Thursday, April 28, 2022

This Is Your Wake Up Call

 This is a stock photo of just the instrument set-up trays for one open heart surgery.

It also requires a dedicated sterile OR. And a sterile pre-op prep area. And a Post Anesthesia Care Unit. With ICU monitoring abilities, and a full Code Blue stocked crash cart and defibrillator. And an ICU. And a cardiac telemetry step-down unit. And one to three board certified cardiothoracic surgeons. And an anesthesiologist or nurse anesthetist. And all the medicines and anesthesia drugs (and their reversal agents) required for that surgery. And all the IVs. And oxygen. And suction. And a central supply unit. And a sterile supply unit. And a circulating nurse or two. And a scrub nurse or two. And the PACU nurse, the ICU nurses, the Tele nurses, and about another baker's dozen techs, from lab, CT, OR, ICU, Tele. And the cardiac rehab folks. And metric f**ktons of antibiotics. All just waiting to take care of one patent.

Got a second patient?

You get to replicate half of that all over again. (I'll spot you the other half, since they're already there.)

Got a third patient? Now you need double everything in the first batch, because you'll need a whole another support pipeline for more patients than one ICU nurse can safely care for.

You can cut corners. That fills body bags, but hey, it's your party.

That's fairly similar to the kind of things you're going to need for one gunshot trauma chest wound.

Guerrilla Hospital? More like Gorilla Hospital. As in run by apes.

You can't just swap a few words and think you're going to replicate the military medical system, let alone the civilian one, for a "partisan" medic, and a "guerrilla" hospital.

Those are based on medical systems you couldn't shoot out of your tailpipe if you ate that whole surgical tray above, and grunted and squeezed for a lifetime.

A military CLS depends on there being a MEDEVAC (which you don't have) to take a casualty to a battalion aid station (which you don't have) or an EVAC trauma hospital (which you don't have), and once stabilized, to transfer them to an out-of-combat-theater tertiary care hospital (which you don't have), followed by ultimate travel to a stateside recuperation and rehab system, (which you don't have). Clever readers will spot a trend here. 

What you can  do is good initial first aid. But short of massive planning and preparation, you don't have any of that second aid, third aid, or rehab. And unless you recognize that, and start to make actual alternative arrangements, what follows your first aid, will be last aid.

I do not recommend leaving things at this stage, but if all you're going to do is stock your IFAK, without even planning for what happens the second time you need that, you're planning to fail. In a Forest Lawn sort of way. Or, far more likely, a Boot Hill sort of way.

Delusional people build castles in the sky, and psychotic people try to live in them. I wasn't being snarky about the OP, but when you start talking about your wonderful ocean liner plan, and all you're missing is, y'know, the BOAT part of that, I'm going to call you on it, 11 times out of 10. And if it stings, that's Reality slapping you in the back of the head.

You want an underground partisan health care system, or a guerrilla hospital? Great.

Why not start with telling me how you're going to do THAT, and do it first, before you tell me the frilly and far less important details at the weed level.

And while you're up, tell me about your partisans, before you start worrying about partisan medics.

If you can't get over your delusions long enough to do that, don't complain when people point and laugh. And if I just pointed and laughed because you share those delusions, maybe it's time to stop smoking mad bongloads of Hopeium, and come back down to planet earth for a spell.

And if all that still goes in your "Too Hard" column, don't you worry none, Snowflake. If you're just going to rely on Turd World/Civil War-era field medicine, you can count on Turd World/Civil War-era casualty levels.

Suture self.


Anonymous said...

Hard truths based on knowledge and logic; keep it up Brother. Keep calling folks on their illogic and failure to.plan, you're doing them (and all of us) a service.
Boat Guy

John Wilder said...

John Wilder, Civil War Surgeon at your service. Seriously - that's what it will be, at best. We might wash the saw between amputations. I guess some of my patients will then be unarmed.

Michael said...

John Wilder Civil War Surgeon a terrible joke but historically accurate.

As someone that worked in trauma centers and MASH units high velocity injuries shatter body systems. Setup's like Aesop so well described was my bread and butter.

Shallow wounds can be treated with ditch medicine of stopping bleeding, treat for shock and so on and home care dressing changes and such. Or as John Wilder might quote with a British Accent "A mere flesh wound".

A M4 bullet through the guts or shattering limbs not so much. For the nitpickers notice I don't even refer to the DOA wounds like central nervous systems and major blood vessels. You know the famous two in the chest rest in the face comments I see so often. THEY get the benefit of a quick death.

I remember the icy calm of morphine when I was blown out of my vehicle in the sand box. I was unconscious when the Medivac flew me to a Field Hospital and Ramstein Germany. Our New CW2 Partisans are NOT going to enjoy that sensation.

Grim truth needs to be faced and planned for. Civil War hospital care HOPEFULLY with better sanitation might be the best you can hope for.

Spiritual preps are as important as even safe water and food. You will meet your maker, best to be on good terms with Him.

Rhea said...

John beat me to that punch. I never read the original article. It would have been a waste of my time. Guerrilla hospital? Yeah, when pigs fly. People who live in reality and have an attention span longer than 30 seconds will remember that infection killed more people in the Civil War than bullets did.

It's these lovely little breaks from reality that make my teeth grind. Post 2020 I don't believe most "Patriots" who believe that they can seize America back by force are anything other than gasbags. The same people who went around screaming that they wanted to know exactly when the lockdown would end - because viruses always tell us when they plan to leave - think they can endure a war of unknown duration? And they have a fantasy guerrilla hospital for the event? Delusional is hardly a strong enough word.


Anonymous said...

I've read some articles on capturing hospitals. My thoughts are:
1) how you going to staff it? I doubt most of the current staff will sign up to work for you for free.
2) Once the supplies on site run out its just a building with fancy toys that are hard to move and need stable power.
3) i doubt the otherside is going to care about it being a hospital. They will bomb or artillery it and not care about the people inside.


Anonymous said...

I was reading your old article you linked to yesterday and it mentioned an ultrasound machine. Price wise they have come down into reasonible ranges 4 to 8k; but you have to know how to use it and more importantly how to interpret it.

I've used industrial ultrasonic machine which are ultrasounds for pipes and steel. I convinced an ultrasound tech once when they were looking at my leg to let me try. I could run it as its close enough to the industrial units and I could make out what i was seeing ( bones and muscle) but I had no idea what i was looking for. Unless you are trained to interpret its not going to be useful beyound the 'yup thats broken' sort of ability.

Also my understanding is most GP doctors are not up on evaluating them either.

Exile1981 said...

It might be interesting to look at the medical support system in modern insurgencies or guerrilla wars to get a realistic appreciation for the level of medical care to expect. I would not look at any conflict where the insurgents were supported by a larger nation. Proxy wars are out. An American insurgency will not have that outside support at first. Maybe never. Then we will see what "guerrilla hospital" really means.

Anonymous said...

Several hospitals I’ve never seen an open heart patient go to PACU; only direct to ICU. Just a detail, and maybe they do where you are.

Bear Claw Chris Lapp said...

I can't suture myself. If things go hot, I expect to die. Not from just lack of medical care and or older age. I have already won though because the toomb is still empty.

Nonlinr said...

I feel like people saw pictures of the Vietnamese tunnel hospitals and think if they could do it so could I. Ignoring the fact they had a government supplying them with things and I doubt the outcomes were much to write home about although I have no numbers and I am assuming surgery in a hole doesn’t go great.

Anonymous said...

Wilder hit it; mid-19th century with sanitation. While the Minie' balls were very destructive, especially of bones, the handgun rounds were about as effective as a .380. Thus, barring infection ( no small feat) far more survivable than getting hit with modern high-velocity expanding bullets.
How much .40 ammo did FedGuv buy during ObaMao's reign?I
Boat Guy

Housewolf said...

The most prominent signal that Putin was planning to invade Ukraine wasn’t the assembly of tanks and troops, it was the assembly of a field hospital on the Ukrainian border. Few in the propaganda media took note, but to me that was the red flag.
Regarding heart surgery, that doesn’t happen much in a field hospital, as what can’t be done simply isn’t.
Reality is, it’s much easier to run a backhoe than a trauma center. Plan accordingly.
Regarding the partisan anything, we can’t even get along amongst like minded brothers, and when it comes to highly organized systems we’re hopelessly fooked.
Change my mind.

Orvan Taurus said...

$HOUSEMATE did Paramedic/EMS and I have NO ILLUSIONS that I can do *anything* near that, let alone more. What I can *I* do? Honestly, ONLY very, Very, VERY basic stuff... and after that it comes down to "GET OUT OF THE WAY!"

Anonymous said...

As a trained level 3 paramedic the hardest thing you will have to decide in a mass casualty event is deciding who you treat and who you don't waste resources on. (Let die).

Anonymous said...

I doubt this was a major conversation during the 1770's. They just did what needed done.

Big Jim Slade said...

This piece should be read aloud at the beginning of every patriot meeting, like the 12 steps are at every AA meeting.

Tucanae Services said...

You don't even need to get shot to F your life up. Gobble a bad batch of eggs laced with Salmonella and your chances of surviving drop without access to a hospital and meds.

Anonymous said...

In times of war, in times of peace, people die. Get over it.

Ohio Guy

Anonymous said...

I will give you some information from my country's history (Poland). The Polish Resistance - the Home Army - was in fact a part of a parallell governance system (The Polish Underground State). So you could get resources beyond what one resistance cell could scrounge, traitors could be dealt with and so on. Also the whole nation was convinced that Germans have to be defeated, so you could count on substantial support from civilians. I've read somewhere - but can't find the source now - that around 15% of the people were actively resisting, 80% were just trying to survive while 5% were collaborating. In such an environment it was possible to organize and run resistance cells in hospitals, especially in Warsaw, and treat wounded soldiers there. It required organization (e.g. specialists providing all kinds of fake documents), trustworthy people (like nuns who were most of the nurses at that time) and sheer guts. So it is possible to use general hospitals to care for wounded guerillas but it is no small feat and rather difficult to replicate in current conditions.

Pat H. said...

Yours truly in the OR, just before I retired in 2005. Hospital is in Palo Alto, CA.

Skyler the Weird said...

Charlie had 'hospitals' in his tunnels and out in the jungle but I doubt anyone would want to be treated in such a guerilla hospital. The stink of Gangrene was supposedly unbearable.

Rollory said...

BAH!!! Big Hospital is CORRUPT and OVERCHARGING and RIPPING US OFF!!! With good ol' American can-do know-how, we can simplify that down to some office staplers, dental floss, and a bit of rubbing alcohol. They'll be BACK UP and RARIN' TO FIGHT in NO TIME! If'n it's good enuff for George Washington, it's good 'nuff for me! PATRIOT FORCE, ASSEMBLE! Trust the Plan, and LEEEEEET'S GOOOOOOOO

Anonymous said...


Kafiroon said...

Most people refuse to acknowledge reality. Bear Claw Chris Lapp has told us all the truth. When it all goes hot, plan on trying to be found with bodies and brass around yours.

Rollory said...

Some Russian military types put together a side-by-side comparison of Russian military first aid kits (top) with Ukrainian equivalent (bottom):

The Russians are not really happy about it.

(Trust the Plan, guys. Putin is wise and good. Ukraine is fake and gay and only fighting because Biden threatened to bomb them if they didn't organize some gay parades; they secretly want to surrender and be raped good and sexy by the big strong manly Russian heroic liberators. The Russians never wanted Kiev anyway, it was all a super-smart distraction. Everything is going according to plan. Russia's super-techy hypersonic missiles totally work - after all, they all have chips manufactured by Texas Instruments - so as soon as Russia starts ramping up production past the 3 prototypes they've already used, we're all in big big trouble. Russia is on a path to inevitable victory. Trust the Plan. The Plan is wise and good. Everything is fine. Trust the Plan.)

Virginia Granny said...

There is a reason that officials estimate a 90 percent casualty rate for when TSHTF.

Within the first 30 days or so, you've lost practically everyone who needs insulin, heart medications, oxygen, dialysis, Narcan, etc. Then you can count in the people who are seriously injured in car wrecks, fires, falls or other accidents, gun fights, plane crashes, and murders - the folks that won't survive long enough to get them to a hospital in the first place. Then add in those who don't have access to clean, unpolluted water, reliable electricity, and enough calories, vitamins and minerals to minimize malnutrition. And don't forget that TPTB will probably kidnap/"draft" medical personnel and force them to work in "controlled" locations, using whatever level of coercion is required to get their attention and obedience.

After all that, whether or not you have sufficient medical supplies, bootleg equipment and partisan witch doctors is almost moot. Anyone who cannot imagine a quick bullet in the head for pain relief needs to be paying more attention to the mass graves in Ukraine.

Anonymous said...

Some thought provoking discussions. Maybe even more difficult will likely be to gain access to basic disinfectant s and maintaining potable water( another uphill battle from the Civil War onwards).

Skyler the Weird said...

More soldiers died in Johnston's Confederate Army of Tennessee camp at Corinth Mississippi from disease gotten from unsanitary waste disposal (don't shit where you eat) than died from bullets and cannonball at Shiloh and Iuka.

Anonymous said...

Been following this thread. Aesop is right. I’m an EMT. Even a simple trauma call on the ambo can use up all the bandages. Now think about the tons you will need for wound care in and after the hospital.

You get someone having an MI, or stroke, if there’s no health care system they can go to, they’re going to be limited to taking aspirin. Outcome will probably be not good. If logistics break down, home O2 will be a problem to get, also other meds people take chronically. Looking at you, diabetics.

How you gonna get O2 for your partisan hospital without someone on the inside? Please don’t tell me you will use nonmedical welding O2.

Your best bet in this possible situation is to do all you can to get healthy now and avoid bad hygiene and getting hurt or sick. If you must fight, never pick a fair fight. Have a way to get clean water on your own. Stop smoking/vaping/drinking/using, and get some low impact exercise if you’re out of shape and work up from there. Go see the dentist now while you can.

As to the creation of parallel clinics: maybe patriots owning a clinic that operates every day normally would be the way to go. Then like a mafia doctor, sneak the partisans in after hours or into a section away from the regular patients. It would take cooperation from your whole staff. One disgruntled employee or informant patient and it’s off to the gulag and your license to practice gone.

More and more, medical supplies are locked in vending machines that you need an employee badge or code to access. Even in EMS and for not just drugs but N95 masks, suction tubing, bed pans, nonrebreathers etc. They’re starting to do this in quickie marts for beverages too. You’re soon not going to be able to get supplies out the back door of one of these places even with an inside man. You will need to OWN one of these places. And this will take some doing if you are starting from scratch.

Also: please don’t think you can take an EMT class, never work on the streets, and 2 or 3 years later be your group’s medic. Please get your numbers and work, you learn 75% of what you need to know by doing it.

Skyler the Weird said...

Another thing to consider is Dental work. Here I sit waiting for a root canal Tuesday I scheduled a month ago. The Amoxicillin prescription ran out a few days ago and the pain is coming back. The Dentist wouldn't prescribe the good stuff. Taking one 500mg Acetaminophen and 3 200mg Ibuprofen barely helps. In a SHTF event, I can't see relying on Echinacea tea and some Homemade Hooch to cut the pain of a tooth abscess.

Robin Datta said...

Once upon a time open heart surgery needed a perfusionist to run a heart-lung machine that was charged with six units of crossmatched blood. I see no reason to doubt that it still does.

A lot of muthas are delighted at the prospect of a low cost, low tech horsespittle replacing the one they think they're famaliar with, while being unaware that each notch of sophistication dialed down will fill another line of body bags.

Anonymous said...

This Slacktical Tactical shit is an epic grift.
One of many ugly viruses spread by the forever wars.
No honor.

You can not serve both God and mammon.

Praise God, Follow the Law, Destroy evil. Don't miss heaven.

Anonymous said...

Have you tried clove oil?