It might sound trite, but if you aren’t breathing you aren’t going to
be surviving. So the first rule of three is to keep on breathing.

In the short term, this means medical preparations. Longer term, it
means personal hygiene and preventatives. For instance, there are
multiple studies that correlate mouth health to overall health. So
while a toothbrush might not be something you would consider to be
“medical preparations,” it should be.

Duration of the Event

Medical events take place in different time frames and with different
response times based on the situation and location.

There’s a joke that, “When seconds count, the police are only minutes
away.” The same is true of medical situations. When seconds count, EMS
is only minutes away. Or worse, hours away. The larger an emergency,
the farther away your EMS team will be.

You need to plan your medical process based on:

• How fast you need to respond
• How long until till EMS arrives to take over
• How long until the victim is at the proper medical facility
• How long until resupply
• At what point do you substitute low skilled personnel for trained
  personnel.

Let’s use a simple event taking place today, in a suburban
environment, as an example. We have a puncture wound that is bleeding
profusely.

You have to get the bleeding under control to keep the victim from
bleeding out. You need to contact EMS to get professional response
started. You have to keep the victim alive until EMS arrives to take
over.

Your skill set and gear should be designed to deal with the first 4
minutes of the event. You then have to keep them alive for the next
40 minutes while EMS arrives and is able to take over. There is no
real need for anything over 40 minutes. 4/4/40 is covered

Let’s look at the same event in a rural environment, or a back country
hiking trip/camp out.

You still have your 4 minutes to get the bleeding under control. But
now you have to keep them alive for a much longer time while you wait
for EMS to get to you. You are well over the 40 minute mark.

Emergencies aren’t always about wounds and immanent death. Here’s a
different scenario. You’re like many people, on a half dozen different
medications for a variety of minor to intermediate medical conditions.
You’re driving home from Washington, DC, when the snow hits and you
find yourself stuck on the interstate for 48 to 72 hours.

Some medications aren’t really going to matter if you miss a day or
two. Others require you to take them religiously, every 6 to 8
hours. Missing a dose can cause (or allow) “bad things” to happen.

People on a 6 to 8 hour dosing schedule will normally carry a dose,
sometimes two. But for that 48 to 72 hours, you really really need to
have your daily medications available to you.

A small wound received today is unlikely to become a serious health
issue. On the other hand, my surgeon friend talks about all the cases
for which he has had to put a person under in order to perform
extensive surgery to deal with a wound that has gone septic.

Most infections today can be treated with medication and simple
cleaning. If it gets bad, medication and medical intervention may be
needed to drain the wound.

But if you are unable to get those medications, how bad is a small
wound? That small wound can go septic with potentially months
before medical services can arrive, what are your options and can you
do what is required?

Hard decisions are sometimes required.

The standard zombie story always has the scene where the love interest
or the character you have come to care for is bitten. They are going
to turn. And everything goes to pieces when that character isn’t put
down in time.

It is hard making that decision. Sometimes you have to do the hard
thing. Mentally, you need to be prepared to do whatever it takes, and
that means thinking things through long before they become a problem.

Fortunately, we aren’t at an apocalyptic moment, and I pray we don’t
get to that point.

Levels of medical needs

A medical issue can be judged by its level. The different levels
determine the level of medical care required. This determination is
called triage, and it’s important. Medical care is both
skill and facility related.

1. BooBoo: These are the nicks and cuts of everyday life. Example: a
   papercut or sliver.
2. Ooops: These are the nicks and cuts and burns of everyday life that
   require a little bit more. Example: a burn from leaning against the
   wood stove that requires home treatment.
3. Ouch: These are issues that require attention and might need to be
   addressed by a medical professional. Example: A cut that is deep
   and bleeding but can be treated at home. Almost but not quite
   needing stitches.
4. Oh Shit: These are issues that are potentially life
   threatening. Example: breaking a leg.
5. Damn: These are the issues where the person will die if you don’t
   do the right thing right away. And then they must be treated by a
   medical professional. Example: a gunshot wound.
6. 911: Your job at this level is to try and keep the person alive
   until the EMTs arrive. After that, you just hope they get to the
   professional in time, and that the professional can fix the
   problem. Example: a heart attack.

First Step

Go get training. If nothing else, get some simple First Aid training.

Types of courses:

• Basic First Aid
• Stop the Bleed
• CPR
• Advanced First Aid
• Back Country First Aid

No matter how much you read, no matter how many gadgets and gizmos you
have in your kit, none of it is going to help if you don’t have the
skills (training) to use it. Reading instructions off the package is
not the same as having skills. Please get some training.

In the same light, when you buy your gear, buy extras so you can
practice. Sometimes you can buy the practice version other times
you’ll just have to buy the real thing and know you are going to
consume it.

Note: I have written three versions of this article. The thing
that kept coming back to me was: I’m not qualified to teach first
aid or any medical “stuff”.

Please get your training. The rest of this article will talk about
how to prepare to keep someone breathing. The implementation of the tools
and techniques are skills you need to learn from appropriate subject
matter experts.

Gear Classifications

Our gear is organized from EDC to household. At the EDC level,
everything fits in gear that is carried all the time. This can
include ankle kits, belt kits, pocket kits, or even purse kits.

The next level above that are Individual First Aid Kits (IFAKs).
These extend or replace the EDC gear. These are bags that can be
carried on Load Bearing Vests/Gear, belts or packs. These kits contain
more gear than the EDC because they are larger.

Next are vehicle bags. These can be slightly larger than IFAKs. They
ride in cars or packs or briefcases. For me, I have one mounted to my
range bag.

Still larger are the medical kits. These are full size bags that
contain medical gear. Where my EDC has a single dose of Ibuprofen,
the house medical kit has a full size bottle.

Finally there are the medical systems. For us, this would be a full
medical suite. It’s not that we know how to use all of this stuff,
but we know doctors that would be able to use it.

Events

One of the things that we do is we have booboo kits and blowout kits
in the same location. The booboo kits have the red cross symbol on
them in order to let people know they are medical gear. Many of them
are red. If I send a kid to the truck and tell them to bring me the
first aid kit attached to the back of the drivers seat, they will
bring me the red bag with the red cross on it.

Right next to that bag is the blow out kit. It has a C.A.T. on the
outside, it is unmarked and is desert tan. If I tell somebody that
KNOWS they will bring me that bag. If I need it, it is available.

Small Events

BooBoos

This is general first aid stuff. Clean and cover. Follow your
training.

Burns

Follow your training.

Blisters

If you have to walk any distance, you know a blister can bring
movement to a halt. Make sure you have good socks (merino wool is the
best available) in your kit so you don’t get blisters to begin with.
Make sure your shoes fit and you have broken them in.

Have moleskin in your kit to help care for those blisters if you get
them. Follow your first aid training.

For us, we attempt to keep pressure off the blister and protect it
from rubbing. This can be accomplished by creating a donut of mole
skin around the blister and then covering it to protect it.

The best way to treat blisters is to not get them. Use gloves and
wear socks. The other day my daughter was complaining about a blister
she had on her foot, she hadn’t bothered to put on socks for a “short”
hike.

Again, use your gloves. Yes, you are big manly men (or strong as steel
women), you can swing an axe or pick for hours. But if your hands
aren’t already callused from doing that type of work, you are highly
likely to get a blister. Wearing gloves can keep that from happening.

Sprains and breaks

If you think it is broken, immobilize it. If it is sprained, support
it. There are all sorts of braces out there. Have some in your kit
just in case. Have some elastic bandages as well.

For immobilization, look into getting yourself a set of SAM splints.
These are thin pieces of aluminum that are foam covered. They fold or
roll up. Pretty cool.

When needed you unfold them or unroll them. Then you make a C channel
or an omega(Ω) shape long ways. This makes the splint ridged.
Use it as your splint, wrap with a tape. Using tape that sticks to
itself is a good way of doing it.

One of the nice things about SAM splints is that they are transparent
to X-Rays. This means that when a person gets to hospital facilities
they can take the X-Rays before removing your splint. This can
greatly reduce the pain felt by the injured person.

Issues needing medication

In your larger bags, make sure you have OTC medications. This
includes:

• Acetaminophen
• Ibuprofen
• Aspirin
• Glucose
• Loperamide HCI (anti-diarrheal)
• Diphenhydramine (antihistamine)
• Calcium Carbonate (antacid)

The gist is to be able to stop pain, stop the runs, stop the runny
nose.

In your IFAK and EDC you should have at least one dose but not much
more than two.

In the larger bags/kits, have a few more. We use individually
packaged doses. They are a little more expensive but they travel
well.

As soon as you have the room, get yourself the full size or extra
large bottles of these meds. Most of them are shelf stable for
years. And when you get towards the end of their shelf life, just
rotate them out.

Large Events

These are life threatening events. Without quick response people will
die. This is where your blow out kit and stop the bleed kits come into
play.

There are major styles of tourniquets, there is the windlass style
(aka Combat Application Tourniquet or CAT) and the elastic compression
style. There are also pneumatic style tourniquets.

With the windlass style, you get the tourniquet in place, you snug it
as tight. Then you start twisting the windlass until the bleeding
stops. The advantage is that these can be applied to yourself or one
handed. They are the oldest form of tourniquet in the world, and they
work.

The downside to CAT is that they do take training and it is difficult
to know how much is enough and how much is to little. Too much
and you can damage nerves and blood vessels. Too little, and your
victim can bleed out. Training, training, training is the answer.

The other style is the elastic compression.

Anybody that has ever used rubber bands to crush a watermelon knows
that it is possible for weak compression to add up to crushing force.

The SWAT-T is an elastic wrap. It has symbols printed on it. When
the wrap is stretched enough, those symbols look like circles with
squares in them. Not enough, they look like ovals and diamonds. To
much, ovals and diamonds.

It is very easy to look and see if you have stretched it enough. When
enough wraps are in place, it will compress the limb enough to stop
the bleed.

These are commonly used in places where untrained or minimally trained
personal will use them, schools for example. This ease of use is their
biggest positive.

The downside is that it can be difficult to self apply. It can be
nearly impossible with only one hand.

The other piece of equipment you should strongly consider is the
Israeli combat bandage. First aid will teach that stopping bleeding
is done by pressure. The Israeli combat bandage/dressing combines a
plastic anchor point with wrapping instructions and methods to allow
you to apply pressure exactly where it is needed.

In addition, it can be used as a tourniquet. All round a great tool.

You should also have something like QuikClot or Celox impregnated
gauze in your blowout kit. This can be stuffed into a wound to put
pressure where bleeding is taking place and to get clotting to start.

Broken Bones

Your first aid training will teach how to deal with broken bones.
Follow that training. Remember that a broken bone can turning into a
bleed out issue if the wrong things are done. Get training.

All the other big events

You really need to get training so you know what to do. Look at
everything from simple first aid to advance life saving courses and
take them. If you are concerned about long term care, when EMS is
some distance away, take a back country first aid course.

Most first aid courses today consist of “stop the bleeding while
somebody else calls 911, wait for EMS to arrive” Back country first
aid teaches what to do when EMS is hours away or even days.

Working up your kit

When in doubt, start small, with an Individual First Aid Kit (IFAK). This
should fall into two categories, “booboo” and “stop the bleed”. Stop
the bleed is what is needed to keep YOU from bleeding out before
medical care can arrive and take care of you.

A personal example, a friend of the family was chopping wood at a camp
out. She missed her swing and used the axe to remove a largish chunk
of her calf. Mom, a nurse, got the bleeding to mostly stop and they
transported the young lady to the hospital. A bunch of stitches later
and she was released. Today she has a scar and a story. If mom
hadn’t been there and known how to stop the bleed, she would likely
have ended up in the ground.

Stop the bleed/blowout kits are designed to deal with the situation
where there is uncontrolled bleeding and people will die unless the
blood flow is stopped. You can have a blow out from a knife/edged
weapon, from a gunshot, from a traumatic amputation. All of these
require you to stop the bleeding.

Basic Stop The Bleed Kit

• Tourniquet. SWAT-T for the untrained, and C.A.T. for the trained.
• Compression Bandage for wrapping and providing pressure to the
  wound
• Compressed Gauze
• Hemorrhage control gauze, QuikClot or Celox
• Nitrile gloves

Notice that there are no band-aids in there. If you need a band-aid,
then you are at the booboo level, not stop the bleed.

You can upgrade this with an Israeli bandage. This is a bandage that
allows compression directly on the wound to stop the bleeding and is
fairly easy to apply.

All of this should fit in a package small enough for you to carry with
you all the time.

If you add to this, you should add some trauma shears, a mini sharpie
marker. Anytime you put a tourniquet on someone, you should
immediately write the time and date on it, the person, or both. This
will aid more experienced medical personnel later. Sharpies provide
good marking on skin, fabric, and everything else.

Once you have your kit, PRACTICE! A C.A.T. tourniquet is amazing, but
until you’ve practiced with it you really don’t know how to deploy
it, or how to get it on. There are two methods, generally. One is to
preform the loop and then move the loop up and over the limb, the
other is to form the loop when needed.

Once you’ve learned how to apply it to your victim, learn how to apply it to
yourself. Now apply it with your primary arm disabled.

Add On

The next step up from a stop the bleed kit is to add:

• Chest Seal
• Israeli Bandage
• EMT Shears
• Wound packing gauze
• SAM Splint with tape
• Triangular Bandages
• Epi Pen

We are still working on keeping the blood inside with these
additions. We’ve added the ability to help deal with a sucking chest
wound, broken limbs, and major allergic reaction (aka anaphalactic shock).

Minor Medical

Add some medications,

• Ibuprofen (pain/fever control)
• Acetaminophen (pain/fever control)
• Aspirin (pain control, helps with heart attacks)
• Diphen (Antihistamine)
• Tums (Antacid)
• Diamode (anti-diarrheal)

Add to that:

• Cotton Swaps
• Conforming Gauze
• Gauze sponges
• 1×3 band-aids
• 2-4 oval band-aids
• knuckle band-aids
• non-stick 2×3 and 3×4 pads
• steri-strips
• wound prep

My go-to web site for medical gear is https://rescue-essentials.com
. Most of the lists I’ve taken from their site because it was easier
than looking through my own bags.

Kit Growth

The IFAK is designed to be used on you. What this means is that
when bad things happen, you use your kit on yourself. If you need to
be treated, your buddy will use your kit to care for you. It is in
your best interest to keep your kit up to date and ready to use.

Your IFAK only has enough gear in it to treat you one time. You need
to expand that to the next larger size. Instead of something you
carry on your belt, it is something that is in a shoulder bag, or a
vehicle bag.

If you carry it in your vehicle, remember that everything ages faster
in the oven-like temperatures of your car.

My IFAK only has a couple of doses of most of those medications, but
my car bag/EDC bag has enough that I don’t mind handing some to a
friend.

Your house bag likely has a few hundred band-aids in it. Buying by
the 100 from Amazon is cheap enough. Add some of the larger SAM
splints, add the small SAM splints.

Add flash lights, a head lamp, all the rest of the gear.

Long Term Medical

So we’ve talked about short term medical care. For longer term you
need to think slightly differently.

One of the most amazing medicines is aspirin. Get yourself two huge
bottles and store them in the cool and dark. Same with Acetaminophen
and ibuprofen, Diamonde and Diphen.

If you take prescription medications, talk to your doctor about how to
get a one month supply. If your doctor isn’t willing to help, you’ll
have to do it. Most prescriptions are done in a 30 day supply. But
in order to keep you from running out, you can get a refill before you
are totally out.

Get that refill as soon as you can. Take the extras and put them
aside for your emergency stash.

Your go kit has a 7 day pill box with all my prescription medications
already loaded. If you have to go just grab the bag and go.

Long term, you need to consider just how long you need. Is it 30
days? 60? 3 months? a year? You might have trouble getting that
much.

But remember, in the US, there are three controls on how much of a
medication you can get:

1. Government controls. This applies mostly to pain medications and
   addictive or precursors medications.
2. Insurance controls. Most insurance companies will only pay for
   ongoing medications. They don’t want you to buy a year at a time.
3. Doctor controls. Your doctor will only write you out a
   prescription for a certain amount per time period.

Talk to your doctor. Tell him you need a backup supply. You can be
as honest with them as you think you need to be. You’re going out of
country on a six month round the world trip (my grand parents did that
a few times). So you need a six month supply. Tell him you want a 90
day back up because you are afraid of SHTF situations.

You should be able to get the prescription you need.

Now go to your local pharmacist and explain that you are paying cash.
That the insurance company doesn’t control this. And if you still
have issues, explain about your around the world trip.

Bad News

Some of us are going to die from lack of medication. If you are a
diabetic taking insulin, you have a limited shelf life on that
insulin. And that shelf life goes down very quickly if it is not
stored correctly.

Do you have high blood pressure, controlled by medication? You’ve got until
your medications run out and by then you better hope you are healthy
enough because you are now playing the “how long till my heart attack”
game.

Personal Hygiene

The best way to handle medical emergencies is to not have them. If
you do have a medical emergency, try and keep it small.

One of the best ways to keep minor injuries small is proper hygiene.

More people died in war from infections and illness than died in battle.

Soap and Water

Wash your hands, then wash them again. Make sure you have bar soap
with you. Enough for a few months. Soap is one of those magical
lifesaving inventions of the modern world.

When you wash your hands, you keep the amount of bad stuff entering
your body down. When you clean yourself, you make sure that all those
scratches and small nicks you got don’t become infected.

And don’t forget to wash your cooking and eating gear as well. Keep
those little bugs at bay. Wash your clothing. It keeps the bugs down
and it helps preserve the cloth. And you don’t end up with your
clothing driving little bits of dirt into your skin.

Don’t forget to wash your mouth too. Toothpaste, toothbrush. Backup
toothbrush. Keeping your mouth healthy means you are less likely to
have your teeth rot in your mouth. A rotting tooth is generating
poisons near your brain. Lots of bad things can come from it.

In addition, if your mouth hurts, you don’t eat as well. Learn to
care for your teeth.

A friend started preparing for the long term. He realized that he
didn’t have good teeth. He realized that he was getting dental work
done two or three times per year. Cavities filled. A tooth pulled.
All of it required work. He suffered with a broken tooth for a couple
of weeks before it could be “repaired”.

In the end he decided to have the rest of his own teeth removed and
dentures made. Then he paid for a backup set of dentures.

I consider that a little extreme. But it was what he felt was
required.

Really long term

There are a number of natural remedies that actually work well. The
dosing is very different. It is worth while reading up on some of
them and learning how to use them. Maybe planting some of them in
your garden “for the beautiful flowers” of course.

Remember there are fluffy bunny types telling you that this natural
thing or that natural thing will do something medical. Many of those
things are either dangerous or useless. Read and learn.

One of those natural, fluffy bunny, purely useless, things was honey.
Until the medical profession did actual double blind studies and
found it works.

Learn how to make soap. Learn how to care for your teeth once your
toothpaste is gone. These are skills that will keep you in good stead.

First: The Rule of Threes
Previous: How Long Will This Go On
Next: Shelter in Place – Part A