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Old October 27th, 2007 #1
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Thumbs up Getting Started In Medical Preparedness

GETTING STARTED IN MEDICAL PREPAREDNESS
WHEN YOU DON’T KNOW WHAT TO DO


Dr. Keith Brown


Authors note – This was originally written in 1998. It has floated around the net for years, having flowers and rotten tomatoes thrown at it. As we see an upsurge in interest in personal preparation again, due to Katrina, Bird Flu, and what have you, I thought I would dust it off and tweak it a bit. Let the flowers and rotten tomatoes begin!


Some people are fortunate. Because of their jobs, callings, or interests they are already involved in medical care or have training and experience in remote and disaster medicine. We frequently work with paramedics, military corpsmen, missionaries, search & rescue teams, and others who have started their education in medicine (it’s an ongoing process - you may quit but you’ll never finish.)

But just as often we are asked for help by an individual or group that has a need for such training, but has no idea where to go or how to begin. It’s a pleasure and a privilege to work with people in this situation. We feel that we have a significant responsibility in getting people new to the field of remote medicine & medical preparedness off on the right foot. Here are some of our thoughts to help you get started.


WHY BOTHER

Everybody needs medical care. Most people worry about having adequate medical care. Very, very few do anything to ensure that they have it. After all, you just call 911 and the ambulance man comes and takes you to the hospital, right? Sure, until he doesn’t. One word for you: “Katrina.”

Need I say more? The problem of ensuring medical care is obvious if you are planning an expedition to Central America, are a bush missionary, or a special operations forces medic behind enemy lines, but not always as clear at other times. It takes hard thought and a careful assessment to determine your needs.

So, the first step for you to ask yourself is “what am I planning for?” The circumstances of your life often dictate your need to develop your medical training and equipment. For example, missionaries overseas or open ocean sailors often do not have access to any sort of acceptable medical care, and must provide their own until they can reach “civilization.”

For others, preparedness is their goal. Be it natural disasters, civil unrest, or what have you, they feel the need to be able to provide medical care for themselves and their families. A personal philosophy of self-reliance is a common theme we find in almost everyone we work with. And finally prevention should not be underestimated.

Knowledge is power, and the ability to recognize and manage medical problems allows you to prevent or minimize the severity of many problems.

With this in mind, sit down and write a clear, concise statement of why you feel the need for advanced emergency medical training and capabilities. This will be the focus and motivation you need to begin. Write as much or as little as needed, but be clear and honest about your intentions.


GETTING STARTED

“You Are Either The Anvil Or The Hammer” – Geothe

Developing a reasonable medical preparedness capability may seem like an overwhelming task. It’s not. Nothing worth having is easily obtained, but you can learn new information, develop new skills, and improve your situation. The key is starting with the basics and using small but sustained, methodical steps to reach your goals.

You need knowledge, experience, and equipment to address the problem of remote medical care. The first two are the most important. We can ship you a prepackaged disaster hospital tomorrow, but without the first two - knowledge and experience - it won’t be of much use.


GAINING KNOWLEDGE

Learn.

It would be ideal if everyone could go to medical school, or devote 2000 hours to a quality paramedic program, then supplement the training with specialized wilderness medicine and other courses, but that isn’t realistic. However, a 40 hour First Responder or Red Cross Advanced First Aid class is within reach of almost everyone. These classes will teach you basic anatomy, medical terminology, patient assessment, and immediate action for common emergencies like bleeding, fractures, and shock.

Everyone in your family or group should have this “medical basic training.” These classes are within driving distance of most communities - call your ambulance service and nearest Red Cross chapter, or we will be glad to assist you in locating a program in your area. We provide this training as well, in a block of several days for those who do not want to devote several weeks to evening classes.

Use this introductory course as a springboard to further your medical education. The advanced topics you can pursue are almost limitless, and should be guided by your anticipated needs, but there are some nearly universal areas that deserve your attention.

Care of trauma patients, especially wound management and basic surgical technique (cleaning, suturing, amputation) and fracture management (splints, casting) is critical. So to is basic pharmacology and medication administration (injections, IV’s), environmental injuries (heat, cold, altitude), medical problems (shock, infection), and prevention (sanitation, water purification.)

Don’t overlook emergency dentistry, and your situation may require knowledge of obstetrics and pediatrics as well. Private classes on advanced topics, self study, and interactive work with your family/group will give you this. The fact that you are reading this publication shows that you are interested and capable of learning independently.


GETTING EXPERIENCE

“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” - Sir William Osler, M.D.

Practical experience complements your medical knowledge. It lets you practice your newly acquired skills and fine tune them, it keeps those skills fresh once you have acquired them, and it provides an invaluable psychological benefit by letting you gain confidence in your knowledge and skills. Caring for the ill and injured is different from other life experiences, and any exposure you can get while learning will better prepare you for the time you have to do it.

Many training programs include observation or assist experiences in hospitals, nursing homes, or ambulance services. Volunteer on a regular basis if you can. Ask the ambulance service if you can “ride along’ once in a while - even one evening a month is helpful. Follow your doctor in their office/hospital. Do anything you can to increase your exposure. Realistic exercises can be extremely valuable, if they simulate actual problems likely to be encountered and don’t degenerate into ridiculous mind games.

You can work with your family and group periodically to review material and practice procedures and skills. We periodically provide advanced training exercises with practical hands on scenarios and performance requirements.


GATHERING EQUIPMENT

We’re not joking about the prepackaged disaster hospital - we can send you one. But that isn’t what you need right now. Remember the sustainable, methodical approach?

The first things that you should acquire, at the same time as you are working on your knowledge and skills, are the “Holy Trinity” of medical preparedness:

Water Purification Capability - Clean, safe water is the most critical item there is, next to air to breathe. You must have water to drink, prepare food, maintain basic sanitation, wash injuries, prepare bandages and instruments, raise food animals, etc. There are a variety of options and methods for water purification and storage. For now, either boil all water for at least 15 minutes or use common household bleach (without the lemon scent) mixed with water that has been filtered through some cloth to remove silt, etc. Use 5 drops of bleach per quart of water and let the water sit for at least one hour at room temperature. Replace your bleach supply every six months.

Antibacterial Soap - We’ll be the first to admit that there isn’t anything cooler than a large tray of stainless steel instruments. Do you know how to use them? Do you know how to use soap? It’s critical to maintaining basic sanitation, limiting the spread of disease, cleaning utensils and instruments, etc. Disease prevention is always your goal. Get a true antibacterial soap, liquid or solid doesn’t matter. It’s cheap in bulk and will last indefinitely. Protect it away from animals, which seem to find it tasty.

Reference Books - We use our references every day, and we practice medicine for a living. You will need reference material, chosen to address your needs. A jungle expedition needs a brief, lightweight reference on medical procedures and tropical medicine. A group preparing for long term disruption of basic services needs comprehensive references on a wide variety of topics. We have a core medical reference library that we recommend for most of our clients – many of them have already been mentioned on this site.

Start with a medical dictionary and a standard paramedic textbook. We recommend Dorland’s Medical Dictionary, as it includes quite a few basic anatomy illustrations, and various reference tables and appendices. The dictionary is a must in order to understand obscure words or references in other texts. The Basic EMT by Dr. Norman McSwain, and Paramedic Emergency Care, authored by Dr. Brian Bledsoe, are some of our favorite emergency texts, although there are many other fine books also.

In addition to the above, you need to start acquiring items of specific need, such as eyeglasses, other currently needed medical equipment, or prescription medications.
The latter is a thorny problem in some circumstances. For now, ask for extra from your doctor. The appropriate tactic to take will vary with your situation, but your physician is much more likely to prescribe extra blood pressure medications than narcotic pain pills.

Another benefit of getting involved with your local ambulance service is that the physician medical director for the service will get to know you and your capabilities, as well as have a greater appreciation for emergency preparedness. You can then approach them about prescription medications.

Finally, seek out physicians with wilderness, travel, missionary, or very rural practice experience, although they can be hard to find. They have a much better understanding of your needs. Call the Wilderness Medicine Society at 1-317-631-1745 and ask if there is a member in your area, or try the International Society of Travel Medicine directory at: http://www.istm.org/. And of course, you can always ask me or investigate our website for additional resources: http://www.gmrsltd.com .


WHAT NEXT

Great. You’ve overcome the single greatest hurdle you face in developing you medical capability: getting started. You are reading this publication. You’ve called your local ambulance service or Red Cross to ask about training. You are working on the “Holy Trinity” of water purification, soap, and reference books. Now what?

Now you can get out your “what am I planning for” statement and develop it into a comprehensive analysis of your current and anticipated needs, capabilities, and training and equipment requirements. For our clients, we start with a comprehensive questionnaire that gathers detailed information from these areas:

- Group Demographics
- Geography
- Current Training & Capabilities
- Portability & Storage Needs
- Time of Need
- Duration of Need
- Special Priorities
- Budget



DON’T STOP NOW

If you have performed a comprehensive analysis of your needs and capabilities you should have a clear agenda of what training, equipment, and medications, you need to acquire.

Continue your education. Now you should know what is available in your area. Watch for area seminars and other opportunities. Seek out private training. If you are in a family or group consider “cross training” with other members so that all your medical knowledge is not focused in one person. Self-study should be ongoing, with formal training at least every year, and family or group training monthly.

As your knowledge and experience expands, so to will your ability to use appropriate equipment. Start with pocket first aid kits for every member of your group and every facility and vehicle. You can expand on these to develop comprehensive medical and trauma kits. Many basic items, such as splints, can be made or improvised.

Give some thought to buying some basic wound care, surgical, and casting materials even if you don’t have the practical experience yet to use them. It’s difficult to improvise an appendectomy. Necessity often forces us to do things with the help of reference material, prayer, and sheer willpower. Or, you may not have the skills to use the equipment, but you may locate someone who does.

And finally, Practice, Practice, Practice! Exercise both your mind and your body with mental and physical practice. Mentally Practice by rehearsing in your mind everything you can think of.

“If this happens then I will do this____,” “I deliver a baby like this____,” “This medicine is used for this____,” “OOPS, I don’t remember how to do this, I’d better look it up.” The finest athletes, surgeons, and musicians use mental practice as part of their daily routine. We do so, and you should too.

Physically practice everything you can. Put splints and bandages on your spouse, kids, pets, furniture. Suture your steaks (remove before cooking!), tie 10,000 surgical knots. Deliver your next child. Practice injections on oranges. Hold all the practical training exercises you can. Make an effort, a very great effort, to get experience caring for actual ill and injured people.


KNOWLEDGE, EXPERIENCE, EQUIPMENT


The process of acquiring these is not overwhelming; it just requires a disciplined, systematic approach, with a clear idea of where you are going and how to get there. We hope that this short introduction will help you get started. We will be happy to assist in any way we can.


As you can see this is quite general & basic, by design, in order to not overwhelm people who are getting their feet wet in the medical care area. Too many times I have encountered people that have tried, but nave been overcome by trying to develop an instant brain surgery capability rather than focusing on the basics.
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Old October 27th, 2007 #2
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