Tag Archives: Doom and Bloom

Triage For The Non-Medical Responder

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‘Who Goes First and Why’
—
I wanted to write today’s post with the goal of familiarizing a non-medical professional with the process of triaging. This would apply if you’re the first person to arrive–accidentally, or on purpose–at a multi-casualty trauma scene whether that happens in our current world, or after a collapse. Triaging is the same, you determine which patients need priority in transport and treatment. What changes after a collapse is the lack of resources available to care for the patients.

I felt I was very qualified to write this post. As a former military medic and civilian paramedic I have been involved in several actual Mass Casualty Incidents (MCIs) and many simulated MCI drills.

As I was doing research for this post I remembered that Dr. Bones, of Doom and Bloom, had recently written on this topic. At the time I had skimmed the information, feeling relatively confident in my ability to handle an MCI if needed. As I went back to review them for this post I realized anything I say would be redundant. Dr. Bones wrote three excellent and very detailed posts on triaging. They are complete with examples and are directed toward the non-medical responder. As I always say, Dr. Bones and Nurse Amy are my definite collapse medicine specialists (I reviewed their book The Doom and Bloom Survival Medicine Handbook a few months ago).

So instead of trying to reinvent the wheel I am reposting Dr. Bones first triage post:

The Mass Casualty Incident: Triage, Part 1

The responsibilities of a medic in times of trouble will usually be one-to-one; that is, the healthcare provider will be dealing with one ill or injured individual at a time.  If you have dedicated yourself to medical preparedness, you will have accumulated significant stores of supplies and some knowledge. Therefore, your encounter with any one person should be, with any luck, within your expertise and resources.  There may be a day, however, when you find yourself confronted with a scenario in which multiple people are injured.  This is referred to as a Mass Casualty Incident (MCI).

A Mass Casualty Incident is any event in which your medical resources are inadequate for the number and severity of injuries incurred.  Mass Casualty Incidents (we’ll call them “MCIs”) can be quite variable in their presentation.

They might be:

  • Doomsday scenario events, such as nuclear weapon detonations
  • Terrorist acts, such as occurred on 9/11 or in Oklahoma City
  • Consequences of a storm, such as a tornado or hurricane
  • Consequences of civil unrest or battlefield injuries
  • Mass transit mishap (train derailment, plane crash, etc.)
  • A car accident with, say, three people significantly injured (and only one ambulance)
  • Many others

The effective medical management of any of the above events required rapid and accurate triage.  Triage comes from the French word “to sort” (“Trier”) and is the process by which medical personnel (like you, survival medic!) can rapidly assess and prioritize a number of injured individuals and do the most good for the most people. Note that I didn’t say: “Do the best possible care for each individual victim”.

Let’s assume that you are in a marketplace in the Middle East somewhere, or perhaps in your survival village near the border with another (hostile) group.  You hear an explosion.  You are the first one to arrive at the scene, and you are alone.  There are twenty people on the ground, some moaning in pain.  There were probably more, but only twenty are, for the most part, in one piece.  The scene is horrific.  As the first to respond to the scene, medic, you are Incident Commander until someone with more medical expertise arrives on the scene.  What do you do?

Your initial actions may determine the outcome of the emergency response in this situation.  This will involve what we refer to as the 5 S’s of evaluating a MCI scene:

  • Safety
  • Sizing up
  • Sending for help
  • Set-up of areas
  • START – Simple Triage And Rapid Treatment

1. Safety Assessment:  Our friend Joshua Wander (the Jewish Prepper of blogspot fame)  relates to us an insidious strategy on the part of terrorists in Israel:  primary and secondary bombs.  The main bomb causes the most casualties, and the second bomb is timed to go off or is triggered just as the medical/security personnel arrive.  This may not sound right to you, but your primary goal as medic is your own self-preservation, because keeping the medical personnel alive is likely to save more lives down the road.  Therefore, you do your family and community a disservice by becoming the next casualty.

As you arrive, be as certain as you can that there is no ongoing threat.  Do not rush in there until you’re sure that the damage has been done and you and your helpers are safe entering the area.  In the immediate aftermath of the Oklahoma City bombing, various medical personnel rushed in to aid the many victims.  One of them was a heroic 37 year old Licensed Practical Nurse who, as she entered the area, was struck by a falling piece of concrete.  She sustained a head injury and died five 5 days later.

2. Sizing up the Scene:  Ask yourself the following questions:

  • What’s the situation?   Is this a mass transit crash?  Did a building on fire collapse?  Was there a car bomb?
  • How many injuries and how severe?  Are there a few victims or dozens? Are most victims dead or are there any uninjured that could assist you?
  • Are they all together or spread out over a wide area?
  • What are possible nearby areas for treatment/transport purposes?
  • Are there areas open enough for vehicles to come through to help transport victims?

3.  Sending for Help:  If modern medical care is available, call 911 and say (for example):  “I am calling to report a mass casualty incident involving a multi-vehicle auto accident at the intersection of Hollywood and Vine (location).  At least 7 people are injured and will require medical attention.  There may be people trapped in their cars and one vehicle is on fire.”

In three sentences, you have informed the authorities that a mass casualty event has occurred, what type of event it was, where it occurred, an approximate numbers of patients that may need care, and the types of care (burns) or equipment (jaws of life) that may be needed.  I’m sure you could do even better than I did above, but you want to inform the emergency medical services without much delay.

If the you-know-what has hit the fan and you are the medical resource, get your walkie-talkie or handie-talkie and notify base camp of whatever the situation is and what you’ll need in terms of personnel and supplies.  If you are not the medical resource, contact the person who is; the most experienced medical person who arrives then becomes Incident Commander.

4.  Set-Up:  Determine likely areas for various triage levels (see below) to be further evaluated and treated.  Also, determine the appropriate entry and exit points for victims that need immediate transport to medical facilities, if they exist.  If you are blessed with lots of help at the scene, determine triage, treatment, and transport team leaders.

5. S.T.A.R.T.:  Triage uses the acronym S.T.A.R.T., which stands for Simple Triage and Rapid Treatment.

The first round of triage, known as “primary triage”, should be fast (30 seconds per patient if possible) and does not involve extensive treatment of injuries.  It should be focused on identifying the triage level of each patient.  Evaluation in primary triage consists mostly of quick evaluation of respirations (or the lack thereof), perfusion (adequacy of circulation), and mental status.  Other than controlling massive bleeding and clearing airways, very little treatment is performed in  primary triage.

Although there is no international standard for this, triage levels are usually determined by color:

Immediate (Red tag): The victim needs immediate medical care and will not survive if not treated quickly.  (for example, a major hemorrhagic wound/internal bleeding) Top priority for treatment.

Delayed (Yellow tag): The victim needs medical care within 2-4 hours. Injuries may become life-threatening if ignored, but can wait until Red tags are treated. (for example, open fracture of femur without major hemorrhage)

Minimal (Green tag): Generally stable and ambulatory (“walking wounded”) but may need some medical care. (for  example, 2 broken fingers, sprained wrist)

Expectant (Black tag): The victim is either deceased or is not expected to live.  (for example, open fracture of cranium with brain damage, multiple penetrating chest wounds)

Knowledge of this system allows a patient marking system that easily allows a caregiver to understand the urgency of a patient’s situation.  It should go without saying that, in a power-down situation without modern medical care, a lot of red tags and even some yellow tags will become black tags.  It will be difficult to save someone with a major internal bleeding episode without surgical intervention.

In the next part of this series, we will go through a typical mass casualty incident with 20 victims, and show how to proceed so as to provide the most benefit for the most people.

Dr. Bones

Links to Doom and Bloom follow-up posts:
Mass Casualty Incident: Triage, Part 2
Mass Casualty Incident: Triage, Part 3

(Friday: What We Did This Week To Prep)

What I Did This Week To Prep 2/3/12

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Reading, and writing my review of, The Doom and Bloom Survival Medicine Handbook this week took a lot of my time, so not as much other stuff got done.

Sarah and I did do a fair amount behind the scenes on the the blog site itself. Sarah does the technical side and I handle the personal networking aspects. Is this a prepper topic though? I believe it is – especially since our blog is about prepping. But any blog you write allows you to teach and learn; it also may have the potential to develop into a business and/or give you more personal independence. Sarah upgraded us from WordPress.COM to WordPress.ORG. WordPress.org is the WordPress software that must be self-hosted (we went with Host Gator for that) but allows for greater flexibility and expansion potential. I’ve been corresponding more with people in the online prepper community; strengthening relationships and starting new ones. We’re also bringing on a new monthly contributor to our blog (more on her next week). Along those same lines, we’re considering having a (different) guest blogger write a post for us each month. So if you–or anyone you know–are interested, send me an email or facebook message (my contact information can be found on the About Trace page).

Last month I wrote a post on the Gerber EAB Lite Utility Knife. There has been discussion on TSP Forum where several people complained about the clip easily breaking off the knife. I’ve carried mine, clipped to my pocket everyday, for several months now without any issues. But just to do some follow-up, I contacted Gerber’s Warranty Department (by email). I told them we have several EABs and expressed my concern about the clip weakness, and asked them for a couple extra clips to keep on hand. They, no questions or hassles, sent me three replacement clips – no charge for shipping or anything. In summary, it’s a good little knife, good customer service experience, and I haven’t had any issues with the clip.

Finally, after reading the Doom and Bloom book, I decided we need to continue actively working on our medical preps. Because of my background, knowledge, and willingness, I’m sure one of my primary roles in a collapse will be as the medic. I believe I need to do as much as I can now to prepare for that role. So, coincidentally, last week on the Doom and Bloom blog, Dr. Bones wrote, Over The Counter Drugs When You’re the Doctor, that included a thorough list of OTC drugs to stock up on. This week he wrote, Must Have Antibiotics, Antifungals, and Antivirals. So, we’ve earmarked some money for additional fish antibiotics (Antibiotics In Your Preps) and are going to stock up on more OTC meds when we go to Costco. How much is too much? Tough call. But they store for a long, long time (Expired, or Not Expired… That is the Question), they’re relatively cheap, they don’t take too much space to store and–in a collapse–they’re irreplaceable.

What did you do?

(Monday: Book Review: Where There Is No Doctor)

Book Review: The Doom and Bloom Survival Medicine Handbook

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by Joseph Alton, M.D. and Amy Alton, A.R.N.P.
(aka Dr. Bones and Nurse Amy)

Dr. Bones and Nurse Amy, of the Doom and Bloom Hour, are my definitive ‘collapse medicine’ experts. So I was thrilled when I heard they had published a  medical survival book and I immediately ordered a copy. When it arrived, I spent several days pouring through it.

I could not be happier, it is outstanding! Dr. Bones and Nurse Amy have written a first of it’s kind, an incredible medical reference in the–previously non-existent–category of collapse medicine.

They tell you what to do when, “Help is NOT on the way” ever.

Collapse: The situation after a TEOTWAWKI event; modern society, infrastructure, and systems as we know it will no longer exist.

Collapse Medicine: Medical care that will be provided when “there is no access to modern medical care, and there is NO potential for accessing such care in the foreseeable future.”

First aid books tell us, when treating a critical patient, to first stabilize then transport to a hospital emergency room. This one doesn’t. This one can’t – in a collapse there won’t be any. This book is written in plain easy to understand English, and it is written for you. You, the non-medical provider who takes it upon his or her self to assume the medical responsibilities for the group; doing your best to keep your people as healthy as you can.

The book begins by teaching you how to become a medical resource. It provides detailed lists of Likely Medical Issues You Will Face, Medical Skills You Will Want To Learn, and Medical Supplies you’ll want/need (including a thorough list of what to stock in your medical kit).

There is not only a valuable section explaining Natural Remedies (including a chapter on Essential Oils) but, whenever possible, it shows you how to effectively use them in conjunction with traditional (allopathic) pharmacology. Someday the only medicines available may be the ones you can grow and gather.

This book is as all-encompassing as I believe it can be. From respiratory infections to fractures to hypothermia to pregnancy and delivery, the chapters and the knowledge continue. There is even a detailed chapter on suturing; including when–and when not–to close a wound. If you can think of a medical problem that you may have to deal with in a collapse, there’s information about it in this book and more. Then, to further your medical education, they include a list of medical reference books you can add to your library and YouTube videos that demonstrate the procedures discussed.

The book concludes with information I don’t believe you’ll find written anywhere else; on the medically controversial topics of stockpiling medications (prescription and over-the-counter), how to use antibiotics (without a doctor’s guidance), and what drug expiration dates really mean.

Finally, I especially appreciate that they dedicated the book to me – okay, all of us. We, who will take on the medical responsibilities when there are no others; the ones who your group will affectionately call ‘Doc’. To us, Doctor Bones and Nurse Amy write, “…we both dedicate this book to those who are willing to take responsibility for the health of their loved ones in times of trouble. We salute your courage in accepting this assignment; have no doubt, it will save lives.”

 

What I Did This Week To Prep 1/27/12

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and Storm After Action Review

Anytime you use your preps–after you neatly put them away for the next time–it’s important to review how things went. What went well? What needs to be changed or improved? And what did you learn? We were pleased with how our preps worked during the storm, and because of them the power outage was only a minor inconvenience.

However, there were a couple of things I needed to follow-up on. I checked the generator to see why it had stopped running. As stated, I assumed it had stopped because it ran out of gasoline. I looked in the tank, it still had plenty of fuel left, and it started just fine. I let it run for about 20 minutes and there were no issues. I don’t know why it had stopped. My only concern was the age of the gasoline in it. When we bought it a year ago the tank was full and we still had that same fuel. The previous owner had added Sta-Bil, but I don’t know when. I decided to drain the tank and fill it with fresh gasoline. I siphoned as much as I could into the Jeep, then let the generator run until it was empty (it ran for over an hour before it stopped – an inadvertent but useful test). Then I added new gasoline and Sta-Bil, started it up to double-check, and put it away.

While working with the generator, Sarah, Ryan and I all practiced starting it.  It’s important that all adults (and as many of the kids as possible) in the home know how to run the critical prepper equipment. We had been concerned that Sarah wouldn’t have the ‘bulk’ to pull-start the generator, but she was able to do it without much trouble.

Next, when the battery bank was in use it had shut off earlier than I expected; I thought it was because of some kind of a surge. But my understanding may have been flawed. Fellow prepping blogger Homestead Fritz send me a link to The 12volt Side of Life; a 12-volt battery information site. I’m going to do some additional research on that topic. I’ve said before, I have a decent amount of knowledge about a variety of topics – but electricity is not one of them (though I’m learning).

Finally, I went by the hardware store and bought an 8-foot, 14-gauge extension cord that will be dedicated to use with the furnace. During the power outage I realized I was one cord short, so we had to shuffle cords around. The battery bank and the furnace are only about six feet apart so it seemed like a waste to use a 25-foot cord, but the smaller ones I own were only 2-prong household types and I needed a heavier duty 3-prong one.

Also this week, I found out my favorite collapse medicine experts, Doctor Bones and Nurse Amy of the Doom & Bloom Hour, had written a book. The Doom and Bloom Survival Medicine Handbook was published last week. I immediately ordered one and just received it in the mail. I’m very excited to have what I believe will be a fantastic medical reference. I’ll post a review on it soon.

I’ve started posting more to the TraceMyPreps Facebook page. I’d encourage you to “like” it and join our budding community; use that forum to comment, ask questions, and give advice. To make it easier I’ve added a ‘TraceMyPreps on Facebook’ like button on the top of the right side of my blog page. Also, right below that is a ‘Follow Blog Via Email’ box, if you sign up there each post I write will be automatically sent to you as soon as I publish it – this is an easy way to keep up on the posts as they come out.

What did you do?

What I Did This Week To Prep 12/2/11

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We planted our winter compost crop seed mix this week. The seeds arrived last week (from Bountiful Gardens), but because the ground was frozen we had to wait for warmer weather. There is a mixture of vetch, wheat, and rye, and then the fava beans are planted separately. We’ve never done this before and are not exactly sure what to expect. Will it look like just a bunch of weeds growing? And it seems strange to plan to grow stuff, just to cut it down and leave it in the dirt. I understand the concept and the experts say it’s a good idea, so the only way to fully understand it is to do it. We also sprinkled Dutch White Clover seeds on the backyard areas with less grass which, hopefully, will expand throughout the yard.

Shooting real firearms in suburbia isn’t very convenient, plus winter is frequently cold and wet when you go to the range, and ammunition quickly gets expensive. So I’m going to try using airsoft guns as an alternative way to practice and teach shooting skills. I got the idea from listening to Jack Spirko’s TSP, Becoming a Better Shooter and Trainer with Airsoft Guns (Episode 671). Last week Ryan and I went and bought a Crossman Air Mag C11 CO2 pistol, a box of CO2 cartridges, and a 2000 pellets (total cost less than $100). We came home and built a frame (8 1/2 by 11 inches), with a plywood back, lined the inside with a towel (to absorb the impact and prevent ricochet), and tacked up a normal piece of paper with a target drawn on it. We hung it on the wall and paced off ten feet. Sarah, Ryan, Alison, Emily and I took turns shooting in our custom indoor-range. I think it will be a good cost and time-saving, teaching and practice tool. Of course it’s not the real thing, but it’s the right weight and size and it allows you to practice: stance, grip/hand placement, sight alignment and sight picture, and trigger control. About the only thing missing is the loud “bang” and recoil. I’m excited about this new training venue. Once we get our skills up to a good level, we can–since it’s not a real gun and can be shot in the house–practice some “what if a stranger breaks into the house” scenarios. I think this will be a good winter activity that will allow any and all of us, who want to shoot, to have almost unlimited practice.

December 1st was yesterday. 2011 is almost over. Now is the time to reflect on our 2011 goals and either hurry up and finish, or revise as necessary. My post the last Friday of this month/year will be: What I Did This Year To Prep. Then, in early January, I’ll write: Goals For 2012. I’d encourage you to reflect back on this year and start thinking about your goals for next year.

Lastly, I wanted to link to some follow-up information regarding antibiotics in our long-term preps. From The Doom and Bloom Hour blog with Dr. Bones, a medical doctor, and his wife Nurse Amy, a Nurse Practitioner: Antibiotics And Their Use In Collapse Medicine, Part 1 and Antibiotics And Their Use In Collapse Medicine, Part 2. I applaud this couple for their diligence and determination to share life-saving material about collapse medicine. It is difficult to get good information on this topic and they are my top resource.

What did you do?

Expired, or Not Expired… Can You Store Medications Long Term?

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What medications* do we keep in our preps? We store: 1) over-the-counter (OTC) drugs: ibuprofen (Motrin), acetaminophen (Tylenol), aspirin, diphenhydramine (Benadryl), pseudoephedrine (Sudafed), loratadine (Claritin), guaifenesin (Mucinex), and 2) antibiotics (that I recently posted about): amoxicillin, cephalexin, ciprofloxacin, doxycycline, metronidazole.

How long can they be stored? They have expiration dates, does that mean they go bad?

Let’s start with what do drug expiration dates mean? Required since 1979, the expiration date is the last date that the pharmaceutical company will guarantee 100% potency (some sources state at least 90% potency). So then we ask, how long does it take a drug to lose it’s beneficial effects?

That is the question that the Department of Defense (DOD) asked the Food and Drug Administration (FDA) in 1985 (the military had over a billion dollars worth of medication stored). So in response, in 1986, the DOD and the FDA began the Shelf Life Extension Program (SLEP).

The SLEP program is documented in the Wall Street Journal article, Many Medicines Are Potent Years Past Expiration Dates, by Laurie P. Cohen, March 28, 2000. The military submitted, and the FDA has evaluated, over 100 drugs – prescription and OTC. The results showed that about 90% of them were safe and effective well past their expiration dates, some for 10 years or longer. Joel Davis, a former FDA expiration-date compliance chief, said that with a handful of exceptions – notably nitroglycerin, insulin and some liquid antibiotics – most expired drugs are probably effective.

In light of these results, a former [FDA] director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer.

Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn’t mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

“Manufacturers put expiration dates on for marketing, rather than scientific, reasons,” said Mr. Flaherty, a pharmacist at the FDA until his retirement in 1999. “It’s not profitable for them to have products on a shelf for 10 years. They want turnover.”

The Harvard Medical School Family Health Guide, in Drug Expiration Dates – Do They Mean Anything?, notes that, with rare exceptions, “it’s true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date”.

Where and how medications are stored is an important factor in minimizing their degradation. Storing in a cool, dry, dark place will maximize their lifespan; when possible keep sealed in their original container until ready to use. Medications stored in bathroom cabinets or shelves could have effectiveness significantly reduced. Be sure to discard any pills that become discolored, turn powdery, or smell overly strong; any liquids that appear cloudy or filmy; or any tubes of cream that are hardened or cracked.

Dr. Bones, from The Doom and Bloom Show, states in his blog post, The Truth About Expiration Dates, “I put forth to you this recommendation: Do not throw away medications that are in pill or capsule form after their expiration dates if you are stockpiling for a collapse. Even if a small amount of potency is lost after time, they will be of use when we no longer have the ability to mass-produce these medicines. I’m aware that this is against the conventional medical wisdom, but we may find ourselves in a situation one day where something is better than nothing.”

(Friday: What I Did This Week To Prep)

* The terms medications and drugs (referring to legal drugs) are used interchangeably.

Post Script: Dealing With The ‘Tetracycline Becomes Toxic’ Myth

There has long been a belief that the antibiotic tetracycline becomes toxic once it has past it’s expiration date.

In Medscape Today’s article, Do Medications Really Expire?, they discusses the original case, “A contested example of a rare exception [of expired drugs possibly becoming toxic] is a case of renal tubular damage purportedly caused by expired tetracycline (reported by G. W. Frimpter and colleagues in JAMA, 1963;184:111). This outcome (disputed by other scientists) was supposedly caused by a chemical transformation of the active ingredient.”

The case was thoroughly evaluated in the 1978 article, Tetracycline in a Renal Insufficiency: Resolution of a Therapeutic Dilemma, it states, “”Old” and degraded tetracyclines have previously been demonstrated to have direct toxic effects on the renal proximal tubule, but because of changes in manufacturing techniques this is no longer a real problem.” It also states, “It has often been stated that the tetracyclines should be avoided in patients with severe renal disease, but, as we shall see, doxycycline represents an important exception to the rule”.

In Cohen’s article on the Shelf Life Extension Program, Many Medicines Are Potent Years Past Expiration Dates, it goes on to state, “Only one report known to the medical community linked an old drug to human toxicity. A 1963 Journal of the American Medical Association article said degraded tetracycline caused kidney damage. Even this study, though, has been challenged by other scientists. Mr. Flaherty says the Shelf Life program encountered no toxicity with tetracycline”.

Dr. Bones and Nurse Amy, from The Doom and Bloom Show, when interviewed on TSP, clearly state that tetracycline past it’s expiration date is safe (episode 736, beginning at 43:45). Nurse Amy concludes the topic with “. . . if they can just get that in their heads that tetracycline isn’t going to kill you when it’s past expiration”.

Medical evidence supports that tetracycline, past it’s expiration date–especially in the form of doxycycline–is as safe as any other expired antibiotic.

Can You Store Antibiotics In Your Preps?

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“The first rule of antibiotics is try not to use them, and the second rule is try not to use too many of them.” – Paul Marino The ICU Book 2007

Cellulitis

Last week in Soap and Water I posted about the risk, in a collapse situation, of an infection–from minor cuts and scrapes–known as cellulitis. I linked to Dr. Bones Doom and Bloom blog post, Cellulitis: An Epidemic in a Collapse. Here’s another good article by Dr. Bones, A Doctor’s Thoughts on Antibiotics, Expiration Dates, and TEOTWAWKI. For additional perspective about antibiotics before and during a collapse I recommend comments by Dr. ‘Walker’ on TSP forum. Additional, non-prepper/collapse, antibiotic information can be found at eMedicineHealth.com.

I need to state, though I was previously certified and worked as a paramedic for almost ten years, I am currently not a medical professional of any type; thus I am not giving any professional medical advice. All the information in this post is from open internet sources. As Dr. Bones states “. . . [these] are hypothetical strategies for a post-apocalyptic setting. They are not meant to replace standard care and advice when modern medical technology and resources are available.” And always remember, the practice of medicine or dentistry without a license is illegal and punishable by law.

So with all the caveats stated:

Antibiotics refer to a substance that kills, slows or disrupts the growth of:

  • bacterial infections: caused by a pathogenic (a ‘germ’/microorganism that causes disease) bacteria
  • protozoan infections: caused by a parasitic disease, i.e. giardia which occurs through ingestion of infected fecal contaminated water or food

Antibiotics do not fight infections caused by viruses, such as: colds, flu, most coughs, and most sore throats (unless caused by strep).

Much of my information comes from Dr. Bones. I trust his advice. I applaud him; he is a medical doctor who is willing to say what he believes will save lives in a collapse situation. But as he clearly states, “[This] advice is contrary to standard medical practice, and is a strategy that is appropriate only in the event of societal collapse. If there are modern medical resources available to you, seek them out.”

As discussed in Soap and Water, describing a collapse situation, there are several things that will aggravate the chances of getting an infection: 1) We will be doing more ‘dirty’ jobs, 2) We will be doing a lot more manual labor and other activities that can easily lead to cuts and scrapes, and 3) Clean water and basic hygiene will not be as accessible or convenient. So a relatively minor wound that is ignored while you continue working gets more contaminated; then the wound isn’t thoroughly washed out because clean water is saved for drinking. In a short period of time that wound can develop a serious infection.

Dr. Bones states in Fish Antibiotics in a Collapse, “These injuries can begin to show infection, in the form of redness, heat and swelling, within a relatively short time. Treatment of such infections, called “cellulitis”, at an early stage improves the chance that they will heal quickly and completely.  However, many rugged individualists are most likely to “tough it out” until their condition worsens and spreads to their blood.  This causes a condition known as sepsis; fever ensues as well as other problems that could eventually be life-threatening. The availability of antibiotics would allow the possibility of dealing with the issue safely and effectively.”

Having antibiotics available in a collapse situation will be very important, even lifesaving. The question is how can we as preppers obtain a stockpile to be used if other ‘medical resources’ are no longer available?

Dr. Bones continues, “After years of using [antibiotics] on fish, I decided to evaluate these drugs for their potential use in collapse situations. A close inspection of the bottles revealed that the only ingredient was the drug itself, identical to those obtained by prescription at the local pharmacy. If the bottle says FISH-MOX, for example, the sole ingredient is Amoxicillin, which is an antibiotic commonly used in humans.  There are no additional chemicals . . .”

So it seems that fish antibiotics are the same drugs as used in human antibiotics. I believe that adding fish antibiotics to my preps is a sound strategy. They are available, without a prescription, through many fish supply websites. I have purchased, or plan to purchase, the following:

  • Fish-Mox Forte (amoxicillin 500mg): used to treat infections of the ears, nose, throat, urinary tract, skin, pneumonia, and gonorrhea
  • Fish-Flex Forte (cephalexin 500mg): used to treat infections of the bone, ear, skin, urinary tract, and pneumonia; it has very low side effects, (it is typically safe for those with penicillin allergies)
  • Fish-Flox Forte (ciprofloxacin 500mg): used to treat infections of bones and joints, sinuses, skin, urinary tract, gastroenteritis (stomach ‘flu’), typhoid, plague, and anthrax
  • Aqua-Doxy (doxycycline 100mg): used to treat infections of the sinus and respiratory tract, skin (staph), urinary tract, intestines, chlamydia, anthrax, Rickettsia, Lyme disease, plague, and cholera
  • *Fish-Zole (metronidazole (Flagyl) 250mg): as an antiprotozoal, used to treat giardia and dysentery

For any medication you choose to stock (antibiotics or otherwise) print out the entire drug card and keep that information stored with the drug; a good online source of drug information is the U.S. National Library of Medicine. Also it’s always best to store them in the original package and, like food storage, keep in a dry, dark, cool place.

If you choose to add antibiotics to your preps it is your responsibility to be thoroughly educated about their usages, contradictions, doses, and side effects. This is something you can’t just buy and figure you have it if you need it. Obtain additional medical publications such as the Physicians Desk Reference (PDR) or Delmar Nurse’s Drug Handbook*. Antibiotics are drugs, taking an antibiotic is a medical treatment, do not take this lightly. When I was going through my Army medic training one of my instructors said, “Every medicine you put into the body is a toxin, be sure the benefits outweigh the risks.”

(Wednesday: Expired, or Not Expired; That Is The Question)

* There are many other good references available, these are just two examples. There is no reason to buy a current edition; older editions are much cheaper and have essentially all the information a layperson would ever need. 

Keeping Wounds Clean With Simple Soap & Water

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Minor cuts and scrapes happen from time to time. Though any open wound is a potential site for infection, we really don’t think much about the small ones other than their initial pain and the inconveniences they cause us as they heal. Most of us live in a world that is relatively safe and even minor wounds don’t happen very often. When they do, the simple steps we take to care for them plus our daily hygiene practices prevent most infections. In rare situations, when the injury becomes infected often the biggest hassle is finding the time to get to the doctor’s office for prescribed antibiotics.

But in a long-term disaster/collapse situation, a minor wound–if neglected–could become deadly. In that scenario, there are several things that will aggravate the chances of getting an infection: 1) We will be doing more ‘dirty’ jobs, i.e. working outside, building fires, handling animals; 2) We will be doing a lot more manual labor, i.e. cutting wood, cooking over a fire, building and repairing, and other activities that can easily lead to cuts and scrapes; and 3) Clean water and basic hygiene will not be as accessible or convenient, i.e. no running water in the house. So a relatively minor wound that is ignored while you continue working gets more contaminated; then the wound isn’t thoroughly washed out because clean water is saved for drinking. In a short period of time that wound can develop a serious infection.

What is the best way to clean and care for a minor wound? Common answers frequently include hydrogen peroxide or alcohol, but not only do both of these harm the healthy tissue they can also delay wound healing. I’ve even heard someone say that ‘alcohol must be the best because it burns the most when you apply it’ – it burns because you are killing the exposed healthy tissue.

The best way to clean a minor wound, and prevent infection, is to remove all debris from the wound with cool, clean running water (this could also be poured or squirted from a container) and a mild soap. Then prior to bandaging it, lightly apply (think chapstick application) petroleum jelly on the wound. This will help the healing process by keeping the wound moist and clean and stop the bandage from sticking. Using antibiotic ointments is unnecessary, they add unneeded cost and may help create more antibiotic resistant bacteria; their main benefit is the same as the petroleum jelly.

Remember there’s a fine line between tough and stupid. The only medical aid available might be from your own group. So plan ahead to minimize injury: wear protective gloves, long pants and long sleeves, and, if appropriate, a helmet and/or goggles. When you do get a minor wound (and you will), make it a priority to clean and dress it as soon as possible. Be sure to know where the nearest first aid kit is kept, have water available for washing, and keep soap in your preps.

Even if you’ve done everything right, there’s a chance infection will occur. The type of infection common in these type wounds is cellulitis. Cellulitis, if not treated by antibiotics, “can cause a life-threatening condition known as sepsis”. This is described by Dr. Bones on his Doom and Bloom blog post, Cellulitis: An Epidemic in a Collapse. I recommend reading it. Next Monday I’ll explain what I’ve learned, and recently done myself, to acquire a stockpile of ‘collapse medicine’ antibiotics.

(Friday: What I Did This Week To Prep)