THE CASE FOR ADVANCED MEDICAL PREPS?

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Often times I hear from people that "I don't need to worry about that stuff, I can't use it anyhow." What they are referring to are more advanced medical preparations, such as suture instruments, skin staplers, IV supplies, injection supplies, etc. And they are correct, if they do not have the proper training and experience then stocking such items would be of no benefit to them. Or would they?

Let's examine this in closer detail. Most people's medical preps consist of a basic first aid kit and a few OTC meds like ibuprofen, aspirin, antibiotic ointment, maybe some cough remedies and cold and flu caplets. Good so far as they go. That may be the extent to which the members of that family are trained.

But let's take this a bit further. Granted, you are not trained to administer IV's, give injections, set bones or perform primary wound closure. As a Paramedic Specialist I am qualified by dint of my scope of practice to perform most of the skills, but primary wound closure - suturing, stapling, even Steri-Strips - are officially outside my scope of practice, as is the setting of even minor fractures and dislocations. Notice I said "officially." Practically all are within my skill range because I took the time to obtain the knowledge. So long as I am practicing under normal rules and for an employer I may not use these advanced skills. But if and when I am operating on my own - a true disaster situation by way of illustration - certain allowances come into play legally. It's called the "reasonable adult" scenario. In other words, what would any reasonable adult with the knowledge have done in the same situation, when regular medical care was hours or even days away?

Here's a potential real world example. In the event of a bad hurricane such as hits every few years or so, one that devastates a wide area, knocking out power, communications, and blocks the local road network. You have a diabetic who is having a severe insulin reaction, to the point they are comatose and the threat to life is immediate. You have IV supplies. You have injectable 50% Dextrose, or even a bag of 5% Dextrose - same sugar content, larger volume. This is the accepted means of rousing them and actually saving their life. Karo syrup by mouth works albeit slowly, and there is the choking hazard, very real that. But their teeth are clenched tight - not uncommon. That route's out. Local EMS can't even get to you. But 3 houses over lives an RN. Skills but no tools in this case.

Your foresight makes it possible to save the life of your loved one, because you had the tools handy for use by a skilled practitioner. Ordinarily the RN would have to have a doctor's order, etc also. But allowances are made in every state for disaster situations. It's a variation of the Good Samaritan laws that protect the "reasonable person" coming to the aid of another on a voluntary basis. Basically, it is a way of saying "You were in need of assistance and I did my best to the extent of my knowledge. If I made a mistake it was an honest one and you in turn cannot hold me to the standards of professional competency."

The same also applies to primary wound closure. You have the tools as it were, and the Physician's Assistant a couple blocks away has the skills and is willing, but she doesn't carry a black bag, just a pocketful of personal tools, the clinic supplies the rest. Ah, now you are starting to see the light!

Look at it this way. You have a couple spare acres of land for planting but darned if you know diddly about farming. You also have seeds and basic tools you put away "just in case." You have a farmer or serious gardener friend though. For a share of the crop, or the extra seeds, they'll come over and tend to matters. Or perhaps trade skills for something else. It's all a matter of perspective. By putting by you were ensuring your future. Put another way you find a small gas-welding outfit at a sale. You didn't even take woodworking in high school, but you have cars, plumbing and other things around the place that may need repair some day. Far easier to find someone with the skills than the tools, if it occurs during a time of great demand. Payment can be negotiated later for the skills to use the tools.

Doctors these days do not habitually carry their black bags. Partially due to concerns about being mugged for the drugs, partially because they no longer work for themselves in many cases and the hospital or clinic supplies everything they need. Rare any more is the doctor that carries more than a favorite stethoscope or oto-opthalmoscope. Not to mention no longer making house calls they see no need for stocking instruments, sutures and other basic tools.

Immediately prior to Y2K I had doctors ordering basic supplies. The reasons given were always nearly identical. They worked for a hospital/clinic/group, and had nothing to work with should the power go out and the hospital/clinic be forced to shut down. They were otherwise totally unprepared to provide their own instruments, basic supplies, casting materials, etc. Drugs they could order and I imagine they did, but they had no syringes, needles, IV catheters or tubing. They were frantic when they understood the potential implications of the (later proven to be overstated) threat they were facing. Some resorted to veterinary med supplies obtained locally because they failed to look ahead in time to order basic meds such as antibiotics and injectable Dextrose for insulin reactions. Doctors panicked the worst of all.

So, in closing, the question must be asked: Should I stock away my own hospital, just in case someone in my family ever needs the resources and the regular hospitals are swamped, or closed, or inaccessible? The answer is, it depends. Like anyone preparing for an uncertain, and as we have this past week seen, very real future, you need to set priorities. First are the basics like water, food, sanitation, self-defense, transportation, heat, etc. A good basic first aid kit is paramount with your preps.

After the basics have been met then address more in depth preps. Food production, long range communication, etc. In this area belongs the more advanced medical preps. After you add enough bandages and dressings, antiseptics and splints and the like, consider infectious disease isolation supplies, sufficient instruments to perform more than splinter removal, plaster dressings for basic casting, and other preps. The lives you save by having on hand the tools needed for those skilled in their use during a time of limited or no access to modern healthcare may well include you own.

So, I've made my case, what do you think? Is it valid, it is enough, should we include veterinary concerns as well, for the animals we raise?

Dale



-- Dale Swanson (ayrman@pcsia.net), September 19, 2001

Answers

dale! i agree! this is great. everyone, take basic cpr too. this is a skill anyone can have that can save a life.

my kids have never gone to a doctor for being sick, and i have handled everything else on my own (they have never needed suturing, which i could do, but they would freak out on me if i tried it), including true whooping cough. not because i am so anti medical establishment but because i have educated myself and know when i need them, when i don't, and what to do when something somes up. a simple call to my aunt (pediatric nurse practitioner) long-distance told me how to fix a dislocated joint in my daughter's wrist when she was young. no big deal. now i could do it again.

for more information in general on how to care for your kids, meaning when do they need a doctor and when do they not, buy HOW TO RAISE A HEALTHY CHILD IN SPITE OF YOUR DOCTOR by Dr. Robert Mendelsehn . No home with young kids should be without it. It is on my recommended book list for all my birth clients.

-- marcee (thathope@mwt.net), September 20, 2001.


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