Hitting the Wall: Legal, Ethical, and Logistical Barriers to Medical Preparedness

The following post on medical preparedness is contributed by Pete Farmer,  who holds advanced degrees in research biology and history, and is also an RN and EMT.

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You’ve done your research, rolled-up your sleeves and made up high-quality first aid kits for your home and vehicles, you’ve spoken with your physician, pharmacist, or other healthcare provider – and solicited their advice on medical preparedness. You have adjusted your plans accordingly. You have built a library and patronize websites like this one as part of your on-going effort to expand your knowledge. Perhaps you have been trained and have acquired experience as a medic, EMT, athletic trainer or patient care tech. Now what? 

By now, you have probably run into some of the intractable obstacles that medical preppers encounter. Legally-restricted access to certain classes of drugs and medical devices, the difficulty of acquiring advanced training without attending an expensive university-level degree program, barriers to entry into the medical and paramedical professions, and much more. Even when one can obtain a given pharmaceutical or drug legally, it is often too expensive to stockpile, or the pharmacy will not or cannot fill your prescription. Some vendors supply only FDA or DEA-licensed organizations, and won’t sell to lay people. The list is nearly endless. 

These problems in turn beg a series of ethical or moral questions. Many other nations have substantially cheaper and/or less-restricted drug formularies than the United States (Mexico, to name one example). Some pharmaceuticals available only by Rx in the U.S. can be purchased legally in those places over the counter, without an Rx script. These compounds range from antibiotics to analgesics/pain killers/narcotics to hormone replacement therapies such as human growth hormone, and many more. Americans can lawfully go to those nations, and purchase such agents, but at present it is unlawful to bring or attempt to bring them into the United States without official permission and the appropriate clearances. This article will not debate the pros and cons of such laws; it simply notes the legal conditions pertaining at the present time. 

Rather than take the law into your own hands, and run the risk of a sizeable fine and/or imprisonment (and loss of your healthcare license if you have one) by smuggling such agents into our country, let me suggest a legal and ethical alternative: getting your elected officials and local/regional disaster preparedness organizations involved. Do some writing of letters and make some phone calls. Visit in person with authorities involved in medical and other forms of preparedness, if feasible. Contact your local Congressman or  state representative. Let’s discuss what to say when you do so…   

1.  Be frank and up-front about what you are doing vis-a-vis medical preparedness and why. Express your concerns clearly and reiterate your desire to follow the law.

2.  Frame medical preparedness as a community issue, one which should be of importance to any conscientious emergency management or public safety professional – not to mention any politician genuinely concerned with disaster contingency planning, mass casualty events, public health outbreaks or the political fallout from same.

 3.  Note that since the law forbids private citizens from stockpiling medicines and most medical equipment as a contingency against future events, and restricts access via the prescription system to many others, ask what is being done by local/state agencies to rectify the problem. Are the authorities in question stockpiling these meds and other needed supplies? What is being done to prepare for that next tornado or hurricane or other disaster? Ask a lot of questions, exercise your rights as a citizen. Don’t assume everything that can be done is being done. Call me a cynic, but my experience and Murphy’s Law prove the opposite.

 4.  As recent history illustrates, the government has a very mixed record at disaster preparedness. Many of us remember the chaos that followed Hurricane Katrina, and the weeks upon weeks that it took local, state, and federal authorities to respond appropriately. FEMA didn’t function as promised; it is that simple. Recall also that during the recent scare (a false alarm, thankfully) over the H1N1 flu virus, the feds were slow in building up the needed doses of vaccine. In fact, the government didn’t accumulate the needed stocks until after the crisis had passed. For concerned citizens, this means keeping the issue before officials and elected representatives. The squeaky wheel does eventually get the grease.

 5.  Much of our society functions on a just-in-time supply chain model. That includes many healthcare providers. The practical consequence of this is that many clinics, hospitals, pharmacies, and suppliers do not have very deep stocks of needed medical supplies, drugs, diagnostic agents, and so forth. We live in an economy designed for efficiency, not resiliency. Bring this state of affairs to the attention of the aforementioned politicians and officials; once they see we care about it, perhaps they’ll care about it. Also, drop a line to your local newspaper and ask to speak to their healthcare or science reporter if they have one; they might run a story on the issue. Emphasize the need for locally-generated and implemented solutions to these problems. We don’t need another dysfunctional and expensive federal bureaucracy that fails to work as advertised when a crisis hits.  

6.  Research and form a position – whatever yours may be – concerning the many roadblocks that our system erects in the path of medical preppers. The issues range from licensing and the problems of over-credentialing to onerous fees and costs of entry, to the government-university cartel which has made entering any medical field a very costly and laborious process. A rich nation can afford these kinds of inefficiencies, but should the America of 2010? To name one example, the military has proved via its system of training enlisted medics and corpsmen (most of whom do not have college degrees), that one need not have a college education to become a healthcare provider. Yet, professional nursing organizations and universities have restricted the civilian scope of practice of these individuals severely. The result is that everyone gets an expensive university education, whether they need one or not. That’s great for the colleges and professional credentialing organizations, but not so good for someone leaving military service with years of practical and useful healthcare experience, who can’t work as anything but a PCT.  Yes, we need highly-trained physicians and other specialists, but to insist that everyone attain that level of expertise is both foolish and wasteful, and does not serve our communities or patients well. Get informed about the issues, and start lobbying your elected representatives. Otherwise, nothing will change until a genuine crisis of some sort hits, and that is an expensive way to learn anything.

 In closing, don’t hide in the closet if you are interested in medical preparedness. It is nothing of which to be ashamed. In fact, you are to be commended for taking the initiative. Most doctors, nurses, firefighters/paramedics, cops, and other first responders and public safety personnel love knowledgeable, squared-away people. They make our jobs easier and help patients get better care. And for goodness sakes, advocate for medical preparedness issues whenever possible.

Copyright © 2010 Peter Farmer

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Herbal Medicine – Start with the Science

Herbal medicine – fact or fiction?

How does one separate the truth from the hype?  Most of what you find online is anecdotal evidence.  Can you trust someone who is trying to make a sale?  It’s one thing to believe a certain treatment is useful in your own particular case (placebo effect or otherwise).  It’s another to recommend its use for others.  I often tell my patient that every helpful medicine or herb is also a potential poison.

The National Center for Complementary and Alternative Medicine offers a free brochure entitled Herbs at a Glance, which outlines what each herb is used for, how it is used, what the science says, and side effects and cautions. 

Download and print this 55-page free booklet at the link above to include with your prepping supplies.  I would consider this a starting place, to guide you toward useful remedies.  

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Mental Health in Tough Times – Part II

The following is Part II of Mental Health in Tough Times, contributed by Peter Farmer, who holds advanced degrees in research biology and history, and is also an RN and EMT.  Please see Part II for the Introduction and Items 1-6.

Today’s list includes 19 more tips on maintaining optimum mental health in tough times, both now and at the end-of-the-world-as-we-know-it.  Thanks, Pete.

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7.  If you have trouble tracking down the source of your mental illness, consider seeing an allergist. Simple, low cost skin tests are available to determine antigenic sensitivity to common environmental toxins and allergens, such as dust mites, mold, and fungi and so on. If you come up positive, remediation and abatement in your home, workplace, and elsewhere can be undertaken as needed.

8.  Lessen your toxic burden to cool systemic inflammation. Drink plenty of water or green tea, exercise until you are perspiring profusely, and use a sauna or steam bath if possible. Some authorities recommend periodic fasting to allow the liver to recover. Milk Thistle is commonly used in Europe as a dietary supplement to assist the liver in detoxification.  Targeted dietary supplementation may be called for under a physician’s supervision.  Note: Toxic levels of heavy metals (lead, mercury, cadmium, etc.) and other metabolic poisons are medical emergencies; if you suspect that you have been affected, do not attempt to treat the problem yourself. Seek professional medical attention immediately.

9.  Exercise has been shown to be as effective as or even more effective than psychoactive medication in lessening the symptoms and effects of mild-to-moderate mental illness, and in promoting emotional and cognitive well-being.  Human beings are designed to move – so get off the couch and do something active.  Neurochemical mapping studies and PET scans have shown that exercise has the ability to remodel the type and distribution of neurotransmitter receptor sites for such mood-critical compounds as serotonin, dopamine, epinephrine, and norepinephrine, among others.  All exercise is beneficial, but be sure to cross-train if possible, so you get the benefits of different types of activity, i.e., aerobic versus anaerobic, intense versus moderate, weight-bearing versus non-weight-bearing, and so on.

10.  Get your sleep – for most people, 7-8 hours of uninterrupted sleep is optimal. If you have sleep problems, get them addressed; high-quality sleep is critical to optimal health and mental/physical resiliency.

11.  Spend some time outdoors every day, if at all possible – running, walking, gardening, doing whatever you like. Important source of vitamin D, and gets you out into the fresh air.

12.  Practice deep breathing exercises.  Yoga practitioners and martial artists have long known the power of deep breathing to calm anxiety and lessen stress.  Sustained aerobic exercise has many of the same benefits. Biofeedback relies upon deep breathing, in part, to allow conscious control of heart rate, blood pressure, etc.  Studies of soldiers, police officers, and others subject to extreme stress have shown that control of breathing is an effective tool in lessening the effects of sympathetic nervous system “acute stress syndrome.” Controlled breathing is also extremely effective for managing lower but still debilitating levels of stress and anxiety

13.  If you are prone to anxiety for unknown reasons, you may suffer from a magnesium deficiency.  Ask your primary care provider whether a test of plasma Mg 2+ is called for.

14.  Cognitive behavioral therapy, as pioneered by David Burns, M.D., and others, is very effective at alleviating some forms of depression and other mental illness.  CBT relies upon the breakthrough discovery that how you feel and how you think are not independent of one another; one’s emotional state is directly and profoundly affected by patterns of thought and “self-talk.”

15.  If you are unhappy with where you are, keep moving. Action precedes motivation, not the reverse. These simply stated guidelines are critical especially for those in difficult or dire circumstances.  The historical and scientific record is quite clear; people do better under difficult or even life-threatening circumstances if they are doing something and not simply passively waiting for help or whatever fate has in store.  All other things being equal, resilient people have better survivability than people who are not – and a critical component of resiliency is taking action, even after setbacks. Or, as the old saying goes, “It isn’t how many times you get knocked down that counts, it is the number of times you get up.”

16.  Cultivate a positive, can-do outlook – even when things look tough.  Whatever your problem, you may fail if you try – but you will most certainly fail if you do not try to improve your circumstances.  And history is full of stories of people who overcame “impossible” odds to solve problems, survive in unbelievably hostile or unfavorable circumstances, and so on. A “can do” outlook is an important part of resiliency.

17.  Get help when you need it, and don’t be afraid to ask for it. Men especially, but many women also, hesitate to ask for help with mental health concerns, fearing that others will think less of them, and that they will be stigmatized as somehow less than others, unfit, unreliable, etc. The truth of the matter is that almost everyone has tough times at some point in their life, and can use a hand.

18.  Know the limits of at-home care. Some mental health problems cannot be solved alone, or only with difficulty. Still others, i.e., bipolar disorder, schizophrenia, etc., require sophisticated medical treatment and are largely unresponsive to “do-it-yourself” care.

19.  Have an annual physical exam, of which a mental health status check is a part. Your primary care physician is an important resource and gatekeeper to mental health specialists, such as psychiatrists, neurologists, etc.  Most general practice physicians have a well-established network to which they can refer patients as needed.

20.  Don’t neglect your spirituality or faith. If you are religious, worship in the manner that you choose.  Practice gratitude; authentic happiness isn’t possible without it.

21.  Lose yourself in your hobby. If you are musical, play or sing when you need to “escape the world;” or simply listen to whatever music soothes you.  If sewing makes you relax and improves your mental being, do that. If nothing makes you happier than tinkering with engines, do that – and so on.

22.  Keep company with other people or a beloved pet. Numerous findings have shown the link between   health, happiness, and being around people you care about.  Unmarried men, for example, tend to die younger than happily-married ones.  Pain, the so-called “fifth vital sign,” according to some healthcare practitioners, is lessened in chronic pain patients when they spend time with a treasured pet or a child.

23.  Help someone else, or simply visit an old friend or perhaps an elderly person in need of company.  Write a letter or call someone with whom you haven’t spoken in a while.  We lessen and are distracted from our own cares, worries, and suffering when we devote time and attention to those of others.

24.  Be curious about the world around you. Read a book in a subject that interests you, write a letter or solve a crossword puzzle, or take on a “do-it-yourself” project that requires concentration. Consider learning a language. Turn off the TV and do something that requires active engagement. Consider it a workout for your brain.  Doing this lessens your chances of suffering mental illness, alleviates symptoms of preexisting disorders, and lessens the odds of memory loss, old-age dementia, and other negative outcomes.

25.  Whatever your circumstances, do your best to be happy, or at least act that way. Angry, embittered and negative people not only suffer terribly from their state of mind, they inflict that suffering on others around them. Especially in a crisis, resilient people have the ability to bounce back, to adapt to whatever circumstances they are facing.  None of us can control how reality unfolds, but each of us can control how we react to it. Sometimes, that isn’t much – but this simple fact made the difference between life and death for some WWII-era Allied prisoners in enemy POW and concentration camps.

This concludes our round-up of mental health in tough times.  Your comments, questions, and suggestions are welcome.

Reference:  “The Ultramind Solution: Fix Your Broken Brain by Healing Your Body First” by Mark Hyman, M.D. Scribner, NY City, 2009.

Copyright © 2011 Peter Farmer

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Week 6 – Question of the Week: Should medication be rationed at TEOTWAWKI? How and why?

Week 6:  2011-04-14

 Today I’m asking our professionals to weigh in on the question:  Should medication be rationed at TEOTAWKI?  How and why?

You, too, are welcome to post your responses and questions below. 

Check back soon and see what our panel of over 100 professionals has to say.

– Doc Cindy
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Protected: Wisdom Teeth – Advanced Treatment Options

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Impacted Wisdom Teeth . . . Answers for TEOTWAWKI

Welcome to the Wonderful World of Wizzys

So what are we going to do about impacted wisdom teeth in a world without dentists? Not to put too fine a point on it…Suffer. Let me explain.

God felt that humans needed 32 teeth to function together and support each other for a lifetime. As a creationist, I believe that before Eve gave Adam the apple and he ate it, that this was true. However when sin entered the world, conditions changed, and all living things were subject to deterioration of their genetic code. These mutations were passed on generation to generation, with each new stage adding its own mutations to the mix. One of the human consequences has been the imbalance of the total width of the teeth exceeding the amount of space in the dental arch.  In some people, we see the effects of this by crowding of the teeth (and the orthodontist gets another job); in others, there is no room for all the teeth and the last ones never erupt fully into the mouth (and the oral surgeon gets another job).

Our evolutionist friends explain this phenomenon as the result of natural selection modifying the jaws to account for modern diet, where food is softer and therefore less mastication is needed. OK, if you say so. I have seen photos of skulls of Anastasi Indians that are carbon dated to c. 3000 BC, they did not have a modern diet…they did have impacted wisdom teeth, go figure.

Regardless of the origin of the problem, the symptoms and underlying causation must be dealt with. Most wisdom teeth related emergency issues in the dental office come from a condition called pericornitis.  This occurs when bacteria is introduced into the pocket around the crown of the semi-erupted lower wisdom tooth. Bacteria and associated toxins lead to irritation and swelling. The swollen tissue gets pinched between the upper and lower teeth. This can be very uncomfortable and lead to the patient keeping their jaw in an eccentric position to avoid the pinch, which leads to chronic muscle stress and associated pain. This infection can in and of itself lead to fever and a sore throat. Another consequence can be trismus, where the masseter muscle goes into spasm limiting jaw opening to about an inch. This problem seems to be unique to third molars. I do not see it during the eruption of the other molars, even though they sometimes come in in a similar manner.

So what will we do if the dentist and his panoramic x-ray machine are no longer in business? Well, as with every other treatment, we have to make keen observation and act to minimize or eliminate the causative factors. If there is significant swelling and trismus, we have to use warm salt water rinses and possibly antibiotics, if available, to get us past the crisis. Aspirin or ibuprofen will help with pain and inflammation.  Assuming that we can see the area, first we need to begin the process of flushing the pocket of tissue that the tooth is contained in. In my practice, I use 0.12% chlorhexidine rinse (Peridex) for this purpose. One could also use warm salt water, hydrogen peroxide, Listerine, or some other reasonable consumable liquid. I use a 5cc syringe that has a curved tip, but one could use any syringe with a needle with the tip cut off, smoothed and bent to fit. The process is to run the tip under the tissue fold as far as can be tolerated and then flush the pocket to remove bacteria and debris as well as oxygenate the area. Do not inject the tissue, just flush the pocket. This may need to be done several times over a day or two, until the acute phase of the pericornitis is resolved. At some point, it may be necessary to remove the tooth above or below the tissue if there is a significant pinching of the tissue that will not let the swelling go down.

Once the acute inflammation is resolved, one needs to evaluate the actual wizzy involved. Without an x-ray, it is problematic to guess at the condition of the whole tooth from the portion of the tooth that you can see. If you have a good grasp of dental anatomy, sometimes a small portion of tooth exposed is enough to deduce the lay of the underlying whole. Believe me when I say that removing anything more complex than vertical and in line with the other teeth is beyond the scope of a neophyte. (I will post a Pro’s only addendum to this for further instructions.)

If no professional help is available, it will be necessary to continue the flushing once or twice a day indefinitely. Only if this is in a teenager is there any real hope that further growth and maturity may resolve the condition. This may be one of those things that will just need to be tolerated in the hard times ahead.

Copyright © 2011 WH2THDR

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Free Download – When there’s no other doctor

Suppose there’s no doctor to help you or your family. Where do you start?

If no physician is available, and you become responsible for the health care of your family or group, what should you know about a patient?

No doubt you’ve completed health assessment forms yourself upon visiting a medical office, emergency room, or your friendly family dentist.  What was it they asked?  And why did they want to know?

Medical students are taught to ask the correct questions before learning the correct answers.  As potential future health care providers, you, too, might want to know the important aspects of a patient’s history. 

Today’s free download will help guide you in your information gathering and record keeping.  Below you can download a modified copy of the Adult Health Assessment Form I used in my own office.  On a single page you’ll have before you the highlights of a patient’s history.  Enjoy!

Adult health assessment FORM Click to the left for download, and again on the page you’re transferred to. 

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Skilled Tradesmen as Public Health Experts: Or, why you should make friends with a good plumber…

The following is another post by our friend Pete Farmer,  who holds advanced degrees in research biology and history, and is also an RN and EMT.

January 4, 2011  

Social Security: Public Health nursing made av...

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If you are at all interested in medical preparedness and the issues that accompany it, you may wish to consider establishing a good relationship with as many skilled tradesmen as possible, and even consider acquiring some basic home-repair and “handyman” skills yourself. Why? The answer is simple. The foundation upon which modern public health rests is comprised not only of medical and scientific discovery, but upon many hundreds of years of advances in fields such as civil and sanitary engineering, the construction trades, manufacturing, and much more. All of us, to a greater or lesser degree, depend upon and take for granted abundant clean water, pest abatement, garbage and waste disposal, electrical/gas power, and shelter. The people who assure that we receive these services are the engineers, technicians, and tradesmen who build and run what we’ll call the public health infrastructure. That includes everyone from the sanitary engineer at the local water purification plant, to the microbiologist who tests your water for Escherichia Coli bacteria and other pathogens, to the building contractor who builds your home, to the plumber who comes running when your pipes burst.  

Maintaining optimal health is orders-of-magnitude more difficult when the basic public health infrastructure of our lives breaks down. This can easily be proven by historical reference to pre-industrial societies whose public health measures were lacking or all-but-nonexistent. Cholera, dysentery, bubonic plague, and other communicable and parasitic disorders were common, and morbidity & mortality from these disorders was high. 

In a post-apocalyptic or disaster scenario, among the most critical tasks for early responders is to restore basic services – water, power, communications – in addition to rendering first aid and medical care, and the provision of food, clothing, and shelter for those affected. Modern high-tech healthcare providers are, almost without exception, highly dependent upon having adequate power, light, and water on command, when and where they need it. Very often, they need distilled, sterile, or deionized water – for everything from scrubbing for surgery to reconstituting drugs for injection. They need high-capacity, surge-protected power, and bright light for examination, diagnosis, and treatment of their patients, and so on. That is why hospitals have extensive engineering departments devoted to maintaining these services, and often have redundant or “independent” sources of power (generators), water, and light. 

Leaving aside the special needs of acute care providers, let’s consider what the average person can do to assure these services are uninterrupted or at least started again as soon as possible after disaster strikes. 

Establish contacts with competent professionals in the building and construction trades, i.e., plumber, heating and air conditioning, electrical, carpentry, etc. Depending on your financial and other circumstances, consider preemptive service to assure that your personal water, power, and heat/cooling infrastructure is in good condition. If you live in a rural area, and can install a large-capacity fresh water tank, consider doing so, or sink a well, or both. 

Redundancy is desirable if you can afford it. Build or purchase back-up systems in case you lose water, power, heat, or other utilities. James Rawles, among others, has written extensively on this topic. Depending on your circumstances, specific needs, and budget, you may wish to purchase a diesel or propane-powered generator, or invest in solar power to augment electricity supplied by the local grid. One relative of mine has installed a home heating system that burns waste coffee grounds from a local coffee manufacturer; another has his home heated with a computer-controlled stove that burns corn kernels. The possibilities are extensive, so do your homework and shop around. A rainwater catchment tank may suit your needs. If you own a pool, it is a ready source of relatively clean water. 

If you are permitted to do so by local zoning ordinances, consider using propane to heat your home and run your vehicles. A large propane tank is unremarkable in most rural communities, and this simple hydrocarbon offers many advantages relative to conventional gasoline, diesel fuel, and natural gas. Conversion kits are available to modify your vehicle for this purpose; any competent mechanic can perform this service. Why propane? True, you are dependent upon deliveries of your fuel, but once it is in that tank adjacent to your home, it is much less subject to being interrupted by events out of your control. A broken gas main on the other side of town doesn’t affect you. And you own it, it is yours to use as you please. 

Another way in which a skilled tradesman can be of help is by inspecting your insulation, roofing, windows, and other parts of your home, and making recommendations for repairs or upgrades to your existing facilities. In a grid-down scenario, having adequate insulation may be not only a money-saver and a luxury, but a life-saver. 

A useful tip I learned from those in tornado or hurricane country is to have on hand the tools and supplies for doing basic reinforcement and/or expedient repairs to your home, in expectation either of being hit with a powerful storm or cleaning up after one. If you have sufficient forewarning of an approaching hurricane, it is standard operating procedure to tape your windows to minimize flying glass, and to reinforce weaker structural areas with plywood or other materials. Some plywood and plastic sheeting, along with various sizes of rough boards, can be used to do makeshift repairs after a storm. Again, consult your local tradesman for the specific tools and supplies to keep on hand. If you live in “tornado alley,” you need a storm cellar or similar reinforced, protected area in which to shelter.  

Escherichia coli: Scanning electron micrograph...

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Is your budget limited? You can take simpler but still valuable measures, such as keeping stored drinking water on hand in sufficient quantity to last a specific number of weeks or months without municipal water service. Keep a decent water purification system on hand, as well as simple chlorine bleach, which may be used to purify impure water. Most hiking stores also sell water purification tablets. Buy several propane lanterns or similar devices to light your home in the event you lose electrical power – and don’t forget the humble candle. They still work fine, and are cheap. Be aware of the necessity of adequate ventilation when using any combustion source of light; do not fall prey to CO (carbon monoxide) poisoning! Observe common-sense fire safety rules, and having a fire extinguisher on hand is always prudent. In case you lose your heating system, keep adequate bedding materials on hand to compensate for the cold. Commercially-available sleeping bags rated to various temperature ranges are adequate for most of us.

 Most folks take for granted a clean, dry place to perform their basic functions of elimination. However, in a post-disaster scenario, you may lose that facility and have to resort to something more primitive, along the lines of a latrine or outhouse. Again, think ahead… do some contingency planning, and remember – you’ll need to site any field-expedient latrine or toilet well-away from your dwelling, any ground water, and preferably downstream of any ponds, streams, etc. on your property. A good reference for this situation would be to consult a military field manual on establishing field sanitary facilities. A common and useful method of containing/disposing of solid waste is to use a cut-in-half 55-gallon drum as the receptacle of your latrine; the waste therein can be burned using gasoline. Solid waste can also be buried or composted. And take note of the prevailing wind direction when sitting your latrine; no point in being downwind any more than you have to. This seems a trivial matter – but as any soldier can tell you, having a clean, dry, and sanitary toilet is critical not only to public health, but morale. And don’t forget the TP…   

Pest abatement: this will vary according to your locale, circumstances, and the prevailing climate in your region; the key factor is to think a bit about how to minimize insect, rodent, or other infestation, not only in your home, but in a post-disaster scenario. If you live in a tropical/subtropical region, or it is hot and humid with standing water, you will need to think about mosquito abatement. That means repellent, mosquito netting, protective clothing, and perhaps chemical agents to treat standing water. In a pinch, oil works as it establishes a thin film on top of the water, prohibiting mosquito larvae from getting established. As far as rodents or other small mammals are concerned, commercially-available traps and poisons are an option, and a dog or cat also can work wonders in keeping them away. Make friends with your local pest control specialist, and you can prevent these issues from becoming problems in the first place. Be aware of local rules and regulations regarding pesticides and similar chemicals. Take the time to familiarize yourself with the local insect varieties, such as ticks, bees, wasps, etc. and make the necessary preparations. If you or a member of your group is allergic to bee stings or similar, have an adequate supply of epinephrine on hand (usually in the form of an “epi-pen” auto-injector, which must be refrigerated). Your general practice M.D./D.O. is a good resource for preparation in this area. Adequate food storage will also do much to minimize pests – so assure that your food is secured properly. Speaking of food…    

If the power goes out, do you have adequate stocks of food on hand, in non-perishable form? If not, consider getting some MREs (Meals Ready to Eat), dehydrated food, or other foods stable in long-term storage. Costco and many other commercial outlets sell pre-made kits containing survival food, or you can easily put together your own cache. In addition to stockpiling a supply of safe, clean water, don’t forget to lay in a good supply of soap, and some basic cleaning gear – buckets, towels, and the like. If the water main bursts, or you lose your source of clean water, not only will you need potable water for drinking and food preparation, you’ll need it for bathing and cleaning. Plan accordingly. 

The foregoing are simply some suggestions on how to get started. The important thing is to devote some thoughtful time and effort to assuring the infrastructure which protects your health. Even the best post-disaster medical care is severely handicapped by inconsistent and/or unreliable food, water, shelter, and sanitation. So, make friends with your contractor or tradesman – you’ll be glad you did. 

Copyright © 2011 Peter Farmer

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Ten Essential OTC Medications to Stockpile

The following article was originally published at www.survivalblog.com.

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Are over-the-counter (OTC) drugs really worth stockpiling?  As a family physician my answer is a resounding yes.  Most of the following were actually prescription medications when first released.  (In higher dosages, several still are.)  Although other OTC drugs are worth considering, these ten have been selected due to their ready availability, affordability, safety in both adults and children, and multi-use potential.  Used alone or in combination, they can effectively treat dozens of conditions including:  headache, fever, sore throats, ear ache, menstrual cramps, heartburn, arthritis, ulcers, diarrhea, allergies, hives, congestion, dizziness, mild anxiety, nausea, vomiting, poison ivy, athlete’s foot, ringworm, eczema, insomnia, backache, gout, diaper rash, yeast infections, and many more common illnesses. 

1.      Ibuprofen (Motrin, Advil) – Among the OTC anti-inflammatory medications, ibuprofen is probably the most versatile.  Primarily indicated for pain and inflammation, it may also be used to relieve headaches, earaches, sore throats, sinus pain, stiff neck, muscle strains, menstrual cramps, arthritis including gout, and back pain.  It is also effective at reducing fever and is generally safe for use in children.  It is not advisable for most stomach-related pain, although may decrease the pain of kidney stones, kidney infections, and possibly bladder infections.  The most common side effect is stomach irritation or heartburn.  When combined with acetaminophen it is nearly as effective as codeine, tramadol, or hydrocodone in relieving more severe pain. 

2.      Acetaminophen (Tylenol) – Acetaminophen is the only OTC pain-reliever that is not an anti-inflammatory drug.  It will not irritate the stomach like ibuprofen, aspirin, or naproxen.  It is useful for the same conditions as ibuprofen, though effectiveness varies according to patient.  As mentioned above, it may be combined with ibuprofen in full doses for more severe pain.  Side effects are very few, though in high dose, especially when combined with alcohol, it can lead to liver failure.  It is available in several pediatric dosages, both for pain relief and fever reduction.

3.      Diphenhydramine (Benadryl) – An inexpensive antihistamine, diphenhydramine is primarily used for drainage due to respiratory infections and nasal allergies, in both adults and children.  It is also indicated for hives and itching, including itchy rashes such as poison ivy.  Although not all patients become drowsy when using diphenhydramine, many do so, making this medication useful for insomnia as well.  Some people find the drug relieves nausea or mild anxiety.

4.      Loperamide (Imodium) – The most effective OTC medication for diarrhea is loperamide, which is available both as tablet form and liquid for children.  It is often useful for relieving intestinal cramping.   

5.      Pseudoephedrine (Sudafed) – Pseudoephedrine is effective at relieving congestion of both the upper and lower respiratory tract due to most common causes including infection, allergy, chemical irritation, and mild asthma or bronchitis.  It frequently has a stimulatory effect, similar to caffeine.  The most common side effects are those resembling a burst of adrenaline:  rapid heart rate, palpitations, and increased blood pressure.  Years ago this drug was used in young children, even babies, though now most pediatricians do not advise it in patients younger than about six years old. 

6.      Meclizine (Bonine, Dramamine) – This antiemetic drug is available both over the counter and by prescription.  It relieves nausea, vomiting, motion sickness, and vertigo-like dizziness.  For some patients it causes drowsiness, and therefore may be used as a sleep aid.  It is related to medications for anxiety and may help with this as well.

7.      Ranitidine (Zantac) – Although several medications are available OTC for the treatment of heartburn, ulcers, and other acid-reducing conditions, ranitidine is among the best-tolerated, is inexpensive, and is also useful for relieving hives. Doctors often advise an acid-reducing medication such as ranitidine for patients who experience stomach upset when taking ibuprofen, though this must be done with caution.

8.      Hydrocortisone cream – The 1% version of hydrocortisone is the strongest steroid cream available over the counter.  It is safe for use in both adults and children in treating inflamed and/or itchy rashes such as eczema, poison ivy, diaper rash, and other minor genital irritations. 

9.      Bacitracin ointment – This ointment is best used to prevent skin infections when the integrity of the skin has been breached, as by an abrasion, laceration, insect bite, or sting.  It also may be used to treat a superficial skin infection such as a mildly infected wound or impetigo.  It is less likely to produce a topical skin allergy than other topical antibiotic preparations that contain neomycin.  It cannot be used to treat deeper infections, however, which generally require an antibiotic by mouth.

10.  Clotrimazole (Gyne-Lotrimin) The same antifungal medication, clotrimazole, is contained in both Lotrimin and Gyne-Lotrimin.  Gyne-Lotrimin may be used to treat both female yeast infections and any other yeast or fungal infection that Lotrimin would treat, including athlete’s foot, jock itch, ringworm, diaper rashes, and skin fold irritations.

Conclusion
For under $50 total a good supply of all of the above can be purchased.  Several of these medications are also available at higher doses by prescription, and may actually be less expensive if obtained from a physician (ranitidine, meclizine, loperamide, and diphenhydramine), even paying full price.  All of the above drugs and many more are discussed in detail in my book, 101 Ways to Save Money on Health Care. The book includes dozens of sections on treating yourself.  Available for under $10 online, the book offers practical advice on treating: respiratory infections, pink eye, sore throats, nausea, diarrhea, heartburn, urinary infections, allergies, arthritis, acne, hemorrhoids, dermatitis, skin infection, lacerations, lice, carpal tunnel syndrome, warts, mental illness, asthma, COPD, depression, diabetes, enlarged prostate, high blood pressure, high cholesterol, and much more.

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Safe Handling of Health Care Waste

Without modern medical waste disposal, what would American hospitals do?

What will you do with bloody gauze, contaminated needles, infectious secretions and excreta when disposal becomes your responsibility?

The Hesperian Foundation offers the following free 33-page download, written to address this question, primarily for third-world countries (which we, too, could become.) 

As with their other publications, this is written at a level anyone could understand.

On page 20 it includes a handy chart for appropriate disposal of all sorts of medical waste, including amputated body parts, feces, blood, and contaminated disposable equipment.

Why not print out this handy guide to include in your medical survival kit?

Click title below to reach the Hesperian Foundation’s download page: 

Safe Handling of Health Care Waste

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