Letter Re: Kanban: America’s Ubiquitous “Just in Time” Inventory System–A Fragile House of Cards

This “just in time” thinking has transformed the medical industry, especially hospitals. The “Central Supply” or stockpile in hospitals has disappeared and in its place are vendors with same day and next day shipping. This includes band-aids, medications, ventilators, equipment etc. In the business setting it makes sense, but in the medical setting it often falters on a day to day basis. In a crisis medical event, surge capacity is limited to how fast the vendors can respond. In a contained disaster, vendors can shift needed supplies to a hospital in as little as several hours. But, in a local area or larger disaster, when several hospitals are requiring materials, vendors can and will run dry. Recently we had an episode where we had to transfer several patients due to lack of ventilators at our facility. We requested more, but the the vendor had already sent them to another hospital that was in need, and this was only the typical flu/pneumonia season! Medications, IV fluids, surgical supply are all limited in supply at most hospitals. Add transportation and trucking problems, and many hospitals with cease to provide our current level of care. Pharmacies are in the same boat, antibiotics and even the OTC meds will quickly run dry, as vendors try to cope with a surge in usage. Thinking in terms of pandemic flu, this will reach crisis levels very quickly, and will set off a domino effect in local area, including rural hospitals and the big city hospitals, affecting routine and critical care. Lesson to be learned, is to stock up on medical supplies including any prescription meds you need, but also antibiotics and symptomatic medications such as Tylenol, Aspirin, Motrin, Imodium, but also on IV fluids, oxygen and other medical materials that could save your life. Obviously, getting an EMT, paramedic, RN, or doctor into your group will be priceless, and life saving, now and into the future.
Another aside, what is the recommendations for your tool cache? Everyone gives there opinion on weapons, and what foods to stock up on, but what basic tools do you recommend to have on hand?
– Mike the MD in Missouri

JWR Replies: I will discuss tool selection in detail in my upcoming non-fiction book: “Rawles on Guns and Other Tools for Survival”. I hope to release it this coming summer.