Medical FAQ, cont

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 aspect 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.
    3.3 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 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 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 quarantine 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 Amazon.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 Foundation 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 labeling. 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:
    Make sure you know exactly what drug you are buying, avoid preparations which contain combinations of drugs and also obscure drugs for which you can find no identical human preparation and 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

The first is designed for someone with some limited medical knowledge and a good book.

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.

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 (i.e. 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 available

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, Benadryl 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 analgesicAspirin, oral wonder drugDiclophenic, 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
Benadryl &/or Claratyne, oral antihistamine (short + long acting)
OTC Cough suppressantBetnesol, 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 phosphate                         30mg tab             60

Analgesics:
Paracetamol                                   500mg tab         100
Diclofenac sodium                         100mg supp            3
Morphine sulphate                       10mg/ml 1ml amp   10
(Codeine phosphate 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               1
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 cloves                                     10mls                      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

Crepe 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 roller 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:
Disposable tongue 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 balloon ) 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
Disposable paper towels 100
Plastic measuring jug 1/2 L 1
Disposable face masks 6
Disposable latex gloves 25

Disposable 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

Doctor's 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

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loucr@globe.co.nz

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.

This page created November 1998 and copyrighted to Alan T. Hagan.

Questions or comments concerning this page or site, but not medical questions, may be sent to Alan athagan@sprintmail.com