This paper was originally written in 1984 by J. Dierking. Since this topic was initially written 25 years ago many things have changed in the health care field. Many changes have occurred in the political arenas that were considered fantasy in 1984. For example, the fall of the Soviet Union, the collapse of the Berlin Wall and the reunification of Germany; were not even considered a possibility in 1984.
So we hope to update the information originally presented and provide alternatives that were not even considered in the original paper. This paper replaces the previous version of SP84-16.
INADEQUATE FACILITIES
Most doctors and Hospital administrators are honest, at least amongst themselves and by law, to Federal inquiries about the state of health care in the United States today. While our present Health care system is adequate for today's needs, it does show some areas that need great improvement.
What are these areas? Basically these are in the treatment of large numbers of patients at any one time.
Our Health care system is set up to take care of one person at a time. Procedures for mass treatments and facilities are sadly lacking. Practice, even where procedures or facilities are available, is on an inconsistent basis. So, when a catastrophe occurs and there are large numbers of patients, the system breaks down.
In the past 5 years there have been 3 instances where this was demonstrated very well:
- The Oklahoma City Bombing: Survivors were transported to hospitals as far away as New York for treatment because local hospitals were overburdened or the treatment needed for burn or broken bone victims was not available except in certain hospitals.
- The LA Riots: Caused a total collapse of the LA hospitals and medical facilities and injured persons were transported all over the state to hospitals that would take the victims or had room.
- Florida Hurricanes: Devastated a large area of Florida. A lot of hospitals were damaged and injured patients had to be transported to hospitals in the state that would take them.
The numbers of injured in these cases never exceeded 1,000 people in most cases, but the large influx of injured and the damage to some health care facilities, denied care to these people. It also caused a great burden to those hospitals. Facilities that were sent the over-run of patients were overburdened themselves and many were unable to provide basic services that were needed in their communities.
If 100 injured can overwhelm the local health care facilities, what might happen if thousands or tens of thousands were hurt or injured at one time? At best it would be chaos to get a doctors appointment. At worst it might lead to collapse of medical treatment as we know it. What are you going to do if you can't get into the hospital or get to see a doctor? What if the Ambulances or police or firemen are not helping take you to the hospital if you have an accident? What if your local emergency room has to close down because they can't get insurance or doctors to man the building? It is already happening in some cases. Can you wait until morning? Can you drive 50 miles or more to a hospital that is open?
WHAT CAN YOU DO? EDUCATE YOURSELF
The first step is education. There is no way you can become knowledgeable overnight in the medical field other than through education. And there is no way you are going to be able to care for yourself other than by educating yourself. Remarkably, there is a great body of information available for anyone interested in educating themselves.There are also many groups and ways you can acquire this information yourself.
FIRST AID/CPR
At the absolute minimum, everyone should have basic First aid and CPR training. Take the advanced courses as soon after the basic courses, as you can as this helps you remember and answer the questions correctly on the first aid tests. Many places and groups provide First aid Training and CPR training. The American Red Cross Association has classes going all the time. Call your local chapter for information. Many churches provide this training to its members as a benefit of membership. Clubs offer these courses to their members and colleges always have a course going somewhere.
HOME NURSING/HOME CARE CLASSES
This is Advanced CPR and First Aid training, along with orderly and basic Nursing skills. You learn to change bedding, adult diapers, adult sanitation, adult hygiene, administer basic medications, take blood samples, take stool or urine samples, take blood pressure and temperature readings and records management. These courses are taught by local hospitals, some churches, colleges, nursing schools and by some home health agencies. Possible other places where instruction is available are the Department of Human Services, Human Resource agencies and nursing homes (retirement homes).
PARAMEDIC/EMT CLASSES
Usually these are offered by hospitals, ambulance or rescue squads/services. Firefighters also take these courses quite often as a result of a Certified First Responder (CFR) initiative where firefighters are dispatched to take care of the injured instead of ambulances, paramedic or EMT squads. Rescue Squads usually have at least 1 person on duty that is a paramedic or an EMT. Colleges also offer these courses. PARAMEDIC AND EMT training is different. The Paramedic courses are harder and more exhaustive, but you are better trained. This does not mean the EMT courses are a push over though.
Both courses require 3 to 6 months in classroom training, 1 to 3 nights a week. Both courses require hospital emergency room work, usually 1 or 2 nights a week and weekends, for the length of the course. Both courses teach emergency treatment of wounds, broken bones, heart attacks, etc. Both courses teach the use of prescribed drugs, schedule II or Schedule III drugs (Schedule II drugs are prescribed drugs and Schedule III drugs are prescribed and administered drugs under doctors direction) and the knowledge to suture up a wound, open emergency airways and do a whole host of things that are necessary to begin treatment of a patient on their way to the hospital. Either course would be good to take if you can afford the time and the cost. Some areas require you to have a reason to take these courses and will not enroll anyone not from a hospital or ambulance, firefighting, rescue or law enforcement background.
FRIENDLY DOCTORS OR NURSES
It has been suggested that a friendly doctor or nurse would provide instruction to you on an individual basis. This would be an ideal situation if you have it available to you, but it is not often an option to the vast majority of the readers of this paper. My doctor is nice and friendly and always has a kind word or good joke to tell, but he does not have the time to spend with me training me in the medical arts. Instead he would rather be on the golf course or taking a trip or a vacation. Nor should I realistically expect him to take time out of his personal life to accommodate my training. If you are lucky and have this option available to you take it and run! For the rest of us it might not be a bad idea to get off our duffs and get this training ourselves.
DENTAL
An often overlooked area of consideration is dental preparations. If you have ever had a bad toothache, you know that nothing hurts as badly as a toothache. Not many places teach dental first aid, but there is one book on the market WHERE THERE IS NO DENTIST by the Hesperian foundation. This book can be ordered through your local book stores and is very valuable.
ALTERNATIVE THERAPIES
Many doctors do not like to offer alternatives to regular medical sciences. However, many are becoming more and more accepted in the medical profession and can be useful if you educate yourself in the fields before you use them.
Naturopathy: Herbal Medicine is very close to regular medical practice. In fact many drugs are made using natural herbs as the prime ingredient. Using these herbs yourself is a lot less hard on your system since plants are usually not as concentrated as most drugs are. The FDA has made health food stores and Naturopathic drug sellers quit making claims about the usefulness of their herbs, but just because it is not been tested by the FDA as a drug does not mean that it does not do the job advertised; especially, if it is the main ingredient in regular medicines.
Chiropractor: Aligns your spine to cure or ease a host of aliments. Many folks swear by them and others swear at them. Try it, you might like it. If you don't then you are not any worse off than you were when you went in.
Acupuncture: The use of needles to block nerve endings to help the body heal or to improve bodily functions. I have tried this in a dentist's office. It works, but I did not like the feeling of the needles in my body. It may be better for you than it was for me, so if you feel you need it, give it a shot.
Holistic: Spiritually healing the soul helps heal the body. A difficult concept...An example: I have seen- doctors advocating a positive mental attitude to help overcome long term sicknesses. It should at least play a part in your total health care plans.
Homeopathy: The idea of like curing like. An example: a bee sting would be treated by massive doses of bee venom. This treatment has grown in popularity and has many regular doctors using it as treatment for illnesses that are impossible to treat or cure using regular medical methods.
Aromatherapy: Treatment of diseases using smells to overcome sicknesses.
Other therapies: garlic therapies, mud pack therapies, mask therapies and a whole host of other therapies all intended to ease pain, cure disease or improve health.
Many doctors may scoff at these health care alternatives, but they may help you. If they do they deserve to be in your survival preparations.
SOURCES
Medicine has a whole host of sources a person may want to acquire. Depending on how specialized you want to become, you can acquire books, magazines and information on just about any subject you might be interested in. It is important to start with the basic sources. These provide the working language, the learning diagrams and the basics:
* Author has in his collection and strongly recommends!
Control of Communicable Diseases in Man - from American Public Health Association
The Physician's Desk Reference - from Medical Economics, Oradell, NJ.
The Merck Manual of Diagnosis and Therapy - from Merk, Sharpe and Dohme, West Point, PA.
*Ship's Medicine Chest and First Aid at Sea - from Public Health Service.
*US ARMY Special Forces Medical Handbook - By Glen K. Craig, available from Paladin Press and a host of other sources.
Emergency Care of the Sick and Injured - by Kennedy from Saunders.
Mountaineering Medicine - by Darvill from Skagit Mountain Rescue Unit.
The Home Medical Handbook-by Angler and Kodet from Association
*Where There is No Doctor &
*Where There is No Dentist - by the Hesperian Foundation, P.O. Box 1690, Palo Alto, CA 94302-1692.
Forgey's Wilderness Medicine - Indianna Camp Supply, P.0. Box 2166, Loveland, CO. 80539.
*Survivalist's Medicine Chest -by Ragnar Benson and available from Paladin Press and a host of other sources.
Surprisingly good medical books can be purchased second hand from almost any college campus. Try after each quarter or semester and look through the books. If one looks interesting then chances are it is not very expensive and you will be able to get a whole lot of information for very little cost.
PREVENTION
Personal hygiene and sanitation is the first step to preventing disease. You are responsible for your actions and if you get a disease because you did not take precautions, then it is your own fault that you caught the disease. A good example is to wash your hands every time you shake hands with someone, or as soon afterwards as you can because it is a proven fact that most colds are transmitted from hand contact. Your hand touches someone with a cold and you do not wash your hands, you then eat or scratch or pick at your face and viola! You have just transmitted a cold to yourself.
WATER PURIFICATION
In the late 1800's, thousands of folks were dying in the cities from dysentery. Even today this can and does cause deaths in third world countries. The bacteria from outhouses pollute the water sources and cause people to get sick. Today all water sources are polluted in one way or another. Guardia, bacteria, viruses and a host of other pollutants are the culprits. All of these little germs can cause a person to be very sick and in extreme cases can cause death. An investment in a good water filter is a must now days.
CONTROL OF INSECTS AND VERMIN
Rats, mice and other vermin can spread disease as can Insects such as the cockroach and the mosquito. It is vital that these insects and vermin be controlled with traps, poison or through natural means.
NUTRITION
Eating properly is very important. A good breakfast, a healthy lunch and a light dinner are good ideas. Remember to eat from all the food groups and to try to stay away from bad foods. Depending on the activities you do, you will need 1 to 3 thousand calories a day. You must have protein in your diet if you are doing any heavy work or if you have children. Most often you need more vegetables and dairy products. More grains will help also. Without a proper diet you will not have the energy you need to survive or to prosper.
EXERCISE
I know folks who have never exercised in their lives. They work on the farm and get all the exercise they need. The rest of us, however, need to do stretches, sit-ups, push-ups and walk, whenever possible. I like going up stairs 5 or 6 flights a day, minimum. If I have time I will go all the way to the top of a 20 story tower and back several times. If you do not have a multi-story office building to walk in, walk around the building you are in. If you can't do this, take a stroll around your block or to the grocery store and carry your groceries back with you. Swimming is good exercise.
DRESSING APPROPRIATELY
It is important that you dress warm in cold weather and cool in hot weather. Getting sick because you forgot your coat or getting heat stroke because you are over dressed is not smart.
PROPER FOOD PREPARATION
Cooking food properly is important to prevent food poisoning. Make sure your eggs are well done, your meat is cooked long enough to kill any germs that might be in it and your vegetables are prepared properly. Food poisoning is not fun and can kill you if you do not get proper medical attention as soon as symptoms appear.
PROPER INOCULATIONS
Getting shots to prevent disease is important and many of us have already had our shots as children.
BUT DID YOU KNOW THAT MANY SHOTS HAVE TO HAVE BOOSTERS TO REMAIN EFFECTIVE?
Well I did not until recently. So, make sure you have had your shots and check with your doctor to see if you need updates on any of the following: Tetanus, Smallpox, Chickenpox, Polio, Mumps, Diphtheria, Measles or any other that you may need.
INFECTIONS
Whether an infected cut or a cold; infections are dangerous and uncomfortable and if left untreated, could lead to more serious and life threatening situation. All cuts need to be treated with antiseptic like iodine, alcohol or other germ killing solutions. They need to be covered or bandaged to let the healing process begin. Colds or other infections need to be treated seriously. Rest and medication help ease the discomfort of fever, aches and body pains; Aspirin, Tylenol, Motrin, etc., help with these discomforts. Antihistamines are good for allergies and many formerly prescribed brands have been de-classified and are now available over the counter like Benedryl, Afrin, Dimmetap, etc., help alleviate symptoms.
WOUNDS, BROKEN BONES, BURNS
Wounds: Depending on the severity, these are usually specialty areas that require specialty knowledge. Bad wounds often require surgery to correct and prevent a patient from dying or getting a bad secondary infection.
Broken bones: Simple fractures are fairly easy to set, but take a long time to heal. Compound fractures and other more serious broken bones might require surgery to fully heal the patient. Again, this is something that is better left to a specialist to do or to study hard for in the event you do not have someone skilled enough to help.
Burns: It takes a long time and a lot of work to repair the damage a burn does to the skin. This is another specialty field that it would be best to leave to a specialist.
BASIC FIRST AID SUPPLIES
Band-Aids (various sizes), sterile saline, pressure bandages, gauze pads (various sizes), gauze rolls (various sizes), cotton balls, cotton tip applicators, Ace bandages (various sizes), butterfly bandages, disposable masks, disposable gloves, petroleum dressings (various sizes), eye dressing kits, scissors (various types), dental mirror, dental pick, Instant heat/cold packs, wire, wood or air splints; adhesive tape (various types), triangle bandages with safety pins and Tufskin/Moleskin for blisters.
MORE ADVANCED MEDICAL TREATMENT
All the first aid supplies plus Oxygen set up, exam light with ear cones, forceps (various kinds), tourniquets, needle holder for suturing, thermometers-oral & rectal, Labstick - urine PH, etc., scalpel with assorted blades, plaster roll gauze & cotton roll felt for casting, urinary catheters, nasogastric catheters for lavage, Hemostats - Mosquito, Kelly; burn solution for oral administration, blood pressure cuff, stethoscope (combination type), I.V. tubing, needles, solutions; airway (child & adult), ear Curette, assorted hypodermic needles and syringes and assorted suture needles and material.
BASIC DRUG SUPPLIES
Iodine antiseptic, salt tablets, triple antibiotic ointment, antihistamines, anti-diarrhea medicine, skin salves for athlete's foot, ringworm, etc.; cold medications like cough drops, cough syrup, cold tablets;
alcohol (not for drinking - swabbing type), burn cream, Aspirin, Tylenol or other pain relievers;
and poison ivy/oak medication. Add anything else that you can think of.
ADVANCED DRUG SUPPLIES
Poison antidotes-such as ipecac syrup and activated charcoal, antibiotics for infections, etc. usually available by prescription only - possibly available as vet medicines; Benimid (antibiotic enhancer) Prescription only, sedatives, hypnotics & tranquilizers for stress- prescription only - use or obtain only with a doctors knowledge and under his care; drugs for shock -Respiratory and cardiac stimulants, antihoptensives and pain killers - by prescription only use only under a doctors care and in accordance with his instructions; muscle relaxants and steroid treatment for poison ivy/oak. Add anything else that you can think of.
It is unlikely that many of the prescribed drugs will be available to you, unless you are an EMT/ PARAMEDIC. Even then, these drugs will be strictly controlled and will be provided only for official use.Do not misuse your authority or you will find that you lose it and your job. If a physician trusts you with any of these drugs or if you have to take some and have some left over; be careful! Often expired drugs lose their potency or become dangerous with age. Storing drugs in the refrigerator may help prolong the life span of the drugs you have, but if they are over 3 years old or if their expiration date is out; dispose of them. See your family physician for refills.
