Four Letters Re: Advanced Medical Training and Facilities for Retreat Groups

In response to BES in Washington’s comment on Paramedics and EMTs I must say that I agree when it comes to workaday medics. A great benefit to having the years of training as a paramedic is that it earns you some credibility.

My advice to paramedics and long time EMTs is to speak to your training officers and EMS directors and find out if your supervising physician or another doctor would be willing to mentor you in surgery[, though observation]. I had the opportunity starting with my paramedic internship to make relationships with quality doctors who wanted to mentor me in advanced surgical skills which were often outside my scope of practice. It is important to somehow become a student under the hospital so their insurance or that of your school will cover you or
this is a pointless exercise.

Getting advanced mentoring means establishing a bond of trust. You need to convince the surgeons and doctors that you are reliable as well as being the type of person that they want to have in their O.R. for hours. It doesn’t hurt to mention a desire to go to medical school in the future, I believe it was my interest and reliability that opened many doors to advanced training that might have otherwise would have remained closed.

The other thing that helped me was taking a part time job in the E.R. on my off days, it was easy to have my beeper go off and run to the O.R. when there was a surgical emergency. I got to see trauma calls come in and because of my special training relationship with many of the doctors and departments I was able to follow many cases from the door to the ICU. I made many career decisions based on the opportunity to advance my skills.

In the end, once you are inside the system as a professional start asking for extra training, remember that the title Doctor means teacher and if approached with the proper attitude most good doctors are very happy to help you learn. – David in Israel


Just a quick note regarding medical training. While the combat medic courses look okay, they are limited. EMT courses require a lot of advanced equipment.
A much better option would be a Wilderness First Responder (WFR) course. It is an 80 hour course over about 10 days that teaches extended care and injury management. It is the gold standard in the outdoor industry. The “wilderness” designation means that definitive medical care is more than an hour away–and then trains you to deal long evacuations or extended care.

There are a number of places offering WFR courses throughout the United States. You can contact the Wilderness Medicine Institute of NOLS for a list of courses, as well as others. What we like about the WMI courses is that they focus on real world scenarios, as well as judgment. They are not about memorizing lists, but about learning how to make good decisions under stress. The courses and on-going recertification are more than worth it, as they keep you sharp and up to date on what the latest issues and concerns are in wilderness medicine.

Perhaps the best thing about WMI and related companies is that their instructors are in the field teaching and doing wilderness medicine all the time–they know what works and what doesn’t work.- Mark R.

Dear Jim,
Thank you for sending us your autographed copy of the best of the blog and the patriots. In response to the posting “Letter Re: Advanced Medical Training and Facilities for Retreat Groups”
I commend the writer for addressing these important issues. Here are a few thoughts to add: Over the years, the field of medicine has become very complex, including training, equipment, and delivery. Lets look at each of these individually.

First, training. It used to be that every physician went through medical school, then completed a general practitioner residency and then specialized in a particular field if they were so inclined. About 10 years ago, that all changed. Now, even before medical school is completed, the students decide which area of medicine they would like to pursue and go directly into that residency program without becoming a general practitioner first. What this means is that physician’s knowledge is highly specialized. Physicians are good at what they do, but lack the knowledge/experience to perform tasks outside their area of expertise. For example, if you were to suffer a bone injury which required an operation, the person you would need to see would be an orthopedic surgeon. However, they would most likely not feel comfortable putting you to sleep. For that, you would need an anesthetist. And, if you also had and abdominal wound (e.g. gunshot), the orthopedic surgeon would most likely not feel
comfortable operating. For that, you would need a general or a trauma surgeon. And if you happened to have burns associated with your injury, you are best off with a plastic surgeon. Now throw a diabetic patient into the picture (for which you need an internist), and you get the picture.

I am a physician, having recently graduated after 14 years of university, including a biochemistry degree, a medical degree, and five years of residency specializing in oncology. If you have cancer, I will
know what to do, but if you put me in an operating room, we’re all in trouble!
The point is that if you have “one physician” in your survival group, don’t expect them to be able to do everything. Medicine is very multi-disciplinary:

General surgeons are best at abdominal wounds and trauma
Plastic surgeons are best at handling burns
Orthopedic surgeons are best at dealing with bone fractures
Internists deal with medical problems like diabetes and heart disease
Anesthetists provide anesthetic to put you to sleep for the operation
Oncologists deal with cancer
Pulmonologists deal with ventilators and such, et cetera.

All of these are highly specialized physicians, but physicians knowledge of cross specialties is limited!

Second, equipment. In third world countries, physicians have wonderful diagnostic skills based on physical examination of the patient. Most American physicians don’t have these skills. We rely very
heavily on tests including X-rays, ultrasounds, CT scans, MRI scans, PET scans, angiography, blood work, laboratory tests with pathologic interpretation, etc, just to name a few. All of these require expensive equipment, laboratories, power to run them, and a radiologist or pathologist (specialized physician) to interpret them. Asking a physician to diagnose your ailments without being able to perform any of these tests is like asking your mechanic to tell you what is wrong with your car without allowing him to lift the hood. It is very difficult! Thus, even if you have a physician with appropriate knowledge in your survival group, if they don’t have access to their equipment, they will be very limited in what they can do.

Third, delivery. Let’s assume that a member of your group becomes ill and that 1) you have a physician in your group with appropriate knowledge and 2) the physician has access to equipment which allows them to diagnose your ailment. Then, the physician would know how to treat you. However, there is a big jump from knowing what you need to actually being able to deliver it.
For example, suppose a member of your group developed a bacterial pneumonia. Lets say your physician was able to perform a chest xray to confirm this. Now the physician knows how to treat you. You need an antibiotic. Now the problem becomes access to appropriate medications/treatment.

What if your retreat does not have any antibiotics on hand? or insulin? or nitroglycerin? or Fentanyl/Versed (anesthetic)? or IV fluids? or blood? or chemotherapy? etc. Many of these are difficult to access and/or store.

In summary, the current healthcare system is highly complex in its training, equipment, and delivery. Many of these issues need to be thought out beforehand when planning your medical room at your retreat. – KLK

Dear JWR & SurvivalBlog Readers (especially DS in Wisconsin ):
I would like to respond to DS concerning his questions. I agree wholeheartedly that nobody should try on-the-job training for medical care without a good mentor. That is what nursing and medical training is for as JWR strongly suggests. I also agree that the human body is complex and can be inadvertently damaged with attempted care. However, the human body does have an amazing ability to repair damage if allowed. This is why I strongly suggested learning techniques to control and stop bleeding, replace lost intravascular fluids and limit infection. In trauma, there is the concept known as the “Golden Hour”. During the first hour after a near-fatal injury, the body can compensate for bleeding by shutting down perfusion of not immediately critical tissues such as kidneys, skin, muscles and extremities, thus permitting limited perfusion of heart, lungs and brain. This is a state known as shock. If the patient can be stabilized in the first hour, the likelihood of survival is dramatically increased. This is accomplished by controlling bleeding and replacing lost fluids. Nearly everyone can be trained to control bleeding, since holding pressure on a dressing is not difficult. Starting an IV is slightly more complicated but is not beyond the ability of most people. Even the most gruesome of wounds, such as a chainsaw injury, will eventually heal if allowed to (although the cosmetics may be less than desirable). If you can get over the “Golden Hour”, you are blessed with what I refer to as “The Tincture of Time”.

My second suggestion was to do everything you are capable of doing, even with the knowledge that survival is unlikely. This is where the concept of errors of commission verses errors of omission comes into play. In my mind, it is better to attempt something life-saving than omit the possibility because the outcome may not be successful. As the quote goes: “Tis better to have tried and failed, than never to have tried at all.” Our mindset has to change from “First do no Harm” to one of “Do the Benefits Outweigh the Risks?”. I don’t think anyone is suggesting reading a guide while doing this, simply suggesting doing something you are capable of doing. The key is not to destroy your psyche with remorse and self criticism if the results are not optimal.

As far as our personal preparations, my wife and I are both experienced medical people and long ago decided that that would be our biggest contribution in TEOTWAWKI. As such, we have an elaborate and extensive setup, not unlike what you describe, however our garage is reserved for other uses currently. We are an extreme case and should not be viewed as a guide. Unfortunately, I feel that JWR seriously overestimates the medical preparation of the general population. Instead of 98%, I would suggest 99.99% of the population is ill-prepared. The biggest asset in a trauma situation would be a couple of cases of heavy duty (I think they are called “heavy days”) feminine pads and some rolls of tape. IV supplies and the skills to administer it would make you invaluable. The “field surgical kit” would simply provide appropriately sized sharp scissors and tweezers/clamps for cleaning out the wound after you have administered the “Tincture of Time”. It is not something to carry while also hauling around an enormous ego. – NC Bluedog