Mike,
I see youve reposted the version 1.0 of the Med FAq find
attached the new version, in two parts.
Medical FAQ version 2.0
September 1997
Craig Ellis
(Copyright.(c) Craig Ellis 1997)
Excluding contributions attributed to specific individuals, all
material is copyrighted to the author and all rights are reserved.
This work may be copied and distributed freely as long as the entire
text and all disclaimers and copyright notices remain intact, unless
my prior permission is obtained. This FAQ may not be distributed for
financial gain, included in any commercial collections or compilations
or included as any part of a wed site without the permission of the
author.
Thanks to Richard DeCastro, Diana and Alan Hagan and Pat Turner for
comments and suggestions.
Any constructive comments and debate are welcome. I welcome
correction in any errors of fact. I apologise for any errors of
grammar or spelling they are entirely mine. I've tried to avoid
detailing specific managements for various conditions as I do not
consider this to be an appropriate forum. I will, however, respond to
specific questions, with suitable references on request.
Disclaimer: The author accepts no responsibility for the use or
misuse of this information. The practice of medicine is something
that should only be practiced by trained professionals. If you start
administering medical or surgical treatments without the appropriate
skills you will kill someone. Even in emergency situations, often no
action is better than uninformed and untrained action. Any practice
of survival medicine should be backed up with appropriate training.
This information is offered as my personal opinion and should not be
taken to represent a professional opinion or to reflect any views
widely held from the medical community.
CONTENTS
Part 1
1) Survival Medicine
2) What Do You Need To Know?
3) Training
4) Organisation
5) Reference Books
6) Medical Kits
Part 2
7) Medications
- Storage and Rotation
- Antibiotic preferences
- Antibiotic summary
8) The Basic Laboratory
9) Simple Medical Tips:
- rectal fluid resuscitation
- death
- gastroenteritis and dehydration
- sterilisation of surgical instruments
10) Alternative Medicine
11) Common Sense Medical phrases
12) Quotes and final comments
BEFORE I START, THE MOST IMPORTANT THING ABOUT MEDICINE, SURVIVAL OR
OTHERWISE, IS ***WASH YOUR HANDS***.
1.0 Survival Medicine:
What is survival medicine? My definition is: "the practice of
medicine in a environment or situation where standard medical care and
facilities are unavailable, often by persons with no formal medical
training". This includes medical care while trekking in third world
countries, deep water ocean sailing, in some cases isolated tramping
and trekking in a developed country and of course post-The End Of The
World As We Know It (TEOTWAWKI).
The basic assumption is that trained doctors and hospital care will be
unavailable for a prolonged period of time and that in addition to
providing first aid, definitive medical care and rehabilitation (if
required) will need to be provided. Also the basics of personal and
public hygiene will also need to be considered.
As is the case with any aspects of preparedness you need to decide
what you are preparing for and plan accordingly. For some it will
only be a 72 hr crisis; For others it will be a major long term
event. Your medical preparations will need to reflect your own risk
assessments, in terms of what knowledge and skills you develop and
what you store. This FAQ is more slanted to longer term preparedness,
but much is applicable to shorter term situations.
2.0 What do you need to know?
The more the better. Keep reading and attend all the courses you can.
In addition to an advanced EMT course the following skills are what I
feel the person filling the role of "medic", should aim to be able to
do:
* Use a medical dictionary and a basic medical textbook.
* Perform basic bandaging and dressings. Clean a wound, debride a
burn.
* Use local anesthetic to numb a wound.
* Debride and suture a wound, but also know when not to suture a
wound, and leave it open or perform delayed closure.
* Deliver a baby and afterbirth. Suture a tear, manage a post-partum
bleed.
* Reduce and immobilise a short and long bone fracture/dislocation.
* Use basic counselling skills.
* Understand basic hygiene and preventive medicine practices.
* Recognise and treat common infections:
- viral flu
- pneumonia
- urinary infection
- wound or skin infection
- common STD's
* Recognise and treat common medical and surgical problems:
- asthma/respiratory distress
- abdominal pain - renal stones/appendix/bilary stones
- allergic reactions/anaphylaxis
* Look after some one who is bed bound, e.g. basic nursing care,
managing the unconscious patient, catheterisation.
* Use basic dental skills, simple fillings, infections, extractions.
* Insert an IV and understand basic fluid resuscitation.
* Improvise medical equipment and supplies.
3.0 Training
The most important aspect of survival medicine is to obtain knowledge
and the skills related to it. Medicine is dangerous and uninformed
decisions and actions will kill people. But, having said that, a lot
of medicine is common sense. Anyone with a bit of intelligence, a good
anatomy and physiology book, and a good medical text can easily learn
the basics. Although, I have to stress: There is no alternative to a
trained health care professional; anything else is taking risks.
Obviously in survival situation any informed medical care is better
than no medical care. Notice I said informed, if you really don't
have a clue what you are doing, you will be very dangerous.
3.1 Formal training
* Professional medical training: One option is undertaking
college study in a medical area e.g. Medicine, Nursing, Physicians
Assistant, Paramedic, Vet, etc. Obviously this is not an option for
many, but it is the ideal situation.
* EMT/Wilderness EMT Course: The much more realistic option.
These courses give an basic background in anatomy and physiology,
medical terminology and the essentials of emergency medicine. It
provides the basis for additional self-directed learning. Most
community colleges offer these courses. The basics are well covered
in the "first responder" courses, which, although very elementary,
provide a good stepping stone to the more advanced courses, while not
requiring the same time commitments as full EMT courses.
3.2 Informal Training
There are a variety of options here. Certainly, locally (New Zealand,
and I realise the US may be different) it is possible to gain some
experience in an ER. In our emergency department we regularly have a
variety of people coming through for practical experience, from army
medics, to off-shore island forest service staff, to fishing boat
medics. If you can provide a good reason for wanting to gain skills
in the emergency room such as "sailing your boat to the South
Pacific", then the potential to gain practical experience in suturing,
inserting IV's, and burns management is there. Another option is
befriending (or recruiting) a health care professional and arranging
teaching through them. It is common for doctors to be asked to talk
to various groups on different topics, so an invitation to talk to a
"tramping club" about pain relief or treating a fracture in the bush
would not be seen as unusual.
3.2 Volunteering
Many ambulances and fire services have volunteer sections or are
completely run by volunteers. Through these services you may be able
to obtain formal EMT training and at the same time gain valuable
practical skills and experience, overcome fear of dealing with acutely
sick people and also work with some great people.
Organisations such as the Red Cross or Search and Rescue units also
offer basic first aid training as well as training in disaster relief
and outdoor skills. It is also often possible to arrange " ride
alongs" with ambulance and paramedic units, as the 3rd person on the
crew.
4.0 Organisation
4.1 If you are alone or just a couple then organising your medical
care is relatively straight-forward. However the larger the group the
more formalised and structured your medical care should be. Someone
within your group, ideally with a medical background, should be
appointed medic. Their role is to build up their skill and knowledge
base to be able to provide medical care to the group. There should
also be a certain amount of cross-training to ensure that if the medic
is the sick one, there is someone else with some advanced knowledge.
The medic should also be responsible for the development and rotation
of the medical stores and for issues relating to sanitation and
hygiene. In regard to to medical matters and hygiene their decisions
should be absolute.
4.2 Another important area is that of confidentiality and trust.
This is a corner stone of any medical relationship. It may seem an
odd thing to mention in regards to a survival situation, but all
doctors, nurses, paramedics will tell you without trust you can't
practice. You need to trust that what you tell your medic will go no
further and personal problems won't become dinner-time conversations.
Obviously, this has to be weighed against the "common good" of the
group, but unless it would place the group in danger there should be
an absolute rule of confidentiality.
4.3 Even in a survival situation documentation is important. You
should keep a record of every patient you treat. What they complained
of, your history and examination, what you diagnosed and how you
managed them, a very clear note of any drugs you administer and a
description of any surgical procedure you perform should all be
recorded. Anyone with an ongoing problem should have a chronological
record of their condition and treatment over time recorded. There are
two reasons for this. First is that for the ongoing care of the
patient, often it is only possible to make a diagnosis by looking over
a course of events within retrospect and it is also important to have
a record of objective findings to compare, to recognise any changes
over time in the patient condition. Second is for legal reasons. If
and when things return to normal it may be important to justify why
certain decisions were made. Detailed notes from the time will make
this easier. It is also useful to have medical records on members of
your group prior to any event, including things such as blood groups
and any possible medical problems.
4.4 The persisting survival theme of how you deal with the "have
not's" when they approach you, applies to medicine as much as to food
and other supplies. Obviously complete isolation is one option, but
this is unlikely to be that common. How do you deal with the stranger
dumped on you with the gunshot wound or pneumonia? It's one thing to
give them a meal, but do you give them them the last of your IV
antibiotics or your one dose of IV anesthetic? You need to have
thought about these things. People can often "live of the land" and
forage for food, but they can not forage for penicillin. Its also
worth realising that these people may be more likely to be in poor
general health and also carriers of infectious diseases. This raises
the question of isolation vs community involvement again. One possible
option may be to quarenteen the refugees for a period before any
contact with your group.
5.0 Reference Books
Good medical reference books are vital. The following is a list in
two parts. First are books I think are a really solid starting point
for a survival medicine library and then a selection of other useful
medical books with varying strengths and weaknesses. What you prefer
is to a great extent personal opinion. Most can be obtained from any
university book shop, Paladin Press or from Amazom.com. There are
titles and authors for all books, but only ISBN's and approximate
prices (US$) for some.
5.1 Must haves:
1) Where There is No Doctor. By Werner. Hesperian Foundaton 1992 $20
If you buy no other medical book, you must have this one. This is
the must-have of survival medicine; it WILL save lives.
Although slanted to the third world (= TEOTW.... environment ?)
and the tropics, it contains the essential basics of all aspects
of medicine.
2) A good medical dictionary.
* Dorland's Illustrated Medical Dictionary. By Dorland 1994 $40
* Mosby's Medical Dictionary. By Anderson 1993 $30
3) An Anatomy and Physiology reference.
* Functional Anatomy and Physiology. By Yamamoto. 1996 $30
* Essentials of Anatomy and Physiology. By Scancon.
ISBN 0803677359
* An anatomy atlas such as Grays or Grants are also excellent
for any do-it-yourself surgery. :-)
N.B there are a number of collectors editions of Grays
anatomy, you should avoid these if possible and purchase
a new edition.
4) Where There is No Dentist. By Dickson. Hesperian Foundation 1983 $9
The only book of its kind. Very good. Dental care is a very under
estimated survival problem.
5) An emergency medicine reference
* Emergency Care in the Streets. By Caroline. 1995. $50
My choice, but both are good books. Textbooks of
paramedic care.
* Mosby's Paramedic Textbook. By Sanders $50
6) A drug reference guide
* In USA - Physicians Desk reference
* In UK - British National Formulary
* In Aust - PIMS
* In NZ - New Ethicals catologue
7) Ditch Medicine. Coffee. Paladin press. ISBN 0873647173 $25
Vital for basic emergency surgical procedures and a stepping
stone into more advanced stuff
8) A Herbal/Medicinal Plant guide to your area. The basis of most of
the modern drugs is in plants and large numbers have potent
medicinal properties. Also local indigenous peoples often have
books about their traditional medicine. You need to be careful
separating out what's useful and what's not, but it may be very
valuable in a major long term event.
A good starting point :
* Medical Botany. W.H Lewis; John Wiley and sons. 1977
ISBN. 0471 53320 3
5.2 General Books (* = my recommendations)
* Oxford Handbook of Clinical Medicine. Hope. Oxford University
Press.1995. $25 excellent coverage of basic medical principles aimed
at the junior doctor level.
* Oxford Handbook of Clinical Specialties. Collier. Oxford University
Press.1993 $25 as above except covers the specialties including OBGYN,
pediatrics, orthopedics and anesthetics.
Current Medical Diagnosis and Treatment. Tierney. Lange. 1997
Up-to-date management of common medical problems, requires some
advanced knowledge.
Oxford Handbook of Emergency Medicine in General Practice. Lawrence.
Oxford University Press. 96. $30 good coverage of the basics of
emergency medicine in easy to read format.
Merck Manual Vol 1: General Medicine. Berkow. MSD. 93. $15 Good
reference, but can be complicated and verbose
Merck Manual Vol 2: Specialties. Berkow. MSD. 93. $15
Both volumes are also available as a combined text, for about $25. The
entire Merck Manual is available for download from the "Virtual
Hospital" site.
International Medical Guide for Ships. W.H.O. ISBN 9241542314
* Ships Captains Medical Guide. Her Majesty's Stationary Office. 1983
My personal favourite. I would recommend this book to everyone. It
covers the management of most common problems in an excellent format,
designed for ships isolated at sea. Also good description of drugs and
when to use them. The new 22nd edition is in press.
The american equivelent is called " The Ships medicine chest and
medical care at sea " and is published by the US office for public
health.
Advanced First Aid Afloat. Eastman.
Onboard Medical Handbook. Gill. $15
Medical Emergencies at Sea. Kessler. ISBN. 0688043402
Medicine for Mountaineering. Wilkerson. $15
Wilderness Medical Society: Practice guidelines for Wilderness
Emergency Care. Forgery. 1995 $10
* Wilderness Medicine: Management of Wilderness and Environmental
Emergencies. Ed Auerbach $175. I recently bought this book, and can
strongly recommend it. Given its price I would suggest only those who
already have a good basic knowledge consider buying it.
* Book for Midwives : A Manual for Traditional Birth Attendants and
Midwives. Klein. Hesperian Foundation. ISBN 0942364228 Best book of
its kind. Safe childbirth in a low-tech environment with minimal
backup.
Maye's Midwifery Textbook. Sweet. ISBN 070201236X
Survivalist Medicine Chest. Benson. Paladin Press. 1983 ISBN
0873642562 $10. A little dated. Some advise I consider a little
suspect but, generally a good book.
Do-It-Yourself Medicine. Benson. Paladin Press 1996. ISBN 0873649184
$20. I have not seen this book, but understand it is the up dated
version of Medicine Chest, and addresses some of that books problems.
Recommended by many.
* US Special Forces Medical Handbook. Paladin Press. 1987. Again a
little dated, but still an excellent book. Even the new edition is
still not completely up to date. But its strengths overcome this.
Good coverage all areas including surgery, dentistry and preventive
medicine.
Wounds and Lacerations - Emergency Care and Closure. Trott. Pub Mosby.
Emergency War Surgery. Bowen. 1994 ISBN 0788102915 $60 Excellent book
but, very technical.
* Emergency War Surgery: US revision of Nato Handbook. G.P.O 1988 $50
ISBN 9999814328. The do-it-yourself surgery guide. Designed for junior
doctors with minimal trauma experience going into a war zone. Starting
to be a little dated, but the basics don't change.
Field Surgery Pocket Book. Her Majesty's Stationary Office. British
version of the above. I personally prefer this one to the NATO
handbook, but each are equally good.
6.0 Medical Kits
6.1 What you stock up on should be related to what you know how to
use and what you can obtain. There are potentially thousands of drugs
and different pieces of medical equipment and you can't stock
everything. Fortunately, it is possible to manage 90% of medical
problems with only a moderate amount of basic equipment and drugs.
Obviously, sometimes the treatment may not be as such high quality as
that provided by a proper hospital, but it may be life saving and
reduce long term problems. For example, a broken tibia is usually
managed by a general anesthetic, an operation for an internal tibial
nail, followed by pain relief and physio. But it can be managed by
manipulation with analgesia and immobilization with an external splint
for 6-8 weeks and as a result the patient may be in pain for a few
weeks and have a limp for life, but still have a functioning leg.
Also, appendicitis has been treated with high dose antibiotics when
surgery has been unavailable such as on a submarine or in the
Antarctic. Although in both cases management is sub-optimal and may
have some risk, in a survival situation it can be done and may be
successful, with limited medication and equipment.
6.2 Obtaining medications can be difficult. The problem is two-fold.
First is access and second is cost. Below are some suggestions for
legally obtaining medicines for use in a survival medicine situation.
* Talk to your doctor. Be honest explain exactly why and what
you want, that you want to be prepared for any disaster and have some
important basic meds available, for if medical care isn't freely
available. Demonstrate an understanding of what each drug is for and
that you know how to safely use it. Most MD's would probably be very
supportive. Although, I would suggest that you don't request
narcotics the first time. Then return the meds when they have
expired, this will confirm that you are not using them
inappropriately.
* Discuss with your MD your plans for a trekking holiday. Most
MDs recognise the importance of an adequate medical kit if you are
travelling in the 3rd world or doing isolated backpacking. Most would
prescribe antibiotics, rehydration fluid, simple pain killers,
anti-diarrhoea meds, antibiotic and fungal creams, and if climbing
steroids and frusemide for AMS.
* Buy a boat. Australia, New Zealand and the UK, require all
boats sailing beyond coastal limits to carry a comprehensive medical
kit. This includes antibiotics, strong narcotic analgesia and a
variety of other meds. Although not a legal requirement in the US, I
imagine most MD's would happily equip an ocean going yacht with a
comprehensive medical kit, especially if you can demonstrate a basic
medical knowledge. The US Public Health service offers suggested
medications and equipment, depending on numbers and expected
isolation.
* Prescription medicines are available over the counter in many
third world countries. I am unsure of the legalities of purchasing
these. I imagine a single course of antibiotics would be unlikely to
be a problem, but that large amounts or narcotics would be illegal.
* Not for human use. Veterinary meds are widely available and
relatively cheap. Several books discuss obtaining them (Benson's
books, see book list), so I won't cover it in detail here. I
personally don't recommend this, but obviously for some it is the only
viable option. Generally speaking most veterinary drugs come from the
same batches and factories as the human version, the only difference
being in the labelling. This is the case for most common
single-component drugs such as antibiotics. If you are going to
purchase veterinary medications I strongly suggest only purchasing
antibiotics or topical preparations and with the following cautions:
(1) Make sure you know exactly what drug you are buying, (2) avoid
preparations which contain combinations of drugs and also obscure
drugs for which you can find no identical human preparation and (3)
avoid drug preparations for specific animal conditions for which there
is no human equivalent. Buy drugs which are generically identical to
their human counterparts, e.g. Amoxycillin 500mg (Vet) = Amoxycillin
500mg (Human), etc.
* Obtaining general medical supplies is often easier. Basic
bandages and stethoscopes, etc. can be bought from any medical supply
house. I understand there is no federal law prohibiting the purchase
of things like sutures, syringes, needles, IV's etc., but some states
can make it difficult. Try looking in the yellow pages for medical or
emergency medical supply houses or veterinary supplies. A number of
commercial survival outfitters offer first aid and medical supplies,
however I would shop around before purchasing from these as their
prices, in my experience, are higher than standard medical suppliers.
The above approaches for obtaining medicines can also be used for
obtaining medical equipment if you do have problems. The most
important point is to be able to demonstrate an understanding of how
to use what you are requesting.
6.3 I've included three kits. The first is designed for someone with
some limited medical knowledge and a good book. A lot of common
problems can be managed with it, minor trauma (cuts and minor
fractures), simple infections and medical problems. The second is
designed for someone with extensive medical training and should be
able to cope with 90% of common medical problems, including some
surgery, spinal and regional anesthesia, general anesthesia with
ketamine, treating most common infections and medical problems, and
moderate trauma. Obviously there is a vast middle ground between the
two. The kits are designed for long-term care rather than to cover
short (48 hrs) delays in getting to formal medical care. The third is
a reprint of the medical scales for British flagged commercial
vessels, to give you an idea of what the "experts" believe is required
for isolated intermediate term survival medicine.
NOTE:
1) I've tried to use the international generic names for drugs.
However, there are some differences between the British and the US
pharmacopoeias and where possible I've tried to include both
e.g. Lignocaine (UK & NZ) = Lidocaine (US)
2) I have not included any quantities. This is dependent on what you
are planning for and what you can afford. Unfortunately most
medications require rotation, with 1-5 year shelf lives, making this a
costly exercise, as they are not like food you can rotate into the
kitchen
3) Always store a supply of any medicines you take regularly. Blood
pressure pills, allergy pills, contraceptive pills, asthma inhalers
etc.
** Small Kit **
---------------------
I have tried to include a description of each item and some uses.
Combat Dressings
Large gauze dressings
Small gauze squares
Roller Bandages elastic + cotton (2in/4in/6in)
Triangular Bandages
Bandaids -assorted sizes and shapes (ie finger tips)
Sleek Tape 1 in. (waterproof, plastic/elasticated tape)
cotton buds (q-tips, cotton tips)
thermometer (rectal or pacifier for children)
Chlorhexidine and cetrimide (antiseptic) or Povidone-Iodine
Antibacterial Soap
Lignocaine 1% (local anesthetic) (USA = Lidocaine)
Augmentin (antibiotic) (a broad spectrum antibiotic)
Acetominophen (mild analgesic)
Dicolphenic (mod analgesic) (a nonsteroidal anti-inflammatory)
Oral Rehydration powder
Loperamide (anti-diarrhoeal)
Benedryl &/or Claratyne (antihistamines, short + long acting)
Adrenaline autoinjector or Anakit (USA = epinephrine)
Morphine Sulphate (strong pain killer) if avaiable
Gamma Benzene Hexachloride (lice/scabies tx)
Clotimoxazole (anti-fungal)
Contraceptive pills/Condoms
Paramedic scissors
Surgical scissors (
Needle holder (Enough to do basic minor
Sm curved clamps (surgery - suturing, draining
Tissue forceps (abscesses, cleaning a wound
Scalpel blades (etc.
Emergency Obstetric Kit (includes bulb suction)
Vicryl 2/0 suture material
Your choice of suture material is up to you. Vicryl is a
synthetic dissolvable one, but takes up to 4-6 weeks to
dissolve, so I think it is the ideal survival thread. But a
variety of non-dissolvable sutures are available which
will last forever.
5ml syringes
20g needles
Oil of cloves (tooth ache)
Emergency dental kit (commercial preparation)
A smaller kit for your bug-out bag could be made up from the above.
Include some combined dressings, a couple of bandages, bandaids, tape,
some tylenol, benedryl and some loperamide.
** Large Kit **
-----------------------
This list may seem extreme, but is designed for a well trained person
in a worst case scenario. Even though it is a long list, it all packs
down, mine which has a similar content packs into two medium size
nylon multi-compartment bags and a Plano rigid 747 box. I haven't
included descriptions of what specific items are, on the assumption
that if you don't know what it is, you shouldn't have it or try to use
it.
General
------------
Large gauze dressings
Sm gauze squares
Combat dressings
Petroleum gauze
Plastic bags
Bandaids - assorted sizes and shapes
Elastoplast dressing
Steristrips - assorted sizes
Tincture of Benzoin
Roller (elasticated + cotton) bandages (2in/4in/6in)
Triangular bandages
Safety pins
Cotton buds
Paper tape (1/2 in/1in)
Sleek tape (1/2in/1in)
Oropharyngeal airways
Resuscitation face mask with one way valve
BP cuff
Stethoscope
Otoscope
Sm Torch (flash light)
Thermometer (rectal for children)
Heavy duty scissors
Space blanket
Air splints (arm/long-leg/short-leg)
SAM splints
Plaster of Paris (or fibreglass) roller bandages (4in/6in)
Multidip. urine test strips
Pregnancy test kits
Sterile and unsterile latex gloves
Scrub Suits
Fluroscene eye strips
Eye patches
Sm eye magnet (for FB's)
Snake bite kit (for those of you unlucky enough to have them :-))
- The Sayer suction kit is recommended. It is slightly
more expensive, but I understand more effective in
removing venom. I refer you here to the excellent
rec.backcountry FAQ on Snake Bites
IV Kit
--------
Normal Saline
Haemaccel or Pentaspan (a colloid resuscitation fluid)
IV giving sets - maxisets + standard sets
Blood collection bags + filter giving sets
Syringes 2/5/10/20 ml
Needles 20/22/24 g
IV cannulas 16/20/24g
Spinal needles 22g
Leur locks/Heparin locks
Tourniquet
Alcohol Wipes
Surgical Kit
------------------
Mayo scissors
Dissecting forceps
Sm curved clamps
Sm straight clamps
Lg curved clamps
Scalpel Handle + Blades (size 11,12,15) or disposable scalpels
Sm Bone Saw
LIft Out obstetric forceps
Emergency Obstetric Kit (includes cord clamps, bulb suction etc)
Suture Material Vicryl 0/,2/0
Chromic 0/,2/0
Dermalon 0/, 2/0
Surgical stapler and remover
Hemilich flutter valve
Penrose drains
Foley Urethral Catheters
Urine Bags
N-G tubes + spigots
Dental KIt
----------------
Oil of cloves
Zinc Oxide paste
Dental mirror
Sharp probe
Compactor
Extraction forceps
Medications
-------------------
Povidone - Iodeine Prep antiseptic skin prep
and/or
Alcohol prep antiseptic skin prep
Chlorhexidine and cetrimide antiseptic handwash
Benalkium Chloride antirabies skin wash
Antibacterial Soap
Paracetamol oral mild analgesic
Aspirin oral wonder drug
Diclophenic oral mod analgesic (nsaid)
Morphine iv/im/sc strong analgesic
Narloxone iv antagonist to morphine
Ketamine iv/im iv anesthetic
Diazepam iv hypnotic/sedative
Atropine iv pre-med/poison anti
Lignocaine top/spinal local anesthetic
Metoclopramide iv/im anti-emetic
Augmentin oral/iv penicillin antibiotic
Metronidazole oral anaerobic antibiotic
Cefaclor oral cephalsporin
Ceftriaxone iv cephalsporin
Ciprofloxacin oral quinolone antibiotic
Mebendazole oral antiparasitic
Clotrimoxazole top anti-fungal
Adrenaline iv/im (USA = Epinephrine)
Salbutamol inhaler asthma/anaphylaxis
Rehydration formula dehydration
Benedryl &/or Claratyne oral antihistamine (short +
long acting)
OTC Cough surpressent
Betnesol oral steroid
Hydrocortisone iv/cream steroid
Loperamide oral antidiarrhoeal
Ergometrine &/or Oxytocin im/iv ecbolic for PPH
Neomycin eye drop antibiotic eye drops
Pilocaine eye drops local anesthetic
Starr Otic Drops antibiotic ear drops
Mupirocin (Bactroban) top topical antibacterial cream
Gamma Benzene Hexchloride top for scabies and lice
Water for injection/normal saline for injection
Oral Contraceptive Pills
Condoms/Cervical Caps/Diaphragms
** Ocean Kit **
------------------------
British medical scales for ocean going ships, from the Marine safety
agency, Merchant Shipping Notice No.M.1607. It is compatible with the
medical treatments described in the "Ship's Captain Medical Guide",
the new edition (22nd) of which will be published shortly. The amounts
suggested are per 10 people.
Drugs
---------
Cardiovascular
Adrenaline 1:1000 1ml amp 5
Glyceryl trinitrate 0.4mg inhaler
1
Frusemide 40mg tab 20
Frusemide 10mg/ml 2ml amp 2
Vitamin K 10mg/ml 1ml amp 1
Ergometrine 0.5mg.ml 1ml amp 2
Atenolol 50mg tab 10
Aspirin 75mg tab 25
Gastrointestinal :
Cimetidine 400mg tab 30
Promethazine 25mg/ml 1ml amp 10
Prochlorperazine 3mg tab ( buccal ) 30
Gylcerol suppository 4gms supp 6
Codeine phos 30mg tab 60
Analgesics :
Paracetamol 500mg tab 100
Diclofenac sodium 100mg supp 3
Morphine sulphate 10mg/ml 1ml amp 10
(Codeine phos as above)
Hyoscine 0.3mg tab 20
Nervous :
Diazepam 5mg/ml 2ml amp 5
Diazepam 10mg tab 20
Chlorpromazine 25mg tab 40
Chlorpromazine 25mg/ml 1ml amp 5
(Hyoscine as above)
Diazepam rectal 10mg/2.5ml rectal tube 4
Anti-allergics/Anti-anaphylactics :
Astemizole 10mg tab 30
Prednisolone 5mg tab 10
Hydrocortisone 100mg/2ml powder for inj 3
Respiratory :
Salbutamol 100 microgms inhaler 1
Beclometasone 50 microgms inhaler 1
Anti-infection :
Benzylpenicillin 600mg powder for inj 10
Ciprofloxacillin 500mg tab 10
Cefuroxime 750mg powder for inj 20
Erythromycin 250mg tab 40
Trimethoprim 200mg tab 30
Medendazole 100mg tab 6
Metronidazole 1gm supp 12
Metronidazole 400mg tab 14
Doxycycline 100mg tab 10
Tetanus vaccine 0.5ml amp 5
Tetanus immumoglobulin amp 1
Rehydration :
Oral Rehydration fluid sachets = 1 L 10
External preparations :
Chlorhexidine and Cetrimide solution
100mls
Neomycin cream 15gm 1
Benzoic Acid 6% oint 50gm 1
Silversalazine cream 1% 50gms 2
Malathion 0.5% cream 200mls 3
Zinc ointment 25gms 2
Potassium permanganate crystals 10gm 1
Hydrocortisone cream 1% 15gm 2
Eye medications :
Framycetin sultphate 0.5% ointment 5gm 4
Betamethasone 0.1%/Neomycin 0.5% eyedrops 5mls 1
Amethocaine eyedrops 0.5% 0.5ml 5
Pilocarpine eyedrops 0.5% 0.5ml 1
Fluorescein eye test strips 1% 10
Nose/ear/throat :
Antibiotic ear drops 5mls
1
Neomycin/polymixin B/hydrocortisone ear drops 5ml 1
Ephedrine nose drops 0.5% 10ml 1
Chlorhexidine gluconate mouthwash 0.2% 300mls 1
Local anaesthetics :
Ethylchloride spray 50mg
1
Lignocaine 1% 20mg/2mls 2ml amp 2
Oil of cloves10mls 1
Lignocaine gel 2% 20g 1
General Medical Supplies
----------------------------------------
Resuscitation equipment :
Oxygen giving set - oxygen reservoir 1
- flow meter 1
- pressure regulator 1
- oxygen tubing
1
- 24% face masks 5
- 35% face masks 5
Suction aspirator
1
Laerdal pocket mask 1
Guedal airway size 3 1
Guedal airway size 4 1
Dressing and suturing equipment :
Suture and needle pack
- sterile non-absorbable 26mm half needle
3
- sterile non-absorbable 40mm half needle
3
- sterile absorbable 40mm half needle 26
- 75mm steri-strips 6
Crape bandage 7.5cm x 4.5 m 4
Elastic adhesive 7.5cm x 4m 4
Trianglular bandage 4
Tubular gauze finger size/ 20m
1
Conforming bandage 5cm x 5m 20
Conforming bandage 7.5cm x 5m 20
Paraffin gauze dressing 10cm x 10cm 40
No 13 BPC Dressings ) 5
No 14 BPC Dressings ) Varying size gauze pad with 5
No 15 BPC Dressings ) attached rollar bandage
4
No 16 BPC Dressing ( eye pads ) 3
Gauze sterile cotton 30 x 90cm 6
Cotton wool 15gm sterile 6
100gm unsterile
3
Adhesive tape 2.5cm x 5m 1
Adhesive suture strips pkt of 5
2
Bandaids assorted 40
Zinc oxide plaster tape 2.5cm x 5 m 1
Gauze swabs 10cm x 10cm 100
Plastic Burns bags 46cm x 31 cm 5
Instruments
- disposible scaples No 23 2
- scissors 18cm 1
- scissors 12.5cm 1
- dissecting forceps 1
- haemostatic clamps 1
- needle holder 1
- disposible razors 2
Examination and monitoring equipment :
Disposible tounge depressors 4
Reactive urine analysis test strips
50
Stethoscope 1
Sphygmomanomter 1
Std clinical thermometer
3
Hypothermia thermometer 1
Sputum cups 2
Specimen jars 2
Equipment for injection,perfusion and catheterisation :
Bladder drainage set ( bag/spigots/tube )
1
Rectal drip set 1
Syringes and needles ( 2ml / 5ml / 10ml of each )
6
Foley ballon catheter 16fr 1
Nelaton catheter 16fr ( no ballon )
1
Penile sheath set 1
General Medical equipment :
Bedpan 1
Hot water bottle
1
Magnifying glass
1
Urine container 1
Ice bag 1
Safety pins 6
Kidney dish ( stainless steel )
1
Lotion bowl ( stainless steel ) 1
Waterproof sheeting 1m x 2m 2
Sterile plastic sheet 90cm x 120cm 1
Nail brush 1
Disposible paper towels 100
Plastic measuring jug 1/2 L 1
Disposible face masks 6
Disposible latex gloves
25
Disposible latex gloves sterile 5
Malleable finger splint 1
Malleable forearm splint
1
Inflatable splints ( half-leg/full leg/half-arm/full arm )
1 set
Thigh collar 1
Neck collar ( sm/med/large ) 1 set
Thomas splint 1
Seton traction kit 1
Disinfectants
- chlorine compound sufficient for 50l water
- general disinfectant 5 L
- insectiside liquid 5 L
hand spray 1
powder form 15 gm
Dental instruments :
Excavator double ended, Guy's pattern 1
Filling paste inserter 1
Dental mirror size 4 1
Cavit tube ( temp filling inserter )
1
Stretcher Equipment :
Neil Robertson/ Paraguard type 1
First Aid Kit (per 10 people)
-----------------
Triangular Bandages 4
Small dressings ( 13 BPC ) 4
Med dressings ( 14 BPC )
2
Large dressings 2
Medium safety pins 6
Bandaids assorted 20
Sterile eye pads
2
Cotton wool 15gms
Disposible gloves 5
Doctors Bag (if doctor is carried on board)
--------------------
Adrenaline 1:1000 1ml amp 5
Aminophylline 25mg/1ml 10ml amp 4
Aspirin 30mg tabs 50
Beclomethasone 50microgm inhaler 1
Chlorpromazine 25mg/1ml 1ml amp 1
Cyclizine 50mg/1ml 1ml amp 5
Dextrose 50% 20ml amp 2
Diazepam 5mg/ml 2ml amp 5
Frusemide 10mg/1ml 2ml amp 5
Glucagon 1mg/ml 1ml amp 1
Glucose infusion 5% 500ml bag 1
Blood glucose test strip
10
Blood glucose lancets 10
Grudel Airways set of sizes 4,3,1
1
Hydrocortisone 100mg/2ml 100mg vial 1
Insulin 100iu/ml rapid action 10ml vial 1
IV giving sets + cannulas + leur lock 16g/18g 6 (3/3)
Laerdal Pocket Mask 1
Plasma substitution infusion fluid 500mls
4
Morphine 15mg/1ml 1ml amp 5
Oxygen Resuscitator bag + tubing 1
Manual suction pump + 2 yankauer & 2 14fr catheters 1
Paediatric paracetamol 120mg tabs 24
Prednisolone 5mg tabs 25
Salbutamol 100 micrograms inhalers
1
Swabs Alcohol 50
Syringe and needle pack - 2ml syringe + 21g needle
2
20ml syringe + 21g needle
2
1ml insulin syringe + 25g needle
2
Stethoscope 1
Sphygmomanometer 1
continued to part 2
Craig Ellis
loucr@globe.co.nz
(
geocities.com/mark_l_anderson)