Obtaining prescription meds( and the end of the world-emedpa!)

So my new year’s resolution this year was to assemble an emergency pack in case of natural disaster, terrorist attack etc. So far my general kit is done (food,flashlights, water, blankets among others) but I would like to add some things to my medical supplies. I have a suture kit and other general first aid supplies. Is there a way I can legally obtain some lidocaine and antibiotics for emergency situations?

Whenever I need ABX I just ask the Pharm rep if they have any extra....

Yes...

Either ask a colleague with a DEA# to write you separate scripts for:

Azithromycin 500mg PO bid # 30

Cipro 500mg PO bid #30

Doxycycline 100mg PO tid #45

Bactrim DS PO bid #30

PenVK 500 PO bid #30

Metronidazole 500 PO tid # 45

Fluconazole 200mg PO bid #30

1 vial of Lido w/o Epi...

A couple vials of solu-medrol

Epinephrine

Some injectable Promethazine

OR...

You should also be able to order most of this from MooreMedical by simply giving them your license and DEA numbers.

The above list of meds is what I carried in REMOTE... "Austere Environments " and allowed me to kill or render harmless most pathogens...

For Trauma... I ascribe to the TCCC/TEMS "MARCH method" so I assess and treat in that order:

Massive Bleeding

Airway

Respiration

Circulation

Head/Hypothermia

So currently have a bag with sutures, a few 5 shot disposable staplers, duct tape, lots of gauze, a few tubes of crazy glue, multiple torniquets, cravats, clamps, Angiocaths, tubing, 500ml bags of 0.9 & Ringers, nasopharyngeal airways, safety pins, a few 14ga 3 inch needles and vasaline gauze...

YMMV...

Contrarian

p.s... the promethazine IM is used to stop the nausea /vomiting long enough to get the PO Meds in and working.

I suppose it would depend on what is considered a disaster and who you are treating. When I was an EMT-P the good Samaritan laws only protect a practitioner if he/she was administering first-aid. Any advanced care was not covered. We use to have trouble from time to time with people on the scene saying "I'm a nurse" or "I'm a doctor". We could easily take control of a nurse at the scene but a doc required a little more finesse. We would respond to the effect "OK, I'm relinquishing the care of the patient to you and you will have to be responsible for mistakes and ride in the back of the truck to the ER". Most times, they would back off and let us do our job. This area is the turf of the Paramedic. It is where they are trained to work. If the medical supplies are just for you or your family, you are probably OK. I ended up, politely as possible, getting my wife to take her I-O tubes and laryngoscope out of our car. She tubes people every working day but could be sued if even something small like a chipped tooth happened at the scene of an accident and the patient could end up with a tooth in a lung. Not to mention working on the ground or in a vehicle or in the dark is much different than an OR.

I made the decision myself to screw the lawyers if it meant saving a life but that is me. Epi for an anaphylactic reaction is a definite will do. An AED (defibrillator) would be a good thing to have available. The rest would depend on how soon the Paramedics can get there. Staying sharp on first aid would probably be better and know things like: Do you remove an impaled object like a stick or piece of metal from someones cranium? Which side goes down with a hemo or pneumothorax? etc.

I got the impression the supplies/meds were for personal or family use. Hopefully they wont sue.

I got the same impression, it is just hard to sit on your hands sometimes in public. Regardless, a pulse-ox would be a good addition. They are reasonable now. http://sportys.com/PilotShop/product/13010

I also got the impression that they would be used during a D-I-S-A-S-T-E-R...

Which means relying on organized medicine and tertiary care that is MINUTES away... when SECONDS count is R-E-T-A-R-D-E-D.

dm123... this is the "PROFESSIONAL PA FORUM" so presumably, you are here congregating with folks who have been practicing MEDICINE long enough to know their personal limitations.

The OP asked a question. The question didn't suggest that this person was going to set up a public emergency medicine service out of their house or vehicle. YOU introduced that notion into this conversation.

Take the lecture that way--------------------------------------->>>

Looking over the list of recommended meds, it appears to be for an approx 2 week time frame. Using that as a baseline time frame, how much IV fluids would you recommend? My primary curiosity lies in the role of being a primary medical provider for 8-12 people during an expedition ie: Grand Canyon for 4 weeks, Himalayas for a couple of months, that sort of thing. My secondary curiosity is for disaster, again for 8-12 people in a non combative role. (not actively seeking to engage enemy, but prepared to defend...hoping to keep high velocity injuries to a bare minimum)

I want to believe there is a balance somewhere that if someone is requiring large amounts of crystalloids despite attempts to stem what is causing their fluid loss, then they may not be viable. Do you even dance with the notion of colloids/volume expanders?

Using the Parkland formula for a moderate/severe burn (disrupted cooking stove, gas line fire in damaged house) a 80 kg pt with a 20% BSA requires over 6 liters of fluid in the first 24 hours...that just gets awful cumbersome to travel with if we're out in the bush on the move.

So what do you all suggest? Where lies the line of diminishing returns? Can that line be determined? Or too many variables based on "mission"?

IF money is no object I would use zofran odt> phenergan, otherwise phenergan is fine.

contrarian has a good list.

would add some suture material and staplers, a few scalpels, betadine, dressings, etc

if you really want a primo kit toss in an IO or 2, some iv catheters and fluids, etc

Congrats emed 11,111 posts!!!!

Some animal feed stores in my state sell antibiotics for animals. Almost all of them are also good for humans too. Obviously you would need your professional knowledge to calculate the correct dosages for humans... but, you know, just FYI if the above really good ideas don't work out.

Legal disclaimer: only use this advice if you have a license to practice medicine, under disaster conditions, or if the zombies come and society is totally ****ed.

don't forget some form of fire-starter and mirror/reflector in your survival kit. Perhaps a boyscout book too just in case you are lost in the wilderness

I also got the impression that they would be used during a D-I-S-A-S-T-E-R...

 

Which means relying on organized medicine and tertiary care that is MINUTES away... when SECONDS count is R-E-T-A-R-D-E-D.

 

dm123... this is the "PROFESSIONAL PA FORUM" so presumably, you are here congregating with folks who have been practicing MEDICINE long enough to know their personal limitations.

 

The OP asked a question. The question didn't suggest that this person was going to set up a public emergency medicine service out of their house or vehicle. YOU introduced that notion into this conversation.

 

Take the lecture that way--------------------------------------->>>

No lecture intended. It is an acquired bias against healthcare provides a Paramedic obtains through experience. Medical practitioners, not in their element, make foolish mistakes. Some would consider a school bus overturning as a disaster. Maybe a person comes upon such while on their way to an "austere" location with their bag of goodies.

I assume we are here to learn from other's experience and knowledge. I welcome advice from others; if I don't agree then I pass on it. To call a post retarded, insinuates unprofessional character and is not what we should be about.

Now I'm gonna preach, feel free to skip this part:

Your response indicates you have never worked in the field outside an ER or clinical setting in the USA. Obviously, a third world country is different. Maybe you are aware of the legalities on the outside, most are not.

Most cases, you have 24 hours to get a wound closed. Unless a person is on an African Safari (I assume this is what you call REMOTE... "Austere Environments "), it shouldn't take that long to get to someplace that can set up a sterile field to suture a wound.

Realistically, would the meds expire before a "D-I-S-A-S-T-E-R...", or melted in the back of your car, or were at home while you are at the store?

Maybe your state is different but in NC, the State Board of Medical Examiners W-I-L-L reprimand, at best, Rx or administering meds without written records justifying them, and not on a paper bag in some “austere” location. There are a few old time folks that will give a script for something to a workmate or friend outside of a clinical setting without records, but they are taking a chance. Heaven help them if a complication occurs, the legal system won't.

Check with your SP to see if he/she will back you up closing a wound or giving a 30 day supply of PO meds to a patient in an “austere” location or outside the state you are licensed in, or away from your SP.

What do you define as "austere"?

let me stir the pot a little :p ...

in one year when these meds expire what will it cost to replace them? Where do you live and what is the risk of natural disaster? On a population level what is the cost effectiveness of having these kits for personal use?

But bravo on preparedness ... people do not do enough, myself included.

Hmmm... a good set of oral and nasal airways w/ a bag/valve mask... maybe not for hiking but good to have following the zombie apocolypse...

Did anyone mention antiseptic of some kind for cleaning potentially reusable supplies (like the BVM)? In a disaster the one-to-a-customer rule might go out the window in a hurry...

if those meds are for personal/family use I would be willing to use them if expired. do you really think pcn is less effective if 2 yrs old?

a lot of expiration dates have nothing to do with efficacy and more to do with selling new supplies....less so with IV meds obviously but I would bet 10 yr old pcn in a sealed container is still good...

10 yr old pcn is going to be like gold when the zombie apocalypse hits :)

if those meds are for personal/family use I would be willing to use them if expired. do you really think pcn is less effective if 2 yrs old?

a lot of expiration dates have nothing to do with efficacy and more to do with selling new supplies....less so with IV meds obviously but I would bet 10 yr old pcn in a sealed container is still good...

Will do, have done for me and my family. Most meds (notice I've learned to never say never) are supposed to be at least 98% effective at the date of expiration. Many end up at expiration going to third world countries.

I did find an old bottle of PCN in a storage locker once. Smelled kind of funky when I opened it so I dumped it. Heat got them. How meds are stored seems to matter.

I suppose in case of terrorism a little atropine might be handy till you can get your gas mask on. And Cipro if you work for the Post Office.

yup, it's a little known secret that pcn can cure zombie-ism within 5 hrs of a bite to prevent conversion to the undead. also cures zombie syphillis which is a big plus....and the dreaded zombie strep pharyngitis....imagine trying to indulge in human flesh with a sore throat...big bummer...

I don't know, we've been seeing cases of MRZA (methicillin-resistant zombie antigen) in our area, so the penicillin is useless. Thankfully Avelox is effective against every bug ever invented, so it's an easy fast track case.