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

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

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

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

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

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

Prepare for the worst, hope for the best.

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

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

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