Medical Preparedness Scenarios: Making Choices

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. 

Planning for the future means making choices, setting priorities, formulating educated judgments, and making predictions about what you and yours will likely be facing.

This is among the most challenging aspects of preparedness; none of us can predict the future infallibly, and almost all of us face economic or other limitations. Because the human body is so complex, so is the process of caring for it. Medical preparedness can therefore seem an insurmountable task. Solve one problem, and there are ten others like it that crop up. The good news is that there are intelligent ways to manage the problems and complexities of medical prepping, and thereby spend your time, money, and effort wisely. 

Let’s examine some of them…

 Before one can solve any problem, one has to understand its dimensions. Before you can prepare to handle a given future medical need or crisis, you will need to identify and study it in depth. What is your goal? If it is to be able to handle routine first aid and basic life support, that entails a very different set of preps than if you are trying to handle the treatment of chronic illnesses such as asthma or emphysema, and different again from handling trauma, burns or similar intensive care, and different still again from delivering babies and the care of neonates. 

The military offers one useful model for understanding medical care, that of echelons.

When someone is wounded on the battlefield, the medic or corpsman on the scene offers first-echelon care – performing immediately necessary stabilization of the patient, such as an initial assessment of the casualty, checking the “ABCs” (airway, breathing, circulation), controlling hemorrhaging, assuring airway patency, fluid resuscitation (generally in the form of IV infusion), splinting, etc. These are either basic or advanced life-support measures, similar to what a civilian EMT or paramedic would do. Second-echelon care is at some sort of forward aid station, and usually involves more invasive procedures or surgery by a physician or physician assistant to further stabilize a casualty for the trip to the rear. Third-echelon care is delivered after medivac to a mobile combat support hospital, which is today’s analog to a MASH unit. Finally, definitive care is given in a fourth-echelon fixed-base facility in the rear. The most complex surgeries and most-complete post-operative care and rehabilitation are offered in such facilities. They are also well-equipped to handle complex diagnostic and treatment issues that may prove beyond the reach of less comprehensive facilities. 

The echelon model gives us the several means to narrow our focus. The chain of care a battlefield casualty goes through illustrates an important truth about medical care: it is a team undertaking.  That means we’re going to be reliant upon others, and they upon us. Identify where in the echelon system you fit, what your role is. 

Most of us aren’t fully trained physicians. That means our level of expertise is by definition narrower than that of a doctoral-level medical practitioner. If you possess some medical training, such as an allied health science, nursing, or perhaps as an EMT, you have a head start on the lay person. If you are a novice, don’t get discouraged – just get started doing what you can, when you can, how you can. 

If you aren’t a surgeon, your role is probably going to be providing life support and stabilization of the patient until you can get him/her to a fully-staffed and equipped hospital. Readers of James Rawles’ “Patriots” (spoiler alert) will doubtlessly recall the scene in which a nurse operates on a man with a gunshot wound, using the manual “Emergency War Surgery,” by Dr. Jeff Fackler. That’s your last ditch scenario, get your patient to a fully-equipped hospital if at all possible. 

So, you’ve decided to learn basic (BLS) and advanced (ALS) support, plus some nursing and perhaps some basic diagnostic skills. That’s your starting point.  What comes next? 

1.  Assess yourself and those for whom you expect to care, both generally and specifically. Read up on how to take a patient history and conduct a physical exam. One does not have to be an M.D. to learn this; EMTs and nurses are expected to know these important skills also. There are many guides and books available for interested readers, as well as websites like this one. A short-cut: ask your family care practioners for a blank assessment form, of the kind new patients fill out upon going to the doctor for the first time, and pay attention to how the doctor and/or nurse examine you upon each new visit, from collecting your complaint, signs and symptoms, to your vital signs.  

Take stock of your health and that of your family or group. What are the ages of the people involved, and their general state of health? Who suffers from chronic conditions, or has on-going medical needs such as a monthly prescription? Who wears eye glasses or uses a hearing aid? Does anyone have allergies, and if so, what preps are necessary to cover them? Is anyone an asthmatic or a diabetic, or perhaps there is a circulatory or heart condition with which to contend.

These and dozens of other possibilities should be considered when building your medical preparedness plans. Use the wealth of resources available to you, from websites like this one, to books, seminars, academic and profession training, and more. Ask questions of your healthcare team. Pay close attention to the contents of different kinds of first aid and trauma kits. Hospitals, clinics, medical labs, and supply houses, as a routine part of their business, have to keep close tabs on what supplies are needed and in what quantities; these are also valuable resources for information, as are local law-enforcement, emergency management and first response providers. 

2.  Economics – most of us have limits to the pool of funds we have available for prepping, including medical preps. That will place constraints on what you plan for and how. The enormous cost of equipping and then using of even a small “clinic” for personal use can be quite daunting. Again, this points to the necessity of cultivating friends and associates with skills in medical and ancillary services. Rawles recommends learning skills that can be used for barter with medical or dental professionals. IF you know plumbing, trade your skill in that for some dental work, and so on.  

3.  Pick the low-hanging fruit first. Many relatively simple medical conditions, illnesses and injuries are readily amenable to home or do-it-yourself treatment. Dr. Koekler has written a book on just this subject [ed. – 101 Ways to Save Money on Health Care], and there are other available also. The Medical Corps (www.medicalcorps.com) offers workshops on expedient and field medical care, staffed by experienced physicians and a former navy corpsman. Military medics are taught basic sanitation and public health as a part of their training, and medical preppers should do likewise with these often simple but critical steps to safeguarding food, water, and basic sanitary needs. Master these skills before even thinking about the really complex stuff, whether surgery, complex medical cases such as chronic illnesses, or trying to manage what physicians call “comorbidity,” or multiple illnesses in one patient.  

4.  Technology – unless you are Bill Gates or Warren Buffett, you aren’t going to be able to afford to build a fully-equipped hospital for your survival needs, and even if you have that kind of money, you alone won’t have the expertise to operate it. It bears repeating – medical care is a team undertaking. To name one example: the most superbly-trained physician in the world is severely hampered without diagnostic tests and lab data, provided by a specialist in clinical pathology and medical laboratory science, operating a fully-equipped lab. Think of how reliant high-tech medicine and surgery has become upon advanced imaging techniques such as magnetic resonance imaging, ultrasound, to say nothing of the now-humble X-ray machine? So, get accustomed to the idea of working within your technological limits, whatever they happen to be. 

5.  Know your limits: “First do no harm” is a fundamental tenet of professional healthcare, and do-it-yourselfers should strive to live by the same standard. Know your limits – what you know and don’t know, and remember the dictum “A little knowledge is a dangerous thing.”  

6.  Legal considerations: medical preppers face an additional barrier to getting ready for future scenarios, namely legal hurdles. Our current healthcare system is designed (in theory anyway) to maximize safety and effectiveness, and is not structured to allow easy entry for would-be practioners. Becoming and remaining a professional doctor, nurse, or other healthcare provider is arduous, time-consuming, and labor-intensive, and even then, access to drugs, medical devices, and treatment modalities is strictly controlled by the FDA, DEA, and other government agencies. To  name one example, private citizens in this country cannot simply buy opioids/narcotics or other controlled analgesic substances; one must be a licensed physician, physician extender, or pharmacist with a valid DEA number to write prescriptions, and there must be an established medical need. These realities inevitably affect medical preparedness.  

(To be continued in subsequent installments)

Copyright © 2010 Pete Farmer

Related articles

• Medical Asset Evaluation, by Dr. C. in Flyover Country (survivalblog.com)