10 Things I Learned from a Couple of Days in the ER

The last few days were interesting to say the least.  I ended up in the emergency room of my local hospital for a couple of days.  Fortunately everything worked out fine, but I noted quite a few things about said experience that doesn't bode well for TEOTWAWKI--let alone a simple disaster--especially for us prepper types...

1. You read that right, I was in the ER for a couple of DAYS because the hospital didn't have a single room available for admitted patients which left everyone who came through the ER and was admitted to languish in the ER.  Note that most hospitals are overcrowded.
2. This typical ER, on a typical day, in a good sized city was PACKED.  There were patients stacked up everywhere...in rooms, in treatment bays, in hallways, in the ambulance bay.  Over the course of a couple of days I noted that mornings were OK but by mid afternoon, there was a maze of people that health care providers had to traverse just to get form point A to point B.  (So guess what a typical ER will look like after a major disaster...).
3. The food was...barely this side of atrocious.  Food is critical to healing so it kind of shocked me that the food would be so lousy.
4. The patients in this ER were also unpleasant, for lack of a better term.  There were plenty of "normal" people but there were also plenty who were: whacked out on drugs, obviously mentally ill, had their own police escort/were handcuffed to their bed/had a police guard, sounded (and looked!) contagious, had illnesses of indeterminate nature, had a range of illnesses and injuries...it was basically a petri dish of social and medical issues that one probably wouldn't want to be around if one had a choice.
5. Medical care doesn't come quickly.  Because there were so many people and a limited amount of staff and diagnostic tools, everyone had to wait in line for everything--to be admitted, to get a room, to see a doctor, to have blood work done, to have an MRI or CAT scan, etc.
6. Medical care doesn't come cheaply.  Fortunately I have insurance but I am guessing my little stay there cost upwards of $10,000.  I had five specialists peek in on me and I am sure each one will send my insurance company a hefty bill, and none actually did anything save for ask me repetitive questions...at this point they didn't even have any diagnostic tests to consult!  But they all got their patient visit in for billing purposes.
7. The staff is overworked (12 hour shifts were typical...who wants to have a nurse on hour 11?) and the hospital appeared to be short staffed.  I am not sure if this is due to budgetary reasons or due to lack of staff available to be hired but it impacts patient care and it impacts the quality of the environment (ie: the few restrooms for patients in the ER were rarely cleaned...the perfect place to spread germs in an environment where you really don't want that to happen).
8. Emergency room care is good for specific medical emergencies like trauma.  When you are an ER doctor, everything looks like a heart attack or stroke.  They ruled out these two options for me so I ended up leaving with the same symptoms I arrived with.  ER care is very good for trauma injuries--the docs are great at seeing body parts that are out of place and putting them back  in place--but not so much for non-specific medical problems.
9. You are pretty much on your own so prepare accordingly.  The BOB came in handy when I ended up staying overnight for what I thought would be a brief visit.  If I needed something I went in search of it myself since the staff was so busy (note that people who aren't so ambulatory should bring someone with them to the ER to help them out). You may get lost in the shuffle so speak up if necessary (the nurse said I was "up next" for a MRI and six hours later she was surprised I hadn't been called yet; when it was time to be discharged I stuck to the nurse like glue so I could sign out quicker instead of waiting hidden--and forgotten--in my room).
10. If you have a medical issue, do seek medical treatment quickly.  With somewhat of a medical background and some research online I was fairly certain what my problem was (actually a problem shared by hundreds online yet without a definitive diagnosis) so I went in kind of already knowing what the outcome would be BUT with high-tech diagnostic equipment available, it would have been stupid of me to eschew such medical care just because I had used Google and came to a conclusion about my problem.  Of course the problem could have been something serious so if you have a problem it behooves you to seek competent medical advice and testing no matter what Google says.

Overall, this was an eye-opening experience since I have actually never been sick, other than a self-treated cold or flu, in my entire life.  Never a broken bone, stitches, any sort of medical tests, etc. so I will chalk this up as a learning experience (and a reminder that during a disaster, medical care may end up being a do-it-yourself sort of thing for all but the most major problems).

Health and Fitness for TEOTWAWKI

Much like planning for food for TEOTWAWKI, if there is a world-wide disaster, or even a very large disaster in your country, you will pretty much be on your own when it comes to your health as well. Unfortunately, compared to say fifty years ago, there is a very large percentage of people who simply won't survive a serious disaster because they rely very heavily on an organized society to provide for them (think meds, doctors, oxygen company, public transit for the elderly and infirm, visiting nurses, welfare medical coupons, welfare/disability payments, et al).
When society collapses, these people will be toast. Here's how to NOT be these people:

• Do what you can to get off medications for chronic diseases. It is much easier to take high blood pressure/high cholesterol/diabetes medications than to go out and exercise and eat the right food. The problem comes when supply lines are down and you can't get these meds. Do whatever is necessary to improve your health to the best of your abilities.
• If you do rely on medications for your current medical conditions, see about stockpiling these medications. Depending on what you take this could be a very expensive proposition. Hopefully you have the cash to do this and a doctor who will understand your need to stockpile (and write you the prescription for say, a year's worth of meds). Another option (don't know how legal this is) is to buy your medications in foreign countries where they cost much less and often don't require a prescription.
• Exercise. A lot. I would suggest parkour but then I imagine me doing parkour and think better of that suggestion. Although I like the survival implications of parkour, any kind of exercise you do will be valuable in a survival situation. Just remember to concentrate on exercises that improve cardio, strength, and flexibility.
• Put together a stellar first aid kit. I would toss in anything that could be even remotely useful in a medical incident but I wouldn't use things I don't know how to use (for example, it is a good idea to have things like ET tubes even if you don't know how to use them in case a nurse or paramedic happens to come by).
• Stock the medications, both over the counter and prescription, that you can use in a survival situation. Everything from Thera-Flu to broad spectrum antibiotics and pain killers that can take down an elephant are suggested. Remember that prescription meds are usually best had with a prescription. Fortunately I have a doctor that understands both the need for stocking such meds and also understands that I know how to appropriately use them. Note, if you don't know how to use said meds, don't guess, you could die. Study up on this topic ahead of time.
• Speaking of meds, plenty of people have considered using veterinary meds which can be had without a prescription and have stocked up appropriately. Again this takes research and education before actually running out to the feed store and buying out their drug section.
• Speaking of studying, it's a good idea to learn about emergency first aid. First responder courses are a good start, an EMT course is even better, if you have the time and desire, maybe become a paramedic (which takes a huge amount of time and commitment).
• The most important thing to remember, especially when you don't have emergency medical services available (like what would happen after a major disaster) is to simply be careful. People take it for granted that they can do some pretty boneheaded things, first, because they either don't realize that what they are doing is dangerous or second, they don't care (witness a wide range of videos on YouTube). However, when there are no doctors or first responders available, again, you will be on your own so extra care and caution when doing anything that could have a negative impact on your health and/or life is in order.
• Finally, if you or a loved one is in a medically vulnerable position (elderly, seriously ill) then you--and they--need to come up with a plan for what you/they would do if there was a disaster that would keep them isolated for weeks or even months. What if they can't get to a doctor? What if they don't have meds? Where would they get their oxygen from? Is having emergency power a necessity? People don't realize the impact that not having these things would have on someone who absolutely relies on them. A friend who provided medical services at the airport after Hurricane Katrina said the thing they most needed after the disaster was, of all things, adult diapers. There were hundreds of elderly and ill people in the sweltering airport terminal in New Orleans and they couldn't get up to go to the bathroom and there were not enough staff to help them get up and go to the bathroom. I'll leave the rest to your imagination.

The bottom line is that like everything else after a major disaster, you will basically be on your own. Plan accordingly.

Prepping For: A Medical Disaster

I stopped into a client's office last week. As usual, I had a great conversation with his office manager who has been like a fixture in his office for nearly a decade. She is always there, morning to night, any time I stop by. She runs everything smoothly and effortlessly, she is a relatively young 40-something, and everyone relies on her--her kids, her husband, her extended family, the people in the office, and especially my client--she's like his right arm.

Fast forward to Sunday morning when I get a panicked call from my client (also a friend) saying that his assistant had had a massive stroke and had been flown to a Boston-area hospital and would I want to meet him there since I happened to be in the city this week. Of course I met him at the ER then checked back in with him the following day and found that the lady was still in a coma with a not-good prognosis.

If you would have asked me last week about the lady, I would have said that she looked like she would live to 90, now it looks like she may not make it through the week. The lesson here is that, like everything else we prep for, prepping for a medical emergency is something that needs to be done now, while we are still able to do it. Here's how:

• Make sure that you have an updated Will, Living Will, and Medical Power of Attorney (where people can find them!).


• Life and disability insurance is something that everyone who has debts/dependants should have.


• If you don't have debt or dependants and have the cash available so that your next of kin can pay for your funeral, you may not need life insurance but disability insurance is a good idea for every adult. Health insurance is a must.


• Although you/your staff/your spouse may be indispensable, the things that they know how to do shouldn't be a mystery to you/your spouse/your other staffers. Job action sheets or a Standard Operating Procedure manual are a good idea, both for your home and your business.


• Cross training is also another good idea. I have seen small businesses where the one person who knew how to write paychecks was out ill/in the hospital/fired/etc and no one else knew how to do paychecks. Not something you want to try to figure out on a Friday afternoon with employees chomping at the bit. This goes for home-type activities as well. If there is something that the spouse "always does", you should probably learn how to do it as well.


• Having a BOB at home and a BOB in the car for each family member is always a good idea. When the lady collapsed, her entire family hopped in the car and drove the few hours it took to get to the hospital while she was flown there. Obviously people aren't in the frame of mind to stop and pack a bag and remember to feed the cat and all of the other things that you need to do to adequately prepare for being away from home for a period of time. At least with a BOB, all of your must-haves will be with you.


• Having a neighbor or friend you can rely on with a key to your home is also a good idea. Note the cat feeding above. They also may need to pick up your kids from school, check in on your elderly parents, etc.


• You also need to have a contact list with you at all times. I have this list on my computer, on my cell phone, and in a printed version in my BOB. Medical emergencies usually require calling lots of people and providing lots of info, this is easier to do if you have the list of people to call at your fingertips.


• If you or a loved one is in the midst of a medical emergency, this website (http://www.caringbridge.org/) is an excellent way to keep everyone updated without making/answering a hundred calls a day.


• Have a responsible person with you at the hospital if at all possible. If one spouse is severely injured/ill, it is always best to have a stable/responsible person with the other spouse at the hospital because in the midst of trauma, the waiting spouse often hears "blah, blah, blah, serious, blah, blah, critical...". The friend can more easily take in all of the information and help with calls to relatives/explaining things to the waiting spouse/etc.


• You need an emergency fund. The family of the lady I told you about above is now holed up in the hospital waiting room, and they also have a room at the hotel across the street from the hospital (in one of the more expensive cities in the country I might add). You will need extra money during a medical emergency for everything from food and beverages for the waiting family to hotel rooms, to gas to get back and forth from home to the hospital, and various other sundries.


• Leave your final instructions with your attorney or in your safe deposit box. There may be many things that you are responsible for in your daily life that no one else will be able to figure out. What will happen with your blogs and websites? Have you been secretly sending support to a child your spouse doesn't know about? All of these sorts of things need to be planned for in the event of your demise/extended incapacity.


• Don't keep stuff that you don't want others to know about. While cleaning out the (massive amount) of papers at my aunts place, I came across a few things that she probably never intended anyone to see. If this is the case, get rid of the items now.


• Don't forget that it is important for all family members to know the basics about emergency first aid response.

So we are still in a holding pattern as far as the lady goes. Many prayers are being said on her behalf and there is always the possibility, no matter how remote, that she will recover, but her family, and indeed my friend's entire office is still reeling from the incident. Take the time now to prepare for this possibility.

How to Save a Life

There are lots of ways that professionals save lives. Trauma surgeons can work miracles in the OR. Paramedics have been glorified numerous times on television because they save lives in such dynamic fashion. Police officers often put their lives on the line to save others.
But did you know that there are specific occasions when only a citizen bystander can save a life? There are many times that a person dies right in front of others because there are some circumstances that simply won't wait for paramedics or an emergency room. Here's how you can be the bystander that saves the life of a stranger (or a loved one):

1. Learn CPR
2. Learn the Heimlich Maneuver
3. Learn how to use an AED
4. Learn basic first aid (bleeding control)
5. Learn rescue swimming

• Note that there are only a handful of reasons that people die immediately and need quick assistance from a bystander, these include loss of heart rhythm, loss of blood, and loss of the ability to breathe. Things like choking, heart attack, drowning, and bleeding out from trauma fall into these categories. There are other emergent situations where there is very little you can do such as traumatic brain injuries and massive traumatic injuries.
• A person who loses their heart rhythm because of heart attack or severe electrical shock, needs immediate CPR. If you wait ten minutes for paramedics to come, the person will be dead. With CPR provided immediately by a bystander, the save rate is actually fairly good.
• Massive bleeding from things such as stab wounds, gun shot wounds, and other traumatic wounds is another common way to die. Quickly. Loss of blood can be remedied for the moment to give the victim a chance for medical help to arrive with either direct pressure on the wound or a tourniquet applied between the wound and the heart.
• Loss of breathing can result from choking on something, near drowning, or respiratory arrest. When someone can't breathe, seconds make a difference. If you see a patron choking on something in a restaurant, calling an ambulance is nice, but again, the guy will probably be dead before the ambulance arrives unless someone knows how to do the Heimlich Maneuver. Also note that when someone is drowning, other then in extreme cold water drowning incidents, there is no time to wait for a dive team to rescue someone. Generally dive teams are used for recovery, not rescue.

Take the opportunity to learn the basic, critical life saving skills that can literally make a life and death difference in someones life.

Some Options for Medical Care

Having been a bit under the weather this week, I got to thinking about medical care. I have been extremely fortunate to have full coverage medical insurance practically since birth. Many people are not that fortunate and healthcare coverage is a major concern (it can also be a major cause of bankruptcy!). Here are some options for care when you get sick--both during "normal" times and during times of disaster:

• Obviously if you are in a life threatening situation (chest pain, shortness of breath, in active labor, a serious infection, been stabbed, been shot, etc), go to the nearest emergency room. The EMTALA Act says that emergency rooms MUST treat you whether you can afford to pay or not. Of course you will get an armload of bills after your treatment, but at least you will be alive to deal with them. Note that in some disasters or TEOTWAWKI scenarios, many hospitals may not be open/staffed.
• Your regular doctor. Hopefully you have a regular general practice doctor that can help you with general medical problems, chronic condition care, and preventative wellness checks. This is a less expensive option than an emergency room and hopefully, with preventative checks, your doctor will be able to find and treat problems while they are still minor. You may want to ask your doctor if he has a disaster plan, just to figure out if he would be available during a disaster situation.
• Community clinics. These range from "free clinics" to "sliding fee scale" clinics, to "you must pay a set fee" clinics. If you do not have insurance, these types of clinics may be the first place to look for affordable care. Less urgent and chronic condition care is very common at these types of clinics. Ditto on the note about disasters and TEOTWAWKI.
• "Urgent Care" clinics are springing up all over around our state. These are a less expensive option than an emergency room for urgent, but not life threatening, conditions. If you don't have insurance you will need to pay at the time of service and there is no way to tell if these places would be open during a disaster (I'm guessing no).
• Lower level providers. In some cases, depending on your jurisdiction and what level of care lower level practitioners can provide, you may be able to get limited types of medical care from Physician's Assistants (PA), Advanced Registered Nurse Practitioners (ARNP), and Registered Nurses (RN).
• Vets. For your everyday medical care/medical emergencies, vets will not treat you. There is a small problem with malpractice and providing care outside of their scope of practice that usually (as it should) stop them from treating human patients. This is not to say that veterinary care is not an option when TSHTF. Way back in the day in very rural areas, it was not uncommon for vets (and farmers who knew some vet skills) to provide antibiotics or sew up a gash on their (human) neighbors.
• Home remedies. I can count the number of times my grandparents went to a doctor on one hand. This was probably because of the cost but also because they pretty much didn't trust doctors unless it was an emergency. What they did do, however, was tap into their huge knowledge of home remedies to treat just about any problem that came along. This is an excellent kind of knowledge to have at any time, but most especially during a disaster.
• Specialized types of medicine. Homeopathy, herbal medicine, and Chinese medicine are considered "alternative" types of medicine however a billion Chinese can't be wrong. These types of medical practices are used to cure a wide range of ailments and most of the components of the medicines and treatments are available to anyone, not just licensed doctors. Note, however, that some of these treatments use plants and other natural items that can be toxic or fatal if used improperly so you really need to know what you are doing before you attempt to use these items.
• Other resources: For other medical care information consider nurse hotlines which can provide information over the phone that may save you a doctor's visit. Also, Poison Control Centers can provide information on whether something that was ingested was poisonous and requires an ER visit or if the substance is actually non-toxic and not a problem.
• And some tips: The best solution to a medical problem is to not have the problem to begin with so preventative care is important. Take care of your health by eating right, exercising, wearing a helmet and seat belt when needed, and generally staying away from situations that can make you ill (stress), injured (skateboarding), or dead (smoking). Getting some medical training is a great idea, so consider signing up for a first aid or EMT class. Make friends in the medical field; during a disaster there will not be enough of these people to go around (look at the situation in Louisiana during Hurricane Katrina). Get some reference books. "When There is No Doctor" is a classic tome and you should also have a book (with lots of color pictures) about the types of plants that grow wild in your area that can be used for medicinal purposes. Also consider planting some medicinal herbs in your garden.

Medical Care Options When You Don't Have Insurance

One problem that I see come up fairly often (more often lately as people are losing jobs left and right and their associated health insurance coverage) is lack of options for medical care. Here's some ideas if you find yourself in this situation:

• COBRA. If you become laid off or in some cases, fired, you may be eligible for COBRA coverage. This basically keeps your current health insurance in affect for a set period of time (sometimes up to 18 month). The catch is that you have to pay for this coverage which can be pretty expensive (especially if you just lost your job!).
• Spouse's insurance plan. You may have been covered by your own employer's health insurance plan but if you lose your job, the first place to look for coverage may be at your spouse's health insurance plan.
• Get another job that has health insurance. Back when Starbucks used to offer pretty good medical insurance for even part time workers, many people who found themselves without medical insurance would get a part time job at Starbucks just for the insurance coverage. While jobs with great medical benefits are getting fewer and fewer, this may be another option if medical insurance is high on your priority list.
• Other health insurance plans. You can purchase your own health insurance, although this isn't an inexpensive proposition. You may get a cheaper rate if you go through an association or organization that you belong to (such as the Writer's Guild or Small Business Association) or you can just check in the yellow pages under "insurance, health"). Be sure you completely understand the coverages, co-pays, and percentage that the insurance pays for various things such as doctor visits, hospital stays, and major medical procedures so you aren't surprised by a big bill.
• Community clinic. There are a range of community clinics available depending on where you live. Some offer low cost doctor visits, some are "free clinics" and offer free or low cost medical care, whereas other clinics may offer free or low cost specialized medical care (ie: pregnancy clinics, immunizations, etc). Most of these clinics base your costs on a sliding fee schedule based on your income.
• DSHS. In our state DSHS (Department of Social and Health Services aka welfare) offers medical options such as coupons for children's medical care for low income families, various plans for chronic medical care, etc. Simply go to your state's welfare office and see what you qualify for.
• Emergency medical care. Most hospitals in the US fall under EMTALA; this is a congressional act which states that anyone needing emergency care must be treated regardless of ability to pay. This basically means that if you have an emergency medical situation, get yourself to the ER and get treatment. You won't have to pay then but you will get an armload of bills after the fact which can sometimes then be paid for by the hospital's charity care program.
• Specialized medical centers. There are a number of medical centers that cater to specific populations such as veterans, American Indians, Shriner's Children's Hospitals, etc. which may be able to treat you if you fall into a covered category. If you are a veteran or have served in the armed forces at all, check with your local VA service center to see if you qualify for care. If you are an American Indian, check with Indian Health Services or your associated tribe to find out more about any health care you are entitled to. If your child has specialized needs, check with your local children's hospital for a referral to a hospital that may provide free or low cost specialized treatment for your child's condition.
• Overseas Medical Care. Medical tourism is getting to be big business. The reason? You can often get prescriptions, medical care, and even major medical procedures done for a fraction of the cost compared to the US. Places such as India, Philippines, Mexico, Brazil, and other countries with a lower cost of living are doing a booming business treating the medical problems of Americans and Europeans. Google "medical tourism" and remember, buyer beware.

Three things to remember: if you are very ill or dying, get medical care first and worry about the bills later. Second, research your options and turn over every stone looking for help. Third, take care of yourself; preventive medicine is better than medical treatment for something that could have been avoided.

How to Handle Any Medical Emergency

Medical emergencies happen all of the time, in fact, these are one of the most urgent of all emergencies you can face. If you run out of money, you probably won’t die. If you lose your job you probably won’t die. If you have a heart attack, you probably will die without quick medical treatment. Here’s some tips to help you take care of any medical crisis that may occur:


Before an emergency happens, be prepared:

• Have a well stocked first aid kit.
• Know some basic first aid skills such as CPR, the Heimlich Maneuver, and how to fix up some basic injuries such as sprains, cuts, minor illnesses, etc.
• If you or anyone in your home takes medication on a regular basis, try to have at least a three month prescription for each necessary medication and always keep a good supply of said meds on hand; you don’t want to run out right as a hurricane hits your town, thus closing down every pharmacy within a many mile radius. This is especially critical with medications needed for acute problems such as Nitro pills for a heart condition or an Epi Pen for someone with serious allergies.
• You should keep a list of pertinent medical information for each family member in an easy to access location; this information should include each person’s name, birth date, name of doctor, doctor’s phone number, allergies, and list of past and current medical issues (chronic medical problems, surgeries, etc). The list should also include the name, dosage, and reason for taking each prescription medication the person uses. In an emergency, this information can be invaluable.
• Other ways to be prepared prior to a medical emergency is by having some useful (but spendy) equipment such as an AED (automatic external defibrillator) which can make the difference between living and dying from a heart attack, taking the time to learn more advanced medical skills through an EMT or Paramedic course, and practicing (ie: volunteering with the local ambulance so you will get some real life experience at treating patients in an emergent situation).
• Having basic first aid/medical books on hand can help tremendously for unusual or uncommon problems that you need more information on.
• Note that the more remote you are, the greater the chance that YOU will be put in the position to have to render medical care. If you live a mile from the trauma center, you could cart the patient there yourself but if you are living in the Central American highlands, medical care could be hours or days away, and your skills and equipment could make the difference between life and death for your friends and family members.

During an emergency, here’s what to do:

• Make sure the scene is safe. If the person is in a burning car, obviously do what you can to carefully remove them from the car. If there has been a shooting, make sure the shooter is gone before you attempt to help the person or you could be the next victim. assess the situation quickly.
• Does the person need basic at-home medical care or will they require immediate medical attention (you can usually tell this by looking at the patient—if they can’t breathe or are having difficulty breathing, if they are having classic symptoms of a heart attack, if they are having a severe allergic reaction such as hives or intense swelling of the face and extremities, if there is copious amounts of blood, if an extremity is positioned very oddly (like a foot facing backwards or bones protruding), or if there is the possibility that the person has a head, neck or back injury, these are good signs that advanced emergency medical care is required.
• In the case of a medical emergency, call 911 immediately or have someone else call before you begin any type of care (you don’t want to start CPR then have to stop to call 911 so call 911 first).
• Administer basic first aid: CPR in the case of a heart attack, the Heimlich Maneuver in the case of someone choking, compress the wound in the case of bleeding, etc.
• Take direction from the 911 operator. They will tell you what you can do to help the patient before the ambulance arrives. If you don’t understand something, ask. If you can’t stay on the phone for some reason, tell them, don’t just hang up.
• Do what you can to keep the patient calm, breathing, and their blood circulating until help arrives.
• Don’t try to perform advanced medical procedures yourself unless there is absolutely no other option. You may have seen someone make a slit in a patients throat on TV then put a tube in to help them breath but if you’ve never done it before, the 911 operator does not instruct you to do it, and medical care is on its way, DON’T DO IT.
• When help arrives, stay out of the way unless otherwise directed and provide necessary information in a clear, concise way to the medical responders.
• In the case of minor emergencies, treat as per the problem (ie: disinfect a scrape, put on some antibacterial ointment and a bandage).
• If you are unsure as to the severity of the situation, you can call the nurse hotline at your local clinic or hospital, call the Poison Control Center in the event of a possible poisoning, or call 911 for direction.

After the emergency, here’s what to do:

• Follow up with the patient to ensure their medical needs are being met.
• Restock any supplies you have used from your first aid kit.
• Find out more—after having lived through such an experience, people are often interested in learning the first aid skills that “they never thought they would use”.

Medical emergencies can be traumatic for all involved but with a little preparedness and practice, you can be the difference between life and death for someone.