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Sunday, October 17, 2010

Dealing With Diarrhoeal Diseases, by Nomad Medic

Escherichia coli - Scanning Electron Microscopy
The recent news of confirmed cases of cholera after the massive flooding in Pakistan highlights a potential threat that anyone could be faced with after a disaster. While cholera has been cited specifically, there are several other diarrhoeal diseases that have similar symptoms and can also kill. These include such pathogens as Rotavirus, Escherichia coli, Salmonella typhi (responsible for Typhoid Fever) and Shigellosis (dysentery).
These illnesses are responsible for a huge number of deaths every year. In fact, the World Health Organization (WHO) reports that there are approximately two billion cases annually. Diarrhoeal diseases account for the deaths of 1.5 million children in the same time period. The majority of these occur in developing countries where availability of clean water, food, and sanitation are limited. How many people reading this are preparing for a situation where you could have limited sanitation, food, or clean water?
The WHO defines diarrhoea as “the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual.” I think we are all familiar with this condition. These diseases are often accompanied by several other signs and symptoms including abdominal pain, fever, increased heart rate, and dizziness.  One of the most disturbing signs that may develop is blood in the stool. As unnerving as this is for the person experiencing it or the one caring for them, this symptom is not as dire as it may appear. In the presence of some of these ‘bugs’, this is part of the disease process and will resolve as the body fights the infection.
Many of these pathogens are ever-present in the world we live in. For example, the bacterium that causes cholera is commonly found in seawater. Outbreaks of these diseases occur when the reservoirs containing the offending pathogen are introduced into a population susceptible to them. After disasters people are often operating in high stress environments and suboptimal conditions. Their immune systems can be depressed to a point that the pathogens get a foothold when they are exposed.
This exposure typically happens via ingestion. This comes from contaminated water sources (i.e. floodwater in the water supply, poor latrine placement causing direct fecal contamination, etc.), contaminated food (under cooked or raw contaminated foods, shellfish from contaminated waters, etc.), or direct oral/fecal transmission (contaminated hands touching lips). Vectors such as flies that stop at the outhouse on the way to your toothbrush have also been cited.
The first and most key step to fighting these diseases is prevention. If we can avoid exposure to these pathogens, we avoid the disease. Depending on the situation, staying ‘Fit to fight’ could literally mean the difference between life and death. There are several points to preventing this though.
Foremost of these preventative steps is that water must be properly treated. While it is not in the scope of this article to go deeply into water purification techniques, I would like to mention a few points. First, start with the cleanest fresh water possible. Collecting from a moving source (i.e. a river or stream) is proffered over a standing source (i.e. a pond). Always try to filter out as many debris as you can. This includes sediments and silts. A study in Bangladesh found that simply filtering water through cloth decreased the incidence of cholera by 48%s. The cleaner the water you start with, the more effective your treatment efforts will be. Chlorination of water is an inexpensive method to treat water as long as you have the supplies available. There are many consideration that must be taken into account when deciding on what amount and what form (liquid versus powdered) to store chlorine in. (Home generation if chlorine is also an option that is used in some parts of the world) As a quick review, the general principal in using unscented liquid chlorine bleach is to use 2 drops of bleach per quart (.5l) of water, 8 drops of bleach per gallon (3.8L) of water, and 1/2 teaspoon (2.5ml) bleach per five gallons of water. Allow to stand for 30 minutes before use. If water is cloudy, double the recommended dosages of bleach. Testing kits, such as used for pools, can be used to monitor the chlorine levels. These should be 1mg/l at storage points, (i.e. piped in cisterns) but .2-.5mg/l at the point of consumption. If you can taste the chlorine, it is over .8 mg/l. The most available means of water treatment may very well be boiling. The principal of starting with the cleanest water available applies as above.  Per the Centers for Disease Control and Prevention (CDC), at sea level water should be brought to a rolling boil and kept there for one minute. At altitudes above 6,562 feet (2,000 m) this needs to be increased to three minutes. Water filter units that rely on mechanical filtering only are generally not adequate to filter out all the pathogens that cause diarrhoeal diseases. Check the manufactures statistics or use a chemical treatment after filtering to be sure. We all understand that we must have water; make sure the water you drink is safe.
The CDC has for years pushed the statement "Boil it, cook it, peel it, or forget it" in regards to eating while abroad. This is intended to directly fight cholera and the similar diseases. Foods must be thoroughly cooked to kill potential pathogens. Most bad bugs are killed when they are brought above 160F (70C) but some must reach boiling at 212F (100C) and held at that temperature for 15 minutes. This is all parts of the food item. That point becomes very important when cooking large pieces of meat or thick stews. Holding food at a temperature where it is literally  ‘steaming hot’ (140F or 60C) and never allowing food to set at room temperature for more than two hours will continue to protect you from illness. All this requires that you can prepare food yourself. Consider this another reason on what should be a long list of reasons to store food. If you are in a food line, soup kitchen, of refugee camp, you have no control over these facts. When it comes to raw foods, use treated water to wash them though cooking is a better way to ensure safety. The ‘peel it’ point is pretty self explanatory; peels and shells protect the parts you eat. Pathogenic bacteria can find their way to your foods. Take steps to ensure any contaminates are rendered safe before you ingest them.
Proper sanitation is key to preventing the spread of these diseases. The #1 most important task in regard to this is frequent hand washing. Ideally this would be done with hot water and soap. Homemade soaps, wood ash, or even the simple mechanical action of scrubbing your hands in clean flowing water will help. Trimming fingernails reduces areas that can trap pathogens. As previously mentioned, insects and other vermin can spread these diseases. Proper steps such as covering latrines, pest mitigation, and the use of insect repellents are necessary. Keep the pathogens away from potential host and you solve the problem.
If people are suffering with any of these conditions, they should be separated from the healthy. Caregivers need to religiously wash their hands before and after contact with these patients. This isolation will decrease the spread of the disease. All waste, clothing, and bedding, from these patients is potentially a source of further infection and must be treated as such. A solution using 1 tablespoon (15ml) chlorine solution per gallon (3.8L) of water can be sprayed on surfaces to disinfect them. Clothing and linens need to be well washed, preferably in hot water with bleach. Exposure to sunlight has been shown to kill many bacteria and viruses. Hanging this clean linen to dry in the sun can also help kill remaining pathogens. There are many reasons the average life expectancy has increased so significantly over the last 100 years. A better understanding of the relation of sanitary and hygienic practices to overall health is not the least of them.
All of these diseases usually respond very well to oral rehydration. Per the CDC ‘With prompt rehydration, fewer than 1% of cholera patients die.’ Fluids should be given as soon as the patient can take them. These should be taken as frequent small amounts as opposed to large volumes at once. The liquid of choice is water with oral rehydration solution added. The commercial versions of this solution contain a plethora of electrolytes, vitamins, and minerals. They are available from many different suppliers and come in a range of flavors. Recipes for making your own abound but this version is common. To 5 cups (~1L) of clean water add 8 teaspoons of sugar and 1 teaspoon of salt. Mix well and have the patient sip slowly. This simple formula is safe and effective though the flavor isn’t anything to write home about. It may be beneficial to add a small amount of powdered drink mix to improve the flavor, especially for children. It is important to not increase the overall sugar levels in this solution by much as this can lead to further dehydration. Other recipes will add sodium bicarbonate (baking soda) and/or NoSalt (potassium chloride). Intravenous rehydration may be needed and should be undertaken using Normal Saline (.9% Sodium Chloride) or Lactated Ringers (Hartman’s Solution). In a PAW, I’d personally reserve IV fluids for other cases if at all possible. Aggressive treatment with oral solutions should preclude the need for an IV infusion. ‘Safe’ food should continue to be offered to the patient though its importance is much less than that of water. Avoid foods such as dairy products, greasy items, or any that cause gas. In these diarrhoeal diseases, it is dehydration that causes death. By staying ahead of the fluids lost, this can be prevented and thus save the patient’s life.
Other medications that may prove useful in cholera or other like diseases are antibiotics. These should be used sparingly and only in severe cases. Due to the development of resistant strains, the most commonly recommended antimicrobial is Ciprofloxacin 500mg twice a day (children should be dosed by weight 15 mg/kg). Acetaminophen (Paracetamol) may be used to combat fever though utilizing the minimizing effective dose will spare the liver some hardship. Anti-diarrhoeal medications such as loperimide (Imodium) should be avoided in severe diarrhoea. Over-use of these medications can lead to a life threatening condition known as toxic megacolon which is just as bad as it sounds. With any medication, be well versed in the contraindications and side effects before you use them. As previously stated, these patients respond well to rehydration and this is the area treatment should be concentrated on.
Cholera, typhoid fever, a dysentery have a well earned reputation as mass murderers. During the American Civil War “The Union army reported that more than 995 out of every 1,000 men eventually contracted chronic diarrhea or dysentery during the war; the Confederates fared no better.” These killers have made appearances in every major conflict to one extent or another as far back as man has recorded history. They crop up during floods, landslide, hurricanes, and other emergencies where ‘basic’ services are interrupted. Armed with a bit of knowledge and by practicing the proverbial ounce of prevention, we can overcome these obstacles.
As with any medical advice, I highly recommend you cross reference anything you read before you use it.

Deliberate Water Storage

Water flowing from a tap

Welcome Preppers and Survivalists,

You Have Three to Five Days Before You Die
After thinking and shelter, water is the most important element of survival.

Don't believe me, try not drinking or eating any liquids for only one day. For me, my tongue starts to swell up, my head hurts, and I get lethargic.

For most people, death follows in 3 to 5 days without water.

Deliberate Water Storage in the Home
As I said in "Expedient Water Storage", a person needs at least one gallon of water a day to survive. This one gallon of water is used for drinking water, only.

So a family of four planning for a three day emergency would need 12 gallons of water. A two-week emergency would require at least 56 gallons of water, just for drinking, and a month's supply of water would be 120 gallons.

Around here, we pay about $1.25 for a litre of bottled water (3.8 liters in one gallon) To make it easy on me, say 4 litres to make a gallon, 12 gallons would cost $60. 56 gallons would cost $280, ouch.

So for the folks getting ready for a short-term emergency (3 to 5 days), bottled water would work, for a price.

But, I'm on a budget; I bet you are too. Plus, I want to store enough water for a 30-day emergency.

Reduce, Reuse, Recycle
One way of cutting costs is to reuse containers. One container is the plastic soda bottle. They come in various sizes, 20 ounce, 1 litre, and 2 litre are common. I have even seen a 3 litre soda bottle when I was traveling to ...

To reuse, just rinse the inside and outside of the bottle with tap water then fill to the top. Screw the original cap on, after rinsing with tap water, then store the bottle in a cool dark place, like a basement.

You don't need to put any chlorine, as a preservative, in the water because most cities already have chlorine in the water. Folks on private wells may want to add 16 drops of 5 1/2 % chlorine bleach to each gallon of water. So a 1-litre bottle would need 4 drops for bleach added to the water.

Now, don't put more bleach in the water thinking "more the better" because too much chlorine can kill.

What I just wrote will work all the time, but this article is "Deliberate Water Storage," so let's get deliberate.

Really Deliberate
To really clean the 20 ounce, one and/or two litre bottles, first peel the labels off the bottles. You want to remove as much as the glue, too. Next, rinse the inside and outside of the bottle, don't forget the cap, with tap water. Let air dry.

As the bottles are air drying, mix one tablespoon of bleach in one gallon of water, this will make a disinfecting bleach solution for the bottles.

Once the solutions is made put the bottles in the bleach water. You want to make sure that there are no air bubbles inside the bottle. Let the bottles sit for thirty minutes. After the thirty minutes, empty the bottles, you can reuse the disinfecting solution, then let the bottles air dry, again.

The bottles are filled with tap water then treated with chlorine bleach. Remember 16 drops for every gallon or 4 drops of bleach for ever quart/litre of water.

Store the filled bottles in a cool dark place such as a cardboard box or basement.

Link:
North Carolina: Division of Child Development - Cleaning and Sanitizing: What’s the difference and how are they done?
http://ncchildcare.dhhs.state.nc.us/pdf_forms/bleach_solution_fact_sheet.pdf

Middlesex-London Health Unit - Mixing of Chlorine (Bleach) Solution for Disinfecting
http://www.healthunit.com/articlesPDF/14708.pdf

Maps and Direction

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Keep maps in your car and know your direction. It could save your life.
I love maps, all kinds of maps. I can still remember some of my first experiences as a young boy learning how to use a compass and read topographical maps. I became instantly hooked with the prospect of navigating through the woods using only a compass and a topo map. Looking at the lay of the land around you, the hills and valleys while facing different directions, and then looking at the map to determine your probable location… what fun it was.
Once you learn how to use a compass and read maps, you never forget. Maps and survival go hand in hand and map and compass reading are essential skills to survival.
Know your direction. Knowing the approximate direction that you are facing, without using a compass, is a skill that will greatly assist you while navigating with a map, and could save your life in a survival situation.
Find your direction during the daytime. Knowing that the sun rises in the east and sets in the west is the basis of determining a direction during day time. Any time during the day, place a stick upright into the ground and mark the spot of the tip of the shadow cast by the stick. Wait about 15 minutes and add a mark at the new spot of the tip of the shadow. A straight line between the two spots will be your approximate east-west line, the west end being the first marked spot.
find-east-west-during-daytime-step-1find-east-west-during-daytime-step-2find-east-west-during-daytime-step-3


Find your direction during the nighttime. If you can find the north star (Polaris) at night (northern hemisphere only), you will know the direction to “true north”. The north star is not the brightest one out there (some people unknowingly assume this), but if you can find the Big Dipper, locate the two stars at the outer edge of the cup. An imaginary line between these two stars will point towards the last star at the end of the handle of the Little Dipper. This is the north star, Polaris.
how-to-find-the-north-star


Keep maps in your car. You most definitely should keep maps in your car and/or your 72 hour emergency kit which should also be in your car. Do not solely rely on GPS to guide you because that system could potentially go down in addition to the fact that a GPS receiver requires power to run. Don’t get me wrong, GPS is fantastic tool that is a nice luxury item to include with your preps.
keep-maps-in-your-car


I keep several maps in each one of our cars.
  • Road Atlas of the state we currently reside in which includes fairly detailed topographical and street maps in about 140 pages. It allows a good “scale” while viewing each page, enough to see local detail of terrain, rivers, and lakes. It also includes blow-up views of the major metro areas. It happens to be from a company named “Benchmark Maps”.
  • Detailed topographical Atlas of the state we currently reside in, including back roads and off road trails. The state is actually split into two Atlas books of about 130 pages each. It happens to be from a company named “DeLorme”
  • Road Atlas of the United States, Canada, and Mexico. It happens to be a “Rand McNally”.


Here are a few links to good road atlas maps:
Rand McNally 2011 Road Atlas: United States, Canada, and Mexico (Rand Mcnally Road Atlas: United States, Canada, Mexico)
Benchmark California Road & Recreation Atlas – 6th Edition
2010 Collins Road Atlas Europe (International Road Atlases)
2011 Collins Big Road Atlas Britain (International Road Atlases)


Do not settle for a simple fold-up state map (although it’s better than nothing!). It is well worth your while to buy a detailed Atlas of your state and another for your country. Keep them in your car, not in your house!



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Modern Survival Blog

A Poor Man's Pre-Fab Underground Shelter

I took this image. It is of a sign directing t...
Hi,
I've encountered a couple of technologies that I would like to share. I hate the way information is delivered on forums in general. You have to read and read and critique each reply to look for those nuggets of helpful info. But thats just me. So I'm almost sure that this information has been shared here before and then lost again. I hope this is a helpful nugget to someone.

The first thing is at this link:
http://www.coonmfginc.com/ProductDetail.aspx

This is an inexpensive NBC fallout shelter that only costs $2100. And for $1500 each, additional shelters can be attached to either end expanding the total square footage and thus room for supplies and people.

Approximate shelter dimensions: Exterior: 96” x 73” x 93”h Access (8' x 6.1' x 7.75')
opening: 24” x 24”
Head height: 72” minimum (6 feet)
Wall thickness: 3/8”

Advertised:
A storm shelter / cellar / or fallout shelter combination, comes complete with 5 built –in shelves surrounding the interior of shelter.Shelves are specifically designed to store quart fruit jars and enough canned goods and other supplies to equip a family for several weeks in an emergency situation. Made from polyethylene plastic that makes for a guaranteed water tight enclosure.

Here is the other technology that some of you may not be aware of that could come in handy regardless of the underground shelter your building:

http://www.hycrete.com/

Hycrete is short for hydrophobic concrete. Basically there is a concrete that is waterproof. Its completely nonporous. And its recyclable. The website has videos that explain further. I can imagine that this stuff is very expensive. And the above described shelter is said to require a minimum 3 ½ yards of concrete to hold shelter in ground in the event of heavy rain. So keep that in mind. Of course not all of the pours have to be hycrete. just the one that gives it some coverage.

Anyways I'm sure that with a watertight shelter combined with a waterproof concrete one could have a shelter that is highly resistive to leaking. And this is a shelter that even i could afford. They shouldn't just be for the Rich. A few of us poor folks should survive.

Peach Strawberry Freezer Jam

Strawberry peach Jam
Photo from Taste of Home
Fresh peaches are my favorite fruit. So, after I’ve eaten my fill of the harvest, I like to find some way of preserving that fresh, fruity flavor for the rest of the year.  I think adding homemade items to my food storage is a treat, and I don’t want canning to be a lost art for my children.  We try to make it a family affair so everyone can learn a little pioneer industry! Last year I made peach pie filling and Peachy Vanilla Syrup. This year I combined the fresh peaches with some strawberries from my freezer for Peach Strawberry Freezer Jam. If you’re still enjoying peaches in your area, give this recipe from Taste of Home a try. It’s a definite keeper!
PEACH STRAWBERRY FREEZER JAM
2 cups sliced fresh strawberries
1 1/4 cups finely chopped peeled peaches
5 cups sugar
3/4 cup water
1 package (1.75 oz.) powdered fruit pectin
DIRECTIONS:
1. In a large saucepan, combine the strawberries and the peaches (I used a food processor to dice the fruit into very small pieces, almost pureed).  Add sugar; mix thoroughly and let stand for 10 minutes.
2. In a small saucepan, combine water and pectin. Bring to a boil; boil for 1 minute, stirring constantly.  Add to fruit mixture and stir for 3 minutes or until sugar dissolves.
3. Ladle into jars or freezer containers.  Cover and let stand overnight or until set, but not longer than 24 hours. Refrigerate for up to 3 weeks or freeze for up to 1 year.
Yield: about 3 1/2 pints (I did 2 batches and got about 12 half-pints)
One week left to enter!One week left to enter!