Post SHTF: Making Medical Decisions by Judy, Part 1

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(From time to time we publish worthy guest articles by aspiring preparedness writers.  This is the first part of a lengthy but erudite submission by Judy, a member of a Wyoming A.N.T.S. colony, which can be accessed here:   A.N.T.S. was founded by our good friend Tim French, whose website ca be found at   You’ll find my comments interspersed in the article under “Dr. Bones says:”


One of the things you can absolutely count on: when the SHTF, it is going to be incredibly stressful for everyone involved. Stress takes its greatest physical and emotional toll on the most vulnerable of our households: the very old, the very young, the ill, the pregnant. You are either not going to have any access to medical care for various reasons: Facilities rendered inoperable by damage from natural disaster, loss of personnel due to pandemic, civil unrest, supply chain interruption. Just the act of getting to existing medical facilities may be too dangerous.  You will have the extremely difficult task of assessing the risk/benefit ratio of home care versus getting to a hospital, and you will have to consider the possible consequences of either decision.  This is NOT an easy choice to make.

Recognizing the factors that contribute to medical emergencies, and being proactive in preventing the emergency from occurring at all, may be the single most important preparation you can make.  You must:

1. Identify who is medically vulnerable.

  • Disaster may impact a number of variables:
  • Shelter (exposure to heat or cold)
  • Availability of medications or symptom remedies
  • Medical treatments and Medications
  • Special Diets
  • Procedures requiring medical supervision, such as dialysis
  • Availability of treatment supplies.
  • Transport issues causing problems for the medically vulnerable (decreased mobility due to disability, increased physical demands).

Some conditions that are not considered high risk, such as normal pregnancy, become high risk when medical backup is not available. Some persons will be especially vulnerable to the effects of heat, dehydration, minor illness, and questionable water purity. The elderly, small children,and pregnant women all stand a greater chance of complications than an ordinary healthy adult or older child.

2. Take preventative measures

A. Make sure everyone in the family is up to date on immunizations. If it has been more than 5 years since your last tetanus shot, get a booster. At least minor injuries are guaranteed to happen during an extended emergency, and tetanus is one of the deadly diseases that CAN be prevented. Seasonal flu and pneumonia vaccinations should not be neglected. An emergency can cause close crowding of refugees and less than optimum hygeine facilities. It would be a good idea to have the shingles vaccination. Someone who has in the past had chickenpox can experience a reactivation of the virus leading to an excruciating swathe of blisters. Shingles can be activated by stress and by decreased immune system function. An increase in cases of whooping cough has become a problem as adults become ill with it due to vaccination immunity decreasing over time, and passing the virus on to infants who have not had their first immunizations. Whooping cough might present as only a cold in a healthy adult, but can be fatal to infants. If vaccinations have not been given for whatever reason, please re-assess this decision because the risk/benefit ratio for vaccinations strongly skew to favor those who don’t become ill with preventable diseases when medical care may not be accessible.

(Dr. Bones says: two camps constantly wage war in the preparedness community, those that are pro-immunization and those that are (sometimes vehemently) anti-immunization.  The latter group is of the opinion that autism and other issues may be caused by side-effects from childhood immunizations.  Although I believe that many immunizations are helpful (for example, we have rarely seen a case of childhood Polio since the vaccine has been in use), but that others are next to useless; influenza vaccines, for example, are effective only if this year’s strain is very similar to last year’s, which is not always the case.  The allegations about autism, obesity, and other recent “epidemics” could also be explained by other factors, such as the high prevalence of high fructose corn syrup use among our children, as much as side effects from vaccines.)

B. Try to arrange for necessary medication prescription refills in at least 3 month supplies.

Most physicians will not authorize extra refills of narcotic pain relievers or frequently abused medications. Rigidly controlled medications are Schedule 2 and Schedule 3, including narcotics and stimulants.  It is very desirable to have a doctor who is familiar with your family member; you can discuss your concerns about why you want to get pre-supplied with medication. It is not necessary to tell him/her that you expect the end of the world as we know it. It is probably enough to say that your insurance situation is getting pretty shaky and you want to make sure your loved one does not run out of medications before you can get a new job/insurance. In today’s health crisis, doctors are very familiar with that worry. If you don’t already have a trusted family doctor, now is the time to start developing that relationship.

It is not advisable to go to several doctors in the hopes of being able to get prescriptions in order to stockpile any controlled medications. You could become labeled as a “drug seeker” at best, or investigated for illegally obtaining controlled substances. Do discuss with your trusted family doctor what to do if you are not able to get medically prescribed pain meds that your family member takes regularly. It is important to know how to safely wean down from the accustomed medication. That is not an ideal situation, but it is better than having full-blown cold-turkey withdrawal.

(Dr. Bones says:  Although I agree that it is unadvisable to go to several doctors, it is important to note that you are free to obtain second opinions even within most HMO plans.  Don’t feel as if you have no choice with regards to healthcare providers.)

C. Keep the patient under the best possible medical control of their condition.

Diabetics should be at optimum blood sugar control through diet and medication. Ask your pharmacist about the storage of medications (ex: does this type of insulin need refrigeration? How long can an opened vial be used? How much does the medication deteriorate after the expiration date?) A diabetic patient with unstable blood glucose is going to be especially vulnerable to heat, cold, irregular meal times, change in diet, illness and wound infections. A person with asthma should have optimum symptom control, and should have an emergency supply of maintenance medications as well as “rescue” medications . They will have to cope with changes in environment (heat, cold, more exposure to environmental triggers due to open windows instead of air conditioning, more physical demands due to travel). These guidelines apply to many other medical conditions. Planning in advance can help ensure that everyone comes through a hazardous time in good health.

D. Take in to account necessary medical devices or medical treatments.

Someone who uses oxygen either constantly or intermittently will need to make arrangements so as not to run out. Oxygen requires a prescription, and isusually delivered by a medical supply company. Again, discuss with your doctor the feasibility of developing an emergency cache. Storage and use of oxygen will have ramifications regarding shelter and heating/cooking. Oxygen in the presence of open flame has the potential to cause a small “mishap” to become catastrophic, endangering all others in the living area. Make sure everyone understands the safety measures for oxygen use.

If someone depends on electricity for the function of medical equipment, such as CPAP machines, having an emergency electrical generator and fuel to run it will be an additional necessity. If a person is dependent on dialysis for kidney failure, ask the doctor for instructions if they are not able to receive dialysis.

(Dr. Bones says:  Don’t forget solar panels as a source of power; consider dedicating a solar setup for essential medical equipment that requires power.)

Contact your local emergency planners to find out where shelters for persons with severe medical conditions might be located. In a prolonged emergency, this shelter will be able to provide more access to life saving treatment than can be provided in an ordinary home sheltering situation. In my experience, the medical shelter allows one caregiver to accompany the patient, and the patient’s supplies and medications should be brought with him/her. The caregiver is expected to provide the patient’s usual care, and the shelter personnel will assist if a medical emergency occurs. The purpose of bugging out (or in) is to provide each person with the safest conditions and an environment that supports their health and well-being. For  medically at risk individuals, this may mean that a shelter is their safest bug-out destination.

E. Get preventive diagnostics; they can save your life.

Make sure you get the preventive tests that are recommended for your age or gender group. Do the colon cancer screening tests. Have the EKG. Get the colonoscopy, if you are considered at risk due to age or family history of rectal cancer, or have intestinal disease, such as Chron’s or Inflammatory Bowel Disease, or diverticulosis. Get the mammogram done. Have the pap smear. Two hundred years ago, surgeons were having pretty good results with wounds to arms and legs, (amputations usually, but the patient usually survived). Until the past 100 years, anything that went wrong in the abdomen was beyond medical science. There was no anesthesia, there were no antibiotics, there were no blood banks handily available. There are more than 16 organs located in the abdomen (I got tired of counting; and that is not including things like ureters and urethra and fallopian tubes). Abdominal emergencies (acute abdomens, as the doctors generically call them) will be the emergency you will be least prepared to treat.

(Dr. Bones says:   Civil war statistics I reviewed showed a 72% and 68% death rate from chest and abdominal wounds, respectively, and this is without considering the permanent disability rate among the survivors.)

F. If you have a problem that needs surgery eventually, sooner is better than later.

If you have gall stones, kidney stones, anything that may suddenly become life threatening, this might be the time to have it fixed. I’ve had surgery four times for intestinal obstruction. If surgical care had not been available, any of those episodes would have killed me, and it would have been an agonizing death. My grandmother died that way. It was many years ago, and she lived in an extremely rural area; she was too far gone with infection to be saved. It is not possible to foresee what conditions we might face. Things that are survivable in a modern hospital may be fatal in an isolated bunker.

(Dr. Bones says:  This is especially true for orthopedic problems like that bum knee, dental issues, and medical illnesses.  Even the surgical correction of poor eyesight with Lasik procedures, now very safe, could greatly increase your chances of survival in tough times)


In the near future, we’ll post the second part of this guest article.  Thanks to Judy for her time and effort in putting forth information for our community.

Dr. Bones



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