TEOTWAWKI Medical Kits

TEOTWAWKI Medical Kits

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 the
treatment may not be as high quality as that provided by
a proper hospital but it may be life saving and reduce long
term problems. For example; a general anaesthetic, an operation
for an internal tibial nail, followed by pain management,
and physiotherapy usually manages a broken tibia in
a hospital setting. In a remote austere situation 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.
Removal of an appendix has been done successfully
many times under local anaesthesia. Although in each case
management maybe sub-optimal and may have some risk
in a survival situation it can be done and may be successful
with limited medication and equipment.
Obtaining medical supplies:

Medications:

Obtaining medications can be difficult. The problem is twofold.
First is access and second is cost. Below are some suggestions
for legally obtaining medicines for use in a survival
medicine situation.
i. 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. This approach depends on your relationship
with your doctor, and how comfortably you are discussing
these issues. 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.
ii. 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, acetazolamide
and furosemide for AMS (although these last 2 have limited
roles in a survival situation). It is also worth requesting

Malaria prophylaxis – the CDC recommends doxycycline for
most regions.
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
analgesias, 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.
iv. Prescription medicines are available over the counter in
many third world countries. While purchasing them certainly
isn’t illegal, importation into your own country may
well be. While it is unlikely that a single course of antibiotics
would be a problem, extreme care should be exercised
with more uncommon drugs or large amounts. Narcotics
shouldn’t be imported under any circumstances. Should
you purchase drugs in the third (or second) world you need
to be absolutely sure you are getting what you believe you
are, the best way is to ensure that the medications are still
sealed in the original manufactures packaging.
v. “Not for human consumption”: Veterinary meds are
widely available and are relatively cheap – you can by human
grade antibiotics from many fish supply stores. Several
books discuss obtaining them (Survivalist Medicine Chest.
Ragnar Benson. Paladin Press is one), so I won’t cover it in
detail here. We cannot recommend this method, 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 singlecomponent
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. Amoxicillin
500mg (Vet) = Amoxicillin 500mg (Human), etc. You use
these at your own risk.
A recent discussion with a number of doctors suggests
that options ii and iii would be acceptable to the majority
of those spoken too. In fact many were surprisingly
broad in what they would be prepared to supply in those
situations. However, be warned the majority of the same
group considered the preparedness/survivalism philosophy
to be unhealthy!

Other medical supplies:

Obtaining general medical supplies is often easier. Basic
bandages, and stethoscopes, etc. can be bought from any
medical supply house. In the USA there is no federal law
prohibiting the purchase of things like sutures, syringes,
needles, IVs, etc. but some states can make it difficult. In
most other countries they are freely available. 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
companies 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.
Pre-packaged Kits: Generally speaking it is considerably
cheaper to purchase your own supplies and put together
your own kit. The commercial kits cost 2-3 times more than
the same kit would cost to put together yourself and frequently
contain items which are of limited value. The more
you buy the cheaper things become – consider buying in
bulk.

Storage and Rotation of Medications

Medications can be one of the more expensive items in
your storage inventory, and there can be a reluctance to
rotate them due to this cost issue, and also due to difficulties
in obtaining new stock.
Unfortunately drugs do have limited shelf life. It is a requirement
for medications sold in the US (and most other
first world countries) to display an expiration date. It is our
experience that these are usually very easy to follow, without
the confusing codes sometimes found on food products,
e.g. — Exp. 12/00=Expires December 2000.
We cannot endorse using medications which have expired,
but having said that, the majority of medications are safe
for at least 12 months following their expiration date. As
with food the main problem with expired medicines is not
that they become dangerous but that they lose potency
over time and the manufacturer will no longer guarantee
the dose/response effects of the drug. We discuss using expired
medications in more detail in Chapter 11.
The important exception to this rule was always said to be
the tetracycline group of antibiotics which could become
toxic with time. However, it is thought that the toxicity with
degrading tetracycline was due to citric acid which was part
of the tablet composition. Citric acid is no longer used in the
production of tetracycline, therefore, the dangers of toxicity
with degradation of tetracycline is no longer a problem.
Aspirin and Epinephrine do break down over time to toxic
metabolites and extreme care should be taken using these
medications beyond their expiry dates.
Despite the above comments “Let the buyer beware.” The
expiry dates ARE there for a reason, and there are almost
certainly other medications which do break down, and become
toxic after their expiry date.
In addition, we recommend that if you are acquiring medications
on a doctor’s prescription that when you have the
prescription filled you explain the medications are for storage
(you don’t need to say exactly what for), and request
recently manufactured stock with distant expiration dates.
The ideal storage conditions for most medications are in
a cool, dark, dry environment. These conditions will optimise
the shelf life of the drugs. A small number of drugs
require refrigeration to avoid loss of potency.These include
insulin, ergometrine, oxytocin, and some muscle relaxants.
Others such as diazepam rapidly lose potency if exposed to
the light.

How much?

This is a very individual question. It depends upon what
you are preparing for and the number of people you will be
looking after. It is impossible to say how much is enough.
In order get a rough idea of what you should stock – think
of your worse case scenario and at least double or triple
the amounts you calculate. Items which never go as far as
you think they will include – gauze, tape, antibiotics, and
sutures. If you have ever been hospitalised or had a close
relative in hospital for even a relatively minor problem take
a look at the billing account for medical supplies and drugs
to get an idea how much can be consumed with even a
relatively small problem. It is simple mathematics; drugs
which you need to take more than once or twice a day disappear
extremely fast – penicillin 4 times a day for 10 days
on a couple of occasions quickly erodes your “large stock”
of 100 tablets! The same number of ciprofloxacin required
only twice a day last longer. Dosing frequency is worth considering
when deciding amounts.

Specific Medical Kits

Everyone has an idea of what his or her perfect kit is and
what he or she thinks is vital – so there is no perfect kitpacking
list. What is perfect for one person’s situation and
knowledge may not be perfect for yours. You need to build
a kit that you are able to understand and use.
In this section we have looked at a basic first aid kit, a more
broad-spectrum basic medical kit, and an advanced medical
kit able to cope with most medical problems. These are
not the perfect kits or the ideal packing list – but they give
you some idea of what we consider are needed to provide
varying levels of care.
There is also frequent confusion over which surgical instruments
to buy, how many of each, and what some actually
do so we have gone into more detail looking at some possible
surgical and dental kits, and what level of care can be
delivered with each.
Note:
1) We’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 we
have tried to include both e.g. Lignocaine (UK & Oz/NZ) =
Lidocaine (US)
2) We 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.
These do not feature on the packing-lists. However, it
is vital to remember the blood pressure pills, thyroid hormones,
allergy pills, contraceptive pills, asthma inhalers, or
what ever you take regularly. Most doctors will issue additional
prescriptions for regular medication to allow an extra
supply at a holiday home or to leave a supply at work. The
main problem likely to arise is covering the cost of the extra
medication which may be expensive and not covered by
insurance. If you have previously had severe allergic reactions
consider having a supply of Epi-pens

Medical Bags:

Before addressing what you need, it’s worth looking
at what you’re going to put it in. There is large selection
of medical bags on the market – military and civilian
styles, rigid and soft construction. They vary in
size from bum bags to large multi compartment backpacks
and vary in price from less than $100 to more
than $500 USD. We have selected 3-4 bags in each
size range – personal use, first responder, and large
multi-compartment bags. They cover a range of prices.
What is right for you will depend on your individual
requirements. If in a fixed location consider buying a
rolling mechanics tool chest and using it as a “crash
cart”.
Personal size:
• Battle pack (Chinook Medical gear)
• Modular Medical Pouch (Tactical Tailor)
• Compact individual medical pouch (S.O Tech)
First responder size
• First response bag (Tactical Tailor)
• Modular bag system (Galls)
• Plano 747M Hard Case (Plano)
• NSW Medical Patrol bag (London Bridge Trading Company)
• Responder II (Conterra)
• Pelican waterproof case
Large kit bag:
• M5 style bag (Tactical tailor)
• MIII Medical pack (Eagle)
• NSW Training/Coverage Medical Backpack (London
Bridge Trading Company) – one of the best large bags on
the market. The STOMP II Medical Backpack from Blackhawk
industries is very similar to the NSW training/coverage
pack from LBTC – but significantly cheaper.
• ALS pack (Conterra)
• Kifaru back-packs (Kifaru) – not specifically medical, but
can be customised inside and out. When you have selected
the bags that suit you, one approach to organising your
medical supplies is:
Personal bag: Carry this with you at all time. It contains
basic first aid gear or in a tactical situation the equipment
to deal with injuries from a gunshot wound or explosion.
First response bag: Carry this in your car; take it with you
when you go camping etc. It contains more advanced first
aid gear and some medical items.
Large kit bag: This is your home/retreat/bugging out medical
kit. It contains your medical equipment as opposed to
simple first aid supplies.
Storage area: In your home/retreat. It contains duplicate
and bulk supplies. Large plastic storage bins are ideal for
this.
Pack/organise/store items that are fragile, easily damaged
by water, or can become messy (most liquids and ointments,
ESPECIALLY tincture of benzoin in any form) in individual
zip-lock plastic bags. For high-value water sensitive
items (pulse oximeters, blood glucose meters, etc.) consider packing in water proof hard cases – such as the Pelican or Otter boxes.

Consider packing items that are used together into “battlepacks”,
ready to use packages – for example, pack an IV
giving set with an IV start set with an Angio-Cath in zip-lock
bag – so you can grab one thing and be ready to go.
Appendix 1 lists some medical suppliers.
EBay is a good source of medical supplies and surgical instruments
but be careful to know what you are buying:
Make certain you know what you want and what it would
have cost from a supplier.
A brief note about airway management
equipment
Before describing in detail packing lists for several possible
kits we should discuss briefly airway management and the
equipment associated with it. The details of this are best
learnt in a First Aid /EMT class. The management of an airway
has a number
of steps:
• Basic airway manoeuvres – head tilt, chin lift, jaw thrust.
• Simple airway adjuvants – oral airways, nasal airways.
• Advanced airway adjuvants – laryngeal masks, Combitubes.
• Endotracheal intubation – this is the gold standard of airway
management. A plastic tube from the mouth into the
trachea through which a patient can be
ventilated.
In addition once you have managed the airway you need
to ventilate the patient either with mouth-to-mouth/mask
or using a mask – self inflating bag combination (e.g. Ambubag).
The reason for discussing this is that you need to decide
how much airway equipment to stock. Our view is that
there is relatively little need to stock anything more than
simple airway devices such as oral or nasal airways unless
you are planning (and have the skills) to give an anaesthetic
for the simple reason that anyone one who requires advanced
airway management is likely to be unsalvageable in
an austere situation. If
simple devices are not sufficient then they are likely to die
regardless and introducing relatively complicated airway
devices will not help. This, however, is an individual decision.

First Aid Kit

A comprehensive basic first aid kit is the building block of
any medical preparations. With relatively simple equipment
and supplies you can stop bleeding, splint a fracture,
and provide basic patient assessment. Table 4.1 lists the
suggested contents for a basic first air kit. The following are
the key components of any kit albeit for a work, sport, or
survival orientated first aid kit:
Dressings – Small gauze squares/large squares/Combined
dressings/battle dressings/ non-adhesive dressings. There
is a vast range. They serve two functions: – to cover and
stop bleeding and to protect a wound. Exactly what you
need is to a large degree personal preference – but whatever
you buy you need small and large sizes, and they need
to be absorbent.
Roller/Crepe Bandages – These go by various names
(Crepe, Kerlix) – but we are talking about is some form
of elasticised roller bandage. These are required to hold
dressings in place, apply pressure to bleeding wounds, to
help splint fractures, and to strap and support joint sprains.
They come in a variety of sizes from 3 cm to 15 cm (1- 4”)
and you should stock a variety of sizes
Triangular bandages – These are triangular shapes of
material which can be used for making slings, and splinting
fractures, and sprains.
Band-Aids – Lots of them and in multiple sizes. They are
useful for protecting minor wounds and skin damage.
Oral or nasal airways and a CPR face shield – We have
already discussed supplies for airway management. Oral or
nasal airways are the basics for assisting with airway management.
Often when combined with basic airway opening
manoeuvres these are sufficient to maintain the airway of
an unconscious person. The face shield is if you need to
perform mouth-to-mouth on someone. This only really an
issue with strangers not close friends or family members.
Sterile normal saline (salt water) or water – You don’t
need expensive antiseptic solutions for cleaning wounds.
Sterile saline or water (and to be honest – even tap water
is fine for most wound cleaning) is all that’s required to irrigate
or clean contaminated wounds. There is no clear evidence
that using antiseptics over sterile water in traumatic
(as opposed to surgical) cuts or abrasions reduces the incidence
of infection. The best way to clean a wound is with
copious amounts of water or saline. It is also useful for irrigating
eyes which have been exposed to chemical, dust,
or other foreign bodies.
Tape – You can never have too much tape. It has 100s of
uses. We recommend a strong sticky tape like Sleek™ or
Elastoplast™. There are many other paper or plastic based
tapes around – the main criterion is that it always sticks
when required.
Gloves – Needed for two reasons. Firstly you have to assume
that everyone you deal with has a blood borne disease.
When you are dealing with family members in an austere
situation this isn’t so important. The second reason is
to try and reduce infection when dealing with wounds. In
the same way that using antiseptics over sterile water for
irrigation of wounds has minimal impact on the incidence
of infection – the same is true for sterile vs. non-sterile
gloves. When managing traumatic wounds (again this isn’t
true for surgical incisions and operations) there appears to
be minimal
difference in infection rates between wound management
with sterile or non-sterile gloves. Exam gloves are not sterile,
can be used on either hand, and are just casually sized
(small, medium, large, etc.). They come in boxes of 50 or
100. Nitrile gloves are more than latex. Sterile gloves are
packed individually and have specific sizes – 7.0, 7.5, 8.0,
etc. Size is important – know your size.
That’s it really, a very basic and limited range of supplies.
As you can see this is considerably less than what is sold in
many commercial first air kits but this is all that is required
in a basic first aid kit. These supplies cover most first aid
situations. They give you the ability to provide basic airway
management, clean a wound, control bleeding, and
splint, and immobilise fractures and sprains. It will also
protect yourself from contamination with the gloves and
face shield.

Basic Medical Kit

The basic medical kit is the next step you take from a basic
first aid kit. The example here is designed for someone with
a basic medical knowledge and a couple of good books. A
lot of common problems can be managed with it; minor
trauma (cuts and minor fractures), simple infections, and
medical problems. Between this and the larger more comprehensive
advanced kit wide spectrum dependent on
knowledge or experience. Most begin with a first aid kit
and expand as knowledge and finances allow.
A smaller medical kit for your bug-out bag could be made
up from the above by adding some medications (such as
acetaminophen, Benadryl, and some loperimide) and some
instruments to a small first aid kit.

Advanced Medical kit

This is designed for someone with extensive medical training
and would allow one to cope with 90% of common
medical problems including some surgery, spinal and regional
anaesthesia, and general anaesthesia with ketamine,
treating most common infections and medical problems,
and moderate trauma. 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. This sort of
amount of equipment packs into two medium size nylon
multi-compartment bags and a Plano rigid 747 box
Table 4.1 Basic First Aid Kit
Bandages and Dressings:
[__] Antiseptic Wipes
[__] Bandage (Crepe) – 50 mm (2”)
[__] Bandage (Crepe) – 75 mm (2.5”)
[__] Bandage (Crepe) – 100 mm (4”)
[__] Bandage (Gauze) – 75 mm (2.5”)
[__] Bandage (Gauze) – 100 mm (4”)
[__] Bandage Triangular
[__] Dressing (Combine) 90 mm x 100 m m
[__] Dressing (Combine) 200 mm x 200 mm
[__] Dressing (Non Adhesive) 75 mm x 50 mm
[__] Dressing (Non Adhesive) 75 mm x 100 mm
[__] Dressing Strip – Elastoplast 75 mm x 1 m
[__] Eye Pads
[__] Gauze Swabs (Pkt 2) – 100 mm x 100 mm
[__] Sticking plasters
Personal protection
[__] Disposable Gloves
[__] CPR Face Shield
Instruments
[__] Clothing Shears
[__] Tweezers – Fine Point
[__] Splinter Probes
Other
[__] Saline Solution 30 mL Tubes
[__] Steri-Strips – 3 mm
[__] Survival Sheet
[__] Tape – 25 mm
Table 4.2. Basic medical kit
Bandages and Dressings
[__] Combat Dressings
[__] Large gauze dressings
[__] Small gauze squares
[__] Roller Bandages elastic + cotton (2in/4in/6in)
[__] Triangular Bandages
[__] Bandaids -assorted sizes and shapes (i.e. fin
gertips)
[__] Sleek Tape 1 in.
(waterproof, plastic/elasticised tape)
[__] Cotton buds (Q-tips, cotton tips)
Personal protection / Antisepsis:
[__] Chlorhexidine (Hibiclens) or
[__] Povidone-iodine (Disinfectant)
[__] Antibacterial Soap
[__] Gloves
[__] Saline solution – for irrigation
Medication:
[__] Lignocaine 1% (Lidocaine) (local anaesthetic)
[__] Augmentin (broad spectrum antibiotic)
[__] Acetaminophen (Tylenol) (mild analgesic)
[__] Diclophenac (Voltaren)
(mod analgesic/antiinflammatory)
[__] Oral Rehydration powder
[__] Loperamide (Imodium) (antidiarrhoeal)
[__] Benadryl &/or Claritin
(antihistamines, short + long acting)
[__] Adrenaline auto injector (Epicene)
(USA = epinephrine)
[__] Morphine Sulphate
(strong pain killer) if available
[__] Gamma Benzene Hexachloride
(lice/scabies treatment)
[__] Co-timoxazole (antifungal)
[__] Contraceptive pills/Condoms
Instruments:
[__] Clothing shears
[__] Surgical scissors
[__] Needle holder ) Enough to do basic minor
[__] Sm curved clamps ) surgery – suturing, draining
[__] Tissue forceps ) abscesses, cleaning a wound,
[__] Scalpel blades ) etc.
Other:
[__] Thermometer (rectal or pacifier for children)
[__] Emergency Obstetric Kit
(includes bulb suction)
[__] Vicryl 2-0 suture material
(Your choice of suture material is up to you – and is covered
in detail elsewhere in this book. Vicryl is a synthetic dissolvable
one, but takes up to 4-6 weeks to dissolve, so I think it
is the ideal survival thread)
[__] 5 mL syringes
[__] 20 gauge needles

Dental:
[__] Oil of cloves (tooth ache)
[__] Emergency dental kit
(commercial preparation)
Table 4.3. The Deluxe Medical Kit
Bandages and dressings
[__] Large gauze dressings
[__] Small gauze squares
[__] Combat dressings
[__] Petroleum gauze squares
[__] Plastic bags
[__] Bandaids – assorted sizes and shapes
[__] Elastoplast dressing
[__] Steri-Strips – assorted sizes
[__] Tincture of Benzoin
[__] Roller (elasticised + cotton)
bandages (2in/4in/6in)
[__] Triangular bandages
[__] Safety pins
[__] Cotton buds
[__] Paper tape (1/2 in/1in)
[__] Sleek tape (1/2in/1in)
[__] Plaster of Paris (or fibreglass)
roller bandages (4in/6in)
[__] Eye patches
Airway
[__] Oropharyngeal airways
[__] Nasal airways (nasal trumpet)
[__] Resuscitation facemask with one-way valve
[__] Self-inflating resuscitation bag
[__] Endotracheal tube/ Laryngoscope
Assessment
[__] BP cuff
[__] Stethoscope
[__] Otoscope
[__] Small Torch (flash light)
[__] Thermometer (rectal for children)
[__] Multi-dip. urine test strips
[__] Pregnancy test kits
[__] Fluorescein eye strips
(+ some liquid tears to wet the strips)
Other
[__] Small eye magnet (for FB’s)
[__] Space blanket
[__] Air splints (arm/long-leg/short-leg)
[__] SAM splints
[__] Sterile and un-sterile latex gloves
[__] Scrub Suits
IV Kit
[__] Normal Saline or Hartmans
[__] Haemaccel or Pentaspan
(a colloid resuscitation fluid)
[__] IV giving sets – maxi-sets + standard sets
[__] Blood collection bags + filter giving sets
[__] Syringes 2/5/10/20 mL
[__] Needles 20/22/24 gauge
[__] IV cannulas 16/20/24 gauge
[__] Spinal needles 22 gauge
[__] Leur locks/Heparin locks
[__] Saline for flushes
[__] Tourniquet
[__] Alcohol Wipes
Dental Kit
[__] Oil of cloves
[__] Zinc Oxide paste
[__] Dental mirror
[__] Sharp probe
[__] Compactor
[__] Extraction forceps
[__] Elevators
Surgical Kit
[__] Mayo scissors
[__] Dissecting forceps
[__] Small + medium needle holders
[__] Small curved clamps
[__] Small straight clamps
[__] Large curved clamps
[__] Scalpel Handle + Blades (size 11, 12, 15)
or disposable scalpels
[__] Small 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
[__] Heimlich flutter valve
[__] Chest drains – various sizes
[__] Drainage bottles or Flutter valves
[__] Penrose drains
[__] Foley Urethral Catheters –
16 French (most useful size)
[__] Urine Bags
[__] Nasogastric (NG) tubes + spigots
[__] Heavy duty scissors
Medications
[__] Povidone – iodine Prep antiseptic skin prep
and/or Alcohol prep antiseptic skin
prep Chlorhexidine and cetrimide anti
[__] septic hand wash
[__] Benalkium Chloride Antirabies skin wash
[__] Antibacterial Soap
[__] Paracetamol (Tylenol) oral mild analgesic
[__] Aspirin oral wonder drug
[__] Diclophenac oral mod analgesic (NASID)
[__] Morphine IV/IMSC strong analgesic
[__] Naroxone IV antagonist to morphine
[__] Ketamine IV/IM IV anaesthetic
[__] Diazepam IV hypnotic/sedative
[__] Atropine IV pre-med/poison anti
[__] Lignocaine (Lidocaine) IV local anaesthetic
[__] Metoclopramide (Reglan) anti-emetic
[__] Augmentin oral/IV penicillin antibiotic
[__] Metronidazole oral anaerobic antibiotic
[__] Cefaclor oral cephalosporin antibiotic
[__] Ceftriaxone IV cephalosporin antibiotic
[__] Ciprofloxacin oral quinolone antibiotic
[__] Mebendazole oral antiparasitic
[__] Co-trimoxazole top antifungal
[__] Adrenaline IV/IM (USA = Epinephrine)
[__] Salbutamol inhaler asthma/anaphylaxis
[__] Rehydration formula dehydration
[__] Benadryl &/or Claritin oral antihistamine
[__] OTC Cough suppressant
[__] Betnesol oral steroid
[__] Hydrocortisone IV/cream steroid
[__] Loperamide oral antidiarrheal
[__] Ergometrine &/or Oxytocin IV/IM ecbolic for
PPH
[__] Neomycin eye drops
[__] Prilocaine eye drops local anaesthetic
[__] Starr Otic Drops antibiotic ear drops
[__] Mupirocin (Bactroban) top topical
antibacterial cream
[__] Gamma Benzene Hexachloride topical for
scabies and lice
[__] Water for injection/normal saline for injection
[__] Oral Contraceptive Pills
[__] Condoms/Cervical Caps/Diaphragms
Surgical Instruments
The above kits are general medical kits – covering the multitude
of medical problems and contain surgical instruments.
However commonly asked questions relate specifically
to surgical instruments – what and how many of
them are required for various levels of surgical procedures.
Below is a detailed list of surgical instruments with 4 levels
of increasing complexity. Note that each level builds on the
one before it. This instrument list reflects our own preferences
and experience under austere conditions. There are
many other instruments that would be helpful (for example
ring forceps to hold sponges, larger retractors, etc.), but
they are not considered vital. This is the bare minimum.
What is it?
Needle holders – shaped like scissors but instead of having
a cutting surface they have two opposed plates with
groves cut into them, and are designed to hold the needle,
and stop it rolling or slipping as you sew. Once you have
gripped the needle a ratchet holds the tips locked so the
needle does not move
Haemostat/Clips/Clamps – Similar in shape to needle
holders but the tips are designed to clamp onto tissue and
to hold it. They have the same ratchet mechanism to keep
them locked and attached once they are attached. They
are used to clip bleeding blood vessels or hold onto tissues
you are working with. There is a massive range of sizes and
shapes depending on what they are designed to clip or
clamp.
Forceps/Dissectors – are shaped like traditional tweezers
and come in various sizes. They either have small teeth
on their tips or are smooth tipped. They are designed to
handle tissues and to help you move tissues round such as
when suturing
Scissors – these are self-explanatory
Retractors – these are designed to hold tissues out of the
way so that you can see what you are doing. They come in
a huge range of sizes and shapes depending on what part
of the body you are working with. Skin hooks or small rightangle
retractors are most suitable for most minor wound
repairs
Level 1: Field Wound Repair Kit
This is a minimal cost unit intended to be carried in a kit
or pack, and be used for minor wound debridement, and
closure of the types of injuries most commonly occurring.
Although it is a pre-packaged “disposable” kit the instruments
may be reused many times with appropriate sterilization
and care. This easily goes in a ziplock bag, and can
be widely distributed, and available among your group.
Level 2: Basic Suture Tray
This is composed of good quality instruments intended for
long term use and resterilization. It is suitable for repair
and debridement of minor wounds and injuries
including simple two-layer closure. This is typical of the majority
of wound care done in a hospital ER.
Level 3: Procedure kit
This kit is capable of complicated multilayer wound repair,
OB repairs, plastic surgery closures, tendon repair, chest
tube insertion. This is suitable for laymen with some training
and experience, and is probably the recommended
level for most as it has the greatest capability vs. expense.
Those with adequate medical training could press this into
service for more advanced problems with some improvisation.
Note: if you anticipate a lot of OB or foreign body
removal a Weitlaner retractor, 5-6” would be very helpful.
A rongeur and rasp are very helpful for bone clean up, traumatic
finger amputations, etc.
Level 4: Major procedures kit
This kit is capable of complicated multilayer wound repair,
OB repairs, plastic surgery closures, tendon repair, chest
tube insertion, emergency abdominal surgery, Caesarean
sections, straightforward amputations, etc. With this kit a
competent practitioner should be able to perform all the
procedures that are likely to be possible in an austere environment.
Table 4.4 Field Wound repair kit
[__] 1 Tube Super-glue Gel
[__] 1 Steri-Strips, and Benzoin adhesive, or duct tape
[__] 1 Betadine swab packet, or skin cleaner of choice
[__] 1 Irrigation syringe and ability to purify at least 2 quarts
water; tablets, etc.
[__] 1 Dressings of choice
Optional items to consider include:
[__] 1 Disposable laceration tray with needle driver, pickups,
scissors, 4x4s, drape
[__] 1 Disposable scalpel, #10
[__] 1 Ethilon, or Prolene, or Silk 4-0 & 6-0
[__] 1 Vicryl or Chromic 4-0
[__] 1 skin stapler, 15 shot
[__] 1 staple remover
[__] 1 Sterile gloves your size
[__] 1 Lidocaine 1% or 2% WITHOUT epinephrine
Table 4.5 Basic suture tray
[__] 1 Needle driver, 5”
[__] 1 Adson forceps ,1×2 teeth
[__] 1 Sharp/blunt scissors, 5” straight
[__] 1 Iris tissue scissors, curved
[__] 1 Mosquito hemostat, curved
[__] 1 #3 Scalpel handle & #10, #11, #15 blades
[__] Ethilon, or Prolene, or Silk suture;
2-0, 4-0, 6-0, cuticular needles
[__] Vicryl or Chromic suture 2-0, 4-0, 6-0 cuticular needles
[__] Skin staplers & remover
[__] Steri-Strips and Benzoin
[__] Several tubes Super-glue Gel
[__] Skin cleaner of choice
[__] Irrigation syringes & ability to purify water
[__] Sterile gloves appropriate sizes
[__] Sterile drapes, disposable or reusable
[__] Appropriate anaesthesia and dressing of choice
Table 4.6 Procedure set
[__] 1 Needle driver, 4-5”
[__] 1 Needle driver, 6-7”
[__] 1 Sharp/blunt scissors, 5” straight
[__] 1 Baby Metzenbaum or Mayo scissors ,5” curved
[__] 1 Iris tissue scissors, curved
[__] 1 Mosquito haemostat, straight
[__] 1 Mosquito haemostat, curved
[__] 1 Kelly haemostat, straight
[__] 1 Kelly haemostat, curved
[__] 1 Peon or Oschner haemostat; 7-8”, curved
[__] 1 Adson, 1×2 teeth
[__] 1 Adson, no teeth
[__] 1 Splinter forceps
[__] 1 Senn 3 prong/blunt + right-angle double end retractor
[__] 1 Allis 4×5 clamp
[__] 2 #3 Scalpel handle and #10, #11, #15 blades
[__] 1 #4 Scalpel handle and #20 or #22 blades
[__] 1 Thin probe
[__] Ethilon, or Prolene, or Silk suture;
0, 2-0, 4-0, 5-0, 6-0, 7-0 cuticular & plastic
needles
[__] Vicryl or Chromic suture;
0, 2-0, 4-0, 6-0 cuticular needles
[__] Skin staplers & remover
[__] Steri-Strips and Benzoin
[__] Several tubes Super-glue Gel
[__] Skin cleaner of choice
[__] Irrigation syringes & ability to purify water
[__] Sterile gloves appropriate sizes
[__] Sterile drapes, disposable or reusable
[__] Appropriate anaesthesia and dressing of choice
Table 4.7 Major Procedure kit
[__] 1 Needle driver, 4-5”
[__] 1 Needle driver, 6-7”
[__] 1 Sharp/blunt scissors, 5” straight
[__] 2 Baby Metzenbaum or Mayo scissors, 5” curved
[__] 1 Metzenbaum, 6-7” Curved
[__] 1 Mayo, 6-7” Curved
[__] 1 Iris tissue scissors, curved
[__] 1 Mosquito haemostat, straight
[__] 1 Mosquito haemostat, curved

[__] 2 Kelly haemostat, straight
[__] 2 Kelly haemostat, curved
[__] 2 Peon or Oschner haemostat, 7-8” curved
[__] 1 Adson, 1×2 teeth
[__] 1 Adson ,no teeth
[__] 1 Splinter forceps
[__] 1 Russian forceps, 6-7”
[__] 2 Senn 3 prong/blunt
+ right-angle double end retractor
[__] 2 Allis 4×5 clamp
[__] 1 Army-Navy retractor
[__] 1 Ribbon retractor
[__] 1 Weitlaner retractor
[__] 2 #3 Scalpel handle and #10, #11, #15 blades
[__] 1 #4 Scalpel handle and #20 or #22 blades
[__] 1 Thin probe
[__] 1 Wire (Gigli) amputation saw or Satterlee amputation
saw
[__] 1 Adson type bone rongeur
[__] 1 Bone rasp
[__] Ethilon, or Prolene, or Silk suture;
0, 2-0, 4-0, 5-0, 6-0, 7-0 cuticular, taper, &
plastic needles
[__] Vicryl or Chromic suture;
0, 2-0, 4-0, 6-0 cuticular & taper needles
[__] Skin staplers & remover
[__] Steri-Strips and Benzoin
[__] Several tubes Super-glue Gel
[__] Skin cleaner of choice
[__] Irrigation syringes & ability to purify water
[__] Sterile gloves appropriate sizes
[__] Sterile drapes, disposable or reusable
[__] Appropriate anaesthesia and dressings of choice
Copyright 2005
Survival and Austere Medicine: An Introduction
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