The Grim Reality of Survival Medicine in Austere Conditions

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Several years ago, I wrote the following for a survival medicine book we had put together. I still think it provides a realistic view of the potential medical environment in a grid down or austere survival situation.

From a healthcare standpoint, a post-SHTF world looks quite grim.

“With no antibiotics, there would be no treatment for bacterial infections; pneumonia or a simple cut could kill again, contagious diseases (including those sexually transmitted) would make a comeback, and high mortality rates would be associated with any surgery. Poor hygiene and disrupted water supplies would lead to an increase in diseases such as typhoid and cholera.

Without vaccines, there would be a progressive return in infectious diseases such as polio, tetanus, whooping cough, diphtheria, mumps, etc. especially among children. People suffering from chronic illnesses such as asthma, diabetes, or epilepsy would be severely affected with many dying (especially insulin-dependent diabetics).

There would be no anesthetic agents resulting in a return to tortuous surgical procedures with the patient awake or if they were lucky, drunk or stoned. The same would apply to painkillers; a broken leg would be agony, and dying of cancer would be distressing for the patient and their family.

Without reliable oral contraceptives or condoms the pregnancy rate would rise and with it the maternal and neonatal death rates, women would die during pregnancy and delivery again, and premature babies would die. Women would still seek abortions, and without proper instruments or antibiotics death from septic abortion would be common again. In the absence of proper dental care, teeth would rot, and painful extractions would have to be performed. What limited medical supplies available would have to be recycled, resulting in increased risks of hepatitis and HIV infection.”

Prepare for the worst, hope for the best.

While this might be just one extreme end of the spectrum, finding yourself in this sort of scenario is not impossible or even unlikely. Like most preppers and survivalists my view of the world is that it is extremely fragile. My personal driver is that we are rapidly approaching ‘peak’ everything – energy, food, population and money and that combined with a natural catastrophe or a man-made one could be enough to throw us back several hundred years.

I’m preparing for a worst-case/grid down scenario but I also accept that something shorter and of less impact is much more likely – but if you are prepared for the worst, then anything else will be a pushover! As Jack Reacher says (paraphrasing someone famous) – prepare for the worst, hope for the best.

For those of you that have read Tess Pennington’s book The Prepper’s Blueprint, she describes a layered approach to preparedness (One = the everyday disasters – power cuts, storms; Two = bigger disasters with medium-term effects – economic collapse, pandemics; three = a complete collapse of civilization)

There are layers to preparing for healthcare needs during disasters.

Within healthcare, a similar layered approach applies to knowledge and medication and equipment required.

  1. “The Everyday Disaster” – solid knowledge of first aid, low-level emergency medical care on the background of a still functioning but possibly delayed or impaired 999/911/000 system. This could be an earthquake or a Cyclone or Hurricane. You may have to provide some degree of extended care, but ultimately the system still works and help will arrive. A good first aid kit, a first aid course, and some common sense will see you through for the majority of medical problems. Some may still die from lack of access to health care, but most will not.
  2. “The Big Disaster” – moving towards self-reliance for medical care, self-prescription/medication, management of simple common emergencies and the availability of equipment and medication is still to a high standard to those that are prepared. There may or may not be some form of medical infrastructure offering support and a level of surgery and specialist services. The ‘have nots’ will likely have minimal health care, but those who have prepared will still have access to basic medical care. Examples of this might be a global economic collapse or a major pandemic but the key point here is that with knowledge and preparation you can still manage the majority of common health problems to a moderately high standard and an end will usually be in-sight.
  3. “The End of the World as We Know It” – absolute self-reliance for all healthcare. Once it is used up it’s gone. No resupply. DIY medications and supplies, wider use of botanicals. What you know and can do is what you have got – basically the scenario I opened with above. With food storage, we talk about always having a plan to make your food supply becomes self-sufficient in the long-term – because you can only store so much. It is the same for self-sufficient medical care – what is left with once all the medical supplies are used up and when there are no medical or nursing schools left to train health workers? What you know and what you can improvise, grow or manufacture will dictate the level of care you can provide.

Sometimes, a pragmatic approach is necessary.

My background is as an acute critical care doctor who has worked and taught extensively around austere medicine and medicine in remote environments for nearly 30 years and I have been writing about survival medicine for 20 years now.

What I write is always just my own opinions and ideas and you are welcome to not agree with me or think I am completely mad. Some of the things I teach and write about aren’t best practice in the modern world of medicine – but they are safe and pragmatic approaches to often-complex problems.

Any comments and ideas are put forward purely for interest and education and I wouldn’t expect you to take anything I say as gospel and you must verify medical facts for yourself, but hopefully, some of what I post will be useful and point you in the right direction.

Hopefully, over the next few months, I will contribute to Daisy some articles which address different aspects of medical care within these different layers, but I also hope to explore some of the philosophical and ethical issues surrounding them, which are an important consideration to Post-SHTF healthcare.

About BCE

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 and from a number of other sites and for purchase from Lulu at

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

Guest Contributor

Guest Contributor

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  • So, I’m hearing nature will reassert it’s self and things will go back to normal.

    The way it was meant to be, once again the strong will survive.

    • Brotherhorse the strong are not match for disease my friend. This gentleman speaks well the truth. Medical advances did little to increase the lifespan of humanity. Effective sanitation did. While I thank the inventor of penicillin I thank Thomas Crapper who invented the flush toilet more. Prevention is better than cures. Gloves and protective eye wear will help keep small injuries and injuries to eyes under control. As I told a Gunny recently you cannot shoot your self out of a disease situation. Spent some money on a good Field Sanitation FM and a copy of the Humanmanure Handbook. Your children will bless you for that wisdom.

      • What I was referring to above is the fact in such a situation more healthy active people will be alive minus snowflakes than couldn’t cope and far less sick, old and leech type will remain.
        btw I also rate as old now myself.

        Modern medicine and the welfare state has caused it’s own cancer on this nation.

        And history.. T Crapper did not invent the flush toilet, however he did innovate and improve.

  • As a former EMT and soldier of 24 years, prepper of 40+, I think the book “Survival and Austere Medicine – 3rd edition” is one of the most important books one can have in their print library. It has more information packed in it than any five books related to ‘survival medicine’, and it’s available for FREE. I’ve worked the streets of a major city, multiple military ‘MedCap’ missions, and one tour of Afghanistan before retiring and I can say without hesitation, this book is a must! (I’ve sent it to at least 6-8 people of like mind.)

    To BCE (and fellow contributors) THANK YOU for this brilliant medical manual.


  • Welcome BCE!
    Can’t wait to read what you have to share! I consider myself pretty well educated and prepared medically to handle most things. I have collected a large number of things/supplies including a field surgical kit. I have made it a point to learn about herbs and wildcraft the ones growing where I live in the Midwest. Got lots of reference books to use and boy do I!
    I am not a fan of the US’s medical system and pretty much avoid it as is. I take care of my own health and that of my hubby and critters too! I count myself fortunate to have a gift for healing and a love of learning.
    Really interested in reading as you share your wisdom in medicine.

    • Dawn,

      Like you, I am grateful for the contributions of people like BCE, and I welcome the chance to add to my personal library as well as my knowledge base. However, having done my share of research and prepping in the past 3-4 decades, I would like to point out that your attitude and philosophy is what is going to carry the day. When people come to my property and see the work we’ve put into it, they immediately blurt out something like “when the SHTF I’ll just come and live with you.” I can only describe in four letter words how annoying it is to hear that!

      Rugged independence, critical thinking, a robust spirit, and a great attitude will be what the survivors (and “thrive-ers”) have in common. Of that I am quite certain. Consequently, I would enjoy reading YOUR posts on what you’ve done to prepare and take care of your family as much as I would from any other credentialed expert. 28 years ago I spent 8 months in Iraq, and the reason we prevailed and thrived was because of our character strengths, not so much our technical skills.

      Thank you for expressing and sharing a philosophy that we all need to hear. Every day! Congratulations on becoming “Master of the Game” of how to succeed in any environment or scenario. Please share more when the spirit moves you!

  • Just reviewed Survival and Austere Medicine. As a former EMT who worked in the public safety field, I believe this is a step or two or three up from the standard EMT training. I’ll try to acquire a print copy of this for my non-electric library. Thank you!

    As for future training, how about embedding some videos in your articles that show how to stitch a wound etc. Perhaps we can all practice stitching up banana skins or something.

  • One “medicine” I would definitely include is natural honey. Ever since reading in a Scientific American article many years ago (when Scientific American was still a leading science magazine) that honey is both a natural antibiotic and an aid to healing, I have used it many times for skin ailments such as cuts, scrapes, fungal infections (e.g. athletes foot), and rashes. With rashes often the rash needs to be scrubbed so hard that it hurts, then apply the honey. Once I cured a staph infection by washing twice a day, then applying honey. The honey stings when it’s first applied, but within 30 seconds the sting goes away, along with the itch if it’s a rash.

    The downside of honey is that it’s messy.

    One time I didn’t recognize that an itch was a rash, so that when I finally applied the honey, the sting was so strong that I was in agony for about 30 seconds. That rash healed up pretty quickly after that.

    I downloaded the austere medicine book and made a quick electronic search for honey, and didn’t find it, which is why I mention it here.

  • Have you ever read anything along the lines of this, Robert F. Kennedy Jr. Exposes Bill Gates & His Relationship With Big Pharma – By Children’s Health Defense , Collective Evolution February 26, 2019

    “Vital statistics data reveal that in the U.S. and elsewhere, fatalities from diseases such as scarlet fever—in the absence of any vaccine—had become quite rare by the mid-20th century. Mortality from infectious diseases such as measles and whooping cough (pertussis) also had declined rapidly, well before the introduction of the corresponding vaccines”

    MUch the same can be said of polio and others.

    I really hope this blog does not become another fact-less-pro-lies-vaccine b.s. outlet, to read this here was a bit sickening, “Without vaccines, there would be a progressive return in infectious diseases such as polio, tetanus, whooping cough, diphtheria, mumps, etc. especially among children.” – what a crock! Do some research, please.

    • thanks helot, I don’t think we will ever agree on this. But what I will say is that I am not uneducated or poorly infomed here. I know the research and what it says – we just have a different view of it. I think certain vaccinations have a role, I think we over vaccinate as a society and I am no fan of big pharma or .govt. The problem it has become so emotive it is nearly impossible to have a discussion on it. BCE

    • I can and I will. But its a bit more complicated than a quick reply does justice. I will work on something over the next few weeks. BCE

  • I actually own this book. Thank you for sharing your knowledge! Look forward to learning more from you.

  • Thanks to BCE and to Daisy for this article but more importantly for the link. I downloaded the book and can’t wait to dive in. I’ve always been a prepper of sorts but kicked into high gear after 9/11. One of the weak areas of my own knowledge and preps is medical self sufficiency. I’ve developed what I think of as pretty good first aid kits for my truck, home, jobsite and BOB but it’s all fairly basic. Looks like I just got handed an opportunity to take it all to the next level. Thanks again.

  • While I’m not disputing all you say, I do think you are making some rather broad statements. We will not immediately forget everything we’ve learned as soon as SHTF. Women have been having babies a long time & it’s well known that the primary cause of “childbed fever” in mothers & failure to thrive infants was lack of sanitation. Surely folks will remember how to do that! There are hundreds of herbs that are used to treat ailments so get a good book & educate yourself. Will there be deaths from things we have treatments for today? Yes. Do I want my appendix out without anesthetic? Emphatically no! But as someone else pointed out, that is survival of the fittest. Also, there will be no more keeping old folks alive past the time they should be allowed to pass with dignity.

    • Linda as both a History Buff and an active medical person I have seen many an older (civil war and earlier) graveyard with a Husband’s name and several wives names (died IN Childbirth) as well as children who died well before adulthood. Pre modern medicine was pretty grim. Maybe it’s not survival of the fittest but of the lucky?

      Linda it’s not that we will forget our modern medicine, we simply will NOT have the working equipment and or medicines (Like insulin) and drop back into the era of get them drunk amputations and a belly wound was wait to see if they survive.

      BTW show some respect for older folks youngster 🙂 the Average age of Nurses in America is over 58…. keeping folks alive who still know about older ways of doing things maybe more useful than those who barely can walk and use a smart phone as they walk into traffic. Quite a few older folks have that unusual skill of “Figure it out and make do” that most youngsters I hire seem totally lacking.

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