Battlefield Medicine in T2k

[Raellus]

Unbelievably, we don't already have a thread dedicated to this topic. (At least, a forum search through five pages didn't turn up much beyond some posts tangentially referencing medicinal drugs). Maybe I missed something, but, in the meantime, let this be a clearinghouse for T2k-relevant medical info.

I've got questions; I hope y'all have answers.

What kinds of pre-war medical supplies would still be available c.2000? What would their availability be (e.g. scarce, rare)?

What kind of ad hoc and/or ersatz substitutes for pre-war medical supplies would in use?

I imagine there'd be few if any one-use, disposable bandages around. I imagine cloth bandages would predominate by 2000. They can be boiled and reused, I believe.

For sutures, cat gut can be used. I assume it wouldn't be too difficult to produce, given its sources. I'm not sure how it could be sterilized, however- unless boiling would suffice.

What about antibiotics? What kind of lab equipment would be needed to culture and grow penicillin? What other anti-biotics could be produced c.2000?

Antiseptics? Ethanol wouldn't be too hard to produce, no? Can methanol be used?

What scientifically-proven, effective herbal remedies would be available (especially in Poland)?

For sedatives/anesthesia, ether and Chloroform, respectively, could be used. How difficult would those substances be to produce in a lab?

-

[castlebravo92]

I suspect growing opium poppies for fun and profit would come back in a big way. Same thing with the devil's lettuce.

You can stitch with normal (sterilized) thread.

Ether is apparently really easy to make in a lab - ethanol + sulfuric acid.

[Claidheamh]

I was just looking into sulfa drugs to see how easy they would be to produce. Apparently they were extracted from coal-tar dyes and require ammonia for their production - it seems like it's the sort of thing that might be producible in quantity in an established area like Silesia with coal production and the resources to set up a lab.

[kcdusk]

I think there would still be a reasonable amount of medical supplies left.

1. We saw with Covid, when masks became compulsory, that industry kicked off and suddenly we had millions of masks. Same with a vaccine, industry responded.

2. So i think with a world wide war, tools of the trade - ie medical supplies, would be required. And be around in big numbers. I think towards the end of the war ("your on your own") medical supplies will be lower but still common.

3. I'm torn on this though. But with nuclear war, there will be lots of death. So less people alive to use the available personal medical kits, which tend to assist the treatment of traditional wounds such as gun shots? So again thinking supplies would be common.

4. On the down side, while numerous in number - perhaps medical supplies (in general) might be aged (weathered or perished). Or not kept at required temperature (some need to be refridgerated, such as blood or other drugs). So i think common for availability but perhaps degraded.

I'm still leaning towards normal medial supplies to treat gun shot wounds as being commonly available.

[bash]

Some unordered ideas on the topic:

• A lot of medical supply stockpiles will be vaporized in TDM or post-TDM destruction. Some supplies will be ok while other stuff will be completely gone by 1999 let alone 2001.
• One advantage T2K survivors have over the past is just more and more widespread medical knowledge. The average nurse in a rural clinic in 1997 is going to have a lot more medical knowledge than one in 1945 or 1865. A lot more injuries and illnesses will be treatable even in poor conditions just because the body of medical knowledge is more complete and more widely disseminated.
• Just knowing why clean water is necessary and how to sterilize equipment will help people medically in T2K.

[Raellus]

Originally Posted by kcdusk

1. We saw with Covid, when masks became compulsory, that industry kicked off and suddenly we had millions of masks. Same with a vaccine, industry responded.

So i think with a world wide war, tools of the trade - ie medical supplies, would be required. And be around in big numbers. I think towards the end of the war ("your on your own") medical supplies will be lower but still common.

Good point, but industry barely kept up with demand during the height of the Covid Pandemic- and no one was lobbing nukes at essential infrastructure back then. During the Twilight War, supply would be diminished by widespread high-intensity warfare (including the use of NBC weapons), but demand would not (at least not to the same degree). This would inevitably lead to shortages of most medical supplies- especially those with military applications.

@Bash: Good point about the positive impact of basic health knowledge. It's shocking to learn how many soldiers died due to preventable infections and diseases, pre-germ theory. For example, during the Mexican-American War, 7 out of 8 US soldiers that lost their lives died as a result of preventable diseases (cholera, dysentery, typhus). Only 1/8 were killed in battle.

@All: How viable would iodine production be c.2000? It would be useful as both an antiseptic and as a treatment for the effects of radiation (and therefore consumed at a pretty rapid rate during the war, I imagine).

-

[castlebravo92]

Put me in the scarcity camp. A single nuclear detonation over a large urban environment would completely overwhelm the country's burn treatment capacity.

1.5 years of high intensity war, then the lights go out but the war keeps rolling on? A lot of medical supplies are going to be in short supply, especially those that depend on the petroleum industry. Even mundane little things like stretchy gauze, plastic syringes, IV bags, and plastic tubing aren't going to exactly be rolling off the assembly line anymore.

Even something like agar (which you would use in a solution to grow bacteria for antibiotic production) comes from bone meal, which presumes a somewhat healthy animal agriculture infrastructure.

Advanced pharmaceuticals requiring 99.9999% pure raws and clean rooms to manufacture? Forget it.

Production would be back to 1850s tech with late 20th century knowledge. Meaning, there would be a lot of people dying from "treatable" conditions, "if only we had the right medicine," while the military hoards scarce stockpiles of existing pre-war medical supplies.

[micromachine]

I agree with Castle on this with a couple of exceptions:

1) Glass manufacture would probably pickup some of the slack of the disposable plastic items that we have all become used to having (albeit with the penalty of increasing the need for cleaning).

2) Homeopathic solutions for painkillers and stomach issues would be back in vogue, if they cane be sourced.

3) Illicit drugs would probably become another source of pain suppression and sedatives if possible to source.

4) No hope/little hope cases would probably be terminated without expending medical supplies...draconian but necessary.

5) Tapes, bandaids, sterile pads and gauze would be all cloth and/or commercial tapes (Electrical tape. etc) with the penalty of either one use and throw or sterilization).

6) Gunpowder and red hot metal with be back in the battlefield medics pouch again.

Captured medical supplies and personnel with be almost as valuable as ammo, food or gas....if they can be located!

[wolffhound79]

Dont forget commercial industry. In the oil and sector in Canada we have lots of industrial medic companies. I know from my work that many of them use to receive equipment from Oil companies when projects ended. The oil Companies didnt want or need the equipment from these sites and ended up usually shipping them to these companies to get rid of them. Im talking about all kinds of gear. Not Medical grade drugs, but the equipment for first aid , and medical stations.

The first company I worked for had me go thru the warehouses they had and I found Tad Radios, oxygen tanks, SCBAs, specialized aircraft medical equipment for transporting patients, all sorts of medical equipment, boxes of bandages, meteorological equipment (many First aiders in the 80s , 90s filled in different roles like air traffic control, security , etc. on remote sites atleast with this company) , plus the stuff they have kept from there own stocks, or purchases of other companies they never got around to inventorying.

Many of them had MTCs , mobile trauma centers built on pick ups, Loaded with medical equipment to help stabilize a patient and IV fluids and some meds, burn kits, along with all kinds of specialized equipment. Many of them had offices spread thru out the various provinces and in many times satellite offices to allow them to operate in an area, those offices had replacement equipment and vehicle parts and fluids. The company I worked for had tons of vehicle parts, vehicle fluids, tires, oil drums, radios for private oil roads, just loads of stuff, trailers and office trailers set up as temporary med bays on sites, and our main office and satellite offices were all out in a rural areas.



Talking with other fleet operations personnel from other companies, we where not the only company with the problem of warehouses and seacans full of old or over stocked equipment. Now that just a sample in this industry, what about other companies in other industries.

[Tegyrius]

For every niche industry that has interesting equipment caches, there will be people who work/worked in that industry who will grab that stuff as soon as they see the collapse on the horizon.

I've been saying for a few years now that once the lights go out, a 50% fatality rate in CONUS is ridiculously low. The whole ag base collapses without modern utilities to drive its supply chain and distribution network. That's the reason I set the global fatality rate at 90% in T2013. The presence or absence of modern pharmaceuticals becomes irrelevant once your urban population is eating wallpaper paste soup.

- C.

[castlebravo92]

Originally Posted by Tegyrius

For every niche industry that has interesting equipment caches, there will be people who work/worked in that industry who will grab that stuff as soon as they see the collapse on the horizon.

I've been saying for a few years now that once the lights go out, a 50% fatality rate in CONUS is ridiculously low. The whole ag base collapses without modern utilities to drive its supply chain and distribution network. That's the reason I set the global fatality rate at 90% in T2013. The presence or absence of modern pharmaceuticals becomes irrelevant once your urban population is eating wallpaper paste soup.

- C.

There is a book published in 1982 by Arthur Katz titled "Life After Nuclear War" that takes a pretty good look at the social and economic effects of a nuclear attack on the U.S..

One of the particular vulnerabilities the US had in the 70s and 80s - that has only gotten worse is economic concentration of infrastructure - particularly oil refineries, downstream chemical industries, and food production.

In particular, food production is very sensitive to a collapse of the transportation system. Additionally, agriculture production accounts for about 10% of US petroleum consumption (not including distribution).

On a pure calorie basis, most parts of the country (excepting New England) are roughly self-sufficient (or better) in calories produced vs calories consumed. However, the problem is, where base agricultural commodities are produced is not typically where food is actually made. Grain is grown in the Midwest and shipped east for processing. Cattle are raised in one area, fed with hay grown in another area, shipped to feed lots for fattening prior to slaughter, then slaughtered and processed in other areas. Other areas can mean several states or more away.

Food processing isn't rocket science and can be localized fairly easily, but would necessitate setting up new supply chains. For example, I have no idea off the top of my head (and 2 minute google search didn't help) where cans and glass jars are even manufactured these days. And food storage would require refrigeration, canning, drying, or salting. 3 out of those 4 require at least a rudimentary operating supply change, and 2 of the 4 would require new & localized manufacturing to offset the lack of availability to procure from the handful of places that do it now.

Ironically, the more people that died from the initial attacks, the faster recovery would likely be. The more survivors, the higher the likelihood of a sustained collapse because it would prevent capital accumulation as the survivors would consume capital stocks (over investment) in order to survive. Capital in this sense are the physical goods that can be used to produce more physical goods. For example, seeds can be eaten, or saved for planting. Oil and gas can be used to look for more oil and gas, or it can be used to keep you warm during the winter.

There's a lot of things a government could do, post-attack, to keep the wheels from coming off right away, but GDW's canon history doesn't really detail the government doing any of it. In fact, it implies heavily a pretty inept response. The late 1998-1999 timeframe is particularly problematic because the government collapses, the national transportation network collapses, and organized food distribution to urban environments ceases. The reason why I say it's problematic is because the urban population in 2000 was ~75% of the population. 90% of these people would die (the idea, for example, that Manhattan would support a population of 120,000 people 3 years after the lights went off is silly. Manhattan has 2,686 acres of "parkland" - which includes things such as parks, green spaces, playgrounds, and basketball courts. Even if you tilled every one of those acres and were able to produce optimal yields of corn (~176 bushels of corn per acre), you would only be able to feed around ~40,000 people with the crop production on Manhattan. There aren't going to be enough rats and pigeons and fishing from the pier to feed the rest. You might be able to make up the shortfall with trading, but that presumes a trade network and that Manhattanites have something worth trading for. And that 40,000 people capacity is max efficiency with good soil, fertilizer, pesticides, etc. So really, it's probably closer to 10,000 to 20,000. And that also assumes that you are actually able to plant and harvest crops without some other power coming in and stealing it or destroying it.

Manhattan had a population of around 1.5 million in 2000, so 1.5 million to 20,000 = a 98.6667% reduction in population. Now, a lot of the people would have fled rather than dying in Manhattan, but that just means most of them would have starved to death in upstate New York or in the civil disorder and violence that came later as food got scarce.

Part of me had a problem with the degree of die off in Twilight 2013, but if you start crunching the numbers, it may not be that far off the mark, especially if you combine it with an inept government response.

[bash]

I don't disagree about Manhattan's population but something to consider is any large city in the US is just going to have tons of shit lying around for salvage. There's going to be thousands of locked supply closets, store rooms, pantries, and other non-obvious areas stuffed with shelf stable goods. Unorganized scavengers in a hurry will pass over locked rooms where organized scavenging parties can methodically clear buildings of supplies.

Effective scavenging would turn up all sorts of trade goods and supplies. I wouldn't argue that scavenging is long term sustainable but it could help sustain a population from 1998 to 2001. There's also a lot of windows and rooftops that would be good for gardening. There's going to be a lot of recipes for preparing potatoes in appetizing ways in T2K.

A lot of former suburbs are also going to be filled with crap. Evacuating populations aren't going to be able to pack everything so there's going to be lots of junk available in garages, pantries, and closets. Even the houses themselves are built of usable materials that can be repurposed.

[castlebravo92]

Originally Posted by bash

I don't disagree about Manhattan's population but something to consider is any large city in the US is just going to have tons of shit lying around for salvage. There's going to be thousands of locked supply closets, store rooms, pantries, and other non-obvious areas stuffed with shelf stable goods. Unorganized scavengers in a hurry will pass over locked rooms where organized scavenging parties can methodically clear buildings of supplies.

Effective scavenging would turn up all sorts of trade goods and supplies. I wouldn't argue that scavenging is long term sustainable but it could help sustain a population from 1998 to 2001. There's also a lot of windows and rooftops that would be good for gardening. There's going to be a lot of recipes for preparing potatoes in appetizing ways in T2K.

A lot of former suburbs are also going to be filled with crap. Evacuating populations aren't going to be able to pack everything so there's going to be lots of junk available in garages, pantries, and closets. Even the houses themselves are built of usable materials that can be repurposed.

Sure...my point wasn't the availability of salvage in NYC, it's the availability of another party on the other side of the deal. Like who would be bringing in the food to trade with NYC, and what would they be trading for the food that they couldn't obtain closer to home where the food is grown? I mean, I like E. Zegna suits as much as the next guy, but I'm not sure there's a lot of stuff in Manhattan and particularly exclusive to Manhattan that would be super valuable in a post-apoc world.

[bash]

Originally Posted by castlebravo92

Sure...my point wasn't the availability of salvage in NYC, it's the availability of another party on the other side of the deal. Like who would be bringing in the food to trade with NYC, and what would they be trading for the food that they couldn't obtain closer to home where the food is grown? I mean, I like E. Zegna suits as much as the next guy, but I'm not sure there's a lot of stuff in Manhattan and particularly exclusive to Manhattan that would be super valuable in a post-apoc world.

Manhattan could be a major source or scavenged "luxury" goods like liquor, cigarettes, and candy. It would also have a huge supply of medicines both over the counter and prescription. There's also going to be untold numbers of first aid kits and other sorts of supplies. The sheets and drapes in a single apartment building could make thousands of bandages and surgical thread.

Besides these there's going to be literal tons of warm clothes, shoes, and other quality of life goods. Additionally cities are jam packed with vehicles. There will be literal tons of parts (including POL) available for scavenging if not complete working vehicles.

[Raellus]

It hasn't been all that long, historically speaking, that surgeons have been able to reconstruct badly damaged limbs. Prior to the medical breakthroughs- imaging, grafting, hardware, tissue transplants, etc.) that allowed for that, amputation was often the only viable option.

As hospitals run out of the tech and tools to repair shattered bone and/or badly mangled tissue, amputation would reassume its place as the go-to treatment for "limbs beyond saving" (or rather, more wounded limbs would classify, by default, as "limbs beyond saving"). Also, a loss of human capital (i.e. highly trained, experienced orthopedic surgeons) would mean that a large proportion of those medical professionals that remain c.2000 would be lacking in the skill department. "Sawbones" would once again become an appropriate appellation for many ersatz doctors in the late Twilight War.

By 2000, there would be a higher than average number- per capita especially- of amputees in the world. It's a likely phenomenon worth noting when constructing NPCs or describing settlements.

-

[Homer]

I read an account of POW medicine in the far east during WW2. All too often, doctors were forced to stand by and watch prisoners die of wounds or disease for lack of medicines or material to do what they knew needed to be done. The medicine was often amazing, including reading about a British Army surgeon performing a successful appendectomy on a hell ship at sea without benefit of anything other than improvised and salvaged instruments and a sedative derived from dental novocaine injected into the spine. The same doctors eventually organized a prison hospital that treated guards and Japanese workers on a quid pro quo of care for supplies. I’d imagine surviving surgeons and medical units in 2000 may be in similar circumstances.

One thing from all POW stories was the dramatic effect of field sanitation, hygiene, and the best possible diet under the circumstances in preventing illness. I’d imagine a major effort to be made by all sides to proactively attack the common vectors of illness in cantonments or static positions. Bleach, lye and carbolic soap, activated charcoal, vinegar, iodine, and diethyl ether or their precursors are some of the eventually sustainable medical commodities that will be valuable salvage or trade. Alternatively, as raw material, infrastructure, and labor are available production can be organized. That said, it’s probably wishful thinking to assume that even the previously mentioned commodities will appear overnight. The danger point may come as modern supplies run low and begin to be exhausted and the decision has not been made to adopt earlier technologies. People will likely die as supplies are rationed and harsh triage is implemented who could have been saved a few years down the road.

Absent this there’s a whole separate discussion on the usages, acquisition, and supply of cocaine, marijuana, heroin and morphine, etc during the post twilight era. The already widespread cultivation of poppies for ornamental and seed uses may be repurposed as sources of opium and processed into laudanum. This practice was common and encouraged in the American South during the Civil War when supplies were short, it could easily come back into vogue.

[Raellus]

Unfortunately, this piece supports the amputation hypothesis presented in post #15.

https://apnews.com/article/gaza-isra...ff68cc71b51fc5

-

[Homer]

What happens to casualties after a battle? Is it a case of treat everyone as you can because you may need the reciprocal favor one day, treat yours leave the rest, maybe even a ceasefire ti recover casualties? And what about the ones who can’t be moved; do you pay the locals and hope for the best?

[bash]

Originally Posted by Homer

What happens to casualties after a battle? Is it a case of treat everyone as you can because you may need the reciprocal favor one day, treat yours leave the rest, maybe even a ceasefire ti recover casualties? And what about the ones who can’t be moved; do you pay the locals and hope for the best?

I think that's really going to depend on the size and resources of a group. By 2001 large set piece battles are going to be rare. When they happen it'll be because the belligerents think they are prepared for it which presumes they would have some sort of medical support lined up even if that means horse drawn MASH setup.

Any large group preparing for combat would be focused on getting not just food, ammo, and POL for the effort but for medical supplies to handle the after effects of battle. Pre-combat preparations would include cooking up purer ethanol, sterilizing bandages for dressings, and generally stocking up on what field medics and MASHes would need.

When it's a small group like PCs getting into a fight they couldn't avoid, medical care very likely means enlisting (by some means) local civilians. Getting that medical help can be a whole adventure seed in itself like getting some supplies/resources the town doctor needs to treat the wounded comrade(s).

Another adventure seed is the PCs moving into a new area and setting up contacts with locals. Getting in their good graces so they can ask them for medical help later would be an important thing to always keep in mind. Roughing them up for some food today might mean they're shit out of luck in a week when they need one of their buddies patched up by the local doctor.