treatment
of addiction as the kappa-opiod receptor is key in addictive behavior.
Overdose will not kill per se, but it will result in a dangerous agitation of
the patient though of short, under 30 minutes, duration. The patient can leap
up and charge about, resulting in secondary injury. Salvia is usable for our
purposes only if the operator pays very close attention to dosage, using only
enough to enable the surgical procedure, but not so much that the operation suddenly
becomes catch-the-delirious-staggering-patient!
My personal experience with salvia has been with use for relief of chronic and
acute pain. It has reliably relieved pain of level 8 (roughly the pain from a
leg being shattered in a bike wreck) completely for 1.5 hours, and kept said
pain at endurable levels for three hours or more from a single salvia dose. Tolerance
does not develop so analgesic doses of salvia can be given consecutively.
A salvia researcher, Daniel Siebert, has published a good on line guide to
salvia which includes his model of “planes of the salvia experience”. As “survivalist
anesthesiologists”, we will be getting our patients to Siebert's “plane” 4
(vivid visionary state-with eyes closed, outside world is “gone”)
to 6 (amnesiac state, also high movement potential!).
Salvia can be purchased as a live plant which grows very well in the Northwest
USA as an indoor plant. It is also available as dried leaves. Dried leaves are
only marginally usable for our purposed though. It is also available as a crude
5x or 10x concentrate, or as a standardized extract. The standardized form is
obviously the best choice for our purposes.
It can be administered by mouth, by chewing 15-20 fresh leaves and holding
the chewed leaves in the cheek for 15 minutes. The effects then last about
45 minutes.
Ingesting the leaves or concentrate is useless as the agent is inactivated
by stomach acid. Or it can be "smoked", (inhaled as a vapor).
Vaporization allows the best titration
to effect, it also is associated with a high “failure rate” as
it is very technique sensitive. When vaporizing salvia concentrate, it is vital
that the concentrate be heated as much as possible, the smoke drawn deeply
into
the lungs, and held there as long as possible. Throat and lung irritation can
happen when using the vaporization method . I have asthma; salvia vapor does
not induce bronchospasm for me, but “your mileage may vary”.
The active agent, salvinorin A is extremely potent, being effective at 200-500mcg
for an inhaled/vaporized dose. Its effects begin in under 30 seconds which makes
titrating an analgesic dose fairly easy. It provides good analgesia, being about
as potent as morphine, though it only provides, at best, two hours of strong
pain relief. After inhalation, drug effects begin to fade within 3-5 minutes
of dosing.
At higher doses of 500-1,000mcg, it provides relative disassociative anesthesia
for about 5 to 7 minutes. However, at these doses the drug causes severe “motor
hyperactivity”. Think a PCP zombie who also drank three double espressos!
Titrating the dose to true disassociative effect, Siebert's “plane” 6,
without the patient lashing about and injuring herself can be tricky.
If used for just relieving the pain of simple wound debridement, having the
patient “smoke” small
amounts of concentrate until they report no sensation when the intact skin
is pricked with a sterile needle . If possible, capture the patient's attention
while the wound is cared for. Patient will probably still be somewhat aware
of
pressure and stretch sensation, thus the need to capture their attention elsewhere.
If a bone must be set or extensive wound debridement is required, then a higher
dose of salvia must be used, preferably along with one of the inhaled agents
listed above. This will mean a brief excursion back to pre-19th Century surgical
practice; the use of sturdy assistants to hold the patient in place. The purpose
here is to keep the patient from moving about and injuring themselves or facilitating
a horrible surgical disaster.
By Prescription:
There are some useful prescription pain killers that are not on DEA lists and
should be fairly easy to obtain. All have the potential for significant side
effects so thorough study is required before using these drugs.
Toradol (ketorolac) is the strongest drug in the NSAID class and is available
in pill , eye drops , and injectable forms. It provides excellent relief of
post-operative pain. It is also an anti coagulant so any bleeding must be under
good control
before giving Toradol. It also can cause serious liver or kidney problems.
Because of these “side properties”, Toradol cannot be used for
more than 2 days of continuous dosing for injection or 5 days of oral dosing
Tramadol is a pain killer which works well for moderate to moderately severe
pain. Or in layperson's terms, it will do for pain relief for most of the common
injuries the survivalist might deal with . It is available as both a pill and
in an injectable form. It does not elicit as much nausea as other opiods such
as morphine and unlike morphine, will not completely shut down the drive to
breathe at high doses. Another bright spot is that Tramadol is rarely associated
with
addiction as it relieves pain without euphoria. If needed, it can also be used
for your dogs or cats.
On the downside, it does lower the seizure threshold so it is a poor choice if
the patient has a history of seizures or is taking other drugs which lower the
seizure threshold.
Nubain® (nalbuphine) is a very strong pain reliever
that is only available in an injectable form. It is incompatible with ketorolac
and is an “opiod
effect reverser”. This means that giving Nubain to someone who is addicted
to opiods will result in withdrawal symptoms. I was told by an Army medic,
who had completed the US Army Field Anesthesia course, that Nubain is ineffective
for bad war wounds.
There are a few prescription “para anesthesia” drugs which should
be stocked. For reversal of overdoses of opiods, stock Narcan (naloxone). It
has significant side effects, be aware, be proactive.
Murphy's Law says that the group member who requires emergency surgical care
will have a full stomach, risking aspiration of vomitus, a serious complication.
Reglan (metoclopramide) is an anti-nausea/vomiting drug and it accelerates
stomach emptying. But do not rely solely on Reglan in the patient who ate or
drank
within a few hours pre-surgical need. Phenergan (promethazine) is a venerable
anti
emetic and sedative that also helps dry up secretions. It is available in both
pill and injectable forms. If injecting it, dilute and give slowly and carefully
as it can cause tissue damage and pain on injection.
Anesthesia and pain control must be factored into planning a survival medical
kit. I hope this article has helped point you in a useful direction. With the
items described in this article, you can provide better, more comfortable medical
care to your group members in a crisis environment. In a 96 hour crisis, you
will have the ability to perform exigent minor surgery. In a TEOTWAWKI scenario,
you will have a solid base for providing general anesthesia care to your group
members.
Bibliography:
Introduction
to Anesthesia
; 9th Edition; Longnecker, edited by: David E. and
Murphy, Frank L.; Saunders; 1997. Good coverage of the theory and practice
of anesthesia from the ground up.
[Textbook of Military Medicine] Anesthesia and Perioperative Care of the Combat
Casualty; edited by: Brigadier General Zajtchuk, Russ and Grande, Christopher
M., M.D.; GPO; 1995. Thorough coverage of the practice of anesthesia in a military
setting. If you need to know how to handle the anesthesia for a wounded comrade,
this is the book. Slanted toward more “high tech” care than usual
survivalist group can deliver but good for its explanations of procedures and
caveats. Also
available online, as free PDFs.
U.S.
Army Special Forces Medical Handbook
; Citadel Press; 1982. ISBN: 0806510455 A very
good general reference. Good, simple chapter on anesthesia using the inhaled
agents discussed in this article with excellent charts showing signs of anesthesia
depth.
Internet Resources:
New York
School of Regional Anesthesia. How to do regional blocks if you have local anesthetic
agents in your kit. Thorough, with very good illustrations.
Several Power Point
lectures on various basic anesthesia procedures as well as presentations on wound care,
orthopedics, and womens' issues.
All the volumes of Textbook
of Military Medicine are available online; for download as [free]
PDFs or as hardcover books for purchase. Lots of useful information for Survivalist
Hospital on anesthesia and wound care, care of environmental injuries, NBC issues, etc. A very informative site
that deals with psychoactive chemicals and herbs. It can be a good research
tool for the survival anesthesiologist. Use the site for research, and be responsible.
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Two Letters Re: Dealing with Uninvited Guests
Dear Mr. Rawles
I would like to add one last letter in response to “Uninvited Guests” and
to let your readers know that the only effective means to control head lice
is by “mechanical” removal. We were unfortunate to live, for a
time, in an area of the country where head lice had become resistant to the
OTC treatments.
This is because most people did not realize that in addition to the application
of something such as Rid, one must also clean one’s
living quarters, as well as systematically go through the lice sufferer’s
hair—strand, by strand, by strand…. Now this may seem very laborious,
but it is amazing how easy this becomes if you do this once a day for at least
a week along with the essential oil treatment that I have listed below. It
took my daughter having lice twice, and the school where my children attended
to tell me that they had, during certain times of the year a 45% infection
rate! Through several conversations with the local health department, and doctors,
the conclusion was reached that the lice had become resistant to the OTC preparations,
which are also not good for anyone—this stuff is poisonous!
Once I came up with my own treatment, my daughter never had lice again, and
thankfully
we moved back to Texas away from the lice infested area that we had lived in.
Here is the treatment that I recommend, and have given to several people I
know. For the most part, the supplies are readily available and plentiful—for
now and everything is non-toxic!
Supplies
-One very fined tooted comb—a metal one with a handle (like a rat-tailed
comb) if you can find it-plastic will not hold up as well
-One regular comb(don’t use this one for lice removal)
-A set of metal hair clips (about 4 or 5)—like the ones hair dressers
use to separate hair when they are cutting it
-Plastic wrap or a hair cap
-a coffee can with a lid-- with olive oil in it—so when you find a bug
or a nit, you can place it in the can to smother it
-a pair of pointed hair trimming scissors
-a pair of pointed tweezers to pick up individual hair strands
-a bright light to shine on your work
-a couple of bath towels
-Essential Oil Mixture- 1 oz of olive oil, 5 drops of tea tree oil, 5 drops
rosemary oil, 3 drops oregano oil
-Plain Olive Oil
When I was going through my daughter’s hair, I would have her sit on
the floor with her head resting on a pillow covered in plastic on the coffee
table. That was she was comfortable, and could read a book, or watch a video—we
are not connected to trash TV). I would sit on the couch with her body between
my legs
Step One: Infuse the hair with the Essential oil mixture, making sure to coat
the scalp, and all the hair strands. Place the plastic cap on the coated hair
and leave on the hair for 30 minutes. This has a two-fold purpose-the body-heat
helps the oil to soak into the strands of hair for ease of running the very
fined toothed comb through the hair, and the heat also helps to kill the bugs.
Step Two: Part hair down the middle and clip each side with the hair clips
Step Three: Beginning with one side of the head, separate and comb out a very
small section of hair from the clip (it is better to go through fewer strands
of hair at a time), and run the fined-toothed comb through each strand of hair
Step Four: As you inspect each strand of hair, look for nits at the base of
the hair near the scalp. Lice lay their eggs at the base of each hair strand—it
is important to get all of these since these are the viable ones and missing
one may start the lice-cycle all over again—any nit higher up is more
than liking not a viable one, but these should be removed as well.
Step Five-If you find a nit on a hair strand single it out with the tweezers
and cut it as close to the scalp with the scissors. Same for a bug( adult lice)
No you will not make your child bald—even if the infestation is severe!
Lice attach their nits with a glue that makes it almost impossible to remove
without losing the nit in the environment—it is best to clip the hair
strand with the nit attached and place it in the olive oil in the coffee can.
Step Six- After each small section of hair has been inspected, use another
clip to twist the hair and separate the now “clean” hair from the
rest of the hair that needs to be inspected. Depending on the amount of hair—my
daughter has very thick hair—you might need to use several hair clips
Step Seven-after finishing with the first half of the scalp, repeat steps four
through six on the other half of the head
When I got the hang of it, I could go through one half of my daughter’s
head in 20 minutes
Step Eight-when the process is complete wash hair a couple times to wash out
the essential oils. Then massage a few drops of plain olive oil into the hair
and comb from the scalp to the tips (Remember—don’t
use the nit picking comb—you do not want to accidentally re-infest) If
the child’s
hair is long enough braid very tightly! The one thing that I was told that
lice do not like oily hair, or hair that is tightly bound—they cannot
attach themselves as readily!
Step Nine-clean and vacuum your house. Any stuffed animals placed an airtight
plastic bag. Any nits that hatch have to have a human host soon, or they will
die. Keep non-washable items in a plastic bag for about three weeks. Wash bedding
daily, and if possible, hang out on the clothes line in the sun to drive.
Repeat this process daily for one week, and then do a preventative once a week.
It is better to catch an early infestation, than to have to deal with a full
out battle! The olive oil also makes hair very shiny!
Although lice infestation may seem like a curse, my daughter and I certainly
made the best of it, and enjoyed our “nit picking” time together!
Best Regards, - Susan M.
Dear Mr. Rawles,
As a Registered Nurse, during my tenure at a local hospital, a nurse practitioner
showed me a simple test to determine if scabies were present in a patient
showing
possible symptoms of an infestation.
Use a Sharpie marker to draw lines between a person's fingers. Allow this to
dry. Take an alcohol wipe and wipe off the dried ink. If dark, narrow lines
are left after the surface ink has been wiped away, it likely indicates the
presence of scabies. The reason is that the critters tunnel under the skin,
leaving a narrow track for the ink to penetrate.
All the best to you and yours, - Publius
« Mexican Flu Update: |Main| Letter Re: Keep Ammo in Original Boxes? »
Letter Re: FDA Restricts Over the Counter Sales of Bulk-Size Hemostatic Supplies
Sir;
I try to keep a gun shot trauma kit with my shooting range supplies; when I
was ordering some new medical supplies from North
American Rescue I was informed that the public can no longer purchase
Quikclot ACS+
or any other such hemostatic from them. The operator proceeded to tell me that
the [U.S.] Food and Drug Administration (FDA)
began regulating these products mid-May because "they go inside the human
body." I
was able to order some of my other products in the "scrape
and light cut" size" but none of the larger quantity hemostatics.
Perhaps some other SurvivalBlog readers might have some insight into this situation
and can offer some advice. Regards, - "Pop N Fresh"
JWR Replies: That is a most unfortunate development. Much
like last year, when Polar Pure iodine crystals were taken off the market, it
sounds like another window of opportunity is closing.
I strongly encourage readers to stock up on Celox and
QuikClot while
there is
still some
remaining inventory available from individual retailers. Several of our
loyal advertisers-- including Safecastle and
Ready
Made Resources--carry these products, and probably still have some left
on hand. I'm sure that they would appreciate your patronage. BTW, please mention
SurvivalBlog whenever you contact any of our advertisers. Thanks!
« Economics and Investing: |Main| Jim's Quote of the Day: »
Four Letters Re: Dealing with Uninvited Guests
Mr. Rawles,
I have read and enjoyed your blog for some time now and thank you
for it daily.
Regarding the recent post on control of head lice, I have found simple light
cooking oil to be startlingly effective. Massaged through the afflicted's
hair and scalp and left for a few hours the oil is meant to suffocate the lice and eggs.
I have used this several times, once I needed to repeat the processes to be
effective,
but in most previous infestations, once was enough.
This treatment can be made apparently more effective by including some Tea
Tree oil in the mix. Hope this helps, - Regards, JeMe.
Jim:
I keep getting such great info that I would not usually think of. Thank God
that your readers are thinkers as well. Regarding, the letter dealing with
uninvited guests I saw in my local Florida newspaper about using Listerine
for lice.
It reportedly
works the first time. SurvivalBlog readers should do Internet searches on
herbal or all natural
cures
for
dealing with these uninvited guests, for the pets as well. Thank you for
the web site. - Dawn
James,
With reference to "Dealing with Uninvited Guests", there is
an easy way to get rid of head lice. Using copious amounts of cheap hair conditioner
on hair, then leaving it in, stops the nits from being able to cling on to
the hair shaft. You must comb it through well to ensure every hair is coated.
Once they drop off they don't survive long without a host (a matter of hours).
You need to treat the whole family otherwise it just passes on the problem.
When my daughter was young, we spent a small fortune on head lice products
and nit combs, until my local hairdresser told me about the conditioner trick.
To help prevent infestations, add a couple of drops of tea tree oil to a final
hair rinse.
Blessings and prayers for your Memsahib, - Luddite Jean
JWR:
I have "been there, done that" with head lice and my daughter. Toxic concoctions
like “Rid,” “Kwell,” etc
are costly and worthless. When my daughter was 8 years old she would come home
from school scratching her head. We finally figured out it was head lice. I
went on internet and read up and decided that getting “Rid” or
some Permethrin based solution would be best so we tried it. The lice would
just swim around in the “killer” liquid on my daughter's scalp.
We tried another brand with Lindane and the same result. Be aware that many
of the “Lice Information” web sites are fronts for a particular
(useless) product. I went back to the internet where there were many “kook” solutions
like suffocating the lice in olive oil – what a waste of olive oil. There
were other “green” concoctions which were designed to suffocate
or poison (naturally) the head lice. I concluded that all the kook remedies
were worthless and were debunked on most of the mainstream web sites as worthless – good
luck trying to suffocate the nits and adult lice. It really drove me mad to
think of my beautiful daughter with her beautiful long hair having “bugs” crawling
around on her head. I wanted them dead and I wanted them dead now. I was desperate.
Then I read some where about merely using plain old hair conditioner – i.e.
putting it on after a shower in copious amounts and leaving it in – and
mechanically removing the noxious lice with a metal nit comb. I was tired of
poisoning my daughter (read the labels – it is poison) and from what
I read the prescription medication was way more toxic. So we tried it - we
bought two quality metal nit combs and slathered on the hair conditioner and
carefully followed the instructions that came with the nit combs. We mechanically
removed the nits and the live adult head lice. You get a cup of hot water and
dunk the nit comb and watch the “body count” of the adult lice
add up. It is satisfying to physically remove them one by one. After two days
there were no more adult lice to be found. The nits were another matter and
for the next couple days we went through my daughter’s hair strand by
strand and pulled out each nit with our finger nails as the nit combs were
ineffective in removing all the nits. It took a total of three to four hours
over the course of three or four days to remove the adult lice and all the
nits. Victory – free at last. A few months later when we found the early
stages of a new infestation we knocked it down quickly in just two days.
Another
aspect of this is the extensive instructions on the web sites and written instructions
about how to treat bedding etc. If you followed all the recommendations you
would spend hours on decontamination and spray toxic poisons around the bed
and house. Thankfully. head lice can only live in hair/scalp otherwise they
die fairly quickly. We found that merely washing the pillow case and sheets
was sufficient without spraying poison in the carpet and all over the place
another bad toxic idea. I shudder when I remember one of the coaches of my
daughter’s baseball team spraying lice “killer” in the batting
helmets and when I asked it was because of widespread lice in the local school.
Nice. My daughter had her own helmet and we told all the other kids it was
only for my daughter to use. Notes: Where we went wrong – we took our
daughter to her pediatrician early on to have her head checked out and we told
that the nits were old and there was no current problem. Wrongo bongo. The
full blown outbreak occurred days later. We called back to request the heavy
duty prescription medication and were told to try the over the counter stuff
as the prescription medication was really toxic and they only prescribe it
when absolutely necessary. Lice have adapted and have developed immunity
to the over the counter medication so aside from it being toxic it is worthless
and expensive – I saw this with my own eyes. I tried it over and over
- to the limits on the warning instructions. Also, when you go on the Internet
you read a bunch of politically correct nonsense about how kids who spread
head lice are not “dirty and unkempt” but some parent(s) at my
daughter’s school were sending a kid(s) to school with head lice – It’s
not the kid’s fault but I disagree, the parents were dirty,
inconsiderate slobs in my opinion.
So, bottom line – get two or more quality
nit combs, slather on the (non-toxic) hair conditioner, follow the combing
instructions
and remove the adult lice and as many nits as possible and then physically
remove all the remaining nits one by one with your finger nails as those nits
really glue themselves to the hair. Carefully dispose of the adult nits you
remove – I treat them as if they were black plague contagions – and
wash the bedding every day until you don’t find any more adult lice and
have removed all the nits. Mechanical removal has several advantages – it
is non-toxic, it uses common hair conditioner (easily stored), it is inexpensive,
and most importantly it works. It may be the only method that actually works.
In a true survival situation you could substitute olive oil or some other similar
substance in place of the hair conditioner. Hopefully we will never have to
deal with the problem again but all the dread is gone and we are equipped,
once and for all to deal with this problem because we have lots of hair conditioner
and three quality nit combs. Simple solution – the best solution - Keep
is simple.
On another note, I just finished reading "Patriots".
It was a great
read, and I could not put it down. Thank you - John M.in California
« Mexican Flu Update: |Main| Five Months Till Armageddon--A Dark View of the Future, by H.I.C. »
Letter Re: Dealing with Uninvited Guests
Mr. Rawles
I have been a faithful reader for about a year now and would like to take this
opportunity to thank you and your contributors for the wealth of information
found on this site. I would also like to thank Anon T. for his article on quarantine
procedures, though I'm wondering if it should be expanded to include "debugging".
I'm referring to head lice, body lice, crabs, bedbugs, mites, and fleas. Nobody
wants to believe
that it will happen to them. It doesn't even have to be a WTSHTF scenario.
In today's economic environment many people are loosing their homes and moving
in with family or friends. With more and more people and their belongings under
one roof, personal and residential cleanliness may begin to suffer. In a SHTF scenario,
add to this stressful situation, not being able to properly bathe, wash hair,
clothing, and bedding as often as they should, and the possibility
of "unwanted house guests" rises.
About 8 years ago, my then two-year-old brought head lice home from day care.
Before
I realized it, I was also beset by lice. My mom said "getting lice isn't
a
sin,
keeping
them is." But getting rid of these little bugs was just short of impossible.
As soon as you think they're gone a nit that you missed hatches, and it starts
all over.
Hopefully this won't be a problem for most of your readers, but they should be
prepared and informed.
|
Treatment products like "Rid" won't be easily rotated before they expire,
so it may be cost-prohibitive to stock it. are there any natural or more cost
affective alternatives? I'm wondering how we will deal with this in the future
when products like "Rid" might not be available. and maybe someone
out there could explain identification and treatment for those readers who have
never been through this. - J.C.M.
JWR
Replies: I agree that it is wise to stock up on anti-parasiticals (pediculicides
and scabicides ) The
active ingredients in Rid and Lindane ("Kwell") can be
effective
for several years. Most of the Rid variants are a 0.5% solution of Permethrin.
The Lindane
solutions
(typically
1%) are
sold
under trade names such as BBH, Bio-Well, G-well, Kildane, Kwell,
Kwildane, Scabene, and Thionex. Some
traditional
treatments for lice that were used in the 19th Century and early 20th Century
might still be viable, but most of them are harsh an potentially toxic, so they
should be considered only in
absolute worst case disasters,
when
modern anti-parasiticals are unavailable. The 1996 article titled Control
of
Human
Lice
Infestations: Past and Present (in
PDF)
from
American
Entomologist provides some interesting history on lice control, including
some lousy methods from the 19th Century. It might sound severe, but when modern
anti-parisiticals can't be found, head shaving is a good starting
point. (But it will give you the Sinead
O'Connor "I'll never be accused
of
being
infested"
look.)
« Letter Re: Any Widespread Flu Will Overwhelm America's Emergency Medical Services |Main| Notes from JWR: »
Biological Threat Assessment and Containment, by Anon.T
When either you or your group is confronted with a biological threat [such
as a pandemic or biological warfare], you must determine the following before
making decisions either for yourself or
for your group.
1) What is the threat?
2) What is the incubation period prior to showing symptoms?
3) How contagious is the threat?
4) By what means is the threat contagious?
5) What is the morbidity rate?
6) What is the mortality rate?
Once you have determined these things, you can make sound decisions that can
get you and your group through a trying time.
Quarantine:
In the event that you are forced to deal with new members joining your group,
[during a pandemic] you will need to quarantine them for a set period of time.
This will assure you and your group that the new-comer's presence does not
cause harm
within
your group.
To set up quarantine you will need the following items which will be detailed
below:
Shelter
Food & Water
Disinfectant
Communication equipment -or- Another pre-determined way of communicating with
the quarantined.
Medicine
Symptom measuring devices and charts.
Rules that the quarantined must follow if they wish to become part of your
group.
A plan should the quarantined not follow those rules.
A plan should the quarantined show symptoms and/or become sick.
A way for the quarantined to expel waste that does not pose a risk of infection
to other members of the group.
There is not a single point above that can be neglected for any reason. Having
to survive a biological threat has nothing to do with niceties or with comfort.
Shelter:
A place [that is downwind,] away from all group activity for the person(s)
in question to be quarantined. How far away is far enough? Miles would be great
but it
is
probably
not economical
so do with what you have to ensure that your group never gets within a 1,000
feet of the quarantined.
Food & Water:
Whatever the food and water that you supply or that your possible guests bring,
they must have means of making it safe for human consumption.
Disinfectant:
You and the quarantined must be able to protect yourselves from the environment
and the biological threat. A strong bleach solution, a rag and a bucket
would be fine for disinfecting everything. Alcohol sanitizer and anti-bacterial
soap
are
luxuries
if you can
afford them.
Communication:
The group and the quarantined must be able to communicate for numerous reasons.
Humans get pent up if they are left in a confined place to their own devices
for long and to limit the risk of the quarantined coming too close to the group,
they must be able to communicate with the group from a safe distance.
Two-way radios with rechargeable batteries and a way to recharge them at the
quarantine site make the best answer to the communication problem, the only
problem is that they are expensive to have spares around and impossible to
outlast the quarantine if power isn’t available to recharge them.
In the absence of two way radios, your group should have a pre-determined plan
for communication should anyone be at risk for the threat, including any quarantined
individuals.
The group should never risk entering a place of possible contamination if it
can be avoided in any way, so a group should have a Communication Center set
up some distance away from the quarantined and a further distance away from
the group.
To allow the best ventilation, Communication Centers should never be indoors
so a tree, a table or a large rock, all make adequate places.
Each member (the group and the quarantined) should have a pen and multiple
sheets of paper (A dry erase board for each group would do fine) of their own
to write on and leave at the communication center. Each member should understand
the nature of the quarantine and the time at which the papers will be picked
up, read and possibly replied to that is consistent with the length of time
that the biological threat is thought to stay active on paper.
(e.g: Every 3 hours from __ a.m. - __ p.m.)
Medicine:
Your group should have medicine that can be used to treat common pains and
injuries so that the quarantined can be comfortable and it will be easier to
gauge their symptoms if they should have any.
Symptom Measuring Devises:
You should include devises that allow the measuring of all symptoms familiar
to the threat. Some adequate symptoms measuring devices include a Thermometer,
a watch for checking pulse and blood pressure and so on.
Rules:
Your group should have rules that everyone in the group must follow and separate
rules that the quarantined must follow if they wish to eventually enter your
group. These rules must include items like; Staying at least _00(0) feet away
from every member of the group at all times, keeping the quarantine area clean
and free of infection, following proper communication procedures, washing all
contaminated clothing upon entering the quarantine area and being honest with
the progression of any and all symptoms including minor symptoms that may or
may not be related to the threat.
Contingency plan for symptoms within the quarantined:
This plan needs special consideration because the quarantined may be members
of one’s own family or close friends and particular thought must be given
to how they will handle the onset of symptoms and how the group must handle
the quarantined should they become less than complacent including delivery
of proper medication to treat the threat.
Contingency plan if the quarantined does not follow the rules:
This plan should be relatively simple. Anyone who puts your group’s health
and safety at risk by not following the rules is not a valued member of any
group and should be avoided like the threat itself.
Waste Expulsion:
Human waste is possibly a carrier of the threat and since it cannot be avoided
it should be taken into consideration.
If there is a working toilet and sink at the quarantine site, by all means
use it.
In place of a working toilet and sink, the quarantined will have to take special
measures to not endanger the group. In an outdoor environment, the group will
have to dig a hole at the quarantine site (Prior to the visitor’s arrival)
at least 5-6 feet deep and mark that area with a flag easily visible to both
the quarantined and the group. The quarantined will then need to expel all
human waste in that hole and only in that hole (to limit the exposure of contaminants
to the quarantine site) and then kick a little bit of the pre-dug dirt back
into the hole covering the excrements.
This is the time where a little lime would go a long way. If at all possible
to acquire, get some lime prior to the threat to have on storage for just such
a need.
Quarantine Items:
2 - 5 Gallon bucket(s) or the equivalent.
Bleach
Rag(s)
Anti-Bacterial soap
Food that does not need cooking (Min. of incubation period worth of food if
able to spare) and additional food left at communication center every day.
Water or a clean water source
2 way radios with rechargeable batteries and a battery charger
Paper and Pens should the 2-way radios give out
Gloves
Mask(s)
Flag(s) for marking human waste site
Watch for keeping time for communication and symptoms
Thermometer
Toilet Paper (If available)
Quarantine Item Set Up:
All should be able to fit within the 5 gallon bucket with the exception of
food and water (Though a little will be placed in there in advance) including
the following items placed on the top:
Rules of the group
Expected quarantine Time
Rules of quarantine
Rules of communication
Rules:
This will be a pre-printed or pre-written page that will be given to
the prospective guests to read and decide whether they are willing to do the
things necessary to join the group.
Hello,
We are very glad to see you healthy and well and are taking the health and
wellness of our group extremely serious. In doing so, we have implemented rules
that you must adhere to without exception if you wish to join our group.
These rules may seem tedious but we are not taking chances when human life
is at stake just as we will not take chances in protecting your health or the
health of any new members to our group.
Firstly, we will not be having any face to face communication. In place of
this, we will provide, among other things, a 2 way radio, rechargeable batteries
and a battery charger so that we may communicate with each other at all times
(or another way of communicating as described later).
The current known incubation period of the threat that we face together is
____ hours or __ days. If you wish to join our group, you will be forced to
quarantine yourself in a location that we provide or set for ____ hours or
__ days to ensure your safety and the safety of our group. If you are not willing
to follow these rules including duration of quarantine, kindly set down this
sheet of paper now and walk away.
At no time will a group member come within 500 – 1,000 feet of you during
your time in quarantine. This is for the protection of all members of the group
and yourself. Do not violate this rule – Use the radio or the aforementioned
way of communicating in it’s place.
Once you enter your quarantine location, you will be required to stay within
_00(0) feet of your quarantine location until the time of quarantine is over.
If you breach this _00(0) feet marker which we will set or determine, you will
no longer be eligible for joining our group. Please follow this rule.
If you do not have food and water with you, food and water will be provided
for you at a drop point that we will disclose later.
Human Waste:
There will be a pre-dug designated latrine that will be used for the disposal
of all human waste. Human waste, which already poses a health safety hazard
is not to be expelled into any container but dropped directly from your body
into the designated latrine as you “go to the bathroom” after
which you are required to kick dirt or shovel lime back into the latrine
to cover
the waste.
Food disposal:
Only prepare as much food to eat and you are going to eat. Any food that is
not consumed is to be buried with the waste as noted above.
Self evaluation and symptom reporting:
We will provide you with the tools necessary to evaluate yourself. You will
be required to evaluate yourself twice a day, once in the morning and once
before bed. You must answer all items honestly. You are to report the following
items to the group:
Appetite: None, Normal or Excessive
Vision: Clear, Blurry or Normal
Fluid Consumption: Normal, Heavy or Low
Temperature:
Physical Well-Being: Tired, Energetic or Normal
Medications taken within the last 24 hours:
Pain: None or on a level of 1 – 10 with 10 being the worst pain you’ve
ever felt.
Stress Level: Low, Moderate or High
Symptoms: ________
Urine Excretion: Yellow, Cloudy or Clear (Was there a hot or burning sensation
when urinating?)
Waste Excretion: How many times a day and; Loose, firm, normal or painful.
Staying Healthy:
We expect that you came to us healthy and we want to see you remain that way.
Please eat 3 meals every day, drink plenty of liquids, busy yourself with items
you brought or by writing a story (not involving the current situation but
rather one that is purely fictional) and following the listed daily exercise
recommendations:
Walking: Even in a confined area, walking moves the blood through your system
and will provide a healthier you.
Arm and leg stretches: Stretching your arms and legs is a fundamental need
that every body has.
Not staying in one spot or position for an extended period of time.
Brushing your teeth daily with or without toothpaste and brushing your body
down (dry shower) with a rag are two essential ways of staying healthy.
Please do not perform any muscle building or muscle retaining exercises during
this time. Muscle building exercises break down your current muscle to rebuild
more and releases toxins into your system. Refrain from any such activity during
this time so as not to confuse the symptoms of muscle breakdown with symptoms
of the threat.
Positive Thought:
Negative thought will not be tolerated in our group. You are a strong person
and you will get through this. Please do not let the dire nature of this threat
overwhelm your sense of self worth or the free will that God gave to you. If
the threat seems overwhelming, know that you are strong and pray for the endurance
to see this through.
Carried Item Quarantine:
Please understand that the items that you brought with you may carry the threat
on them for an unknown amount of time. The group will decide which items can
be cleaned, used or disposed of without hesitation or regard to personal feelings.
You may at no time keep an item that the group feels is dangerous.
That is it. Those are the rules required by anyone who wishes to join our group
and anyone who leaves our group for any amount of time.
If you are not 100% sure that this move is right for you and 100% sure that
you will abide by these rules, there will be no hard feelings between us. Please
put this paper down on the ground, wave a goodbye and walk away now.
We thank you for your patience and understanding during these difficult times
that we all must face.
If you are positive beyond doubt that you will abide by these rules and any
rules that the group may impose in addition to these, please fold this paper
up and place it in either your shirt or pants pocket. At this time we will
disclose the location of items that we will be providing you and further our
communication together.
Go on to Document #2
Document #2 – On a separate sheet of paper
Hi,
We are very glad that you have chosen to quarantine yourself from our group
before joining it. This shows that you care as much about our well being
as we do yours and proves your willingness to put the group’s needs
ahead of your own. In no way does quarantine mean isolation, we look forward
to communicating
with you using the two way radios that we will provide or the use of a communication
center that we will set up.
We know that this can be an emotional time. Please do not let your emotions
run your self control, will for life or care for others. We are here to communicate
with you throughout this entire time and we look forward to spending time with
you once you join our group.
The location that you will be staying in during your quarantine is:
________________________________________________
We will provide the following items for you if you do not already have them
on hand.
2 - 5 Gallon bucket(s) or the equivalent (for the cleaning of clothes and items.)
Bleach
Rag(s)
Anti-Bacterial soap
Food that does not need cooking (Min. of incubation period worth of food if
able to spare) and additional food left at communication center every day.
Water or a clean water source
2 way radios with rechargeable batteries and a battery charger
Paper and Pens (In case the 2-way radios give out or for story writing)
Gloves
Mask(s)
Watch (for keeping time for communication and daily health evaluations.)
Thermometer
Toilet Paper (If available)
Radio Operation:
Provide instruction for radios here
Communication Center:
The communication center will be at the following location.
________________________________________________
We will be using the communication center for the supply or re-supply of
all goods including the items that you will get once entering quarantine.
We will
also use it for communication if the radios fail to work properly. We will
be checking for communication every ___ hours (1 hour beyond the time that
the threat is thought to survive on paper) from ____ a.m. to ____ p.m. daily.
Please flag a
new communication by placing __________ over the paper or dry erase board
for the group to see.
Proper Communication Etiquette:
As you can probably tell, we are limited by the items that we have on hand
including paper. Please write legibly and please tear off the paper at the
bottom of your communication so that the rest of the paper may be saved for
later use.
To limit the risk of exposure, we will not be touching any communication items
at the communication center. It will be your job to dispose of all paper used
for communication by placing it in the latrine.
Emergency Communication:
A true emergency is something that is life threatening and that cannot wait
until our next communication. We will never cry wolf to you so please express
the same care and respect for us.
If the need should arise for emergency communication, the universal distress
code that we will use is 3 of anything, 3 seconds apart.
That means 3 loud whistles 3 seconds apart, 3 bangs on the bottom of a bucket,
3 shouts using
the word “Emergency” or 3 blows on an air horn.
We will continue to use this code every 3 minutes until visual confirmation
can be made of the person issuing the emergency code and the group.
Example use of the Emergency Distress Code: Whistle Whistle Whistle – Wait
3 seconds - Whistle Whistle Whistle – Wait 3 seconds and then finally
Whistle Whistle Whistle now wait 3 minutes and repeat.
That covers it. We are so glad to see you well. Please fold this paper up,
place it in your pocket and follow the schedule below:
Schedule:
Now:
Gather your items and bring them with you to the quarantine site.
Leave all items well outside of the quarantine site until proper decontamination
can be fulfilled.
Before entering the Quarantine Site: Remove any outer clothing which may be
contaminated and place all items inside the bleach/water solution that is in
the bucket provided for you at the site.
Next, take a rag and rinse your body over with the bleach and water solution
from head to toes. Bleach will not hurt you at the strength it is diluted to.
Please wash well your hair, face, hands and all exposed body parts.
Dry off with clean rag provided.
Enter Quarantine site
« Mexican Flu Update: |Main| Letter Re: Diverters and Pre-Filters for Roof Rainwater Catchment »
Three Letters Re: Stocking Up on Prescription Medicines
Jim-
I want to publicly commend “SH from Georgia” on his excellent
and concise article on stocking prescription drugs for a TEOTWAWKI
scenario. I agree with just about every point that he has made. Adding metronidazole
to the list is a great addition, and his comment about having medications on
hand so that a physician might use them to your benefit is a point that I was
contemplating, as well. Of course, the list of “med-prep” logistics
that one could store is lengthy, and will be limited by 1.
budget; 2. knowledge
base, and 3. storage ability. SH’s list is very doable
from all of these angles. If I were to make my own list, my only point of departure
would be to emphasize again that these drugs will be quite precious. Most of
the
upper respiratory infections that are currently treated with antibiotics would
resolve spontaneously without them, e.g., acute sinus infections, mild ear
infections and a sore throat not accompanied by fever. I purposely left out
amoxicillin
because it is a wimpy antibiotic that is currently rarely effective for the
sort of infections that will unequivocally require antibiotic therapy in an
austere environment. A final recommendation: for anyone stockpiling prescription
meds, having a current copy of the Physicians
Drug Handbook
(Not to be confused with the
Physician's Desk Reference (PDR)) would be indispensable. - RangerDoc,
MD, FACS
JWR:
A quick note on one of the medications that SH from Georgia mentioned:
Metformin does not usually work until you reach 1000-to-1500 MG dose. Also,
it is important to note that the tablets [of this particular medication]
should not be
cut. Everyone should always double check everything
concerning
medications.
All the drugs [in this family] are also now going to have black
box warnings soon for possible heart problems! - Russell M.
Hello,
I am a retail pharmacist in Philadelphia. The letters with regard to stocking
up on medication and medical supplies were great. I'm glad to see other Pharmacists
into preparedness. There are
a few other things I thought I would mention.
A good topical anti-fungal cream could prevent a lot of unpleasantness. Generic
Lotrimin (clotrimazole) applied twice daily for a week or two can treat ringworm
(a fungal skin infection), athlete's foot and jock itch. Lamisil and Lotrimin
Ultra are a bit more potent but probably aren't worth the additional cost.
SH's letter was great and he really knows his stuff. Another antibiotic that
might be useful in people who are allergic to amoxicillin/penicillin, etc (those
same people can also be cross-sensitive to cephalosporins (keflex, etc)) is
azithromycin (z-pak) or erythromycin (ery-tab). They are broad-spectrum and
are usually tolerated well (some G.I.side effects like cramping and diarrhea).
If someone is unable to find a like-minded prescriber there are plenty of veterinary
medicines that can be used by people available at pet supply/agricultural stores.
I have seen tetracycline, amoxicillin, and sulfa drugs which were to be used
on everything from fish to horses. These would be fine to use in post-SHTF circumstances. They go by different brand names but are the same medicine.
One would just have to take care to use appropriate dosing as they are usually
in different strengths than human dosage forms. Ragnar
Benson has some books
on these topics.
Another thing is to have a good supply of natural medicines available(grow
echinacea as an antibiotic and elderberry as an antiviral (flu prevention/treatment).
There are many others.
Staying in good health and thinking "preventative" is a good way
of decreasing the effects of some of the major killers. It seems as though
the American way of life conditions many people to wait until a problem occurs
to start thinking about their health, but you wouldn't wait until your engine
locks up to change your oil. Diabetes, heart disease and cancer risk can be
reduced by proper diet, exercise, stopping smoking, etc. This will allow you
to be free of any "maintenance medications", insulin, etc. that might
be difficult or expensive to stockpile.
I just finished reading "Patriots" , it is awesome work!
Take care, - S.T. in Philly
« Letter Re: Prince of Wales Island, Alaska as a Retreat Locale? |Main| Note from JWR: »
Three Letters Re: Stocking Up on Prescription Medicines
Jim,
In regards to stocking up on prescription medicine your readers may want to
use the book "Wilderness
Medicine"
by
William Forgey, M.D. as a good starting point. A couple of other "beginner
books" are "Where
There Is No Doctor"
by
David Werner and "Where
There Is No Dentist"
by
Murray Dickson. Amazon.com is running a special on all three books for $42. [JWR
Adds: The latter two books are available for free download, but
I recommend getting hard copies for your survival reference library.]
I took the book "Wilderness Medicine", to my doctor's office
and discussed the list of medicines Dr. Forgey recommends and my doctor advised
it was a very good reference. Our doctor advised a lot of the medicines listed
were included in his supplies that he keeps at home.
Included in the book is some information on multiple uses of the medicines
as well as alternatives if you run out of one of them.
My doctor also recommended the following prescriptions: Cipro, Tamiflu, and
Relenza.
We had to search for a preparedness minded doctor but they are out there if
you seek them out. Thanks, - Art
Mr. Rawles,
In response to Bryan’s request for a list of medications that may be
worth adding to your preps, the following is my humble reply. I am a pharmacist,
of the clinical variety (the kind that works in hospitals and clinics helping
docs manage acute drug therapy, as opposed to the community pharmacists, who
dispense drugs and valuable information to the public) with 27 years of hospital
pharmacy experience. Please don’t think that my recommendations are the “gospel
truth”. This e-mail is off the top of my head, and I’m sure many
others will add to, or detract from, my suggestions. If there’s one thing
I’ve learned over the course of my career, it’s that there are
very few definitive answers to medical questions.
Now, it should go without saying (but I’ll say it anyway) that these
recommendations are in no way meant to suggest that you should self-medicate
under normal circumstances. The safe and effective use of medications is a
risk:benefit game, best assessed by your doctor. No drug is absolutely safe,
and the proper diagnosis of illness and treatment with medications is an endeavor
that consumes lifetimes of study. Having said that, in a TEOTWAWKI situation,
the risk:benefit equation shifts, and sometimes the risk of doing nothing will
exceed the risk of using some drugs without the oversight of a physician.
To get started, as my good buddy and I always say, “you must define
your goal before you can hope to decide on the appropriate action”. So
here’s the goal: suggest some commonly available drugs (prescription
and over-the-counter (OTC))
which could be stored in preparation for foreseeable calamities in an extended SHTF or
TEOTWAWKI situation – either for self-medication, or for selection by
a “country doctor” who has the knowledge, but not the drugs. I
will focus on drugs that may have a chance of making a difference in acute
situations without heroic measure beyond the ken of most non-medical folks;
that is, no designer drugs for the syndrome of the week will be included. Also,
I will stick to generically-available drugs in order to seek cost feasibility.
I will avoid “controlled substances” (those federally regulated
by the DEA) – a
difficult obstacle when it comes to pain management, because we must exclude
all of the opiates. Also, though I use mostly intravenous medications in the
hospital, this list focuses on oral medications, for obvious reasons. Finally,
in TEOTWAWKI, we will simply have to accept that certain conditions lead to
shorter life spans, so drugs for the treatment of chronic diseases are not
included. Nutrition, trauma, infection are about all we can hope to impact – and
surgery is more important than drugs in trauma. Those with diabetes, severe
hypertension, heart disease, and other all-too-common chronic maladies will
have to wing it….not to say that it isn’t a good idea to have several
months of your specific medications on hand to get through a temporary interruption
in our normal flow of life.
I will resist the urge to get into details about bacterial resistance patterns,
differential diagnosis, viral vs. bacterial infection, dosing, duration of
therapy, etc. It would be much better to chat with your local medical person
about the specifics. These are just the very basics – I’m sure
a rational argument could be made for almost any drug.
ANTIBIOTICS – the breakthrough that promoted chronic diseases and cars
to the top of the mortality list
Ciprofloxacin (common brand name: Cipro) – usually dosed 500 mg twice
daily, this wonder drug covers a broad spectrum of pathogens, and is reasonably
effective in treatment of urinary tract infections, pulmonary infections, skin
infections, and gut infections. Bonus: can treat or prevent pulmonary anthrax
infection, prophylaxis against bacterial meningitis, and has a fighting chance
against gonorrhea. Sold by prescription only.
Cephalexin (common brand name: Keflex) –usually dosed 250-500 mg every
six hours. A reasonable choice for upper respiratory (ear, nose, throat) infections
and skin infections, including prevention of infections secondary to lacerations.
Small risk of problems in folks with severe penicillin allergy. Sold by prescription
only.
Metronidazole (common brand name: Flagyl) – usually dosed 250-500 mg
every six hours – This oft-overlooked drug has good activity against
the class of bacteria called “anaerobes”, and is useful in treatment
of diverticulitis, some gynecological infections, and would be a welcome addition
to cephalexin in the event that a “home appendectomy” is to be
tried on the kitchen table (just kidding…sort of). This drug can also
treat (or cause…go figure) a severe, and oft-fatal type of diarrhea,
called Clostridium difficile colitis (aka, pseudomembranous colitis). Don’t
mix alcohol with this one! But then, who will have booze in TEOTWAWKI anyway?
(no offense to the home distillers out there!). Sold by prescription only.
Amoxicillin (common brand name: Amoxil) – usually dosed 500 mg every
eight hours – Good for ear, throat, urinary tract, and some soft tissue
infections. If started immediately, may prevent bad infections secondary to
animal bites, including humans, but if the infection has already begun, bigger
guns are usually needed (different bacteria are problematic with various species,
but we’re talking generalities here). Bacterial resistance has cut into
the effectiveness of amoxicillin over the last 20 years, but it would sure
be better than nothing, especially in a more rural setting (the nastiest bugs
always hang out in crowds!). Sold by prescription only.
Other possible generically-available antibiotic candidates include good ole
penicillin (G or VK), ampicillin, amoxicillin/clavulanate (common brand name:
Augmentin), sulfamethoxazole/trimethoprim (common brand name: Bactrim or Septra – a “sulfa
drug”), and doxycycline (common BN: Vibramycin)
ANTIFUNGALS – just one
Fluconazole (common brand name: Diflucan) – About the only reason to
have this on hand is for vaginal candidiasis. (Ladies, you can probably diagnose
that one as well as your doc!). Other uses would be difficult to diagnose at
home. A single 150 mg tablet shows very good efficacy in this indication – but
I suspect that the 200 mg tabs would be cheaper to obtain in quantity, since
the 150 mg tablet is individually packaged for the indication. In this scenario,
an extra 50 mg won’t hurt. Perhaps one of my community pharmacist colleagues
could confirm or deny my suspicion. Sold by prescription only.
VITAMINS – much more important when on survival rations!
Multiple Vitamins – get several of the biggest bottles of a generic multi-vitamin
that you can find at the warehouse club. If you’re eating white rice
three times a day, a vitamin a day (or even three times a week) may dramatically
extend your chances of survival. OTC
Vitamin C (ascorbic acid) – Very good to have around when citrus and
greens are not available…remember scurvy? (Though I hear you could eat
a pine tree). A couple of big bottles of Vitamin C 500 mg could stave off scurvy
for your family for quite a while. A quarter of a tab a day would be sufficient,
probably less (Dietitians should fill in the details here). OTC
Vitamin D – If you’re expecting a nuclear winter, you’ll
need this in the absence of sun…but then again, after reading [Cormac
McCarthy's novel] “The Road”, I’m not sure I would
want to stick around for that one! OTC
ALLERGY DRUGS
Antihistamines – Of course, seasonal allergies will have to be tolerated,
but it wouldn’t hurt to have some diphenhydramine (common brand name:
Benadryl) on hand for particularly bad cases of poison oak and bad (but not
anaphylactic) bee stings, etc. Available OTC
Corticosteroids – Along the same lines as above, perhaps a few methyprednisolone
dose packs (common brand name: Medrol Dospak) would be good for more serious
allergic reactions. Sold by prescription only.
Epinephrine – Though I promised to “stay oral”, I must mention
Epi, because it is probably the only thing that may save someone experiencing
a bona fide anaphylactic allergic reaction (tongue swells, throat closes down…can’t
breathe). The injectable form in ampoules (1mg/ml) is much cheaper, but the
Epi-Pen product is a pre-filled syringe that is ready to go. Sold by prescription
only.
ANALGESICS (pain control)
Ibuprofen (common brand names: Motrin, Advil) – Pretty good for what
ails you, since we’re not talking about narcotics. Strengths are headache,
bone pain, tooth pain, and general sprains/strains. It’s a good anti-inflammatory
(unlike acetaminophen) and will bring a high fever down. Available OTC
Aspirin – Still good for headaches and fever (except in children--do
a web search on Reyes Syndrome), but beware the enhanced risk of bleeding if
used for pain secondary to traumatic injury. Though ibuprofen theoretically
can cause a similar problem, it’s much rarer than with aspirin. Bonus:
Though heart attack mortality will undoubtedly go back up to early 20th century
levels in TEOTWAWKI, a chewed aspirin tablet (325mg) at onset of chest pain
may improve your odds in the absence of any other medical intervention. If
an old bottle of aspirin smells strongly of vinegar, it is probably kaput…but
it wouldn’t hurt you to try it.
Hydrocodone/Acetaminophen (Common brand names: Vicodin, Lortab, Lorcet, etc.) – I
said I wouldn’t include controlled substances, so this one is not included….but
just so you know, this combination of an opiate and acetaminophen (Tylenol)
is probably the minimum analgesic intervention that would help much with traumatic
visceral pain. But the laws involved and the risk of misuse complicate the
issue greatly. Be sure you’re not putting yourself at legal risk before
deciding to get prescriptions for this, or the more strictly controlled analgesics
such as oxycodone/acetaminophen (Percocet), morphine, meperidine (Demerol),
and others.
GASTROINTESTINAL MEDS – “Keep it movin’ – slow it down”
Soluble Fiber (common brand names: Metamucil, Citrucel, Fibercon) – May
be essential to keep things moving in the early days of survival rations (though,
as it is oft pointed out on this blog, eat what you store and the transition
will be much smoother). Available OTC
Docusate Sodium (common brand name: Colace) – stool softener…’nuff
said
Loperamide (common brand name: Imodium) – this antidiarrheal could save
a life, but be sure to study up on when, and when not, to use it. In bacterial
enteritis it may do more harm than good. Available OTC, though if you have
a pharmacist friend, they may be able to order a bottle of the caps much cheaper
than the OTC boxes.
TOPICALS – Cuts, burns, and scrapes
Antibiotic Ointment (“triple” bacitracin/neomycin/polymyxin or “double” bacitracin/polymyxin)
Good to reduce the risk of infection in minor cuts and scrapes. Many folks
suffer a contact dermatitis when exposed to neomycin, so many docs are recommending
the double formula these days (common brand name: Polysporin).
Silver Sulfadiazine cream (common brand names: Silvadene, Thermazine) – A
lifesaver in severe burns, but you’ll need a big jar of it.
Eye Wash – It’s basically just sterile salt water, but good to
have when you need it!
Obviously, this is a starter list. I will apologize in advance for the glaring
omissions that I’m sure friends and colleagues will point out.
A word on stability – as we’ve discussed on this blog before, the
manufacturer’s expiration date has been found to have quite a bit of
wiggle room by our Department of Defense, that has, commendably, conducted
their own degradation studies in order to extend the shelf life of the military
drug stockpile, and thus save us poor taxpayers a buck or two. For obvious
reasons, this [Shelf Life Extension System (SLES)] data is closely guarded,
so we don’t know the specifics. A few details have leaked out, and it
seems that most drugs are “good” (meaning within a reasonable range
of their original potency – usually 90%) for years beyond the
labeled expiration date when stored appropriately. For most tablets and capsules,
cooler, darker, and dryer is better (low oxygen is also good). I would suggest
that you ask your pharmacist to add the manufacturer’s expiration date
to your pill bottle for a frame of reference. Many pharmacy computer
systems default to one year from the fill date on the prescription label, irrespective
of the actual date on the stock bottle. The bottom line is this: the
drugs on this list (with the possible exception of doxycycline) do not degrade
to a toxic compound; they only loose potency over time. If you refer to Mr.
Rawles’ excellent novel, "Patriots" ,
you will note how the characters titrated the dose up to allow for potency
loss post-expiration date. When to do this, and by how much is a crap shoot,
but in TEOTWAWKI it is better to have tried and lost, than never to have tried
at all!
Here’s hoping and praying that we all die in our beds at 101 years of
age, with our wives (or husbands) lilting voice in our ear, saying, “I
told you that you were wasting money on all that survival stuff!!!” Regards,
- SH in Georgia
Mr Rawles,
I'm a retail pharmacist working in Louisiana and am new to prepping. Many of
my patients come to me asking for advice on low cost medications that will
still yield positive outcomes. As a result I've gained valuable insight into
the potential for stockpiling medications on a budget. I hope this helps:
Stockpiling mediations for WTSHTF can
be a daunting task, even for those with an idea of their current medicinal
needs. For those currently taking prescription medication, the question is
usually affordability and accessibility. Most insurance plans will not pay
for supplies larger than 90 days, and paying cash for prescriptions is usually
cost prohibitive. While greater accessibility exists in countries such as Mexico
or Canada, crossing the border with large quantities of medication is usually
asking for trouble, thus requiring multiple trips. And while the lower costs
of medications outside of the US has been frequently touted, quality can be
suspect. Internet pharmacies in places such as India or even China will ship
to your front door, but only after paying a "doctor" for your required
by law "consultation", usually costing anywhere from 75 to 125 dollars.
So what are the options?
There is a two fold strategy regarding lowering your drug cost to allow for
cost efficient stockpiling. First, talk with your doctor or pharmacist about
generic medications. Generics save as much as 80% over their brand name equivalent,
are covered on every insurance plan, and because of the cost will allow for
bulk purchases. A prescription is good for one year from the date it is written,
so unless the medication is a controlled substance, you may purchase as much
as a years worth of medication at a time(provided your doctor has authorized
that many refills). Second, for those taking multiple medications, talk to
your doctor and pharmacist about decreasing the number of medications you are
taking by increasing the dose of others or changing the medications altogether.
This strategy can best be illustrated in the following example:
Patient "X" is a 55 year old Type II (non-insulin dependent) diabetic
with a history of coronary artery disease. His current medications are as follows:
Drug Condition Cost/month
Actos 30 mg diabetes $240
Zetia 10 mg cholesterol $110
Plavix blood thinner $170
Cardizem LA 240 blood pressure $125
Total medication cost/ month= $645
After consulting with his doctor and pharmacist, the following changes were
made:
Drug Condition Cost/month
Metformin 500 mg diabetes $4-$10
Simvastatin 20 mg cholesterol $4-$20
Warfarin 5 mg blood thinner $4-$10
Atenolol 50 mg blood pressure $4-$10
Total medication cost/month= $16-$50
These are cash prices, not insurance co-pays. Insurance plans would not allow
you to purchase medication for stockpiling purposes.
Also, in the same manner that firearms and ammunition should be purchased in "common
calibers" to allow for ease in buying or bartering, so should medications.
Even if you do not take maintenance medications it might make sense in the
long run to build up a supply. In much the same way as we seek out kindred
survival spirits in firearms,food storage, etc, it is possible to find doctors
that may write prescriptions for conditions that you could potentially (wink,wink)
develop. Medications used to treat blood pressure or diabetes will be in short
supply post-TEOTWAWKI,
and it will take several growing seasons for herbal remedies to make their
way through the production pipeline. Also, family members, friends and other "guests" will
undoubtedly forget their medications in their attempt to G.O.O.D..
Of the top 20 drugs prescribed in the US in 2007, four were for blood pressure,
three were for cholesterol, three for GERD (heartburn/ulcer), three for depression,
three for asthma/allergy, and one each for thyroid,osteoporosis, sleep and
blood thinning. For the sake of brevity, let's focus on the three conditions
typically undeserved by over the counter medications:
1) Atenolol: A common beta blocker medication used to treat blood pressure.
Common dosages begin at 25 mg daily to twice daily. Purchase the 100 mg strength
and cut them in fourths.
2) Metformin: Sulfonylurea class medication used to treat non insulin dependent
diabetes. While other drugs such as glipizide or glyburide are less expensive
they can also lead to hypoglycemia (low blood sugar) if dosed incorrectly.
Metformin does not have that problem. Can also help lower LDL (cholesterol)
and tryglycerides- but so will the average post-TEOTWAWKI diet. Dosages begin
at 500 mg, twice daily. Where possible, buy the 1,000 mg strength and cut them
in half.
3) Tramadol: Non-narcotic pain reliever. Does not have many of the sedating
side effects of Lortab, Vicodin, Norco, etc and is not a controlled substance.
Tramadol also does not cause the stomach problems (reflux, ulcerations) commonly
seen with ibuprofen, aspirin, and naproxen (non-steroidal anti-inflammatory
drugs (NSAIDS)). This will make them easier to obtain as most physicians are
more comfortable writing prescriptions for non narcotic pain relievers. Typical
dosage is 50 mg up to four times daily as needed.
There are thousands of over-the-counter medications used to treat an unlimited
variety of ailments. This can make stockpiling medications difficult. Every
health care professional has their personal recommendations, but the following
are the five OTC items that should be bought in bulk. They are cheap, effective,
and each covers a wide range of potential maladies:
1) Aspirin
Can be used to relieve pain, relieve inflammation, thin the blood and lower
fever (do not take on an empty stomach)
2) Benadryl (diphenhydramine)
Can be used to treat itching, rash, allergic reactions, and is the most common
ingredient in over the counter sleep aids (will cause drowsiness)
3) Pepto-Bismol
Can be used to treat indigestion, nausea, heartburn and diarrhea.
4) Neosporin
Antibiotic ointment for cuts, scrapes and burns
5) Primatene Mist
The only over the counter inhaler capable of minimizing the symptoms of or
stopping an acute asthma attack.
No first aid kit is complete without those five. - LA, R.Ph .
JWR Adds: In several places, "LA" mentioned cutting
pills in halves or quarters. This is best accomplished a with a tray-type pill
cutter, since cutting pills with a knife --especially those that are not pre-scored
for cutting--tends to be messy and inaccurate. Note that many drug companies
give away plastic pill cutters marked with their corporate logos as promotional
items, so the chances are good that your local retail pharmacist will have
some available,
free for
the
asking.
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Letter Re: Stocking Up on Prescription Medicines
James,
I have just visited with our family physicians about a stockpile of
prescriptions medications. Seems that two of them are "preppers" and are
putting a plan together for their families.
They physicians are more than willing to write scripts for meds, they really
are supportive of the plan and like the Wal-Mart list. For some reason, they
will not recommend specific drugs, they will prescribe but not recommend.
I wonder if a pharmacist and Ranger Doc might be willing to put together
a specific list of recommended prescription items and you could put it in the
blog. This would be a great help.
Thanks. Your blog is my #1 read every day. - Bryan W.
JWR Replies: You are fortunate to be associated with like-minded
doctors. Just keep in mind that legally they can only prescribe drugs that
are within "the scope of practice" of their respective speciailties.
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Two Letters Re: That Post Die-Off Fragrance
Mr. Editor:
In regards to EM Joe's post regarding "That Post Die-Off Fragrance," I
too spent 30 years in Public Service as a Forensic Investigator attending and
investigating numerous death scenes and autopsies involving decomposing bodies.
I used to use copious amounts of Vicks Vapor-Rub, both on my upper lip and
even stuffed up the nose. One day, while attending an autopsy on a real "stinker",
the pathologist conducting the post mortem exam observed me and my faithful
jar of Vicks and informed me that if I used enough of the stuff I would eventually
erode away the mucus membranes in the sinus cavity. Just Dandy I thought to
myself, soooo I asked what would be a good alternative? He responded by saying
that a good activated
charcoal filter mask would do the trick for a short time. However, for
long term the mask and a
small single drop of Oil of Clove on the exterior front portion of the mask,
between the nose and mouth would work wonders. I employed this method for approximately
25 years with no side effects. A caution when using this method is to use only
a single drop of oil and not make direct skin contact with the Oil of Clove.
It has a tendency to burn the skin. Regards, - Surfin' Cowboy
Jim:
I worked in around Gulfport,
Mississippi after Hurricane Katrina as an insurance adjuster. Most of the
deaths occurred next to the ocean where the storm surge killed people and animals.
You could
drive
down
the interstate
6 to 8 miles north from the kill zone and still smell decaying flesh. This
came from all the dead pets, wildlife, sea life, and a few dead people. (a
warehouse full of frozen chicken didn't help either)
If it is summertime, the problem takes care of itself in about 2 weeks. We
pulled out of the worst area for a week or so to let nature take its course.
Obviously the duration depends of the time of year. In the summertime in the
deep south we have 100 degree weather and near 100% humidity. Bodies quickly
decompose to little more than bones in a very short period of time.
Like anything, you quit smelling it and will not notice it unless you leave
the area and come back - J.
« Letter Re: Food Storage--Will People Ever Learn? |Main| Note from JWR: »
Letter Re: That Post Die-Off Fragrance
I have read many [preparedness-oriented] web pages and other scenarios of
the impending collapse as they see it. A common theme in most of them is there
will be a
sudden and
short
lived phase of total chaos. In your novel "Patriots" I
remember the couple who took to a storm drain while the blood ran in the streets
overhead.
So let's say we are unfortunate enough that this really does happen, and at
least half the people on the planet get wiped out in short order. Meanwhile,
the other half can do nothing more than fight, run, and hunker down. And those
survivors of the great collapse are all very careful about cooking odors, no
perfumes, plain soap only, etc. The survivors are just dang busy setting up
their means to survive, because its a new, tough world. But just weeks earlier,
it was a much more sanitized
world. In my 30 years as a Paramedic I was called out many times to check out "that
foul odor" coming from somebody's house or apartment.
I can't even begin to imagine what its going to smell like with about three
billion fresh corpses scattered around rotting without a single funeral
home open for business.
I can tell you its probably not going to smell too good! Heaven help us who
are down wind of a major city!
Sure, in time the problem will fade away. But let's face facts, most people
don't have any real exposure to the possible stench "The Big Die Off" will
conjure up. So, what are some recommendations to get through "The Big
Stink" while you are trying to survive the post social chaos event? Vicks
Vapo-Rub under the Nose? I can tell you from first hand experience that it
offers only minimal relief. I became quite good at putting on a Fire Fighters
Self Contained Breathing Pack. Some of our Tactical Team Medics who went to
New Orleans in the days following Hurricane Katrina can tell you a little about
how its going to smell. Most of them ordered new uniforms after their deployment,
since the old uniforms had taken on a new fragrance. - EM Joe
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Three Letters Re: Deer Ticks - The Threat Within Your Perimeter
Jim,
Good post about Lyme Disease today. I live in Connecticut and caught Lyme in
1995. Took me years of antibiotics to get it into remission. Also, please
note that on 50% of people get the classic "bulls eye" rash. I
didn't, and as a result I was misdiagnosed for five months while it established
itself
in my neurological system.
I recently purchased some special undergarments from Rynoskin which
the ticks and other bugs can't get though. Maybe some of your readers would
be interested. Cabela's sells their own version, called Bugskins but I'm not as familiar with it.
Keep up the great work. I enjoy the blog out here in Blue country!
All the best, - Joe from Connecticut
James:
I found your post on deer ticks and Lyme Disease of much benefit. I would
like to share with you a brief account of a man I knew who contracted
a
very peculiar illness. He suffered from severe malaise (general
weakness) which was misdiagnosed by the local doctors a number of times.He
was diagnosed with anything ranging from influenza to Rocky Mountain Spotted
Fever and even cancer. As it turned out, he had Lyme disease contracted via
a deer tick
His symptoms were not much different from what Bill S. described in his letter
but apparently at the time, it was not recognized for what it was. there was
as
much early
suspicion of Lyme disease as there is now.
My point is that we cannot be too cautious when it comes to our health. even
with competent doctors, things can get missed.
This gentlemen endured quite a long recovery, partly due to lack of early
recognition and partly because Lyme disease is a nasty one. It was years before
he was "right" again. - M.D.T.
Hello Mr. Rawles,
The definitive studies on ticks were concluded in Oklahoma some 30 years ago,
in detailed deer habitat/population studies. (See the reference below.) The
results of the studies indicated that 90% of the ticks occur only in a small
portion of the outdoor habitat. Perhaps as little as 5% of the habitat.
That particular habitat is the area where deer bed down regularly.
I live on five acres and in contact with the vegetation outside daily, in waist
high shrubs, knee high grass and under some heavy growth of trees. Rarely do
I find a tick on me, here in western Oklahoma.
Generally the potential occurrence for ticks on humans is overstated. Because
people simply do not regularly pass through, work in or visit the bedding areas
of deer.
This does not however belittle the fact that just one tick can pass to a human
a disease condition that can impact health negatively. Fear of ticks from outside
activities is generated when warnings are described to the public. If you stay
away from deer bedding areas your chances of having a tick transfer to you
are very low.
The other environmental condition for ticks to gravitate to is a yard with
outside penned dogs. Watering tanks serviced by windmills or solar pumps for
livestock will also be used by deer, bobcats, coyotes and many small mammals.
Watering places frequently will have over runs of water leaving behind pools
of water
on the ground.
These areas may have higher concentrations of ticks.
Beat the odds:
- Always inspect yourself for ticks after being outside.
- If you have an outside
dog in a fenced yard treat the dog's sleeping area with insecticides.
- Stay
out of deer bedding habitat.
But for the first time in more than a year yesterday I picked a crawling
tick off of my neck heading for the hairline.
If in a bugout situation stay away from deer bedding areas for sleeping or
rest stops. You can spot these areas. The deer will leave behind a mashed
down area of vegetation [usually] in brush and/or under low trees. You can
also see the imprint of where deer rest and sleep under trees where there is
less
vegetation.
Distinctive well-used trails will lead to these areas.
Type of habitat that is based on ecological descriptions of a community of
plants have a significant effect on the ability of ticks to maintain a population
of individuals.
Reference: White-Tailed Deer
Utilization of Three Different Habitats and Its Influence on Lone Star Tick
Populations, by Carl D. Patrick and Jakie A. Hair, The
Journal of Parasitology, Vol. 64, No. 6 (Dec., 1978), pp. 1100-1106. Published
by: The American Society of Parasitologists
Understanding ticks is more complex than just understanding the potential
for disease transmission. Cordially,-
JWC in Oklahoma
« Economics and Investing: |Main| Three Letters Re: Deer Ticks - The Threat Within Your Perimeter »
Mexican Flu Update:
WHO Says Up to Two Billion Will Get Swine Flu
Swine Flu: A Survivor's Tale
Swine Flu Kills
30-Something Woman in Texas (First US Citizen Casualty)
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Letter Re: Deer Ticks - The Threat Within Your Perimeter
People who venture into the woods or fields should be aware of a very serious,
but underreported, threat to their health, the deer tick. Deer ticks carry
and transmit Lyme disease and a half dozen other serious diseases. Deer ticks
can be found in most parts of the world. They are very common in Central
Wisconsin which has a large population of deer, their preferred host. Thanks
to the anti-hunting nuts and poor government management practices deer can
found in residential neighborhoods, including large cities.
Most people are familiar with the dog or wood tick, a large, easy-to-spot tick
that feeds on human blood and is very ugly when engorged. It is however, relatively
benign. The deer tick is especially dangerous because it is very small, smaller
than a match head. Their size makes it very difficult to detect on clothing
or on your body.
Two years ago I was bitten a number of times while clearing land for our retreat.
It was prime deer tick habitat; heavily wooded, high grasses and lots of deer.
You may not know that you have been bitten by a deer tick (unless the tick
is still embedded). It will however sting like a bald face hornet – and
for a good 24 hours.
After I started developing the symptoms I put two and two together and did
some Internet research. I suspected that I had Lyme disease. I had the classic
bulls-eye rash on my hip; it looks like the Target logo. The primary symptoms
were extreme fatigue and body aches. After years of outdoor work and practicing
yoga I could barely get out of a chair.
I went to the local clinic. The NP took one look and said, “You’ve
got Lyme”. She said she had got it earlier in the year, her husband the
year before. I was given antibiotics. The symptoms went away within three days.
I thought I was cured.
The following year I was not the same, better, but still lacking energy. Over
the last year I have experienced the same deep fatigue as well as many other
symptoms. I had previously been very healthy. The symptoms come and go and
express themselves in a variety of ways. Reported symptoms include heart, lung,
visual and mental problems – it can be fatal. It is one bad bug.
I cannot say for sure what the cause of my problems is or recommend a treatment.
Lyme disease is poorly understood and often misdiagnosed or not diagnosed at
all. It is a complex issue and requires much research into the subject. Most
physicians are Lyme illiterate; they don’t have a clue about the disease.
One place to start is with a Google search for Joseph J. Burrascano, Jr., M.D.
for information from one of the foremost Lyme experts. Also see http://www.turnthecorner.org/lyme-disease-quick-facts.htm
for more information.
Prevention is the best medicine. When we have been in tick territory we do
a complete body check in the evening – head to toe. Ticks prefer the
torso; I have been bitten in the center of the back, hip and groin. I was recently
bitten under my arm, my wife under her breast. Ticks live in tall grass, especially
along human or deer paths. They are most active during the spring and early
summer. A powerful tick repellent should be used around the ankles, wrists
and neck. I wrap my socks with wide duct tape – sticky side out, to trap
ticks; it works, but is no substitute for a full body check.
It is reported that if you remove the tick within 24 hours of being bitten
the disease will not be transmitted and not all ticks carry the disease, this
may be wishful thinking. If you do get a tick follow these instructions for
removal: http://www.lyme.org/ticks/removal.html
Note that dogs can get Lyme. There is a dog vaccination available.
I urge everyone who visits or lives in areas with a deer population to exercise
constant vigilance for deer ticks. If you are bitten you should consult a physician
familiar with Lyme disease. Failure to do so can lead to serious long term
consequences.- Bill S.
« Letter Re: The Tightwad Gazette Books |Main| Snippets From the SurvivalBlog Archives: Communications and Monitoring Advice »
Letter: Re: Long Term Health Care Needs in TEOTWAWKI
Good Morning,
You may have addressed this previously, but I could use your
help on this issue. Our six year old daughter has significant medical needs
(none requiring
electricity thankfully) requiring us to shelter in place. We live outside a major
metro area and probably wouldn’t want to be on the roads anyway. Any comments
for those of us who fit this bill? Thanks - Jeremy
JWR Replies: Yes, this has been addressed. See this
letter in the archives, from 2007.
OBTW, be sure to follow the back-links there for the previous SurvivalBlog article
on
mid-size photovoltaic systems for medical needs such as sleep apnea CPAP machines
and small refrigerators
for insulin storage.
« Letter Re: Concerns About Toxicity in Water From Roof Catchment Rainwater |Main| Notes from JWR: »
Health, Hygiene, Fitness and Medical Care in a Coming Collapse, by RangerDoc
Spiritual Fitness
Let us start this discussion by confronting a stark fact of life: very few
of us, living the life of North American citizens, are fit to survive for a
generation in an austere, off the grid, world. First of all, few of us have
the philosophical orientation to be survivors. I know in my bones that without
God’s help, my family’s ability to survive in a prolonged state
of austerity is worse than questionable. As an evangelical Christian, I understand
that my own commitment to preparedness is a function of my ongoing submission
to God’s will. It could have been otherwise. He could have willed me
to pursue other ventures: sacrificing my own survival for the benefit of others
as I helped them “escape the storm”. Is this not the philosophical
basis of soldiering and of the missionary? Self-sacrifice, even to the point
of death. That was Jesus’ example of discipleship. So I diverge from
that example only by virtue of an ongoing conversation with my Lord and Master,
and He urges me to prepare for the worst, so that my family and my “retreat
posse” will survive. I know not His particular purpose in this endeavor,
but I trust His will implicitly. It is my personal belief that the Lord calls
all family leaders to provide deeply for the sustenance and well being of their
families. But unless you have had this conversation with the Author of life,
you may not be philosophically and spiritually “fit” for the challenging
times to come. And God may have a different path for you to pursue, in the
service of His Kingdom. Remember that Jesus has called us all to Himself and
He wants you to trust Him today! Preparedness is not a hobby- it is a calling.
In this vein also, I do not condone the “secret squirrel” approach
to preparedness. Being discreet about the specifics of our preparedness plans
is a wise tactic in these dangerous times, but failing to share our wisdom,
insight and knowledge with others who could effectively use this information
for good is, in my estimation, downright sinful. So much for my personal philosophical
bias.
Physical Fitness
Second of all, few of us have the physical fitness level required to be 19th
century farmer-builder-warriors, which is what we may be called to become.
Example: Thirty five years ago, I was a carpenter and gardener: climbing, lifting,
sawing, digging, hammering. I joined the US Army to become a Ranger. And, boy,
did I find out how poor my aerobic fitness was. Fast forward ten years: I was
then a medical student and an avid, competitive triathlete. I visited my buddy’s
place (Yeah, he’s in the “posse”) and helped him cut, stack
and split firewood for a day. Well, my “designer body” ala swim-bike-run
was exquisitely fit aerobically, but that episode of real labor left my body
an aching mess for the next three days! Now I am a 60 year old surgeon who
mixes aerobic exercise with gardening, light carpentry, resistance training,
hiking
with the Boy Scouts, woodcutting, et cetera, so that I can be at least minimally
fit for the challenging lifestyle that would be required in a TEOTWAWKI world.
If you are overweight, smoking and sedentary, you are engaged in a futile fantasy
to think that you will survive in a post-apocalyptic world, surrounded by your
storage food, guns and ammo. These are mere possessions that will swiftly be
taken from you by the ravenously hungry horde of healthy young men who have
heard about your stash. Start your physical preparedness plan with physical
fitness.
Preventative Medicine
Next issue: public health measures. For many years I taught and practiced medical
and surgical care in austere environments. In the late 1990s I was the chief
of the medical special response teams for the US Army, Pacific, and taught
disaster planning and medical care in austere environments around the world
as a Department of Defense consultant. If I had to choose between having access
to modern medical care and having a sound public sanitation system and clean
water,
it
would
be a no-brainer. The clean water and hygienic handling of human waste as first
perfected in the twentieth century have saved many more lives than have antibiotics
and modern surgery. Hepatitis, polio, typhoid fever, dysentery and other waste
and waterborne diseases have defeated far more armies throughout history than
have poor tactics and strategy. Witness [German General Erwin] Rommel’s
own struggle with hepatitis during the North Africa campaign of WWII, which
he
roundly lost,
in spite of
his brilliance as a military tactician. If you have a retreat, please remember
this simple principle: keep you food and water supply as far as possible from
latrine sites. Controlling mosquitoes may be important in some areas, to avoid
epidemics of West Nile Virus, malaria and yellow fever. The current H1N1 flu
pandemic should remind us all that we need to protect ourselves from infectious
disease. There is much more to learn about field sanitation and hygiene, so
please consider reviewing this
comprehensive resource.
Now you have arrived at the next step. You are right with God and your body
has been worked into a lean, mean, diggin’, buildin’ and fightin’ machine.
You have an ample and reliable source of potable water and your latrines are
at least 100 yards downhill from your water supply. You have a half ton of
lime ($30-40 worth) to sprinkle in the latrine. Your food is stored securely
and safely away from vermin, fungus and other pests. After 2-3 years of experimenting,
your food growing skills and garden are adequate. You have established sound
and reliable defense and OPSEC measures, to include perimeter defense, adequate
weapons capability, mastering of small unit operations and tactics and adequate
familiarization with improvised weapons and tactics and redundant communications
systems. Whew!! That was a lot of work! Now, and only now, should you plan
your strategy for medical, dental and surgical care.
Medical Care in Austere Environments
Number one principle: avoid injuries and illness. In practical terms that means
maintaining sound health and hygiene, as above noted. It includes scrupulous
avoidance of horseplay, as well. What a tragedy to break your ankle playing Ultimate
Frisbee during planting season, when every able body will be needed to secure
your frugal harvest for the year. Without the availability of operative orthopedic
care, many of our ancestors became lifelong cripples from simple injuries such
as this. Skiing and mountain biking will be absolute no-no’s unless truly
necessary for operational reasons. Sorry, but fun activities are way low on the
list of gotta-do’s in a survival environment.
Next: eat to survive, not for fun. No one will care what you prefer in your diet,
least of all your retreat cook, who is tasked with cobbling together a nutritious
meal from whatever is on hand. (As an aside, when my very wise wife and I developed
the list of friends that we would invite into our “retreat posse”,
the overarching selection criteria, following a Judeo-Christian moral orientation,
could be characterized as “high skill, low maintenance” personality
traits). Multivitamins will be most helpful, but probably can be stretched to
one every other day or even two per week, if there is a shortage. Include adequate
fiber in your diet. In our stores, we have large containers of Metamucil, for
instance, to avoid constipation. When encountering this problem, the French Maquis
(WWII resistance fighters) would ask a local farmer for some butter or lard and
eat 2-3 tablespoons…like grease through a goose! We also have a simple
formula for an oral rehydration solution to treat dehydration following diarrheal
illnesses, heat injury, or trauma- induced hypovolemia. Please copy the data
on this site of the Rehydration Project (http://rehydrate.org/solutions/homemade.htm)
for an excellent and simple description of homemade rehydration remedies.
Take scrupulous care of your teeth! Floss at least three times per week and brush
at least twice daily. Toothpaste is nice, but not necessary. Baking soda works
almost as well and it is not only cheap, but has many other uses. Buy 20 pounds
of baking soda.
I strongly urge all to get a copy of Where
There Is No Dentist by
Murray Dickson.
It is available from Ready Made Resources. This is an excellent and authoritative
manual that is easy to put to use by someone with at least a modicum of medical
training, for example an EMT.
Now the fun part you were all waiting for: interventional health care, i.e.,
the practice of medicine and surgery in an austere environment. To start with,
I strongly recommend getting a copy of the list of $4 prescription medications
available at Wal-Mart pharmacies. The array of inexpensive medications is astounding.
Antibiotics, antihypertensives, hormone replacements, topical medications, eye
and ear preparations- they are all on this list. Ten to fifteen years ago, most
of these items were very expensive “designer drugs”. If you need
antihypertensives, see if your doctor will prescribe drugs off this list and
then get him to write you a 6-12 month prescription. Also ask him to write you
prescriptions for the antibiotics that I recommend below. You should also get
several bottles of eye and ear antibiotic drops. Admittedly, this may be an uphill
battle. Hopefully you can educate your physician about the importance of preparedness
and make him an ally. Tell the Wal-Mart pharmacist that you are going on a mission
trip to a distant land without access to pharmaceuticals. This would not really
be a lie, would it?! Don’t worry about your cholesterol- it will drop on
your new diet…but then, my guess is that the survival lifestyle will also “cure” most
hypertension and non-insulin dependent diabetes. But, please, try to get to that
level of lean fitness prior to encountering the “SHTF” dilemma. I
recommend a stockpile of four antibiotics that will treat most conditions that
will really require them: pneumonia, anthrax, urinary tract infections, skin
infections, and wound infections: Cephalexin 500 mg, Ciprofloxacin 500 mg, Doxycycline
100 mg, and Septra DS (SMZ/TMP DS). These can all be taken by folks with penicillin
allergies, with the possible exception of the cephalexin. The number of tablets
that you need will be based on the size of your group. All of these are dosed
for adults but can be split or crushed for children. Echoing the advice of Jim
Rawles, having a retreat member with significant medical experience, e.g., an
advance practice RN, a PA or, ideally a practicing physician, will enable you
to utilize
these medications optimally. In my humble estimation, about 30-40% of antibiotic
prescriptions currently doled out by my colleagues are unnecessary, and often
done to placate demanding “health care consumers” because it is often
too frustrating and time consuming to educate folks in the office. Although these
medications are inexpensive now, when you have a limited supply that must last
months or years, they will become precious allies in your fight for survival
that must only be used when life or limb are at risk. The expiration dates on
the bottles of meds that you receive at the pharmacy are really made up, since
no pharmaceutical company really studies the time-related efficacy and safety
of these drugs carefully. The expiration dates are always much earlier
than the true degradation dates, except for liquid and injectable medications.
Almost
all medications are probably still safe and effective for at least 1-2 years
after the printed expiration date. Almost every doctor friend of mine gives his/her
family expired medications from their sample shelves! If you live within 200
miles of a nuclear power plant, a large military base or a major urban center,
it is prudent to stockpile a 1 month supply of iodine supplements for each member
of you family, to avoid the long term carcinogenic effects of a nuclear fallout
emergency. These are really cheap, have long shelf lives, and can be purchased
from several of the advertisers on this web site.
Wound and Trauma Care
Let’s start by making life simple: any soap with water works as an adequate
antiseptic for scratches and scrapes, and good ol’ Vaseline works nearly
as well as a wound dressing as the expensive antibiotic ointments. Large second
or third degree burns are another story, however. Having worked in the developing
world as both a military doc and as a medical missionary, I have observed for
myself the well known fact that flame injuries are a major cause of death and
disability in primitive cultures. Open fires are often used for heating and cooking,
resulting in frequent flame injuries, especially to children. Children are neither
wise nor well coordinated, and they fall into fires. Get several large jars of
Silvadene cream for extensive burn use only. Keep it refrigerated, or even frozen
as long as possible to extend its shelf life. This stuff is somewhat expensive,
but not easily replaced. OTC topical antibiotics like bacitracin ointment could
be substituted in a pinch. Extensive burns (larger than the palm of your hand)
should be cleaned with soap and water and dressed with antibiotic ointment and
sterile gauze reapplied daily until fully healed. When you run out of Silvadene,
use Vaseline (get 50 lbs of it- it has many, many practical uses).
I currently teach advanced tactical medics for the US Army, SWAT teams and
the
U.S. Border Patrol. We teach them suturing techniques. But, unless you can
really clean a wound within 12-24 hours of its occurrence and close it surgically
with a truly aseptic technique- sterile gloves, drapes, sutures and instruments-
it should be left open to heal by itself. Otherwise it will likely get grossly
infected, pus out, and require you to take out your precious suture material
and use your precious antibiotics to treat the now deep wound infection. Soap
and Water will take care of this wound better, along with copious irrigation
with previously boiled water (allowed to cool, of course). “The solution
to pollution is dilution!” Clean the wound with a 50/50 mix of hydrogen
peroxide and sterile water if it gets crusty or develops a thick discharge and
change the dressing daily. If large vessels, tendons, nerves or bones are exposed,
the wound will require suturing, but only after extensive cleaning and irrigation,
followed by several days of sterile dressing changes and the administration of
oral cephalexin three times each day, and then only with the cleanest, sterile
technique.
Orthopedic Injuries
Basic first aid techniques are most important to acquire for all preppers. This
is especially true for injuries to bone, joint and spine. The first aid techniques
that I learned as a Boy Scout almost 50 years ago are still relevant today. Taking
a Red Cross First Aid course is really important as the minimum medical training
for anyone seriously facing a survival situation. However, when there is no doctor
available, you will be required to go several steps further. Fractures must be
set into their normal , functional positions and then casted or splinted effectively
when you are the final medical authority. Additionally, if the fracture is open,
i.e., there is a break in the skin where the bone had poked through, this wound
must be thoroughly washed and irrigated, dressed with a sterile dressing and
antibiotic ointment, and broad spectrum antibiotics given for a week. Serious
spinal injuries may be a death sentence in this situation, invoking the principle
of expectant care (see “Triage principles” below).
Pain Relief and Anesthesia
Okay, so this part comes easy to me. Not only is my wife a former marathon runner,
triathlete, and cross country cyclist, she is also a total Christian babe. And
an anesthesiologist. She has taught me how to perform total IV anesthesia, using
relatively inexpensive drugs given by injection, thereby not requiring the use
of inhalational agents. Most of the procedures that can be done outside of the
hospital are short- under one hour in duration. In the austere environment, the
group surgeon would ideally be prepared and equipped to perform the following
major surgical procedures: Debridement of dirty wounds; open ligation of major
bleeding vessels; appendectomy; cholecystectomy (removal of a diseased gall bladder);
cesarean section. Although endotracheal intubation may be required, the presence
of a ventilator and oxygen can be circumvented. A bag-valve device will be necessary
for manual ventilation. Intravenous equipment and fluids are required. Again,
the amounts of each will depend upon your situation, but I would recommend having
at least four liters of normal saline IV solution for each member of your group.
Ignore the expiration dates: salt water does not degrade. Avoid using this precious
resource for routine causes of dehydration. Use the rehydration solutions instead.
Put up an ample supply of Tylenol, Motrin and Aleve. If possible, store a supply
of stronger narcotic pain medications, such as Vicodin.
Triage Principles
Triage is the function of rationing medical care in the context
of limited availability. This may mean a limitation in supplies, time, facilities,
transportation or professional medical providers. In a TEOTWAWKI scenario, all
of these factors may be in short supply.
The four triage categories are as follows:
1. IMMEDIATE: These victims have life threatening conditions that will a) result
in death if not promptly addressed and b) can be remediated with the judicious
use of assets on hand. An example would be a deep laceration to the groin with
arterial bleeding from the femoral artery. The immediate application of pressure
or, if necessary, a tourniquet, will save a life. This could then be treated
with definitive surgery later.
2. DELAYED: This describes serious conditions that are not immediately life
threatening, but that will require medical attention in hours to days to avoid
serious disability
or even death. An appropriate example would be a humerus fracture sustained
while having piggy back chicken fights in the back yard (you’ve already
forgotten: no horseplay!)
3. MINIMAL: This category includes illnesses and injuries that are self limiting:
small lacerations, a non-displaced finger fracture, a short episode of diarrheal
illness, etc. These folks need to keep working!
4. EXPECTANT: When medical resources are severely limited, they must be used
to derive the greatest survival benefit for the community. That means that
using a lot of medications, supplies and manpower in attempts to resuscitate
profoundly
ill or injured patients is unethical. These unfortunate folks will be unlikely
to survive regardless of your best efforts. They are triaged as expectant,
meaning that they are likely to die. Examples include severe shock, quadriplegic
injuries,
or multiple gunshot wounds to vital organs. They should be treated for pain
if possible, and given comfort and affection until their demise. This will
save
resources for those who are salvageable and can continue to contribute to the
group’s survival.
Medicolegal disclaimer: Please do not use
any
of the above advised techniques or methods unless you have no possible access
to professional medical care. This advice is not at all applicable,
and may in some instances be harmful, if you have access to professional medical
care. - RangerDoc, MD, FACS
« Mexican Flu Update: |Main| Note from JWR: »
Responding to a CBRNE Event, by J. Paramedic
CBRNE is an acronym for Chemical-Biological-Radiological-Nuclear-Explosive
events. [It is most commonly spoken "Sea-Burn"] This article gives
a general guideline for responding to such incidents, geared toward the
individual
or small group with basic medical/trauma care abilities and
little to no rescue capability. Some details about each type of event are
also included. Note that I am a paramedic; my training is geared toward that
venue, and this essay reflects that. However, many of the same principles
are relevant to anyone forced by circumstances to respond to such incidents,
not just public safety personnel.
Deliberate Attacks Versus Accidents
Most CBRNE events will be accidents or natural occurrences - chemical spills,
pandemics, etc. Some, however, may be deliberate attacks. The most likely candidates
are explosive devices, which are relatively cheap, do-it-yourself, low-risk
endeavors. Chemical, biological, radiological and especially true nuclear attacks
are
expensive and high-risk. For example, creating a nuclear device requires obtaining
plans, a large team of scientists in multiple specialties, esoteric materials,
and so on. And that is just to build the device - a delivery system is still
needed. Bringing these elements together is expensive, difficult and time-consuming,
and likely to attract unwanted attention. Overall, the cost and risk-to-body-count
ratio is much better with conventional arms and explosives; accordingly, these
are the most likely forms of deliberate attack.
Safety
The first priority must always be making sure that you and yours do not become
victims. If you become injured, you cannot help others; furthermore, you require
assistance, which draws resources away from other victims. Consider the following:
Scene Safety: Look for fires, unstable structures, weapons or dangerous persons.
Look up, down, and all around - remember that not all threats come from ground
level. If you do not have the training or equipment to help safely, then wait
for those who do. Leave the area if necessary. Do not try to provide aid in
an unsafe area - move victims if necessary. In some cases, you may even have
to leave them behind. Remember, you cannot help others if you become
a casualty.
Contamination:
CBRNE events pose a high risk of contamination. Do not expose
yourself to chemical or infectious agents or to radiation. If you do not have
appropriate personal protection equipment (PPE) - do not approach the incident
site. PPE is discussed in more detail later. Keep in mind the "Rule of
Thumb" - get far enough away from the scene that you can completely cover
it with your outstretched thumb. Remember to go uphill and upwind of
the affected area.
Secondary Devices: In the case of a deliberate CBRNE attack, be aware that
there could be additional threats or devices waiting for responders. While
these are generally directed at police, fire, EMS or other official agencies,
if you are trying to help, or have the bad luck to be at the scene, you share
the danger.
Organization
In the case of CBRNE event, public safety agencies – police, fire and
EMS – will have initial responsibility for scene management. Whatever
you believe the long-term consequences will be, initially these agencies will
be functioning. What follows is a description of their organizational model.
If they are on the scene, you will be expected to function within that structure,
if you are permitted to assist at all (for safety and liability reasons, you
may not be). However, even if a CBRNE event occurs where public safety agencies
cannot respond, the principles of this structure are still appropriate for
your own use.
Overall responsibility for managing a given event will, at least initially,
fall to a single person, designated as Incident Command. If the event can be
managed with less than 7 or so responders, this person (and perhaps a Safety
Officer) may be the only command personnel needed. However, a CBRNE event is
likely to require a considerably larger response. It has been found that a
single individual cannot effectively direct more than 3-7 people; 3-5 is an
even better number. This is referred to as an effective span of control.
Accordingly, for an event of large size, additional levels of organization
will be introduced
in order to maintain an appropriate span. Regional or functional divisions
are used as necessary. For example, the Incident Commander may appoint a Rescue
Chief, a Medical Chief, and a Fire Suppression Chief for a large-scale response.
(Note that regional or functional elements and leaders are appointed by Incident
Command. Some are standardized across the nation, while others will vary geographically
depending on local organization, preference and tradition.) Each of these individuals
will in turn direct about 3-5 subordinates. Depending on the number of responders,
each of those subordinates could in turn direct a team of 3-5 responder, et
cetera. The keys are that (1) each responder reports to one and only one supervisor,
chief, or other leadership element; (2) each leader directs no more than 3-5
subordinates directly; and (3) overall responsibility for the scene falls to
a single Incident Command. It is essential that there is no freelancing – a
disorganized response can lead to inefficiency, an unsafe scene, oversights
or mistakes resulting in poor outcomes, additional injuries [, needless contamination]
or even deaths.
Zones
Geographically, a scene will be divided into three zones: a central hot zone,
a surrounding warm zone, and a safe cold zone.
The hot zone is the immediate site of the incident, and may
expand based on wind, spill or rainwater runoff, etc. Only trained responders
with appropriate
equipment should be in the hot zone. Depending on the incident type, this could
mean fire department, HazMat or other type teams.
The warm zone surrounds the hot zone. Operating in the warm zone may also call
for specialized training and equipment, but not always and not as much. Decontamination,
which is discussed below, is usually performed in the warm zone.
Finally, the cold zone is the [ostensibly] safe area surrounding
the warm zone. Basically this is the rest of the world. Additional resources
and
treatment
centers will
normally be located in the cold zone.
Decontamination
Decontamination will be necessary when it is likely that victims or responders
have been exposed to chemicals, biological agents or radiation. The most common
method of mass decon is gross decon. Essentially, victims are instructed to
disrobe (it is estimated that in many cases this can remove up to 90% of contaminants)
and are run through a large “shower” area, then given clean garments.
On a smaller scale, you or your family members can self-decontaminate by disrobing
and showering. It is recommended that garments that must normally be pulled
over the head be cut off, instead. In some cases more detailed decon may need
to
be performed,
for example a wound contaminated with radiological material. In this case,
wash the specific site with soap and water, making sure not to contaminate
others or other areas of the body while doing so (wear appropriate PPE). Note
that victims should in most cases be decontaminated before receiving medical
care or first aid. The exception is an immediate life-threatening condition,
such as a severe hemorrhage, which may receive preliminary treatment prior
to decon.
Personal Protective Equipment (PPE)
This discussion will deal with two forms of PPE: medical PPE and chemical protective
gear. It is essential to wear appropriate PPE in any CBRNE event to avoid becoming
contaminated or spreading contamination to others.
Medical PPE includes gloves, masks, gowns and eye protection. Follow the Universal
Precautions philosophy – assume that everyone is a potential
carrier of dangerous infections, and behave accordingly. Wear gloves whenever providing
treatment, and change them between patients. Also be aware of the following “special” situations:
Splash protection – when “splashes” are anticipated (for
example with childbirth, massive hemorrhage or vomiting) wear eye protection,
a mask and a gown
Contact precautions – some infections, such as certain MRSA varieties,
can be passed skin-to-skin, and call for contact precautions; wear gloves and
a gown
Droplet precautions – infections spread in mucus or respiratory secretions
may be transmitted over short distances by coughs and the like; wear a surgical
mask when in close proximity. (The CDC says within three feet [but coughs can
project droplets 10 feet or more.])
Airborne precautions – infections with airborne spread, such as tuberculosis,
call for an N95 mask; ideally, the patient should be in a negative pressure
room
Chemical Protective Equipment comes in four levels:
Level A calls for a Self-Contained Breathing Apparatus (SCBA) and a sealed
chemical protective suit. Note that no single suit type protects against all
forms of exposure. Generally, Level A protection is used only by trained HazMat
Technicians.
Level B calls for an SCBA and a non-encapsulated (non-sealed) chemical protective
suit, such as a Tyvek suit.
Level C consists of a filter-type respirator and chemical protective clothing,
gloves and boots (same as type B).
Level D includes standard work clothes – uniforms, surgical scrubs, turnout
gear – which give some skin/splash protection, and no respiratory protection.
Triage
Once proper PPE is in place, the response has been organized, and the scene
has been rendered safe, care for victims can begin. After safety, preventing
or minimizing the loss of life is the highest priority. A CBRNE event is likely
to produce a large number of victims, and could easily exceed response capabilities.
When this happens, the goal must be to do the greatest good for the greatest
number.
Haphazardly rendering aid to random victims will result in chaos and poor treatment
priorities, which will in turn lead to unnecessary loss of life or poor outcomes
for victims. It is important to apply triage procedures. “Triage” simply
means “to sort,” and refers to sorting victims into groups based
on severity. The first competent care-giver to arrive at the scene of a mass
casualty event should begin triaging – sorting – victims. The following
categories are pretty much universally recognized:
Red or Immediate – These persons have severe injuries, but are likely
to be able to be saved. The are “salvageable.” Given the seriousness
of their condition, they receive treatment (and transport to the hospital,
if available) first.
Yellow or Delayed – These are the people with serious but not life-threatening
injuries. They are the second group to receive treatment, after the Reds/Immediates.
Green or Minimal – These are folks with only minor injuries. After
all the reds and yellows are taken care of, they can be taken care of.
Black or Expectant – These victims are dead or expected
to die. Any victim who cannot breathe on their own should be triaged into
this category.
If manpower
or resources are limited, they should not be expended on these victims, who
will
probably not survive anyway.
Once triage is completed, treatment can begin.
Treatment
Some comments specific to incident type will be included later. For now, consider
the following general assessment and treatment priorities (note that this is
a mere overview; detailed first aid skills should be sought elsewhere):
Mental Status – Assess whether the patient is awake, unresponsive, confused
or lethargic, etc. An unresponsive patient should be considered Red/Immediate.
A confused patient will probably be Yellow/Delayed, assuming no additional
problems are found. Next check the ABCs:
Airway and Breathing – Check to see whether the victim is breathing.
If not, open their airway by tilting the head or (if injury is suspected) by
lifting the jaw forward. If the patient does not breath on their own at this
point, consider them Black/Expectant. If they do, ask whether they are having
difficulty breathing and listen to their breath. Difficulty breathing, rapid
breathing or strange breathing sounds indicate at least a Yellow/Delayed patient.
Severe or progressive difficulty breathing indicates a Red/Immediate patient.
Circulation – First, if a patient has no pulse, they are dead, and are
Black/Expectant. Second, check for bleeding. If bleeding is found, it should
be controlled. Place direct pressure on the site; this should control the bleeding.
You may have to maintain pressure for several minutes, then place a dressing
and bandage. If the bleeding does not stop, and is from an arm or leg, apply
a tourniquet. In the past tourniquets were viewed with great caution, but it
has been found that they can be safely used for up to several hours without
long-term negative effects. At any rate, one cannot worry too much about an
arm or leg when a victim – possibly a loved one – is bleeding to
death. Finally, keep a bleeding patient warm (cover them with a blanket) and
elevate their feet; this will help combat shock.
Those of you with CPR training will notice that I’ve omitted rescue breaths
and chest compressions from this discussion. That’s because (1) in a
mass casualty situation victims needing these interventions will be Black/Expectant,
and will not be treated; and (2) unless high-level follow-on care – paramedic,
ER and/or ICU – is available, CPR alone is unlikely to save a cardiac
arrest victim. And I simply don’t
have space to include such details here. I do, however, recommend that everyone
seek out first aid and CPR training, at a minimum.
Finally, remember that scene safety comes before treatment. If necessary, move
the victim. In general it is good to leave trauma victims in place, in case
there is some spinal damage. However, when the scene is unsafe, you have to
move.
Specific Incident Types
Explosives Events
Remember that explosive devices can also include some biological, chemical
or radiological (“dirty bomb”) contaminant; and that there could
be secondary devices waiting for responders. (Note that explosives will usually
destroy any included biological or chemical material, making explosive dispersal
of such agents unlikely to succeed.)
Explosives create blast-type injuries, which are classified as follows:
Primary Blast Injuries: pressure-related injuries from the blast wave, these
can affect internal organs such as the intestines, lungs or inner ear without
visible external injuries
Secondary Blast Injuries: these are injuries from objects (shrapnel, debris,
etc.) striking the victim
Tertiary Blast Injuries: if a blast is powerful enough to throw a victim into
the air, they will sustain injuries from striking the ground or other objects
Quaternary Blast Injuries: all other injuries, including burns and the like
Here are some basic treatment ideas:
Bleeding should be controlled by direct pressure and, if necessary, tourniquet.
Broken bones, sprains, etc., can be splinted
Burns should be covered with clean – preferably sterile – sheets
or dressings; do not put any salves or chemicals on any but minor burns, as
they will have to be washed out later – very painful for the victim
Victims with neck or back pain or tenderness, or loss of sensation or movement,
should not be moved unless absolutely necessary, as they may have suffered
spinal injury, which may be worsened by movement. However, this is much less
likely than television and first aid instructors would have you believe.
Chemical Events
Chemical events require proper PPE; otherwise, follow the “Rule of Thumb.” Remember
that wind and water run-off can spread contaminants. Also remember that chemical
events may not be immediately apparent. Multiple victims with quickly-developing
symptoms, as well as dead flora or fauna in the area, are the most likely signs.
A special note should be made for organophosphates. These produce a condition
commonly called SLUDGE (salivation, lacrimation, urination,
diarrhea, gastrointestinal distress, and emesis), which in layman's terms is
the sudden onset of soiling yourself, peeing on yourself, crying and vomiting
everywhere.
They
merit special mention because these are the type of exposures for which Mark
I kits and other atropine/2-PAM kits are indicated, as well as valium for possible
seizures.
Biological Events
Biological events can be difficult to detect, and to protect against, because
often there is no scene. Generally, multiple victims will present with “flu-like
symptoms” or other complaints to multiple health care providers. The
main signs are multiple patients with similar complaints, especially when the
symptoms, the demographics, or the season are unusual. For example, large numbers
of healthy young people complaining of flu symptoms in the middle of summer,
clustered in certain areas, is a sign of an exposure or pandemic. Isolating
the source is a matter of finding “common ground” between the victims – think
of lots of people suffering from nausea, vomiting and diarrhea after eating
at the same restaurant.
Speaking of flu-like symptoms, I thought it might be timely to share with you
the following guidance that I’ve received from my EMS agency regarding
the current “Swine flu” –
1. Suspect swine flu in a person who:
- has a cough, runny nose or sore throat; and
- has a fever more than 101.4F; and
- has been to an “endemic area” in the last 7 days
Endemic areas currently include Mexico and affected areas of the USA.
2. Distance is considered adequate protection; however, if one must approach
a suspected swine flu patient, a surgical mask is recommended.
3. Only if one must be in a confined space with a suspected swine flu patient
is an N95 respirator recommended.
These recommendations come from our medical director based on CDC and other
agencies’ information and advice.
Victims of a biological agent (i.e., an illness) can often be treated, depending
on the agent; preventing further spread within a population can usually only
be accomplished by isolation or – on large scales – by quarantine.
Nuclear or Radiological Event
As noted previously, deliberate nuclear attacks are relatively unlikely, due
to their expense and risk when compared with conventional methods. “Accidents” are
also rare, as modern-day reactors and the like are designed with multiple redundancies
and dead-man’s-switches. We are many years removed from the technologies
of Chernobyl and Three Mile Island, or so experts say. Smaller radiological
events are more likely. Of course the first thought in most minds is the “dirty
bomb,” a conventional explosive with radioactive material.
Radioactive materials are usually divided according to the following types:
Alpha particles cannot penetrate clothing or often even skin; however, they
are very dangerous if somehow introduced into the body
Beta particles can be absorbed by protective clothing
Gamma rays are stopped only by several inches of lead [or
several feet of earth or concrete], and easily penetrate human beings, damaging
organs along their
paths.
The severity of radiation exposure will depend on time, distance and shielding – a
shorter exposure, over a greater distance, with more shielding in between,
will be less severe than the opposite. Radiation effects various bodily systems.
Inhaled radioactive material can damage the lungs. Radiation can also produce
severe burns; these will present as severe itching, but over time will reveal
significant damage.
In evaluating the severity of radiation exposure, the easiest reliable measure
is time to onset of vomiting. If a victim starts vomiting within one hour of
exposure, their exposure is severe. Beyond two hours, exposure is probably
mild to moderate.
You may find it useful to stock geiger counters, personal dosimeters, or potassium
iodide (KI)
for your family. Information on all of these topics is already archived
on SurvivalBlog, so I will not go into them here.
Otherwise, without specialized facilities, the best you can do for a victim
of radiation poisoning is to decontaminate and treat symptoms as they arise.
Remember that with a sufficient dose of radiation the victim can themselves
become a source of radiation, and pose a contamination risk.
Summary
In the case of a CBRNE event, essential include a scrupulous eye to safety,
an organized response, careful use of personal protective equipment (PPE)
and decontamination to prevent spread of contamination, triage of victims,
and
the best treatment
available.
Remember
that you will probably not be able to do as much as you would like. You must
do the greatest good for the greatest number. Finally, remember your priorities:
after safety, preventing the loss of life comes first. Then you can worry about
protecting property and/or the environment, and long-term recovery. These topics,
however, are beyond the scope of this essay. I hope you find the information
contained here useful in your preparations, though I hope you never have to
use it in a true CBRNE event.
« Mexican Flu Update: |Main| Letter Re: The Rush Has Begun for Flu Prep Logistics »
Six Letters Re: Adapting Family Food Storage for Gluten Intolerance
James,
I found out last year I am gluten intolerant, and my little girl was
symptomatic with me. In our case, we found we can't tolerate any grains--not
even corn
or rice. Below are some ideas for those with either condition or who are on
lower-carbohydrate diets for health reasons.
* In addition to beans, other carbohydrate-rich foods that you can store include
potatoes, yams, peas, beets and tapioca. To avoid the additives found in some
dehydrated foods, I have freeze-dried potatoes, yams, and peas. I also have
some home-canned yams and plan to grow more. Beets are only available in regular
cans. I have those, plus regular canned peas and potatoes. Tapioca isn't as
nutritionally rich as some of these others, but it's nice to be able to have
a treat and it stores well. (Most prepared puddings have problematic thickeners.)
In terms of rice, I did some research when I was eating grains. White rice
is
the least nutritious grain--eating it actually depletes your body's nutritional
reserves, which isn't a good idea in a stressful SHTF situation
(where the stress alone will deplete you of B complex). Brown rice is much better
for you, but
doesn't store well. So I would suggest storing more corn than rice, and using
rice as a treat or as a break from monotony.
* Don't forget lentils. They aren't used nearly enough in American cuisine (mainly
soups). I have found some fabulous Middle Eastern and Indian recipes for them.
They store well, and are a wonderfully nutrient dense food. The brown ones don't
always look that appetizing, so I often opt for the red ones. You can add these
to tomato sauce or spaghetti sauce dishes to boost protein and not even realize
they're there. And like most anything else, they taste even better with cheese
on top.
* To avoid the corn syrup present in nearly all canned fruits, I looked until
I found a local store brand that uses only pear juice. (I can't have sugar either,
and won't use artificial sweeteners.) I pay extra for a couple of other fruits
at Whole Foods that are also canned in pear juice. I have also canned a variety
of fruit. And I store some freeze-dried fruit instead of the dehydrated, which
sometimes have some unfriendly additives and aren't necessarily cheaper. Nice
fruit is important when you can't have a traditional breakfast. Canned or freeze-dried
can be heated and turned into a compote, or put into a smoothie for a nice breakfast
shake--one of my daughter's favorites.
* Finding MREs
for a bug-out bag was very difficult. One
company makes gluten-free
MREs, but they don't run batches every year--so the MREs
may last only a year or two. I finally found one Mountain House pouch entree
that looked okay (chicken with potatoes), and opted for that, plus canned meat
and pouch sides of veggies (potatoes, peas, etc.).
* Coconut flour has a shelf life of 1 year at room temperature, possibly longer
if you have a cold basement. I have been experimenting with recipes and found
it yields a result similar to wheat flour. Coconut pancakes are similar to buttermilk
pancakes. It is not cheap ($7 / lb.) but you use a lot less of it per recipe
than regular flour. Bob's Red Mill makes some, and you can buy it in larger bulk
quantities on the web. Due to the expense, for us it is a treat on weekends,
birthdays, holidays, etc. But the results so far have been good, and the taste
is scrumptious. It also works as a substitute for flour if you're making oven-fried
chicken or breaded things. Coconut flour is a carb[ohydrate], but it has a high
fiber content (6 g/serving),
which
helps with blood sugar stabilization. Those watching carbs could top coconut
pancakes with peanut butter (and a dash of honey or syrup), or heat up some frozen
or canned fruit to make a simple compote that's lower in carbs than maple syrup.
* Almond flour is a fabulous substitute for wheat flour, and yields results that
are more similar to flour-based breads (rice and corn products tend to be dry).
There are also two great books with wonderful recipes for the Specific Carbohydrate
Diet (Grainfree Gourmet). However, it is twice the price of coconut flour, and
is not suitable for using in a SHTF situation because it can easily go rancid
if it's kept out of of a freezer or a refrigerated environment. It is also not
calorie-free.
But it is really nice to work with if you're watching carbs because
it counts
as a protein. For this reason, it's my choice for "bread" for holiday
meals.
* I have also had to change a lot of my condiments and sauces. Soy sauce, for
example, is wheat-based. So I use Bragg's Liquid Aminos. Most ketchups, barbecue
sauces, and relishes include corn syrup. I found a barbecue sauce and ketchup
that don't, and now make my own ketchup with a recipe I found on the web. I also
make up my own Worcestershire sauce. It doesn't take long, and I know it's safe
to consume.
* Since I can't use cornstarch to thicken, I use arrowroot--and have a lot of
it on hand. I also use mashed potato flakes (the kind without preservatives that
lasts about a year) to thicken soups and in place of cracker crumbs in recipes.
* Where I have been put on a lower carb diet, I have had to pay more attention
to protein than many folks do in their preparations. I need protein, and can't
produce it myself. So I try to have an extra deep larder of it: dehydrated eggs
(for scrambled eggs), canned cheese, freeze-dried cheese, freeze-dried cottage
cheese (good with canned fruit on top), lots of salmon (for salmon breakfast
patties), and lots of canned meat from Best
Prices Storable Foods. After Hurricane
Ike, we used some of our canned meat. It was great, and I didn't get sick (unlike
a friend who at store-bought meat with lots of additives). I can't buy canned
beef or pork in the stores--too many additives I can't have.
* One critical change has been to play to what we can eat and truly enjoy. My
husband loves pineapple. So I used the internet to find several recipes we can
eat that use pineapple. They're now family favorites--and safe for me and my
little girl to eat. This really helps with the sense of deprivation, which can
be an issue in sticking to any diet. Focusing on these new delicious finds has
helped ease the pains of missing pasta, oatmeal, etc. So for morale purposes
if nothing else, I've made sure our larder includes the ingredients for the "family
faves" that we can eat.
* For snacks, we usually eat dried fruit and nuts. I have a good stock of both,
especially the nuts, since I can't grow them here (not enough room for a pecan
tree). While they won't keep long-term, they will keep a good year and I rotate
my stock. Buying in bulk from www.nutsonline.com and www.bulkfoods.com has saved
me a ton of money and yet let me make sure I'm getting fruit without syrups or
sugar added.
* Another snack is fresh bananas with peanut butter on them, honey optional.
I have also been stocking up on banana chips--these make a great substitute for
crackers. Since I plan to nurse a new baby this summer and won't be able to eat
peanuts while nursing, I have also been stocking up on almond butter.
* Instead of granola bars, we eat fruit strips (100% real fruit) or Lara bars.
Since these are rather pricey, I'm learning how to dry fruit and looking into
recipes to make my own bars. But in the meantime it works, and they would be
great in a bug-out bag. I always keep some in my purse and in the diaper bag.
(Finding snacks I can eat while "out" is very difficult.)
* For "junk" or convenience foods, we often use potatoes and sweet
potatoes. We make oven-baked fries, and buy the occasional bag of chips for garnishing
stir-frys or giving crunch to a soup or salad (instead of croutons or crackers).
* When sick or overheated, I can't rehydrate with Gatorade (sugar, etc.). So
I either make my own Gatorade, or drink fruit juice and eat a fresh banana. We
also store fruit juice in various forms (100% juice pouches for my daughter,
bottles for when we're sick or going through a heat wave).
* I also can't start eating again after the flu or morning sickness with crackers
or noodle soups. So I make my own Gatorade and use baked potatoes, mashed potatoes,
or yams. My toddler preferred oven-baked fries the last time she was recovering
from the flu.
* I have also had to change our shampoo, lotions, and even over-the-counter (OTC)
medicines to avoid grain products and sugar. For OTC medicines, I usually look
for the dye-free packages, and these usually have fewer troublesome ingredients.
Since my 3-year-old daughter was symptomatic with me, and the doctor indicated
my soon-to-be-born son will most likely inherit the genetic tendency, our whole
family has switched to my diet. (My husband is a saint! He does get bread and
normal food when he eats out with his clients.) With my daughter, it is much
easier to simply not have "off-limit" foods in the house.
As a postscript, I found out I was gluten intolerant because I was eating what
I was storing. I was subclinical--did not exhibit any of the traditional symptoms
despite eating a "healthy" whole-grain diet for years--until I tried
a homemade bread recipe that called for extra gluten. In my case, the results
were catastrophic. However, I am so grateful to found out before I needed to
rely on my supplies (and good medical care might be unavailable). Needless to
say, I am a big advocate of using what you store. - CL in Houston
Sir,
After reading your post today Letter Re: Adapting Family Food Storage for Gluten
Intolerance I remembered reading recently about Kamut a possible low gluten
wheat substitute for individuals what are gluten intolerant. I did a quick
search on your blog and could not find a previous article about Kamut so
I thought I would drop you a note to let you know about it.
You can read more about
Kamut at the Walton Feed web site.
Regards, - Eric in The Desert
Sir,
My youngest daughter and I are sensitive to gluten. We have discovered
that "alternative" grains
like millet, quinoa, and amaranth are quite good. All three can be cooked as
is as a side for supper or as a "porridge" for breakfast. Also, all
three can be ground into flour or purchased bulk as flour from different sources.
Sorghum and buckwheat are also good alternative flours. Millet would be good
for anyone to investigate storing. It stores for a long time with little preparation
-- one to two years. It can be stored longer with better preparation -- oxygen
absorbers, etc. You cook millet like rice. You rinse then boil or you can rinse,
toast, then boil. But, you use less millet than rice per cup of water. So the
millet goes a lot farther. Generally, you cook 1 cup of millet per 2-1/2 cups
of water. I cook brown rice at 1 cup of rice per 1-3/4 cups water. However,
because of this, when grinding and baking with it, your baked item may be a
bit dry from the millet absorbing so much liquid. With a touch of practice,
you can remedy that.
As you mentioned, there are many good sources for cooking gluten-free. Blogs
are wonderful resources. You can find a lot of practical advice from people
who are dealing with it on a day to day basis.
And here is an
excellent blog on going gluten-free. - Emma
Mr. Rawles,
Another place to get gluten free recipes is Frugalabundance.com.
I hope that this proves helpful to any SurvivalBlog readers that are gluten
intolerant.
Regards, - Gloria
Hi Jim:
I read Tim's post yesterday about his wife being diagnosed with Celiac disease.
As you may recall, I was the one who posted one year ago about my daughter
being diagnosed with type 1 diabetes and a month later, learning she and
my other ladies having Celiac disease. I can certainly sympathize with Tim
as it is daunting and overwhelming when a loved one is initially diagnosed.
From our year long experience with this, here is what I can offer.
The blessing and curse of these times is Celiac. While so many foods include
wheat and gluten as part of their overall production, many more foods are now
Gluten Free. This is driven in part by a growing awareness of the Celiac disease,
gluten intolerance in general, links of gluten and Autism and simple dietary
issues. More foods than ever are gluten free. We began by eliminating all sources
of gluten and wheat from the house. Any wheat or gluten in our house would
cause my diabetic daughter to begin to violently throw up, causing dehydration
and ketone spikes. So it all went away. What was usually a two or three grocery
store ensemble has now grown to seven (7) different stores in our region in
order to find the various things. One store carries some things, another store
different things and so on. Our best sources for gluten free foods has been
the local Fred Meyer (owned by Kroeger) and Whole Foods. Some products are
now clearly marked as "gluten free" so spotting them has been easier.
For instance, instead of a loaf of wheat bread, we now use rice flour bread
made at Whole foods (about 65% more expensive that regular whole wheat bread).
Instead of the usual wheat flour waffles on the waffle maker, it's now waffles
made with rice or tapioca flour from the local health food store (Manna Mills).
The treat of freezer cookies are accomplished with a brand of gluten free freezer
cookies from Whole Foods. Cereals are rice or corn based. All chips are either
corn tortilla or pure potato and we eat far more rice eaten as a staple.
One of the things we have encountered is that the carb load on these are typically
higher, leading us to better watch our weight and how much we eat. As I indicated
before, our grocery bill went up over 50% in one night when we switched. Many
of these foods have a significantly shorter shelf life, especially when processed.
As an example, a loaf of rice bread in my cool, dry house will spoil within
36-48 hours. But we found many, many on-line and local resources to help us
in making the correct food decisions. My girls religiously reading the labels,
looking for any signs of gluten, wheat or wheat family products that could
contaminate. There is a very good magazine called Living Without which addresses
foods without certain items such as gluten or wheat. Amazingly enough, our
local Kroeger owned store was found to have a sizeable gluten free section
in the natural foods section. And of course, we eat less processed foods, more
fresh fruit and vegetables.
Naturally, the shift from a wheat based survival foods platform to a rice based
platform was expensive. Many survival, dehydrated and MRE based foods were
given away as they all contained either wheat or gluten. I bulked up on more
rice and shelf stable wheat free survival foods (very little out there, I must
admit).
Last November, our family took a much needed vacation to Disneyland. It was
one of our most positive eating experiences as we learned that Disney (and
other major theme park enterprises) takes Celiac disease seriously. They had
gluten/wheat free alternatives based upon breads made in our area by Energee
Foods. My girls were able to enjoy pizzas made with tapioca flour crust. We
were even able to communicate with the head chef for Disneyland food service
for information. That made for a more enjoyable trip. A visit to a local Von's
and Trader Joe's and we had a great gluten free vacation.
For Seattle, Washinton area SurvivalBlog readers, here is
a list of local stores we have been successful
in finding wheat free or gluten free foods at:
Costco - Rice chips, corn tortilla chips, beans (bulk and canned refried),
rice, Robert's gourmet foods like Smart Puffs
PCC (Puget Consumers Co-Op) - Commercially produced gluten/wheat free foods
Whole Foods - Wheat free bread, rolls, pizza crusts, Angeline's
Manna Mills - Bulk rice and tapioca flours
Fred Meyer - Crackers, Bob's Red Mill gluten free flours, cereal, rice cakes,
soy crackers, etc.
Ener-gee foods - Local commercial based gluten free foods (products used
exclusively at Walt Disney resorts)
Trader Joe's - Wheat and gluten free frozen waffles, pancakes, chips, crackers
I wish Tim and the other Celica readers great success! - MP in Seattle ( a
Ten
Cent Challenge subscriber)
Hi There,
In response to your reader post about food storage and gluten intolerance,
I would like to add that if you plan to mill your own grains, and plan to
store wheat for those that can eat it, you will need to get two grain mills
and never mill grains containing gluten on your gluten free mill. Mills are
too difficult to fully clean and there will be traces
of gluten left from milling grains such as wheat or barley.
Every coeliac has a different level of intolerance, but it is not worth risking
problems. Gluten free grains suitable for beer making are probably also suitable
for substituting for wheat and barley in other foods too. Some of these are
millet, buckwheat, corn, rice, quinoa and sorghum. Just remember to only use
your gluten free mill to mill gluten free grains
and store both the whole grains and flour in separate dedicated containers.-
The Anonymous Economist
« Economics and Investing: |Main| Six Letters Re: Adapting Family Food Storage for Gluten Intolerance »
Mexican Flu Update:
The first really good news on the flu outbreak came yesterday: Scientists
See this Flu Strain as Relatively Mild. I am hopeful that the current strain
won't mutate into something more inimical. But be sure to be
well prepared, and get in the habit of frequent
hand washing, regardless.OBTW, if I were in a position of influence, I'd recommend
that the custom of handshaking be temporarily replaced with saluting, as was
done
during the 1918 Spanish
Flu Pandemic. (But alas, these days some segments of society might see that
as
overly militaristic
and politically incorrect.)
Reader Pat M. suggested an
interesting article in Science Daily on social isolation to prevent
the spread of influenza.
OBTW, to minimize "casual
contact",
I recommend curtailing social events, and shifting to family wilderness activities
such
as hiking
and rock hounding.
If
you are
a
target
shooter, instead of going to public ranges do your shooting on
remote BLM land, or on private land (with permission.)
The latest flu headlines:
The Binder sent us a link to a Newsweek article that suggests that
the number of flu cases may be under-reported in Mexico: City
of Fear; How the swine flu is terrorizing Mexico's capital. An on-scene report.
Queensland
residents told to stockpile food amid flu fear
WHO
to Stop Using Term "Swine Flu" to Protect Pigs
Vaccine Promised as US Cases Passes 100
More than 40 Probable Cases in Illinois
48 Confirmed Cases in New York State
Three New Cases Confirmed in Britain
Swine Flu Spreads to 11 States, 100 Schools Closed
Pandemic of Panic
E-mail From Trucker to Steve Quayle
Government Issues Guidance on Facility Closure: School Dismissal and Childcare
More
Than 300 Schools Now Closed in US "Closing a school alone won't stop
community spread. "If a school is
closed, it's not closed so kids can go out to the mall or go out to the community
at
large," Homeland Security Secretary Janet Napolitano said. "Keep
your young ones at home."
Hong Kong Confirms Asia's First Case of Swine Flu (now known as H1N1) Detected
in Mexican man who had come from Shanghai.
Security Agent Likely Caught Swine Flu on Trip with Obama
NYC Mayor Says Many Sick People Not Tested, Number of Cases Probably Higher
Doctor in Washington State Saw 22 Patients Before Falling Ill
Ft. Worth: Mayfest, Other Events Cancelled Over Flu Concerns
Harvard Medical School Cancels Classes Over Possible Swine Flu
« SurvivalBlog Reader Survey Results: Conveniently Bypassed Areas |Main| Note from JWR: »
Mexican Flu Update
I recommend that SurvivalBlog readers seriously think through the implications
of successive waves of Mexican Flu sweeping around the globe for the next three
years. From
what we've already seen of its virulence after the normal "cold
and flu season", then the next couple of winters could bring very high
rates of infection
and overwhelm the healthcare system. Please take the time to watch Dr.
Henry Niman of
Recombinomics discussing"Swine" flu. His projections
are disturbing, to say the least! Think this through folks, on a macro scale:
How would a pandemic impact your work? Commuting? Grocery shopping? Church activities?
School? (If you are not yet homeschooling, then you should plan on it!) Your
vacation
plans? Summer camp? Family holiday get-togethers? Sports and cultural
events? These
implications
are enormous. As SurvivalBlog readers, you are already
accustomed
to contemplating
abstractions
at this level and getting "ahead of the power curve." You also likely
have
the
benefit
of
superior
training
and
a deep
larder.
And, hopefully,
many
of you took my advice three years ago, and began to develop home-based businesses.
(Mail order businesses will undoubtedly flourish, as people shun face-to-face
sales.)
There are no guarantees, but you have a better chance
of getting through this
unscathed than most of your neighbors. Hopefully, all of you read the backgrounder
on family flu preparedness, that I've had posted here are SurvivalBlog
for more
than
three
years.
But
if
not... Now is
time
to make the requisite adjustments to your daily routine and to top
off
your
logistics:
- Now is the time to order several boxes of N95
masks
and
rolls of bandage tape (for sealing any mask edge gaps )
- Now is the time to buy a steam
vaporizer
(new,
or used -- Try Craig's
List for used ones)
- Now is
the
time to approach
your family doctor, and
ask for a scrip for Tamiflu.
- Now is
the time to
lay in a supply of Sambucol (Elderberry
extract.)
- Now is the time to lay in supplies
of hand sanitizer (with aloe) and latex gloves--or nitrile gloves for
those with latex allergies
- Now is the time to stock up on Vitamin C, Vitamin D, and Guaifenesin expectorant
- Now is the time to buy a couple of Bag Valve Masks
- And
lastly, for
this and umpteen other contingencies, now is
the time to acquire an honest one year supply of storage food (or more) for
your family. Buy some extra, for charity.
If
you
wait
too long,
then those
supplies
will
either be
non-existent,
or exorbitantly priced. By the time most of the sheeple think
this through (or have it explained to them by the talking heads on the
Idiot Box),
you will have long since "topped off" your
preps. But
not if you
hesitate. As my friend Bob in Tennessee is fond of saying: "Panic
now, and avoid the rush." [The Memsahib adds: If you've been consistently
panicking since 1999 with no ill effects on your spouse's mental health,
then give yourself a pat on the back.]
Mark my words: A true pandemic will disrupt supply chains,
starting with relatively exotic items (such as antivirals), but eventually
working down to basic commodities. Be ready.
Today's flu headlines:
Panic buying and government distrust in Mexico
1st
US Swine Flu Death: Toddler in Texas (visiting from Mexico) Flu also
now in Austria and Germany
"Patient Zero" may have been found. A 5-yr-old who lives near a pig
farm.
Access to Safe, Reliable Food Essential in Pandemic
Swine Flu Tracking On-Line
Ron Paul: Putting Swine Flu in Perspective
Dr. Len Horowitz: Mexican Flu Outbreak 2009 Special Report
Swine Flu Worries Shut Down Three Private California Schools
US Swine Flu Cases Now Officially at 68
Schwarzenegger, Obama Boosts Efforts Against Swine Flu
WHO Warns Swine Flu Threatening to Become Pandemic
World Takes Drastic Steps to Contain Swine Flu
Biden Tells Family to Stay Off Planes, Subways
Mexico Shuts Nonessential Services Amid Swine Flu
Asia Suspected Swine Flu Cases Rise
All Ft. Worth, Texas, Schools Closed Over Flu Fears
49 Confirmed Cases in NYC
CDC Latest Facts and Figures Re Swine Flu
Obama: US May Close Schools to Battle Swine Flu
Swine Flu Could Threaten Millions with Other Diseases
« Letter Re: Adapting Family Food Storage for Gluten Intolerance |Main| Jim's Quote of the Day: »
Mexican Flu Update
Cheryl wrote to mention an article that described using Vitamin
D to prevent a cytokine storm The dose is 2,000
units of Vitamin D per kilogram (1 kg = 2.2046 pounds), once per day. Thus,
for an average 150 lb. adult, the dose would be would
be
136,060 units of Vitamin D. This is to be taken for three days. (I.U. Equivalence:
50,000
units = 1.25 mg) My Strong Proviso: The usual fat soluble vitamin (KADE)
warnings apply. Don't over-do a good thing. You should discuss vitamin D testing and replacement with your physician before acting on that doctor's recommendations! Vitamin D supplement limits vary depending on body weight, diet, and exposure to the sun.
Today's flu headlines:
WHO
pandemic threat level raised to 5 out of 6
New Flu Strain is a Genetic Mix
First
US Swine Flu Death, Cases Now in 10 States
France urges Mexican flight ban
Cuba Halts Mexico Travel (First Country to Do So)
Pandemic Risk Grows as New Cases Emerge US cases now at 64, Mexico 152 dead,
over 2,000 infected
US Flu Deaths Seem Likely as Outbreak Spreads
Scary Advertisements From 1976 Flu Outbreak Today they tell us to stay calm
Mexico
City Mayor: One more death, toll stabilizing
« Letter Re: Home and Ranch Methane Gas Generators |Main| Mexican Flu Update »
Letter Re: Adapting Family Food Storage for Gluten Intolerance
Hi Jim,
I wonder how many other preppers out there have the same issue we just discovered.
My wife has always had trouble with her digestive tract. Recently we discovered
that she is has Coeliac's disease which means she is gluten intolerant. She
can no longer eat gluten which it seems is in just about every type of prepared
food. It comes from Wheat and is obviously in anything that has wheat in
it, but it is also in lots of other things including vitamins, tomato paste,
some candies, etc. It has been quite an adjustment for us!
This makes it difficult for us to store wheat as she cannot eat it. The rest
of us can, but it is hard to have lots of wheat based meals that part of the
family cannot eat. So, does anyone else out there have any experience storing
wheat substitutes or will we have to stock up more on rice and beans instead?
Best Regards, - Tim P.
JWR Replies: This topic has been raised before in SurvivalBlog,
but because Celiac Disease (aka gluten-sensitive enteropathy) is so commonplace,
it is worthwhile to discuss it further.
The good news is that because gluten-sensitive enteropathy is so common, there
are a wide range of gluten-free
foods on the market, and their are a wealth of gluten-free
recipes available online. The book Gluten-Free
Girl
by
Shauna James Ahern is an excellent resource. Needless to say, to start, you
will need to adjust your food storage program to have a much higher ratio of
corn and rice rather than wheat, to accommodate having some family members
that are gluten intolerant.
So that you don't get totally bored with eating rice and beans, look into
the non-gluten "grains" available, such as Quinoa. Another possibility
is Spelt. However, I should note that some allergy doctors contend that Spelt
is too closely related to wheat for it to be trusted as a celiac replacement
grain. Both of these grains are available in bulk from Internet vendors such
as Walton Feed for much
less that you'd pay at your local health food store.
The Lengthy List of Aliases
Gluten is found in the following: malt flavoring (from barley), hydrolyzed
vegetable proteins, caramel coloring (non US made), Monosodium Glutamate (MSG)
(non-US made), dextrins (especially vitamins and medications), wheat starch
and the big catch-all "natural flavors". These could be anything,
so you need to ask the manufacturer, and even then they may not be able to
tell you with certainty whether of not they are gluten-based. Of these, MSG
is the most difficult to identify because it is now pervasive in prepared foods,
and can hidden under a profusion of aliases. These deceptive labeling practices
have been flagged
by the FDA. According to the book Battling
the MSG Myth
, some
MSG synonyms include: Calcium Caseinate, Sodium Caseinate, Gelatin, Hydrolyzed
Protein, Hydrolyzed Vegetable Protein (HVP), Textured Protein, Textured Vegetable
Protein (TVP), Monopotassium Glutamate, Hydrolyzed Plant Protein (HPP) Yeast
Extract, Glutamate Autolyzed Plant Protein Yeast food, Yeast Nutrient, Glutamic
Acid, Sodium Caseinate, Autolyzed Yeast, Vegetable Protein Extract, Senomyx
(a wheat extract that is often just labeled as "artificial flavor"),
Calcium Diglutamate, Monoammonium Glutamate, Magnesium Diglutamate, and others! Beware
of any ingredient that includes the words Hydrolyzed or Autolyzed. Similarly,
beware of: Malted Barley Flour, Malt Extract, Soy Protein, Wheat Protein, Whey
Protein, Corn Starch, Citric Acid, Corn Syrup, and Dextrose.
« My Experience with a Field Gear Invention, by Mike B. |Main| Notes from JWR: »
Mexican Flu Update
It has been reported that the incubation period for the Mexican Swine
Flu is 4-to-5 days, and perhaps as long as 10 days in children.
That's the "hot" period when someone infected is shedding the virus.
This is bad news for epidemiologists. With modern air travel, this means that
there
is
probably no stopping the flu from making it to the far reaches of the globe.
So now, all that we can do is wait, watch, and pray that it doesn't mutate into
a more lethal strain. Barring that, my guesstimate is that it will be every country
with a couple of months. The crucial time will be next
winter
in
the
Northern Hemisphere. It is now Fall in the Southern Hemisphere, so their upcoming
flu season might give us a preview of what
will
happen up here, next year. Are you ready
to hunker down when the flu hits your
town?
Here are today's flu headlines:
The
Government’s Forecast if Flu Problem Explodes: Two Million Americans
Die "Ninety million citizens would get sick. The economy would shut
down."
DHS Sets Guidelines For Possible Swine Flu Quarantines
Official:
US Flu Victims May Be Infecting Others Confirmed cases in Asia Pacific
and New Zealand
Schumer
Bragged About Cutting Pandemic Funding (Well, now we are all in Deep
Schumer.)
Swine Flu More Dangerous than Bird Flu
Why
Does the Swine Flu Kill Healthy People?
WHO Revises Scale For Pandemic Alerts
Mexican
Reports: Flu Much Worse Than Reported "The truth is that anti-viral
treatments and vaccines are not expected to have any effect, even at high doses.
It is a great fear among the staff. The
infection risk is very high among the doctors and health staff. There is a sense
of chaos in the other hospitals and we do not know what to do. Staff are starting
to leave and many are opting to retire or apply for holidays. The truth is that
mortality is even higher than what is being reported by the authorities, at least
in the hospital where I work it. It is killing three to four patients daily,
and it has been going on for more than three weeks." - Dr. Antonio Chavez
Two Swine Flu Cases Confirmed in Scotland
Swine Flu Boosts Demand For Face Masks, Antivirals
Swine
Flu Warning Raised as Virus Crosses Continents Now at Level 4. Could
become Level 5 in the next few days.
Washingtonians Prepare for Swine Flu
Flu: Worst Case Scenario
Swine
Flu Epidemic Enters Dangerous New Phase "The virus poses a potentially
grave new threat to the U.S. economy, which was showing tentative early signs
of a recovery. A widespread outbreak could
batter
tourism, food and transportation industries, deepening the recession in the
U.S. and possibly worldwide."
40 Cases of Swine Flu in US to Date (No Deaths)
WHO Confirms Pandemic Alert Level Raised to Level 4
Swine Flu Cases Around the World
Swine
Flu Fears Close Schools in CA, TX, NY
Americans Told to Wear Masks as Swine Flu Spreads Around the World
« Letter Re: Tapping the National Medications Stockpile |Main| Jim's Quote of the Day: »
Mexican Flu Update
The death toll in Mexico now at
149, and climbing, with more than 2,000 patients are hospitalized there. Containment
appears unlikely. For a flu to spread this rapidly outside
of the normal
"cold
and flu season"
tells us something about its ferocity. I suspect that we will see multiple
waves of infection, with the worst of them probably being next winter
in the
Northern Hemisphere. Mutations are impossible to predict. The only good news
is that at least in the long term, viruses tend to mutate into less
lethal strains. (The most lethal--a la the Marburg type hemorrhagic
viruses--are so lethal
that the
hosts don't live long enough to pass on the viruses to others. Hence the tendency
for many bugs is to become less virulent. The common cold (acute viral rhinopharyngitis),
it is said, probably started out as a killer, many centuries ago.)
SurvivalBlog Editor at Large Michael
Z. Williamson sent us a link to the first really
practical
article on using N95 masks that I've ever seen, by Tara Smith.
Mentioned a useful CDC background
piece: Antiviral
Drugs and Swine Influenza
Reader Matt J. in Kentucky notes: "Wal-Mart in Louisville, Kentucky is already
out of N95 masks, but the hardware stores like Home Depot and Lowe's have 20-packs
readily available (I bought two 20-packs at Lowe's and one 20-pack at Home Depot."
OBTW, Bob at Ready
Made Resources mentioned that sales have been very brisk, and they are
now nearly out N95 masks, despite buying all that their wholesale
suppliers had
on hand. He also mentioned that their inexpensive full
protective suit ensembles are going fast
Here are some of the day's flu headlines:
World closer to swine flu pandemic
Swine
Flu: Five Things You Need
to Know About the Outbreak Thanks to Dave (at Captain
Dave's) for the link
Texas Closes More Schools as Flu Spreads
Obama:
Flu Matter of Concern Not One of Alarm (yet)
Mexico City Now a Zombie City
Call Your Congressman! US Says Not Testing Travelers From Mexico
Swine
Flu Hits Ernst & Young in Times Square, N.J. Department of Health
Confirms Five Probable Cases
Flashback to 1994: CDC to mix avian, human flu viruses in pandemic study
« Flu and Antibacterials, by David in Israel |Main| Mexican Flu Update »
Letter Re: Tapping the National Medications Stockpile
Jim,
Sunday, the US Department of Homeland Security (DHS)
announced that they would open up the National Stockpile of medications to provide
antivirals to areas
that may need them. This comment is a big clue to the real concern that this
is already getting out of control. The National Stockpile is rarely tapped so
this is a big event and a potential trigger for those out there who need to be
aware. Luckily this year’s human flu was resistant to Tamiflu so there
appears to be stock left, but this is also the end of the season so normal supplies
are low. Relenza is another antiviral that is available and the swine flu is
sensitive too, (at this point). Tamiflu [dosing] is weight-based for children
and Relenza is not indicated for patients less than seven years old. I would
suggest that anyone with significant medical conditions obtain an antiviral prescription
from their friendly doctor now, and not later. Obviously large
cities, especially those with international airport hubs, and those on the border,
or with large migrant populations probably aren’t the best places to be
right now. What triggers a bug out is individualized, but there is a definite
advantage of being in a small town. But even Kansas hasn’t been spared
with this one. With schools being shut down, that forces adult parents to stay
home which causes shortages of employees not only at the mall, but the grocery
store, the shipper, the police station, the hospital, the gas station…etc… Plan
accordingly for any last minute items you need. - Mike the MD
« SurvivalBlog Reader Survey: Conveniently Bypassed Areas |Main| Letter Re: Tapping the National Medications Stockpile »
Flu and Antibacterials, by David in Israel
James
I constantly see recommendations for people to use hand sanitizer especially
every time the flu-de jure becomes a problem. Over my years as a
firefighter/paramedic many of my co-workers used hand sanitizer on a regular
basis, the most frequent
users often ended up with cracked skin and infections or scabs at the corners
of their fingernails. These users even ended up occasionally spreading the
fungus to me and other non antibacterial users due to their compulsive wiping
of antibacterial compounds onto steering wheels and other surfaces.
Your best protection is not to nuke your own protections and hope any bacteria
die, but rather enhance your own systems. Vinegar rubbed onto the hands doesn't
remove your body's protective oils, it also doesn't cause the [drying and]
cracking that alcohol based rubs do. Acidophilus is available in capsule form
which
can be
opened and rubbed onto damp hands, acidophilus is a powerful microscopic security
force that works in symbiosis with your body. I also had a policy of not using
soap but spraying with dilute vinegar after rinsing my hands, sometimes rubbing
in a few drops of olive oil, my hands stayed soft making my wife happy, the
toughened skin stayed tough, and my skin protection layer stayed intact.
Day to day long periods of wearing of latex or nitirile gloves will cause your
hands to crack and dry out. Since you will probably not encounter open puddles
of body fluid by surprise cotton gloves, safety or eye glasses, and a cotton
or better yet a HEPA face mask should help prevent acquiring any airborne hyper-communicative
diseases if you need to go into a public place. Carry nitrile gloves and safety
glasses in case you are called to provide first aid. Be sure to safely remove,
bag, and wash any reusable protection before entering your home or vehicle.
Top attention should be placed on keeping your hands away from your face, especially
the mouth and eyes. When I was a paramedic instructor I had the students hands
dusted with UV-glowing
powder. After class I brought out the black light, nearly everyone's face showed
that they had touched or itched, even knowing that they
would get extra credit for coming up clean.
Unfortunately I never had time to set up a proper scientific study with control
groups, but my experience, and those who followed my advice was generally positive,
most of the antibacterial gel users had hard cracked hands with our resident
black fungus in the cracks and occasional infection at the corners of the nails.
Why didn't the gel users stop? They really believed they were protecting themselves.
As for flu, if you keep yourself properly fed including dark leafy vegetables
and citrus, don't work yourself to exhaustion, keep yourself warm, clean, and
dry and you should be much more resistant, even if this is finally the super
flu that the government has been waiting for all these years. - David in Israel
JWR Adds: I agree that antibacterials are over-used on a
day-to-day basis, but they are appropriate in the short term, when a
true viral killer is stalking the
streets. Many years ago, I heard that mixing 20% (by volume) of aloe vera liquid
with typical methyl alcohol-based antibacterial "hand goop" will prevent
drying
skin. BTW,
I've noticed that some commercial antibacterials are now sold with aloe added,
although I wonder at what ratio.
In addition to disposable gloves, don't overlook the need for glasses with
side protection and disposable booties that can be shed and discarded just
before you get in your car or truck.
Disposable
Tyvek suits are nice, but their use on a daily basis might be prohibitively
expensive
« Letter Re: Sambucol and the Cytokine Storm |Main| Note from JWR: »
Mexican Flu Update
The new H1N1 swine-avian-human influenza is certainly getting its share
of headlines. It will be interesting to see how this event progresses, and
the reactions of the populace and governments. Here are some updates:
The Mexican Flu now has a
Wikipedia page that seems to be kept quite up to
date.
Here is a Google map showing
the locales of confirmed and suspected cases
Doc D. mentioned this piece at Mashable: How
To: Track Swine Flu Online
SurvivalBlog readers in Texas and Southern California have already noted shortages
of Sambucol at their local drug stores. It is safe to assume that if the contagion
spreads rapidly that there will be lots of shortages of N95
respirators, disposable coarse-mesh paper masks (not much good against
even clumped viruses), hand
sanitizer, Tamiflu, Sambucol, Cipro, and canned goods.
Several SurvivalBlog readers have written to mention that Mexico City
is a powder keg. For example, reader Greg C. wrote to ask: "Has anyone thought
about where 20 million residents of Mexico City will go when
they all start to panic and bug out of the city?"
Have you ever wondered how viruses can spread so quickly? A YouTube
animation of airline flight paths is fascinating. (Thanks to Susan W. for
the link.)Whilst there, I spotted a
worldwide view of air traffic.
Safecastle (one of our advertisers), reports that they've had a huge increase
in sales of HarzardID
decontamination kits. I don't expect those to last long.
News Headlines: (Special thanks to Cheryl, aka "The Economatrix"
for sending most of these)
Swine flu and deaths in healthy adults--cytokine storm?
Asia on alert over swine flu threat
Face
Masks Analyzed as Aid in Flu Pandemic (Thanks to Matt R for the link.)
Matt adds: "Home Depot and Lowe's both sell
N95 respirators." (So do several Internet vendors such as Ready
Made Resources.) And speaking of masks, Chris W. suggested a FDA
reference page.
WHO Declares International Concern Over Swine Flu
Mexico May Isolate Patients with Deadly Swine Flu
Eight
New York Students Likely Have Strain of Swine Flu 30 children in Bronx
daycare have flu-like symptoms
Swine
Flu Could Mutate to More Dangerous Strain
No
New Local Cases of Swine Flu Reported Locally (San Diego, CA) "However,
they continued to caution that more illnesses are likely to surface as local,
state and federal disease investigators examine more people
suffering
flu-like symptoms."
Swine
Flu to Be Probed, No Pandemic Yet (Imperial Valley, CA)
Mexico
Fights Swine Flu With "Pandemic Potential"
Swine flu cases discovered in Canada
NYC School Cases Confirmed Swine Flu
U.S. Declares Public Health Emergency Over Swine Flu
Swine
Flu Empties Mexico City's Streets Official Numbers: 81 dead, 1,324 infected
in Mexico; Suspected cases elsewhere including New Zealand
Swine Flu Fears as New Zealand Students Quarantined
CDC: Flu Has Spread Widely, Cannot Be Contained
Texas Health Dept. Closes School; Bans Sick Reporter From News Conference
Third Texas Case Of Swine Flu Confirmed; Family Quarantined
Seventh
Case of Swine Flu Confirmed in California
US
to begin asking about flu at the border. (Why didn't they close the
border, 48 hours ago?)
Canada Confirms Four Cases
Mexico Streets Empty as Swine Flu Toll Climbs
Swine Flu: White House Has Unusual Sunday Briefing
Anxiety Grips Hospital Waiting Rooms as Fears of Swine Flu Spread Through the
City
World
on Alert Over Mexican Killer Swine Flu as Pandemic Fears Rise Suspected
cases also in France, Israel. Medical personnel said symptoms began like normal
flu, but then victims' temperatures shot up, with paralysing muscle
aches.
Swine Flu: Panic Spreads Worldwide
British Airways Cabin Crew Member Quarantined; Fell Ill on Flight to UK From
Mexico
And in closing, here is a PDF to keep in your reference file: a
very detailed description of how to perform Chest Physical Therapy on a person
who is having difficulty clearing their lungs. (A tip of the hat to reader
John H.)
« Letter Re: Caught Between OPSEC and a Hard Place |Main| Mexican Flu Update »
Letter Re: Sambucol and the Cytokine Storm
Jim,
Reading through your flu background article [Protecting
Your Family From an Influenza Pandemic], I found your mention of [the Elderberry
extract] Sambucol. I'm going to get some but you might want to read the
article on Elderberry posted at the fluwiki web site.
It sounds generally positive about Sambucol for seasonal flu, but does say
this regarding avian flu:
"However, elderberry also increases cytokine production. One specific
concern with H5N1 infections is the possibility that this strain of flu may
induce
cytokine storm, leading to ARDS and the high mortality associated with it.
It is unknown if the increased circulating cytokines that elderberry and other
alternative medicines induce could increase a victims risk of cytokine storm.
Medical science does not currently know the exact mechanism that triggers cytokine
storm. We cannot say if increased cytokine levels before or during infection
is a risk factor for ARDS or an effect of some other mechanism that begins
the inflammatory cascade that results in it. High cytokine levels are documented
to be associated with ARDS, but causation is unknown..."
Regards, - Matt R.
« Letter Re: Atheism and Choosing Your Neighborhood |Main| Note from JWR: »
The Mexican Flu and You
In the past
24 hours I've received dozens of e-mails from SurvivalBlog readers about the
emerging Mexican Flu. Some news stories have included cryptic comments from
heath officials, implying that the mechanism of infection makes this particular
virus "very difficult to contain." This leads
me to conclude that those infected have a long latency period during which
they are infectious, yet, they do not display frank symptoms. This does not
bode well for any hopes of containing the spread of the virus.
Then we hear a
CDC official stating: "The swine flu virus contains four different
gene segments representing both North American swine and avian influenza, human
flu and a
Eurasian swine
flu." That strikes we as something very peculiar.
The disease is respiratory, and has one strong similarity to the 1918 Spanish Flu: "The
majority were young adults between 25 and 45 years old," said one official
under
the condition of anonymity. Since, young and healthy people with strong immune
systems are the most likely to succumb, this might indicate that the biggest
killer is a cytokine storm--a collapse caused by the human immune
system's over-reaction to a
pathogen.
I strongly recommend that everyone reading this take the
time to re-read my background article on flu self-quarantine and other precautions: Protecting
Your Family From an Influenza Pandemic. The details that I give there are
quite important. Pay special attention to my discussion of the shortage
of hospital
ventilators.
If anyone in your family is immunosuppressed, consider
yourselves on alert. Make your final preparations to hunker down,
immediately.
In the next few days, there is a good chance of wholesale panic, including
some well-publicized "runs" --probably first for hand sanitizer and face masks,
and soon after for bottled
water and groceries. Plan on it.
UPDATE: The BBC News
web page Mexico
flu: Your experiences has some updates posted from individuals
in Mexico City
To summarize, here are some key quotes from a
recent article:
"This outbreak is particularly worrisome because deaths have happened
in at least four different regions of Mexico, and because the victims have
not been vulnerable infants and elderly.
"The most notorious flu pandemic, thought to have killed at least 40 million
people worldwide in 1918-19, also first struck otherwise healthy young adults."
...
"But it may be too late to contain the outbreak, given how widespread the
known cases are. If the confirmed deaths are the first signs of a pandemic, then
cases are probably incubating around the world by now, said Dr. Michael Osterholm,
a pandemic flu expert at the University of Minnesota.
"No vaccine specifically protects against swine flu, and it is unclear
how much protection current human flu vaccines might offer."
Current statistics show a less than 10% lethality rate, but of course the
first wave of flu victims are getting access to the best medical care available.
If the contagion spreads, sheer numbers will quickly overwhelm hospital
facilities--particularly the number of mechanical ventilators available. So
the lethality rate may rise, even if there is not a viral mutation.
Here
are the latest headlines on the flu, as well as some background pieces. I'll
post
more
links,
as they
become
available.
Swine Flu, Mexico Lung Illness Heighten Pandemic Risk
Swine flu could infect U.S. trade and travel
Mexico Races to Stop Deadly Flu Virus
Spanish Flu Survivors Remember
Some Facts About Past Flu Pandemics
WHO ready with antivirals to combat swine flu
Possible Swine Flu Outbreak at NYC Prep School
California Expects To Find More New Flu Cases
Swine Flu Jitters Sparks Sell-Off In US Hogs
Swine Flu Resources
Most Mexico fatal flu victims aged between 25-45
Swine
Flu May Be Named Event of ‘International Concern’ by WHO
[A UK] County's masterplan to deal with flu pandemic
« Letter Re: Thanks for SurvivalBlog |Main| Letter Re: A Flat Tire as Learning Experience, by Rock O. »
Letter Re: Choosing Antibiotics to Store for Emergencies
Mr Rawles,
I have been reading Survivalblog for a couple of years now and want to thank
you for providing such a wonderful resource. I also participated in the April
8th Amazon book bomb and just finished reading "Patriots:
A Novel Survival in the Coming Collapse" for the
first time. I couldn't put it down and read it in one sitting. That being said,
I
must point out one potentially harmful error in your mention of tetracycline.
I am starting my final year of pharmacy school and have been working in my
family's
drugstore for 25 years. Tetracycline is the only [antibiotic] drug I know of that actually
"goes bad" and becomes toxic when it goes out of date. For this reason, I would
not suggest tetracycline for a TEOTWAWKI medical
kit.
I would suggest that readers consult with their physicians and inquire about
susceptibility patterns in their particular geographic location. The major
strains of staphlococcus aureus, MRSA,
and the various pathogens that cause pulmonary and upper respiratory infections
will vary from region to region. Thus, the
choice of antibiotics for your G.O.O.D. kit
may vary as well. This is a prime example of why all readers should follow
your advice and try to diversify the
talents
in your retreat group. A doctor, pharmacist, RN, EMT, PA,
etc. would be a valuable addition. I am fortunate in that regard, as my children's
pediatrician is like
minded and goes to church with us.
Keep up the great work. Thanks, - TR in the State of Franklin
« Economics and Investing: |Main| My Initial Experiences with Concealed Carry, by AceHigh »
Two Letters Re: TEOTWAWKI Medical Skills: Thoughts on Becoming a "Woofer" (Wilderness First Responder)
JWR:
Richard B.'s post is dead-on about how awesome Woofer training is. I'm WFR-qualified,
and I agree that it is a great 10-day/night training program. However, there
are a few things that WFR training targets that doesn't quite cover
TEOTWAWKI situations. I've also taken Medical
Corps (the makers of KIO3
and one of your advertisers) "Care in Extreme Situations" course,
and two different tactical medicine classes through Suarez International (their
TC3 class includes live fire).
One key phrase in the definition of Wilderness Medicine is "more than
one hour from definitive care," and many of their techniques are designed
around patient stabilization and transportation. A few of their techniques
are advanced, in-field treatments, but the expectation of their
approach is that the hospital will provide much needed care sometime in the
future.
The Medical Corps class
provides some amazing additional "I'm the only
available medical care that you're going to receive" type of medical information,
that supplements the more basic care that WFR provides. One example they brought
up on the class were a group of American who ended up on a Tsunami ravaged
island in Indonesia, and because they were the most educated people there (i.e.,
they could read and they had seen episodes of the television show ER)
they were most advanced medical care available on the island, with no training
whatsoever.
That class
is geared
towards that sort of 'extreme situation.' They also provide an amazing amount
of information regarding supplies you can keep on hand to assist with mass
casualty events, long term events, what's good to have in the event you have
to be the medical services for 'your village.'
A Tactical Medicine class provides the much needed technologies for those first
couple minutes after an injury occurs (normally from the point of view of 'I
just got shot' or 'My pal just got shot,' but the techniques are applicable
to "I just cut my leg off with a chainsaw at my Idaho retreat after the
collapse and no one is coming to rescue me... ever ... so I need to do something now.") Live fire medicine is exciting. They also provide a lot of good
information regarding the pro's and con's of various items in your 'blow out'
kits (and its amazing to hear the points of view of various instructors ...
some approach it from a "This is what you carry" and others from
the point of view of "this is what makes a good device, so if you need
to improvise, here's the characteristics you need to target."
Here is how I categorize my three levels of training:
*Tactical Medicine: * The Ambulance is five minutes away, you've got 90 seconds
before you bleed out. Return fire as needed.* You're the ER doctor* now, the
real doctor will help you later.
*Wilderness First Responder Training: * Help is an hour or a day away. The
victim needs to be taken to the doctor or might just need a Band-Aid, that's
for you to figure out and decide what do with them (*sometimes you treat, sometimes
to make sure that they can make it to treatment*). You evaluate and stabilize
the patient, and if necessary move them so they can get to the real doctor.
*Medical Corps:* "Care in Extreme..." You are the only doctor that
the victim(s) are ever going to see. Do your best with them to keep them alive,
do your best to keep other people from becoming victims, and do your best to
treat them for the long haul .... *You are the doctor (dentist).*
The more medical classes that I get and the more classes with 'hands on the
patients' sort of interactions, the more I realize how much I don't know
and the more
courses I want to take.
- C. in Fort Collins
.
JWR;
I just wanted to pass on an additional direction that the general public
can take advantage of for excellent medical emergency training with an outdoor
focus. The Outdoor Emergency Care (OEC) classes, put on nationwide by the
National Ski Patrol, are nearly identical to the description of the recently-posted
Wilderness First Responder article. The National Ski Patrol opens their classes
to
skiers and non-skiers of all stripes, including those who just wish to know
more about first responder emergency medicine. The course is around 100 hours
of class time - significantly more independent study time - and is completed
with
both a written and practical examination and OEC Certification. (It is recognized
nationally). Refreshers are required each year to maintain certification.
One of my main reasons for posting this alternative is availability of class
offerings
is wide and duration is usually set to a much longer period of time than
the concentrated 9 or 10 day of the Woofer class as described in the posting.
More information can be found at the OEC Zone website or at National Ski
Patrol website. As an aside, the curricula for OEC Technician is basically
designed
with and to be nearly identical to a Basic EMT certification following near
identical study guides and standard of care protocols. Regards, - Rick S.
« Four Letters Re: A Well-Rounded Skillset Requires Both Range-Based and Force-on-Force Training |Main| Note from JWR: »
TEOTWAWKI Medical Skills: Thoughts on Becoming a "Woofer" (Wilderness First Responder), by Richard B.
Background
Most people I know prepare for medical emergencies by buying a first-aid kit,
maybe taking a class, maybe buying some additional supplies, and calling it
good. In an urban setting we typically expect to have professional assistance
in less than an hour, but natural or man-made disasters could change this to
days, weeks, months – or longer. I often work and play outside – skiing
and motorcycles, construction and heavy-equipment, and off-grid living. I’ve
fallen from horses, bicycles, and a roof. I live in earthquake and volcano
country, and I’ve helped
raise three sons.
I’ve been motivated for more than 40 years to be ready for whatever
comes my way – “expect the unexpected”. And part of my prep
has led me to study “improvisational backcountry medicine”.
In an emergency, providing medical care requires knowledge, practice, equipment
and supplies, and the right mind-set. Emergencies are charged with emotion
and unpredictability. In this brief commentary I’m advocating two things:
investing (time/money) in a comprehensive training program that provides hands-on,
real-world scenarios, and then, putting together a full kit that will meet
the needs of your current or probable family/community, and allow you to fully
utilize your skills.
As a teen--in the 1960s--I took Red Cross courses (First Aid, Lifesaving,
and Water Safety Instructor). Then the Army sent me to Vietnam for a couple
of years where I had the “opportunity” to get some up-close and
personal trauma-care experience. A decade later I went to back to school and
earned a nursing degree. And just recently I took a Wilderness First Responder
(WFR or “woofer”) class, eighty hours of realistic instruction
and practice with dozens of what-if scenarios (medical and trauma). Without
question the WFR is the best program I know for a 360-degree approach to survival
medicine.
Wilderness First Responder – The Training
A Wilderness First Responder is an individual who has completed a structured,
accredited training program and passed both a written and practical exam. Most
of the people I trained with had a professional motivation – they work
for an organization that made the WFR credentials a requirement of employment.
Our group included river-rafters, mountain climbing guides, “executive
training retreat” leaders, a couple of Emergency Medical Technician (EMT)s,
and Search & Rescue
(SAR) volunteers. The program is designed to help you deliver individual
medical-delivery skills, but just as importantly to be an effective team-member
or even the medical leader (“chief medical officer”).
My class was hosted by The Mountaineers in Seattle, and conducted by Remote
Medical International (RMI). There are other good providers, all over the country
(and the world). The orientation of my program was wilderness recreation, but
my interest is living and working off-the-grid and the training was perfect
for that, also.
In class we defined “remote medicine” to mean that you have limited
equipment and supplies, you’re an hour or more from additional help,
and you may be the only one providing care – or your helpers may know
little or nothing, and may even impede you. You are the one in charge, the
one responsible. Think about the implications if the individual needing help
is you, or someone you love. And then make the time to get ready. Prepare to
be a survivor.
A cardinal rule of medicine is “do thy patient no harm”. If someone
is down, do you stay? Do you go for help? Should you leave him on his back,
on
his side,
or as he fell?
We used makeup and prosthetic “broken bones”, “internal organs” and
protruding “broken bones” to make it all seem more real. The responders
were not told in advance what to expect when they came on the scene. We had
outdoor night-practice sessions. No matter their background or experience,
everyone learned something new.
Quoting from the curriculum documents, here is an overview of what we covered:
Day One: Course Overview & Patient Assessment
Introductions & Course Overview
What is Remote Medicine?
Role of the Medical Officer
Communications/Telemedicine
Medical-legal Considerations
Primary Survey
Physical Exam
Vital Signs
Patient History
Documentation
Day Two: CPR
CPR for the Healthcare Provider
Considerations for Remote Environments
Oxygen Administration
Day Three: Trauma Management
Orthopedic Injuries
Shock
Neurological Trauma & Injury
Day Four: Trauma Management
Wound Management & Infection
Chest Injuries
Dental Emergencies
Lifting & Moving Patients
Patient Packaging & Transportation
Day Five: Medical Emergencies
Cardio-respiratory Emergencies
Acute Abdominal Pain
Metabolic Illness & Allergic Reactions
Medication Administration Lab
Day Six: Medical Continued/Environmental
Genitourinary Medicine
Neurological Illness
Altitude Related Illnesses
Psychological Emergencies & Rescuer Stress
Lightning
Mass Casualty
Day Seven: Environmental
Frostbite & Non-Freezing Cold Injuries
Hypothermia
Heat Illness
Immersion & Near-Drowning
Health & Hygiene
Search and Rescue & Group Management
Austere Patient Care and Survival
Day Eight: Environmental/Logistics
Dive Emergencies
Plant & Chemical Poisoning
Animal Attacks & Envenomation
Pre-Expedition Health Screening & Planning
Remote Medical Kit & Supplies
Day Nine: Testing
Practical Exam
Written Exam
Debrief & Evaluations
The Skills
And here are some of the skills we learned (and practiced, and demonstrated
to each other and to our instructors!)
* demonstrate comprehension of the legal concepts related to medical care,
and
relate their interpretation to patient care.
* demonstrate a working professional vocabulary for communicating their patient
assessment and care with other responders.
* demonstrate skill at gloving and de-gloving, and describe the techniques of
body substance isolation.
* demonstrate rudimentary execution of a Scene size-up, Primary Survey, and Secondary
Survey, assessing and managing the scene for safety; demonstrate rapid, effective
moves out of harm's way, application and management of the tourniquet, verbalize
a General Impression, assess the ABC's, and effect interventions, obtain multiple
sets of vitals signs, a patient history and a thorough head-to-toe physical exam.
* demonstrate a basic skill in making SOAP notes.
[Subjective (Location, age, sex, MOI/history of events, Symptoms), Objective
(LOC, RR, HR, SCTM, ROM [repeat at 15 min.]), Assessment (Fracture/Hyothermis/
...), PLAN (clean, bandage, splint, ...)]
* be able to describe the introduction of pathogens into the body, and the body's
inflammation responses.
* be able to accurately assess and manage oxygen delivery, airway interventions
and management, and use of the bag-valve mask (BVM).
* recognize the potential danger of thunderstorms, respond appropriately to an
approaching storm, assess and manage related injuries.
* describe the management of submersion incident (drowning) casualties.
* describe and demonstrate the assessment and management of shock.
* assess and manage chest pain, satisfactorily and appropriately perform CPR,
and know the backcountry protocols for initiating and stopping CPR.
* demonstrate competence in carefully approaching the study and use of medications.
* communicate the responsibility of the WFR in public health matters (water,
food handling, and hygiene).
* understand North American bites and stings; recognize and manage intoxication,
envenomations, and allergic reactions, provide wound care. Students can assess,
measure, and administer 0.3ml volume intramuscularly.
* demonstrate command of assessing and managing the three levels of injuries
to the head and provide long-term care.
* demonstrate command of spinal cord/spinal column assessment criteria, conduct
a thorough physical exam for cord injury ("clear" the spine), improvise
a C-collar, and demonstrate correct rolls, moves, and lifts with spinal precautions.
* demonstrate recall of prevention, assessment, and management of hypothermia,
frostbite, non-freezing cold injuries.
* be able to prevent, recognize, and manage dehydration, heat exhaustion, heat
stroke, heat cramps, and sunburn.
* be able to prevent, recognize, and manage high altitude problems (AMS/HAPE/HACE).
* demonstrate competence at safely conducting carries (pacstrap, split-coil,
piggyback, backpack, and fireman's)
* fabricate a manageable, comfortable, and protective hypowrap.
* demonstrate correct packaging, organization, communication, and carrying skills
with a spine-board and the Stokes litter.
* demonstrate competence with the fundamental principles and operations of a
technical rescue, can safely tie-in, and demonstrate rudimentary team skills
with communicating, anchoring, belaying, lowering and raising a low-angle-configured
rescue litter.
* demonstrate familiarity with "essential" items, search-victim care
items, and radio conduct.
* demonstrate knowledge of the purpose, principles, and parameters for trek planning.
* relate the principles and conduct of SAR operations, the considerations for
evacuation options, and conduct around helicopters.
* demonstrate proper management of open wounds, describe infection assessment
and care.
* relate the dynamics of missile wounds, the assessment criteria for evacuation,
and expedient field treatment for missile, and arrow / spear injuries.
* describe evaluation and management techniques of burn injuries.
* describe the steps and technique for assessing and managing the sprained ankle,
and demonstrate effective taping of the ankle.
* be able to demonstrate assessment and management of fractures; apply commercial
and improvised stabilizing and traction splints.
* demonstrate ability to assess and manage dislocations, and demonstrate skills
to relocate the shoulder, patella, and digits, and forearm.
* demonstrate effective teamwork in managing patients with insults to multiple
primary systems.
* demonstrate organizing and managing a response to a multiple casualty scene,
rapidly sorting, prioritizing, and managing patients for critical care and evacuation.
* describe the assessment and management of common EENT problems.
* demonstrate thorough, courteous technique in assessing the "medical" patient.
* assess and manage abdominal problems, demonstrate improving skills in getting
a medical history, and demonstrate knowing when to evacuate the patient.
* describe assessing for, and managing diabetic emergencies.
* relate the assessment and management of common genitourinary (GU)
illnesses,
and instruct others
in hygiene and prevention in the backcountry.
Reading about this stuff is not enough. There is no substitute for hands-on
experience
and developing muscle-memory. And by the way, certified WFRs are required
to
take
a refresher
every couple of years so they don’t get rusty.
Disclaimer: I mention Remote Medical International (RMI) in
this article – they
were great, and they provide medical training, equipment, and supplies. I have
no financial stake in the firm. There are other great companies out there – search
for “WFR” and you’ll turn up a handful.
About the Author: Richard B. has worked as a general contractor, business
consultant,
US
Army combat photographer, Registered Nurse, railroad carpenter and brakeman,
and as a forest
fire-fighter.
« Economics and Investing: |Main| Product Review: AmericaStone Knife Sharpener »
Letter Re: TEOTWAWKI Medicine and Minor Surgery
James,
In general, [the recent medical articles are] great stuff to have on your web
site. However, it is really best for trained and knowledgeable medical and
paramedical
people
to get
involved
in medical and surgical issues rather than looking at these as Do-It-Yourself
projects! With all due respect to your many readers with far greater mechanical
intelligence
than I have, the Almighty engineered the body and sustains it in a more complicated
manner (beyond human comprehension) than the best human conceived and built
retreat plan!
As soon as you finish a course of antibiotics, drink yogurt, (fermented) buttermilk,
or kefir a few times a day for a few days to replenish good bacteria in your
guts and prevent the likelihood of getting an antibiotic-associated diarrhea.
Please make sure a patient is not allergic to the antibiotic being considered
or a related antibiotic (any Penicillin allergic patients is allergic to all
the similar drugs (e.g, Augmentin, amoxicillin, ampicillin, dicloxacillin,
etc). About 10% of patients with a real drug allergy to a penicillin will be
cross allergic to any cephalsporin class antibiotic such as Keflex (cephalexin),
cephadroxil, cefdinir, Cefzil (cefprozil), etc. I highly recommend people with
serious allergies to any of these drugs print out from a Google search (or
copy from a medical text) all the drugs in the class every couple of years
because new ones are constantly being introduced into medicine.
Without getting too technical the penicillin and cephalosprin class drugs all
share a chemical structure called a beta lactam ring. If you are allergic to
any of these antibiotics, ask your doctor if you should be considered allergic
to other and even all beta lactams. The beta lactam-containing antibiotics
are even more broad than just penicillin-type antibiotics and cephalasporins
and also include very potent and broad-spectrum activity non penicillin and
non cephalosporin antibiotics such as Primaxin (imipenem) other "penems" and
aztreonam (all are injection only drugs at this time).
Also use of Cleocin (clindamycin) is very significantly associated with a diarrhea
that may prove fatal if the specific toxin that causes this "pseudomembranous
colitis diarrhea" is not quickly neutralized with either oral vancomycin
or Flagyl (metronidazole), very different types of antibiotics that kill the
Clostridium difficile bacterial overgrowth germ that produces the toxin. In
fact, use of any antibiotic or anticancer drug may result in this type of serious
diarrhea that needs this specific treatment. But this complication is particularly
associated with use of clindamycin (even short exposures) and more than 10
day courses of all other antibiotics.
It is best to treat cellulitis and indeed any minor skin infection, with warm
soaks several times a day, before resorting to use of antibiotics and surgical
incision to drain pus and look for a foreign body. Packing material, if needed,
can also be made of any wick shaped piece of clean latex to temporarily drain
pus and other fluids. As long as there is no latex (rubber) allergy, one may
improvise to use a clean and rinsed of powder residue strip from a latex glove,
unlubricated condom, or even a balloon. Change the packing material daily.
When drainage of fluid from the wound slows, usually only takes 1-3 days, let
the wound close on its own after irrigating it with warm sterile (requires
vigorous boil for 10 min) water or packaged sterile saline solution.
Pharmacists are also great resources for their knowledge of drug side effects
and allergy-related issues. Diabetics or people taking steroids (such as for
asthma, bronchitis, lupus and other rheumatologic diseases, etc), should expect
their blood sugars to go very high when they experience infections and understand
that their bodies are less capable of fighting infections.
Bottom line: people with medical skills and knowledge and those with mechanical
and gardening knowledge, etc. need to band together and help each other out
when the situation calls for more than a few band aids, an epoxy repair, and
growing a few veggies for supplemental fresh produce in the summer. - Yorrie
in Pennsylvania (a retired physician)
« Letter Re: TEOTWAWKI Medicine and Minor Surgery--Part I: Ingrown Toenails |Main| Note from JWR: »
TEOTWAWKI Medicine and Minor Surgery--Part II: Skin Infections, by Dr. K.
Introduction
The skin has three layers.
1. The epidermis is the outermost layer. It protects our bodies from the environment
and has pigment cells.
2. The dermis is the middle layer, and it contains hair follicles, sweat glands,
oil glands, and capillaries.
3. The hypodermis (or subcutaneous layer) is the inner layer, and it contains
layers of fat that provides cushion and insulation for our body… some
more than others.
Any of these layers can become infected, in whole or in part. In a TEOTWAWKI scenario, that minor scratch could lead to a painful death. Knowledge is vitally
important. Understanding how to prevent and treat a skin infection is relatively
straightforward, and it could be a matter of life and death when TSHTF.
Signs of a skin infection are pain, redness, swelling, warmth and/or drainage
of pus.
Definitions
Cellulitis: a diffuse infection of the dermis and subcutaneous tissues. Signs
of cellulitis are red, warm, swollen, and tender skin.
Erysipelas: similar to cellulitis, but this infection is more superficial and
has very clear borders.
Skin abscess: a collection of pus that is in the dermis and subcutaneous tissues.
An abscess presents as a tender mass just under the skin. It is pink to red
and may be warm to the touch.
Furunlce (or “boil”): an infection of the hair follicle that causes
an abscess.
Carbuncle: a collection of several boils that grow together. This looks like
a very large abscess.
Causes
These skin infections can develop in any individual and most are caused by
bacteria. Having minor scrapes and cuts, insect bites, rashes, burns, swelling,
or being around another person with a skin infection can increase your risk.
Having diabetes, being immunosuppressed (HIV,
on chemotherapy medicines, autoimmune disease, etc.), or having a history of
methicillin-resistant Staphylococcus aureus (MRSA)
infections also increases your risk.
Complications
If an infection is left untreated, it can keep spreading into the surrounding
tissues and into the bloodstream. This may lead to local tissue damage, a body-wide
infection, and even death in a worst case scenario.
Prevention
All skin wounds, no matter how minor, should be cleaned and dressed immediately.
Changing the dressing when it becomes wet or dirty will aid in prevention.
In a TEOTWAWKI scenario, you cannot afford to brush aside that thorn scratch
or knife nick. Take the time to clean it right away. Skin infections don’t
care how tough you think you are.
Antibiotics
Cellulitis and erysipelas are sometimes watched and not treated with antibiotics
right away. However, if these infections become severe (which can happen quickly),
IV antibiotics are the best choice. In a TEOTWAWKI scenario, IV antibiotics
will be much harder to store and/or obtain. Because of this, I recommend using
oral antibiotics with cellulitis and erysipelas immediately.
Antibiotics are typically not needed with a draining abscess or after an incision
and drainage (I&D). Once the pus pocket is ruptured, your immune system
usually takes care of things rather well. However, I would start antibiotics
if a growing redness and warmth develops after the wound has been drained.
Also, I would start antibiotics right away if the patient has multiple skin
infections, the patient is immunosuppressed, the patient has previous MRSA
infections, or if the patient has signs of body-wide infection (feeling ill,
fever, nausea and/or
vomiting, increased heart rate, low blood pressure, etc.).
Any of the following oral antibiotics (unless there is an allergy) should be
used for 10 days minimum, but can be used longer as long as the infection is
improving (search past Survivalblog posts for medication procurement):
Adults
Cleocin (clindamycin) 300 mg every 6 hours (currently treats most MRSA)
Dicloxacillin 500 mg every 6 hours
Keflex (cephalexin) 500 mg every 6 hours
Children
Cleocin (clindamycin) 30-40 mg/kg per day divided in 3-4 doses (treats most
MRSA)
Dicloxacillin 25-50 mg/kg per day divided in 4 doses
Keflex (cephalexin) 25-50 mg/kg per day divided in 3-4 doses
Non-Surgical Treatment
Small boils and small abscesses may respond very well to non-surgical treatments:
* Keep the infected area elevated.
* Warm compresses (a clean wash cloth soaked in hot water and wrung out) and
warm water soaks will help promote drainage.
* If it comes to a head, continue with warm compresses until it ruptures.
* Wash with antibacterial soap.
* Continue to use warm compresses until the pus stops flowing.
* Apply antibacterial ointment (such as Neosporin) over the wound.
* Keep a clean and dry dressing in place over the wound.
* Wash the wound and change the dressing 2-3 times a day.
* There should be improvement in about a week.
* If there is a growing area of redness and warmth, consider antibiotic treatment.
Surgical Treatments:
Incision and Drainage
Larger boils, larger abscesses, and carbuncles require incision and drainage
(I&D)
to heal.
Note: A surgical option, regardless of the problem, is always best treated
by someone who has been trained to perform the procedure. You don’t want
to be patient number one in a survival situation. Finally, while I am explaining
how to do this procedure, I only recommend that you attempt this in a post-TEOTWAWKI
scenario where there are no other healthcare options. Proceed at your own risk.
Supplies
Light (a bright headlamp works well. Consider working outside in the bright
sunlight.)
Non-sterile gloves
Sterile gloves
Alcohol or povidone-iodine solution (sold as Betadine)
Gauze pads
10-mL syringe
25- to 30-gauge needle
12- to 18-gauge needle if desired
Lidocaine 1% or 2%
No. 11 or 15 blade scalpel or sterile razor blade
Curved hemostats (small device that resembles scissors but has curved clamps
instead of blades) a pair of needle nosed pliers (sterilized) can be used in
a pinch
Packing material (such as iodoform gauze which are thin medicated gauze strips)
Scissors
Dressing Materials:
Antibiotic ointment such as Neosporin
Gauze for wrapping the wound
Roll of 1-inch tape
Step-by-Step Instructions
1. Have the patient get into a comfortable position. Have them lie down if
possible just in case they pass out - it can happen to anyone! [JWR
Adds: Vasovegal and other fainting responses are highly unpredictable.
Just the sight of spurting blood can induce a faint in even someone that big
and macho. In two separate incidents, I've personally witnessed two "manly
men" who claimed "no problem, it won't bother me" pass out,
unconscious, within moments of seeing their own blood.]
2. Clean the wound. Put on non-sterile gloves and clean the entire wound and
surrounding tissue with povidine-iodine or alcohol.
3. Numb the wound with medicine: The easiest method is a field block. Inject
the lidocaine around the base of the wound on all sides. If the wound is not
on a small body part, you can use lidocaine with epinephrine.
Note: Make sure the lidocaine does not have epinephrine in it if the wound
is on a small body part. Epinephrine is a vasoconstrictor, meaning it clamps
down blood vessels. This can prevent circulation. If you stop circulation with
medicine, you have no idea how long it will last, and you could kill tissue.
Your patient won’t feel the procedure, but they may lose a body part!
Bottom line: Never use epinephrine on the fingers, toes, ears, penis, or nose.
Note: Please read how to load lidocaine and inject it in Part I: Ingrown
Toenails. [JWR Adds: Of course check for contraindications and potential
drug interactions before using any "-caine" drugs!]
Note: Please read how to dull the pain without medicine in Part I: Ingrown
Toenails
4. Make an incision. Using the scalpel blade or sterile razor blade make a
straight cut the entire length of the abscess (the deepest red central portion
of the abscess). The cut should be deep enough to go to the subcutaneous tissues.
Try to follow the natural skin folds for a more cosmetic healing (do an online
image search for “cleavage skin lines” to see an illustration).
For small infections, you may be able to drain the abscess by perforating it
with the large bore (a 12-18 gauge) needle.
5. Probe the incision if large enough. If there are no pain meds, this will
be painful. Insert the curved hemostats to slowly spread out the tissues under
the cut. This will break up some of the connective tissues that may be holding
pockets of pus. You also may find a foreign body (thorn, glass, etc.) that
was actually causing the infection.
6. Express the wound. Provide gentle pressure to the sides
of the wound to squeeze out any extra pus and blood. Do not be aggressive here.
7. Pack the wound. If the wound is big enough to leave a pocket, then filling
the wound with a medicated packing material (iodoform gauze) will aid in healing.
Using the hemostats, stuff the material into the wound until full. Leave about
a half inch hanging out of the wound. This tail aids in drainage. Trim to size
with a pair of scissors.
If the wound is not very large, you do not need to pack it.
8. Dress the wound. Apply antibiotic ointment over wound. Apply a bulky gauze
wrap, but do not wrap it too tight. It will throb as sensation returns. Use
acetaminophen or ibuprofen for pain.
9. Check the wound after 24 hours. If there continues to be more pus draining,
remove the packing material, repack the wound, and change the dressing. Keep
checking every 24 hours. When the drainage stops, perform warm water soaks
3-5 times daily, change the dressing, and apply topical antibiotic ointment.
Healing should occur in 7 to 10 days.
Surgical Complications
Infection: The wound will have some initial throbbing, but should start to
improve dramatically in a few days. If your patient is having an increase in
pain, swelling, redness, warmth, or drainage, there is likely a continuing
or secondary infection. If this occurs, start antibiotics as described above.
Consider probing the abscess a second time to make sure no pockets of pus are
hiding.
Things to consider
If the wound involves the hand or the abscess is very large, it will be very
difficult to treat without IV antibiotics and potentially major surgery. This
would be a case where attempting to find a physician may outweigh the risks
of leaving your retreat. In rare cases a skin infection can spread to the facial
tissue (this is called necrotizing fasciitis or “flesh eating disease”).
Signs of this infection are intense pain out of proportion to the wound, fast
swelling, spreading redness, fever, and vomiting. This would be a case where
lack of immediate surgery by highly trained physicians will mean death.
Training
It will be difficult to acquire hands on training for this procedure unless
you work in the medical field. However, this is a fairly straightforward procedure.
If you see it once, most people should be able to repeat it. One way to see
how it is done is to go to the doctor with a friend or family member who has
an abscess or boil. Another option is to do an online video search for “I&D”.
There are currently a few videos up that give a nice demonstration.
« Economics and Investing: |Main| TEOTWAWKI Medicine and Minor Surgery--Part II: Skin Infections, by Dr. K. »
Letter Re: TEOTWAWKI Medicine and Minor Surgery--Part I: Ingrown Toenails
Jim:
In Part I of his article, Dr. K. mentioned some options on do-it-yourself cautery.
My suggestion is to consider buying new tips [not contaminated
by solder metals and rosin]
and a butane soldering torch for times when no electricity is available. For
example, see:
Pro-120
Tectra Tools
UT-100
TS600
Regards, - Craig W.
« Letter Re: Jared Diamond Predicts the End of Cheap Oil and an 85% Global Population Decline |Main| Note from JWR: »
TEOTWAWKI Medicine and Minor Surgery--Part I: Ingrown Toenails, by Dr. K.
Introduction
Onychocryptosis (ON-ee-ko-krip-TOE-sis), an ingrown toenail, is a very common
problem that usually affects the big toe. This occurs when the corner of the
toenail grows into the soft tissue on the side of the toe. This can cause pain,
redness, inflammation, and even an infection. Signs of an infection are warmth
and drainage of pus. Prevention and treatment of an ingrown toenail is relatively
basic, and it is a valuable skill to have at TEOTWAWKI.
Causes
An ingrown toenail is caused when the nail curves down and grows into the skin
at the nail border. The most common causes of an ingrown toenail are improperly
trimmed toenails and poorly fitting footwear. Other causes include unusually
curved toenails, excessive sweating, trauma, fungal infections which cause
the nail to grow abnormally, cancers, and even obesity.
Complications
If an infection is left untreated, it can spread into the toe bones. This may
lead to amputations, and even death, in rare, worst case scenarios.
Prevention
If you are working outside a lot, which would be most of us in a TEOTWAWKI
scenario, then study boots are recommended; consider steel-toed boots if you
don’t already have them. Regardless of the footwear you use, make
sure that they fit properly! There should not be too much pressure on the top of
your toes, and shoes should not
pinch
your toes together.
Toenails should be kept at a length even with, or just barely shorter than,
the tips of your toes. Too long and toenails can break easily or get jammed
into the toenail base. Too short and the toenails can be pushed down by your
shoes and grow into the soft tissue of the toe. Trim your toenails straight
across or with a slight curve. Do not curve your nails to match your
toes, and do not trim the outer angles of your toenails. Finally, do not pick,
tear,
(or bite!) your toenails; only use a toenail clipper and file.
Non-Surgical Treatments – this treats 70%+ of ingrown toenails
* Wear very comfortable shoes; consider wearing sandals until the ingrown nail
resolves.
* Soak the foot in warm water 3-5 times a day for 15-20 minutes. Add 1 teaspoon
of salt per pint of water.
* Gently push the tissue away from the nail and gently lift the nail up after
each soaking.
* Place small, clean tufts of cotton under the edge of the ingrown nail. This
relieves some pressure and helps the nail grow above the skin edge.
* Rub a topical antibiotic ointment (such as Neosporin) over the ingrown nail.
* Place a soft bandage over the ingrown nail.
* Keep the foot dry.
* Take some acetaminophen (Tylenol) or ibuprofen (Motrin, Advil, etc.) as directed
on the bottle for pain relief.
* If there is no improvement in 2-3 days, then consider the surgical option.
Surgical Treatments: Toenail Removal
Note: If you have had ingrown toenails in the past, there is a good chance
you will have ingrown toenails again. If you have had repeated ingrown toenails,
consider having your nails surgically treated before TSHTF. A surgical option,
regardless of the problem, is always best treated by someone who has been trained
to perform the procedure. You don’t want to be patient number one in
a survival situation. Finally, while I am explaining how to do this procedure,
I only recommend that you attempt this in a post-TEOTWAWKI scenario where there
are no other healthcare options. Proceed at your own risk.
The most effective way to treat an ingrown toenail that has not responded to
non-surgical treatment is lateral nail avulsion with matricectomy. What does
that mean? Let’s break it down. Lateral nail avulsion is digging out
and removing one side of the toenail all the way down to the base. Imagine
the nail is roughly a square. The ingrown part is on the left side for example.
About 1/5 of the nail, the left 1/5, is removed from top to bottom. The remaining
4/5 is left completely intact. Macticectomy is the process of destroying the
matrix, or root, of the nail. By removing one side of the nail, the pressure
is removed because there is no nail pressing on the tissue any more. This also
allows the infection to drain. By destroying the root on that side there is
a very slim chance of the toenail growing back in that area. Over time the
skin will heal and you will be left with a skinnier toenail that is unlikely
to become ingrown again. Now how do you do this?
Supplies
Light (a bright headlamp works well. Consider working outside in the bright
sunlight.)
Non-sterile gloves
Sterile gloves
10-mL syringe
27 to 30-gauge needle
Lidocaine 1% or 2%
Povidone-iodine solution (sold as Betadine at most drug stores)
Gauze pads
Drape (sterile sheet)
Iris scissors (small, 3-4 inch long scissors with fine, sharp points)
Bandage scissors if desired (scissors with one side’s outer edge flattened
for protection)
Nail splitter if desired (heavy duty scissors with very short, thick blades)
Hemostats (small device that resembles scissors but has clamps instead of blades)
a pair of needle nosed pliers (sterilized) can be used in a pinch
Sterile rubber band if desired
Cautery device – read the step-by-step instructions for details
Dressing Materials:
Antibiotic ointment such as Neosporin
Gauze for wrapping the toe
Roll of 1-inch tape
Step-by-Step Instructions
1. Have the patient lie down on a table with their knees bent. Their feet will
be flat on the table. Pull up a chair and put on non-sterile gloves.
2. Clean the entire toe with povidine-iodine.
3. Numb the toe with medicine: If you have lidocaine (1% or 2%) without epinephrine,
keep reading to learn how to perform a digital block, i.e. numbing, of the
big toe.
Note: Make sure the lidocaine does not have epinephrine in it. Epinephrine
is a vasoconstrictor, meaning it clamps down blood vessels. This can prevent
circulation to the toes. If you stop circulation with medicine, you have no
idea how long it will last, and you could kill the tissues in the toe. Your
patient won’t feel you remove their toenail, but in a few weeks their
toe may fall off! Bottom line: Never use epinephrine on the fingers, toes,
ears, penis, or nose.
3A.) Load the lidocaine into the syringe. I have no idea what kind of container
of lidocaine you will have, but the standard container is a small jar with
an injectable, rubber stopper. Remove the cap and clean the stopper with alcohol.
Draw back the syringe to draw in about 8-10 mL (or cc’s) of air. Then
push the needle into the rubber cover. Inject the air into the jar of lidocaine;
this prevents a vacuum from forming after repetitive uses. (If the jar is full,
you may have fill the syringe a bit at a time so the rubber cover doesn’t
pop off when you inject a full syringe of air – I learned this the hard
way!) Invert the jar so the needle tip is completely covered with lidocaine.
Draw back the syringe to the 8-10 mL mark. Remove the needle from the jar.
Point the needle up. Tap the syringe to get the majority of the air bubbles
to the top. Slowly depress the syringe to express the air bubbles from the
syringe. Usually a little of the lidocaine will shoot out. It is not vital
to remove all the air, just as much as you can.
3B.) Find the MTP joint (metatarsophalangeal joint). The first joint next
to the big toenail is the PIP joint (proximal interphalangeal). The second
joint, and usually larger of the two, is the MTP – it connects the toe
to the rest of the foot.
3C.) Find the injection sites. They are about one-eighth inch above the MTP joint
(that is one-quarter inch down the toe, closer to the nail). There are three injection
sites: one directly on top of the toe, one exactly on the right side, and one
exactly on the left side.
3D.) Inject the lidocaine. Always inject a needle perpendicular to
the skin. Puncture the skin with the needle and insert to a depth of about
2 mm
(skin
is about 1.5 mm thick). Pull back on the syringe to make sure you are not in
a blood vessel; if you are, you will see a bunch of bright red blood fill the
syringe (if this happens, withdraw the needle and try again a little to the
side). You will want to inject about 2 mL of lidocaine at each site. This will
sting and burn and then go numb.
3E.) Wait. Wait 5-10 minutes for the block to become effective. If need be,
you can give another 1-2 mLs if your patient is still feeling pain. When the
toe is numb, proceed.
4. Dull the pain with no medicine: If you do not have lidocaine, things are
going to be painful. There are topical numbing medicines available, but these
are not nearly as effective as an injection. Most of them are in the same family
as lidocaine and are mixed with a cream to make application easier. Another
option is to try a topical dental pain reliever such as Orajel or Anbesol (these
are topical benzocaine), but again this will only take the edge off. A final
option, if you have access to it, is ice; cold temperatures can numb a toe
pretty well. An ice water (or snow water) bath is likely the safest way to
numb a toe; but be mindful that a cold, numb toe is also a sign of frostbite.
It’s a careful balance, and I would always err on the side of too much
pain. Pain will go away eventually, but a frostbitten toe may never heal. Keep
in mind, depending on the person and their pain tolerance, your patient may
be able to just grin and bear it.
5. Re-wash the toe with povidine-iodine. Put on sterile gloves. Place a sterile
drape over the foot. A small hole in the drape to pull the toe through will
keep your surgical field clean.
6. Insert the tip of your closed iris scissors under the corner of the nail
on the side it is ingrown. Work the tip down the entire side freeing it from
the tissue of the toe. If there are no pain medications, this will be very
painful. You should now have the entire side unattached.
7. Split the nail into two pieces. Using a nail splitter, bandage scissors,
or iris scissors cut the nail from the free end straight back to the base.
You should now have split the nail into 2 pieces (1/5 is the side with the
ingrown nail; 4/5 is the healthy side). These pieces are still connected at
the root.
8. Apply tourniquet. Some physicians use a sterilized rubber band to wrap around
the toe a few times. This acts as a small tourniquet to reduce blood loss which
makes it easier to see what you are doing. Having done both, I personally like
having a tourniquet in place. Remember to use the tourniquet for the shortest
amount of time possible to avoid permanent damage (less than 10 minutes).
9. Remove the toenail. Grab the ingrown toenail with a hemostat. Attempt to
grab as much as possible with one bite. Pull straight out toward the end of
the toe and to the side at the same time (do not pull up or down or twist).
If the nail breaks, just re-grab the remaining nail and pull in the same motion
as before. No piece of nail should remain. Some other tissues can look like
a nail deeper at the root, but the nail to be removed is hard to the touch
of your hemostat.
10. Destroy the matrix. There are a few ways to do this. The most effective
and the easiest to perform at home is cautery. Cauterize (i.e. burn) the nail
forming matrix (root) in only the area where the nail root was removed. This
is probably
the most delicate part of the whole procedure. The idea is to burn just the
root and not the surrounding tissue – think of the old game Operation.
Cauterize the entire area twice to make sure you didn’t miss a spot.
Since most people will not have an electrocautery machine, a small soldering
iron [with a fresh tip] will work in a pinch (haven’t you read "Patriots" ?).
If you have no electricity, you can consider heating up a thin piece of bare
wire in a flame
to keep it very hot and use small needle nose pliers to hold it. Another method
is to apply a Q-tip soaked in phenol solution to the root. This chemically
cauterizes the matrix. This is not as effective and you have to buy and store
the solution, but it is another option. Again only apply it to the root; it
will kill any tissue it touches.
11. Apply antibiotic ointment over the raw tissue. Apply a bulky gauze wrap,
but do not wrap it too tight. It will throb as sensation returns.
12. Change the dressing, clean with warm water, and apply topical antibiotic
ointment daily. Use acetaminophen or ibuprofen for pain. Avoid strenuous exercise
for at least a week.
13. The empty nail bed will fill in with normal tissue in the next few weeks.
Your patient will be left with a healthy, but skinnier, toenail.
Surgical Complications
1. Not all the nail was removed or not all of the root was destroyed: This
may happen, even to the best of us. The best course of action is to just wait
and see if the nail that grows behaves or not. If it does not, just repeat
the procedure.
2. Infection: The toe will have some initial throbbing, but should start to
improve dramatically in a few days. If your patient is having an increase in
pain, swelling, redness, warmth, or drainage, there is likely an infection.
If this occurs in the first few days, it is likely a bacterial infection from
Staphylococcus aureus. Oral antibiotics are your best choice and are usually
very effective.
Any of the following oral antibiotics (unless there is an allergy) should be
used for 10 days (search past Survivalblog posts for medication procurement):
Adults
Cleocin (clindamycin) 300 mg three times a day
Augmentin (amoxicillin with clavulanate) 875 mg / 125 mg twice a day
Dicloxacillin 500 mg every 6 hours
Keflex (cephalexin) 500 mg every 6 hours
Children
Cleocin (clindamycin) 30-40 mg/kg per day divided in 3-4 doses
Dicloxacillin 25-50 mg/kg per day divided in 4 doses
Keflex (cephalexin) 25-50 mg/kg per day divided in 3-4 doses
If the infection occurs after a week, there is an increased chance it is a
fungal infection. Fungal infections can usually be treated by stopping the
antibiotic ointment and applying a topical anti-fungal cream such as Lotrimin
(Clotrimazole), Nizoral (Ketaconazole), or Naftin (Naftidine hydrochloride).
3. The toe is taking a long time to heal and is dusky in color. Some parts
are turning black. What happened? The tourniquet was kept on too long, the
toe was kept in/on ice for too long, or the cautery was too deep. Don’t
let this happen to you! Don’t keep the tourniquet on for too long. 5-10
minutes should be plenty of time to remove the nail and cauterize – use
a stop watch. Remember to err on the side of too little numbing with ice. Be
gentle with the cautery – this is a shallow procedure. This is not common,
but if this does happen consider oral antibiotics and consider attempting to
remove the blackened tissue. This would be a case where attempting to find
a physician may outweigh the risks of leaving your retreat.
Things to consider
If an ingrown toenail is really severe, has a severe infection, and is affecting
both sides of the nail, it is better to remove the entire nail and not do cauterization.
Remove the nail. Let things drain. Let things grow back. If things are heading
in the same direction, then you can treat it surgically as described above.
It is much safer to operate on a toe that is not infected.
Training
It will be difficult to acquire hands on training for this procedure unless
you work in the medical field. One way to see how it is done is to go with
a friend or family member who is having this procedure. Let them know that
you are interested in health care (that you love the Discovery Health Channel or
something like that) and you would be honored to help them through this event.
Another option is to do an online video search for “toenail removal
surgery”. Keep in mind that every practitioner does things a little different.
For example, some use cautery (this has been proven to be the most effective),
but some still use the chemical phenol. Some use the tools listed above, and
others have their own favorites. There are many ways to skin a cat and to remove
a toenail.
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Emotional Stressors During Societal Collapse by Campcritter
As determined men and women of yesteryear made their way west to make for
a better life, pioneer women often kept journals of their life on the great
prairies or sent letters home to their sisters back East. In those letters
they described the silence as the most unwelcome guest. These brave women
wrote about being left for weeks on end alone, lost in an endless sea of
grass with only the wind for company while the men hunted or went for supplies.
In some cases the quiet was so severe that it became unbearable and the women
developed mental problems. One young mother in 1853 wrote, “Silence
is an evil creature, it stalks you by day, watching, waiting, ever vigilant.
By the dark of the moon it strangles your thoughts and slips away with your
sanity.”
Imagine now, that we are about six weeks into a societal collapse. You are
sure you have prepared yourself fairly well. You’ve made all the plans
and stocked all that needs to be stocked and you feel pretty confident that
you
and yours can weather whatever comes, right? After all, you have given lots
of time and energy to making sure that you have everything that you need. You
have provided for your physical well being, but have you taken the time to
consider what happens to the family’s emotional stability when life as
we know it suddenly takes a turn south?
In all the preparedness information out there, there seems to be an expectation
that ones emotional response to real world stressors are somehow less important
than the physical. Or maybe people are not wanting to deal with that which
is yet unknown and frankly, just too scary for most of us to comprehend. What
happens to the emotional intellect when forced to shoot another human being
for the first time or watch helplessly while a loved one dies of an illness
or a massive wound. How about dealing with feral pigs, dogs and any other typically
domesticated animals? Can you let your children out of your sight to play in
the yard or do you live with constant fear they may become a meal for a once
beloved family pet or the zoo animal that hasn’t eaten in a week? These
are real life situations that need to be discussed along with beans, bullets
and band aids. Even Tom Brown, “The Tracker“, writes of feral dogs
of his youth while living in New Jersey.
Now that the stores are not being stocked you have used up all that was in
the cupboard and freezer and have broken into your stored rice and beans. Everyone
in your household has been about four weeks without McDonald’s, potato
chips, Spaghetti-Os, wine, beer and cigarettes. The family complains of being
gassy and bloated and by now the cravings are so bad that even the neighbors
lawn ornament is beginning to look good. Tempers are just one spark away from
ignition within the family unit. Depression sets in as Sissy hysterically cries, “I’m
never ever going to use a flush toilet ever again!” It becomes apparent
that holding this unit together is going to be a real challenge. Isn’t
it is amazing how a change in diet can trash the family dynamics?
My field of study for the past 25 years has been in Holistic Nutritional Sciences.
This field is centered around the whole body and everything that goes into
it, air, water, plants, the soil plants are grown in and the health of animals
that are used for food. Current research indicates there are definite changes
in body chemistry when one gets off the processed and junk food hamster wheel.
As chemicals, heavy metals and other toxic particles leave the body there is
what has been described as a healing crisis and it can be all too real for
the ones that suffer through it. Think for a moment, you have suddenly been
forced to do without coffee or cigarettes, a real nightmare for some. What
will you feel like in a few days? Your children have been forced to do without
their favorite French fries or soft drinks. What will be their mood in a week
or so? If you have ever been witness to a loved ones kicking of the habit you
will appreciate that it is not always a pleasant happening. These are a few
of the more obvious, lets take a look at some lesser known problems with our
modern situation.
Currently there are about 3,000 substances added to food that are on the FDA’s
generally regarded as safe (GRAS) list but the GRAS can not guarantee that
an additive is 100%
safe for every human because not every human has the same biochemistry.
Food colors seem to be most problematic for young children in that they can
be toxic to the nervous system, kidneys or liver. And don’t get me started
on genetically modified foodstuffs, it makes me screaming mad. I can’t
say anything good about altering the perfection of the natural world. The fact
that this brand new life form was not studied long term and released into the
unsuspecting publics food supply makes me nuts. Were humans really meant
to eat a corn plant with say, a petunia's DNA? Of course, that’s a much
simplified version but I believe there are some things that we just weren’t
meant to ingest. Genetically modified ingredients in infant formula being number
one on my list to scream about. My list to scream about on the subject of GMOs
just scratches the surface here ,but that rant is for another day. ( hint:
get as many open pollinated seeds as you can ASAP. That means yesterday. If
you don’t have a garden get open pollinated vegetable seeds anyway, they
will make great barter in the near future. Most seeds are viable between 2
and 5 years.)
An application of malefic hydrazide is routinely sprayed on potatoes and onions
to keep them from sprouting but did you know that this potentially toxic chemical
is sprayed on tobacco products in the U.S., and some chemicals such as propylene
glycol, glycerin, or sorbitol are not always listed on a label. Aspartame as
in Nutrasweet and Equal has been shown to be a precursor to Alzheimer’s
and Parkinson’s diseases. What happens to the body when it doesn’t
get it’s daily dose of acrylamide (a carcinogenic chemical created when
potatoes and corn chips are baked or fried at high temperatures) or when the
body is deprived of high fructose corn syrup from soft drinks? For some people
they can have the same painful withdrawal symptoms as from coffee, cigarettes
or drugs. I have seen people become depressed, angry, foggy in the head, sluggish
and almost manic when taken off processed foods. Raw foods do an excellent
job of cleaning out lots of toxins that accumulate in our fat. (See Power
Foods by Stephanie Beling, M.D. and Rawsome by Brigitte Mars)
More and more young people are becoming diabetic, something very rare at the
turn of the century. My neighbors eight year old child has to be monitored
for high cholesterol, it’s just shocking! Students are under much more
stress these days than ever before which can result in emotional eating and
behavioral
problems. More cravings with less food available could be overwhelming to children
who aren‘t understanding why they can‘t have a second helping.
Even my own grandchildren are such fussy eaters, what happens when they no
longer have access to their junk foods and are forced to eat “real food”?
And by the way, their idea of what real food ( pull it out of the freezer and
pop it into the microwave) is and my knowledge of whole real food doesn’t
line up. Where as there lies the problem. When at Grams house you need to adapt
or go without. (wink, wink, I have been know to bend just a little, sometimes.)
Also, eating a constant diet of freeze dried storable foods and garden produce
can have an undesirable set of problems all it’s own. Much more water
needs to be taken in or the system seems to get painfully backed up.
What about those pioneer women? They didn’t have GMOs or cell
phones. They certainly didn’t need a good detox diet but many did keep
journals to help insure some sanity. Writing stuff down is almost like talking
to a friend. If our world does the "Patriots" thing,
we all will be pioneers in our own right. Picture a world of teens without
their
cell phones, blackberries, computers, music or anything else that makes them
tick. The withdrawal symptoms from the “NEED” to communicate alone
surely should scare even the hardiest amongst us. Taking care of the emotional
person is very personal and challenging. Learn what you can about the food
you have been eating and the world around your retreat and take charge now.
The mental health you save may be your own!
A note to Grandparents: You are hereby requested to help keep our history alive.
Talk to your Grandchildren about your history, our country’s history
and how we got to this point in the world. Write it down if needed. Teach them
all the skills that they will need in their future. Plant the seed early, grandchildren
seen to respond to grandparents easily. Their world will be inherently different
than the one we lived in. Teaching them how to garden, fix a roof, sew a shirt,
harvest and save seeds, cook a stew, etc., everything that you know. What you
don’t already know how it do, learn it together. They are going to need
all the advantages that we can give them.
Favorites from my library:
Cookin'
with Home Storage
by Vicki Tate (Excellent) [JWR Adds: Tate's book is also one of our favorites.]
Staying Healthy
with Nutrition by Elson M. Haas, M.D. There is a section in this book about
detoxification and fasting. (Excellent) This one is my
all
time favorite, it is so worn. 1,141 pages
Never Be Sick Again by Raymond Francis, M.Sc. He tells why disease happens
and how to avoid it.
Nutrition and Mental Illness by Carl C. Pfeiffer, Ph.D., M.D. Written
in layman language, very interesting, surprising causes of some symptoms.
The Ultimate Nutrition Guide for Women by Leslie Beck, R.D. (Very Good)
She tells women why they have health problems and how to deal with them.
Superpigs and Wondercorn by Dr. Michael W. Fox (About GMOs.)
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My Tale of the Hurricane Rita Evacuation. August, 2005, by Dan G.
I was working in a pawnshop in Aransass Pass Texas, about 20 miles North of
Corpus Christi, Texas. Two days earlier my wife and I watched the destruction
of New
Orleans on National Television, the news coverage was continuing around the clock
as the drama unfolded.
Gasoline had shot up from $1.56 to $2.99 a gallon overnight and of course
I had to fill up that morning to get to my menial low paying job. Late that
afternoon
a rich looking couple driving a huge brand new pickup truck, came into the pawnshop.
They spoke very loudly about how their family members in New Orleans did not
have electricity and were relying on them for help. How they communicated [with
those in New Orleans], I did not know. The pawn shop owner had two used generators
and this couple was
desperate to buy them, even hundreds of miles away from Louisiana, generators
had become scarce. The couple bought both of them, at an extra high price, and
the owner asked how they were going to get them to New Orleans for their family
members to use. “Well” said the man, “we can’t drive
up there because the roads are closed, so we are going to take these to the UPS
office and have them shipped to New Orleans, no matter what it costs.” No
one revealed to this man the flaw in his thinking. My Wife and I had a good laugh
about that when I got home that day.
September 20, 2005.
We were very concerned about Rita’s progress that night, after Katrina
everyone was in near panic.
September 21, 2005
They called the evacuation that morning, we had no money and our car was hardly
running, there was no way it would make it inland several hundred miles, even
if we had money for gas. The storm looked like it was going to make a direct
hit where we lived in Rockport, Texas 30 miles North of Corpus, and right on
the coast. Our financial situation was dire, my Wife had lost her job, and after
an altercation with my manager at the pawnshop, I had quit mine. We were awaiting
an inheritance to come through, but it had not happened yet. The job prospects
in the small tourist town, in the off season, were grim. I thought about just
sitting tight, but the lives of my Wife and kids prompted me into action. With
reluctance and a feeling of failure as a man, I called my Father for help.
Jobs, money and status were the code that my father lived by, even though he
had never held a low wage job in his life. He agreed to help, and reservations
at a hotel in Wimberly Texas were made, before the golden horde set out from
Houston. We would leave in the morning in my father’s truck, heading roughly
two hundred miles inland. Wimberly is located between Austin and San Antonio
Texas. I spent the afternoon of that day boarding up my Father’s house
in the nearly 115 degree heat and humidity. After that was accomplished my Wife
and I needed to pick up a few things in town including a prescription. It was
completely surreal in Rockport late that afternoon. The streets were all but
abandoned, trash fluttered in the wind on the empty sidewalks, most business
were already closed. The schools had closed at noon that day, and the children
sent home. Even the sky had a peculiar orange brown cloud cover that was unnerving.
A hand painted cardboard sign adorned the windows at Super Wal-Mart stating that
the store would be closing at 6pm, less than an hour away. The parking lot contained
a handful of RVs and pick-ups with travel trailers, all of them were loading
up canned goods, bottled water, propane, charcoal, flashlights, batteries and
ammunition. We had about $6 at the local bank, but we also had a $300 overdraft
privilege, the decision was made to exercise it. The ATM machines had been limited
to dispensing only $80 at a time for only 3 transactions, to keep the machines
from running out of cash. The ATM’s were also adorned with crudely made
cardboard signs. We took our $80 out 3 times, with a $25 overdraft charge each
time, that we would owe the bank at a later date. Inside Wal-mart it looked as
if the hurricane had already struck, the store was a mess, and the employees
had a haggard appearance. We picked up the prescription, there were no more batteries
to be had, but I needed a box of .45 ACPs.
People had paid attention to the mayhem that followed hurricane Katrina, this
was evident at the ammunition counter. They were out of shotgun shells, all common
rifle rounds were gone, the same held true for common pistol rounds. All they
had were oddball cartridges, .357 SIG, .45 G.A.P. .17 Remington, .300 Weatherby
Magnum, et cetera. Even the .22 LR were gone. There would be no .45 ACPs for
me, so we headed home. We passed several gas stations, again with crude signs,
stating they had only premium fuel. We got home to get ourselves and our kids
ready to
evacuate in the morning. The television news reported that the hurricane was
gaining
strength, they still had no idea where it would make landfall, and residents
of Houston were “urged” to evacuate now in a few hours it would be “mandatory”.
I felt it was imperative for the members of my family to be equipped with proper
footwear, in case there was trouble and we wound up walking. My 11 year old fashion
aware daughter proved to be a problem, all she had was girly shoes that were
otherwise useless. We scrambled to find her some walking shoes, deep in the closet
we found a pair. Also in the closet we located a forgotten partial box of .45ACPs,
at least my magazines would all be loaded. I vowed to never be caught
without
essentials like walking shoes and ammo again.
We packed light, I backed up my family photos and writings onto a CD-ROM and
packed it, we included socks and a change of clothes for everyone, all of our
important paperwork and identification and full canteens. Into my backpack went
half of our cash, one 1911 Colt .45 Automatic with five magazines on a gun belt,
one large Ontario Razor sharp hunting knife, one Swiss Champ, my medications
including a good supply of aspirin, salt tablets and Dramamine. One compass,
a military poncho, foot powder, boonie hats and a copy of “Conan the Adventurer” By
Robert E. Howard. Everyone also had high energy snacks and a poncho. As we went
to bed that night the TV reported more bad news.
September, 22 2005
This would be the day that I would learn how truly fragile our complex modern
society is, I would also learn that by avoiding groupthink and with a little
forward planning most hazards could be easily bypassed.
After disconnecting the water, electricity and gas to our house my Dad arrived
and we loaded up by 9 a.m. . As I got into the truck my Father handed me a
Texas Roads map book and said, “I have picked out our own evacuation
route.” he
had traveled the roads of Texas his entire life and knew every back road there
was. The penciled in evacuation route would prove to be our saving grace. Many
lives were lost that day because people and bureaucrats could not or would
not read a simple road map; instead they relied on digital gimmickry and an
unswerving belief that the interstate highway system was the only roadway available
to them.
Urgency bordering on panic was wafting on the air, you could feel the tension,
and see the worry on other motorists faces. We headed out on the first of many
Farm to Market (FM) roads crisscrossing the state. Traffic on these back roads
was still heavier than I had ever seen it. Towns we went through appeared deserted
until you reached gas stations that were near riot conditions many were out
of gas. Luckily my father had filled up the previous night, if he hadn’t
we may have very well been stranded in the choking gasping heat that day. We
switched back and forth onto differing FM roads to avoid more and more traffic,
every town was congested, we had long waits at every stop light and four way
crossing. A three hour trip had turned to six hours and counting, we stopped
at small hamburger joint for lunch, it was jam packed, as we ordered we overheard
other folks talking. Rumors were flying about accidents, fires, turmoil and
gridlock on Interstate 10, they still had no idea where Rita was headed. We
got our order and headed back out eating in the truck, the little town was
swamped with cars and people, one person was driving on the sidewalk, there
were no police in sight.
Between towns on the FM roads it was easy going, but as you neared any community
there was chaos, as the afternoon progressed, many a crude sign could be seen
proclaiming “No more gas”, No more food”, this was repeated
again and again. We were coming up on Seguin Texas when traffic came to a halt,
we were about to cross over I-10 the main evacuation route out of Houston.
Out of the truck window along the horizon I could make out several columns
of black smoke. It took over an hour to travel the two miles to the overpass
and then I saw I-10. All the lanes had been re-routed to head west only, It
was like a scene from a movie, as far as I could see there were lines of cars,
both to the east and the west pointed in a single direction. There was no end,
none of them was moving, more columns of smoke could be seen in the distance
what caused them I did not know.
Heat rippled off the metal and in automobile exhaust, the evacuees could not
turn off their engines, if they did there would be no air conditioning and
heat prostration would quickly find them, especially the old and the very young.
Along the roads sides people could be seen walking, I guess they had abandoned
their vehicles in search of a respite from the heat. A fuel truck was also
traveling on the road side, it was not stopping for anyone, and a few police
cruisers traveled the road sides as well, the only vehicles in motion along
that nightmarish interstate.
Late in the afternoon we arrived in Wimberly and checked into the Motel, which
was completely booked and we were the last people with a reservation to arrive.
My father was staying with a friend in Wimberly and he left us his truck. We
headed to the grocery store to lay in our supplies it was crowded but not overrun
yet. We bought three days of food for a family of four and headed back to the
hotel. The storms heading was still uncertain, but at last we enjoyed some
peace and laughter. Later that night we decided to run back into town and get
some ice cream, there was chaos in Wimberly this time. The grocery store we
had been at just hours earlier was stripped bare. They had cleaning supplies
and some make-up but that was about it, there was no more food of any kind
to be had, no drinks, no water and no toilet paper. The streets were packed
stalled cars littered the roadways and every gas station was out of fuel. We
went back to the hotel, grateful that we had bought supplies earlier. We watched
the TV and heard horror stories of what was going on, events that we had witnessed
throughout the day. The night passed without incident.
September, 23 2005
We spent the day relaxing at the hotel late in the afternoon Hurricane Rita
made her turn to the North making the previous two days an exercise in futility.
She struck in the early morning hours on September, 24 between the Texas/Louisiana
border, while we were safely asleep at the hotel. We went home as the storm
moved inland.
Lessons Learned:
I believe that after Katrina officials overreacted to Rita in ordering the
evacuation of Houston, Many died needlessly. This is a danger we still face
today, not just the storms but the hysteria surrounding them.
After our experience we gave up on the coast and moved to Oklahoma, we live
a hundred miles from any major city and we keep stores of food, ammo, water
and medical supplies on hand in case we need them in a hurry. Never
again will we be caught unprepared!
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Herbal Cures at Your Doorstep, by Organic Cathy
"Health care" in America - while having "evolved" - leaves
much to be desired i.e. cost, effectiveness, government restrictions of natural
medicines, deaths caused form "modern" medicine, control and pharmaceutical
greed to name just a few. in the blaring light of reality of today's coming
collapse even simple health care will be challenging to say the lease.
While I am not formally trained in herbal medicine, I do have some medical background
and twenty plus years of growing and using herbs and more recently delving into
wild herbs. TEOTWAWKI will change the availability of "home health care" from
government regulated pharmaceutical based approached to real home health care
where individuals - especially those in remote areas - will need to rely on what
is at hand.
I hesitate to even approach this subject, as it is vast, involved, time consuming
and can be very overwhelming. On the other hand, knowledge of hers is powerful
and very useful in survival situations.
History show that American Indians were knowledgeable in plant medicines, including
a spiritual link. That, backed up by the medicine woman or man with extensive
training passed on from one generation to the next.
The colonists - especially housewives - were responsible for their family's health
and well being. Many medicines were grown in the kitchen gardens. The medicines
that couldn't be grown were purchased at apothecaries that carried items imported
by ship. This entailed a dangerous and lengthy trip to the nearest outpost. When
doctors made house calls he expected basic herbs to be on hand provided by the
household.
When the SHTF many
will be on their own. Medication supplies - any and all - will most likely be
disrupted along with everything else. While I have a small
supply of basic meds (over-the-counter pain/.fever medication, cold, and diarrhea
etc) I've chosen to focus on what I can use from nature in my local area: wild
herbs,
plants,
trees as well as growing my own. As mentioned above limited supply and what I
have on hand will eventually expire or will run out. Also important besides growing
my own medicine is the knowledge of what grows wild in my zone will allow me
to wild harvest a variety of medicinal plants in the event of evacuating my home.
I consider it my mental G.O.O.D. kit.
Knowledge literally weighs nothing on my back but can mean everything in survival
situations.
So, having said all that, What to do? Medicinal plant knowledge IS overwhelming!
But don't let fear take up valuable energy. Start with the basics. There are
a number of excellent resource books out there (a list will follow). Build a
library of your own. Create your own resource book: three ring binder or notebook.
If (as is the case with most of us) money is tight, go to the library and take
out books on home remedies, wild herbs in your areas as well as medicinal plants
(trees, shrubs, berries etc.) and take lots and lots of notes. Search the internet
for free articles, videos, and any other information to be found on medicinal
plants. There is a wealth of information out there. Talk to those knowledgeable
in herbs - most local fairs have booths of homemade herbal products - talk with
these people - have specific questions to ask as usually they are very busy with
ten more people waiting to do the same thing. Do you know family,friends, relatives,
neighbors who grow and/or use their own herbs? Visit nurseries that sell herbs
and speak with staff there, this is what they do for a living.
Join together with friends who share this interest and take turns attending different
workshops. Share the information. This works well in regards to books, CDs,and
so on to keep the cost down. Take a botany class, join the Audubon or Sierra
Clubs, subscribe to herbal magazines, check out your local extension office -
there is a vast amount of resources for little or no cost, look for fliers (
I am notorious for picking up these at fairs, farmers markets, nurseries, health
food stores, agricultural shows and on and on). Newspaper articles, magazines,
television shows, and documentaries are also information sources. The point is
there
is
information
everywhere
if
you
pay attention!
Start your own herb garden. I've grown/started many over the years due to multiple
moves. Last year after unearthing an incredibly beautiful rock pile I transformed
it into an herb center. It is relatively small but individual "pockets" allowed
me to plant all kinds of different herbs! (Side note: many herbs are invasive
so be mindful where and how these are planted - know growing information for
each plant you want to grow). Some herbs can take years to become established
and usable for medicine, so start now.
Nature walks. Begin now educating yourself on what grows in your area; learn
the habitat and growing cycle. Throughout the year I'm constantly looking at
plants that grow in my area - what it looks like in the spring all the way to
maturity and harvesting. Even in the winter as some plants are still visible
above the snow and I take note of its location so that I can return during the
growing season. Understand how these plants grow and spread, so as not to annihilate
its growth cycle when harvesting. Many wild plants are extinct or on the verge
due to over harvesting. Take note of the location of the plants you find and
its abundance. One of the biggest challenges is plant identification! Be
absolutely
certain you know the plant before harvesting!
All inclusive books with good pictures, drawings, uses, preparation etc. is hard
to come by. That is not to say there aren't good ones out there you just may
need more than one reference guide. Again talk with knowledgeable people. I personally
learn better from being shown than reading. When I discover or am shown a new
plant I do extensive research to make sure it is exactly what I think it is.
The Google image search is great in this area because numerous pictures are available
all in one place.
Once you are confident of what a plant looks like, where it grows, how it grows
(wild/cultivated/both), its uses, administration (teas, tinctures, poultices
etc), side effects, interactions with other herbs and/or pharmaceutical medications
and any allergies associated with the plant move on to the next one. (You do
not have memorize this information but have it available for reference either
in your resource book or library.) For example, one of my favorite herbs is Echinacea
(boost your immune system). I have used it for years but last year was the first
time I've tried growing it. Another favorite is chamomile (helps with digestion
and sleep) - easy to grow and use.
This past summer I studied my lawn! There are many "weeds" that grow
naturally and have multiple uses. For example common plantain: rub the leaf on
bug bites to relieve the itch, apply to burns and can be used a a diuretic just
to name a few of its uses. If you are looking for a specific remedy, see if the
plant(s) grow in your area and start looking! Last year my son got into poison
ivy which resulted in quite a rash. A local man was selling an once of sweet
fern for $12.00! It grows naturally in my area. Being a tightwad I researched
what it looked like and its habitat and set out hunting for it. I finally located
it, harvested some, prepared it and it worked wonderfully with no side effects.[JWR
Adds: It goes without saying, but for liability reasons, I must remind
readers that using
your
lawn
as
a
source
for
medicinal
herbs
or
salad greens is an option only if you use no chemical
fertilizers, pesticides,
or weed
killers.]
This can and is time intensive but well worth the effort. The best way to approach
it that I have found is to incorporate it into my daily life. No matter where
I was or what I was doing outside I constantly scoped0ed out the surrounding
plants. At night I would search the internet and/or my books to identify the
plants. The sweet fern for example, and wild blueberries, both of which grow
in the wild locally. Knowing what sweet fern looks like and the type of area
where it grows allowed me to locate it easily which happened to be in the same
vicinity as the blueberries! Can you say multitasking? I also discovered this
winter while reading a "weed" book that one of the "weeds" that
all but consumed my garden, one that we tirelessly ripped up, is a wild edible
plant! Another popular "wee" of our garden turned out to have medicinal
properties.
I by no means have extensive leisure time to devote to medicinal plants. Last
year we had a huge garden with over twenty-five different varieties growing which
I canned, froze, ate and gave away, picked wild and cultivated blueberries, strawberries,
apples, (making jellies, applesauce, and freezing) and what my garden didn't
produce, I purchased form local farmers markets. My significant other built a
sizable three room addition that was completed in about tow and half months.
We picked, cleaned, froze and pickled fiddleheads. I mention this only to help
others be aware of what can be accomplished when you set your mind to it. As
survival focused individuals, we are all busy! Things are going to be busier
as the economic crisis gathers speed and we tirelessly work to prepare. I did
sit down and endlessly study I plug away at it whenever time allows - even during
the winter months. It does not matter how much you know or don't know. Start
where you are at, keep it simple, be consistent (even if it means consistently
inconsistent!). If you learn only one plant a month that is twelve in a year's
time and that is significant! BTW, if you have specific health issues tailor
your
research to plants that address them. Often insurance companies do not allow
you to refill prescriptions before your supply is down to less than a one week
supply.
So
get going, good luck, and God bless!
PS: If you have insurance, now is the time to take care of your ignored health
issues, as it will be much more difficult and expensive after the SHTF.
Starter list of books: (These are just a few suggestions to start with. You
can design your library to fit your needs)
A Field Guide To Medicinal Plants and Herbs - (for your region) from
the Peterson Field Guide Series
Tom Brown's Field Guide - Wilderness Survival by Tom Brown
Back To Eden by Jethro Kloss
The Complete Guide to Herbal Medicines by Charles W. Fetrow and Juan R. Avila
The Herb Book by John B. Lust
A field guide to weeds in your area. [Ask your USDA Agricultural
Extension Office Agent. They often have free reprints and fact sheets on weeds
available]
Herbs you can start with: (The information that follows the herbs is
very brief and general. Be sure to do your own detailed research)
Aloe: Vera -- Easy to grow/maintain houseplant; a must for every household
- burns
Cayenne: powder -- Gel cap or spice bottle; bleeding (internally and externally),
shock
Comfrey -- plant/salve for wounds, cuts, scrapes
Goldenseal -- Supplement/salve, fighting infection
Echinacea purpea (Purple Cone Flower) -- Boosts immune system
Peppermint -- Stomach ailments
White Willow Bark -- Same active ingredient as aspirin
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Letter Re: Advice on Contact Lenses
Mr. Rawles
I've worn contact lenses for all of my adult life. On your published advice,
I've also bought two pair of inexpensive glasses, from LBEeyeware--a
company mentioned in SurvivalBlog That was great advice. ($23 per pair, complete?
You can't beat that!) The glasses are the correct prescription, but after
so many years of wearing contacts, glasses feel downright "clunky" to
me. I worry about breaking them, much more than I ever worried about losing
or tearing
a contact.
My
question is: What should I do about spare contact lenses and solutions? Should
I skip them--and
just
plan to
wear
glasses
when
the "Schumer
Hits the Fan"--or, should I stock up? Thanks for your amazing web site
and great books. I'm taking the 10
Cent Challenge! you can expect my payment in silver dimes, ASAP! - Pat
in Georgia
JWR Replies: Thanks for bringing up a topic that I've meant
to address for quite some time. If you feel more comfortable wearing contacts,
then I see no reason why you shouldn't
stock
up on spare
disposable
soft contacts
and extra bottles
of saline and cleaning solutions. Just one proviso: Do not try
to "stretch" your supply by going longer between discarding sets
of contacts. Getting
an eye infection would be tragic, especially in the midst of a disaster. Once
you've used up your contact lens supplies, just switch to wearing your eyeglasses.
One excellent source for very inexpensive contact lenses and supplies
is 1800CONTACTS.com.
Since they are a SurvivalBlog affiliate
advertiser, we get a little piece
of the action when you place an order, if you use our link to their
site. So this is a good way to both get prepared, and to help support SurvivalBlog.
Thanks!
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Letter Re: Some Preparedness Lessons Learned
James,
The need for usable skills in tough times, goes without need for embellishment.
The grand question is: which skills are the most valuable? In any situation
the basic needs are obvious – food, shelter, and clothing. Choosing what
I would concentrate on learning, became predicated on what I could do, and
what the community could provide in stressful times.
I moved some time ago from the gulf coast to Tennessee to retire and begin
preparing for the coming events. I moved into a community which is pretty much
self sufficient, mostly by religious choice. Livestock husbandry ranges from
cattle (mostly for milk), goats to chickens, hogs and horses.
I began to raise goats several years ago, starting with Boer cross. After several
discussions I have crossed them with a strain of milk goat to reduce the size
(and therefore the quantity of meat to be preserved) and gain the benefit of
milk products. I researched the process of cheese making and using products initially
supplied from New England Cheese Makers, learned the processes. It was very interesting
to discover that the rennin (for assisting in cheese making) actually comes from
the stomach of ruminators, another by product of the goats.
Preserving meats became my next concern. When talking to many folks, they believe
that they will just run out and kill fresh meat when needed. Not only will the
game be decimated in no time, but without a method of preservation it is wasteful.
Preferred methods around here are smoking, honey and salt boxes for curing and
preserving. The use of honey as a preservative turns out to be one of the very
best. Honey has a natural bacteria inhibitor, and curing smoked meats in honey
just makes life better. This in turn has determined the need for bees – My
neighbor already has a couple of hives which produces enough for now. The use
of honey reduces the dependence on obtaining sources of salt. In addition they
are many maple trees in the area which folks tap during the winter and early
spring. Many families have ponds a raise fish, which are canned by cold packing
or salting and drying.
Having fresh water is a paramount concern. Even with a spring the water quality
can change with the amount of rain causing algae blooms. These can range for
digestive distress to just foul taste. The stream water cannot be used without
treatment, as we have otters, beavers, coyote, foxes, and a whole range of other
critters, so amoeba type problems are probable. Boiling water is the surest,
but is often not the most practical. Any numbers of excellent water filters are
available, but the Big Berky is the most popular here. In any case the water
has to be pre-filtered to remove organic matter. This can be done by straining
through
a clean cloth, then passing through/over a disinfecting agent such as a silver
compound, or the addition of non-detergent bleach. The next best is a cistern
collecting rain fall, but even this can have issues as it tends to clean smoke
dust and pollen from the air on its way down.
As for the vegetable gardens the goats do help with the fertilizer which is composted
and added to the garden. The area I live in is pretty much a “rock farm” so
there is a constant need to remove the rocks from the garden areas and add in
soil from the hills behind us. This soil is usually pretty acidic with all of
the hardwood trees. Most folks use lime from the feed stores – haven’t
found a good substitute yet.
Clothing is one of the details that I have struggled with. The ability to produce
cloth is beyond most of us. Wool makes for great outer wear, but lousy underwear.
Goat hair can be made into quite durable garments, somewhat at the expense of
comfort. We have chose to use GI surplus wool socks, sweaters, BDUs
(because they are very durable) and purchase and store long and regular underwear.
We
do have a real cobbler in the community that does make very nice shoes/boots,
but I still have a back up pair. Many women here weave or quilt (using discarded
clothing as well as new cloth). I do keep some “unisex” clothing
on hand for whomever – mostly in the form of overalls. They are fairly
cheap and commonly worn in the area, and during the cold weather are an additional
layer. We have had most days at or below freezing and night down to zero. I have
looked into tanning leather – it is a noxious process and can be done.
I am choosing to have the hides tanned while I still can and store them against
the future need as clothing.
Our cabin is solid cedar timbers, and smells great! The downside is that there
is a constant need to stay on top of the chinking and calking, to reduce drafts – I’ve
used 22 tubes already this winter. We thought that pellet stove would be a great
idea – wrong. First it requires electricity. With the
power out you have to fire up the generator which is noisy and uses expensive
fuel. Second the stove
can burn corn or compressed hardwood pellets. Corn is food or the animals and
us, and tough enough to grow enough as is. Besides using the corn leaves the
odor of burned popcorn as exhaust. Compressed wood pellets are used on an average
of 80# per day at a cost of ~$9.00 / day. Pulling the stove this spring and going
to a straight quality wood burning stove that can be used to cook on. To back
up a wood burning stove an axe, buck saw, splitting wedges or a maul, and or
chain saw are required based on how much free time you can devote to it. Setting
aside wood requires a year round effort to keep from killing yourself. Although
we have electricity I do have a pitcher pump ready to install in the event it
is needed. And have simple kerosene lanterns for light. I prefer the straight
wick models, as the mantels have become very had to come by recently.
Health concerns in rural living also means, that you have to have a working knowledge
of first aid and basic medicine. The Red Cross has good courses on first aid
and the older Boy Scout manuals give an acceptable knowledge as well. Around
here there is a good deal of herbal medicine practiced. This is good for preventive
and minor issues. I have chosen to invest in some older college texts on anatomy,
physiology, and pharmacology, and a physician’s desk reference. These books
help in diagnosing, but will be of minimal help if/when the main line drugs are
not available. They are great for showing how to stitch and bandage wounds more
severe than the first aid books cover. We keep a well stocked medicine chest
with off the shelf medicines, and rotate them as needed. As we find local remedies
that are effective, we also include them (i.e. willow bark tea as a substitute
for aspirin).
I have learned rudimentary blacksmith skills, and collected some of the tools
as well as books on the subject. I can fashion horseshoes, wheel rims, forge
weld, make cut nails and a few other tasks as required. There are many better
skilled in this community and it will be more time efficient to trade/buy their
services.
I have a full time gunsmithing business which has been sorely needed in this
area – seems like everyone has one that they need fixed. So much for a
retirement business….
The acquisition of books, and how to reading material can spell the difference
between existence and some degree of comfort. In addition it is my considered
opinion the education of young people is severely unbalanced. The possession
of text books, classics, and recreational reading allows one to educate children
when contact is limited. The community has a long history of home schooling.
These kids routinely pass the high school exit exams (same tests as the state
requires for graduation) with higher scores, and at an earlier age. Most parents
seek out folks whom are well versed to teach the children. Oh yea, one by product
is that the kids are very respectful, and thoughtful.
In conclusion I thought that preparation for tougher times meant more beans,
bullets, and bullion. As it turns out, the retraining of my mind and attitudes
has presented the larger challenge. Understanding how you store food, is nearly
as important as what you store. What you can make is as important as what you
can do without (toilet paper?) Knowing that one person cannot do all that is
required, only means that you learn the skills to assist your community which
will supplement everyone’s survival/ quality of life. I thought that being
retired would allow me to kick back and enjoy some good libations. It has turned
out to be the greatest learning curve of my life – and I love it. Jim’s
preparedness course is a great place to start. But the real preparedness is in
the doing! - Dennis S.
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Did the American Indians Have it Right?, by MMJ
In these trying times when civilizations are at the brink of disaster and
many people are already in personal collapse, we should look back through history
to find out how to salvage what we have and how to survive what is to come. [Minor
rant snipped.] It seems that economic collapse is imminent and that at some
point in the near future it is going to be every man for
himself. As we watch countries collapse, global economies fail and people
across the world starve and die, I ask myself has any culture or civilization
in history gotten it right?
The nomadic hunter-gatherer lifestyle led by the American Indians may be the
way that many in the future may need to survive. The thought of a
survival retreat is nice, but what if a toxic gas cloud is coming your way?
Or a band of starving armed men and women discover your location and decide
that you have what they want? Are you equipped for a small arms battle? Lets
face it, most of us are not. Many of us still need to live in an urban environment
to make a living (while we still have the need) and having a stocked retreat
is just not feasible. When the sh*t hits the fan you have to ask yourself,
will you have enough time or even be able to get to your survival retreat?
For most of us the answer is simply no. So how can we prepare
for the impending collapse that most certainly awaits all of us? Thinking like
an Indian may
be the answer to your concerns. Mobility can be the key to survival. Having
a plan of escape for several different scenarios and banding together with
other like-minded people and loved ones who have also planned ahead to deal
with the inevitable collapse of our society. Going where you can survive for
short periods of time comfortably and being able to use the natural resources
available to you wherever you may end up, can be the answer to survival for
you and your loved ones.
The Indians moved with the food, with the climate in small tribes, which was
best suited to their survival. They learned to use what was provided by nature
to live, wild edibles and medicinal uses of plants, as well as some amount
of farming and of course hunting. But they also learned to take only what they
needed so that when they were to return they would have what they needed again.
This is a lesson that most of us in modern society have long since forgotten.
We have for so long here in America lived the life of gluttony (which has probably
led to collapse of more societies than we realize) that when the end comes
most of us will not know what to do or how to survive, which will not end pleasantly
for those of us stuck in the urban areas. Those of us who plan ahead and have
the ability to survive on the go while getting out of the way of the sh*t storm
that will be left behind in most urban areas after the end comes. We will be
the ones that will thrive in the face of adversity. We will be the ones left
to create a better way--a way that works.
As I contemplate the future happenings I know with utmost certainty that the
plan that I have derived will keep my loved ones and me safe and out of harm's
way. For I have thought and planned like an Indian would, made preparations
to survive on the go with a minimal amount of supplies but with the knowledge
required to get what I need from what nature has to offer. But you may ask
what if nature is damaged beyond repair, then how will you survive? Well my
answer is simple, at that point nobody will survive and mankind will cease
to exist. A gloomy thought but still one worthy of contemplation.
The reality
is there is no right or wrong answer or single philosophy that is the definite
end all to be all correct way to do it for any situation. Survival is fluid
and every situation has to be dealt with accordingly. Creativity as well as
preparation will see you through. Remember that nature taught the Indians
how to survive, they didn’t have books, schools, survival manuals or
hospitals etc… and they did just fine until the European man came with
their gluttony and took from them what was theirs, to exploit it for their
gain
and greed.
As I end my letter, I leave you with this:
“Prepare yourself with the knowledge that you hope you never
have to use, and you and yours will be just fine.” - MMJ
JWR
Adds: I will append MMJ's article with the caveat that based on
studies
of skeletal remains, the average life expectancy for pre-Columbian
Native Americans was only 18.6 years. That was
before white men brought with them European diseases. As Hobbes
put it so succinctly: "...the life of man, solitary, poor, nasty, brutish,
and
short."
A pampered sedentary lifestyle may be bad for one's cholesterol numbers,
but a hunter-gatherer nomadic lifestyles is no picnic.
At this juncture, for the sake of balance I'll also re-post something that
I originally posted to SurvivalBlog back in September of 2005:
You should discard any fantasies that you might have had about strapping
on a backpack and disappearing into nearby National Forest to “live
off the land.” IMHO,
that is an invitation to disaster. Too many things can go wrong: You will
lack
sufficient
shelter. You will not be able to carry enough food reserves. Your one rifle
and your one pistol, and your one axe, once lost or broken
will leave you vulnerable and unable to provide for your sustenance or self
defense. Any
illness or injury
could be life threatening. Even just a dunking in a stream in mid-winter
could cost you your life. Also, consider how many thousands of urbanites
will probably
try to do the same thing. Even if you manage to avoid encounters with them,
those legions of people foraging simultaneously will quickly deplete the
available wild game in many regions. Furthermore, on your own you won’t
be able to maintain sufficient security. (You must sleep, after all!) For
countless
reasons, playing “Batman in the Boondocks” just won’t work.
So forget about the "one pack" solution, other than as a last resort--for
example, in the event that your retreat is overrun.
Any of you that do not live at your intended retreat location year
round should
have a “Get out of Dodge” (G.O.O.D.)
pack ready at all times. Keep it in the trunk of your car in case circumstances
force you to hike all or part of the way to your retreat. (A sub-optimal
situation, as described in my novel "Patriots".)
Be sure to inspect your G.O.O.D. pack regularly and rotate any first aid
supplies, chemical light sticks, jerky, dried fruit, or other perishables.
While MMJ's planned approach of traveling in a group is preferable to a solo “Batman
in the Boondocks”, I still have my doubts about its viability, especially
in harsh climates.
« Letter Re: Real World Observations on Fighting Crime and Criminals |Main| Note from JWR: »
Depression Proof Jobs for a 20 Year Depression - Part 2: Developing a Home-Based Business
Yesterday, in Part1, I discussed the "safe" and counter-cyclical occupations
for the unfolding economic depression. Today, I'd like to talk about one specific
approach:
self-employment
with a home-based business.
I posted most the following back in late 2005, but there are some important
points that are worth repeating:
The majority of SurvivalBlog readers that I talk with tell
me that they live in cities or suburbs, but they would like to live full
time at a retreat in a rural area. Their complaint is almost always the same: "...but
I'm not self-employed. I can't afford to live in the country because I can't
find work there, and the nature of my work doesn't allow telecommuting." They
feel stuck.
Over the years I've seen lots of people "pull the plug" and
move to the boonies with the hope that they'll find local work once
they get there. That usually doesn't work. Folks soon find that the most
rural jobs typically pay little more than minimum wage and they are often
informally
reserved for folks that were born and raised in the area. (Newcomers from
the big city certainly don't have hiring priority!)
My suggestion is to start a second income stream, with a
home-based business. Once you have that business started, then
start another one. There are numerous advantages to this
approach, namely:
You can get out of debt
You can generally build the businesses up gradually, so
that you don't need to quit your current occupation immediately
By working at home you will have the time to home school your children and
they will learn about how to operate a business.
You can live at your retreat full time. This will contribute to your self-sufficiency,
since you will be there to tend to your garden, fruit/nut trees, and livestock.
If one of your home-based businesses fails, then you can fall back on the
other.
Ideally, for someone that is preparedness-minded, a home-based business should
be something that is virtually recession proof, or possibly even depression
proof. Ask yourself: What are you good at? What knowledge or skills
do you have that you can utilize. Next, consider which businesses will flourish
during bad times. Some good examples might include:
Mail order/Internet sales/eBay Auctioning of preparedness-related products.
Locksmithing
Gunsmithing
Medical Transcription
Accounting
Repair/refurbishment businesses
Freelance writing
Blogging (with paid advertising) If you have knowledge about a niche industry
and there is currently no authoritative blog on the subject, then start your
own!
Mail order/Internet sales of entertainment items. (When times get bad, people
still set aside a sizable percentage of their income for "escape" from
their troubles. For example, video rental shops have done remarkably well
during recessions.)
Burglar Alarm Installation
Other home-based businesses that seem to do well only in
good economic times include:
Recruiting/Temporary Placement
Fine arts, crafts, and jewelry. Creating and marketing your own designs--not "assembly" for
some scammer. (See below.)
Mail order/Internet sales/eBay Auctions of luxury items, collectibles, or
other "discretionary spending" items
Personalized stationary and greeting cards (Freelance artwork)
Calligraphy
Web Design
Beware the scammers! The fine folks at www.scambusters.org have
compiled a "Top 10" list of common work-at-home and home based business scams
to beware of:
10. Craft Assembly
This scam encourages you to assemble toys, dolls, or other craft projects
at home with the promise of high per-piece rates. All you have to do is
pay
a fee up-front for the starter kit... which includes instructions and parts.
Sounds good? Well, once you finish assembling your first batch of crafts,
you'll be told by the company that they "don't meet our specifications."
In fact, even if you were a robot and did it perfectly, it would be impossible
for you to meet their specifications. The scammer company is making money selling
the starter kits -- not selling the assembled product. So, you're left with
a set of assembled crafts... and no one to sell them to.
9. Medical Billing
In this scam, you pay $300-$900 for everything (supposedly) you need to start
your own medical billing service at home. You're promised state-of-the-art
medical billing software, as well as a list of potential clients in your
area.
What you're not told is that most medical clinics process their own bills,
or outsource the processing to firms, not individuals. Your software may
not meet their specifications, and often the lists of "potential clients" are
outdated or just plain wrong.
As usual, trying to get a refund from the medical billing company is like trying
to get blood from a stone.
8. Email Processing
This is a twist on the classic "envelope stuffing scam" (see #1 below).
For a low price ($50?) you can become a "highly-paid" email processor
working "from the comfort of your own home."
Now... what do you suppose an email processor does? If you have visions of
forwarding or editing emails, forget it. What you get for your money are instructions
on spamming the same ad you responded to in newsgroups and Web forums!
Think about it -- they offer to pay you $25 per e-mail processed -- would any
legitimate company pay that?
7. "A List of Companies Looking for Homeworkers!"
In this one, you pay a small fee for a list of companies looking for homeworkers
just like you.
The only problem is that the list is usually a generic list of companies, companies
that don't take homeworkers, or companies that may have accepted homeworkers
long, long ago. Don't expect to get your money back with this one.
6. "Just Call This 1-900 Number For More Information..."
No need to spend too much time (or money) on this one. 1-900 numbers cost money
to call, and that's how the scammers make their profit. Save your money --
don't call a 1-900 number for more information about a supposed work-at-home
job.
5. Typing At Home
If you use the Internet a lot, then odds are that you're probably a good
typist. How better to capitalize on it than making money by typing at home?
Here's
how it works: After sending the fee to the scammer for "more information," you
receive a disk and printed information that tells you to place home typist
ads and sell copies of the disk to the suckers who reply to you. Like #8,
this scam tries to turn you into a scammer!
4. "Turn Your Computer Into a Money-Making Machine!"
Well, this one's at least half-true. To be completely true, it should read: "Turn
your computer into a money-making machine... for spammers!"
This is much the same spam as #5, above. Once you pay your money, you'll
be sent instructions on how to place ads and pull in suckers to "turn
their computers into money-making machines."
3. Multi-Level Marketing (MLM)
If you've heard of network marketing (like Amway), then you know that there
are legitimate MLM businesses based on agents selling products or services.
One big problem with MLMs, though, is when the pyramid and the ladder-climbing
become more important than selling the actual product or service. If the
MLM business opportunity is all about finding new recruits rather than selling
products or services, beware: The Federal Trade Commission may consider it
to be a pyramid scheme... and not only can you lose all your money, but you
can be charged with fraud, too!
We saw an interesting MLM scam recently: one MLM company advertised the
product they were selling as FREE. The fine print, however, states that
it is "free
in the sense that you could be earning commissions and bonuses in excess of
the cost of your monthly purchase of" the product. Does that sound like
free to you?
2. Chain Letters/Emails ("Make Money Fast")
If you've been on the Internet for any length of time, you've probably received
or at least seen these chain emails. They promise that all you have to
do is send the email along plus some money by mail to the top names on
the list,
then add your name to the bottom... and one day you'll be a millionaire.
Actually, the only thing you might be one day is prosecuted for fraud.
This is a classic pyramid scheme, and most times the names in the chain
emails
are manipulated to make sure only the people at the top of the list (the
true scammers) make any money. This scam should be called "Lose Money
Fast" -- and it's illegal.
1. Envelope Stuffing
This is the classic work-at-home scam. It's been around since the U.S. Depression
of the 1920s and 1930s, and it's moved onto the Internet like a cockroach
you just can't eliminate. There are several variations, but here's a sample:
Much like #5 and #4 above, you are promised to be paid $1-2 for every envelope
you stuff. All you have to do is send money and you're guaranteed "up
to 1,000 envelopes a week that you can stuff... with postage and address
already affixed!" When you send your money, you get a short manual
with flyer templates you're supposed to put up around town, advertising
yet another
harebrained work-from-home scheme. And the pre-addressed, pre-paid envelopes?
Well, when people see those flyers, all they have to do is send you $2.00
in a pre-addressed, pre-paid envelope. Then you stuff that envelope with
another flyer and send it to them. Ingenious perhaps... but certainly illegal
and unethical.
From all that I've heard, most franchises and multi-level marketing schemes
are not profitable unless you pick a great product or service, and you
already have a strong background in sales. Beware of any franchise where you
wouldn't have a protected territory. My general advice is this: You will probably
be better off starting your own business,
making, retailing, or consulting about something where you can leverage
your existing knowledge and/or experience.
---
In closing, I'd like to reemphasize that home security and locksmithing are
likely to provide steady and profitable employment for the next few years,
since hard
economic times are likely to trigger a substantial crime wave. After
all, someone has
to keep watch on the tens of thousands of foreclosed, vacant houses. (If not
watched, then crack cocaine addicts, Chicago syndicate politicians, or other
undesirables might move in!)
« Letter Re: Kids and Home Security |Main| Note from JWR: »
Perspectives on Prepping on a Very Low Income, by Kuraly
I was raised in a missionary family, on nine different mission fields around
the world. At the age of nineteen, I went out to serve the Lord on my own in
the former Soviet Union. I had no formal Theological training, but was accepted
by the missionary societies of my denomination because of my experience under
my father and my willingness to go to dangerous areas.
I married, and my wife and I have now six children. A few years ago, due to
some changes in my theology, I fell out of favor with my denomination and had
to return home to the USA. I was faced with a situation of suddenly having
to feed and care for a large family with: 1. no formal education/training/skills
of any kind and 2. very little understanding of the southern American culture
that I found myself living in. I was forced to take very low-paying jobs and
survive on a low-income.
With our savings we were able to buy a small rural house and 7.5 acres in the
southeast. We were able to pay cash, I wanted it to be ours with no strings
attached, regardless of what the future held. I figured that at the very least
we would have a roof and some plantable land. I bought in the area my parents
lived in to help care for them as they progressed in years.
Our income is very limited. I work at just above minimum wage. I work a full-time
job and another part-time job. I am thankful that the Lord provides.
As I studied current events I became concerned about the possibility of a world-wide
economic and/or societal collapse of some kind, or a societal break-down here
in the USA resulting from any number of possible reasons. I had witnessed the
chaos of the nineties in the former Soviet Union, had watched doctors and physicists
sweep streets and live off of potatoes and bread for months on end, and I was
concerned about my responsibility to feed my family should a similar collapse
happen here.
What can you do when you have very limited means? Actually there is much you
can do. It amounts to setting goals and getting your family on board with you.
The first thing I did was (after my wife and I had many long talks and she
began to see things in a similar way), I gathered the family around and explained
everything to them. I explained about our limited means, exactly how much money
was coming in, how much went to utilities, fuel, etc. I explained what I believed
the dangers were. I explained what we needed to do as a family. Let me interject
here that after being born and growing up on a third-world mission field, they
were far from spoiled children! They were accustomed to living in tight quarters,
washing in cold water, eating cheap, and basically just "roughing it."
My first priority was for two weeks worth of provisions. We began to buy a
few extra cans of food when we went shopping. I set a goal of 20 dollars per
week for prepping. Some weeks ten dollars of canned goods and/or dried foods
like rice, beans or noodles, and ten dollars in ammo or medical supplies. Some
weeks just food, some weeks just extra gasoline. We bought gas cans at thrift
stores and garage sales for a dollar apiece, Large scented candles (better
than nothing) at closeout sales and garage sales for 30 and 50 cents, and just
about anything we could scrounge that might come in handy if the lights went
out. It did not take us long to build up enough supplies to last two weeks
in an emergency. We had enough gasoline to drive to work for two weeks (if
needed), enough food for our family plus a little extra, and candles, radios,
batteries and other odds and ends to get by.
I had also along the way added
to my ammunition stocks for my Winchester .30-30, and my bolt-action .22 LR.
After we reached the point where we felt we had enough for a two-week catastrophe,
we began to focus on the six-month time frame. This opened up many entirely
new possibilities. since the food required for this amount of time was such
a major expense, we had to make sure that it would last for several years.
This raised the issue of long-term storage in buckets, mylar bags and oxygen-absorbers.
We had to save for months to buy an order of oxygen-absorbers and mylar bags
on e-bay! We found low-cost buckets and began to fill them with rice, feed
corn, corn meal, noodles, beans etc. Anything that was inexpensive. We taught
the children to like corn-meal mush and grits since they might get quite a
bit of it one day!
Gradually we worked our way up to 30 buckets. At this point I made a strategic
decision. I decided that we needed to invest our extra funds in gardening.
Not entirely stopping the food storage, but reducing it in favor of procuring
means and experience in growing and canning our own food. We began to buy canning
jars and lids to put away in the attic for the future. My father gave us a
tiller with a blown engine which we were able to get fixed, and we began to
garden. The first garden was not very well thought-out. Some things grew, some
did not. But we learned. We learned first-hand what pollination means and about
soil fertility. We learned about bugs and blight. We gained valuable experience.
We also invested in chickens, and watched some of them die, some of them be
eaten by neighbor's dogs, some get eaten by our dogs, and the hardy survivors
begin to lay eggs. We watched them eat their own eggs and learned to give them
calcium. We let half of them free range and half range in portable pens that
we built which have an open floor that we could move each day to fresh grass.
We learned how to make them roost and lay where they were supposed to.
We bought some rabbits and learned a lot, real fast! We experimented with many
types of portable cages for rabbits which would allow us to move them from
one grassy spot to another without giving them time to dig a burrow. Sometimes
we would wake up and find rabbit carcases torn to shreds, because a neighborhood
cat had gotten to them. My kids handled most of this, and they learned things
the hard way.
If you haven't figured it out yet, We were totally green. I spent my life traveling
and overseeing the translation of Christian literature into foreign languages.
My wife is a musician. We had zero experience at any of this, and no one around
that we knew to advise us. We had to learn everything from scratch. We bought
a goat and promptly saw it attacked and killed by a stray dog. That hurt,
financially as well as emotionally. After sending the dog to join the
goat "on the other side", I bought another goat. and then another.
These have survived. We have learned to care for them.
Gradually I am seeing my children grow confident in their relationship to the
animals under their care. Gradually we are learning the needs of these animals
and how to make them produce for us. If we had had some kind of hands-on training,
it would have saved the lives of a lot of animals, but we didn't. I am happy
to announce a much higher survival rate for animals that we bring home now.
I felt like I needed a greater firearms capability (what man doesn't?). I thought
long and hard. At first I bought a Mosin-Nagant since they were so cheap ($75)
and the ammo was dirt-cheap as well. I then began to consider what type of
semi-automatic I could afford. I looked at the prices of ammo which was very
critical since I would have to train my entire family to shoot. At the time
the best deal for us appeared to be the SKS rifle.
It was cheap (a good quality Yugo[slavian SKS] was less than $200), dependable,
semi-auto and the ammo was
very cheap at the time. I later added a cheap 12 gauge pump, and last but not
least,
a
17 round Bersa Thunder 9mm. After purchasing these guns I began to pick up
ammo for them when I could find it on sale. I have gradually gotten up to about
500 rounds for each of them.
I then turned my attention to our home and it's defense. While we live in the
country, we are close to our neighbors 100 yards +/-, about five miles from
a small town, about 15 miles from a large town, and about 90 miles from Atlanta
(upwind fortunately). My greatest concern is our proximity to the road. The
house is only about 65 feet from the dirt road in front of our house. A looter
or burglar/rapist could be at the door or windows before the dog barked. In
response to this my next expenditure is to be fence posts, fencing, and barbed
wire, along with a row of thorny bushes in front of the wire next to the road.
Our house is a soft target, offering no ballistic protection. My remedy/forlorn
hope is to have plenty of sand and gravel on hand, and to start checking the
thrift stores for pillow cases to buy and store. perhaps we would have time
to bag up sand bags and at least harden up certain corners or rooms of the
house. We also have several large piles of sandstone (we live on top of a mountain)
which could be placed strategically and then perhaps sand bags on top of that.
We could also cut logs and add that to the mix.
Our water supply is a [grid-powered] electric well. This is one of my biggest
worries. We have made it a priority to buy a generator at least strong enough
to run
the
well and freezers for an hour or two a day. I know that this is only a temporary
solution but is about all we can handle right now. I am very thankful for the
non-fiction writing contribution about the siphon pumps for wells such as mine,
that offered up new possibilities which I have not had time to address yet.
We also have a neighbor 1/4 mile away which has an artesian spring on his property,
though it has extremely high iron content. I have purchased two 330 gallon
plastic livestock watering tanks and several drums which I can fill at the
first sign of trouble. I can also load them on my little trailer and pull them
down to the neighbor's to fill up from his well. I just need to check on the
ramifications of the high iron content.
I am also trying to fill up as many containers as possible with gasoline. I
add Sta-Bil and plan to use/rotate it yearly (as long as the price stays low).
I would like to keep at least 250 to 500 gallons on hand at all times. I buy
old gas cans at yard sales and just found a source for cheap 55 gallon drums
with sealed lids ($3). I may start using them instead.
Our immediate plans are to build more pens and raise more chickens and goats,
maybe a pig or two. We also look forward to planting a much bigger garden this
spring and maybe use some of our hard-won experience of last year. We also
want to involve the kids in martial arts classes if we can afford it, as well
as herb-collecting hikes from the local community college field school (which
are free and fun). We want to spend more time with them in the woods and in
the garden so that they feel comfortable there and begin to think about survival
from their own perspective. We also are beginning to exploit the library for
free resources for them to study on various topics.
The future of this country looks grim. As Christians we have "read the
back of the Book" and we know Who wins. Our responsibility is to be good
stewards of the talents we have, perform our duties as husbands and wives,
mothers and fathers, and ultimately, to trust Him for that which is beyond
our vision and power.
« Three Letters Re: The Risk to Reward Ratio in Getting Concealed Carry Permits |Main| Note from JWR: »
Preparing Your Feet for TEOTWAWKI, by The Surgeon
This essay will cover several common foot problems which can be prevented with
proper care. These problems can lead to impaired walking, running, and decreased
mobility, which may adversely affect survival in a serious post disaster situation.
The foundation for this information is basic knowledge gleaned from the 1930s
edition Scout Handbook, which relied heavily on Lord Baden Powell’s experience
in the British Army.The author is a Board-Certified Surgeon.
The feet have a hard job to do. They support the weight of the body standing,
walking, running, and jumping. Any time there is excess body weight, the added
load on the feet can result in problems. These include plantar fasciitis and
ankle sprains. There is a much higher incidence of Type II Diabetes in the obese,
and this leads to a host of foot problems, many of which can be life-threatening.
Ingrown toenails are a common preventable problem. There is a congenital predisposition
based on the geometry of the nail, and this is made into a problem by the bad
habit of keeping the nails too short and ripping the nail off instead of trimming
or filing it straight across. This leads to a spicule of nail which points into
the soft and delicate tissue of the nail fold, where it causes irritation, inflammation,
and finally chronic infection and pain.
The preventive treatment is to keep the nail as thin as possible by filing
the surface, which makes it flexible instead of rigid, and to avoid any ripping
of
the nail. The nail should be gently filed or trimmed straight across, with only
enough rounding of the sides to prevent digging into the skin. A small tuft of
cotton can be wedged between the nail and the nail bed if needed to prevent digging
in until the nail grows long enough. [JWR Adds: I concur that
a relatively "square" cut is best, as has been encouraged by military organizations
since
before the
1850s. However,
readers are forewarned that changing the profile of toenails radically can cause in-growth,
so make any changes gradually!]
Sometimes cutting a “V” notch
in the center of the leading edge can relieve the pressure on the sides until
it grows out.
There are proprietary systems which involve gluing a rigid polymer or metallic
strip across the nail to pull up on the sides. In theory this should work.
It is difficult to get any adhesive to work on nails, but they are worth a
try.
If things have gotten too far out of hand, and a spicule of nail is growing
into the nail fold, then a thin portion of nail will need to be removed by
a surgeon
or podiatrist.
This can be done as an office procedure with local anesthesia. The procedure
itself is not very hard but I have found that getting good anesthesia requires
some skill and patience and I would not recommend it as a “do-it-yourself” project.
The nail matrix needs to be destroyed either by cautery or by a caustic agent
to prevent re-growth on the affected side. Recovering from this to achieve
normal walking takes several weeks.
Parents and partners need to look out for each other and their children since
this can become a serious problem. Education about proper foot care starts
early along with toothbrushing.
Immersion foot or trench foot is caused by chronic exposure to water and extreme
environmental condition, either hot and humid or cold. The best prevention
is avoidance of immersion, and if this should occur, dry socks need to be put
on
after drying and powdering the feet. It is helpful to have spare boots. The
time to break these in and waterproof them is now.
Ankle sprains can be extremely debilitating. Wearing well-fitted ankle high
boots, laced securely, best prevents this. There is a great product available
wherever
animal health supplies are sold called Vet rap made by 3M. It is flexible elastic
wrap that is self-adherent. It provides excellent support for those who have
previously injured their ankles, and it makes an all-purpose first aid dressing
material, which can help hold a pressure dressing in place, or keep a splint
immobile. If you would like to pay more, the human version is called Coban.
I would recommend the 4” size.
Diabetics need to take special care of their feet. In a survival situation
it is extremely unlikely that you will be able to get the specialized care
needed
to treat a diabetic foot infection, so prevention is key. Because of the peripheral
neuropathy which many diabetics develop, the feet may lose sensation. It is
very important to frequently inspect the feet for any injury, nails rubbing
on the
skin, pressure sores, etc. This is best done with a partner so all parts of
the foot can be seen. Nails need to be cared for meticulously. Cotton tufts
can be
placed between the toes. Shoes must be “shaken out” frequently
to make sure that no pebbles or debris get inside. Well-fitting high boots
are less
likely to get debris inside than sneakers or low-cut footwear.
Smoking can lead to severe peripheral vascular disease with loss of arterial
supply to the toes and feet. In a normal situation it can lead to gangrene
and amputation. Combined with diabetes it can result in more severe atherosclerotic
changes in the blood vessels. It can also make the smoker more susceptible
to
frostbite.
Who can help you meet these challenges? Most experienced outdoorsmen and soldiers
have learned the hard away about these issues. Next to making sure the troops
get enough water to drink, foot care comes a close second. It might be a good
idea to link up with a healthcare provider to make sure you don’t have
any remediable issues such as ingrown nails that require attention.
Diabetic control and smoking cessation can be approached with your primary
care doctor. There are specially trained nurses who frequent senior centers
and nursing
homes, providing basic foot care. Those with a nursing background might check
out this type of training. For good quality shoes with plenty of toe room,
and custom made inserts for pressure relief, you’ll need to see an orthotist.
Having healthy feet is critical to maintaining a tactical readiness for future
possible disaster. Some chronic foot problems develop over years, so now is
the time to make appropriate changes in one’s habits.
« Economics and Investing: |Main| Real World Observations on Fighting Crime and Criminals, by Eli »
Letter Re: Gaining Situational Awareness and Old-Time Knowledge
Jim,
Situational Awareness has a number of definitions, from the rather complex
to the "simple". They include:
- The process of recognizing a threat at an early stage and taking measures
to avoid it. (Being observant of one's surroundings and dangerous situations
is
more an attitude or mindset than it is a hard skill.)
- The ability to maintain
a constant, clear mental picture of relevant information and the tactical
situation including friendly and threat situations as well
as terrain.
- Knowing what is going on so you can figure out what to do.
- What you need to know not to be surprised.
This comes to mind because of my recent reading of your novel, "Patriots".
(An excellent book. A must have for any "prepper".) The book
is primarily about a group of people who joined together to survive in the "days
after". The daily requirements of surviving in times of roving bands of
criminals and martial law enforcers were covered rather forcefully. Many of the
challenges they faced required an armed response, and situational awareness was
often discussed. For the kinds of situations in which the "Patriot" folks
found themselves, the extremely helpful explanations of such matters as OPSEC and
LP/OPs are very helpful to anyone facing what is soon coming for many of
us.
As the book describes, situational awareness is absolutely vital to survival
and success in our near future.
But, while situational awareness is most commonly thought of as a conflict skill,
there are also other kinds of situational awareness. On Yahoo Groups, there is
a discussion group about surviving in the days after. One of the most prolific
writers has several times recently warned the readers to "Get out of the
cities now !". He's even suggested moving to very unpopulated areas and
using wood pallets to erect shacks. IMHO, this is a suggestion that will cause
many people great harm. Folks, with little or no preparations, suddenly moving
to the land to escape the "Golden
Horde", will likely fail or die.
Just reading the stories of the many pioneers who moved west, will quickly sober
you up from any "can do/don't know" thinking.
I have lived nearly all my life on a farm. I have developed a deep knowledge
of the land. It has come at the great expense of many missteps, failures, successes,
hard work and time. I call it having situational awareness of the environment.
I know what certain kinds of clouds mean when forecasting tomorrow's weather.
I know that the vine-like plants with three shiny leaves aren't so good to eat
or touch. I know a dead snake can still bite. People just coming to the land
for
the first
time will have little of that knowledge.
For untold years and many generations, the knowledge of how to live on the land
and be self-sufficient was passed down thru families. In farm country, school
was often found at the back fence. If you or your Grandfather didn't know something,
the farmer next door often did. I remember many times in my youth when I'd be
out working the land and the guy next door would be out on his. Often as not,
we'd stop and stand by the line fence and talk. ...And I learned lots. But, now,
much of this passing on of knowledge is lost. Farmers more commonly sit 12 feet
in the air, driving an air conditioned combine, following the turns suggested
by the GPS receiver
on the dash. Your parents most likely worked in a factory
or
a
shop, than on a farm. What was common family knowledge just a couple generations
ago,
such as maple syrup making, canning, gardening, butchering, animal husbandry,
etc., etc., is gone. The "chain" is broken. Without
this great deal of passed on knowledge and experience, nearly any farm endeavor
can, and often
will, lead to unexpected disaster.
This is where Situational Awareness comes in. "The need to know, so as not
to be surprised." The list is endless, but for starters:
- Knowing the good bugs from the bad in the garden
- Knowing fresh horse manure
will kill a garden, fresh chicken m. will help
- Knowing only 3 or 4 ounces
of yew leaves--a common landscape plant in much of
the US--can kill a horse
- Knowing how to split wood so that the axe won't
glance off and chop your leg
- Knowing that burning certain kinds of wood in
your wood stove means you need to clean the chimney twice a winter so you
don't burn down your house [with a chimney fire]
- Knowing the nice, fresh,
clean, free flowing, mountain stream may be full of giardia.
- Knowing that,
when plowing with a horse, you should never tie the reins together and put
them around behind your back so your hands are free to handle
the plow.
(This was the way it was done in the novel "Dies the Fire" [by
S.M. Stirling).
If your horse happens to shy and takes off running, you will be dragged along
the ground
and be seriously hurt. The proper way to plow is with the reins over one
shoulder and under the other. Then, if your horse runs, you just duck your
head and
the reins slide off.
- Knowing that crows in the garden are bad because they
eat the new planted seeds, but crows around your chicken coop are good
because they keep away
the hawks
that will eat your chickens.
- Knowing that if your tractor suddenly starts
making a new sound, this is not good. Stop immediately and figure out what's
going on, before something
breaks.
- Learning to look around you when walking, instead of only staring
at the ground for
your next step, (as most people do).
And on it goes. I have lived decades on the land. There's not a day goes by
that I don't learn something. But even with all my handed down knowledge and
hard-fought
experiences, I'm not even sure I could make a go of suddenly heading out
to the "country" to build a cabin and barn, till the soil, cut fire
wood, store food for man and beast, and more. It's just awful hard without lots
of prep's. And I can tell you, without an extensive knowledge of what the "environment" around
you is telling you, it's darn near impossible. ...(Taking a walk in the woods
can hurt just as much as a walk on certain inner city streets.)
So what are you to do ? Well, having a "G.O.O.D." bag
and great escape vehicle is a start. Having supplies, tools and seed already
in place really helps.
But once you get to your retreat site, have a plan, have some knowledge of how
to do, what to do. Practice now. If you think you're going to learn while living
in a wood pallet shack, you won't. You'll most likely die. If there's no more
Elders to ask, get to know the other "elders"--books.
Go to local farms and ask to spend time just helping, so you can learn something.
Go to a school to
learn skills; like tracking, orienteering and fire building without matches;
(one of the best, imo, is Midwest Native Skills Institute). Never take charcoal
or
lighter fluid on a picnic, learn to gather what burns. Go camping in winter,
instead of just when it is "pretty" outside. Find a "big animal" vet.
and ask to attend and help when birthing a calf. Most especially, turn off your
tv. Use your time to learn to sew, or knit, or make soap. Pick up (fresh) dead
animals on the road and practice skinning them and then tan the hide. [JWR
Adds: Needless to say, consult your state Fish and Game laws before
doings
so!]
Find
local crafts people
and
acquire
a
skill,
such
as
weaving,
or
candle
making,
or
tin
smithing, because having a survival trade in a cashless society may keep you
alive. Learn to listen. Throw away those darn ear plug music things. Learn situational
awareness. What is the wind telling you about the day ? What does the sudden
and not normal crowing of a rooster warn you of ? What does the setting of the
moon in a certain place on the horizon tell you about the season ?
Learn what it takes to live on the land, before you have to suddenly move there.
Learn what nature, the land, and new tasks are telling you, before you find yourself
in a difficult situation, ...(un)aware.
- Jim Fry, Curator, Museum of Western
Reserve Farms & Equipment, Ohio
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Letter Re: Some Online Resources on Determining Prescription Drug Shelf Lives
James,
I worked for 20 years as an analytical chemist and was responsible for running
experiments to determine the expiration dates of our medicines. We were always
conservative when setting limits.
There are many factors that affect the stability of medications. The most easily
controlled by the end user is temperature. As a general rule for biological
compounds near human temperatures the rate of decomposition approximately doubles with each 18° F rise in temperature
and is roughly halved with each 18° F fall in temperature. So
if the shelf life of a medicine is six months at 90° F and about three
months at 110° F. That same medicine is expected to decompose about the
same amount during four years in a refrigerator as it would in one year at
room temperature or 16 years in a freezer.
Once a package has been opened oxygen, water, or microorganisms may enter the
medicine and dramatically shorten it's shelf life. In general
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Letter Re: Some Online Resources on Determining Prescription Drug Shelf Lives
Sir:
For the survivalist planner determining actual prescription drug shelf lives
is a critical subject. Yet little discussion or research has been submitted
survival
web sites.
The following are some concise and factual sources with information on this
critical survival planning subject.
Congressional investigation: Extending The Shelf Life of Prescription Drugs
Military Stockpiles 'Expired' Drugs
Shelf
Life of Prescription Medications (from Mickey Creekmore's blog, July, 2008.)
From the Pittsburgh Post-Gazette: Drugs
may outlast label date
Many Medicines Are Potent Years Past Expiration Dates (a Wall Street Journal article,
re-posted by The End Times Report)
From Associated Content: Drug Expiration Dates: How They Benefit the Pharmaceutical
Companies
Additional sources are welcomed. Regards, - Sam A.
JWR Replies: This topic was covered
fairly well in SurvivalBlog in 2006, but it bears re-visiting. Expiry
dates marked on both prescription and non-prescription medicines are very
conservative, for
two reasons:
1.) Legal
Liability, and
2.) Profit.
By having early expiries, the pharmaceutical companies sell more drugs (replacing "expired" stocks),
which means more profit.
Tetracycline is one drug that has often been cited as being unsafe when
out-of-date, but that reputation has largely been overcome by events. As it
was explained
to me by by a SurvivalBlog reader that is a doctor in New Zealand, in
the 1980s tetracycline had an unstable composition. It broke down 6-to-12 months
post-expiry
date and
became
potentially
toxic from
the
degradation products of the binder. But since late-1980s, the new binders
have been much more stable.
This letter to SurvivalBlog from 2006 is worthy of re-posting:
Sir:
Regarding your blog entry on the subject of prescription medications, I wish
to provide you with information regarding expiration dates: I work for
a pharmaceutical company. While profit is a reason why expiration dates
can
be conservative, it is not due to "planned obsolescence."
Here is the way things work in the U.S.: drug companies are required to
put an expiration date on all drugs. Companies are required to prove to the
FDA that the drugs will remain safe and effective through the expiration date
on the drug (when stored as described on the label). Generating that proof
is
expensive, and it gets more expensive the farther the expiration date is
from the date of manufacture. So the drug companies don't want to spend money
on
expiration date studies (known in the industry as "stability studies")
any further in the future than is necessary, but must spend money on stability
studies (at a minimum) that will avoid an expiration date that is too close
to the date of manufacture (defined as expiration dates that could be reached
prior to the drug being sold, or would cause customers to avoid the purchase
of drugs that will soon expire).
What does that mean for consumers who want to store drugs beyond the expiration
dates? There is not one answer for all drugs. Some drugs are truly ineffective
or unsafe very soon after their expiration dates. Others can be almost "as
good as new" for decades after the expiration dates have passed. Thanks
for the great novel, and a great blog. - Mr. Pharmacopoeia
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Field Gear on a Shoestring Budget: Ten Project Examples, by George S.
The following are some hopefully useful field expedients, substitutes and
spares, all
of which can be had for a buck to about ten bucks each:
#1: Drywall Saw: if you don’t have one of those all-purpose $49.95 survival
knives or field shovels from Gerber or Glock with the accessory root saw, or
you’ve found that the finger-length saw blade on a Swiss Army folder
leaves a lot to be desired when cutting a 2x6 [board] down to size? A bow saw
or flexible survival kit saw are a couple of possible candidates that may be
up
to the
task, but so too is an inexpensive drywall "stab" saw. The blade
on the one I got for a buck in the closeout tool bin at my local Big Box store
hardware department has a blade just a smidgen under 7 inches long and saw
teeth that cut on the push stroke on one edge and reversed teeth that work
on the
draw stroke on the other. It also has a sharp enough tip on the blade point
to poke through drywall or thin wood paneling, hence the term "stab" saw.
The handle on mine, made/distributed under the GreatNeck
brand, P/N 4932, is
hard plastic and black rubber, comfortable enough to use for repeat cutting.
Though that handle included a molded-in flap pierced for a lanyard or hang
cord, the handle itself is stout enough to be drilled at the butt end for a
hole for a wrist lanyard or dummy cord. So I modified mine to eliminate any
chance of the cord tearing through the molded flap. I also did a little reshaping
of the handle on my saw with a file to get it to better fit my hand, so there
is enough material molded around the blade at the handle end for personal modification
to suit.
In addition to the obvious uses for field carpentry, mine’s proved useful
on the rib cage and pelvic bones when field dressing whitetail deer. There
are certainly other times in the woods when a nice quiet saw is to be preferred
to noisier if sometimes quicker tools like machetes or hatchets, as well as
being lighter in weight. A drywall saw is easily carried in a homemade or improvised
leather or nylon web belt sheath, or a short length of metal tubing can be
squashed flat and the saw blade inserted, both for protection for the blade
from other residents in a toolbox and to keep the saw from chewing holes in
a pack or rucksack pocket. Mine also fits in a scabbard meant for an M7 bayonet
for an M16 rifle,
which I picked up for a couple of bucks in the junk box at my favorite army-navy
surplus store. That has the total cost for my saw under
five bucks, so I went back and bought two more, one for a pal and one as a
spare for myself. Using a saw to cut those little figure-four release triggers
for small game snares or dead
fall
traps beats doing that task with most knife
blades, by the way, though setting snares in the cold is not real high on my
list of fun things to do. But if
you’re going to try it, I suggest you first practice setting the things
when it’s warmer out...and using a saw instead of a knife to build your
hare-trigger releases. (Yes, that spelling was intentional!)
#2: Snow Camo Overwhites: I live in snow country where sets of military over-white
trousers and parka can be useful during the white time of the year, and yes,
I have a good set. But my back-up plan consists of a large white vinyl trash
bag that can either be used for its intended purpose or can instead have neck
and arm holes poked into it in a pinch, then to be worn to help keep drizzle
and sleet off. It’s considerably more glossy and shiny than I care for,
which can be cured either with a few vertical stripes of flat white automotive
spray paint, or an XXXXXL white t-shirt can be added over it- unless, of course,
you are a XXXXXL T-shirt size as is, and you have to use a white pillowcase
or kiddy bed bed sheet substitute instead. Really large used T-shirts go for
50 cents each at my local Goodwill thrift store, and since I’m not planning
on wearing these against my skin, I’m not the least bit squeamish about
getting one that’s been used. And while I was there I found a pair of
much-dripped-on white painter’s pants for a buck, too, oversized and
baggy, just right for wear over warmer trousers underneath. A few shots with
the ol’ 99-cent can of flat white spray paint, and I was right in business.
Admittedly, they were still loose enough on me that I needed a pair of elastic
carpenters’ suspenders to help hold them up, and those suspenders were
available only in blue or red, not white. Out came the flat white spray can
again, which took care of that, backed up by a wrap or two of white athletic
bandage tape over the too-shiny buckles, which both locked them in place and
ensured there wouldn’t be any giveaway shine even if the paint flaked
a bit. It didn’t hurt to have that pair of short lengths of tape handy
should they be needed for other uses, either. That white spray paint also works
real well on surplus store desert helmet covers to whitenize them for winter
wear, then useable either as field jacket or parka hoods, or as, of all things,
wintertime helmet covers.
#3: Inexpensive Lockblade Folding Knifes: I like nice pretty folding knives,
both factory and custom, and some are so pretty and beautifully crafted that
it seems like sacrilege to drop one in a pocket, let alone open it up and actually
use it; the one I got as a present a couple of years back is like that. So
in my pocket rattling against my keys instead is the cheapie $1 lockblade folder
I picked up in the sporting goods/camping supplies department at my local Wal-Mart.
Packaged as "Ozark Trail #3074," the knife’s 31⁄4" blade
is jinked (partially "sawtoothed) along the rear third of its belly
edge, is marked "stainless," and is retained by a screw, making sharpening
and other maintenance simple. The knives’ handles/scales are a hard black
plastic that’s sufficiently impact resistant that of the dozen or so
examples I have none have yet suffered breakage or cracking, though one that
came in contact with a hot Jeep exhaust manifold melted and blurred a bit.
Now that one’s a "parts queen" donor for any of the others
that might have a blade chip or snap a point. That hasn’t happened yet,
the only replacement so far needed on my stable of cheap Chinese folding pointy-sharpie
things having been that of a replacement blade pivot screw that came loose
on one and got away in my pocket. The scales are a little squarish for my taste,
easily fixed by rounding off the edges and corners with a file or sandpaper,
and yep, there’s a well-placed hole for a dummy cord lanyard or key ring.
One so equipped resides on a spare bootlace that goes around my neck when I’m
kayaking in the summertime, and twin brothers of the cheapie Wal-Mart folder
live in the glove box of each of my vehicles, my tool boxes, in one pocket
or another of most of my rucks and daypacks, on my key chain and there’s
one in the drawer of my computer desk where it does double duty as letter
opener and box tape slicer. There are some users who don't care for the idea
that the
knife can be disassembled and have concerns that parts can become
unattached and lost. I haven't had that happen yet, but I figure screw tightness
checks are routine maintenance,
and I will use a threadlocker if I think it's necessary.
#4: Singlepoint Balance Sling: I had always wanted to be a high-speed, low
drag, tactical operations operating operator, but had never been able to come
up with one of the $35-$50 3-way HK or
Vickers slings that all the gun shop commandos and SWAT Team
guys who’ve never fired a shot in a real world
gunfight keep insisting to me that all the real professionals use. Adding a
center-of-balance attach point for a centerpoint sling is a simpler alternative,
and can be accomplished with nothing any more complicated or expensive than
a screw-in eyebolt at the point where the wrist of a shotgun’s butt fits
into the gun’s receiver, an expedient that goes at least as far back
in historic use as Doc Holliday’s sawn-off double-barreled scatterguns.
For the sling itself I used a five-foot length of black 1-inch wide tubular
webbing as used for rock climbing harnesses, also very useful for belts and
regular weapons slings. The advantage of using the tube web in this application
is that the tube web is hollow inside, and inside went a 48-inch-long elastic
bungee cord. The hook of one end of the bungee’s elastic shock cord was
then crimped to the front snaploop of a very used AK-47 sling
that had pulled out the oil-rotted threads holding it on, though all sorts
of alternate snaps
and swivels [or a 550-cord loop] could be used instead. The ones found on $2
surplus Swiss gas mask bags are especially excellent, with or without the bag
strap attached. The hook then attaches either to an AK or other rifle’s
front sling swivel, or at the new midpoint location if the hardware for that
application is installed. A friend who saw and tried my centerpoint sling on
my AK wanted one for his new M4 configuration
AR-15, and since he already had a sling attach point installed as the stock
locking plate of his CAR-15,
all I had to do was add the sling’s body loop and the strap with the
swivel snap. In his case, that snap was made from a pear-shaped key ring mini-caribiner,
after threading a short piece of clear plastic gas line tubing over it to keep
it from scratching the rifle finish and keep potential rattling silenced.
At the other end there’s a loop just large enough to go over the user’s
shoulder across the chest front, again with the elastic cord keeping it snug.
With the sling snap attached at the midpoint I can hold my rifle in both hands
and extend it out to arm’s length in front of me, and the elastic and
slightly muzzle-heavy weight with a loa
