Tuesday, March 19, 2013

Equipping the Disaster Clinic: The Basic Stuff

Stocking the room comes next. This is mainly a simple list, thin on explanation, just for information. Mentally, I'm going around the prototypical room, and the ER, to cover what a practitioner would expect to find ready to hand in most cases, but in any case somewhere.

Nota bene that quantities are blank. I don't know how big your group is, or your facility, or how many people you're expecting to treat daily, nor for how many days/months/years.
When X  is the number of items to stock, given the formula  A x B x C x D x E x F x G = X, and no values for the variables, there's no way for me to give you that answer. Work it out for yourselves, or do further planning and consultation. I can tell you that having approximately 10 of almost everything was generally enough to see the average room in a 50+ bed ER through 8-12 patients a day in the busiest ERs in the country. But obviously, if you have less than 50 rooms, more patients, and more days, (or one horrendous disaster/battle/whatever) you'd obviously need more stuff. The ultimate question is how deep you want to go, and for how long. My last hospital had two on-site stockrooms and a 10,000 ft2 warehouse just for ER supply overstock, refilled with any number of items daily, for reference. Knock yourselves out.

The Basic Stuff:
You're going to need a set of cables (and ideally, at least 1 set of spares) for whatever monitor you organize for your treatment room. You'll need single-use sticky leads for the end of the EKG leads; lots of them. You'll need an assortment of BP cuffs size infant through adult thigh size, and several different styles of pulse-ox monitor clip: fingertip, stick-on, ear clip.

Also a thermometer that covers the hypothermia range down to the high 80s, and both oral and rectal probe attachments. Otoscope and opthalmoscope with a supply of speculums.

For delivering 02, you'll need nasal cannulae, face masks with and without reservoir bags, and bag-valve masks. Adult and pediatric sizes depending on your needs assessment.
OP and NP airways.

Suction tips, tubing, and canister(s) for the blood, fluids, or yecch! you suck out.

A cart or cabinet(s) for treatment supplies. Craftsman tool cabinets and equivalent work great, and so do a lot of other things.

Instruments like trauma shears, bandage and operating scissors, hemostats, needle holders, and forceps. Ring cutter and spare blades.

Scalpels in a variety of sizes, and suture material in a plethora of varieties.

Clean gauze squares by the tube, along with sterile 2x2s, 3x3s, 4x4s, and abdominal dressings.
Gauze rolls 1", 2", 3", 4", 6".
Both clean and sterile cotton swabs. Wooden tongue blades. Cotton balls.
Tape rolls 1" and 2", paper, plastic, silk, and waterproof.
Assorted bandaids. Eye bandages, pads, and hard eyeshields. Steri strips.
Tegaderm equivalent clear bandage.
Betadine, Benzalkonium chloride, chloroprep applicators, sterile saline for irrigation.
Double and triple antibiotic ointment.
Hydrocortisone 1% cream.
NuSkin or liquid bandage spray.
Iodoform gauze packing. Penrose surgical drains.
Casting materials, splint padding, SAM and wire splints.
Hare and Sager leg splints, etc.
ACE wraps 2", 3", 4", 6": lots and lots.
Wrist, ankle, knee, elbow braces. Leg immobilizers, post-op shoes, slings, crutches.
Burn sheets, at least one whole body set incl. face sheet, and multiple small, medium, and large covers. Waterjel ointment.
Chux bedliners:a truckload.
Gynie speculum w/light. Maternity pads.
Soft and hard restraints.
Patient slider board and vinyl carry litter/draw sheet.
Transport litter(s): standard, folding, Stokes, etc. with security straps.
Cervival collars, hard backboards.

Bedpans, urinals, barf basins/bags/buckets, washbasins, water/ice pitchers.
Sheets, gowns, pillowcases, blanket(s), pillows, towels, washcloths.

AFAIK, all of this is commercially available, and generally without Rx.
It constitutes the bulk of what's used day in and day out in any major emergency room or urgent care clinic, 24/7/365. While you could get yourself into trouble with this, you'd really have to work at it. Some people could get into trouble with a kid's plastic pretend doctor kit from the toy store, so I can't help that some people should be tied up in a padded room for their own safety. Just don't be that guy.

You could also do a lot of good with it, provided you had (or are) a practitioner with the training, licensure, and skills to take proper advantage of it in rugged times.

In another post, I'll cover the Rx meds and items, and eventually the dreamlist stuff. Probably not all in a row, but we'll see.

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