Worst case scenario medical care

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Reader Maureen F. emailed to me an excellent list of observations made by a medical doctor, Michael Karch, M.D., who treated victims of the 9/11 attack in New York City. He wrote a lengthy article that you can read here. This particular comment is rather chilling:

“To get to Ground Zero, one has to walk thru a maze of 6-12 inch ash, paper, twisted iron, mud, junk, rubble….it looked like a tornado had hit the city.”

Just in case you want to be prepared for another tornado, the upcoming hurricane season, or just generally prepared, here are a few of his suggestions for providing medical care immediately following a worst-case scenario. Some suggestions are specific to medical personnel but many are relevant to us all.

General tips

Everyone, even those with no experience, can help in a disaster. These are the first, most basic steps that everyone should take to stay safe and be a real help. If you show up totally unprepared, you can actually make things worse by becoming another victim. Make sure you at least have these basics covered.

  1. Get to the site as soon as possible. In the case of 9/11, many of the rescue leadership (Fireman chiefs, higher level cops) were either taken out immediately or busy (physicians, nurses, techs) at local overwhelmed hospitals. Think about it, if the Pentagon and White House had been taken out as planned, all central leadership would have been out. Recovery and/or retaliation requires organization to be effective.  When I got there, there was mass chaos and a systematic medical infrastructure complete with an understanding of triage as well as a communication system of runners had to be made.
  2. Wear boots and durable paramedic type pants with multiple pockets, not scrubs which provide no warmth and are for all intents and purposes useless.
  3. A helmet, gas mask with filters, and goggles are a must. Asbestos levels are considered high at 1.25. They were measured at 5.2 at Ground Zero 48 hours after the fact and at 1.75 at the Stuyvesant High School “hospital” 72 hours after the fact. Without goggles, the dust was blinding. Eye washing consumed 75% of our effort. I had my eyes washed out 6 times and I never took my goggles off.
  4. Take a large backpack so that supplies can be shuttled to the front zone.
  5. Take water and a filtration system. (See above re: air quality. That dust will be in the water, too.)
  6. Take food, canned, MRE, bars, etc. Even if there does happen to be some available (don’t count on it), that doesn’t mean you can stop what you are doing to go eat when you need to.
  7. Headlamps. There is no power and it is impossible to sew in the dark much less get anywhere without a light. Extra batteries.
  8. Raingear, raingear, raingear. Even if it doesn’t rain, the fire hoses drench everything.
  9. Extra socks. In fact, pack all your extra clothes in large zip lock bags to keep them dry. (See above re: fire hoses.) Wool is your friend.

Medical care basics

  1. Fractures are common with ankle fractures being the most common. Take plaster with you to a MASH unit.
  2. Nylon suture is needed for small lacerations to get these men back on the field working.
  3. Silvadene is a must as is betadine.
  4. We used literally cases of B&L saline contact eye solution to wash out glass, fiberglass, and dust from eyes.
  5. Most injuries are extremity related, so roll type dressings (Kerlex) actually work much better than 4×4 with tape, for example. These dressings also fall off more easily with sweat.
  6. Headlamps – remember there is no power and it is impossible to sew in the dark much less get anywhere in the dark without a light. Extra batteries.
  7. Raingear, raingear, raingear…even if it doesn’t rain, the fire hoses drench everything.
  8. Extra socks. In fact, all extra clothes packed in large zip lock bags to keep dry.
  9. Anything can be made with duct tape, knife, pliers, and clothes hanger wire.
  10. A large black marker for making signs.

Read his entire list and the article in full here.

Originally published May 24, 2011

9 thoughts on “Worst case scenario medical care”

  1. What is silvadene?

    I have sterile eye wash and rewetting drops that are past their use by date that I have kept to wash out wounds in an emergency situation. I'm not sure exactly how bad it can go, but I can see a lot of situtions in which it would be a lot more sterile than anything else readily available.

    Thank you for this advice. It's always great to have realistic, experience-based advice.

    1. Silvadene is a topical anti-biotic used previously in burn care victims. Now used widely in wound care for many years. Very effective against skin flora (staph). Obtained by perscription. Betadine, however, is over the counter and can be used in many of the same circumstances. Also available in large quantities…….

  2. I work for a FD and I always take our "outdated" items that can still be used in an emergency…I dont take meds but sealed sterile water, airway items and bandages…Always a good thing to have just in case….

  3. Look up USNERDOC on youtube. He has a bunch of good medical advice about preparing for emergencies and such.

  4. Also watch the videos from The Patriot Nurse. She's very to-the-point with info you won't hear from traditional sources.

  5. For hemorrhagic wounds, consider Celox powder or Celox-impregnated gauze. It has ingredients that encourage clotting and are much more effective than simple kerlix dressings.

    Dr. Bones

  6. I have QuickClot in each of our car emergency bags and the ones I gave my nieces for Christmas in case of a bad car accident. They are small versions, but far better than nothing. I have told people about these quite a few times and their response is always, in short, that they didn't know they existed and they are interested in buying them for their own car kits. I doubt they do buy them because most people don't even have a car kit, but they definitely don't think I'm daft for having it when I explain the logic, and maybe one or two people will buy them and it will help someone some day. It's not cheap, but it's worth the money to potentially save a life.

    My prom date died when he had a motorcycle accident at night and he bled to death before he was found and my first boyfriend could have, but it was broad daylight and medical care got to him quickly. (Yes, I have major issues with motorcycles as a result.) But I definitely agree that people should have it. One thing I learned: there is an older and a newer version. The older version tends to feel like your skin is burning and newer ones don't.

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