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Field Health: Introduction to Field Health Concerns

Most of the discussion around medical concerns are geared towards the Type I emergency. What about the longer term threats to health? Join us to dive deeper.

April 23, 2020
By:
J. Allen

Introduction

Moving Past the Sexy Stuff

The literature of disaster preparedness is extensive with opinions and ponderings of what we would call the “sexy stuff.” These things include the contents of a car-kit, items for your EDC, and a hundred ways to start a fire with a toothpick and your car keys. 

However, the concerns that arise during Type II-III events are often unaccounted for. The old adage goes “it’s what you don’t know that kills you.” In 2012 when Hurricane Sandy demolished systems of the Nassau County Sewage Facility, and millions of gallons of greenish-gray soup consisting of half-treated human waste flooded into the surrounding area, I doubt there was anyone who found a way to solve the problem of being without a capable sewage system with a Glock 43 and Benchmade Griptilian. 

In 2010 after a 7.0 Richter earthquake shook Haiti, waste management devolved into whatever could be scooped up and hauled off with construction equipment. Mountains of combined rubbish, biohazardous materials, and human waste were piled less than a mile from the Caribbean waters due to a lack of any other sophisticated system to deal with refuse on the island. The ecological and health consequences of such massive amounts of waste in woefully insufficient infrastructures are impossible to measure.

...But they are possible to minimize. 

The stark truth of disasters are that the vast majority of deaths and suffering could not have been prevented by anything you carry in your IFAK. 

Death by the Numbers

Some have a preparedness approach that are more akin to readying themselves for a firefight than readying themselves to survive. While it isn’t a bad thing to know how to handle yourself when a gunfight breaks out, should it be your chief concern? 

The Disaster Medicine and Public Health Preparedness journal published in 2008 that of the 966 deaths they attributed to Hurricane Katrina, 20 of them were due to firearms or gas poisoning. At most, 2% of deaths from Katrina could be blamed on a hostile shooter. 

Even if one were preparing for a direct battle, history shows that infection has killed more than any munitions. A notable example is the Marine assault of Guadalcanal in the Pacific Theater of WWII. Despite heavy fighting in tunnels, assaulting pillboxes, and crowded trench warfare, the main cause of death was infection. Specifically, malaria took more men out of the fight than anything; which is unsurprising considering some villages reported a 47.3% infection rate due to mosquito density. It’s hard to keep up operations if nearly half of your forces are catching fever. 

In an environment where emergency medical services cannot be relied upon for the duration of days to weeks, the priority to avoid disease and infection can trump many other concerns.

Iodine and toilet paper has saved more men in war than morphine and tourniquets, and likewise have done the same in disasters.

Preventative Medicine

Your best weapon against disease will be preventative medicine. This is an umbrella term that encompasses prophylactics, field hygiene, field sanitation, and waste management. In layman’s terms, it is the methods by which you keep yourself, your stuff, and your area clean. The approaches to these ideas and the literature that informs it are almost universally based in the world of structured disaster response teams that are operated and maintained by government forces.

For this reason, much of it won’t be useful to the person who is trying to see themselves and their family through an event of moderate or prolonged duration. To address this I would like to introduce the concept of Domain Maintenance, which I prioritize into three categories; your Physical Domain, Immediate Domain, and Auxiliary Domain. These three considerations can act as a prioritization and consideration tool when assessing your living situation and forecasting your needs. 


Physical Domain

Simply, this is yourself. Your body physically in terms of health and cleanliness. The physical domain carries a lot of questions and considerations. In terms of preparedness, you can perform a self-audit to see if you are optimizing your health choices in a way to see you through an event if you needed to.

How you determine this is very dependent on what your general level of health is including things like your fitness level or any chronic illnesses you have. Do you have any habits such as nicotine addiction? Do you have enough dental health that you could forgo care for two or three weeks if needed? Would you have the ability to carry a family member up a couple flights of stairs if you had to? 

During a prolonged disaster you can use many of these same questions to determine your most immediate needs. Do I have a way of bathing myself? Do I have enough of my medications or do I need to seek out more? Have I allowed myself enough rest to not weaken my immune system? Have I had enough food and water intake? Thirst, starvation, sleep deprivation, and uncleanliness are all issues that you can expect, and therefore anticipate. When making your initial assessments of a situation, these are all things you should create contingencies for first and foremost. 

Immediate Domain 

Your immediate domain is your current living area and your equipment. There are many ideas that will be tie-ins to your physical domain considerations when assessing the hygiene level or potential of your immediate domain. Are you currently near any areas of danger? Are you close to dirty or stagnant water? Will your equipment erode or be damaged by the environmental conditions? 

These skills are ones that are well practiced by military organizations when choosing areas in which to bivouac. Excluding tactical concerns, careful consideration is given whether they could expect water to pool during a heavy rain, or if the wind causes an area to be particularly colder than another. For pioneers traveling west during the 1800’s, these decisions were a daily practice. 

Auxiliary Domain

Items under your auxiliary domain are items of resource and waste to consider. You can think of them in terms of inputs and outputs. Resources like water and batteries can be considered inputs. Trash and human waste are outputs, or things to get rid of. 

Proximity to items of resource is something to consider carefully. Which good things will come a crowd, and if you are trying to stay safe and separated from a large group, staying too close to an area of high traffic could compromise your safety considerations. Large populations in close proximity is a hotbed for infectious disease. If you are constantly intermingling with several or dozens of others who are in a similarly dirty environment such as New Orleans during Katrina, you could risk piggybacking a disease right back to your group. 

Outputs are of great importance. One must wisely choose a place and method with which they want to dispose of their trash and how to deal with the human concern of going to the bathroom. Choosing a site and method that is well enough away and contained from your immediate domain is important, but one must also employ a method that provides enough convenience that isn’t willing to relieve themselves somewhere closer, defeating the purpose of your preparations. 

Practical Exercise

Dealing with hygiene issues as they appear is generally simple and something many don’t even need training in. Soap and water is a simple concept that many can apply intuitively. The way hygiene becomes deadly is by not being recognized. We can sharpen our skills in predicting environment concerns before becoming an issue by performing quick, periodic audits of ourselves and our living situation. 

Hygiene isn’t a “skill” in the way that we consider vehicle repair or bush-crafting. It is a network of habits. It is something to be routinely implemented rather than learned in a YouTube video. Some have better habits than others, but we can all improve and refine our priorities.

Hygiene isn't a skill, it is a network of habits.

Below are a series of questions to ask yourself and answer honestly. This won’t go on any report card, but can likely highlight some shortcomings or identify new behaviors you will want to develop that could put you in a better situation to stay clean and healthy during a Type II or III disaster. 

Personal Domain Questions

  • o Do I have any untreated dental issues?
  • o Will I have enough contact solution to last? Are my glasses
  •     prescriptions current?
  • o Can I run a mile without having to walk or stop?
  • o Do I have allergies and ways to deal with them?
  • o Do I have any disabilities?
  • o Could I combat an infection right now? What would I need?

Immediate Concerns:

  • o Do I have clean clothes on? Do I have clean clothes available?
  • o Are there dirty dishes in my kitchen right now?
  • o Is there expired food in my refrigerator?
  • o Are my cooking areas ventilated and clean?
  • o Do I have a problem with ants or fruit flies?
  • o Do I have a problem with mosquitoes?
  • o Are my pets clean and free of ticks or fleas?

Auxiliary Concerns:

  • o Would I have enough water not only to drink, but to wash myself
  •     and gear?
  • o If the sewer system stopped working, do I have a backup plan?
  • o If the garbage service stopped running, do I have a backup plan?
  • o Am I including pet and cooking waste into my backup plans?


More to Come

The purpose of this article was to introduce the Field Health mindset and considerations. I hope you will find the rubric if prioritization for concerns helpful. 

Follow up articles will include a deeper dive into each domain to contain specific skills and advice on how to remain healthy personally, keep your gear and immediate are cleanly, and ways to manage your resources and waste to keep from creating additional concerns. 

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J. Allen is a guest contributor and active member of the discord. He has written for multiple preparedness and firearms publications. His background is in combat medicine, with experience stemming from service as an Army Combat Medic, TCCC Instructor, and disaster medical relief. ISG is a great resource for knowledge, and even more can be found on the social media community.




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