Several years ago, the Food and Drug Administration (FDA) decided that access to veterinary antibiotics was too easy for the average citizen. They announced that there would be an increased “stewardship” of these drugs (life-savers in survival settings) in the future. Thus began the implementation of Industry Guidance #213, also known as the Veterinary Feed Directive (VFD). This action was meant to discourage the use of veterinary antibiotics and, hopefully, decrease antibiotic resistance.
While this directive applied to food-producing livestock, there was no rule against access to antibiotics used in the pet trade, specifically those targeting aquarium fish or pet birds. Despite this, the writing was on the wall; large distributors like Thomas Labs, maker of “Fish-Mox,” quietly ended their line of products. Other producers rose to fill the void, but the selection was less and availability less reliable.
Recently, the FDA issued Industry Guidance #263, a ruling that all remaining over-the-counter “medically-important” veterinary antibiotics should be “transitioned” to prescription-only by June 2023. Product labels will now state: “Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.”
What does this mean for the preparedness community? The original article I wrote on “fish antibiotics” (about 15 years ago) was meant to give the off-grid medic a way to keep long-term disaster survivors from succumbing to minor infections that might turn into life-threatening ones. That concern still exists today, and you might agree we’re no less likely to suffer a major catastrophic event today than we were then. Having antibiotics around would save lives if the medical infrastructure collapsed. Not having them, well…
Websites that address this issue state that there will be no more OTC/non-prescription feed antibiotics available for use in food animal species. Unless you’re in the habit of eating your pet goldfish, though, there doesn’t seem to be a specific ban on currently available aquarium meds. Some sites note the rules apply to companion animals as well. Most likely, you’re not quite that close to the fish in your aquarium.
The FDA has its reasons for wanting to control veterinary antibiotics. A few years back, 73 percent of total antibiotic use in the U.S. was in the food-livestock industry. This was not meant to treat infection, but given because animals fed antibiotics seemed to mature faster and get to market quicker. Now, it will be illegal to use them for that purpose. Producers now need to obtain authorization from a licensed veterinarian to use them for prevention, control, or treatment of a specifically identified disease.
Nonetheless, limiting the preparedness community’s ability to access veterinary antibiotics for stockpile purposes will mean lives lost in the event of a long-term disaster event. Even if a person has a relationship with a licensed veterinarian, how many vets will even see small animals like a pet rodent, chicken, or parakeet? If they do, how many will see a sick guppy?
The amount of veterinary antibiotics the preparedness community puts in their medical storage is not even a drop in the bucket compared to the total used. Having said that, I would guess the government will eventually get around to controlling every aspect of our lives; this will be no different. If you’re the family medic and are concerned about a scenario where infections may run rampant among your people, consider getting a supply while they’re still available.
(Note: I’m not suggesting using any of your stockpiled antibiotics in normal times without the supervision of a qualified medical professional. This article relates to the availability of medications like these for long-term off-grid survival settings.)
Some sources that still offer over-the-counter “fish” antibiotics:
The destruction caused by hurricane Ian in Florida recently was widespread and devastating. Flood waters teeming with contaminants and debris posed a hazard to all who ventured out after the storm. You can bet that there was a run on tetanus shots after citizens had a painful encounter with the proverbial “rusty nail” and other objects. In off-grid settings, tetanus is an ever-present risk. The family medic should have knowledge of risks, symptoms, treatment, and prevention.
What is Tetanus?
Tetanus (from the Greek word tetanos, meaning tight) is an infection caused by the bacteria Clostridium tetani. The bacteria produces spores (inactive bacteria-to-be) that primarily live in soil or the feces of animals. These spores are capable of laying dormant for years and are resistant to extremes in temperature.
Tetanus is relatively rare in the United States, with about 50 reported cases a year. Worldwide, however, there are more than 500,000 cases a year. Most are seen in developing countries in Africa and Asia. Still, we should realize that developed countries may be thrown into third world status in the aftermath of a mega-catastrophe. There’ll be many more cases that could be your responsibility as medic to identify and treat.
Causes of Tetanus
Most tetanus infections occur when a person has experienced a break in the skin. The skin is the most important barrier to infection, and any breach in the armor leaves a person open to infection. The most common cause is some type of puncture wound, such as an insect or animal bite, a splinter, or even that rusty nail. This is because the bacteria is anaerobic (doesn’t like oxygen); deep, narrow wounds are exposed to less O2, providing a favorable environment for C. tetani. Any injury that compromises the skin, however, is eligible: Burns, crush injuries, and lacerations can also be entryways for tetanus bacteria.
Tetanus spores
When a wound becomes contaminated with Tetanus spores, the spores become full-fledged bacterium and reproduce rapidly. Damage to the victim comes as a result of a strong toxin excreted by the organism known as tetanospasmin. This toxin specifically targets nerves that serve muscle tissue.
Tetanospasmin binds to motor nerves, causing “misfires” that lead to involuntary contraction of the affected areas. This neural damage could be localized or can affect the entire body. You would possibly see the classical symptom of “lockjaw”, where the jaw muscle is taut; any muscle group, however, is susceptible to the contractions if affected by the toxin. This includes the respiratory musculature, which can inhibit normal breathing and become life-threatening.
The most severe cases seem to occur at extremes of age, with newborns and those over 65 most likely to succumb to the disease. Death rates from generalized Tetanus hover around 25-50%, higher in newborns.
You will be on the lookout for the following early symptoms:
Sore muscles (especially near the site of injury)
Weakness
Irritability
Difficulty swallowing
Lockjaw (also called “trismus”; facial muscles are often the first affected)
Initial symptoms may not present themselves for one to two weeks. As the disease progresses, you may see:
Progressively worsening muscle spasms (may start locally and become generalized over time)
Involuntary arching of the back (sometimes so strong that bones may break or dislocations may occur!)
Fever
Respiratory distress
High blood pressure
Irregular heartbeats
Complications of untreated tetanus can lead to a fatal outcome in one out of four people. The death rate for newborns is even higher.
Treating Tetanus
The first thing that the survival medic should understand is that, although an infectious disease, tetanus is not contagious. You can feel confident treating a tetanus victim safely, as long as you wear gloves and observe standard clean technique. Begin by washing your hands and putting on your gloves. Then, wash the wound thoroughly with soap and water, using an irrigation syringe with 3% hydrogen peroxide to repeatedly flush out any debris. This will, hopefully, limit growth of the bacteria and, as a result, decrease toxin production.
You will want to administer antibiotics to kill off the rest of the tetanus bacteria in the system. Although not used as prevention, antibiotics will decrease the toxin load and speed recovery. Metronidazole (Aqua-zole, Flagyl) 500mg 4 times a day or Penicillin 500 mg 4 times a day are among some of the drugs known to be effective. Muscle relaxants like tizanidine and cyclobenzaprine are used to treat spasms, but are unlikely to be available to the off-grid caregiver.
Additional strategies include IV hydration, if available, and keeping the patient as comfortable as possible in a quiet and dimly-lit environment.
Late stage Tetanus is difficult to treat without modern technology. For this reason, it’s important for the survival medic to monitor anyone who has sustained a wound for the early symptoms mentioned earlier.
As medic, you must obtain a detailed medical history from anyone that you might be responsible for in times of trouble. This includes immunization histories where possible. Has the injured individual been immunized against tetanus? Most people born in the U.S. will have gone through a series of immunizations against diptheria, tetanus, and whooping cough early in their childhood. Booster injections for tetanus are usually given every 10 years (or if 5 years have passed in a person with a fresh wound, sometimes along with tetanus Immunoglobulin antitoxin).
Tetanus vaccine is not without its risks; severe complications such as seizures or brain damage occur in rare cases (less than one in a million). Milder side effects such as fatigue, fever, nausea and vomiting, headache, and inflammation in the injection site are more common.
Given the life-threatening nature of the disease, though, this is one vaccine that you should encourage your people to receive, regardless of your feelings about vaccines in general. If not caught early, there may be little you, the off-grid medic, can do to treat your patient without all the bells and whistles of modern medicine.
Many of us have heard of the “stomach flu” but not the actual virus that causes it: Norovirus. Norovirus has been in the news lately when a long-term outbreak occurred among more than 220 rafters and hikers in the Grand Canyon National Park from April to mid-June of this year. Less well known is 448 norovirus cases reported in the U.S. from Aug 2021 to March of this year. That was six times the number of cases reported during the same time the year before.
We personally an experience with the virus a few years ago when my wife sampled “The World’s Best Hot Dog” at a street stand in New York City while visiting our daughter. Believe me, it’s no fun, and considering that norovirus can be found everywhere from the Big Apple to the Grand Canyon, the family medic should know about it.
ABOUT NOROVIRUSES
The National Foundation for infectious diseases reports that noroviruses are the most common cause of acute stomach and intestinal infections in the United States, The U.S. reports 19 million to 21 million cases a year. Humans are, apparently, the only hosts of the virus. It affects people of all ages, but it’s particularly dangerous in the elderly, the very young, and those with weakened immune systems. Except for this year, winter is the most common time for outbreaks.
The virus was formerly known as the Norwalk virus because the first known outbreak took place at an elementary school in Norwalk, Ohio. Scientists identified the virus in 1972 from stool samples and renamed it “norovirus.” Since then, it’s been identified everywhere from cruise ships to nursing homes.
Norovirus is very contagious (just 5-20 viral particles can cause illness) and is easily transmitted through contaminated food or water, close personal contact, and even by air droplets from vomit, contaminated kitchen counters, and even toilet flushes. Infection can be passed from person to person for a time even after apparent recovery.
Here’s how contagious the norovirus is: In one outbreak reported in 1998, 126 people were dining at a restaurant when one person vomited onto the floor. Despite a rapid cleanup, 52 customers fell ill within three days. More than 90% of the people who later dined at the same table reported symptoms. More than 70% of the diners at a nearby table got sick; at a table on the other side of the restaurant, the rate was still 25%.
Norovirus is a hardy microbe, and is known to survive for long periods outside a human host. It can live for weeks on countertops and up to twelve days on clothes. It can survive for months in still water. Disinfectants containing chlorine, however, like bleach will quickly eliminate it, as will sufficient heat.
SYMPTOMS OF “STOMACH FLU”
The symptoms of the stomach flu include nausea and vomiting, watery diarrhea, and (sometimes severe) abdominal pain, usually within 12 to 48 hours of exposure. Along with this, muscle aches, headache, and fever may be seen. Luckily, life-threatening illness is rare, with dehydration being the main danger in those infected with the virus. Symptoms may last several days before eventually subsiding.
Unlike some viruses, immunity to norovirus is only temporary. Antibodies against the virus at thought to last up to six months after recovery. Also, there are various types of noroviruses, getting one doesn’t protect you against others.
Outbreaks of norovirus infection often occur in closed spaces such as cruise ships, nursing homes, schools, camps, and prisons. Shellfish, such as oysters, and salad ingredients are the foods most often implicated in norovirus outbreaks (except, of course, “the World’s Best Hot Dog”).
TREATING NOROVIRUS
As is the case with most viruses, there is no known cure for norovirus infection. Antibiotics will not be effective, as they are meant to kill bacteria, not viruses. Treatment involves staying well-hydrated. Suspect dehydration if you see these signs and symptoms:
· Dry mouth
· Decrease in quantity or dark color of urine
· Dizziness when standing up
· Decreased elasticity of skin (it “tents” when pulled)
· No tears when crying or unusual irritability in infants
Using antidiarrheal meds like loperamide (Imodium) and anti-vomiting drugs like Ondansetron (Zofran) may also help.
PREVENTING NOROVIRUS
A cure may not be available but prevention is another issue. To decrease the chance of norovirus infection:
· Wash your hands frequently with soap and water (norovirus is relatively resistant to alcohol), especially after using the restroom or handling food. Be especially sure to do this for 2 weeks after becoming infected (yes, you can be contagious for that long).
· Wash food before cooking; cook shellfish thoroughly.
· Frequently disinfect contaminated surfaces with a bleach solution (the EPA recommends 5-25 drops of bleach per gallon).
· Keep sick individuals away from food preparation areas.
· Avoid close contact with others when you are sick, and don’t share utensils or other items.
· Wear disposable gloves while handling soiled items.
· Immediately remove and wash clothes that may be contaminated with vomit or feces. Machine dry if possible.
It may be difficult to completely eliminate the risk of norovirus infection, but careful attention to hand and food hygiene will go a long way towards avoiding the stomach flu.
The Altons at Doom and Bloom Medical have a couple of articles on burns. The first is on First and Second Degree Burns, while the third covers Third Degree Burns. Here’s an excerpt from the first of the articles, as always, more pictures in the original article:
A wide variety of situations, both in normal times and disaster settings, put us in proximity with high levels of heat. If we’re knocked off the grid, it won’t be unusual to cook food over a fire of our own making, something very few do on a regular basis. As such, the survival medic will often be faced with burn injuries. Having the materials and knowledge to treat burns will be absolutely necessary in times of trouble.
Burns can be caused by contact with sources other than flames, including:
• Scalds due to contact with hot water or steam.
• Contact with electricity associated with lightning or another source.
• Friction burns due to contact with hard surfaces such as roads (“road rash”), carpets, or hard flooring.
• Skin exposure to extreme cold and winds. Yes, extreme cold can cause burns.
• Chemical spills.
• Radiation due to contact with energy emitted by x-rays and other medical testing or treatment, “dirty bombs,” or thermonuclear explosions.
In general, the different types of burns are treated similarly, although some burns, like those caused by electricity or radiation, may cause internal damage without destroying the skin. Inhalation of superheated air may cause damage to lung tissue. Off the grid, the lack of advanced care will make these cases a challenge for the medic.
The severity of a burn injury and resulting chance of death or disability depends, in part, on the percentage of the total body surface involved, as measured by the “rule of nines.”
Assessing the percentage of body surface area burned is standard practice and helpful in modern medicine. It may, however, have less practical benefit in austere settings where transport isn’t an option. In any case, knowing the “rule of nines” may give the medic an idea of the chances of recovery for a burn victim.
Burns to the face, feet, hands, genitals, and lungs are considered the most problematic. Burns that go completely around a body part, say, an arm, cause constriction that may affect circulation. Areas with a lot of scar tissue may have limited mobility.
BURN DEGREES
Besides total surface area involved, an important factor is the amount of penetration of the burn. This is usually measured in degrees.
First-Degree Burns
Most burns you’ll see will be due to excessive exposure to the sun. A majority of cases will be “first-degree burns.” In first-degree burns, the patient may be red as a lobster, but only the superficial layer of the skin (the “epidermis”) is injured.
A first-degree burn will appear red, warm, and dry. It will be painful to the touch, especially when large areas of skin are involved. Fortunately, major complications are rare unless other symptoms such as nausea and vomiting appear. Treatment is simply focused on relieving discomfort.
Immersion in a cool bath will be helpful; at the very least, run cool water over the injury. A cool moist cloth on the burn for 20 minutes will give some relief. So will anti-inflammatory medicines such as Ibuprofen. Aloe vera, zinc oxide, and benzocaine sprays are effective alternatives. Expect the discomfort to improve after 24 hours. Until then, avoid constrictive, tight clothing and wear light fabrics, such as cotton.
Prevention, of course, is worth a pound of cure. To avoid this type of sunburn:
• Don’t “sunbathe” (a tan is not healthy).
• Avoid the peak sun hours for the time of year and latitude.
• Wear long pants and sleeves, hats, and sunglasses.
• Spend time in the shade whenever possible.
If extended exposure to sunlight is unavoidable, be certain to use a sunblock. Apply 15 minutes prior to going outside and re-apply frequently throughout the day. Even water-resistant sunscreens should be reapplied every one to two hours. Most people fail to put enough on, so be sure to use plenty.
As an aside, sunblock and sunscreen are not the same thing. Sunblocks contain tiny particles that “block” and reflect UV light. A sunscreen contains substances that absorb UV light, thus preventing it from penetrating the skin below. Many commercial products contain both. Sunblocks and sunscreens should be an integral part of your medical storage.
The SPF (Sun Protection Factor) rating system was developed in 1962 to measure the capacity of a product to protect against UV radiation. It measures the length of exposure to the sun before you burn. A SPF (sun protection factor) of at least 15 is recommended. It takes about 20 minutes without sunscreen for your skin to start turning red. SPF 15 blocks 94 percent of the sun’s rays, SPF 30 blocks 97 percent, and SPF 45 98 percent. The higher the number, the longer it takes for the skin to burn.
Although the increase in protection may seem small, higher SPF numbers are especially beneficial to those with fair skin. They offer better protection against long-term skin damage leading to cancer.
Besides the sun, first-degree injuries will most likely be related to cooking or campfires. Using hand protection will prevent many of these burns, as will careful supervision of children near campfires and food preparation areas.
Second-Degree Burns
Second-degree burns are deeper injuries that penetrate through the superficial epidermis and partially through the deeper layer of the skin (the “dermis”). Thus, they’re often called “partial thickness burns.” While first-degree burns may cover a large percentage of surface area without becoming life-threatening (but are painful), a relatively small percentage of the body covered with significant second-degree burns may require serious medical intervention.
Unlike first-degree burns, which appear dry, second-degree burns will be moist and often have blisters with reddened bases. The area will have a tendency to weep clear or whitish fluid. Second degree burns will cause swelling as well, so it’s important to remove rings and bracelets.
To treat second degrees burns:
Remove the victim from the heat source immediately. Run cool water over the injury for 10-15 minutes (avoid ice, which will traumatize already-damaged skin). After washing and running water over the wound, pat the area dry. The next step is to apply moist skin dressings such as Xeroform, Spenco Second Skin or non-stick dressings (Telfa pads) with thin layers of products like aloe vera or Aquaphor. Be sure to replace regularly and review the progress of healing. Other actions should include:
• Removing jewelry like rings and bracelets (swelling may cause painful constriction).
• Elevating burned extremities.
• Applying cool compresses.
• Giving oral pain relief such as Ibuprofen (Advil).
• Applying anesthetic creams such as benzocaine or lidocaine.
• Avoidance of “peeling” burned skin, which sometimes comes off in sheets.
• Protecting adjacent burned fingers and toes with a dry barrier in-between.
• Encouraging hydration.
• Using a “tenting” method to keep sheets above extensive burns.
We’re often asked whether to pop blisters associated with second-degree burns. It’s wisest to avoid the lancing of blisters, if possible, unless they’re infected and filled with pus. Some very large blisters will, however, break with the slightest pressure and may benefit from controlled drainage. If this is the case, use a sterilized needle or scalpel blade to pierce the side of the blister near the base. The roof of the blister is often retained to provide additional protection to the healing base.
It’s important to avoid the use of lard or butter on burns: They tend to keep in heat and may worsen the injury. Egg whites and toothpaste, long considered to be home remedies, may increase the risk of infection. It’s better to use sterile saline solutions to keep the burn area and (non-stick) dressing moist, especially in severe burns.
In part 2 of this series, we’ll discuss third-degree burns. Is there anything the survival medic can do if confronted with this life-threatening issue?
Stuck Pig Medical will be offering its Partisan Life Saver course in Spokane, WA on October 21-23, 2022. Stuck Pig Medical usually offers its courses at the Brushbeater training site in North Carolina, so it is rare to have one out here in Washington. Sign up and pay for the class through the Stuck Pig Medical store part of their website – CLICK HERE. If you’re really serious about some medical training, you can join the second tier of Stuck Pig Medical’s Patreon and have access to twice-weekly, live-streamed, medical classes of one to two hours in length for a cost of about $15 per month. Sign up early before all of the spots are gone.
Partisan Life Saver: $600 A three-day course that is the next step up from the TCCC course. The TCCC course is not a prereq for this. Covers everything that is covered in the basic course, but goes more in-depth on the subject. This is a wet course, which means fake blood is used, bring clothing that you don’t mind being potentially stained.
Topics covered: *Why TCCC is important *How to treat battlefield/trauma wounds *What interventions should you get *How to pack an IFAK *How to make things to practice with
Everything is provided for the class, if there is something specific you want to try out, feel free to bring it to class.
If you order an IFAK or Bleeder Kit in conjunction with this, put in the notes if you want it shipped to you, or if you would rather just pick up the kit(s) when you show up for class.
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**This module will include herbal Field materials students will use to demonstrate understanding of preparations in remote environments.
Herbal First Aid subjects include:
-Fundamental herbal care concepts
– the necessary shift in thinking
-Wound Care and Infection Management using herbs
-Injury, shock, pain and herbs
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-Gastrointestinal herbal first response
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In a destabilized society, traumatic wounds may be commonplace is scenarios where there is a desperate population and no rule of law. Even routine activities of daily survival may cause injuries that could become life-threatening. Therefore, the family or group medic must always be prepared to deal with bleeding wounds. Some of these, especially those in the abdomen and chest, are likely to be fatal without advanced medical care. In this article, let’s commemorateNational Stop The Bleed Month (I’m a certified instructor through the American College of Surgeons) by concentrating on those hemorrhages that are survivable.
Cuts in the skin can be minor or catastrophic, superficial or deep, clean or infected. Significant cuts (also called “lacerations”) penetrate both layers of the skin (dermis and epidermis) and are associated with bleeding, the amount of which depends on the blood vessels disrupted. Knowing how to manage hemorrhagic wounds quickly and effectively will be of paramount importance for the survival medic.
In studies of casualties in recent wars, 50 percent of those killed in action died of blood loss. 25 percent died within the first “golden hour” after being wounded. The golden hour is the time after which a victim’s chance of survival diminishes significantly if untreated, with a threefold increase in death rate for every 30 minutes without care thereafter.
If there is active bleeding and the wrong artery is severed, however, it could take just a few minutes for a person to “bleed out” and be beyond medical help. A severed femoral artery can lose more than a pint of blood a minute. With hemorrhage, the reality should, perhaps, be called the “platinum five minutes” instead.
Venous bleeding manifests as dark red blood that drains steadily from the wound, while arterial bleeding is bright red (due to higher oxygen content) and comes out in spurts that correspond to the pulse of the patient. As the vein and artery usually run together, a serious laceration can have both.
Once below the level of the skin, large blood vessels, muscles, and nerves may be involved. You’ll identify more problems with vessel and nerve damage in deep lacerations and crush injuries. In any case, bleeding control must be achieved.
In response to fatalities due to bleeding in recent military conflicts, the U.S. instituted Tactical Combat Casualty Care (TCCC) guidelines. It is thought that up to one in five deaths from hemorrhage in the field may be prevented with quick action by those at the scene. Civilian and law enforcement authorities have established similar strategies in response to the hard lessons learned by our soldiers; so should the family medic.
BLOOD BASICS
It’s worthwhile for the medic who may be dealing with bleeding wounds to know some basics about blood. Blood is a specialized fluid that comprises about 7-8 percent of a person’s total weight. It’s involved in:
• Delivering oxygen to the body from the lungs and eliminating carbon dioxide (a process called “gas exchange”).
• Forming clots that stop hemorrhages.
• Transporting substances that fight infections and disease.
• Delivering waste products to the kidneys and liver.
• Helping to regulate body temperature.
There are four main components to blood:
Red blood cells (RBCs): RBCs are the cells that carry oxygen to body tissues, thanks to a special iron-containing protein called “hemoglobin.” Red cells account for 40-45 percent of total blood volume. They start as immature cells in the bone marrow that mature and are released into the bloodstream. The average lifespan of a red blood cell is about 120 days.
White blood cells (WBCs): These cells account for only about one percent of total blood volume, but are extremely important for fighting infection and disease. There are several types, including short-lived cells deployed for immediate response and longer-lived ones that regulate the function of immune cells, make antibodies, and directly attack infected cells and tumors.
Platelets and other clotting factors: These are small cell fragments that allow bleeding to stop by gathering at the wound site and helping to form a clot. Like RBCs and WBCs, they originate in the bone marrow.
Plasma: A yellow liquid that transports all of the above throughout the body.
Together, these components are referred to as “whole blood.”
PHYSICAL EFFECTS OF BLOOD LOSS
Evaluating blood loss is an important aspect of dealing with wounds. An average size human adult has about 10 pints (4.73 liters or 4730 ml) of blood. The effect on the body caused by blood loss varies with the amount incurred. The American College of Surgeons recognizes four classes of acute hemorrhage, along with expected signs and symptoms:
Class I: Hemorrhage is less or equal to 15 percent of blood volume (1.5 pints/750 ml) in an average adult male. 750 ml is the amount in a bottle of wine. A person donating 1 pint of blood is giving slightly less than 500 ml. At this level there are almost no signs or symptoms, although some may have a slightly rapid pulse and feel vaguely faint or anxious.
Class II: Hemorrhage is 15 to 30% loss of total blood volume (1.5-3 pints/750-1500 ml). The body’s efforts to compensate for less red blood cells at this point results in a faster heartbeat and breathing rate to speed oxygen to tissues. This patient will appear pale and skin will be cool. They’ll feel shaky, weak, and anxious. Blood pressure remains, for now, within normal range. Urine production begins to slow down in order to retain fluid volume.
Class III: Hemorrhage is 30 to 40% loss of blood (3-4 pints/1500-2000 ml). At this point, the heart will be beating very quickly and breathing very fast as the body encounters difficulty getting enough oxygen to tissues. Blood pressure drops. Smaller blood vessels in extremities constrict to keep the body core circulation going. This patient will be confused, pale, and in hypovolemic (low blood volume) shock. Urine decreases significantly. In normal times, blood transfusion is usually necessary.
Class IV: Hemorrhage is more than 40% of total blood volume (greater than 4 pints/2000 ml). The heart can no longer maintain blood pressure and circulation. All parameters are well outside normal range and the patient becomes lethargic due to lack of oxygen and circulation to the brain. Without major resuscitative help at this point, organs like the kidneys fail. The patient loses consciousness. Heart rate and respiration slows and eventually ceases as the patient dies.
ABCDE VS. CABDE
The traditional initial field assessment of a victim usually involves the acronym ABCDE. Although ABCDE may mean different things to different people, one interpretation goes as follows…(continues)
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 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.
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.
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)
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.
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:
Lower Valley Assembly 