As many complicated things do, it started with a simple question. What should I have in my medical kit? Well yes……….But what if?..............Is it enough? And so on.

Final “challenge”: Medical supplies for 10 people for 2 years.
Assumptions: 4 couples ages 18-30, 1 couple over 55
No preexisting health issues
No medical training beyond CPR and 1st aid
Little or no chance of resupply
Little or no chance of outside medical or surgical care


The following is my initial try at this request. Your input is appreciated. Most of the quantities were derived by WAG theory (wild assed guess), so input here especially sought.

If this seems too TEOTWAWKI, I apologize in advance.
Marty: if this belongs elsewhere – please move it.




Medical Supplies – 10 people for 2 years



Drug DOSE(usual regimen) Stock available

Allergy:
Diphenhydramine 25mg (1 or 2 PO q 4-6 hours) 100 x 3
EpiPen 4
Methylprednisilone Dose-Pak 2


Antibiotics:
Cephalexin 500mg Tabs (QID x 7-14 days) 100 x 2
Ciprofloxacin 500mg Tabs(BID x 3-14 days) 500 x 1
Doxycycline 100 mg Tabs (1 BID 7-21 days) 100 x 2
Levofloxacin 500 mg Tabs (QD x 5-28 days) 100 x 2
Metronidazole 500 mg Tabs (1 BID 7-14 days) 100 x 1

GI:
Bismuth subsulfate 130mg Tabs (2 q 1 hour – max 32/day) 500 x 2
Bonine or Dramamine
Glycerin suppositories
Loperamide 2mg Tabs (Max 16/day) 100 x 1
Metamucil or Citrucel
Promethazine suppositories 12.5 mg ( 1-2 q8-12 hours)
Ranitidine 150mg Tabs (1 BID indefinitely) 100 x 1


Hygiene:
Birth control pills (1 pkg/female/month) 96 pkgs
Clotrimazole 200mg vaginal suppositories
feminine sanitary napkins
Soap (2 bars / month) 48
Shampoo (1 Qt/2mo) 3 gal
Toilet paper (1 roll/person/week) 1000
Waterless Hand Cleanser (1 Qt/ 2mo) 3 gal

Ocular:
Eye Pads
Eyewash
Flourescein eye stain
Blue light (for use with flouriscein stain)
Diclofenac solution 0.1%( 1 drop QID up to 5 days)
Gentamicin oint. 0.3% (1/2” oint. TID x 5 days)
0.5% Moxifloxin drops (1 drop TID x 10 days) 2 bottles
Patanol (1 drop BID up to 6 weeks) 4 bottles
1% prednisilon acetate drops (1 drop TID x 10 days) 2 bottles
Prescription and Reading glasses (spare)
Sun glasses (spare)

Oral/Dental:
Cavit G 40gm x 2
Dental First Aid Kit (www.dentalkitfortravelers.com) 2
Dental mirror 5
Toothbrushes (3/person/year) 60
Toothpaste


Pain and Inflammation:
Acetaminophen 500mg Tabs 100 x 1
ASA 325 mg 1000 x 1
Codiene 30mg.Tabs (1-2 PO q4-6 hours) 100 x 2
Ibuprofen 800mg. Tabs 100 x 10
Oxycodone 10mg Tabs 50 x 1


Topical:
Blist-O-Ban
Clotrimazole 1% cream
Gold Bond Powder
1% Hydrocortisone Ointment
Moleskin
Sun Screen

Wound Care:
Adhesive tape – 1”
antibiotic ointment
band-aid bandages
bandages-knuckles and fingertips
butterfly bandages
Kling roller gauze
4x4 gauze
non-adherant dressing
Povidone Iodine 10% solution
Spenco 2nd Skin
Sterile Saline
"super glue"

Misc:
Elastic roller bandage – 4” 12
Gloves – nitrile
Gloves - Sterile
Kendrick Traction Device (KTD) 1
SAM splints - XL 2
SAM splints – Standard 2
SAM Splints – Finger 2
Thermometer – oral 6
Saline Nasal Spray
Trauma Shears
Multi-vitamins (1/person/day) 7500

References:
National Center for Complementary and Alternative Medicine
Merck Manual
Where Women Have No Doctor
Where There Is No Dentist
Where There Is No Doctor
Wilderness Medical Care
WMS Flashcards




Surgical Kit:
Mayo or Small Standard Needle Holder 1
Mosquito Curved Hemostat 1
Iris Scissors or Small Surgical Scissors 1
Tissue Forceps with teeth 1
Disposable Razor 1
#10 Disposable Scalpel 10
#11 Disposable Scalpel 10
Suture 3-Pack 3-0 Silk or Nylon w/ Curved Cutting Needle 10
Surgical Staple Gun (optional) 5
1% Lidocaine Hydrochloride Injection USP with preservative
Needles, variety pack including
ten 18ga x 1.5, ten 22ga x 1.5, ten 25ga x 1.5, and ten 27ga x 1.5
5 cc plastic syringes 20





Thanks in advance. Let the stones and opinions fly!

Intriguing....My first reaction is that for a group that size for that length of time, someone (or two) should get training beyond First Aid. Where will they will be living? The kit should probably reflect special demands imposed by the environment. I think I would want to consult with a physician with specific knowledge of the individuals involved, e.g., how many might require appendectomies or something similar during the ensuing two years of isolation? Any chance for phone/radio consultations?

Make friends with a local ER doc and his DW; invite them to join your group; when SHTF he can raid the ER stash before joining you.

If you have the staples, have the staple remover.

Maybe add clindamycin? You know sometimes they double dose with metronidazole, or if docs are worried about toxin production.

I would double, or triple, the 4" roller gauze. Add maybe 12-24 2" or 3" too, b/c the 4" is sometimes too much.

More tape - it goes fast (ask a nurse)

Doculax?

Albuterol MDI?

WHO oral rehydration salts? Missouri doesn't exactly have nice dry summer-time temps.

Interesting thought on the Traction splint. You plan on leaving a person in that for 6-12 weeks? Maybe some sort of splinting supplies for stabilization, not just traction. Plus, lots of EMS and fire dept's will put a cardboard splint around a traction splint anyway.

OB kit.

1 or 2 packs of bloodstopper product (Celox, etc).

1 Asherman chest seal

First up, right off the bat, that means no antibiotics. They are very specific as to what responds to them, they are expensive, and many of them get scary if they go south. And nothing injectable. If you think you are going to stitch with a book propped up on their leg, torture some oranges now.

In fact, nothing Rx. All your meds should be OTC, simply because most OTCs have a MUCH longer shelf life than the legal department at the manufacturer says they do. It also means you can get them easily, without raising too many eyebrows.

And if you ask for three years off the pill, I want to know your physician and pharmacist's reactions.

I'm just going to brain storm here:
LOTS of dressing materials, sterile. Splinting materials. Home birth supplies. Iodine, rubbing alchohol and saline. Rehydration salts, or just baking soda, lite-salt (mix of magnesium and sodium clorides) and some sugar. A good anti-fungal, both for atheletes foot and jock itch. Talcum powder. Cough suppresents and anti-allergy meds. Toenail clippers. Lice shampoo. Razors and hairbrushes and combs. A good mulitvitamin and sprouting jars to get you fresh greens (yes, I consider this to be medical).

I agree with Ironraven, you want more of the stuff that everyone can use. How many bandaids do you go through per day with a little cut while you're working in the yard or keep getting your hands wet? LOTS, if you're anything like me.

Yes, antibiotics aren't one-kind-for-everything. If you want to have something that is general-purpose and has a long shelf live under most conditions, talk to your doctor and explain what you're trying to do. Emphasize that this is for a Haiti-like situation, you're not just trying to self-medicate.

Sue

Just my .02

I agree with everything said so far. Just an FYI: for example Minocyline can be toxic if out dated. If I was going to ask for antibiotics from a Dr., I would ask for very stable gram + and Gram - antibiotics - such as amoxicylin. Not the best for everything but great for a lot of things. It is all a trade off. One thing is going to be a reality: the longivity of human life span will decrease without the chemical and technical advancement of our current medical treatment.

If I was to go as far as you are going with the long term medical supplies - I would stock up on the following:

More advance knowledge. The more you know the more you can do
Knowledge of herbs and homeopathic treatments and what is available in your area.
I would also get (and this is from way out in left field) some casting supplies. You break a bone even in todays world and you need a cast. Not having the ability to set a bone correctly in post TEOTWAWKI would almost be a death sentence.

I have been doing some thinking on this as well and I have been trying to get my supplies in order:

This is my last purchace: http://www.medstarsutures.com/servlet/the-MEDICAL-SUPPLIES-cln-Skin-Stapler/Categories

I have no offiliation (?spelling) other then researched the best price for the product offered.

I also found a casting kit for a reasonable price but I cannot find the link. I will have to post it later when I find it again.

Perhaps this would be more useful in long term/TEOTWAWKI and worthy of its own thread? Has it been done already? There are a few threads already on medicinal herbs. How about a thread that combines herbal remedies and other home remedies. I believe there are also several books on home remedies that would warrant inclusion in a survival library.

I have a tough time imagining a situation where two years of medical supplies wouldn't be either too much or too little. Any disaster that eliminates outside medical care for two years seems likely to last quite a bit longer than that.

For this reason, it may make more sense to get a couple months worth of medical supplies and otherwise concentrate on training. Maybe you could look at an Outdoor Emergency Care or Wilderness First Responder course. They may be better-suited for longer-term care with limited resources than an EMT-B course, which assumes you have a working healthcare system to back you up.

It may be worth looking into herbal remedies, which frequently have an active ingredient that has been tested for efficacy. You do need to be careful though, since "The dose makes the poison." Homeopathic remedies, on the other hand, have consistently failed to show any effect beyond placebo in well-structured clinical trials.

I like the idea that you are stocking up like this though probably for different reasons than you. The Haiti earthquake showed how quickly medical supplies can be used up. It seems you are located well within the New Madrid fault zone which, when it goes will dwarf what is going on in Haiti.

Remember, there's no such thing as too much gauze.

-Blast's $0.02

I was actually trying to reinforce the fact that there is no substitute for knowledge. Unless you have a hospital with all the supplies, staff and the ability – there is no way to plan for every contingency. However if you have a more then basic knowledge and are able to adapt and improvise for various situations, the odds of surviving are dramatically increased. Homeopathic may not have proven much better then a placebo – but doing something has been proven much more effective then doing nothing. If a person is dying and a prayer is said and that person believes that it will make them better, then by its very nature it was better then not saying a prayer.

I have had the opportunity to be an EMT and an RN in very rural America. Am I an expert? No – not even close. But I would bet that most of the experts would agree that any and all knowledge accumulated would probably be of more benefit the all of the stock piles of supplies and not know what to do with it.

In this scenario, I would have to say the intention was very good, but was destined to fail when following up with or in unison with further learning then just the basics of first aid and CPR.

I am not trying to be a nay sayer or act like an elitist but before I added my comment about casting material, I should have stopped at learn more… and for that I apologize.

IIRC, the OP IS a doctor...

At this point this is just a mental exercise.
Actually advanced training was part of the discussion.

Avg lifetime incidence of appendicitis is ~7% (male 8.6%, female 6.7%) peak incidence ages 10- 30.
Annual risk ~ 1:440 (0.25%).

Worst case scenerio: no outside consult available.

Within our circle of friends are several nurses, APNs, and Docs (including surgeons & ER). Who shows up depends on how rent the fabric of society is.

If you have the staples, have the staple remover.: added

Maybe add clindamycin? You know sometimes they double dose with metronidazole, or if docs are worried about toxin production. : good thought, metronidazole for use with fluoroquinolone for abd catstrophe: appendicitis, PID, diverticulitis, etc - clinda would extend coverage. ABX are a poor second choice, but if surgery not available,may be best 2nd choice.

Tape, dressings, etc quantity would be in boxes, if not cases.

elastic roller bandage = ACE wraps

Doculax? : Pysillium products & glycerine supp. should be enough?

Albuterol MDI?: added

WHO oral rehydration salts? Missouri doesn't exactly have nice dry summer-time temps.: Have you tasted most of the rehydration salts? YUCK. Would use 1/2 strength Gatorade - nearly equivalent & much better taste. Missuri weather: hot & humid summers, cold, wet winters (below 0 degrees F last week) You move to Missouri for the weather only if you really like the change of the seasons.

Interesting thought on the Traction splint. You plan on leaving a person in that for 6-12 weeks?: Suboptimal, but absent a surgical option it may be the only option.

OB kit: Having done deliveries in the field, in a car in the ER parking lot, and in the hospital, all you really need are gloves, clean sheets, a clean shoelace, & something to cut the cord. Under the postulated circumstances maternal obesity would likely not be an issue & likely small birth wt. infant due to less than optimal nutrition. Not the best for the infant,but would simplify delivery.

Asherman chest seal: added

bloodstopper product (Celox, etc): mixed reviews with limited medical resources for after care.

herbal remedies and other home remedies. I believe there are also several books on home remedies that would warrant inclusion in a survival library.: research underway for appropriate tomes. Suggestions welcom.

I am loosely involved with local disaster planning. I am located in central MO. The expectation in case of the New Madrid fault slipping is that there will be minimal damage locally. HOWEVER we will likely have a large influx of "refugees". There is also concern regarding resupply - much of our supply comes from the east - having to cross Missouri & Mississippi River bridges that will be closed for an indefinite period of time, if not from damage, from closure until inspected. Major power sources include Bagnall Dam, Callaway Co. Nuclear plant, and Labadie Plant (coal fired plant - supplies REA system) - all at risk in a major earthquake of potential severity predicted.

Remember, there's no such thing as too much gauze.: Agree, see above.

If trained people are available, they need supplies (I remember a similar discussion re: a BOB that resembled a field hospital - have to have supplies for trained people to use).

Though I can't cite the source off the top of my head, there is data to support the use of MOST drugs well beyond the expiration date safely (from military research I think). Most drugs just lose potency with age - tetracycline being a notable exception (toxic side effects from "old" tetracycline).

Rehydration salts: see above post

good anti-fungal, both for atheletes foot and jock itch,anti-allergy meds: on list

Cough suppresents: codeine on list, probably need to add non-narcotic

Toenail clippers. Lice shampoo. Razors and hairbrushes and combs: added

Yes, I agree.
At this time this is a mental exercise and we had to start somewhere.

Advanced training is being discussed. Depending on the specific circumstances we actually have a significant number of medical professionals that would be involved.

herbal remedies: agree. Reference recommendations appreciated.

Just wanted to point out that Hesperian has "Where There is no Doctor" and other similar books available for free download from their website: http://www.hesperian.org

Given how cheap the printed versions are, I don't get the idea of downloading books like "where there is no doctor". If you're gonna print it out you'll spend more time, ink , and paper than a printed version and all you'll have is a bunch of oversized paper that still needs to be bound or put into a protective cover. If you leave it as a digital file, your medical references are now dependent on you having a working, powered computer available when you need it the most.

Somebody please explain the rationale to me. I can see having a version on a thumb drive but I sure wouldn't want that to be my only copy.

Nothing personal Ratbert, I'm just curious.

I tend to do both.
I download a lot of material to read and for some of it I purchase the book from a bookstore even after I have an electronic copy.

You are right about the cost of printing John.
It is not cheaper to print out a book than it is to buy it.
Part of the reason I download is there are some books that are just not easily available in hard copy anymore.

Another reason is that most hardcopy books would not be available in an emergency anyhow.
Most likely you would not have the book with you when SHTF or you would lose it as the S. was hitting the fan.
If you needed to be mobile then books are usually too heavy to travel.
Also I see a lot of people with the unopened text on the shelf and they assume they automatically have the knowledge available.
You need to practice skills if you are going to use them, so it is better to have an electronic copy that you have practiced the ideas in until they are natural than relying on paper.
The middle of an emergency is not the time to be learning out of a book.
With electronic text I can print off a few sheets and go out and attempt what it says.

For references it can make sense just to write (or print) copies of relevant charts, maps and tables.
(One thing I do is put simple cooking instructions with dried foods.
Like a few reliable bread recipes with the flour, a couple of slow pot recipes for the beans.)
I also have some well abused manuals and guides in my stored kits.
Since I abuse the hell out of field guides and similar texts I purchase a lot of mine from used book stores. By the time I am finished a season the texts are very marked up with editing and are starting to fall apart.

That all said I do recommend the Hesperian texts. They are simply written and good info, also very reasonably priced and the Hesperians do good things with their earnings from the sales.

Thanks everyone for the input. This is a work in progress.

Here are a few suggestions for herbal/home remedy books:

Peterson Field Guides Series:

"Medicinal Plants and Herbs"
There are two versions, one for Eastern/Central North America, one for Western North America.

"Edible Wild Plants"
Again two versions, one for Eastern/Central North America, one for Western North America. Not as relevant to the topic but thought I would mention these as well.

The Green Pharmacy series by James A Duke
There are several versions of these. Note that James Duke contributed to the Peterson Field Guides as well.

"The Doctors Book of Home Remedies" by the editors of Prevention Magazine Health Books
I believe this is the home remedy book I was thinking of.

There are many many others available but as I am just getting into this I can barely vouch for the ones I have already mentioned. As I said the Peterson Field Guides are always reputable. Hopefully others on the forum will pitch in some reputable authors and titles (or start a new thread - I may do this myself ). There is probably a local group that has many home remedy recipes. Some local Doctors, especially in a rural setting, have knowledge of some home remedies. I would venture a guess that some forum members could contribute as well (Up in the sky, it's a bird, it's a plane, no it's Blast).

BOT (sort of), in a TEOTWAWKI situation you will have to face the grim reality that there will be people who cannot be saved. Even something far from it, like what we are seeing in Haiti. Two years worth of supplies will only postpone the inevitable. Sorry I can't be more optimistic.

I agree with everyone else about training. Knowledge is power and the ability to improvise from available materials will go a lot further than stockpiling supplies. FWIW and YMMV