Survival Medicine Hour: School Safety Solutions, Fungal Infections, More

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Survival Medicine Hour: School Safety Solutions, Fungal Infections, More



Recently, Joe Alton MD wrote about school safety solutions in the wake of mass killings perpetrated by the disgruntled and deranged. Some of these strategies aren’t expensive, and those that are should make you ask: How much is it worth to save the lives of our young people by aborting these murderers? Find out what simple changes would lead to a much safer environment for our young people in these uncertain times.



Plus, Joe and Amy Alton tackle a questions from a listener in Germany that asks about how to deal with fungal infections in situations where modern pharmaceuticals aren’t available. All this and more on the latest Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy!

To listen, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

Follow them on twitter @preppershow, Facebook at Doom and Bloom(tm) and YouTube at DrBones NurseAmy Channel, and check out their medical kits, books, and other supplies at!

Some Alton medical kits


Re-Thinking School Safety

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Re-Thinking School Safety


A high school in Sante Fe, Texas was the scene of a mass murder recently, with at least 10 people killed and as many more wounded. A 17-year-old student, who was able to take a shotgun, a pistol, and some “pipe bombs” onto the school grounds, has been identified as the assailant. 

Unfortunately, incidents like that at Sante Fe High School make headlines on a regular basis. Schools have been the most recent targets, but churches, workplaces, and other “Gun Free” zones are equally at risk.

Those who are disturbed, disgruntled, or politically motivated are often armed, not only with weapons, but with a blueprint: a blueprint drawn up by previous attacks, and still a work in progress. It is constantly being tweaked to maximize casualties, and any potential killer can access it just by reading `

Given the “success” that the unhinged have had, it is amazing that most still consider mass shootings to be something that happens elsewhere. The sad truth is that there’s no reason to believe your home town is immune to such events. This became painfully clear as a shooter killed 17 at a high school just a few miles from our home in February, 2018.

Attitudes may, however, be changing. When a teenage girl was interviewed by a news outlet, she said:

“It’s been happening everywhere, I’ve always kind of felt it like eventually it was going to happen here too. I wasn’t surprised, I was just scared.”

This is perhaps the saddest statement of the New Normal: The average teenager is no longer surprised that a mass casualty event might occur at her school.

It’s time to replace complacency and fear with action to keep our schools safe. A number of steps can be taken that might help in this mission.

Improving security is clearly a priority, but how exactly can this be accomplished? Placing trained security at school entrances is of paramount importance. Many schools have taken steps in this direction, but more are needed both in numbers and visibility. If it is obvious that trained, armed security is a feature of every school entrance, some gunmen may abort their missions.

Entrances should funnel visitors through areas with trained security and, perhaps, scanners that can identify weapons. Entry points should be limited in number, and most should be locked down except for emergency exits. School perimeters should be fenced and monitored.

Of course, some will ask how schools can afford multiple professional security officers. The question should be: How can our society afford to have our children mowed down in these attacks? The price for school safety isn’t cheap, but it’s too important to pinch pennies.

Some areas might be able to supplement their paid personnel with trained volunteers. There are likely a number of people in each community who are committed to school safety and willing to donate some time to keep students safe. These people can be assembled into teams and trained to identify threats, notify authorities, and provide first aid when needed.

An issue that should be addressed immediately is the protocol related to fire alarms. Shooters have learned to pull alarms in order to get targets out of classrooms into corridors, where they are easier targets. This tactic was used by the gunman in the South Florida high school incident. At Sante Fe, a teacher set off the alarm in an effort to warn of the attack, but with the same end result: multitudes of unsuspecting targets densely packed in the halls.

Fire alarms are necessary, of course, and an orderly process is needed to move large numbers of students out of buildings. The same process isn’t the best strategy for terror events, however. A clearly different alarm, possibly a siren or foghorn, should warn of this type of incident; trained staff should then respond by entering and quickly exploring hallways while awaiting police response.

Instilling a culture of situational awareness would be a way to decrease future attacks and casualties. Situational awareness is a state of calm, relaxed observation that maximizes the ability to spot threats. These threats are known as “anomalies”; learning to recognize them can identify suspicious individuals and save lives.

Situational awareness also involves always having a plan of action when a threat occurs, even if it’s as simple as making a note of the nearest exit at the mall. This may seem like plain old common sense, but in this era of smartphones, so many of our youngsters are oblivious of their surroundings. Before, the worst that could happen was a bump on the head for walking into a streetlamp. Today, the consequences may be much worse.

Teach our citizens to avoid the natural paralysis that occurs in unexpected circumstances. The gunman at Sante Fe caused twenty casualties; a shooting at a Orlando nightclub caused 200. it’s possible that quick action while a gun was being reloaded might have made a difference in the outcome.

Having said that, it’s hard to act when your brain isn’t trained to do so. When such training occurs at a young age, however, it becomes second nature and might save lives. A strategy such as the Department of Homeland Security’s “Run, Hide, Fight” triad are simple enough and could be part of the answer.

Given the importance of saving lives, why not train our students in simple first aid techniques to stop bleeding? Rapid action by bystanders is well-known to decrease the number of deaths from hemorrhage. Add “Reducing” bleeding to “Reading, ‘Riting, and ‘Rithmetic” as part of school curriculum, and lives might be saved.

Identify persons of interest through their social media posts. Many active shooters are vocal about their intentions. You might be concerned about “big brother” monitoring our public conversations on Facebook and other sites, but you must answer this question:  How many deaths might occur as a result of ignoring warning signs? Privacy and public safety must achieve a reasonable balance.

We must always be on the lookout for signs of trouble. Even if this drives some potential gunmen underground, it might identify others in time to prevent an attack.

Provide first aid kits for bleeding in public venues that can be accessed by those at the scene. With supplies, the Good Samaritan will be more likely to save a life. I predict that these kits will be fixtures on the wall next to the fire extinguisher in the uncertain future. Although you might consider it overkill, putting a tourniquet in your high school student’s backpack (and teaching them how to use it) may not be a bad idea. So is the idea of buying a gun safe to limit access appropriately.

Of course, the recent debate on arming teachers must depend on the community. In some areas, few teachers will have firearms

training. In others, many will. Simple possession of a weapon, however, is useless without knowledge and experience in its use.

Despite the above recommendations, our response as a nation has been slow to correct the problem. I say that era must end. Let’s stop being “soft” targets. We must forsake the notion that shootings are just part and parcel of the New Normal. Instead, we must begin the process by which we change our attitude and level of vigilance as a society.

You don’t have to be a Department of Homeland Security official to know that there are more active shooter events on the horizon. A prepared nation wouldn’t be invulnerable to attacks, but its citizens would have a better chance to survive them

Joe Alton MD


Learn more about active shooter incidents and many other disaster preparedness issues in the award-winning Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon.

Can You Prepare For A Volcano?

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Can You Prepare For A Volcano?

Can You Prepare For A Volcano?

Uh oh...

Uh oh…

There are a number of disasters, natural or man-made, where a great deal of preparation greatly increases your chances of survival. Then there are others, like volcanic eruptions or asteroid strikes, where your option are, to say the least, more limited. You might not consider a volcano as the most likely event to ruin your day, and you’d be right. Still, it makes sense to know about them and what you might be able to do to prevent being a victim of one.

A volcano is a rupture in the crust of the earth which allows lava (molten rock at 750-1250 degrees Fahrenheit), ash, and gases to escape from deep below the surface. The violence of volcanic eruptions is so great that boulders can come raining down from the sky to flatten houses and, perhaps, you.

Most have the impression that a volcano is a conical mountain with smoke and fire spewing from the top, such as you see today in Hawaii. In actuality, however, most volcanos can be active without displaying physical signs for thousands of years.

Volcanoes can also take a number of forms: In Yellowstone National Park, a huge dormant super-volcano looks more like flat land than a cone. Indeed, it takes some observation to know you’re walking on top of it. Geysers like ‘Old Faithful” exist as evidence that there’s still a great deal of pressure and molten rock below the surface.

Old Faithful Geyser


One doomsday scenario includes the eruption of this huge land feature, which is called a “caldera” (meaning “cauldron” or “cooking pot”). This disaster last happened 640,000 years ago, but it’s thought to be an event that is likely to occur again “soon”. In geologic time, “soon” means in the next 40,000 years or so.

If you live in a volcanically active area, there are a few things that you can do to decrease the chance of becoming a victim. Monitor volcanic activity reports via NOAA radios and evacuate the area if authorities believe an eruption is imminent. Have a plan in place to get the family together via texting, email, social media, etc.

Know several routes out of the area; roads may be blocked by fire, thick ash, or lava flows. Visibility and breathing might become difficult, so respirator masks and goggles should be worn by every member of the group.

That's not snow, it's volcanic ash!

That’s not snow, it’s volcanic ash!

Ash can also damage engine parts and stall escape vehicles, so be prepared to go on foot if necessary. Any equipment with moving parts that must remain outside as your evacuate should be covered with tarps.

The most intelligent decision is to hit the road, Jack, and take a good amount of supplies with you. There are circumstances, however, where you might be unable to leave your home. While you can’t expect even the most solid house to be much protection from a wall of lava, you might still be able to achieve protection from volcanic ash:

·       Close all windows and doors

·       Block chimneys

·       Stay under the sturdiest part of the roof (ash can be very heavy)

·       Have food and water stored in quantity

It imperative to have at least several days supplies packed and ready to go at a moment’s notice. I call this a “G.O.O.D.” bag (Get Out Of Dodge!).

It’s also important to have a good kit to deal with medical issues. You’ll need materials that that treat burns and orthopedic injuries as well as masks, goggles, and flashlights for every member of the family. You might not consider these items to be medical in nature, but they’ll help you breathe and see even if the ash is falling thickly, and you’ll be in better physical shape and more likely to survive.



No masks and no shelter? Place a damp cloth over your nose and mouth and cover your skin as much as possible. Of course, protection in the form of work gloves, sturdy high-top boots, and head coverings (a hard hat even seems prudent here) will decrease your chance of injury as you escape the area. Avoid low-lying areas that might be a natural conduit for lava. Stay clear of areas downwind of the volcano; ash and flying debris will be thickest there.

Don't let this happen!

Don’t forget the pets

Don’t forget your pets: Have a “G.O.O.D.” bag for them as well. Here’s the Red Cross’s recommendations for emergency pet kits and a plan of action that will increase your animals’ safety in times of trouble:

You might not always have a lot of options in a disaster, but you can always improve your chances of surviving even in the worst situations.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about disaster preparedness and 150 medical topics you might face off the grid in the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. Plus, fill those holes in your medical supplies at!

Third Edition

Third Edition

ASIDE: Can you stop a lava flow? Here’s some ways they’ve tried:

Survival Medicine Hour: Spring Camping Safety, Snakebite, More

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Camping Safety

Camping Safety

School is winding down, and families are starting to think about that camping trip to the mountains or shore. Camping safety is important, and a lot of factors need to be considered like weather, gear, and more to make a camping trip memorable (and I mean in a good way, not a bad way). What you need to do to deal with common injuries, supplies you’ll need, and even a little about snakebite, since those critters are waking up from their cold-weather slumbers.

venomous snake bite

venomous snake bite

all this and more on the Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP!

To listen in, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

Follow us on Twitter @preppershow  YouTube at drbones nurseamy channel

Facebook at our Survival Medicine Group DrBones NurseAmy or Doom and Bloom pages

Check out our kits and books at


Survival Medicine Hour: Wound Closure in Survival Settings, More

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wound closure

Important factors when deciding to close a wound off the grid

Injuries occur in disaster and other off-grid settings, and some of those break the skin or even go into deeper layers, like subcutaneous fat and muscle. When do you close a wound and when is it wiser to keep it open? Also, if you’re going to close it, what materials should you use and why? Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, take you through the decision making process and much more in this episode devoted to wound closure in survival situations.

Suture Training is important, but so is open wound care

Suture Training is important, but so is open wound care

Follow Joe and Amy on Twitter @preppershow, plus their YouTube Channel at drbones nurseamy, and Facebook on their Doom and Bloom(tm) page!

To listen in, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Amy's garden

Amy’s garden

Fill those holes in your medical supplies with kits and individual supplies at

The Survival Medicine Handbook, Third Edition

The Survival Medicine Handbook, Third Edition


Survival Medicine Hour: Wound Cleaning, Medical Backpacks, More

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dealing with open wounds

dealing with open wounds

The right equipment is important for anyone to do a job efficiently. You wouldn’t expect a steak knife to cut a tree down better than a saw, or see a hunter have the same success with a catapult as opposed to a rifle. The same goes for the containers you put supplies in, especially one you have to carry with you while bugging out or away from your retreat. The right medical backpack allows you to work effectively as a medic, while giving you the ability to have plenty of materials and minimizing back problems. Dr. Bones and Nurse Amy discuss what goes into choosing a good medical backpack.

A loaded first aid kit with medical supplies for trauma,burns, sprains and strains and other medical issues

Picking the right medic bag

Plus, some basics of wound cleaning off the grid. In normal times, you can pass off a person with a wound to a hospital, but after a disaster, it’s your responsibility to see the wound to full recovery. That means diligent and strict attention to wound cleaning. We talk about some strategies for wound care off the grid that will decrease the risk of wound infections and increase the chances for survival.

All this and more on the Survival Medicine Hour with Joe and Amy Alton!

To listen in, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Dr Bones/Nurse Amy

Dr Bones/Nurse Amy

Follow us on Twitter @preppershow, Facebook at Doom and Bloom’s page, and YouTube at DrBones NurseAmy channel

Plus, get a copy of the Survival Medicine Handbook’s award-winning Third Edition at

2017 Book Excellence Award Winner in Medicine

2017 Book Excellence Award Winner in Medicine

All About Arthritis

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Arthritis Pain and Inflammation

Arthritis Pain and Inflammation

The human body is a marvel of engineering. Its dexterity, strength, and stamina allow amazing feats of athleticism and, yes, survival in the worst adversity; but wear and tear takes its toll over time on just about everything with moving parts (even you). The resulting loss of work efficiency and mobility, bad enough in normal times, can decrease your chances to succeed after a major disaster.

The moving parts in our skeletal frame are known as joints. Each one has varying amounts of range of motion and strength. They are remarkably durable, but break down with time and strain. The longer lives of modern humans has, thus, caused a high prevalence of joint disease called “arthritis”.

It’s thought that 54 million Americans today suffer from some form of arthritis, and that the number will rise to 78 million by the year 2040.  Although you might consider arthritis a disease of the elderly, two-thirds of the cases occur in pre-retirement age individuals.

Some cases of arthritis get their start with an injury

Some cases of arthritis get their start with an injury

Risk factors for arthritis include:

Age: Many types of arthritis are more common as people get older

Sex: Women are more likely to get certain types, such as rheumatoid arthritis, while men are more prone to a form of arthritis known as “gout”.

Family history: Some types of arthritis seem to run in families.

Injuries: Increased strain can injure joints, which can eventually lead to arthritis. This is seen in athletes, but can occur from manual labor, after surgery, or an accident.

Obesity: Those who lead sedentary lifestyles and are obese suffer long-standing strain on the joints in the hips, knees, and back, which can lead to arthritis.

Symptoms of Arthritis

Swollen knee

Swollen knee

Symptoms of arthritis may include:

  • Pain
  • Swelling
  • Joint stiffness and decreased range of motion
  • Reluctance to use the affected joint due to discomfort
  • Accumulation of fluid or other material (like uric acid in gout) in the joint space
  • Muscle weakness (with chronic arthritis)
  • Fever (if caused by an infection)

Types of Arthritis



osteoarthritic changes to the knee

osteoarthritic changes to the knee

Osteoarthritis is the most common form of arthritis, especially in older individuals.  It can affect just about any joint in the body.  Hands, feet, back, hip, and knees are most commonly affected, but osteoarthritis can occur even in the spinal column.

Osteoarthritis is acquired by daily wear and tear on the joints, although it can also be a long term effect of a previous injury which accelerates degeneration. Obesity can increase stress on joints and lead to osteoarthritis, as well.

Warm compresses are useful to treat discomfort and stiffness.  Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin are helpful, as is Capsaicin cream or ointment.



The worst cases may require oral or injectable steroids.  Sometimes, a needle is placed to drain excess fluid from an affected joint to give relief. This is call “arthrocentesis”. This procedure may decrease pain, but could introduce infection into the joint if not performed with care.


Rheumatoid Arthritis

Severe rheumatoid arthritis

Severe rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common auto-immune disease in the world today. In RA. the body’s immune system attacks its own tissues. The attack is not only directed at the joint but to other parts of the body.  Unlike some other joint diseases, rheumatoid arthritis tends to affect the same joint on both sides of the body. Women seem to be more susceptible than men.

Rheumatoid arthritis especially affects joints in the fingers and wrists, but is also common in knees and elbows. Over time, it can lead to severe deformities if not treated. Rheumatoid arthritis occurs in younger populations than osteoarthritis, even striking children on occasion.

Changes seen in rheumatoid arthritis

Changes seen in rheumatoid arthritis

Other symptoms associated with rheumatoid arthritis that you might not see with degenerative osteoarthritis:

  • Dry mouth
  • Dryness, Itching or burning in the eyes
  • Insomnia
  • Strange sensations in the hands or feet
  • Nodules under the skin
  • Chest pain when taking a breath

At present, there is no cure for rheumatoid arthritis. Treatments concentrate on easing the symptoms. Medical therapy includes strong anti-inflammatory medications such as oral steroids (example: Prednisone).

Another auto-immune disorder that can cause joint disease is known as Systemic Lupus Erythematosus (SLE). Although usually diagnosed by blood testing, Lupus can be differentiated from rheumatoid arthritis due to its one-sided nature. You will also see patients with SLE experience hair loss and body rashes. Lupus is often treated with long-term oral steroids.

Even though rheumatoid arthritis cannot be cured, it is thought to be possible to prevent the condition from worsening. Weight loss is one way to improve symptoms and prevent progression. Physical therapy to strengthen muscles and joints is also thought to be helpful.


Bacterial Arthritis

Bacterial arthritis (sometimes called “septic” arthritis) is often the result of some penetrating injury that allows organisms to invade the joint space. It can also occur from within, as when a blood infection (septicemia) or bone infection (osteomyelitis) has spread to a joint.

Common skin bacteria, such as Streptococcus and Staphylococcus, are the usual suspects; certain sexually transmitted diseases, like gonorrhea can also be the cause, although viruses and even fungi may be involved.

Typical symptoms of a bacterial arthritis are the same as osteoarthritis, except that the patient may have a fever and may exhibit redness or warmth over the affected joint. In addition to treatment for pain, arthrocentesis (removal of fluid with a needle) and intravenous antibiotics in the Keflex family (cephalosporins) or others may be helpful if the cause is bacterial.


Psoriatic Arthritis



Psoriasis is a relatively common skin condition that causes the formation of multiple red, scaly patches. This leads to itching and may be considered by some unsightly, but 30 per cent of sufferers also develop inflammation of the joints known as “psoriatic arthritis”.

Psoriatic arthritis victims may be differentiated from degenerative arthritis by nail changes that look like fungal infections, redness in the eyes, excessive fatigue, and swollen fingers and toes (the areas most commonly affected). The condition is most commonly treated with NSAIDs like ibuprofen for pain, steroids, and anti-psoriasis pharmaceuticals. Early treatment may lead to less severe damage to joints.



Gout with Tophi

Gout is another condition that destroys joints over time. Inflammation is caused by deposition of uric acid crystals in the joint.  Some people simply produce too much uric acid or don’t eliminate it well.  Obesity is a major risk factor, as is diabetes. This illness occurs primarily in men; a history of certain types of kidney stones may be associated with episodes of gout.

The presentation of gout will appear as:

  • Inflammation in one or two joints. The big toe is the classic example, but knees and ankles may also be affected.
  • Warm, red, painful joints. The pain is throbbing and often severe. Even laying a sheet over it may cause pain.
  • Fever.
  • Episodic repeat attacks (50% of cases).
What gout feels like

What gout feels like

After multiple episodes, permanent damage occurs and the joint loses its range of motion. Chronic sufferers may also develop lumps composed of uric acid crystals called “tophi”.  Tophi are lumps below the skin, mostly around joints like the big toe. They may drain chalky material from time to time.

Specialized prescription drugs are available for gout, such as Colchicine and Allopurinol.  If you have a family member with gout, encourage them to stockpile extra medications; they won’t be found in your standard medic’s storage.

Lifestyle and dietary changes may be helpful in improving the quality of life of individuals with gouty arthritis. Consider:

  • Avoiding alcohol
  • Reducing how many uric acid elevating foods you eat. These include: Liver, red meat, herring, sardines, anchovies, kidney, beans, peas, mushrooms, asparagus, and cauliflower. .
  • Avoiding fatty foods
  • Eat enough carbohydrates

Natural Options For Arthritis



From an alternative standpoint, there are various treatments for joint pain caused by arthritis.  Glucosamine supplements are popular. It should be noted that glucosamine sulfate preparations have more evidence for their effectiveness than glucosamine hydrochloride. Take 1,500 milligrams once a day on a regular basis.

Glucosamine, when paired with chondroitin sulfate 800-1,200 milligrams a day, has been shown to possibly slow progression of some arthritic conditions.

Two teaspoons of lemon juice or apple cider vinegar mixed with a teaspoon of honey twice a day is a time-honored treatment.  Other oral supplements reported to be effective against joint pain are:

  • Turmeric powder
  • Soybean Oil
  • Avocado Oil
  • Rose hips
  • Fish Oil (no more than 3 grams per day)
  • Selenium
  • Bathua leaf juice
  • Alfalfa tea

For external use, warm and cold compresses are useful. Warmth increases blood flow to the joint, while cold decreases inflammation and swelling. Other options include:

  • Capsaicin ointment or cream
  • Use Arnica essential oil on affected areas (good for muscle aches as well)
  • Apply warm vinegar to aching joints.
  • Mix powdered sandalwood into a paste; it has a cooling effect when rubbed on a joint.

A number of other modalities may alleviate the pain of arthritis and improve range of motion. Acupuncture, massage therapy, and physical therapy may alleviate muscle spasms. Electricity delivered by a device known as a TENS (Transcutaneous Electrical Nerve Stimulation) unit may be helpful. Other suggest magnets applied to injured joint. These are just a few of the many alternative remedies available. Do your own research and make your own conclusions.

Joe Alton MD

Joe Alton MD

Joe Alton MD

Fill those holes in your medical supplies with kits and individual items from Nurse Amy’s store at

And don’t forget your copy of the latest edition of the award-winning Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way!

The Third Edition

The Third Edition

Video: Amputation in Survival Settings

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Amputation in survival settings

Amputation in survival settings

One of the worst injuries that can occur in a disaster or other off-grid setting is the traumatic amputation. In the Civil War era. amputations on the battlefield or later in the field hospital resulted in 1/4 to 1/2 of the victims succumbing to their wounds. In an EMP attack, we could easily be thrown back to that era medically, and we should consider what can be done for those injured so horrifically.

Joe Alton MD attempts to tackle this delicate subject that others won’t touch in this video, knowing the limitations on the medic and the lack of sterility in most instances. See him explain his thoughts and rationale on what can and can’t be done, and some tips on what to do when confronted with the traumatic amputation.

To watch, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton MD

Dr. Bones and Nurse Amy

Amy and Joe Alton

Fill those holes in your medical supplies with individual kits and supplies from Nurse Amy’s entire line at

three compact first aid kits great for hiking and camping made by Amy Alton of


Click here to view the original post.


Trauma is a common cause of nosebleeds

Trauma is a common cause of nosebleeds

A common, often minor, problem that causes significant anxiety for both the patient and the caregiver is the nosebleed, also known as “epistaxis”. More than 50% of the population will experience a nose bleed during their life, although only about 10% will require medical aid to stop it. Most significant bleeds will occur either at a very young age (2-10 years) or much later (50-80 years of age).


Nasal Anatomy (common area of nosebleed origin circled)

Nasal Anatomy (common area of nosebleed origin circled)

The lining of the nose is supplied richly with blood vessels. When this lining is eroded, bare veins and arteries have a tendency to “leak” in a constant ooze.

About 90% of the time, the hemorrhage is coming from the front of the nose (“anterior”), near the cartilage-bearing septum. This location, known as “Little’s Area” or “Kiesselbach’s Plexus” contains numerous small arteries and veins where bleeding can originate. Bleeding comes from one nostril only in the grand majority of cases.

In a small percentage of cases, bleeding starts in back of the nose (“posterior”) where other arteries are located. These nosebleeds have a tendency to occur more often in the elderly, be heavier in volume, and more difficult to stop. The diagnosis is usually made when the usual measures for an anterior nosebleed have failed. A posterior nosebleed may be suspected by heavy bleeding from both nostrils or by blood draining down the back of the throat.

where posterior nosebleed originate (compare with anterior illustration above)

where posterior nosebleed may originate (compare with anterior illustration above)


Epistaxis may occur for a number of reasons. Of course, trauma to the nose and face is a common cause. This trauma may be caused by anything from a blow to the face to excessive nose-picking. Other risk factors include:

  • Exposure to dry air, especially if very cold or very warm (say, from space heaters in winter)
  • Sinusitis and other infections affecting the nasal cavity
  • Foreign objects in the nose
  • Excessively forceful nose-blowing
  • Allergies
  • Nasal septum abnormalities or complications from surgery to correct them
  • Use of drugs inhaled through the nose. These can be recreational, such as cocaine, or therapeutic, such as afrin (oxymetazoline) or neo-synephrine. Note that Afrin and neo-synephrine are habit-forming!
  • Blood clotting disorders
  • Liver or kidney disease
  • Chronic alcohol abuse
  • Tumors in the nasal cavity
  • Non-inhaled medications that “thin” the blood, like coumadin, aspirin, plavix, nsaids, etc.

High blood pressure (Hypertension) is associated with nosebleed, but it is uncertain which is the “chicken” and which is the “egg”. Is the elevated pressure causing the bleeding or does anxiety associated with seeing blood cause the blood pressure to rise?


Nosebleeds rarely cause life-threatening hemorrhage, but some signs may tip you off to excessive blood loss, including:

  • Weakness
  • Fainting
  • Dizziness
  • Confusion
  • Rapid heart beat
  • Bleeding from any place other than the nose
  • The presence of fever

If modern medical facilities are available, persons with these symptoms should present there for care.


Luckily, few nosebleeds will cause heavy bleeding and most can be treated at home by following a few general steps:

  • First and foremost, stay calm. Anxiety will speed the pulse and cause more rapid bleeding.
  • Sit up but not back; leaning forward will more effectively prevent blood from flowing down the back of your throat.
  • Using your index finger and thumb, apply pressure by tightly pinching the area of cartilage below the bony part of the nose (pinching the bony part does little to stop the bleeding). Pinch towards the face. A commercial nasal clip is available for the purpose (see image below).
  • Breathe through your mouth while holding pressure for 10 minutes.
  • If the bleeding successfully stops, don’t blow your nose, bend over, or strain for the next day.
  • If bleeding doesn’t stop, blow out residual clots and consider a spray like Afrin with 5-10 more minutes of pinching the nose.
Nasal Clip for nosebleeds

Nasal Clip for nosebleeds

If these simple instructions fail to achieve the desired result, a more thorough evaluation is warranted. To determine the location of the bleed, caregivers may spray a decongestant or saline solution into the nostrils. This will constrict the blood vessels, make visualization easier, and may even stop the bleeding. An instrument called a nasal speculum is then placed into the nostril to look inside.

using a nasal speculum and silver nitrate to cauterize an anterior bleed

using a nasal speculum and silver nitrate to cauterize an anterior bleed

If the bleeding is from an easily-seen blood vessel towards the front of the nostril, it may be cauterized with a swab stick containing a chemical called silver nitrate.


If this fails to stop bleeding, a packing with petroleum jelly may be required to apply pressure to the leaking vessel. Other packing materials contain blood-clotting agents like Celox, which comes in a ribbon option, or drugs like oxymetazoline (Afrin) or neo-synephrine to help stop the bleed (beware of elevating blood pressures with the last two). Sometimes, synthetic sponges (Merocel) and balloons are needed to stop bleeding, especially posterior bleeding.

Placing an anterior pack

Placing an anterior pack with a “bayonet” forceps

To place a simple anterior packing into the nose, gauze impregnated with petroleum jelly is gripped with a “bayonet” forceps and inserted into the anterior nasal cavity.  The first packing layer is inserted straight back along the floor of the anterior nasal cavity, not at an upward angle. Additional layers of packing are then added in accordion-fold fashion. A nasal speculum (pictured in a previous image) can be used to hold the positioned layers down while a new layer is inserted.  Packing is continued until the nasal cavity is filled. Be aware that you could traumatize the nasal cavity if placement is poorly performed.

It should be noted that nasal packing is an uncomfortable procedure usually performed in the emergency room. Significant pressure is usually required to be effective and the packing must stay in place for a good 48 hours or so.

A true posterior bleed may be difficult to stop without specialized equipment like balloon catheters such as the Rhino-Rocket, The Epistat catheter, or the Simpson Plug. A urinary Foley catheter balloon may also be an option to apply pressure to a posterior bleed.

The "Rhino Rocket" balloon catheter

The “Rhino Rocket” balloon catheter

Although cold temperatures are known to constrict blood vessels, it is unlikely that an ice pack would effectively deliver enough cold to the origin of the hemorrhage while at the same time allowing the application of pressure to the area. Given the choice, applying pressure is more important. Having said that, ice packs are important in nasal trauma cases to decrease swelling.

Here’s a useful video on various ways to stop a nosebleed:


Once you’ve had a significant nosebleed, you’ll do everything possible to not have another one. Here are some strategies that will decrease the chances of a recurrence:

  • Prevent nasal dryness. Moisten your nasal cavity with petroleum jelly or antibiotic ointment. Use a cotton swab to gently smear a thin layer inside several times a day, especially before going to sleep. Alternatively, use a saline nasal product. Spraying it in your nostrils helps keep the inside of your nose moist.
  • Use a humidifier to increase the humidity in your home during winter.
  • Don’t smoke. Smoking can dry out the inside of your nose.
  • Don’t pick your nose or allow your child to do so.
  • Don’t blow your nose forcefully.
  • Keep fingernails short so as not to traumatize the lining (if you must pick).
  • Avoid excessive use of decongestants and allergy medications, which can dry out your nose.
  • Discuss other medicines you take with your health care provider to make sure they aren’t a factor in your nosebleeds.

Nosebleeds can be scary, but most can be dealt with successfully with limited supplies, even in an austere environment. With some materials and knowledge, they can be a bump on the road, not the end of the road for the prepared individual.

Joe Alton MD

Joe Alton MD

Joe Alton MD

Learn more about nosebleeds and 150 other medical topics in the Third Edition of the Survival Medicine Handbook, the 2017 Book Excellence Award winner in medicine! Also, fill those medical holes in your survival supplies by checking out Nurse Amy’s entire line of kits and individual items at

Survival Medicine Hour: James Rawles, Staph, Chest Trauma, More

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Survival Medicine Hour #373

rib fracture

rib fracture

Joe and Amy Alton, aka Dr. Bones and Nurse Amy discuss chest trauma, including rib fractures, ballistic and projectile trauma, and pneumothorax. Plus, an interview with Survival Blog’s James Rawles on a book he wrote about a hypothetical Christian homeland in his novel “Land of Promise”.

James Rawles' Land of Promise

James Rawles’ Land of Promise

Plus, a series of listener questions about things like Staph infections, food-grade diatomaceous earth, and much more!

To listen in, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Nurse Amy/Dr. Bones

Nurse Amy/Dr. Bones

Learn about 150 medical topics off the grid in the award-winning Third Edition of The Survival Medicine Handbook: The Essential Guide For When Medical Help is Not on the Way.

How To Survive Home Fires

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6 Important Things To Know To Help You Survive A Home Fire

Apartment house fire

Apartment house fire

At least 12 people, including four children, were killed, with several others injured, in a massive apartment building fire in the Bronx, NY this week. Although the circumstances are unclear, it appears that it was started by a child playing with a stove.

170 firefighters were dispatched to the four-alarm fire, located in a five-story walk-up in the Bronx, just a block from the world-famous Bronx zoo. The crews (the first of whom arrived in three-five minutes) worked to control the blaze in 15-degree temperatures.

Having written about the recent wildfires in California, the story made me think about what you should do to protect your family from becoming victims of a building fire.

New York City, which has many older buildings, has been the site of winter fires causing multiple casualties in the past; I wrote about one in 2015. Gas leaks and frayed wiring are often the culprits, as well as inappropriate use of space heaters.

6 Things To Know About The Nature Of Home Fires

The nature of fire in buildings

The nature of fire in buildings

Every year, millions are at risk for, and thousands of people are killed or injured by, fires in the U.S. Many of these deaths and injuries can be prevented with some knowledge of the nature of fire. You must understand the following six points:

1) Most people who die in fires don’t die because of burns as much as from asphyxiation (suffocation). Fire consumes available oxygen that you need to breathe, and produces harmful gases and smoke. Inhalation of even a small amount of these can disorient you and affect your ability to respond appropriately. Even if there is little smoke, some poisonous gases are invisible and odorless. Some people who die in bed appear to have not woken up at all, most likely a result of toxic inhalation. That doesn’t mean the bodies can have burns on them, but they are often not the cause of death.

2) Fire spreads rapidly. A small fire can go out of control in less than a minute if not extinguished rapidly. Many house fires occur at night when everyone is asleep, making it possible for smoke and flames to engulf the entire building before you are even aware of it. Sometimes, rooms can combust all at once, a phenomenon known as a “flashover“. Opening hot doors can cause a fire effect called a “backdraft“, which appears similar to an explosion.

3) The environment in a fire is likely to be dark, not bright as you might think. Black smoke can easily make it impossible to see clearly as well as cause eye irritation. This leads to confusion as to where the best avenues of escape might be.

4) Heat from a fire can burn you, even if you’re in a room that isn’t on fire itself. Breathing in super-heated air can burn your lung tissue and is more lethal than burns on the skin.

5) Hot air rises. Most people understand this concept, but not the extremes you’d experience in a fire. Air that is just hot at floor level becomes much hotter at eye level. This is why you should stay close to the floor as you make your way out of the building.

6) Fire needs fuel (and oxygen) to survive and grow. People unwittingly feed fires by keeping all sorts of flammable clutter around the house. Don’t collect old newspapers or other combustibles, especially near heaters or stoves.

What To Do In A Fire

A plan of action made before a fire occurs will greatly increase the chances for survival. Here are some important considerations:

  • Make it clear to everyone that there’s a fire. Hit the fire alarm or loudly yell “Fire!”. You should have previously identified at least two exits and conducted fire drills with your family so that they know exactly what to do.
  • Get the heck out of there if it’s clear the fire isn’t the kind that can’t be doused easily by your fire extinguisher (you should have more than one placed in susceptible areas). Don’t wait to grab personal items, you might have only seconds to safely leave.
  • Get down low and crawl to an exit to be least exposed to heat and smoke. Cover your nose and mouth with a cloth if possible. Authorities often suggest wetting it, a good idea if you can do it quickly without delaying your leaving the building. Covering your body with a wool blanket is an option, but don’t use a wet one; when wet, wool will conduct heat more quickly and cause burns.
  • Once you’re at the exit, touch the doorknob or the door itself before opening. If very hot, leave it closed and pick another exit. If the door isn’t hot, open it slowly; close it if fire or heavy smoke is present.
  • Call 911 as soon as you exit the house. If you are missing someone, tell the firefighters where they might be located in the building. Same with pets. Returning to a burning building to search for someone may be heroic, but it is also extraordinarily dangerous. One person was killed when he re-entered the building in the Bronx fire to look for more victims.
  • If someone catches fire: stop, drop, and roll. Stop them immediately, drop them to the ground, and roll them until the fire is out. Smother the flames with a thick towel or blanket if available.

Trapped in the Building

Trapped in a burning building

Trapped in a burning building

Many peoples’ worst nightmares involve being stuck in a burning building. There are a number of things, however, that you can do that will give you time until help arrives.

First, stay calm. People who are agitated may panic and make decisions that lead to very bad outcomes.

Do everything possible to let rescue personnel know you are there. If you can communicate with firefighters, let them know where you are, using either your cell phone or by signaling for help from a window. If possible, hang a sheet out to make it obvious where you are.

Speaking of windows, tear off any window treatments, like curtains. They are flammable and might prevent you from being seen. Make sure that your windows are not secured  in a fashion that prevents opening them in an emergency.

If there’s a bathroom or sink, fill it with cold water and soak whatever cloth items are available. Use them to block the ventilation duct (turn the system off) and the spaces under and around doors. If you’re in a bedroom, soak the mattress and put it up against  the door; secure with a chair.

If there’s a bathroom, there’s likely to be an exhaust fan. If it works, you can clear some smoke with it.

If you still can’t get out of the building and smoke is building up, wet a towel and cover your nose and mouth with it. Grip the towel with your mouth and breath through your nose (it’s a longer route to your lungs). Get down low to the ground, as mentioned above.

Many deaths and injuries from fires are preventable with a little planning and quick action. Be aware of fire hazards in your home and work to eliminate them before a disaster strikes.

Joe Alton MD

P.S. I have great respect for the firefighters who fought this huge blaze is such difficult conditions. They are true heroes.

Joe Alton MD

Joe Alton MD

Find out more about fires, burns, and 150 other topics in disaster settings in the award-winning Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

The Survival Medicine Handbook

The Survival Medicine Handbook

Burn Injuries On and Off The Grid

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second degree burn

second degree burn



burn injuries

burn injuries

Whether caused by a raging wildfire or due to an accident while preparing food, burns are a major challenge both on and off the grid. Injuries from burns that require medical help top one million each year in the United States, with thousands of deaths reported. These numbers are alarming, given the fact that, in modern times, few are us are exposed to fire as often or directly as our ancestors were. Despite this, only a small percentage of families have formulated and practiced an escape plan for their own homestead.

There are different types of burns. the American Burn Association’s statistics show their relative frequencies:

  • 44 per cent: burns from flames
  • 33 per cent: scalds caused by exposure to hot fluids (50 per cent of burns in children)
  • 9 per cent: contact with a heat source
  • 4 per cent: electrical burns
  • 3 per cent: chemical burns
  • 7 per cent:   miscellaneous causes

Of course, anyone who sustains a serious burn should be transported immediately to a hospital, preferably one with a dedicated burn unit. After a disaster, however, these facilities may be inaccessible or overwhelmed by a large number of casualties. Therefore, it is possible that the average citizen may be required to provide burn care in disaster settings.

Off the grid long-term, the risks are even greater. Without power, we will be cooking over fires more frequently.  The potential for significant burn injuries will rise, especially if small children get too close.  It’s important for the “medic” to have a working knowledge of burns and their treatment.

Rule of 9's: Front torso 18%, back 18%

Rule of 9’s: percentages slightly different in babies

The percentage of body surface area is often used to determine the severity of injury. A system known as the “rule of 9’s” is thought to give a rough estimate of the risks involved. Any burn covering more than the size of, say, your palm is serious enough to be medically evaluated. In survival settings, the general health (not to mention work efficiency) of a group member already under stress may be impacted.

(Note: Normally, the palm area measure is used only for burns that are more than superficial, but I believe that all burns this size or greater should be brought to the attention of the medic.)

burn degrees

burn degrees

Off or on the grid, burns are best categorized by “degrees”, a measure related to the depth of penetration. The deeper the burn damage, the graver the consequences for the victim.

1st degree burn (sunburn)

1st degree burn (sunburn)

FIRST DEGREE BURNS:  First-degree burns affect the epidermis, the topmost layer of the skin. A typical example would be a “sunburn”. These burns appear red, warm, and dry, and are painful to the touch. Mild swelling may occur. Dry, dead skin will cause itching, but peels off after a period of time. No scarring is expected.

Although most first-degree burns are minor, extensive ones must be watched closely. They can cause dehydration and even enough heat loss to cause hypothermia.

Treating a first-degree burn: Treatments for a first-degree burn include:

  • Cool water soaks for five to ten minutes (many make the mistake of running cold water over the burned area for only a few seconds). Avoid ice, which traumatizes already-damaged skin by decreasing circulation to it.
  • Pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol). After a day or so, the pain will subside.
  • Anesthetic ointments and burn gels containing aloe vera.
  • Antihistamines for itching.

Expect complete healing in a week or so.

second degree burn

second degree burn

SECOND-DEGREE BURNS:  Second-degree burns, sometimes called “partial-thickness” burns, affect the deep layer of the skin (the “dermis”). You will see areas that are painful, swollen, and appear moist rather than dry. The area will have a tendency to weep clear or whitish fluid. These injuries often have a number of blisters of various sizes.

Treating a second-degree burn: Treatment for a second-degree burn should be quick and intensive. The faster treatment is begun, the faster the recovery. Consider:

  • Running cool water on the burn for 15 minutes or longer.
  • Quick removal of rings, bracelets, and necklaces due to rapid swelling that occurs.
  • Bandaging the wound with non-stick dressings like Telfa pads. Avoid the use of cotton balls as dressings due to the sloughing off of fibers that can increase the likelihood of infection.
  • Using specialized burn dressings like Xeroform; similar dressings can be improvised using gauze and petroleum jelly.
  • Giving pain medicines as needed.
  • Applying antibiotic cream to blisters to prevent infection.

Blisters may be numerous, but should be broken only if very large or it is clear they would break during normal activity or in bed. The “Popping” of blisters may increase the risk of infection. If you feel it’s necessary, puncture with a sterilized needle at the base and leave the skin covering the raw area.

Keeping the area protected from infectious organisms is important; dressings should be changed at least daily. Most second-degree burns heal in 2-3 weeks without thick scars, but may leave the skin darker than its original color.

third-degree burn

third-degree burn

THIRD-DEGREE BURNS:  A severe type of burn injury, third-degree burns damage the full thickness of the skin and, often, deeper structures like the nerves and blood vessels below the skin. Once the damage goes through the skin, you have lost your body’s “armor”, causing the rapid loss of fluids and ensuing dehydration. Loss of body heat is also a major issue.

Third-degree burns can vary in appearance based upon the type of burn incurred. They may appear white and waxy, charred brown, or black.  The area may feel stiff or “leathery”.

Treating a third-degree burn: Start by following the steps for a second-degree burn. Long-term care is much more complex, however. The skin lost in an injury is normally replaced by new skin cells produced by the dermis. The dermis, however, has been destroyed in a third-degree burn, so skin can only grow from the edges of the wound. This not only takes more time than the patient has, but also results in thick scarring.

Sometimes, skin edges have dead tissue which must be cut away so living tissue behind it can grow; this (sometimes painful) process is known as “debridement”.

In normal times, gaps left by extensive burns are treated by “skin grafting”. A skin graft is skin taken from an uninjured area and placed on the site of the burn. Skin taken from the injured person is less likely to be rejected than if taken from another individual.

Of course, the technology needed for skin grafting won’t be accessible off the grid. The best that might be done in a remote setting would be covering the area where skin no longer exists with products like honey or aloe vera gel. A non-stick covering is then applied for protection. Celox hemostatic gauze, when wet, makes for a serviceable burn bandage. Dressing major burns, however, can compromise blood flow as swelling occurs. As such, these wounds shouldn’t be wrapped tightly, if at all. Vigilance is needed to keep the wound clean so as to prevent infection.

Expect these wounds to require a very long time to heal. Often, a “contracture” will develop as a result of scarring. This is a condition where deformity or loss of movement occurs in joints due to the stiffening of muscles and other tissues. The result, at the very least, is loss of range of motion.

Fourth degree burn

Fourth degree burn

FOURTH-DEGREE BURNS: Once considered just a severe case of a third-degree burn, the damage extends down through subcutaneous fat to muscle and bone. The tissue appears dark, dry, and “crispy”. Third and fourth-degree burns are often described as painless, as the nerve endings have been destroyed. These burns, however, often have second-degree and first-degree components at their peripheries, which can be very painful.

Treatment for Fourth-Degree Burns: Even in the most advanced settings, treating fourth-degree burns is complex and may even involve amputation of an affected limb. Without a modern burn unit, the survival rate for third- and fourth-degree burns covering any significant portion of the body will be very low. This is due not only to destruction of tissue; the inability to replace fluids rapidly in these patients and the high frequency of infection will be factors, as well.


-Failing to run cool water on the burn for the time recommended.

-Using ice on burnt skin.

-Ignoring airway burns. With smoke inhalation, airways may swell rapidly and cause breathing difficulties. Signs include severe coughing, hoarseness, black-specked sputum, and facial burns.

-Popping blisters unnecessarily. Intervene only when they are very large or interfere with function.

-Assuming a burn is less of an issue than it is. Even a first-degree burn, like an extensive sunburn, can be dangerous if steps aren’t taken to avoid further exposure and keep up the level of hydration.

-Using lard or butter as a home remedy. These substances can trap heat in and cause a delay in healing. Other home remedies, like aloe vera, are more preferable.


Toddlers and Campfires = Burns

Toddlers and Campfires = Burns

Burn care in an off-grid setting is difficult, so it makes sense to do everything possible to prevent these kinds of injuries. As your people may be performing activities of daily survival to which they are not accustomed, perhaps the most important advice is to be certain that they are wearing appropriate personal protection like gloves, masks, goggles, and footwear. Any burn injury prevented is one less headache (and perhaps, heartache) for the medic. Other considerations:

  • never allow children to be unsupervised near a campfire or wherever food is being cooked or water boiled.
  • Don’t let kids play with matches or lighters.
  • Apply sunscreen 15 minutes before going out in the sun and reapply frequently.
  • Avoid cooking if you are impaired by exhaustion (or alcohol/drugs).
  • Avoid smoking inside your shelter or anywhere there are flammable materials (or maybe not smoke at all).
  • Keep firewood and other flammables away from buildings.
  • If you have power, be wary of space heaters; leave a good space between them and anything combustible.
  • Avoid using frayed electrical cords.
  • Learn how to recognize gas leaks.
  • Have and know how to use fire extinguishers.
  • Have functioning smoke alarms.

Last but not least, have a plan of action for a fire at your homestead, and practice drills so that family members will know exactly what to do. This includes a method of communication and a place to meet in the event that you are separated from each other.

The risk for burn injury exists even in the best of times. Off the grid, they represent a major challenge to the caregiver. The ability to recognize and treat different degrees of burns will be an important skill for the medic in tough times.

In future articles, we’ll review electrical, chemical, scalds, and other burns, as well as ways to recognize and treat them effectively. We’ll also discuss some natural remedies that will work to help speed recovery from burn injuries.

Joe Alton MD

Dr. Alton

Dr. Alton

Find out more about treating burns and 150 other medical issues in disaster settings in the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide For When Medical Help Is Not On The Way.







Survival Medicine Hour: Acid Reflux, Colds vs Flus, Medical Barter Items, More

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Survival Medicine Hour #366

Colds vs. Flus

Colds vs. Flus

Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, discuss a number of topics, including honey as a treatment for burns, how to tell colds vs. flus, medical barter items, acid reflux, using glues to close wounds, and much more!

Honey, if raw and unprocessed, has antibacterial effect and may be useful to treat burns in situations where modern medical care is not a possibility.

Honey as a treatment for burns

Honey as a treatment for burns

Do you have a cold or the flu? Here’s some tips on how to tell the difference.

Most survivalists consider ammunition to be the most important barter item, but how about items that could heal, instead of cause, wounds? Dr. Alton bets that medical supplies would be important barter items in a post-disaster economy.

Glue in place

Glue in place

Medical glues and even Super-glue, may be valuable items for closing wounds. Here’s how to use glue to close a wound (remember, that it’s more important to know when a wound should be closed and when it should remain open!).

acid reflux

acid reflux

How many people do you know that have problems with stomach acid? In a disaster, those people will still be there, and they need your help. Dr.Alton tells you everything you need to know about gastroesophageal reflux disease (G.E.R.D.).

To listen in, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

The Altons

Follow us on twitter @preppershow, Facebook at Doom and Bloom(tm), and YouTube at DrBones NurseAmy channel.

Fill those holes in your medical supplies with kits and individual items from Nurse Amy’s store at!





Survival Medicine Hour: Natural Burn Remedies, Ingrown Nails, Lone Wolves

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Survival Medicine Hour Podcast #365

lone wolf

Lone Wolf?

Does the “lone wolf” have an advantage or disadvantage in situations where you’re knocked off the grid and long term survival is not a sure thing? Joe Alton MD and Amy Alton ARNP discuss the importance of community in tough times, even if it’s just an extended family.

3rd degree burn

3rd degree burn

Plus, after discussing first and second degree burns last week, Dr. Alton, aka Dr. Bones, tackles third degree burns, a difficult challenge for the survival medic, as well as natural burn remedies that might help speed recovery for some of the injured.

off grid ingrown toenail strategy

off grid ingrown toenail strategy

Lastly, minor conditions like ingrown toenails may not seem like much to those who watch The Walking Dead, but they’re a major impediment to work efficiency. Not being able to take a step without pain isn’t likely to increase your chances for survival. Dr. Alton talks about what can be done to prevent and treat this condition off the grid.

To listen in, click below:

Wishing you the best of health in good times or bad!

Joe and Amy Alton

The Altons

The Altons

Hey, follow us on twitter @preppershow, YouTube at DrBones NurseAmy channel, and Facebook at Doom and Bloom. And check out the Third Edition of the Survival Medicine Handbook on Amazon!

Third Edition

Third Edition






6 Ways To Curb Active Shooters

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6 Ways to Curb Active Shooters Attacks

Can we end active shooter events?

Can we end active shooter events?

The recent shootings in diverse settings greet Americans with tragic news on a regular basis. Gunmen identify soft targets in diverse settings, from concerts in Las Vegas to church services in small towns.

it should be clear to you that there is no place safe from the bad intentions of the deranged, disgruntled, and politically-motivated. Vehicular attacks, bombings, shootings, even stabbings indicate that we’re likely to be in for a rough ride in the future.

You might think that the “successes” achieved of late by active shooters are random occurrences. New records for casualties, however, show there is a blueprint that is being refined to deadly effect.

The selection of soft targets is becoming a science, and is leading to higher numbers of deaths and injuries. If those with bad intentions are getting better at creating mayhem, it stands to reason that our society must get better at thwarting those intentions. Here are six ways that would, in my opinion, decrease the number of shooter incidents  (and casualties):

  1. Improve security in areas at risk. I would define an “area at risk” as just about anywhere where a crowd of people would gather. Better protection at malls may be a matter of hiring more trained personnel, but establishing a safety team in other places, such as a church or workplace, can increase the level of vigilance and identify threats early.
  2. Establish volunteer safety officers in rural areas and small towns where there may not be law enforcement and emergency medical personnel just around the corner. These persons should have training in security, firearms, and first aid for bleeding wounds. If there are volunteer fire departments, while not trained volunteer safety departments?
  3. Instill a culture of situational awareness in our society. Situational awareness is a state of calm, relaxed observation of factors that might indicate a threat. These are called “anomalies”; learning to recognize them can identify someone who may have bad intentions. Situational awareness also involves always having a plan of action when a threat occurs, even if it’s as simple as making a note of the nearest exit at a concert. Seems like common sense, but in these days of smartphone distractions, many are oblivious of their surroundings.
  4. Teach our citizens to avoid the natural paralysis that occurs in an unexpected event. This paralysis occurs as a result of “normalcy bias”, the tendency to discount risks because most days proceed in a certain standard manner; we assume that today will be the same. By teaching simple courses of action such as the Department of Homeland Security’s “Run, Hide, Fight” triad, the decision-making process may be more intuitive and more rapidly implemented. This is more effectively taught and ingrained at a young age.
  5. Teach our students simple first aid strategies to stop bleeding, the most likely cause of death in these scenarios. Rapid action by bystanders is thought to decrease the number of deaths from hemorrhage. Add “Reduce” hemorrhage to “Reading, ‘Riting, and ‘Rithmetic” as part of school curriculum, and lives might be saved.
  6. Provide first aid kits for bleeding in public venues that can be accessed by those at the scene. With supplies, the Good Samaritan will be more likely to save a life. I predict that these kits, already on the market, will be fixtures on the wall next to the fire extinguisher in the uncertain future.

Despite the above recommendations, our response as a nation has been to do little to correct the problem. I say that era must end. Let’s stop being “soft” targets. We must forsake the notion that shootings are just part and parcel of the New Normal, and begin the process by which we change our attitude and level of vigilance, not in isolated cases, but as a society.

I’m not an official with the Department of Homeland Security, but I know that there are more active shooter events in our future. A prepared nation wouldn’t be invulnerable to attacks, but its citizens would have a better chance to survive them.

Joe Alton MD

Dr. Alton

Dr. Alton


Medical kits to stop bleeding are good items to have in these uncertain times. Check out kits specially designed by us for workplaces, schools, places of worship, and other public venues that might save a live in the hands of the Good Samaritan.

Multi-person Kit for Bleeding

Multi-person Kit for Bleeding


Survival Medicine Hour: Off-Grid Pregnancy Care, Cloves, Bleeding Kits

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The Survival Medicine Hour Podcast #357

off-grid pregnancy care

off-grid pregnancy care

What if you had to care for a pregnancy off the grid? Would you identify it as early as you should without pregnancy tests and ultrasounds? How can you assure the well-being of mother and baby during the pregnancy. Joe Alton MD and nurse-midwife Amy Alton, ARNP discuss how to keep an eye on that pregnant lady in your group from beginning all the way to 9 months (labor and delivery coming next time).

Amy's multi-person bleeding kit

Amy’s multi-person bleeding kit

Also, what would be the items you’d want in a kit for a public venue where a gunman could cause multiple casualties? Nurse Amy discusses what’s in her multi-person kit specifically meant for bleeding wounds at schools, churches, workplaces, etc.,  and how it could be a lifesaver in active shooting incidents and other disaster settings.

Plus, natural remedies are important in good or bad times, but especially when modern medicines aren’t being produced, such as in survival scenarios. Joe Alton MD discusses the health benefits of cloves and why you should have some in your survival medicine cabinet.

All this and more in the latest episode of the Survival Medicine Hour with Joe and Amy Alton!

To Listen in, click below:

all the best,

Joe and Amy Alton

Joe and Amy Alton

Joe and Amy Alton

We’re pleased to announce that the third edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way has won its category (medical) in the 2017 Book Excellence Awards! Thanks to all for their support.

Why Do Active Shooters Succeed?

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Why Do Active Shooters “Succeed”?

location of vegas shooter and targets

location of vegas shooter and targets

You might associate armed attacks with wars or survival scenarios, but they can occur in normal times as well. The recent mass shooting at the Mandalay Bay in Las Vegas is a reminder that, in these toxic times, no one is safe from those with bad intentions.

It’s hard to read the news without seeing reports of the latest mass shooting by terrorists, the deranged, the disgruntled, and in the shooting in Las Vegas, people with no apparent motivation at all. Few believe that they could possibly wind up in the crosshairs of a gunman’s sight, but it can happen anytime and anywhere. Why do they seem to “succeed” so often and what would be your response to the “active shooter”?

Many of the concert-goers in Las Vegas were victims of what we call “normalcy bias”: That’s the tendency for people to believe everything follows a pattern and that the day will proceed normally because, well, it usually does. It’s a natural response for most, and is reinforced by the rarity of mass casualty incidents.

But when a shooter event breaks that pattern, the unprepared brain takes time to process the situation. People think that the sound of gunfire is, instead, a burst of firecrackers, a blown tire, or anything less threatening than an assassin out to kill them. This pause leads to a type of paralysis than was worsened in Las Vegas by the ready availability of alcohol. By the time good judgment came into play, many were already victims.

Given the circumstances, the rapid action of Las Vegas law enforcement is to be commended. Remarkable, in fact. Police were receiving multiple false reports that made it appear that there were multiple shooter events in a half-dozen casinos. There was even a car with wires sticking out of the trunk at New York New York casino’s valet that was thought to represent a bomb. Listening to police radio communications during the event, it’s amazing that such a coherent response was possible.

(Note: You might be interested to hear what was said on the radio. If so, you’ll find a partial transcript of the first hour or so of the event at the very bottom of this page)

mandalay bay

The shooter was at Mandalay Bay, but reports of shooters also came in from several other casinos (all false)

Most citizens, indeed, believe that the good people of law enforcement and homeland security are always right there. While these agencies do the best they can to counter situations like this, most mass shooting events end so quickly (the Orlando nightclub shooting is an exception) that the chances are slim that help will be immediately at hand. It took just one 31 second period for the Las Vegas gunman to shoot 280 rounds, and possibly just 9-11 minutes (according to Las Vegas Police) before he ended his own life.

Without a plan of action, the average person follows the herd. If fifty people around you (or in Las Vegas, 22,000) drop to the floor, your natural tendency is to do the same. Cowering in fear in plain view of the shooter, however, is a recipe for a very bad outcome. By having a plan before a shooting event occurs, you’ll have a better chance of getting out of there in one piece.

These are things you should be thinking about, calmly and rationally, whenever you’re in a crowd. It may seem extreme to have to consider such options, but the headlines suggest otherwise. This relaxed vigilance is called “situational awareness“, a concept first put forth by a military pilot to pertain to dogfights but which has special importance today for the average citizen.

The standard recommendation, in order, by the Department of Homeland Security is “Run, Hide, Fight“. In the case of the Mandalay Bay shooter, the distance between the shooter and his targets effectively precluded the ability to fight, so running away from the kill zone and/or hiding in buildings and vehicles saved lives. Situationally-aware concert-goers were saved by a high index of suspicion and, hopefully, a low blood alcohol level when the bullets started flying.

If you’re inside, know where the exits are. If you’re outside, know the nearest route away from the area or reasonable nearby shelters. Know who near you appears nervous or suspicious. If you’re in a crowd, stay in the periphery, not center stage. Assume that the sounds of gunshots are gunshots, not firecrackers. Know the direction the gunshots are coming from and head the other way. Primed for a possible emergency, you’ll decrease the chance of becoming a victim.

Sounds simple, doesn’t it? But in this era of people immersed in their smartphones, few are situationally aware. In the old days, this might result in a bump on the head from walking into a lamp post. Today, the results can be tragic.

Don’t be the soft target that assassins look for. Remain situationally aware at all times, and decide how important it is for you to be in the midst of large crowds. Perhaps it was once paranoia, but in these uncertain times, it’s more like common sense.

Joe Alton MD

Dr. Alton

Dr. Alton

Learn more about situational awareness, disaster medical preparedness, and much more in the 700 page third edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, 2017 winner of the Book Excellence Award in the category “medical”. Also, Nurse Amy has designed two kits specifically meant to stop bleeding in one or several victims after a disaster such as occurred in Las Vegas. You’ll find them at

AS PROMISED: THE RADIO TRANSCRIPT OF THE ACTIVE SHOOTER EVENT IN LAS VEGAS (as best  as I could hear and understand it, call signs omitted):

We got shots fired! Sounds like an automatic firearm.

Anyone have eyes on the shooter?

It’s coming from up there. It’s coming from Mandalay Bay. I see shots coming from Mandalay Bay, halfway up!

We have multiple 415 (assault/battery with a gun)… do we have surge?

We have an active shooter! We have an active shooter inside the fairgrounds!

Just advising, there are people down on stage left.

Dispatch: We now have an open line with a female saying there is a shooting.

Control, that is correct, shots fired from Mandalay Bay. There’s many people down, stage left, just be advised.

If anyone covering southwest corner between Mandalay Bay and the venue…

I need eyes. Somebody in the CP, can you tell me where it’s coming from?

Dispatch: We’re hearing it’s from Mandalay Bay!

I’m at Mandalay Bay and the boulevard. I need five officers on me.
We have multiple casualties, GSWs in the medical tent! Multiple casualties!

Be advised, shots are coming from Gate 7.

We have a rifle deployed, we’re in front of Mandalay Bay. We’re trying to see where shots are coming from. If anyone can advise if they’re coming from Mandalay…

Dispatch: It sounds like it’s either Mandalay, or Luxor, we cannot tell…

We need the boulevard shut down at Russell northbound right now.

I’ll shut it down, I’m coming back that way

It’s coming from, like, the 50th or 60th floor, north of the Mandalay Bay. Coming out of a window.

Seeing multiple flashes in the middle of Mandalay Bay on the north side. Kind of a, on the west tower, towards the center of the casino. Like one of the middle floors.

Multiple GSWs, on the east side…

On the 31st floor, I can hear automatic fire coming from one floor ahead.

Be advised, it is automatic fire, fully automatic fire from an elevated position. Take cover.

That’s correct, it is full automatic fire.

Multiple GSWs to the chest, legs, femoral arteries, at the medical tent, (Gate) 4A, off of Giles south of Reno!

Flashing coming up from a third of the way up center tower of Mandalay Bay!

All units stop coming northbound on Las Vegas Boulevard, because he’s shooting this way, horrible cover spot.

I have a gunshot victim at gate 4, in the leg.

I got one down, gunshot wound to the leg, Reno and Giles, I also have another female gunshot in the mouth.

We need to send medical when you can over to Reno and Giles, expedited, please.

Dispatch: They’re being advised.

Just be advised, we’re pinned down on the east side las vegas boulevard. We’re gonna be north of Mandalay Bay drive, we’re about 40 or 50 people pinned against this wall. We’re taking gunfire. It’s going right over our heads. There’s debris coming over our heads. So we’re pinned down here with civilians.

I have a gunshot victim at gate 4. Gunshot to the leg.

Hey, we can’t worry about victims. We need to stop the shooter before we have more victims.

Officer shot…

We have multiple, multiple victims shot. Get the medical kit, we got a victim shot in the leg.

Hey, officers please stay calm, just relax, we’re trying to get this set up, just stay calm.

I’m running out of blankets here…

Shut down the elevators, take the stairs.

South Central, make the CP (command post) south central
Lots of people with wounds…

32nd floor

He’s still firing. There’s just the two of us

Hey guys, we got a female with a gunshot wound to the head
I’ve got a gunshot officer

Shut down the 15 for medical, officers going to the hospital
Does anybody have eyes on the shooter

Do we have Mandalay Bay shut down

Get people out and start covering the walls

I got two victims at gate 6, chest and head. We need immediate medical

Be advised: we are taking fire from a very high floor, we believe coming from The Mandalay Bay

Any officers that respond here, gonna be in plain sight.

Any officer coming will be in plain sight

Dispatch: Do not go on the boulevard

Strobe light coming from the east side of Mandalay Bay
I need a lieutenant to set up another command post on las vegas and Tropicana

All units need to start staging so we come from Tropicana
We’re getting from civilians that there might be three shooters.
Set up a perimeter, Tropicana and Russell, and lock a good outer perimeter down. We need a perimeter now.

Arriving, I’ll establish a command post now.

I’m here on the 32nd floor, room 135, I need the SWAT.

UNC Trauma, shoulder wound

We can’t worry about the wounded right now, we have to eliminate the threat

A white car going the wrong way down las vegas boulevard
Multiple GS victims over here on the east side of this building. I got numerous victims, got a five man team to provide cover

We need multiple medical evacs on the south stage

We also have a security officer shot in the leg on the 32nd floor. He’s standing right be the elevator

He shot down the hallway and hit the security guard

We have a four man team up here and another element coming to us

We’ve got at least two shooters, 29th and 32nd floor

Shut the lights down in the venue

Please be advised have all units have vehicles locked. People trying to get in there trying to grab shotguns

Put the CP at South Central, we have logistics

I need a unit to establish command. I’m pinned down with another officer, I need radio instructions

Dispatch: Is there a unit that can establish command
Stuck in traffic on the boulevard

Multiple casualties on the concert floor, stage right

We need the northbound boulevard shut down

Please take all EMS personnel to gate 2B, no sorry, gate 4A, gate 5 for evac

We’re gonna need a medical triage set up close to the CP when we get evacs. If we can get a medical liaison there, start setting that up

Setting up a temporary triage area at the boulevard and Tropicana at the southwest corner

I’ve got an officer with a gunshot wound to the neck just north of the venue

Multiple people running across the runway

I have multiple resources here, we are setting up IC here, is that what we want to do?

Just be advised, there are multiple trucks loading people to send to the hospital. Just let them know.

Black possible Chevy truck ripping out of here, several people confirmed, just keep an eye out

All officers, do not respond to the east side of the boulevard north of the Mandalay drive. This is not a secure position. We will be pinned down.

At the convention center entrance, we are moving into the casino
We have an eight man element clearing casino floor, moving up to the 32nd floor

Be advised, we have a medical tent

SWAT: Has anyone from the outside heard any further shots?

That’s negative, for about 15 minutes we have not heard any shots

(whispering) In the hallway on the 32nd floor

We are clearing the left wing now.

We have two more strike teams making their way to Mandalay Bay by foot

We’re trying to clear the event, pushing everyone to the east
We have a white RV with an older white male in fatigues and a black bag. Came from that area of the shooting. Went into the motor home. Need additional units.

I had a civilian take a patrol car. Need somebody be over here at Giles. I need medical.

Need some more units over here. I’m being overrun by citizens trying to take patrol cars.

We have several thousand people making their way from Gate 5
Giles and Ali Baba. Several, several casualties

(whispering) We believe it’s the northernmost room on the 32nd floor of the Mandalay Bay

I need a couple of officers to come help me push citizens off of the main stage

We have a lot of 419s (dead bodies) on the main stage inside the concert area

Probably about 20 419s around here

Confirming that I have casualties at Ali Baba and Giles east of the Catholic shrine as well as in the Mandalay Bay so we have two scenes.

They’re trying to send medical, send over all of them

Whoever with the maintenance guy at the Mandalay Bay, we need the key for the elevator at the main bank of elevators. We have a whole bunch of us waiting to go up.

I need to know if I have that floor evacuated other than our suspects. We got snipers going up so I need to know that’s evacuated.

That’s gonna be a negative.

We’re still clearing floors. We got two on floor 32 in the hallway
We’re doing evacuations down the hallway

SWAT: we’re coming up the stairwell

We have several 419s on the main stage. I need a couple more officers to help me clear this area.

Confirming that Mandalay Bay and Giles and Alibaba are the two shooting locations. Is there a third?

SWAT: We need to be careful of booby traps. On the stairwell, talk to y’all later

Be aware there’s an officer coming down the stairwell

We have a 12 man element coming into the Mandalay Bay. Strike team.

Is it confirmed that there were no shots from the Luxor?

Do you need more resources up there or you good?

We have the hallway contained.

I have three critical patients in my vehicle, I’m taking them to sunrise. Is there any available vehicles to assist me to get the traffic out of my way?

We have a ton of rescues that are available.

We need to roll now!

Go ahead and go.

Please be advised I’m now transporting five critical to Sunrise.

Please call and let them know I have five in route.

We are going to start establishing certain roles. First, we’re going to have a casualty collection point at Tropicana and the boulevard. I will get someone to liaison that in a moment. We’re going to contain around Mandalay Bay. I will get you a lieutenant for that in just a moment.

I am at Tropicana, I can fill that role for you.

SWAT: We are right outside the door.

Medics are asking if they can proceed to four seasons and Las Vegas boulevard or if they can have officers drive the vehicles that are there with injured civilians down to a safe area.

I have strike teams available, I need to know where to deploy them.

Medics are saying if there’s any reports of civilians in vehicles on four seasons and the boulevard. They can’t get to them safely, but if officers can drive those vehicles to a safe area, they can service them.

We are near the sports book at Mandalay Bay, we have one male WMA wearing a maroon or black shirt near the entrance.

Possible suspect at Circus Circus, we need an ETL on that.

We’re going to have a lot of people transporting in pickup trucks en route to the hospital. Please advise the hospital.

Please be advised we have the singer and citizens on the bus and the manager is adamant that they do not want to exit the bus.

We’re going to develop a route for them to exit.

UNC is at capacity. All units be advised do not transport unless it is life threatening. They need to go to Valley.

We have possible reports of shots fired inside New York New York…

Dispatch: We are getting reports there is a possible 415 at the front desk, New York New York

Black Audi with a possible 445 at the Luxor valet.

SWAT: We are at the end of the hallway, there are officers to acknowledge so we don’t have a crossfire.

We acknowledge, go ahead.

SWAT’s in place.

We have another GSW at the Motel 6.

Do we have a 415A at New York New York?

It originally came in to say many subjects were down.

Two shots were fired inside New York New York, we have approximately 150 people sheltered in place in the kitchen. Two shots were fired inside casino floor, And there are several subjects down at New York New York “Zumanity”.

No answer from security.

In Valet, waiting on a strike team to arrive. Everything seems quiet here.

I need someone to get in through the cameras to see if this is a diversion. I have three metro SWAT basically assembled, two are going up the tower, one is heading over to New York New York so we don’t completely split our forces.

Dispatch: Ok, now I’m getting information on an active shooter at Tropicana.

Please advise bomb squad to deal with the issue over there at Luxor. The 445 device.

Dispatch: Please be advised, there is an active shooter at Tropicana. There is an active shooter at Tropicana. Please be advised, we’re getting multiple reports of shooters at multiple locations. May or may not be diversion.

Entering New York New York with a SWAT team.

I’m outside Tropicana, not hearing any 434s (illegal shooting). This could be a diversion.

Dispatch: Be advised, 70 civilians at the stand aviation hunkered down. We’re getting calls from people sheltered in place, they’re not injured. Do you have any instructions for remaining sheltered in place? Please assign someone in there to keep track of people who have injured calling in.

We have a bunch of ambulance on Tropicana. Do they have Force Pro with them if there’s a e a 415A at the Trop?

Dispatch: Please be advised, we have a hispanic male, dark skin with an afro and dark clothing with a backpack at the Hooters squatting in the driveway. Looks like a suspect.

Do we need more strike teams, we have other agencies calling.
Dispatch: If we have other Tac teams, if we have bodies available, have them come in to our staging area, south central command.
We’re gonna need a roll call of those in Mandalay and the strike teams.

SWAT: I’m at the suspect’s door. I need everyone to be aware of the hallway and get back. I need to pop this to see if we can any response from this guy, see if he’s in here or if he’s moved somewhere else.

Dispatch: SWAT has explosive breach, all units move back, move back.

SWAT: (whispering) breach breach breach

(explosion heard)

We’re in this room, one suspect down.

One suspect down in room 135, 32nd floor Mandalay Bay

SWAT: Preparing to breach adjoining room, floor 32. Explosive breach.


SWAT: We got the east room secure, one suspect down, multiple firearms. This is definitely where he was firing into the crowd.

I’m getting reports that medics are getting shot at, at the Tropicana.

We have made contact inside Tropicana, no shots fired.
We are at Tropicana. No shots fired.

Security at New York New York says no shots fired.
Do we have an update on the possible 445 at Luxor?
We have it locked down.

Clear the area, do nothing else for the time being.

Now we’re getting shots fired at Caesar’s and the Bellagio…..

Can Churches Be Made Safe Again?

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Can Churches Be Made Safe Again?

Can Churches Be Made Safe?

church safety

A gunman entered the Burnette Chapel Church of Christ in Antioch, Tennessee, killing one and injuring several others at a September 24th Sunday religious service. This heinous act of violence in a place of worship underscores the need for a strategy that churches can implement to keep congregants safe.

There is no place where crowds gather that is immune to the bad intentions of a disgruntled, deranged, or politically-motivated individual. Therefore, a culture of situational awareness must be instilled in every citizen. This attitude of calm vigilance is especially needed in religious venues.

Unfortunately, not all pastors prioritize church safety at the level needed in this toxic climate. The premise that their ministry is based on peace fails to take into account that there are those who consider places of worship to be “soft”targets. In this era of active shooters and anti-Christian feeling, pastors must make sure their flock is safe, just like any shepherd. In the New Normal, it’s has become part of the job description.

In my role as medical preparedness writer, it’s my mission to help the average citizen promote the well-being of loved ones in disasters. Lately, I’ve written about hurricanes and earthquakes, but shooter events like the one in Antioch are also instances where mass casualties can occur. These casualties might be minimized with a plan of action and quick action.

Large churches may choose to hire security professionals and install video surveillance technology. Smaller and less affluent churches, however, might benefit by establishing what I call a “safety ministry“. This group should be comprised of parishioners who have some security experience, such as active and former law enforcement, military veterans, and carefully selected others. Members should evaluate the layout of the church and grounds for weak spots and organize a plan of action for calling 911 and other measures when needed.

This goal might best be accomplished with the cooperation and assistance of local police. They can help train church members in how to identify the behavior of possible perpetrators of violence. The pastoral staff should be actively involved in this training to assess liability issues that might arise, and to insure that the safety ministry is not perceived as a “goon squad”.

The call for volunteers for such a ministry should be made publicly and their purpose should be frankly (but calmly) explained so as to emphasize their benefits to all those attending the church. The formation of a security group in private might otherwise tend to cause concern instead of reassurance.

A simple way to avoid or abort acts of violence in places of worship is the placement of friendly but visible “greeters” or ushers at church entrances. These people can look for anomalies, such as someone inappropriately dressed for the weather. If a person seeking entry is wearing an overcoat in hot weather, it could be because they are concealing a weapon. Having greeters outside could also make it easier to identify those acting nervously, loitering in the parking lot, or otherwise exhibiting suspicious behavior.

Safety ministry personnel should have the ability to close and lock doors to prevent a gunman from entering. Conversely, they can also open all the exits that could be used to direct congregants out of harm’s way when necessary. Ushers can also look for packages left behind that might hide an explosive device.

In an active shooter event, multiple casualties are incurred, leaving wounded and bleeding victims at the scene. Safety Ministry personnel should have training on how to stop bleeding and equipment such as first aid kits geared to help them accomplish this goal. Indeed, the church might consider arranging such training for their entire congregation.

Although this article is geared towards security during services, a plan of action should be organized for other times during the week as well, and certainly for youth group meetings and other activities sponsored by the church.

Of course, the elephant in the room is the question as to whether non-professional security personnel should be armed. I can’t give you the answer. This is a decision that must be made taking local laws, risk levels, and the wishes of the congregation into consideration.

Sadly, I envision a future where safety ministries are standard operating procedure for our places of worship. Additionally, I predict that first aid kits will be fixtures next to the fire extinguishers on the walls of every place where crowds gather.

It may be a major challenge to protect people of faith these days, but preparing for untoward events should be the responsibility of every pastor and congregant. With a plan of action, they’ll have the best chance to keep our churches safe in the uncertain future.

Joe Alton MD

dr. alton

Joe Alton MD

(Note: I don’t claim to be a security professional, just an old country doctor. If you have additional advice on how to improve the safety of people of faith, send your tips to!)


Besides Church, it’s never a bad idea to have a first aid kit for the home and/or vehicle. Feel free to check out Nurse Amy’s entire line of kits and supplies at You’ll be glad you did.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook Third Edition

Wound Care Essentials!

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Wound Care Essentials Cat Ellis “Herbal Prepper Live” Audio player below! Are you ready to act as your own emergency medic if you needed to? Even if you have taken a first aid certification class for work, you’re not really prepared for much beyond put pressure on the wound and call 911. But, what if … Continue reading Wound Care Essentials!

The post Wound Care Essentials! appeared first on Prepper Broadcasting |Network.

Survival Medicine Hour: Earthquake, Birthing Supplies, Hemorrhage, More

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Survival Medicine Hour #355

earthquake damage

earthquake damage

What would you have done if you were in Mexico City during the recent earthquakes? Is there anything that might have increased your chances of survival? In this episode of the Survival Medicine Hour, hosts Joe Alton MD and Amy Alton ARNP talk about earhtquakes in general and give you safety tips that could save a life.

birthing supplies

birthing supplies

Plus, what supplies would you need for delivering a baby and caring for a pregnancy in tough times? Nurse Amy put on her Expert Council hat from Jack Spirko’s Survival Podcast to answer a listener’s question. In addition, one of our readers sends us an entertaining story about her son’s hornet sting and some natural remedies she uses for her allergy-prone family.

Direct Pressure on Bleeding Wound

Bleeding wound

Lastly, is it time to add a 4th R to Reading, ‘Riting, ‘Rithmetic in school curriculums? Should Reduce hemorrhage classes be talk in view of the risk of injury during natural disasters, shooter events, even car crashes? Sounds crazy, but would it save a life?

All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton, aka Dr. Bones and Nurse Amy! To listen in, click below:


BTW, you can follow us at twitter @preppershow, YouTube at DrBones NurseAmy channel, and Facebook at our Doom and Bloom page or our survival medicine group “survival medicine dr bones nurse amy”


Don’t forget to check our medical kits and supplies at, plus our latest edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon and on this website.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook Third Edition

Survival Medicine Hour: Post-Irma, Floods, Shoulder Dislocation

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Survival Medicine Hour #354


close shave #1: Gatlinburg, Nov. 2106

This Survival Medicine Hour 9/15: Hurricane Irma has wreaked havoc on Florida, Georgia, and South Carolina, and our hosts Joe and Amy Alton, aka Dr.Bones and Nurse Amy have now had two different homes survive destruction in a year: Their place in Gatlinburg on Ski Mountain, where 100 homes burned to the foundation last November as part of a huge human-set wildfire, and now their home in South Florida from Hurricane  Irma’s winds. We’ll talk about flood survival and give you some tips on what to do in the aftermath of storms like Harvey and Irma.

hurricane winds

close shave #2: Irma

Also, your shoulder is the most flexible of your joints, but also the least stable and most likely to be dislocated by trauma. Find out more about how to recognize and treat this painful but common wilderness and off-grid injury.

shoulder joint: most flexible, least stable

shoulder joint: most flexible, least stable

To Listen in, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Nurse Amy and Dr. Bones

Nurse Amy and Dr. Bones

We’d like to announce that we’ll be holding an 8 hour class on 10/21 near Knoxville, TN, where they’ll impart a lot of knowledge and teach a lot of hands-on skills! Check’s classes page to find out more!

Don’t forget to follow us on Twitter @preppershow, Facebook at Doom and Bloom(TM), and YouTube at DrBones NurseAmy!

Earthquake Safety: What You Need To Know

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Scene from 1985 earthquake that killed 10000

Scene from 1985 earthquake that killed 10000

A 7.1 magnitude earthquake struck Mexico City on Tuesday, September 19, collapsing buildings, killing at least 250, and injuring hundreds more throughout the region.  The latest tremor event came hard on the heels of an 8.1 magnitude quake off the coast just 2 weeks ago, which killed almost 100 and even generated a small tsunami wave. Various aftershocks measuring up to 4.9 have been recorded since Tuesday’s quake hit at 1 pm local time.

Although there is no “season” for earthquakes like there is for hurricanes, yesterday’s tremors occurred on the exact date that a 1985 event killed close to 10,000 Mexicans in the capitol.

The United States, especially (but not exclusively) the West Coast, is also susceptible to natural disasters like earthquakes. Indeed, just a few days ago, citizens in Los Angeles experienced 3.6 magnitude tremors, but no deaths or major damage was reported.


The West Coast and some areas of the Midwest are located over what we call “fault lines“.  A fault is a fracture in a volume of base rock in the earth’s crust. Mexico City itself is not located on a fault line, but sits on an old lake bed that amplifies nearby tremors. This disrupts buildings that were constructed on the surface, making them prone to collapse.

Earthquakes have been blamed on climate change by some, but the movement of the earth’s plates occurs miles below the surface. This shifting releases a tremendous amount of energy, sometimes referred to as a “seismic wave”.

The strength of the Mexican earthquakes have measured using something called the “Richter scale“.  This measurement (from 0-10 or, theoretically, more) identifies the magnitude of tremors at a certain location.  Quakes less than 2.0 on the Richter scale are common occurrences unlikely to be noticed by the average person. Each increase of 1.0 magnitude, however, increases the strength by a factor of 10. The highest-intensity earthquake ever recorded was The Great Chilean Earthquake of 1960 (9.5 on the Richter scale).

Most people have heard of the Richter Scale and assume that all earthquakes are measured using it. However, a newer measurement, the Moment Magnitude scale, is thought to be more accurate for higher intensity quakes. The Moment Magnitude scale calculates each point of magnitude as releasing more than 30 times the energy of the previous one.

If the fault lines shift offshore, a “tsunami” or tidal wave may be generated.  In Fukushima, the 2011 earthquake (8.9 magnitude) spawned a large tsunami which caused major damage, loss of life, and meltdowns in local nuclear reactors. Tsunami warning were issued for both the Japanese and Ecuadorian earthquakes reported this week. The tsunami generated by the quake 2 weeks ago off the coast of Mexico was only 2.3 feet, however.


A major earthquake is especially dangerous due to its unpredictability. Although researchers are working to find ways to determine when a quake will hit, there is usually little warning. This fact makes having a plan of action (before an earthquake hits) a major factor in your chances of survival.

This plan of action has to be shared with each family member, even the children. It’s unlikely that a disaster will occur at the moment that the entire clan is together. Unless the earthquake happens in the dead of night, it’s unlikely everyone will be together in the house. You might be at work, your spouse at home, and the kids at school. An important part of an earthquake survival plan is making everyone aware of where to meet. It could be your home, or perhaps more sturdy public buildings like a school or office building that might be earthquake-resistant. In any case, knowing where to meet in the event of (really, any) disaster will give you the best chance of gathering your family and surviving together.


Grab and Go Deluxe First Aid Trauma Kit

Have a good medical kit

To be prepared, you’ll need, at the very least, the following supplies:

  • Food and water (including water filters like the LifeStraw, Mini-Sawyer, and Katadyn)
  • Power sources like batteries, solar rechargers, and generators
  • Medical supplies and medicines
  • Tents, sleeping bags, and other camping equipment
  • Clothing appropriate to the weather
  • Fire extinguishers
  • A tool kit, including  an adjustable wrench to turn off gas, water, etc.
  • Means of communication like cell phones, walkie-talkies, radios
  • Cash! (don’t count on credit or debit cards if the power’s down)
  • Copies of important documents, including insurance policies

(these supplies are discussed in detail in the latest edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

In areas at risk for earthquakes, the school system and municipal authorities usually have formulated a disaster plan. They may even have designated a quake-proof shelter; this may be the best place to go. Make certain to inquire about your town’s precautions in case of a seismic event.

Besides the general supplies listed above, it would be wise to put together a separate “get-home” bag to keep at work or in the car.  Nonperishable food, liquids, and a pair of sturdy, comfortable shoes are useful items to include in this kit.


In the home, it’s important to know where your gas, electric, and water main shutoffs are.  Make sure that everyone of age knows how to turn them off if there is a leak or electrical short.  Know where the nearest medical facility is, but be aware that you may be on your own; medical responders are going to be overwhelmed and may not get to you quickly. In addition, roads may be impassible due to damage or traffic snarls.


Something you shouldn’t stand under during an earthquake

A good look around your house might identify fixtures like chandeliers and bookcases too unstable to withstand an earthquake. Examine cabinets for heavy objects on high shelves, and replace them to bottom shelves where they will help with stabilization.

In the family room, flat screen TVs, especially large ones, could easily topple.  Be sure to check out kitchen and pantry shelves for glass objects or pots and pans that could topple. In the bedroom, check the stability of anything that might be hanging over the headboard of your bed and could fall on you as a result of a nighttime quake.


drop cover hold

3 words to remember when an earthquake hits

What should you do when the tremors start?  When things start shaking, you’ll have to keep a cool head and, if indoors, get under a table, desk, or something else solid and hold on. Cover may protect you from falling objects. This strategy is called “Drop, Cover, Hold“. If hard cover isn’t available, even a mattress could serve as a shield. If no cover is available at all, considering heading to the corner of an inside wall.

Of course, you might choose to run out of the building. You’re more stable, however, on your knees than standing or running, so get down to prevent a fall from causing injuries. While the building is shaking, don’t try to run out (especially if you’re on an upper floor); you could easily fall down stairs or get hit by falling debris.  Don’t try to use elevators. You should stay clear of windows, shelves, and kitchen areas.

It’s often taught that you should stand in the doorway because of the frame’s sturdiness. It turns out, however, that in modern homes, doorways aren’t much more solid than any other part of the structure. Even if it were, you could still get hit by falling objects.

Once the initial tremors are over, go outside.  Once there, stay as far out in the open as possible, away from power lines, chimneys, walls, and anything else that could fall on top of you.


You could, possibly, be in your automobile when the earthquake hits.  Get out of traffic as quickly as possible; other drivers are likely to be less level-headed than you are. Don’t stop your car under bridges, trees, overpasses, power lines, or light posts. They’re likely to topple in a major quake. Stay in your vehicle while the tremors are active; turn on the radio to find out more about the event.



Even after the tremors stop, there are still dangers. Gas leaks are one issue to be concerned about; make sure you don’t use your camp stoves, lighters, or even matches until you’re certain all is clear (and, certainly, never inside). Even a match could ignite a spark that could lead to an explosion.  If you turned the gas off, you might consider letting the utility company turn it back on.

Buildings that have structural damage may be unstable or have loose concrete which could rain down on the unsuspecting. Falling stone from damaged buildings killed rescuers in the Oklahoma City bombing and the World Trade Towers collapse.

Power may be down, and many will be tempted to use generators. It’s important that generators are used, not just outside, but well away from the interior of the home. A family of four in Florida after Hurricane Irma was hospitalized when a generator was used outside but too closely to the home’s entrance.

Don’t count on telephone service after a natural disaster.  Telephone companies only have enough lines to deal with 20% of total call volume at any one time.  It’s likely a much higher percentage of lines will be occupied after a disaster.  Interestingly, this doesn’t seem to apply to texts; you’ll have a better chance to communicate by texting than by voice due to the wavelength used.

That cell phone will also come in handy if you’re trapped under rubble after an earthquake. Voice calls or texts might alert rescue personnel to your plight. If you live in quake country, you might consider a whistle on your keychain. It’s loud and will last longer than your voice as a signal for help. Don’t give up if help doesn’t arrive immediately; people can live several days without water, and much longer without food. With any luck, rescuers will find you.

Even if you have been injured, your house, even if  earthquake-resistant, will probably require some cleanup. Remember to wear sturdy shoes, work gloves, and protective goggles while you’re picking up after the quake. Enter damaged buildings at your own risk, and look before your step.

Joe Alton, MD

Joe Alton MD

Joe Alton MD

Find out more about infectious disease and much more with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook Third Edition

How to Handle Dental Emergencies In Survival Situations

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Video: How To Apply A SOFT-T Tourniquet

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Direct Pressure on Bleeding Wound

Bleeding wound

The Special Operations Forces Tactical Tourniquet (SOFT-T) is one of the most popular tourniquets made, with many selecting it as their item of choice to control severe extremity bleeding. The SOFT-T is reliable, sturdy, and easy to apply, especially when only one hand is available to the casualty. The US Army Institute of Surgical Research reports a 100% effectiveness rate in stopping hemorrhage.

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Tourniquets like the SOFT-T are used in a life-threatening situation, and its ease of application is a major advantage when no time is available for training purposes. Having said that, it’s important to become acquainted with the use of every item in your medical kit.

The SOFT-T particularly shines during transport, with a screw that that can be fastened to prevent accidental release during the jostling that can occur during evacuation to a modern medical facility or, in a survival scenario, to your sick room or hospital tent.

Here’s Nurse Amy to show you the method of application of the SOFT-T.

For 10 critical principles of tourniquet use, check out her video on the subject here:

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Wishing you the best of health in good times or bad,

Amy and Joe Alton

Dr. Bones and Nurse Amy


For a review of several popular tourniquets (and much more), check out the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at You’ll be glad you did.

Just some of our kits and supplies

Just some of our kits and supplies

Learn how to stop bleeding in emergencies

Survival Medicine Hour: Nuclear Blasts, Water Safety, Eclipse Eye Safety

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Solar Eclipse (via Wiki)

In this episode of the Survival Medicine Hour, Joe Alton MD, aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy discuss the types of nuclear weapons and the damage they cause in the form of shock and heat waves. Plus, the different types of radiation emitted by detonations of nuclear bombs: Alpha, Beta, Gamma, X-ray, and Neutron radiation. Also, what are the damage zones for, say, a Hiroshima type bomb and what are the chances you’ll survive?

Plus, it’s still pretty hot out and the kids will want to be at the pool, lake or beach. Here’s 12 water safety tips that can prevent a near-drowning mishap, the second most common cause of death in those 14 years old and under by injury. Find out what actually happens when you drown (hint: it’s not all screaming and thrashing around).

Prevent Drowning

Lastly, how to safely view the coming solar eclipse. Did you know that old eclipse glasses more than three years old no longer give you protection, and that homemade filters or sunglasses will not do the job?

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton! To listen in, click the link below:


Wishing you the best of health in good times or bad,

Joe and Amy Alton

Amy and Joe Alton

Follow us: Twitter @ preppershow, Facebook at Doom and Bloom(tm), and YouTube at drbones nurseamy channel

Don’t forget to check out Nurse Amy’s entire line of medical kits and supplies at You’ll be glad you did.







Shoulder Dislocations

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Anterior shoulder dislocation accounts for 95-97% of cases

Of all the joints in your body, the shoulder has the greatest range of motion. This flexibility comes at the cost of low joint stability. 50% of all major joint dislocations seen in U.S. emergency rooms involve the shoulder joint.

A dislocation is an injury in which a bone is pulled out of its joint by some type of trauma. Dislocations commonly occur in shoulders, fingers, and elbows, but knees, ankles, and hips may also be affected.  The joint involved looks visibly abnormal and is unusable.  Bruising and pain often accompany the injury.

If the dislocation is momentary and the bone slips back into its joint on its own, it is called a subluxation. Subluxations can be treated the same way that sprains are, using the R.I.C.E.S. method.  It should be noted that the traditional medical definition of subluxation is somewhat different from the chiropractic one.


Detailed shoulder anatomy (wiki)

First, a short anatomy lesson. Unlike the kids’ song, there is no “shoulder bone” connected to the “arm bone”. The shoulder actually consists of three bones: the upper arm bone (known as the “humerus“), the shoulder blade or “scapula“, and the collarbone, also called the “clavicle“. The head of the humerus fits into a socket in the scapula. This socket (the “glenoid cavity“) is stabilized by ligaments, strong connective tissues that keep the humerus centered in the socket. These connective tissues, along with muscles and tendons, form a capsule that keeps the joint stable. Significant weakening of the capsule can cause the humerus to be dislocated.

The patient with a shoulder dislocation will come, usually holding their forearm for support, with complaints of pain and an arm that will appear obviously out of place. Swelling is not unusual. You might notice that the shoulder appears “lower” than on the uninjured side.

Of course, if there is medical care readily available, the patient with a shoulder dislocation should go directly to the local hospital. Indeed, some dislocations may only be reduced surgically under general anesthesia. In an off-grid setting, however, you are on your own and will probably have to correct the dislocation yourself.  This is known as performing a “reduction”.


Reduction is easiest to perform soon after the dislocation, before muscles spasm and the inevitable swelling occurs.  Not only does reducing the dislocation decrease the pain experienced by the victim, but it will lessen the damage to all the blood vessels and nerves that run along the line of the injury.  The faster the reduction is performed, the less likely there will be permanent damage. Unfortunately, a joint that experienced a dislocation may have a tendency to go out of place again in the future.

If help is not forthcoming, expect significant pain on the part of the patient during the actual reduction procedure. Giving some pain relievers like ibuprofen or stronger might be useful before the procedure to decrease discomfort.  Prescription muscle relaxers such as Cyclobenzaprine (Flexeril) are also helpful.

The use of traction will greatly aid your attempt to fix the problem. Traction is the act of pulling the dislocated bone away from the joint in such a fashion as to give room for it to slip back into place. This goal can be accomplished in various ways, depending on the type of dislocation.

The following procedures for reducing a shoulder dislocation are just some of the techniques used in this excellent video from Larry Mellick, MD of the Medical College of Georgia:

Method 1: Have the patient lie face down on a surface high enough that the arm (including the shoulder joint) dangles without hitting the ground. Place the patient’s arm into position slowly for the least discomfort.

Wrap a 15-20 pound weight around the forearm and wrist (again, not hitting the ground). Although they could hold the weight in their hand, this may tense the muscles, and you need them to relax. Once the muscles are relaxed enough (maybe 10 minutes or so), the arm should pop back into place.

Method 2: Have the patient lie on their back. With their elbow at a 90-degree angle, slowly rotate the arm outward with the palm facing the sky. This should be a slow movement, and pain should be a sign to slow down.

Now, raise the arm so that the hand is behind their head, as if they were scratching the back of their neck. The action is similar to a baseball pitcher about to throw a ball. Once their hand is behind their head, slowly help them reach for the opposite shoulder. This motion should move the arm back into place.

Method 3: If you are alone with your patient, place your foot against the side of the patient’s chest and apply slow traction by pulling the arm while holding the wrist with the palm facing up. This, again, must be done slowly and gradually until the arm pops back into place.

If you’re fortunate enough to have an assistant, wrap a towel or sheet around the upper chest of the patient and have the assistant pull in the opposite direction to provide counter-traction. This avoids having to use your foot for that purpose.

If these procedures are successful, pain and movement should be immediately improved, although it is normal to have some continued discomfort in the injured shoulder. Your patient may benefit from the placement of ice packs to reduce swelling and a sling to immobilize the joint while it heals.

Full recovery will take about 4-12 weeks, depending on the age and physical condition of the patient. should be noted that the dislocation itself or the reduction procedure could possibly disrupt blood vessels or nerves, leading to circulation issues as well as effects to sensation and motor function.

Orthopedic injuries will be common in any austere setting. The medic has to be ready to take the initiative when the ambulance is not on the way if full use of an injured extremity is to be recovered.

Joe Alton MD

Joe Alton MD


Find out more about orthopedic injuries in remote settings (and much more) with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at

Grab and Go Deluxe First Aid Trauma Kit

Our Grab N Go Medical Kit

Types of Nuclear Weapons and Their Effects

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Ground Blast with Fireball

Given the fragile state of affairs on the Korean peninsula, fears of a nuclear incident are higher than at any time since the Cold War. With good reason, most people associate use of nuclear weapons with devastating outcomes. Few, however, know much about the different types and their actual effects.

(by the way, It’s pronounced “noo-clee-ar”, not “noo-cu-lar”)


Until the recent missile launches by North Korea, most people were concerned about the use of “dirty bombs“ by terrorists. A dirty bomb is not technically a nuclear weapon. It uses conventional explosives to disperse radioactive material in the general area. Usually, the effect of the explosion causes more damage and casualties than the radioactive elements.

Our concept of an “atomic bomb“ as developed by the Manhattan Project in the 1940s is one that uses “nuclear fission”. The explosion is caused by a chain reaction that splits atomic nuclei. The result is a wave of intense heat, light, pressure, and kinetic energy equaling thousands of tons (also called kilotons) of TNT. This is followed by the release of radioactive particles in a cloud that resembles a mushroom (if a ground blast). Mixed with dirt and debris, the particles fall back to Earth, contaminating crops, animals, and people. This will happen in the area of the detonation, but will also be blown elsewhere by the prevailing winds.

Atomic bombs gave way to hydrogen bombs, which are best described as “thermonuclear” weapons due to the generation of extreme heat during detonation. H-Bombs use a process known as nuclear fusion, which takes two light nuclei and forms a heavier one, using variations of hydrogen atoms called “isotopes”. This fusion process requires high temperatures and usually involves a fission reaction as discussed above to initiate. H-Bombs don’t just generate power in the kilotons; they can reach levels in the megatons (millions of tons) of TNT.

Another type of thermonuclear weapon is the “neutron bomb“, which generates much less kinetic energy and thermal damage, but much more radiation. Enhanced radiation weapons like the neutron bomb generate a fusion reaction that allows neutrons to escape the weapon with only a limited blast. Originally designed by the United States to counter massive Soviet tank formations, the neutron bomb is an example of a tactical nuclear weapon. The effect is to leave infrastructure mostly intact while wiping out human targets due to massive radiation.

Blast and Heat Waves cause more % damage than radiation in a fission bomb detonation


The impact of a nuclear bomb is dependent on its “yield”, a measure of the amount of energy produced. The Hiroshima A-Bomb had a yield of 15 kilotons, while the “Tsar Bomba” detonated by the Russians in 1961 had a yield of 51 megatons (51,000 kilotons!). Most of the weapons stockpile of the U.S. and Russia consist of bombs in the 100 to 500 kiloton range, much stronger than Hiroshima and much weaker than Tsar Bomba. This is because they are meant to be fired at major cities in clusters rather than one large bomb, which would be easier to intercept than, say, 20 smaller ones.

Damage is caused by:

  • Blast effects (kinetic energy) – damage due to the explosion and resulting shock wave
  • Heat (thermal energy) – damage generated by extreme heat
  • Radiation (initially and later via fallout) – both local and, later, far-reaching
  • Electromagnetic pulses (EMPs) – disrupts telecommunications, infrastructure

You can expect a generally circular pattern of local damage, but various factors come into play besides the yield of the weapon. The altitude of the explosion, weather, wind conditions, and nearby geologic features play a role. The U.S. government estimates the distribution of damage for fission bombs to be distributed in the following manner:

  • 50% shockwave
  • 35% heat
  • 5% initial blast radiation
  • 10% fallout radiation

Hiroshima Burn Victim

(Note: I don’t have the data in front of me, but it stands to reason that H-bombs would likely cause a higher percentage of heat damage while Neutron bombs would cause more radiation damage than the above model for a standard fission bomb.)

The atom bomb dropped on Hiroshima in 1945 flattened buildings over a roughly 4 square mile area and killed 60,000 people immediately. Another 90,000-140,000 succumbed later to injuries and radiation exposure. Although this represents a total of 150,000 to 200,000 fatalities, the entire population did not perish. At the time of the explosion, there were about 350,000 people in Hiroshima, including 43,000 soldiers. This shows that, although horrific in its effects, that distance from ground zero and other factors play a role in a nuclear weapon’s lethality, as does the power of the bomb itself.

A 50 megaton H-Bomb like the Russian “Tsar Bomba“, however, would cause a much larger circle of devastation than the Hiroshima bomb, with widespread fatalities at least 20 miles from ground zero and third-degree burns 50 miles away. Windows were reported shattered from the test detonation as far away as Norway and Finland.

You might think there isn’t anything you can do in a nuclear attack, and if you’re at ground zero at the moment of detonation, you’re right. But your chances of survival, given some time, distance, and protection, may be better than you think. Well talk about’ what you can do to increase your chances of survival in future articles.

Joe Alton MD

Joe Alton MD


Find out more about disasters (natural and man-made) with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at

Doom and Bloom(tm) Med Kits

Survival Medicine Hour: Survival at Sea, Pt.2, Radiation Sickness, More

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Burn victim of Hiroshima detonation

In this episode of the Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy discuss the recent saber-rattling from North Korean leader Kim Jong Un, our responses, and what to do if your area is hit by radiation from an atomic blast (or a nuclear reactor meltdown). Dr. Alton also talks about what to do if you’re lost at sea: How to get food and water, protection from the elements, and even a little about shark attacks!

Solar Still

All this and more on the Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP.

To listen in, click below:

Wishing you the best of health in good times or bad,

Joe and Amy Alton, aka Dr. Bones and Nurse Amy

Nurse Amy and Dr. Bones

Find out more about radiation sickness, survival at sea, and 150 other medical topics with the 700-page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at


Radiation Sickness

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Radiation sickness

Many consider a nuclear attack an outlandish scenario to which only conspiracy theorists subscribe. Unfortunately, the threat of a nuclear incident, accidental or purposeful, exists, perhaps more than in recent years, due to recent developments in the Korean peninsula.

Atomic weapons can decimate a population from thermal blasts, but it also causes illness and death due to exposure from radiation. Although populated areas have experienced detonations only twice, (Hiroshima and Nagasaki in 1945), nuclear reactor meltdowns and other events have occurred from time to time since then, such as in Fukushima in 2011 and Chernobyl in 1986.

In an atomic explosion, radiation is just one of the possible causes of casualties; heat effects and kinetic energy damage near the blast will cause many deaths and injuries. Radiation released into the atmosphere, however, can have devastating effects far from “ground zero”.

A nuclear event produces “fallout”.  Fallout is the particulate matter that is thrown into the air by the explosion. It can travel hundreds (if not thousands) of miles on the prevailing winds, coating fields, livestock, and people with radioactive material.

The higher the fallout goes into the atmosphere, the farther it will travel downwind.  This material contains elements that are hazardous if inhaled or ingested, like Radioiodine, Cesium, and Strontium. Even worse, fallout is absorbed by the animals and plants that make up our food supply. In large enough amounts, it can rapidly become life-threatening. Even in small amounts, it is hazardous to your long-term health.

A nuclear power plant meltdown is usually less damaging than a nuclear blast, as the radioactive material doesn’t make it as high up in the sky as the mushroom cloud from an atomic bomb. The worst effects will be felt by those near the reactors. Lighter particles, like radioactive iodine, will travel the farthest, and are the main concern for those far from the actual explosion or meltdown. The level of exposure will depend on the distance the radioactive particles travel from the meltdown and how long it took to arrive.


The medical effects of exposure are collectively known as “radiation sickness” or “Acute Radiation Syndrome”. A certain amount of radiation exposure is tolerable over time, but your goal should be to shelter your group as much as possible.

To accomplish this goal, we should first clarify what the different terms for measuring the quantities of radiation mean.  Scientists use terms such as RADS, REMS, SIEVERTS, BECQUERELS or CURIES to describe radiation amounts. Different terms are used when describing the amount of radiation being given off by a source, the total amount of radiation that is actually absorbed by a human or animal, or the chance that a living thing will suffer health damage from exposure:

Marie and Pierre Curie

BECQUERELS/CURIES – these terms describe the amount of radiation that, say, a hunk of uranium gives off into the environment. Named after scientists who were the first to work with (and die from) radioactivity.

RADS – the amount of the radiation in the environment that is actually absorbed by a living thing.

REMS/SIEVERTS – the measurement of the risks of health damage from the radiation absorbed.

This is somewhat confusing, so, for our purposes, let’s use RADS.  A RAD (Radiation Absorbed Dose) measures the amount of radiation energy transferred to some mass of material, typically humans.

Some effects of radiation exposure (wiki commons)

An acute radiation dose (one received over a short period of time) is the most likely to cause damage.  Below is a list of the effects on humans corresponding to the amount of radiation absorbed. For comparison, assume that you absorb about 0.6 RADs per year from natural or household sources.  These are the effects of different degrees of acute radiation exposure on humans:

  • 30-70 RADS: Mild headache or nausea within several hours of exposure.  Full recovery is expected.
  • 70-150 RADS: Mild nausea and vomiting in a third of patients.  Decreased wound healing and increased susceptibility to infection. Full recovery is expected.
  • 150-300 RADS: Moderate nausea and vomiting in a majority of patients.  Fatigue and weakness in half of victims.  Infection and/or spontaneous bleeding may occur due to a weakened immune system. Medical care will be required for many, especially those with burns or wounds.  Occasional deaths at 300 RADS exposure may occur.
  • 300-500 RADS: Moderate nausea and vomiting, fatigue, and weakness in most patients.  Diarrheal stools, dehydration, loss of appetite, skin breakdown, and infection will be common.  Hair loss is visible in most over time.  At the high end of exposure, expect a 50% death rate.
  • Over 500 RADS: Spontaneous bleeding, fever, stomach and intestinal ulcers, bloody diarrhea, dehydration, low blood pressure, infections, and hair loss is anticipated  in almost all patients.  Death rates approach 100%.

The effects related to exposure may occur over time, and symptoms are often not immediate. Hair loss, for example, will become apparent at 10-14 days.  Deaths may occur weeks after the exposure.


radiation dosimeter

In the early going, your goal is to prevent exposures of over 100 RADS. A radiation dosimeter will be useful to gauge radiation levels and is widely available for purchase.  This item will give you an idea of your likelihood of developing radiation sickness.

There are three basic ways of decreasing the total dose of radiation:

1) Limit the time unprotected. Radiation absorbed is dependent on the length of exposure. Leave areas where high levels are detected and you are without adequate shelter.  The activity of radioactive particles decreases over time.  After 24 hours, levels usually drop to 1/10 of their previous value or less.

2) Increase the distance from the radiation. Radiation disperses over distance and effects decrease the farther away you are.

3) Provide a barrier. A shelter will decrease the level of exposure, so it is important to know how to construct one that will serve as a shield between your people and the radiation source. A dense material will give better protection that a light material.


Radiation burns post-Hiroshima bombing

The more material that you can use to separate yourself from fallout, the more likely you won’t suffer ill effects. Barrier effectiveness is measured as “halving thickness”. This is the thickness of a particular shield material that will reduce gamma radiation (the most dangerous kind) by one half.  When you multiply the halving thickness, you multiply your protection.

For example, the halving thickness of concrete is 2.4 inches or 6 centimeters.  A barrier of 2.4 inches of concrete will drop radiation exposure by one half.  Doubling the thickness of the barrier again (4.8 inches of concrete) drops it to one fourth (1/2 x 1/2) and tripling it (7.2 inches) will drop it to one eighth (1/2 x 1/2 x 1/2), etc.  Ten halving thicknesses (24 inches of concrete) will drop the total radiation exposure to 1/1024th that of being out in the open.

Here are the halving thicknesses of some common materials:

  • Lead:   4 inches or 1 centimeter
  • Steel: 1 inch or 2.5 centimeters
  • Concrete: 4 inches or 6 centimeters
  • Soil (packed): 6 inches or 9 centimeters
  • Water:  2 inches or 18 centimeters
  • Wood:  11 inches or 30 centimeters


By looking at the list above, you can see that the same protection is given with 1/6 the thickness of lead plating as that of concrete.


Eliminating external contamination with fallout “dust” is important before absorption occurs. This can be accomplished d with simple soap and water. Scrub the area gently with a clean wet sponge. Safely dispose of the sponge and dry the area thoroughly.

Internal contamination is a more difficult issue. Emergency treatment involves dealing with the symptoms.  Once the diagnosis is made, methods that may help include antibiotics to treat infections, fluids for dehydration, diuretics to flush out contaminants, and drugs to treat nausea.  In severely ill patients, stem cell transplants and multiple transfusions are indicated but will not be options in an austere setting.  This hard reality underscores the importance of having an adequate shelter to prevent excessive exposure.

Protection is available against some of the long term effects of radiation. Potassium Iodide (known by the chemical symbol KI), taken orally, can prevent radioactive Iodine from damaging the specific organ that it targets, the thyroid gland. The usual adult dose is 130 mg daily for 7-10 days or for as long as exposure is significant. For children, the dosage is 65 mg daily. KI is available in a FDA-approved commercial product called Thyrosafe.

Thyrosafe (Potassium Iodide)

Taking KI 30 minutes to 24 hours prior to a radiation exposure will prevent the eventual epidemic of thyroid cancer that will result if no treatment is given. Radiation from the 1986 Chernobyl disaster has accounted for more than 4,000 cases of thyroid cancer so far, mostly in children and adolescents. Therefore, if you only have a limited quantity of KI, treat the youngsters first.

Although there is a small amount of KI in ordinary iodized salt, not enough is present to confer any protection by ingesting it.  It would take 250 teaspoons of household iodized salt to equal one Potassium Iodide tablet.

Pets may also be at risk for long-term effects from radioactive iodine. It is recommended to consider 1/2 tablet daily for large dogs, and 1/4 tablet for small dogs and cats.


Don’t depend on supplies of the drug to be available after a nuclear event. Even the federal government will have little KI in reserve to give to the general population. In recent power plant meltdowns, there was little or no Potassium Iodide to be found anywhere for purchase

Betadine Solution

If you find yourself without any KI, consider this alternative:  Povidone-Iodine solution (brand name Betadine). “Paint” 8 ml of Betadine on the abdomen or forearm 2-12 hours prior to exposure and re-apply daily. Enough should be absorbed through the skin to give protection against radioactive Iodine in fallout.

Betadine as an alternative for KI

For children 3 years old or older (but under 150 lbs or 70 kg), apply 4 ml. Use 2 ml for toddlers and 1 ml for infants. This strategy should also work on animals. If you don’t have a way to measure, remember that a standard teaspoon is about 5 milliliters. Discontinue the daily treatment after 3-7 days or when Radioiodine levels have fallen to safer levels.

Be aware that those who are allergic to seafood will probably be allergic to anything containing iodine. Adverse reactions may also occur if you take medications such as diuretics and Lithium. It is also important to note that you cannot drink tincture of iodine or Betadine; it is poisonous if ingested.

Although many don’t view a nuclear event as a likely disaster scenario, it’s important to learn about all the possible issues that may impact your family in uncertain times.

Joe Alton MD

Dr. Alton

Find out more about survival medicine with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at

Medical Kits by Doom and Bloom

12 Water Safety Tips

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Keep her safe this summer

In warm weather, a lot of outdoor activities will include waterfront areas like the lake or beach. A dunk in the local water feature is refreshing, but puts many, especially children, at risk for injuries; of these, drowning is one of the most tragic.

Among those 14 years old and under, drowning is the second most common cause of injury-related death (car accidents are first). More than 800 kids die due to drowning mishaps every year, and thousands more sustain nonfatal injuries, sometimes involving significant brain damage.


Keep an eye on the little ones at all times

There are a number of factors which increase the risk of drowning. They include:

Poor swimming ability: Simply put, if you can’t swim, your chances of drowning increase.

Poor supervision: Drowning can happen relatively quickly and without a lot of noise. Even the presence of lifeguards may not save you on the beach, and unsupervised small children could die even in the bathtub.

Location: Although home swimming pools are the most likely places that young children drown, most adult drowning events occur in natural, boating, or wilderness settings.

Lack of Barriers: Pool fences that separate the pool from the yard reduces a child’s risk of drowning by 83%.

Lack of Life Jackets: 88% of boating deaths by drowning involve people who weren’t wearing life vests.

Alcohol: The majority of deaths by drowning in adolescents and adults involve impaired judgment and coordination caused by drinking.

Seizure Disorders: Drowning, often in the bathtub, is the most common cause of death by injury for those with a seizure disorder (epilepsy).


mouth below water level, silent gasping without calling for help may alert you to someone in trouble

The act of drowning if usually associated with non-swimmers screaming and thrashing about. This may, indeed, lead to drowning, but once begun, it’s as likely to be a silent event.

In the early stages, very little water enters the lungs due to a spasm of the windpipe that seals the airway. This prevents passage of water into the lungs, but also air. As a result, the drowning person is unable to call for help. Within a short period, they lose consciousness, leading to a set of reactions in the body that ends in cardiac arrest.

These reactions may appear unremarkable, but are important to recognize. They include:

  • Forward position with the mouth at or below water level
  • Alternatively, supine with head tilted back and mouth open
  • Eyes glassy and open
  • Gasping for air instead of yelling for help
  • Swimming ineffectively
  • Flailing arms and legs in a failed effort to rise out of the water

At this stage, the process may still be reversed with prompt and effective resuscitation. Survival rates depend strongly on the duration of immersion.


Pools and Lakes are common risk areas for drowning

At the beach or in the wilderness, you might encounter a distressed person in the water. Your first response will be to jump in and help. The victim, however, may be panicking and flailing around. To avoid injury and reduce the risk that you’ll become the next victim: Reach, Throw, Row, Go.

  1. Reach out to the person with a stick or oar.
  2. Throw the person a lifeline, life preserver, or other floating object.
  3. Row out to the person in a canoe or other boat if available.
  4. Go into the water only when there is no other option.


In circumstances where you encounter a person in trouble in the water:

  • Shout for help.
  • Remove the person from the water in a safe manner (Reach, Throw, Row, Go).
  • In normal times, call Emergency Medical Services.
  • Begin CPR, using both chest compression and rescue breathing. Chest compression alone is insufficient for drowning victims.
  • If available, use an automated external defibrillator (AED) and assist in transport to a modern medical facility if possible.


Here are 12 safety tips to keep your family safe from drowning mishaps:

  • Take Swimming lessons: Don’t go into swimming-depth water if you don’t know how to swim. Swimming lessons are provided by many municipalities throughout the country, even for very young children. So are CPR classes, which are very important when it comes to aiding drowning victims.
  • Keep strict supervision on minors: Children in the water should always be supervised by a responsible, sober adult. For preschool children, the adult should be close enough to touch the child and not involved in any other activity.
  • Utilize the “Buddy System”: Everyone, even adults, should always swim with another person or persons.
  • On the beach, beware rip currents: Know the meaning of flags on supervised beaches. High waves, discolored water, debris, and channels of water moving away from shore are signs of dangerous conditions. If caught in a rip current, swim parallel to shore until free, then diagonally towards the beach.
  • Foam “noodles” or inflatable toys don’t take the place of life jackets. Be firm about using the right equipment, even for adults.
  • Pool fencing saves lives: Four-sided fencing 4 feet high with a high latch is the safest way to prevent small children from falling or jumping into the pool and getting into trouble. Don’t leave toys near the pool after swimming.
  • Be aware of the weather: Thundershowers often whip up the water with strong winds, increasing the risk of drowning.
  • Be physically fit: Swimming involves exertion, so make sure you’re up to the challenge.
  • Avoid alcohol: Any water activity is more dangerous if you’re drinking.
  • Don’t hyperventilate: Taking rapid deep breaths to see who can stay underwater longest may cause a blackout.
  • Use the shower, not the bathtub, if you suffer from a seizure disorder. The odds of drowning are much lower if you avoid the tub. Any outdoor swimming activity should be done only with one-on-one supervision.
  • In the wilderness, be wary of river crossings. Fast moving water may knock you off your feet, even if less than a foot deep.

Make that summer trip to the beach or lake memorable (in a good way) by knowing how to recognize and treat near-drownings. You’ll be glad you did.

Joe Alton MD

Dr. Alton


Find out more about survival medicine with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at

Our new motorcyclist medical kit

7 Antiseptics For Your Medical Kit

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Betadine is a Iodophor-type antiseptic

I’ve often said that, in a major disaster, we may be thrown back to a bygone era where modern medicine is not an option. Indeed, we can expect civil war-era statistics with regards to major abdominal and chest trauma outcomes, but we will still be ahead of our ancestors even if we’re thrown off the grid. That’s because of modern knowledge of antisepsic techniques.

The word antiseptic comes from the greek words anti (against) and septikos (putrid or rotten).  Antiseptics are substances with antimicrobial properties applied to living tissue to reduce the possibility of infection. Antiseptics, it should be noted, are not antibiotics. Antibiotics are meant to destroy bacteria within the body. Antiseptics are also different from disinfectants, which destroy germs found on non-living objects. All of these are important supplies for the survival medic.

Infected wound

We have a number of videos on this website that discuss antibiotics and what your options are in a survival scenario. If you haven’t been here before, use the search engine and you’ll find there are more than you think. We haven’t, however, talked a lot about antiseptics. Let’s discuss the most popular types on the market that might be candidates for your survival medical kit.

Iodophors: Iodophors like Betadine contain iodine, a substance that can also be used to purify water, but is combined with a solubilizing agent, povidone, which makes it, unlike pure iodine, relatively nonirritating and nontoxic to living tissue. Iodophors work against a broad array of microorganisms and don’t need to be heavily diluted. I will admit that I do dilute my Betadine if I use it on open wounds for regular dressing changes.  Iodophors are effective in killing microbes within just a few minutes.


Chlorhexidine Gluconate: This substance, perhaps better known by its brand name “Hibiclens”, is helpful  against many types of germs, although it’s not very effective against fungal infections. It’s relatively long-lasting, however, compared to some other antiseptics. For this reason, Hibiclens is popular as a way to prepare areas for surgery and for healthcare providers to scrub their hands before patient encounters.

Alcohol: Ethyl Alcohol (also called ethanol) is another tried and true antiseptic product. It, along with isopropyl alcohol, kills many different types of microbes and is fact acting and inexpensive. The problem is that alcohol has a drying effect on skin, the oral cavity, and vagina. It has a tendency to inhibit the development of new cells, so use it for an initial wound cleaning but not for regular care.

Benzalkonium Chloride: BZK is a mild antiseptic and is easily tolerated by most people. One of the most popular first aid wipes or sprays, some say that it has a special effect against the rabies virus, but there’s little hard data supporting this claim.

Hydrogen Peroxide: Hydrogen peroxide is used to clean wounds and reacts with blood to form an impressive foam. This is because blood and most cells contain an enzyme called catalase. Catalase reacts with hydrogen peroxide, converting it into oxygen and water. This effect makes it popular for household first aid in common mishaps like abrasions, but not a great candidate for regular dressing changes due to its drying effect on new cells. It can be used as a mouth rinse in the oral cavity, however, making it a candidate for a survival dental kit.

PCMX (Parachlorometaxylenol or chloro-xylenol for short): Available in more brand names than you can count, this substance is effective against most germs. It’s less potent, though, than chlorhexidine and iodophors, although the antiseptic effect lasts longer. PCMX can be irritating, so don’t use it on mucous membranes like the oral cavity and vagina.

Bleach and baking soda added to just-boiled water in the right proportions can make an effective antiseptic solution

Bleach: Bleach can be found as either a sodium hypochlorite (Clorox) solution or can be improvised with calcium hypochlorite granules, also known as “Pool Shock”. Used more as a disinfectant than an antiseptic, bleach in very dilute solutions (0.5% or less) can make Dakin’s solution, a time-honored method to clean wounds. Be sure to watch our recent two-part video on this website that shows you how to make it easily and affordably.

I’m sure you know of more products that can serve as antiseptics for your survival sick room. Armed with these items, your chances of succeeding when everything else fails, at least as a medic, go up exponentially. Be sure to get the supplies and knowledge that will save lives in times of trouble.

Joe Alton MD

Joe Alton MD

Find out more about stopping hemorrhage and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at!

Video: 10 Critical Principles of Tourniquet Use

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Video: 10 Critical Principles of Tourniquet Use

SOF-T Tourniquet

In this video, Nurse Amy steps in front of the camera to discuss important principles with regards to tourniquet use to stop massive hemorrhage.  Besides the imperative to apply pressure to stop the bleeding, Amy discusses the concept of pressure loss, the length of time the tourniquet should be placed, and when to transition the tourniquet to a pressure dressing with hemostatic agents. Nurse Amy (an advanced registered nurse practitioner) gives you strategies that will help prevent rebleeds, and other factors that make tourniquet use appropriate and generally safe.

To watch, click below:

Wishing you the best of health in good times or bad,


Amy and Joe Alton

Amy Alton ARNP

Find out more about stopping hemorrhage and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at!

Survival Medicine Hour: Poison Plants, Setting a Fracture, More

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various fracture types; note open fracture 2nd from left


In the this episode of the Survival Medicine Hour with Joe Alton MD and Amy Alton ARNP, aka Dr. Bones and Nurse Amy, our hosts discuss what you would do with a fractured bone off the grid or after a disaster where modern medicine is just not an option. Dr. Alton’s take on the subject might shock modern medical professionals, but you have to do what you can, with what you have, where you are, in tough times. Topics including placing a cast, open fractures, re-aligning bones (known as “reductions”) and more.

typical rash of poison ivy

Also, the Altons talk about what to do when you’re outdoors and surrounded by poison plants like poison ivy, oak, and sumac. How to identify plants, diagnose and treat the rash, plus natural remedies that might help.

All this and more on the latest Survival Medicine Hour with Joe and Amy Alton! To listen in, click below:

Hey, do us a big favor and follow us on twitter @preppershow, Facebook: Doom and Bloom or join our group at Survival Medicine Dr Bones Nurse Amy, and YouTube at DrBonesNurseAmy!

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Joe and Amy Alton



Find out more about poisonous plants, fractures, and 150 other medical topics in the survival mindset with the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. And don’t forget to fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and supplies at!

Grab and Go Deluxe First Aid Trauma Kit

Grab N Go Medical Kit

Video: Making Dakin’s Solution, Part 2

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Video: Making Dakin’s Solution, Pt. 2

Open wounds are prone to infection

In this video (part 2 of 2), Amy Alton ARNP, aka Nurse Amy, demonstrates how to make Dakin’s solution for the care of open wounds, followed by some comments by Joe Alton MD, aka Dr. Bones, on how to vary the strength from full (5% sodium hypochlorite) down to 1/8 strength, how long it last when stored properly, and some other important things to know about this additional tool for the medical woodshed in survival settings.

To watch, click below:

In case you missed it, here’s Part 1 of the video:

Video: Making Dakin’s Solution, Part 1…-solution-part-1/

Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

You can make Dakin’s solution with regular household items, but for medical supplies you can’t make on your own, check out Nurse Amy’s entire line of kits and individual items at You’ll be glad you did.

Survival Medicine Hour: Wilderness Safety, Snake Bite, More

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Survival Medicine Hour #347

wilderness safety

In this episode of the The Survival Medicine Hour with Joe Alton, MD, aka Dr. Bones, and Amy Alton, ARNP, aka Nurse Amy, discusses how to make those summer outdoor outings with your family, as well as off-grid survival scenarios, safer for all involved. To make a wilderness experience memorable (in a good way), you’ll need to know what factors will make the environment friendly or not-so-friendly, with injuries as the end result. Amy and Joe tell you what you need to bring in your medical kit.

Pit vipers!

One thing you might not bring is that old snake bite kit! Dr. Bones talks about current thinking regarding the old standard, and what to do if you have a group member suffer a venomous snake bite when modern facilities are not an option.

All this and more on the latest Survival Medicine Hour with the Altons! To listen in, click below:


Hey, do us a huge favor and….

Follow us on: Twitter @Preppershow      Facebook at DoomandBloom(tm)     YouTube at DrBones NurseAmy     Instagram at DoomandBloomMedical

Wishing you the best of health in good times or bad,

Joe and Amy Alton

Nurse Amy and Dr. Bones

Find out more about snake bites and 150 other medical topics in times of trouble by getting a copy of the 700 page Third Edition of The Survival Medicine Handbook, now available on Amazon! And don’t forget to get a solid medical kit from Nurse Amy’s often-imitated, never-equaled entire line of supplies at! You’ll be glad you did.

Snake Bites in Austere Settings

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rattlesnake (image by wiki)

Off the grid, you will find yourself outdoors a lot, with activities like gathering wood for fuel, foraging, and hunting required to keep body and soul together. In warm weather, you just might find yourself face-to-face (or maybe face-to-ankle) with a snake.

Most snakes aren’t poisonous, but a few are, including some species common in North America. The term “poisonous snake” is probably incorrect, as venoms and poisons are not the same thing. Poisons are absorbed in the gut or through the skin, but venom must be injected into tissues or blood via fangs or a stinger. Interestingly, it’s usually not dangerous to drink snake venom unless you have a cut or sore in your mouth. Having said that, please don’t test this out at home.

Venomous snake bites have a distinct appearance due to the hollow fangs at the front of the mouth. This differs from non-venomous snakes, which have a more uniform appearance.

Since snakes are most active during the summer, most bite injuries occur then. Not every bite from a venomous snake transmits toxins to the victim, however; indeed, 25-30% of these bites will be “dry” and show little or no ill effects.  This could be due to the short duration of time the snake has its fangs in its victim or whether the snake had bitten another animal shortly beforehand. Many other snake bites are only slight “envenomations” and resolve without major intervention.

In most cases, it’s not hard to tell whether there’s venom in the bite. Snake bites containing venom tend to cause a painful burning sensation almost immediately. Swelling at the site may begin as soon as five minutes afterwards, and may travel up the affected area towards the body core.

Venomous Snakes in North America: Pit Vipers and Elapids

Many snakes have enough venom to deliver more than one bite

The two to worry about in North America are the pit vipers and the elapids. Of these, the pit vipers are responsible for the grand majority of venomous bites in the United States.

Pit vipers like rattlesnakes and water moccasins are identified by the presence of a heat-sensing “pit” organ between the eye and nostril on both sides of the head. They are, perhaps, more easily recognized by their triangular-shaped heads and slit-like eyes.  Rattlesnakes will, of course, have rattles that make noise when they’re threatened.

Pit viper bites tend to cause bruising and blisters at the site of the wound.  Numbness may be noted in the area bitten, or perhaps on the lips or face.  Some victims describe a metallic or other strange taste in their mouths. Serious bites might cause spontaneous bleeding from the nose or gums, irregular heart rhythms, or difficulty breathing.

Red touches yellow, kill a fellow…

The elapids include cobras and mambas, but the main North American representative is the colorful coral snake. Coral snakes appear very similar to their look-alike, the non-venomous king snake.  They both have red, yellow, and black bands and are commonly confused with each other. The old saying goes: “red touches yellow, kill a fellow; red touches black, venom it lacks”.  In other words, if the red band is next to the yellow band, it’s a deadly coral snake. If the red band touches the black band, it’s a non-venomous king snake. It should be noted that this old saying only applies to coral snakes in North America.

red touches black, venom it lacks…

Coral snake bites are “neurotoxic” and will cause mental and nerve issues such as twitching, confusion, and slurred speech.  Later, nerve damage may cause difficulty with swallowing and breathing, followed by total paralysis.  Luckily, only 73 coral snake bites were reported in the U.S. in 2013.

Preventing Snake Bites

Wear high tops in snake country

An ounce of prevention, they say, is worth a pound of cure.  High-top boots and long pants are always a sound strategy when hiking in the wilderness. It’s important to be aware of where you’re putting your hands and feet.  Be especially careful around areas where snakes might like to hide, such as hollow logs, under rocks, or in old shelters. Wearing sturdy work gloves would be a wise precaution if you can’t avoid these places.

If you let snakes know you’re near, they tend to leave the area. Snakes have no outer ear, so treading heavily creates ground vibrations much more easily “heard” by them than, say, shouting.

In warm weather, many snakes like to be active at night. This means that nocturnal outdoor activities are inadvisable without a good light source.

Treating a Snake Bite in Austere Settings

Pit viper bites often have bruising, sometimes blisters

The standard treatment for a venomous snake bite is “anti-venin”, also called “anti-venom”. Anti-venin is an animal or human serum with antibodies capable of neutralizing a specific biological toxin. Any hospital will have it, but in survival scenarios, this product will be a scarce commodity. If there’s no help coming, consider these steps:

  • Keep the victim calm. Stress increases blood flow, thereby endangering the patient by speeding the venom into the system.
  • Stop all movement of the injured extremity. Movement transports the venom into the circulation faster, so do your best to keep the limb still.
  • Clean the wound thoroughly to remove any venom that isn’t deep in the wound.
  • Remove rings and bracelets from an affected extremity. Swelling is likely to occur.
  • Position the extremity slightly below the level of the heart; this slows the transport of venom.
  • Wrap with clean, loose bandages further up the limb than usual. Pressure bandaging is thought to be helpful for elapid bites, but may be risky for pit viper bites, as it may cause tissue damage.In any case, keep the wrapping somewhat less tight than when dressing a sprained ankle. If it is too tight, the patient will reflexively move the limb, and spread the venom around.
  • Avoid tourniquets, which do more harm than good.
  • Draw a circle around the affected area. As time progresses, you will see the area shrink if it improves or grow if it worsens. By the way, this is a good strategy to follow for any local reaction, infection, abscess, or hematoma.

The limb should then be rested and, perhaps, immobilized with a splint or sling.  The less movement there is, the better. Keep the patient on bed rest, with the bite site lower than the heart, for 24-48 hours. This strategy also works for bites from venomous lizards, like Gila monsters.

Snake bite kits aren’t always recommended anymore

It is no longer recommended to make an incision and try to suck out the venom with your mouth.  The amount of venom removed is thought to be very little and oral bacteria could introduce an infection. Snake bite kits are available for your backpack, but are out of favor with most wilderness medical professionals. The Sawyer Extractor (a syringe with a suction cup) is modern and compact, but ineffective in eliminating more than a fraction of the venom. These methods fail, mostly, due to the speed at which the venom is absorbed by the body.

You may wonder why I haven’t suggested antibiotics as a treatment for snake bite. Interestingly, snake bites don’t cause infections as frequently as bites from cats, dogs, or humans.  As such, antibiotics are used less often.

Parting Thoughts on Snake Bite

A snake doesn’t always slither away after it bites you.  It’s likely that it still has more venom that it can inject, so move out of its territory or abolish the threat in any way you can. To many, this entails killing the snake. Even severing the head from the body may not render it harmless, however: it can reflexively bite for a period of time.

Elapids and pit vipers may respond differently to an encounter with a human. Coral snakes are not as aggressive as pit vipers and prefer fleeing to attacking.  Once they bite you, however, they tend to hold on. Rattlesnakes prefer to bite and let go quickly. Unlike elapids, though, pit vipers may be reluctant to relinquish their territory to you, so leave the area as soon as possible.

Snakes can be dangerous, but they want to avoid you as much as you want to avoid them. Keep an eye out, wear decent gear, and both you and the snake will be the happier for it.


Joe Alton MD

Ol’ Doc Bones

Fill those holes in your medical supplies by checking out Nurse Amy entire line of kit and individual items at!



Survival Medicine Hour: Wound Debridement, Shock Treatment, More

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Wound Debridement

In this episode of The Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss the Wilderness Medical Society’s special edition on combat casualty care guidelines applied to survival settings, where they coincide and where they diverge. Also, some basics on an important part of wound care, wound debridement, the removal of dead skin from a healing open wound. Studies show that antibiotics are important to prevent and treat wound infections, but debriding dead tissue from a wound is important to aid recovery as well.

People in shock lose heat quickly

Also, more on the different types of shock, and what to do if you have to treat someone deteriorating rapidly from some of the various types. All this and more on the latest Survival Medicine Hour with Joe Alton MD, and Amy Alton ARNP!

To listen in, click below:


Wishing you the best of health in good times or bad,


Joe and Amy Alton

Nurse Amy and Dr. Bones

Hey, fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and individual items at You’ll be glad you did. And don’t forget, the 700 page third edition of the Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way is the most comprehensive book you’ll find written on medical care in times of trouble!

Wound Debridement in Survival

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Wound Debridement in Remote Settings

Maggot debridement of open wound

Injuries in remote settings like a wilderness trail or survival homestead pose challenges to the medic not experienced in long-term wound care. Ordinarily, a system exists to evacuate victims of such injuries to modern medical facilities. In situations where that option doesn’t exist for the foreseeable future, however, the average person may be medically responsible from the point of injury to full recovery.

This is a novel (and sobering) thought for most, and the tools needed to provide regular wound care and the medications to prevent and treat infection may not be at hand. For this reason, I have spent years writing articles on the importance of antibiotics as part of a prepared individual’s medical supplies.

Although I’ve written extensively on antibiotics in survival settings, I’ve written less on wound debridement. Originating from the French “desbrider (to unbridle), debridement is the act of removing dead or foreign material in and around a wound.

Debridement was likely first discovered to be a useful medical tool in wartime, where grossly contaminated wounds were common. The horrific wounds incurred in armed conflict seemed to do better if damaged and dead tissue was aggressively removed. This tissue may be on the edges or throughout the injury. It usually appears discolored, often blackish with a foul odor, although it could also appear white.

By removing dead tissue that, by definition, will not heal, you eventually reach a level where live tissue exists. After debridement, the remaining tissue can recover in a cleaner environment or might, in certain circumstances, be a candidate for wound closure.

Why Should You Debride a Wound?

Sharp debridement

Despite the benefits of debridement, some less-trained survival medics might (understandably) be reluctant to intervene. It is important for them, therefore, to understand the detrimental effects of allowing non-viable tissue to remain in an open wound.

The first is lack of exposure. An open wound is best evaluated when all the dead tissue is removed and the amount of viable material is known.

Next is the suppression of the healing process. Tissue that is no longer viable serves as a place for bacteria to grow, especially the nasty ones that cause serious issues like gangrene. These bacteria slow the healing process in open wounds by competing with growing cells for nutrients.

Necrotic (dead) tissue also causes inflammation in nearby tissues and increases the chance of sepsis (a body-wide infection).

Finally, failure to remove non-viable tissue interferes with the ability of live tissue to naturally close an open wound (a process called granulation).

Removal of non-viable tissue by debridement and treatment with antibiotics helps a wound to heal, but either treatment alone does not give you the best chance of avoiding infection, according to studies cited in a recent issue of Wilderness and Environmental Medicine (2017; Vol. 28, #2S).

The above article referenced an evaluation of open fractures, a severe injury found in both wilderness and survival settings. The results seem to show that surgical intervention and antibiotics given within 2 hours is associated with the lowest rate of infection. When antibiotics are given on time but surgery is delayed, higher rates of infection are seen. When surgical intervention occurs on time but antibiotics are delayed, even higher rates are noted, although signs of infection may not appear for three days or so.

Wound Debridement in Survival Settings

There are various ways to debride a wound, but only the following, in my opinion, would be options in a survival scenario:

Sharp Debridement: Using a scalpel and scissors, dead tissue can be quickly removed. Some surgical skill is useful for the best results.

Mechanical Debridement: Aggressive wound irrigation helps remove debris and leads to a cleaner wound, but results aren’t as complete or as rapidly seen as with sharp debridement. Less skill is required, however, to achieve the end result.

Biological Debridement: Maggot therapy. The larvae of the green bottle fly is used to digest dead tissue and bacteria. One way to collect maggots is to place, say, a dead rat or squirrel in a bag with small holes at the bottom and hang it over a plate or pan to collect the maggots that fall out after a few days. More on maggot therapy in a forthcoming article.

Here is a video from “authority guide”‘s YouTube Channel demonstrating the technique of sharp debridement:

Your goal in debriding a wound is to have clear margins of live healthy tissue on all sides. This tissue will bleed somewhat (a sign of life!), but is unlikely to hemorrhage. Moist dressings should then be used to cover the wound and changed regularly.

Debridement takes place at modern facilities in normal times. In survival scenarios, the procedure should take place where there is good lighting (and the bulk of your medical supplies). Having an assistance to help is always a good idea. In the inexperienced, the anatomy of a deeply necrotic wound may be unclear; the medic should have a good textbook on anatomy in their survival library and learn as much as possible before a long-term disaster takes place.

Bottom line: Live tissue heals, dead tissue doesn’t. Debridement allows you to remove the dead material so the live tissue can heal.

Joe Alton MD

Joe Alton, MD

Find out more about long-term wound care in austere settings by getting a copy of our 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. Also, fill those holes in your medical supplies by checking out Nurse Amy’s entire line of medical kits and supplies at

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook 2017 Third Edition




Survival Medicine Hour: Dakin’s Sol’n, Shock, HPV, Garlic

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Survival Medicine Hour #344

Direct Pressure on Bleeding Wound

Bleeding wounds need long-term care. Are you ready?

In this episode of the Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, tackles a number of tough topics like, what can you put in an open wound to prevent and treat infection if a disaster happens and all you have is household items? Here’s how to use bleach and baking soda to make Dakin’s solution, used for over 100 years to prevent death from infected wounds.

Also, Nurse Amy discusses the uses of garlic, it’s not just for cooking! It’s got great antibiotic properties and more…


Plus, there are a variety of types of shock, and we’re not talking about the emotional kinds. Dr. Bones discusses hypovolemic, hemorrhagic, and cardiogenic shock in this ongoing series about dealing with a life-threatening event.

Finally, Joe Alton MD answers a question for the Survival Podcast’s expert council about whether the HPV exam is worthwhile to give to preteens. Find out more about this virus and the controversy surrounding it.

All this and more on the Survival Medicine Hour! To listen in, click below:


Wishing you the best of health in good times or bad,

Joe and Amy Alton

The Altons

Hey, fill those holes in your medical storage by checking out Nurse Amy’s entire line of kits and supplies at You’ll be glad you did!

Dakin’s Solution for Wound Care

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Dakin’s Solution

Dakin’s Solution by Century Pharm.

One of the challenges facing the caregiver in austere settings is how to prevent infection in open wounds. After a disaster, people may be forced to perform activities of daily survival to which they are not accustomed. Injuries may occur as a result. Infections will be more likely in areas where hygiene and sanitation are questionable; without advanced medical care, a bad outcome may be the end result.

A simple and affordable method that was used as far back as World War I may be the answer for the medic: Wound care with Dakin’s solution.

Dakin’s solution is the product of the efforts of an English chemist, Henry Drysdale Dakin, and a French surgeon named Alexis Carrel. In their search for a useful antiseptic to save the lives of wounded soldiers during WWI, they used sodium hypochlorite (household bleach) and baking soda to make a solution that had significant protective effect against infection. The chlorine in the solution had a solvent action on dead cells, which prevented the accumulation of bacteria in open wounds.

(As an aside, both sides in the war were also using chlorine in gaseous form as an anti-personnel weapon!)

Today, Dakin’s solution is still considered effective enough to be used after surgery and on chronic wounds, like bedsores, by many practitioners. It’s easily prepared and can be made stronger or milder by varying the amount of bleach used. Use it simply to clean the wound during dressing changes by pouring onto the affected area, or to moisten dressings used in an open wound.

Dakin’s Solution Recipe

pan with lid (image by pixabay)

To make Dakin’s solution, you’ll need just a few items. This recipe is from Ohio State University’s Department of Inpatient Nursing:

  • Unscented household bleach (sodium hypochlorite solution 5.25%, avoid more concentrated versions).
  • Baking soda (sodium bicarbonate)
  • A pan with a lid
  • Sterile measuring cup and spoon (sterilize by boiling)
  • Sterile canning jar and lid

Of course, wash your hands beforehand, just as you would with any medical procedure. Then:

1. Put 4 cups (32 ounces) of water into the pan and cover with the lid.

2. Boil the water for 15 minutes with the lid on.

3. Remove from the heat source.

4. Use the sterile spoon to add ½ teaspoon of baking soda to the water.

5. Add bleach (sodium hypochlorite 5.25%) in the amount needed (see below).

6. Pour into sterile canning jar and close with a sterile lid.

7.  Label and store in a dark place.

The amount of sodium hypochlorite to add:

Full Strength  (0.5%):       95 ml (about 3 oz. or 6 tablespoons)

Half Strength (0.25%):     48 ml (3 tablespoons plus ½ teaspoon)

!/4 Strength   (0.125%):    24 ml (1 tablespoon plus 2 teaspoons)

1/8 Strength  (0.0625%):  12 ml (2 ½ teaspoons)

Note: 3 teaspoons = 1 tablespoon = 14.7 ml; 2 tablespoons = 1 US ounce = 29.5 ml

Once canned, it’s been said that Dakin’s solution will remain potent for about 30 days. For survival purposes, however, I would make it as I need it for wounds or maybe have just make just a few jars at a time. Once open, discard the remainder after a day or so. You may also consider Century Pharmaceutical’s buffered version of Dakin’s that is thought to last about a year.

Using Dakin’s Solution on Wounds

dressing an open wound

Pour into wound once daily for mildly infected wounds, twice daily for heavily infected wounds with drainage of pus. Alternatively, moisten (not soak) dressings used inside the wound (not on top of the skin) with a mild strength solution and observe progress. I would prefer using it as a cleanser as opposed to a regular component of a wet dressing. Some studies show that use in this manner may be injurious to developing cells. Having said that, if you’re dealing with a severe infection (as opposed to preventing one), it may be reasonable to incorporate Dakin’s into the dressing.

Dakin’s solution can be used as a mouthwash for infections inside the oral cavity, but must never be swallowed. Swish for about a minute before spitting it out no more than twice a week.

Full strength may irritate skin, so consider protecting skin edges with petroleum jelly or other skin protectant/moisture barrier. Look for evidence of skin rashes, burning, itching, hives, or blisters. If irritation occurs, drop down to a milder strength or discontinue. Do not use in those allergic to Chlorine.

It should be noted that not all practitioners agree about the benefits of Dakin’s solution. Certainly, there may be other options with regards to regular wound care, including sterile normal saline and sterilized tap water. Antibiotics also play an important role in treating infected wounds, and a good supply is important for any medic in a remote setting. However, Dakin’s is well tolerated by patients and is simple to make with affordable ingredients. It’s another tool in the medical woodshed for scenarios where modern medical help is not on the way.

Joe Alton MD

Joe Alton MD

Learn about wound infections and 150 more medical topic in remote or disaster settings by getting a copy of our 700 page third edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Benadryl as a Local Anesthetic in Survival?

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Benadryl as a Local Anesthetic in Survival?

diphenhydramine (Benadryl)

A major obstacle in the ability of the survival medic to deal with the issue of wound closure is the lack of an easily available (and stockpile-able) form of anesthesia. With the most popular local anesthetic, lidocaine, a prescription item, it may be difficult to obtain enough to adequately fill the need in long-term disaster scenarios.

We often mention in our podcast that we learn as much (really, more) from our readers and listeners than they do from us. Now, we are informed that diphenhydramine (Benadryl) may serve, in its injectable form, as a reasonable alternative for local anesthesia.

You won’t find this information at or other general medical information sites. Ordinarily, you’ll read that diphyenhydramine (DPH) is an antihistamine that reduces the effects of natural chemical histamine in the body. Diphenhydramine is used to treat sneezing, runny nose, itching, watery eyes, rashes, and some cold or allergy symptoms. It also serves as a remedy for motion sickness, a hypnotic (sleep-inducer), and even to treat certain aspects of Parkinson’s disease.

Benadryl comes in oral form as well as an injectable solution. Although controversial, the injectable has been used as a local anesthetic since 1956. It has been used in minor skin, dental, and podiatric procedures, especially in those allergic to lidocaine. This comment from a pharmacist’s emergency medicine blog:

“In one validation study for its use as a dermal anesthetic, a prospective, randomized, double-blind, placebo-controlled study was conducted to assess both the degree of anesthesia (in square millimeters) and pain associated with injection in 24 subjects who received 0.5-mL injections of 1% DPH, 2% DPH, 1% lidocaine, and 0.9% sodium chloride placebo. Subjects who received 1% DPH achieved equivalent level of anesthesia relative to 1% lidocaine (p = 0.889); in addition, 1% DPH more effective in this outcome compared to 2% DPH. However, subjects did experience greater perception of pain at injection with both concentrations of DPH relative to 1% lidocaine (more pain perceived with 2% DPH), with some subjects experiencing persistent discomfort in the injected area for up to three days following injection. In another study evaluating other concentrations of  DPH for local anesthesia, although a concentration of 0.5% DPH was deemed similar in perception of pain by patients upon injection compared to 1% lidocaine and a viable alternative to 1% lidocaine in maintaining local anesthesia, it was less effective than lidocaine when used for repairing minor skin lacerations in the face. In other head-to-head comparisons of 1% DPH and 1% lidocaine, similar levels and depths of local anesthesia were achieved.”

Like all drugs, there are possible adverse effects. The use of DPH as a local anesthetic may be associated with local necrosis (tissue death) at the site of injection. This usually occurs from the use of excessively high concentrations of the medication. As such, you will see it contraindicated as a local anesthetic on most medical websites. At normal dosages, sedation may be noticed, as well as local soreness. Be aware that it might burn as it is administered and that its safety is not confirmed in distal areas like fingers, toes, ears, and nose.

Injecting local anesthetic

The recipe is as follows, again from our pharmacist’s blog:


Draw up entire contents of vial containing 50 mg/mL diphenhydramine into the syringe. This should measure to a volume of 1 mL.

Dilute the contents of the syringe with 4 mL of 0.9% sodium chloride to yield a final volume of 5 mL.

Clearly label the contents of the syringe with the medication label as “Diphenhydramine 1% (10 mg/mL).”

Usually, the appropriate effect can be achieved with 2 ml or so of the injectable Benadryl. Use as little as possible to achieve the desired effect.

From the standpoint of availability, I was able to order the product as a private citizen (as opposed to a physician) from at least one veterinary website. That doesn’t mean that it is widely available, however.

The survival medic’s job is a difficult one. Searching for additional tools in the medical woodshed isn’t easy, but necessary if the medic is to be effective in an austere off-grid setting. Of course, in normal times, seek modern and standard medical care from qualified professionals.


Some additional support from conventional medical journals for the anesthetic effect of diphenhydramine:

Green SM, Rothrock SG, Gorchynski J: Validation of diphenhydramine as a dermal local anesthetic. Ann Emerg Med 1994; 23:1284-1289.

Ernst AA, Marvez-Valls E, Mall G, et al. 1% Lidocaine versus 0.5% diphenhydramine for local anesthesia in minor laceration repair. Ann Emerg Med 1994; 23:1328-1332.

Dire DJ, Hogan DE. Double-blinded comparison of diphenhydramine versus lidocaine as a local anesthetic. Ann Emerg Med 1993; 22:1419-22.

Ernst AA, Anand P, Nick T, et al. Lidocaine versus diphenhydramine for anesthesia in the repair of minor lacerations. J Trauma 1993; 34:354-7.


Joe Alton, MD

Joe Alton MD

Fill those holes in your medical storage by checking out Nurse Amy’s entire line of medical kits and supplies at You’ll be glad you did.

some of Nurse Amy’s kits

Safe Summer Camping

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Camping Safety


The kids are out of school, the weather’s great, and families are planning this summer’s camping trip. Camping is a great way to create bonds and memories that will last a lifetime. A poorly planned outdoor vacation, however, becomes memorable in the worst way, especially if someone gets hurt. A little planning will make sure everyone enjoys themselves safely.


Not the best choice for a family camping trip

If you’re not a veteran camper, don’t start by attempting to climb Yosemite’s El Capitan. Start by taking day trips to National Parks or a local lake.  Maybe you could start using that firestarter tool, setting up your tent, and making a campfire in your backyard to get through the learning curve. See how things work out when you don’t have to stay in the woods overnight. If the result is a big thumbs-up, start planning those overnighters.

Whatever type of camping you do, you should always be aware of the capabilities and general health of the people in your party. Children and elderly family members will determine the limits of your activities. The more ambitious you are, the more your plans may be beyond the physical ability of the less fit members of your family. This leads to injuries as the end result.


An important first step to a safe camping trip is knowledge about the weather and local terrain you’ll encounter. Talk with park rangers, consult guidebooks, and check out online sources. Some specific issues you’ll need to know:

  • Temperature Ranges
  • Rain or Snowfall
  • Location and Status of Nearby Trails and Campsites
  • Plant, Insect, and Animal Issues
  • Availability of Clean Water
  • How to Get Help in an Emergency


hypothermia polar bear club

Probably Not Dressed for Success in the Snow

A very common error campers make is not bringing the right clothing and equipment for the weather and terrain. If you haven’t planned for the environment, you have made it your enemy.

Although Spring and Fall have the most uncertainty with regards to temperatures and weather, storms can occur in any season. Conditions in high elevations lead to wind chill factors that could easily cause hypothermia. Here’s the thing with wind chill: If the temperature is 40 degrees, but the wind chill factor is 20 degrees, you lose heat from your body as if the actual temperature were 20 degrees. Be aware that temperatures at night drop precipitously. Even summer rain can lead to a loss in body temperature if you get soaked.

In cold weather, you’ll want the family clothed in layers. Use clothing made of tightly woven, water-repellent material for protection against the wind. Wool holds body heat better than cotton does. Some synthetic materials work well, also, such as Gore-Tex.

That’s all well and good in cool temperatures, but if you’re at the seashore or lakefront in the summer, your main problem will be heat exhaustion and burns. Have your family members wear sunscreen, as well as hats and light cotton fabrics. Sunscreen should be placed 15 minutes before entering a sunny area and re-applied to skin that gets wet or after, say, a couple of hours.

If you don’t take the environment into account, you have made it your enemy

In hot weather, plan your strenuous activities for mornings, when it’s cooler. In any type of weather, keep everyone well-hydrated;  dehydration will cause more rapid deterioration in physical condition in any climate.

The most important item of clothing is, perhaps, your shoes. If you’ve got the wrong shoes for the activity, you will most likely regret it. If you’re in the woods, high tops that you can fit into your pant legs will provide protection against snakebite and tick bites. Tick populations are on the rise in the Northeast and Midwest, so beware of signs and symptoms of Lyme Disease. If you choose to go with a lighter shoe in hot weather, Vibram soles are your best bet.

Special Tips: Choosing the right clothing isn’t just for weather protection.  If you have the kids wear bright colors, you’ll have an easier time keeping track of their whereabouts. Long sleeves and pants offer added protection against insect bites and poison ivy.


Real estate agents’ motto is location, location, location and it’s true for camping safety too. Scout prospective campsites by looking for broken glass and other garbage that can pose a hazard.

Look for evidence of animals/insects nearby, such as large droppings or wasp nests/bee hives. If there are berry bushes nearby, you can bet it’s on the menu for bears. Berries that birds and animals can eat are often unsafe for humans to eat. Advise the children to stay away from any animals, even the cute little fuzzy ones. Even some caterpillars are poisonous.

bear poop

Bear Droppings! Camp somewhere else!

Learn to recognize poison ivy, oak, and sumac.  Show your kid pictures of the plants so that they can look out for and avoid them. The old adage is “leaves of three, let it be”. Fels-Naptha soap is especially effective in removing toxic resin if you suspect exposure. The resin can stick to clothes, so cur chips off and use for laundering.

Build your fire in established fire pits and away from dry brush. In drought conditions, consider using a portable stove instead, like the EcoZoom.  In sunny open areas, the Sun Oven will give you a non-fire alternative for cooking. About fires: Children are fascinated by them, so watch them closely or you’ll be dealing with burn injuries. Food (especially cooked food) should be hung in trees in such a way that animals can’t access it. Animals are drawn to food odors, so use re-sealable plastic containers.

If you camp near a water source, realize that even the clearest mountain stream may harbor Giardia, a parasite that causes diarrheal disease and dehydration.  Water purification is basic to any outdoor outing.  There are iodine tablets that serve this purpose, and portable filters like the Lifestraw and the Mini-Sawyer which are light and effective.  Boiling the water first is a good policy in any situation, although time-consuming. Remember to add one minute of boiling for each 1000 feet of elevation above sea level. Water boils at lower temperatures at higher altitudes, and takes longer to kill microbes.


Glen Martin’s Book on Navigation

Few people can look back to their childhood and not remember a time when they lost their bearings. Your kids should always be aware of landmarks near the camp or on trails.  A great skill to teach the youngsters is how to use a compass, a skill you can find in Glen Martin’s new book “Prepper’s Survival Navigation“. Besides a compass, make sure children have  a loud whistle that they can blow if you get separated.  Three consecutive blasts is the universal distress signal. If lost, kids should stay put in a secure spot instead of roaming about. Of course, if you have cell phone service….


Even if you’ve clothed the kids in protective clothing, they can still wind up with insect bites.  Carry a supply of antihistamines, sting relief pads, and calamine lotion to deal with allergic reactions.  Asking your doctor for a prescription “EpiPen” is a good idea if anyone has ever had a severe reaction to toxins from insect bites or poison ivy.  They’re easy to use and effective, and few doctors would refuse to write a script for it.

Citronella-based products are helpful to repel insects; put it on clothing instead of skin (absorbs too easily) whenever possible. Repellents containing DEET also can be used, but not on children less than 2 years old. Don’t forget to inspect daily for ticks or the bulls-eye pattern rash they often cause.  If you remove the tick in the first 24 hours, you will rarely contract Lyme disease.


Get a Medical Kit!

Besides appropriate clothes, insect repellants, and a way to sterilize water, you will want to carry a medical kit to deal with common problems.  This should contain:

  • Antiseptics to clean wounds (iodine pads are good)
  • Bandages of different types and sizes: butterfly, roller, pads, moleskin, elastic (Ace wraps)
  • Cold packs to reduce swelling
  • Splints (splints and larger conforming ones)
  • Burn gel and non-stick dressings like Telfa pad
  • Nitrile gloves (some people are allergic to latex)
  • Bandannas or triangular bandages with safety pins to serve as slings
  • A bandage scissors
  • tweezers (to remove splinters and ticks)
  • topical antibiotic cream
  • Medications:

Oral antihistamines (such as Bendadryl)

Pain meds (Acetaminophen, Ibuprofen, Aspirin, also good for fever)

1% hydrocortisone cream to decrease inflammation

BZK (Benzalkonium Chloride) wipes for animal bites

Your personal kit may require some additional items to handle special problems with members of the family that have chronic medical issues.  Take the above-listed  items and add more to customize the kit for your specific needs. Maybe adding a tourniquet, hemostatic gauze, and an Israeli dressing for more significant injuries? Perhaps some antibiotics for longer backcountry outings?

In an emergency, the most important thing to do is to simply stay calm. If you have the above supplies, you can handle a lot of medical issues in the wilderness. Gain some knowledge to go along with those supplies, and you’ll have the best chance to have a safe and fun outing with your family.


Joe Alton, M.D., aka Dr. Bones


Joe Alton MD

Are you ready to deal with medical issues when the you-know-what hits the fan? You will be, if you get a copy of our #1 Amazon Bestseller “The Survival Medicine Handbook”.

The Survival medicine handbook Third Edition 2016

The Survival Medicine Handbook Third Edition

Survival Medicine Hour: Nailbed Injuries, Wound Closure, Mass Casualties

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American Survival Hour #340

Nailbed Injuries

In this episode of the Survival Medicine Hour, Joe and Amy Alton discuss small injuries like those to the nail bed, and large, massive injuries like those seen in mass casualty events. What do you do if you’re the first on the scene of a bombing or other multi-injury event? These days, as the recent events in England have taught us, a mass casualty incident (MCI) can occur anytime and anyplace there’s a crowd.

Plus, Joe and Amy talk about  the factors to consider before deciding to close a wound. Wounds should only be closed in certain circumstances in off-grid settings. Find out how to use the best judgment in this week’s Survival Medicine Hour with Dr. Bones and Nurse Amy!

When to close a wound?

To Listen in, click the link below:


Wishing you the best of health in good times or bad,

Joe and Amy Alton

Dr. Bones and Nurse Amy

Joe and Amy Alt

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To Close or Not to Close a Wound

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To Close or Not to Close a Wound?

typical laceration

typical laceration

When a laceration occurs, our body’s natural armor is breached and bacteria, even species that are normal inhabitants of our skin, get a free ticket into the rest of our body.  Microbes that are harmless outside the body could be life-threatening inside the body.

It only makes common sense that we want to close a cut (also known as a “laceration”) to speed healing and prevent infection. There is controversy, however, as to whether or not a wound should be closed.  When and why would you choose to close a wound, and what method should you use?

A laceration may be closed either by sutures, tapes, staples or medical “superglues” such as Derma-Bond or even industrial “Super-Glue” (the prescription product tolerates getting wet better).

After rendering first aid, which includes controlling the bleeding, removing any debris, flushing debris out of the wound (known as “irrigation”), and applying antiseptic, you will have to make a decision.

What are you trying to accomplish by closing a wound?  Your goals are simple.  You close wounds to repair the defect in your body’s armor, to eliminate “dead space” (pockets of air/fluid under the skin which could lead to infection), and to promote healing.  Although less a consideration in normal times, a well-approximated wound also has less scarring.

It sounds, you’d think, as if all wounds should be closed. Unfortunately, closing a wound that should be left open can do a lot more harm than good, and could possibly put your patient’s life at risk. Take the case of a young woman injured some years ago in a fall from a “zipline”:  She was taken to the local emergency room, where 22 staples were needed to close a large laceration. Unfortunately, the wound had dangerous bacteria in it, causing a serious infection which spread throughout her body.  She eventually required multiple amputations (including her hands!).

We learn from this an important lesson: Namely, that the decision to close a wound is not automatic but involves several considerations. The most important of these is whether you’re dealing with a clean or a dirty wound.

Most wounds you’ll encounter in an off-grid setting will be dirty.  If you try to close a dirty wound, such as a gunshot, you have sequestered bacteria, bits of clothing, and dirt into your body.  Within a short period of time, the wound may show signs of infection. An infected wound appears red, swollen, and hot. In extreme cases, an abscess may form, and pus will accumulate inside. The infection may spread to the bloodstream, a condition known as “septicemia”, and become life-threatening.

wound infection

wound infection

It may be difficult to fight the urge to close a wound. Leaving the wound open, however, will allow you to clean the inside frequently and directly observe the healing process.  It also allows inflammatory fluid to drain out of the body.  The scar isn’t as pretty, but it’s the safest option in most cases. In addition, if you’re truly in a long-term survival scenario, the suture material or staples you have aren’t going to be replaced. It’s important to known when a closure is absolutely necessary and when it’s not.

Other considerations when deciding whether or not to close a wound are whether it is a simple laceration (straight thin cut on the skin) or whether it is an avulsion (areas of skin torn out or hanging flaps).  If the edges of the skin are so far apart that they cannot be stitched together without undue pressure, the wound should be left open.



Another reason the wound should be left open if it has been open for more than 6-8 hours. Why? Even the air has bacteria, and there’s a good chance that they have already colonized the injury by that time.

Let’s say that you’re certain the wound is clean. It’s less than 8 hours old. Here are some other factors that would suggest that closure is appropriate:

  • The laceration is long or deep. The exception would be a puncture wound from an animal bite. These bites are loaded with bacteria and should be kept open in austere settings, in my opinion.
  • The wound is located over a joint. A moving part, such as the knee, will constantly stress a wound and prevent it from closing in by itself.
  • The wound gapes open, but loosely enough to suggest that it can be closed without undue pressure on the skin.

An item unlikely to be found after the you-know-what hits the fan

It’s important to realize that you will only have a limited supply of staples and sutures. Feel free to mix different closure methods like alternating sutures and Steri-Strips, or even adding duct tape improvised into butterfly closures when you’ve run out of medical supplies. You’d be surprised to see what qualifies as medical supplies when the chips are down.

If you are unsure, you can choose to wait 48 to 72 hours before closing a wound to make sure that no signs of infection develop.  This is referred to as “delayed closure”.  Some wounds can be partially closed, allowing a small open space to prevent the accumulation of inflammatory fluid.

Penrose Drain

Penrose Drain

Drains, consisting of thin lengths of latex, nitrile, or even gauze, might be placed into the wound for this purpose. Although these can get quite expensive, “Penrose” drains are a reasonably priced version of these that are still used in some operating rooms. Drains have a tendency to leak, so place a dressing over the exposed area.

Many injuries that require closure (and some that don’t) also should be treated with antibiotics in oral or topical form to decrease the chance of infection.  Natural substances with antibiotic properties, such as garlic or raw, unprocessed honey, may be useful in survival scenarios.

The decision to close a wound involves developing sound judgment, something that takes some training and experience. For that reason, we’ve taught wound care classes throughout the country, not just to teach the mechanics of how to “throw” a stitch, but to impart the knowledge of just what makes for a “close-able wound”.

Injuries are part and parcel of survival. Make sure that you can handle them, as well as infectious disease and all the other problems that will confront the medic in times of trouble.

Joe Alton, MD

dr. bones

Joe Alton, MD

Find out more about wound closure and 150 other off-grid medical topics in the third edition (700 pages!) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available here or at

Mass Casualty Triage Basics

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mass casualty incidents

Given the horrific events surrounding the Ariana Grande concert in Manchester, UK, we have come to realize that we may never be safe in today’s world. The bombing is new evidence, however, that no target is off limits to the terrorists in our midst. We can expect more episodes of terror in the western world in the future, and many will involve mass casualties.

The Mass Casualty Incident

The responsibilities of a caregiver is usually one-to-one; that is, the healthcare provider will be dealing with one ill or injured individual at a time.  This encounter usually falls within their expertise and resources.  There may be a day, however, when you find yourself confronted with a scenario in which multiple people are injured.  This is referred to as a Mass Casualty Incident (MCI).

A Mass Casualty Incident is any event in which your medical resources are inadequate for the number and severity of injuries incurred.  MCIs can be quite variable in their presentation.

Types of Mass Casualty Incidents

MCIs can be quite variable in their presentation:

  • Doomsday scenario events, such as a nuclear weapon detonation
  • Terrorist acts, such as occurred in Manchester
  • Consequences of a storm, such as a tornado or hurricane
  • Consequences of civil unrest or battlefield injuries
  • Mass transit mishaps (train derailment, plane crash, etc.)
  • A car accident with, say, four people injured (and only one ambulance)

 Responding to a Mass Casualty Incident

The effective medical management of any of the above events required rapid and accurate triage.  Triage comes from the French word for “to sort” (trier) and is the process by which medical personnel can rapidly assess and prioritize a number of injured individuals and do the most good for the most people. Note that I didn’t say: “Do the best possible care for each individual victim”.

Let’s assume that you were at the concert in Manchester, the Christmas market in Berlin, or the Boston Marathon when a bomb went off.  You are the first one to arrive at the scene, and you are alone.  There are twenty people on the ground, some moaning in pain.  There were probably more, but only twenty are, for the most part, in one piece.  The scene is horrific.  As the first to respond to the scene, you are “Incident Commander” until someone with more medical expertise arrives on the scene.  What do you do?

Your initial actions may determine the outcome of the emergency response in this situation.  This will involve what we refer to as the 5 S’s of evaluating a MCI scene:

  • Safety
  • Sizing up
  • Sending for help
  • Set-up of areas
  • START – Simple Triage And Rapid Treatment

Safety Assessment:  An insidious strategy on the part of terrorists when they target crowds is to set off primary and secondary bombs.  The main bomb causes the most casualties, and the second bomb is timed to go off or is triggered just as the medical/security personnel arrive.  This may run counter to your instinct to help, but your primary goal is your own self-preservation. Keeping the medical personnel alive is likely to save more lives down the road.  Therefore, you do your family and community a disservice by becoming the next casualty.

As you arrive, be as certain as you can that there is no ongoing threat.  Do not rush in there until you’re sure that the damage has been done and you and your helpers are safe entering the area.  In the immediate aftermath of the 1995 Oklahoma City bombing, various medical personnel rushed in to aid the many victims.  One of them was a heroic 37-year-old Licensed Practical Nurse who, as she entered the area, was struck by a falling piece of concrete.  She sustained a head injury and died five 5 days later.

Scene at the Boston Marathon bombing

Sizing up the Scene:  Ask yourself the following questions:

  • What’s the situation?   Is this a mass transit crash?  Did a building on fire collapse?  Was there a bomb?
  • How many injuries and how severe?  Are there a few victims or dozens?  Are there “walking wounded” that could assist you?
  • Are they all together or spread out over a wide area?
  • What are possible nearby areas for treatment/transport purposes?
  • Are there areas open enough for vehicles to come through to help transport victims?

Sending for Help:  If modern medical care is available, call 911 and say (for example):  “I am calling to report a mass casualty incident involving a multi-vehicle auto accident at the intersection of Hollywood and Vine (location).  At least 7 people are injured and will require medical attention.  There may be people trapped in their cars and one vehicle is on fire.”

In three sentences, you have informed the authorities that a mass casualty event has occurred, what type of event it was, where it occurred, an approximate number of patients that may need care, and the types of care (burns) or equipment that may be needed.

Set-Up:  Determine likely areas for various triage levels (see below) to be further evaluated and treated.  Also, determine the appropriate entry and exit points for victims that need immediate transport to medical facilities, if they exist.  If you are blessed with lots of help at the scene, assign triage, treatment, and transport team leadership roles.

S.T.A.R.T.:  Triage uses the acronym S.T.A.R.T., which stands for Simple Triage and Rapid Treatment.   The first round of triage, known as “primary triage”, should be fast (30 seconds per patient if possible) and does not involve extensive treatment of injuries.  It should be focused on identifying the triage level of each patient.  Evaluation in primary triage consists mostly of quick evaluation of respirations (or the lack thereof), perfusion (adequacy of circulation), and mental status.  These are known as “RPMs” and are a (very) basic indication of the level of injury.

Other than controlling massive bleeding and clearing airways, very little treatment is performed in primary triage. Controlling hemorrhage is best done with commercial tourniquets, for example, the SOF-T, CAT, or SWAT. It’s a sad sign of the times that I recommend carrying one of these if you have to go to areas where there are large crowds and little security. Tourniquets can be improvised with belts, bandannas, and other items, but are more difficult to apply effectively.

Although there is no international standard for this, triage levels in the U.S. are usually determined by color:

Immediate (Red tag): The victim needs immediate medical care and will not survive if not treated quickly.  (for example, a major hemorrhagic wound/internal bleeding) Top priority for treatment.

Delayed (Yellow tag): The victim needs significant medical care within 2-4 hours. Injuries may become life-threatening if ignored, but can wait until Red tags are treated. (for example, an open fracture of the femur without major hemorrhage)

Minimal (Green tag): Generally stable and ambulatory “walking wounded”, but may need some medical care. (for  example, broken fingers, superficial burns)

Expectant (Black tag): The victim is either deceased or is not expected to live.  (for example, a large open fracture of cranium with brain damage, multiple penetrating chest wounds

Patients may be identified with colored tape or triage casualty cards, but you’re unlikely to have these on hand. In that case, simply mark the victims’ foreheads with the numbers 1,2,3, and 4 indicating the priority for urgent care

casualty card produced by sos products

Knowledge of this system allows a patient marking system that easily allows incoming medical personnel to understand the urgency of a patient’s situation.  It should go without saying that, in a power-down situation without modern medical care, a lot of red tags and even some yellow tags will become black tags.  It will be difficult to save someone with major internal bleeding without surgical intervention.

The surviving victims of the Manchester bombing were “fortunate”, if I may use the word, that emergency personnel were on the scene in minutes. Although the death count is currently at 22, many more of the 60 wounded would not have survived without their assistance and transport to modern medical facilities.

We live in a more dangerous world these days, something I call “The New Normal“. In the New Normal, increased vigilance and situational awareness will be needed if you want to stay safe in crowds. In future articles, we’ll explore further how to deal with mass casualty incidents as a medical asset, and also how to avoid becoming a victim of those who want to disrupt civilized society.

Joe Alton, MD

Dr. Alton

Learn more about mass casualties, active shooter, terror events, and 150 other medical topics in times of trouble in the 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.

Survival Medicine Hour: Eye Issues, Fractures, TENS units

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Pink Eye, aka Conjunctivitis

In this episode of the Survival Medicine Hour, Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, discuss how to deal with various eye issues that can confront a medic in an off-grid survival setting, like Pink Eye, foreign objects, styes, and more. Plus, our hosts impart some basics on how to deal with broken bones.


Dr. Bones also answers a question from Jack Spirko’s Survival Podcast Expert Council, of which he’s a member, regarding the potential for use in survival scenarios of TENS units. TENS units are battery-powered items that deliver electrical stimulation to muscles and nerves to help with pain relief.

All this and more in the latest Survival Medicine Hour! To listen in, click below:

Hey, do ol’ Dr. Bones a big favor and follow us on twitter @preppershow, YouTube at DrBones NurseAmy, and Facebook at Doom and Bloom(tm). You can also join our Facebook group at Survival Medicine DrBones NurseAmy!

Joe and Amy Alton

Joe and Amy Alton

Find out more about survival eye issues, fractures, and much more in the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. Also, check out Nurse Amy’s entire line of kits and individual supplies for the survival medic at!

Survival Medicine Hour: John Steinbaugh of Xstat, Wound Packing, Obesity

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cover celox with roller gauze

Packing a Bleeding Wound

In this episode of The Survival Medicine Hour with Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, we welcome John Steinbaugh of RevmedX to discuss his XStat product (which we previously mentioned was not an ideal product for the preparedness community), plus new products that his company has to help stop hemorrhage in wounds. Learn about the XGauze and Parabelt, plus some realities about TCCC guidelines and the issues that companies go through getting new technology to the public.

obesity fat

extra weight will decrease chances for survival

Plus, a question for Dr. Bones as a member of Jack Spirko’s popular Survival Podcast Expert Council, this time about what to do with obese group members once the trigger event occurs for a SHTF situation.

Lastly, Dr. Alton talks about how to pack wounds effectively, and some recommendations from a doctor-paramedic team’s recent article in the Journal of Emergency Medical Services.

All this and more in the latest episode of The Survival Medicine Hour with Joe and Amy Alton. To Listen in, click below:


Follow us on Twitter @preppershow

YouTube: DrBonesNurseAmy channel

Facebook: Doom and Bloom


Wishing you the best of health in good times or bad,

Joe and Amy Alton


Dr. Bones and Nurse Amy

Learn more about bleeding wounds and 150 other survival medicine topics in the Third Edition (700 pages!) of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon.

How To Pack A Bleeding Wound

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bleeding wound

Bleeding Wound

The failure to control hemorrhage is a common cause of death in trauma situations. With the increased number of active shooter events in the United States, the average citizen should have knowledge of basic methods to stop heavy bleeding. The government’s Stop The Bleed Initiative is attempting to foster awareness of the importance of this type of education.

In the April 2017 issue of the Journal of Emergency Medical Services (JEMS), Dr. Peter Taillac and EMT-P associates Scotty Bolleter and A.J. Heightman put forth their recommendations for the packing of hemorrhagic wounds with plain and/or hemostatic gauze such as Quikclot, Celox, and others. In addition, they reinforce the principles of direct pressure and tourniquet use to control bleeding and save lives.

In 2012, The American College of Surgeons (of which I’m a retired Fellow) and other organizations formed a joint commission to improve survival in heavily bleeding injuries. While endorsing direct pressure as a primary technique to reduce hemorrhage, the commission reviewed evidence for the use of hemostatic gauze, finding it to be an effective tool in 90% of cases.

Packing of wounds is useful in many situations, but not all. Wounds of the neck are problematic, for instance, due to the risk of compressing airways. Packing injuries in the abdomen, pelvis, and chest may not be effective due to the deep nature of the bleeding vessels. This is one reason why, in an off-grid setting, the death rate (called “mortality”) from these wounds is so high. Statistics from the Civil War put mortality rates for major injuries in these regions at close to 70 per cent, a figure that might be expected in long-term survival scenarios.


Celox Gauze is approved by the TCCC

Tactical Combat Casualty Care guidelines approve hemostatic gauze as dressings of choice for severe bleeding. These products use materials that enhance or produce clotting. QuikClot uses Kaolin, an original ingredient in Kaopectate; Celox and Chitogauze use Chitosan, a product made from the shells of crustaceans. XStat, made by RevMedX, is preferred by TCCC for hemorrhage in areas like the axilla (armpit) and groin. A new product, Xgauze, was recently described to us by John Steinbaugh of RevMedX as an effective item to control bleeding without kaolin or chitosan, using instead expanding sponges built into the dressing itself.

xgauze by revmedx

Xgauze by RevmedX

According to Dr. Taillac’s team, proper packing of wounds with plain or hemostatic gauze include the following steps:

  • Quickly and aggressively apply direct pressure with a gloved hand, clean dressing or cloth, or even the knee or elbow while breaking out your supplies. Explore the wound with your fingers to find the source of bleeding, using nearby bones, if possible, to increase the effectiveness of pressure.
  • Tightly (and I mean, tightly) pack the wound cavity as deeply as you can while continuing to apply pressure on the bleeding vessel. Pack directly onto the vessel itself. Although hemostatic gauze is effective, sufficient pressure with plain gauze may be enough.
  • Maintain pressure on the packed wound for at least 3 minutes.
  • Place a tight pressure dressing (Israeli Battle Dressing, Olaes Bandage, etc.) over the whole thing.
  • Splinting the wound will immobilize it and help prevent re-bleeds during transport.
Direct Pressure on Bleeding Wound

Direct pressure with a gloved hand and cloth barrier

The above method, along with appropriate use of tourniquets, should be effective in controlling hemorrhage. If the dressings become saturated, however, it may be necessary to use more packing or to start over. A second tourniquet may also be needed. In normal times, this might best be done during transport to a modern medical facility. In long-term survival settings, get the victim to where the bulk of your supplies are.

It is thought that 1 in 5 deaths from hemorrhage may be prevented by rapid action. Know the procedure and, have no doubt, you will save lives in disasters or other times of trouble.


Joe Alton, MD


Joe Alton, MD


Learn more about hemorrhage and over 100 other survival medicine topics  in the 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way, available at Amazon. Plus, check out Nurse Amy’s entire line of kits and supplies at


Survival Medicine Hour: Jack of Black Scout Surv., Gallstones, Fish Hooks, More

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jack richland black scout

Jack of Black Scout Survival

In this episode of the Survival Medicine Hour podcast, Joe Alton, MD and Amy Alton, ARNP, aka Dr. Bones and Nurse Amy, welcome back Jack of Black Scout Survival‘s popular YouTube channel to talk about his work and other important issues. Plus, Dr. Bones tells you all you need to know about gall bladder stones, a condition that affects 10-15 percent of the populations, and certainly would be an issue for the medic taking care of a large mutual assistance group.

gall bladder stones

Lastly, some ways to remove a fish hook from an outdoor mishap.


All this and more on the latest Survival Medicine Hour with Joe and Amy Alton!


To Listen in, click below:



Some of the items mentioned in today’s interview with Jack of Black Scout Survival:

Benchmade SOCP



Zebra pen f701


Wishing you the best of health in good times or bad,

Joe and Amy Alton

joe and amy radio

Dr. Bones and Nurse Amy


Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of kits and individual items at


The family medical bag and just some of its conten

Self Defense Laws in Australia.

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Another Australian citizen is attacked and he has no way to defend himself from these thugs using machetes. It is against the law in Australia to carry anything specifically for use in self defence. We are not allowed to carry guns, knives, batons, pepper sprays, or tasers. Women are getting raped & murdered, men are being attacked and killed, but the Australian government will not do anything to help us protect ourselves, not on the streets, and not even in our own homes.

Survival Medicine Hour: Dental Exams, Bleeding Control, Tourniquets

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The basic dental exam

The Survival Medicine Hour, on March 11, 2017, is hosted by Joseph Alton, MD aka Dr. Bones and Amy Alton, ARNP, aka Nurse Amy of In today’s show, Dr. Alton reviews the steps of a dental exam for those who find themselves in a remote area or post-disaster and who need to care for someone with an immediate dental issue. Expect more segments on individual dental problems that might confront the medic in remote or post-disaster settings.

soft-t tourniquet

The Sof-T tourniquet

Accidents happen everyday and you may find yourself as the person responsible for saving a life of someone who’s hemorrhaging. Severe injuries with bleeding can be scary to non-medical persons. Knowing some basic steps to stop bleeding are important to understand and share with your family members. Plus, a review of different tourniquets that might be useful for your medical kit.


All this and more on the Survival Medicine Hour! To listen in, click below:


Wishing you the best of health in good times or bad,


Joe and Amy Alton


Dr. Bones and Nurse Amy

If you’re concerned about a disaster taking you off the grid long term, have you thought of putting some dental supplies in that medical kit? Check out Nurse Amy’s dental kit at! Compare it with any other and you’ll know it’s the essential kit for long-term survival settings.

How To Make Natural Tiger Balm

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How To Make Natural Tiger Balm The time-proven blend of herbal ingredients in Tiger Balm provides safe and effective topical pain relief for sore muscles, arthritis, neck and shoulder stiffness, and just about any other minor muscle or joint aches or pains that may come your way. Tiger Balm is a topical analgesic (pain reliever) …

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Choosing Sutures

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As we go around the country teaching the art of suturing pig’s feet to aspiring porcine podiatrists, we are often asked about how to choose the appropriate suture needles and material for different types of injuries.  There are a wide variety of choices and, today, we’ll discuss what is available and what is most effective for different types of wounds.


First, let’s identify some of the qualities of the optimal suture.  The suture should:


·        Be sterile

·        Be easily worked with

·        Be strong enough to hold wound edges together while they heal

·        Be unlikely to cause infection, tissue reaction or significant scar formation

·        Be reliable in its everyday use with every type of wound


It is rare, if not impossible, to find a single suture type that meets all of the above criteria, but there are many that will serve if chosen properly.


In the United States and many other countries, a standard classification of suture has been in place since the 1930s.  This classification identified stitches by type of material and the size of the “thread”.  Suture diameters most commonly used in humans (and pigs, I would think) is measured in zeroes, much like buckshot.  2-0 (00) suture, for example, is thicker than 5-0 (00000) suture. The more zeroes, the finer the “thread”. Finer sutures have less tissue reaction and heal faster, but are more difficult to handle for those without experience.


In addition to size, sutures are classified as absorbable and non-absorbable.  An absorbable suture is one that will break down spontaneously over time but not before the tissue has had sufficient time to heal.  Absorbable sutures have the advantage of not requiring removal after healing has taken place. This type of suture is commonly used in deep layers, such as muscle, fat, organs, etc.  A classic example of this is “catgut”, actually made from the intestines of sheep or cows.


(Aside: Catgut was once also used in the manufacture of stringed musical instruments and tennis racquets.)


Catgut is usually found in “plain” and “chromic” varieties. When dipped in a chromic acid salt solution, catgut lasts longer in the body while remaining absorbable.


Although still popular, catgut has been replaced by synthetic absorbables for many applications. examples of synthetic absorbable suture include “Vicryl” (polyglycolic acid), “PDS” (polydiaxanone), and others. These tend to last longer than catgut sutures, but will eventually be absorbed by the body.


Nylon suture package depicting size, needle shape, and length of “thread”

Nonabsorbable sutures are those that retain their character for a very long time, and will stay in the body until removed.  As such, normal immune response will cause the development of scar tissue, sometimes called “encapsulation”, around these sutures if used in internal body structures. 


Nonabsorbable sutures are best used in skin closures and situations that require prolonged tensile strength. They include monofilaments (such as “Nylon” and “Prolene”) and braided multifilaments (such as ”Surgical Silk”). Monofilaments like Nylon are useful because of less likelihood of harboring bacteria, whereas braided multifilaments have nooks and crannies for these organisms to hide. Monofilament also glide more easily through tissue. In trade, braided Silk is somewhat easier to handle than Nylon for many and often used for teaching purposes.


I recommend Nylon in most survival situations, with 2-0 or 3-0 Nylon ideal for those new to the suturing skill.  This size “thread” is easy to handle and useful for aspiring medics to learn surgical knot-tying.


The size of the “thread” you’ll use depends on the area of the body being repaired. Slowly healing tissues such as skin and tendons require nonabsorbable sutures; wounds in rapidly healing areas such as the inside of the cheek and vagina (childbirth) are best repaired with absorbables. 


In survival settings, cosmetic results are less important, but surgeons generally use smaller sutures in delicate areas such as areas on the head and face.  5-0 or 6-0 Nylon would normally be the choice here, but require more skill in handling.  Skin sutures should be placed, in my opinion, about 1/2 inch or so apart in most instances. This will allow drainage while keeping the wound together.  Areas over joints or other moving parts should be closer together. In wounds not near joints, say, the forearm, the sutures may be further apart and could be interspersed with Steri-Strips or butterfly closures.

suture needles

typical suture needles (chromic catgut)


The type of needle is also an important factor in choosing suture material. Needle that are less traumatic to sensitive tissues, like the lining of the bowel and other deep structures, are round on cross-section. These are known as “atraumatic” or “tapered”. Needles that are best on tough areas like skin are triangular in shape on cross-section and are referred to as “cutting” needles. Most suture needles that are useful for skin form a 3/8 circle; needles for deep work are often ½ circle in shape.


Having said all of the above, the choice of suture needles and material will vary depending on the user. Each surgeon will have his or her preferences based on their experience.


How long skin sutures remain in place before removal is dependent on the body part repaired.  Face wound sutures are usually removed relatively soon (5 days) compared to, say, a forearm wound (7-10 days).  Thicker skins, such as the sole of the foot should stay in somewhat longer.   Sutures placed over the knee or other joints should remain in place longer, 2-3 weeks, in my opinion.


Remember that the act of suturing is more traumatic than using butterfly closures, Steri-Strips, surgical glue, and others due to the fact that you are making more punctures in an area of skin already injured.  Each extra “hole” you create could allow the entry of bacteria into the wound. 


One last relevant point:  When you practice suturing on your pig’s foot, you are learning a skill, not a trade.  The practice of medicine without a license is illegal and punishable by law; as long as modern medical care exists, seek it out.


We’ll talk about staples, medical glues, and Steri-Strips/butterfly closures in future articles.


To see me suture in real time, here’s my YouTube video:

Joe Alton, MD

joealtonlibrary4Find out more about wound closure and 150 other topics in our 700 page Third Edition of the Survival Medicine Handbook: The Essential Guide for when Medical Help is Not on the Way“. Find suture kits and individual sutures at Nurse Amy’s store.

How to Survive Field Injuries

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How to Survive Field Injuries From snake bites to sore teeth, this guide will help you tackle almost any accident. All of these injuries are quite common and a little trip to the doctor can normally sort these out! What if there were no doctor? What if you were stranded or SHTF? I would recommend …

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Oakland Warehouse Fire: Surviving in a Crowd

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The fire in an Oakland warehouse that was a refuge for artists and a venue for dance parties has now claimed 36 lives with several persons still missing. In the past, I’ve written about safety in wildfires and also in homes over the years; this time, I’ll explore the issue relating to fires in public venues like concert halls.

Concerts and theatres have long been areas at risk for fire. In 1903, Chicago’s Iroquois theatre was the site of an inferno which caused 600 deaths. In 1942, the Cocoanut Grove nightclub in Boston claimed 492 lives. In 2003, 100 perished in the Station nightclub in Warwick, R.I. during a concert by the rock band Great White.

Most public venues have important fire protection strategies such as sprinkler systems, fire exits, and fire extinguishers. Indeed, fire codes have evolved to make most of these places quite safe.

The phenomenon of “flash concerts”, however, places crowds of people in locations without these safeguards. This puts the onus on concert-goers to become more situationally aware, something few patrons of these events even think about.

What is situational awareness? Situation awareness involves understanding what’s going on in your immediate vicinity that might be hazardous to your health. I don’t mean second-hand smoke here; I’m talking about knowing what dangers may exist that you can avoid or abolish with your actions. Especially important for soldiers in a combat zone, it’s now become just as important for the average citizen in any large crowd.

The situationally aware person is in a constant state of what I call “Yellow Alert”, a relaxed awareness of their surroundings. At Yellow Alert, a concert-goer has a much better chance to identify threats than someone with their nose buried in their smart phone. Although many might enjoy the use of recreational drugs, like marijuana or ecstasy, it’s much safer to have your wits about you at these events. Mentally marking nearby exits, fire extinguishers, and alarms when you first arrive will allow you to have a plan of action if the worst happens.

A good spot at a concert is front and center, but you might be safer at the fringe of the crowd. In the center, your choice of escape route is governed by the crowd rather than good judgment.

Who’s at fault? Although Derick Almena, the manager of the Oakland warehouse, was understandably distraught during an interview with the TODAY show, he must bear responsibility for the conflagration, as must the owner, Chor N. Ng (whose daughter claims, says the LA Times, that he didn’t know people lived in the building). Here are some reasons why:

·        The 10,000 foot warehouse, also known as the “Ghost Ship”, had no sprinkler system nor fire alarms. No word on the number of fire extinguishers, if any.

·        Piles of discarded furniture dotted the interior.

·        Staircases were partially supported by wooden pallets.

·        Construction and electrical work was performed on an impromptu basis, often without permits or proper inspections.

·        A number of recreational vehicles, presumably with gas in the tanks, were in the warehouse.

Oakland city officials, however, are also culpable. The LA Times reports that, since 2014, several complaints were lodged for building and fire code violations without apparent action by the city after investigation. The Fire Marshall blames severe understaffing for the shortcomings, the responsibility for which must also be borne by Oakland’s city government. Zac Unger, an official with the firefighter’s union, was quoted as saying “Had a fire inspector walked into that building and seen the conditions in there, they would have shut the place down.”

Unfortunately, the responsibility for your safety may ultimately lie with the average citizen. Incorporate situational awareness into your mindset when in any public venue, and you’ll stand the best chance to avoid and escape becoming a casualty of a fire or any other calamity.

For more information on becoming situationally aware and how to deal with building fires, read my articles “How a Fighter Pilot’s Strategy Could Save Your Life: The OODA Loop” and “Surviving a House Fire”.

Joe Alton, MD

When to Close a Wound

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There are many injuries that a medic will face in a survival scenario, and a common and potentially life-threatening one occurs whenever the skin is broken. Your skin is your body’s armor; when it is breached, infectious organisms enter a highway which can transport them to just about any part of the body. Therefore, it makes common sense that you’d want to close that breach to speed healing and lock out infection. Indeed, that’s exactly what happens thousands of times daily in emergency rooms in normal times.

The off-grid medic has a dilemma, however: Most wounds in survival will be dirty, and providing a sterile environment for a surgical procedure is a difficult challenge. You could make the work area as clean as possible, but sterile? Not likely. As such, you should wisely choose what wounds should be closed and what wounds should be left open.

Many medics can’t imagine not closing a tear or cut in the skin (called a “laceration”), but it’s a reasonable way to deal with contaminated wounds in situations where you can’t assure a sterile, or even clean, field on which to work. Lacerations that are kept open must be dressed and cleaned regularly until they’re fully healed.

Open wounds heal through a process called “granulation”, where new tissue forms at the base and sides until the defect in the skin is fully healed. Essentially, “from the bottom up”. This tissue is somewhat granular in appearance, hence the name.


To Close or Not to Close?

To paraphrase Hamlet, “To close or not to close? That is the question!” To answer this questions, we must examine what our goals are in closing a wound. Among other reasons, you close wounds to:

  • Repair the defect in the body’s armor, thus preventing infection in a clean wound.
  • Accelerate the healing process. Wound edges that are touching heal faster than those that aren’t.
  • Decrease scarring. Scarring is less of an issue in survival, unless the scar would, say, limit the range of motion of a joint in extremity.

A note about bleeding: Although closing a wound may apply pressure to bleeding areas, it is not a substitute for hemorrhage control, also known as “hemostasis” before closure. Consider the application of direct pressure first on the bleeding area, a method that succeeds in many cases. Also, for major blood loss, have tourniquets, hemostatic agents like Celox or Quikclot, and pressure dressings as part of your medical storage.

So what factors come into play when deciding to close a wound or to keep it open? Consider keeping the wound open in these circumstances:

The wound is dirty. Are the circumstances suspicious for contamination? In survival scenarios, the answer is often yes. In austere environments, even WHO (the World Health Organization) agrees that the safest course of action is to keep it open.


Candidate for closure IF clean

Here are some circumstances where wounds should be kept open:

  • The wound is infected. Infected wounds have a certain appearance: They are red, swollen (sometimes appearing “shiny”), warm to the touch, and may drain pus.
  • The wound is colonized (infected but not yet showing signs). Even the air has bacteria; you can expect a wound to be colonized within 6-8 hours or so.
  • There is dead tissue in the wound. This tissue won’t bleed when it is cut and often appears discolored or black. No closure should be performed without removing dead tissue first (a procedure known as “debridement”).
  • Puncture wounds, especially from mammalian (including human) bites have lots of bacteria and shouldn’t be closed. Interestingly, snake bites become infected less often than, say, cat or dog bites, but don’t close them either.
  • The wound edges are so far apart that closing them would cause undue pressure. This occurs with injuries like “avulsions”, where entire areas of tissue are missing.

wound infection

Here are situations where you should consider closing the wound:

  • You’re certain the wound is clean. This usually requires witnessing the injury as it happens.
  • The wound has been open less than 6-8 hours.
  • The laceration is long or deep enough to penetrate the entire thickness of the skin. A deep wound would allow you to see underlying tissue such as subcutaneous fat.
  • The wound is located over a joint. A moving part, such as the knee, will constantly stress a wound and prevent it from closing in by itself.
  • The wound gapes open loosely, suggesting that it can be closed without undue pressure on the skin (and won’t close at all without your intervention).

In future articles, we’ll explore wound closure materials, techniques, and theory.

Joe Alton, MD


Joe Alton, MD

Learn all about wound care and wound closure methods via our DVD or in the Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.  View our entire line of medical kits and supplies at

Wildfire Preparedness and Our Gatlinburg Home

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2015 Birdhouse Inn Mountain Paradise View!

The view from my home as I’d like to remember it

It’s been a very busy year for firefighters, with heat waves, drought, and human malice or carelessness causing large areas to burn from Canada to California. You may have heard me say that you probably won’t  be affected by a disaster today, tomorrow, or next week. Over a lifetime, however, the chances aren’t quite as small. Add in your children’s lifetimes, and their children’s, and the odds are greater still. I’ve personally been through hurricanes, tornadoes, civil unrest, and the Mariel Boatlift unscathed other than for some missing roof tiles and a conversion to positive for tuberculosis (thanks, Fidel). We were even stranded in Europe due to a volcanic eruption in Iceland.

And now wildfire. A particularly intense one recently struck a place I know and love: Gatlinburg, Tennessee. Home to the entrance of the Great Smoky Mountains National Park, I’ve had a vacation home there for 20 years and spend Spring and Fall there. I love hiking in the backcountry, and if I cannot say that I’ve walked the entire length of the Appalachian Trail, I can say I’ve walked its entire width.

With multiple fires spreading through the popular resort town, the mountain that my house is situated on lit up like a match.  In the dry, windy conditions, hundreds of homes were burnt to the ground. As of this writing, I have not yet heard of the fate of the home in which I’ve accumulated 20 years of memories. The likelihood is that it no longer exists. Much more importantly, homes of many permanent residents have been destroyed, leaving them homeless; the businesses that employed those people were incinerated.

Putting my feelings aside for a moment, let’s talk about what you can do in the face of an irresistible force like a wildfire. How can you protect your property (and yourself) from being devastated by fire? Two main principles for property defense are 1) vegetation management and 2) creating a “defensible space”. The main strategy for personal defense is “Get Out Of Dodge”.

An important factor in wildfire preparedness is what we call “vegetation management”. With vegetation management, the key is to direct fires away from your house. There are several ways to accomplish this, all of which require vigilance and regular maintenance. 

You’ll want to clean up dead wood and leaf piles lying within 30 feet of your building structure. Pay special attention to clearing off the roof and gutters. Although you may have spent time and money putting lush landscaping around your home, you may have to choose between attractive, yet flammable plants and fire protection.

You’ll want to thin out those thick canopied trees near your house, making sure that no two canopies touch each other. Any trees within 50 feet on flatland, or 200 feet if downhill from your retreat need to be thinned, so that you’re pruning branches off below 10-12 feet high, and separating them by 10-20 feet. No tree should overhang the roof. Also, eliminate all shrubs at the base of the trunks.

Lawns and gardens should be well-hydrated; collect lawn cuttings and other debris that could be used as fuel by the fire. If water is limited, keep dry lawns cut back as much as possible (or remove them).


From a wildfire perspective, a defensible space is an area around a structure where wood and vegetation are treated, cleared, or reduced to slow the spread of flames towards a structure. Having a defensible space will also provide room to work for those fighting the fire.

The amount of defensible space you’ll need depends on whether you’re on flat land or on a steep slope. Flatland fires spread more slowly than a fire on a slope (hot air and flames rise). A fire on a steep slope with wind blowing uphill spreads fast and produces “spot fires”. These are small fires that ignite vegetation ahead of the main burn, due to small bits of burning debris in the air.

Woodpiles and other flammables should be located at least 20-30 feet away from structures. Gardening tools should be kept in sheds, and those sheds should be at a distance from the home.  Concrete walkways and perimeter walls may serve to impede the progress of the fire.

Attic and other vents should be covered with screening to prevent small embers from entering the structure. Additional strategies for the home can be found at

Of course, once you have created a defensible space, the natural inclination is to want to, well, defend it. Unfortunately, you have to remember that you’ll be in the middle of a lot of heat and smoke.

The safest recommendation, therefore, would be to get out of Dodge if there’s a safe way to leave. It’s a personal decision but realize that your family’s lives may depend on it. If you’re leaving, have a bag already packed with food, water, extra clothes, batteries, flashlights, and more. Don’t forget to bring your cell phone, any important papers you might need, and some cash.

As an added precaution, make sure you shut off any air conditioning system that draws air into the house from outside. Turn off all your appliances, close all your windows and lock all your doors. Like any other emergency, you should have some form of communication system established with your loved ones in case you’re not together.

Medical kits should contain masks, eye and hand protection, burn ointment (aloe vera is a natural alternative) and non-stick dressings. Specialized burn dressings are available that incorporate both. Gauze rolls and medical tape can be used for additional coverage. Round out your kit with scissors, cold packs, and some eyewash (smoke is a major irritant to the eyes).

If your routes of escape are blocked, make sure you’re dressed in long pants, sleeves, and heavy boots. A wool blanket is very helpful as an additional outside layer because wool is relatively fire-resistant. Some people think it’s a good idea to wet the blanket first: Don’t. Wet materials transfer heat much faster than dry materials and will cause more severe burns.

If you’re inside a building, stay on the side farthest from the fire and with the least number of windows (windows transfer heat to the inside). Stay there unless you have to leave due to smoke or the building catching fire. If that’s the case and you have to leave, wrap yourself in the blanket, leaving only your eyes uncovered.

If you’re having trouble breathing because of the smoke, stay low, and crawl out of the building. There’s less smoke and heat the lower you go. Keep your face down towards the floor. This will help protect your airway, which is very important. You can recover from burns on your skin, but not from major burns in your lungs.

As of this writing, I’m still waiting for public access to my part of the mountain in Gatlinburg to be reinstated. If my home survived, it could have been due to the principles I’ve followed above, but it could also be just the wind direction or some timely rain. I’d like to believe it’s the former, but, heck, I’ll take the latter.

Joe Alton, MD

Please take a moment to include firefighters, medical personnel, and the citizens of Gatlinburg in your prayers. Also, a donation to the American Red Cross can be sent to First Tennessee Bank to aid fire relief efforts. The Johnson City Press reports that the First Tennessee Foundation will match donations up to $50,000. Send a check for any amount payable to the American Red Cross to:

First Tennessee Bank              

P.O. Box 8037

Gray, TN 37615

attn: Ms. Teresa Fry

Medical Supplies for the Homestead

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image by

If you’re a homesteader, you’ll want to be ready for any eventuality. In a remote location or austere environment, the importance of medical self-reliance can’t be overemphasized. Injuries and illness can happen anytime due to a storm, wildfire, earthquake, or other disaster.

Medical strategies abound for these mostly short term scenarios that are both reasonable and effective.  An entire medical education system exists to deal with limited wilderness or disaster situations. This system is served by a growing emergency supply industry and, in some cases, supported by federal taxes.

When you happen upon a victim in normal times, your goal is to:

  • Evaluate the injured or ill patient.
  • Stabilize their condition.
  • Transport them to the nearest modern medical facility.

This series of steps couldn’t make more sense; you’re not a physician, after all.  Somewhere, there are facilities that have a lot more technology than you have.  Your priority is to get the patient out of immediate danger and then ship them off to a higher medical resource.

It seems reasonable for the average citizen to expect the rescue helicopter to be on the way. But what if it isn’t? Some homesteads are far from the nearest hospital. When modern medical help isn’t at hand, quick action on your part may be necessary to save a life.

You never know when you might be the medical “end of the line” in the uncertain future. To be effective in that role, you need supplies.

Prepper Medical Supply Kit

Family Medical Kit

The availability of medical supplies may just save a life in troubled times, but without an idea of what medical items should be stockpiled, your effectiveness as an emergency caregiver may be compromised. Not having the right equipment at hand is like trying to eat a steak with a wrench and a screwdriver instead of a knife and fork. Purchasing these items all at once would be hard on the wallet, so the best strategy Is to slowly stockpile the medical supplies you need.

This article is meant to be a guide to which supplies would help you become an effective caregiver as opposed to being an in-depth discussion of how to use each one. To help you become a well-equipped homestead caregiver, we’ll list common medical issues and what items you’ll need to deal with them.



N95 mask

To begin with, however, let’s talk about personal protection.  No, I’m not talking about condoms, although they can be important additions to your storage. I’m not talking about firearms, either, although military medics are now usually armed.  I’m referring to protecting yourself and others from injuries and infectious disease.

Don’t ignore the power of prevention. In any remote environment, you will be performing daily activities that carry risk of injury.  Chopping wood for fuel would be one example. Eye and hand protection in the form of goggles and work gloves could prevent various injuries. Here are some other items that would be protective:

Gloves: I recommend nitrile gloves due to the increasing number of latex allergies reported recently. I would use size 8 or “large”, as gloves that are too small tend to break.  Gloves come in both sterile and non-sterile varieties.  Get lots of the non-sterile for everyday work, but don’t fail to have some sterile pairs as well.

Face Masks: These can be simple ear-loop versions or could be more advanced in the form of N95 and N100 “respirators”. These are masks that block out 95 or 100% of airborne particles larger than 0.3 microns.

Coveralls, Boots, and Headgear:  In mosquito-infested areas, there are special coveralls and headgear made from netting that are lifesavers. In epidemics of infectious disease, however, hazardous material suits that cover the body, head and feet are more pertinent for the person in charge of the sick room.

General items: Some items are of good general use for medical issues.  One of my favorites is the “EMT shears” or “bandage scissors”.  This is a special scissors meant to allow you to cut through clothing so that you can accurately assess the level of injury that you’re dealing with.

Another general item that would be highly useful would be a headlamp.  Injuries can occur at night as well as during the day. Using a headlamp frees up both hands to better handle emergencies.

A good supply of antiseptics will be important to keep your people healthy. Antiseptics are germ-killing substances that are applied to living tissue, usually skin, to reduce the possibility of infection. Antiseptics are different from antibiotics, which are meant to destroy bacteria within the body, and disinfectants, which destroy germs found on non-living objects, like kitchen or survival sick room surfaces.

I consider household bleach to be the simplest disinfectant for cleaning sick room work surfaces, but it’s too strong to apply to living tissue. Instead, consider Betadine (Povidone-Iodine solution), Chlorhexidine (Hibiclens), Alcohol , Benzelkonium Chloride (BZK), or Hydrogen Peroxide.  These can be found in small bottles, gallon jugs, and in wipes impregnated with the antiseptic.

Some of the most important medical supplies you’ll accumulate will be those used to deal with injuries. Let’s outline what you’ll need in your role as a homestead medic:


In an austere environment, it might be difficult to get through the day without some minor injury, such as a burn while cooking, blister while hiking, or a splinter from hauling wood. The average person has, over the course of their lives, dealt with more than one of these. Helpful items to have include:

  • Soap and water and antiseptics: To clean out minor wounds. Antibacterial soap is not necessary, however. The FDA (Food and Drug Administration) determined that it doesn’t give additional protection against infection.
  • Adhesive Bandages: various sizes and shapes to protect a scratch or abrasion from getting worse.
  • Moleskin: Have a supply of these to deal with common blisters on areas that receive friction.
  • Tweezers: With a magnifying glass, these will be useful to remove splinters or other small foreign objects.
  • Styptic Pencil: Although most minor bleeding stops with direct pressure, a styptic pencil can be used for razor cuts and is a helpful addition to your kit. For a natural alternative, Cayenne pepper powder is reported to have similar effects on minor bleeding.
  • Eye wash, cups, and patches: For minor eye irritation and injuries.
  • Gauze packing: for nosebleeds.  Dental cotton rolls and tampons are alternatives.
  • Burn Gel or Aloe Vera: To apply to small burns.



The popular SAM Splint

Few of us, even couch potatoes, have avoided the occasional sprain or strain.  In situations where we are exerting ourselves, these will be more common, not to mention the possibility of fractures. You should have available:

Cold Packs:  These are available commercially or can be made with ice.  Cold packs help reduce the swelling often seen in sprains and strains, as well as provide some relief from pain.

Elastic Wraps: Elastic “Ace” wraps help stabilize an injured joint and decrease the chance of re-injury. Use compression in tandem with cold to decrease pain and swelling.  Don’t forget to elevate the injured limb above the level of the heart. Elastic wraps can also be used to cover bandaged wounds and to secure splints in place.

Slings: Commercial triangular bandages or improvised bandannas both are well suited to make a sling, these are useful to stabilize an arm or shoulder injury. The commercial versions usually come with safety pins.

Splints: Commercial “SAM” splints are flexible and can be cut or shaped to immobilize a sprain or fracture.  These vary in size to fit anything from a finger bone to a thigh bone. You can improvise with sticks and strips of cloth or even a folded-over pillow and duct tape.

Anti-inflammatory medications:  Ibuprofen is an over the counter medication to reduce swelling and pain in orthopedic injuries, and can be accumulated in bulk.  Salicin from the green underbark of willow trees is helpful for pain and, incidentally, was the base substance for the first aspirins ever made. Natural remedies such as Arnica salves are useful to decrease bruising, swelling, and pain (use on intact skin only).  Various anti-inflammatory medications also come in patches that can be applied to the back or other strained areas.

Heat Packs:  These won’t reduce swelling much, but can be used during recovery from an injury to help relax and loosen stiff tissues. They also stimulate blood flow to injured areas.



EMT shears or bandage scissors can help expose a bleeding wound

The injury that non-professionals fear most is the bleeding wound.  With the right supplies, however, even heavy bleeding can be staunched successfully.  In addition to a blunt-edged scissors to expose the injury, the well-prepared medic will have:

Gauze: Bulk non-sterile gauze (some of our kits carry bricks of 200 at a time) is valuable as a medical storage item to apply pressure to bleeding areas.  Even one hemorrhagic wound could require you to use all the dressings that you had accumulated over years of stockpiling,  so get plenty.

Dressings come in squares of varying sizes and shapes. Roller bandages wrap around the area, and non-stick pads of various sizes (not technically “gauze”) are good for burns and other injuries. Carry a variety to increase the versatility of use.

Although I recommend storing tampons, it is more for its traditional use than to treat gunshot injuries, which vary in size (especially exit wounds). A tampon would not always be the right size for the cavity created by the projectile; they are best used for nose bleeds combined with compression.  Maxi-Pads, however, are excellent items for your medical storage.

Specialized Pressure Dressings:  It’s difficult to keep pressure on a wound with your hands without becoming tired, so special dressings like the Emergency Bandage™ (aka the “Israeli Battle Dressing”) allow you to wrap wounds that have the tendency to bleed.  These are an absorbent pad attached to an elastic bandage that comes with a “pressure applicator”. Used correctly, each turn of the wrap increases the pressure on the wound, which can help control bleeding.

Tourniquets:  In circumstances where bleeding can’t be stopped with pressure alone, a tourniquet may do the job. Tourniquets can be improvised with a bandanna and a stick or they can be high-tech commercial items such as the CAT or SOFT-T tourniquet.  Some tourniquets, like the SWAT, can serve double duty as a tourniquet, back-up tourniquet, or pressure dressing.

Blood-Clotting Powders/Dressings:  Also known as “hemostatic agents”, these are effective and easy to use. Available as a powder or powder-impregnated dressings, Celox™  (the most popular brand) is made from Chitosan, a component of crustacean shells. Celox™ will even stop bleeding in patients on blood thinners.  Although it is made from shrimp shells, the company states that can be used on people allergic to seafood.  Hemostatic agents are useful but expensive items. Remember, however, that they might save a life.



Dealing with open wounds in a remote setting requires good judgment as well as supplies. Most of these wounds should be kept open, but there are various supplies to help you close a wound as well as supplies that allow you to care for an open wound until it closes on its own by a process called “granulation”. In a remote homestead or survival setting, you never know when or if help will be on its way. You’ll need to be ready to care for that wound from beginning to end.

Antiseptics and sterile gloves:  As mentioned earlier in this article.

Sterile Gauze: Although non-sterile gauze is often used to stop hemorrhage, sterile dressings are best to use in open wounds as they heal. With commercial sterile saline or water solutions (or even boiled water), you’ll provide the type of environment that newly forming cells need to fill in a wound.  Dry sterile dressings to cover the moist dressing in the open wound will help keep the area clean. Some call this technique “wet to dry”.

Certain dressings, such as “Telfa™”, are non-stick and especially useful for burns or other injuries where removal might be painful. Some burn dressings like “Xeroform™” are dipped with petrolatum to protect healing areas where the skin was damaged or burned off. Alternatively, petroleum jelly could be added to improvise a similar item. Honey has also been used for this purpose, but make sure to get the raw, unprocessed version.

Wound Closure:  Closing a wound is risky (most wounds acquired outdoors are contaminated) but there are circumstances where it may be appropriate. Always start with the least invasive method such as Steri-Strips or even duct tape fashioned as butterfly closures. Sutures and staples can form a strong closure, but they also add more punctures to the skin that could become infected. Super glue is a safe method unless you happen to be allergic to the chemical (Cyanoacrylate). It is used in some underdeveloped countries without incident.

Additional Supplies:  Dry sterile dressings to cover the moist dressing in the open wound will help keep the area clean. Medical tapes to hold everything in place are helpful and come in cloth, self-adhesive, and paper (least allergenic).  Tincture of Benzoin is an adhesive liquid that comes in ampules that will help secure the tape. Triple antibiotic ointment and oral antibiotics are likely to be needed to prevent and treat infected wounds.  Consider having a thermometer to determine whether a fever is present.

I’ll bet you can think of other useful items that you’d want to keep in that homestead medical cabinet. We haven’t discussed, for example, the medications and natural remedies you should have on hand. We’ve addressed these before on this website, though, and will update in a future article.


I commonly see books that give you numerical amounts of medical items to have if you’re the caregiver in an austere environment or in a long-term survival scenario.  My opinion is simple:  You can never have too many of any medical supply.  They are expended more quickly than you think. If you’re in a remote location or other austere setting, have as much as possible in your storage.

A parting thought: You can have all the beans in the world and all the bullets in the world, but it won’t amount to a hill of beans and you’ll just shoot yourself in the foot, if you don’t have the bandages.

Joe Alton, MD


Whether you’re a homesteader or a city dweller, you need medical supplies to deal with injuries and illness in the uncertain future. Check out Nurse Amy’s entire line of kits and individual items at Also, keep a copy of our brand new Third Edition of “the Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way” in your survival library.


Portions of this article were first published in Backwoods Home magazine.

Video: The OODA Loop of Situational Awareness

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Are you safe here?

In this companion video to a previous article, Joe Alton, MD, aka Dr. Bones, discusses a fighter pilot strategy that might save your life in a terror event. Originally meant for aerial dogfights, the OODA loop was developed by Colonel John Boyd and has been used in everything from business to active shooter scenarios. Incorporating the OODA loop into your mindset will help instill the culture of readiness that is so important in the New Normal of the uncertain future.

To watch, click below:

Wishing you the best of help in good times or bad,


Joe and Amy Alton


The Altons

Survival Medicine Hour: Tom Martin of APN, Shooter Issues, Summer Germs, Natural Remedies

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Summer Germs

In this episode of the Survival Medicine Hour with Joe and Amy Alton, aka Dr. Bones and Nurse Amy, Tom Martin of American Preppers Network joins us to talk about his new show, plus a serious look at the recent shooter events and when violence is the answer to stop the fatalities. Also, places you’ll be this summer that could make you seriously sick if you’re not careful. Nurse Amy continues her discussion of natural remedies that will help for orthopedic injuries. Dr. Bones also talks about what the medic’s priorities should be when under fire in hostile survival scenarios. All this and more on the latest Survival Medicine Hour.



To listen in, click below:


Wishing you the best of health in good times or bad,


Joe and Amy Alton

joe and amy radio

Don’t forget to check out our brand new Third Edition of the Survival Medicine Handbook, as well as our Zika Virus Handbook, both available on Amazon. And fill those holes in your medical supplies at Nurse Amy’s store!

Alligator Attacks

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danger alligator

Take this sign seriously


While reading of the tragic attack by a Florida alligator on a two year old boy recently, it struck me that, although I’ve written about bear encounters, animal bites, and shark attacks, I’ve never written about alligators or crocodiles. Yet, we sometimes see gators in the lake behind our home here in South Florida, and they can be very dangerous.

Alligators are crocodilians, which also include crocodiles, caimans, and some other species. Solidly built and reaching large sizes, you might be surprised to know that these powerful reptiles’ closest relations still in existence are birds. Although humans are usually not on these carnivores’ menu, they aren’t the pickiest eaters. As a result, there are about 300 attacks reported yearly worldwide that lead to injury or death. Attacks by crocodilians occur mostly in Africa and Asia, mostly by Nile river crocodiles, but have also been reported in North America, South America, and Australia.

alligator range


alligator smile

Looks slow and clumsy; it’s not.

Although alligators look clumsy and slow on land, they can actually reach a speed of 10 mph. In the water, however, they can be agile and seriously fast. It makes sense to give them a wide berth whenever they are seen. This isn’t always easy, as their modus operandi is to stalk and ambush with only their eyes, ears, and nostrils above water. Once they grab hold of their victim, they hold it underwater until it drowns.

Situational awareness, so important in survival, will help avoid an encounter with an alligator. Attacks can occur both in the water and the water’s edge.Watch for mounds of vegetation that could represent a nest and stay away from murky water or shallow swampy areas of vegetation. Swimming in alligator territory is unwise, and they are especially attracted to splashing around. If you find yourself in the water unexpectedly, get out as quietly and quickly as possible.

alligator vegetation

Alligators might be hard to spot in swampy vegetation

Attacks by crocodilians most often occur at dusk or at night. Nesting mothers are, unlike other reptiles, protective of their young, and have a nasty temper. Having a flashlight or head lamp will alert you to their presence at night in or out of the water by the reflection of light from their eyes.


alligator in water

Most images for this article by

If you spot a gator on land, stay 75 feet away. If you’re camping in alligator country, make sure that your tent is six feet above the water line and at least 150 feet from the water’s edge. Store all food securely and avoid leaving scraps around that might attract them. Especially keep a close eye on dogs and children near the water’s edge. Alligators prefer smaller prey that they can easily drag into the water.

Alligators will sometimes hiss when they feel threatened. If they charge, run as fast as you can in the opposite direction from the water. If they catch you, they’ll try to drag you in. Once you’re in, your chances of survival drop greatly.


alligator above water

alligators can jump vertically out of the water

Let’s say you, somehow, find yourself in the jaws of an alligator or crocodile. If it lets go, it was just a defensive reaction, but if it holds on and tries to get you in the water, you must fight. The eyes are most vulnerable, and gouging at them might be your best chance. After that, any trauma you can inflict to the head might discourage it enough to let you go.

If all has failed and you’re in the water, there’s still a chance. The alligator has a flap of tissue in their throat that prevents it from drowning. If you can grab hold of or damage this tissue, called the “palatal valve”, water will flow down its windpipe and your attacker might just release you.

If you manage to get out of the water, realize that any bite wound is probably already colonized with the huge amount of bacteria that alligators have in their mouth. Even  a minor bite will become infected if not treated with antibiotics.

Joe Alton, MD


Hey, check out the brand new 2016 edition of The Survival Medicine Handbook at, over 670 pages of medical info you’ll need in times of trouble.


Survival Medicine Hour: Urban Survival, Slowly Healing Wounds

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In this episode of the Doom and Bloom(tm) Survival Medicine Hour, Joe Alton, MD and Amy Alton, ARNP discuss what it takes to be an effective medic in an urban survival setting. From dealing with contaminated water to controlling a bleeding wound, there are special considerations that must be taken into account when surviving in place in the town or city. Find out what items you should have and how to approach the bleeding wound. Plus, Dr. Alton answers a question from “rancher”, a member of Jack Spirko’s Survival Podcast audience, about how to deal with thinning skin as you age and spend time in the outdoors. Conventional and natural remedies are discussed to help wounds in fragile skin heal faster.

Also, the new 2016 Third Edition of the Survival Medicine Handbook has hit Amazon, and it’s 670 pages of plain English advice on what to do in a disaster when the hospital is far away or just plain no longer exists. Get a copy today for your survival library.

To listen in to the podcast, click below:


Wishing you all the best in good times or bad,


Joe and Amy Alton





VIDEO: Active Shooter Bleeding Control Kit in Action

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cover celox with roller gauze

Would you be able to stop severe hemorrhage in the aftermath of a terror attack? In Amy Alton, ARNP, aka Nurse Amy’s latest video, she puts on a realistic demonstration of her First Aid Bleeding Control Kit in action after a simulated active shooter event. Each item in the kit is demonstrated as if utilized by a civilian with no training. We believe a kit like this should be available in every workplace, mall, school, and, really, any place at risk for this type of event. The items in the kit are meant to be easy to implement and effective in the control of bleeding.

Small Bleeding Control Kit image

Bleeding Control Kit

To watch, click below:




Wishing you the best of health in good times or bad,


Amy Alton, ARNP and Joe Alton, MD

Amy Alton Everglades Close up 400 x 600

Amy Alton, ARNP

Video: Brown Recluse Spider Bites

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brown recluse penny

In this companion video to the article on the same subject, Joe Alton, MD discusses what he believes to be a brown recluse spider bite incurred by his wife Amy Alton, ARNP while tending to her medicinal and vegetable garden. Learn all about Brown Recluse Spiders, how to recognize their bites, and how to treat injuries caused by spider venom. And don’t worry, Amy is slowly but surely recovering.

Amy Alton Everglades Close up 400 x 600

To watch, click below:



Wishing you the best of health in good times or bad,


Joe and Amy Alton, aka Dr. Bones and Nurse Amy


Brown Recluse Spider Bites

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Brown Recluse wiki

Brown Recluse Spider (wikipedia)

You might have seen our articles and videos on snakebite, but in a survival scenario, and really, everyday life, you will see a million insects for every snake; so many, indeed, that you can expect to regularly get bitten by them. Insect bites usually cause pain with local redness, itching, and swelling, but are rarely life-threatening, although some fleas and mosquitoes can transmit some pretty nasty diseases.

Amy Alton Everglades Close up 400 x 600

Nurse Amy

This time, we’ll talk about spider bites, and for a very specific reason. My lovely wife, Nurse Amy, has what we suspect is a brown recluse bite. As you know, we’re big on gardening and Amy spends a lot of time putting her green thumb to work growing some food. Well, there are bugs in any garden, and wouldn’t you know it, Amy got bitten by something. It started off as a blister, but then eroded the skin before stabilizing, and is now slowly healing.

brown recluse penny

adult brown recluse (wikipedia)

Although tarantulas and other large spiders cause painful bites, most spider bites don’t even break the skin.  In temperate climates, two spiders are to be especially feared:  The black widow and the brown recluse. Today, we’ll talk about the brown recluse.


The brown recluse spider is, well, brown, and has legs about an inch long.  Unlike most spiders, it only has 6 eyes instead of 8, but they are so small that it’s difficult to identify them from this characteristic.


Victims of brown recluse bites report them to be painless at first, but then may experience these symptoms:


  • Itching
  • Pain, sometimes severe, after several hours
  • Fever
  • Nausea and vomiting
  • Blisters


The venom of the brown recluse is thought to be more potent than a rattlesnake’s, although much less is injected in its bite. Substances in the venom disrupt soft tissue, which leads to local breakdown of blood vessels, skin, and fat. This process, seen in severe cases, leads to “necrosis”, or death of tissues immediately surrounding the bite. Areas affected may be quite extensive. The same venom that acts to liquefy an insect’s innards for consumption causes the “flesh rotting” effect in human wounds.

Brown Recluse Bite

Amy’s spider bite

A common appearance of a brown recluse bite is the formation of a reddish blister, surrounded by a bluish area, with a narrow whitish separation between the red and blue, giving a “bull’s-eye” pattern. In some people, however, very little effect is noted or the appearance can be quite variable, as seen in the above image of Nurse Amy’s bite.


Once bitten, the human body activates its immune response as a result. Immune reactions can go haywire, destroying red blood cells and kidney tissue, and sometimes hampering the ability of blood to clot appropriately.  These effects can lead to coma and, eventually, death.  Almost all deaths from brown recluse bites are recorded in children.


The treatment for spider bites includes:


  • Washing the area of the bite thoroughly
  • Applying ice to painful and swollen areas
  • Pain medications such as acetaminophen
  • Enforcing bed rest in severe cases
  • Warm baths for those with muscle cramps due to black widow bites, but stay away from applying heat to the area with brown recluse bites
  • Antibiotics to prevent secondary bacterial infection


Home remedies include making a paste out of baking soda or aspirin and applying it to the wound. The same method, using olive oil and turmeric in combination, is a time-honored tradition. Dried basil has also been suggested; crush between your fingers until it becomes a fine dust, then apply to the bite. One naturopath uses Echinacea and Vitamin C to speed the healing process.  Be aware that these methods may be variable in their effect from patient to patient.


There are various vacuum devices and kits available that purport to remove venom from bite wounds. Unfortunately, these suction devices are generally ineffective in removing venom from wounds. Tourniquets are also not recommended and may be dangerous.


Although antidotes known as “antivenins” exist and may be life-saving for venomous spider and even scorpion stings, these will be scarce in the aftermath of a major disaster. Luckily, most cases that are not severe will subside over the course of a few days, but the sickest patients will be nearly untreatable without the antivenin.


Now, brown recluses are relatively new in Florida, but have been frequently reported recently in Florida, usually in the North. In the year 2000 alone the Florida Poison Control Network had recorded nearly 300 alleged cases of brown recluse bites in the state. Having said that, other infections or bites may appear similar, and some doctors feel that the brown recluse is often blamed for reactions that have nothing to do with it. other insect bites and some infections may also be the culprit.


Amy’s bite is getting better, but it’s important to know that spiders exist and to keep a close eye out for them as you tend to your survival garden.


Joe Alton, MD

tent joe's kids

Are you ready to deal with medical issues you might encounter in a disaster? With our #1 Amazon bestseller The Survival Medicine Handbook and Nurse Amy’s entire line of medical kits and supplies, you’ll get a head start on keeping it together, even if everything else falls apart.

Video: Active Shooter Bleeding Control Kit, Part 2

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In part 2 of a series on hemorrhagic wounds incurred in a terror or other active shooter event, Amy Alton, ARNP discusses what she believes would be a reasonable item for a bleeding control kit and why she chose specific items for the kit she designed for the average citizen in the workplace, school, or mall.

Small Bleeding Control Kit image


To watch, click below:


Wishing you the best of health in good times or bad,


Amy Alton, ARNP, aka Nurse Amy

Are you equipped with the supplies you’ll need to deal with medical issues in times of trouble. Check out Nurse Amy’s entire line of kits at her store at

Video: Mass Casualty Triage, Part 2

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In this part of Joe Alton, MD’s series on Mass Casualty triage, Dr. Bones discusses the RPMs of primary triage, plus the various triage levels. In the comments section, you’ll find 10 victims to triage. We’ll go over these in part 3, coming up soon!


To watch, click below:


Wishing you the best of health in good times or bad,


Joe Alton, MD

tent joe's kids

Videocast: Rib Fractures, Pneumothorax, Sleep Deprivation

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rib fracture

Dr. Joe and Amy Alton, aka Dr. Bones and Nurse Amy put on a live videocast every first and third Wednesday of each month in collaboration with the nice folks at This time, they talk about rib fractures, collapsed lungs, chest seals, and do some demonstrations. Also, they discuss some important things you should know about sleep deprivation, a major issue in any SHTF scenario…


To watch, click below:



Wishing you all the best of health in good times or bad,



Joe and Amy Alton

Fill those holes in your medical supplies by checking out Nurse Amy’s entire line of medical kits at

Traumatic Brain Injuries

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Most head injuries cause superficial damage and are not life-threatening. Indeed, most head injuries amount to only a laceration of the scalp, a black eye, or a painful bump. These wounds, however, can hide damage inside the cranium, the part of the skull that contains the brain. Injuries that affect the brain are called traumatic brain injuries (TBIs). It’s important for the medic to recognize when trauma to the skull has caused damage that is more than superficial.



Concussions are the most common type of TBI. A concussion is associated with a variety of symptoms that are often immediately apparent. The presentation differs from one individual to the next. Although you might expect a loss of consciousness, the victim may remain completely alert. Headache is actually the most commonly seen symptom. Other symptoms include:



• Dizziness
• Confusion
• Nausea
• Loss of motor coordination
• Blurred or double vision
• Slurred speech
• Ringing in the ear (also called “tinnitus”)
• Difficulty focusing on tasks at hand



A person with trauma to the head may be knocked unconsciousness for a period of time. In most cases, they will “wake up” in less than 2 minutes. You can expect them to be “foggy” and behave inappropriately (put me in, coach!). They may not remember the events immediately prior to the injury.



Loss of consciousness is a serious concern. If the victim is “out” less than two minutes, the patient will merit close observation for the next 48 hours. You should examine for evidence of superficial injuries and determine that the patient has regained normal motor function. Make sure they can move all their extremities with normal range and strength.



Rest is prescribed for the remainder of the day. When your patient goes to bed, it will be appropriate to awaken them every two or three hours, to make sure that they are easily aroused. In most cases, a concussion causes no permanent damage unless there are multiple episodes of head trauma over time, as in the case of boxers or other athletes in contact sports.



It should be noted that a physical strike to the head is not necessary to suffer a concussion. A particularly jarring football tackle or the violent shaking of an infant can cause a concussion or worse traumatic brain injury. This is because the brain “bounces” against the walls of the cranium. When injury occurs at the site of a blow to the head, it’s called a “coup” injury. Just as often, it can occur on the opposite site of the head, known as a “contrecoup” injury.



In many cases, evidence of direct trauma to the skull is visible. An “open” head injury means that the skull has been penetrated with possible exposure of the brain tissue. If the skull is not fractured, it is referred to as a “closed” injury. An indentation of the skull is clear evidence of a fracture and the outlook may be grim, due to the likelihood of bleeding or swelling in the brain. A closed injury may still become life-threatening for the same reasons.



The brain requires blood and oxygen to function normally. An injury which causes bleeding or swelling inside the skull will increase the intracranial pressure. This causes the heart to work harder to get blood and oxygen into the brain. Blood accumulation (known as a “hematoma”) could occur within the brain tissue itself, or between the layers of tissue covering the brain.



Without adequate circulation, brain function ceases. Pressure that is high enough could actually cause a portion of the brain to push downward through the base of the skull. This is known as a “brain herniation” and, without modern medical care, will almost invariably lead to death.



There are a number of signs and symptoms which might identify those patients that have a serious TBI. They include:



• Prolonged loss of consciousness
• Convulsions (Seizures)
• Worsening headache over time
• Nausea and vomiting
• Bruising (around eyes and ears)
• Bleeding from ears and nose
• Worsening confusion/Apathy/Drowsiness
• One pupil more dilated than the other
• Indentation of the skull



If the period of unconsciousness is over 10 minutes in length, you must suspect the possibility of significant injury. Vital signs such as pulse, respiration rate, and blood pressure should be monitored closely. The patient’s head should be immobilized, and attention should be given to the neck and spine, in case they are also damaged. Verify that the airway is clear and breathing is regular. In a collapse, this person is in a life-threatening situation that will have few curative options if consciousness is not regained.



Other signs of a traumatic brain injury are the appearance of bruising behind the ears (Battle’s sign) or around the eyes (raccoon sign). This indicates internal bleeding in the cranium, despite the impact not occurring in those areas. Bleeding from the ear itself or nose without direct trauma to those areas is another indication. The fluid that drains out may be clear; this may represent spinal fluid leakage.



In addition, intracranial bleeding may cause pressure that compresses nerves that lead to the pupils. In this case, you will notice that your unconscious patient has one pupil more dilated than the other.



A severe consequence of bleeding in the brain is a stroke, (also known as a cerebrovascular accident or CVA). It represents damage to the brain caused by lack of blood supply. This could occur in a head injury due to a blockage of blood flow to a portion of the brain. This blockage could be due to a clot, a hemorrhage, or anything else that compromises the circulation in the area. Another possibility is a defect in a blood vessel known as an “aneurysm” which could rupture even in the absence of a traumatic event.



Whatever functions are associated with the part of the brain affected will be lost or impaired. These patients often present with an inability to speak, partial or complete blindness, and paralysis or weakness of one side of the body and face. The stroke is usually heralded by a sudden severe headache.



Strokes may also occur due to other reasons as well, such as uncontrolled high blood pressure. Although it may not be difficult to diagnose a major CVA in an austere setting, few options will exist for treating it. Blood thinners might help a stroke caused by a clot, but worsen a stroke caused by hemorrhage. It could be difficult to tell which is which without advanced testing.



Keep the victim on bed rest; sometimes, they may recover partial function after a period of time. If they do, most improvement will happen in the first few days.



Trauma to the head may have negligible consequences, or it could have life-threatening consequences. In some circumstances, there may be little that you, the medic, can do in a long-term survival situation.



Joe Alton, MD


Learn more about traumatic brain injury and over 100 other medical topics in austere settings in our Amazon bestseller “The Survival Medicine Handbook“, with over 270 5-star reviews!

Injuries to the Nail Bed

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Minor injuries can sometimes be a major detriment to the function of a member of your survival group. Although perhaps not as life-threatening as a gunshot wound or a fractured thighbone, nail bed injuries are common; they will be more so when we are required to perform carpentry or other duties to which we’re not accustomed.



Nail Anatomy



Your fingernails and toenails are made up of protein and a tough substance called keratin. They are, as you can imagine, similar to the claws of animals. When we refer to issues involving nails, we refer to it as “ungual” (from the latin word for claw: unguis).


The nail consists of several parts:



The nail plate (body): this is the hard covering of the end of your finger or toe; what you consider to be the nail.



The nail bed: the skin directly under the nail plate. Made up of dermis and epidermis just like the rest of your skin, the superficial epidermis moves along with the nail plate as it grows. Vertical grooves attach the superficial epidermis to the deep dermis. In older people, the nail plate thins out and you can see the grooves if you look closely. Like all skin, blood vessels and nerves run through the nail bed.



The nail matrix: the portion or root at the base of the nail under the cuticle that produces new cells for the nail plate. You can see a portion of the matrix in the light half-moon (the “lunula”) visible at the base of the nail plate. This determines the shape and thickness of the nail; a curved matrix produces a curved nail, a flat one produces a flat nail.


In a nail “avulsion”, the nail plate is ripped away by some form of trauma. The nail may be partially or completely gone, or may be lifted up off the nail bed. Ordinarily, depending on the type of trauma, an x-ray would be performed to rule out a fracture of the digit; you won’t have this tool available without modern facilities, but you can do this for an avulsed nail:.




• Clean the nail bed thoroughly with saline solution, if available, and irrigate out any debris. Paint with Betadine (2% Povidone-Iodine solution) or other antiseptic. If you have local anesthesia, you might want to use some; this area is going to be tender.



• Cover the exposed (and very sensitive) nail bed with a non-adherent (Telfa) dressing. Some add petroleum jelly for additional protection. Change frequently. Avoid ordinary gauze, as it will stick tenaciously and be painful to remove.



• If the nail plate is hanging on by a thread, remove it by separating it from the skin folds using a small surgical clamp. You can consider placing the avulsed nail plate on the nail bed as a protective covering; it is dead tissue but may be the most comfortable option. Avoid scraping off loose edges, as it may affect the nail bed’s ability to heal.



• If the nail bed is lacerated, suture it (once cleaned) with the thinnest gauge absorbable suture available (say. 6-0 Vicryl). Be sure to remove any nail plate tissue over the laceration so the suture repair will be complete.



• Place a fingertip dressing. You might consider immobilizing the digit with a finger splint to protect it from further damage.



• Begin a course of antibiotics if the nail bed was contaminated with debris.



In some crush injuries, such as striking the nail plate with a hammer, a bruise (also called an “ecchymosis”) or a collection of blood may form underneath (a “hematoma”). A bruise will be painful, but the pain should subside within an hour or two. A hematoma, however, will continue to be painful even several hours after the event. A bruise will likely appear brownish or blue, but a hematoma may appear a deep blue-black.



For a bruised nail, little needs to be done other than giving oral pain meds, such as Ibuprofen. For a significant hematoma, however, some suggest a further procedure called “trephination”. In this instance, a very fine drill (or a hot 18 gauge needle or paper clip) is used to make a hole in the nail plate. This opening must be large enough to allow blood that has collected under the nail to escape. Once the pressure is relieved, the pain will abate.


This procedure should not be performed unless absolutely necessary, as the pain will eventually decrease over time by itself. If you go too deep through the nail, you may further injure the nail bed. The finger must be kept dry, splinted and bandaged for a minimum of 48 hours afterwards.




It’s important to know that damage to the base of the nail (the germinal matrix) may be difficult to completely repair, and that future nail growth may be deformed in some way. In situations where modern medical care is available, a hand surgeon is often called in to give the injury the best chance to heal appropriately. Even then, a higher incidence of issues such as “ingrown” nails may occur over time. A completely torn-off nail will take 4-5 months to grow back, maybe more.


Joe Alton, MD

Self Aid

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A Basic Self-Reliance Approach To Self Aid: Part 1
Josh “7P’s of Survival

Self AidThis week we will be talking about all things first aid or self aid; whichever, you prefer in a woodland environment. I have been a first responder since I was sixteen and have served in a variety of capacities including wilderness First Responder and EMT along with a few levels of Ambulance based certifications. Over the last, well almost 20 years now, I have been presented with a wide variety of challenges, situations, training scenarios and just plain weird situations that have helped me deal with most injuries using a very simple kit which will all easily fit in a haversack with room to spare for your 10 Piece kit.

During the show we will:

2-9-16 thCA7XBOBI1) discuss what I prefer to carry when going into the woods alone (which is 99% of the time for me);

2) Discuss what I would take into the woods if I’m planning on acting as a first responder or primary care giver; and

3) Common Medicinal Plants/Trees that I like to use and generally keep in my kit (there are 10 right now I believe) and how to use them generally.

I believe this will take up the bulk of the hour, but if for some strange reason I have extra time I will start work next weeks show which will be a very compact wilderness first aid class.

It is my hope to speak with many of you during the show about what you carry in you IFAK (Individual First Aid Kit) and why you chose those items. I will then show how you can potentially lighten your load utilizing the technology in your kit, nature and a few tips/tricks for increased success!
Visit 7P’s Survival Blog HERE! 
Join us for The 7P’s of Survival “LIVE SHOW” every Tuesday 9:00/Et 8:00Ct 6:00/Pt Go To Listen and Chat

Listen to this broadcast or download “Self Aid” in player below!

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Survival Medicine Hour: Bleeding Control Kit, Herbal Teas, Zika update, more

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Direct Pressure on Bleeding Wound

Bleeding wound

Would you have the materials and knowledge to stop heavy bleeding if you were confronted with it? In these violent times, you should be prepared to deal with injuries that could be life threatening and have the equipment that might save a life. Hear Amy Alton, ARNP, explain her thinking in designing a compact med kit that deal with hemorrhage that she believes should be in every workplace, classroom, and homestead. Also, Joe Alton, MD, talks about natural remedies when he goes over some herbal teas. Plus: Why does Zika Virus in Brazil cause birth defects, while no major history of the problem seems to occur with Zika virus in its original territory (Africa and Asia)? Is a mutation the cause? All this and more on the latest Survival Medicine Hour with Dr. Bones and Nurse Amy.


To listen in, click below:



Wishing you the best of health in good times or bad,



Joe and Amy Alton


Check out Nurse Amy’s latest kit “The First Aid Bleeding Control Kit” at her store at




Guest Post: Top Ten Things To Know About Ballistic Protection

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Covert body armor can be worn under clothes


(DR BONES SAYS: From time to time, we post articles from aspiring writers in the field of medical preparedness. This time, our guest author is Chris Taylor of SAFEGUARD body armor who gives a top ten countdown of important things to know about ballistic protection. And now, Chris’s article ).



Preparedness is no easy task; it requires an understanding of the situations you will find yourself in and the methods by which you can survive them. The most important thing to safeguard is your safety, as only by being properly protected can you keep yourself alive.

Proper protection can mean a number of different things, from first aid, to self-defense. However, an often overlooked method of keeping oneself safe is by employing body armor. Bullet proof vests are more accessible and protective than ever, and yet there are still a number of important things to understand before grabbing the nearest vest. Here are the top ten most important aspects of body armor everyone should know:


10.) Body Armor is Available for Everyone
Body armor usually conjures up images of high-visibility protective vests worn by the Police, or ultra-protective tactical armor worn by SWAT teams and the Military. Similarly, many assume that these products are difficult to obtain, and are only reserved for these people. While there are some restrictions on how body armor may be purchased and used in some areas (check local regulations before you purchase), body armor is available for anyone to purchase and wear. Indeed, anyone who faces the threat of attack or injury should consider a protective vest, as it could help save their life.

9.) Body Armor covers a lot of products
As we’ve seen above, body armor refers to a wide range of protective clothing; everything from stab proof vests to helmets is considered body armor, and it can be difficult to know exactly what you need and what you are getting. The products can be loosely grouped into ‘soft armors’ and ‘hard armors’, depending on the materials they use to offer protection. However, within each of these groupings there are variations that need to be considered.


female body armor

female body armor

8.) Different threats mean different protection…
These variations exist in order to combat different threats, as certain weapons or attacks require different materials to provide protection. For example, bullet proof vests cannot protect against many stab wounds, which cannot protect against spike attacks like ice picks. Similarly, ‘soft’ bullet proof vests cannot protect against high-velocity ammunition. To add to the confusion, many vests meant to protect injury from sharp objects also come with ballistic protection. While this will be discussed later, it is important first to know what threats you need protection against; if you will be facing rifles, you need armor with rigid plates. If you will be facing edged weapons, you need armor with stab protection. If you are facing spiked weapons, you need spike protection. All of these protections can be found in addition to ballistic protection.

7.) Not completely bulletproof
However, even a bullet proof vest is not completely bullet proof. There is no such thing as complete protection against a bullet, particularly when bullets come in all shapes and sizes. A bullet proof vest will certainly increase your chances of surviving an attack involving a firearm, but it should never replace caution and diligence.


6.) Levels
While no vest can offer 100% guarantee against bullets, vests at different levels offer some assurance against certain ammunition types. Ballistic protection is tested and graded by the National Institute of Justice, which assigns ‘levels’ to bullet proof vests. These NIJ Levels outline exactly what threats a vest can protect against. This means that vests at lower levels cannot protect against higher caliber ammunition, whereas higher levels can offer greater protection. The highest level of ‘soft armor’ available is Level IIIa, which will protect against the vast majority of handgun ammunition. The highest level of ballistic protection available is Level IV, which is only achievable with rigid plates, and can protect against even armor-piercing ammunition.

5.) How it works
Many do not know exactly how a bullet proof vest provides protection, and understanding how the materials involved work helps distinguish between the different levels and types available. ‘Soft armor’ uses fabrics like Kevlar, which have an incredibly high strength-to-weight ratio. This allows them to trap bullets and disperse their energy, slowing them to a complete stop. These materials are lightweight and flexible, allowing them to be worn even under clothing. Higher levels, however, need rigid plates that use materials like Ceramics and Polyethylene, which are incredibly strong and even deflect or absorb bullets. These plates are much thicker and heavier, and yet still light enough to be worn in covert vests.



4.) Different Styles
In addition to being split along numerous protective lines, body armor can also be found in ‘covert’ and ‘overt’ styles. This means that a vest is designed either to be worn under clothes or over clothes. Covert armor offers discreet protection at all levels, and can even use rigid plates. Some covert vests are even designed to help keep the wearer cool. On the other hand, overt vests are worn over clothing and have more variety in the materials used and the extras available. For example, overt vests can use waterproof and high-visibility covers, and can be equipped with additional pockets and clips, as well as logos and insignia.



Overt body armor

3.) Proper fitting
It may sound obvious, but ensuring your vest fits you properly is just as important as ensuring you have the right level of protection and style. In a hostile situation, freedom of movement is very important, and you need to be comfortable in order to perform to the best of your ability. Body armor should be comfortable enough to be worn for extended periods, meaning you don’t have to worry about your protection. Armor that does not fit properly may also have gaps in protection, leaving you vulnerable. Many vests are fully adjustable, but making sure you have the right size is very important.

2.) Keep it clean
Just as important is keeping your armor well maintained. Many do not realize that body armor and the materials used only have a limited lifespan, and without proper maintenance, this will be reduced dramatically. Vests need to be cleaned regularly and stored correctly, just like all clothing. The carrier, which is the vest itself, can usually be machine washed and often only consists of materials like cotton. The protective inserts, on the other hand, should only be cleaned with a mild cleaning agent and a gentle sponge, to avoid causing damage to the protection. Armor should be stored out of sunlight, should not be crumpled, and should have nothing stored on top of it. Moreover, all vests should be inspected regularly, and if any damage or deformity is found, you should replace your armor immediately. Many manufacturers recommend having multiple carriers to ensure you always have clean armor to wear.



looks great, but not much help against bullets

1.) Wear it
The most important thing to know about a vest is that it can only protect you when it is worn. Again, this seems obvious, but all too often people are injured or even killed despite owning body armor. Choosing the right vest and keeping it well-maintained is important, but unless you wear it when it is needed, it cannot protect you.

Head Wound & Concussion Care

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Head Wound & Concussion Care!
Host: Dr Bones & Nurse Amy “Survival Medicine Hour”

Head Wound  gash 001In this episode of the Doom and Bloom(tm) join Dr. Bones and T. D. Bird, the African Gray Parrot (T. D. stands for “That Darn”) as he discusses head wound injuries and some new research on concussions, the open head wound, and issues related to gastric reflux. Also, the FDA does an about-face regarding whether to use aspirin as primary prevention for heart attack.

When the medically-responsible person evaluates a head wound, the following question must be asked: What am I trying
to accomplish by stitching this wound closed? Your goals when performing wound closure are simple.

You close wounds to:Head Injuries th (1)
Repair the defect in the body’s armor.
Eliminate “dead space” that can lead to infection.
Promote healing.
Provide a pleasing cosmetic result (less scarring).
Sounds like every wound should be closed, doesn’t it? Unfortunately, it’s more complicated than that. Closing a wound that should be left open can do a lot more harm than good, and could possibly put your patient’s life at risk.

Head InjuriesAlthough a daily low dose of aspirin has been shown to be effective in preventing a re-occurrence of a heart attack or stroke, the FDA is now warning people who have not had a first heart attack or stroke that taking an aspirin every day may not have a benefit. In fact, doing so may actually cause serious side effects.

Suffering a concussion can be a different experience for everyone – and now, new imaging research has revealed that the recovery process may actually be more difficult for one gender than the other. Dr. Bones talks about head injuries in general and the new research.
Get “The Survival Medicine Handbook” HERE!
Visit Joe and Amy’s web site at:

Listen to this broadcast or download “Head Wound & Concussion Care” in player below!

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Put the 24/7 player on your web site HERE! 
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Survival Medicine Hour: Active Shooters, SWAT-T, Superbugs

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Would you know the right plan of action if you were caught in an active shooter situation? Having a plan of action in advance may mean the difference between life and death? Joe Alton, MD gives his take on what to do in a mass casualty incident. Also, Dr. Alton discusses antibiotic-resistant superbug CRE, as well as Dr. Brock Blankenship’s SWAT-T, a tourniquet that might be a good addition to many workplace and schools’ first aid kits.


To listen in, click below:


Wishing you the best of health in good times or  bad,



Joe and Amy Alton


Joe Alton, MD and Amy Alton, ARNP


Survival Medicine Hour: Nosebleeds, Flu Vaccines, Natural Diabetes Remedies, More

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Last year’s vaccine was 20% effective, is next year’s any different?


What do you know about FLUAD, the latest flu vaccine? How is it different from older versions? Also, are there any natural remedies that might have a beneficial effect on diabetes (more than you think)? Joe Alton, MD discusses these topics plus using Afrin for nosebleeds, and how to approach head trauma. All this and more on Amy and Joe Alton’s Doom and Bloom(tm) Survival Medicine Hour.


To listen in, click below:


Wishing you the best of health in good times or bad,


Joe and Amy Alton


Hey, looking for a Christmas present for that older child or prepper in your family? Check out our board game Doom and Bloom’s SURVIVAL!, a great way to get the whole family together  and have a fun family game night!


Top 5 Injuries People Will Get After The SHTF

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Today I want to share another interesting video by The Patriot Nurse. In this one she talks about the 5 most common injuries people will get after the SHTF. This is a very helpful list because if you know what the most common injuries will be, you’ll know […]

The post Top 5 Injuries People Will Get After The SHTF appeared first on Urban Survival Site.

Videocast: Bear attacks, E. Coli, more

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black bear


What would you do if you came upon a full-grown bear on the trail? There’s black bears all over the place here in the Great Smokies, and you should know how to stay safe in a encounter with one of these beautiful, but potentially dangerous, animals. Also, Joe and Amy Alton discuss the latest E. Coli outbreak, this time originating in some Northwest Chipotle restaurants.


Not a bear


To watch, click below:



Wishing you the best of health in good times or bad,



Joe and Amy Alton

2015 Birdhouse Inn Mountain Paradise View!

Bear Attacks

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black bear

Black Bear

The Great Outdoors is, well, great, but there’s also danger in them thar hills, and it pays to know what to do when you encounter it.



I’ve talked about animal bites in videos, but I haven’t shown you any actual animals. Although we’re here at the Birdhouse Inn, the best bird’s eye view of the mountains in the Great Smokies, we’re not talking about birds today. We’re talking about bears.



Bears are mammals of the family Ursidae, and I’ll bet you don’t know what their closest living relative is: It’s seals. There are a number of species of bear but the one around here is the American black bear. 1800 bears live in the Smoky Mountains and many of them have become very accustomed to humans.



There are several in the area around this property, mostly youngsters that have decided that Halloween pumpkins are a tasty treat. I guess we should have known, because bears, indeed, eat more plant matter than meat, taking in opportunistically whatever they can find, like acorns. Poor crops of such foods, called mast, result in bears moving out of their back country territory to look for alternative food sources, like your trash. Even though black bears are only 8 ounces when they’re born, males (also known as boars) can wear 500 pounds or more. This puts you in danger, no matter how “cute” you think these critters are.

newborn black bears

Newborn black bears


To prevent injuries from bear encounters, situational awareness is the order of the day. Watch for disturbed trash, fresh tracks, and of course, actual bears.

bear droppings

Probably from an actual bear…

Some basic advice: Don’t hike alone. Whenever possible you should hike in groups, 90% of people injured by bears (mostly grizzlies, I suspect) in Yellowstone National Park were alone or with only one other hiking partner.



Avoid hiking at dawn, dusk, or at night, times that bears are out in warm weather months. You’re just as likely to come upon a bear as it is to come upon you.



You might think it’s not too smart to yell “Hey, Bear!” or sing “The Star Spangled Banner” on the trail but, actually, bears don’t like noise and it’s actually a pretty good strategy, especially when traveling near babbling brooks or other settings where normal hiking noises might be muffled. Just don’t do it with a hamburger or hot dog in your hand.



When you encounter a bear, it will, hopefully, be at a distance: If so, and the bear doesn’t see you, keep out of sight and go slowly behind and downwind of the bear. If the bear does see you, slowly retreat the way you came. A bear in defensive mode will huff, hiss, or slap the ground with its paws, telling you that you’re too close. So put some distance between you and the bear. However, don’t run, it might activate a chase response in the animal.



If the bear follows you quietly, ears erect, and its attention is clearly directed at you, it is likely in predatory mode and not acting defensively. Make yourself appear larger, louder, and threatening. Groups should stay together to look like a bigger threat. A bear that is initially curious or testing you may become predatory if you appear meek. A deterrent like pepper spray, at least, or other items of personal defense will become very handy. Pepper spray is most effective at close range, say 5-10 feet.



If the bear attacks, don’t run. You can’t outrun a black bear. Don’t climb a tree unless you’re a squirrel, you’re not 10 years old anymore, it takes longer than you think, and your pursuer is a very good climber. Use your deterrent and fight for your life, because that’s what’s at stake. Kick, punch or hit the bear on the face, eyes, nose, with whatever you have.


Probably a better tree climber than you

You also should not play dead. Bears will feed on carrion like deer carcasses, so why pretend to be one? If you do, however, keep your backpack on, lie face down and clasp your hands over the back of your neck with your elbows protecting the sides of your face. A bear that’s just protecting its cubs may decide you’re no longer a threat.



Which leaves you with bite and claw injuries that may be bleeding, so make sure that backpack has dressings, tourniquets, antiseptics, and other supplies needed for treating wounds. Here’s an article on dealing with animal bites and one on active bleeding



Studies have shown that bears accustomed to humans never live as long a life as truly wild bears. Bear lose their fear of people by being fed by them. As a result, many of these are hit by cars or end up euthanized. Remember this: A bear that’s fed is a bear that’s dead.



Joe Alton, MD


Can’t bear to be without a good medical kit? Check out Nurse Amy’s entire line over at!



images via commons.wikipedia

Video: Glue as a Wound Closure Method, Part 2

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dermabond in place

In part 2 of his series on skin adhesives, Joe Alton, MD, aka Dr. Bones, compares skin glues to traditional sutures/staples as a method of skin closure, the procedure to apply glue to a wound, and about how commercial super glue compares to the much more expensive (10-15 times or more) medical glues. To watch, click below:



Here’s wishing you the best of health in good times or  bad,



Joe Alton, MD




Video: Glue as a Wound Closure Method, Part 1

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skin glue applied

There are lots of ways to skin a cat, but how many ways can you close a cat’s skin? Well, just about as many as you can close a human’s skin! Joe Alton, MD, aka Dr. Bones, co-author of the Survival Medicine Handbook, talks about the benefits of skin adhesives as a wound closure method and their limitations. Part 1 of a 2 part series corresponding to a recent article on the same topic.





Wishing you the best of health in good times or bad,



Joe Alton, MD

tent joe's kids

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House Fire, smoke inhalation and burn care!

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House Fire, smoke inhalation and burn care!
Cat Ellis “Herbal Prepper Live

House Fire FRFD TrucksA couple of months ago, our smoke detectors went off. I didn’t think much about it at first, as they had only ever done that when one of their batteries was near dead. Then the doorbell rang, and the elderly man who lives on the first floor of our house yelled through our intercom to get out, there was a fire.

I had just finished working out when the alarms went off. I had just ordered the kids to grab their emergency bags and get out, when my husband had come running up three flights of stairs from the basement to get us. The smoke was already all the way up to the third floor in the stairwell. It was so dark from the smoke, we could barely see. And as we got closer to the first floor and the fire, it got harder to breathe.

House Fire Grease fire 1st floorFor someone with a bad knee, I hustled it down those stairs as fast as I could. My husband had to carry our daughter. Even though we had run fire drills, she froze at the sight of the smoke at the top of the stairs. My husband went back in to get the elderly woman on the first floor. She was still trying to put the fire out. It didn’t click in her head that it was time to leave.

House Fire Damage through ceilingThankfully, the fire was put out quickly and didn’t get an opportunity to travel through the walls of the house. Thankfully, the only injuries were minor smoke inhalation (my husband), and some minor burns (the elderly tenant on the 1st floor).

You prepare for emergencies. That’s what preppers do. But, sometimes it takes an emergency to show you where the holes in your plans are. We found some major holes in our plans. We also did some things exactly right. We were extremely lucky, though, that this was only a minor housefire. We got to learn a lot without any major injuries or worse.

Let me share with you what we learned going through this experience, what we have changed as a result, plus some thoughts on dealing with smoke inhalation and burn care. Let our experience help you get better prepared for a house fire.
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The post House Fire, smoke inhalation and burn care! appeared first on The Prepper Broadcasting Network.

Skin Glue in Survival

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There are many ways to skin a cat, but how many ways are there to close a cat’s skin? Pretty much, the same number of ways that you can close a human’s skin. Sutures, staples, and tape butterfly closures like steri-strips are common methods, but there’s another one: topical skin adhesive glues.


Topical glues have been around since the 1940’s, but it took more than 3 decades for them to be approved for human use. Since that time, they have become the favorite method of closure for some surgical procedures.


This article will discuss the properties and uses of skin adhesives, especially as they apply to survival scenarios. Therefore, we will forego a discussion of cosmetic results, as they would be less important in austere settings.


Topical skin adhesives (or glues) are liquids made from a mixture of cyanoacetate and formaldehyde called cyanoacrylate. These glues become solid upon contact with skin, thus holding wound edges together.


The original cyanoacrylates (methyl-cyanoacrylate) comprise what is now industrial Super Glue. Medical versions were then developed (octyl- and butyl-cyanoacrylate) that were meant specifically for human skin. Some brands include Dermabond, Surgiseal, Liquiband, and others. These are mostly by prescription only, and are roughly ten times the cost of regular Super Glue.


Benefits of Topical Skin Adhesives


Topical skin adhesives are useful in a number of specific circumstances, and have some benefits not seen with some other methods of wound closure:


• They are quick to apply.
• They are a relatively painless method of closure.
• They don’t leave the “hatch marks” seen with sutures and staples.
• They don’t require removal. Skin glues slough off by themselves spontaneously after 5-10 days.
• They don’t require anesthetic injections, which makes them less problematic to use in children or those afraid of needles.
• They create an environment which speeds healing.
• They decrease the risk of wound infections with certain bacteria (gram-positive like Staph).


Indications for skin closure with glue


Topical skin adhesives are best used for simple cuts such as some traumatic lacerations. Use them for:


• Wounds that are completely dry (no longer bleeding).
• Areas where there is no skin tension (not difficult to pull together manually).
• Hair-free areas .
• areas not inside the mouth.
• children, to avoid pain of local anesthetic injection.
• Short-medium length lacerations


Topical adhesives are not helpful or may be dangerous if used:


• Inside the mouth or other internal cavity.
• In other high-moisture areas such as the groin or armpit.
• Around the eyes without extreme caution.
• On joints (unless immobilized with splints).
• Very long lacerations
• On avulsions (areas where skin flaps have been torn off due to trauma) or very jagged lacerations.
• Infected wounds.
• Wounds with dead tissue, like gangrene.
• In those with known hypersensitivity to the chemical compound.


Comparing skin adhesives to sutures and staples



Traditional methods of skin closure include sutures and staples. The following are considerations when comparing these to topical skin glues:


• The wound strength with glues is less than with staples or sutures, probably only 10 per cent or so in the early going. After several days, the healed skin strength with glue is nearly equal to other methods, especially if used in conjunction with butterfly closures.
• Although anti-bacterial ointments can be applied on top of suture/staple closures, they weaken the strength of skin adhesives.
• Blood or fluid may collect under the adhesive. Although drainage from the wound is acceptable with suture or staple closures (and may be preferable to collection under the skin), infection risk may be increased with glues or even prevent skin healing.



How to use topical skin adhesive glue:

skin glue applied


Before using any method of skin closure, meticulous care must be taken to completely flush out debris and bacteria in the open wound. This should be done with an antiseptic solution like betadine or sterile saline. Any bleeding must be completely controlled. If deep layers are needed to close dead space, sutures can be used for this purpose as well as to decrease any tension on the wound edges.


When you are ready to close the skin:


• Approximate the wound edges carefully (best done by an assistant).
• Gently brush the glue over the laceration, taking care not to push any below the level of the skin.
• Apply about three layers of the adhesive over the wound, preferably widening the area of glue to increase strength of closure.


• Once completely dry, consider adding steri-strips to increase the strength of the closure.


It should be noted that some people experience a sensation of heat to the area when the glue is first applied. Encourage your patient to avoid picking at the closure or scratching it.



What about Super Glue for skin closure?

super glue


Many underdeveloped countries may not be able to afford the expensive medical glues. In some, like Cuba, emergency rooms have had to resort to industrial Super Glue. As a closure method, it is comparable, but it should be noted that Super Glue closures must be kept dry as they may break down more easily that medical glue.



Some people will experience skin irritation or even mild burns from the industrial version. You can test for this beforehand by having those in your group place a drop of Super Glue on the inside of their forearm. If there is a significant reaction such as redness or itching, avoid this method of closure on that person, or use the prescription version.



In my experience, gel versions of Super Glue are easier to handle due to less dripping.



Of course, standard medical texts will tell you to avoid Super Glue altogether. In a survival setting, you will have to make decisions based upon what you have available. The medic will often have to “make do” with suboptimal methods and equipment, but something is better than nothing. It will be easier to stockpile commercial glue than the more expensive medical skin adhesives.



As the survival medic, you should know how to use all the tools in the medical woodshed. If you learn the pros and cons of every method of skin closure, you’ll be better able to succeed, even if everything else fails.


Joe Alton, MD

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Stop Bleeding Fast With This Weed

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This article first appeared at The Prepper Project I was out in the yard one beautiful May afternoon when I made an exciting discovery. It was a tall, scraggly plant towering a good foot and a half above the other weeds scattering our overgrown yard. I crouched down to get a closer look and immediately … Continue reading Stop Bleeding Fast With This Weed