EMS in austere conditions question

[Medic2588]

Greetings,

Through my travels throughout the EMS world I have somehow stumbled into a disaster response team (particulars will go unmentioned) that would be providing incident management on large scale emergencies. Upon finding out my background, our leader volunteered me to take on the duties of team medic for force protection in the event we are operating in an out of the way location with little or no emergency medical care available.

So my question to the tactical operators out there is:

With limited diagnostic equipment available to you (I MAY be able to swing a Lifepak 12 but can't be sure), what sort of equipment and medication (both ACLS and OTC) would you consider 'essential' for immediate life saving intervention in austere conditions? What sort of austere conditions? Use your imagination and we would probably respond, short of open combat.

Any suggestions would be greatly appreciated.

Devin

[crotchitymedic1986]

I would look at the thomas packs that contain medicines and airway stuff in one big back pack. The rest of the equipment list would be determined by what type of vehicle you would be using, if any.

http://www.thomasems.com/

[Medic2588]

Thanks for the link crotchity... and no vehicle here. My main purpose is incident management, but they want a medic to provide a little more than first aid to the team members if someone gets sick or injured

[chbare]

Depends on the specific environment and the intelligence you can gather prior to deployment. For example, Cipro and Flagyl are two very important medications where I live and work. However, when dealing with "non westerners," I find other agents such as mebendazole are important.

You will be operating in the US or will you be deployed in an international setting? The problems will vary according to geographic location, logistical availability, current world events, and level of pre-existing infrastructure. For example, I had fairly good logistical support and intelligence regarding the medical situation when I deployed following Katrina. However, our level of support is somewhat limited in Afghanistan and we go through many local channels to obtain supplies and equipment. Obviously, some of this is because I no longer have military supply/logistical channels open as a civilian.

Spend some time researching and create a list of "mission essential" equipment that you would utilize on every deployment. Then, have a modular "kit." Allow for flexibility and never forget the importance of planning and preventative medicine. Simple concepts such as up to date vaccinations and a malaria control/prevention program may in fact reduce morbidity and mortality much more than a pile of cardiac medications.

Take care,

chbare.

[CTXMEDIC]

Greetings,

Through my travels throughout the EMS world I have somehow stumbled into a disaster response team (particulars will go unmentioned) that would be providing incident management on large scale emergencies. Upon finding out my background, our leader volunteered me to take on the duties of team medic for force protection in the event we are operating in an out of the way location with little or no emergency medical care available.

So my question to the tactical operators out there is:

With limited diagnostic equipment available to you (I MAY be able to swing a Lifepak 12 but can't be sure), what sort of equipment and medication (both ACLS and OTC) would you consider 'essential' for immediate life saving intervention in austere conditions? What sort of austere conditions? Use your imagination and we would probably respond, short of open combat.

Any suggestions would be greatly appreciated.

Devin

you were the best qualified candidate? Seems to me like you should already know what you need. just sayin...

[chbare]

you were the best qualified candidate? Seems to me like you should already know what you need. just sayin...

Nothing wrong with sharing thoughts and ideas. Even the most experienced person may learn something new when people throw out their thoughts.

Take care,

chbare.

[Doczilla]

This process starts with a medical threat assessment of health hazards in the area in which the team operates as well as current health issues among team members, operational profile, and length without resupply. I agree with having a modular setup that you can quickly configure based on mission parameters.

If you are on your own for <24 hours, not too much modification is necessary. If evacuation of a patient may take significantly longer due to distance, tactical considerations, or available resources, you'll dial down the ACLS stuff (like, to nothing) and increase capabilities for sustainment. ACLS really has no role in the remote austere environment, because it is unlikely that an "arrest" in the field with significant time to hospital (days) will survive, and the cost in weight, cube, and price for lives saved is extremely high. Airway equipment and the like is less important, since you can't really BVM someone for days.

Infectious disease becomes the most significant health threat in the remote environment absent hostile fire. Antibiotics are a must if you can't easily evac someone. Oral antibiotics will almost always suffice.

Pain management is huge, so copious amounts of tylenol and advil. Narcotics will be necessary for that team member that sustains a serious injury that renders them incapable of continuing the mission and requiring evac.

Benadryl for allergies, rashes, as well as sleep aid. It's sometime tough to get to sleep in a large tent of people.

You should have equipment to render water safe to drink in the event that this capability is not available in your other team resources. A mission which is extended by unavailability of resources will mean that the water you brought with you may not be adequate. This may be as simple as bringing boiling pots or requiring all team members to carry purification tablets. The MIOX system is another way to go.

Ensure basic hygiene through training and proper equipment. I can't overemphasize the importance of proper foot care. The book "Get Selected for Special Forces" has the best foot care chapter I have ever seen, and is a must read if you're going to the field.

Really, the best thing you can do at this point for your team is secure additional training for providing care in this environment, which departs from traditional EMS in a number of ways. Go to GMRSLtd.com and sign up for one of their courses (highly recommended), or Deployment Medicine Intl and sign up for their OEMS or DMOC course (also highly recommended. I have no financial interest in either of these companies). It sounds like these courses are exactly what you'll need in terms of preparation for that environment.

'zilla

[Richard B the EMT]

However, when dealing with "non westerners..."

Clarification, please: Are you using the term "Westerner" to be European/American geopolitical versus "Asian" (or whatever the currently politically correct wording is now), or someplace depicted in a "John Wayne as cowboy/cavalry officer" movie?

[tniuqs]

In that light ... DipROM

The Diploma of remote and offshore medicine (in the UK) may be an idea as well.

cheers

[chbare]

Clarification, please: Are you using the term "Westerner" to be European/American geopolitical versus "Asian" (or whatever the currently politically correct wording is now), or someplace depicted in a "John Wayne as cowboy/cavalry officer" movie?

I am using the term rather loosely to describe people who essentially live west of Afghanistan. Mainly, European and American. It is not uncommon for us to develop severe GI illness within the first few weeks of entering the country. Unfortunately, about seven months ago, when I first came in to country, I learned just how "uncomfortable" these conditions can be. Obviously, Cipro and Flagyl can be quite useful. Not to say you take Cipro every time you have loose stool; however, for severe diarrheal illness...

Take care,

chbare.