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.