As I lounge about my home this week recovering from a laparoscopic hand-assisted radical nephrectomy,  a procedure involving a fair bit of medical technology, I am struck by how few people appreciate the rapidity and degree to which their health care availability and delivery would decline in a grid-down post-SHTF scenario. This week, doctor as patient ponders that he would be screwed, tumor still in place, as such operations would not only be unavailable,  they would be impossible,  with no such resources likely at the ready,  and not survivable for lack of support if they were.

Simple things often taken for granted, like tetanus shots, will be scarce.  That rusty nail you stepped on during a recon patrol may kill you, as Clostridium tetani does not sleep, like the Pseudomonas aeruginosa in your shoe. Got ciprofloxacin?  Little infections become big problems when you have nothing to treat them with.

A former patient of mine was taking out her trash at dusk in an urban neighborhood of a midsized southern city. Confronted by two men, she gave them the car keys they demanded, yet they still shot her in the abdomen. Less than a mile from a level I trauma center. Despite rapid transport, modern technology, and state of the art care, she died. How do you think you will fare if you are gut-shot at night on patrol, in twenty degree weather, miles from even a basic aid station? You climb a tree to establish your position or establish a more favorable comm link; it’s raining. You slip and fall, and now your thigh has a forty five degree angle. Femur fractures can easily lose two to four units of blood in short order. Got packed cells? Morphine?

In William Forschten’s post-EMP novel One Second After, the protagonist’s overriding concern is scavenging for and maintenance of a supply of insulin for his diabetic daughter, who eventually dies from diabetic coma that he is powerless to prevent. Americans are the most heavily medicated society in history; while diseases related to obesity would likely fade as food supplies dwindle, the prospect of dealing with the hordes of dependent people suddenly cut off from their psychotropic medications, and there are millions of them,  seems unpleasant indeed. Chronic maintenance medications,  from insulin requiring refrigeration to anticonvulsants to bronchodilators for lung disease to antiplatelet agents for coronary stents, will dwindle in supply until they are unavailable. Those people will simply die if there is no natural, available alternative. My wife awaits a kidney transplant…Got sterile dialysis supplies? Got cyclosporine? Many of you had the flu this year. Imagine the misery without the supportive medications you took.

Modern American medicine has enabled many of us with chronic problems to live productive, functional lives, extended our lifespans and kept the Reaper at bay. The margin,  though, is razor – thin.  Existing inventories are scant with just-in-time delivery systems which, analogous to food and produce delivery, are easily disrupted with no alternative.  The purpose of this blog, as it develops,  is to promote an appreciation of the problems faced in the grid-down world, and provide a forum for discussion of how to handle them.


9 thoughts on “”

  1. Jeremiah Johnson, tough as he was, died of “jaundice”. Today’s ERCP w lap choley would have treated the obstructing gall stone that killed him.


  2. That is a very good true article… Like people have said to me before the Place to go is the Pharmacy when the SHTF. But other people will have that idea as well. Maybe not as fast as some of us but I can speak from experience from being in D’iberville, ms on 8/29/2005 when Katrina Hit it was a true SHTF event. I was down there working with a local ambulance company but after it hit for 2 days we were essentially on our own… Their were numerous people breaking into pharmacies not only for drugs they needed but for drugs they wanted for pleasure…Being a MD you are at a distinct advantage with being able to aquire and store meds.. esp. antibotics….. I think those will be golden.. Pain meds also… But you as a individual you run into a problem like I Do out here at work.. YOU are the HIGHEST level of care… what happens if you go down…. Who can take care of you? Anyway back to the Article.. within 6months just about everyone that is dependent on meds to live every day like insulin or dialysis, CHF Patients will be gone.. and in a most painful way at that.. I also agree a GSW to the chest in a SHTF situation you better get right with god quick because chances are your not gonna live to see the next day… most of this is the ramblings of a aggravated paramedic working offshore waiting on a helicopter “that was suppose to be here two hours ago” so I can go Home.


  3. I believe that in an extended SHTF event-along with scarce to non-existant medications and medical supplies,there will be far too few people who know enough about basic medical care to care for the sick,injured,and those wounded in gunfights defending their families,homes,and property.
    Those of us who know at least basic wilderness first aid may have a slightly better chance than those who know little about first aid and medical care.
    Dr’s will be in very short “supply” and there ain’t gonna be no med schools or residency programs up and running-other than learn as you go trial and error for those not fortunate enough to count a Dr among the members of their tribe.
    Learn as much as you can now-that’s the way I look at it.


  4. You don’t have to postulate a SHTF scenario. If Obamacare is fully implemented, it may well become “weaponized”, just as the IRS and EPA have. Tea Party affiliation, donations to the “wrong” political party, blogging or commenting in the wrong places could earn you a denial of care, or care provided so slowly that you end up dying, as do cancer patients in Canada and England.

    Also, since this administration holds great admiration for the way NIH is run in England, you may well end up being denied dialysis if you are over fifty – just as it is currently the case over there.

    Add to that an influx of millions more illegal aliens, stampeding across the border for “amnesty”, and there will not be enough physicians, nursing staff, technicians, or even beds available to care for everyone in need of same.

    Maybe the S has already HTF? Just not in the way we thought it might.


    1. I agree, that’s one scenario, kind of like a “slow burn” civil war. It’s always best to not be a patient, and to assume as much responsibility yourself for your own care


      1. As a former RN who has worked OR, ER, Psych/PTSD (VA) and as a pharmacy tech and EMT in my younger days, that would certainly be ideal, but difficult for folks with diabetes controlled with insulin, and others with disorders requiring medication. Especially since the “law” (regulations?) limit civilian access to medications. Some of it we might get around with pet antibiotics (Fish Mox, etc.), but insulin and other prescription meds are problematic.

        Good info, nonetheless. Good luck with your nephrectomy. My father had that surgery due a tumor also, but his was before much (any?) laparoscopic surgery was being done (’72). Hopefully your recovery will be much quicker and easier.


    2. Well, it was hand-assist laparoscopic, certainly not as painful as the old traditional way, but it still hurt, even with Exparel in the wound. All these modern improvements, that just simply won’t be available…..


      1. Yes, in that situation we’d be lucky to manage comfort care. I feel for you. I’m looking at the first of two PLIFs, spanning four failed discs, in another week. I’d hate to have to live with this pain for what’s left of my life, but it _is_ survivable, so I can’t whine and snivel about it.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s