Hypothermia and Frostbite

What is hypothermia?

  • Hypothermia is caused by prolonged exposures to cold temperatures. When exposed to cold temperatures, your body begins to lose heat faster than it’s produced. Lengthy exposures will eventually use up your body’s stored energy, which leads to lower body temperature.  Cold temperatures can be brought on by a number of factors such as ambient air, dampness, water, and wind exposure to name a few.
  • Body temperature that is too low affects the brain, making the victim unable to think clearly or move well. This makes hypothermia especially dangerous, because a person may not know that it’s happening and won’t be able to do anything about it.
  • While hypothermia is most likely at very cold temperatures, it can occur even at cool temperatures (above 40°F) if a person becomes chilled from rain, sweat, or submersion in cold water. Heat loss to air and water are the most common causes of hypothermia.

In fact, most cases of hypothermia occur when temperatures are between 30 and 50 degrees F. Windy conditions and wet clothes can work together to chill the unaware, even on a summer day. In water temperatures from 70-80 degrees, exhaustion or unconsciousness can set in within 3-12 hours; 60-70 degrees, 2-7 hours, and in water from 50-60 degrees, you could be unconscious in 1-2 hours.

Statistics

Each year there are approximately 700 to 1500 patients in the United States who have hypothermia noted on their death certificate. Adults between the ages of 30 to 49 are more likely affected, with men being ten times more likely than women. However, the true incidence of hypothermia is relatively unknown. Even with supportive in-hospital care, the mortality of those with moderate to severe hypothermia still approaches 50 percent.

Who’s most at risk?

Victims of hypothermia are often:

Symptoms of hypothermia

Adults and children:

  • Shivering (in the beginning shivering may be a sign of hypothermia, however it isn’t always present).
  • Exhaustion or feeling very tired
  • Confusion
  • Fumbling hands
  • Memory loss
  • Slurred speech
  • Drowsiness

Babies:

  • bright red, cold skin
  • very low energy

Hypothermia is a medical emergency. If you notice any of the above signs, take the person’s temperature. If it is below 95° F, get medical attention immediately!

If you are not able to get medical help right away, try to warm the person up.

  • Get the person into a warm room or shelter.
  • Remove any wet clothing the person is wearing.
  • Warm drinks can help increase body temperature, but do not give alcoholic drinks. Do not try to give beverages to an unconscious person.
  • Warm the center of the person’s body—chest, neck, head, and groin—using an electric blanket, if available. You can also use skin-to-skin contact under loose, dry layers of blankets, clothing, towels, or sheets.
  • Get the person proper medical attention as soon as possible.

A person with severe hypothermia may be unconscious and may not seem to have a pulse or to be breathing. In this case, handle the person gently, and get emergency assistance immediately.

  • Perform CPR, even if the person appears dead. CPR should continue until the person responds or medical aid becomes available. Keep warming the person while performing CPR. In some cases, hypothermia victims who appear to be dead can be successfully resuscitated.

How to prevent hypothermia

  • Dress in loose layers, allowing air trapped between clothing to maintain warmth
  • Make sure you are hydrated.
  • Eat sufficient calories to maintain body heat
  • If caught in an emergency situation don’t eat snow, it will drop your core body temperature. Only drink water or other liquids that are above freezing point
  • Small children (and elderly) may not be aware they are cold, always be aware of their clothing- hat, gloves, boots, dry warm socks are essential wear

Frostbite

What is frostbite?

Frostbite is a type of injury to the skin caused by freezing. It leads to a loss of feeling and color in the areas it affects, usually extremities such as the nose, ears, cheeks, chin, fingers, and toes. Frostbite can permanently damage the body, and severe cases can lead to amputation (removing the affected body part).

Who’s most at risk?

Those at risk for frost bite:

  • Have poor blood circulation
  • Are working outside in the cold
  • Are not properly dressed for extremely cold temperatures
  • Are exposed to a cold wind chill
  • People who have cardiac insufficiency, diabetes and stroke
  • Heavy alcohol consumption

What are the signs and symptoms of frostbite?

If you notice redness or pain in any skin area, get out of the cold or protect any exposed skin—frostbite may be beginning. Any of the following signs may point to frostbite:

  • A white or grayish-yellow skin area
  • Skin that feels unusually firm or waxy
  • Numbness to exposed area. Ears, nose, chin, hands, and feet are most at risk for frostbite

A person who has frostbite may not know they have it until someone else points it out because the frozen parts of their body are numb.

If you notice signs of frostbite on yourself or someone else, seek medical care. Check to see if the person is also showing signs of hypothermia. Hypothermia is a more serious condition and requires emergency medical care.

If (1) a person shows signs of frostbite, but no signs of hypothermia and (2) immediate medical care is not available, do the following:

  • Get the person into a warm room as soon as possible.
  • Unless absolutely necessary, do not walk on feet or toes that show signs of frostbite—this increases the damage.
  • Do not rub the frostbitten area or massage it at all. This can cause more damage.
  • Put the areas affected by frostbite in warm—not hot—water (the temperature should be comfortable to the touch for unaffected parts of the body).
  • If warm water is not available, warm the affected area using body heat. For example, you can use the heat of an armpit to warm frostbitten fingers.
  • Do not use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming. Affected areas are numb and can easily burn.

Don’t substitute these steps for proper medical care. Frostbite should be checked by a health care provider.

The following is an excerpt from the American Association of Dermatology:.

How to prevent frostbite

  1. Dress in loose, light, comfortable layers. Wearing loose, light layers helps trap warm air. The first layer should be made of a synthetic material, which wicks moisture away from your body. The next layer should be insulating. Wool and fleece are good insulators and hold in more body heat than cotton. The top layer should be windproof and waterproof. A down parka and ski pants can help keep you dry and warm during outdoor activities.
  2. Protect your feet and toes. To protect your feet and toes, wear two pairs of socks. The first pair, next to your skin, should be made of moisture-wicking fabric. Place a pair of wool or wool-blend socks on top of those. Your boots should also provide adequate insulation. They should be waterproof and cover your ankles. Make sure that nothing feels tight, as tight clothing increases the risk of frostbite.
  3. Protect your head. To protect your ears and head, wear a heavy wool or fleece hat. If you are outside on a bitterly cold day, cover your face with a scarf or face mask. This warms the air you breathe and helps prevent frostbite on your nose and face.
  4. Protect your hands. Wear insulated mittens or gloves to help protect your hands from the cold.
  5. Make sure snow cannot get inside of your boots or clothing. Wet clothing increases the risk of developing frostbite. Before heading outdoors, make sure that snow cannot easily get inside of your boots or clothing. While outdoors, if you start to sweat, cut back on your activity or unzip your jacket a bit.
  6. Keep yourself hydrated. Becoming dehydrated also increases the risk of developing frostbite. Even if you are not thirsty, drink at least one glass of water before you head outside, and always drink water or a sports drink before an outdoor workout. In addition, avoid alcohol, as it increases your risk for frostbite.
  7. Recognize the symptoms. In order to detect frostbite early, when it’s most treatable, it’s important to recognize the symptoms. The first signs of frostbite include redness and a stinging, burning, throbbing, or prickling sensation followed by numbness. If this occurs, head indoors immediately.

 

 

 

 

 

 

Traveling in cold weather- Are you prepared?

At 1PM Monday January 3rd, 2022, Senator Tim Kaine started his 2-hour commute from his Virginia home to Washington DC. This 2-hour commute turned into a 27-hour ordeal. A surprise blizzard, dumping about a foot of snow paralyzed both lanes of traffic on Interstate 55, causing hundreds of motorists to be stranded along one of the East Coasts busiest thoroughfares. Senator Kaine stated he had a warm coat and a full tank of gas.  He also stated he hadn’t had anything to eat except an orange that a family coming back from Florida was handing out from the box of oranges that they had picked up while vacationing.

Senator Kaine was in a highly traveled route, one where you would not expect that traffic could be at a standstill for over 24 hours. Luckily, no one needed medical care during this ordeal.  It could have turned out disastrous.

 

Moral of this story: A weather emergency can happen to anyone, anytime, anywhere.

Commuting, whether by car, bus, subway, train, or bike can have unexpected emergencies that can spell disaster for the unprepared.

Just because your travels take you through highly populated areas doesn’t make you immune to the perils of adverse weather events.

Winter travel can be life threatening, especially if you haven’t prepared.

In high rainfall areas flooding is common. Roads can be swept away from flood waters; rivers can overrun their banks. Mudslides can close roads. High winds can knock down power lines and tip over high sided vehicles. Fog limits visibility and can be treacherous. Avalanches are also a danger. While driving home 2 men were caught in an avalanche that buried their car. Luckily, they had cellphone service and were able to call for help.

Medical preparedness extends beyond what is in your medicine cabinet (which is important). In the case of cold weather, being prepared is essential.

At home you are in a much more stable environment compared to travel. Hopefully you have thought about what to do if your lights and source of heat are out for an extended time due to a weather event (ice storm, high winds, tornado, hurricane, etc.) If not, take a few minutes to note and make a list of what you may need. There are many lists and advice on the internet. So, I won’t go into too much detail. However, a home based medical supply list should include:

  • Basic first aid kit
  • Prescription medication and a way to prepare and take it
  • Flashlights with extra batteries (Headlamps are handy, it frees hands for other chores, especially in a medical emergency)
  • A safe way to stay warm (indoor safe propane heater, for instance)
  • Backup power for anyone on oxygen or cpap or other medical devices.

Even a last-minute trip to the grocery store before a storm can prove life threatening.

If you must drive in this weather there are some apps you can download to your phone  that could help you decide if, when and best route to take. These should only be used for areas with strong cell phone coverage. An essential item for anyone traveling in rural or spotty cellphone areas is the Garmin GPS. These devices were issued to staff at my place of employment when I worked in rural Idaho. These and devices like these are used by backwoods skiers, hikers, and rural workers. These devices use satellites and can send a SOS signal to whomever you set them up for, along with EMS services.

A few well thought out items can mean the difference between life and death when traveling. Not having a change of socks after stepping out of the vehicle to clear snow from the exhaust can lead to hypothermia. Know the signs of hypothermia and what to do.

Skipped medications can also be life threatening.

Action Plan:

Inventory your car, take note of what you have and what you need to get prepared. If your main source of travel is subway or bus, dedicate a small backpack to items necessary to wait out an emergency if transportation comes to a halt for an extended period of time.

Some travel items to include would be:

Note- if traveling on public transportation you won’t be able to carry all items listed, nor will you need to. A small pack with extra meds, drinks, food, and a flashlight may be all you need. Consider your own situation and take it from there)

  • Laminated maps of area traveling (If leaving area and unfamiliar with where you are headed)
  • GPS tracker
  • Cellphone with recharger and/or extra battery
  • A few days’ worth of medications and way to administer (insulin vial, syringe, etc.)
  • Snack bars and boxed juices, bottled water
  • Extra pair of socks, shoes, hats, and gloves
  • Hand warmers
  • Raincoat or poncho
  • Headlamp and flashlights with batteries
  • Basic first aid kit
  • If traveling with child still in diapers make sure have extra, plus wipes
  • Whistles with lanyard to signal for help
  • Extra blankets, sleeping bags, etc.
  • Tow strap
  • LED road flares
  • Shovel and small bag of kitty litter for under wheels stuck on ice

A few other considerations:

  • Let someone know where you are going, route and when expected to arrive.
  • Take into consideration passengers if traveling by car. Ages, needs, and if stranded for long period of time activities like color books, etc. for children.
  • Remember to always try to keep your gas tank at least half full. Even short commutes can turn treacherous. Inclement weather can cause gas shortages.
  • Top off windshield wiper fluid, use fluid rated for below freezing weather.
  • Avoid rushing to the grocer during weather events by keeping pantry well stocked.

 

Our Fragile Medicine Supply. Get Ready Now

Over the past two years we have been subjected to upheaval on every level of our lives. What we thought was stable, consistent, and taken for granted is not the case.

Unlike regional disasters the global pandemic is and will continue to affect every facet of life. To put it bluntly, our infrastructure is crumbling before our very eyes.

Everyday life has been affected on every level. Chip shortages which are used in the manufacture of computers, appliances and our vehicles are headline news. The transportation industry has taken a hit. Ports are clogged with ships waiting to unload goods. Illness has prevented workers from working in the agricultural fields and meat processing plants. Avian influenza (bird flu) has affected flocks in several states. In Kentucky alone 240,00 chickens tested positive and will be culled.

The global pandemic has affected our way of life.

Our dependence on other countries for our medications is often overlooked.

All one has to do is to look at the list of medication shortages facing our country right now. As of this writing there are 165 listed.

Our dependence on China and India for medicines

In July 2019 the U.S.-China Economic and Security Review Commission held a hearing on the United States’ growing reliance on China’s pharmaceutical products. In the discussion, Gary Cohn, then chief economic advisor to President Trump, argued against a trade war with China by invoking a Department of Commerce study that found that 97 percent of all antibiotics in the United States came from China. “If you’re the Chinese and you want to really just destroy us, just stop sending us antibiotics,” he said.

According to Dr Sakthivel Selvaraj, Director, Health Economics, Financing and Policy, at the Public Health Foundation of India (PHFI) New Delhi, India imports almost 80% of active pharmaceutical ingredients (APIs) and intermediates from China, which is huge and needs be reduced. These ingredients are used in the manufacture of over the counter and prescription medications. India imports these ingredients due to the fact the production cost is 20-30% less in China.

Some of the medicines India relies on Chinas API to manufacture are:

  • Paracetamol (Tylenol)
  • Ciprofloxacin (Cipro)
  • Metformin (Glucophage)
  • Acetylsalicylic acid (Aspirin)
  • Ofloxacin (Floxin)
  • Metronidazole (Flagyl)
  • Ampicillin (Antibiotic)
  • Amoxicillin (Antibiotic)
  • Ascorbic acid (A form of vitamin C)
  • Intermediates, on the other hand, are chemical compounds that are used in producing APIs.

In March 2020 India banned 26 drugs from export. A month later they lifted the ban on 24 of these drugs due to pressure from the U.S. At any time, a country could shut its export doors, due to political pressure, illness, transportation logistics, shortage of APIs or other reasons.

Will there be more medication shortages?

Given the fact that our dependence on vital, lifesaving antibiotics and other drugs is in the hands of other countries, until we can start to source and produce these medications in our country the outlook is very poor.

On a positive note: In August of 2021 the FDA approved a, USAntibiotics , based out of Bristol, Tennessee to produce two of the most widely prescribed antibiotics , Amoxicillin and Amoxicillin Clavulanate.

In addition, in response to the Cares act the National Academy of Sciences, Engineering and Medicine will conduct a study to examine the security of the medical product supply chain and provide recommendations.  This study and implementation will take time. Our infrastructure will need a major overhaul to implement this.

This is a step in the right direction, however

What can we do?

Action Plan

  1. Get out your notebook and go to your medicine cabinet. Pull out all your creams, drops, supplements and any other treatments you have. Write them down. Start with prescription medications first. Check the amount and refills you have left. If this is a medication for a chronic conditions (Diabetic, high blood pressure, etc.) Do you have enough to get you by for a few months if supply chain is disrupted or totally collapses? When is your next appointment to get these medications refilled? If you are running low contact your medical provider and ask for a few months stock to have on hand in case of supply disruption.
  2. How are your other medical supplies stocked? If you are low on antibiotic ointment, burn cream, bandages, get those stocked as well.
  3. Be prepared. A well-stocked medicine cabinet with emergency antibiotics is a step forward in the right direction. Antibiotics can treat many infections before they become life threatening: Strep throat, skin infections, travelers’ diarrhea, animal bites, urinary tract infections, ear infections to name a few.

Be prepared. The hard fact is that our supply chain is disrupted, and it isn’t coming back anytime soon.

Food and Health

(An often-overlooked medical prep)

If the past 2 years have taught us anything it is how fragile our supply chain is.

A well-stocked pantry offers so much security on many levels. Knowing that no matter what is going on in the world you are able to feed yourself and your family is peace of mind.

As food prices continue to climb will become increasingly necessary to take a look at your household’s food supply.

There are many freeze dried foods in #10 cans available for long term storage.   A simple review of the labels reveal many of these are not a good choice for populations with special dietary needs. Food allergies, high sugar content, etc.

Nutritional deficiencies lead to disease and illness

It is highly advised that you attempt to get nutrition from your food. However, in some instances a good quality vitamin supplement may be necessary. Consult your primary care provider for guidance.

The CDC website on nutrition and benefits of healthy eating is a good place to start to learn about nutrition and how food choices affect health.

Take out your notebook and write down all the people in your household.

Note the following:

  • Does anyone have special dietary needs?
  • Food allergies?
  • Diabetic?
  • Low sodium/ cardiac diet?
  • Kidney diet?
  • Low oxalate diet?
  • Difficulty swallowing or chewing?
  • Autism? (Some with autism have aversions to some food textures and tastes)
  • Any very young in the house?
  • Recent injury or surgery? The body requires more protein and vitamin C, along with minerals to repair and heal.
  • If you live in a warmer climate, do you have oral rehydration items stocked (Pedialyte, Gatorade, or better yet oral rehydration powder?)
  • Ample supply of juices, water, etc. for emergencies, such as low blood sugar in diabetic household members?
  • Do you have food and medication stocked for minor illnesses, such as diarrhea, nausea, constipation, allergic reaction to food or drink (hives, rash, etc.)?

 

Assessing each person’s diet, itemize your pantry. Are you able to provide the necessary diet with what you have stocked? Could you make a few adjustments in your food to accommodate everyone?

Also consider age and sex. An older woman will require less calories than a young man.

Children- they can be quite finicky. Do you have stocked foods that are shelf stable, nutritious and something they will eat?

Does anyone in your household have difficulty chewing or swallowing? If so, what accommodations can you have ready to make sure they are able to eat?

A well-stocked pantry takes into consideration all of the above, and also is nutritionally balanced.

Action plan:

  • Assess everyone in your households’ dietary needs.
  • Record in a notebook what your panty already has. For instance, if there is a diabetic in your home white rice may not be a good choice for them. However, white rice may offer a lot of readily available calories for someone working outdoors.
  • Make a menu for each person with special dietary needs. Start with a 3-day menu, then a week, 2 weeks, etc. Most menus can be rotated every 2 weeks. This makes meal planning much more manageable. The goal is to eventually have a years’ worth of healthy food stored.
  • Budget extra for your weekly/ monthly trip to the grocers to fill in the gaps.
  • When at grocer’s pick up extra items on your list to fill in the nutritional gaps. This may take several weeks to accomplish.
  • Store food in cool dark dry area
  • Itemize, date, and organize your food.
  • Rotate food.

 

Food preparation

Scratch cooking is often more inexpensive and nutritious than prepackaged meals. If you haven’t learned to cook this is a great time to learn. Involve all members of the household.

If you are lucky enough to know a good cook, ask them if they could teach you. If not there are some wonderful channels on You Tube that can help you get started.  A very popular You Tube channel– Mary’s Nest is a great channel to start with. She has many videos teaching how to transition to a traditional food’s kitchen on a budget.

Also, fermented foods, which are found in every culture of the world are an excellent source of vitamins and health promoting probiotics. They are easy to make and store well.

Microgreens, nutrition powerhouse

In addition, microgreens provide fiber, vitamins, and enzymes. Sprouting seeds, such as broccoli, alfalfa, mung beans, peas etc. are a fast, easy, inexpensive addition to your food supply.

 

Pneumonia

Pneumonia is an infection of the tiny air sacs of the lung called alveoli. Alveoli absorb oxygen from inhaled air. When alveoli become infected, they fill up with fluid, making transport of oxygen throughout the body difficult. Pneumonia can range in severity from a mild illness to a severe, even life-threatening illness.

2.56 million people died from pneumonia in 2017. Almost a third of all victims were children younger than 5 years, it is the leading cause of death for children under 5.  (after premature birth)

Phlegm in the lungs during pneumonia

Who gets pneumonia?

Pneumonia is a very common illness, which any person can develop. People more likely to get pneumonia include adults 65 years or older, children younger than 5 years old, people who smoke, people with ongoing health conditions, such as chronic obstructive pulmonary disease (COPD), diabetes, congestive heart failure, sickle cell anemia, or conditions that weaken the immune system, such as HIV/AIDS, cancer therapy, or organ transplantation. Pneumonia might also be more likely to occur after some kinds of lung injury – for example, after lungs have been damaged from breathing in chemicals.

How is pneumonia spread?

Some germs that cause pneumonia can spread through the air, by direct contact with an infected person, or by contact with contaminated objects. Some causes of pneumonia can come from the environment and can be spread in dust or other fine particles (e.g., water vapor). Some germs that cause pneumonia are not spread from person to person – for example, a person who loses control of breathing (e.g., during a seizure or while intoxicated) could vomit and then inhale stomach contents and bacteria into the lungs and develop pneumonia.

There are 3 types of pneumonia. Bacterial, viral and fungal pneumonia.

Bacterial pneumonia. Pneumococcal disease is caused by bacteria called Streptococcus pneumoniae and is the most common type of bacterial pneumonia. Other bacterial causes of pneumonia are Haemophilus influenzae, Mycoplasma pneumoniae Staphylococcus aureus (commonly found in healthcare settings), Chlamydia, Legionella species. Bacterial pneumonia is treated with antibiotic therapy. A vaccine is available for some strains of bacterial pneumonia.

Pneumococcus bacteria can cause infections in many parts of the body, including

  • Lungs (pneumonia)
  • Ears (otitis)
  • Sinuses (sinusitis)
  • Brain and spinal cord tissue (meningitis)
  • Blood (bacteremia)

Complications of pneumococcal pneumonia include:

  • Infection of the space between membranes that surround the lungs and chest cavity (empyema)
  • Inflammation of the sac surrounding the heart (pericarditis)
  • Blockage of the airway that allows air into the lungs (endobronchial obstruction), with collapse within the lungs (atelectasis) and collection of pus (abscess) in the lungs.
  • Walking pneumonia- Mycoplasma pneumoniae bacteria commonly cause mild infections of the respiratory system. The most common illness caused by these bacteria, especially in children, is tracheobronchitis (chest cold). Lung infections caused by M. pneumoniae are sometimes referred to as “walking pneumonia” since symptoms are generally mild. Sometimes M. pneumoniae can cause more serious lung infections that require care in a hospital.

Viral pneumonia cannot be treated with antibiotics. Antivirals are sometimes prescribed, along with symptom management. Common causes of viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19).

 NOTE: Secondary infection of bacterial pneumonia can happen after a person becomes ill with influenza or another virus. At that point, an antibiotic would be indicated. 

Fungal pneumonia is caused by the inhalation of spores and is difficult to diagnose. It is estimated that up to 20% of people infected are unaware they have it. It can sit latent for years, and sometimes resolve itself on its own. It is treated with antifungal medication. 

The signs and symptoms of pneumonia 

  • Cough, which may produce greenish, yellow, or even bloody mucus
  • Fever, sweating, and shaking chills
  • Shortness of breath
  • Rapid, shallow breathing
  • Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
  • Loss of appetite, low energy, and fatigue
  • Nausea and vomiting, especially in small children
  • Confusion, especially in older people

When to call the doctor

If pneumonia is suspected due to symptoms and the patient is under the age of 5 or immune-compromised or has other risk factors such as heart or lung disease, smokers, asthmatics, and diabetics call healthcare provider. Early detection can lead to reduced hospital stays can be lifesaving. 

Call your healthcare provider for the following symptoms if the above risk factors don’t apply:

  • Bluish tinge to lips, fingers
  • Difficulty in taking deep breaths 
  • Chest congestion which is painful when breathing 
  • Consistent fever of 102 or above degrees Fahrenheit 
  • A hacking cough which produces phlegm or pus 
  • A fever that resolves then comes back after a few days. This can be an indicator that a viral illness has a secondary bacterial pneumonia in addition to the virus. 

How are different types of pneumonia classified?

The various types of pneumonia are classified according to a number of characteristics. To treat these types, it’s essential to know whether somebody caught pneumonia at home, in a hospital, or in a nursing home.

Community-acquired and nosocomial pneumonia

If you develop pneumonia at home, it’s referred to as community-acquired pneumonia (or CAP for short), even if you are admitted to the hospital during the course of the illness.

If you develop pneumonia while in the hospital, it is called hospital-acquired (HAP for short) or nosocomial pneumonia. Pneumonia is considered to be nosocomial if it starts at least two days after you are admitted to the hospital, or within three months of a hospital stay.

Doctors can also classify pneumonia even more exactly, considering whether somebody became infected in a retirement or a nursing home, at a medical facility such as a dialysis center, or while receiving artificial respiration.

Why is classification important for the treatment?

Community-acquired pneumonia is usually caused by pneumococci, whereas nosocomial pneumonia is often connected with staphylococci, various intestinal bacteria, and special germs such as Pseudomonas aeruginosa. Some of those bacteria can be multi-resistant, meaning they are resistant to several antibiotics. That is why different antibiotics are usually needed then for treating community-acquired pneumonia.

Mild, moderate or severe pneumonia

To be able to provide the right treatment, doctors also classify community-acquired pneumonia as mild, moderate, or severe. 

Pneumonia is considered to be mild with no increased risk if the patient is:

  • is younger than 65 years old,
  • is conscious and lucid,
  • has normal blood pressure and pulse,
  • is not breathing too fast (fewer than 30 breaths per minute),
  • has enough oxygen in their blood,
  • has not been given any antibiotics in the past three months,
  • has not been in the hospital in the past three months, and
  • does not have any other severe medical conditions.

People with mild pneumonia can be treated at home and are given antibiotics or antivirals in tablet form.

Symptomatic treatments for mild pneumonia include:

  • Over the counter pain reliever reducers such as Tylenol, Advil or Aleve (Note: do not give aspirin to young children)
  • Expectorants to help thin out secretions and bring up phlegm
  • Avoid smoke and secondhand smoke
  • Use a humidifier
  • Steamy baths help open airways
  • Warm fluids, keep hydrated to thin secretions and bring up phlegm

Avoid cough suppressants unless recommended by your healthcare provider.

The signs of moderate pneumonia include drowsiness and confusion, low blood pressure, worsening shortness of breath, and risk factors such as old age and underlying diseases. People with these symptoms need to have treatment at a hospital. Some will be given a combination of two different antibiotics, at least at the beginning of the treatment.

Pneumonia is classified as severe when the heart, the kidneys or the circulatory system are at risk of failing, or if the lungs can no longer take in enough oxygen. Treatment with an antibiotic infusion in intensive care is then usually needed, sometimes with artificial respiration or additional drugs such as corticosteroids.

Pneumonia in children is only classified as either “not severe” or “severe.”

A word about phlegm/sputum

There seems to be confusion about the color of phlegm/sputum and what it means as far as the infection is concerned. Yellow or green phlegm or sputum can be indicative of an infection. However, viral bronchitis presents as green sputum as a normal feature as does bacterial load from those with COPD. Given the rising incidence of antibiotic resistance sputum or phlegm color should only be one of other symptoms associated with the initiation of antibiotic therapy. 

How can pneumonia be prevented?

How long can an infected person carry the germs that cause pneumonia?

Most people who are exposed to the germs that cause pneumonia do not become ill or develop only mild respiratory illness. Fewer develop pneumonia. How long a person can spread a respiratory germ depends on the type of germ and the treatment the person receives (antibiotic therapy, etc.) For some cases of pneumonia, such as influenza or tuberculosis individuals need to stay home until they are no longer contagious. Consult your primary health provider for guidance in these instances. 

Clean Water is Medical Preparedness

One of the most important medical preparedness items to store and have readily available is clean water. According to the CDC about 7.2 million people every year in the United States fall ill due to waterborne diseases. 

During or shortly after a natural disaster, such as a fire, earthquake, tornado, hurricane, or other inclement weather one of the first parts of the infrastructure that we rely on and fail is our public water supply. If the water supply is disrupted the risk for waterborne disease goes up. If this happens our toilets won’t function properly(if at all), our ability to cook, bathe and drink clean water is compromised. We lose the ability to sufficiently take care of our waste. This can lead to water contamination.

In 2014 in the United States, 17 waterborne pathogens caused an estimated 7.15 million illnesses, 601,000 emergency department visits, 118,000 hospitalizations, and 6,300 deaths. They incurred $3.3 billion in direct healthcare costs, which includes insurance and out-of-pocket payments.

Every year, more people die from unsafe water than from all forms of violence, including war.

In this article we will discuss:

  • Common waterborne pathogens that cause illnesses
  • How much water to store and how to disinfect water
  • Where to find containers to store water
  • Choosing a water filter
  • This week’s steps to take

Note this is not an exhaustive list, just a sample of waterborne pathogens)

Common waterborne pathogens that cause gastrointestinal symptoms, such as

 vomiting and diarrhea

(Please refer to “How to Treat Diarrhea” page)

  • campylobacteriosis
  • cryptosporidiosis
  • giardiasis
  • norovirus infection
  • Shiga-toxin producing Escherichia coli (STEC) infection O157
  • non-O157 STEC infection
  • salmonellosis
  • shigellosis
  • vibriosis (including infections caused by Vibrio alginolyticus, parahaemolyticus, vulnificus and other species)

Waterborne pathogens that cause respiratory symptoms:

  • Legionnaires’ disease
  • nontuberculous mycobacterial (NTM) infection
  • Pseudomonas pneumonia
  • Waterborne pathogen that causes skin infection
  • Pseudomonas septicemia

How much water to store and how disinfect water

(Taken from CDC website, along with notes and observations in italics)

  • Store at least 1 gallon of water per person per day for 3 days for drinking and sanitation
  • Try to store a 2-week supply if possible.
  • Note: My husband and I live in the mountains, our well was down for a few weeks. 1 gallon of water per person is not enough to sustain life and provide adequate hygiene. I recommend at least 2 gallons, preferably 3 per day for 2 weeks per person)
  • Consider storing more water than this for hot climates, pregnant women, and persons who are sick.
  • Diarrhea, vomiting, fever and other acute illnesses require increase liquid intake. Storing water after the fact makes no sense. Just be sure to have sufficient water supply on hand before an emergency or grid down situation.
  • Observe the expiration date for store-bought water.
  • Replace non-store-bought water every 6 months.
  • Or sanitize and purify the water before using it.

Store a bottle of unscented liquid household chlorine bleach (label should say it contains between 5% and 9% of sodium hypochlorite) to disinfect your water, if needed. Before filling with safe water, use these steps to clean and sanitize water storage containers: 

  1. Wash the storage container and rinse completely with water.
  2. Sanitize the container with a solution made by mixing 1 teaspoon of unscented liquid household chlorine bleach in 1 quart of water. Use bleach that contains 5%–9% sodium hypochlorite.
  3. Cover the container tightly and shake it well. Make sure the sanitizing bleach solution touches all inside surfaces of the container.
  4. Wait at least 30 seconds and then pour the sanitizing solution out of the container.
  5. Let the empty sanitized container air-dry before use OR rinse the empty container with safe water (water that has been treated).
  6. Pour clean water into the sanitized container and cover with a tight lid

Another way to sterilize water (but doesn’t remove chemicals) is solar sterilization. This method utilizes the UV sterilization effect from the sun. It is best done between the 15th and 35th latitude North and South (near the equator) Plastic or glass bottles are set out in the sun for a period of time. Check out the process here:

Where to find containers to store water

When my husband and I started our journey to medical preparedness and self-sufficiency we purchased 5-gallon blue water totes at our local Walmart. These can be found in the camping section of almost any box or sporting goods store. They are fairly inexpensive, store well, are sturdy, and can be moved easily (given the fact that water is very heavy this is a bonus) We now have water stored on our property in 55-gallon food-grade plastic barrels, along with several of these totes.

By the way, a popular item called a water BOB which is essentially a bladder you place inside your bathtub and fill with water. These can be found online. The advantage is that you fill these just before an anticipated event. The disadvantage is if the event is not anticipated you won’t be able to use these. 

Other ways to store water

I have sanitized and stored water in glass containers from food (think spaghetti sauce containers) we had consumed. Another way is to use empty, sterilized soda bottles. Used juice bottles with lids work, also. We keep a few gallons of water stored in juice bottles in our car for emergencies, also.

Swimming pools as a source of water

There has been debate over whether drinking swimming pool water in an emergency good practice is. I personally would still filter it for chemicals and organic matter. Or use it to wash clothing and dishes, etc.

Water Catchment system

Water catchment systems are a great way to capture and store water. However, not all states and municipalities allow this. I am a member of the ARCSA ( American Rainwater Catchment Systems Association. They have many free courses and guides on how to safely catch and store rainwater. I highly recommend this organization. They helped us with setting up a catchment system to water our gardens. Many cultures utilize this system for their primary drinking water. 

Choosing a water filter 

The topic of water filters is a vast one. 

When choosing a water filter be sure to choose one that can not only filter out bacteria but also chemical pollutants

I recently purchased the Lifestraw Flex  ( I found this link through REI and it is on sale right now) to store with my preparedness supplies. It removes bacteria, protozoa and reduces VOCs and chemicals.  It uses no electricity and has its own attached container.

Other water filtration systems that are highly recommended are the Berkey water system. This system is pricey and may be out of the reach for some. 

If you do an online search you will come across many ways to filter water from lakes, rivers, ponds, puddles. Charcoal with sand is another way to filter water. Here is a paper describing how to filter water from Utah State University

On a side note- putting together a port a potty and privacy tent is easy and stores in a small footprint. If your toilet isn’t working you will be glad you have this!

 You will need the following:

  • 5-gallon plastic bucket
  • Bags to line bucket
  • Baby wipes for cleaning
  • Hand gel 
  • Gloves to remove bags
  • Snap on toilet seat found in the camping section of any sporting goods store
  • There are products on the market that you can put in the bottom of the plastic bag for absorption and smell. We have used in the past cedar shavings. Baking soda works well, also. 
  • A pop-up shower tent for privacy
  • All the supplies except the tent can be stored in the bucket (just snap the seat on).

Clean water for drinking and hygiene is a necessity. It should be a priority when planning your medical preparedness kit. 

This week’s steps to take:

  • Take note of how much water you will need for your immediate household.
  • Plan for a water supply in your vehicle.
  • Decide on where the best place to store the water (preferably a cool, dark area)
  • Once you have done this, purchase or clean and repurpose containers to store adequate water. Be sure to label and date the containers.
  • Download the article on the management of diarrhea and place in your notebook.
  • Bonus step will be to put together the port-a-potty