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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; 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:

*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.


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



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.


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



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 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

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
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.)

When You Know the Storm is Coming.


We know there are all kinds of great lists out there, especially pertaining to emergency preparedness.  We love this one by blogger, Mike Smith, and wanted to share …

Get them done immediately!

  • Get prescriptions refilled now, especially if your doctor must approve the refill.
  • If you have a relative at home that requires electricity for life-assistance purposes, you will want to move he or she outside of the higher wind zone.
  • If you can get an electrician to install a generator, get it done. Do not try to install a generator yourself. 
  • If you don’t have a generator, get a power inverter or two. Radio Shack and similar stores sell them. They are a “poor man’s generator” and will keep your cell phone, laptop, and similar items charged. Tell the person in the store what you want to run off it so you get one of the right size. Do not try to run the inverter for hours at a time as that is tough on your car’s battery. Charge the cell phone (for example) and let the charge run all the way down, then use the inverter to recharge.
  • Keep your car’s gas tank full.
  • If you live in a 250-year flood plain (you can check at city hall or your library) or on the coast figure out your evacuation strategy now. Make your list of things you will take with you. Be prepared to leave at short notice.
  • Bring in outdoor furniture and other items that could become airborne.
  • Fill a few gas cans (the type you would use for your mower) to have extra in the event of power failures.
  • Purchase extra food staples. Without power, stores will be closed. Things that require less preparation are better. Bottled water is especially important. Get a Coleman stove.
  • Purchase extra batteries for your cell phone and other essential equipment.
  • If you need insulin or other medicine that must be kept chilled make plans now.
  • Consider what you would do if you were without electricity for a two weeks. If you have an invalid living with you that requires electricity, there will be areas that will be without for weeks. Be proactive.
  • If you live in a heavily wooded area, does someone in your vicinity have a gasoline-powered chain saw? Does it have fuel and a reasonably good chain/blade? Test it, now.
  • Get to an ATM. Without power, credit card readers and ATMs will not be working. In a disaster, cash is king.
  • If you are in the high wind or flood area, thoroughly photograph your home and possessions now. You will need it for insurance purposes. This includes trees, shrubs, etc. Then, if using a digital camera, upload to internet so it will be there after the storm in case the worse happens. Be nice to insurance adjusters!

Whether you evacuate or not, stockpile some good books, magazines, board games and keep a good attitude. Look at this as one of life’s adventures.

There is nothing wrong with a few prayers!

(found on )

8 Ways to Appear that You are Home when You’re Away.


Before you head out of town or to visit relatives, you may want to take some security precautions to keep your home safe – even if you have a security system.  Many home intrusions are considered crimes of convenience.  If a criminal thinks your home looks like an easy target, you might get a rude awakening when you return.  Enjoy peace of mind with these tips to make your home look occupied while you’re away:

  1. Ask a neighbor to help.  If you have a neighbor you can trust, work out a buddy system when one household is away.  Ask your neighbor to check your mail, water your plants, and check locks.  Criminals often look at mailboxes to determine whether a homeowner has been by the house recently.
  2. Turn on the radio. You may use satellite radio, your phone, or your television when you’re home, but a simple old-fashioned radio will do the trick when you’re gone.  Turn on a talk radio station loud enough that voices can be heard from outside the home.
  3. Keep a light on. Invest in some motion sensor lights outside and/or some timed interior lights that are scheduled to come on for a few hours at night.  Intruders prefer dark, empty-looking homes to target and can’t tell the difference between you turning on a light and a strategically placed timer.
  4. Check the phones. If you still receive calls through a landline, consider diverting calls to your cellphone or setting the ring on the lowest volume possible.  Phones ringing off the hook are a pretty good indicator that nobody is home.
  5. Reorganize your household schedule. You may think about your home’s cleaning service or landscaping schedule before you leave.  Do not leave a message on the front door.  Arrange for services beforehand or keep important numbers in your cell for a quick call on-the-go.
  6. Avoid posting on social media. Wait until you are home from vacation to post those great beach pictures or to detail the highlights of your adventures.  Unfortunately, many potential intruders could be people in your own network, and giving them updates about your whereabouts could be a go-ahead to ransack your home for valuables.
  7. Be wary of notifying the police. At one time, many experts recommended telling your local police department if you are away.  Today, it’s far too easy for the information you pass along to be stolen or hacked.  Only talk to police if you trust that your information will be secure.
  8. Invest in a modern alarm system. Today, home security systems are designed to keep up with the latest trends in home intrusion.  With some, you can even keep an eye on your home while you’re away through a secure, mobile portal.


(Original article found on

Present Danger?


(The following was originally printed in the Journal of Civil Defense: June 1978)

Excerpts of a statement given by Eugene V. Rostow of the Committee on the Present Danger to the U.S. Senate Committee on the Budget (March 1, 1978)

Nothing could be more useful to the nation now than a serious public discussion about the nature of Soviet policy and the problems it poses for us . . .

We believe that prudent and resolute action by this session of the Congress, substantially increasing the Administration’s Defense Budget, could mark one of the finest hours in its long and glorious history. . .

But Secretary Brown seems to suggest that we have to do no more now than keep the situation from getting any worse than it is. We emphatically disagree . . .

There is no harmony between the words and the music of the Administration’s budget. The Administration’s proposals do not meet the implacable arithmetic of the problem. The budget does not meet the Secretary’s stated goal of maintaining the status quo. It therefore fails both as a diplomatic signal and as a security measure. It simply isn’t enough to restore our deterrent strength, both strategic and conventional. Moreover, it fails the most important test of a Defense Budget: to give us full confidence in our ability to protect our national interests in peace. The Administration’s budget proposals would leave the Soviet Union’s military effort still growing more rapidly than ours, thus further increasing their lead -in many important categories of military strength . . .

The government is in a strange mood, a mood which reminds me of the ‘thirties,’ when we and the British hesitated between action and inaction until it was too late to prevent World War 11 . . .

This time we must not wait for a new Pearl Harbor to arouse us. The risks of such a course are too grave to be contemplated. In this situation of incipient crisis, we should follow one of-Parkinson’s most perceptive laws-his observation that the success of a policy is measured by catastrophes which do not happen. The budget proposed by the Administration does not meet Parkinson’s standard . . .

If the Secretary of Defense is wrong in his assessment of the present situation, we may well face the prospect that the Committee on the Present Danger identified in its 1976 statement: “Our alliances will weaken; our promising rapprochement with China could be reversed. Then we could find ourselves isolated in a hostile world, facing the unremitting pressures of Soviet policy backed by an overwhelming preponderance of power. Our national survival itself would be in peril, and we should face, one after another, bitter choices between war and acquiescence under pressure.” . . .

Four fundamental and adverse developments have taken shape since 1972, when the SALT Agreement was signed. The Soviets have made extremely rapid progress in MIRVing their missiles. Since their missiles have more throw weight than ours, this raises the first problem-how many warheads are they deploying per missile? What is the destructive power of each warhead? And what is the accuracy of these warheads, and what will it be in the future?

The second great change since 1972 is that the Soviets have made some of their ICBMs mobile, despite what the Senate was told on that subject when SALT I was ratified. The President has said that the Soviet Union is already deploying mobile ICBMs. The experts agree that it is in a position to deploy them on a large scale and quickly.

Third, recent reports of Soviet progress in antisatellite satellites-killer satellites-threaten our chief means of intelligence, communications and control. There is no need to underscore the importance of this development.

Fourth, we must note the significance of the Soviet civil defense programs. Even if imperfect, these programs reduce the effectiveness of our deterrents.

These four developments alone-and there are others-transform the problem of strategic deterrence . . .

No President of the United States should ever be put into the position of having to choose between holocaust and the surrender of vital American interests.

About:  Eugene V. Rostow, executive committee chairman of the Committee on The Present Danger, is Professor of Law at the Yale University Law School. He was formerly under Secretary of State for Political Affairs.