5 More Underrated Pieces of (Mostly) Medical Knowledge

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Recently we published an article about 5 underrated pieces of simple medical knowledge. Here are 5 more in a similar theme.

Low-tech contraception is a must during a disaster.

Women in an austere environment die during their pregnancy, delivery and in the post-natal period much more frequently than they do in a modern western health system. Even in 2nd and 3rd world countries who have taken western techniques of hygiene and risk reduction in pregnancy to heart, they still have maternal death rates of 10 x what ours in the Western world are.

Retaining the ability to control fertility is vital for women to keep themselves safe and prolong their lives in primitive environments.

While in a long-term disaster babies are important, immediately after a major grid-down disaster, fertility control is going to be important. Not having babies for the first couple of years may be an important consideration. For some, this might be stocking up on condoms or oral contraception. For others, it may be perfecting (if you haven’t already) the timing of ovulation with body temperature and mucus changes.

A good meal and a comfortable bed can be great healers.

If someone is unwell and you are not sure exactly what is the problem or what do – prescribe a rest, a good meal and a comfortable bed. This is often a good place to start.

This approach was first described by an Arabic scholar and physician Avicenna over 1000 years ago. In a time when medicine often did as much damage as it did good, he recognized that time was a great healer but that it could be optimized and hurried along by paying attention to simple details: ensure the patient is rested, ensure they are comfortable and protected from the elements and ensure they eat a meal of food they are familiar with – these things together will help to heal the person. A thousand years later the same basic tenants apply – resting comfortably in a warm (or cool) room having had a good (appropriate) meal and having a good sleep can have a huge impact on the patients mental and physical health. You may be limited in what you can do medically, but these little humanitarian things can go a long way.

The placebo effect isn’t a bad thing.

If you take 100 people with a very painful injury and give them sugar pills and tell them that it is a strong pain killer – 15-25% will have a significant improvement in their pain. This is despite them not being given any actual drug. The mind is a powerful thing. This is not a bad or negative thing – it is positive for patient care. Part of the placebo effect is derived from the “theater of medicine” – the medics appearance and manner, the clinic setting (the smell of cleaning products), the tools – all play a part. I am not advocating deception, but it is important to understand the role the mind plays in medical care – even in acute illness or injuries.

Here’s the first thing to do during an emergency.

The first thing to do in an emergency is to stop and to think. Calm yourself down and identify what the priorities are. Things will go from bad to worse if you simply charge into a situation without taking the time to think – in medicine the only two absolute immediate action items are – the control of life-threatening hemorrhage and to deal with an obstructed airway or absent pulse. For everything else taking 20-30 seconds to calm yourself down and to come up with an initial action plan can be lifesaving. For the immediate action items – drill them so you can do them with your eyes closed, and while you are doing them by rote, you free up time to think about your next step.

The patient is the one with the disease.

This is more for your emotional well being than a specific piece of medical advice. Medicine can be stressful and the transference of anxiety and depression from patients or their families to their carers is a well-documented problem. This is often amplified when working in austere situations where you are more limited in what you can do both from a diagnostic and treatment point of view. You are constantly dealing with stressful and sometimes really depressing situations and it takes its toll on you. This simple piece of advice – “the patient is the one with the disease “– reminds you that it is the patient who has the problem – you are doing your best in the circumstances and if you start to take on the stress associated with having the illness or injury as well as from treating it, the combined weight can break you – it is tragically common – health care providers are over-represented in both depression and suicide. It gets worse the more illness and injury you are exposed to. You need to look after yourself, don’t use all your emotional energy looking after your patients and don’t take the weight of the world on your shoulders. Your mental health and looking after it is as important as the patient’s physical health and emotional needs.

(** the last two are adapted from the 10 rules of the House of God, from the book – “The House of God” by Samuel Shem.)

About the Author

BCE is a Critical Care doctor who has 25 years’ experience in pre-hospital, remote and austere medicine. He has been a prepper/survivalist for even longer and pessimistically thinks a grid-down long-term collapse is not far away. He is passionate about improving medical knowledge within the prepper community and he is currently working on a book about truly primitive medicine and improvisation. He lives somewhere south of the equator on a Doomstead in a (hopefully) quiet isolated part of the world.

He helped write and edit the book “Survival and Austere Medicine” which is available for free download at https://www.ausprep.org/manuals and from a number of other sites and for purchase (at cost) from Lulu at http://www.lulu.com/shop/search.ep?contributorId=1550817

Questions, comments, and criticisms are welcome – post here and he will respond.

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  • Three items to add to the list:

    1) One tip I learned from years as an EMT – and more importantly, as a grandpa – is that nothing works better for little kids than having some Winnie The Pooh Band-aids. It doesn’t matter what the problem is: a Winnie The Pooh Band-aid on the arm or leg does a lot to calm them down and stop the crying. It distracts them from the injury and they focus on the WTP character. My first aid kit has a zip lock bag labeled “WTP”, and it gets used as often as anything else in the kit.

    2) Is it fractured? While it’s a safe bet that few or none of us have access to X-ray equipment, a stethoscope and a tuning fork can be used to confirm a fracture. Do a search on YouTube for some good videos on how to do it. Tuning forks are available on Amazon.

    3) Under the “Really bad times” heading – It’s not just something from Medieval times: maggots are being used today in modern medicine settings because they can effectively do things that no other technique can. Maggots are used to debride wounds because they eat only dead flesh. Do a search for medical use of maggot. Yeah, kind of gross, but nasty wounds aren’t pretty either.

    • Leeches are another ancient and “icky” medical tool that are being used in contemporary medicine. They are used to encourage circulation in reattached extremities and to alleviate congestion in bruises in crushing injuries.
      Both maggots and leeches can also be utilized as fishing bait, maybe a good way to get rid of “used” ones?

  • Re: “The patient is the one with the disease.”

    ‘Respite for the caregiver’ is a term I thought often of when attending to my parents, especially when you watch them become “children” again. It helps to have other people who can rotate shifts with you. Good to know there are more organizations nowadays to help.

  • Please learn about disease vectors. Hand washing, masks and eye protection for the caregiver. Medical Isolation is not cruel but a wonderful way to prevent a visitor or even a welcome family member getting home during SHTF from giving all of you a nasty flu or worse.

    Being able to rehydrate the sick is important. Rectal Irrigation with a salt and sugar purified water is used in Search and Rescue teams as well as MASH units when an IV cannot be done.

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