By BCE
One of the problems with medicine is that there are lots of gadgets – everywhere you look there is a machine that wrrrr’s or goes ‘ping’. There are lots of useful gadgets which you could invest in, but most are horrendously expensive or require extensive servicing or very specific batteries to make them work.
In the same way that night vision goggles act as a force multiplier from a security perspective, many of these gadgets act as a force multiplier from a medical perspective. But what do you invest in?
There are 6 medical devices that may be useful when the SHTF.
In this list are some (mostly) cheap but potentially very useful pieces of medical equipment, whose usefulness can be glossed over or under-estimated.
There are two caveats – first, none of these items should come before getting your basics sorted – these are nice to have and not must have and second while these items are useful to have, you do need to have slightly more than a basic knowledge to use most of these items – you don’t need to be an expert and it is more than possible to teach yourself to safely use these devices – but it is more than a basic level.
In no particular order, these are some medical devices you should consider.
AED (Advisory external defibrillators)
Having an AED on hand could save lives.
AEDs (Advisory external defibrillators) are what you see hanging on the walls of malls, gyms, train stations, and airports. When the heart finds itself in a chaotic rhythm a shock from the defibrillator stops the heart and hopefully when it restarts the rhythm is less chaotic and more organized. Education about when and how to use them is provided on entry-level first aid courses.
Heart attacks are common. In a post-SHTF situation, they will still be common. The two things which have been shown to save someone who has had a heart attack is taking aspirin immediately and then for at least a few weeks and having access to a defibrillator. Clot-busting drugs and having stents placed are life-saving but hard (impossible) to reproduce in an austere or grid-down environment. Fortunately, simple aspirin and treating shockable arrhythmias after a heart attack drops the chance of death from around 30% to around 10% – all the other interventions only further reduce the risk a few further percents. The big bang for the buck is in the simple things.
They retail for between $400 and $2000 USD – that’s a lot of money. It certainly isn’t something to buy before getting your other medical supplies sorted out. But if you can afford one it is a useful addition – given the frequency of heart disease and heart attacks. They have also become ubiquitous around public places – the chances of stumbling across one while foraging post-SHTF is high and worth grabbing if you do.
Philips HeartStart AED Home Defibrillator
Fingertip Pulse Oximeter
Finger-tip pulse oximeters are useful and inexpensive.
A pulse oximeter measures the % of oxygen in your blood. The closer to 100% the better, but anything below the low 90’s is bad. It requires some medical knowledge to use and interpret, and I will write a separate article on that. At its most basic level, it tells you how effectively the lungs and gas exchange are working in the body.
Reasonable quality devices can be found online for $20-100 – obviously, you get what you pay for – a $100 US device will likely be better quality than a $20 Chinese one. But even the cheap ones generally work well and at that price, there is potential to buy a back-up.
Zacurate Pro Series Pulse Oximeter
Otoscope
An otoscope can be used to examine ears.
You don’t realize you need a special device to look in someone’s ear until you need to and you don’t have one! Looking for signs of infection of the ear canal or middle part of the ear – both common and relatively simple problems to diagnose and treat – is almost impossible without one. Locating and removing a foreign body can be very difficult. It is within the scope of most beginning medics to develop the skills to examine an ear. You have to look at lots of normal ears to recognize abnormal ones and once you have an otoscope you can start looking!
A simple one with a bright focused LED, powered by a AAA battery and a 100 disposable ear pieces will only set you back $20-30 USD. The fancy ones run to hundreds of dollars – but simple, functional ones can be found for relatively small amounts of money. North American Rescue make a “corpsman’s ENT kit” which contains all you need to examine the ear and eye – it’s a bit pricey but is potentially useful. (This similar one is available on Amazon.) But simply buying an otoscope and learning to examine ears is not rocket science and useful skill.
Glucometer
Glucometers allow you to check glucose levels.
Knowing a patient’s glucose level isn’t something that diabetics alone need to know – it is important to know a blood glucose level in anyone who is seriously ill, especially in children. Like several these devices they are not prohibitively expensive and in most areas, do not require a prescription. Because of the number of diabetics needing to check their blood sugars, they are common and easily available.
Go for a simple device – there are some very complicated computer linked glucometers out there on the market now and they are best avoided for our purposes.
On Call Express Blood Glucose Monitoring System
Blood Pressure Cuff
Blood pressure can be monitored with a manual cuff.
Automatic or partial automatic blood pressure cuffs are useful and relatively cheap and should form part of your medical kit when it expands beyond just first aid. However, they don’t last forever and from a technological point of view are hard to repair. A slightly older fashioned manual blood pressure cuff has the potential to be useful especially in a longer-term disaster.
They are still widely commercially available and run between $20 to $100. Manual cuffs do need to be occasionally calibrated and technically, that can be a bit of a challenge but is doable if you prepare in advance. Even if not perfectly calibrated, it will still provide consistent measurements.
Professional Manual Blood Pressure Cuff
Mercury Thermometer
Get an old-fashioned mercury thermometer for your kit.
These have largely gone due to the risk of the mercury in them, but they can still be found online and in some antique shops. Many can be found in old family first aid kits. If you can get hold of a few they are worth having. They don’t require batteries and are accurate. They can be put under the tongue and a couple of minutes later you have an accurate core temperature.
They are slim and made of glass so there is a risk of them breaking. But provided you are careful with them they can last (literally) a lifetime. Remember the rule of redundancy – one is none – you need to try and store a few of them.
American Scientific Tube Thermometer
Do you have the equipment on this list?
Are there any pieces of equipment you have or recommend that aren’t included in this list? Let us know if you agree or disagree with this list in the comments section.
About the Author
BCE is a Critical Care doctor who has 25 years’ experience in pre-hospital, remote and austere medicine. He has been a prepper/survivalist for even longer and pessimistically thinks a grid-down long-term collapse is not far away. He is passionate about improving medical knowledge within the prepper community and he is currently working on a book about truly primitive medicine and improvisation. He lives somewhere south of the equator on a Doomstead in a (hopefully) quiet isolated part of the world.
He helped write and edit the book “Survival and Austere Medicine” which is available for free download at https://www.ausprep.org/manuals and from a number of other sites and for purchase (at cost) from Lulu at http://www.lulu.com/shop/search.ep?contributorId=1550817
Questions, comments, and criticisms are welcome – post here and he will respond.
Speaking of BP Cuffs; Cabby had minor surgery on his ankle years back, and they used a BP Cuff, on my lower leg, to restrict the blood flow. In a post event world one could theoretically use a BP Cuff as a tourniquet, or restrictive band. But do know the difference before trying it out. ????
BP cuff (heavy duty, shock resistant), stethoscope, 2 glass mercury free thermometers (made by Gertherm), 2 livestock thermometers (rectal, guess they could be used on a human), and the usual assorted first aid supplies.
Got some stuff for livestock that I guess could be used on humans.
you’ll probably want a stethoscope to go along with that manual blood pressure cuff. be sure the ear pieces actually fit in your ears sufficient to block most room noise. a decent ‘scope comes with extra ear pieces or you can buy a diff size for a few dollars.
you might even want an alternate cuff. these things are not one-size-fits-all. if your cuff fits large adults, you won’t get any accuracy on a kid. but the wrap part itself is replaceable with other size cuffs. you can use an adult cuff on a kid’s thigh and check the pulse behind the knee. not as accurate, but maybe adequate.
My PA would always insist that the bare minimum of equipment was an Otoscope. He would use it for Ears, Eyes and throat exams. Close ups on splinters removal and laceration exams.
I’m surprised you can even still buy a mercury thermometer anymore after all of the “freaking out” from our *glorious* media.
Yes, we have one. Still works after 60+ years. I had it growing up.
I was pretty surprised when I found them on Amazon!
Not a fan of some of the stuff on your list. So I use my glucometer (if I have test strips and good batteries) and their blood glucose is high. Do I have insulin to give them to bring it down? Or, I use my defib to cardiovert a guy…now what? Do I have cardiac drugs to stabilize, a few dozen defib pads, and infinite electricity to recharge the device’s batteries for recurrent SVT/V-fib? Will I have oxygen to stabilize while I troubleshoot if the pulse ox reading is low? My concern is the initial treatment and follow-on care. Will any of the electronic devices survive an EMP? My Faraday is already packed with high priority electronics (comm gear, solar equip and spares, testing meters, etc). Am I going to hump them in my bug-out-bag? Sorry…just can’t see spending money on high end electronic medical gear. BP cuff and stethoscope, thermometer, and even the otoscope…great. But even then, “they” have to know how to use them, what the readings mean, and have a method of corrective care. Most people can’t do basic ABC stabilization or CPR. Better to spend the money on clotting bandages, fish ABX, and some good survival med books. My thoughts.
Understood but don’t fully agree. So if blood stopper and tourniquets etc are used, exactly what is available to clean and close wounds, provide drainage, create sterile fields, irrigate etc??
I have the listed items above plus but realize even the pulse ox is a late sign for perfusion, is ineffective in the cold and worthless with carbon monoxide on board. I have added incentive spirometers, loads of homecare supplies and equipment to prayerfully keep folks going while they heal. Sadly with all gear, current meds, hospitals etc folks pass away daily from trauma and illness. In my opinion not nearly enough time, money and training has been invested by our community in the medical side of prepping. Be safe!!
Sparky — I concur… there are a LOT of things that would be nice to have IF everything else is covered already…. exp, I would like to have a fully stocked and staffed ER, OR and ICU on site — a hydroelectric plant on site would be great too….. on the other hand there IS a good case for most of the stuff in the article….
True enough. But I did prefix my comments with things to consider after you have you basic medical gear squared away and that some knowledge is required – completely agree with your second to last sentence….. this is the next step……
Low glucose is just as important as high glucose to recognise and treat – agree high blood sugars due to diabetes limited options – but hypoglycaemia is a common problem in the third world and disaster situations – and they are the best analogy (IMO) of SHTF medical care.
This carries on with an AED – aspirin and an AED can bring down the death rates considerable if you have an heart attack / MI – obviously they are not perfect in isolation – but with both arrhythmias and cardiac arrest in an Austere situation they can substantially lengthen life. Other drugs are nice – but as a definitive treatment for many situations they can stand alone – it might be suboptimal – but still life saving and prolonging. Batteries always an issue – but short to medium term are manageable – long term all bets are off.
All the pulse ox tells us is the effectiveness of breathing and while we get used to having oxygen available if low – that is a luxury for much of the world and knowing a patients SpO2 is still useful in its absence.
The three things I always take of this list we when working in Austere situations are pulse Ox, otoscope and several thermometers.
Explanation relevant. Especially the part about filling the basic equip/supply inventory first. Sorry if I came across blunt…bad habit; retired military. However, in response, I can do much of the same with a simple assessment. If in austere conditions and the “victim” has no hx of diabetes, I can assume hypoglycemia and treat. If they improve, follow up with some carbs for prolonged release. If not, at least I know what I’m dealing with (assume no insulin available). Or I can treat chest pain with ASA sublingual if no concurrent sx or hx of stroke or internal bleeding (pulse, B/P, pupils, one sided weakness, trauma hx, etc). More people will die from ingesting bad water, poor hygiene, communicable disease transmission, and trauma than anything else. That’s where I’ve focused my medical emphasis at this point. Field expedient ABC, trauma treatment, and hygiene/infection control/waste management/vector control. We’re all guessing (intelligently I hope) at this point. That’s why it’s important to have these avenues for discussion. No one knows everything; I learn something new with each article. Who knows, I may be the one having the heart attack swinging an ax splitting firewood (or other tasks requiring maximal exertion)…not something I do every day. Thanks for the reply.
Have to agree with Sparky here. The AED is nice, put I seriously doubt your going to stock the supplies or the TRAINING to provide follow up care.
Part of CPR is providing ventilations, none of that equipment is mentioned, again training for proper use needed.
Let’s say you successfully use an AED post SHTF, are you prepared to care for the likely outcome of a permanently comatose patient ?
“Sparky,” your thoughts aren’t worth the electrons which were inconvenienced by displaying your thoughts to me. IF you had offered useful, practical alternatives, your thoughts might have risen to the level of worthy of electron inconvenience.
Air way nasal and oral ventilation bag neck braces far more important and likely to use. Stethoscope don’t cheap out same with BP cuff.
O2 sensors have a pulse monitor get one with both but know how to check without.
Ankle, knee, wrist and thumb braces in various sizes.. Crutches. All of the above can frequently be found in thrift stores for pennies on the dollar. Spoon handle makes a great substitute for a tongue depressor when examining throats and or tonsils.
Excellent additions, “me.” Thank you for your contributions. I would add, a colloidal/ionic silver generation device and at least an ounce of pure silver (this is actually doable for less than $50) – which serves as a competent substitute for antibiotics on most situations – and a couple of chiropractic devices: a “Neck-Pro,” which can alleviate cervical spinal compressions; and a lumbar back support belt, which can relieve and support healing of lower back injuries.
A blood pressure cuff without a stethoscope is pretty much worthless.
Sorry – as always paired together – didn’t specifically mention – should have been clearer!!!.
However in reference to your comment – far from being worthless without a stethoscope – you can always determine the systolic blood pressure with the cuff alone and taking the patients radial pulse – still a useful trick!!
Never heard it called “advisory.” Automatic External Defibrillator.
I think it simply hinges on what continent you live in. Automatic is predominately North American. Advisory is more English. The published literature uses both interchangeably. BCE
Interesting article as always, but I would appreciate hearing more about low tech alternatives that will continue working without power in case of a total grid down situation. Also, I read about someone testing their blood glucose using something like a litmus paper. Would that be useful to know in a shtf situation? And what do you need to do a test like that? Thanks!
DMSO might be a good thing to add to your emergency medical supplies. You mix it with other needed medications that you might need to penetrate the skin better. Got mine in the Horse department at Tractor Supply.
I have had Scabies TWICE now and it is AWFUL, and you need to stop the mites eating you up ASAP! Permethrin cream externally and IVERMECTIN internally are normally needed to kill them. In SHTF you can’t just run to the drug store any old time, and they might not have them on hand even in normal times.
I can’t stress enough how important it is to diagnose Scabies quickly and start treating it. I am going to try and get some Permethrin powder (if Possible) and would mix it with DMSO if needed in SHTF. I also have some Horse Ivermectin for SHTF use only.
I am hypothesizing that I might be able to mix Tea Tree Oil with some DMSO and get it to penetrate better. Tea Tree Oil will not penetrate the skin itself to the depth where the Scabies Mites are eating you alive. And they itch badly so have some Xylocaine cream and Hydrocortisone cream ready to go to. You can also get Permethrin spray to treat your shoes and other surfaces. It says not to use it on yourself and is poisonous to pets but the percentage in it is quite a bit less than the 5% Permethrin cream. You need to get your pets out of the area and open the windows when you spray to clear out any areosols and promote rapid drying.
FWIW you can use the Permethrin spray against Bedbugs, and it is also used (in low percentages) against head lice.
My Scabies attacks always begin on the feet or ankles and I strongly suspect that my dogs or cat bring them in so need to stop running around barefoot in the house.
I caught scabies from an illegal. She was a cashier at the local grocery. After I reported my experience to the health department, they started tracking. You never know what experience will befall you. I went to my local dermatologist and got a cream that I used one week-head to feet. Then 7 days later the same procedure. It was cured fast. If you suspect your dogs or cats are infected, then get them to a vet. My dogs are groomed every 30 days, as a clean pet is a healthy pet. Especially for the owner!
I strongly recommend a pair of tweezers with a micro end… Essential for taking care of potential eye issues.
http://shopping.roboz.com/micro-scissors-micro-forceps-groups/micro-dissecting-forceps
This is the style I refer to.
With regards to glucose related stuff… [Relevant experience: Misdiagnosed Type 2 for two years, nearly died from DKA. Finally correctly Diagnosed Type 1 (LADA) after hospitalization and near death, insulin dependent.]
First off, let’s get some things out of the way about the testing units themselves.
1) A glucometer like this is accurate to about +/-10%. It’s not flawlessly accurate.
2) You need to know the range on it. They vary. Some will read “LO” below certain numbers like 40mg/dl or “HI” above certain numbers like 500. Others will have a larger range.
3) Test strips need to be rotated in your supplies. They go bad over time or if the package is damaged in shipping.
4) Be aware that a bad test strip will give a false reading. If you have reason to think someone is at, say 200mg/dl and get a strip that says 550mg/dl, retest them a few times to see if one is an outlier from a bad strip. DO NOT just trust that one is correct. A bad strip can be off high or low by hundreds of points.
5) Learn to read these things if you’re going to bother getting on. <70 is hypoglycemic. 140 is hyperglycemic IF, and I stress IF, the person is healthy, uninjured and fasting. If they’ve eaten anything recently they could be well in excess of 140. Contrary to popular belief a carb heavy meal will spike a non-diabetic sometimes into the 200’s depending on what they ate. Diseases spike everyone’s blood sugar, as do injuries. A healthy, normal person should be between 70 and 130 six to eight hours after eating.
6) Be aware that lancets punch holes in your hands/where ever you test. This can lead to infection, especially in someone chronically high on glucose from not managing their diabetes correctly because they could have poor circulation.
OK, with that out of the way.
There are a few things to consider here.
First, the testing even when working correctly isn’t particularly useful in most cases unless 1) the person is a diabetic and 2) has some clue what they’re doing. Realistically only an endocrinologist or someone who’s a diabetic will know what this reading means for their own personal physiology. A non-diabetic who’s <40mg/dl has really serious issues that eating some sugar isn't going to fix. They're septic, have internal bleeding etc. Do not trust a GP about this. They don't know very much about diabetes. So little in fact that a whole team of them darn near killed me with their shenanigans.
Secondly, if you have someone who's a diabetic things are tricky. Hopefully they know what's going on and have the appropriate medications.
A Type 2 diabetic will usually take an oral medication such as Metformin. Combined with proper diet and exercise they'll be fine. In a SHTF situation I wouldn't be super concerned about their glucose levels because no matter what they eat they'll probably be working their rear off. Realistically the worry here is hypoglycemia from harder work than they're used to combined with the anti-diabetic drug they take. Correct this with SUGAR. Not a candy bar, it has too much fat and will not be adsorbed fast enough. A soda, sugar, glucose tabs or a candy of straight up sugar like Skittles or Jelly Beans is the way to go.
Now, let's be real here for a second. A Type 2 is a fat person. Period. That's how Type 2 works. They're too large for their pancreas to handle. Diet and exercise bringing that weight down will eventually bring them back to pre-diabetes glucose levels. Unless they've been a Type 2 for a long time, haven't listened much and have damaged their pancreas by overworking it for too long. That person is insulin dependent. Without insulin they're probably screwed. Short of that however, they'll become normal as they get to a healthy weight. Keep in mind that T2 can show up in people who are as little as 20lbs overweight so they may really need to get it "right" before their glucose levels return to pre-diabetes levels for a long period of time.
A Type 1 is insulin dependent. Their pancreas is shot. Without insulin they will go into DKA and die. It's that simple. If they don't know their insulin dosages you have a serious problem because you're going to have to guess for them. Too much will cause problems, too little will cause problems. Short term, lows are extremely dangerous. Long term highs cause damage. If you have such a person and have to figure out their dosages you need to test them regularly and experiment with how much insulin tends to do what. This person, without knowledge on their own, is a drag. They're time consuming to deal with and when they go hypo they may become disoriented, confused and potentially violent until their blood sugar comes back up. Or, without sugar, depending on how far they overdid the insulin they may pass out and die.
There are test strips that test urine and require no batteries. They're cheap. They are however not a great choice for two reasons. First, they'll only register a reading in wide bands. They really don't give you better than a 150mg/dl ballpark of what's going on. Secondly, the amount of time that it takes for glucose to enter the urine is about four hours so really that strip isn't very accurate and it's telling you what was going on four hours ago rather than right now.
All that said, the strips are better than nothing and as long as the person doesn't have "brittle" diabetes test strips should keep them fairly safe for quite a long time provided the meds are on hand to correct for highs and food is available for lows. If they really are experienced these problems should be minimal anyway.
Realistically the bottom line is this: If someone's insulin dependent and has a good stash of insulin that they know how to use as well as a glucometer with extra batteries and plenty of strips (or sensors and the ability to recharge a hand scanner unit) then they're going to be fine in the short to medium term. However, be aware that insulin, unopened and refrigerated will last for a couple of years and probably longer than that expiration date. However, once it's opened it's only good for 28-30 days according to the package and realistically will suffer serious loss of potency after about 35 days.
This has a couple implications that I won't bother with but I will say this: unless/until the FDA approves the oral insulin pills currently being tested this person, if they've been stockpiling, has six months to a year to get to better medical care/electricity/supplies. After that, they're pretty well boned because even if they have a ton of unopened insulin without it being kept cold, much of it will be useless after that time frame. Insulin is expensive to the point that stockpiling it is hard to do. Insurance won't pay for extras and this stuff is very, very pricey because of all the T2's saying "give me the insulin" rather than putting in the work to get healthy. A trip down Mexico way may be in your future to stock up on insulin so that your regular Rx can be rotated like food on your shelves should be.
With regards to a diabetic in your group or family unit: Until they run out of meds, they're potentially a valuable member of your group and if you can get them more meds they can continue to be that.
Here's the really bad news:
Under certain circumstances you may have to make a terrible decision as to what you value more: Their continued participation in helping your group or, quite frankly, the lives of other people outside your group.
No other insulin dependent diabetic is going to willingly give you their insulin because DKA is a TERRIBLE way to die (ask me how I know). You're most likely going to have to kill them and take it or find another source which can be stolen. The realistic chances you can make this in the field from pigs is virtually nil. At a certain point it will become a situation where you watch a friend/loved one/useful companion die slowly and horribly, kill them yourself or kill others to keep your pal alive. Nature is a cruel mistress and this is how it is. If you can't hack that idea, well, hopefully you don't know a diabetic because if SHTF and you have one in your friends or family this decision is coming eventually. Welcome back to the "state of nature".
Also, be aware that they themselves may become irrational if they enter DKA and knowing what's coming they may go off on their own to find more medication. I know I would because I know what DKA is like and I know what being told "We don't know how your alive" feels physically. One way or another I'm not going back to that place and I highly doubt any other T1 would willingly do so either.
If they're already in DKA they may be low on electrolytes, not thinking straight and desperate. This could make them extremely violent towards people they don't know. I would rate it as extremely unlikely that they'd hurt someone they knew and liked but… a stranger gets between them and a vial or pen of insulin and I wouldn't be shocked if the person would literally be willing to rip throats out with their teeth to get at that insulin.
One piece not mentioned is an oxygen concentrator. Obviously it runs on electricity, and for backup might need an alternate power source. If a person’s oxygen saturation is dropping the idea is to get it back up into the 90s.02 concentrators are simple technology that don’t cost too much. In an emergency they might make the difference between someone making it and not making it.