GET YOUR MEDIC READY FOR ANY­THING

DUR­ING A DIS­AS­TER, MORE IS BET­TER WHEN IT COMES TO MED­I­CAL SUP­PLIES AND KNOWL­EDGE.

American Survival Guide - - TABLE OF CONTENTS - By Joe Al­ton, M.D.

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.

DI­AG­NOS­TIC AIDS

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.

HEMORRHAGIC TRAUMA

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,

Hem­con, Chi­to­gauze

• 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

OR­THO­PE­DIC

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.

IN­FEC­TION

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.)

BURNS

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

MIS­CEL­LA­NEOUS

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.

LONG-TERM RE­AL­I­TIES

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.

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