Doom and Bloom: Active Shooters In The New Norm

The Altons at Doom and Bloom Medical write about Active Shooters in the New Norm and training and first aid for the same.

On March 23rd, 2021, a man thought to be mentally disturbed entered a Boulder, Colorado grocery store and began a shooting rampage. 21-year-old Al Aliwi Alissa, born in Syria but living in the United States since the age of three, managed to kill 10 people, including a police officer, before disrobing and surrendering to authorities. It’s thought that the gunman has a long history of anger issues and may have paranoid tendencies.

The shooting follows an incident where another 21-year-old killed 8 people in Georgia at local massage parlors, which he saw as a form of temptation for what is described as a “sex addiction.” The recent shootings in diverse settings follow a lull during the 2020 COVID-19 pandemic.

In the last few years, shooting events by the disaffected, disturbed, and disgruntled have occurred on a regular basis.  Schools, churches, places of business, and other public venues are now fair game for those with bad intentions. Armed not only with weapons but with a blueprint from previous incidents, gunmen can identify soft targets easily and are more “successful” in achieving their goal of creating mass casualties.

Like COVID-19, have these events become part of the “New Normal”? Should we just get used to them?

You might think that the “successes” achieved by active shooters occur at random. The increase in the sheer number of casualties, however, reveal a strategy that is being refined to deadly effect.

The selection of soft targets is becoming a science and is leading to higher numbers of deaths and injuries. In the 2018 South Florida high school shooting, for example, the gunman activated the fire alarm to make sure there would be lots of targets in the hall. To create confusion, he tossed smoke bombs (but prudently wore a gas mask).

If the ill-intentioned are now that much better at creating mayhem, it stands to reason that our society must become better at thwarting those intentions. Here are ways that would, in my opinion, decrease the number of shooter incidents and the deaths caused by them:

Improve security in areas at risk. I would define an “area at risk” as just about anywhere where a crowd of people would gather. Better protection at malls or grocery stores may just be a matter of hiring more security personnel. Given the loss of so many jobs during the pandemic, it’s not a bad idea to train and hire workers specifically to keep an eye out for those with bad intentions. If the money isn’t there, establishing and training a volunteer safety team in places like churches, schools, or workplaces can increase the level of vigilance and identify threats early.

Although the recent attacks occurred in cities, rural areas aren’t immune. Establish volunteer safety officers in small towns where there may not be law enforcement and emergency medical personnel just around the corner. These persons should have training in security, firearms, and first aid for bleeding wounds. If there are volunteer fire departments, while not trained volunteer safety departments?

Instill a culture of situational awareness in our society. Situational awareness is a state of calm, relaxed observation of factors that might indicate a threat. These are called “anomalies”; learning to recognize them can identify suspicious individuals and save lives.

Situational awareness involves always having a plan of action when a threat occurs, even if it’s as simple as making a note of the nearest exit in whatever building you’re in. Seems like common sense, but in these days of smartphone distractions, many are oblivious of their surroundings.

Identify persons of interest through their social media posts. Some active shooter candidates are vocal about their intentions. You might be concerned about “big brother” monitoring our public conversations on social media. It concerns me also, but you must answer this question:  How many deaths are you willing to accept in your community due to a lack of vigilance?

We must always be on the lookout for signs of trouble. Even if this drives some potential gunmen underground, it might identify others in time to abort their mission.

In the case of Alissa, his sister-in-law felt compelled to take a gun away from him when he was acting erratically. In some states, it is possible for family members or police to ask the court to order the temporary removal of firearms from someone who may present a danger to others or themselves. A judge makes the determination to issue the order based on statements made and actions of the person in question. Controversial? Yes, but it could save lives.

Each municipality must set a mechanism (and an earlier trigger) for the authorities to apprehend and interrogate suspicious characters. Indeed, Ali Aliwi Alissa was a known person of interest to authorities before the attack.

Learn how to stop bleeding in wounds
Learn how to stop bleeding in emergencies

Learn how to stop bleeding in emergencies: Teach our citizens to avoid the natural paralysis that occurs in an unexpected event. This paralysis occurs as a result of “normalcy bias”, the tendency to discount risks because most days proceed in a certain standard manner; we usually assume that today will be the same.

By teaching simple courses of action such as the Department of Homeland Security’s “Run, Hide, Fight” triad, the decision-making process may be more intuitive and more rapidly implemented. This is more effectively taught and ingrained at a young age. Make sure it’s a part of every child’s education.

We should also teach our students simple first aid strategies to stop bleeding, the most likely cause of death in these scenarios. Rapid action by bystanders is thought to decrease the number of deaths from hemorrhage. Add “Reduce” hemorrhage to “Reading, ‘Riting, and ‘Rithmetic” as part of school curriculum, and lives might be saved.

Provide first aid kits for bleeding in public venues. In the last few years, bleeding kits have been packed into fire extinguisher wall cabinets in many public venues and can be accessed by those at the scene. Unfortunately, in most places, there isn’t a sign that indicates their presence. With supplies, the Good Samaritan will be more likely to save a life. I predicted, years ago, that these kits will be fixtures everywhere one day. It’s good that they’re there, but let the public know they are.

Our response as a nation has been to do little to correct the problem. I say that era must end. Let’s stop being “soft” targets. We must forsake the notion that shootings are just part and parcel of the New Normal and begin the process by which we change our attitude and level of vigilance, not in isolated cases, but as a society.

The above recommendations wouldn’t affect the average (sane) citizen’s right to bear arms. It would mean more situational awareness so that people can be more ready to “Run, Hide, Fight”.  

If it means more surveillance, we should realize how much there is already. Watching people who publicly threaten violence more closely makes sense; so does increasing access to mental health resources to, perhaps, prevent someone from going off the rails.

The New Normal is an angry, dangerous place. The American identity has been replaced by many tribal ones; Most seem to hate each other. It’s a recipe for disaster that’s likely to get worse if we don’t reverse course, but that takes fortitude and determination on the part of all parties.

You don’t have to be a Department of Homeland Security official to know that there are more active shooter events on the horizon.  Watch for anomalies in behavior and always have a plan of action. A prepared nation wouldn’t be invulnerable to attacks, but its citizens would have a better chance to survive them.

Joe Alton MD

CPR, AED & First Aid Certification Class at Bleyhl’s Grandview, Mar. 24, 2021

Would you like to get certified in CPR, AED & First Aid?
Do you need to renew your current certification? We invite you to join us on Wednesday, March 24th for a training led by Firepoint Training Associates, LLC. We will be offering two classes on Wednesday, please see below for more information.
Cost:
$35
Location:
Bleyhl Co•op Main Office
940 E. Wine Country Rd. Suite A
Grandview, WA 98930
Class:
March 24th
8:30am – English
1:00pm – Spanish
Please contact (509) 492-1281 with questions.

Click here to register

Prolonged Field Care: Medical Support to Resistance

Prolonged Field Care published an article originally from the 2019 Special Warfare magazine on Survivability: Medical Support to Resistance  which discusses “a whole-of society approach to preparing military and civilian medical resources that will build readiness and resiliency… improve casualty mortality rates and enable both resistance members and allied forces to sustain the fight.”

Hope is a primary driver of resistance movements, and the best way to keep hope alive in a resistance movement is to keep people alive. There are many aspects to enhancing survivability of a resistance movement, and medical support is one critical part. Doctrinal military health service support constructs, such as combat support hospitals or forward surgical teams, will be wholly inadequate to support resistance movements in a peer conflict in Europe for the primary reasons that they are overmanned and under trained. This article will discuss a whole-of society approach to preparing military and civilian medical resources that will build readiness and resiliency of our allies or partners, improve casualty mortality rates and enable both resistance members and allied forces to sustain the fight to regain territorial sovereignty against an illegal occupation. Medical infrastructure is vastly different in peacetime Europe than in more austere areas frequented by U.S. Special Operations Forces. Medical evacuations begin with calling 112, the European 911 equivalent, ambulances arrive to provide pre-hospital care, sometimes with physicians onboard, the patient is transported to a trauma center, and medical care is generally comparable to U.S. standards. If peer conflict occurs again in Europe, medical infrastructure will be severely degraded and significant obstacles to medical support will immediately arise, especially regarding extremely prolonged evacuation times and scarce resource availability. The U.S. military has not faced as severe a challenge to provide medical support since World War II. The SOF medical community has been bracing for the regression of medical support in emerging conflicts since at least November 2017 when U.S Army COL (Ret.) Dr. Warner “Rocky” Farr published The Death of the Golden Hour and the Return of the Future Guerrilla Hospital; yet the existential threat facing Eastern Europe poses the worst case scenario for medical support to resistance. The restricted mobility for friendly forces in territory occupied by a peer adversary will severely limit external medical support to U.S. SOF and our allied partners, including the resistance. The isolation of U.S. and allied forces in a denied environment will by necessity convert the delivery of medical care from a linear progression of medical evacuations from point of injury to higher echelons of care outside the combat zone, to a cyclical progression of evacuation, treatment, convalescence and return to duty, all completely within occupied territory.

A resistance scenario in Europe presents a unique risk to U.S. SOF supporting resistance movements, as organic capabilities will not be able to provide required medical support in this tactical environment. Recent exercises have demonstrated that U.S. SOF surgical teams will be severely restrained and may not be survivable in a denied environment, and conventional medical forces will likewise be absent. U.S. SOF medics are highly capable within their scope of practice, but over-inflation of their ability results in commanders miscalculating risk; a medic’s ability to reduce serious risk is often predicated on access to definitive care. The Maquis in occupied France and Partisans of Yugoslavia faced similar challenges in World War II but were still able to provide medical support despite great odds. The relevance of these historical precedents might be limited, however, by exponential advances in technology over the last 75 years. Providing medical support to U.S. SOF and resistance forces will be immensely challenging, but there is one great advantage over historical precedence: there is time and space now to enable ourselves and our allies and partners to be prepared to provide medical support to resistance prior to conflict, instead of reacting after a violation of a country’s national sovereignty.

BACKGROUND

In early 2018, SOCEUR conducted a multinational SOF exercise focused on irregular warfare and resistance in the Baltic region of Eastern Europe. Key medical lessons learned from the exercise were that medical evacuation in restricted areas during peer conflict is incredibly challenging, and U.S. SOF surgical teams as currently configured and trained will have low, if any, chance of survival in occupied territory. It was evident that planning medical support solely using only a U.S. military doctrinal construct was impractical and ineffective; civilian medical resources were identified as, and will necessarily be, the center of gravity for medical support to resistance. Resistance doctrine was turned to as a possible solution to the way ahead, but existing doctrine was found to be largely inadequate for the range of potential operational environments in future conflicts against a peer adversary in Eastern Europe. The focus of U.S. resistance doctrine on unconventional warfare and resistance movements assumes that conflicts have already begun or are ongoing. Furthermore, reverse engineering resistance constructs prior to conflict is difficult because it is impossible to forecast who and what will survive the initial invasion. The whole-of-society approach advocated by the Resistance Operating Concept was embraced as a potential solution for addressing critical gaps in providing medical support to resistance.

WHOLE-OF-SOCIETY APPROACH TO MEDICAL SUPPORT FOR RESISTANCE

The SOCEUR Surgeon’s Office has developed a whole-of-society approach to enable medical support to resistance (Figure 01) as a tiered approach to improve trauma care from point of injury through surgical intervention, convalescence and return to duty. Additionally, it aims to increase medical interoperability with Allies and partners in preparation for a resistance scenario in Eastern Europe.

U.S. SOF MEDICINE

The core of this approach begins with increased readiness for U.S. SOF. If peer conflict in Eastern Europe occurs, U.S. SOF medics will be required to treat casualties on extended timelines with limited supplies. Proficiency in Prolonged Field Care improves the SOF medic’s ability to do this, but is dependent on the medic’s ability to transfer casualties to higher echelons of care for definitive treatment or required convalescence. SOF surgical teams may be part of the solution, but will require manning changes and additional training in order to improve survivability in peer-adversary occupied territory.

Previously, the SOCEUR Surgeon’s office developed and conducted a course in UW medicine for surgical teams. This training was conducted as a proof of concept in Fall 2017, and was subsequently turned over to U.S. Army Special Operations Command with a request to further develop UW training for SOF surgical teams. Currently, the SOCEUR Surgeon’s office is continuing to develop Trojan Footprint as an opportunity for U.S. SOF medical units to practice UW medical tactics and techniques in a major exercise. The command is developing training opportunities for U.S. SOF medics and surgical teams to work in partner-nation trauma centers in Eastern Europe. This aims to achieve multiple objectives including enhanced interoperability of U.S. medical personnel and potential partners, information sharing regarding medical materiel and techniques and potentially to raise standards of trauma care as best practices are shared between allies and partners. The strong relationships that would be created by this course of action would be mutually beneficial. These types of training opportunities may be expanded beyond U.S. SOF to other U.S. military medical personnel, further increasing interoperability and alliance building. SOCEUR is also assisting USSOCOM to define the Special Operations Forces Baseline Interoperability Standards for medics and surgical teams. These efforts attempt to link SOF medical requirements to National Defense Strategy priorities in order to develop the force for the future, and not simply to fight the last battle. Finally, current U.S. SOF doctrine on medical support to resistance appears to have gaps in Eastern Europe’s potential operational environment, especially with regard to preparing Allies and partners to conduct resistance prior to conflict. Working with USASOC’s medical teams will help develop future iterations of doctrine in order to prepare U.S. SOF for best success in an extremely challenging environment… (continues)

Click here to download a PDF version of the article.

Urban Survival Network: Nine Important Survival Antibiotics Every Prepper Should Know

Urban Survival Network has an piece on Nine Important Survival Antibiotics Every Prepper Should Know. Someone recently quipped that there are two stages to serious gut infections: Stage One you wonder is you’re going to die, and Stage Two you wish you would die. My wife, who spent some days hospitalized because of such while in the Peace Corps, confirmed the truth of this witticism. Questionable meat/food and bad water, staples of a disaster situation as well as remote third world villages, can lead to just such circumstances. In good times, the doctor and antibiotics may only be a miserable, embarrassing few hours drive away, but in a disaster…

It often happens that preppers overlook antibiotics as a part of their preps, but these wonder meds can actually turn out to be life savers. Effective and easy to use, survival antibiotics will certainly come in handy post collapse and when you’re having to deal with an infection. To be completely honest with you, I had been blissfully unaware of the many types of antibiotics that existed until not too long ago when I developed an infectious colitis in my colon. I didn’t know about the condition until I was in excruciating pain and I went to see my doctor. This infection was triggered by a bacterial infection, and one of the causes may have been through the consumption of uncooked meat.

The situation was life-threatening and it was something I could no longer ignore – this is where antibiotics stepped in and literally saved my life. For no less than 10 days I took a cocktail of two different antibiotics (Metronidazole and Ciprofloxacin) and in less than two weeks I was back on track. I do not even want to think about what could have happened to me if I didn’t take the antibiotics. Now just put yourself in my shoes – what if you were confronted with a similar situation and were in urgent need of medication? This is why stocking up on survival antibiotics could be a serious matter.

In this article you will find the top 9 most efficient and most widely used survival antibiotics, but before we move on to describing each type it is important to understand that I am not a doctor and I am not entitled to give any medical advice. If you want professional and competent advice, I strongly recommend you to consult your doctor as he/she is the only one who can give you the details you need.

Also, it is important to understand that one should never take antibiotics for a simple cold, a small fever or a slight pain – these medications are aimed exclusively at bacterial infections and they should be taken only in case of emergency, and only when your doctor tells you to. If you take antibiotics on a constant basis, you will become immune to them and their efficiency will be decreased in the long term, which means that you will have a hard time trying to treat bacterial infections in the future.

Like any other type of medication, antibiotics may trigger some side effects – if you notice a rash, then you might be allergic to a compound in the antibiotic, and you must stop taking the medication and consult your doctor immediately. Also, the meds must be taken for as long as recommended by your doctor, even though you may feel better after only a couple of days – this does not necessarily mean you have overcome the infection completely!

In a nutshell, there is a wide range of antibiotics available on the market and they come in many different sizes, shapes and strengths. The following antibiotics can treat most bacterial infections, and for further information on antibiotics, their uses and their mechanism of action I strongly recommend you to read some medical books (many of them are available in PDF format as well). Having said that, here are (in my opinion) the top 9 most efficient survival antibiotics:

1. Cephalexyn
Cephalexyn is currently one of the most commonly used antibiotics for respiratory infections of all kind, mainly pneumonia and severe bronchitis. At the same time, doctors prescribe Cephalexyn to treat middle ear infections as well. This survival antibiotic comes with few adverse reactions and what’s most important is that it can be safely used by children as well as by pregnant women.

2. Amoxicilin
Amoxicilin has almost the same mechanism of action as Cephalexyn, keeping in mind that it is aimed at respiratory infections and it deals with the same types of bacteria. Children and pregnant women can safely take Amoxicilin to treat bacterial infections, although this survival antibiotic can trigger serious allergic reactions. If you notice any of the signs that indicate an allergic reaction, stop taking Amoxicilin and get in touch with your doctor immediately.

3. Ciprofloxacin
Ciprofloxacin can be considered an all-purpose survival antibiotic, given the fact that it can treat a wealth of infections, from infections of the prostate and the urinary tract to bronchitis, pneumonia, bacterial diarrhea and even the infectious colitis I was talking about at the beginning of the article. However, it must be mentioned that Ciprofloxacin must never be used by pregnant women and children at all costs!

4. Metronidazole
Metronidazole is widely used for the treatment of anaerobic bacteria and it is commonly used in conjunction with other survival antibiotics to treat colitis, diverticulitis and other infections of the intestines. Moreover, it is also very good for the treatment of meningitis, lung and bone infections as well as for the treatment of bacterial vaginosis. Nursing or pregnant women and children should avoid taking Metronidazole.

5. Sulfamethoxazole And Trimethoprim
This is a combination of powerful antibiotics that are especially created for urinary tract infections and respiratory infections. At the same time, this antibiotic cocktail is highly efficient against staphylococcus aureus that is resistant to Methicillin – a very strong strain of staph .

6. Ampicilin
Ampicilin is certainly one of the most popular survival drugs at the moment, because it carries a very low allergy risk and it is aimed at treating different infections like gastrointestinal infections, bacterial meningitis, infections of the respiratory tract and even the feared Anthrax.

7. Azithromycin
Azythromycin is not exactly the cheapest survival antibiotic on the market, but it is a very versatile and effective medication as it treats Syphilis, Typhoid, Chlamydia, Lyme disease and a wealth of respiratory tract infections. It has some side effects like nausea and diarrhea but they are rare, therefore it is generally safe to use.

8. Erythromycin
Erythromycin treats the well-known Lyme disease, Chlamydia, Syphilis and various infections of the respiratory system and middle ear. Nonetheless, it must be mentioned that Erythromycin can trigger several unpleasant side effects, from diarrhea and vomiting to nausea and severe abdominal pain. Even so, it is still great to have this survival antibiotic around, just in case!

9. Doxycycline
Doxycycline has the same effects as Erythromycin. Doxycycline can treat some dangerous illnesses such as Malaria or Typhus. This antibiotic must never be used by pregnant/nursing women or children. You’ll also need to drink a lot of water while on Doxycycline. This Antibiotic can be found as “Fish Cycline”, and although not intended for humans, it can still be used with little issue (unless of course expired).

Conclusion
To sum it up, you don’t need to have all 9 survival antibiotics when you travel – you only need two or three types that cover the widest variety of infections, just to stay on the safe side. They should be kept in the refrigerator to expand their lifespan (without freezing them, as this affects their efficacy). These antibiotics are cost-effective and they can save your life or the life of somebody dear to your heart, so make sure you do not neglect them! It is better to have them and not need them, than to need them and not to find them at a looted/plundered drug store.

Raconteur Report Reminds “Tourniquets Work”

From Aesop at Raconteur Report, Medical Tip: Tourniquets Work reminds you to get tourniquet training if you don’t have it already.

One of the local constabularies recently encountered Nameless Crazy Person with butcher knife in hand, agitated and in a stabby mood. Despite repeated commands, NCP refused to drop knife, and/or broke the containment bubble, whereupon officer plugged NCP. Unknown number of rounds fired, but two connected.
One to each arm. (-25 points for lousy marksmanship at knifefighting – which is knifefight dying – distance. Bonus points for unintended humanitarian efforts.)
One nicked the right outer bicep. Literally, a flesh wound. Rub some dirt on it (or, in this case, a wad of 4x4s) and walk it off. No harm, no foul.
Other round: in the stabby knife-wielding arm, 9mm or 40SW pellet entered the upraised left arm proximal to the inner elbow, and travelled along the near-horizontal upper arm, and exited just below the left armpit (axilla for medical types).
Neither round close to anything obviously vital, except…
 
Round #2, during its journey through the meaty bicep area, must obviously have punctured/torn/lacerated the L brachial artery, i.e. the one what all the blood from Mr. Heart travels in to arrive in the rest of Mr. Arm.
Result: a steady blurp-blurp-blurp of bright red blood, all over the ground.
To his everlasting credit, Constable quickly applied first an Israeli Battle Dressing to the arm of the now knifeless suspect, to whom the application of lead had reduced his crazy efforts noticeably. Which IBD application slowed the blurp-blurp nary a whit.
So, reverting to academy-standard (nowadays) training, he whipped out his CAT Tourniquet, and lashed that sucker down just like in training videos, and turned off the blurp-blurp in about 6 twists of the windlass, despite the pained response from NCP.
Medics brought NCP to our world, where our trauma nurse and trauma doc were certain that applying a TQ was waaaaaay overkill, but “Bless their hearts for doing too much instead of too little”. So, they untwisted that TQ, and were immediately rewarded with blurp-blurp-blurp of bright red arterial blood, again.
I twisted the TQ back on and tightened it, and we sent NCP directly to trauma surgery for vascular repair, so that he could continue to be crazy with two functioning arms.
And I told the paramedics and the PD officer responsible for the TQ that they’d saved an actual life with that thing, because NCP would have died at the scene in about two minutes if they hadn’t tourniquetted off the flow of arterial blood from a “mere” arm wound. Which not only saved his life, it prevented about two trees-worth of resultant officer-involved homicide paperwork.
TL;DR:
Put the effing TQ on if the bleeding doesn’t stop with pressure, and make it holy by cranking the hell out of it.
 
You needn’t carry four TQs on your body, but you have four limbs, so if you like them, and you enjoy living, you’d be well-advised to have four TQs somewhere close by, like kit/pack/bag, etc.
Not at home in your medicine cabinet 20 miles away.
When you need one (or, God forbid, more than one) it will be Right Effing NOW, and not “in twenty minutes or so”.
If you’d rather ignore that advice: Suture self.
FTR, trauma literature based on medical trauma data from Sandbox I and Sandbox II have documented applications of as long as 4 hours before removal in surgery with no residual harm of any kind to extremities as a result of the TQ application, in young, otherwise-healthy, military-aged troops. YMMV, but they are not in any way “sacrificing a limb to save a life”, anytime in the last 20 years. If you’re within that time span for arrival at definitive medical care, and it’s medically justified, it’s better to slap one on than watch your patient exsanguinate and die.
And now, refresher training for those who wish it:

“This sh*t works!” – everyone who’s ever needed one.

Thus endeth the lesson.

 

Practical Self Reliance: How to Make an Herbal Tincture

Ashley Adamant at Practical Self Reliance has another well written and highly useful article with How to Make an Herbal Tincture. As usual, more pictures and instruction through link.

Herbal tinctures are extracts made from medicinal plants, mushrooms, or lichen.  Whether made with alcohol or glycerite, homemade tinctures are a shelf-stable way to preserve the medicinal benefits of herbs for year-round use.  They’re an easy way to always have natural medicine on hand at a moment’s notice.

Homemade Yarrow Tincture (Alcohol extract of yarrow)

Homemade Yarrow Tincture (Alcohol extract of yarrow)

Making your own herbal tinctures is a deeply satisfying feeling, and once made, it’s incredibly comforting to know that you have shelf-stable herbal medicine ready whenever it’s needed.

Essentially, you’re distilling all of the therapeutic properties of any given plant material into a super-concentrated, super-powerful elixir that can be taken for any number of health concerns. Depending on the tincture in question, the benefits range from preventative to immune-boosting to sleep-inducing — all in a dropperful of herbal extract!

What you might not realize about tinctures is how easy they are to make. All you need to get started is your desired plant material, a solvent, and a solid 6 to 8 weeks for the extraction process to complete itself.

What is a Tincture?

A tincture is a concentrated herbal extract prepared with alcohol, a solvent that extracts the active medicinal compounds from alcohol-soluble plant matter. Tinctures are a means to ingest super-condensed herbal extracts for their medicinal properties.

The use of tinctures isn’t a new activity, people from all over the world have been making tinctures for thousands of years.

Today, the tincture market is rich with options. You could purchase a tincture for every ailment you can think of, but the prices are often high — especially when you’re buying multiple tinctures at once.  Usually, tinctures are around $12 to 15 an ounce, but the same medicine can be made for pennies on the dollar.

When you make your own tinctures at home you can choose the best quality ingredients to make a potent tincture, all at a fraction of the price of a store-bought version.

Homemade tinctures are made with minimal equipment, using the leaves, flowers, roots, bark, and flowers of fresh or dried herbs and mushrooms as plant material.

Tincture vs. Herbal Extract

You might notice the term “herbal extract” is sometimes used interchangeably with the word “tincture” when you’re reading up on the topic, but there is a difference between the two classifications.

A tincture is prepared using alcohol as a solvent to extract the desired compounds from plant material. Glycerite tinctures use vegetable glycerin as a solvent, and are generally considered part of the tincture family.

An herbal extract is an umbrella term that refers to plant material extracts made with various types of solvents including, but not limited to, alcohol, oil, honey, and vinegar.

How are Tinctures Used?

Depending on the particular extract you’re using, tinctures are taken orally or applied externally. Tinctures are dosed by the dropperful, and are often dropped directly under the tongue, where they’re absorbed into the bloodstream more quickly.

Different types of tinctures have different recommended dosages and means of ingestion. Bitter tinctures, which are taken to stimulate the appetite and relieve signs of digestive distress, are typically ingested 15 minutes before eating.

Some tinctures, like those made from lemon balm and motherwort, tend to be fast-acting, and are of the soothing variety.

Tinctures mades from adaptogenic and immune-boosting herbs and mushrooms, such as ginseng root or reishi mushrooms, must be taken continuously over a period of several weeks before their therapeutic benefits are apparent.

Not all tinctures are meant to be taken orally. Tinctures prepared with black walnut and yarrow are, among others, applied directly to the skin or mixed in with a carrier oil or basic lotion.

Topically-applied tinctures are used to treat everything from parasitic infection to eczema, and certain types can even be mixed in with misting sprays or face cream to add powerful herbal benefits (and at a fraction of the cost of commercially-made, herb extract-enriched beauty products).

Types of Tinctures

By definition, alcohol-based tinctures are the only “true” tincture, although some resources are laxer about this than others.  Glycerine based or Alcohol-free “tinctures” aren’t technically tinctures, but they’re often referred to by this name since they’re pretty much equivalent in terms of how they’re used.  (Technically, they’re glycerites.)

Some plant materials, such as dried mushrooms, contain high amounts of both alcohol-soluble and water-soluble compounds. When this is the case, the double extraction method is the way to go. It’s an additional step, but an easy one, and you’ll find that the result is definitely worth the (very minimal) extra time it takes.

If you prefer an alcohol-free extract, you can also make a potent glycerite tincture using vegetable glycerin — the method is almost exactly the same as a tincture with alcohol, which I’ll walk you through below.

Are Tinctures Shelf Stable?

Because tinctures are prepared with ethyl alcohol they have a naturally long shelf life. Alcohol drastically slows down natural decomposition and the growth of bacteria, so if properly stored a tincture can last for a couple of years (even longer if the alcohol is 100-proof or higher).

Never use isopropyl alcohol (rubbing alcohol), it’s toxic to ingest and therefore not suitable for making tinctures — although it can be used to make herbal liniments for external use.

All of my tinctures are made using vodka. I like to use Smirnoff because it’s relatively inexpensive, but not so cheap that it’s completely unpalatable.

Some people prefer to make their tinctures with brandy or rum — pretty much any high-test alcohol can be used. Make sure you choose alcohol that’s at least 80-proof (40 percent) for making tinctures or, if you can find it, 100-proof (50 percent) or higher to ensure safe preservation.

Once the tincture is ready to be decanted, I carefully transfer the extract to a dark amber glass bottle with a dropper and store it in a darkened location away from any light or heat sources — no need for refrigeration.

If stored with care, tinctures will maintain their potency for 2 to 3 years (with some higher alcohol preparations lasting up to 5 years).  The Herbal Academy has an excellent guide to the shelf life of herbal preparations, which has much more specific and detailed estimates, depending on how the tincture is prepared.

How to Make a Tincture

The first step when preparing a homemade tincture is to select your plant material.

One question I see regularly is in regards to using fresh or dried herbs, and if one is better than the other. The answer I would give is: there are advantages to choosing either medium!

Depending on where you live, fresh herbs can be found growing wild or in your garden, which makes them readily available. Fresh herbs have a high water content, which means they’re susceptible to spoilage if they aren’t used immediately after being picked. If you’re fortunate enough to have a surplus of fresh herbs, I would recommend drying them for later projects using this guide to preserving herbs.

If you’re making a tincture from dried herbs, you can use herbs you’ve dried yourself or you can buy the best-quality dried herbs. Dried herbs have a maximum shelf life of 2 years, if you aren’t drying the herbs yourself it’s important to find a source with rapid product turnover.

The main mechanism behind tincture-making is the same: put plant material in a jar, cover with alcohol, and let steep for several weeks. However, a little bit of finesse with herb to alcohol ratios will result in the most potent of tinctures.

For a tincture made with fresh leaves and flowers, finely chop or grind clean plant material (the goal is to expose as much surface area as possible). Fill a jar about 3/4 of the way with chopped leaves and flowers — don’t pack the jar too tightly.

Cover the contents of the jar completely with alcohol and seal with a lid.

How to Make Chickweed Tincture

Making chickweed tincture with fresh chickweed

If you’re preparing a tincture using dried leaves and flowers, you’ll want to fill a jar about 1/2 of the way full with dried plant material.  Dried herbs are more concentrated, and they absorb liquid and expand during the extraction process.  If you fill the jar completely full, your yield will be pitifully small (but intensely concentrated).

Cover the contents of the jar completely with alcohol and seal with a lid.

To make a tincture with either fresh or dried bark, berries, and/or roots, finely chop or grind the plant material to expose optimal surface area or to release the juice of berries.  Roots and bark are especially hard to extract, so increasing surface area is important.

Fill the jar 1/3 to 1/2 full with chopped bark, berries, and roots.  These materials tend to be even more concentrated and expand further than dried flowers or leaves.

Cover the contents of the jar completely with alcohol and seal with a lid.

I always use a standard canning jar, but I use a plastic mason jar lid when making tinctures. There are certain tinctures that will, over time, eat through plastic.

Most tinctures need to sit for a period of 6 to 8 weeks before they can be used, during this time the alcohol extracts beneficial alcohol-soluble compounds found in the plant material.

Store developing tinctures in a cool, dry place away from light. Give them a good shake every couple of days, keeping an eye on alcohol levels. If at any point it appears the alcohol level is getting lower, add more to the jar to completely cover the plant material to prevent unwanted mold growth.

When you’re ready to bottle your tincture, it will need to be strained first. The easiest way to do this is to line a funnel with a cheesecloth, placing the tip of the funnel directly into a dark amber glass bottle.

I often skip the cheesecloth and just use a fine mesh strainer, which is usually fine enough for most tinctures.  If you’re making a tincture with particularly fine material, like pine pollen tincture, definitely go with cheesecloth.

How to Make A Tincture without Alcohol

If you’re abstaining from alcohol for any reason you can still make a tincture using a different menstruum. A menstruum is a term that refers to the solvent chosen for making extracts.

Food Grade Vegetable Glycerine has been used as a solvent to make tinctures called glycerites for close to 200 years. It has a syrupy texture and sweet flavor, making it an excellent choice for tinctures that will be ingested by children.

Most recipes for glycerite tinctures are made with 75 percent vegetable glycerin and 25 percent water, resulting in an herbal extract with a shelf life of 14 to 24 months.

You can also use vinegar as a menstruum when preparing an herbal extract — I like to use apple cider vinegar as a solvent because it has the best taste, but almost any kind of vinegar will work. As long as the tincture is made with no less than 5 percent vinegar, it’s generally shelf-stable for a minimum of 6 months (usually longer).

Like alcohol-based solutions, tinctures made with glycerine or vinegar are made by soaking herbs or mushrooms in the menstruum for several weeks to extract therapeutic and medicinal properties.

Common Herbal Tinctures

Tinctures can be made from most types of medicinal plants or mushrooms, but the specific benefits of each herbal extract will depend on the specific herbs used.  Here are a few of the most common types of homemade herbal tinctures, along with their benefits:

Black Walnut Tincture

If you have black walnuts to harvest, a homemade black walnut tincture is a great way to use those otherwise inedible walnut husks that would normally be discarded. Black walnut tinctures are applied topically and are prized for their anti-fungal and anti-parasitic properties thanks to a natural abundance of tannins.

Tinctures made from black walnut husks are a rare source of land-based iodine, making them a good tincture to have on hand for disinfecting wounds and irritated skin.

My post about the benefits of black walnut tincture provides all the instructions you need to make your own potent tincture…

This article continues with additional specific herbal tinctures.

Doom and Bloom: Anemia

The Altons at Doom and Bloom Medical talk about Anemia and how to recognize and deal with it in survival situations.

In survival scenarios, there are plenty of occasions where the medic will encounter a group member suffering from anemia. Anemia is a condition in which you lack enough healthy red blood cells in your circulation. Red blood cells are what make your blood, well, red; their job is to carry oxygen to your body’s tissues and carbon dioxide away. If you don’t have enough of these tiny, disc-shaped cells, it can have major effects on your health.

Red cells primarily consist of a protein made in bone marrow called hemoglobin. In men, anemia is typically defined as a hemoglobin level of less than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.

Anemia happens for different reasons. Survivors in a prolonged disaster setting are unaccustomed to being off the grid, and could easily injure themselves and bleed heavily from a wound. This is the most sudden cause of severe anemia, but it can also occur from lack of production due to malnutrition or medical conditions that destroy red blood cells or shortens their life span (normally, about 115-120 days).

Depending on the cause, signs and symptoms of anemia may vary.  If your patient’s case is mild and they’ve had it for a while, their body may have accommodated to the extent that they might not have symptoms. If they do occur, they might include:

  • Fatigue
  • Weakness
  • Headache
  • Pale or yellowish skin
  • Cold hands and feet
pale inner eyelid seen in anemia

Simple blood tests could identify the problem, but won’t be available off the grid. Just checking under the lower eyelid, however, may reveal a hemoglobin deficiency. Normally, the inside of the eyelid is light red or pink; in anemia, it’s very pale or yellow. Worse cases can cause major symptoms:

  • Irregular or fast heart rates
  • Shortness of breath
  • Dizziness or lightheadedness
  • Chest pain

The worse the anemia, the less productive your group member will be, so it’s important to do everything possible to treat it and increase the hemoglobin level.

Iron deficiency is the most common cause of anemia. It’s often seen in women who are or were recently pregnant.  Heavy periods will also cause iron-deficiency anemia. Treatment usually involves oral supplements like ferrous sulfate or ferrous gluconate. The usual dose is 325 mg (65 mg of elemental iron) three times a day. Some complain of intestinal issues at that dose: dark stools, constipation, nausea, and cramps. This can take a lot out of a person, so consider a lower dose or every other day dosing in those afflicted. Be aware that caffeinated beverages may delay iron absorption, while vitamin C at 500 mg promotes it.

In addition to iron, your body needs folate (vitamin B9) and vitamin B12 to produce enough healthy red blood cells. A diet lacking in these and vitamin C can impair the production of red cells. Some people get enough B12 but can’t absorb it due to an autoimmune reaction, causing a condition called “pernicious anemia”.  Special B12 injections are given for this and other conditions.

Anemia can also be related to inflammation. Certain diseases, such as cancers like leukemia and lymphoma, AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease and other inflammatory ailments can lower production of red blood cells or destroy them. For these, you have to treat the main problem, a major challenge for the off-grid medic.

Another group of anemias are known as “hemolytic” (blood disintegraters). They develop when red blood cells are destroyed faster than bone marrow can replace them. You can inherit a hemolytic anemia, or you can develop it later in life.

Sickle cell anemia (sometimes called “sick-as-hell” anemia) is a type of hemolytic anemia. It’s caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal (sickle) shape instead of a disc. These irregular blood cells die prematurely, resulting in a chronic shortage. Patients, often African Americans, go into what we call “crises” that can be very painful when these abnormally shaped cells clog small blood vessels.

Hemolytic anemias can also be caused by certain drugs, which can cause the immune system to mistake your own red blood cells for foreign substances. The body responds by making antibodies to attack and destroy its own cells. Make sure your healthcare provider knows if you take any of these medicines:

  • Cephalosporins like Keflex
  • Fluoroquinolones like Levaquin
  • Penicillins
  • Nitrofurantoin (Macrodantin) and phenazopyridine (Pyridium; used for bladder infections)
  • Levodopa for Parkinson’s disease
  • Dapsone for skin disease
  • Quinidine for irregular heartbeats
  • Methyldopa for high blood pressure
  • Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs

Dietary sources of iron may be helpful, so adjust your food storage and survival garden goals accordingly. Eating a diet high in meats, especially red meats, may help. Nonmeat iron sources include:

  • Spinach and other dark green leafy vegetables
  • Peas and certain other legumes like chickpeas
  • Beans
  • Dried fruits, such as prunes, raisins, and apricots

Some foods are Iron-fortified, like certain cereals and breads. Many also have B12 added, as well. Other food sources of B12 are:

  • Meats, such as liver, beef, fish, and poultry
  • Eggs
  • Dairy products

For folic acid:

  • Spinach and other dark green leafy vegetables
  • Black-eyed peas and other dried beans
  • Beef liver
  • Eggs
  • Bananas, oranges, and related fruits and juices

As mentioned earlier, vitamin C is a tool to help absorb iron. Good sources of vitamin C can be found in many fruits as well. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.  Vegetables rich in vitamin C include tomatoes, peppers, broccoli, brussels sprouts, potatoes, and spinach.

Joe Alton MD

Doom and Bloom: The Case for Fish Antibiotics

The Altons at Doom and Bloom Medical talk about The Case for Fish Antibiotics and their viability for human use in emergency cases when there is no medical system to which to resort.

More than a decade ago, I was the first physician to advocate for the storing of antibiotics marketed for tropical fish and pet birds as a potential tool for the medic in long-term survival settings. Although I never recommended them for use in situations where there is a functioning medical infrastructure, I believe, despite criticism, that having a supply of these on hand will save lives, otherwise lost from bacterial infections, in a prolonged off-grid disaster scenario.

Accumulating over-the-counter drugs for the medic’s storage may be a simple enterprise, but not prescription medicines. Even with a sympathetic physician, the ability to obtain the quantity needed to be an effective caregiver for a survival community is limited, at best. Antibiotics are one example of life-saving medications that would be in short supply off the grid.

The inability to have antibiotics at hand may cost some poorly prepared individuals their lives in a survival situation. There will be a much larger incidence of infection when people have to fend for themselves and are injured as a result. Any strenuous activities performed that aren’t routine in normal times can lead to injuries that break the skin. These wounds will, very likely, be dirty. Within a relatively short time, they might begin to show signs of infection in the form of redness, heat, and swelling.

Treatment of such infections at an early stage improves the chance they will heal quickly and completely. However, many rugged individualists are likely to “tough it out” until their condition worsens and the infection spreads to their blood. If the medic has ready access to antibiotics, the problem can be nipped in the bud before a tragic outcome occurs.

Some solutions for medical issues off the grid without medical help, like fish antibiotics, may save lives

The following is contrary to standard medical practice; it’s a strategy that is appropriate only when help is not on the way. If there are modern medical resources available to you, seek them out.

Antibiotic Options

Small quantities of antibiotics can be obtained by anyone willing to tell their doctor that they are going out of the country and would like to avoid “Travelers’ Diarrhea” or other infections common at their destination. Likewise, asking for medications that must be taken early in an infection, like oseltamivir (Tamiflu) for influenza, is a reasonable strategy; after all, not everyone can get in to see their doctor right away, and the antiviral Tamiflu is most effective in the first 48 hours after symptoms begin.

(Note: Tamiflu is an anti-viral and only works against influenza (and not COVID-19. Antibiotics have no effect against viruses at all.)

This approach is fine for one or two courses of therapy, but a long-term alternative is required for the survival caregiver to have enough antibiotics to protect a family or survival group. In the aftermath of a disaster, some deaths may be unavoidable, but bacterial-related deaths are unacceptable. This concern led us to what we believe is a viable option: aquarium and avian antibiotics.

Betta splendens

For many years, we have kept tropical fish in aquaria and tilapia in ponds. We also have parrots as pets. After years of using aquatic medicines on fish and avian medicines on birds, we decided to evaluate these drugs for their potential use off the grid. They seemed to be good candidates: All were widely available, available in different varieties, and didn’t require a medical license or prescription.

A close inspection of a number of these products found exactly one ingredient: the drug itself, identical to those obtained by prescription at the local pharmacy. A bottle labeled aquatic amoxicillin, for example, had as its sole ingredient amoxicillin, which is an antibiotic commonly used in humans. Unless they’re listed on the bottle, there are no additional chemicals to makes your scales shinier or your feathers more colorful.

Any reasonable person might be skeptical about considering the use of aquarium antibiotics for humans, even in disaster settings. Those things are for fish, aren’t they? Yet, a number of them only come in dosages that correspond to pediatric or adult human dosages.

The question became: Why should a one-inch guppy require the same dosage of, say, amoxicillin as a 180-pound adult human? We were told that it was due to the dilution of the drug in water. However, at the time, there were few instructions that tell you how much to put in a ½ gallon fishbowl as opposed to a 200-gallon aquarium (they have them now, however).

Finally, the “acid test” was to look at the pills or capsules themselves. The aquatic or avian drug had to be identical to that found in bottles of the corresponding human medicine. For example, when (in 2010) we opened a bottle of FISH-MOX FORTE 500 mg distributed by Thomas Labs and a bottle of Human Amoxicillin 500mg (DAVA pharmaceuticals), we found:

human amoxicillin by DAVA pharmaceuticals

Human Amoxicillin:         Red and Pink Capsule, with the letters and numbers WC 731 on it.

Fish amoxicillin (the brand is now defunct)

FISH-MOX FORTE: Red and Pink Capsule with the letters and numbers WC 731 on it.

There are still a number of examples today, including:

fish versions of different antibiotics
Appearance of same antibiotics made by human pharmaceutical companies

Logically, then, it makes sense to believe that they are essentially identical, manufactured in the same way that human antibiotics are. Further, it is our opinion that they are probably from the same batches; some go to human pharmacies and some go to veterinary pharmacies or bottling companies. Over the years, readers in the human and veterinary pharmacy fields have confirmed this.

This is not to imply that all antibiotic medications met the criteria. Many cat, dog, and livestock antibiotics contain additives that might cause ill effects on a human being. Look only for those veterinary drugs that have the antibiotic as the sole ingredient.

There has been significant controversy regarding these medicines as some have chosen to use them in normal times against our recommendations, which only apply to long-term survival scenarios. As a result, the original distributor of these drugs, Thomas Labs, eventually stopped production in response to political pressure.  For now, other brands with names like FISH-AID and others have, at the time of this writing, filled the void by offering a number of veterinary equivalents online. Expect volatility in terms of availability as a number of these drugs are placed under increasing government control in the future.

VETERINARY “EQUIVALENTS”

Having antibiotics in quantity will help the medic save lives in survival scenarios

Here is a list of antibiotics that are commercially available in aquatic or avian form as of the writing of this article:

AMOXICILLIN,  (Amoxicillin 250 mg and 500 mg)

AMPICILLIN 500 MG

PENICILLIN 250 mg and 500 mg

CEPHALEXIN 250 mg and 500 mg

METRONIDAZOLE 250 mg and 500 mg

CIPROFLOXACIN 250 mg and 500 mg

CLINDAMYCIN 150 mg

AZITHROMYCIN 250 mg

LEVOFLOXACIN 500 mg

SULFAMETHOXAZOLE/TRIMETHOPRIM 400 mg/80 mg and 800 mg/160 mg

DOXYCYCLINE 100 mg

MINOCYCLINE 50 mg and 100 mg

FLUCONAZOLE (anti-fungal) 100 mg

Most of the above come in lots of 30 to 100 tablets which can be bought in multiples. This makes them eligible for the survival medic to stockpile for prolonged disaster events. As recently as December 2020, we were able to purchase several without a prescription.

Antibiotics are not candy; they must be used judiciously in survival scenarios

Of course, anyone could be allergic to one or another of these antibiotics, but it would be a very rare individual who would be allergic to all of them. It should be noted that there’s a 10% cross-reactivity between Penicillin drugs and cephalexin (Keflex). If you are allergic to penicillin, you could also be allergic to Keflex. For those who can’t take penicillin, there are suitable safe alternatives. Any of the antibiotics below should not cause a reaction in a patient allergic to Penicillin-family drugs:

  • Doxycycline
  • Metronidazole
  • Tetracycline
  • Ciprofloxacin
  • Clindamycin
  • Sulfamethoxazole/Trimethoprim
  • Levofloxacin
  • Minocycline

This one additional fact: We have personally used some (not all) of these antibiotics as veterinary equivalents on our own persons without any ill effects. Whenever we have used them, their effects have been indistinguishable from human antibiotics.

Having said this, we recommend against self-treatment in any circumstance that does not involve the complete long-term loss of access to modern medical care. This is a strategy to save lives in a post-calamity scenario only.

Finding Out More

Although you might think that any antibiotic will work to cure any disease, specific antibiotics are used at specific doses for specific illnesses. The exact dosage of each and every medication in existence for each and every disease is well beyond the scope of this article. It’s important, however, to have as much information as possible about medications that you plan to store.

This information is available in a number of drug reference manuals (with images) in both print and digital form. Online sources such as drugs.com or rxlist.com are other useful sources, but we recommend a hard copy for your medical library in case a disaster affects the internet.

Your manual should list medications that require prescriptions as well as those that do not. Under each medicine, you will find the “indications”, which are the medical conditions that the drug is used for. Also listed will be the dosages, risks, side effects, and even how the medicine works in the body. It’s okay to obtain a book that isn’t the latest edition, as information about common drugs doesn’t often change a great deal from one year to the next. Try to obtain a recent copy, though, as occasional changes do occur.

For those skeptical of our opinion on this topic, we ask you to imagine this circumstance: A disaster has occurred that has knocked you off the grid and sent you on the road. Your family is performing activities of daily survival like chopping wood for fuel, something they’ve never done before. Your son or daughter cuts themselves and, in a day or so, the wound becomes red, hot, and swollen. There may be the beginnings of a fever. You only have a bottle of “fish” amoxicillin. Would you use it? We’ll let you decide.

Joe Alton MD

Doom and Bloom: When a Person Faints

The Altons at Doom and Bloom Medical have an article about what to do When a Person Faints. I once fainted while standing in early morning PT formation in the Army, probably from a combination of low blood sugar and low hydration. Well, I vomited and then fainted, so I hit at least one of the warning signs which the Altons mention. I think I also hit “momentary lack of attention.” After questions from a medic and a drink of water, I was able to continue with PT as usual with no further issues. Anyone can faint, but sometimes more rest is better.

Even 6’4″ military men may experience fainting

We often write about medical strategies when a society collapses, but, sometimes, an individual may collapse as a result of fainting (also called “syncope”). It usually occurs when a drop in blood pressure (“hypotension”) doesn’t allow enough oxygenated blood to reach the brain.

Someone who has fainted must be differentiated from the person who has “seized” from epilepsy. Fainters won’t exhibit jerky movements as in a Grand Mal seizure or stare into space as in a Petit Mal seizure. Also, a person who has had a seizure tends to be difficult to rouse for a period of time. This is called a “post-ictal” state and may last for 30 minutes or so before it resolves on its own. Most people who have only fainted will regain alertness relatively soon after the episode.

(Note: Grand Mal and Petit Mal are no longer used in the latest nomenclature of seizures. They changed the whole system in 2017, but most people still know them by these names.)

There are a few signs that a person is close to fainting:

  • Cold, clammy skin
  • Nausea or vomiting
  • Complaints of feeling lightheaded or weak
  • A sensation of spinning
  • Tunnel vision or blurriness
  • Yawning
  • Slow pulse
  • Momentary lack of attention

(Note: More than once, I’ve had a surgical intern or other assistant faint dead away during a grueling and long surgical procedure.)

Survival scenarios almost guarantee the medic will be confronted with a person who has fainted at one point or another. Simple activities of survival, such as long hikes to retreats, work sessions in hot weather, and hiding out in hot shelters without climate control, can make certain group members prone to syncope. In addition, skipped meals and dehydration will put many of your people at risk.

Low blood sugar and various other medical conditions can cause fainting. Good hydration and appropriate dietary intake will prevent most episodes. Glucose or honey packets, for example, can help raise a person’s blood sugar that has gone dangerously low. Have some in your kit. Others may pass out due to irregular heart rhythms, extreme stress, or even pregnancy.

If someone feels as if they are about to collapse, they should sit down and put their head down between their knees to increase blood flow to the brain. If you see someone who is fainting from a standing position, hold and gently lower them to the ground on their back. In normal times, of course, you would have someone call emergency medical services as soon as possible.

If help isn’t coming, it’s up to you to quickly evaluate the victim. If the patient fell to the floor, there is always the possibility of a head injury. Evaluate for obvious wounds and rule out concussion.

A person who has had a simple fainting spell will usually be breathing normally and have a steady, regular pulse. Raise their legs about 12 inches off the ground and above the level of their heart and head. This position will help increase blood flow to the brain. Assess the patient for evidence of trauma, bleeding, or signs of a seizure. If bleeding, apply direct pressure to the wound. If no pulse or breathing, begin CPR.

(Seizure disorders are discussed on this website here.)

After the first few seconds, you have determined that the victim is breathing, has a pulse, and is not bleeding. Tap on their shoulder (some say to gently shake) and ask in a clear voice “Can you hear me?” or “Are you OK?”. Loosen any constricting clothing and make sure that they are getting lots of fresh air by keeping the area around them clear of crowds. Look for a medical alert bracelet that may give clues as to their health issues. If you are in an area that is hot, fan the patient or carefully carry them to a cooler area. Cool compresses may be helpful.

If you are successful in arousing the patient, ask them if they have any pre-existing medical conditions such as diabetes, heart disease or epilepsy. Stay calm and speak in a reassuring manner. People oftentimes are embarrassed and want to brush off the incident, but be aware they are still at risk for another fall.

Once the victim is awake and alert (Do they know their name? Do they know where they are? What year it is?), you may have the patient sit up slowly if they are not otherwise injured. Don’t let them get up for 15 minutes or so, even if they say that they are fine. If you are not in an austere setting, emergency medical personnel are on the way; wait until they arrive before having the patient stand up. Off the grid, however, you will have to make a judgment as to whether and when the victim is capable of returning to normal activities. A period of observation would be wise.

As dehydration and low blood sugar are possible causes, some oral intake may be helpful during recovery. This is appropriate only if it is clear that they are completely conscious, alert, and able to function. Test their strength by having them raise their knees against the pressure of your hands. If they are weak, they should continue to rest. Close monitoring of the patient will be very important, as some internal injuries may not manifest for hours.

Doom and Bloom: Asthma in Survival

The Altons at Doom and Medical have an article about Asthma in Survival.

Asthma is a chronic condition that limits your ability to breathe. It affects the tubes that transport air to your lungs, collectively known as the “airways”. Asthma affects 20 million Americans and is the most common cause of chronic illness in children. Off the grid, increased stress and exposure to new substances will only makes things worse. The family medic must know how to recognize and treat symptoms with limited supplies.

When people with asthma are exposed to a substance to which they are allergic (an “allergen”), airways become swollen, constricted, and filled with mucus. As a result, air can’t pass through to reach the part of the lungs that absorbs oxygen (the “alveoli”).

During an episode of asthma, you will develop shortness of breath, tightness in your chest, and start to wheeze and cough. This is referred to as an “asthma attack”. In rare situations, the airways can become so constricted that a person could suffocate from lack of air.

Here are common allergens that trigger an asthmatic attack:

  • Pet or wild animal dander
  • Dust or the excrement of dust mites
  • Mold and mildew
  • Smoke
  • Pollen
  • Severe stress
  • Pollutants in the air
  • Some medicines
  • Exercise

Yes, you can trigger an asthmatic attack with exercise. This doesn’t mean you shouldn’t stay in shape. Exercise strengthens lungs, which helps improve asthma control.

There are many other myths associated with asthma; the below are just some:

Asthma is contagious. (False)

You will grow out of it. (False; it might become dormant for a time but you are always at risk for it re-emerging.)

It’s all in your mind. (False; although may trigger it, it’s very real.)

If you move to a new area, your asthma will go away. (False; it may go away for a while, but eventually you will become sensitized to something else and it will likely return.)

Asthma should only be treated when an episode occurs. (False; asthma is best treated with constant medication to reduce frequency and severity of attacks. Encourage your asthmatic group members to stockpile meds.)

You will become addicted to your asthma meds. (False; inhalers and oral asthma drugs aren’t addictive. It’s safe to use them on a regular basis.)

Here’s are two “true” myths: Asthma is, indeed, hereditary. If both parents have asthma, you have a 70% chance of developing it compared to only 6% if neither parent has it. Also, asthma does have the potential to be fatal, especially if you are over 65 years old.

(Note: In the 1980s, I treated a pregnant patient who had the worse type of asthma attack, called “status asthmaticus.” Once she improved somewhat, she insisted on going home against my advice  to care for her other children. She returned that night in an irreversible state of oxygen loss. Both mother and baby perished.)

PHYSICAL SIGNS AND SYMPTOMS OF ASTHMA

Asthmatic symptoms may be different from attack to attack and from individual to individual. Some of the symptoms are also seen in heart conditions and other respiratory illnesses, so it’s important to make the right diagnosis. Symptoms may include:

  • Cough
  • Shortness of Breath
  • Wheezing (usually of sudden onset)
  • Chest tightness (sometimes confused with coronary artery spasms/heart attack)
  • Rapid pulse rate and respiration rate
  • Anxiety

Besides these main symptoms, there are others that are signals of a life-threatening episode. If you notice that your patient has become “cyanotic”, they are in trouble. Someone with cyanosis will have a blue/gray color to their lips, fingertips, and face.

Cyanosis

You might also notice that it takes longer for an asthmatic to exhale than to inhale. As an asthma attack worsens, wheezing may take on a higher pitch. As the attack worsens, the patient suffers a lack of oxygen that makes them confused and drowsy; they may possibly lose consciousness.

Asthma vs Heart Attack

As an asthma attack may resemble a heart attack, the medic should know how to tell the difference. For Asthma is usually improved by using fast-acting inhalers, a strategy that doesn’t offer relief from a heart attack or other cardiac events. Cardiac patients often have swelling of the lower legs, also called “edema.” This is rarely seen with asthma. Asthmatic also don’t have arm and jaw pain that is often seen with heart attacks. Those with a history of cardiac chest pain improve with the angina drug nitroglycerin.

Although both may be associated with shortness of breath, few will confuse the symptoms of COVID-19 with asthma, but suffice it to say that COVID-19 is associated with fever and loss of taste or smell.

DIAGNOSING ASTHMA

On physical exam, use your stethoscope to listen to the lungs on both sides. Make sure that you listen closely to the bottom, middle, and top lung areas as described in the section on physical exams.

In a mild asthmatic attack, you will hear relatively loud, musical noises when the patient breathes. As the asthma worsens, less air is passing through the airways and the pitch of the wheezes will be higher and perhaps not as loud. If no air is passing through, you will hear nothing, not even when you ask the patient to inhale forcibly. This person may become cyanotic.

typical peak flow meter

Sometimes a person might become so anxious (a “panic attack”) that they become short of breath and may think they are having an asthma attack. To resolve this question, you can measure how open the airways are with a simple diagnostic instrument known as a peak flow meter. A peak flow meter measures the ability of your lungs to expel air, a major problem for an asthmatic. It can help you identify if a patient’s cough is part of an asthma attack or whether they are, instead, having a panic attack or other issue.

To determine what is normal for a member of your group, you should first document a peak flow measurement when they are feeling well. Have your patient purse their lips over the mouthpiece of the peak flow meter and forcefully exhale into it. Now you know their baseline measurement. If they develop shortness of breath, have them blow into it again and compare readings.

In moderate asthma, peak flow will be reduced 20-40%. Greater than 50% is a sign of a severe episode. In a non-asthma related cough or upper respiratory infection, peak flow measurements will be close to normal. The same goes for a panic attack; even though you may feel short of breath, your peak flow measurement is still about normal.

TREATMENT OF ASTHMA

Asthma bronchodilator in inhaler

The cornerstones of asthma treatment are the avoidance of “trigger” allergens, as mentioned previously, and the maintenance of open airways. Medications come in one of two forms: drugs that give quick relief from an attack and drugs that control the frequency of asthmatic episodes over time. In panic attacks, however, these medicines are ineffective; treatment for anxiety is discussed elsewhere in this book.

Quick relief asthma drugs include “bronchodilators” that open airways, such as Albuterol (Ventolin, Proventil), levalbuterol (Xopenex HFA), among others. These drugs should open airways in a very short period of time and give significant relief. These drugs are sometimes useful for people going into a situation where they know they will exposed to a trigger, such as before strenuous exercise. Don’t be surprised if you notice a rapid heart rate on these medications; it’s a common side effect.

If you find yourself using quick-relief asthmatic medications more than twice a week, you are a candidate for daily control therapy. These drugs work, when taken daily, to decrease the number of episodes and are usually some form of inhaled steroid. There are long-acting bronchodilators as well, such as ipratropium bromide (Atrovent HFA). Another family of drugs known as Leukotriene modifiers prevents airway swelling before an asthma attack even begins. These are usually in pill form and may make sense for storage purposes. The most popular is Montelukast (Singulair).

Often, medications will be used in combination, and you might find multiple medications in the same inhaler. The U.S. pharmaceutical Advair, for example, contains both a steroid and an airway dilator. Remember that inhalers lose potency over time. Expired inhalers, unlike many drugs in pill or capsule form, have less effect than fresh ones. Physicians are usually sympathetic to requests for extra prescriptions from their asthmatic patients.

NATURAL TREATMENT OF ASTHMA

Ginger

In mild to moderate cases of asthma, you might consider the use of natural remedies. Some involve breathing exercises:

Pursed-lip breathing: This slows your breathing and helps your lungs work better. Breathe in slowly through your nose for two seconds. Then position you lips as if you were whistling, and breathe out slowly through your mouth for four seconds.

Abdominal breathing: Similar to pursed-lip breathing but focuses on using the diaphragm more effectively. With your hands on your belly, breathe as if you were filling it with air like a balloon. Press down lightly on the belly as you slowly exhale.

There are also a number of substances that have been reported to be helpful:

Ginger: A study published in the American Journal of Respiratory Cell and Molecular Biology indicates that ginger is instrumental in inhibiting chemicals that constrict airways. Animal tests find that extracts of ginger help ease asthmatic symptoms in rodents. Use as a tea or extract twice a day.

Ginger and Garlic Tea: Add three or four minced garlic cloves in some ginger tea while it’s hot. Cool it down and drink twice a day. Some report a benefits from just the garlic.

Other herbal teas are thought to help: Ephedra, Coltsfoot, Codonopsis, Butterbur, Nettle, Chamomile, and Rosemary all have been used in the past to relieve asthmatic attacks.

Caffeine: Black unsweetened coffee and other caffeine-containing drinks may help open airways.  Don’t drink more than 12 ounces at a time, as coffee can dehydrate you. Interestingly, coffee is somewhat similar in chemical structure to the asthma drug Theophylline.

Eucalyptus: Essential oil of eucalyptus, used in a steam or direct inhalation, may be helpful to open airways. Rub a few drops of oil between your hands and breathe in deeply. Alternatively, a few drops in some steaming water will be good respiratory therapy.

Honey: Honey was used in the 19th century to treat asthmatic attacks. Breathe deeply from a jar of honey and look for improvement in a few minutes. To decrease the frequency of attacks, stir one teaspoon of honey in a twelve-ounce glass of water and drink it three times daily.

Turmeric: Take one teaspoon of turmeric powder in 6-8 ounces of warm water three times a day.

Mustard Oil Rub: Mix mustard oil with camphor and rub it on your chest and back. There are claims that it gives instant relief in some cases.

Gingko Biloba leaf extract: Thought to decrease hypersensitivity in the lungs; not for people who are taking aspirin or ibuprofen daily, or anticoagulants like warfarin (Coumadin).

Lobelia: Native Americans actually smoked(!) this herb as a treatment for asthma. Instead of smoking, try mixing tincture of lobelia with tincture of cayenne in a 3:1 ratio. Put 1 milliliter (about 20 drops) of this mixture in water at the start of an attack and repeat every thirty minutes or so

Further research is necessary to determine the effectiveness that some of the above remedies have on severe asthma, so take standard medications if your peak flow reading is 60% or less than normal.

Don’t underestimate the effect of diet on the course of asthma. Asthmatics should:

  • Replace animal proteins with plant proteins.
  • Increase intake of Omega-3 fatty acids and vitamin D.
  • Eliminate milk and other dairy products.
  • Eat organically whenever possible.
  • Eliminate trans-fats; use extra-virgin olive oil as your main cooking oil.
  • Always stay well-hydrated; more fluids will make your lung secretions less viscous.

Finally, various relaxation methods, such as taught in Yoga classes, are thought to help promote well-being and control the panic response seen in asthmatic attacks. Acupuncture is thought by some to have some promise as well.

I’m sure you have your own home remedy that might work to help asthmatics. If so, let us know!

Joe Alton MD

Doom and Bloom: Hypothermia in Austere Settings

The Altons at Doom and Bloom Medical have an article on Hypothermia in Austere Settings.

As we head into the colder part of the year, I thought I’d talk about the dangers of exposure to cold. On or off the grid, if you don’t take environmental conditions into account, you have made Mother Nature your enemy, and she is a formidable one, indeed.

Hypothermia is a condition in which body core temperature drops below the temperature necessary for normal body function and metabolism. The normal body core temperature is defined as between 97.5-99.5 degrees Fahrenheit (36.0-37.5 degrees Celsius). Symptoms related to cold exposure occur once the core temperature dips below 95 degrees (35 degrees Celsius).

HOW THE BODY LOSES HEAT

Besides simply breathing out warm air, the body loses heat in various ways:

Image by JEMS

Evaporation: The body perspires (sweats), which releases heat from the core. Heat loss through evaporation increases in dry, windy weather conditions.

Radiation: While the body makes efforts to maintain normal body temperatures, the body loses heat to the environment when the ambient (surrounding) temperature is lower than about 68 degrees F. Much lower temperatures cause heat loss more quickly.

Conduction: The body loses heat when its surface is in direct contact with cold temperatures, as in the case of someone falling from a boat into frigid water. Water, being denser than air, removes heat from the body much faster.

Convection: Heat loss where, for instance, a cooler object is in motion against the body core. The air next to the skin is heated and then removed, which requires the body to use energy to re-heat. Wind Chill is one example of air convection: If the ambient temperature is 32 degrees F but the wind chill factor is at 5 degrees F, you lose heat from your body as if it were actually 5 degrees F.

A surprising amount of heat is lost from the head area, due to its large surface area and tendency to be uncovered. Direct contact with anything cold, especially over a large area of your body, will cause rapid cooling of your body core temperature. When the Titanic sank in 1912, hundreds of people fell into near-freezing water. Within 15 minutes, they were probably beyond medical help.

GENERAL SYMPTOMS OF HYPOTHERMIA

The body, when it is exposed to cold, kicks into action to produce heat once the core cools down below 95 degrees F. The main mechanism to produce heat is shivering. Muscles shiver to produce heat, and this will be the first symptom you’re likely to see. As hypothermia worsens, more symptoms will become apparent if the patient is not warmed.

The diagnosis of hypothermia may be difficult to make with a standard glass thermometer because it doesn’t register below 94 degrees Fahrenheit. Unless you have a thermometer that can measure low ranges, it may be difficult to know for certain that you’re dealing with this problem.  You should assume that anyone with altered mental status encountered in cold weather is hypothermic until proven otherwise.

Aside from shivering, the most noticeable symptoms of hypothermia will be related to mental status. The victim may appear confused and uncoordinated. As the condition worsens, speech may become slurred. The patient will appear apathetic, lethargic, and uninterested in helping themselves; they may fall asleep. This occurs due to the effect of cooling temperatures on the brain; the colder the body core gets, the slower the brain works. Brain function is supposed to cease at a body temperature of about 68 degrees Fahrenheit, although there have been exceptional cases where people (usually children) survived even lower temperatures.

To learn about hypothermia in dogs, click here.

LEVELS OF HYPOTHERMIA

Some sources differentiate different levels of hypothermia body temperature:

MILD: (93-97 degrees F; 33.9-36.1 degrees C)

A person with mild hypothermia will usually still be awake and alert, but shivering. Hands and feet will be cold, and they may complain of pain or numbness in the extremities. Loss of dexterity is often noted.

MODERATE: (90-93 degrees F; 32.2-33.9 degrees C)

In moderate hypothermia, you’ll see all of the above, but mental status begins to alter and efforts to produce heat by shivering may decrease or even stop.

SEVERE HYPOTHERMIA: (82-90 degrees F; 27.8-32.2 degrees C)

The severely hypothermic person will stop shivering and mental status changes become clearly apparent. Expect to see confusion, lethargy, and memory loss. The victim’s muscles appear less flexible; they will be uncoordinated and speech will be slurred. An unusual apathy or denial regarding the seriousness of the situation is often noted.

CRITICAL HYPOTHERMIA (less than 82 degrees F (27.8° C))

Once less than 82 degrees F, the victim will likely be unconscious. Respirations will be impaired and the pulse slow and difficult to feel. Skin will be cold and cyanotic (blue) and muscles will be rigid. Pupils may be dilated.

Individual cases may vary somewhat.

TREATING HYPOTHERMIA

Immediate action must be taken to 1) prevent further heat loss and 2) reverse the ill effects of hypothermia. Important measures to take are:

Get the person out of the cold. Transport as soon as possible to a warm, dry location. If you’re unable to move the person out of the cold, shield them as much as possible. Be sure to place a barrier between them and the cold ground.

Exercise to produce heat in mild cases: In alert victims who can move without difficulty, mild exercise can help raise body temperature (as long as they stay dry). Avoid exertion in those with moderate hypothermia or worse, however, and in anyone with altered mental status.

Monitor breathing. A person with severe hypothermia may be unconscious. Verify that the patient is breathing and check for a pulse. If none, still assume the patient is revivable and begin CPR. Elevate the feet as you would for anyone in shock.

Take off wet clothing. If the person is wearing wet clothing, remove them gently. Ignore pleas of “leave me alone!” Cover them with layers of dry blankets, including the head, but leave the face clear (see image above).

Share body heat. There may be circumstances when it’s necessary to warm the person’s body by removing your clothing and making skin-to-skin contact. Then, cover both of your bodies with blankets. Some people may cringe at this notion, but it’s important to remember that you are trying to save a life. Gentle massage or rubbing may be helpful, but vigorous movements may cause unnecessary trauma.

Give warm oral fluids. If the affected person is alert and able to swallow, provide a warm, non-caffeinated beverage to help warm the body. Despite the image of St. Bernards saving alpine mountaineers with casks of brandy around their necks, alcohol is a bad idea. Alcohol may give you a “warm” feeling, but it actually causes your blood vessels to expand; this results in more rapid heat loss from the surface of your body and negates the body’s efforts to stay warm. Alcohol and recreational drugs also cause impaired judgment: Those under the influence might clothe inadequately for cold weather.

Use warm, dry compresses. First-aid “shake and break” warm compresses or warm (not hot) water in a plastic bottle will effectively apply heat to the body core if placed on the neck, chest wall or groin. Don’t use hot water, a heating pad or a heating lamp directly on the person. The extreme heat can damage the skin, cause strain on the heart, or even lead to cardiac arrest.

PREVENTION OF HYPOTHERMIA

An ounce of prevention is worth a pound of cure. To prevent hypothermia, you must anticipate the climate that you will be traveling through, including wind conditions and wet weather. Condition yourself physically to be fit for the challenge. Travel with a partner if at all possible, and have enough food and water available for the entire trip.

It may be useful to remember the simple acronym C.O.L.D. This stands for:  Cover, Overexertion, Layering, and Dry.

Cover: Protect your head by wearing a hat. This will prevent body heat from escaping from your head. Instead of using gloves to cover your hands, use mittens. Mittens are more helpful than gloves because they keep your fingers in contact with one another, conserving heat.

Overexertion:  Avoid activities that cause you to sweat a lot. Cold weather causes you to lose body heat quickly; wet, sweaty clothing accelerates the process. Rest when necessary; use rest periods to self-assess for cold-related changes. Pay careful attention to the status of your elderly or juvenile group members. Diabetics are also at high risk.

Layering: Loose-fitting, lightweight clothing in layers do the best job of insulating you against the cold. Use tightly woven, water-repellent material for wind protection. Wool or silk inner layers hold body heat better than cotton does. Some synthetic materials, like Gore-Tex, Primaloft, and Thinsulate, work well also. Especially cover the head, neck, hands and feet.

Dry: Keep as dry as you can. Get out of wet clothing as soon as possible. It’s very easy for snow to get into gloves and boots, so pay particular attention to your hands and feet.

If left untreated, hypothermia leads to complete failure of various organ systems and death.  People who develop hypothermia due to cold exposure are also vulnerable to other cold-related injuries, such as frostbite and immersion foot. We’ll discuss those and some specific clothing strategies in the near future.

Joe Alton MD

Doom and Bloom: Soft Tissue Infections

The Altons at Doom and Bloom Medical write about Soft Tissue Infections. More pictures are in the original article.

All injuries carry a risk of infection. When the skin is breached, various microbes can invade and cause damage. Inflammation in soft tissues known as “cellulitis” may develop when bacteria enter through a crack or break in your skin. Fortunately, infections from minor wounds are relatively easy to treat today due to the availability of antibiotics. Without them, any bacteria may become life-threatening if it enters the circulation.

If germs invade the soft tissues below the superficial level of the skin (the “epidermis”), they can rapidly infect the main layers of soft tissue below. These include the deep layer of the skin (the “dermis”), the subcutaneous fat, the muscle layers, and various blood vessels and nerves.

image by Cerevisae 

Cellulitis may be easy to deal with in normal times, but it will be an epidemic in the aftermath of a major disaster. This is not because it’s contagious; it isn’t unless you have an open wound yourself or exchange bodily fluids. Expect cases simply because of the sheer number of injuries incurred from performing activities of daily survival in less than sanitary conditions.

Without antibiotics, infections can spread to lymph nodes and the bloodstream, rapidly becoming life-threatening. The end result might affect the entire body, referred to as “sepsis.” Once sepsis develops, inflammation of deep structures like the spinal cord (“meningitis”) or bone marrow (“osteomyelitis”) can further complicate the situation. In the past, sepsis was usually fatal.

The bacteria that can cause cellulitis are on your skin right now. Normal inhabitants of the surface of your skin include Staphylococcus and Group A Streptococcus. They do no harm until the skin is broken and they enter deeper tissues where they don’t belong. In recent years, a resistant bacterium called MRSA (Methicillin-Resistant Staphylococcus Aureus) has arisen which causes cellulitis resistant to the usual antibiotics.

As an aside, Cellulitis has nothing to do with the dimpling on the skin called “cellulite”. The suffix “-itis” simply means “inflammation”, so cellul-itis simply means “inflammation of the cells.”

The signs and symptoms of cellulitis must be recognized as early as possible. They include:

  • Discomfort in the area of infection
  • Fever and Chills
  • Exhaustion (fatigue)
  • General ill feeling (malaise)
  • Muscle aches (myalgia)
  • Heat in the area of the infection compared to non-affected areas
  • Redness, usually spreading towards torso
  • Swelling in the area of infection (often appearing shiny and causing a sensation of tightness)
  • Drainage of pus or cloudy fluid from the area of the infection
  • Foul odor coming from the area of infection
  • Hair loss at the site of infection (less common)
  • Joint stiffness caused by swelling of the tissue over it (less common)

Cellulitis commonly occurs in an extremity, such as a leg. In these cases, it’s helpful to keep the limb elevated. Other strategies include warm or cool compresses or soaks to the affected area, and the use of ibuprofen (Advil) or acetaminophen (Tylenol) to decrease pain, discomfort, and fever.

Although the body can sometimes resolve cellulitis on its own, treatment usually includes the use of antibiotics. These can be topical, oral, or intravenous. Topical therapy helps more to prevent infection than cure it.

As most cases of cellulitis are caused by bacteria, they should improve and disappear during a 7-14-day course of therapy with medications in the Penicillin, Erythromycin, or Cephalosporin (Keflex) families. Amoxicillin and ampicillin are particularly popular. MRSA cellulitis can be treated with clindamycin and the sulfa drug combination of sulfamethoxazole/trimethoprim (SMX-TMP). It’s important to complete the full course of therapy.

Adult dosing:

-Penicillin, amoxicillin, cephalexin, or ampicillin 250-500 mg orally four times a day for 7-14 days (Amoxicillin also comes in 875 mg).

-Clindamycin 150-300 mg orally three times a day for 7-10 days.

-SMX 800 mg-TMX 160 mg orally twice a day for 7-10 days.

Those allergic to penicillins can still take clindamycin or SMX-TMP. It should be noted that not all sources will recommend the same dosage, frequency, and duration of therapy for a particular drug. In resistant infections like MRSA, combination therapy with SMX/TMP and Cephalexin 500 mg orally four times a day for 7-14 days may be necessary.

As with all medications, the longer the therapy and the higher the dose, the more likelihood that adverse reactions may occur. A much more comprehensive discussion of antibiotics can be found in Alton’s Antibiotics and Infectious Disease: The Layman’s Guide, or online at drugs.com and rxlist.com.

All the drugs mentioned above are available in veterinary equivalents (at least at present). In a survival situation, however, antibiotics will be precious commodities. You, as medic, should dispense them only when absolutely necessary. The misuse of antibiotics, along with their excessive use in livestock, is part of the reason that we’re seeing an epidemic of antibiotic resistance in this country.

 

Spotter Up: The EDC Tourniquet

Eugene Nielsen at Spotter Up has a pretty comprehensive article on The EDC Tourniquet.

According to published research, reported in the October 2017 issue of the Journal of the American Medical Association (JAMA)), the average response time in the US from the time of a 911 call to arrival of EMS on scene was seven minutes. This increased to more than 14 minutes in rural settings. A person can bleed out from a severed femoral artery in less than five minutes. You do the math.

By the time EMS arrives it may be too late. You need to be your own first responder.. Photo: Public Domain.

In an active shooter or terrorist incident, emergency personnel won’t reach victims until the threat has been neutralized. During the Paris attacks on 13 November 2015, it was over 160 minutes from the time the terrorists fired the first shots in the Bataclan theater until the responding emergency personnel were able to reach those inside the venue.

The reality is that you’re going to be your own first responder. Bystanders will always be first on the scene, whether it be terrorism or other criminal act or an accident. In the Boston Marathon bombing on 15 April 2013, bystanders employed improvised tourniquets to save lives. Time consuming and inefficient, but it was all that they had. Don’t plan to improvise if the need arises. Always have a real tourniquet.

Data from the Boston Marathon Bombing found that six of the rubber and improvised type tourniquets had to be subsequently replaced with C-A-T® tourniquets. Additionally, the most common EMS tourniquet on scene consisted of rubber tubing and a Kelly clamp.

Roughly 80% of combat deaths and 50% of civilian trauma deaths are attributable to hemorrhage. It’s the most preventable cause of death in compressible injuries. The proper use of tourniquets saves lives.

Hypovolemic Shock

Time is of the essence. Hypovolemic shock occurs where there is an acute fluid or blood loss in the body. It’s a life-threatening emergency. Hypovolemic shock is most often secondary to rapid blood loss (hemorrhagic shock). It causes inability of the heart to pump the essential blood needed to the body, resulting in multiple organ failure due to inadequate cellular oxygenation. There are four stages of hypovolemic shock.

No, it’s not an ancient torture device, although Roman soldiers may have begged to differ. It’s a Roman thigh tourniquet circa199 BCE to 500 CE. It’s made from bronze. Photo: Welcome Collection. Licensed under the Creative Commons Attribution 4.0 License.

Stopping the blood loss before patient goes into Stage II shock, ie., blood volume loss up to 15% (~750 mL), keeps survivability at around 94%. If blood loss continues and the patient is in Stage II (30% or ~1500 ml) or greater, the survivability goes down to 14%, without any blood being administered. These figures are based on a US Army Institute of Surgical Research (USAISR) study conducted in 2006 and 2007.

Tourniquets

While I recommend that everyone carry a trauma kit, a tourniquet (and gloves) needs to become part of your everyday carry (EDC) at the at the very minimum. Tourniquets have emerged as the standard of care in the tactical environment due to their ease of use, rapid application, and complete stoppage of blood loss. Current protocol considers the tourniquet an initial lifesaving intervention to control massive hemorrhage from an extremity.

The old dogma of “save a life, lose a limb” has been proven to be false. A tourniquet can safely remain in place for up to two hours. Thousands of combat veterans are walking around today with all their limbs because their lives were saved by tourniquet use.

The use of tourniquets on the battlefield isn’t new. As far back as Alexander the Great’s military campaigns in the fourth century BC, tourniquets were used to staunch the bleeding of wounded soldiers. The term “tourniquet” dates from the 17th century and originated from the French “tourner” meaning “to turn”. .

Tourniquets have emerged as the standard of care in the tactical environment. Combat Application Tourniquet (C-A-T) is recommended by CoTCCC and standard issue to the US military. First responders and others are most likely to have trained with the C-A-T. Photo: North American Rescue.

Tourniquets lost popularity after the US Civil War, having been blamed for complications that resulted in amputation. This misunderstanding has unfortunately persisted, especially as it pertains to tourniquet use in civilian settings.

Although there have been several studies in the past that have looked at tourniquet use in civilian settings, the survival benefit for patients has been unclear. However, new research shows that for civilian patients with peripheral vascular injury, prehospital tourniquet use is associated with dramatically improved odds of survival.

The study, titled “Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury,” was published 29 March 2018 and reported in the May 2018 issue of the Journal of the American College of Surgeons (JACS). This study was a multi-institutional retrospective review of all patients sustaining peripheral vascular injuries admitted to all 11 urban Level I trauma centers in the state of Texas from January 2011 to December 2016.

The study found that “Although still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.” Simply put, tourniquets save lives.

Popular commercial tourniquets include the Combat Application Tourniquet® (C-A-T®), SOF® Tourniquet, RevMedx® TX® Series Ratcheting Medical Tourniquet -Tactical™ (RMT-T™), SAM Extremity Tourniquet (SAM-XT™), Tactical Mechanical Tourniquet™ (TMT™), SWAT-T® and Rapid Application Tourniquet System®® (R.A.T.S.®) / Rapid Tourniquet. Each has its pros and cons. All are capable of occluding blood flow when properly applied.

No longer a last resort, a tourniquet is now considered an initial lifesaving intervention to control massive hemorrhage from an extremity. SWAT-T is a versatile tourniquet that has proven effective in studies and has been successfully fielded in combat. Photo: H&H Medical.

As of this writing, the C-A-T, RMT-T, SAM-XT, SOF Tourniquet (SOFTT-W), TMT and TX Series (TX2 and TX3) are  the only US military Committee on Tactical Combat Casualty Care (CoTCCC) recommended non-pneumatic limb tourniquets. It’s important to keep in mind that the CoTCCC, a division of the DoD Joint Trauma System, is looking at tourniquets for use on adults in combat by trained military personnel. not for use by civilians with limited training or for use on children.

The C-A-T, RMT-T, SAM-XT, SOF Tourniquet, TMT and TX Series are windless/ratcheting tourniquets. The SWAT-T (Stretch, Wrap and Tuck Tourniquet®) and R.A.T.S. are elastic wrap tourniquets.

A plus to elastic wrap tourniquets is that they pack down into a significantly smaller size, making them easier to carry. They’re also considerably less expensive than windless/ratcheting tourniquets. On the downside, elastic wrap tourniquets require a wider range of motion to apply. The latter can make self-application more difficult.

The SWAT-T and R.A.T.S. can be be employed for higher axillary and groin applications than windless tourniquets. They may also be employed for pediatric and K-9 applications, where standard windlass tourniquets cannot. A study of commercial tourniquets conducted in Israel, and reported in a paper submitted to the 2018 NAEMSP Scientific Assembly, found that the SWAT-T and R.A.T.S. were the best tourniquets for use on children.

It should be noted that North American Rescue states that the C-A-T has been shown to be effective on limbs as small as five inches in circumference. It should also be noted that the TX Series ratcheting tourniquet is available in a pediatric model designed specifically for children.

The SWAT-T is a versatile medical multi-tool that may be employed not only as a tourniquet, but also as pressure dressing, occlusive device, elastic bandage, sling and swathe, used to secure a splint, and more. If the SWAT-T is employed as a pressure bandage or dressing, it’s important to check for a distal pulse after application. Although not a CoTCCC-recommended tourniquet, the SWAT-T has been the subject of several studies which demonstrated it’s efficacy.

PHLster Flatpack is a great way to EDC a windlass tourniquet. Flatpack is shown with SOF Tourniquet (SOFTT-W). Photo: PHLster Holsters.

PHLster Flatpack Tourniquet Carrier

No tourniquet does you any good if you don’t have it with you when you need it. I have found the PHLster Flatpack® Tourniquet Carrier from PHLster Holsters to be a great, low-profile way to EDC a windlass tourniquet for easy, one-hand deployment. Designed for versatility, it allows you to carry a folded and staged windlass tourniquet on your belt, in a pocket or with MALICE CLIPS® for MOLLE/PALS mounting..

Training

Having the necessary tools is only part of the equation. Equipment is only as good as your training. Basic emergency medical training should cover the entire spectrum of lifesaving skills. And like shooting, they’re perishable skills.

Emergency medical training should be part of the basic skill sets of every firearms owner. In fact, it should be part of the basic skill sets of everyone. The time to learn isn’t when someone is bleeding out.

The National Association of Emergency Medical Technicians (NAEMT) and STOP THE BLEED® are excellent resources that can direct you to courses in your area. Dark Angel Medical offers a free online introductory course designed to teach the basics of bleeding control.

Kerry Davis of Dark Angel Medical discussing hemorrhagic injury management and tourniquet placement with two students in Direct Action Response Training (D.A.R.T.) course. Hemorrhage is the most preventable cause of death in compressible injuries. It accounts for approximately 80% of battlefield deaths and 50% of civilian trauma deaths.

Dark Angel Medical also offers an outstanding two-day Direct Action Response Training (D.A.R.T.) course at various locations around the country. All participants receive BCON (Bleeding Control) certification from the American College of Surgeons. It also provides 16 hours of CEU’s, per CECBEMS, to NREMT EMT-Basics/Advanced and Paramedics. I have taken the D.A.R.T. course and highly recommend it. Dark Angel Medical is also a great source for trauma kits and components. I have taken the course and highly recommend it. Idid an article on the D.A.R.T. course recently for Spotter Up.

The online learning platform Deployed Medicine is also valuable resource. It’s used by the Defense Health Agency (DHA) “to trial new innovative learning models aimed at improving readiness and performance of deployed military medical personnel.” Learning assets include the standardized Tactical Combat Casualty Care All Service Members (TCCC ASM) Course curriculum developed by the Joint Trauma System, which is part of the DHA. You don’t have to be a member of the military to take advantage of its resources.

Some Final Thoughts

Preparedness requires the proper mindset, training, and tools. It doesn’t just happen. It’s a way of life and takes some effort. And it’s about preparing for possibilities, not just probabilities.

Carry a proven tourniquet. Not all tourniquets are created equal. I recommend carrying at least two tourniquets. This will leverage your capability. I carry a C-A-T as my primary EDC tourniquet and a SWAT-T as my secondary/backup tourniquet

Buy from a reputable source. If you try to save a few bucks you may wind up with poorly made counterfeit. Counterfeit tourniquets are a growing problem. They can cost lives. The life you save may be your own or that of a loved one.

Practice with the tourniquet in situations that are similar you may encounter. Get a spare/training tourniquet for this purpose. Don’t use the actual tourniquet that you will be counting on in an emergency. Practice both strong and support side applications.

The Medic Shack: Amputation – First Aid and Post Aid

Chuck at The Medic Shack talks about amputating injuries, first aid for them, and post aid while using photos from his son’s recent injury. So be warned of finger amputation photos through the link.

This post is on Amputation. What first aid and also post aid needs to be done.

NOTE: Some of the images at the end of this are graphic. They are of my son’s finger and the wound. 

This site contains affiliate links to products. We may receive a commission for purchases made through these links. This does NOT increase the price of the product you may purchase.

Background

Normally when I write a blog post its from current events, past experiences both civilian and or military. This time I am using my youngest son as our topic. This past week (Tuesday the 4th of August) he had a pretty normal day at work. He works at a motorcycle accessory shop. Sells gear and he is about the most requested tire man in the city.

People bring him tires to mount that they bought from all over. From the store he works at to mail order The reason he is so requested is he cares for the customer and the motorcycle. Never scratches or damages a rim. He recently did a set of tires that the rims cost 2 grand each. Personally requested by the bike owner. Not bad for a 19 year old young man. Today’s post ties in to one from may on one we did years ago on Emergencies 

Where did my finger go?

He and his manager were moving out the old tire machine for the brand new one the store bough. As they were lifting it on the pallet the old one came on, the bead breaker slipped out of position, dropped down and amputated his lift index finger between the 3rd knuckle and the nail bed. (Knuckles are counted from nearest to the hand to the finger tip. Think of drawing and angle from the cuticle backwards from that point at a 45 degree angle to the 1st knuckle. If folks have taken my classes or shooting classes from some of my friends, you have heard me say that a traumatic injury is not a painful as it looks. For a while at least.

According to Ryan it felt like he pinched his finger. Not to bad. He went to keep lifting and he looked down and saw the blood covering the floor and tire machine. His mechanic glove was torn and the end of it was missing. The body has amazing self preservation tools. I’ve know gunshot victims who were shot, walked down a flight of stairs with a suspect in custody, put them in the patrol car and then died.

First Aid

STOP THE BLEEDING! This cannot be stressed enough STOP THE BLEEDING. Even an injury like my son Ryan has can be dangerous if the bleeding is not stopped. When blood is spilled on the floor it looks 5 times as much as it is.

The blood loss Ryan had was about ¼ a cup 60 cc more or less. It looked like more. MUCH more. 2 fluid ounces is not much in the grand scale of the body. An adult will have approximately 1.2-1.5 gallons (or 10 units) of blood in their body. The average us 1.2 gallons or 5 liters

Now the scary part. The ½ cup of blood he lost was in the first minute! And it was not pure arterial flow. It was a mixed flow. The finger tips do not have large arteries in them The vessels are about 1/32nd of an inch in diameter (.79 mm). DIRECT PRESSURE.

Ryan has been trained extensively in first aid. Well he HIS my and his mom’s son. Growing up in a medical family has advantages. He squeezed below the wound and yelled he needed something to help hold it. His manager and the vendor grabbed shop towels and put pressure on it. Sat him down with his hand higher than his heart and called 911.

If at all possible retrieve the amputated part, wrap in clean cloth or sterile bandage material, place in a baggie, and place that baggie into one containing ice. This gives the surgeons the best chance of re-attachment.

To tourniquet or to not tourniquet.

There is a sorted history on the tourniquet. Lets go back to the 1980’s As an old medic, when we had a wound that needed a tourniquet, we put it on, marked a “T” on the patients forehead with date and time of application. If your patient was going to be with you for a few hours, every hour or so we would loosen the tourniquet for a short time to allow blood to the part below the tourniquet. The reapply it.

This did not work as well as expected. For a tourniquet to work it has to be tight. TIGHT. When it is applied correctly. Tissues will be damaged. When tissue is damaged there is swelling. We call it edema. So when we let off the tourniquet, let some blood down, then re applied it, the bleeding would stop and all was good in the world. Until the patient bled out. What happened was when the tourniquet was re-applied, it compressed the edema, and stopped the flow. But once the edema had been moved, the tourniquet was now loose…(continues)

Click here to read the entire article at The Medic Shack.