Help me be the most useful person you'll know after the apocalypse!
September 22, 2010 12:46 AM   Subscribe

Where can I learn about practical post-apocalyptic medical skills?

Are there any books about how people might use our knowledge of medicine after a complete collapse of civilization? This kind of thing fascinates me. I've thumbed through some "survival manuals" and really all I can get from them is that first aid kits will be at a premium. Obviously that's not sustainable in the long run. What do you do when there aren't any hospitals? Is it possible to produce penicillin without factories? How can people prevent infection from setting in without antibiotics?

Good how-to books about dealing with lacerations, broken bones, and the like in the absence of professional medical care are also welcome. First aid is not exactly what I want because a lot of it concentrates on getting the patient to survive until professional medical help arrives. Neither is wilderness first aid because, although it is a little closer, it also concentrates on keeping the patient stable until help can be found. I'm really drawing a blank on what to search for.

I'm asking this because I'm writing a novel that takes place after a rapid depopulation of Earth, but also because this is really really interesting to me. Sorry to be another Post-ApocalypseFilter question, and thanks!
posted by wayland to Health & Fitness (15 answers total) 87 users marked this as a favorite
Where There Is No Doctor is a guide for providing medical care in third world situations, but I imagine it would be useful in an apocalyptic environment as well.
posted by amyms at 12:57 AM on September 22, 2010 [5 favorites]

I also recommend Where There is No Doctor. Hesperian also makes their book available for free download as a as a PDF file. They also have several additional guides (covering dentistry, midwifery, sanitation, etc.)
posted by RichardP at 1:30 AM on September 22, 2010 [11 favorites]

There'll be a need for old-fashioned (and some some say forgotten) physical assessment techniques like auscultation, palpation and percussion after the apocalypse. Googling those three words (along with "physical assessment") will lead to lots of really interesting, low-tech stuff to try on yourself and friends - for free!
posted by klarck at 4:10 AM on September 22, 2010 [1 favorite]

I morbidly enjoyed reading this nuclear war survival skills handbook from 1979, updated in 1987, which includes lots of advice about how to survive after an apocalypse, especially tested methods for building shelters. It has a basic chapter about medicine without doctors, which may be another helpful place to start.
posted by dreamyshade at 4:20 AM on September 22, 2010

Two ideas that might get you there indirectly.

A couple of times I've come across tremendously detailed 19th century home medical texts. From memory, they often focused either on physical remedies or on on medicinal ones drawn from locally available herbs and other materials. I can't remember titles, but googling "19th century home medicine text" produces a ton of likely looking results.

In a similar vein, I remember the textbook for St John Ambulance senior first aid certificates being a lot more detailed when I was a child than it is now. There was an old copy on my second grade class bookshelf. Reading it got it across to me for the first time that babies had to be delivered. If I remember correctly, it provided detailed instructions.
posted by Ahab at 4:55 AM on September 22, 2010

klark, if you had to see my assignments for lab for the last month, inspection/auscultation/palpation/percussion definitely hasn't been forgotten .. but yes, good skills to have.

i'll nth ahab's recommendation. reading about the practice of nursing and medicine in the pre-antibiotic eras is fascinating, especially in light of the rampant increase of antibiotic resistant bacteria right now. that period after the discovery of sanitization/sterilization and before antibiotics i find fascinating, since i wonder if that's really the direction we're going, is a focus on infection control. in a post-apocalyptic future, preventing infection would probably be a big deal, if there's no steady source of antibiotics. also going back to the days of routine quarantine and isolation, as you won't be getting any more vaccines anytime soon.

i did take a wilderness EMT course a few years ago, and while i understand your reservations (as an EMT course, the emphasis is necessarily on stabilization until you can get them to a hospital), i do think that the wilderness portion did an excellent job on teaching diagnostic skills/awareness in absence of higher technology, as well as a focus on making do with what you've got (which when you combine all the stuff in your hiking packs, isn't a whole lot).

maybe it's the difference between doing a wilderness EMT class and a wilderness first aid class, but we spent a fair amount of time talking about longer-term care potentials and treatment, as a lot of our instructors (and classmates) were involved in more extreme hiking/guiding trips in very remote areas, where getting timely help could be a serious problem. so there's all these little differences, like learning how to relocate a dislocation (don't do that as an urban EMT!), basic pharmacology, more information on broken bones/splinting/applying traction and wound care techniques and issues than you ever get as an urban EMT.

a lot of management of chronic issues is fairly technology driven. diabetes/hypertension/cardiovascular issues/etc. studying herbalism would probably be the way to go (disclaimer: approximately one bazillion of my friends are herbalists, i suppose i am biased). on the other hand, after the apocalypse, people with these kinds of chronic health issues and disability are probably less likely to survive running away from zombies. hm. still, herbalism for your bioregion (although is this nuclear war in your post-apolcaypse? or some other environmental catastrophe (beyond the current one)?) is still a fantastic skill.

hm. i haven't finished my cup of coffee yet. this is a topic i find endlessly interesting. maybe that's how i wound up here in nursing school.

although after the apocalypse, my father likes to point out that a lot of technology isn't going to disappear overnight - there'll be a long period of scavenging and hoarding dwindling supplies. so that could always be a part of your story, too.

alright, now i'm just avoiding my clinical lecture .. happy reading :)
posted by circle_b at 5:30 AM on September 22, 2010 [3 favorites]

I have 3 Physician friends who did tours with "Doctors Without boarders". The stories they tell sound "Post Apocalyptic". See the movie, read anything by people who have done those tours.
They have some serious tricks.
posted by Studiogeek at 6:19 AM on September 22, 2010

I was coming in to suggest books on herbalism and massage/chiropractic/other manipulative therapies, but really I'm just going to 2nd circle_b.

Pain management is also going to be key; before anaesthesia, shock/pain killed a lot of surgical patients before infection even got a chance. (You might look into some accounts of Civil War battlefield medicine, or the novelist Fanny Burney's recount of undergoing a mastectomy without anaesthesia for some good examples of what pre-anaesthesia surgery was like.) Scavenging and hoarding of anaesthetics/analgesics might be an option. I think it's more likely that for pain relief, herbal remedies would be used (willow bark [salicylic acid, an NSAID]; various preparations of opium poppy [morphine]; probably other ones that I don't know about). Anaesthetic is trickier; probably the easiest one to obtain in a post-apocalyptic world would be diethyl ether, which can be synthesized from grain alcohol and sulfuric acid, although it's kind of dangerous to make and also requires tight temperature controls on the reaction. (Not sure where you'd get sulfuric acid from, but if 14th-century alchemists could make it, so could a post-apocalyptic town).

In terms of preventing infection, people will just have to take precautions to keep stuff clean. There most likely will not be autoclaves, but people will still be able to boil materials like bandages, suture thread, etc. Silver and silver compounds are also useful as topical antibacterials (ever seen those band-aids with the silver on them?), so people might start using those again. (You wouldn't want to drink colloidal silver every day though, a) it is kind of toxic, and b) you will turn blue-gray in color.)
posted by kataclysm at 6:52 AM on September 22, 2010 [1 favorite]

Don't forget alcohol as a disinfectant. It also works as an anesthetic if you drink enough. There will be people who make a still, regardless what the rest of the world looks like.
posted by CathyG at 7:50 AM on September 22, 2010

I would highly recommend taking a Community Emergency Response Team course. The one I took was short (1 week, hour and a half a night), free, and chock full of apocalypse-ready emergency tips (how to search a house for survivors, how to triage, how to deal with bleeding, etc) for the civilian or by-stander. It's kind of a different experience than reading a book - you learn how to splint a leg, for example, and while I might understand it conceptually, the practice added value.

Mine also provided a sweet emergency go kit and hard hat, which are always handy, although not so much for book-writing.
posted by quadrilaterals at 8:33 AM on September 22, 2010

This is actually part of the reason I decided to go back to school. I also collect pre-WW2 medical books - my cutoff because that's when antibiotics really became available. So I'll second the finding of a good home health book or two from the early 20th century. Nursing books from that era are also useful. I also have a 'Wartime Guide Book' which was for household use during WW2 - partially useful. The early books discuss things which anyone can do, such as setting up isolation, changing diet for particular diseases, managing minor illnesses w/o drugs.

That being said - you totally need to get some modern training, since there are definitely things that change as it appears some things are better practice. This is especially true with neurological injuries, from what I've seen, but also things like 'don't paint people with mercury.' Some things are going to be impractical or impossible - see: mercury - but also w/r/t, for example, plants. What herbs are still around? What ones are you going to get to? Do you really want to use the ones growing on the old industrial site? For modern training, any of the above are good suggestions. A RN program will teach you many of the physical assessment things, and the good programs will minimize the use, at least at the beginning, of the fancier equipment.
posted by cobaltnine at 9:05 AM on September 22, 2010

shock/pain killed a lot of surgical patients before infection even got a chance.

"Shock" in a non-medical sense, similar to pain, kills no one.

Wilderness Medicine by Auerbach is the bible on Wilderness Medicine type stuff.
posted by gramcracker at 11:02 AM on September 22, 2010

There must be emergency medical textbooks that med students and residents use that you could purchase and read up on. Also I would think nursing might help.

As far as producing anti-biotics I think that would take some cellular biology advanced knowledge but who knows. Are you aware that certain anti biotics for animals can be purchased prescription-free for cheap on amazon? So someone could have stocked up.

Also there is a free series of books called "Where there is no doctor, a village health care handbook. I think its put out by the hesperian foundation. You can find many of their books to download for free on their website.
posted by Twinedog at 11:25 AM on September 22, 2010 [1 favorite]

Are you aware that certain anti biotics for animals can be purchased prescription-free for cheap on amazon?

And you can buy them at your local pet supply stores and at tropical fish stores, too. Of course, they're labeled "not for human use", but you'll see some very familiar antibiotic names sold over the counter there at very low prices...

Anyway. You should also get copies of texts like Where Women Have No Doctor and A Book For Midwives: Care For Pregnancy, Birth, And Women's Health and everyone's favorite Ina May's Guide to Childbirth. Otherwise you might end up like Scarlett, Melanie, and Prissy, stuck saying "I don't know nothing about birthing no babies!" while your city burns around you. And realistically, a non-professional like you or me probably can't learn to perform emergency surgery just from reading a textbook (no offense), but we might be able to figure out basic midwifery situations, and it does seem like it could be a far more common medical situation than, say, treating zombie bites. I mean, half the population is female, and in a Mad Max situation, there probably won't be reliable birth control available, so after the initial depopulating event is over and once food supplies return to decent levels, the next health crisis will be getting your average female survivor through her eight or twelve or however many pregnancies, and then scrounging up health care for the resulting children.
posted by Asparagirl at 6:05 PM on September 22, 2010

a) I was talking about shock in the medical sense, which is actually related to pain management, because

b) Pain kills. There's quite a bit of corroborating evidence (these citations were the result of about 30 seconds on PubMed) suggesting that adequate pain management is important for a good surgical outcome. Pain is a stressor, and while a little pain and a little stress might be "good" in terms of regulating immune system function, extreme and unabated pain is probably not a good thing -- after all, septic shock, acute respiratory distress syndrome, post-operative ileus, and multiple organ failure are all linked to soluble mediators (including prostaglandins and pro-inflammatory cytokines), many of which are known to be dramatically upregulated during pain states in both pain patients and in animal models of pain. Why do you think that chronic pain patients have so many comorbidities with other physical ailments? Why do you think that the Surviving Sepsis Campaign gives the second-highest "quality of evidence" rating to the importance of setting appropriate protocols for sedation, analgesia, and weaning off sedatives? And it isn't just septic shock -- cytokine production is implicated in multiple organ failure and death following traumatic shock, hemorrhagic shock, and a combination of trauma with hemorrhage. It's true that there are many other forces driving pro-inflammatory cytokine production in these patients besides pain pathways, but it's relatively easy to reduce a big chunk of pro-inflammatory cytokine production by not activating pain pathways to begin with.

The past 10-20 years of the pain research literature have been literally filled with papers in animal models and human subjects suggesting that appropriate pain management is not only humane, but life-saving. Unfortunately, not everyone in the medical community has taken the trouble to acquaint themselves with the scientific evidence, which is why we are still churning out an astonishing volume of doctors and nurses spouting off macho rhetoric like "Pain never killed anyone." Pain actually killed a lot of people, and it's still killing them; it just does it by sneaky and indirect means. The nervous system is amazingly and intricately linked with the immune system in ways that we are only beginning to tease apart, but it's already clear that untreated pain is about as good for a patient as, say, bathing surgical incisions in sewage run-off.
posted by kataclysm at 8:19 AM on September 23, 2010

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