Emergency Medical Care Post-SHTF: Part 1 – Overview

natural_disaster-300x224One subject that is seldom discussed when talking about preparing for a calamity is what to expect and how to handle emergency medical situations during a time when dialing 911 is not an option. As we saw with Hurricane Katrina’s aftermath, there may come a time when the phones are out and you can’t call an ambulance for help. This article is part 1 of a 3 part series on the subject of emergency medical care after the SHTF.  Part 1 will cover medical emergencies where I will go over some basic steps on how to deal with likely medical issues as well as some idea as to what you may expect to see in both short term and long term situations.  This article aims to help you begin to develop your medical reaction plan to deal with problems before they arise.

Allow me to briefly give you a little background on myself and my personal experiences. I am a certified EMT from the State of Louisiana. I have been a volunteer firefighter and medical first responder for a couple of years. Through my industrial work, I have been trained as a HAZMAT Technician, a confined space and high angle rope rescue technician, swift water rescue, rescue boat operator, and trained as an incident commander. Emergency response is a passion of mine and I train rigorously.

Medical Emergencies


Medical emergencies can arise from any number of circumstances from long term health problems such as heart disease or diabetes, respiratory system compromise, traumas, and so on. I’m going to break down the medical portion into a scenario based discussion for reasons that I’ll explain in each section.

Short Term Scenario (3-5 days duration)

katrina20In this scenario, all public services to an area or region will be disrupted for a short period of time. The phone lines are most likely down and there is no easy way to call for help.

With power being out, persons with chronic issues that require refrigerated medicines, such as refrigerated insulin, may be in some trouble. Similarly, people who rely on portable oxygen machines will also begin to suffer both due to the lack of oxygen and extreme temperatures from lack of air conditioning or heating. Having a generator to power this equipment will only last so long as you have a supply of fuel to keep it running. Patients with heart problems or other chronic illnesses will also need a large enough supply of medications to outlast the event. If the scenario is severe enough you may have someone go into cardiac arrest or other medical emergency by the stress of the event even if they have enough medication. If that happens, reaction time is critical to saving a life. If the person stops breathing and/or their heart stops beating you will have to start CPR if you have any hope of saving their life. If a family member has a history of allergic reactions, especially to insect stings, it is critical to have a couple of Epi pens handy.

Climate can also prove one of the biggest factors for medical emergencies in a short term disaster.  Those who have lived through a hurricane can attest to the oppressive humidity and heat coupled with the lack of air conditioning and the need to do physical labor to clean up the area. It is crucial that you pay attention to yourself and those around you because heat injuries can kill quickly. Water breaks need to be frequent.  If at any time you or your family members stop sweating, immediately stop all work, move them to a shaded cool area, and make them drink large amounts of water. It does not take much to move from heat exhaustion to heat stroke, where the body begins overheating and shutting down. Heat stroke can be fatal and hard to reverse due to the patient usually losing consciousness and not being able to drink water to replenish fluids.

Another issue that you will likely run into is that of long term care of trauma (we will discuss this further in Part 2).  You will need to control bleeding quickly and effectively. The process to do that is direct pressure, elevation and a tourniquet. If you have a Quik-Clot type agent you can put that in there ahead of tourniquet. With any blood loss, you have to watch closely for signs of shock which include increased heart rate, decreased blood pressure, cold or clammy skin, feeling tired, etc. and treat by elevating the feet and covering them with a blanket.

Long term care for wounded and medical patients is going to be difficult at best. They won’t be able to move without assistance, will require constant care, and you will have to watch for signs of sepsis, fever, etc. Your main goal is to try to preserve life as best you can. Unfortunately, you will have to triage your patients and that is going to include rationing medicines and supplies.

Intermediate Scenario (5 – 30 days duration)

SHTF 1For an intermediate emergency or natural disaster such as a Yellowstone eruption, New Madrid Fault breaking loose, etc, there may be response in localized areas as well as outside agencies entering a region to restore services. However due to logistics, panic from those affected, and general bureaucratic ineptitude, the ability to provide meaningful help will be limited at best.

In addition to the considerations mentioned in the short term scenario above, which would naturally be exacerbated by the longer period without electricity and life sustaining equipment and medications, there are a few other items that should be considered. With a decline of basic services, food availability will be limited at best. It is at some point that malnutrition comes into play and you will begin to see nutrition disorders such as scurvy as well as poisoning from eating poor quality foods. Having a supply of food for you and your group is obviously the best plan of action, as is a garden to supplement your stockpile. It is also at this point that you may start seeing diseases pop up resulting from poor sanitation and dead bodies that are not properly cared for. It is for this reason that a bit of isolation, both physically and geographically, will be a blessing. Washing of your hands, bathing, and clothes washing regularly will be vital to staying healthy. Finally, it’s likely that even though deaths will result from such a calamity, life will go on. Women will not suddenly become un-pregnant because society collapses, and so there will be births to contend with.

Long Term Scenario (30+ days duration)

10506These are the TEOTWAWKI scenarios. Life is completely turned upside down with no foreseeable end in sight. These are the economic collapse, EMP, or whatever scenario. You and your family are on your own and the cavalry ain’t coming.

Unfortunately, long term survivability of persons with chronic ailments that require medicines or equipment to sustain life will be poor. As such, disease control will be all the more important starting with dealing with the dead. Even though it is unpleasant and strenuous work, the bodies of those who pass away must be buried as soon as practical. When a person dies, the bodies immediately start to decompose and release fluids. In areas where wood is plentiful, cremation may be an easier alternative than digging. Prompt, but respectful burial is going to be crucial to preventing the spread of disease. This is also the point that dental issues may present themselves. Proper sanitation, including proper dental hygiene, will be vital.

Lastly, in such a scenario, extreme care must be taken with your medicines and supplies. Rationing of medicines will be necessary. You will need to consider what your options are of resupplying your group with medical supplies and medicines. As an example of a rather unorthodox resupply option (that I do NOT recommend for anything other than the most dire situation) is the use of veterinary medicines for human use. A common livestock medicine that’s available over the counter at many farm supply stores is Liquamycin which is, you guessed it, livestock only penicillin. It is up to you as to where you can find supplies to get you through the tough times. Here is a good guide for Veterinary Drugs for Human Consumption, Post-SHTF.

As you can see, medical emergencies will require some foresight to properly deal with.  If you, your family, and your team are ill or weakened from disease, your effectiveness and chances for survival WILL be negatively affected.

In the next part of this series, I will go into a deeper dive regarding trauma emergencies, covering some basic treatments and likely scenarios.


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