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For anyone to do their job properly, they’ll need the right equipment. Imagine a carpenter having to use a steak knife as a saw, or a hunter using a pea shooter instead of a rifle. The same goes for the medic. The successful healthcare provider has spent a lot of time and energy (and some money) on accumulating a good amount and variety of medical supplies. The more the better, since you don’t know how long you might have to function without access to modern medical care.
It’s important to note that the value of many medical supplies depends largely on the knowledge and skill that the user has obtained through study and practice.
A blood pressure cuff isn’t very useful to someone who doesn’t know how to take a blood pressure. Concentrate on first obtaining items that you can use effectively, and then purchase more advanced equipment as your skills multiply.
Don’t forget that many items can be improvised; a bandana may serve as a triangular bandage, an ironing board as a stretcher or thin fishing line and a sewing needle might be useful as suturing equipment. A careful inspection of your own home would probably turn up things that can be adapted to medical use. Look with a creative eye and you’ll be surprised at the medical issues you are already equipped to deal with.
Sterile Vs. Clean
A significant factor in the quality of medical care given in a survival situation is the level of cleanliness of the equipment used. You may have heard of the terms “sterile” and “clean”, but do you have more than a vague idea of what they mean?
When it comes to medical protection, “sterility” means the complete absence of microbes. Sterile technique involves hand washing with special solutions and the use of sterile instruments, towels, and dressings. When used on a patient, the area immediately around these items is referred to as a “sterile field”. The sterile field is isolated and closely guarded to prevent contact with anything that could allow microorganisms to invade it.
To guarantee the elimination of all organisms, a type of pressure cooker called an “autoclave” is used for instruments, towels, and other items that could come in contact with the patient. All hospitals, clinics, and medical offices clean their equipment with this device. Having a pressure cooker as part of your supplies will allow your instruments to approach the level of sterility required for, say, minor surgical procedures.
Of course, it may be very difficult to achieve a sterile field if you are in an extremely austere environment. In this case, we may only be able to keep things “clean”. Clean techniques concentrate on prevention by reducing the number of microorganisms that could be transferred from one person to another by medical instruments or other supplies. Meticulous hand washing with soap and hot water is the cornerstone of a clean field.
In most survival settings, this may be as good as it gets, but is that so bad? With regards to wound care, there is very little research that compares clean vs. sterile technique. In one study, an experiment was conducted in which one group of patients had their wounds was cleaned with sterile saline solution, the other group with tap water. Amazingly, the infection rate was 5.4% in the tap water group as opposed to 10.3% in the sterile saline group. Another study revealed no difference in infection rates in wounds treated in a sterile fashion as opposed to clean technique. Therefore, I usually recommend clean, drinkable water to treat most wounds.
To maintain a clean area, certain chemicals are used called “disinfectants”. Disinfectants are substances that are applied to non-living objects to destroy microbes. This would include surfaces where you would treat patients or prepare food. Disinfection does not necessarily kill all bugs and, as such, is not as effective as sterilization, which goes through a more extreme process to reach its goal. An example of a disinfectant would be bleach.
Disinfection removes bacteria, viruses, and other bugs and is sometimes considered the same as “decontamination”. Decontamination, however, may also include the removal of noxious toxins and could pertain to the elimination of chemicals or radiation. The removal of non-living toxins like radiation from a surface would, therefore, be decontamination but not disinfection.
It’s useful to know the difference between a disinfectant, an “antibiotic”, and an “antiseptic”. While disinfectants kill bacteria and viruses on the surface of non-living tissue, antiseptics kill microbes on living tissue surfaces. Examples of antiseptics include Betadine, Chlorhexidine (Hibiclens), Iodine, and Benzalkonium Chloride (BZK).
Antibiotics are able to destroy microorganisms that live inside the human body. These include drugs such as Amoxicillin, Doxycycline, Metronidazole, and many others. We’ll discuss these in detail later in the book.
Medical Kits
Most commercial first aid kits are fine for the family picnic or a day at the beach, but we will talk about serious medical stockpiles here. There are four levels of medical kits that we will identify. The first kit is a personal carry or individual first aid kit, sometimes called an IFAK. Every member of a group can carry this lightweight kit; it allows, in most cases, treatment of some common medical problems encountered in the wilderness or when travelling.
In some military services, the IFAK or personal carry kit is useful to the medic as a source of supply. If a squad member is injured, the medic will first use items, as needed, from the wounded soldier’s kit. This is a resource multiplier and allows the corpsman to carry more advanced medical equipment in their pack.
The second kit listed below is the “nuclear family bag”: This kit is mobile, with the items fitting in a standard large backpack, and will suffice as a medical “bug-out” bag for a couple and their children. It is, in my opinion, the minimum amount of equipment that a head of household would need to handle common emergencies in a long-term survival situation.
The third kit is a “medic at camp” kit, one that the person responsible as medical resource for the group would be expected to maintain in an expedition camp.
The fourth kit is the “community clinic”, or everything that a skillful medic will have stockpiled for long term care of his/her survival family or group.
Don’t feel intimidated by the sheer volume of supplies in the clinic version; it would be enough to serve as a reasonably well-equipped field hospital. Few of us have the resources or skills to purchase and effectively use every single item. If you can put together a good nuclear family bag, you will have accomplished quite a bit.
The Community Clinic Supply List
(long-term care center)
All of the above in larger quantities, plus: Extensive medical library
- Treatment Table
- Plaster of Paris cast kits (to make casts for fractures)
- (4in/6in) Naso-oropharyngeal airway tubes (to keep airways open)
- Nasal airways (keeps airways open)
- Resuscitation facemask with one-way valve
- Resuscitation bag (Ambu-bag)
- Endotracheal tube/Laryngoscope (allows you to breathe for patient)
- Portable Defibrillator (expensive)
- Blood Pressure cuff (sphygmomanometer)
- Stethoscopes
- CPR Shield
- Otoscope and Ophthalmoscope – (instruments to look into ears and eyes)
- Urine test strips
- Pregnancy test kits
- Sterile Drapes (lots)
- Air splints (arm/long-leg/short-leg)
- SAM splints
- Scrub Suits
- IV equipment, such as:
- Normal Saline solution
- Dextrose and 50% Normal Saline IV solution
- IV tubing sets - maxi-sets + standard sets
- Blood collection bags + filter transfusion sets
- Syringes 2/5/10/20 mL
- Needles 20/22/24 gauge
- IV kits 16/20/24 gauge
- Paper tape (1/2 in/1in) for IV lines
- IV stands (to hang fluid bottles)
- Saline Solution for irrigation (can be made at home as well)
- Foldable stretchers
- Paracord (various uses)
- Triage tags (for mass casualty incidents)
Surgery Kit (extremely ambitious):
- Sterile Towels
- Sterile Gloves
- Mayo scissors
- Metzenbaum scissors
- Small and medium needle holders
- Bulb syringes (for irrigating wounds during procedures)
- Assorted clamps (curved and straight, small and large)
- Scalpel handle and blades (sizes 10, 11, 15) or disposable scalpels
- Emergency Obstetric Kit (includes cord clamps, bulb suction, etc.)
- Obstetric forceps (for difficult deliveries)
- Uterine Curettes (for miscarriages, various sizes),
- Uterine “Sound” (checks depth of uterine canal)
- Uterine Dilators (to open cervix; allows removal of dead tissue)
- Bone saw (for amputations)
- Sutures, such as:
- Vicryl; 0, 2-0, 4-0 (absorbable)
- Chromic 0, 2-0 (absorbable)
- Silk, Nylon or Prolene 0, 2-0, 4-0(non-absorbable)
- Surgical staplers and staple removers
- Chest decompression kits and drains – various sizes for collapsed lungs
- Penrose drains (to allow blood and pus to drain from wounds)
- Foley Catheters – Sizes 18, 20 for urinary blockage
- Urine Bags
- Nasogastric tubes (to pump a stomach)
- Pressure Cooker (to sterilize instruments, etc.)
- Additional Prescription Medications
- Medrol dose packs, oral steroids
- Salbutamol inhalers for asthma/severe allergic reactions
- Antibiotic/anesthetic eye and ear drops
- Oral Contraceptive Pills
- Metronidazole, oral antibiotic and anti-protozoal
- Amoxicillin, oral antibiotic
- Cephalexin, oral antibiotic
- Ciprofloxacin, oral antibiotic
- Doxycycline, oral antibiotic
- Clindamycin, oral antibiotic
- Trimethoprin/Sulfamethoxazole, oral antibiotic
- Ceftriaxone, IV antibiotic
- Diazepam IV sedative to treat seizures
- Diazepam in oral form, sedative
- Alprazolam, oral anti-anxiety agent
- Oxytocin (Pitocin) IV for post-delivery hemorrhage
- Percocet, (oxycodone with paracetamol/acetaminophen),
- strong oral pain medicine
- Morphine Sulfate or Demerol, strong injectable analgesic
I’m sure there is something that I might have missed, but the important thing is to accumulate supplies and equipment that you will feel competent using in the event of an illness or an injury. Some of the above supplies, such as stretchers and tourniquets, can be improvised using common household items.
It should be noted that many of the advanced items are probably useful only in the hands of an experienced surgeon, and could be very dangerous otherwise. Also, some of the supplies would be more successful in their purpose with an intact power grid. These items just represent a wish list of what I would want if I were taking care of an entire community.
You should not feel that the more advanced supply lists are your responsibility to accumulate alone. Your entire group should contribute to stockpiling medical stores, under the medic’s coordination. The same goes for all the medical skills that I’ve listed. To learn everything would be a lifetime of study; truthfully, more than even most formally-trained physicians can accomplish. Concentrate on the items that you are most likely to use regularly and be grateful of assistance from others in your group.
