Sunday, December 29, 2013

The Essence of Survival Medicine

In 1982, I entered the Army at the MEPPS center in Richmond, Va. The next morning I was on my way to Fort Leonard Wood, MO. After what seemed like an eternity, I graduated from Basic Training and was shipped off to Fort Sam Houston, TX for ten weeks of combat medical training. Prior to joining the Army, I had been certified as an EMT- Cardiac in the Commonwealth of Virginia. This meant that I was trained to start IVs; interpret basic cardiac rhythms, give cardiac drugs under a doctors order, and insert esophageal airways. I was a legend in my own mind. I had saved lives for a living and if you didn't believe me, just ask me. I was ready to change the Army.
     Little did I know, the Army had plans of its own. Upon my arrival at Fort Sam Houston, I found out that a lot of other EMTs and even paramedics had the same idea I had. After about a week, we realized that other than basic first aid and starting IVs, the Army was not going to teach us anything we had ever learned before. In essence, they were going to teach us how to take care of patients under more mundane conditions. Oh yeah, we trained in the field learning to ford a stream with a patient in tow on a litter and how to low crawl through the mud dragging a litter with an angry combative patient on it. We braved simulated artillery rounds going off all around us while we crawled through the woods. We were taught that in the heat of battle, when others might be moving back, the medic moves forward toward that voice yelling "MEDIC!!" I had a blast in that part of my training, but that wasn't the bulk of my training. That was all part of being a soldier. The bulk of the training was much more than blood and guts, though I did not appreciate it at the time. A lot of people think that military medics are trained to be junior doctors. Hell, some medics thought of themselves as junior doctors and some of them were.
     Medics are now trained to the basic EMT level or beyond. They were in the testing phase of that in the late 1980's. Yet, that still remains a small part of their training. The basic EMT course was about 120 classroom hours, or roughly three semester hours. The basic combat medic course was roughly 400 hours, or 25 semester hours. Even at that, we  were barely trained to perform the following duties:
  • Administer emergency medical treatment in a  battlefield environment
  • Assist with outpatient and inpatient care and treatment at forward aid stations and in the hospital
  • Interview patients and record their medical histories
  • Taking patients' vital signs
  • Draw blood and prepare for laboratory analysis
  • Keep health records and clinical files up-to-date
  • Administer oral, intravenous and injectable medications
  • Administer stabilizing treatment and triage
  • Plan and conduct evacuation from the battle field and provide emergency care enroute
  • Preventive medicine
  • Field sanitation
  • Clinical medicine
  • Supportive care in the event of delayed transport often under hostile fire.
     The essence of military medical care is not high speed heroic feats of daring do, but rather excellent life sustaining and health preserving care on a daily basis. It is teaching the troops to care for themselves and to stay healthy. That being said, the essence of military medicine is nursing care. That is why they have Clinical Specialists, Licensed Practical Nurses, teaching the combat medic course along with EMT instructors and paramedic instructors. Prior to going through the combat medic course, I had no clue how to sustain a patient through the first couple of hours. A well trained medic or nurse can initiate treatment and keep a patient alive for a long time if surgery can be delayed. Often they can nurse them back to health without surgical intervention. In fact, I will go so far as to say that if a patient is not in need of surgery in a survival situation, a nurse could very well restore the patient to full health through nursing interventions and care.

The Essence of Survival Medicine is Excellent Nursing Care
Learn first aid and how to start IVs and insert airways. Learn EMT and paramedic skills. However, attend a nursing assistant training program also or better yet an LPN program to learn those skills that will make a difference in a patients life or death struggle over the long haul.

An Uncertain Future

What lies in the future for the vast majority of Americans? No one really knows for sure. However, you can bet that your future as it pertains to the future of the United States is being planned for you even now. The best and brightest political minds in this country and others are hard at work. Am I talking conspiracy? No, just good old common sense.
     You see, no matter how important you are to those around you and to yourself, in the grand scheme of the world at large, and the country to a lesser degree, you are not that important. Even at election time, you are only one vote. In reality your vote doesn't count in a presidential election, because the electoral college is in control. In local elections you are more important, as far as your vote at election time. But, between election cycles you lose a lot of the power and influence you hold on election day. So, to that extent, your future and everyone else's future is uncertain. "Wait a minute, you say, "if my government is truly not concerned about me and my future, then who will take care of me in the future?"
     As an adult, no one is responsible for you or your future. Regardless of what you have been led to believe, You and you alone are responsible for your care and feeding. Even healthcare practitioners in many areas are throwing their hands up and saying, "we have done all we can do, there is no more." In the future, resources will be more limited. The new Affordable Care Act is just and only that, an "act." I came to this realization when I volunteered in a free clinic in rural appalachia.
     The Affordable Care Act appears to work in this manner. Now I could very well be wrong about this. If I am, someone please correct me. Here goes: If you earn enough money to pay taxes, you are required to have health insurance which you are responsible for purchasing and paying premiums on. If you are unemployed or do not draw a check large enough to pay taxes, you are essentially flying under the screen of the healthcare radar. Since you do not pay taxes you are relatively unknown to the IRS. For reporting purposes you are non-existent and thus considered covered by default. Remember, the IRS is the entity that is charged with enforcing the mandates of the Affordable Care Act. Yet, you are not covered because you do not make enough money to buy health insurance through the exchanges. Stories are surfacing about people that are being told that they do not make enough money to sign up on the exchange. One would say, "those people are covered by Medicaid, Medicare or a state run health plan. Not so, since you have to meet certain guidelines to be on these programs. Being poor does not mean automatic or guaranteed coverage. Neither does being sick and unable to work.
     This is further evidenced in the influx of new patients to free clinics whose criteria are based on income. At the free clinic, you get medical care from people who are often volunteers. Often those people are highly skilled physicians, surgeons and Nurse Practitioners. Yet, their hands are tied to a great extent due to lack of resources. My experience is that people can see healthcare providers in any one of many venues. Yet the problem is obtaining the medicines and supplies that are outrageously priced and only available by prescription. The cost of these supplies are borne in large part by the insurance companies who may or may not approve the item.
     So, what is the answer? What can one do to improve their chances of survival in this new era of "healthcare?" Education is the key to most problems you encounter in life. One must be educated on how to maximize their health and decrease the possibility of disease in their life. I am redesigning this training blog to include information on self care. The information will be drawn from my own experiences in caring for patients in the field. I will teach as I learn.
     I encourage my readers to provide input and offer topic suggestions that I can research and write about. If you have heard of a remedy that has been used in the past, send me some information about it. I will research it and post my findings. For the first time in my life, I believe we are in the midst of an evolving survival situation. This is not one where you get your bug out bag and head for the hills. This is one where neighbors are responsible for helping neighbors and doing the right thing. Together we can weather this storm, for it too will pass.