When Hospitals Will Be Impossible To Get To, What Meds You Want In Your Personal SHTF Pharmacy?

DISCLAIMER: Always consult a medical doctor before using any new medications, prescription or not. This information is intended to be used as a general guide of what types of medications would be most useful in a post-societal breakdown situation where there is no formal access to medical care, and you are forced to become your own doctor. In no way is this information intended to be formal medical advice, ergo I take no responsibility for what you do with this information after you read it – this does not substitute for medical school!

In any crisis event, you could be on your own for days… even weeks. Hospitals could be impossible to get to. In fact, if we have a bioterrorism attack, plague, or viral outbreak, going to a hospital could be even more dangerous than staying home.

Your town could be without running water for a month or more. No washing. No flushing toilets. No way to shower, clean dishes, or cleanse wounds.

Every year, poor sanitation kills more than 2 million people around the globe. We don’t see the effects of this very often in the United States, but in a real crisis, poor sanitation is deadly.

I was once asked what five drugs I’d want to have with me on a desert island if those and only those. At the time I wasn’t experienced enough in clinical practice to intelligently answer this question, but now reflecting back on this question I think I can come up with a half-decent list.

My Top Five Medications:

1. Antidiarrheal such as Loperamide: In the event that your water purification system fails or is expended, a water-borne disease will be a real life-threatening problem. It’s important to be cautious with the use of any antidiarrheal because it has the potential to cause a rare but serious complication of causing the intestines to be paralyzed. Also, be very cautious using this medication when there is blood in the stool because it can be a sign of a bacterial source (such as Shigella), which sheds a toxin that, in theory, if is kept in the intestines longer by promoting decreased bowel movements, will actually cause a longer duration of diarrhea, and hence more total water losses. If diarrhea sticks around for more than a few days, it’s prudent to start an antibiotic such as levofloxacin or azithromycin.

2. Antiemetic such as Zofran ODT or Phenergan: Our largest amount of potential water loss is not in urine – it’s in secretions from our GI tract. Luckily our colon when disease-free is efficient and absorbs most of these secretions before they can escape. However, if we’re suffering from some viral illness that’s causing us to vomit, all of the stomach and intestinal secretions will be lost because they never get a chance to reach the colon, hence my choice of an antiemetic for the same reason as the antidiarrheal – just preventing losses from the opposite end. The first line of trying to keep vomiting minimal is diet modification: dry bland foods such as crackers, rice, bananas, toast, in addition to very small portions or sips of electrolyte replacement solutions such as Pedialyte or a homemade solution (1L of water + 6 teaspoons sugar + ½ teaspoon salt, better to make a little more diluted than more concentrated which can be more harm than good). But when dry heaving prevents anything from staying down, I prefer using Zofran oral dissolvable tablets (ODT) which can be absorbed under the tongue, eliminating the need to swallow and keep it down for it to be absorbed. Phenergan is also a very good option if you can keep down a pill.

3. An antihistamine such as Benedryl: Great for multiple scenarios. One it’s great for allergic reactions, insect stings, bites, swelling, whatever type of thing activates an immune response it usually does the trick. It’s also used to help with sedation (which in a SHTF scenario, may prove very useful when trying to calm down enough to get some much-needed sleep). It can also be used to treat vertigo.

4. Antiinflammatory such as Aleve: This is a no-brainer. You’ve got so many potential uses for an NSAID such as this. It’s great as a mild-moderate pain reliever. It can be used to treat sore throats, arthritis, injury pain, and fevers. The reason I chose Aleve instead of Ibuprofen or Tylenol is that you only need to take this once every 12h. The only real downfall of this medication is that since it’s more potent, it is more prone to cause stomach ulcers with prolonged use, and you need to take food with it to minimize that risk. Now when it comes to medications that kids use I’m assuming you always have children’s Tylenol or Motrin on-hand already. Just remember Tylenol is the best for any age, but ibuprofen (Motrin) can only be used if the child is 6 months of age or older. Also, in pregnant patients, you only want to use Tylenol.

5. An antibiotic such as Levofloxacin or Azithromycin: This is a difficult one, but if I had to choose ONE antibiotic for adults it would be Levofloxacin (Levaquin) for its versatility and power. It can treat anything from pneumonia, skin infections, intra-abdominal infections, bacterial diarrhea, urinary tract infections, to anthrax (if god forbid it came down to biological terrorism). It’s a potent drug, and usually is quite safe to use but like any drug has some side effects to watch out for being renal dysfunction (common) and tendon rupture (rare). Azithromycin is an excellent choice as well since it can be used for strep throat, pneumonia, ear infections, mild skin infections, or sexually transmitted infections. A great strength of this drug is that it usually only requires a few days of treatment (3-5 days), meaning you can store a lot of this and then only need to give someone 3-5 pills to treat their infection, not exhausting your supply. Other antibiotics like amoxicillin are dosed 3 times a day for 10 days (30 pills) which is about 10 times more than you need to store.

Runners-up include the following:

1. Prednisone (excellent for any type of respiratory exacerbation related to asthma or emphysema. Epi-pen (especially if you or your family members have any type of severe allergy).

2. Albuterol (easy to store up since most docs will give you refills on this, and remember that even if you have young children, an inhaler is just as effective as a nebulizer, and as long as you get a spacer for the inhaler, you can store extra albuterol inhaler refills much easier and they last longer than the ampules of liquid albuterol.

3. Narcotics such as Vicodin, Norco, or Percocet that may be useful for an injured person that requires good pain control for a repair or relocation of a dislocated limb, reduction of a fracture, etc.

4. Ativan – same reason as the narcotic, but to help calm down in a very stressful situation, or to help sleep if the Benadryl does not cut it.

***Note: if you have a family member that is dependent on certain medications for chronic use (insulin, blood pressure meds, anticoagulants) then this is obviously a backup storage priority, and hopefully your doc understands the need to store these for emergency sake.

Lastly, my take on fish antibiotics is this:

If you have the ability to stock something up that is *nearly* the name (and sometimes identical) to the human analog, and were unable to acquire a comfortable amount of “human-grade” antibiotics, wouldn’t you want to be able to have SOMETHING to treat your son with when they started to develop a skin infection after hurting himself playing outside, or when your wife contracted bacterial diarrhea from drinking a contaminated water source?

Hence my opinion on that is pretty clear – in a SHTF world, where a simple infection may mean the difference between life and death unless you have the proper antibiotic to treat the infection, the risk of surely dying outweighs the risk of using antibiotics intended for aquatic use, and if I had the option of using them or watching helplessly as my family died, I would definitely use those “aquatic” antibiotics if our society broke down and access to medical care was non-existent.

Good luck with the preps and thanks for reading!