Medical planning and training is a huge subject among preppers, and with good reason. In a large-scale disaster or worst case scenario, medical treatment may be impossible to access. Preppers, as a group, know more than the average person, but there is one area that very few preppers even seem to notice: Homecare Nursing.
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My Experience with Homecare Nursing
I am a Licensed Practical Nurse, EMT, Wilderness EMT, phlebotomist, and CPR/ First Aid instructor. I also instruct disaster medicine with a well known firm and am currently working on my RN. In addition to all that, I work full-time and have done this over the last several years. In addition to this training, I have had the opportunity to care for two relatives on hospice.
I have noticed that many preppers want to know how to suture a wound or remove “the bullet” or some other “glamorous” task. But the more training I receive and practice in the field, the more I realize how much I do not know, in spite of all my training and experience. That concept really scares me but it’s a healthy fear. Preppers will benefit from that realization as well.
The first steps are to learn the basics and have the proper supplies ready. Then, take the next step to learn how to suture a wound or remove a bullet.
The Most Neglected Medical Training
The most ignored area in medical training that I have seen in survival circles is homecare nursing. Per longtermcare.gov, a person age 65 has a roughly 70% chance of needing some type of long-term care services and supports before they die. However, it’s not just the elderly who may require homecare nursing. Anyone with special needs may also require more specialized care.
So while it may be a boring subject, but it’s an absolute necessity to keep your patient alive and viable.
It saddens me when I deal with a person (young or older) who has contractures, bed sores, develops pneumonia, or just fights to maintain some level of independence because no one in their life provides basic homecare nursing skills.
A Basic Overview of the Homecare Nursing Skill Set
Good basic patient care can be learned and mastered by becoming a CNA (Certified Nursing Assistant). The job of CNAs is to take temperatures and blood pressures, give bed baths, turn, and feed patients. They help monitor for bed sores, pressure areas, changing incontinent patients, and providing basic necessary care. It may not have the glamour or prestige of removing a bullet, but basic patient care is actually more necessary.
Bed Sores
Not everyone understands that a person cannot lie in bed for hours, days, or even weeks without someone really involved in their care. An immobile patient must be turned and checked every two hours. If you turn them and see a red mark on their side, butt, or back, you are probably looking at a bedsore very soon. Bedsores can kill patients!! I have seen Stage 4 pressure ulcers that go to the bone. Do not let that happen. Patients need to be clean, dry and intact – always!
Daily Exercise
Bed-bound patients need to be exercised daily to help prevent contractures, a shortening or distortion of muscle or connective tissue. Contractures ultimately have the patient going into a fetal position. In nursing school we have worked with patients that required four adults to just change them and get them out of bed.
Very, very sad.
This exercise involves having the patient move all their joints through their full range of motion. One or more caregivers may have to help with this. Start with the head by going side to side and rotations, move to the neck, shoulders, arms, fingers, knees and toes.
Pneumonia
I also use incentive spirometers for lung exercises, which can help prevent pneumonia. If that is not available, try chest physiotherapy. Try cupping your hands and have the patients on their side. Use your cupped hands and tap on the patients back to loosen anything in the lungs. Be care to not use too much pressure but tap several times a day.
Homecare Nursing Supplies
- Gloves – No latex. I prefer Nitrile for durability (available at Costco). It is impossible to have too many. I personally have 10 –12 cases. Each case has 10 boxes of 100 gloves. (Latex allergies are fairly common; there are nitrile allergies but they are far more unusual.)
- Bed pan
- Urinal – Male and female.
- Wash basin
- Emesis basin
- Bed pads for incontinence – Reusable or disposable. The reusables are strong and can be used to help turn/ reposition your patient
- Incontinence briefs (diapers) and pull-ups
- Baby wipes – You can never have enough.
- Thicken – Makes liquids thick for people with swallowing difficulties.
- Nosey cups – Plastic cups with the nose section cut out to help with liquids for patients with limited mobility
- Incentive spirometers – Lung exercisers.
- Walkers
- Crutches
- Cane – Carbon Fiber is far lighter than other options.
- Bedside commode
- Gait belt – Assistive belt to help a patient ambulate.
- Thermometer
- Oximeter – Necessary to keep track of blood oxygen level
- Blood pressure cuff and stethoscope
- Manual wheelchair
- Hand Cleaner
- Clorox and sprayer
- Bed with hand cranks – I designed a “raised platform bed” for homecare nursing because I could not justify a hospital bed with hand cranks. The raised bed allows me to care for the patient without killing my back.
Sourcing Supplies
Other than your typical medical supplies store, you may be able to find some items second-hand.You’ll want to check them closely for quality and function. Ask to plug items in or for batteries to test them.
Final Thoughts About Home Care Nursing
This is just a starting point to help you begin to think about skills and supplies you may want to add to your repertoire. While it is far from complete it should give you an idea about needs for your patients. The American Red Cross may offer classes in your area to provide more training.
Remember, everyone in your family or group will need training and practice. Someday, the patient may be you, and these simple procedures may save a life, including your own. Also and most important, many of these tasks are not fun. Many are done for infants and young children without any thought. Please be kind and offer privacy and dignity to your patients. Treat them as you would want to be treated.
What homecare nursing items would you add to this list?
Guest post by Dave, LPN, EMT, WEMT. Originally published February 3, 2011 and updated.
Great post Lisa! This is a critical skill to learn for any type of emergency. Your list of items is great!
Excellent info! Really timely and well thought out. Appreciate your post!
This is a great article, but being medically prepared could go so much farther. As a Respiratory Therapist living in the interior of Alaska, I see on a daily basis the effects of not only being unprepared, but the devastating impact of smoking, alcohol abuse, etc, on one's ability to survive and thrive in an adverse environment. Knowledge is power! The more you know, the better you can adapt and survive, and aid those around you!
Dan, thanks for the comments. You are so right about being medically prepared. I know that Dave has two other articles planned on the topic, but if you would like to add information or provide an article yourself, that would be great. Such a relatively small percentage of our population has medical training, and yet in the future, that could become the greatest area of need.
Dan,
I agree with you on how much further medical preparedness can go. The "medical" topics are massive. I was trying to cover basics and start the wheels turning for everyone. I know as a Respiratory Therapist you see the long term effects of our poor lifestyles.
Take care and stay safe!
Dave, LPN,EMT, WEMT
Another person in your community who has extensive knowledge of human anatomy and physiology is your local funeral director. Many of the classes they are required to take are pre-med classes. As they are in the business of caring for families in times of severe distress, most are very compassionate people. They are also wayyyy past any 'gross' factor. They would be a good resource if medical personnel are in short supply for whatever reason.
That's quite good advice. I'm amazed by how much medical information is retained, even by people no longer in the medical field. My sister was an RN close to two decades ago, and still remembers so much of her training. Heck, I remember all the basics of First Aid from a class I took when I was in 7th grade!
I also remember all my first aide classes I took in Girl Scouts. That id’s one reason I became a Registered Nurse. I started as a CNA, then worked as LPN and RN in both the long term care unit and the acute care unit (hospital). Now I’m in the emergency department. I noticed that I did not get any first aide training in nursing school, though.
Great point. I would never have thought of them, but it makes a lot of sense. I'd also include a couple more obvious groups – pharmacists, physical therapists and chiropractors. While none are a replacement for an MD, all bring invaluable knowledge.
Outstanding post and information ~ thank you so much! I'd add extra bedding and towels, skin lotion, lots of plastic shopping-type bags for disposing of soiled items (bags with handles so they can be "tied"), room freshener spray & laundry detergent. This isn't from a medical background, only experience but I hope it can help someone.
Excellent article. This is something I have been worried about being unable to do. Your instruction laid it all out in simple, empathetic terms. Thank you so much for taking the time to share you knowledge. I am much more confident that I would be able to care for a bed-ridden loved one. Best of all that’s good to you.
Great Article Dave! As a full-time caregiver for a family member, I have to agree that a lot of people look past the mundane (and likely!) aspects of caregiving. So you suture a wound closed, or splint that broken leg… and then what? Leave you patient laying in the yard, or expect them to get up and be back to normal? Most injuries or illness that require that level of treatment are going to require significant follow up care, and many people are unprepared (in skills and supplies.) I think you did a great job of reminding people of that an encouraging preparedness for the most likely scenarios!
Thank you for the kind words Mrs S. It became very clear to me in doing homecare for family members what is necesary in time, skills and materials.
Your family member is very blessed to have you caring for them!
Keep up the good work!
Dave
You are right on target with respect to learning the basics. Too many posts I've seen cover emergent situations and not the recovery period afterward.
Something to think about along with this is entertainment for the patient. Attitude has a huge impact on our health and healing. If you are stuck being bedridden and your caretaker has others to take care of too you are going to get bored and possibly depressed pretty quickly. When I took care of my grandpa while my mom was at work toward the end of his life he was always happier when someone could take the time to sit with him and play cards or something.
Great article Dave. I hope you have your RN by now & stayed in Home Health.
I am always teaching “clean & dry” to new caregivers & that there is little difference between granny & baby except babies cry when wet or hungry.
I am always happy when people take responsibility for their own health as it is more important to them than anyone.
Great article! I worked in home health for many years and cared for my mom for three. The things I learned from that experience involved the importance of good nutrition and cleanliness. The long term care of any patient requires vigilance and prompt care of infections. I would suggest various sizes of bandages and wound care supplies, not for the gunshots, etc, but for skin breakdowns, falls, burns and other day- to- day accidents that can become serious or deadly in an aged person, child, or those with chronic illnesses. There are a number of common products like vinegar that are excellent for antiseptic purposes. A study of wound care and herbal medicine would also be helpful in survival situations. Most wounds do not require suturing, but they do require daily cleaning and care to promote healing and prevent infection.
Just a suggestion. This would be a good topic for the Alton’s next book along the lines of their “Alton’s Antibiotics and Infectious Diseases” and similar one topic books.
Great idea! I’ll pass that along to him.
about that wound suturing–you shouldn’t do it unless you absolutely know the wound is clean. which it probably isn’t. a sutured wound that isn’t clean will soon be full of pus soup. you and your patient won’t want to deal with that. keeping a wound clean until it can heal without suturing is hard to do, so plan on lots of wound cleansing and bandaging supplies.
and if you do decide suturing is the best plan, consider butterfly tapes or steri strips instead. takes much less skill for the practicioner, is less painful for the patient, works very well for shallower wounds, and is readily available. folks wanting to learn basic emergency/disaster care can also consider the free CERT classes many communities give. that’s Citizens Emergency Response Training. there are many classes on natural disasters, medical emergencies, pandemic responses, triage, search and rescue, etc.
I agree completely. There’s a lot more to suturing than just having a needle and thread.
Ever notice how EVERY movie or TV program has the “wounded” person up and about and in the fight shortly thereafter. I suspect most folks take it for granted that we all heal quickly and get back to ‘normal’ UNTIL we don’t. Especially the elderly, they don’t heal quickly like they did when in their twenties and thirties. Thanks for the mindset of reality in this article.