GET YOUR MEDIC READY FOR ANYTHING
DURING A DISASTER, MORE IS BETTER WHEN IT COMES TO MEDICAL SUPPLIES AND KNOWLEDGE.
More is better when it comes to medical supplies.
In normal times, we have the luxury of a modern and well-equipped medical system through which the nearest fully stocked ambulance is often just minutes away, 24/7/365. So, it’s hard to imagine a scenario in which the average person might become the greatest asset left to their family. Yet, that’s exactly what can happen after a natural or manmade disaster or when we venture off the beaten path.
Many American Survival Guide readers are well-acquainted with first aid; indeed, some are formally trained medical professionals. That training was based on the existence and support of a modern medical system. In a true long-term survival setting, however, there will be no access to hospitals or other facilities for the foreseeable future, and it will be difficult, at best, to disseminate critical medical training to a population that is preoccupied with everyday survival.
Placed in such a situation, the medic in the field must make a major change in both mindset and materials. He or she has to transition from a focus on stabilization and transport to being an effective caregiver with limited equipment. Instead of just a stop on the way to a higher medical resource, the medic becomes the highest medical resource for that person from the beginning to the end of their treatment. For highly trained personnel, this is a huge adjustment—the equivalent of moving from a modern city to a remote homestead of an earlier time.
It has been said that treatment is only limited by the equipment that can be carried and the training of the medic. In long-term survival, this is not necessarily so. Many will not realize that extended power outages will eventually render a lot of advanced medical equipment, such as ventilators, inoperative. After an EMP hits, a paramedic’s expert intubation of a victim will do little good without rapid transport to a well-equipped unit. You might be able to “bag” someone for a while, but by no means is it a long-term solution.
So, what is appropriate equipment for the survival medic? Although some medical supplies are universal, such as bandages, others might depend on the environment, the availability of power and the existence of nearby hostiles. Still more depends on who comprises the group of people for whom you’re medically responsible: Are they a team of Navy Seals, or are they your aging parents or your young children?
THE JOB DESCRIPTION
In order to know what supplies would make you more effective in your role as medic, you must know what medical skills you could be called upon to apply in a long-term scenario.
Of course, you need to know how to stop bleeding, but you might be surprised at some of the other issues you must be ready to treat. On a daily basis, you’re more likely to be confronted with infections and chronic illness, such as high blood pressure. It’s important to know how to deal with trauma, but that’s only part of the job description of the survival medic.
To become an effective medical resource for the long haul, you’ll want to learn how to perform the following:
• Take vital signs, such as pulses, respiration rates and blood pressures
• Perform a thorough physical exam and assessment
• Place bandages on fresh injuries and also provide chronic wound care
• Treat sprains, fractures and other orthopedic injuries
• Treat burns of varying severity
• Identify and treat bacterial, viral, protozoal and fungal infectious diseases
• Identify and treat head, pubic and body lice, as well as bedbug, tick and other insect bites
Perform a normal delivery of a baby and placenta
Identify venomous snakes and treat the effects of their bites, as well as those of other animals
Identify and treat various causes of abdominal, pelvic and chest pain
Recognize and treat allergic reactions and anaphylactic shock
Identify and treat sexually transmitted diseases
Evaluate and treat dental problems (replace fillings, treat abscesses and perform extractions)
Recognize and treat various skin conditions
Care for the bedridden patient (treat bedsores, make transport considerations) Establish basic hygiene and sanitary protocols
Counsel the depressed or anxious patient (you will see a lot of this in times of trouble)
Perform basic medical procedures, such as inserting an intravenous line
Close a wound with sutures, staples, glues or other methods (and, more importantly, know when to close a wound)
• Use antibiotics and other drugs judiciously
• Improvise with natural products and found objects when supplies run out
You can see how challenging it might be to learn all the above, especially with an eye toward long-term care.
Perhaps the most important medical skill is knowing how to prevent injuries and illnesses. You should spend much of your time ensuring the basics, such as whether your people are appropriately dressed for the weather or are using hand and eye protection during work sessions. You must learn to recognize situations that place your people at risk. If you can do this, you’ll avoid many headaches … and perhaps some heartaches.
ITEMS FOR PERSONAL CARRY
Before a disaster occurs, it should be standard procedure for each person to put together an individual first aid kit (IFAK). This makes room in the medic’s bag for advanced items and provides the opportunity for self-help. The medic should guide their group on exactly what items should be in the individuals’ IFAKS.
THE SURVIVAL MEDIC HAS TO TRANSITION FROM A FOCUS ON STABILIZATION AND TRANSPORT TO THAT OF BEING AN EFFECTIVE CAREGIVER WITH LIMITED EQUIPMENT.
While out and about, the main issue will likely be common trail injuries, but hostile encounters could result in major hemorrhages. The IFAK should include the ability to deal with both. Useful items include tourniquets, pressure dressings, hemostatic (blood-clotting) gauze, sterile bandages, ace wraps, moleskin, burn gel, antiseptics, Mylar blankets and tape.
THE MEDIC’S KIT
The medic, while foraging in hostile or unknown territory, should carry items that somewhat mirror a military medic bag: multiples of IFAK materials, along with additional items such as chest seals, decompression needles, nasal airways, 36-inch malleable splints and more. Medics with training and access to IV fluids might bring some bags of normal saline and IV setups. Be cognizant of the weight, however, because each liter of IV solution adds 2.2 pounds to your pack!
THE EQUIPPED LONG-TERM SURVIVAL MEDIC
The long-term medic must have a base of operations from which to work. Therefore, an area of the retreat or camp should be designated as the “sick room” or “field hospital.” This space should be away from common areas and furnished with cots, an examination table, counter space and storage. It is here that you will treat victims of infectious disease and injuries—although it is best to have a barrier of some sort between the two (or two separate “units”).
Here is a compendium of items I believe should be in your backpack, sick room and/or hospital tent. It isn’t a complete list, but it is comprehensive enough to allow you to deal with many different issues. Items that serve in multiple categories are not repeated for the sake of space.
PERSONAL PROTECTION GEAR
Personal protection gear is important to protect both the caregiver and the patient. Items to stockpile in quantity include:
• Gloves: Be sure to get nitrile or other hypoallergenic varieties; there is an epidemic of allergies to latex.
Masks: Simple surgical or the moreadvanced, but still affordable, “N95” type.
Aprons, gowns and face shields. These are useful for caregivers in epidemic scenarios. Eye, hand and foot protection: Emphasizing the importance of the use of goggles, work gloves and boots will prevent many injuries/contaminations.
Shears: EMT shears/bandage scissors give you the ability to fully expose a wound without incurring injury.
Headlamp, flashlight, glow sticks: Injuries don’t always occur during the day.
Penlight: To evaluate pupillary reaction; additional light source. Stethoscope: To listen to heart and lung sounds for signs of irregular heartbeats, pneumonia and asthma. Manual blood pressure cuff: Can take blood pressures or can double as a tourniquet on extremities. Thermometer: Old-timey glass thermometer for off-grid settings Of course, for as long as the batteries last, higher-tech items—pulse oximeters, oto- and ophthalmoscopes, Doppler fetal heart monitors, blood pressure devices and automated defibrillators—will increase your diagnostic and therapeutic options.
Tourniquets (CAT, SOF-T, SWAT, RATS and others): Current thinking recommends tourniquet use early in the treatment of significant hemorrhage. Many of these models can be placed with one hand for when the casualty is the medic. SWAT tourniquets are easier to place with two hands but might serve double duty as a pressure dressing or to stabilize splinted extremities. Have multiples in your kit.
Pressure dressings: Israeli dressings, Olaes bandages or others • Hemostatic gauze: Celox, Quikclot,
• Gauze bandages (roller dressings, gauze or nonstick pads) ranging from 2x2 inches all the way to 18x30 inches
• Hemostats: Instruments that allow you to clamp off bleeding wounds (best used by the experienced) • Tape: Various types and sizes
• Nasal and oral airways: For nasal airways, you should have some lubricant on hand.
Chest seals: Bolin, Asherman, Hyfin
or others for sucking chest wounds Decompression needle: 14-gauge; 3.25 inches for collapsed lungs Mylar or other blankets: To prevent heat loss in those suffering from shock
IV supplies: If available, IV set-ups and 1-liter bags of Normal Saline and Ringer’s Lactate
Structural aluminum malleable (SAM) splints: These range from finger splints to 36 inches or longer. Elastic wraps: Ace or adhesive Coban Ice/heat packs: Many of these are disposable “shake-and-break” items; others can be reused.
Casting material: Plaster of Paris or fiberglass
Triangular bandage or cravat: To serve as a sling for an injured arm Neck collar: For cervical spine injuries
WOUND CARE AND CLOSURE
Antiseptics: Isopropyl alcohol, povidone-iodine (Betadine), hydrogen peroxide and benzalkonium chloride (BZK) will be useful for everything from wound care to sick room sanitation. Even household bleach, mixed with baking soda in boiled tap water, makes a helpful solution— known as “Dakin’s solution”—that can prevent infections in bedsores and other open injuries. Be aware that antiseptic “wipes” can dry out over time unless sealed in plastic. Butterfly closures, Steri-strips, duct tape with tincture of benzoin: This is the least-invasive option. Tincture of benzoin acts as a glue to anchor the tapes.
Glues: Medical glue is better than Super-glue, but both work in a pinch if placed correctly.
Sutures: Both absorbable (catgut, polyglycolic acid) and non-absorbable (silk, nylon, Prolene)
Staples: These are a good way to close straight-line lacerations.
Needle holders, clamps, Adson’s forceps (at least two), scissors, standard laceration tray Scalpels: #10, #11 and #15 are best for incising and draining abscesses or removing dead tissue from wounds.
Irrigation syringe: 60cc or 100 cc to flush out debris during acute and chronic wound care
IN ORDER TO KNOW WHAT SUPPLIES WOULD MAKE YOU MORE EFFECTIVE IN YOUR ROLE AS MEDIC, YOU MUST KNOW WHAT MEDICAL SKILLS YOU COULD BE CALLED UPON TO APPLY IN A LONG-TERM SCENARIO.
Saline solution: Used to keep open wounds clean and healing. A sterile saline solution can be produced easily by placing two teaspoons of salt in a liter of water, boiling the solution for 15 minutes with a pan and lid, and storing it in sterile canning jars if not used immediately.
Antibiotic ointment: Prevents infection in healing skin wounds.
Antibiotics: Without antibiotics, minor infections become life threatening if they make their way into the bloodstream (a condition known as “septicemia”).
Certain antibiotics can be accumulated in quantity by obtaining their veterinary equivalents. These are often repackaged and distributed as “fish” and “bird” antibiotics (such as Fish Mox Forte [amoxicillin 500 mg]). Not all veterinary antibiotics qualify for human use, however. Antibiotics aren’t candy and must be used judiciously. (More information can be found in the section on medications in The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way.)
Burn gel: This often contains a local anesthetic and soothing substances such as aloe vera. Burn dressings: Xeroform brand; alternatively, improvise with gauze and petroleum jelly or raw, unprocessed honey.
MEDICINES (OTHER THAN ANTIBIOTICS)
Pain meds: These include ibuprofen (Advil), acetaminophen (Tylenol), aspirin (Bayer), naproxen (Aleve) and other common, over-the-counter medicines, as well as whatever stronger meds you can find.
Anti-diarrheal meds: Loperamide (Imodium), Pepto-bismol and others
Stool softeners, laxatives: Peri-colace and others to deal with the constipation that often goes along with eating MRES
Anti-nausea: Meclizine (Antivert) can be used for motion sickness or other dizziness.
Antihistamines: Diphenhydramine (Benadryl) will help with allergy symptoms, but at 50 mg doses, it will also serve as a sleep aid. Also, consider prescription Epi-pens to deal with severe allergic reactions, such as anaphylactic shock.
Nasal decongestants: Phenylephrine, Pseudoephedrine (Sudafed) Expectorants: Guaifenesin to loosen up thick phlegm
Antifungal agent: Clotrimazole (Lotrimin) for treating ringworm, athlete’s foot and other fungal skin infections
Hydrocortisone 1% cream: Used to decrease inflammation in the skin Lidocaine cream: Topical anesthetic Antacids: Tums, Rolaids or PeptoBismol for acid reflux or upset stomach Lice shampoo
Blister care: Moleskin or other products help protect healing blisters Various scissor sizes Tweezers: To deal with splinters and other small foreign objects Magnifying glass: To see the above Eye patch, eye cup, eye wash Styptic pencil: For minor bleeding Adhesive bandages: Band-aids, for example, to protect small healing wounds Tongue depressors: To detect sore throats Lip balm, sunscreen Insect repellent Water purification tablets Oral rehydration solution Oxygen cylinders and bag valve mask: These provide temporary breathing support. Instant glucose or honey: For low-sugar episodes Nit comb: For lice infestations Labor and delivery tray: Comes as a packet with all you need. Portable litter/stretcher Hand sanitizer, soap Safety pins, rubber bands, paper clips, paracord, cotton balls and swabs: Good for general “Macgyver-ing.”
Survival medical library: A good book on anatomy, a book of medications such as the Physician’s Desk Reference or Merck Manual, my Survival Medicine Handbook or a thorough wilderness medicine guide. Even a book on herbalism would be a useful addition to the group library.
Dental kit: Yes, a dental kit! If you are preparing to be medically ready, you’ll need to be “dentally” ready, as well. Perhaps you won’t need dental supplies when there are a few days without power, but in a long-term setting, these items are very important.
It’s never a bad idea to have more than you need of every item. If a disaster knocks you off the grid, you’ll be taking care of more people than you expected (you can count on that!), and supplies will eventually be overextended. For example, even one major hemorrhage could take up the majority of the average person’s supply of dressings.
You’ll see medical kits online that claim a capacity to handle the medical problems of “X” number of people. In reality, the amount of medical supplies needed for a group is determined by the physical health of those people and the conditions encountered. If you have a dozen Army Rangers entering unfriendly territory, the medical supply contents would be somewhat different from those of a large family of mixed ages living in a peaceful, remote homestead.
If you have all the items on the lists above, congratulations—you have more than 99 percent of people who consider themselves “medically prepared.” If you have the knowledge and skills needed to use those items, your group is in good hands.
If you don’t have these items, take the time now to accumulate the knowledge and supplies needed to be an effective long-term survival medic. If you apply yourself, you’ll save lives in times of trouble.
PERHAPS THE MOST IMPORTANT MEDICAL SKILL IS KNOWING HOW TO PREVENT INJURIES AND ILLNESSES.
Whenever possible, use the least-invasive method for wound closure: Steri-strips and medical glues.
Medicines for group members must be stockpiled, especially those for chronic conditions.
Put together your medic’s bag so that emergency and items used most often are easy to find.
Whether you’re enduring a short- or long-term disaster, be ready to deal with bleeding wounds.
Below left: The medic must know basic first aid, including wrapping an ankle—which is likely to be a common injury location.
Below right: The truly well-prepared medic is able to use commercial supplies and improvisations for wound closure and other treatments.
Staples are quick and easy but are not replaceable in a true long-term survival scenario.
Below: The right medic’s bag allows easy visualization and access to important items.
Left: Orthopedic supplies include SAM splints, roller gauze and padding.
Right: Your duties as medic include more than just physical ailments. Keeping spirits up and attitudes positive will be challenging in a serious survival situation. Far right: Long-term care is more difficult to execute and manage than a quick transport to the hospital. Some injuries could take months of re- covery time.
Left: In unknown territory, the medic should consider including a portable stretcher in their kit.