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Managing Pain in a Pinch

Pills in woman hands.

by Cynthia J. Koelker, MD

Excerpt from Armageddon Medicine, How to Be Your Own Doctor in 2012 and Beyond

The daily queue of suffering seems endless. Toothache, stomachache, headache, earache, back pain, leg pain, joint pain, neck pain, sore throat, sore feet, sore muscles, sore eyes. People come to you seeking relief – relief from their pain, and relief from fear. Are you up to the task of helping others, or ready to run away? Becoming a healer is not for the faint of heart.

If and when the medical community collapses, those left to carry on will need an armamentarium of tools to deal with pain. Even if it’s only your own problems and those of your family that you’ll be facing, learning how to relieve pain now, before you’re in the midst of crisis, will spare you needless worry. Pain is the #1 symptom that drives patients to physicians today. Pain will remain a fearsome opponent tomorrow, no matter what catastrophe brings the world to its knees.

Pain and fear go hand in hand, two sides of the same coin. Fear is pain’s best friend, its evil ally. Relieve one and the other may subside, at least to tolerable levels. I know what it is to fear pain. Every time I visit the dentist my childhood dread of drilling on a nerve rears its ugly head. It’s not a rational process. My childhood dentist didn’t believe in novocain. I’ll never get over it.

People can often tolerate an amazing degree of pain if given hope that the condition is only temporary. Labor pain is every bit as bad as any other sort of pain, yet how many women suffer through hour after hour of gut-wrenching torture without requesting so much as an aspirin? People will also endure an incredible amount of pain if they believe good will come of it – such as a new baby, or saving another’s life.

As a healer, you’ll need to dispense more than a dose of narcotics. Having enough medical knowledge to understand a disease process will help you foresee the course of the disease and offer hope of recovery. Even if you cannot relieve the pain, you can relieve fear – both fear of unending pain, and fear of being alone. If you lack the tools to deaden the pain, don’t think you’re doing no good. Like a child who wants his boo-boo kissed, adults, too, want to know that someone cares.

In this regard, doctors are not necessarily the best healers. Physicians are aloof by training and sometimes by nature. Once you try helping others, you’ll learn that part of the patient’s suffering becomes your own. Taking on the pain of the world is a crushing burden. Doctors cannot function when they are overwhelmed by too heavy a load, and so often limit their emotional involvement. But emotional involvement is a powerful salve. An infant with an earache may be comforted in its mother’s arms. “Hold me” may be a laboring wife’s request of her husband, knowing he cannot take the pain away.

I emphasize the non-medicinal treatments of pain because: 1) sooner or later they may be all you have; 2) stretching your supply of pain relievers will help you treat more patients; and 3) many people are intolerant of or allergic to pain medications.

The best way to relieve pain is to eliminate the underlying cause. Deliver the baby, lance the abscess, pass the kidney stone. Pain is your friend when it comes to diagnosis, but sometimes you’ll just have to treat it regardless of cause.

The English language has many words for various kinds of pain: aching, stabbing, burning, stinging, piercing, numbing, cramping, throbbing, tingling, smarting, lancinating, agonizing, and nagging, to mention the most common. The type of pain will clue you as to both cause and severity. The fluent or bodily-aware patient will be able to describe their discomfort in some detail. Others will simply say they hurt.

Beyond what a patient may say, their body language will alert you to the intensity of their distress. A smiling teenager flirting with her beaux does not need narcotics, even though she says she’s dying of pain. A silent man curled up in the fetal position has something serious going on.

The art of medicine includes deciphering both what a patient wants and needs. Some patients request no medicine, if they can only be permitted a day off work. Others prefer to pop a pill and keep going. In America, we overmedicate because we rest too little. Sleep is a powerful analgesic. If pain medication is not available, simply getting a person to rest and/or sleep may be the ticket to relief.

Doctors use many classes of drugs to alleviate or prevent pain: anti-inflammatories, steroids, narcotics, antidepressants, anti-anxiety drugs, anti-seizure drugs, beta-blockers, calcium channel blockers, triptans, muscle relaxers, sedating antihistamines, caffeine, nitroglycerin, antacids, oxygen, anesthetics, and even alcohol. We don’t always know how these drugs work. A patient does not have to be depressed for an anti-depressant to relieve pain. Thinking beyond traditional pain medications will broaden your ability to offer relief.

On treating pain-

Whereas patients focus on pain abatement, doctors often focus on functional improvement. Generally speaking, physicians do not necessarily aim for complete relief of pain, but rather sufficient improvement to permit adequate functioning. Relieving all pain can actually make a situation worse, allowing the patient to injure himself. A truck driver with chronic back pain may say he’s feeling no better, but now is able to unload his cargo. A migraine patient may report her headaches are as bad as usual, but hasn’t missed a day of work in a year. It is difficult to measure how much a patient hurts. It’s much easier to measure how well a patient functions.

Despite current medical thinking, I’m not much of a believer in patient-reported pain scales, though others find them useful. Among my patients, they seem to make little difference in clinical treatment, at least with chronic pain. Patients have difficulty remembering how much they were hurting last week or last month compared to now.

The one situation where a pain scale may be useful is where short-term observation (hours to days) of a hurting patient is possible. Asking the patient to report pain on a scale of 0 to 10 may yield a measure of improvement, or lack thereof. In the current medical environment, pain scales are often more a matter of documentation than a meaningful addition to medical care. It makes little sense to collect the information if it is not going to be used as a basis for treatment. Patients must understand the scale well to offer significant feedback. Many patients will report their pain as 8 or 9 out of 10 when it is obvious from their behavior that it is not this intense. If you are going to use a pain scale, take the time to explain it thoroughly. It also helps to use words or pictures to demonstrate the degree of pain, as in the list* below. Check online if you want an example with pictures.

0 – No pain

2 – Annoying

4 – Uncomfortable

6 – Dreadful

8 – Horrible

10 – Agonizing

When doctors evaluate pain, one of the immediate goals is to determine if it is life-threatening or not. Is chest pain a heart attack? Is abdominal pain appendicitis? If you think you have an emergency on your hands and have the option of referring to a hospital or physician, please do so. But the goal of this discussion is to focus on what you can offer on your own, without emergency back-up. Here are a few examples to consider:

Up to this point, we haven’t mentioned pain relievers per se. Oxygen, positioning, and nitroglycerin may not only improve the underlying problem, but also relieve the patient’s discomfort to a degree. As for direct pain treatment, you probably won’t have injectable morphine available, but oral Vicodin, Percocet, or even tramadol may offer some relief. Nausea frequently accompanies severe heart pain, and you may need to treat with OTC meclizine or a prescription anti-emetic (Phenergan, Vistaril, Compazine) to allow the patient to keep narcotics down. Also, if the patient is agitated, calming him may decrease his oxygen consumption, thereby decreasing chest pain. Valium, Xanax, or Ativan (all controlled prescription drugs) may be helpful.
Say a patient is experiencing excruciating chest pain in association with a likely heart attack. What can you do about it? First, give the patient an aspirin, to thin the blood a little, and perhaps limit further damage. This will not alleviate the pain, but may do some good in the long run. If you have oxygen available, have the patient inhale it at a rate of 2–3 liters per minute (per the machine’s gauge). The pain of a heart attack is partly due to inadequate oxygen within the heart muscle, somewhat like leg pain in a runner, and improving oxygenation may lessen the discomfort. Assuming you don’t have oxygen available, have the patient lie in the bed with his upper body propped up on several pillows. This decreases the work of breathing compared to lying flat, with less demand on the cardiac muscle. Next, give nitro. Nitroglycerin lessens heart pain by opening up the coronary circulation, thus delivering more oxygen to the heart. Nitroglycerin sublingual (dissolved under the tongue) offers very quick but short-term relief; nitroglycerin paste, patches, or delayed release capsules offer longer-term relief, but are slower to take effect.

Medically speaking, this is about all you can do – but still it’s not all you can do. Hold the patient’s hand or rub their neck, if this seems to comfort them. Offer a cool washcloth if they are sweating. Allow a calm, supportive family member to assist you. Keep disturbing or anxious relatives out of the room. Offer to pray with the patient, if this seems appropriate. Offer fluids unless the patient is vomiting. Two reasons fluids are withheld in the hospital are that the patient is getting an I.V. anyway, and that a surgical procedure may be around the corner, with associated anesthesia and risk of vomiting. Your post-Armageddon patient is not going to undergo a heart bypass or stenting, and does not need to suffer dehydration on top of a heart attack. Be careful, though, if the patient is short of breath, as excess fluids may worsen a case of congestive heart failure.

Now, whatever you’ve done with the equipment at hand, don’t blame yourself if the patient dies. We are simply not in control of everything. You did not cause the patient’s heart attack and you’ve done what you can to help.

Your next patient is a 45-year-old woman, complaining of chest pain as well, but who doesn’t appear ill. Chest pain in a person under about 50 years of age is more likely related to the lungs, ribs, or digestion than to the heart. In an asthma patient, when the lungs are tight and the patient is short of breath or wheezing, opening the airways (with an inhaler or steroids) may do more to relieve pain than any pain reliever. If the patient is breathing normally but complains of pain on inspiration, this is usually pleurisy (inflammation of the lining of the lungs) or rib-cage pain. Either way, anti-inflammatory medicine such as ibuprofen, naproxen, or even aspirin is helpful. (Remember, though, that if you’re wrong and the pain is coming from the stomach, these drugs may aggravate the problem.) In our index case, there is definite tenderness when you palpate along the rib margins. The heart and lungs cause pain, not tenderness. If rib tenderness is present, you can be fairly confident the problem is musculoskeletal, that is, not serious, and again an anti-inflammatory should help relieve the discomfort. Heat or ice (and not wearing an underwire bra) often help as well.

Next in line is your 30-year-old nephew who works hard and parties harder. His chest is hurting, too, sort of burning, and you can see he’s hung-over. Home-brew will be available even in the worst of times. Chest pain due to acid reflux (often aggravated by alcohol or anti-inflammatory medications) requires a different approach altogether. Pain medication is not the answer. Decreasing the amount of stomach acid refluxing into the esophagus will alleviate this pain. Baking soda and liquid antacids offer almost immediate relief, which is a diagnostic test in itself. Any of the OTC antacid reducers (Pepcid, Tagamet, Zantac, Axid, Prilosec, Prevacid) will afford longer-term acid suppression. Since these medications will not be available forever, avoiding heartburn triggers is only sensible (NSAIDs, alcohol, tobacco, spicy food, fried or fatty food, citrus fruits, tomato products, chocolate, caffeine – yes, avoid all the good stuff).

At first your 40-year-old cousin thought the pain was in her right lung, but now it seems focused in the upper abdomen, toward the right. She’s pretty sure it came on after eating half a jar of peanut butter. The pain is dull to sharp, mostly aching, but with cramps coming in waves, with intermittent nausea. This type of pain is typical of gut pain, probably stemming from gallbladder irritation. With gut pain, narcotics may help, but NSAIDS (anti-inflammatory drugs) should be avoided. Sleep, relaxation, a hot bath, and abstaining from eating also offer partial relief. These same measures help individuals with colitis, kidney stones, kidney infection, diverticulitis, and other intra-abdominal irritations.

Very light massage is a technique that helps gut pain by distracting the mind from the deeper pain. This is part of the basis for the efficacy of effleurage, a TENS unit (transcutaneous electrical nerve stimulation unit), and even a hot shower. Just as an Internet connection can only carry so much information at once, the human nervous system can only process so much neural input at one time. The heat of a hot shower takes at least several minutes to penetrate sore muscles, but partial relief begins the moment the skin is stimulated. Laboring women sometimes massage their own bellies to lessen the deep pain. Anyone can experiment with this superficial massage technique, which works not only for gut pain, but other deep pains as well. Light oil massage works similarly.

Deep massage is best described and taught by a professional masseuse, which I am not. But even an untrained friend can give a good backrub that relieves the tensions of the day. I’ve had many patients obtain as much relief from a professional massage as from medication or physical therapy. The relief may be short-lived, and the massage may need to be repeated in a day or two, but this natural remedy is used worldwide for pain relief. In fact, in countries where there isn’t a drugstore on every corner, touch therapy is the primary mode of pain relief.

Doing anything at all is nearly always better than doing nothing. Placebos, which have no physical basis for helping, still do so about a third of the time. Hope is a natural narcotic, and people will try a multitude of peculiar and likely ineffective therapies on the basis of hope alone. This is also how so many crackpot therapies work their way into the health care field. Anything, even a sugar pill, will help somebody. Part of the benefit is mind over matter; part is giving your body time to heal on its own. Many patients who think an antibiotic cured them overnight were simply going to be better by the next day anyway. Applying cool cabbage leaves to tender, engorged breasts is purported to relieve the discomfort, but perhaps grape leaves, lettuce leaves, or a cool wash cloth would accomplish as much. Still, applying cabbage leaves lies in the realm of “doing no harm,” plus it gives the mother something active to do. People prefer to be in charge of their own bodies.

As a physician I struggle with the need to be honest with my patients versus the desire not to deprive them of the placebo effect. Modern medicine prides itself on “truth.” But for anyone who believes in a certain therapy, even one proven by medical science to be ineffective, for that individual the relief is real. After an Armageddon event, the placebo effect may be a doctor’s strongest ally. A placebo may be a pill, a procedure, an activity, or a dressing. Whatever you do, choose your placebos wisely and first, do no harm.

Natural remedies also include biologically active chemicals such as opium and salicin (from which aspirin is derived). Through the years, the pharmaceutical industry has developed many refinements, but these two are the original basis of all narcotics and anti-inflammatory medications, including codeine, morphine, hydrocodone, oxycodone, ibuprofen, and naproxen. When supplies of pharmaceutical pain relievers run out, healers will need to resort to the original, naturally-available painkillers.

White willow bark contains the natural pain-killer salicin. For a full discussion, see the University of Maryland Medical Center (UMM) website, which includes details of dosing, drug interactions, side-effects, and recipes for willow bark preparations made from commercially available supplies.[1] Of course, stockpiles of willow bark will run out as quickly as stockpiles of aspirin, and it makes more sense to learn to recognize the tree, and either locate it within your community or plant your own. Other types of willow may also be effective.

 

Willow Bark Tea Recipe (from UMM)

 

Boil 1–2 teaspoons of (commercially-available) dried

white willow bark in 8 ounces of water

Simmer 10–15 minutes and let steep for half an hour.

Drink one cup 3–4 times daily as needed.

Narcotics are the strongest pain relievers and will be the hardest for preppers to come by. Doctors are extremely unlikely to prescribe enough to stockpile and so, aside from learning to prepare your own, are there any alternatives?

Tramadol is a prescription painkiller, nearly as strong as codeine or hydrocodone, at least in the narcotic-naïve patient. People who get a “high” on narcotics are not fond of this drug. Whereas a few years ago it was quite expensive, now the cost is on a par with ibuprofen. Because it is less likely to be addicting, doctors are happy to use it more freely for many conditions ranging from headaches and stiff necks to sciatica and broken bones. If you have a good relationship with your doctor, you may be able to obtain a small supply, which you should plan on reserving for serious pain. The normal dose is 50–100 mg every 4 to 6 hours.  (Note: This paragraph was written in 2011, before the change in approach to pain medicine nationwide.  As of 2017 it is much less likely your doctor will give you even a small supply of tramadol unless you have a current need.)

Secondly, the combination of Tylenol plus an anti-inflammatory is nearly as strong as the narcotics hydrocodone or codeine, and in many patients, works as well or even better. As long as a patient can tolerate the ingredients separately, they are well-tolerated in combination. With 500-count bottles of Tylenol, ibuprofen, and naproxen sodium readily available over the counter at minimal cost, anyone can lay in a good supply for future use.

Of course, anti-inflammatories (NSAIDs) are not tolerated by every patient. Any NSAID may cause stomach discomfort or even an ulcer with prolonged use. They should always be taken with food to minimize contact with the stomach lining. Some patients are able to tolerate an NSAID if they take an acid-lowering drug (such as Pepcid, Zantac, Prilosec, or Prevacid). Allergies to NSAIDs are not uncommon, and sensitive individuals may develop hives or wheezing.

For musculoskeletal pain (strains, sprains, fractures, injuries), the NSAIDs, narcotics, and Tylenol are useful, but again, don’t limit yourself to thinking of pills as the only way to alleviate pain. Rest, ice (or heat), splinting, wrapping, and taping are all measures that decrease pain by lessening the stress on the affected body part.

Again, the main point is to get beyond thinking that pain pills are the answer to pain. Yes, they have their place, when the pain is disabling and nothing else works. But overall, especially with the supply of narcotics severely limited, do what you can to avoid them, and save the “big guns” for situations that truly warrant their use.

Checklist – items to include in your medical supplies:

Tylenol and OTC NSAIDs – ibuprofen, naproxen sodium, and aspirin
Prescription tramadol, narcotics, muscle relaxers, sleep aids, antidepressants, beta-blockers, calcium channel blockers
Oxygen tank or concentrator; extra tubing
Hot water bottle or reheatable rice bag
Athletic tape; Coban; elastic wraps; ankle, wrist, finger, and hand splints; slings
OTC Prilosec, Prevacid, Pepcid, Zantac (or generics); liquid Maalox; baking soda
Oil of clove for dental (nerve) pain
Actions to take:
Learn about using willow bark at the University of Maryland Medical Center Web site (at http://www.umm.edu/altmed/articles/willow-bark-000281.htm); also, locate a local source of willow bark or plant your own trees.
Study up on massage and effleurage techniques
Download a pain scale you find useful

[1] University of Maryland Medical Center: http://www.umm.edu/altmed/articles/willow-bark-000281.htm

*originally  written as “table below”.

Radiation Issues

The explosion of a nuclear bomb in the city.

The explosion of a nuclear charge in a big city.

By:  Sharon Packer (TACDA Board Member)

The nuclear threat from North Korea has prompted many callers during the past few weeks, asking about the effects and attenuation of radiation.  There is a great deal of misinformation about radiation from fallout. The following old rule of thumb for shelter design still holds true. NBC shelters should have four feet of dirt cover, or three feet of concrete cover to give a minimum PF level of 1,000 from fallout. If a “rainout” should occur, or if the sheltered area is within 1.5 miles of a potential primary target, the shelter will require a minimum of eight to ten feet of cover. Shelter entrances require careful engineering, as most of the radiation exposure will come from these entrance areas.

I recently reviewed a series of articles about Nuclear Weapons Effects, written by Carsten Haaland, of the Oak Ridge national Laboratory. The entire series of articles can be found in our Journal of Civil Defense published in 1990. Some of you may be fortunate enough to still possess these journal articles. I have re-typed, in part, the section on ‘Fallout’ and ‘Rainout’ for this current article.

 FALLOUT FROM NUCLEAR DETONATIONS

Carsten M. Haaland, Oak Ridge National Laboratory

 What is Fallout?

Fallout is the radioactive dust that comes back to earth as a result of a nuclear explosion at the surface of the earth, or at an altitude low enough for the fireball to engulf solid materials. Fallout dust may look like sand, ash or crystals, depending on the kind of material engulfed by the fireball. If the material engulfed is ordinary earth or sand the fallout will look like sand, but if the engulfed material contains calcium to the extent found in concrete buildings or coral, the fallout may look like ashes. Large dense particles will descend faster than very small particles. For this reason, fallout particles several hundred miles downwind from a nuclear surface burst will be very small, somewhat like particles in atmospheric pollution, and the nuclear radiation from the fallout will be greatly reduced.

The danger of fallout arises from the intense and highly penetrating nuclear radiation emitted from it, which produces a potentially lethal hazard to people in the vicinity unless they have protection. Large areas, covering hundreds to thousands of square miles, depending on the yield and number of surface detonations, can be poisoned with fallout such that radiation from the contaminated area is hazardous or lethal to an unprotected person passing through or dwelling in the area, for periods of days to weeks after the detonations.

Sharon's article #1

 

How is Fallout Produced?

When a nuclear weapon explodes near the ground, the instantaneous release of incredible energy makes a huge pit or crater. Tons of earth in the crater are instantly changed from solids into hot gas and fine dust, by the tremendous heat and pressure from the bomb explosion. This hot gas and dust, together with vaporized materials of the bomb itself, form a giant fireball that rises like a hot-air balloon to high altitude. This material spreads out, cools, and becomes more dense as it rises. The fireball stops rising when its density reaches the same density as the atmosphere into which it has risen.

Some of the dust and heavier particles that are drawn up with the fireball form the stem of the mushroom cloud. The dust in the cap of the mushroom spreads out horizontally when the fireball stops rising, and begins to be shaped and drawn along by the winds at that altitude. This dust cloud can be carried for hundreds of miles by the upper winds. The dust falling and drifting to the earth from this moving cloud becomes the radioactive fallout with which we are concerned. Somewhat confusingly, the process itself; that is, the dust’s action of falling and drifting to the ground, is also called “fallout”.

The dust in the stem and in the mushroom cloud becomes radioactive mostly from the fission products created in the nuclear explosion that become stuck to part of the dust particles. The air around the particles does not become radioactive, and neither do the ground-surface materials on which they settle.

The smallest particles of fallout can be carried hundreds of miles by the wind before reaching the earth. Most of the fallout will come down to the ground within 24 hours after the detonation. Very small particles come down very slowly and may be spread over large areas of the earth’s surface in the downwind directions over time periods of many days, even weeks. This delayed fallout is sometimes called “worldwide” fallout, although most of the fallout comes down in the hemisphere in which it is produced (Northern or Southern). Fallout that arrives within the first day or two after the explosion poses a much greater threat to human life than does delayed fallout.

Because the rate of fall of a fallout particle depends on the size, shape and density of the particle and on the local winds (Haaland, 1989), the pattern of deposition on the ground can be highly irregular. The pattern shown in Fig. 1 resulted from measurement of radiation intensities on the ground after the nuclear test named TURK at the Nevada Test Site in 1955, a 43 kiloton tower shot (Glasstone, 1977). The pattern shown in Fig. 2 shows how an “idealized” fallout pattern is used to estimate fallout on the city of Phoenix, Arizona, resulting from a hypothetical ground burst of a 10 megaton nuclear weapon on Luke Air Force Base (Haaland, 1987a).

 

Sharon's article #2

 

Radiation from Fallout

The radioactivity from fallout decays and fades away by natural processes. The radioactive materials produced by the nuclear explosion are unstable. These materials change (or decay) into a stable condition by shooting out nuclear radiation, such as alpha, beta, and gamma rays. Gamma radiation is by far the most dangerous of the three kinds of fallout radiation, because it can penetrate the entire body and cause cell damage to all parts, to the organs, blood and bones.

A more detailed discussion of the kinds of fallout radiation and their potentially harmful effects may be found in Radiation Safety in Shelters, CPG 2-6.4, 1983, available from the Federal Emergency Management Agency, Washington, DC. The penetration of gamma radiation through matter, dose-factors for the body, comparison of fallout radiation with initial nuclear radiation, and other topics, are discussed in great technical detail in Fallout Facts for Nuclear-Battlefield Commanders (Haaland, 1989). Methods of providing protective shielding from lethal fallout contamination have been presented by Chester (1986) and Spencer (1980).

Decay of Radioactivity

Some materials decay into their stable form faster than others. Those that change fast produce intense nuclear radiation in the first few moments after a nuclear explosion. Those that decay more slowly, such as cesium-137 and strontium-90, may be responsible for measurable nuclear radiation years after the explosion. These particular radioisotopes may enter the body through the food chain and may remain for long periods in certain parts of the body. The increased radioactive emissions from these isotopes (above the normal radioactive emissions from potassium-40 which exists in our bodies) may increase the potential for various cancers.

Because many materials in the fallout cloud decay quickly, the nuclear radiation from a given quantity of fallout is most intense in the first moments after detonation and its intensity rapidly falls to lower levels. This behavior can be approximately described by a rule of thumb called the seven-ten rule. This rule applies only to fallout of the same “effective” age. If the fallout results from unclear detonations that all exploded within a few minutes of each other, then the “effective” age is the same as the actual age, the time measured from the mean time of the detonations. If the fallout is produced from detonations that are separated in time by more than a half-hour or so, then the average decay rates of the different clouds of fallout are sufficiently different. The concept of “effective” age must be applied to estimate the decay rate of the composite fallout. Methods have been developed for determining the effective age of composite fallout from simple measurements by a survey meter and the use of a monogram (Haaland, 1989).

The seven-ten rule states that the measured radiation intensity from a given quantity of fallout particles will decay to (1) one-tenth as much when the fallout becomes seven times older than the effective age at the time of measurement, (2) one-hundredth (1/10 x 1/10) as much when the fallout becomes forty-nine times (7 x 7) older than the effective age at the time of measurement, and so on. The unit of time can be seconds, minutes, hours, half-days, days or whatever period of time is appropriate for the situation. For instance, if the measured level of radiation is 1,000 R/hr., after 7 hours the radiation level will decay to 100 R/hr.  After 7 x 7 hours (about 2 days) the radiation level will decay to 10 R/hr. After 7 x 2 days (about 2 weeks) the radiation level will decay to 1 R/hr.

 

Sharon's article #3

 

Rainout

If the air is humid, the nuclear explosion may start a local rain. The fireball from a low-yield nuclear detonation, less than a few hundred kilotons, may not rise above the troposphere. In this case, if it is already raining or if the explosion starts a rain shower, much of the radioactive material will come quickly to the ground as “rainout”. A light rainout produced low-level fallout-type radiation after the Hiroshima and Nagasaki detonations, even though the fireballs did not engulf solid materials on the ground. Radiation from rainout could be extremely intense and localized if the fireball does not rise above the rain cloud, because the fallout cloud has not had a chance to spread out as it does when carried a long way by the wind, and it has not had as much time to decay. If the rainfall is heavy, the fallout may be washed into gutters, ditches, and storm sewers, from whence it may be carried into streams and rivers. In this case the earth surrounding the ditches, sewers and streams, and the water itself will provide shielding to greatly reduce the fallout hazard to local residents. However, radioactive material, like dirt and sand particles, can collect in unpredictable locations under these circumstances to produce highly lethal concentrations. A radiation survey meter will be needed to help detect, and avoid remaining in such locations.

Conclusions

Fallout radiation is a potential hazard that must be considered in the event of nuclear attack. The magnitude of the area covered, the geographical shape, and the levels of radiation intensity CANNOT be precisely predicted. Protection by shelters is possible, and radiation management through the use of rate meters and dosimeters will reduce the potential risk.

It’s Wise to Blend in

gang street

A John Farnam “Quip” – July 7, 2017

 

“A great deal of intelligence can be invested in ignorance,  when the

need for illusion is deep.”

Saul Bellow

 

It represents enormous conceit to believe that police can do  anything

to stop crime, particularly violent crime.  What we do is  deter/displace it.

We discourage it at a particular moment, and thus move  it to other places.

That’s about it!

 

There is nothing we can do to “make people obey the  law.”  All we can

do is make them wish they had.  In most of Western Civilization, our

tools for accomplishing the latter are extremely limited and  largely

ineffective, and becoming less effective all the time!

 

As individual Operators, we can make ourselves, our routine,  and our

personal environment, as invisible and unattractive as we are able, to  both

conventional criminals and violent leftist political ideologues.   There is

little we can do to influence world events, which are currently more

than a little frightening and ominous.

 

Something every Infantry Officer learns early in his  career:

“Any position can be taken, when the attacker is willing to pay the price.”

 

Thus, sufficient determination and commitment will overcome  all

“access controls.”  When VCAs must be physically stopped, you will have

no choice but to personally, decisively effect the “stopping”.  You’ll

get  dirty, maybe wet!

 

“Proactive security” is mostly myth.   Some still insist that people with

evil, violent intent can somehow be  “detected” shortly before they

carry out their terrible crimes.  Mostly  wishful thinking, and “false positives”

create all kinds of civil-rights  issues!

 

The only reliable predictor of individual future behavior is

individual past behavior.  Best advice is to have nothing to do with

people  who have displayed toxic behavior in the past.  Get away from

them, and get  them out of your life!

 

To reiterate:

 

1) The only authentic “first responders” to precipitous,  violent

criminal acts, are prospective victims directly at the scene, at the

critical moment.  Even then, they are effective in preventing/limiting

carnage only when armed, trained, alert, and pivotally decisive.

 

2) Imagining that it is possible to predict/prevent spasmodic,  violent

criminal acts through “scientific preemptive measures” represents a

fatal fantasy.  Don’t bet your life on it.

 

3) Imagining that “access control,” no matter how sophisticated nor

formidable, will suffice to protect you from harm, represents  another

fatal fantasy.

 

4) Imagining that police/security personnel will arrive “in  the nick

of time” represents yet another fatal fantasy.

 

5) Imagining that it is somehow “immoral” to effectively defend  oneself,

including the precise application of deadly force, is a foolish  concession to

naive liberals/leftists.   Liberals are only too anxious  to “sacrifice”

the lives of others (but never their own), in order to “preserve  their

sensibilities”.

 

6) Only the well-armed, well-trained, aware, and otherwise

well-prepared have any chance of living through a violent attack by

traditional  VCAs, or as we’re seeing in increasing numbers, violent leftist ideologues.

 

“There are only two kinds of men in this world: Honest men and

dishonest men. Any man who says the world owes him a living is

dishonest. The  same God who made you and me made this Earth. And, He

planned it so that it  would yield every single thing that people on it

need.  But, He was careful to  plan it so that it would yield up its wealth only in exchange

for honest labor.

Who insist on sharing that wealth, while contributing nothing, are dishonest.”

Ralph Moody

 

/John

John S. Farnam, president of Defensive Training International, is one of the top handgun instructors in the world. He has personally trained thousands of federal, state and local law enforcement personnel, as well as non-police, in the serious use of firearms. In addition, he has authored four books on the subject — “The Farnam Method of Defensive Handgunning,” “The Farnam Method of Defensive Shotgun and Rifle Shooting,” “The Street Smart Gun Book,” and “Guns & Warriors – DTI Quips Volume 1.” (For all book orders, contact Vicki at vk.farnam@gmail.com)

Water Purification … EMP

rough stream

Thoughts on water purification as shared by one of TACDA’s advisory board members, Paul Seyfried ….

Hi,

Thanks for the heads-up.   As most of the attendees are well into their fifties, sixties, and seventies, I wonder just how far they’ll get on foot or pushing a bicycle.  Water is HEAVY, and there may be precious few (none) sources of water that are suitable for using a single or two-stage water filter.  Pollution.  Even the best “emergency” water filters cannot deal with urban chemical pollutants.

So far, most evacuees in the US in recent memory had a source of good water in the areas they evacuated to.  The EMP problem will eliminate that stop-gap.  No one, without a well and the ability to use that well without grid power, will have  safe water.

Don’t be a refugee.  Find a relative out of town that is willing to have you pre-position generous supplies there.  That will assure your support if you are able to get out, and that you won’t be a burden on the host.  Over-achieve on the food and clothing end of the list….it may last a lot longer than you think!  From casual conversations with guys like Bron Cikotas and Lowell Wood, they revealed that any species of a new grid will take between 10 and 20 years, and it may not be Americans that restore it.  The “experts” that assert a “months-to-a year” time window for restoring the power grid are just not realistic.  Also consider that among the suffering and dying population will be the very people who know now to install high voltage transformers and equipment.  IF they can get it, and IF they can pay for it with now-worthless American dollars from suppliers abroad, and IF they can transport it around the country without fuel, water, food, and security that we now enjoy at re-supply points along the way.

I know a man who is one of only a dozen or so who know how to splice high voltage cable.  I’m not talking the 12,000 volt stuff, I mean 500,000+ transmission lines.  A dozen such men are adequate for the random incidents where their skills are needed.  It’s the same demand for installing 700 ton extreme-high-voltage transformers at power plants.  Don’t need too many of those on a daily basis.  But melt down 6,000 EHV transformers, and you have a problem.  How do we contact these men (no communications)?  Which of them are willing to leave their starving and thirsty families to travel long distances in a grid-down country to work on your power plant (assuming they could get the huge list of gear to restore the plant) assuming they are alive by the time they need him?

With all of the perils and pitfalls of evacuation, it is probably the only way forward for city dwellers, because there will be nothing in the city for them.  The cities will die.

You can pass this short video of a talk by Bronius Cikotas about the consequences of a CME or EMP on the nation.  https://www.youtube.com/watch?v=ZpHjP1j70Xo    The follow-on videos about EMP are also excellent! He softened his remarks for the audience….but over a hamburger at Hires in September 2014, Bron left his line of conversation about life in Virginia to say, “They cities will die.  Get OUT.”  The way he said it, out of the blue- and then moved on, was unexpected.  I’m going somewhere with this, and it relates to a conversation I had with the water works engineer in West Jordan in the lobby of his building.  I just drove to the water works and walked in asking for someone from the engineering staff.  A kindly man in his fifties came out and addressed my questions about how, where, West Jordan gets it drinking water.  Indeed, his comments applied to the Wasatch Front, not just WJ, with the possible exceptions of their wells.

West Jordan gets 82% of its water from the reservoirs in the mountains….Jordanelle, Pine View, etc.  It is piped down through very large concrete aqueducts.  If an earthquake damages these, it may take 3 or 4 months to repair them.  “But we could keep the city alive with the wells, if the quake didn’t disrupt them…….if no one takes a shower. It would be close.”   I then asked, “What about EMP?”   I got no tap dancing, hemming or hawing.  He looked right at me and said, “The city will die.”  Almost exactly what Bron said at Hires.  It’s likely he had attended the EMP seminar Bron was presenting at the Little America Hotel on the morning of 9/11, which was adjourned by the events in New York City.  About 600 city and state officials were in attendance, those associated with law enforcement, utility management, etc.

In Lowell Wood’s 1999 testimony on EMP, he discusses the challenges of “bootstrapping” the grid.  It is bleak.  It is wise to consider the importance safe, clean water has on the priority list of our preparations.  Without the grid, municipal water will be a fond memory and the largest factor in the demise of hundreds of millions of Americans.  Those relying on emergency backpack filters will soon find themselves in serious trouble as their filters become hopelessly clogged using ditch water.  Virtually all filter manufacturers use tap water to rate their capacities.  In my experience in the high Uinta mountains,  I had to clean my Katadyn filter after only a few quarts of clear stream water.  It was frustrating and time consuming.  With cloudy, muddy water, it would be much worse.

What is needed for long-term water filtration is multiple stages….starting at 20 microns, and moving down to the .3 micron level so that one filter is not overwhelmed by trying to handle the whole task.  Processes to handle viruses and chemicals need to be included.  The best filter I’ve found for the long-term water problem is the Lakewater Filter by Vitasalis (Equinox) out of Michigan.  Six processes (still not as good as the 19 to 23 stages your city uses) instead of one or two.  It requires power to use….so alternative power is also high on your list.  It will provide plenty of water for the long haul for showers, cooking, drinking, etc.

Plan and DO for the long haul. In virtually any nuclear confrontation with our very real enemies, you can count on loss of the grid and all its attendant benefits.

Paul

Civil Defense Abroad

St Petersburg Russia

From the “Journal Archives” ….. Journal of Civil Defense, Jan-Feb 1978

Reports and repercussions of the 1977 American “Civil Defense Debate” are appearing in foreign publications. In Great Britain, The Journal of the Institute of Civil Defense digs into Congressional hearings and says: One Republican, Congressman William Whitehurst, also argued that it would be criminal to give up hope of defending against a nuclear attack when civil shelters could reduce casualties “down to 20 million.” But the new director of the Pentagon’s Defense Civil Preparedness Agency, Mr. Bardyl Tirana, said there was no question of building blast shelters for the civil population, which would cost far more than the sums being voted. “Frankly, we do not seek an increase,” he said. “All we would do with the funds is accelerate our program. We’re not going to build shelters or do any industrial hardening, as some people have suggested.”

********

Russians carefully monitored the hearings, and General of the Army A. I. Radziyevskiy in an interview with V. Aleksandrov printed in the Canadian Emergency Planning Digest for September-October 1977 has praise for “sober minded” Americans who play down civil defense. In answer to a question about claims of a stepped-up Russian civil defense made by the American press, American generals and Boeing Aerospace Company Radziyevskiy says:

“They are totally baseless. Soviet civil defense has never threatened anyone and has always pursued humane aims.

“As in the past, the main tasks of civil defense are: to protect the population during war; to increase the stability of the functioning of the national economy in wartime and to eliminate the consequences of an aggressor’s attack on peaceful cities and villages . . .

“Naturally, the civil defense organization and its methods of protecting the population and national economy from an aggressor’s air attacks and natural catastrophes are constantly being improved. However, this fact, which was recognized during the conclusion of the ABM Treaty, was no obstacle to its signing and alarmed no one until 1976, when the struggle over the US military budget for the next few years broke out.

“Seeking an increase in the military budget, American ‘hawks’ are now trying to belittle US civil defense potential as much as possible. Yet in the past, when the military-industrial complex had to convince American public opinion that the vast sums being spent at the taxpayer’s expense to implement extensive civil defense programs were being used most effectively, they enthusiastically praised the achievements of US civil defense . . .

“While knowing of the United States’ extensive civil defense programs, the Soviet Union has never called these measures a threat to the peace and security of other peoples, and has never tried to depict them as an obstacle to ending the arms race or to general disarmament. Indeed, it is not hard to understand that with the ending of the arms race and the total elimination of weapons of mass destruction and their means of delivery, the need for civil defense measures will also recede of its own accord. Therefore, the attempt to present civil defense measures as an insurmountable obstacle to further progress at the Strategic Arms Limitation Talks is just as ridiculous as an attempt to lead a jackass backwards along a road . . .

********

Closer to home, Soviet Scientist M. A. Markov writes a persuasive article for the Bulletin of the Atomic Scientists (November 1977) which is meant to refute Richard Pipes’ statement in the July 1977 Commentary. Pipes said:

“Since the mid-1960s, the proposition that thermonuclear war would be suicidal for both parties has been used by the Russians largely as a commodity for export. Its chief proponents include staff members of the Moscow Institute of the USA and Canada, and Soviet participants at Pugwash, Dartmouth and similar international conferences, who are assigned the task of strengthening the hand of anti-military intellectual circles in the West.”

Markov tackles his mission pretty well and he tries to reemphasize the title of his article, which is “Have We Learned to Think in a New Way?” He quotes the Pugwash Manifesto in saying that “There can be no winners in a third world war.” A familiar goblin, and he points out:

“With the appearance of the nuclear weapon, and with the threat of global destruction of life on earth, arose the realization that the use of this weapon was tantamount to self-destruction . . .

“The duty of scientists is to warn the world about this god of war donning the mask of a pacifist, and to warn about the military strategists’ temptation to unleash a preventive war for ‘humanistic’ ends. . .

“The genie has been released from the bottle, and it only remains for us to search for different forms of limiting its spread and preventing its aggressiveness. The danger is that an accumulation of plutonium can take place in reactors designed for generating nuclear energy for peaceful purposes.

” . . . The disappearance of an atmosphere of mutual suspicion and fear in favor of an atmosphere of security will lead to a new economic order and to the peaceful cooperation among people in solving tasks common to all mankind.”

********

Prominent among those whom the Soviets would like to discredit is Major General George Keegan, who retired a year ago as Chief of Air Force Intelligence . Following are excerpts of an interview published in Human Events of September 24, 1977:

“ . . . The Soviets have taken extraordinary steps to harden, protect and shelter their military, leadership, industrial and population resources from nuclear attack . While Soviet cities would be destroyed, they would probably suffer no more than four or five million fatalities to our 160 million.

“ . . . Future catastrophe can be averted – just as World War II could have been prevented.

“All the United States has to do is continue making a prudent, objective assessment of what the Soviet Union is doing and assuring that we don’t let it happen. Prudent and adequate investment in security and defense is basically what is required. In my opinion, we are not doing that today . . .

“Altunin [Soviet Chief of Civil Defense] has over 200 general officers on active duty from the several services, serving directly on his staff, or in command of civil defense in all the major cities of the Soviet Union. He is known to have many dozens of regiments of civil defense troops that are assigned principally to supervising city defense throughout the Soviet Union. His organization includes several large military academies like the Air Force Academy or West Point exclusively devoted to training civil defense officers.

“After four years of the most intensive training in civil defense, they graduate with the equivalent of a college degree, are commissioned second lieutenants, and spend their entire 35- to 50-year career in civil defense. Ultimately, these young officers become the commanders of civil defense detachments throughout the cities of the Soviet Union.

“ . . . There is no longer any mystery about the matter of Soviet civil defense . The difficulty is that you cannot get senior officials of the U. S. government to believe, because to believe would simply be to put detente, SALT and the ABM treaty of 1972 in an extremely adverse light.”

 

 

North Korea Nuclear EMP Attack: An Existential Threat

We here at the American Civil Defense Association felt this was important to share;

Statement for the Record
Dr. William R. Graham, Chairman
Dr. Peter Vincent Pry, Chief of Staff
Commission to assess the threat to the United States from
Electromagnetic Pulse (EMP) Attack
To
U.S. House of Representatives
Committee on Homeland Security
Subcommittee on Oversight and Management Efficiency Hearing
October 17, 2017

North Korea Nuclear EMP Attack:
An Existential Threat

During the Cold War, major efforts were undertaken by the Department of Defense to assure that the U.S. national command authority and U.S. strategic forces could survive and operate after an EMP attack. However, no major efforts were then thought necessary to protect critical national infrastructures, relying on nuclear deterrence to protect them. With the development of small nuclear arsenals and long-range missiles by new, radical U.S. adversaries, beginning with North Korea, the threat of a nuclear EMP attack against the U.S. becomes one of the few ways that such a country could inflict devastating damage to the United States. It is critical, therefore, that the U.S. national leadership address the EMP threat as a critical and existential issue, and give a high priority to assuring the leadership is engaged and the necessary steps are taken to protect the country from EMP.        (Read entire address here.)

My disaster preparedness secret weapon: Hydrogen Peroxide

hydrogen peroxide

BY ALEX HOLLINGS

When putting together a disaster plan, it’s important to prioritize human needs in the way that you prepare.  To put together a solid short-term survival plan, you need only to address the most basic of human necessities: water, shelter, food, and security, but as short-term survival transitions into “well I guess this is what’s left of the world now,” it’s important to have a plan in place that can help you get by a bit longer than just the first few days after a disaster.

While ensuring you have adequate food and water will prevent death from hunger or dehydration, it’s important to remember that those are often the very easiest forms of death to avoid.  We worry about supply lines drying up after the collapse of our infrastructure for good reason, but humans have been surviving without grocery stores and running faucets for millennia… what tends to kill us in such situations often isn’t a lack of food, but rather a lack of hygiene.

Enter my favorite survival item: hydrogen peroxide.  Most of us are familiar with the brown bottle of bubbling goodness from our childhoods, when our mothers would pour a bit of the elixir onto our scraped knees to disinfect it before armoring the wound with a Batman band-aid and providing an emergency booboo-kiss for pain relief.  While wound care is certainly one of the things hydrogen peroxide is good to have around for, it’s far from the only thing.

In order to discuss some of the other important uses for the magic brown bottle, I’m going to have to delve into some of the health issues that may impact a person in an extended survival scenario; some of which are likely to sound gross, but it’s important to plan for potential health hazards other than gunshot wounds and zombie bites, because dying of an infection all by yourself will leave you just as dead as the sexier alternatives we see on TV.

Hydrogen Peroxide for Mouth Care

I’m not normally one to close my eyes during a rough scene in a movie – but watching Tom Hanks remove an infected tooth with an ice skate in “Cast Away” was tough for me.  I don’t like going to the dentist, let alone the idea of serving as my own using bits of trash I found on a beach, but I have to credit the movie for including an element of survival that is often ignored in movies and television: dental hygiene.

An infected tooth is a serious issue.  If left unchecked, and infection can spread throughout your body, possibly even killing you without antibiotic treatment.  Beyond that, an infected tooth can make eating an excruciating endeavor and can serve as a serious distraction when you need to keep your wits about you.  If at all possible, one should avoid having to do their own oral surgery, and hydrogen peroxide can help.

That same brown bottle you use on cuts and scrapes is also a FDA approved mouth wash.  Pouring a mix of hydrogen peroxide and water into your mouth and swishing it around once in a while may not give you the same fresh breath you’d get from a tooth-brush and a new tube of Crest Whitening, but it could keep the bacteria in your mouth from going rogue and rotting you from the inside out.  Keeping your teeth intact will keep you eating, and hydrogen peroxide can help stave off infections and even cavities.

Hydrogen Peroxide to Fight Fungus

Athlete’s foot and other fungal infections of the hands and feet can be serious trouble for the long-term survivor.  The reduction in available means of hygiene that may come after a disaster could leave you more vulnerable to this sort of ailment, and yet again, hydrogen peroxide can help kill the fungus causing itching and burning on your extremities.

Perhaps more important though, is hydrogen peroxide’s ability to combat yeast infections.  While we tend to think of such things as a uniquely female issue, and in today’s world, we even see it as more of an inconvenience than a matter of life and death, developing a yeast infection in a survival setting is bad news and must be addressed.

Hydrogen Peroxide is safe to be used as a douche for women suffering from a yeast infection after the stores have long stopped stocking Monistat, and can be used externally for men suffering from the same ailment.  Didn’t know men could get yeast infections?  They absolutely can – and the resulting itching, burning and open sores could lead to any number of further infections, or simply leave you too distracted to handle your day-to-day survival needs with the level of focus they require.  Hydrogen peroxide will not work as well as traditional anti-fungal medications, but as a multi-use tool, it’s good to know that you can keep the swamp-rot off your fingers and toes as well as out of your underoos with the same bottle you keep around for wound care and oral hygiene.  I’d just recommend cleaning the spout before switching between uses (just kidding, do not put the spout inside any part of you, use a different means of application).

Hydrogen Peroxide for Cleaning (everything)

If you wear contact lenses, hydrogen peroxide and water can be used to clean them between uses – extending the life of your contacts and possibly your ability to see if you don’t have access to your glasses.  It can also be used to clean food containers and utensils, water carriers, or even cooking surfaces to kill things like salmonella.

You can also use a mixture of hydrogen peroxide and water to clean and disinfect your clothes.  A clean pair of undies may not sound like the most important thing after the end of the world, but remember, we haven’t evolved to prefer the smell and touch of clean things for no reason.  Cleaning your clothes will help prevent skin irritations and even infections.  In fact, using hydrogen peroxide to clean your underwear could prevent you from having to using hydrogen peroxide to treat a yeast infection in the first place.

Hydrogen Peroxide for Farming

In a long-term survival situation, cultivating your own food may be a necessity, but if you weren’t blessed with a green thumb, you’ll likely need all the help you can get in order to turn your little garden into something that’ll feed your family.  Believe it or not, hydrogen peroxide can also help you start to grow your own food.

Adding a small bit of hydrogen peroxide to the water you pour on your plants can help fertilize the soil, prevent mold and mildew from developing, and even help an ailing plant regain its health.  Soaking seeds in water that contains a small amount of hydrogen peroxide will even make them germinate faster.  It’s important to use the correct amount of hydrogen peroxide however, otherwise it could kill your plants before they have a chance to grow.  Check out this chart to help you determine how much peroxide you should mix with water for various agricultural needs.

These handy uses for the old brown bottle in your medicine cabinet are far from all of the ways hydrogen peroxide can benefit a disaster victim attempting to transition from short-term to long-term survival.  I highly recommend doing some research and attempting to use hydrogen peroxide for things like oral hygiene once or twice before the world comes crashing down on you.

And maybe grab an extra bottle or two of the stuff the next time you go shopping.  Just in case.

ABOUT THE AUTHOR

Alex Hollings served as an active duty Marine for six and a half years before being medically retired from service. As an athlete, Hollings has raced exotic cars, played Marine Corps football and college rugby, fought in cages, and even wrestled alligators. As a scholar, he has earned a master’s degree in Communications from Southern New Hampshire University, as well as undergraduate degrees in Corporate and Organizational Communications and Business Management.