Casualty/Trauma Care & Supplies In Austere Conditions

Per a request to MDs and SF 18Ds (of which I am neither, being instead a trauma nurse of some years' experience) on John Mosby's "mountain guerrilla" blog, I offer my two cents:

Under the heading of “What would you want to pre-stock/cache to care for casualties with moderate to severe trauma under semi-austere conditions?”

Rather than go all Pollyanna, I’m going to be blunt: The first thing you’re going to need, to quote Col. Trautman from “First Blood”, is “A large supply of body bags.”

Major trauma and gunshot wounds (GSWs), under field conditions, have a much higher likelihood of turning live people into dead ones, despite all your efforts. It’s not a certainty, but the likelihood is much greater, so let’s deal with worst things first. You absolutely need, along with the mental and emotional toughness to deal with this fact, the physical ability to properly bag and tag the remains, and inter them without creating a pandemic among caregivers and survivors. Plague, cholera, typhoid, and a host of other medieval ailments await humanity if you can’t accommodate this eventuality. So casualty bags, a place to bury them, and a crew of people to do it, will have to be provided for. Both Korean War M.A.S.H. hospitals and their modern 21^st century equivalent have a Graves Registration Unit, for good reason. You also need to record the deaths, and mark the graves – overtly or covertly – so that next of kin might have some opportunity to recover the remains in better times.

That leads to a need for chaplain(s) or equivalent, to perform the associated rites and rituals. They serve dual duty for those not imminently leaving this world for whatever might come afterward, and such care can have a great impact on casualty recovery. I don’t care if you’re personally an atheist, literal piles of documented peer-reviewed studies underline the point that physical casualties need spiritual care. Do not neglect this aspect if you want optimum outcomes.

You’re undoubtedly going to have personal effects, as well as weapons and gear from said casualties, so you’ll absolutely need to have the people and space to deal with, store, inventory, and be accountable for safeguarding and/or passing along such items, with absolute integrity.

Then there are the casualties themselves, and their care, which was certainly the main reason for the query.

Once you move beyond primary care for injuries and wounds during the first hours or day, your patients’ concerns balloon from mere initial treatment to the full range of human survival: you now have to deal with hydration, nutrition, elimination, cleanliness and personal hygiene, as well as continued medical management, wound care, infection control, and other therapies.

In short you’re now looking at creating a hospital, at minimum, however primitive, and at most essentially re-creating an entire healthcare system continuum, whether you meant to or not. The alternative is to shoot your wounded.

Hospital Rule One: Cleanliness Is Next To Godliness. As was demonstrated in the Crimea by Florence Nightengale, or the American Civil War by Clara Barton, and every conflict before or since, clean patients and wards heal, and dirty ones kill.

So immediate needs: Betadine, bleach, Bactine, hydrogen peroxide, isopropyl alcohol, Lysol, Cavicide disinfectant (or equivalents). Sterile dressings and clean bandages (dressings are what you put on the open wound, bandages hold the dressing in place, thus the latter only need to be clean, while the former need to be sterile). Silk, plastic, and paper adhesive tape. Q-tips. Penrose wound drains. Ace wraps, Iodoform gauze, sterile surgical gloves, drapes, and sponges. Clean exam gloves, patient gowns, slippers, sheets, blankets, towels, washcloths, basins, bedpans, urinals, commodes, sponges, toothbrushes, combs, disposable razors, soap, shampoo, lotion, water pitchers, cups, meal trays, dishes and utensils. Enema supplies, sterile urinary catheters in a range of sizes and collection bags.

{Edit addition: And lest we forget - like I did - you need a means of disposing of poo, pee, dirty diapers, gowns, sheets, bloody and pus-filled bandages, and all other assorted nastiness, far from patients, food, water supplies, and anyone you have any regard for. "Red bags" for biohazardous waste are only the beginning of solving your problem, not the ultimate solution. Just as in Rawlesian survival, think systems, not just a list of stuff.}

BP cuffs, thermometers, stethoscopes, and at least a basic drugstore pulse oximeter. Ideally otoscope and laryngoscope, plus disposable speculums and tongue blades.

A host of over-the-counter (OTC) meds. IV fluids, poles and hooks to hang them, administration kits, tubing, catheters, etc. (Most of which is Rx.) All the oral antibiotics you can lay hands on. Other Rx meds if you can get them legally and store them safely.*

You’ll need “holy water”. Q.: How do nuns make holy water? A.: they boil the hell out of it.

So a water supply, the equipment/capability to boil water, do piles of laundry, sterilize instruments and equipment, wash hands, and bathe, cook for, and feed a patient/patients for days or weeks.

Food stores, and the ability to heat/cook/prepare them. Vitamins, both multi and individual types. Supplemental and homeopathic remedies.

Splinting and casting materials, crutches, slings, braces,  post-op shoes.

Surgical instruments (both reusable and disposable), a full range of sterile suture materials.

Higher-end: Laboratory-quality microscope, test tubes, slides, centrifuge, and associated lab equipment. Refrigeration capability, and blood collection/storage/transfusion equipment.

Top-drawer: Cardiac and/or vital signs (VS) monitor/defibrillator, and some X-ray/ultrasound capability (dream list, and a tad pricey, but doable, and since you asked…).

And hopefully a surgeon and/or ER doc, physician assistant, nurse(s), orthopedist/physical therapist, pharmacist, homeopath, nutritionist, etc. to help you take advantage of all of it, as well as the cooks, laundry, orderlies, and associated minions who do the grunt work. Even if it’s just one or two people, but obviously, the more people you can staff, the better you’ll do. And all the notebooks, paper, pens/pencils, and index cards you can get to keep charts on your patients. At a minimum, so that the person who takes over the next 12 hour shift for you while you or the doctor sleeps knows what’s going on with the patient, what to do/not do, and so you do too when you take over again after them.**

I didn’t go into quantities for any of the above, because whether you acquire 2 or 200 of something depends upon resources, storage space, etc.

Lest this sound extreme, it can be readily accommodated bare-bones in an average two-bedroom house if it were a dedicated care station, and it’s pretty much the range of supplies/equipment I’ve had at my disposal in ERs ranging from basic 2-bed units, up to world-class 60+ bed Level I ER/trauma centers. Imagine a widow/er in a large house with 2-3 spare bedrooms and ideally a full basement with an empty garage (let alone farmhouse/ranch with a bunkhouse and full barn with basic indoor plumbing! Happy day!), and you or I could set up a full-on clinic/mini-ER/surgery/recovery ward for as long as food, water, and expendable supplies and medicine held out, sufficient to care for a battalion of troops and/or a town from 500-1000 people pretty easily. All it takes is space and money, just like pretty much everything else in life. You could do it as small as one dedicated treatment room in a large bedroom, but there are economies of scale, and trying to do everything in a space the size of a 20’ Conex container is barely possible, but it’s a distant third choice, IMHO. I think it’s kind of geometric: If you allot 2x the resources compared to a medic with a cot and an aidbag, you can probably do 4x as well. If you allot 5x the space/equipment, you can do 25x as well, and so on.

Some quality references are the “Special Operations Forces Medical Handbook, 1st or 2d Ed., ca. 2008” (not to be confused with the ubiquitous, somewhat helpful, but woefully obsolete and outdated SF Medical Handbook ST 31-91B from ca. 1982 or so), and “Survival Nurse”, by Ragnar Benson, which is a decent if minimal overview on setting up a basic casualty care mini-facility in rugged conditions. An especially ideal one specifically for this topic is "Improvised Medicine: Providing Care in Extreme Environments " by Iserson, 2012, which is precisely geared towards pulling a hospital out of your back pocket in crappy locales or after disasters and other extreme events. And at least one comprehensive textbook of standard nursing practice by Mosby, Lippincott, etc. Along with all the CURRENT physician/medical references you can acquire, from textbooks to periodicals, hard copy, CD, digitized, and any videos/DVDs/BDs of care, procedures, etc. The obvious step beyond setting up such a capability is to make it, so much as possible, a “teaching” facility, so that you can start multiplying and disseminating the knowledge to as many people as possible, both to better care for your patients now, and to ensure the capability isn’t lost. “Two is one, and one is none” works for hospitals, doctors, nurses, etc. just as well as it does for shovels and bug-out bags.

 

*Meds, which are probably 50% of modern Western medicine, are another huge issue, especially regarding pain control. I realize we’re talking about operating in an insurgent or post-zombie apocalypse environment, but in preparing for worst cases, it’s worth noting that an illegal stockpile of minor narcotic pain relievers stored with one firearm, now, could get you enough federal enhancements at sentencing to pretty much screw the rest of your life and twenty other peoples’. Due diligence and common sense are called for.

** I’m not, at this point, going into all the specialty items for care regarding eyes, ears, nose, and throat concerns, or dental injuries, or burn care, or amputation care/prosthetics, all of which are likely co-components of wounds from penetrating and blast trauma after association with getting shot, stabbed, fragmented, and blown up, and nearly killed. Mainly because it would be an encyclopedia, a pitifully sketchy one at that, and there are numerous textbooks on the subject.

Women in The Military

If you look to the right, you’ll see the majority of the blogs I read most days are by current or former military members. One of them, American Mercenary’s, is once again looking at the utility/necessity of women in the .mil, and the recent decree from SecDef Leon "I'm Outta Here, So The Next Guy Can Deal With The Blowback" Panetta that “Women shall be assigned to combat units, because Susan B. Anthony.”

I respect AM's opinion, and I also recognize he's in a tough spot: an officer hoping to someday make field grade and get to retirement and a pension (or if not, faced with a promotion to  U.S. Civilian, First Class), besides not being in a position, as a serving officer, where he can freely tell the Ranks Above Reality that “The Emperor Is Naked!” even if he disagreed with this or any other policy.

 I don’t envy the position that puts him in, but those are constraints I don’t suffer from, and the "pro" argument for the policy is one I have no compunction about calling pure undiluted horseshit.

Women, for a host of reasons, have absolutely no place in combat units. (For the record, my SWAG is that would be 97% of the Marine Corps, probably at least 60-70% of the Army, any Navy ship longer than 8 feet, and any airbase outside of CONUS, or any U.S. military aircraft that leaves the airspace beyond our international borders.) The vast majority of women even in the service can't and couldn't meet the (formerly "normal", and now "male") physical requirements, not only the basic ones, but the MOS-specific requirements, and of those that could, you’d be lucky to find more than you could count with your fingers who could a) also handle the psychosocial toll b) wanted to be there  c) would last long enough to make the expense of dual accommodations cost-effective and d) would bring ANYTHING to the party that couldn’t be had better in spades from literal legions of male recruits with absolutely none of the costs, drawbacks, or social and military upheaval dragooning women into the mix has and will continue to create. More than that, were it not for the second-rate physical requirements, lower than males’ on purpose merely to allow women to gain admittance to the military in the first place, more than 95% of women would never have made it into the service in any capacity, and for that reason alone, don’t really belong there either. (So to the fewer than 5% of women who could meet the male physical standard, most of these remarks don't apply.)

But between AM’s posts in support of the new policy, and some of the half-brained comments, you’d think that all warfare in over 6000 years of recorded human history has totally changed in just the last 20 years - or is it the last 20 days? - to the point that now it's utterly impossible to prosecute a war successfully without Superchicks in the platoon. The thumping noise you hear is millions of troops from field marshals, generals, and admirals down to mere privates dating back to Babylonia spinning in their graves, if not the cacophony of their bony fleshless mandibles chattering in unrestrained mirth at such nonsense. 

Clearly, the total lack of women on the other side is the only logical explanation for our walkaway overwhelming military dominance against Iraq in 1991 and 2004. Gosh, if only we'd had women in combat in Vietnam and Korea, those gals could have blown those enemies right off the map, and then had the Rockettes square off against Ivan in the Fulda Gap for mere sport, making all that Cold War military spending a waste of good money.

And if you believe that, I can get you a killer deal on oceanfront property in Kansas.

The argument then gets made that we “need” women in all the newly created “Operations Other Than War” positions. I understand hearts and minds very well, and it's worth noting that the doctrine was pioneered by a bunch of  knuckle-dragging Marines and soldiers in places like Haiti, Nicaragua, and the Phillipines, when there were NO women involved in implementing it. In fact, other than a very few nurses in actual running-water brick & mortar hospitals and headquarters on paved streets, no women were present in the military services whatsoever, and yet those poor helpless men seem to have coped with the lack just fine. As Casey Stengel used to tell people, “you could look it up”.

The example furnished in one comment  was having some empathetic understanding female troop present to share the pain when our roughneck raiders kick down doors, break furniture, and get muddy bootprints on the camelhair rugs in whatever Trashcanistanian locale in the third world we’re currently heartlessly oppressing.

Calling a reality episode of "Ophrah" an "Operation Other Than War" is accurate, because the former has absolutely nothing to do with waging war - which incidentally is the first, second, and third through ninetyeighth purpose for raising, maintaining, and deploying the military. If Hadji's sister has a problem with her broken door, I don't give a flying fig who unruffles her feathers. But it sure as hell doesn't require anybody in a military uniform. Doors get kicked in all the time here in the U.S. by people in uniforms from Anchorage to Key West (not to mention Baghdad, Kabul, Riyadh, Cairo, Amman, Damascus, Islamabad, Teheran, ad infinitum where - I'm spitballing here - I'm willing to wager any amount the number of female officers has always hovered somewhere between 0.00% and 0.00%,  still does, and short of a religious reformation or thermonuclear rehabilitation of the culture, always will), and it pisses people off here too when their stuff gets broken. But they mainly just want the cash for a new door, and I don't think dollars, dinars, or deutschmarks ever came in military uniforms, or with internal or external genitalia attached, nor need to. And maybe one could look up whether we send  a Certified Non-Testicular Interior Decoration Restoration, Sympathy, and Snivvel-Wiping Team into Pakistan or Yemen every time we whack another Al Queda douchebag  and break a few windows, or whether we either just send a bag of condolence money, or simply a brusk suggestion on which words in the dictionary to find "Sympathy" between. (For those who never served, that lexical location would be betwixt “$#!^” and “syphilis”.)

I’d love to hear the results of that research, because if we aren't carpet-bombing Yemen with an Avon Lady follow up team after every Hellfire strike, it kind of begs the BS question of what makes them so imaginarily necessary in Iraq, A-stan, or anywhere else, ever, and leaves the argument in favor of the military “needing” them  standing on the curb with its pants around its ankles.

Sorry to use logic and all, but I can't help not having picked the silly side of this argument.

Bugging In Pt. III

Now we’ll suppose that for reasons of relative youth, lack of funds, bad luck, travel, poor foresight, or simple stupidity, you can’t do any of the things in the preceding articles in series, and can’t perform all the modifications on your domicile. So what do you do?

What follows breaks down two ways: locations you have some control over, and those you don’t. The former are places like apartments, condos, workplaces, and other locations which, while you don’t have carte blanche to alter or modify, you have at least some, even if only by default  and frequency of occupation. The latter are any other places, ranging from a hotel in a foreign city to whatever circumstances leave you within when whatever happens, happens.

For those you can control somewhat: you can still upgrade basic security. Windows can still receive anti-breakage and privacy applique. Doors, if in any way possible, should be replaced with the sturdiest commercial industrial-grade fireproof doors (which are usually helpfully metal-clad and heavy-duty break-in resistant) you can locate. The step below that is to at least make sure all exterior doors are solid wood, not hollow-core, and skin the outside with sheet steel overall or steel/brass reinforcements over hinges, lockset, and deadbolts. If your structure is wood-framed or solid masonry, replace the (probably 1 ½”) screws holding locks, hinges, etc. with 4-5” screws to punch past the 1” pine pre-hung doorframe and into the actual wall reinforcing members. Put at least 1 and ideally 4 cane bolts (L-shaped bolts) at each of the door’s corners, 2 upwards, and 2 downwards. If all 4 are installed and secured, even shooting out the locks and hinges with a breaching shotgun won’t allow the door to be opened. Acquire plywood sheets pre-cut to fit over each window, inside and out. Both sides, because if and when necessary, you’re better off covering both sides, after opening the windows completely, and screwing/bolting the half where there’s no glass together, outside to inside, which will hold it in place without requiring. You can further build in the previously mentioned cross-holes for visibility/gunports if you so choose. They can be stored behind bookcases or furniture, under beds, in the backs of closets, etc. If you have large patio doors on a balcony, put exterior grade sheets outside, upright, and painted or texture painted to look like the walls they’re covering, and screwed/bolted to them, such that you can remove them and block over the glass patio doors in a hurry, while occupying almost no space in the meantime and attracting no notice. If plywood is difficult, 1x12” boards can also go under and behind furniture, or laid at the bottom of each row of bookshelves until needed, and even stained to match the bookshelves in the meantime, with no one but yourself knowing they’re there until you need them. They’ll also nestle quietly across the tops of kitchen shelves that leave space between the shelf unit and the actual ceiling. You may also want to get a pair or two of brackets to hold a door bar or two in place, use a stud-finder to spot the wall joists, and get enough lagscrews to emplace them, but not actually put them in until you need to, to preserve the capability without jacking up your security deposit in the meantime.

In times of trouble, blocking up access to a multi-user building to just one stairwell/exterior doorway are extreme but possibly very prudent courses. Anything from spare lounge furniture to padlocks and lengths of chain might suffice to secure extra entryways and stairwells, and channelize friend and foe into one more-easily watched and guarded access point.

Quickly-emplaced doorbraces that wedge from floor to doorknob aren’t a bad idea. Imagine yourself the office worker or teacher in an unlocked office or schoolroom when you hear gunshots down the hall, and coming closer. A $50 quickbrace could save multiple lives. So could a discreetly installed cane bolt or other inside-only door security hardware. Nothing is perfect, but something may be enough to beat nothing. Nitrile gloves, booties, hooded gas mask, and tyvek suit take up about the same space as a small purse or backpack. For travel/work use, they’ll do a better job of getting you out of a smoky or chemical-filled building than a wet-t-shirt.

For water, even while traveling, a small bottle of unscented hypochlorite laundry bleach and an eyedropper can be had just about worldwide, and will ensure drinking water for weeks for an investment of a couple of dollars. And Camelbak hydration pouches come in dozens of sizes and colors, not just military khaki tan and olive drab. One should be part of your everyday carry, and one kept at work, in the car, etc. A large storage bladder called a “water bob” is a bathtub sized water bladder that sits in an empty bathtub, and turns 100 gallons of dead space into an emergency water storage reservoir provided you have 20 minutes to fill it up. You can always fill it with unsafe but readily available water, and add bleach to purify it, if practical.

Food needs to be light, and compact, which usually means dehydrated, thus pricey. Do what you can to store as much as possible. A hide-a-bed sofa can be gutted, and you can build quite a pantry into the lower portions of an L-sectional sofa. Reading nooks in window seats, benches in dinettes, and dead corner space in kitchen cabinetry can also serve as hidden storage for your supplies, also being advantageously out of sight to all but a determined ad thorough search.  Windows, exterior walls next to them, or balconies on the 3^rd or higher floors may be equipped with exterior-grade cup hooks, and you can acquire and hang flexible solar cells for power to run a radio, laptop, and small (12V and/or LED) lights. All of which are better than none of the above. With a couple of marine batteries, you might be able to store enough power to run a microwave once or twice a day, and an RV/marine 12V hotplate/coffeepot. Hot food is much more appealing than cold gruel, and can be had for a small investment in happier times.

Don’t overlook attic/crawlspace options. I once had an apartment whose closet floor provided the sole access to 6000 cubic feet of crawlspace – 3’ high. Obviously, in an earthquake/building drop, not so great. But in civil unrest, having a secure, pre-sandbagged hidey hole with a couple days food and water to which I could remove myself into in emergency was more comfort than nothing. I built a small sleeping area, with enough room outside to cook on a brick grill, next to an underbuilding vent, tarpapered, sealed, padlocked, and surrounded by sandbags on 4 sides. It’s probably still there. An overhead area might provide a place to squirrel away lighter bulky items (paper napkins/towels/toilet paper?), provided they’re sealed from insects/vermin. Also look for voids. I had a wall that enclosed the underside of an outdoor staircase, which netted me an area half the size of my living room in hidden storage, inaccessible to anyone but me, all for the investment of one sheet of sheetrock, some spackle compound, and a gallon of white paint. I note that only this week, a similar but far smaller space in Wales was discovered as the repository of 20+ firearms and ammunition, carefully stored there for nearly 20 years since the UK banned virtually all firearms, and all in perfect state of preservation. Imagine the possibilities with a few 4’ lengths of 8” PVC and a house sized crawl space.

On the subject of storage, whether for work, school, or near home, storage spaces ranging from closet-sized to room size are available nearly nationwide, usually for a reasonable price, as long as you pay the rental. A 5’x10’x8’ high storage “closet” you could access 24/7 could hold quite a bit of personal necessities, canned food, a barrel of stored clean water, and a hidden locking gun safe with a few key items secured within, without impacting your tidy home digs or other location, and without making you a pariah at work, while providing a life-saving cornucopia of necessaries for you if you were a student or an office worker when some sort of local or general disaster struck. I’d much rather try to hoof it a couple of blocks on foot to that, and then move on homeward perhaps miles or days, than try to survive on what you might be able to legally and securely squirrel away in a file drawer at work or a college dorm. Be aware that most have posted notices about not allowing storage of things like gasoline or ammunition, and warning that “detection dogs” patrol the premises. Unless they also run nuclear storage facilities, such notices are boilerplate for the boobs, and the only “detection dog” available is usually the on-site residing lease agent’s shih tzu or tabby cat. Use common sense and secure storage principles, and you’ll be the only one to know about a small military surplus ammo can of ordnance and 5 gallon jerrycan of emergency gasoline that you stock with fuel preservative and rotate through the stash every 12 months.

For travel, and other such circumstances, you’ll need to rely on what you can carry with you every day, and what you can acquire inexpensively before you go or once you arrive. An SAS-style cargo-pocket kit in a small tin or nylon pouch, together with multiple exit strategies, are your friend at this point. A multitool, flashlight, single-edged razor, compass, wire saw, firestarter, personal first-aid kit, a water container, water purification device/tablets, and some protein/power bars, soup, tea, sugar, salt and boullion packets, along with perhaps a packet or two of tuna or beef jerky, poncho, candle or two, and a couple of big trash bags would fit in a pouch the size of a small video camcorder, and probably keep you alive anywhere on land between either polar icecap long enough to make your way to a better place. Hence copies of passport and visa(s),credit cards, cash & coin (local and dollars/euros/whatever), local map(s), more cash, GPS/locator, more cash, cell/satphone, even more cash, and an alternate travel/relocation plan (or three) would also be a splendid idea. Making or acquiring suitable on-body stashes for cash, papers, etc. on both ankles, around your neck, in a hidden belt/underwaist belt, and various hidden pockets isn’t James Bond nefarious, it’s simple survival and theft/robbery protection. And other than the knife-blade on a multitool, would breeze through security and checkpoints without a second glance in packed or carried luggage.

Treat your life like something worth saving, and you probably will. Follow alternative pathways at your own peril.

Dear Mr. Tyrant Asshole

No, No, NO!

You will not get away with pretending to mouth the words “I respect the Second Amendment” and in the same breath attempt to gut the very provision of self-defense it affirmed as an inalienable right of free people everywhere.

Trying to re-instate the asinine ban on “assault weapons” (which have actually been restricted since the NFA of 1934) by trying to take away the rights of free people to buy naughty-looking black plastic semi-automatic rifles and magazines holding more than 10 rounds, neither of which have anything to do with making us safer, just with disarming us in perpetuity, is the most egregious attempt to destroy freedom you’ve undertaken in 4 years in office, and that’s saying something, believe me.

Your unconstitutional unlawful decrees by fiat, known as “executive orders” are nothing but a vainglorious and grasping overreach for a power found nor authorized NOWHERE in the United States Constitution.

I will not abide by them. If Congress, in acts of irredeemable stupidity and treasonous co-conspiracy with you, attempts to usurp the rights of every American, they will only bear with you the guilt of being petty tyrants in their own right, and your minions in spirit and deed. Our Founding Fathers had a remedy for that, and should the congress decide that lawfully purchased and rightfully possessed weapons are within their purview to deny, they will deserve, with extreme prejudice, the exact treatment meted out to 700 British regulars one fine spring day in April over 237 years hence.

And for the record, @$$hole, even were you to repeal the entire Second Amendment tomorrow, with 435 House Votes, 100 Senate votes, a 9-0 affirmation by the Supreme Court, and the concurrence of all 50 state legislatures, it would affect Americans’ natural law, pre-existing, and inalienable rights to military-styled arms NOT ONE GODDAMNED WHIT. Being a professed “Constitutional scholar” in your shorter-than-your-memory span of law school teaching, you knew this before you flapped your piehole this morning.

But if you nonetheless seek to take away rights, and the concrete means to affirm those rights, from myself and every other American, you deserve the same remedy offered to King George III, and delivered at the business end of 8 years’ worth of “assault weapons” in the hands of formerly peaceable, law-abiding, and patriotic American colonists. And believe you me, I intend to do no less in service of the same end: liberty.

Before that eventuality, I’ll expend every bit of capital and energy I have to see your liberty-usurping offal defeated, in both houses of Congress, injucted and overruled in the courts, and ridiculed, derided, and ignored by every American I can reach in print, on the Internet, in meetings, and face-to-face, one-on-one, until the mere mention of your name causes people to spit to clear the bad taste after they mouth it. Your activities to date have given me a huge leg up in that respect, but this latest overreaching outrage should push the effort over the top, and make it a downhill coast to victory.

If and when your attempts are thwarted, you will remain no less a tyrannical jackass, and deserve no more respect, even for the office, than King George III deserved for holding his with such horrible intent and despotic action.

And should your horrible nonsense somehow squeak past those whose office is to prevent such puerile idiocy, I will similarly do everything in my power to undermine and overthrow it, its intent, and its champions.

I will learn metalworking, in order to manufacture and distribute as many high-capacity magazines as I find humanly possible to as many like-minded people as I can find. I will learn metal milling, and fabricate every part of every banned weapon I can, and likewise assemble and distribute them to as many patriotic citizens similarly unwilling to become subjects. I will do so 24/7/365, with no oversight, no paperwork, no taxes, and no compliance with or regard toward your petty grasping decrees in pursuit of expanding your malodorous and malignant regime.

And if anyone decides coming around to pick up whatever they think I own is a good idea, they’re fair targets. Not just that day, but every day, everywhere. Getting coffee, shopping, mowing the yard, whatever. And should so much as one person’s spouse, family, household, or premises anywhere and anytime, be in any way impacted by those efforts of thoughtless toadying minions, federal, state, county, or city, foolishly attempting to enforce your unlawful decrees, then likewise their families and properties are similarly fair targets. Ditto for every bureaucrat, secretary, clerk, judge, commissioner, down to the lowest janitor at the remotest outpost of your unlawful, tyrannical reign.

You’re going to get, I swear, Hear Me O God, exactly the sort of revolution you seek to foment, in numbers that will see you, in a just universe, impeached, if not swinging at the end of a gibbet after your unsuccessful defense for treason charges. If that’s too harsh, and they don’t like that, they can switch sides, publicly, and refuse to enforce your unlawful decrees, or simply quit their jobs. If you don’t like joining that sort of struggle, you can resign, and flee the country ahead of the posse. It’s not like it’d be the first time you found refuge in foreign lands.

So let’s be blisteringly clear: you want a revolution, you’re going to get it. You’ve just announced you want to march on Lexington. I’m here to tell you I’ll be meeting you there, and behind every wall and tree coming and going. Take one more step at your own peril. And pack a lunch, and bring  a lot of friends you won’t mind sacrificing. I’m well-armed and provisioned, and a damned good shot, as multiple tests in the service of this country allowed me to demonstrate with pleasure, and this is one of those things I’ll neither forgive nor forget. Because, you monumental foreign-born usurping ignoramus, I’m an actual American, and unlike you, I took MY oath to preserve, protect, and defend the Constitution seriously, unlike you and your retard henchmen.

And the number of blood brothers I have out there are going to bring you to your knees, and your regime to its end, so help me God.

You WANT that fight?

Bring it.

Bugging In Pt. II

On to the other considerations of staying in place.

Brushfires, nearby chemical cloud, or worse, you’re going to need a means for breathable air. Masks and chem suits are a short-term expedient, like space suits. They provide mobility, and short-term protection. But you’ll have to have a sealed life-support “capsule” sort of safe room/area, with, at minimum, a place for sanitation, food prep, sleeping, and a minimal leisure area. Best choice is to simply set up these areas now to operate under such restrictions, make them sealable for several days, and provide yourself with suitable chemical filtration. Essentially, you’re talking about lots of plastic sheeting and duct tape over every opening in, under, over, and through the outside roof, walls, crawl spaces, etc., plus a current hand-cranked air filter and spare filter elements top provide daily breathing air. Expecting to deal with this for more than a couple of days in the case of chemical or fallout problems is probably a good reason to seek shelter elsewhere, unless you have a sealed sub-grade shelter bunker under or adjoining your house. 3’ of intervening earth and clean air solves most CBRN problems, as long as you can eat, drink, cook, sleep, and use the bathroom without either suffocating or being contaminated.

Water concerns require the ability to collect and store, and purify water, to the tune of 1 gal/person/day. For anything over a month, a cistern and rainwater collection are a minimum. Determine what pipes, cables, utilities, etc. pass under your house and property and where, and when practical consider digging a well (if you are on city water, and don’t already have one). It’s far less difficult than most people imagine, unless the water table is hundreds of feet down. Find a spot in the backyard, or punch a small hole in the garage foundation, take care of business, install a pump, and cover up what’s left with a faux water tank, air compressor, A/C unit, or what have you. Have the water tested commercially. Assuming it passes muster, bury a cistern (poly or concrete, whatever) below your frost line, and start pumping water into your emergency supply tank. Solar panels can power the pump, you can put a small tank in the attic or garage overhead, and a roof-panel solar heating set-up will give you clean, available, and hot water, at pressure. Over time, you could start transitioning off metered water supply; 1% a month over 4 years would cut your bill in half. You could continue to water the yard/garden with city water, and if city supplies fail, do without entirely, all while being a water-conserving good guy and providing for yourself in tougher times. Spares for your pump and solar systems should be added over time.

For food, a minimum 3-month supply of canned food should be a starter, with eventually 1-3 years (almost everything canned lasts this long anyways) being the goal. Start simple: Just buy double what you need, every week. In 1 year, you’ll have 1 year’s extra canned food. In 3 years, you’ll have 3 years’, and your grocery bill drops to half again. You should also plant whatever you can manage in your yard. Books like “Backyard Homestead” are a great place to start, for any size lot. If you have room to park the car(s) in the driveway, and build a carport, do so. Convert the former car garage into storage for canned foods. Another excellent use is to look into aquaponics. This combines raising hydroponic food with raising tanked fish. The fish wastes become plant fertilizer, and the plants and a biofilter clean the water for the fish, and depending on how much you raise, you can provide yourself with hundreds of pounds of fresh vegies and fresh fish, virtually forever, with minimal attention and regular fish feeding. If you have room to do this in the backyard in an outbuilding or dedicated greenhouse/fishhouse, by all means do so. Replace fruitless trees with fruit trees, nut trees, berry bushes, etc. Replace wasted lawn with raised bed planters. You’ll eat healthier, live happier, get needed exercise, and make trips to the grocery store less and less necessary. If you didn’t use the garage for aquaponics, make it a HQ for canning and preserving food. Ideally, your own fresh-raised bounty.

Rabbits and chickens also provide meat and eggs in minimal space, needing only feed and water, and their waste products provide great fertilizer for growing food. They’ll also provide fertile soil to raise earthworms, for sale, for live bait, and/or to feed your fish and chickens.

Power off the supply grid is essential, for a variety of reasons. If wind or water power is an option, good on you. For most of us, the only reliable source is the sun. Start small, and add panels and battery storage as you can afford to do so. Like water, your goal is to eventually wean yourself off metered power. You can cut 10% just by being thrifty; if you go to solar at 1% a month, in 7 years, you’re off the power grid. If you can get off it completely, great. If you choose, or are forced, not to, be ready to do so anyways if it fails, and minimize your expense and vulnerability in the meantime, by slowly making preparation now to do without. Start with solar water heating. Then power for the well pump you don’t have, and the aquaponic farm. Then start taking the house back from the power company, room by room.

And as bunny-hugging friendly as sustainable power may be to the “Save The Rainforest” crowd, in a major crisis, possibly long-term, the frigging rainforest can look out for itself. The priority is keeping you and yours alive and relatively well-off. The biggest boon to life expectancy over the last 2500 years, bar none, has been hot and cold running water, and the resultant sanitation improvements it allows. The longer you can maintain running water and indoor plumbing, the longer your lifespan will resemble that of civilized humans, rather than mud-wallowing dirt-eaters in the Middle Ages.

With shelter, air, water, food, power (and thus climate control) taken care of, about the only thing you can’t pull out of your back pocket is money to pay the property tax and mortgage. That’s assuming there’s a civic entity functional to collect it.

Beyond that,  you should make provision for two things: medical care, and communication.

I say medical care, and not first aid, because in a crisis, there may not be any further medical back-up to your first aid. You may thus be required to become second and third aid, in order to prevent giving last aid. In other words, you’ll need to stock enough supplies to run a personal/family clinic, for anything short of catastrophic events, and possibly including major trauma. Once again, you’ll be recreating all the advances in medical/nursing care, as well as you are able, that have occurred since Florence Nightengale was working the night shift in the Crimea. Fortunately, much of it revolves around good nutrition, clean clothes and supplies, and clean running water. With the coming of Obamacare, and the debacle on the American healthcare system that will entail, you’ll be far better off equipping and stocking a spare room as a clinic and gaining a basic medical self-care competence than you will in depending on the soon-to-be catastrophically declining standard of care in official hospitals. For far less than you’d spend on a years’ health insurance premiums, you could equip a one-room state-of-the-art treatment room, lacking only CT scan and rapid turnaround lab results. Step one is actually setting out to set one up, and step two is learning to functionally utilize it. Your goal isn’t to put the local hospital out of business. Instead, it’s to be able to pick up the slack if it’s suddenly or rather permanently unavailable. You’re creating a back-up plan, but a serious one, not a make-believe one.

Communication is a two-way affair. Literally. You need to make provision for getting information, and for sending information. Think of multiple levels, and work out the details. Internet, satellite, cable, broadcast TV. FM, AM, SW/Ham, CB, and GMRS/FRS radios, including scanners that pick up air, maritime, and military signals. Satellite, cell, and hardwired phones. Snail mail, package delivery, and couriers – both official and unoffical. And ways to send and receive media and messages through each. You may want some facility with encrypted signals, codes and ciphers. For example, a thumb drive is currently the size of two nickels, and holds 16GB of data. That’s enough space to just about hold a bible of data or 20 minutes of hi-def video with audio, in something you could conceal at the bottom of a packet of gum. A year from now, the same drive will be double to quadruple the capacity. Learn how to leverage this capability into the power to stay alive, well, and informed if things get less civilized in the near future. Technology that you don’t use and master is just magic and fireworks.

Next time, what to do when you’re not bugging in to a typical house.

Bugging In Pt. I

With prior efforts, we’ve looked at taking care of immediate survival needs. So now the question is whether you’re staying put, or leaving for someplace better suited to sustain you. We’ll start where you are, and assume you’ve decided to stay where you are.

Wherever that is, for whatever reason, you’ve decided staying put is the wisest option.

So your needs, unsurprisingly, are going to be exactly the same as in the previous series. Except now, you need to make provision for yourself, and however many others are actually or are likely to be with you, for anything between 30 hours and 30 months. So let’s revisit the survival Rule Of Threes once again.

First off, where you stay needs to be secure. You can’t man the perimeter 24/7, you need to be able to sleep occasionally. So it needs to protect you (& Co.) from whatever may come your way. I’m going to assume you don’t (yet) live in a medieval castle (pity, that) and work with what you probably have. We’ll work from the outside inwards, starting with a typical house/lot.

You’ll need at a minimum a fenceline around the perimeter. However decorative it may or may not need to be, it has to be practical. Meaning it has to stop people from simply walking onto your site. A bare minimum would be the fairly ubiquitous 6’ high chain-link fence. 8’ or more is better still. A large “Beware of Dog” sign, and a big doghouse and large bone in front, with or without an accompanying large dog, wouldn’t go amiss. It also helps justify the fence to any curious folk. The ability to, at appropriate time, place barbed wire or even better, barbed razor tape/concertina atop this perimeter should be allocated for. A series of holes for concrete-filled metal bollards, which can be dropped (and locked) every 5’ along the perimeter will stop most vehicle attempts to pass. “Decorative” large concrete planters, at least along the front (rear and/or sides if you have street,  alley, or neighbors’ driveways along them) can be constructed large enough to stop an M1 tank, if need be. Once again, planting them with beautiful flowers, and more practical herbs and salad veggies will help diffuse suspicions or complaints. A 5’ solid obstacle, poured in place and anchored below grade will stop Abrams and Bradley tracked vehicles. Orienting them as diamond rather than squares will also make seeing all sides, and if necessary, shooting at all sides from inside your perimeter, a possibility, without compromising their basic function. If you already have masonry walls around any or all sides, so much the better. Simply add another wall 3’ inside, along with cross-bracing to the perimeter wall, fill with gravel or reinforced concrete, and top with decorative iron spikes. It’s how ¾ of the world lives all the time (nota bene domestic compounds in Iraq, Afghanistan, etc.). So don’t be shy.

The walls of your domicile are likely stick-built (i.e. 2x4s) and stucco, or something similarly easily permeable by projectiles. Another “decorative” line of planters, 3 to 4 feet tall, a similar thickness, with, for example,  6-inch thick reinforced front, rear, and side walls, and the center void filled with ½” or so pea gravel, will stop most anything short of sustained .50cal machinegun fire, not to mention vehicular attempts to breach the walls. Putting in 4-footers, and making the topmost 12” topsoil, and planting them -again- with either decorative flowers and front-draping ivy, and/or more practical garden herbs and medicinal plants would be wise, and once more help with concealing their actual utility. This provision is far less unsightly and far better protection than stacks of sandbags, and eliminates last-minute back-breaking labor. You’ll also make the house quieter. If making nicey-nice includes setting the front wall back 3’ so you can plant a green “Eff Off!” hedge in front of the wall, both to green things up and prevent graffiti, so be it. (And if local codes try to hijack your entire front yard as view space for “curb appeal”, find out where you can start, build there, and plant the intervening space with the thorniest berry bushes you can find, surrounded by the tallest and sturdiest wall/fence allowed.  It’s green space for butterflies and songbirds. You can fight city hall, just not head-on.)

The minimum provision for windows should be, like those in hurricane country, exterior brackets or frames capable of readily receiving ¾” plywood covers, slid into place and screwed down. Unlike hurricane country, I’d have each of them with a cross-shaped hole positioned where you could both see out from inside, or open the window behind and shoot out from inside if necessary. Painting the outside to look like sheet steel with rivets isn’t a bad idea. Hollywood does it all the time, and it fools millions. What it doesn’t do is provide the same projectile stopping abilities as sheet steel. If/when you can provide yourself with actual shutters, of layered steel, with the same cross slits, by all means, do so.  Covering the steel with a non-threatening wood veneer is, once again, good camouflage.

When next you re-roof, concrete tiles or other flameproof coverings are highly advisable. You may even get a fire insurance break as a bonus. A series of bright lights under roof eaves, pointing at the yard and perimeter without being visible from half a block away aren’t a bad option. Lights way up near the peak of the roof pointing downward, same thing. Lights up high should be tall enough to make tampering difficult, and as hardened from slingshots, bb guns, and actual firearms as you can prudently make them with minimal fuss. A ground level alternative is to put them around the perimeter, pointing outward in criss-cross intersecting angles, and covered with brick or concrete except through their main axis. You can even put stainless mirrors inside and offset the lights from the light-exit hole by 90 degrees, making direct attempts to knock them out difficult.

Any decorative patio glass doors need to go. Period. Replace all but 3’ with one of the aforementioned concrete planters. For the rest, as with other exterior doors, hardened exterior doors should be sought. Hardened being anything from skinning the outside with a sheet of mild steel, up to replacing the regular door with layered sheet steel in a metal frame, with a suitably Leave It To Beaver friendly wood veneer. A peephole or small glass lookout hole more than 3’ from the handle are the only holes I would advise, other than one capable of admitting a muzzle from the inside pointing outwards, and securable from the inside. While you’re at it, get rid of any offset access to your doors. Make getting to them a relatively long (at least 6’) tunnel. That takes away the ability of people you can’t see to “stack up” on either side of your door, and puts any approach into a “fatal funnel” downview from your peephole, or if needs be, downrange from your muzzle.

The ability, in times of distress, or simply ordinarily, to put either wood 4x4 or steel pipe drawbars across your doors from the inside should be provided for. Whether it’s home invaders or police with the wrong raid address, making it nigh impossible to bash in your front door may very well save your life.

Get the super-duper hurricane laminate for all your glass that makes it break resistant. Apply it to all windows, on all sides of the house. It means no one with a hammer or crowbar is going to break in on a sunny day, it means nothing is going to blow through the glass in a hurricane, tornado, or high wind day, and it means shards of glass from a window won’t be flying around the room if the neighbors have a gas explosion. Then put the 100% mirrored reflective surface on it as well, so no one outside can see in.

Don’t forget to beef up any connecting doors to garages, attics, balconies, or basements too, along with the doors from them to the outside. If it helps, walk around the outside of your perimeter, and the outside of the actual domicile, imagine you had a chainsaw, a crowbar and half an hour uninterrupted, and see where you could get in, and what improvements would make it difficult or impossible to do so.

If you note that this making your home a fortress is much like what dope fiends do with their crackhouses, congratulations. I hope you regard your life as at least as vital as a crack dealer views his livelihood. Yes, it seems extreme. But when it comes to any number of scenarios, sitting amongst potential swarms of rioting human beings demands your preparations exceed the abilities of whatever or whoever is outside trying to get in. Second place in the Home Invasion sweepstakes, from 10,000 B.C. to now, is frequently eternal slumber, usually after some particularly nasty treatment. So you can start this small, but you’ve got to work all the way to doing all of this. Half measures will get you completely killed, or perhaps rightly lead you to deciding that perhaps staying put isn’t such a wise plan.

In Pt. II, we’ll look at other necessities. In Pt. III, options for those not in traditional home/lots.

First Aid

When it comes to medical aspects of survival, they tend to be of two types: Type I is “It Can Wait A Minute”, Type II is “Right Effing Now!”. You need to be prepared for both.

A lot of medical necessities are covered by taking care of the previous priorities. E.g., if you built a fire and made a shelter, you’ve solved your hypothermia problem for as long as the firewood holds out.

What’s left for Type I provision are things like sunscreen and lip balm, a small number of OTC meds for pain control and minor maladies, and the like.

Type II supplies for yourself are things to deal with bleeding, the hole(s) in your hide allowing it, and orthopedic supplies for fractures, dislocations, and sprains. You aren’t going to use airway supplies on yourself. But if there may be others present during your adventure, they may need them, or they may need to use them on you, so you should carry them anyway.

But before I break a rule, and give you a list of stuff, there’s something you have to do to prepare long before you need that stuff:

GET PROPERLY TRAINED!

You will not, after a 1-day first aid and CPR class, be doing field appendectomies (at least not on anyone you actually want to save). The absolute bare-bones minimum training you should pursue is basic certification as an EMT, emergency medical technician. (For reference, that’s 2 steps below a paramedic, 4 steps below a registered nurse, and 6 or more steps below a doctor). It’s also 140+ hours more time than a 1 day first aid and CPR class, and enough conveyed wisdom to turn you into a reasonably competent field medic with 20 times more training than 95% of the public at large. If you want, by all means go further, but don’t, in any event, think with less you’re ready to do much more than call 9-1-1, and even that last isn’t a dead certainty.

You need this training because you can pull a can of food out and feed yourself, you can probably pull a weapon out and defend yourself, but you can’t pull out a first aid kit, add water, and get a reconstituted emergency doctor ready at the scene to fix your boo-boo. So you either train to succeed, and live, or fail to train, and quite possibly die. Go. Take. A. Serious. Class. It’s offered through extensions and occupational training in many areas. It’s also the main entry requirement for emergency patient care, and you may discover that you both like it, and are good at it, and discover your new career field. Ask me how I know.

Having that training, you need the tools to do the job.

First item to go in your kit, and first thing that should come out of it when you open it: non-latex exam gloves. It keeps other people’s blood off you, and your cooties out of your patient, which may keep both of you alive. End of lesson.

Second, a headlamp. Because invariably, you’ll need more light somewhere, and holding it robs you of a hand you’ll need elsewhere. Ditto for clamping a light in your teeth. Get a nice LED headlamp, and put it in the same pocket/pouch your exam gloves are in.

Trauma shears. The kind that can cut through Levi jeans or a penny with ease. Or a seat belt that won’t unlatch, or the laces or leather on a boot on a broken foot/ankle.

A wad of gauze 4x4s. I don’t care if they’re sterile, I do care if they’re clean. Stupidly, most companies package them in paper. Put 5-20 in a small ziplock baggie, and they’re now clean, and relatively waterproof.

Sterile non-preserved saline eyewash. These are squirt bottles with a cap that punctures the seal when used. That means until you use it, they’re sterile. And despite “expiration dates”, guess what will be inside in 10 years? If you guessed “sterile non-preserved saline” you may have a knack for this sort of thing. And besides being eye-safe, hence very useful for cleansing foreign bodies out of an eye(!), by squeezing it, you have a small handheld wound cleansing firehose that you can use to blast crud out of a hole in someone (even yourself) despite the lack of any convenient plumbing, in the middle of nowhere. Fancy that. Carry two or more.

Bactine, Betadine and double or triple antibiotic ointment. To clean and disinfect wounds.

OTC meds: small quantities of aspirin, acetaminophen (Tylenol), and ibuprofen (Advil/Motrin). All relieve pain, and all reduce fever. Aspirin thins blood (good for possible heart attacks, bad for forehead lacerations). All have indications (when you should use them) and contraindications (when to not use them.) Any allergy to a medicine is an absolute contraindication. They also have effects (what you want them to do) and side affects (what you may not want them to do, and should know about). Once again, this is serious stuff, and a 1-day class isn’t going to get it done. Next, some diphenhydramine (Benadryl), an antihistamine. Which cuts down on hives, rash, itching, and allergic reactions. Temporarily. Also an antacid (Tums, etc.), and an antidiarrheal like loperamide (Immodium) to help you stop when all you want to do is go. Pseudoephedrine (Sudafed) for runny noses and plugged sinuses. You could add a whole drugstore, but there’s not much benefit to be gained carrying tons of other stuff beyond that list.

If there are any medications you personally need, for asthma, high blood pressure, diabetes, gout, allergies, whatever, etc., there should be some of them in your emergency kit - separate from the common meds, and clearly labelled as your personal Rx meds. There should also be a copy of your insurance card, and a copy of your personal medical history and info, summarized on a 3x5” index card. Blood type (if you know it), medical history, including surgeries, diagnosed conditions, and the meds you take for those conditions*, and any allergies**. If there’s room for a doctor’s phone number and emergency contact phone number, you’ll save potential rescuers having to beat all that info out of you someday, particularly when you might not be up to the game of 20 questions they’d need to play, because perhaps you aren’t conscious. Repeat as necessary for all members of your family/party/tribe/outting/whathaveyou.

At this point, you have replicated in the space of 1 sandwich-sized baggie, everything the hospital ER will do for you right up until the doctor sees you.

So now it’s time for the next things you’ll need.

One or two nasopharangeal airways, and K-Y jelly. NP airways look like rubber trumpets, and after a squirt of K-Y, etc., go into one or both nostrils to help maintain an airway with minimal muss and fuss, or more complicated interventions on your part.

One or two adhesive chest seals (e.g. Asherman) – I prefer two on the theory that whatever made a hole going in may have made one going out, and you'll need to seal both holes. More than two chest holes and your work is cut out for you. But a chest seal that prevents or stops tension pneumothorax (look it up) is way more fun that trying to fix one once it’s happened.

A large bore catheter/needle to solve the problem I just had you look up, in case it happened before you could deploy your sticky chest seals.

Blood-congealing gauze (Quick Clot, etc.) for large, profusely bleeding extra openings.

Israeli 4” and/or 6” pressure dressings, to seal and put pressure on the gauze dressing above that you just crammed into that gaping wound.

Ace wrap(s), to double up on the pressure on the dressing above, and also to treat ankle, knee, and wrist sprains. Carry several, e.g. 2", 3", 6".

A CAT (combat application tourniquet) or 4 for temporary application, either because proper medical assistance is nearby, or to briefly impede/decrease the outflow of blood long enough to let wound elevation, pressure dressings, and blood clotting mechanisms kick in. Current medical reports from Iraq and A-stan are that field tourniquets to extremities applied for up to 6 hours demonstrate no or negligible complications or long-term effects. But if you need it more than 6 hours, you may be sacrificing a limb, and then probably they’re going to die anyway from gangrene and/or other infection within days if you have no access to definitive medical/surgical care.

More gauze 4x4s, or 2x2s, 3x3s.

Medical adhesive tape. Waterproof, silk, plastic, paper. Ideally 1 of each. Small scissors to cut it.

SAM folding aluminum splint roll.

Waterjel for burns. Moleskin or Secondskin for blisters. Sunscreen, lip balm, insect repellent. Quality splinter tweezers. All self-explanatory.

That’s it. If you want the bulk, you might add a stethoscope, BP cuff, and a thermometer. But most of what they’d tell you could be discerned without them, since they only expand your abililty to see, hear, and touch. So they’re ultimately optional. A CPR mask with one-way valve, for when 9-1-1 is within minutes. (Because when it’s not, though you do CPR or artificial respiration until you pass out, your patient likely isn’t going to make it.)

That kit will equip you to deal with minor to major trauma – punctures, lacerations, incisions, etc., fractures/sprains/dislocations, burns, blisters, sunburn, allergies, and countless minor medical problems/illness.

More mainly consists of more of the above, rather than endless numbers of new things.

What you really don’t need:

One of those small field instrument/minor surgery kits. Because as anything less than a duly licensed and properly trained physician’s assistant or doctor, you aren’t going to probe injuries, remove bullets, or sew up holes. Because you’re likely not going to tote around  a quart of betadine and sterile saline for each event , plus sterile field, drapes, and gloves, along with 20-30 varieties of sterile suture material at $15 apiece for every possible injury. Nor are you likely going to be able to properly clean such wounds sufficient for surgical repair, and come up with the necessary local anesthetic necessary to make the experience less than screaming torture for your patient. Nor a selection of antibiotics to make field wound closure of poorly cleaned wounds not result in a massive and possibly life- or limb-threatening infection for said patient. Do your best to clean and disinfect them with the other supplies, pack and wrap them, and monitor them regularly while changing dressings, yes. Try to be a 19^th century surgeon, and you can expect 19^th century mortality levels. So no. No matter how many pig’s feet you practiced on with bootleg suture material.

Note that this is for relatively short-term emergencies and predictably small events that you can and should anticipate. It isn’t a list for long-term scenarios nor to replicate/replace a hospital if such is available. The kit above, with your proper training to utilize its contents, will enable you to deal with about 80% of what you might face, and closer to 100% of what you might successfully address. In extreme circumstances, the other 20% are things which are going to happen, and some people you aren’t going to be able to save. You do the best you can with what you know and what you’ve got, and until your patient is obviously dead. Circumstances will dictate what happens after that, and it may not be pretty. Prepare for things accordingly.


* Pet Peeve #1: If, for example, you take blood pressure meds, you have high blood pressure: controlled. If you have uncontrolled high blood pressure, and don't take meds, you have high blood pressure and "low grey matter titer" - in layman's terms you're stupid! So don't try to pretend you have no history, then rattle off a list of 37 meds for all those things you just said you don't have. Conversely, don't rattle of a list of the 14 hypochondriac problems you imagine you have, and list no medications, unless you want to add "I'm a moron" to your medical history. I and 20M medical professionals worldwide thank you for your attention to this matter.

** Pet Peeve #2: Rash, swelling, hives, and swelling up like a tick with anaphylaxis are allergic reactions, potentially life-threatening. Nausea, vomitting, and feeling yucky or loopy when they gave you codeine, Vicodin, Demerol, morphine, Fentanyl, etc. are not "allergic" reactions, they're possibly annoying but normal side affects to the use of opioid pain killers. Hint: Morphine etc. make almost everyone nauseous, cupcake, so you're not allergic, you're human. There are other reactions to things that indicate an adverse reaction, or a sensitivity, so we want to know about them. But don't tell everyone you're "allergic" to something if you don't have the first freaking clue what you're talking about. They'll just write you off as a crybaby and a moron, which won't endear you to those attempting to care for you, or improve your outcome.

Signal

Assuming you want to get found, having accounted for all your more pressing survival needs, how to go about it is today’s concern.

All other things being equal, if you were travelling in a vehicle, unless you’ve landed someplace horribly unsuitable, stay next to it or close by. A car, boat, or airplane is far larger search target than you are, and thus much easier for someone up in the sky to pick out down on the surface from altitude than your tiny body will be. Having it painted in a contrasting paint scheme like blaze orange or canary yellow is also a great help. I knew a boat skipper who’d painted his deck bright yellow, and the top of his cabin overhead blaze orange, because he’d taken the time to ask some helo pilots from the Coasties what would make their lives easier should they have occasion to come looking for him. A little bit of ribbing about his boat’s markings meant nothing to him, but being visible and recognizable should the need arise was a source of peace of mind on that score. If you don’t want a blaze orange car, consider a surplus parachute, or a poly tarp and some bungie cords to serve the same purpose on demand.

For travel on foot, a similar expedient can be arranged. A couple of yards of blaze orange nylon can be sewn or velcroed to one side of a military poncho liner, even doubled over so that if deployed it opens up to make a 5’x10’ splash of color on the ground, for a negligible weight penalty.

Next, you need flashier means to announce your presence. Being visible from 93 million miles, the Sun is perfect during daylight hours. The expedient of a small survival signal mirror, or even a car mirror yanked off for the purpose, gives you the ability to reflect the sun where you choose, as anyone who’s ever had some fun with a mirror on the beach at a friend’s expense knows. The type with Morse Code on the back and a convenient center hole for aiming the thing as you use it are quite helpful.

At night, your own sources of light project a long way. Battery operated strobes are readily available that are waterproof, and flash all night for 3-5 nights continuously on a single fresh D-cell battery. They’re small, so packing them unloaded, and keeping two fresh D-batteries outside, and popping them in as needed will prevent the misfortune of ruptured battery cells in a hot vehicle or stored kit. You can duplicate this capability with add-ons for common flashlights like Mini-Maglites, that’ll flash for you continuously, and have brighter but power saving LED bulb add-ons, in a smaller package.
Plan B is a flare gun and a collection of fresh flares for day or night, and pyrotechnic smoke signals for daytime use only.

Plan C would be a signal fire, with the means to make it smoky in daylight, or just burn continuously at night.

And for all events, if you can spare the cost, the gold standard is the newer line of personal locator beacons (PLBs) available at backpacking/sailing/flying websites/stores. Once registered, if you use them your personal data and precise location will be received by orbiting satellites, and transmitted down to the appropriate rescue organization to use in locating you and collecting you. Again, if you’re trying to be found, those are hard to beat. For those really seriously prepared, a handheld marine or aircraft radio are a fair amount of bang for the buck. I can’t guarantee that airliners passing overhead will be monitoring the distress/emergency Guard station (121.5 Mhz) for aircraft, but if the choice was trying it or not, I’d give it a shot. Someone 5-6 miles up you can talk to is always a lot closer than someone 10 miles away on the ground you can't.

By the same token, having a card with emergency numbers and an Iridium sat-phone means almost never being out of touch with civilization. Making phone calls from the middle of the Sahara is a novelty. Making them when you’re 40 miles from a trailhead and your leg is broken is a lifesaver.
A GPS or three comes in handy for the same reasons. Of lesser, but sometimes sufficient utility, are HAM and CB radios, and ordinary cell phones. Although for planning purposes, you may vary well need them most just after you’ve gotten out of range of anybody helpful.

The other caveat is that electronic devices will conk out just when you need them the most desperately, which is why I mention them last. The proper back up for GPS is a map and compass, and the know-how to make use of them at any time (I still rely on them primarily. GPS is nice, and I appreciate it, but overreliance on it will get one killed. Robin Williams’ routine about his car GPS advising him to “Turn Right Now!” in the middle of the Golden Gate Bridge is not only humorous, it’s instructive.)

And last of all, the humble sports whistle (ideally a pealess design like the Fox 40) will make a deafening amount of racket, and last far longer than your vocal cords will if you’re trying to let those within hearing know where you are. For the nylon, the mirror, and the whistle, and assuming you’ve already dealt with fire-making concerns when concerned with the shelter/warmth section, you’d be out of pocket about $30. Start throwing in pyrotechnics and electronic wondergadgets, and you could spend a few thousand.

So, the question comes down to where you’re going, and how much is your life worth?

Beans

Now I’ve gotten to one of the least important things for short term survival, and the most indispensable thing for long-term survival: food.

For temporary emergencies, other than giving you something to chew on while you think and plan, food isn’t much help. A few protein and granola bars, a package of beef jerky, and a few packets of cocoa, coffee, tea, and soup are more than enough to see you safely through a few days.

But if things are going to be primitive for awhile, food necessities break down, again into threes, to food you store, food you grow, and food you acquire.

Food you store is just that: the stuff you’ve socked away for just-in-case. My parents, having gone through the Great Depression, Always had at least a month’s canned good stuffed in pantry cabinets. Not that they planned it, it just worked out that way. I suppose when you’ve grown up with occasional dinners of One Potato & One Onion Soup, you don’t take food for granted. But that’s a distant memory for the few still alive who were there. Most folks practice just-in-time shopping. That is stupid beyond description. The shortest “good by” dates on canned goods are 2 years out, and most are at three to five. That means for simply the money, the space, and the effort to tote it home, you could provide yourself with the exact same food you’re eating right now, for three years. Obviously, most people don’t have the means to buy it all at once, but you could is the point. If every week you just doubled up, next New Year’s Day, you could be sitting on a spare year’s food, just adding an extra week every week. Most folks, unless they have 4 growing kids, could work on that without breaking a sweat, although some would have to cut out frivolous spending. That’s where it gets hard.

Besides canned goods, staples, like dried corn, whole wheat, sugar, salt, beans, and rice, can be stored in 5 gallon pails with CO2 and oxygen absorbers, sealed in mylar, and the stuff will last decades without a thought.

Whatever your situation, I challenge you to not let this year go to waste without bulking up your food back-up. Not having to scavenge during a pandemic, civil unrest, or after a local/regional disaster keeps you off the road, out of refugee bread lines, and out of sight, and could quite literally save your life in troubled days. We may be facing those again rather sooner than later.

Then there’s food you grow. Whether you have some small planting pots on a patio, or a suburban side or back yard, or more, by planting your stored (heirloom, not hybridized, and hence not able to be reproduced from saved seeds of the first crop) seed. Any number of survival sellers online sell a #10 can of veggie seeds. Once your canned goods and staple foods run out, you’ll need something to eat. When you’re facing starvation is no time to learn how to grow food, and mistakes then can cost your life; start learning now. You can sprout seeds in a sunny window year-round. Come this spring, get out and plant a little something, or a lot of something. It’ll do you good, it tastes great, there’ll be no mystery additives, and the skills and experience you gain could save your life someday, and those you care about. Having the know how to grow food could also make you a precious commodity in lean times. If you have the space and inclination, try your hand at rabbits or chickens. Most cities, even in densely populated areas, allow you half a dozen or more chickens. You can have more eggs than you want for the price of feed and water, and the occasional fresh chicken from your extra. As a side benefit, the chickens will eat a lot of the bugs and things that would be eating your garden if you let them. Why not turn those pest bugs into meat and eggs, and save yourself from eating chemicals and pesticide?

Books and magazines on hobby farming and turning your suburban lawn into a suburban farm abound. Start where your interest is, and expand. Extra food that’s fresh can always be bartered for other necessities, or given to friends and neighbors who’re needier.

Acquired food: Game that you hunt or trap, fish that you catch, and other items that you forage. It bears a historical reminder that until relatively recently (Napoleon’s time, specifically) all armies throughout history foraged for their food and subsisted off the land and and its inhabitants. Lacking an army, let alone a supply chain, you may have to survive in similar fashion.

If bodies of water are in the area you are, fishing gear should be included. An assortment of hooks, weights, and swivels, plus a couple of lengths of suitable line can be fitted into a spool of thread-sized container. Bait can be as simple as finding some of the local bugs and worms. Every fly and lure is no more than an artificial attempt to recreate the critters that fish eat. You can catch yourself a lot of tasty meals with just crickets and worms.

Traps and snares are also a possibility. In survival courses in the military, they cover the idea, but you’re seldom in a position to make use of it. First of all, you don’t want A trap, or A snare. You want dozens of them. Hoping your one lone snare wire will catch you a rabbit or squirrel is a good way to starve hopefully. Setting 20 snares and a whole line of traps, if there’s anything to be caught, can mean you’ll not just survive, but thrive. A good knife, the know how (Hint – AGAIN: Practice now.) to carve sticks into traps and twist wire into snares, and the effort to make 15 or 20 at a time can make a forest or field your grocery store. Set the traps, and check them at least daily. Same with snares.

(Caveat: There are game laws in every state and province. Breaking them can lead to big fines or worse. You’ll also piss off your neighbor if you snare and strangle their cat. So don’t get caught breaking laws, and don’t get stupid. But learn what you’re doing while life is comfortable, and your belly is full. Starvation may concentrate your mind, but mistakes can get permanent then as well. Make your mistakes now, when your future to be isn’t riding on how well you place the trigger on a deadfall or Figure 4. And as a rule, you should know your state’s game hunting, trapping, and fishing regs anyways, because when your life is at stake, those rules go out the window, and most of the things they tell you not to do are the things that will keep you alive long enough to get back to the land of Game Wardens. Given how some folks think wardens pop out of trees, if you’re lost and starving, maybe a game warden will pop out and rescue you right after you set that illegal trap. It beats starving.)

And get the books and field guides, and learn from someone local, what plants grow around you that you can harvest to cook, or eat raw. And learn what there is that’ll kill you deader than canned tuna; you’ll be amazed how much suburban agriculture resembles more the poison lab of the Borgias than the Garden of Eden.

As with the other systems that meet your vital needs, there’s no one thing you can pack away to solve the food problem, or any other problem. Have a Plan B. And a Plan C. Two is one, and one is none, when something your continued survival depends on gets lost or broken. Or just doesn’t work out like you assumed it would. Mother Nature can be a biotch. So make provision in all of the ways above, and in the other threads, and let the Grim Reaper collect up those other poor, lazy, and stupid folks who weren’t as smart as you.