The Guerrilla Hospital by DVM

It is time to put this out there. What do we think about a garage or basement hospital, should someone theoretically need one? I’m not talking about field-care but, rather, the second level of care for guerillas (one step removed from the battlefield). The time may be here soon for MEDICAL when, like guns, ammo, and food you will be stuck with what you have, with NO RESUPPLY. I know there are great medical minds out there willing to give advice. I will get us started. I ask that you temper your comments with a heavy dose of realism. Please don’t suggest something that would be out of reach for most of us.

GOAL: Have a place, supplies, and people, and policies to handle skirmish injuries for your Team, day or night. How about a goal of handling a gunshot, a burn, and a motor vehicle accident? Your combat medic will get the injured person to your doorstep. What will you do next?

LOCATION: Should be inconspicuous but near your area of operation, like a suburban garage, basement, etc. Medical supplies must be at the location. Medical Team must either live there on site, be able to get there quickly, or be there on standby for the duration of any missions.

PERSONNEL: You use who you have. Here’s where there’ll be wide variation between groups, unless we organize regionally later in the fight (and why haven’t we done this yet?). Something is better than nothing. Tailor your program to your people. Do you have an RN, a PA, a dentist, an MD, a veterinarian? Anyone with any medical knowledge is going to be valuable. Like COMMS, the time will come when it will be irrelevant whether anyone has a current medical license. Do not get hung up on this detail. Who is going to be in charge? Who is going to help? Will you have a formal security element at your G-Hosp or just a shotgun leaning in the corner?

CAPABILITIES: Total transparency here: my team has IV fluids (albeit expired), IV stands, IV catheters and administration sets, and oral antibiotics. We have three large laundry baskets full of bandaging supplies, splints, gloves and cleaning supplies. We have local anesthetics, needles/syringes, NSAIDS like acetaminophen, ibuprofen, etc. We have BP cuffs and stethoscopes. We have a couple of tracheal tubes. We have maybe 10 pairs of sterile operating gloves but only 15 packets of suture material. We have basic surgical instruments, but they will be cold-sterilized. The photo below is not my Team’s, but is from a medical mission trip I was on in Central America.

What we lack is fancy electronic equipment: EKG, blood oxygen meters, blood chemistry analyzers, centrifuges, autoclaves (more about that below). We have no gas anesthesia machine.

FLOW: There should be an assessment area (think examination room at a Dr’s clinic). Similarly there must be a treatment area. Somehow this area must be cleanable from blood, body fluids, etc. Ideally it would have running water, a sink or floor drain. How about some curtains for a little privacy. Will everyone be treated as outpatients (gone by morning light) or will some stay in a bed a few days?

HAZARDOUS WASTE REMOVAL: What will you do with bloody clothes, drapes, bandages?

BODY REMOVAL: What will you do if someone on our side doesn’t make it?

Photos are mine, from a medical trip to Central America. The stethoscope in the top photo had no bell on the end of it and was non-useable. Very symbolic of that trip. There were also no gloves at that clinic. We worked there two or three weeks.

DVM is a retired Doctor of Veterinary Medicine and Professor of Human Anatomy and Physiology, devout Christian, Father and American Patriot.

Spread the love
                

Share This Story, Choose Your Platform!

About the Author: NC Scout

NC Scout is the nom de guerre of a former Infantry Scout and Sergeant in one of the Army’s best Reconnaissance Units. He has combat tours in both Iraq and Afghanistan. He teaches a series of courses focusing on small unit skills rarely if ever taught anywhere else in the prepping and survival field, including his RTO Course which focuses on small unit communications. In his free time he is an avid hunter, bushcrafter, writer, long range shooter, prepper, amateur radio operator and Libertarian activist. He can be contacted at [email protected] or via his blog at brushbeater.wordpress.com .

20 Comments

  1. Shadow Walker July 17, 2020 at 09:57

    I’m glad someone brought this up because it’s been on my mind for some time. A few thoughts. Total intravenous anesthesia can go a long way ( think wisdom teeth extraction, or colonoscopy procedures ). You wake up and it’s all over. No big anesthesia machine needed. Versed, fentanyl ,and propofol will help. A pre-tracheal stethoscope would be really helpful. Many rescue squads use portable monitoring equipment to cover that aspect. Post op pain will be helped by Tylenol 8HR Arthritis, and /or Aleve ( 12 hour ). An anti nausea med could be needed also, and of course some way to suction the airway. Good nursing care would be most beneficial. Never ever forget our Nurses. Enough for now. Great article.

  2. recon prepper July 17, 2020 at 10:41

    great stuff my group im in has me an ex emt instructor and another person who is a currently certified nurse. We see so many groups that are guns and ammo and nothing else. We know that medical is also important and have been lucky enough to get plenty of supplies stored up. For an autoclave you can use a pressure canner to clean stainless tools. Or you can also use an oven to dry sterilize as well. We also know its not the cool guy gun shootouts that will get you as much as mosquitos, ticks, the common cold, sprained ankles, spider bites, snake bites, etc. Its the little things that get you that we will have to worry more about.

  3. Brian S. Donahue July 17, 2020 at 12:28

    In general I think this may be a workable concept, but I have a few initial thoughts. First, for ID: I’m an MD with 24 years of practice experience in a major university hospital system.

    I know this is a very broad generalization, but my first concern is about personnel doing things they’re not licensed or qualified to do, simply because of urgency, limited access, or the naive but well-intentioned assumption that some care is better than no care. Yes, I do understand the concept of triage, of battlefield medicine, or working with limited resources, etc. I’ve provided care in third world countries where unusual approaches have been the standard. But I’ve also been in situations where harm has been done, so I wish to start by providing some thoughtful caution in regard to scope.

    Perhaps a reasonable approach would be (as you suggest) to have a set of persons pre-identified, with generally outlined lists of procedures and treatments that they are reasonably qualified to do, and with procedures and protocols that are reasonably outlined. All of this would take planning and training, of course, like everything else.

    Joe Alton’s book on survival medicine seems like a great starting point. (It’s on my reading list.)

    I’m also a bit concerned about professional liability. Yes, I’m familiar with Good Samaritan laws, but perhaps a medical-legal expert can chime in on this.

  4. Daniel July 17, 2020 at 12:31

    Sam Coffman over at The Human Path is an ex-SF medic. He runs a school in Texas, wrote The Herbal Medic book and is a premier source on using the natural when big pharma or a trauma center aren’t available. Not another tree hugger he covers everything from what to get, how to make it and how to use it. One whole chapter on clinic setup and operation and another on childbirth. Buy the book from his site and not Amazon – it’s in color but the Amazon version is a B/W knockoff for a lot more $$.

    He’s quick to point out you’re much more likely to blow an ankle than get shot and the man is a goldmine – it was worth finding his youtube stuff and every podcast he’s been on since he’s very generous with the info. I have pages and pages of notes just from that.

    Yarrow, Chapparal. Plantain (the weed, not the banana), echinacea(sp), cayenne, activated charcoal, honey, sugardyne, ankle basketweaves to get the casualty mobile since you *really* don’t want to carry them out, eyewashes, infection mitigation and on and on and on.

    It’s also worth the time learning how the Roman army handled the wounded since their repeated return to service rates were impressive.

  5. SemperFido July 17, 2020 at 18:24

    Buy the books “Where there is no doctor” and “Where there is no dentist.” Designed by experts with the idea of village medics providing care. Then read them now before everything goes to hell..

  6. ethrane July 17, 2020 at 20:09

    I am an anesthesiologist in practice. I have put a lot of thought into
    this regarding equipment, supplies, etc. My opinions follow.

    If you dont have an anesthesiologist or nurse anesthetist in the group,
    please don’t try you hand at general anesthesia. It would be tough
    enough for someone trained to work under those conditions. The learning
    curve is steep and trauma is not the place. I am afraid triage is going
    to be a critical function. Without resupply, there are a number of
    injuries you are just not going to be able to treat. Not that you
    couldn’t try, but you could use all of your supplies on one injury and
    still have the pt not survive. That sort of triage. Abdominal wounds
    penetrating the gut, major organs or vasculature. Thoracic wounds with
    damage to the heart or lungs. Head wounds (open skull) or injury to the
    major arteries of the neck. What you wont have is large stocks of
    blood, antibiotics and oxygen. These would essentially be lethal. The
    sad thing is it will take days for some of these individuals to actually
    die.

    What you will be able to treat: Wounds to the extremities up to and
    including above and below knee / elbow amputations. Peripheral vascular
    injuries treated immediately with a tourniquet in the field. Facial,
    rib and long bone fractures. Child birth, neonatal resuscitation,
    fevers. Sepsis would be touch and go. Repair of lacerations, local
    abscess,etc. would be doable. Imagine civil war medicine but with
    providers understanding what is wrong but limited by what they could
    actually do.

    What you can stock up on. All the field / IFAK stuff of course. In
    addition, IV fluid (and how to make more). Oral rehydration solution
    (and how to make your own). Soap, gloves, masks. Forget the
    endotrachial tubes. If you need one, most likely the patient going to
    die. Get some LMAs. Easy to place, easy to reuse. Plan to reuse
    equipment and have the ability to resterilize. A pulse oximeter would
    be really helpful (they are about $10 on Ebay).

    Think about the use of local / regional anesthesia. In WW2
    appendectomies were done under spinal. Works for labor and lower
    extremity injuries. Axillary block for upper extremity injury. Easy to
    carry (just a couple of needles and a bottle of local.

    Propofol for sedation, TIVA (total IV anesthesia) is a possibility for
    short procedures (like setting a bone, D/C, arterial ligation), but you
    have to have some way to ventilate the pt (think lma) if you get too
    deep. This is a huge topic. The key is not to get injured, pregnant or
    infected. Suffering is going to be off the charts as we watch friends,
    family and loved ones die from conditions survivable only a few months
    before.

    • johnyMac July 18, 2020 at 10:47

      Amen ethrane. Would you be interested in doing a few articles? Drop me a line at [email protected]

      73 & God Bess Brother

  7. Anonymous July 17, 2020 at 21:41

    4.5

  8. GK July 18, 2020 at 10:50

    It’s really smart to start talking about this now. We know that an injured person can consume several personnel to protect and move the victim from one local to another. Multiply that by many victims and we have a serious logistical problem. To give an example of this; those first two people shot at Capitol Hill in Seattle were only 15 blocks from HarborView’s Trauma Hospital. It’s my understanding they had to send in the chopper to grab them at the park. Even worse Swedish medial centers are all over that hill, and Virginia Mason is only but about 6 blocks away. There were/are medical supplies all over that hill.

    Due to the hit and run nature of this asymmetrical event that’s about to unfold, it may be more efficient to have medical teams go to the trauma, rather than group the victims at a local that will require huge security resources. Sort of like the tunnels in Nam. There will be sympathizers that have already bought up medical supplies, and it may be a very prudent act to start setting up several remote locals to provide services. The problem here is connecting with them now, pre-big ugly. The idea being that it takes a small constituency to protect each medical team that is hard to pin down local, rather than large security forces for the victims and hospital.

    Antibiotics, Antibiotics, Antibiotics! For local stitches, rub a little anbesol around the wound and sew it up. Or, suck it up buttercup. One more thing.
    https://amzn.to/2ZIyayy

  9. GK July 18, 2020 at 11:56

    Messed up and accidentally left some stuff out of last comment.
    Epipens, Maxipads, Tampons, and Pseudoephridine. Have even considered diapers for absorptive purposes.

  10. Stumpknocker July 18, 2020 at 14:02

    Prep as much as possible:
    If you can be in contact with a md that can write rx’s now(oral antibiotics, steroids-decadron, etc) even if the md is not in your “group”- go and complain of ear/throat pain and try to get rx’s.
    Talk to those in your group that work at hospitals now and have a “resign plan”. What events would cause a nurse or someone with access to a ‘pyxsis’ or a anesthesia cart to quit their job and walk out. With that plan what can they leave with. Some might argue with this tactic but hospitals are corrupt corporations that send people into massive amounts of debt. Use that resign plan to raid a pyxsis, storage room, iv and bandage supplies, iv meds and po meds.
    Otherwise, go to Costco and stock up on Tylenol,Motrin,Benadryl,neosporin,Imodium,gauze,ace wraps, and children’s po meds. -my time in Nicaragua showed me how precious a handful of Tylenol can be.
    Become a hypochondriac-big the heck out of your md-where a mask and play the role. And don’t throw anything expired away.

    • johnyMac July 18, 2020 at 14:22

      Many, many moons ago when living on our sailboat in MDR, CA. another boater and friend was a doctor. His wife and he wanted to cruise on down the Mexican coast and if they liked the lifestyle they were going to head off west to Tahiti. I did a lot of splicing for him to augment my salary at West Marine. One day he showed me his medical chest. The chest was a pelican case and it it he had all kinds of things but mostly medicines in it. I was blown away and asked him a lot of questions about the case and how I could get those Rx’s. One day I was down at his boat splicing a 3/4″ nylon rode to 200′ of 3/8″ chain. He walked up behind me and said, “I have a present for you”. It was a albeit smaller pelican case it was a case full of a lot of RX items.

      Each bottle had the name of the item and a number. The number corresponded with different ailments in a paperback book that accompanied the case. During my delivering boat stage of my early life, I took that case on every voyage I skippered. It came in handy more times then I can count.

      Today, I don’t know a friendly doctor who would do the same thing. That case got lost in one of my many moves for WM but it was pretty depleted anyway.

      Good stuff Brother,
      73 & God Bless

  11. Jay July 18, 2020 at 18:04

    As a practicing CRNA I agree with ethrane. Get a pulse ox and auto bp cuff from local drug store. Any abdominal wounds or chest wounds need a real surgeon right away. Something to think about. Ultrasound guided regional anesthesia. Look it up. I have an ultrasound that hooks to my iPhone Cost $2k. USGRA is a skill -don’t expect to pick it up in the moment.

  12. Anonymous July 18, 2020 at 18:43

    5

  13. Evan Rees July 18, 2020 at 18:55

    As a 30 year paramedic, expedition medic and one of our groups medics, this is a great thing to discuss. We are lucky as we are fat on medical staff-PA, 2RNs, 3 tactical medics, so we have lots of imput and kit. One of the best books that I used overseas was the ships captains guide to medical emergencies, hard to find but awesome, and the SF medical handbook-a standard in remote and austere medicine. Have regular trainings with your clinic group, include triage, standard roles, etc. Many of my emergency evacs overseas were due to tooth problems. If you have people with the contacts, DO a dental rotation if you can. Have the proper gear to treat dental emergencies-remotemedicine.com-has a great selection of the proper kit. Saline can be made in the kitchen, have a lot of it around for lavage if you have to deal with any penetrating trauma. Make sure you have good sterile surgical tools packaged and ready to go-available online from several sources.

  14. B July 23, 2020 at 12:14

    Get yourself a home care nurse. They have access to a bunch of medical supplies. Then, you’ll wan an ER, ICU, and probably critical care nurse. Your medics should be with the troops. ER nurses and medics work well together, mostly.

  15. B July 23, 2020 at 13:29

    I recently completed the Family Herbalist program through the School of Natural Healing. Medications will run out if things go sideways. Herbs, if used correctly are safe and do not have the side effects that synthetic medications do. There are many texts out there covering herbs. SNH is the one that I went with and so far I’m happy with what I’ve learned. I will leave a few here.

    Disclaimer: if you don’t know what your doing, don’t do it. There are many herbs out there, such as poison hemlock, that will kill the shit out of you. Make sure, if foraging herbs, you know precisely what it is you are gathering. Use herbs at your own risk. Also, this information is given freely. I receive no compensation, monetarily, or otherwise for providing this.

    There are a number of different routes each of these can be taken, but assuming folks will be snoopin & poopin in the woods I will include those that can be used in the woods without a lot of prep. All recommended doses are for adults. Use 1/2 dose for teenagers (13-16), 1/4 dose for children (6-12), 1/8 dose for babies (2-6), and 1/16 dose for infants under 2 yrs. Where multiple herbs are listed, on or all can be used separately or in conjunction for teas, poultices, or fomentations. Use equal parts in combination.

    According to SNH, to help stop bleeding you can, in addition to direct pressure, use Cayenne tincture, 10-12 drops, in conjunction with Horsetail tincture 10-15 drops every couple of minutes until bleeding stops. Cayenne powder can be placed directly on the wound. In the field, Shepard’s Purse, Yarrow, or Horsetail poultice can be applied directly to the wound. If infection develops, apply a Plantain poultice.

    Colds/Flu drink Nettle, Horsetail, or Yarrow tea 3-4 cups per day.

    Diarrhea is the body’s way of flushing something it doesn’t want out, but if it gets too bad a person can become quite dehydrated. In the field, drink Yarrow, and/or Catnip tea, 2-3 cups a day. Inner barks of Aspen, Larch, Birch, Oak made into tea will help stop diarrhea.

    Exhaustion, in the field, drink Nettle tea, 2-3 cups per day. Also, Alfalfa, Dandelion, Mullein tea will help increase energy.

    Fever, Yarrow tincture, 10-15 drops 3 times a day or Yarrow tea, 4-6 cups a day. Elderflower and Peppermint tea is excellent for helping with fevers. Keep in mind, a fever is your body’s natural defense against pathogens. It is not recommended to stop a fever immediately. Let your immune system do its job.

    Infections, in the field, drink Plantain, Yarrow, Oregon Grape tea, 3-4 cups a day. Make a poultice of the same material and apply to the area. Garlic oil can be taken internally. Honey has antibiotic and antifungal properties.

    Poison Ivy, Oak, & Sumac, use Plantain, Mullein poultice or fomentation over affected area. Drink Plantain, Nettle, Yarrow, and/or Catnip tea, 3-4 cups per day.

    Pneumonia, drink Plantain tea, as hot as you can take it, 2-3 cups a day. Drink Yarrow tea, 2-3 cups a day.

    Abscesses, in the field, use fresh Yarrow or Plantain as a poultice over abscess. Drink Yarrow or Plantain tea 2-5 cups a day.

    Allergies, in the field, drink Nettle and Mullein teas, 2-4 cups a day. Raw honey from the local area can also help with seasonal allergies. 1-2 tsps three times a day.

    Frostbite: (mild) apply Cayenne Heat Ointment over area and wrap. Cayenne tincture internally, 10-20 drops 4-6 times a day. If the person’s skin is white or grayish with no pain, just tingling or numbness, do not massage the frostbitten area, but bring the person to a place out of the elements. Then gently warm the area. Do not allow to refreeze. In the field, apply Mistletoe poultice over affected area. Drink Nettle tea, 4-6 cups a day.

    Herbal preparations

    Teas (infusions): made from the flowers and/or leaves of fresh or dried herbs. (Herbs may be whole, cut or powdered). Bring to a boil, one or more cups of water and add 1 tbsp of fresh herb or 1 tsp dried herb to each cup of water. Remove from heat and let steep for 10-20 mins. For extra strength, steep longer. Strain and add honey to sweeten if desired. REMBMBER, never boil your herbs.

    Teas (Decoction): mad from the bark, inner bark, or roots of trees and herbs. Bring to a boil, one or more cups of water. Add two tbsp of cut-up root or bark to each cup of water. Gently boil for 5-10 minutes, then remove from heat and let steep for 25-35 mins. Strain and repeat the process with the same herbs. Add both liquids together and add honey to sweeten if desired.

    Fomentation (Compress) take a piece of natural cloth (cotton, wool, etc.) and dip into warm infusion or decoction (teas). Wring it out just enough so it isn’t dripping. Place over the desired area and secure with a piece of plastic or tape.

    Poultice: made by heating fresh or dried herbs in water and straining, placing the herbs in a natural cloth and securing with plastic or tape. Poultice can also be made by chewing, bruising, or chopping fresh herbs and placing them directly on the skin.

    Tinctures (Extracts): tinctures are more concentrated than teas and can be easily assimilated. Mix 8oz of dried/cut herb, or 4oz powdered herb to 16oz (1 pint) of alcohol (must be at least 80 proof, Vodka or Everclear brands are recommended). Age for 14 days, shaking bottle 2-4 timesf a day, gently mixing well. After 14 days, strain and pour into amber glass bottles and cap tightly. Tinctures will keep this way indefinitely with little loss of potency. It is the ideal way to store herbs if you want them to last. If you don’t want to ingest the alcohol, simply add your tincture dose to a cup of hot water. The alcohol will evaporate.

    Herbal oils: cover desired amount of fresh or dried herbs with olive oil. Keep in a warm place for 2-3 weeks or warm on low heat for 1.5-2 hours, stirring occasionally. Do not boil. Strain and press oil from herbs. Store in refrigerator to keep from spoiling. Add vegetable glycerine to keep for longer periods.

    Ointments: cover desired amount of herbs with olive oil. Gently warm on low heat for 1.5-2 hours, stirring occasionally. Strain and add melted beeswax to reach desired consistency. Ointment of coconut oil or cocoa butter can be made simply by heating herbs in melted oil and straining. This ointment must be kept cool (<80F) or it will melt.

    These are only a few of the herbs and preparation techniques that can be used to treat many of the ailments that may be experienced during an extended camping trip. Hope they help.

    Dr. Christopher has many herbal formulas that are available on Amazon. X-Ceptic Tincture is highly recommended to have on hand for infection.

  16. MechMedic July 24, 2020 at 14:32

    This is a subject I’m so excited to have been brought up. I have been wanting to go deep into this subject but my lack of relevant experience is a small barrier. SF medics and people who have worked medically in austere environments have a bunch of knowledge on this subject.
    The biggest thing is having the supplies on hand.

  17. Jonathan Ramey July 26, 2020 at 20:51

    I also have been preparing for just such a task. I have a USGI hospital bed, cases of first aid supplies, antibiotics, NSAIDs, vitamins, bed sheets for said hospital bed, pee pads and a EZUP tent that can be used as an isolation room. I did 24 plus years in oakland fire dept as a FF/EMTD. So while I’m no doctor, I’ve handled everything from live births, gunshot and knife wounds, crushing victims and major chemical and fire burns among other things. Oh and I did sleep in a Holiday Inn a few times.
    Where I live I hope I will ever need to use these supplies in the manner the article states, but one never knows with all the un-imaginable events taking place.

    I’m willing to help and Patriot with whatever I can.

  18. Anonymous March 17, 2021 at 19:35

    4

Comments are closed.

GUNS N GEAR

Categories

Archives

Spread the love