For Clinicians | Off-Grid Health Care

A Guide to Medical Preparation When the System Fails (aka SHTF)

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Your patient has already Googled “SHTF medical” at 11pm. They didn’t bring it up at the visit because they don’t think you’ll know what to say. They might be right.

They are not alone. Behind every shortage story (saline, Adderall, Ozempic, amoxicillin liquid, the two weeks of hurricane evacuations that emptied a region’s pharmacies), patients are running a quiet clinical question through their head: “What’s reasonable to have on hand,…… just in case?”
Most of us were never trained to answer it. Yet, when we hedge, the prepper internet doesn’t. It tells them to buy fish antibiotics and trust no one. Our silence on the subject isn’t helping our patients: it’s giving them only extremes to turn to for answers.

Today we’re talking about this question. The category is appropriate medical preparation, sized to the disruptions families actually face, not a doomsday-world-is-ending scenario.

The framework breaks into five modules: medication, trauma and wound care, water and sanitation, power and continuity, and household-specific layers. A sixth, capability, makes the rest work or not.

Medication: chronic supply, contingency supply

This is where preparation actually starts, and where the bulk of the work is. The hurricane Katrina chronic-disease data is dated but still the cleanest evidence we have on what happens when a region’s pharmacies go offline, settles the question of priority. Of medications dispensed to evacuees in San Antonio, 68% were for chronic disease. Cardiovascular alone was 39%. The federal stockpile supplied 9%. Retail pharmacies covered 73%¹.

What we don’t really recognize here is that the patient’s own medicine cabinet is the primary line. Federal caches and DMAT formularies are backstops, not plans.

So the first tier is the chronic supply, patient-owned. A 90+ day on-hand supply of every prescription the household can’t go without, paired with a written list any pharmacist can act on (drug, dose, prescriber, pharmacy). You might object that this isn’t preparation, it’s just well-managed primary care. Yep. That’s the point. The category isn’t separate from primary care. It’s primary care that takes evacuation, supply chain disruption, and Friday-night closures seriously. Ready.gov anchors a 3-day baseline kit². Disaster medicine literature pushes 30 to 90 days for chronic meds³. What actually holds up in a big disaster is closer to 90 days to have on hand.

The trickier prescriptions to navigate are controlled substances. Schedules III through V are workable. During a governor’s declaration, pharmacists in most states can dispense an emergency supply (typically up to 30 days) without a new prescription on file⁵. Coverage varies by state but typically includes medications like benzodiazepines, tramadol, and codeine combinations, the prescriptions most likely to surface in a sheltered population.

Schedule II is the cliff. Stimulants and most opioids. A declared disaster does not, by itself, authorize a Schedule II refill. That takes a fancy, specific DEA waiver, and the waivers are inconsistent. We don’t endorse stockpiling. We also don’t have a clean way to tell a patient on a Schedule II to save some each month, because clinically that’s the opposite of how these medications are supposed to be taken. There is a gap. They should just know ahead of time, and so should we, that navigating this one is inherently just going to be very tricky.

The second tier is the contingency supply. The prescription half: short-course antibiotics, antifungals, rescue inhalers, oral rehydration salts, basic wound care. The OTC half: acetaminophen, ibuprofen, diphenhydramine, loperamide, antacids, electrolyte tablets, meclizine, loratadine, bismuth subsalicylate. The clinical logic for the prescription half is the same one telehealth platforms already use for the same conditions, with the same prescribing patterns and the same evidence base. The only difference is timing. Same medications, same standards, prescribed before symptoms arrive instead of after.

This is the gap JaseCase is built to close: amoxicillin-clavulanate, azithromycin, ciprofloxacin, doxycycline, metronidazole, a methylprednisolone dosepak, ondansetron, triamcinolone topical, plus the OTC backbone.

Trauma: bleeding control, wound care, burns

The medication layer is what you have when the pharmacy is gone. The trauma layer is about what you do in the minutes before EMS can get there. Hemorrhage is the only category of injury where a layperson can credibly outperform “wait for the ambulance,” and that’s the core of this section.

Stop the Bleed has been around long enough that most clinicians know the program by name, but the kit itself doesn’t follow most patients home. The core list is short and CoTCCC-vetted: a CoTCCC-listed windlass tourniquet, hemostatic-impregnated gauze (kaolin-based is the canonical mechanism), a 4 to 6 inch pressure dressing, nitrile gloves, trauma shears, and a permanent marker for time-of-application⁶. Skill-retention data argue for refreshing training every 1 to 2 years⁷. The fact that a tourniquet is in the kit doesn’t mean a patient knows when to reach for one.

That set, plus a pair of vented chest seals, a space blanket for hypothermia prevention, and a casualty card, is what separates a real household IFAK from a box of band-aids. NPAs and needle decompression are training-dependent. They belong in the kit when a household member has been trained to use them, and they don’t when no one has.

Most calls to use the kit aren’t going to be trauma though. They’ll be wound care, and the Wilderness Medical Society’s 2014 austere wound care guidelines are the cleanest reference⁸. Irrigate with at least 1 liter of potable or disinfected water at pressure (a 30 to 60 mL syringe with an 18 gauge angiocath does the job). No additives in routine wounds. Close clean, low-tension wounds within 8 to 12 hours, up to 24 for the face, with adhesive closure strips or tissue adhesive. Sutures and staples belong in trained hands, not a kitchen. Pack contaminated wounds open and watch them. AAFP evidence is clear that plain white petrolatum is equivalent to triple antibiotic ointment for routine wound aftercare, with less contact dermatitis and less selection pressure on resistant flora⁹. The kit version: petrolatum, non-adherent dressings, gauze rolls, adhesive strips, tissue adhesive, sterile gloves. Teach the household what infection actually looks like: spreading erythema, streaking, purulence, fever, increasing pain.

Burns are the injury most under-prepared for, and the field guidance has changed. The American Burn Association and the 2025 Annals of Emergency Medicine literature now support 20 minutes of cool running water (not ice, not butter) within 3 hours of injury, with measurably better outcomes¹⁰. Cover with a non-adherent dressing or plastic cling wrap. Hydrogel burn dressings are a field-acceptable third option per ABA, distinct from the older silver sulfadiazine cream that’s no longer first-line. The household version of “what to do with a burn” is simpler than what most of us grew up teaching: water, time, clean cover.

Splints, briefly. One 36-inch SAM splint covers the realistic home use case. Radiolucent, reusable, immobilizes wrist, forearm, ankle, and cervical spine when folded. Add a triangular bandage and a couple of ACE wraps. 

One frame to hold through the rest of this: kits scale with capability. A household with a trained member can credibly carry a higher-tier kit. The category is appropriate medical preparation, sized to capability.

Water and sanitation

Back to fundamentals here. In austere medicine, dehydration is the leading preventable cause of death, and sanitation failures drive much of the rest. The kit answer for both is cheap and simple.

Start with safe water. Ready.gov’s anchor is 1 gallon per person per day¹¹. Treat the source with whatever you have available. Boiling for 1 minute (3 minutes above 6,500 feet) is the gold standard. Unscented household bleach (5 to 9% sodium hypochlorite) works at 8 drops per gallon of clear water or 16 drops per gallon of cloudy water, 30 minute contact time¹². For filtration, the spec that matters is “≤1 micron absolute,” which screens out Giardia and Cryptosporidium; viruses still need chemical disinfection on top.

Then rehydration. The WHO low-osmolarity oral rehydration salt formula (75 mEq sodium, 75 mmol glucose, 20 mEq potassium, 10 mEq citrate per liter) is the standard¹³. Commercial ORS packets are cheap to stock; the home recipe in a pinch is 1 liter of clean water, 6 level teaspoons of sugar, and half a teaspoon of salt. One thing worth telling patients over and over again: adult sports drinks are not pediatric ORS. The sodium is too low and the sugar is too high to treat clinical dehydration in a child, and this really matters when the household has small kids and no power.

Infection prevention is the third leg, and it’s mostly about hand hygiene and a few pieces of PPE. CDC guidance: soap and water for 20 seconds, 60% alcohol hand rub as backup, nitrile gloves (not latex), N95 respirators for smoke and infectious exposure, household bleach for surface disinfection¹⁴. Gloves don’t replace handwashing. We all know to wash our hands. This is the reminder: scrub them, and scrub them well. As basic as it gets, and as load-bearing as anything in the kit.

Power, monitoring, documentation, communication

Four things beyond the supplies themselves. Power: durable medical equipment needs a backup plan. CPAP and BiPAP units run off a portable battery overnight; oxygen concentrators draw too much for that, and the answer is standby tanks, not bigger batteries.

The refrigerator is the harder problem.  I know you’re already thinking about insulin, because the idea of a disaster panics any diabetic patient. Insulin is stable at 59 to 86°F for up to 28 days unopened, per FDA emergency guidance⁴. Do not freeze. Use it warm before going without.

Beyond the insulin window, GLP-1 agonists run 14 to 56 days at room temperature depending on product (Ozempic 56 days at up to 30°C, Trulicity 14)¹⁵. Most injectable biologics fall in a similar window. The point a patient needs to hear in the office, before a hurricane forecast lands: check the package insert for the room-temp tolerance of their specific medication, pack a cooler with ice packs (not direct contact), and don’t freeze any of it.

Monitoring: a thermometer, a validated home blood pressure cuff, a glucometer for diabetics, and a pulse oximeter cover the household use case, with the FDA Safety Communication caveat that pulse-ox devices overestimate true saturation in darker-skinned patients¹⁶. Skip the otoscope; non-clinicians can’t reliably interpret what they see. 

Documentation: the patient’s kit should include a written med list with doses, an allergy list, photos of every pill bottle (the label itself is a functional clinical document), insurance and immunization records, an advance directive, and recent labs on a thumb drive. HIPAA doesn’t block emergency disclosure¹⁷. 

Communication: four pre-emergency setups worth pushing at a routine visit. Patient portal credentials stored somewhere accessible, the prescriber’s direct line saved, a regional telehealth fallback identified before the season, and a backup ER chosen if the usual system is overwhelmed.

Pediatric, mental health, household specifics

A generic kit doesn’t fit a specific household. Here’s a few specific populations who need specialized resources in an emergency. 

Pediatric. Weight-based dosing for acetaminophen, ibuprofen, diphenhydramine, and ondansetron printed on a card the household can read at 2am¹⁸. Pediatric ORS, not adult sports drinks. Ready-to-feed formula in any household with an infant; powder requires safe water that may not be available. Children’s medication doses can be improvised from adult bottles sometimes if truly needed, but beware your numbers: the math is the most common error in field pediatric care.

Mental health. Continuity of psychiatric medications is the under-discussed half of disaster planning. SSRIs, mood stabilizers, antipsychotics, and benzodiazepines: discontinuation syndromes and decompensation are the predictable failure modes when an evacuation runs longer than the on-hand supply. The Schedule II hardship from Module 1 lives here too; stimulants and opioids are the gap. Brief acute insomnia in a sheltered population is expected and self-resolves; eye masks and earplugs are kit items worth recommending.

Pregnancy. A pregnant patient needs an earlier evacuation trigger, a clean emergency birth kit, and prenatal vitamins added to the chronic supply per ACOG¹⁹.

Older adults on polypharmacy need indications named on the med list, not just drug names, plus spare hearing-aid batteries and glasses.

A dental emergency kit (Dentek temporary filling, clove oil, ibuprofen-acetaminophen combo) covers most field dental needs; antibiotics for systemic signs only, ER for swelling extending under the tongue or to the eye.

Capability, and the cliff

A kit you don’t know how to use is decoration. The previous five modules describe the contents of a household’s medical preparation; this one describes what makes that preparation actually work.

Capability is training. Stop the Bleed certification, a basic wound care class, comfort with the medications in the kit, a household conversation about who in the family knows what. Most of this is free or close to it. None of it gets done if we as the clinician haven’t said it out loud during a routine visit.

Which brings us to the cliff.

Patients are figuring this out themselves. They are Googling at 1am and going down Reddit rabbit holes. They are taking dosing advice from prepper forums because the clinical voices have stayed quiet. Healthcare’s collective response to “what should I reasonably have on hand?” has been to hedge or say, ‘you can’t have any prescription on hand ahead of time. That’s not responsible. You’ll be treated only after you need it”. 

The void doesn’t stay empty; somebody fills it.

The failure is at the category level. We never named the thing the patient was asking about, so we never built the framework for thinking about it. The category has a name now: appropriate medical preparation. The framework is the five modules above. The work is making sure the patients in our practices encounter our voice in this space before they encounter someone else’s.

A few of us are charting the grey area in public. We are publishing the criteria, the dosing thresholds, the kit composition, the indications, and the limits, week after week, so that what a curious patient finds when they search is a clinician’s framework rather than a forum’s. This is the work Jase exists to do. If you have patients asking the SHTF question and you want a clinically rigorous resource to point them to, we work with HCPs directly. The goal is not to sell to your patient. It’s to make sure your patient has the guidance of clinical help in this emerging area.

Sources

1. Greenough PG, Lappi MD, Hsu EB, et al. Chronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees. American Journal of Preventive Medicine. 2007;33(3):207-210. PubMed: 17826580.
2. Ready.gov, Build A Kit (3-day baseline). ready.gov/kit
3. Healthcare Ready, A Review of State Emergency Prescription Protocols; supporting disaster medicine literature on 30 to 90 day chronic-medication supply.
4. FDA, Information Regarding Insulin Storage and Switching Between Products in an Emergency.
5. DEA Pharmacist’s Manual; Healthcare Ready, Review of State Emergency Prescription Protocols (Schedule III through V emergency dispensing coverage varies by state).
6. American College of Surgeons / Stop the Bleed, kit composition and CoTCCC-listed contents.
7. Goolsby C, et al., skill-retention data on Stop the Bleed training (the underlying evidence base for the 1 to 2 year refresh recommendation).
8. Wilderness Medical Society, Basic Wound Management in the Austere Environment (2014 practice guidelines).
9. American Academy of Family Physicians, wound care evidence: petrolatum vs. triple-antibiotic ointment.
10. American Burn Association field guidance; Annals of Emergency Medicine (2025), Cool Running Water as a First Aid Treatment for Burn Injuries. PubMed: 40985917.
11. Ready.gov, Build A Kit (water anchor: 1 gallon per person per day). ready.gov/water
12. CDC, Making Water Safe in an Emergency; CDC water filtration guidance (the ≤1 micron absolute filter spec for Giardia and Cryptosporidium).
13. World Health Organization, Oral Rehydration Salts: Production of the new ORS.
14. CDC, Guidelines for Personal Hygiene During an Emergency; supporting CDC respiratory protection and wildfire smoke guidance for N95 use.
15. GLP-1 manufacturer prescribing information (Novo Nordisk for Ozempic, Eli Lilly for Trulicity, current US labeling).
16. FDA Safety Communication: Pulse Oximeter Accuracy and Limitations (2021, updated 2022).
17. ASPR-TRACIE, HIPAA and Disclosures in Emergency Situations fact sheet.
18. AAP pediatric dosing charts (acetaminophen and ibuprofen); Lexicomp Pediatric and Harriet Lane (diphenhydramine and ondansetron weight-based dosing).
19. American College of Obstetricians and Gynecologists Committee Statement No. 15 (January 2025): Preparing for Disasters: Addressing Critical Obstetric and Gynecologic Needs of Patients.