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Tuesday, March 30, 2010

Prepper Medical Kit

We all know the story; the quake/flood/hurricane will come and we will be on our own for 96 hours or more. This includes medical care as the nearest hospital will be reduced to gravel and the nearest doctor will be buried alive in wreckage.

We have also read innumerable posts for medical kits we can make to enable us to perform heroic measures and pull through anything medically. Many have seen the catalog ads for "field surgical kits", kits that contain just enough instruments to get us into trouble while enabling us to perform little real "surgery".

Here is my contribution to the survival med kit guide. Kit is for dealing with trauma only. Kit does not duplicate common items found in "standard" kits, such as gauze pads and medical tape. It consists only of items that will enable a prepper to provide care beyond basic first aid for a few days. This kit is based on the idea that deus ex machina, definitive, care will not be available for 96 hours or less. It will enable the careful prepper to:
  • Cleanse and debride wounds. And deal with wound infection.
  • Provide initial care for burns covering significant locations and areas of the body, such as to help prevent death from overwhelming swelling, compartment syndrome, or burn shock. As a general idea: dealing with body surface burns of 35% or less or involving hands/feet/perineum. Note that cutting burn eschar to enable better breathing or caring for compartment syndrome requires [relatively "easy"] surgical intervention, so the surgical unit described below would be required.
  • Fractures of long bones, with basic capability to deal with open fractures. Capability to reduce femoral fracture and reduce the chance of death from pelvic fracture.
  • Animal/human bite care.
  • Very basic care of knife or gun shot wound (GSW) from looters,etc. For "flesh wounds", not for organ hits, and only care to improve breathing efficiency temporarily for lung hits.
  • Provides a very basic eye and ENT capability. This is real specialist country so the kit will only cover initial care for injuries that are very prone to later complications if certain basic interventions are not applied near the time of injury. Examples: bruising of ear, heavy bruising of nose, foreign object in eye.

First, a few book suggestions. There are others out there, but these are listed on several online prepper/disaster sites as good resources. Remember, medicine is very complex. So know your limitations, only prep to the medical intervention level that you can competently deal with. You will always be a prepper trying to keep a companion alive, never an "instant doctor" who can suddenly perform as well as the professionals.
  • (Anatomy) McMinns (excellent illustrations!) or Grants are good choices for seeing where vital structures generally lie. A surgical anatomy might be useful, Skandalis' book can be found often on Amazon for under $5.00.
  • (Technique) Atlas of Emergency Procedures, by Rosen, et al, is expensive new but covers many of the lifesaving procedures preppers may need to perform, in a clear, well organized manner. Field Guide to Urgent and Ambulatory Care Procedures, by James, David M. , covers a broad range of common emergency procedures in good [text] detail, including ENT and dental procedures.
  • (Wound Care) Wounds and Lacerations, Emergency Care and Closure, Trott, Alexander; this is the best manual for learning about general wound care and closing wounds. Used copies are sometimes available from Amazon or used book stores, this one is a keeper if you buy it, you will never give it away!
  • (Online Reference) Survival and Austere Medicine (how do the pros do it under these conditions?), Borden Institute (extensive military medicine reference. Especially note the lessons-learned book for Iraq/Afghanistan), Operational Medicine (Online learning resource for many common procedures).
Dental Unit: See my previous post for a solid, simple dental disaster kit.

Pain Control Unit: See my previous posts on survivalist analgesia/anesthesia: herbs for analgesia/light anesthesia and coverage of pain control drugs not on DEA lists, with notes on local anesthesia.

Diagnostic Unit: stethoscope, bp cuff, thermometer, penlight, 128Hz tuning fork (poor man's xray machine when used with stethescope), prepackaged eye trauma diagnosis kit (fluorescein strips, cobalt blue light, eye magnet with loop), precordial stethoscope (for monitoring vitals during surgery or for prepper "intensive care/resuscitation"). This unit will cost about $150. Without eye unit, about $70.

Airway Unit: "pop-up" CPR mask with oxygen fitting, pocket CPR mask, (1) set of nasopharyngeal airways (safer to use and causes less gagging than oral pharyngeal airways). Definitive airway equipment: (1) Ashermann chest seal (for sucking chest wounds), (1) Combitube (adult size only), (1) needle cricothoracotomy kit (for tension pneumothorax. Costs about $25), (1) chest tube set (optional as the procedure is very invasive, but can save the life of someone with tension pneumothorax or bad hemothorax). This unit, without chest tube, will cost about $120.

Oxygen Unit: Oxygen tank with variable regulator with good, readable gauge (D cylinder is best generally. E cylinder provides for longer usage. B cylinder is good for mobile operations), (2) packages of oxygen tubing , (1) each pediatric and adult simple face mask, (1) humidifier unit, with sterile water. Oxygen can make a great difference in outcome if it is used safely, and properly. First and foremost: no high flow oxygen for over 12 hours for laypeople! This unit will cost about $270.

Burn Unit: (2) burn sheets, 4 oz+ of colloidal silver (for prevention of burn infection), (1-3) tubes of povidine/antibiotic ointment (for infection), (1-3) 4oz burn spray with 30% lidocaine, nonstick dressings in various sizes, (2) nonstick roller bandages (e.g. Coflex AFD), (1-5) Tegaderm(r) type film dressings ("replaces" burned skin for non-extensive burns). For treatment of burn shock, include iv setups with at least (3) 1L bags of normal saline (do not use ringers lactate for burn victims). Burn shock can require staggering amounts of fluid replacement and requires careful monitoring to prevent disaster; know the fluid calculation formulas; read up very well. This kit, without the iv component, will cost about $110.

Wound Unit: Comes as four modules: bleeding control, cleansing, closure, surgical. The first two require common sense and some reading. Closure requires some reading up to intensive study and practice on pieces of meat/gelatin film "skin". Surgical, of course requires intensive study and practice for anything beyond very basic debridement or splinter removal. Cost, without surgical unit, will be about $170 (assuming that you buy the sutures and Zerowets in bulk with others). Cost of surgical unit is about $120 or more for the items not in the closure unit.
[Dressings and bandaging] (2) Bloodstopper(r) type dressings or military field dressings. a few Tegaderm(r) type film dressings, tampons (for GSW), several Kerlix(r) type roller bandages (for bandaging and for packing wounds), good commercial tourniquet (know how to use it! Improperly used, tourniquets can kill). [Hemorrhage control] QuikClot® and/or Hemocel® gauze squares (at least one packet, consider two or more gauze squares); Vistec® type lap pad package (1 or 2), more Kerlix® type gauze rolls in 2'' and 4'' width; (2) sterile surgical towel pack.

[Cleansing] (2) 15ml and (3) 100ml Shurclens(r) ampules (excellent for wound cleansing; good for embedded asphalt too), chlorhexidine surgical/hand scrub (not as safe in wounds but does a very good degerming job), irrigation syringe packages (20 or 60ml size), (2) Zerowet(r) shields for use while irrigating wounds (make a group order: about $55/50 shields), hydrogen peroxide (dilute 1:1 with water for irrigation). Instruments: adson tissue forceps, curved kelly hemostat, splinter/dressing forceps, (several) Medipoint Splinter Out(r) packs (inexpensive and versatile!). Dakin's solution can be used for infected wound care; it is easily made from plain bleach, baking soda, and sterile water.

[Closure] (2-4) strips of butterfly strips, (2-5_ packets of wound closure strips. Sutures: 3-0/4-0 and 5-0 in nylon or Novafil or Prolene (two each size, use for closure of skin); 4-0 and 6-0 in Dexon or Vicryl (two each size, used to close deeper structures, absorbable so does not need removal, do not stock gun show-bought chromic gutit is a poor choice). Webster needle holder (one each short and long). Stapler, 5 shot (one or two). Staple removal kit, sterile (one per stapler stocked). Suture removal kit ( enough to cover the sutures stocked).

Surgical care] scalpels: (2) each: #10, #15, and #11 . Scissors: straight and curved iris scissors, curved metzenbaum or mayo scissors (one each at a minimum). Forceps (“tweezers”): adson tissue forceps, dressing/splinter forceps, curved iris forceps, Russian tissue forceps (two each is best). Hemostats: curved and straight mosquito type (at least two/each), atraumatic (one for sure, an extra, curved, would be useful for many tasks). Retractors: a pair of senn retractors, consider a pair of small rake types. Good set of magnifying glasses/loupes.

Orthopedic Unit: With this kit, we can stabilize a pelvic fracture, hopefully well enough so the victim survives until help is available. Mortality is very high for unstabilized pelvic fractures, hence including a pelvic splint. We can reduce a femoral fracture enough to pull the victim through. We can do pretty durable splinting and can, with extreme care, reduce some dislocations or fractures in order to re-establish blood supply. Unit cost will be around $600, including backboard. SAM pelvic splints run around $70/each.

SAM pelvic sling (one each: standard and small, consider also one extra-large), Kendrick Traction Device (for femoral fractures), backboard with straps, adhesive felt (one roll); SAM soft shell splint (2-4). Several commercial cardboard splints in various sizes. Consider having a roll or two of casting tape and some stockinette for lining improvised casts.

Eye/ENT Unit: This unit will enable basic, vital care for broken or severely bruised noses, bad ear bruising, persistent nosebleeds (not associated with head injury!!!), and care of simple foreign object in eye/minor corneal abrasions. Again, this is specialist territory, if you stock it, learn from the pros and read up on the procedures. Note that this unit contains prescription meds, to be prescribed by an opthamologist. Cost, without prescription meds and Desmarre retractor, will be about $110. Meds will cost around $40-60.

(2) Bayonet forceps ( usable for dental also), (1) nasal pack set , (3) #14 Foley catheters (usable for urinary catheters also), nasal speculum (1 medium), #15 scalpel, disposable ear curette ( a few in child and adult sizes), (1) Hartman ear forceps (“alligators”), spray bottle of nasal decongestant (1-2), strong penlight, packing strips for wounds, 0.25”X5yd (one)/ Desmarres retractor (one. Can improvise with paper clips); , antibiotic eye drops (5ml), diclofenac or ketorlac eye drops (5ml), sterile eye wash, 4oz (2), roll of saran type wrap, (1) fox eye shield, eye dressings-sterile (4-6, usable for many types of wounds)

May you never have to use this "extended first aid" kit.