It stands to reason that infection will be a big issue confronting the survival medic. Bad water, improperly cooked food, and injuries from activities of daily survival all may lead to microbes invading the body. These infections, left untreated, may cause deaths that would otherwise be preventable if there were access to antibiotics. Assuming you agree, the question would, then, be: How much of a supply is enough?

This question is vexing because it is extraordinarily difficult to answer. We could simply say 20, 50, 100, 1000 of a particular antibiotic, but one size doesn’t fit all. There are a number of factors that the medic for each family or survival group must take into account to make a reasonable determination:

What Happened?

In terms of the quantity of medicine you’ll need, the aftermath of a storm is very different from, say, an epidemic. This is not to say that a non-disease event can’t cause an epidemic. In Haiti, an earthquake did so much damage to the infrastructure that it caused a cholera outbreak.

How long will it take for modern medicine to make a comeback?

If the disaster in question is a hurricane that knocks out the power for a week, the likelihood is that you won’t require a huge supply of antibiotics. In fact, a number of infections, like the intestinal inflammation caused by giardia, may take longer than a week to show symptoms. If the disaster is an EMP from a nuclear detonation 200 miles over St. Louis, however, you may be off the grid for decades.

How many people are you responsible for?

Unless you’re a jack-of-all-trades, you’ll need people with other skills to increase your chances for survival. These people have the same possibility of getting an infection as those for whom you’ve planned, placing an additional burden on an already-limited supply of antibiotics

Who are you taking care of?

Although even the healthiest, most robust young adult can become ill with an infection, those with weakened or undeveloped immune systems are most at risk for a bad outcome. If your group is heavy with young children, elderly folks, or the chronically ill, you’ll be more likely to expend your antibiotics and should have more.

What’s the environment like?

Air. Water. Food. Poor quality or contamination of any of these can cause your risk of infection to rise significantly and, thus, your requirements for more antibiotics. The terrain may be problematic if steep and rugged, causing injuries that may become infected. Extremes of temperature can weaken individuals who aren’t appropriately clothed.

What medical supplies does the rest of your group have?

Are you the designated medic for an extended family, group, or community? If so, are you the only one charged with the responsibility to accumulate items for medical storage? A group that has multiple people working to obtain antibiotics and other medical supplies puts less burden on the medic.

How good is the medic?

A recent survey showed that a significant number of patients who came to their doctors with respiratory infections, including influenza, left the office with a prescription for antibiotics. Giving antibiotics for viral infections does absolutely nothing to cure them.

The medic must have the ability to recognize bacterial vs viral infections (described in “Alton’s Antibiotics and Infectious Disease: a Guide to Available Antibacterials in Austere Settings”); otherwise, important medications will be wasted on those that won’t benefit from them. You’ll need a lot of antibiotics if you use them like candy.

Another sign of a good medic is assuring proper sanitation and hygiene. If the medic allows the latrine to be built right next to the local water source, contamination and disease will follow. The medic who doesn’t supervise the purification of water and preparation of food is risking their family’s health. So will the medic who doesn’t insist on proper personal protection like work gloves and eyewear. This medic will have a lot more infections with which to deal.

So, what’s the number of antibiotics you’ll need? At least, a full course of therapy for each member of your group. In truth, however, there are never enough medical supplies. Accumulate more than you’d think necessary for the disaster about which you’re most concerned. Consider those extras as barter items, or better yet, as items you “donate” to save other members of your community. You’ll become known in the area as a healer who uses their medical skills and supplies to save lives. Over time, your good works will be recognized as so valuable that others expend their own resources to protect…you.

Joe Alton MD

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