in: Health, Health & Fitness, Podcast

• Last updated: April 23, 2024

Podcast #983: Grid-Down Medicine — A Guide for When Help Is NOT on the Way

If you read most first aid guides, the last step in treating someone who’s gotten injured or sick is always: get the victim to professional medical help.

But what if you found yourself in a situation where hospitals were overcrowded, inaccessible, or non-functional? What if you found yourself in a grid-down, long-term disaster, and you were the highest medical resource available?

Dr. Joe Alton is an expert in what would come after the step where most first aid guides leave off. He’s a retired surgeon and the co-author of The Survival Medicine Handbook: The Essential Guide for When Help is NOT on the Way. Today on the show, Joe argues that every family should have a medical asset and how to prepare to be a civilian medic. We discuss the different levels of first aid kits to consider creating, from an individual kit all the way up to a community field hospital. And we talk about the health-related skills you might need in a long-term grid-down disaster, from burying a dead body, to closing a wound with super glue, to making an improvised dental filling, to even protecting yourself from the radiation of nuclear fallout.

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Cover of "the survival medicine handbook," featuring a red first aid kit on a road under a stormy sky, by Joseph Alton MD and Amy Alton APRN.

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Brett McKay: Brett McKay here and welcome to another edition of the Art of Manliness podcast. If you read most first aid guides, the last step in treating someone who’s gotten injured or sick is always get the victim to professional medical help. But what if you found yourself in a situation where hospitals were overcrowded, inaccessible, or non-functional? What if you found yourself in a grid-down, long-term disaster and you were the highest medical resource available? Dr. Joe Alton is an expert in what would come after the step where most first aid guides leave off. He’s a retired surgeon and the co-author of The Survival Medicine Handbook: The Essential Guide for When Help is NOT on the Way. Today on the show, Joe argues that every family should have a medical asset and how to prepare to be a civilian medic. We discuss the different levels of first aid kits to consider creating from an individual kit all the way up to a community field hospital. And we talk about the health-related skills you might need in a long-term grid-down disaster from burying a dead body, to closing a wound with superglue, to making an improvised dental filling, to even protecting yourself from the radiation of nuclear fallout. After the show is over, check out our show notes at

All right, Joe Alton, welcome to the show.

Joe Alton: Hey, thanks for having me. I really appreciate it, Brett.

Brett McKay: So you are a retired obstetrician and pelvic surgeon, and you’ve stayed busy in your retirement by helping families prepare medically for long-term disasters. How’d you end up doing that?

Joe Alton: Well, Brett, I was exposed to disaster medicine very early in my career as a volunteer DMAT member, Disaster Medical Assistance Team member for the aftermath of Hurricane Andrew down here in South Florida in 1992. And that led me, like many Floridians honestly are now, to become what you would call a hurricane prepper. And that means instead of the three days worth of food and supplies the average American has on hand, we’d have a couple of weeks worth. But I really have to say, it was Hurricane Katrina in 2005 that opened my eyes to medical preparedness, serious medical preparedness. I mean, it was then that I saw what happens when the ambulance isn’t just around the corner. And that’s not because we didn’t have hundreds of medical personnel converging on the Gulf Coast. I knew it was going to be a big disaster. So that was going on even before the storm was completely through. But the providers and the technology were just not able to get to victims due to all the flooding. I figured that any number of disasters could actually do that. An earthquake, for example, could make roads impassable and people couldn’t get to you, for example.

Really, any disaster with enough casualties can overwhelm the existing infrastructure. If there’s a three car wreck in a two ambulance town, I mean, you could have a bad outcome. So I figured if I can teach the average person how to deal with injuries and illness and put some supplies in their hands, well, then maybe some tragic outcomes might be avoided. So my mission became to place a medically prepared person in every family before a disaster occurs.

Brett McKay: All right. So you co-authored a book called The Survival Medicine Handbook. And this is a tome of a book. It is, I think it was 700 pages. You co-authored this book with your wife, who’s also a nurse practitioner and a midwife. And your goal is, again, it’s a comprehensive guide to medicine in a situation where it’s a grid down situation. You might not have immediate medical access. And so how to manage things you might encounter in that period. I’m sure a lot of people have read first aid books on, say wilderness first aid or maybe prepper first aid, but you argue that those books will only get you so far in a long-term disaster scenario. How so?

Joe Alton: Well, there are a lot of books on first aid, even for wilderness settings. And many of them are really quite good, but they fail to take into account that in a true survival, long-term survival scenario, there’s no access to medical medicine, modern medicine, rather, for the foreseeable future. And that becomes a problem when every chapter of your first aid book or your medical book ends with, and get to the hospital or, and seek a qualified medical professional. Because in real terms, no such thing exists when the medical infrastructure is collapsed. And so our entire book is pretty unique in that it assumes that some disaster has happened and you no longer have the option of accessing modern medical care, maybe for the long run. And the book addresses the average citizen in plain English, as if they were the last line of defense when it comes to your family’s wellbeing in a disaster. That’s because it’s a real possibility.

Brett McKay: So a lot of the first aid books out there are geared towards taking care of the situation so you can get to medical help. But in a long-term disaster, professional medical help may not be available. So what considerations do you have to think about to deal with that situation?

Joe Alton: Well, let’s take an injury for an example. I mean, what is the difference between today and in a grid down situation when it comes to encountering somebody who’s sick and injured? Let’s say even in the normal times, let’s say they broke their leg in a car accident. What do you want to do? You want to stabilize that person, do what you can for them and get them to the nearest medical asset. That makes sense. So you’re not a doctor after all. And once you ship the patient off, your responsibility has been discharged and you’re on your merry way. But what if that’s not an option? I mean, grid down, your responsibility extends from the point of injury to full recovery. Will you be able to provide daily wound care for this person? Would you be able to identify if a wound infection is occurring? Would you have a plan of action to rehab that person and get them on their feet again, make them productive as a group member as they most certainly would have to be in an off-grid disasters type setting. I mean, you have to do this and that’s the difference. You have to be ready to be the highest medical asset left and be effective in that role.

Brett McKay: And another thing we’re going to talk about in detail later on in a bit, another thing you have to think about as the medical asset in your family is you have to think about preventative medicine. It’s just basic things you don’t have to think about because we live in the 21st century, sanitation, hygiene, things like that to prevent sicknesses.

Joe Alton: You’re absolutely right. The important thing to know is that you can prevent headaches and heartaches as the family medic if you have a plan to enforce sanitation and water disinfection and food preparation, things like that. And these are sort of part of your job description.

Brett McKay: As part of the medical asset. So one of the things you talk about in the intro of the book in the first few chapters is before you start thinking about buying medical gear, I know guys love that. It’s the one thing I think a lot of guys love about survival or prepping is buying gear. It’s fun. But you say before you even do that, there’s two things you probably need to think about in order to become a medical asset. One is establish a community, put yourself in a strong community and then two, get your personal health in order. So first, how can being part of a robust community help with medical care or healthcare in a long-term survival situation?

Joe Alton: Well, I mean, as a community, let’s take some examples from TV. Have you seen the show, Alone?

Brett McKay: Yes.

Joe Alton: Well, there you go. In Alone, they drop you off alone with some supplies, probably as much as a person might be able to reasonably carry a fair distance. And they plop you off into the off-gridest of off-grid locations. And that person has to find water. They have to make it drinkable. They have to find food. They have to cook it properly. They have to make a shelter. They have to worry about personal protection. They have to deal with injuries and other medical issues that occur along the way. I mean, how much easier would it be to have a group of like-minded individuals with that common goal of surviving? I mean, these guys survive and they survive for an extraordinary amount of time in my opinion, but it’s not for a normal lifetime. I mean, they’re there for 90 days. And when at the end of the 90 days, they look pretty ragged. I mean, a person can survive alone for a time, but you can see on Alone, on the show Alone, that it’s a pretty miserable existence. So that’s something that I think is so important to have people that can thrive.

And how about skills? I mean, I have medical skills, but I have very few tactical skills. For example, I probably couldn’t take a part in AR-15. I probably wouldn’t be very good in a firefight, but there probably are people that would be. And having people with skills that can complement each other would make for the possibility of the existence that could make a village.

Brett McKay: Yeah. Now we had an Alone contestant, a winner on the podcast a while back ago, Jim Baird.

Joe Alton: Oh, yeah.

Brett McKay: Him and his brother won. And one of the big takeaways from that conversation I had with him and also watching the season that he was on, on Alone, it was amazing to see how little tiny injuries could just devastate you. That actually ended people’s time on the show. You just, you sprang an ankle and then you’re done. Even having another person there, it wasn’t enough. You needed to have maybe two or three more people because that one person couldn’t do, you’re basically working for two people now and they just didn’t have the energy for it.

Joe Alton: Yep. [chuckle]

Brett McKay: Yeah. Okay. So have a community. What about personal health? What parts of your personal health should you have in order in order to be ready medically for a long-term grid down scenario?

Joe Alton: Well, what I hope people are doing now, I mean, eating a healthy diet, exercising, staying away as much as possible from addictive substances that wouldn’t be around in a grid down situation, like maybe alcohol or tobacco on top of that. And this is something that people are surprised to hear me say is that you should be using the high-tech available today to fix issues that would be a problem off the grid. I mean, if you have a bum knee, that’s not going to be very helpful off the grid and would certainly not increase your chances of survival. So see an orthopedic surgeon now, get it fixed. You have terrible vision, consider a LASIK procedure. For example, I had classic near sightedness blind as a bat. I got it done probably 30 years ago, probably one of the first people to get it. And now I have the eyes of an eagle, a very old eagle now, I’ll admit, but still.

Brett McKay: Okay. So yeah, get your health in order. So you’re ready for that scenario. So you talk about becoming a medical asset in your family. And when you’re a medical asset, it means you take on different responsibilities. You’re not just providing first aid, but there’s other roles you take on. We mentioned one of them. You’re sort of the chief sanitation officer of your family. Any other responsibilities that a medical asset needs to take on in order to take care of the healthcare of their family?

Joe Alton: Well, Brett, I mean, of course you’re the chief medical officer, but you’re gonna have to deal with a lot of other things too. You’re gonna have to deal with dental issues as well. Now, I’m not talking about a week without power due to a storm. I’m talking about a long-term scenario, a few months off the grid. And you’re going to wind up facing as many patients on a daily basis with dental problems as medical problems. And you’ll even have to extract a tooth now and then. 90% of dental emergencies in the past were treated that way. I’m not talking about Roman times. I’m talking about the early to mid 20th century. And you’re going to be responsible also for making sure we talked a little bit about water disinfecting. You got to make sure water is disinfected properly. Foods prepared and cooked thoroughly. Human waste is disposed of safely. These are things that are part of your job description. You’re also the chaplain. You may not have to deal with bullet wounds on a daily basis. I hope, at least I hope not, but you’re going to see anxiety and depression on a daily basis of some major disaster hits.

You need not only to be sympathetic and understanding, but you’re going to also have to be confidential as well. Nothing loses the trust of a group than a non-confidential medic, somebody that doesn’t keep people’s private things to themselves. Well, one other thing, you also actually going to be the quartermaster who decides when your limited supplies of medical items are dispensed. It’s not a committee decision. It should be the medic.

Brett McKay: You also have in here medical archivists. So you got to keep track of people’s issues.

Joe Alton: Yes, that’s right. That’s another thing. And that’s something you should probably do now. If you knew who was going to be in your extended family or in a mutual assistance group, you should probably interview them beforehand and keep everything of course, confidential, as I mentioned, and you should definitely learn what their medical issues are, what their family history is, what vices they might have. I mean, are they heavy smokers or do they drink a lot? And you should try to sort of steer them in the direction of getting healthier. And the fact that you would know what medicines, let’s say a person is on, would help you sort of encourage them to get more of these medicines, stockpile some of them so that you don’t have somebody with very high blood pressure showing up at your retreat with their last three days of blood pressure medicine and that’s it.

Brett McKay: Okay. So let’s get into skills and gear here. Do you recommend people like just a lay as an average citizen, take any sort of formal intensive training to get ready for a grid down disaster scenario when it comes to healthcare?

Joe Alton: I think a good start is just go through your municipality and see what courses that they have available. Many times they have free courses available for first responders or CERT members, Community Emergency Response Team members, other people that will be willing to volunteer in disaster settings. Sometimes they’ll have stop the bleed courses. Seek these out. And like I said, they might even be free. And there are, of course, a lot of wilderness first aid courses out there, a lot of companies that put forth these kinds of courses. You can find them online. I’m sure your experience may vary with them, I have to say. But all of these courses do prepare you to do what you need to do, stabilize and transport victims in normal times, but not so much for long-term care. So therefore, what I recommend to people is that when you take each class, think about what you would do if transport to a modern medical facility was not an option. What would you do with that particular individual, that particular sickness or that particular injury? And that’s the key is to have the right mindset and a plan of action in situations where you’re not going to be able to take that person to a higher medical asset.

Brett McKay: One of the most useful things that I’ve done, I really enjoyed it, too. I need to go back and do it again. I took like a first aid CPR certification class. It was done at one of the community colleges here in town. It was a couple hours, I believe. But not only did you do the CPR, but they just went over like basic first aid, what to do about burns, head injuries, big wounds. And I remember I learned a lot. But what I realized is that knowledge and like we actually practice some skills, like how to how to bandage things and things like that. But I realized that stuff, that knowledge and those skills, they degrade if you don’t use them. Like you have to constantly refresh yourself on it.

Joe Alton: You’re absolutely right. We teach wound care class and wound closure class. And I teach people how to suture close simple wounds and things like that. And more importantly, when to close a simple wound and when to leave it open and provide open wound care. And I always make sure I give people extra sutures to take home and they keep their instruments so that they can practice. Now, whether they all do or not, that depends. But you have to develop muscle memory for just about any of these things. And the more you do it, the more effective you’ll be at.

Brett McKay: Okay. So take some sort of class that’s out there. You can find different things out there, but as you do kind of keep in mind, well, how can I take this further and how would I apply this in a long-term grid down situation?

Joe Alton: It’s a mindset.

Brett McKay: Yeah. Let’s talk about medical supplies now. And you’ve got, I love this section because I love checklists. You have these checklists for different medical kits. You think people should start building up so they’re ready for that long-term situation. The first kit is an individual first aid kit. What are some of the things that you would recommend people keep in this individual first aid kit? So every person in your house or your group is going to have one of these, correct?

Joe Alton: Right. Ideally, you would want everybody in the group to have it. In the military now, everybody carries, every infantryman, for example, carries an IFAK kit and the medic carries a more advanced kit that allows him to put an IV in and things like that. But these guys will carry things like a tourniquet to stop bleeding, maybe a burn gel and dressings, elastic wraps to wrap orthopedic injuries, things like that. And I think that that would be a good start for a first aid kit. We have a number of kits on our store that we designed that are very compact, but they manage to deal with a number of different issues that are most commonly seen. So an individual first aid kit, I think for every member of the family would be good, especially in situations where you have to be on the road. So it just depends on the situation. Does your 10-year-old have to carry a first aid kit to school? No, probably not. But in a true long-term disaster situation, which is what I write about, this is something that everybody should have.

Brett McKay: Yeah. This is good just to have if you go on a hike or backpacking trip. I always carry one and it’s got things, band-aids, got Benadryl in there. We got pain relievers, so Tylenol, Advil.

Joe Alton: Right. Moleskine, things like that.

Brett McKay: Moleskine, things like that. And you also have, I thought it was in raw honey packets. What’s the raw honey packets for?

Joe Alton: Raw honey has actually very strong and actually accepted medically antibacterial properties. And so you can use raw honey for a number of things. And of course you can use it to treat hypoglycemia, low blood sugar cases, but you can also put it on burns and other injuries and it actually would have an antibacterial effect.

Brett McKay: That’s interesting. Alright, so that’s the first kit. Start building up a basic individual first aid kit. The next one is the vehicle kit. What’s the vehicle kit for and what kind of stuff are you keeping in that?

Joe Alton: Well, the vehicle kit is more extensive and it really allows you to carry things that you might not be able to carry. Like in other words, a sturdy pair of boots if you found yourself stranded in a blizzard or something like that. And you have to actually go somewhere, although of course it might be better to stay in the car. It has changes of clothes, it would have foldable, multi-tool, shovels, tow ropes, flares, rock saw, things that would help you in situations where you’re in your vehicle. And also it has more of every item.

And the reason why is because you’re not physically carrying this. And so you have the ability to deal with not only things, but do you deal possibly with multiples of things, more than one injury?

Brett McKay: Yeah, we got an article on the site about what to keep in your car. And people are like, that’s kind of a lot of stuff. Like, when would you ever use that? It can come in handy. So my dad, I remember it was this probably 30 years ago. He was driving from Oklahoma City to Albuquerque on I-40 and in the middle of the Texas panhandle. He got stuck in a blizzard, and he was in his car, I think, for a while. I mean, I think it was like a day, but it was well stocked. He had blankets and he had some stuff. And so he was able to ride it out until he’s able to get towed out.

Joe Alton: It’s something that can be a serious thing if you have to make the right decisions. There’s one guy who got stranded. He decided he was going to go for help, and they found him the next morning and he did not make it.

Brett McKay: All right, so the third kit is the family kit. You’re going to keep this at your home, or if you got a retreat somewhere, you’re going to keep it there. And this thing is massive. This was a lot of fun to look through because it’s so big. You break it up into different modules. So what sorts of modules do we have in this family kit?

Joe Alton: Well, of course, we talked about dental situations, so a dental module would be there. You would have, depending on the makeup of your group, you would have maybe a module for a delivery of a baby. You might have your surgical modules with the ability to do more extensive things like sewing some tendons together, things like that. A lot of daily wound care items, because this is something that you can easily do if you are able to stay in place.

Eye care modules, things like that, in case there’s foreign objects. And a lot of people, when they do activities of daily survival that they’re not really accustomed to, they can injure themselves. And so you could be chopping wood and you wind up getting a splinter in your eye. So we have the ability to deal with foreign objects that could get caught in your eye. Just a lot of different things. We’re beginning to get to kits that have hundreds of items. And indeed some of our biggest kits in our entire line will have hundreds of items in them.

Brett McKay: Yeah. One potential module you might have, if you’ve got small kids, a pediatric module. So you have… Make sure you have medications for them.

Joe Alton: Yes, exactly. So you have all sorts of stuff in these situations. You want to have maybe growth diaries, and then you can identify basically how well your young people are doing by, if they’re growing in a normal fashion. And so that’s something that they might have. You have a lot of different sized things, like a CPR mask for an infant would be different than a CPR mask for an adult, and blood pressure cuffs, things like that. So there are a lot of items that are sort of size differential.

Brett McKay: So the fourth kit is… This is if you’re going all in, you want to actually have a field hospital. What sorts of items are in this kit?

Joe Alton: Oh, boy, that’s… I got about 10 pages of…

Brett McKay: I’m looking at it right now.

Joe Alton: And each page has 50 items each. So, I mean, you would have everything from, gosh, biohazard suits to operating tables to… I mean, we’re talking about a real mash unit kind of deal.

Brett McKay: When would you want to do that? I mean, you have a question in the book that you try to answer, which is, how much is enough? When do you know? Well, yeah, maybe I’m good at the family kit and I don’t need to go field hospital.

Joe Alton: Well, I think that it’s probably very few people that will reach the point where field hospital is what they’re going to wind up being responsible for. So I think that people really just need to get the items that are going to be able to deal with the most common issues that they’ll expect to be confronted with. And what we have here, I mean we’re talking about medical…

I’m looking through my list right here because I don’t remember all 500 things that are on here, but we’re talking about automatic portable defibrillators, and we’re talking about oxygen concentrators and things like that. Things that you would need if you had… You would have to have some solar power, for example, to get enough power to, let’s say, do some oxygen concentration. These are some of these items that you’re going to need a little power. And if you’re ready to put together a field hospital, you will have taken power into account. So at least if it’s solar power.

Brett McKay: Another point you make, kind of a broader mindset point you have to take when it comes to medical care in a long term disaster scenario, is that you have to adjust your expectations of what’s possible in this situation. I think today we take it for granted. It’s like, well, if something happens to me, I just go to the doctor and I’ve got medicine. Or if even like a serious thing happens. It’s not so serious. There’s things we can do. I mean, I guess what I’ve read is that people are surviving gunshot wounds more often because our skill and technology has gotten better.

One of the points you make is that in a long term situation, long term disaster situation, the best you can do is maybe just make people feel comfortable and you might not be able to cure them. You have to be okay with that.

Joe Alton: We have to be very, very realistic about what can be done and what can’t be done. In an off grid situation, you can expect a gunshot wound to the abdomen or a gunshot wound to the chest to probably have a 70% death rate. And it’s a terrible thing to say and certainly not the case today with modern medical facilities, but it’s what’s going to happen. And if it’s not the actual trauma from the injury itself, it’s the chances for infection.

Again, remember, your skin is your armor, and so once you have breached that armor, you have that chance of infection.

Brett McKay: That brings up a point I want to talk about. In the book, you talk about how you can plant a garden with herbs and plants that have medicinal purposes. But what do you do about prescription medicines like antibiotics for infection? Is it possible to stockpile antibiotics?

Joe Alton: There are some companies that are beginning to offer, “emergency antibiotic packs” with a televisit, as long as you fill out an application and do a televisit. So these are becoming more popular. They’re just popping up now. And I believe that there’ll be a thriving industry in this probably in the next few years, or at least until the state medical boards get a hold of them.

Brett McKay: What about special medications like insulin? Say someone’s diabetic, is that tough to stop…

Joe Alton: Brett, insulin like that are basic insulins like regular and NPH are actually over the counter in most states these days. You can get them as you need them.

Brett McKay: We’re going to take a quick break for your word from our sponsors.

And now back to the show. We’ve talked about supplies, we’ve talked about getting some training, hoping we can talk about some specific skills here in a bit. But I want to turn to this idea of hygiene and sanitation, because if anyone’s read any history book about war, war up until the 20th century, really, most of the casualties came from poor sanitation. Men were dying of dysentery, cholera, things like that. In a grid down scenario, there might be a situation where you no longer have flushing toilets. So you have to think about human waste. So what do you do about human waste in a grid down scenario?

Joe Alton: Well, human waste should always be buried if you don’t have a toilet. Now, if you have a toilet, you have two gallons of water. Even if it’s wastewater, you can actually flush that toilet, if it’s the typical configuration of the toilet in your home today, by flushing two gallons of water into the toilet, and it will actually flush. But if you’re out, let’s say you’re on the road, you’ve been driven from your home, you’re on the road, human waste, you’re in a retreat in the forest somewhere. Human waste should be buried no closer than 200ft away from the main water source to prevent contamination.

And the medic, if you’re in a community, let’s say you’re the medic for an actual community, that you should have an idea of how to put together a community latrine. And so the dimensions would depend on the length of time, of course, that’s needed, and the number of people in your group. If you had a small group, an 18 inch wide by about 24 inch deep, several feet long, that probably would work pretty well. A longer trench in some kind of partition sheet. If your group is big enough to have more than one person using it at a time, and you keep the dirt from the trench that you dug in a nearby pile with a shovel, and that covers up the waste after each use. So that’s something that would be good for dealing with human waste.

But you’re absolutely right about the importance of sanitation. In the past, entire populations succumbed to diseases that cause diarrhea, leading to severe dehydration. You mentioned cholera and dysentery. Those can be very, very lethal. I mean, more soldiers in the civil war died of these issues than from bullets or shrapnel. So, again, this is probably the third or fourth time we’ve mentioned already, but the medicine has to strictly enforce water disinfection, proper food preparation, waste removal, and more, or infection’s gonna run rampant among other people.

Brett McKay: So here’s something I’m sure people may have thought about if they’ve kind of do these hypotheticals in the head of, like, a long term disaster scenario where you’re not gonna have access to the comforts of modern life for a long, long time. What if someone dies? What are you supposed to do with the body? ‘Cause, like 200 years ago, when someone died in your family, you knew what to do today, you call the funeral home and they take care of everything, so what are you supposed to do?

Joe Alton: This is something that most people have absolutely no idea what to do, and you have to figure out what to do with the body. The body should be placed in a body bag. These are currently commercially available, by the way, and some of them actually have handles to facilitate transport. But if you don’t have these, you can found items like plastic sheeting, bedsheets from abandoned homes. These are things that you can use. Choosing a place to bury them is important. I mean, it should be at least 200 to 250 meters. That’s about 800ft from any water that might possibly be used by the living. That’s very important.

But the funny thing is that if you can properly dispose of the dead body and in that type of location, it doesn’t have the ability… It doesn’t really cause major contamination of the environment. So that’s something that’s important to know.

Current grave guidelines suggest a depth of about five or 6ft. That’s 1.5 meters, and preferably that amount of space above the water table. In some places, that’s really difficult to achieve. Down here, our water table is like 6 inches below the ground. That’s why you see in this area, the older crypts are either concrete and they bury them in the ground, but they’re buried in concrete. Or if you go to places like New Orleans, you see that everybody’s buried above the ground.

Now, you also use something called quicklime, and that’s calcium oxide. It’s been used in burials for centuries, but people think that it’s being used to speed the decomposition of the body, but it actually preserves tissue, which is funny. So why is it useful? Because it actually eliminates odors that attracts flies and animals. And there’s actually a formula for that. 1 kg or 2.2 pounds of lime per 10 kilograms of body weight.

Brett McKay: So you mentioned dental issues. You might not think that you have to take care of a dental problem in a long term situation, but you would. I mean, what are some of the dental issues you think are treatable in a long term disaster scenario?

Joe Alton: Well, the grand majority of dental issues can be dealt with by extraction, as I mentioned earlier, including dental decay. You also need to learn how to fasten loose crowns, replace loose fillings, lost fillings, broken teeth, knocked out teeth, tooth abscesses, gum inflammation. These are all things that you can easily deal with, with the right materials, but you can definitely take care of dental decay. Lost fillings you could put together with clove oil, two drops of clove oil and zinc oxide powder will put together a hardening filling material, material type of cement that will last for a pretty good long time. And you can use it to fasten a loose crown. And of course, you need to have extractors. There are extractors for different types of teeth. And there are probably as many different types of extractors as there are different types of teeth.

Brett McKay: And of course, with dental care, an ounce of prevention is worth a pound of cures. You gotta take care of your teeth. Even in a grid down scenario, brush your teeth, floss, and avoid all the sugary foods. Don’t eat too much of that raw honey. Save that for the…

Joe Alton: Right. Save that for the hypoglycemic patients.

Brett McKay: So in this book, you cover lots of different medical care skills that you think someone might need to know in a long term situation. What do you think are, let’s say, five skills you recommend people prioritize learning, either because, they’ll be especially common or because they’re not the kind of things you’ll have time to consult a textbook or your book to figure out how to do it in an emergency.

Joe Alton: Oh, boy. Well, I have like 40 that I’d like you to know. But if I had to pick five, of course there’s a sexy, sensational stuff like how to stop bleeding. That is, of course, always very important. And there’s a whole stop the bleed apparatus nationally that will help you learn that. But we, of course, we talk about it in detail, and we also describe all the different tourniquets and things like that in our book. And they’re good. There are pros and cons.

You can also expect to deal with a lot of orthopedic issues, ankle sprains and things like that. Of course, there’s going to be respiratory infections. That’s going to be very, very common. Open wounds. You need to deal also how to deal with significant problems. I think the ability to use a flexible splint to treat a bunch of different issues, I think that’s a big skill. The use of cravat or bandana or triangular bandage. We have videos to show you how to use that in seven different ways for different things. I think those are good skills to have because they handle different issues. So I think that’s important.

And of course, as we mentioned before, maybe the most important skill to obtain is how to enforce preventative strategies against injuries and illnesses. And to do that, you have to actually get the knack of observing simple things, such as whether your people are dressed for the weather and enforcing the use of hand and eye protection during work sessions. I mentioned you can really save yourself a lot of headaches as a medic and maybe heartaches if you can keep these people protecting themselves and adequately dressed for the weather. I think that’s important.

Of course you want to be able to treat burns and you want to treat open wounds, and you want to be able to close a wound if you absolutely have to. But more importantly, you need to know when to close a wound and when to not close a wound because you can lock in some bacteria and could cause some major issues.

Brett McKay: Okay, so we got know how to stop a bleed, know how to use different splints for orthopedic bone breaks, sprains and things like that, knowing how to do preventative medicine, and then how to deal with wounds. On the wound issue, like how do you know if you should leave a wound open or close?

Joe Alton: Well, if a wound is obviously dirty, in which a lot of wounds will be, if you happen to be on the road and in a situation where you know you’re not in a controlled environment, your wound is going to be dirty. And so if it’s an animal bite, for example, it’s going to be dirty. And these days, in the emergency room, they’ll actually close some of these wounds, but off the grid, you should definitely not close them. You should treat them as an open wound and just make sure that you keep them clean.

And we talk about, in detail, the ability to perform that daily wound care. And that’s why I think that’s a very important thing to be able to know. And you have to be able to identify when a wound is not getting better and when you may need to break out that last course of antibiotics that you’ve been saving, because in the end, that could save a life.

Brett McKay: Can you superglue a wound shut? I’ve seen that. If you decide you can shut this wound, can you superglue it?

Joe Alton: Yes. I’ll tell you exactly how. Take superglue, and I want you to use the gel version of it. It’s much easier to handle than the liquid version. So take superglue gel and hold the skin together, the cut edges of the skin together, and apply a line of superglue gel on top of that, holding it together, wait for it to dry, and then take a second layer, put a line over the first layer, and then go around and around in an ever widening oval for a couple of layers, then hold that together and let that dry, and then do it one more time on top, and even a little wide, a more widened oval. And if you do that and allow that to dry properly between, then you should do okay… It should be okay.

And the good news is that we’ll have an even less chance of infection than if you close it almost any other way because of the sealing of the superglue. Now, if you don’t hold the skin together properly, you’re going to put superglue in between the two cut edges, and they’re not going to close. It’s something that you just have to do. You might practice on, make a cut in a pool noodle and try to practice with that until you get that right.

Brett McKay: In regards to tourniquet, I know tourniquet use can be controversial. People have really strong opinions about it. Anything people should take into account when they think, well, maybe I need to use a tourniquet here?

Joe Alton: Well, I’ll tell you that the committee on Tactical Combat Casualty Care has stated recently that if you know that you’re dealing with heavy bleeding, that the use of a tourniquet should be your first course of action. Normally they recommend direct pressure with your hands and with either gloved hands or a hand with a barrier between the wound and the hand, but some sort of cloth or something like that. But they’re saying if you know you’re dealing with arterial bleeding or the bleeding is just of a volume that is serious, then use that tourniquet as the first course of action.

And that is a departure from previous eras. And in World War I, they actually called it The Devil’s Instrument because a lot of people just left it on too long and wound up causing nerve damage or even amputation. But you can definitely keep a tourniquet on for a period of time, at least two hours without permanent damage.

Brett McKay: I mean, okay, so the idea of a tourniquet, you’re supposed to put that on there so you can get to professional medical help. What do you do if you have severe bleeding in a long term situation?

Joe Alton: What I would say is you would transport that person to where the bulk of your medical supplies are. And there is a way to transition from a tourniquet to a, let’s say a compression bandage that you can actually do. Now, in normal times, you want to just get that person to the hospital. But if you don’t have the ability to get somebody to a hospital, then you might just have to transition that tourniquet to a pressure dressing by itself. And if you do, then you want to use on the actual wound itself something called a hemostatic dressing. And a hemostatic dressing is impregnated with material like kaolin or chitosan. And this is a blood clotting material. And so what you do is you apply it directly on the bleeding vessel, and you hold it in place for three full minutes, and it actually will stop the bleeding, even arterial bleeding, if you apply pressure and do it for the right amount of time.

I actually was talking to somebody who was a follower of our website, and he was a purchaser for the Navy in Hampton Yards, and he talked about a study that they did in which they basically hung up a pig and they shot it with a 9 millimeter and severed its artery, its femoral artery. And so they used the quick clot material, which is a brand of hemostatic dressing, held the pressure on it, and it stopped the bleeding. And then what they did is they shot the other leg, and they took the dressing out, the hemostatic dressing out, and then put the hemostatic dressing in the second wound and actually stopped it the second time around.

So it is something that, if you know how to use these things, when you have the right materials, the right hemostatic dressings, you can actually stop the bleeding in, at least from the standpoint of the emergent bleeding.

Brett McKay: Related to this idea of bleeding like gunshot wounds, are there any special things you got to think about there?

Joe Alton: Gunshot wounds, of course, are going to be difficult to treat off the grid. You have to remember that there’s things that happen when there is a projectile that enters the body and it forms a permanent channel, which is where the bullet actually went, physically went through. That’s called permanent cavitation, but it also forms something called temporary cavitation. And temporary cavitation is a shockwave that occurs as a result of the bullet passing through with speed through the body. And so if you shot me just under my liver, for example, I would have a channel that went through the area just under my liver, but there would be liver damage, and I could bleed to death as a result of the temporary shockwave that went through and disrupted liver tissue.

Brett McKay: Okay, I’m sure everyone’s thought about this at one point. What do you do in the case of a nuclear disaster? Because I think people have heard about radiation sickness. Are there things you can do to mitigate that?

Joe Alton: Well, nuclear disasters, believe it or not, if you’re not standing at ground zero, you actually have a pretty good shot at surviving. In Hiroshima, they lost more than 100,000 people total to the bomb. But it was a city that included the military that was there at the time, had swelled to 450,000 people at the time of detonation. So you have a shot to survive this. In the early going, your goal is to prevent exposure, and you want to prevent exposure over 100 rads, let’s say. Rad is the amount of radiation that’s absorbed by a living thing. So you might want to have a radiation dosimeter, and that gauge is radiation absorbed. And it’s widely available online. You can find it anywhere. This item predicts the likelihood that you’re going to develop it. But there are three basic, different ways to decreasing the total dose of radiation.

One, limit time spent in the open. Radiation damage is dependent on the length of exposure. So leave areas where high levels are detected and no adequate shelter is available. That’s important. The activity of radioactive particles decreases over time, which is great. After 24 hours, the levels have dropped a 10th of their previous value or less. Then you want to increase the distance from the radiation source. A lot of this is common sense. Radiation disperses over distance. And the effects will be decreased in proportion.

Nuclear reactor meltdowns common evacuation patterns include a complete 10-mile circle. Or if you looked at the pattern, it looks like a keyhole or an old timey keyhole comprising of, let’s say, a two mile circle and an additional three miles radiation radiating from the direction of the prevailing winds. So that’s something that’s important to know.

And then shielding, shielding, shielding, shielding. Shield your people to decrease radiation where they are. In many cases, they’re going to have to shelter in place, and the shielding is going to decrease exposure exponentially. So it’s important to know how to construct a barrier between your people and the radioactive source. And denser materials will give greater protection. Now, let me talk about halving thickness for a second. When I say halving thickness, I’m saying H-A-L-V-I-N-G. Shielding effectiveness is measured in terms of this. This is the thickness of a particular material that will reduce gamma radiation, the most dangerous kind, by one half. And when you multiply halving thicknesses, you multiply your protection. So let’s say the halving thickness of concrete is 2.4 inches or 6 cm. So a barrier of 2.4 inches of concrete is going to drop between you and the radiation.

It’s going to drop the exposure by half. If you double that and make it 4.8 inches, it drops it to 1/4th, one half times one half. Tripling it drops it to 1/8th. And 10 halving thicknesses drops the total radiation exposure to one in 1024th. So if you’re in a concrete bunker that’s 24 inches thick, you are 10 halving thicknesses thick. And so you’re exposed to only 1/1024th of the outside environment. So that’s something that’s important. Now, treating radiation thickness. You treat them as you would burn patients. But once you’ve received four to 500 rads, however, there’s not too much that can be done. You either survive or you won’t.

Brett McKay: And there’s like a medication you take for your thyroid?

Joe Alton: Yes. Well, that’s a also protective thing. For one thing only. And that is thyroid cancer. And you would take… An adult would take 130 milligrams of potassium iodide once a day or 65 milligrams a day if you’re a child. And it’s very useful to prevent thyroid cancer down the road, then the people that are getting thyroid cancer from Chernobyl, those people were children when they were exposed. So if you have a limited amount of this, the brand is called Thyrosafe. We have it on our store. And this is something that you would only give… If you had limited amount, only give it to the kids.

Brett McKay: Gotcha. Well, Joe, this has been a great conversation. Where can people go to learn more about the book and your work?

Joe Alton: Well, we’ve written several books. The main one now is called The Survival Medicine Handbook: The Essential Guide for When Help is NOT on the Way. And it’s now in its fourth edition. You can find it in black and white on Amazon, in color and spiral bound versions at our site, at, along with an entire line of medical and dental kits for the serious medic in times of trouble. Now, our website at now has over 1500, 1500 articles, videos, podcasts and more on medical preparedness. We also have a YouTube channel called Dr. Bones, Nurse Amy. That’s a nickname of mine, Dr. Bones, that has about 300 videos. You also find my articles on the newsstand in Backwoods Survival Guide, Off Grid Recall, Backwoods Home, Prepper’s Survival Guide and other magazines in the homesteading and survival genres.

Oh, and on Facebook we have survival medicine, Dr. Bones, Nurse Amy groups. We have a group that’s 8000 strong there. You’ll get all my articles and videos on that too. Also have presence on PrepperNet and [0:47:03.0] ____.

Brett McKay: Fantastic. Well, Joe Alton, thanks for your time. It’s been a pleasure.

Joe Alton: Same here, Brett. Thank you so much for having me.

Brett McKay: My guest today was doctor Joe Alton. He’s the co author of the book The Survival Medicine Handbook. It’s available on You can find more information about his work at his website, Also check out our show notes at, where you can find links to resources where you can delve deeper into this topic.

Well, that wraps up another edition of the AOM podcast. Make sure to check out our website at where you find our podcast archives as well as thousands of articles that we’ve written over the years about pretty much anything you think of. And if you haven’t done so already, I’d appreciate it if you take one minute to give us a review on Apple podcast or Spotify. It helps out a lot. And if you’ve done that already, thank you. Please consider sharing the show with a friend or family member who you think would get something out of it. As always, thank you for the continued support. And until next time it’s Brett McKay reminding you to not only listen to AOM podcast, but put what you’ve heard into action.

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