My brother has started getting interested more regarding prepping and is asking questions. The Ebola situation is precipitating his interest. I don't care what triggered it just as long as he is finally getting on board. He is asking lots of medical questions and I provided some guidance. I decided to share it here as it may be useful for some of you. This isn't perfect and has lots more to consider but its a start from a medication perspective. Criticisms are, as always, welcome. Enjoy. AT -------------------- Some medical preparation thoughts and suggestions in light of Ebola. It is not probable there will be an outbreak in the US, but the odds are unequivocally not zero either. As is being seen in Africa, Ebola is taking a toll on health care workers who are allegedly trained to not get infected and yet a good number have been. Should an outbreak occur in the US, the helicopter moms will swamp the doctors’ offices and the ERs will be the front lines with the most afflicted and consequently most contagious. It seems probable that if Ebola breaks out in the US some health care workers will be infected. Given the mortality rate and hype, it seems very probable that a lot of health care workers will bail on their jobs. Consequently, it seems reasonable to assume the US health care system, already significantly weakened by Obamacare, will become grossly over-whelmed and could partially collapse. Additionally, one probably wouldn’t want to risk infection by even going near a hospital or doctor’s office where the highest concentration of the infected will be. So, folks need to be able to deal with many medical issues on their own. Here are some suggestions to help get started. Training Obviously whatever courses one can take the better. Wilderness medicine course, EMT or even First Responder training would be very good. At the very least, CPR and First Aid are a minimum for all. The problem with these is they all operate on the premise that more skilled care in the form of a doctor, PA or nurse practitioner will ultimately render the final care. However, if going to the professional is a really bad or non-existent option, then what? Armaggedonmedicine.com offers some courses, like suturing, that look good for stuff that is not taught in conventional early responder training as it is assumed those treatments will be performed by docs, NP’s or PA’s in a hospital. Some of the wilderness medicine courses get closer as it is assumed professional treatment may be weeks away so one must resolve many issues on their own. NOLS, NASAR and others often sponsor courses like that. Training resources Books There are at least three books I recommend (the first two are available on Amazon the third at Cindy’s website Armaggedonmedicine.net. There are also other wilderness medicine or societal collapse medical books to consider but I very much like the first three: - Wilderness Medicine 6th Edition by William Forgey – I have used Bill’s books for 30 years. It’s a more manageable size to carry and not just keep in the library. - Survival Medicine Handbook, 2nd Edition by Joseph Alton - Armaggedon Medicine by Cynthia Koelker - Dr. Paul Auerbach has several good books on wilderness medicine Youtube There are some good training videos on suturing, casting, etc. that should be viewed and reviewed while you still can and before you need them. Alton produced some of these. Websites There are several that seem reasonable and credible (there is a lot of myth and conventional wisdom that is garbage floating around the prepper world, beware). Armageddon Medicine - Survival Medicine | How to be your own doctor when there's no other choice Doom and Bloom (TM) | Survival Medicine and Preparedness by Dr. Bones and Nurse Amy SurvivalBlog.com | The Daily Web Log for Prepared Individuals Living in Uncertain Times. - this has a vast collection of articles written by readers. Many are very good. Sadly, the publisher has a 1500 word minimum for all submissions so there is often a lot of noise to filter through as people tender Seinfeldian pontifications to meet the 1500 word requirement. Many of the submissions are not from credentialed experts but lay people with lots of personal experience or strong opinion. Some of the content is still very good and some is crap. Caveat emptor. « What to do when help is NOT on the way I’m less impressed with this one but there is still some good stuff from a physician.There are many other websites promulgating medical advice but I’d start with the first three and exhaust their information before expending time elsewhere. Supplies - Antibiotics Prescriptions Ideally, you’d have your family doc issue a number or prescriptions for the medications you might need in the future and has your doc’s help preparing. However, with all the government scrutiny they get and other concerns, you might not have much success here. Read Koelker’s article on Survialblog.com about trying to get your physician’s help. You might also save this option for something like lidocaine or epinephrine (Epi-pen) which may be harder to obtain through non-prescription means. Online prescriptions If help from your doctor doesn’t work or it doesn’t secure enough antibiotics for you, there is a website at http://antibioticsforsurvival.com that will perform a “telemedicine” assessment of your needs and provide prescriptions and sell you an antibiotic package. The price used to be $250 for a 5 drug package providing 2-5 courses of treatment of each medication. The price is now up to like $279. Note that the medications sold on this site will be “human” consumable and will be dispensed with a prescription. If you wanted to give a portion of your stores to a friend or relative it would technically be illegal. Fish antibiotics You can do better than the above for the same quantities with fish antibiotics. Plus you can order a lower quantity of the fish drugs and cut your costs to 1/3 to 1/2. Yep, you can buy the same meds for fish/aquarium use that are sold for humans. Note that you can buy, sell or give these away with no legal issues as no prescription is required (might need to include original packaging to prove the drugs in your possession don’t need a prescription). Oddly, fish are a lot smaller than a person yet these meds do not come in fish size doses and remarkably fish seem to require the exact same dose sizes as humans. If you want to read more about using “fish antibiotics” read Alton’s book, see his website or ready what Koelker has written about them. Dose Sizes When buying fish antibiotics, you can purchase the “forte” versions which are the larger dose per tablet. These are roughly 50% more for the same number of tablets but provide double the amount of antibiotic and one can cut tablets in half (except for some time release drugs) to reduce doses for smaller/younger people. Also a bottle with 100 tablets may be only twice the price of a bottle with 30. So the best bargain is to get the larger bottle in the larger dose. However, there is value in having multiple smaller packages. I have found a source of imported antibiotics that seem legit that are almost all blister packed. You can distribute them in original packaging and when the seal is opened, your whole stash is not opened. You can also cache your meds in multiple locations and won’t have all your antibiotic eggs in one location. So that is something to consider. Fish Antibiotic Brands One brand that seems probable to supply the same stuff as human versions are those packaged and distributed by Thomas Labs out of Arizona. Alton compared human and fish antibiotics and saw they had the exact size, shape, colors and numbers and identifiers on the tablets. Some of the other brands may be cheaper but I have less confidence you’d get USP human versions packaged as fish drugs. I don’t know that Thomas Labs offers azithromycin so you may need to consider other options for that. They do package erythromycin which is extremely similar (Zythromax was derived from erythromycin). I think azithromycin is preferable as it comes in tablets instead of a powder and would be more robust to pack in a travel bag or store. Sources There are some survivalist websites selling fish antibiotics such as SurvivalCamping.com but I found the same Thomas products much cheaper on ebay. One seller in particular, Countryside Pet Supply, was about the best price on everything. The stuff I purchased from them arrived in 3 days. It seems they sell a lot and the expiration dates on mine were all at least a year or more out though I have seen a few sellers advertise expirations longer than that. Imports I found a website (who is also an ebay seller) out of Florida. It is http://aquabiotics.net and they have a couple dozen medications including a couple anti-fungal medications. His service is very prompt and seems to be a good seller. His medications are all imported from foreign manufacturers, mostly India and Taiwan. Their products are almost all blister packed, he discloses the country of origin and you can see close up photos on his website.In my order he included a list of specific manufacturers and country of origin for everything single thing they had available. I can’t verify the potency of the drugs but the packaging and labeling looks very real and legitimate. I looked up a couple of the manufacturers which turned out to be large international pharmaceutical manufacturers who did manufacture medications for human consumption. I noted with what I received and is shown in many of the photos on the website, the blister packs have a second label pasted over the labeling on the back of the pack indicating that this is for aquatic fish and not for human consumption. It certainly looks like legitimate medications used for human treatment that was re-labeled with a goofy stick-on to claim these are for fish and then imported to the US. He also has a sister website http://aquabiotics.us where he promotes the legitimacy of his imported products and raises some good questions about other products. Frankly, I am reasonably impressed enough with this supplier that I will likely order more from him. Which Ones to Buy? Cindy Koelker has a list of recommendations at Seven Antibiotics to Stockpile and Why, by Cynthia J. Koelker, MD - SurvivalBlog.com. She also discusses that if you could only have 5 or even just 3 which ones those would be. Joe Alton lists 9 in his book which about matches Koelker’s list. Judging from what Koelker writes and integrating it with Alton’s comments I think a fair priority would be as follows. 1. Cephalexin 2. Ciprofloxacin (Levoquin is similar and a bit stronger and lot more $) 3. Metronidazole 4. Sulfamethoxazole-trimethoprim (SMZ_TMP 5. Azithromycin (or erythromycin which is a powder) 6. Doxycycline (or tetracycline) 7. Amoxicillin (cheap might get the big size) 8. Clindamycin Dr. Forgey recommends four for remote travels (days or weeks to reach modern medicine). His choices are Levoquin, doxycycline, metronidazole and azithromycin. The moral of that story is he wasn’t thinking fish drugs or TEOTWAWKI and still his choices to carry a few antibiotics into the wilderness are essentially on the list (Levoquin is not exactly the same of Cipro but very similar). This consistency between several different doctors with different perspectives does generate confidence in the quality of the above list. There are more fish antibiotics available such as nitrofurazone, oxytetracycline, penicillin, augmentin and ampicillin but they don’t add much infection coverage beyond what can be treated with the above meds. Because the top several meds that Koelker recommends don’t match exactly the list from Forgey, it seems prudent to just get those on both of their lists which is 1-6 minus number 4. But SMZ-TMP is good for MRSA so it would probably be good to include that. Hence, I suggest get at least the first 6. Amoxicillin is cheap and good for lots of common things like strep-throat, so you may as well get it. What the heck, if you can swing it, just get all 8 of those listed above. Side Effects It is critical to understand the risks and side effects. Ideally, you do not take any of these unless a doctor has diagnosed the condition and prescribed the right medication and dosing. If you are going to be your own doctor because the societal situation makes it absolutely impossible to see a physician, PA or nurse practitioner, then you need to understand the risks and side effects for each and the contra-indications. For example clindamycin can cause mild diarrhea to fatal colitis. Ciprofloxacin can cause tendinitis or even tendon rupture, and increased risk in people over 60. Doxycycline can make one sensitive to the sun. Other drugs have bad effects for pregnant women or young children. You MUST have a good reference to be able to know and understand these things. There can be drug incompatibilities with other drugs or supplements. Mix metronidazole and alcohol and good chance you’ll be worshipping the porcelain throne. The Physician’s Desk Reference (PDR) or other resources can help here. Doses Of course you need books, the Physician’s Desk Reference (get an older copy for cheap as it will have all the above drugs) to know how much of what to take when. Here is a dosing guide to help your selection of how much to buy. http://armageddonmedicine.net/wp-content/uploads/2014/05/Antibiotic-Indications-and-Dose1.pdf. How much to order? Below is another chart of the typical dosing and common durations of treatment to generate a better guess as to quantities one may want to have on hand. Of course there are many deviations up and down depending upon the specific infection and history of what typically works for it. So, this is a very very rough estimation NOT for guiding treatment but only for estimating the quantities one may wish to order. Cost In the smaller sizes with the smaller quantity tablets you are looking at roughly a hundred bucks for 6-7 of these Personal Choice My personal option is I will stick to either the Thomas Labs or probably more likely now, the aquabiotics.net products as saving a few more dollars with some other suppliers doesn’t seem worth the risk of lower quality meds. Supplies – Other Meds and Options Anti-virals Antibiotics do not treat viral infections. They may treat a secondary bacterial infection but not a virus like cold, flu or Ebola. I am not currently aware of a good anti-viral medication being somehow available in the US (like fish antibiotics) without getting a prescription. I have read that large quantities of vitamin C, garlic and honey have anti-viral properties and presumably zinc. In terms of best preparing for Ebola probably good quantities of Tamiflu would be good to have on hand but that is a prescription drug. I have seen internet pharmacies offering it or the generic version but I am skeptical. Seems unlikely the real deal could get shipped into the States through legitimate channels without a prescription but maybe they do the telemedicine thing and give you one based on what you tell them on-line. I don’t know and haven’t investigated this much yet. Colloidal silver Silver has anti-microbial properties and is often coated on surfaces or integrated into ceramic water filters to kill microbes. One physician on line I have conversed a bit with claims that some of the antibiotic resistant bacterias can be treated effectively by combining colloidal silver with the usual antibiotics. I have not corroborated that. Frankly, I am skeptical of some of the miracle claims for colloidal silver but it probably can’t hurt if you don’t take too much (it can literally make you blue if the particle sizes are large and you consume a lot). One can make their own and it’s pretty easy (just read about it and haven’t tried it). You need pure (distilled) water, several nine volt batteries, some alligator clip wires and some 99.99% pure silver. There are kits one can buy that have very pure silver wire but there isn’t much surface area slowing the process. Many of the silver bars one can buy are adequately pure. It’s an electro-chemical reaction that causes a very small amount of silver to go into suspension in micro-particle sizes. There is actually a small instrument available for not a lot of bucks to measure dissolved solids in a liquid which can be helpful in getting the concentration correct. You need to read about using it for yourself. The FDA has banned sellers of colloidal silver from claiming any health benefit and it is sold as a supplement. Silver in a couple forms is making its way into bandages and ointments and indeed does seem to have some good antibacterial results including with MRSA infection when used directly on the infection within the bandages. Anti-Fungals One prescription that may be good for yeast and fungal infections including some forms of meningitis is fluconazole. (I included it in the table above.) It is available as a fish med but seems to only come from the Ukraine and Thailand. Another anti-fungal is ketoconazole. Koelker’s dosing chart indicates it can cause significant liver damage and Alton says that occurs in rare cases. Joe also indicates ketoconasole is not effective for fungal meningitis and I have found that fluconazole may be prescribed for that condition (yeah, like we’re really going to do a spinal or cerebral tap and confirm that!) Oh well, any way fluconazole if often used for vaginal yeast infections and this is something many women can diagnoses pretty readily. Pain Meds Pain can be a big deal and it can wear down not just the injured or ill but those caring for a loved one. You should plan on treating it. There are some OTC pain meds for which much has already been written. Go read the books or peruse the internet for plenty of stuff there. Many docs seem to write a script for hydrocodone at the drop of a hat (I have 6-7 bottles of that crap as it just doesn’t work for me, beats me why the drug addicts crave it). Certainly don’t go doc shopping for prescriptions but when your doctor asks if you are in pain for something, then “Yes, I am in a lot of pain” is the right answer and store-up that stuff. Medication Effectiveness Over Time Medication expirations So, you spend a hundred bucks or two and will it all be wasted when the medications “expire” in a year or two? There is some info on Koelker’s website and in Alton’s book and other locations referencing various studies examining the expiration dates and remaining efficacy of medications beyond those dates. As a general rule, the dates have little relevance to the degradation of the drug. The Army found many drugs and antibiotics were still quite potent 10 and 15 years well past their expirations. The drugs that degraded most were all those in liquid form. FEMA studied drugs in their stockpiles and found the pill and tablet drugs were all still good 2-10 years past their expirations. One study at UC San Francisco found 14 drugs in a pharmacy store room that were 28-40 years old. They analyzed the medications and found 12 of the 14 to still be at 90% or greater strength. The FDA has issued a authorization for Tamiflu to be used up to 5 years past its expiration date based upon research. Frankly, a drug that is 70-80% of its full strength is still far better than nothing (seems one could also up the dosage a bit to compensate) and data suggests drugs can be stored for years and years and still be adequately effective. Much has been written on tetracycline and related antibiotics such as doxycycline becoming toxic with age. Dr. Alton discusses this in his book (you need to buy it!) and indicates that this seems to be based upon just one disputed data point and a subsequent study with doxycycline noted no ill effects with the test subjects. Lots of prepper web sites will rail about not using old tetracycline but its easy to recommend NO, you have to actually know what you are talking about to recommend yes. Me personally? I just don’t think I’d worry about it but I’m am making no recommendation. Storage It seems that oxygen, heat and light are the most significant factors in degradation we have in our control (I haven’t figured out how to stop time yet). I have my stockpiles meds sealed inside additional bags stored in the dark in the bottom of my refrigerator. I wouldn’t hesitate using these in a SHTF situation 10 years from now. I don’t think you want to use the freezer as I did see something alone the line (don’t recall where) that some drugs can be compromised by freezing but I haven’t determined precisely which ones as yet. I have noted with the freeze dried food such as Mountain House that their pouches have a 5 year shelf life but if they came in a sealed plastic bucket and you don’t break the seal, MH says some can last up to 20 years. This suggests to me there is oxygen or moisture migration through the Mylar pouches that compromises the long term storage. (I have some first-hand engineering experience with moisture migration through cast aluminum) I think if you sealed the medications in their original packaging inside of a stout larger container that had been purged of oxygen (flood it with nitrogen or argon), added an O2 absorber and desiccant and kept this in the bottom of the refrigerator, this would be the ultimate storage solution and medications could last for decades. Other Medical Preparations Allergic reactions. Dr. Koelker has some good perspective on those and alternatives to epinephrine (Epi-pen) for allergic reactions. Ideally you do want to have a couple Epi-pens in your stash. It is critical for severe allergic reactions. and some Benadryl (diphenhydramine) in your stores. Benadryl is OTC and is fairly fast acting and is a go-to in the medical community for allergic reactions. It can also be used as a sleep aid (check the active ingredient in Sominex sometime) Fluids The problem with many infections and viruses are the fluid loss and inability to adequately maintain hydration. IV fluid replacement would be desirable as a more advanced prep. It requires special skill but you might still stock some fluids, IV tubing and needles as somebody may know how to use them. A person can also get some re-hydration rectally so being able to plumb their butt with sterile saline would be better than nothing if they are vomiting everything swallowed. Most IVs have expirations but what little info I could find suggests they may to be good well beyond the expiration date, especially the saline solutions. For oral hydration, stocking Gatoraide or G2 sports drink powder mixes would be very good as they replace lost electrolytes and improve the taste making it easier to drink larger quantities of fluids. Broken limbs Dr. Koelker advocates being capable to treating broken bones. Casting supplies are non-prescription and it is not hard to perform. You do need to read her or Alton’s book and watch appropriate training videos on when and when to NOT apply a cast and on how to cast correctly. Materials are available on Amazon and ebay but I also found a kit from a company called Orthotape (http://orthotape.com) which offers a fiberglass casting kit with the stockinette, padding and casting material in one box. About $50 for a full leg which isn’t bad considering the price to purchase the materials individually. You can save some going with plaster casting instead of fiberglass but the glass ones are lighter and more robust if they get wet (which you very much want to avoid). Without an x-ray (there are some cheap DIY x-ray tutorials on the web now) it is hard to confirm a fracture. The books offer some suggestions to confirm a fracture. Another I learned I think in EMT training was holding the handle of a vibrating tuning fork against a bone (through the skin). This can sometimes differentiate between a tendon or ligament injury and a fracture as the vibration will hurt with a fracture as it travels through the bone but won’t affect a soft tissue injury at all. Bandages and all that. There are ample lists of first aid supplies etc. that are recommended. Go search on those as my list probably won’t be much better. However, there are few a thoughts to consider When dealing with wounds (say a gun shot) dressings and bandages are used at like 3-4 times the rate most people expect. So if you think 3 trauma dressings are enough, you need to bang that up to like a dozen or more because if you use them, you’ll use a lot. I learned this from my days 30 years ago as an EMT. You’ll also need to plan not just for a few hours but for days or weeks. You need boo-boo kits to deal with scrapes and little cuts, but you need more significant supplies and bandages to deal with much more significant events, e.g. a major cut 3-4 inches long, a major burn where the a large patch of skin is peeling off or is burned away, stuff like that. Look at the stuff that is in a First Responder or EMT trauma kit and that is the kind of stuff you need and in a bit larger quantity. Pack that stuff inside vacuum sealed bags and most of it should keep darn near forever. I have some stull from 25 years ago that is vacuum sealed and if I opened them today they still have that medicinal smell like when new. This also keeps everything preserved should it get wet or something. Maybe I’ll think about this some more and maybe add some more to this. Equipment A basic list of various pieces of equipment are warranted to have in your stores. Some are for diagnosis and some for treatment. This is not a complete list but is a starter. o Stethoscope – purpose is obvious but it is critical for assessing lungs and bowels as much as heart. o Sphygmomanometer (a blood pressure cuff) o Thermometers – fever thermometer and also a hypothermia version) o Otoscope – checking the ears is important for infection, etc. Beware of getting a cheap one. I did that and it was crap. Ultimately got a nice Welsh-Allyn and it was well worth it. I suggest avoid rechargeable ones in favor of changeable batteries. Mine uses AAs which I have tried to standardize on for all kinds of things from LED flashlights to radios to headlamps. o Oxygen with regulator and masks. There are various injuries like lung injuries from a fire or pneumonia in which respiratory function is significantly compromised. O2 can make all the difference in the word. An oxygen concentrator may be a good deal if it can be powered in a grid down situation. Lots of those are available on ebay and often Goodwill or thrift stores. o Suction. This is not high priority but for face injuries and some illnesses being able to suction out a person’s throat can help breathing and improve their comfort a lot. Personal protection There are reasons beyond attempting to prevent infection of a wound you may be treating. Consider if a family member becomes ill, it is best to keep it from spreading and yet care still needs to be rendered for them. Worst case someone is potentially exposed to Ebola. They will need to be kept quarantined and every precaution must be exercised to avoid any others being infected. o Gloves –Nitrile are the standard since latex sometimes presents an allergy risk. These are handy for painting and other dirty jobs. o Goggles – must seal around the eyes as blood can squirt or splatter into the eyes behind just safety glasses and the eyes are about as direct of path for viral infection as the nose if not more so. A face shield to wear over that is good too, especially if you are removing the deceased who may have died from Ebola. o Mask – and N95 is the minimum and an N100 style mask would be good. Home Depot, Amazon, ebay good sources. o Coveralls – Tyvek coveralls with a hood are pretty good. They are like $6-7 a set on Amazon and ebay. You’ll need to tape the gloves to the sleeves to seal them. To remove them, you first need to spray down with some diluted bleach and then water to decontaminate before exiting. You’ll need to be wary to remove them carefully turning them inside out without touching the outside and then wash in diluted bleach if you don’t have the luxury to just burn them. o Rubber boots or shoe covers. Fluids drip onto shoes all the time, and then when you take them off or don them again you touch them. You want lots of disposable shoe covers if you are going to care for anyone infected.