Triagle - Emergency care : XVIII - Improvised hospitals - Part II : (18th of 18 installments)

In consideration of any disaster, and particularly in consideration of a possible act of war, the problem of immediate and continuing supplies will be of major concern. With many warehouses destroyed or inaccessible, and with transportation facilities greatly reduced, planning for disaster must include plans for local or nearby depots of supply. Rather, it becomes a study in improvisation. Every hospital should consider its needs in case the usual supplies are cut off for a protracted period of time. In the 1960s and 1970s, there was a Federal program known as HRDI, or Hospital Reserve Disaster Index. The local pharmacies are able to supply not only pharmaceutical items and dressings, but also many other articles useful in emergency batteries, flashlights, transistor radios, "canned heat", paper plates and cups, picnic items, etc. Nearby private laboratories will augment the hospital laboratory, not only in routine medical work, but also in assuring a safe water supply. In the case of communities which are rural centers, extra supplies of food may be obtained from local farmers

Triagle - Emergency care : XVII - Improvised hospitals - Part I : (17th of 19 installments)

In the event of major disaster, it may become necessary to improvise hospital facilities. This may be done by activating and existing stored hospital, or by mobilizing trained personnel, requisitioning supplies, and establishing an austere hospital in a previously selected building. Such improvised hospitals may be used in a number of situations: to replace an existing hospital, damaged beyond salvage; to augment an existing hospital which has been damaged, but portions of which are still usable; to handle a portion of the patient load where existing hospitals are overwhelmed with casualties; to be set up in an area hit by disaster where no hospital exists; and to establish specialized units, such as burn wards or wards for those exposed to ionizing radiation. The providing of additional hospital facilities is a complex problem, and should be planned in advance of any disaster. It is not impossible to organize such a hospital after disaster occurs, but it becomes vastly more difficult to do so

Triagle - Emergency care : XVI - Emergency childbirth - Part II : (16th of 19 installments)

As soon as the baby is born, the mother will want to know if it is normal, and whether it is a boy or a girl. This concern over the health of the newborn is almost universal, and the mother should receive reassurance at once. If the attendant does suspect any abnormality, it is better to procrastinate at this point, and await the diagnosis made by a physician. The newborn should be shown to the mother, then immediately placed along the abdomen of the mother, with the head slightly lower than the body, and with the mother's hand holding it safely in place. This reassures the mother, and it also helps further to drain the airway. One of the risks of childbirth is the failure of the uterus to contract after delivery. The after-care of the mother is really just common sense. She should remain lying on her back for about two hours

Triagle - Emergency care : XV - Emergency childbirth - Part I : (15th of 19 installments)

It is usually better to do nothing, than to do something incorrectly. This axiom applies to all emergency medicine, but perhaps to a greater degree in emergency childbirth. Nevertheless, babies are born outside the hospital, and this will occur even more frequently in disaster situations. It is important that the personnel assisting in the delivery do in fact assist - but never interfere. During early labor, the mother may be up and about as she tolerates it. In fact, this activity may help the labor process. She should receive no medication (unless it is a medication prescribed by her doctor, and vital to her well-being). Many medications pass through the junction of the placenta and the uterine wall, and may thus adversely affect the baby. In the hospital environment, the mother is usually "prepped" in advance of delivery, if possible. Do not push or pull the head, and keep hands out of the birth canal

Triagle - Emergency care : XIV electrical injuries : (14th of 18 installments)

In the discussion of electrical injuries and the treatment of those injured by electricity, it is interesting to note the parallel between electricity and ionizing nuclear radiation: both are forms of energy and both can serve us in many areas. Improperly handled, however, or out of control, both may inflict serious injury or death. The human body has a fairly high resistance to electricity, which accounts for one of the phenomena in electrical injury. If a sufficiently high electric current is applied across or through the heart, it will disrupt the normal electrical mechanism. The ordinary household current, which varies from 115 to 230 volts is deadly under certain conditions

Triagle - Emergency care : XIII - Transportation of the sick and injured : (13th of installments)

One of the oldest axioms in medicine is "Primum non Nocere", meaning "First, do no harm". This is applicable in any medical practice and perhaps even more so in emergency and triage care. In triage care, often decisions must be made in seconds - which of course increases the risk or error. This principle: "First, do no harm" is perhaps especially applicable in the transport of casualties. The old Army rule of "Splint'em where they lie" is still a good rule in most instances. Remember the causes, the prevention, and the treatment of shock. Whenever possible, respiration and pulse should be satisfactor; major bleeding controlled; major fractures immobilized; wounds covered; and pain alleviated - before even moving the victim. Once again, in medicine there are many rules and many exceptions. Should you be in an area where there is imminent danger of explosion; release of poisonous gases; if the structure in which you are working is about to colapse; or if there is a fire which threatens both you and the casualty - then, in such cases, common sense must prevail and you must move the patient as quickly as possible even if you must temporarily disregard the usual preparations for moving