Sat. July 20, 2019 – nice day, but kinda hot

85F and 81%RH at 830. National forecast calls for rain in the area, but the local forecast is overcast and clouds, high of 98F. THAT should be stifling.

Speaking of stifling, you guys should be well aware of my ongoing issues with heat, and the current heat wave sweeping across the country. Heat injuries are no joke and take a long time to recover completely.

Do Not push it in the heat. All joking about the media overreaction to ‘summer’ aside. People will die this weekend. There are resources for you to use. OSHA has a heat danger app which will help you determine rest periods and dangerous conditions. Know the signs of heat injury-

https://www.osha.gov/SLTC/heatstress/heat_illnesses.html

Heat stroke is a life threatening emergency that needs immediate treatment. Look at that chart, review the symptoms and the first aid. Heat stroke victims may appear drunk, shuffling feet and confused. Hot dry skin is an indicator- they need to be cooled and treated immediately. I can tell you from personal experience, knowing the signs can save lives. There are at least two people alive today because of the heat illness awareness briefing I gave before an event in Dane County WI.

Speaking of Dane County, WI, they made front page of the DailyMail…. this was the view out my wife’s hotel window in Madison WI. https://i.dailymail.co.uk/1s/2019/07/20/03/16272534-7266921-image-a-43_1563589860533.jpg

Take advantage of Mr. Carrier’s invention and stay inside and cool. Go to a movie, a store, or the hardware store and hang out in their AC. Just be aware, hot grumpy people are easily angered. If the advice “don’t be there” can’t work, keep your head up, and your eyes moving. While you’re looking for threats, look for people in distress too. It feels really good to save a life.

nick

Fri. Feb. 16, 2018 -Pandemic flu preparedness

NB- after seeing how big this comment was, and recalling RBT’s instructions to me, I am promoting this comment to a Post.

On an entirely separate subject, pandemic preparedness….

https://asprtracie.s3.amazonaws.com/documents/aspr-tracie-hcc-pandemic-checklist-508.pdf

I’m looking thru the CDC’s Flu Pandemic readiness checklist for health care providers and I see a whole bunch of stuff that’s worth thinking about.  So I’m highlighting some here:

3.11 Pre-identify strategies and resources to ensure behavioral health support for staff to mitigate adverse stress and grief and loss reactions.

[translation- EMS is gonna have family and friends that die from the pandemic- try to keep them working]

3.12 Determine virtual coordination mechanisms that will enable remote engagement of senior staff to prevent exposures and maximize ability to engage in both daily and incident operations”

[translation- senior staff need to be kept out of the treatment areas to keep them alive while everyone else risks dying.]

“3.21 Develop criteria for on-scene denial of transport by EMS personnel for influenza-like illness and other patients – with or without on-line medical control – ideally regional rather than agency-based criteria and process.

[trans- figure out at what point do you stop bringing flu cases into the hospital and effectively quarantine them at home, and when you let EMS make that decision on their own.]

3.22 Develop/provide patient information sheets on homecare for influenza-like illness
including usual clinical symptoms and course, infection prevention, treatment, and when to seek additional medical care.

[trans- people are on their own at some point, figure out what point, and give them some info about what to do]

3.23 Develop/provide patient information sheets for other conditions that may be left without transport if the service volume suggests a relevant need (e.g., minor injuries).

[trans- again, you’re gonna be on your own, with minimal guidance]

3.24 Determine alternate transport resources and triggers to utilize them, e.g., private
ambulance, wheelchair, contract/courier, for hire vehicles, military assets, buses

[trans- martial law at some point, and how many NG or regular Army units will want to deploy into a Flu zone? How many will be ABLE?]

Here’s a nice one:

4.5 Determine actions that the state emergency management or public health agency is likely to take that affect health care including:

• Suspension or modification of requirements for hospitals or clinics

[when will you be able to use tents, parking lots, warehouses]

• Specific emergency orders or actions that may limit liability or expand scope of
operations (for facilities and providers, including volunteers)

• Requests for 1135 waivers from the Centers for Medicare & Medicaid Services (CMS)

• Crisis standards of care activation

[when will you drop normal operations and just do whatever you can without liability- ie at what point does S really HTF?]

• Issuance of clinical guidelines for care and resource allocation

[when do you start rationing and triage?]

‘Taking powers’ of the state relative to medical materials and staff (i.e., does the state have ability to commandeer resources under their emergency powers and does this include medical materials?)

[trans- when will they come for YOUR stuff, and do you need to give it to them. side question- where would ‘the state’ be TAKING the siezed materials????]

• Promulgation or enforcement of legal obligations of medical staff to provide care

[trans- when will they come for YOU, and what if anything can you do about it?? this is where preppers worry about ‘being on a list’ of EMS or First Aid trained, or CERT, etc, can they force you to provide medical aid? what if you are licensed?]

And these are grim:

4.38 Develop a plan for implementing a supplemental facility security/controlled access plan (which may be phased) particularly during the peak pandemic weeks to assure controlled campus ingress and egress and monitoring.

4.39 Provide patients and staff with information about stress responses, resilience, and available professional mental health resources. Develop staff monitoring for those exposed to high levels of cumulative stress or specific severe stressors (death of coworker, etc.).

4.40 Consider ways to maintain staff resilience and morale when congregate gatherings and close physical contact are discouraged. This may need to include memorial services for staff members.

4.41 Determine if the fatality management plan is sufficient for an increased volume of decedents at the facility

 

 

There’s lots more and it’s worth looking at. After all, this is what CDC thinks your local health care providers need to consider and plan for WRT flu pandemic.

-EMS not transporting sick people
-facilities and services shut down or reaching capacity and rationing of other treatment
-local authorities SEIZING medical supplies
-local authorities FORCING med staff to work
-deaths among EMS, facility staff, and care providers
-physically securing the treatment areas
-giving priority to staff family and pets
-using the military to provide transportation, reserve medical services, and security
-too many dead people to deal with normally

nick

(the link came to me in the weekly newsletter I get for EM and first responders)

Thursday, 29 June 2017

08:55 – It was 60.7F (16C) when I took Colin out at 0615, partly cloudy and calm. Barbara is out filling bottles for science kits, which she’ll be doing most of the day. She’s headed down to East Bend, outside Winston, around 1700 to have dinner with her friend Marcy. She should be back mid-evening.

As it turned out, it wasn’t the water heater. It was one of the copper feed lines coming out the top of it. Two guys from Shaw showed up yesterday around 1100 and replaced both the old copper lines with PEX. It took them less than half an hour. They were both surprised that we had a 110V well pump. Neither of them had ever seen one before.

A few minutes after they left, Jay Shaw stopped back with a sheath of paint swatches to show me. He matched the existing paint pretty closely with an off-white color called “cotton ball”. I told him that, fortunately, Barbara didn’t really care about the exact color as long as it was an off-white and a reasonably close match for what was on the walls now.

I ordered 250 grams of reagent-grade (AR) iodine crystals off eBay yesterday. Thirty bucks, including shipping from China. If it weren’t for federal regulations, I could have just ordered it from Fisher Scientific or another US supplier. But that involves an incredible amount of paperwork, so much so that many US vendors no longer sell elemental iodine, and if they do the cost is outrageous.

Understand, I’m not breaking any laws by ordering iodine on eBay. It’s perfectly legal for me to buy it, import it, or possess it in any quantity. It’s just illegal for US resellers to sell elemental iodine to US customers without going through all the regulatory bullshit. I can even sell iodine solutions, as long as I don’t sell more than 30 mL at a time and it’s less than 2.2% iodine w/v. That’s fortunate, because every kit we sell includes a 30 mL bottle of Lugol’s iodine solution, which is 1.27% w/v iodine in a 2% solution of potassium iodide.

For that matter, it’s trivially easy to isolate elemental iodine from potassium iodide, which is completely uncontrolled. I could order a hundred kilos of KI, and no one would blink an eye. And all it takes to convert that potassium iodide to iodine is some hardware store muriatic acid (hydrochloric acid) and a jug of supermarket chlorine bleach. I did that as a demo at MakerFaire in 2008 to demonstrate how futile federal regulations are.

Lisa emailed me an update of their progress. They’re well past her initial goal of food/water/shelter for three months, but are still accumulating LTS food and other supplies. They’re now studying for their Technician Class ham radio licenses in preparation for taking the test in August.

They’ve also stocked up on OTC medications, bandages, etc., but Lisa came across one of my posts about SHTF antibiotics and wants to get some. She said that the source I recommended, aquabiotics.net, appears to be out of business. Their web page is still up, but it’s nothing but a placeholder.

They’re actually still in business, but not on the Internet. PayPal and other credit-card processors have banned them solely because they’re selling antibiotics. The owner, Dave Folsom, is now processing orders solely by email. Email him at dcfolsom@reagan.com and ask for his current price list. Decide what you want, total up the price, and send him a check. I know that’ll probably make a lot of people nervous, but I’ve bought from him twice that way, and each time he’s shipped exactly what I ordered via USPS Priority Mail the day he got the check.

I suggested to Lisa that for the six of them (assuming no drug allergies) she order at least a few courses each of 100 mg doxycycline, 800/160 mg SMZ/TMP, 875/125 mg amoxicillin/clavulanate, and 400 mg metronidazole. And, in case nothing else works, at least a course or two of 500 mg levofloxacin. Stick them in the freezer, and don’t even think of touching them unless the S has really, really HTF and you’re convinced the patient is going to die if you don’t take desperate measures.

More email from Jen. They routinely run readiness exercises every time there’s a three-day holiday weekend. This one is four days, which is better still. They’re starting as of 1800 tomorrow and running their exercise through next Wednesday morning. David is on call for a couple of those days, so he has to keep his cell phone on, but otherwise they’ll be completely off-grid for the duration. No grid power or other utilities, no TV other than DVDs and other local stuff, no Internet (although they do cheat and check email and news sites in case there’s a real emergency), etc. These exercises became routine for all of them a long time back. As Jen says, it’s essentially just a family camping trip at home.

Brittany and her family are also doing a readiness exercise over the holiday weekend. These aren’t as routine for them, yet, because they haven’t been doing them as long or as often as Jen and her family have, but they did get most of the bugs worked out some time ago.


11:15 – I forgot to mention one new thing Jen and her family will be trying out. In past readiness exercises, their main problem was keeping a 24×7 watch, particularly when it was just the six of them participating. So they decided to install an HD NV surveillance system. The system they bought has eight Ethernet PoE 1080P surveillance cameras with IR illuminators, and is rated for 100-foot detection at 0 lux (with the IR working). Those cameras feed into a 16-port DVR that has all kinds of bells and whistles.

Jen’s husband, brother, and nephews spent some time last weekend getting cameras mounted and everything installed. The cameras and DVR have standard Ethernet RJ-45 jacks. They mounted the cameras under the eaves at each corner of the house facing out at 45-degree angles and at the center of each wall, facing out at 90 degrees, and ran pre-made Ethernet cables to each camera. Jen didn’t want a bundle of Ethernet cables coming down into the house proper, so they declared the main floor utility room to be their comm center and ran all the cables back there.

They were a bit concerned that the rated 100-foot IR detection range was insufficient, so they also bought one PoE IR illuminator, installed it under the eaves near one of the cameras, and ran an Ethernet cable back to the comm center. They’re going to try that one camera with and without the supplementary IR illuminator and see how much difference it makes. If it greatly increases the range, they’ll install seven more IR illumintors, one per camera.

They’ll power the illuminators with an old 8-port Ethernet hub, of which they have several. They also bought a low-end BPS that should run the cameras, DVR, and illuminator for a long time on battery. The comm center is near their solar power charge controller and battery bank, so in a grid-down situation they’d be able to power their surveillance gear indefinitely.

I’m looking forward to hearing how that all works. They spent a fair amount on all the gear, but getting a smaller system costs only a few hundred dollars and would be a useful security supplement.

Monday, 24 October 2016

09:54 – Barbara is off to the gym. This afternoon, she’s volunteering at the Friends of the Library bookstore, and tomorrow evening she’s volunteering at the annual library Quiz Bowl. Yesterday, her new friend JoAnne from the historical society stopped by with her husband, Jeff, and their son, Colin, who’s 15. They have roots in Sparta and have owned a vacation home here for 15 years, but they’re just now in the process of moving here from New Jersey to live full-time. Jeff is 55 and just retired as manager of a waste water treatment plant after a 33-year career in water treatment.

After numerous email questions to me and Jen’s husband, David (a veterinarian), Brittany has decided what antibiotics to order for her, her husband, and their two young children. I suggested and David concurred (in his role as a layman) that Brittany and her husband should read the detailed data sheets for each antibiotic on drugs.com before deciding. Brittany also asked my advice on where to order, expecting that I’d know who offered the best prices and quality. I suggested aquabiotics.net as an inexpensive source of good-quality antibiotics.

After careful consideration, mainly because of the side effects in children, Brittany decided to order two 50-packs of these ($30 total), which is five courses of doxycycline. She also decided to order two 50-packs of these ($30 total), which is five to seven courses of SMZ/TMP, five 50-packs of these ($67.50 total) or a total of 100 grams, which is 2.5 courses at 4,000 mg/day for ten days, or ten courses at 2,000 mg/day for five days of metronidazole, and one 24-pack of these ($32 total), which they’ll use in combination with ordinary 500-mg amoxicillin capsules they already had to provide three courses of amoxicillin/clavulanate. They decided to pass on the ciprofloxacin entirely, and instead buy two 30-packs of these ($42 total), which is four to six courses of levofloxacin. Levofloxacin is a more expensive later-generation fluoroquinolone, similar to ciprofloxacin but with fewer resistance issues.

The idea of self-prescribing antibiotics scares the hell out of Brittany, which is good. It scares the hell out of me, too, even more so because I know a fair amount about them and their side effects. But Brittany intends to store these medications in the freezer against a truly catastrophic emergency, using them only as an absolute last resort. She looks at this purchase as a one-time outlay of $200+ on insurance.

Brittany’s first job in high school was working at a local pharmacy. As she said, most people who walk into a pharmacy and see hundreds or thousands of large bottles of drugs on the shelves behind the counter probably just assume that means the pharmacy keeps enough drugs on hand to fill prescriptions for weeks or months on end. She knows the truth is different. Most pharmacies get daily or more frequent deliveries of drugs, and what they have on hand of any particular drug at any given time may be a one-week supply, or less. If the transportation chain breaks down for any reason, a community may have at best a week’s or ten days’ supply of most critical drugs. That’s counting everything: pharmacies, hospitals, emergency-care clinics, doctors’ offices, veterinarians’ offices, everything. As Brittany said, a doctor without access to drugs is severely hampered in what he can do. But if the patient can provide his own drugs based on the doctor’s recommendation, there’s a much better chance of a good outcome.


Sunday, 23 October 2016

10:00 – Email from Brittany yesterday, CC’d to Jen. Like many preppers, with only a couple of weeks until the election, Brittany is trying to make sure she has all her ducks lined up.

She’s been reading about fish antibiotics, and wanted to know which specifically I’d recommend she buy RFN. With the usual disclaimer that I am neither a physician nor a pharmacist and so as an unqualified person all I can do is tell her what I would store in her place, I mentioned the following, assuming that neither she nor her family has any allergies to any of these antibiotics:

1. Doxycycline — probably the most flexible of readily-available broad-spectrum antibiotics. The usual adult course of treatment is one 100-mg tablet/capsule every 12 hours for a week to ten days, which means that a bottle of 60 tablets is 30 days’ worth, or three to four full courses. (For a dozen people, I’d keep 12 to 25 courses on hand.)

2. SMZ/TMP — another readily-available broad-spectrum antibiotic. The usual adult course of treatment is one 400/80-mg tablet every 12 hours for a week to ten days, which means that a bottle of 60 800/160-mg tablets is 60 days’ worth, or six to eight full courses. (For a dozen people, I’d keep 12 to 25 courses on hand.)

3. Metronidazole — another readily-available broad-spectrum antibiotic, which is also active against anaerobic bacteria and many protozoal pathogens. Although it varies with the disease being treated, the usual adult course of treatment is 2,000 to 4,000 mg total per day (at 7.5 mg/kg) divided into three or four doses for five to ten days, which means that a bottle of 60 500-mg tablets (30 grams total) is one to two full courses of treatment for a 150-pound adult. (For a dozen people, I’d keep 12 to 25 courses on hand.)

4. Ciprofloxacin — another readily-available broad-spectrum antibiotic. The usual adult course of treatment is one 500-mg tablet/capsule every 12 hours for seven to fourteen days, which means that a bottle of 60 500-mg tablets is two to four full courses. (For a dozen people, I’d keep 6 to 12 courses on hand.)

Although it’s harder to come by than the antibiotics listed above, I’d also want to keep a few courses of 875/125-mg amoxicillin/clavulanate on hand. Resistance to plain amoxicillin is now so widespread that many physicians treat it almost as a placebo, so don’t bother stocking it or other beta-lactam antibiotics.


Saturday, 13 August 2016 Home made first aid kits

Based on comments from a previous post, here is some discussion of basic first aid kits.

FWIW, I like to build my basic kits and my much more capable ‘car kits’ around a makeup organizer or a toiletries organizer. I find them often in thrift stores and yard sales for only a buck or two.

https://www.amazon.com/BAGSMART-Toiletry-Cosmetic-Organizer-Breathable/dp/B01BWJDLIU/ref=sr_1_9?ie=UTF8&qid=1471111289&sr=8-9&keywords=hanging+toiletry+organizer

https://www.amazon.com/Toiletry-E-BLOOMY-Organizer-Capacity-Mysterious/dp/B0157PJZV2/ref=sr_1_10?ie=UTF8&qid=1471111289&sr=8-10&keywords=hanging+toiletry+organizer

New comments, or additions are in [square brackets]

nick

Dave says:
22 August 2015 at 15:18 (Edit)

Here are the contents of my under $10 first aid kit:

30 clear adhesive bandages
0.33 oz triple antibiotic ointment
50 extra strength acetaminophen tablets
50 alcohol prep pads
5 2×2 gauze pads
5 3×3 gauze pads
5 yards of 1/2″ adhesive tape

Everything listed above fits in a one quart zip top bag.

[I think you are a bit heavy on bandaids, and could use more styles. I like the fabric ones as they stick well. Consider having a couple of sizes of traditional shapes, plus finger tip and knuckle, and at least one big one for a skinned knee.]

nick says:
22 August 2015 at 20:15 (Edit)

Hey Dave, some things to think about adding,

tube of crazy glue (to glue skin, stings like fire but works)
wet naps (get some at chick fil a)
packets of sunscreen (like a condiment pack at fast food, might be in the sample size section of your store)
sunblock chapstick
fewer tablets,
gloves- vinyl if you are worried about latex allergies.
moleskin
scissors
flashlight
knife

[trauma shears are great, but a good sharp ‘kitchen’ style scissor works well. Any scissor is better than none, as long as it is sharp. For a knife, even a ‘wallpaper’ style disposable box cutter works- the kind with snap off blades. It’s cheap, sharp, and small.]

OR just buy one of these kits. I have several versions and like the quality and what’s included.

http://www.adventuremedicalkits.com/medical-kits/adventure-first-aid-0-5.html

http://www.adventuremedicalkits.com/medical-kits/adventure-first-aid-1-0.html

http://www.adventuremedicalkits.com/medical-kits/adventure-first-aid-2-0.html

The 1.0 kit is a good balance of price and performance.

In general, you are right that you can put together a better kit for the money, but the Adventure Medical kits do a good job of proving that wrong (or LESS right.)

nick

BTW- great job taking that step! Keep adding to your preps!

[I still like the AdvMed kit as a starting point.]

Dave says:
23 August 2015 at 14:06 (Edit)

@nick

The first aid kit is intended to go in a vehicle emergency kit, which will be a little stripped down to start with. I’m betting that I’ll be there with a knife and a flash light that I’ll remember to grab the flash light out of the car. The other suggestions look like things I will want to add when I expand the kit.

The things I think are missing:

1. Oral rehydration salts.
2. A splint and a more effective pain reliever than acetaminophen.
3. A weeks supply of my prescription meds.
4. Some loratadine tablets.

The last item is for my wife, and the other things are things I actually could have used at one point or another. On our last vacation, my wife and I both could have used the oral rehydration salts. Would have made the vacation a little less memorable.

[the anti-diarrhea meds are a staple of my kit, and in my briefcase, and my boo boo kit. I don’t think you need anything stronger than Tylenol but you might want to consider fewer Tylenol tabs, and adding a few anti-inflammatory tabs, like Motrin, and a few anti-histamines, like Benadryl. I carry electrolyte salt tablets, for dehydration and hangover relief. Splints are likely overkill, and are pretty easy to improvise. ]

[I also think, due to the changing nature of the threat, that you need to consider gunshot or other trauma, even in a basic kit.   I’d add 2 rolls of Kerlix and a couple of 4×4 gauze pads.

A penlight, a Sharpie marker, and a large safety pin would be good adds too.  An instant cold pack is nice if you have the space.

You can still fit this into a pretty compact package, and it adds a great deal of capability.]

[Medical prep in general is a big topic and deserves more in depth coverage, but I’m gonna limit this post to the basic first aid kit.]

nick

 

 

ADDED_____________ 2pm

 

Finally found a couple of the others, so I’ll make this even more of a mega post!

 

  • nicksays:

    Ok, I’ll bite, since I’m in serious work avoidance mode.

    And I’ve got my ‘blowout kit’ right here in my range bag.

    Small samsonite toiletries bag, about 2.5x4x7 inches, that unzips in a clamshell and lays flat.

    Loose in the middle,
    israeli bandage
    trauma shears
    medical tape
    maglite (if you use led, it must have good color rendering)
    3 pr gloves

    in the loops on one side
    4x sterile pad, 3×3 folded in half
    1x roll kerlix
    1x roll gauze
    4x sterile pad, 3×3 folded in half
    extra shears

    in the zippered mesh pouch on the other side
    8x assorted size and shape fabric bandaids
    4x alcohol prep pads
    2x single use Povidone-iodine ointment
    4x kleenhanz antimicrobial moist towelettes
    1x envelope of wound closure strips (steri-strips) 8 @3 inches
    2x maxi-pads, full size, generic, no fragrance
    1x package, 2 @4×4 topper dressing sponges
    1x 4×4 Exuderm OdorShield (what I had handy as a chest seal)
    1x black sharpie marker
    1x sheet of paper, folded for notes

    So there is some stuff in there that is not strictly gun shot treatment, but then I don’t have to carry another ‘boo boo’ kit (although I carry my altoids tin one whenever I’m with the kids.)

    The bags in my vehicles are scaled up versions of the blowout kit, and include gorilla tape, more of everything, ice packs, etc. I’d have to get one out to go thru and list it all.

    nick

    [OFD asked if that all fit in the Samsonite toiletries bag]

    yep all that fits in the little Samsonite bag. The bag goes into my range bag most of the time. Since I don’t travel with the range bag, the blowout kit goes into my carryon. I checked the TSA rules, and trauma shears meet the rules for allowed scissors, and they didn’t steal them on my last trip.

  • nick says:

    Ok, ‘boo boo kit’ in an altoids tin, goes in pocket whenever I go anywhere with the kids.

    Loose, or in top half

    6x assorted shapes and sizes fabric bandaids, incl one big enough for a scraped knee
    3x sheets of rite-n-rain notepad paper.
    3x imodium anti-diarrhea med

    tucked firmly and completely into the bottom half
    6x alcohol wipes
    1x single use triple antibiotic cream
    1x small tube crazy glue
    4x fabric knuckle bandaids
    1x One third of a paper book of matches
    1x wooden golf pencil
    1x prethreaded sewing needle, 18 inch black thread, wrapped around pencil
    1x lens cleaner wipe
    2x stick of caffinated chewing gum (BlackBlack, from asia)
    1x safety pin

    It is a little puffy, and won’t quite stay closed by itself, so I have a rubber bracelet around the outside (like the ‘live strong’ bracelets)

    I also wrote “med only” on it to remind myself not to put anything with a blade in it so I can take it on the plane.

    If I had a small tweezer, I’d include that too. and since I carry a credit card sized magnifier in my wallet, I don’t need one in my kit.

 

 

 

I like toiletries organizers or cosmetics organizers for medical bags. They fold open flat, sometimes with a pouch that folds out again for a tri fold, they have zippered mesh pouches and elastic loops. They are super cheap at yard sales and thrift stores, and some of them are better quality than the chinese import tactical bags. No external molle, but that’s not a problem. I like them about 8 x 9 x 3 inches for truck bags. Big enough to hold a lot of supplies, small enough to fit under a seat. I wouldn’t recommend the classic ‘dopp’ bag, or any other that just zips open on the top (shaving bag). You want it to fold open and lay flat so you can see everything.

 

[nick]