Hitting the Wall: Legal, Ethical, and Logistical Barriers to Medical Preparedness

The following post on medical preparedness is contributed by Pete Farmer,  who holds advanced degrees in research biology and history, and is also an RN and EMT.

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You’ve done your research, rolled-up your sleeves and made up high-quality first aid kits for your home and vehicles, you’ve spoken with your physician, pharmacist, or other healthcare provider – and solicited their advice on medical preparedness. You have adjusted your plans accordingly. You have built a library and patronize websites like this one as part of your on-going effort to expand your knowledge. Perhaps you have been trained and have acquired experience as a medic, EMT, athletic trainer or patient care tech. Now what? 

By now, you have probably run into some of the intractable obstacles that medical preppers encounter. Legally-restricted access to certain classes of drugs and medical devices, the difficulty of acquiring advanced training without attending an expensive university-level degree program, barriers to entry into the medical and paramedical professions, and much more. Even when one can obtain a given pharmaceutical or drug legally, it is often too expensive to stockpile, or the pharmacy will not or cannot fill your prescription. Some vendors supply only FDA or DEA-licensed organizations, and won’t sell to lay people. The list is nearly endless. 

These problems in turn beg a series of ethical or moral questions. Many other nations have substantially cheaper and/or less-restricted drug formularies than the United States (Mexico, to name one example). Some pharmaceuticals available only by Rx in the U.S. can be purchased legally in those places over the counter, without an Rx script. These compounds range from antibiotics to analgesics/pain killers/narcotics to hormone replacement therapies such as human growth hormone, and many more. Americans can lawfully go to those nations, and purchase such agents, but at present it is unlawful to bring or attempt to bring them into the United States without official permission and the appropriate clearances. This article will not debate the pros and cons of such laws; it simply notes the legal conditions pertaining at the present time. 

Rather than take the law into your own hands, and run the risk of a sizeable fine and/or imprisonment (and loss of your healthcare license if you have one) by smuggling such agents into our country, let me suggest a legal and ethical alternative: getting your elected officials and local/regional disaster preparedness organizations involved. Do some writing of letters and make some phone calls. Visit in person with authorities involved in medical and other forms of preparedness, if feasible. Contact your local Congressman or  state representative. Let’s discuss what to say when you do so…   

1.  Be frank and up-front about what you are doing vis-a-vis medical preparedness and why. Express your concerns clearly and reiterate your desire to follow the law.

2.  Frame medical preparedness as a community issue, one which should be of importance to any conscientious emergency management or public safety professional – not to mention any politician genuinely concerned with disaster contingency planning, mass casualty events, public health outbreaks or the political fallout from same.

 3.  Note that since the law forbids private citizens from stockpiling medicines and most medical equipment as a contingency against future events, and restricts access via the prescription system to many others, ask what is being done by local/state agencies to rectify the problem. Are the authorities in question stockpiling these meds and other needed supplies? What is being done to prepare for that next tornado or hurricane or other disaster? Ask a lot of questions, exercise your rights as a citizen. Don’t assume everything that can be done is being done. Call me a cynic, but my experience and Murphy’s Law prove the opposite.

 4.  As recent history illustrates, the government has a very mixed record at disaster preparedness. Many of us remember the chaos that followed Hurricane Katrina, and the weeks upon weeks that it took local, state, and federal authorities to respond appropriately. FEMA didn’t function as promised; it is that simple. Recall also that during the recent scare (a false alarm, thankfully) over the H1N1 flu virus, the feds were slow in building up the needed doses of vaccine. In fact, the government didn’t accumulate the needed stocks until after the crisis had passed. For concerned citizens, this means keeping the issue before officials and elected representatives. The squeaky wheel does eventually get the grease.

 5.  Much of our society functions on a just-in-time supply chain model. That includes many healthcare providers. The practical consequence of this is that many clinics, hospitals, pharmacies, and suppliers do not have very deep stocks of needed medical supplies, drugs, diagnostic agents, and so forth. We live in an economy designed for efficiency, not resiliency. Bring this state of affairs to the attention of the aforementioned politicians and officials; once they see we care about it, perhaps they’ll care about it. Also, drop a line to your local newspaper and ask to speak to their healthcare or science reporter if they have one; they might run a story on the issue. Emphasize the need for locally-generated and implemented solutions to these problems. We don’t need another dysfunctional and expensive federal bureaucracy that fails to work as advertised when a crisis hits.  

6.  Research and form a position – whatever yours may be – concerning the many roadblocks that our system erects in the path of medical preppers. The issues range from licensing and the problems of over-credentialing to onerous fees and costs of entry, to the government-university cartel which has made entering any medical field a very costly and laborious process. A rich nation can afford these kinds of inefficiencies, but should the America of 2010? To name one example, the military has proved via its system of training enlisted medics and corpsmen (most of whom do not have college degrees), that one need not have a college education to become a healthcare provider. Yet, professional nursing organizations and universities have restricted the civilian scope of practice of these individuals severely. The result is that everyone gets an expensive university education, whether they need one or not. That’s great for the colleges and professional credentialing organizations, but not so good for someone leaving military service with years of practical and useful healthcare experience, who can’t work as anything but a PCT.  Yes, we need highly-trained physicians and other specialists, but to insist that everyone attain that level of expertise is both foolish and wasteful, and does not serve our communities or patients well. Get informed about the issues, and start lobbying your elected representatives. Otherwise, nothing will change until a genuine crisis of some sort hits, and that is an expensive way to learn anything.

 In closing, don’t hide in the closet if you are interested in medical preparedness. It is nothing of which to be ashamed. In fact, you are to be commended for taking the initiative. Most doctors, nurses, firefighters/paramedics, cops, and other first responders and public safety personnel love knowledgeable, squared-away people. They make our jobs easier and help patients get better care. And for goodness sakes, advocate for medical preparedness issues whenever possible.

Copyright © 2010 Peter Farmer

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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2 Responses to Hitting the Wall: Legal, Ethical, and Logistical Barriers to Medical Preparedness

  1. Dana S. says:

    Preppers: Support your local Vet! I’ve read *stuff* on prepper sites that could be interpreted as ‘Social Unrest: Mob Seize Vet Meds…” In fairness: Responsible people will not…
    Here’s what you need to know:
    1. Not all Vet meds/equip can or easily be used on humans.
    2. Some Vet Hospitals have specialized fiber optic tools for major ortho: Stealing this stuff will not help humans! (No field joint replacements on people by pa-c’s
    3. Your Vet remains an invaluable PH resource! Police dogs, horses, rat eating cats, security dogs, etc: still need care whatever!
    4. Large cat or other big critter loose? Your Vet is usually able to knock it down. Non-lethally.

    Activism: Educate/encourage your Vet to stock long on Rabies vax, iv sets/bags,
    Anesthetics (‘P’ apparently is still unavail some places…

    Offer personal support, security, pay your bill on time so she/he can risk stocking past ‘normal’…educate Vet & staff, if they are not aware of these issues!

    Remember: Practitioners are leery of discussing medical details with lay people!
    Couch your concern in ‘concern that assets remain for my doggie’!

    You’ll give the Practice a reason to encourage All clients to stay current on vax!

    Remember: Animals help people. Vets and vet techs care deeply about their pets! No one should interfere with an animal practice for a speculative ‘help people’ motive.

    • Doc Cindy says:

      Thank you, Dana. I agree, and during the midst of (or the aftermath of) a crisis, human and veterinary doctors should work together. Raiding any medical facility is a bad idea, at least if such a facility remains in operation. If the population is greatly reduced through catastrophe, and no doctor of any sort can be found, then having your community band together and decide what to do with available medical resources may be the best idea. Truth, fairness, honesty, as well as self-reliance and community responsibility, should be valued as highly after an Armageddon-event as before.

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