The Grim Reality of Survival Medicine in Austere Conditions

The Organic Prepper – by BCE

Several years ago, I wrote the following for a survival medicine book we had put together. I still think it provides a realistic view of the potential medical environment in a grid down or austere survival situation.  

From a healthcare standpoint, a post-SHTF world looks quite grim.

“With no antibiotics, there would be no treatment for bacterial infections; pneumonia or a simple cut could kill again, contagious diseases (including those sexually transmitted) would make a comeback, and high mortality rates would be associated with any surgery. Poor hygiene and disrupted water supplies would lead to an increase in diseases such as typhoid and cholera.

Without vaccines, there would be a progressive return in infectious diseases such as polio, tetanus, whooping cough, diphtheria, mumps, etc. especially among children. People suffering from chronic illnesses such as asthma, diabetes, or epilepsy would be severely affected with many dying (especially insulin-dependent diabetics).

There would be no anesthetic agents resulting in a return to tortuous surgical procedures with the patient awake or if they were lucky, drunk or stoned. The same would apply to painkillers; a broken leg would be agony, and dying of cancer would be distressing for the patient and their family.

Without reliable oral contraceptives or condoms the pregnancy rate would rise and with it the maternal and neonatal death rates, women would die during pregnancy and delivery again, and premature babies would die. Women would still seek abortions, and without proper instruments or antibiotics death from septic abortion would be common again. In the absence of proper dental care, teeth would rot, and painful extractions would have to be performed. What limited medical supplies available would have to be recycled, resulting in increased risks of hepatitis and HIV infection.”

Prepare for the worst, hope for the best.

While this might be just one extreme end of the spectrum, finding yourself in this sort of scenario is not impossible or even unlikely. Like most preppers and survivalists my view of the world is that it is extremely fragile. My personal driver is that we are rapidly approaching ‘peak’ everything – energy, food, population and money and that combined with a natural catastrophe or a man-made one could be enough to throw us back several hundred years.

I’m preparing for a worst-case/grid down scenario but I also accept that something shorter and of less impact is much more likely – but if you are prepared for the worst, then anything else will be a pushover! As Jack Reacher says (paraphrasing someone famous) – prepare for the worst, hope for the best.

For those of you that have read Tess Pennington’s book The Prepper’s Blueprint, she describes a layered approach to preparedness (One = the everyday disasters – power cuts, storms; Two = bigger disasters with medium-term effects – economic collapse, pandemics; three = a complete collapse of civilization)

There are layers to preparing for healthcare needs during disasters.

Within healthcare, a similar layered approach applies to knowledge and medication and equipment required.

  1. “The Everyday Disaster” – solid knowledge of first aid, low-level emergency medical care on the background of a still functioning but possibly delayed or impaired 999/911/000 system. This could be an earthquake or a Cyclone or Hurricane. You may have to provide some degree of extended care, but ultimately the system still works and help will arrive. A good first aid kit, a first aid course, and some common sense will see you through for the majority of medical problems. Some may still die from lack of access to health care, but most will not.
  2. “The Big Disaster” – moving towards self-reliance for medical care, self-prescription/medication, management of simple common emergencies and the availability of equipment and medication is still to a high standard to those that are prepared. There may or may not be some form of medical infrastructure offering support and a level of surgery and specialist services. The ‘have nots’ will likely have minimal health care, but those who have prepared will still have access to basic medical care. Examples of this might be a global economic collapse or a major pandemic but the key point here is that with knowledge and preparation you can still manage the majority of common health problems to a moderately high standard and an end will usually be in-sight.
  3. “The End of the World as We Know It” – absolute self-reliance for all healthcare. Once it is used up it’s gone. No resupply. DIY medications and supplies, wider use of botanicals. What you know and can do is what you have got – basically the scenario I opened with above. With food storage, we talk about always having a plan to make your food supply becomes self-sufficient in the long-term – because you can only store so much. It is the same for self-sufficient medical care – what is left with once all the medical supplies are used up and when there are no medical or nursing schools left to train health workers? What you know and what you can improvise, grow or manufacture will dictate the level of care you can provide.

Sometimes, a pragmatic approach is necessary.

My background is as an acute critical care doctor who has worked and taught extensively around austere medicine and medicine in remote environments for nearly 30 years and I have been writing about survival medicine for 20 years now.

What I write is always just my own opinions and ideas and you are welcome to not agree with me or think I am completely mad. Some of the things I teach and write about aren’t best practice in the modern world of medicine – but they are safe and pragmatic approaches to often-complex problems.

Any comments and ideas are put forward purely for interest and education and I wouldn’t expect you to take anything I say as gospel and you must verify medical facts for yourself, but hopefully, some of what I post will be useful and point you in the right direction.

Hopefully, over the next few months, I will contribute to Daisy some articles which address different aspects of medical care within these different layers, but I also hope to explore some of the philosophical and ethical issues surrounding them, which are an important consideration to Post-SHTF healthcare.

About BCE

BCE is a Critical Care doctor who has 25 years’ experience in pre-hospital, remote and austere medicine. He has been a prepper/survivalist for even longer and pessimistically thinks a grid-down long-term collapse is not far away. He is passionate about improving medical knowledge within the prepper community and he is currently working on a book about truly primitive medicine and improvisation. He lives somewhere south of the equator on a Doomstead in a (hopefully) quiet isolated part of the world.

He helped write and edit the book “Survival and Austere Medicine” which is available for free download at and from a number of other sites and for purchase from Lulu at

The Organic Prepper

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