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Be careful to draw the wound edges together only enough to control the bleeding and not to closely approximate them, as you want the wound to be able to drain easily. These are the wounds for which an ER doctor would probably give antibiotic prophylaxis, with an older drug such as doxycycline or trimethoprim-sulfa, or a cephalosporin such as cephalexin (Keflex). Crush wounds of the extremities also should not be sutured, even if they look awful, but should be cleaned as much as possible given the level of contamination and then bandaged. Because “crush wounds” can be expected to swell so much, primary closure could be detrimental.

In a situation in which it could be days before a medical professional would be consulted, you should know that sutures of the face and scalp should be removed in four to five days, lest the sutures themselves cause scarring. An uninfected facial wound should be healed in that time. Steri-Strips can be removed from the face at that time. For wounds of the upper extremities, leaving sutures in for seven to ten days is advisable, depending on the extent of the wound, and for the lower extremities up to two weeks. If Steri-Strips or tape have been used, they may need to be reapplied during that time period. Keeping the wound clean and dry is the goal, but if sutures are used to close the wound, it can be washed daily with soap and water after the first twenty-four hours. If a wound becomes obviously infected, with purulent (yellow or green) discharge, swelling, and redness, it will have to be opened up at least partially and allowed to drain to prevent septicemia.

Tetanus prophylaxis should also be addressed. Puncture wounds and deep, heavily contaminated wounds are considered tetanus-prone. The vaccine for tetanus has been used for several decades and is considered very safe if one is not allergic to any of the components, so keep your vaccination status for tetanus up-to-date.

The best way to avoid wound infection is to avoid the wound in the first place. Be careful. Make your children wear their shoes outside of the house. Lacerations from stepping on broken glass and puncture wounds from thorns or tacks in the feet are fairly common in the ER and are usually preventable. Accidents will happen to even the most cautious, but they will be proportionately less than to the heedless or reckless.

Extended Care of the Chronically Ill in TEOTWAWKI

When thinking through your plans for TEOTWAWKI, it is important to consider caring for chronically ill family members. Some of these issues can probably be foreseen, such as the need for photovoltaically powered CPAP (constant positive airway pressure) machines for sleep-apnea patients, and refrigeration of insulin. But other chronic conditions might arise after the onset of a crisis and are hence more difficult to anticipate and plan for.

Chronic Care

It may be difficult for us to confront the issue of care for the chronically ill, because it can seem so overwhelming. These issues demand our attention, our concerted planning, and considerable financial commitment. There is such a wide range of chronic illnesses and disabilities, and it is impossible to address them all, but I will mention a few of the most common disorders that will require advance planning:

Kidney Disease

In a grid-down situation, dialysis patients will be in trouble once the hospital backup generators run out of fuel. To see a loved one slowly dying because their blood is turning toxic would be absolutely heartbreaking. The best solution might seem extreme, but it might be your only option: Move to the Big Island of Hawaii, or to a natural-gas-producing region, or near a refinery in an oil-producing state. There are any number of different circumstances, including an EMP attack, wherein the continental-U.S. power grids will go down, but the lights will stay on in Hawaii. In Hawaii, each island has its own independent power-generation infrastructure.

Moving to a natural-gas-producing region (such as parts of Oklahoma, Arkansas, Texas, New Mexico, and several other