V.
A creature’s habitat is the place where it lives. This could be a forest, a lake, or the underside of a leaf. If you’re a human being, your habitat is likely a town. When you are in an environment that is not your own, careful planning is necessary to avoid running afoul of the elements.
The focus of your medical training should be general, but also take into account the type of environment that you expect to live in if a disaster occurs. Learn how to treat the likely medical issues for the climate in which you’ll find yourself.
Many aspects of climate can pose risk, especially extremes of ambient temperature. Humans are susceptible to damage as a result of being too cold or too hot. The body has various methods it uses to control its internal “core” temperature, either raising it or lowering it to appropriate levels. The body core consists of the major internal organ systems that are necessary to maintain life, such as the brain, heart, and liver. The remainder (skin, muscles, and extremities) is the periphery.
The body regulates its core temperature in various ways:
• Vasoconstriction. Blood vessels tighten to decrease flow to periphery, thereby decreasing heat loss.
• Vasodilation. Blood vessels expand to increase flow, thereby increasing heat loss.
• Perspiration. Sweat evaporates, causing a cooling effect.
• Shivering. Muscles produce heat by movements that create warmth.
• Exertion. Increasing work levels produce heat; decreasing work levels decrease heat.
Body temperature can also be regulated by adding or subtracting layers of clothing to match the environment.
Hypothermia is illness due to exposure to extreme cold. Hyperthermia, better known as heat exhaustion or heat stroke, is illness related to exposure to excessive heat.
Many environmental causes of illness are preventable with some planning. If you are in a hot environment, don’t schedule major outdoor work sessions in the middle of the day. If you absolutely must work in the heat, provide a canopy, hats, or other protection against the sun. Be certain that everyone arrives well-hydrated and gets plenty of water throughout. Expect each person to require 1 pint of water an hour while working in the heat. Failure to take the above precautions could lead to dehydration, sunburns, and increased likelihood of work injury.
Likewise, those in cold environments should take the weather into account when planning outdoor activities in order to avoid hypothermia issues, such as frostbite. Youngsters, especially, will run out into the cold without paying much attention to dressing warmly. Adults will often ignore the wind-chill factor. Drugs and alcohol may impair judgment and precipitate a cold-related event.
Part of the healthcare provider’s role is to educate each and every member of his or her family or group on proper planning for outdoor activities. Monitor weather conditions as well as the people you’re sending out in the heat or cold. If you don’t, your environment becomes a formidable enemy.
HEAT-RELATED EMERGENCIES
In the wilderness or after a natural disaster, you may find yourself without shelter to protect you from the elements. You are most likely to encounter hyperthermia (heat stroke), a common condition, in the heat of summer. However, even in cold weather, significant physical exertion in an overclothed and underhydrated individual could lead to significant heat-related injury.
The ill effects due to overheating are called “heat exhaustion” if mild to moderate, “heat stroke” if severe. Heat exhaustion usually does not result in permanent damage, but heat stroke does; indeed, it can permanently disable or even kill its victim. It is a medical emergency that must be diagnosed and treated promptly.
The risk of heat stroke correlates strongly to the heat index, a measurement of the effects of air temperature combined with humidity. Exposure to full sun increases the reported heat index by as much as 10–15 degrees.
Simply having muscle cramps or a fainting spell does not necessarily signify a major heat-related medical event. Heat cramps often occur in children who have been running around on a hot day. Getting them out of the sun, massaging the affected muscles, and providing hydration will usually resolve the problem.
A significant rise in the body’s core temperature is required to warrant a diagnosis of heat exhaustion. As many heat-related symptoms may mimic other conditions, a thermometer of some sort should be part of your medical supplies.
In addition to muscle cramps, fainting, or both, symptoms of heat exhaustion can include the following:
Confusion
Rapid pulse
Flushing
Sweating
Nausea and vomiting
Headache
Temperature elevation up to 105 degrees
If no action is taken to cool the victim, heat stroke may ensue. Heat stroke, in addition to all the possible signs and symptoms of heat exhaustion, can include the following symptoms:
Loss of consciousness
Seizures
Bleeding (seen in the urine or vomit)
Rapid and shallow breathing
If not dealt with quickly, shock and organ malfunction may ensue, leading to your patient’s demise. The skin is likely to be hot to the touch but dry; sweating might be absent. The body makes efforts to cool itself down until it hits a temperature of 106 degrees or so. At that point, thermoregulation breaks down and the body’s ability to use sweating as a natural temperature regulator fails. In heat stroke, the body core can rise to 110 degrees or more.
You’ll notice that the skin becomes red, not because it is burned but because the blood vessels are dilating in an effort to dissipate some of the heat.
In some circumstances, the patient’s skin may actually seem cool. It is important to realize that it is the body core temperature that is elevated. A person in shock may feel cold and clammy to the touch. This finding could mislead you, but simply taking a reading with your thermometer will reveal the patient’s true status.
Treat people suspected as having hyperthermia as follows:
• Get them out of the sun or other heat source.
• Remove their clothing.
• Drench them with cool water (and ice, if available).
• Elevate their legs 12 inches above the level of their heart (the position for treating shock).
• Fan or otherwise ventilate them to help with heat evaporation.
• Place moist cold compresses on their neck, armpits, and groin.
Why the neck, armpit, and groin? Major blood vessels pass close to the skin in these areas, and you will more efficiently cool the body core if you apply cold compresses there. In the wilderness, immersion in a cold stream may be all you have in terms of a cooling strategy. This is a worthwhile option as long as you are closely monitoring your patient.
Oral rehydration is useful to replace fluids lost, but only if the patient is awake and alert. Patients who are altered in mental status might “swallow” the fluid into their airways, which causes damage to the lungs.
You might think that acetaminophen or ibuprofen could help to lower temperatures, but this is actually not the case. These medications are meant to lower fevers caused by an infection, and they don’t work as well if the fever was not caused by one.
Wear clothing appropriate for the weather. Tightly swaddling an infant with blankets is a recipe for disaster in hot weather. Have everyone wear a head covering. A bandanna soaked in water, for example, would be effective against the heat. Much of the sweating we do comes from our face and head, so towel off frequently to aid in heat evaporation.
If you can avoid dehydration, you will likely avoid heat exhaustion or heat stroke. Work or exercise in hot weather (especially by someone in poor physical condition) will easily cause a person to lose body water content and become dehydrated. Carefully planning your outdoor work in the summer heat and keeping up with fluids is a major step in keeping healthy and avoiding heat-related illness.
COLD-RELATED MEDICAL ISSUES
Hypothermia
Hypothermia is a condition in which body-core temperature drops below the temperature necessary for normal body function and metabolism, which is 97.5–99.5 degrees.
The body loses heat in various ways:
• Evaporation. The body perspires (sweats), and as the perspiration evaporates, it cools the body.
• Radiation. The body loses heat to the environment anytime that the ambient (surrounding) temperature is below the core temperature. For example, you lose more heat if exposed to an outside temperature of 20 degrees than if exposed to 80 degrees.
• Conduction. The body loses heat when its surface is in direct contact with cold temperatures, as in the case of someone falling from a boat into frigid water. Water, being denser than air, removes heat from the body much faster.
• Convection. Convection is a form of heat transfer where, for instance, a cooler object is in motion against the body core. The air next to the skin is heated and then removed, which requires the body to use energy to reheat. Wind chill is one example of air convection: If the ambient temperature is 32 degrees, but the wind chill factor is at 5 degrees, you lose heat from your body as if the ambient temperature were actually 5 degrees.
The body, once it is exposed to cold, kicks into action to produce heat. The main mechanism to produce heat is shivering. Muscles shiver to produce heat, and this will be the first symptom you’re likely to see of hypothermia. As the condition worsens, more symptoms will become apparent if the patient is not warmed.
Aside from shivering, the most noticeable symptoms of hypothermia will be related to mental status: confusion, lack of coordination, and lethargy. As the condition worsens, speech may become slurred; the patient will appear apathetic and uninterested in helping themselves, or may fall asleep. This occurs because of the effect of cooling temperatures on the brain: the colder the body core gets, the slower the brain works. Brain function ceases at about 68 degrees, although I have read of exceptional cases in which people (usually children) have survived even lower temperatures.
Preventing hypothermia means anticipating weather conditions you may encounter and dressing appropriately. It may be useful to remember the simple acronym COLD, which stands for cover, overexertion, layering, and dry:
Cover. Protect your head by wearing a hat. This will prevent body heat from escaping. Instead of using gloves to cover your hands, use mittens. Mittens are more helpful than gloves because they keep your fingers in contact with one another. This conserves heat.
Overexertion. Avoid activities that cause you to sweat a lot. Cold weather causes you to lose body heat quickly, and wet, sweaty clothing accelerates the process. Use regular rest periods to self-assess for cold-related changes. Pay careful attention to the status of your elderly, juvenile, or diabetic group members.
Layering. Loose-fitting, lightweight clothing in layers insulates you well. Use clothing made of tightly woven, water-repellent material for protection against the wind. Wool or silk inner layers hold body heat better than cotton does. Some synthetic materials also work well.
Dry. Keep as dry as you can. Get out of wet clothing as soon as possible. It’s very easy for snow to get into gloves and boots, so pay particular attention to your hands and feet.
Travelers should anticipate the climate they will be traveling through, including wind conditions and wet weather. They should condition themselves physically to be fit for the challenge, travel with a partner, if at all possible, and have enough food and water available for the entire trip.
One factor that most people don’t take into account is the effect consumption of alcohol can have in cold conditions. While it may give you a “warm” feeling, alcohol actually causes your blood vessels to expand, resulting in more-rapid heat loss from the surface of your body. The body reacts to cold by constricting the blood vessels, so expansion would negate the body’s efforts to stay warm. Alcohol also causes impaired judgment, which, for example, might cause those under the influence to choose clothing that would not protect them in cold weather. This also goes for various “recreational” drugs.
If you encounter a person in a cold environment who is unconscious, confused or lethargic, you should always assume they are hypothermic until proven otherwise.
Immediate action must be taken to reverse the ill effects of hypothermia. Make sure to do the following:
Get the person out of the cold. If you’re unable to move the person, shield them from the cold and wind as much as possible.
Take off wet clothing. If the person is wearing wet clothing, remove them gently. Cover them with layers of dry blankets, including the head (leave the face clear). If you are outside, cover the ground to eliminate exposure to the cold surface.
Monitor breathing. A person with severe hypothermia may be unconscious. Verify that the patient is breathing and check for a pulse. Begin CPR if necessary.
Share body heat. To warm the person’s body, remove your clothing and lie next to the person, making skin-to-skin contact. Then cover both of your bodies with blankets. Some people may cringe at this notion, but it’s important to remember that you are trying to save a life. Gentle massage or rubbing may be helpful.
Give warm fluids orally. If the affected person is alert and able to swallow, provide a warm, nonalcoholic, noncaffeinated beverage to help warm the body.
Use warm, dry compresses. Use a dry warm compress and apply only to the neck, chest wall or groin. These areas will spread the heat much better than putting warm compresses on the extremities, which sometimes worsens the condition.
Avoid applying direct heat. Don’t use hot water, a heating pad or a heating lamp to warm the person. The extreme heat can damage the skin and causes strain on the heart.
If left untreated, hypothermia leads to complete failure of various organ systems and to death. People who develop hypothermia because of exposure to cold are also vulnerable to other cold-related injuries, such as frostbite and immersion foot.
Frostbite and Immersion (Trench) Foot
Frostbite, or the freezing of body tissues, usually occurs in the extremities and sometimes the ears and nose. Initial symptoms include a “pins and needles” sensation and numbness. Skin color changes from red to white to blue. If the color then changes to black, gangrene has set in. Gangrene is the death of tissue resulting from loss of circulation. This usually results in the loss of the body part affected.
Immersion foot (formerly known as “trench foot”) causes damage to nerves and small blood vessels from prolonged immersion in water. This condition appears similar to frostbite but might make the affected foot look more swollen.
Frostbite or immersion foot is treated with a warm-water (no more than 104 degrees) soak of the affected extremity. When treating these conditions, keep in mind the following:
Don’t allow thawed tissue to freeze again. The more often tissue freezes and thaws, the deeper the damage. If you can’t prevent your patient from being exposed to freezing temperatures again, you should wait before treating, but not more than a day.
Don’t rub or massage frostbitten tissue. Rubbing frostbitten tissue will result in damage to already-injured tissue.
Don’t use heat lamps or fires to treat frostbite. People with frostbite are numb and cannot feel the frostbitten tissue. Significant burns can ensue.
You can use body heat to thaw mild frostbite. You can put mildly frostbitten fingers under your arm, for example, to warm them up.
Cold Water Safety
Water doesn’t have to be cold to cause hypothermia. Any water that’s cooler than normal body temperature will cause heat loss. You could die of hypothermia off a tropical coast if immersed long enough. Two common situations where death from exposure occurs is when a boat capsizes or someone falls through ice.
Anyone traveling in a boat should do the following to protect against hypothermia in the event the boat capsizes:
Wear a life jacket. It can help you stay alive longer by enabling you to float without using a lot of energy and by providing some insulation. The life jackets with built-in whistles are best, so you can signal that you’re in distress.
Keep your clothes on. While you’re in the water, don’t remove your clothing. Button or zip up. Cover your head if at all possible. The layer of water between your clothing and your body is slightly warmer and will help insulate you from the cold. Remove your clothing only after you’re safely out of the water, and then do whatever you can to get dry and warm.
Get out of the water, even if only partially. The less percentage of your body exposed to cold, the less heat you will lose. Climbing onto a floating object will increase your chances of survival, even if you can only get part of your body out of the water. However, don’t use up energy swimming unless you have a dry place to swim to.
Position your body to lessen heat loss. Use the heat escape lessening position (HELP) to reduce heat loss while you wait for help to arrive. Just hold your knees to your chest; this will help protect your torso (the body core) from heat loss.
Huddle together. If you’ve fallen into cold water with others, keep warm by facing each other in a tight circle and holding on to each other.
What if you’re hiking in the wilderness and what looks like a snow field turns out to be the icy surface of a lake? Whenever you’re out in the wild, it makes sense to take a change of clothes in a waterproof container so you’ll have something dry to wear if you get wet. Also have a fire starter that will work even when wet.
You may be able to identify weak areas in the ice. If a thin area of ice on a lake is covered with snow, it tends to look darker than the surrounding area. Interestingly, thin areas of bare ice without snow appear lighter. Beware of areas of contrasting color as you’re walking.
Your body will react to a sudden immersion in cold water by an increased pulse rate, blood pressure, and respirations. It is important to do the following:
1. Keep calm. You have some time before you succumb to the cold.
2. Breathe in and bend backward to get your head out of the water.
3. Tread water and remove objects that weigh you down.
4. Turn in the direction you came from. The ice was strong enough there.
5. Spread your arms widely on the ice.
6. Kick your feet to get momentum, and try to lift a leg up onto the ice.
7. Once on the ice, roll in the direction you came from. Do not stand up!
By rolling, you are spreading your weight out, instead of concentrating it on your feet. Crawl away until you’re safe, and then work to get warm immediately.
ALTITUDE SICKNESS
In any survival situation, we might find ourselves having to relocate from a home at sea level to a retreat in the mountains. When this becomes necessary, it’s likely that you will be moving fast. The rapid change in elevation will, for some, cause altitude sickness, also known as “acute mountain sickness” (AMS). This condition occurs as a result of entering an area with lower oxygen availability and reduced air pressures without first acclimating oneself.
AMS occurs most commonly at elevations approaching 8,000 feet above sea level, and is aggravated by exertion. Although it is usually a temporary condition, some patients may develop complications in the form of “edema” of certain organs. Edema is the accumulation of fluid; in altitude sickness, it may occur in the lungs (pulmonary edema) or brain (cerebral edema). Either of these conditions can be life threatening.
Like many illnesses, the best strategy against AMS is prevention. Choose the route to your retreat so that the ascent is as gradual as possible. Do not attempt more than 2,000 feet of ascent per day. Ensure that your people do not overexert themselves as they ascend, and provide lots of fresh water. Avoid the consumption of alcohol on the way.
Some normal people may be susceptible to AMS at lower elevations than others. If you have no choice but to make a rapid ascent, you should closely monitor every member of your party. Patients will usually present with symptoms similar to a hangover. If mild, they commonly include the following:
Fatigue
Insomnia
Dizziness
Headaches
Nausea and vomiting
Lack of appetite
Tachycardia (fast heart rate)
“Pins and needles” sensations
Shortness of breath
In severe cases, you may see the following:
Severe shortness of breath
Confusion
Cough and chest congestion (not nasal)
Cyanosis (blue or gray appearance of the skin, especially the fingertips and lips)
Loss of coordination
Dehydration
Hemoptysis (coughing up blood)
Loss of consciousness
Fever (rare)
Treating AMS first requires rest, if only to stop further ascent and allow more time to acclimate. If available, a portable oxygen tank will be useful upon onset of symptoms. A diet high in carbohydrates is thought to reduce ill effects.
A medication commonly used for both prevention and treatment of AMS is acetazolamide (DiamoxTM). It has a diuretic effect, which means that it speeds the elimination of excess fluid from the body by urination. Usual dosages of acetazolamide are 125–1,000 mg a day, usually starting 2 days before the planned ascent.
In normal times, you should notify your physician that you are planning a trip into high elevations and would like to avoid altitude sickness. Usually, you will be given an acetazolamide prescription in case of emergency.
There is some evidence that gingko giloba may be helpful in the natural prevention of altitude sickness. A small amount of an extract of this substance has been shown to enable the brain to tolerate lower oxygen levels. For centuries, Native Americans have benefited from using gingko for AMS.
WILDFIRE PREPAREDNESS
Fire is one of nature’s ways to renew the land. Some seeds, such as those of the lodge pole pine, actually require fire to help them germinate. Despite the long-term beneficial effect to the forest, fire is an issue that presents a danger to the humans in it. Although wildfires may occur at any time of year, summertime in drought-prone areas is a particularly dangerous time.
One relevant strategy is vegetation management. Your goal is to direct fires away from your shelter, and there are a few ways to do this:
• Clear dead wood lying near your retreat. Keep woodpiles and sheds away from structures.
• Consider removing living vegetation from around your home. This might mean that you’d have to remove those thorny bushes you’ve planted under your windows for defense purposes.
• Have a shelter made of fire-resistant materials. A wood-frame home with wooden shingles will go up like a match in a wildfire.
So, let’s create a defensible space—an area around a structure where wood and vegetation are treated, cleared, or reduced to slow the spread of wildfire towards a structure. Having a defensible space will also provide room to work for those fighting the fire.
The amount of defensible space you’ll need depends on whether you’re on flat land or on a steep slope. Flatland fires spread more slowly than a fire on a slope. (Hot air and flames rise.) A fire on a steep slope with wind blowing uphill will spread quickly and produces spot fires—small fires that ignite vegetation ahead of the main burn because of small bits of burning debris in the air.
You’ll want to thin out thick-canopied trees near your house. This means any nearby tree within 50 feet on flat land or 200 feet if downhill from your retreat. Prune branches off below 10–12 feet high; trees should be separated by 10–20 feet. Also eliminate all shrubs at the base of the trunks.
Of course, once you have a defensible space, the natural inclination is to want to defend it, even against a forest fire. Unfortunately, you have to remember that you’ll be in the middle of a lot of heat and smoke. This would make it difficult unless you’re in full fire protection gear. The safest option, if there’s a way out, would be to leave.
If you’re leaving, have your supplies already in the car, as well as any important papers you might need to keep and some cash. If you have electricity, make sure you shut off any air-conditioning system that draws air into the house from outside. Turn off all appliances, close all windows, and lock all doors. Let others know where you’re going.
If there is any possibility that you might find yourself trapped in a fire, dress in long pants, a long-sleeved shirt, and heavy boots. A wool blanket is very helpful as an additional outside layer because wool is relatively fire resistant.
If you’re in a building, stay on the side of the building farthest from the fire outside. Choose a room with the least number of windows. (Windows transfer heat to the inside.) Stay there unless you have to leave because of smoke or the building’s catching fire.
If that’s the case, wrap yourself in that blanket, leaving only your eyes uncovered. Some people think it’s a good idea to wet the blanket first. Don’t. Wet materials transfer heat much faster than dry materials and will cause more severe burns.
If you’re having trouble breathing because of the smoke, stay low and crawl out of the building if you have to. There’s less smoke and heat the lower you go. Keep your face down towards the floor. This will protect your airway. Don’t forget to have some eye wash in your supplies, as smoke irritates your eyes.
If you encounter a person who is actually on fire, you have to act quickly. In circumstances where a person’s clothes are on fire, remember the old adage “stop, drop, and roll”:
Stop. The victim will be panicked and likely running around trying to put out the flames. This generates wind, which will fan the flames. Stop the victim from running away.
Drop. Knock the victim to the ground. If possible, wrap them in a blanket. Heavy fabrics are best.
Roll. Roll the victim on the ground until the flames are extinguished. Immediately cool any burned areas of skin with water.
Smoke Inhalation
Other than burns, which are discussed in another part of this book, you can become seriously ill or even die simply from inhaling too much smoke. Remember, you can heal from burns on your skin, but you can’t heal from burns in your lungs. Common causes of smoke inhalation injury include the following:
• Simple combustion. Combustion uses up oxygen near a fire and can kill a person simply from oxygen deficit, known as hypoxia. The larger the fire, the more oxygen it removes from the area, especially a closed space.
• Carbon dioxide. Some byproducts of smoke may not directly kill a person but could take up the space in the lungs that oxygen would ordinarily use.
• Chemical irritants. Many chemicals found in smoke can cause irritation injury when they come in contact with the lung. This amounts to a burn inside the lung tissue, which causes swelling and airway obstruction. An example from World War I is chlorine gas.
• Other asphyxiants. Carbon Monoxide, Cyanide, and some Sulfides may interfere with the body’s ability to use oxygen. Carbon Monoxide is the most common of these.
Symptoms may include the following:
Cough
Shortness of breath
Hoarseness
Upper airway spasm
Eye irritation
Headaches
Pale, bluish, or even bright-red skin
Loss of consciousness leading to coma or death
Your evaluation of the patient with smoke inhalation may show soot around the mouth, in the throat, and in nasal passages. These areas may be swollen and irritated. The victim will likely be short of breath and have a hoarse voice.
Of course, you will want to get your patient out of the smoky area and into an environment where there is clean air. You must be very careful not to put yourself in a situation where you are likely to succumb to smoke inhalation yourself. Always consider a mask before entering a conflagration to rescue a victim. Be prepared to use CPR if necessary.
It is important to have some way to deliver oxygen to your patient if needed. There are portable oxygen canisters that can get oxygen quickly into the lungs.
Don’t expect a rapid recovery from significant smoke inhalation. Your patient will be short of breath with the slightest activity and will be very hoarse. These symptoms may go away with time or may be permanent disabilities.
Planning escape routes and having regular drills will enable your people to get out of dangerous situations quickly. If everyone knows what to do in advance, you will save precious time.
STORM PREPAREDNESS
There are few people who haven’t been in the path of a major storm at one point or another. Most of those in the path of an oncoming storm will not have planned for its arrival. Some will even openly flaunt their disregard by seeking exposed areas. This is an instance where a lack of common sense can have dire consequences.
If you fail to plan ways to protect yourself and your family, you may find yourself having to treat significant traumatic injuries in the immediate aftermath. Loss of your shelter may expose your family to hypothermia or heat stroke. Later, flooding may contaminate your water supplies and expose you to serious infectious disease. Preparing to weather the storm safely will avoid major medical problems later on.
Tornado Preparedness
A tornado, or “twister,” is a violently rotating column of air that is in contact with both the surface of the earth and the thunderstorm (sometimes called a “supercell”) that spawned it. From a distance, tornadoes usually appear in the form of a dark funnel with all sorts of flying debris in and around it.
Tornadoes may have winds of up to 300 miles per hour and can travel for a number of miles before petering out. They may be accompanied by hail and will emit a roaring sound reminiscent of a passing train. It can be terrifying.
There are almost a thousand tornadoes in the United States every year, more than are reported in any other country. Most of these occur in “Tornado Alley,” an area that includes Texas, Oklahoma, Missouri, Kansas, Arkansas, and neighboring states. Spring and early summer are the peak seasons.
Injuries from tornadoes usually come as a result of trauma from all the flying debris that is carried along with it. Strong winds can carry large objects and fling them around in a manner that is hard to believe. Indeed, there is a report that, in 1931, an 83-ton train was lifted and thrown 80 feet from the tracks.
Although some places may have sirens or other methods of warning of an approaching twister, it is important to have a plan for your family to weather the storm. Having a plan before a tornado approaches is the most likely way you will survive the event.
If you see a twister funnel, take shelter immediately. If your domicile is a mobile home, leave! They are especially vulnerable to damage from the winds. Get to the nearest building that has a tornado shelter; underground shelters are best.
If you live in Tornado Alley, consider putting together your own underground shelter. Unlike bunkers and other structures built for long-term protection, a tornado shelter has to provide safety for a short period of time. As such, it doesn’t have to be very large; 8–10 square feet per person would be acceptable. Despite this, be sure to consider ventilation and the comfort or special needs of those using the shelter.
If you don’t have a shelter, find a place where family members can gather if a tornado is headed your way. Basements, bathrooms, closets, or other inside rooms without windows are the best options. Windows can easily shatter from impact because of flying debris.
For added protection, get under a heavy object, such as a sturdy table. Covering your body with a sleeping bag or mattress will provide an additional shield. Discuss this plan of action with each and every member of your family or group in such a way that they will know this process by heart. Children should be taught where to find the medical kits and how to use a fire extinguisher. If possible, teach everyone how to safely turn off the gas and electricity.
If you’re in a car and can drive to a shelter, do so. Although you may be hesitant to leave your vehicle, remember that they can be easily tossed around by high winds; you may be safer in a culvert or other area lower than the roadway.
In town, leaving the car to enter a sturdy building is appropriate. If there is no other shelter, however, staying in your car will protect you from some of the flying debris. Keep your seat belt on, put your head down below the level of the windows, and cover yourself if at all possible.
If you are on a hike and caught outside when the tornado hits, stay away from wooded areas. Torn branches and other debris become missiles, so an open field or ditch may be safer. Lying down flat in a low spot in the ground will give you some protection. Make sure to cover your head, if at all possible, even if it’s just with your hands.
Hurricane Preparedness
A hurricane is a large tropical storm with winds that have reached a constant speed of 74 miles per hour or more. In the United States, hurricanes regularly ravage the Gulf of Mexico and the East Coast, causing billions of dollars of damage. Unlike tornados, which can pop up suddenly, hurricanes are first identified when they are hundreds, if not thousands, of miles away. We can watch their development and have a good idea of how much time we have to get ready.
Hurricanes are categorized on the basis of severity, using the Saffir-Simpson Hurricane Wind Scale. Higher-category storms may cause incredible damage and loss of life, such as occurred in Hurricane Katrina in 2005. You will have to put together an effective plan of action with regards to shelter, food, power, and other important issues.
You may also have to make a decision regarding evacuation. Unlike some disaster scenarios, you can actually outrun one of these storms if you get enough of a head start.
If you live on the coast or in an area that has flooding, there will be rising waters (storm surge) that might be enough of a reason to leave. The authorities will issue an evacuation order in many cases. A municipality often will assign a hurricane-resistant public building in your own community as a designated shelter.
If you choose to leave town, plan to go as far inland as possible. Hurricanes get their strength from the warm water temperatures over the tropical ocean; they lose strength quickly as they travel over land.
In any case, have your supplies ready to go. Although most people pack for seventy-two hours off the grid, that number is relatively arbitrary; be prepared to at least have a week’s supply of food and drinking water, as well as clothes and medical supplies.
You should have an idea of what your home’s weak spots are. Since South Florida was devastated by Hurricane Andrew in 1992, new homes there must have the strength to withstand 125 mph winds. Most homes, however, are made to handle 90 mph. (Hurricane strength is 74 mph.) If the coming storm has sustained winds greater than that, you may not be able to depend on the structural integrity of your home.
If you decide to stay, make sure you designate a safe room somewhere in the interior of the house. It should be in a part of the home most downwind from the direction of the winds. Make provisions for any animals you will be sheltering and move all outdoor furniture and potted plants either inside the house or up against the outside wall, preferably secured with chains. Put up hurricane shutters if you have them. Flying debris can turn into missiles during hurricanes.
Indoor planning is important, as well. Communications may be out in a major storm, so have a National Oceanic and Atmospheric Administration (NOAA) weather radio and lots of fresh batteries. You will likely lose power, so fill up your gas and propane tanks early in every hurricane season.
As the storm approaches, you’ll want to fill up bathtubs and other containers with water. Turn your refrigerator and freezer down to their coldest settings, so that food won’t spoil right away if the power fails. Make sure you know how to shut off the electricity, gas, and water, if necessary.
There’s another kind of power you should be concerned about—purchasing power. In the aftermath of a storm, credit-card verification may be down; without cash, you may have no purchasing power at all.
Lost roof shingles are common after a hurricane, so have some waterproof tarps available. Repair crews are going to be busy after a major storm and might not get to you right away. In South Florida after Hurricane Wilma in 2005, there were still tarps on roofs more than a year later.
If you’ve hunkered down in your home during the storm, make sure that you’ve got books, board games, and light sources for when the power goes down. This will decrease anxiety and improve morale. Take time to discuss the coming storm in advance; this will give everyone an idea of what to expect and keep fear down to a minimum.
After the storm, inland floodwater may be polluted. Do not walk around in, drink, nor bathe in this water. Thorough sterilization is required. Do not eat food that has come in contact with floodwater; if unopened cans of food have been contaminated, wash them off with soap and hot water before opening.
Also, watch for downed power lines; they have been the cause of a number of electrocutions. You should never touch someone who has been electrocuted without first shutting off the power source; if you can’t shut off the power, you will have to move the victim. Use a nonmetal object, such as a wooden broom handle or dry rope. If you don’t, the current could pass through the individual’s body and shock you.
EARTHQUAKE PREPAREDNESS
Hurricanes are more significant for residents of the Gulf or East Coasts of the United States, but the West Coast and even some areas of the Midwest have their own disaster to worry about—earthquakes. Some populated areas are near fault lines, a fracture in a volume of base rock. This is an area where movements, or seismic waves, release energy that can cause major surface disruptions.
The strength of an earthquake is measured using the Richter scale. Quakes less than 2.0 on the scale may occur every day, but are unlikely to be noticed by the average person. Each increase of 1.0 magnitude increases the strength by a factor of 10. The highest registered earthquake was the Great Chilean Earthquake of 1960 (9.5 on the Richter scale).
If the energy is released offshore, a tsunami (tidal wave) may develop. In Fukushima, Japan, a powerful earthquake (8.9 on the Richter scale) and tsunami wreaked havoc in 2011, causing major damage, loss of life, and meltdowns in local nuclear reactors.
A major earthquake is especially dangerous because of the lack of notice given beforehand. Make sure each member of your family knows what to do, no matter where they are when an earthquake occurs. Unless it happens in the dead of night, it’s unlikely you will all be in the house together.
To be prepared, you’ll need, at the very least, the following:
• Food and water
• Power sources
• Alternative shelters
• Medical supplies
• Clothing appropriate to the weather
• Fire extinguishers
• Means of communication
• Money (don’t count on credit or debit cards being useful if the power’s down)
• An adjustable wrench to turn off gas or water
Figure out where you’ll meet in the event of tremors. Find out the school system’s plan for earthquakes so you’ll know where to find your kids. It would be appropriate to, at least, have some food, liquids, and a pair of sturdy, comfortable shoes to keep in your car in an emergency.
Especially important to know is where your gas, electric, and water-main shutoffs are. Make sure that everyone has an idea of how to turn them off if there is a leak or electrical short. Know where the nearest medical facility is, but be aware that you may be on your own; medical responders are going to have their hands full and may not get to you quickly.
Look around your house for fixtures, such as chandeliers and bookcases, that might not be stable enough to withstand an earthquake. Flat-screen TVs, especially large ones, could easily topple. Be sure to check out kitchen and pantry shelves.
What should you do when the tremors start? If you’re indoors, get under a table, desk, or something else solid, or get to an indoor hallway. You should stay clear of windows, shelves, and kitchen areas. While the building is shaking, don’t try to run out; you could easily fall down stairs or get hit by falling debris. Some recommend standing under a doorway but it turns out that most doorways aren’t any more solid than any other part of the structure.
Once the initial tremors are over, you can go outside. Once there, stay far away from power lines, chimneys, and anything else that could fall on top of you.
If you’re in your automobile when the earthquake hits, get out of traffic as quickly as possible; other drivers are likely to be less level-headed than you are. Don’t stop under bridges, trees, overpasses, power lines, or light posts. Don’t leave your vehicle while the tremors are active.
One issue to be concerned about is gas leaks; make sure you don’t use your camp stoves, lighters, or even matches until you’re certain all is clear. Even a match could ignite a spark that could lead to an explosion. If you turned the gas off, you might consider letting the utility company turn it back on.
Don’t count on telephone service after a natural disaster. Telephone companies only have enough lines to deal with 20 percent of total potential call volume at any one time. It’s likely all lines will be occupied. Interestingly, this doesn’t seem to include texts; you’ll have a better chance to communicate by texting than by voice because of the wavelength used.
ALLERGIC REACTIONS AND ANAPHYLAXIS
In a survival situation, you may have to vacate your home and head to the outdoors. In the process, you may expose yourself to insect stings, poison oak and ivy, and strange food items to which you aren’t accustomed. When your body reacts against a particular substance, we call it an “allergy.”
Allergens are foreign substances that cause allergies. Our response to them can be negligible or it can be life threatening. Anaphylaxis (or anaphylactic shock) is a severe reaction and can affect the entire body. If severe enough, it can be fatal.
Minor and Chronic Allergies
Mild allergic reactions usually involve local itching and the development of a patchy, raised rash on the skin. These types of reactions may go away by themselves or with medications, such as diphenhydramine (Benadryl).
Chronic allergies may manifest as a skin condition, eczema. This is a red, patchy rash in different places that is itchy and flaky. This type of rash usually responds well to 1 percent hydrocortisone cream, although sometimes a stronger steroid cream, such as clobetasol (prescription) may be necessary. The very worst cases may require oral steroids, such as prednisone.
If the allergic reaction is minor, there are various essential oils you can apply to relieve symptoms such as itching:
• Peppermint
• Lavender
• Chamomile (German or Roman)
• Calendula
• Myrrh
• Cypress
• Helichrysum
• Wintergreen
• Eucalyptus
• Blue Tansy
• Aloe Vera
To use the above oils, you would dilute 50/50 with olive or coconut oil; apply 2 drops to the affected area daily.
Hay Fever
Hay fever, also known as allergic rhinitis or seasonal allergy, is a collection of symptoms, mostly affecting the eyes and nose, that occur when you breathe in something you are allergic to. Hay fever may be triggered by dust, animal dander, insect venom, fungi, or pollens. Sufferers of allergic rhinitis can have the following symptoms:
• Nasal congestion
• Sneezing
• Red eyes with tearing
• Itchy throat, eyes, and skin
Antihistamines, such as Claritin and Benadryl, are old standbys for this type of allergy. Alternative therapies for hay fever include essential oils for use on the skin from the following:
• German chamomile
• Roman chamomile
• Lavender
• Eucalyptus
• Ginger
Apply 2 drops to each temple, 2–4 times per day. Alternatively, add 1 drop of the oil to a bowl of steaming water, covering the head with a towel and inhale slowly for 15 minutes. A number of teas to drink that may be useful are licorice root, stinging nettle, and St. John’s wort. Drink 1 cup daily 3 times a day.
Neti pot
A neti pot is a useful item to have to deal with allergic reactions affecting the nasal passages. It looks like a small teapot. With a neti pot, you can wash out pollen and clear congestion and mucus. Use with a sterile saline (saltwater) solution daily as follows:
1. Bend over a sink.
2. Tilt your head to one side.
3. Keep your forehead and chin at the same level to keep water out of your mouth.
4. Breathe through your mouth during the procedure.
5. Insert the spout gently into your uppermost nostril.
6. Pour the solution so that it drains through the lower nostril.
7. Blow your nose to clear your nostrils.
8. Tilt your head to the other side, and repeat with the other nostril.
Recently, there have been concerns about neti pots from the FDA. They warn that the pots are meant to be used with sterilized saline; in 2011, two people lost their lives to infections after using contaminated water.
Asthma
Asthma is a chronic condition that affects your ability to breathe. It affects the airways that transport air to your lungs. When people with asthma are exposed to an allergen, these airways become inflamed and swollen. This decreases the diameter of the airway, and less air gets to the lungs. As such, you will develop shortness of breath, tightness in your chest, and start to wheeze and cough (an “asthma attack”).
In rare situations, the airways can become so constricted that a person could suffocate from lack of oxygen. The following are some common allergens that trigger an asthma attack:
• Pet or wild animal dander
• Dust or the excrement of dust mites
• Mold and mildew
• Smoke
• Pollen
• Severe stress
• Pollutants in the air
• Some medicines
There are many myths associated with asthma, including the following:
• Asthma is contagious.
• Someone with asthma will grow out of it.
• If someone who has asthma moves to a new area, his or her asthma will go away.
And the following is true:
• Asthma may become dormant for a time, but the risk that it will return is always there.
• Asthma is hereditary. If both of a patient’s parents have asthma, the patient has a 70 percent chance of developing it, compared with only 6 percent if neither parent has it.
• Asthmatic symptoms may be different from attack to attack and from individual to individual.
The following are the main symptoms of asthma:
Cough
Shortness of breath
Wheezing (usually sudden)
Chest tightness (sometimes confused with a heart attack)
Rapid pulse rate and respiration rate
Anxiety
Besides these main symptoms, there are others that signal a life-threatening episode. A patient with asthma who has become cyanotic—has blue/gray color to their lips, fingertips, and face—is in trouble.
In severe asthma, it takes longer to exhale than to inhale. Wheezing may take on a higher pitch. A patient who has spent too much time without adequate oxygen will become confused, then drowsy, and then possibly lose consciousness.
To make the diagnosis, use a stethoscope to listen to the lungs on both sides. Make sure that you listen closely to the bottom, middle, and top lung areas. In a mild asthmatic attack, you will hear relatively loud, musical noises when the patient breathes. As the asthma worsens, less air is passing through the airways and the pitch of the wheezes will be higher and perhaps not as loud. If no air is passing through, you may hear no sounds at all.
You can measure how open the patient’s airways are with a simple diagnostic instrument, the peak-flow meter. By having a patient forcefully exhale into it, you can identify whether his or her cough is part of an asthma attack, or whether they are having a panic attack instead, which can have some of the same symptoms.
Take a baseline peak-flow measurement when the patient is well. With moderate asthma, peak flow will be reduced 20–40 percent. Greater than 50 percent is a sign of a severe episode. With a cough that is not related to asthma, or upper respiratory infection, the peak flow will be close to normal. The same goes for a panic attack; despite shortness of breath, the peak flow is still about normal.
The cornerstones of asthma treatment are avoiding allergens that trigger attacks and maintaining open airways. Medications come in one of two forms: drugs that give quick relief from an attack, and drugs that control the frequency of asthmatic episodes.
Quick-relief drugs include inhalers that open airways (known as bronchodilators), such as Albuterol (Ventolin, ProventilTM). These drugs should open airways quickly and give significant relief. Don’t be surprised if you notice a rapid heart rate in patients on these medications; it’s a common side effect.
Patients who use quick-relief asthmatic medications more than twice a week are candidates for daily control therapy. These drugs work (when taken daily) to decrease the number of episodes and are usually some form of inhaled steroid. They may be in the form of pills or inhalers. Remember that inhalers lose potency over time. An expired inhaler, unlike many pills or tablets, will lose potency relatively quickly.
It’s important to figure out what allergens trigger a patient’s asthma attacks and work out a plan for avoiding them as much as possible. Furthermore, make sure to stockpile as much asthma medication as possible in case of emergency. Physicians are usually sympathetic to requests for extra prescriptions from their asthmatic patients.
Mild to moderate cases of asthma can be helped with the use of natural remedies. There are actually quite a few substances that have been reported to be helpful.
With a number of these substances, further research is needed to corroborate how much these affect severe asthma, so take standard medications if your peak flow reading is 60 percent of normal or less.
Don’t underestimate the effect of your diet. To improve your diet and ease your asthma, try the following:
• Replace animal proteins with plant proteins.
• Increase intake of omega-3 fatty acids.
• Eliminate milk and other dairy products.
• Eat organically whenever possible.
• Eliminate trans fats and instead use extra-virgin olive oil as your main cooking oil.
• Always stay well-hydrated; drinking fluids will make your lung secretions less viscous.
Finally, various breathing methods, such as taught in yoga classes, are thought to help promote well-being and control the panic response seen in asthmatic attacks.
Natural Remedies for Asthma
Ginger and garlic tea. Put four minced garlic cloves in some ginger tea while it’s hot. Cool it down and drink twice a day.
Other herbal teas. Ephedra, coltsfoot, codonopsis, butterbur, nettle, chamomile, turmeric, and rosemary all have the potential to improve an asthmatic attack.
Coffee. Black, unsweetened coffee is a stimulant that might make your lungs function better when you are having an attack. Don’t drink more than 12 ounces at a time, as coffee can dehydrate you.
Eucalyptus. Use in a steam or direct inhalation to open airways. Rub a few drops of oil between your hands or in steaming water and breathe in deeply.
Honey. Breathing deeply from a jar of honey should improve breathing in a few minutes. To decrease the frequency of attacks, stir 1 teaspoon of honey into a 12-ounce glass of water and drink it 3 times daily.
Licorice and ginger. Mix licorice and ginger (½ teaspoon of each) in a cup of water. Warning: Licorice can raise blood pressure.
Mustard oil rub. Mix mustard oil with camphor and rub it on your chest and back.
Vitamin D. Some asthmatics have been diagnosed with vitamin D deficiency.
Anaphylactic Reactions
In a small percentage of people, an immune response to an allergen may affect more than just a local area. Severe allergic reactions involve various organ systems and can be quite dangerous.
Anaphylactic reactions were first identified when researchers tried to protect dogs against a certain poison by desensitizing them with small doses. Instead of being protected, many of the dogs died suddenly the second time they got the poison. They were killed by their own immune systems going out of control.
The following are proven causes of anaphylaxis:
• Drugs—dyes injected during x-rays, antibiotics (such as Penicillin), anesthetics, aspirin and ibuprofen, and even some heart and blood pressure medicines
• Foods—nuts, fruit, and seafood
• Insect stings—bees and yellowjacket wasps
• Latex—rubber gloves made of latex
• Exercise—often after eating
• Idiopathic—meaning “of unknown cause”
It’s important to recognize the signs and symptoms of anaphylaxis, because the faster you treat it, the less likely it will be life threatening. They include the following:
Rashes. This often occurs at places not associated with the actual exposure, for example, an all-over rash in someone with a bee sting on the arm.
Swelling. This can be generalized, but sometimes isolated to the airways or throat.
Breathing difficulty. Wheezing is common, as in asthmatics.
GI symptoms. These can include diarrhea, nausea and vomiting, or abdominal pain.
Loss of consciousness. The patient may appear to have fainted.
Paresthesias. This can include strange sensations on the lips or oral cavity, especially with food allergies.
Shock. Blood pressure drops, respiratory failure leading to coma and death.
Fainting is not the same thing as anaphylactic shock. You can tell the difference in several ways: Someone who has fainted is usually pale in color, but a patient in anaphylactic shock will often appear somewhat flushed. The pulse in anaphylaxis is fast, but a person who has fainted will have a slow heart rate. Most people who have just fainted will rarely have breathing problems and rashes, but these will be common signs and symptoms in an anaphylactic reaction.
With food allergies, victims may notice the effects occur very rapidly; indeed, their life may be in danger within a few minutes. People who have had a serious anaphylactic reaction should be observed overnight, as there is, on occasion, a second wave of symptoms—sometimes several hours after the exposure.
A major player in this cascade of anaphylaxis is histamine, which triggers an inflammatory response. Medications that counteract these ill effects are known, therefore, as antihistamines. These drugs may be helpful in mild allergic reactions. In tablet form, antihistamines such as diphenhydramine (Benadryl) take about an hour to get into the bloodstream properly.
In an anaphylactic reaction, this isn’t fast enough to save lives. If it’s all you have, chew the pill to get it into your system more quickly. It still, however, may not be enough. As such, we look to another medicine that is more effective: adrenaline, known in the United States as epinephrine.
Adrenaline (epinephrine) is a hormone that is produced in the adrenal glands, small organs near the kidneys. Epinephrine makes your heart pump faster, widens the air passages so you can breathe, and raises your blood pressure. The hormone works successfully against all of the effects of anaphylaxis. Therefore, it should be part of your medical supplies.
Adrenaline (epinephrine) is delivered through an injection. Inhalers have been tried in the past but have disadvantages. Anaphylactic reactions cause difficulty breathing. If you can’t inhale, you won’t get much benefit from an inhaler.
The EpiPen is the most popular of the various commercially available kits to combat anaphylaxis. It’s important to learn how to use it properly. Here’s how you do it:
1. Remove the EpiPen from its case.
2. Hold it firmly in your fist.
3. Remove the cap (some have two caps).
4. Have the patient sit or lie down.
5. Hold the thigh muscle still.
6. Press the end firmly against the thigh in a perpendicular fashion; it should click.
7. Hold for 10 seconds.
8. Massage the injection site.
9. Dispose of the needle safely.
Remember that the EpiPen won’t help you if it isn’t readily accessible. Any allergic members of your family or group should always have it in their possession.
Because it’s a liquid, adrenaline (Epinephrine) will not stay effective forever, as some pills or capsules might. Be sure to follow the storage instructions. While the EpiPen should not be stored in a hot place, it also shouldn’t be kept where it could freeze, which will damage its effectiveness significantly.
You will have limited quantities of this drug, so when do you break into those precious supplies? An easily remembered formula is the rule of D’s:
Definite reaction—an obvious, major reaction, such as a large rash or difficult breathing.
Danger—any worsening of a reaction after a few minutes.
Deterioration—use the EpiPen before the condition becomes life threatening. When in doubt, use it. It’s wise to have more than one handy.
An imminent danger is probably likely only if your patient has difficulty breathing or has lost consciousness. Inhalation of stomach acid into the lungs or respiratory failure is a major cause of death in these cases.
Some people may not be able to take adrenaline (epinephrine) because of chronic heart conditions or high blood pressure. Make sure that your people consult with their healthcare providers to make sure it’s safe for them to use.
POISON IVY, OAK, AND SUMAC
Poison ivy
Unless you live in Alaska, Hawaii, or the middle of the desert, the outdoors will have a population of poison ivy, poison oak, poison sumac, or all three. Once exposed to one or the other, 85 percent of the population will develop an immune response against it that will generate an itchy rash of varying degrees of severity. Winter does not eliminate the possibility of a reaction, as you can have a reaction against the urushiol (the toxic oil that causes a reaction after the first sensitizing exposure) even when vines or shrubs are dormant.
As the saying goes, “leaves of three, let it be.” Although it is true that poison ivy comes in “leaves of three,” so do many other plants. Familiarize yourself with what it looks like.
Poison ivy and poison oak are very similar in that they both have urushiol. Poison ivy leaves may be pointier, with poison oak often looking more like, well, oak leaves. One or both is present just about everywhere in the continental United States.
Poison sumac is a shrub or small tree, growing up to nearly 30 feet in height in parts of the eastern United States. Each leaf has 7–13 pointy leaflets. Although poison sumac has the same irritant present in poison ivy and poison oak, it is far more powerful. Simply inhaling smoke from burning poison sumac has been reported to cause death by suffocation.
All of these plants contain urushiol. The oil is in the vines, leaves, and roots. The best prevention is not allowing your skin to come in contact with the oil. If you can’t avoid being close to these plants, take the following precautions:
• Wear long pants, long-sleeved shirts, work gloves, and boots in areas known to have the plants.
• Consider an over-the-counter lotion, IvyBlockTM, as a preventative. Apply it as you would a sunblock to likely areas of exposure. Theoretically, it will prevent the oil from being absorbed by your skin.
The rash takes from several hours to several days to become apparent, and will appear as red, itchy, patchy bumps. Sometimes the rash appears almost linear.
Urushiol can remain active for years, even on your clothes, so thorough laundering is necessary. Routine body washing with soap will not be useful after 30 minutes of exposure, as your system will already be producing antibodies. Hot water seems to help the oil absorb into the skin, so use only cold water early on. After all the irritant has been absorbed, however, hot water baths are recommended by some to relieve itching.
Cleansers that remove resin or oil, such as Fels-Naptha soap or TecnuTM poison oak and ivy cleansers, are more effective than regular detergent and can be used even several hours after exposure. Rubbing alcohol is another reasonable option and easily carried as hand sanitizers or prep pads.
Even if you choose not to treat the rash, it will go away by itself in 2–3 weeks. Although it is temporary, it could be so itchy as to make you absolutely miserable. Diphenhydramine (Benadryl) at 25–50 mg dosages 4 times a day will be helpful in relieving the itching. It’s important to know that the 50 mg dosage will make you drowsy. Unfortunately, calamine lotion, an old standby, and hydrocortisone cream will probably not be very effective. Some astringent solutions, such as Domeboro, have been reported to give relief from the itching.
Severe rashes have been treated with the prescription dose pack of Medrol (methylprednisolone, a drug similar to prednisone). Prednisone is a strong anti-inflammatory drug and will be more effective in preventing the inflammatory reaction that your antibodies will cause.
There are several alternative treatments for poison ivy, oak, and sumac:
• Apple cider vinegar (use to cleanse the irritated area)
• Essential oils mixed with Aloe Vera gel, such as tea tree, lemon, lavender, peppermint, geranium, and chamomile
• Baking soda paste
• Epsom salt baths
• Jewelweed (mash and apply)
• Chamomile tea bag compresses