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DISCLAIMER:

None of this info is intended to diagnose, treat, cure, or prevent any illness or disease. Consult with your physician for
diagnosis or treatment. Do your own research before trying anything. While reasonable care and diligence has gone
into the compiling of this information, we accept no responsibility for the use or misuse of this information.
We in no way endorse practicing these techniques except in the catastrophic disaster, austere or remote environment
situation. In many areas it is illegal to practice medicine or operate a clinic without a license. This information is offered
as personal opinions and should not be taken to represent a professional opinion or to reflect any views widely held
within the medical community. All of this information is provided merely as a springboard for further research.

Always seek professional medical care when it is available.

“...as ye go, preach, saying,


The kingdom of heaven is at hand.
Heal the sick...
...freely ye have received, freely give.”
Matthew 10:7-8

Special Thanks:
Many heartfelt thanks to those who had a part in reviewing, testing, consulting, proofing, and encouraging.
This resource would not have been the same without your service of time, talent, experience, and hospitality.
May God richly bless you.

The E. Family, D.M. “Doc”, Karen B.
John Dinsley, www.BuyActivatedCharcoal.com

“The husbandman that laboureth must be first partaker of the fruits.” - II Timothy 2:6

© 2014 Daniel Valles, informedchristians.com All rights reserved.


This material may be duplicated in whole, not in part, for free distribution only. Not intended for resale.
To God Be The Glory. Dedicated to the Tribulation saints (Daniel 11:32-35). Scripture quotations are from the King James Version.
Seek Jesus Christ of Nazareth first, and highest, above all; in service to Him, this was prepared for you.
“...A certain man went down from Jerusalem to Jericho,
and fell among thieves, which stripped him of his raiment,
and wounded him, and departed, leaving him half dead.
And by chance there came down a certain priest that way:
and when he saw him, he passed by on the other side.
And likewise a Levite, when he was at the place,
came and looked on him, and passed by on the other side.
But a certain Samaritan, as he journeyed, came where he was:
and when he saw him, he had compassion on him,
And went to him, and bound up his wounds, pouring in oil
and wine, and set him on his own beast, and brought him
to an inn, and took care of him.
And on the morrow when he departed, he took out two pence,
and gave them to the host, and said unto him,
Take care of him; and whatsoever thou spendest more,
when I come again, I will repay thee.
Which now of these three, thinkest thou,
was neighbour unto him that fell among the thieves?
And he said, He that shewed mercy on him.
Then said Jesus unto him,
Go, and do thou likewise.”
Luke 10:30-37
TABLE OF CONTENTS
Table of Contents

Orientation.................................................1 Personnel ................................................. 43


Disaster : Needs ........................................3 Sustainability ......................................... 44
Portable Facilities ....................................6 Sewage ..................................................... 45
Staffing ..................................................... 10 Power System ........................................ 46
Administration / Office ....................... 11 Water Treatment ................................... 49
Pharmacy / Lab...................................... 12 Improvised Sinks .................................. 53
Patient Receiving / Prep ..................... 15 Hand Washing ....................................... 55
Exam / Consulting Room ................... 16 Laundry .................................................... 56
Soiled Utility Room .............................. 18 How to Make Bleach ............................ 59
Clean Utility Room ............................... 22 Potassium Hydroxide (Lye) ............... 62
Operating Room ................................... 23 Re-using Gloves (non-sterile) ........... 64
Operating Tent ...................................... 31 Sterilizing Gloves .................................. 66
Ventilation ............................................... 32 Forms ........................................................ 67
Recovery .................................................. 33 Persecution ............................................. 77
Quarantine / Isolation ......................... 34 Reference Sheets .................................. 78
Food & Kitchen ...................................... 35 Pep Talk .................................................... 85
Restroom ................................................. 39 Supply Lists ............................................. 87
Janitorial .................................................. 40 Survival for the Soul............................. 90
Personal Protection ............................. 41
Why this Book?
Crash Course
In the middle of raw circumstances, you do not have
the luxury of time in explaining to others the why’s
and why-not’s of basic, yet valuable (and often life-
saving) information. This book is a great way to quickly
get people on the same page regarding safe practices
during your situation. Supervision is still recommended.

No Internet Access
When disasters strike, the infrastructure goes down;
the luxury of internet research and comparison is gone.
This book is EMP-proof, requires no batteries, signal,
connection, or charger. Upgrades easily with #2 pencil.

Concise Reference
There are a bajillion books on disasters, first aid,
survival, wilderness experience, etc. - yet often in true
circumstances you don’t have the luxury of time to flip
through a small library trying to find and piece together
the raw data that you need. This digest assembles key
data points on important subjects as a reference guide.
It does not have all the information, though. So, while
the sun is still shining bright, read through that other
stack of books for in-depth information, but keep this
one handy for when the balloon goes up.

Life Happens
Ask the people living in cities affected by civil strife and
chaos (Syria, Iraq, Ukraine, South Sudan, etc.) if they
thought their cities would be without reliable power and
water a few years ago. Life happens; things fall apart.
The more complex a system, the more catastrophically it
can come apart. Foresee the future and live prudently.
ORIENTATION

Where’s the Hospital?!


This guide is compiled to help out in the disaster situations where
medical professionals are available, but the infrastructure is not.
Frequently in the news you will hear of a major catastrophic disaster that cripples most of
a community’s infrastructure, including the medical facilities. For example, after the major
earthquake in Haiti, there was an overwhelming need for medical help, but many of the
buildings were unsafe or out of commission. Even when medical teams were rushed to the scene,
they still had to labor for days without the mobile field hospitals, since those had to be flown into
the area’s only airport - which was not only affected, but also overloaded. While care and aid can
be given under those circumstances, it is very limited, and the patient outcome is not as good as
when the medical teams have some critical facilities.

Improvisation Engineer
Oftentimes, in these scenarios, an Improvisation Engineer will travel with the initial medical
teams to help rig up some of the absolute basics that are essential for effective care. In our case,
we are helping to train you to be the Improvisation Engineer. Your situation and resources will
vary greatly, but this guide can help give you an idea of the essentials that need to be addressed.

1
Common Disaster Medical Injuries to Expect
• Minor musculoskeletal injuries (ankle sprains, etc.)
• Major musculoskeletal injuries (fractures, dislocations, etc.)
• Allergic reactions
• Medication / drug withdrawals / mental health
• Minor open wounds
• Heat stroke
• Burns
• Gastroenteritis, Vomiting, Diarrhea & resulting dehydration
• Dental
• Respiratory infections (bronchitis, influenza, pneumonia, etc.)
• Skin infections, ear infections

Our Goals (and Yours)


• Educate on the importance of a clean, maintained medical facility.
• Help with planning and improvisation for those anticipating natural disasters, political and
economic instability, and those with already-limited access to established medical facilities.
• Provide a detailed look at many of the less glamorous (yet vital) components that contribute to
maximum and efficient use of the facilities, and providing the best environment possible (under
limited conditions) to favor a better medical outcome.
• Provide information on an average lay person’s level so they can contribute toward, and focus
on, facility engineering and maintenance, while allowing medical professionals to focus on
what they do best. Oftentimes right after a major disaster, there is a lot of potential labor
that can quickly help in picking up and cleaning out an area for medical teams to work from.
This needs to be a priority. People will be more likely to pitch in labor if they know it is for the
community good.
• You will probably be more likely to have medical help come (and stay a while) if you have
at least a place that is conducive to them. Likewise, you will be more likely to have medical
professionals from your community (nurses, EMTs, etc.) volunteer portions of their time if they
have an adequate way to use those skills, and they know they are effectively contributing in a
positive way.
• Provide advice for home-level use, as well as a larger community / group use.
• To assist new missionaries to possible outreach ideas, assist those in a long-term duration
disaster events, and to help those already in developing countries provide a higher level of care
with limited resources.
• Prevention is the best medicine; and if you can provide those you assist with a higher level of
proper care, you will save both of you trouble, resources, medicine, time, energy, frustration, and
heartache down the road.

2
DISASTER : NEEDS

Attainable Goals
The particulars of your situation, people, resources, etc. will vary widely. It is up to you
to make the best assessment of your situation, what potential capacity and resources
you have to work with, and then work toward that capacity. You will most likely have to
accomplish it in stages, and with various milestones. Be sure that you properly assess your
genuine situation needs, so your energies and resources are properly directed.
You must also recognize your limits, and not over burden your capacities (resources and
people) by unrealistic expectations. Assess what you can do, and strive to do it well.
Knowing your limitations also means giving realistic expectations to others of what is
possible. Always err on the side of caution in your estimates. You can always over achieve
and increase capacity, but it is demoralizing and dishonest to promise the moon.

Resource Consumption
This chart, though generalized, gives you a concept of the vast resource
needs that different levels require. Part of your responsibility is maintaining
a system that is sustainable for the needed duration. It does little good to
create a large medical setup and then burn through supplies and resources
overnight - unless your particular situation actually requires such.

Start at the Beginning


The scope of this book covers information that could
potentially bring you to the capacity of Stage 6 or 7
(depending on other factors); yet, anyone can
start with Stage 1, and should.

The next two pages are reference guides and checklists to use in your situation. You may want to print extras to have on hand.

IMPROVISATION IMPROVISATION
ENGINEER GUIDE ENGINEER
PRIORITY LIST

3
PORTABLE FACILITIES

Tents
Portable garages can make excellent improvised medical facilities for triage, patient
examination, storage, administration needs, and even operating rooms. Large
family camping tents can also serve a similar purpose if they have enough room to
comfortably stand up in.
Portable facilities gives you more options, especially when pre-planning. With many
of them, you could load what you need for 2-3 tents just on one pickup truck and
deliver to an affected area - or if you have to evacuate an affected area.
Find a smooth and level place to set up in, removing any rocks or pinecones.
If time permits, rake a very thin layer of pine needles (.5”) over the area to help
cushion the tarp and prevent punctures. Old carpet or carpet pads can also make a
good base. Lay down a tarp(s) to make for easy cleanup, and also to keep dust and
dirt down inside. A clean, larger tarp can then be laid down on top of that.

Entry Mats
Gather up old carpet, door mats, large cardboard, etc. to help shed dirt from people’s shoes.
The more the better. Keep in mind people will probably be in a hurry coming in.

Electrical & Safety


Lighting can quickly be rigged up with clamp lights. White interiors will greatly help the light
bounce and create ambient lighting.
Make sure all your overhead lights are secured well. Run a piece of twist-tie wire or zip-tie
through the clamp side looping over what it is secured to. This way, if the structure gets
bumped or shaken, and the clamp loses some of its grip, at least the lamp won’t fall onto
someone or in the middle of something important.
Have all cords well secured to the frame to prevent loose cordage from snagging on someone
or tripping someone up.
Also, in portable facilities such as tents, the possibility for rain leaks and flooding must
always be kept in mind. Keep all connections and power strips up off the floor and away from
potential leak areas.

6
Air Handling
Tents can quickly become extremely hot and stuffy during the summer. During the winter,
their thin sides help them lose heat quickly. While air conditioning would be ideal during the
summer, just having a blower exchange fresh outside air makes a world of difference.
With a medically-minded portable facility, though, we have to keep in mind that we can’t
have the occupants with a large, direct air draft disturbing them and blowing things around,
especially in an area performing minor or major surgery. The solution is to blow air into the
facility in a diffused manner that spreads out the draft.
For our improvised air handling, we cut a hole near the eave of the tent (we made it star-
shaped so we could patch it back together later if we needed to) and secured two duct collars
on either side of the tent end wall. These could also be fashioned out of large tin cans.
We used some salvaged 10” flexible duct for the outside connection to our blower. We
removed the fiberglass insulation since it gets wet and heavy when it rains, but we kept the
mylar outer sheath to protect the flex duct from the sunlight.
A tarp was tucked up under the tent roof to add extra protection to the air duct, pass-
through, and blower equipment.
On the inside, we used the mylar sheath from another section of salvaged flex duct.
These are a few inches larger in diameter than the duct itself, and are also reinforced with
fibers, making it possible to cut small holes without worrying about them ripping larger.
We cut several 2-3 inch sized holes at about a forty-five degree angle. This way they were
not shooting the air out straight down, but angled it to where it would blow on an average
person’s head and upper body without disturbing their work area.
Use straps to secure the diffusion tube, making sure they do not constrict the tube when it
inflates from the air pressure.
See the chapter on Ventilation for more about what this could be hooked up to.

Litter Systems
Using stretchers / litters and litter stands / folding
sawhorses, you can have portability and flexibility.
This is especially important for triage or trauma
situations where patients will be expected to
be brought in straight on the stretchers, and
immediately worked on.
Sturdy, folding metal sawhorses allow you to
quickly expand your capacity. Stretchers are easy to
improvise with just poles and wrapped blankets.

7
Improvised Stretcher
Take two poles (sturdy sticks, flag poles, pipes, fence poles, etc.) Lay them on an
open blanket, dividing the blanket into thirds. Fold the blanket thirds over the poles,
overlapping in the middle. The patient’s weight and friction on the blankets will keep
it from slipping, although you may want to use safety pins or sew it more securely
when time permits.

Transfer Sheet
These are basically a heavy-duty cloth stretcher, with handles. These can be rolled up
and transported easily. Poles can slide in to make it easier if available. There is a strap
in the middle to help secure the patient during transport.
Transfer sheets also come in handy when moving a patient from tight or restricted
areas that a pole version cannot easily get into. Sometimes these are also used for
transferring a patient within a room, from a bed onto an operating table, etc.

Improvised Portable Main Light


Using just a clamp light and a microphone stand, you can have an potable directional light
for surgical situations. Slide one or two 2.5 pound lifting weights around the base to prevent
tip-overs from the stand being top-heavy and slight bumps.
Leaving the microphone holder on gives an extra holder to help secure the clamp light and
keep it from slipping or sliding. Be sure to wire-tie or zip-tie the clamp end securely, and also
keep the cord tied or wrapped to the pole to prevent tripping or snagging.
Having a portable light allows you to quickly move and adjust it according to your available
space, people in the room, and the patient area being worked on. The lamp shade is
important to keep the light glare from blinding the medical workers, and keep it primarily
directing the light to the area of attention.

8
Improvised Scrub Sink
A large shipping crate or Rubbermaid tough box forms a great foundation for a
temporary stand-alone sink. For the basin, use a plastic container large enough to
catch water while easily allowing the user to wash their arms and elbows without
touching the container.
For the water source, easily-sourced water containers with a knob valve can
be perched on milk crates or other boxes to get it to nice height. These water
containers can be swapped out as needed. Use a tie-down strap to keep the setup
secure from accidental bumps or other mishaps. The water container needs to
be slightly forward over the edge to minimize splashing, and allow the user to
navigate more freely under the faucet. You may need a small board under your
water container to extend the lip and keep the container from collapsing under
its weight on the edge. The basin can be easily taken elsewhere and emptied as
needed. If available, a drain hose could be attached to the plastic basin to make
things easier.
A small table nearby holds the soap and other items that the user will frequently
need. In this setup, reusable cloth hand towels are placed on top of the water
container. The white bucket is for the soiled towels once they have been used.
Keep in mind that with plastic tarp flooring, areas around the sink may be slippery
due to water splashing; mop or wipe as needed.

9
STAFFING

If non-medical personnel can keep the infrastructure and facilities running smoothly, then the
medical professionals can be much more efficient in their tasks and efforts. Be sure that everyone
on the team has clearly defined roles and responsibilities; this greatly helps reduce ambiguity, and
things slipping through the cracks. Expect double-duties under the circumstances. Here are some of
the various staff needs (depending on setup, people, situation, etc.):

Administration - makes sure everything works as a whole, and that everyone knows
what they are doing as far as scheduling, training, staff meetings, etc. This can include
patient record receiving and most of the office work.
Maintenance - keeps power, water, sewage, etc. working.
The main Improvisation Engineer, with crew.
Sanitation - OCD (Obsessive Compulsive Disorder) about quality control procedures.
Makes sure facilities are kept clean to the highest level possible. Heads up the disinfection
and sanitizing processes including laundry crew.
Medical Professionals - provide medical care with the collective support of the rest
of the team. Head medic works with Administrator to best balance abilities and needs
without surpassing team capacity.

Depending on your situation, there will be tasks that responsible children and young adults can assist in to help meet the
facility needs and maintenance. These help them feel like they are contributing something in the midst of uncertainty, and also
lessens a lot of the grunt work and minor tasks for the medical professionals. These could include: gathering firewood, tending
fires for boiling water, folding linens, toting water and supplies around camp, conducting routine maintenance checks, keeping
walkways and main areas swept and clear of trash, fixing lunch and patient meals, etc. Just be sure that they know what areas
they should never be in - areas with biohazards (laundry receiving, etc.); always make sure they are supervised and within sight.

10
ADMINISTRATION / OFFICE

This is a dedicated place solely for the routine organizational tasks.


• Record Keeping • Mini-library
• Office Work • Correspondence
• Research • Billing / Services
• Scheduling & Appointments • Supply Requisition
• Printing / Writing Patient • Budget / Cash
Care Instructions • Communications

This may be as simple as a chair and table in a tent; however, organization is


critical when chaos is abundant. A level-headed person who can help keep things
organized will take a large load of concern off of the medical staff.
Any emergency or disaster can quickly create disorganization, loss of efficiency,
overlapping, time loss, and energy loss.
Schedules, clear responsibilities, lists, organization, etc. will all contribute to
increased efficiency, reduced redundancy, and greater use of time and energy.

11
PHARMACY / LAB

The Pharmacy and Lab should be the most secure place in your facility or camp.
Unfortunately, it will be targeted by those with drug addictions, or seeking
items for the black market. The room should be secure from break-in, as well as
resistant from smash-and-grab tactics during day operations. All cabinets, bins,
or containers holding anything of potential value should be lockable. This is a
staff-only area.
This may also be the area where supplies (pharma and herbal) are prepared for
patient treatment and follow up care. Blood and urine tests are conducted on
samples sent here.

Sink Area:
• Work sink for water, hand washing, and cleanup of non-biohazard material only.
• Hand washing instructions posted.
• Paper towels / single-use cloth towels
• Drying racks
• The water should either be clean enough for drinking and medical purposes, or have a
dedicated in-lab countertop ceramic filter for the best water quality.

See our Common Medical Recipes reference in Digest Vol.1.

See suggested Pharmacy / Lab Supplies List in back

12
Specialized Tasks. After instruments have been disinfected and cleaned,
they would probably be prepped here for sterilization.

Water heating ability. This may be accomplished by a variety of means:


hot pot (12v or 120v), hot plate and kettle, sterno/gas and kettle (ventilate well), etc.
This would be for herbal teas, washing utility items, hot compresses, ointments, poultices, etc.

Medical Cooler. Depending on your needs, power, and supplies, you may need a cooler or fridge
for medicines that need to be kept cool (insulin, etc.). Note: the 12 volt coolers will use quite a bit of
energy, and are not efficient. These will only give you a 30-40°F drop in temperature from the room
ambient temperature. For short term, you might have to just use a cooler and ice, insulated very well
with blankets on all sides. Rock salt could be added sparingly to the ice to get longer duration times,
but it will take some experimentation depending on your volume. You could also use single-use cold
packs in a very small cooler as well, if you just have one or two items.

Transferring & the Transfer Case. Many times in these limited situations, the lab and
pharmacy will also double as a clean workroom for assembling and sterilizing surgical packs.
When transporting the sterile packs from here (or clean storage) to the operating room/tent,
they need to be in a clean hard-surface container that is only used for this purpose.
Keep in mind that a lot of man hours and scarce resources are involved in preparing sterile
packs and equipment. Special care must be given to ensure that the sterile work is not
compromised and wasted, resulting in unnecessary work repetition and greater potential
for harm to the patient.
• The container should be large enough to easily hold large packs without compression.
• Metal packs should never be placed on top of paper or cloth wrapped packs.
• Newly sterilized packs should not be handled or used while hot.
• Sterile packs should always be lifted off of storage shelving, not pulled.
• Staff should wash hands before handling any sterilized packs and the transfer container.
• The container should also periodically undergo high-level disinfection by soaking in a
chlorine solution for 20 minutes, then rinsed three times with boiled water, then air dry.

13
Sterilizing
Many items will come from the Soiled Utility Room that have been disinfected, and are ready for sterilization.
In general, disinfected bed linens do not need to be sterilized unless intended for burn victims.

See Disaster Crash Course Digest Vol. 1 for more in-depth discussion on Sterilizing

(this list continues the checklist where the sterilizing procedures, started in the Soiled Utility Room, left off.
See Soiled Utility Room chapter, and reference sheet in the back)
4. STERILIZE (various options)
• Bleach sterilizing solution (separate from disinfecting solution).
• Metal instruments should soak no longer than 30 minutes.
• Alternate: If bleach is not available, boil instruments 20-30 minutes at full boil.
• Alternate: Soak instruments in Isopropanol Alcohol (70% or 91%) (7:1 alcohol to water) for 15 minutes.
• Autoclave

5. DRY:
• All items must be air dried, or dried in an oven.
Towel-drying is prohibited to avoid inadvertently spreading contaminations.

6. STORE
• Label and store properly.

Wrapping Packs
When wrapping surgical packs, instruments, etc. for autoclaving, you may not always have medical
paper wraps, or purpose-made cloth wraps. There are several improvisation options.
• Kraft paper. Large rolls can be found in paint or home improvement stores.
• Newspaper.
• Cloth with a tight weave which allows steam penetration. Duck or canvas should not be used.
• An ideal wrap would be a cloth wrap, then covered by paper.
• Common painters tape (typically blue) can be used as a substitute for sterilization tape.

14
PATIENT RECEIVING / PREP

This area is not the lobby or waiting area; it is a transition area where patients
change into their gowns, and undergo any procedures prior to surgery
or further treatment.
This area can also be a general emergency receiving area, bypassing the typical
lobby and front areas, going almost straight to surgery if need be. It is a second
waiting and staging area.
It is important to have a room or hallway prior to surgery that can serve as a type
of mud-room and air lock, to minimize the operating room being open directly
to the outside air and conditions. Outdoor adverse conditions would include mosquitoes, flies, potential wildfire
smoke, volcanic ash falls, etc. The point is to have a way to keep most of the outdoors - outdoors.
It needs to be able to accommodate a gurney/litter/stretcher and its handlers.
Depending on the scope of your situation, you may need an initial receiving area where triage can be performed.

Extreme Disaster
If conditions such as volcanic ash or fallout are anticipated or encountered, the room should have a filtered air
handler to provide a positive air pressure inside, blowing dust and ash away from the door as people enter.
Compressed air hoses and sprayers may need to be present outside for staff to blow off as much as debris
as possible before entering. The air compression systems will need to be protected and filtered from the
conditions as well. Inside the room, a shop vacuum cleaner could be rigged up to cycle the air, drawing air
from the floor area, filtering it through a fine paper filter (type used when sanding plaster), and blowing back
down on the occupants to further dislodge particles, etc.
Note that most power inverters, in general, do not like the high start load of vacuum cleaners / shop vacs,
and recommend against using them with such.

15
EXAM / CONSULTING ROOM

This room is where general patient consulting, examinations, checkups, and routine treatments take place.
Minor surgeries such as ingrown toenails, stitches, etc. can also take place in these areas.
• The floor should be easy to mop, with baseboards along the walls; mopped (with disinfectant) weekly and as needed.
• The Exam Table should be at least 6’, with a washable surface. A plastic-topped folding table will work well, but you should
reinforce and support the center to handle the heavier patients as well as the constant stress toward the middle.
• A regular table could be covered with a wipeable vinyl cloth if need be. Massage tables also make great examination tables.
If custom-making tables, make the table a few inches higher than normal tables. This makes it easier on the medic instead
of having to hunch over as much.
• A folding exercise mat can make the hard table more comfortable for some patients, especially when lying down;
but cover the mat with a wipeable vinyl cloth / tablecloth.
• Have a sturdy footstool to aid patients (especially younger and elderly) getting onto the table.
• Have a chair or stool (preferably rolling) for the medical provider. Make sure it is easy to wipe down and clean.
• Keep a folding chair handy for the patient’s guardian, spouse, caregiver, translator, etc. when they accompany them.
• For tents, and similar structures, place tarps down on the ground for a clean floor. You may need to place down cardboard,
canvas tarps, old carpet, etc. first as a cushion to prevent the plastic tarps from bunching and tearing as easily.

16
Hand sink with soap and towels (mainly for staff use). Have instructions
readily available regarding proper hand washing.
Alcohol-based hand cleaners could also be here, as well as hand lotion.
Washing your hands several times a day will affect them.
Disposable gloves ready nearby.

A complete and well-stocked First Aid cabinet. The staff should be able to take care
of many minor needs without leaving the room or tent. The cabinet should remain
locked until needed.
Basic consumables (cotton balls, qtips, band-aids, tongue depressors, etc.) can
remain out in the open. Ideal containers for these will open with only one hand.
In a more improvised environment, these supplies should be kept in a container
(Rubbermaid, etc.) with a lid that can keep bugs and vermin out during the night.
During the day, you would remove the covers, and work from them.

Work station: a small table or shelf for the medical provider to write notes on, fill out
records, place items, etc. Make sure a few standard office supplies are available.
Have a trash can for common trash, but have separate receptacles handy for
biohazard waste if need be.

Fans (ceiling, box, 120v, 12v, hand, etc.) can go a long ways toward
making sick patients more at ease, especially when faint. It also
makes things a lot better for the medical personnel and their morale,
especially if there is no air conditioner.

Miscellaneous Items for the Exam / Consulting Room:


• Wall mirror
• Pre-made commonly-used kits (lacerations, sutures, etc.)
• Patient supplies (gowns, etc.)
• Weight scale & measurement for height
• Coat hooks

17
SOILED UTILITY ROOM

The Soiled Utility Room is where all waste is processed and disinfected. Materials used during
surgery and patient treatment are safely handled here, away from clean supplies and areas.

Work Sink
Having a dedicated sink where all soiled material is processed greatly minimizes the occurrence of
cross-contamination. This sink is only to be used for handling soiled material, and not as a source
for drinking water, dishes, etc.

Counter Space
It should have enough counter space to bring in materials from normal operations for processing,
and safely work with them without unnecessary closeness to the soiled items. Have a dedicated
counter area where disinfected items can be placed apart from soiled items. Many times these
items will need to air dry, such as cleaned bed pans.

Shelves
As items are processed and dried (especially larger items such as bedpans and urinals), these can
be stored until ready for further cleaning steps. Also, you will have a number of pans, basins, tubs,
etc. that will need storage space.

Cleaning Supplies
The soiled utility room should have everything it needs to process the soiled
waste. This includes disinfectants, cleaners, protective clothing, hand soaps,
hand towels, etc. Staff should not have to leave the room in the middle of a
process to get something needed.

Adequate Ventilation
Chemicals, noxious odors, and potential contaminates call for this room to be
well ventilated with fresh air for the staff safety, and to prevent them from
also affecting other areas of the medical facility.

18
Soiled Laundry Area
Soiled linens, gowns, garb, etc. take up bulk space so have a dedicated area
that can hold soiled laundry until later disinfecting and processing.

Separate Bins
You will need dedicated containers to separate what needs to be disinfected
from what does not need to be disinfected, as well as regular trash.

Always observe all safety measures when handling waste!


(See guidelines in Janitorial chapter)

What Needs to be Disinfected?


• Used sharps
• Blood and bodily fluids
• Bandages, swabs, and other wastes that carry body
fluids, blood, or feces
• Feces from people with infectious disease (cholera)
• Bedding from all people

In short, any instruments, clothing, bedding, or material


contaminated with bodily fluids, or having been in contact
with an infectious person. Bedding will always have at least
dead skin cells and potentially harmful germs (flora) from
the patient.

What Does Not Need Disinfected?


• Any material not contaminated with blood or body fluids
(paper, cardboard, plastics, glass, metal).
• Feces from healthy people
• Chemicals used in disinfection, laboratory tests, and cleaning
• Disinfecting and cleaning wastewater
• Body parts

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Safe Disinfectant:
Ingredients: Vinegar, Hydrogen Peroxide (3% or 6% (better))
Preparation: Mix equal amounts, and store in a closed container.
Use: Cleaning commonly handled surfaces such as tabletops, railings, chairs, etc.

Bleach Disinfecting Solution:


Ingredients: Bleach, Water
Preparation: Make a 5% bleach solution. Store in container with tight cover, such as a bucket and lid.
The mixture will lose strength, and new mixtures will have to be made each day. Bleach comes in various
strengths. Here are various ratios: For 5% available chlorine, use it straight. For 10% available chlorine,
add 1 part bleach to 1 part water. For 15% available chlorine, add 1 part bleach to 2 parts water.
Use: Items contaminated with blood or body fluids (gauze, cotton, tools, gloves, etc.) are soaked for
a minimum of 10 minutes. Items, such as instruments, that will be reused must be disinfected in this
solution before being washed and cleaned.

Acidic Bleach Disinfectant:


Ingredients: Bleach, Vinegar, Water
Preparation: In a plastic or glass container, mix 1 cup (8oz) bleach and 1.5 gallon water.
Then add 1.5 cups 5% vinegar. Stir with wooden or stainless steel utensil.
Use: Strong surface or area disinfectant. Put in a garden pump sprayer to spray larger areas.
Clean solution off surface after ten minutes, since it is a strong oxidizer.

FYI: A variation of acidic bleach disinfectant is what the CDC used when disinfecting sites affected
by anthrax bioterrorism. Technically, bleach is considered a pesticide. This acidic solution required
professional application, again due to the strong oxidizing power and powerful fumes.
The solution involved 1 part bleach (5.25-6% sodium hypochlorite), 1 part white vinegar, and 8 parts
water. The bleach and an equal amount of water were first combined, then the vinegar added, then
the rest of the water. Treated hard, non-porous surfaces remained in contact with the bleach solution
for 60 minutes. Treated Personal Protective Equipment (PPE) and containers being removed from the
area required only 10 minutes contact time with the bleach solution.
[http://www.epa.gov/pesticides/factsheets/chemicals/bleachfactsheet.html]

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Bleach Bucket / Container
Use a container that has a tight-fitting cover to hold the disinfecting solution (such
as bleach). Ideally, use a smaller inner container with holes (strainer, basket, etc.)
for the disinfected items to be placed into. Make sure the bleach solution fills the
inner container, covering the materials inside of it. You do not have to fill up the large
container with disinfecting solution - just enough to cover the items to be disinfected.
Let soak for the appropriate disinfecting time.
You may want two buckets: one for disposable waste, and one for reusable items.

Making an Inner Container


If you find a plastic bucket that is a perfect size to fit within your larger lidded bucket,
you can drill a number of holes into it to make the inner strainer.
A multi-size (step) drill bit will make cleaner holes in plastic than a regular drill
bit; preferably drill from the inside out, making sure there are no burs left where
contaminates may reside.

Chemical Safety
The chemicals used for disinfecting can be harmful, and should be used with
adequate care and safeguards, in a well-ventilated area.
Wear gloves, safety glasses, face mask, and protective clothing to protect yourself
when handling or disposing of chemicals.
Keep all chemicals clearly labeled, and properly stored. Check frequently for leaks.

Soiled Utility Room Procedures


(See Reference Sheets Section)

See Pharmacy / Lab chapter to continue sterilization steps.

21
CLEAN UTILITY ROOM

Typically, a Clean Utility Room would have a variety of supplies


commonly used, as well as a workspace to assemble and prep
supplies. These rooms would adjoin Operating Rooms, or similar
spaces, so staff does not have to run all the way to the main supply
inventory. It saves valuable space in the operating room by not
having large amounts of all the supplies in the same room, but still
very close at hand.
For our purposes, having a clean storage and work area close
to the needed areas is what is critical.
Your main inventory will probably be secure in another place due to
space. Having nearby supplies will be most apparent if your areas
are in separate tents, portable buildings, containers, etc. and getting
resupply would involve going outside.
In a disaster situation, a large rack of bulk supplies in the same room as the operating room often accomplishes
the same task. Everything needs to be carefully organized, in a certain place, and clearly labeled. If an item is
needed in the middle of an operation, you do not have time to dig around for it in storage.
When it comes time for a surgery, you should have all supplies near at hand to get started
(linens, protective clothing, etc.).

22
OPERATING ROOM

Why Such A Controlled Environment?


Cleanliness is paramount regardless of what type of surgery is being performed;
because any surgery represents that a significant opening is present in the body’s
natural defense - the skin.
The Operating Room (OR) should be the absolute cleanest room or space you can set aside.
Since the procedures in this room involve opening the human body, and performing invasive
techniques during the process, the chance for infection to get straight into the body and critical
organs is much higher than normal. The human skin is a barrier that normally has a host of
flora and organisms (good and bad) living on the outside surface; usually they cannot enter the
body except through the eyes, mouth, nose, other mucous membranes - and cuts and wounds.
Whenever an opening is made in the skin (intentional or otherwise), the risk of infection starts
to dramatically rise, especially if it is a large opening in the skin barrier.
The two greatest sources of infection related to surgery are the patient’s own skin flora
and that of the occupants in the room. This is why seemingly insane care and procedures are
paid to cleanliness and contamination prevention. Most of the precautions are to prevent the
patient’s skin flora and the staff’s skin flora from entering the wound.
This is also why there should be very strict policies to allow only the people who absolutely
need to be there, even when not in use. If possible, patients brought to the medical facility
should be handed off to operating room staff (via gurney) so outsiders do not track and carry
additional material into the room.
The Operating Room time and use is the most expensive resource in any hospital. So many
interdependent services come to play in this one area, with the absolute highest care given to
patient safety and outcome. The greater care and safeguards present in the Operating Room will
drastically contribute to patient health and reduce the danger of serious and deadly infection.
If you do not give the highest level of prevention possible against infection, you can
easily have more casualties due to wound infection than you do from the overall
disaster or greater situation. You will not always be able to do the care that you
would like, but you should know what you should strive for to make the best of it.

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Doors
Whether you are set up in a tent, shipping container, or building, make sure the doors
leading into the room are large enough to accommodate a wheeled gurney or even
two people carrying a stretcher. There needs to be sufficient room to maneuver and get
the patient onto the operating table. Doors, flaps, or hanging plastic tarps need to be
closed to keep outside air and insects to a minimum. Have a way for other staff to see the
progress without opening the doors.

Scrub Station
A dedicated sink used only for hand washing. Make sure the faucet is high
enough that the person can easily scrub and rinse almost their entire arm.
We used a shower extender that allows us to adjust it to the right height, and
direct the spray better. It uses a durable, low-pressure shower head with an easy
adjustable valve on the head to adjust flow and spread; this saves water, but
also gives a good spread from our gravity-fed water line. Unlike modern facilities
with touchless faucets, a staff person will have to operate the faucet for others.

Towels
Whether you use disposable paper towels or reusable cloth hand towels, make sure they are
the cleanest that you can get, and give careful attention that the ones in storage are sealed
in plastic bags or sealed containers until ready for use. If using uniform washcloths as drying
cloths, have a special bin where used cloths are placed. Each cloth is used only one time before
the cloths go through disinfection, laundry, and sterilization. Once dry, they are folded once,
stacked, and bagged. Technically, all towels in the Operating Room should be sterilized.

Lighting
Depending on your circumstances, you need to have some source of strong light overhead,
and preferably directable. This would be in addition to some room lighting as well. In a tent
or limited environment, this can be accomplished by either a staff member holding a strong
flashlight, or use a microphone stand with extension to hold a duct tapped flashlight.
LED bulbs will use less power and battery life; some are more pleasing to the eye than others.
Have spare bulbs handy.
White (or light colored) walls will reflect more light, saving power, and greatly enhancing the
mood of the room. Skylights or translucent roof panels can be great power savers enabling
you to do a lot of work (operations, restock, janitorial, etc.) with minimal light and power use.
Especially on solar power systems, this allows greater power allowance to charge for night
uses and emergency operations (which in a disaster situation will be true).

24
Operating Table
Just like the exam room, the table can be a variety of things, as long as it is easily
cleanable. A washable vinyl cloth may be placed over boards, tables, etc. to give
the needed place.
The primary focus is that the horizontal surface be sturdy, clean, and cleanable.
Even in modern hospitals, every part of the operating table below the horizontal
surface is always considered non-sterile and contaminated (and treated as such).
Have wide straps (velcro, belts, etc.) to gently restrain the patient (without
constricting) and keep them positioned correctly and safely (theirs and yours).
Additional side supports for the arms to be extended may be needed at times.
Keep in mind that sometimes the operating table may just be a stretcher brought
in with a patient already on it, and laid across two sturdy sawhorses. This type of
system is often used in military field hospitals, and is referred to as a litter stretcher
and stand supports.

Instrument Cart(s)
You will need an organized way to find critical instruments, tools, and supplies. A common,
wheeled, tool cart with ball-bearing drawers can work very well. The top also doubles as a
work surface.
Make sure the drawers are clearly labeled for what is in them, with large, legible letters.
Eliminate as much ambiguity as possible.
Have trays and organizers to keep items separate as the cart is rolled around.

Stands
Wheeled laptop podiums and folding trays make efficient and convenient use
for holding supplies near the operating table during surgeries. With laptop
podiums, invest in the tallest ones, not the cheapest (shortest) ones.

On-Hand Supplies
While your supplies may vary depending on availability, try to have at least some of
everything you might possibly need in a surgery or emergency situation. Have labeled, open
containers for important items that allow quick grabbing. Valuable items, hard-to-obtain
medicines, etc. should be kept in a lockable cabinet with restricted access to OR staff only.

25
General Operating Room Principles
To gain a better understanding of the resources needed for the operating room, this list gives you an idea
of the level of attention given to maintaining a clean and largely sterile operating area. If your situation
calls for any type of major surgery, your job as the Improvisation Engineer is to facilitate making this
happen as much as possible. This information is also provided for all assistants who may be drafted to
help the medical professionals if need be. Train those who you think will be assistants, quiz and practice.
• Asepsis: the absence of infectious organisms. Surgical procedures are done in a manner to minimize or
eliminate the patient’s exposure.
• People are a major source of bacteria in the operating suite.
• Sterile Field: the area where the highest level of sterility and avoidance of contamination is present.
This is the zone directly above the horizontal surface of the operating table, and centered around the
surgical site. Only the horizontal surface of the table is considered sterile.
• Only sterile items are used within the surgical field.
• Scrubbed persons should not allow their hands, or any sterile item, to fall below the level of sterile field
or waist level.
• Items of doubtful sterility are considered unsterile.
• Whenever a sterile barrier (drape, gown, etc.) is permeated, it is considered contaminated.
• Surgical gowns are considered sterile in front from shoulder to level of the sterile field, and at the
sleeves to 2” above the elbow cuff.
• The back of the gown is not considered sterile.
• Sterile persons touch only sterile items or areas. Unsterile persons touch only unsterile items or areas.
• Movement within or around a sterile field must not be contaminated. Scrubbed persons should stay
close to the sterile field, and if they must change positions, they must turn face to face or back to back
while maintaining a safe distance between themselves and other people and objects.
• If you think that you have contaminated yourself (gown or glove) tell the circulator and change.
• If someone else tells you that you did contaminate yourself - don’t disagree - change.
• Standard precaution - creation of a neutral zone where instruments are put down in a sterile area and
picked up, rather than passed hand to hand. This can also be done by passing the items on a small tray.
This prevents accidental puncture or stabbing with sharps.
• Avoid handling needles manually.
• Verbally announce when you are transferring a sharp instrument.
• The surgeons will give the team details of the operation to be performed. The Improvisation Engineer
needs to be aware of any particular equipment or resource needs that the operating room personnel
may have.
• One you have your Operating Room established, have checklists to simplify the task of the operating
room personnel when setting up for surgery. In an emergency, you need to make sure a vital task,
resource, or step is not forgotten.

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Scrub Routine & Entering the OR
The scrub process removes as much potential contamination from your skin as possible. This information
is provided for all assistants who may be drafted to help the medical professionals if need be. Train those
who you think will be assistants, and practice.
Pre-Scrub:
• Be wearing scrubs and have your hair covered with cap or bouffant cap.
• Remove jewelry.
• Apply facemask - tie two strings on top of head, and the other two behind neck.
Pinch noseband to assist it in holding mask in position.
• Have shoe covers on, or wrap your shoes in plastic bags.
• Apply protective eyewear.

Scrub (5 minutes):
• Select scrub sponge. Place on sink.
• Wet both hands and arms to elbows with water.
• Wash both hands and arms with antimicrobial soap. Leave soap on to allow germicidal action.
• Use a finger pick to clean fingernails and cuticle beds - under running water.
• Rinse off soap.
• Pick up sponge, and apply soap to hands and arms. Do not rinse soap.
• Scrub one hand for 90 seconds - all spaces.
• Scrub second hand for 90 seconds - all spaces.
• Scrub first arm from wrist to forearm - 30 seconds.
• Scrub second arm from wrist to forearm - 30 seconds.
• Scrub first arm from forearm to elbow (1” above) - 30 seconds.
• Scrub second arm from forearm to elbow (1” above) - 30 seconds.
• Rinse hands and arms.

After Scrub:
• Enter the Operating Room. Do not use your hands to open doors. Use your hips.
• Accept the sterile towel from scrub person and pat dry your hands. Make sure towel only touches your
arms and hands - no other part of you. Bend slightly forward at the waist when using larger towels.
• Scrub staff will present your gown.
• Slide arms through arm sleeves - but not beyond the cuff - keep your hands hidden inside the gown.
Your ungloved hand should never touch the front of the sterile gown. The staff will then tie the inside
and back of your gown.
• They will then glove you.
• You are now ready to enter the sterile field.

27
Operating Room Considerations
• Minimize People Traffic. The OR should be located in an area to minimize unnecessary passing
traffic by people, including staff. Make sure it has adequate access for emergency cases and patient
transport, but generally the area needs to be restricted or distant from people traffic.
• Staff Only. The only exceptions may be family members who are needed to keep the patient calmer
and suppressed, especially if no anesthesia is available. Make sure they wear appropriate protective
clothing, gloves, shoe covers, etc. Keep outsiders at a bare minimum (especially family) as they can
get hysterical if things are not going as they would like. You don’t need more problems.
• No Outside Shoes Allowed. Have designated shoes (flip flops if need be) for OR use. Nothing
from any other area should be tracked in. If need be, use plastic bags over shoes (you should do this
anyway if you do not have disposable shoe covers).
• Filtered Air. The Operating Room must have a way of filtering the air. This alone will dramatically
impact infection rates. If nothing else, try to allocate resources to have a small window AC unit for the
Operating Room, and clean the filter regularly. The cooler temperatures will inhibit microbial growth,
and the unit will somewhat filter the air as it cycles it. Also, with everyone in the Operating Room
wearing full body protective clothing, and the patient draped, it can get very hot in there, running the
risk of heat-related injuries as well, depending on the time of year.
• Do What Is Right. Cultivate an environment conducive to admitting mistakes. Any error should
be able to be owned up to immediately and recognized without reproach as ethically and morally
correct. Anything done in the Operating Room should be always done the best way possible
considering the circumstances. Anyone on the OR team should be confident that at any time mistakes
can be readily addressed and corrected without drama or browbeating. Debriefing, counseling, and
further training can come later. The patient’s best outcome is the mission and goal - not our ego.
• Fire Safety. Depending on your setup and available supplies, keep in mind that the Operating Room
may be an oxygen-rich environment. In addition to that, there are many flammable items such as
drapes, gowns, etc. Any piece of faulty equipment, room wiring, etc. can short out and lead to sparks
and arcing. If oxygen is going to be used, give careful inspection to equipment, cord insulation, etc.
Have multiple fire extinguishers readily available. Make sure everyone knows the fire evacuation
procedures. Typically, in the case of a fire, the anesthetist addresses the source feeding the fire
(oxygen), the surgeon addresses the cause of the fire (cauterizing, etc.), and the nurses address
the fuel for the fire (drapes, gowns, etc.). Practice evacuating a patient during fire drills.
• Cleaning. The OR surfaces must be cleaned with detergent between cases. Any equipment in direct
contact with patients must also be cleaned. Blood and other contaminants on the floor should be
dealt with as soon as possible. Blood is a lot easier to clean up while it is still wet. Do not store items
on the floor, as this will hinder floor cleaning. Floors should be cleaned every day with detergent,
ideally twice (start and end of day). Use lint-free cloths for damp-dusting and cleaning.
Do a complete cleaning of the room every day.
• Organized. Only items that need to be in there should be present. Supplies should be kept minimal
to ensure proper stock rotation. Keep it clutter free to aid in cleaning, and to give the most room to
staff, and also contribute to a less hazardous work area.

28
Surgery Patient Sign-In Checklist
The Improvisation Engineer needs to make sure that this process is made as smooth as possible, in regards
to the staging, traffic flow, and transfer. The purpose of this checklist is to protect the patient from harm.
In an emergency arrival, at least try to get the red bolded information to safeguard against further harm.

Patient Prep:
• Confirm patient identity. Assign identity bracelet.
• Collect as much medical history as possible.
• Make sure potential tests and checks are complete.
• Make sure the patient has been properly assessed.
• Inform the patient of the transfer and help put them at ease.

Operating Room:
• Safe transfer to operating table.
• Confirm operative site with patient and notes.
• Visually check for surgeon’s mark at the correct site [Mark made by surgeon prior in patient prep].
• Check patient understands and agrees to the procedure. Act in the best interests of the patient when
they do not have the capacity to make the decision for themselves.
• Be sure consent paperwork is complete, correct, signed and dated.
• Allergies noted on a separate bracelet.
• Check if prescribed pre-medication has been given.
• Confirm time when patient last ate or drank.
• Check if patient has: dentures, loose teeth/caps/crowns, hearing aids, glasses/contacts, pacemaker/
defibrillator, prosthetic implants.
• Make sure documentation is with patient, including: medical and nursing notes, test results, x-rays,
prescription chart.
• Remove jewelry and body piercings.
• Treat patient as an individual. Their particular needs and medical history may affect their care
(transfer techniques, medical history, anesthesia, etc.) Be aware of individual needs.

• Patient is now handed over to Anesthesia, if available.


• TIME OUT. Final confirmation of patient identity, operative site, and procedure to be performed.

Post-Surgery:
• All sharp items removed. Disposable material discarded.
• Transfer patient. Operating room staff must give anesthetist and team required support.
• Final briefing.
• Intermediate or final room cleaning.

29
Draping the Patient
The patient and surfaces in the operating room are covered with sterile drapes as a barrier to protect
the exposed tissue from contamination. The drapes also serve to protect the surgical team from
contamination originating from the patient (body fluids, etc.).
• Cover the operating table.
• Cover the stands.
• Cover the patient’s non-surgical areas.
• Use 4 drape towels to outline the operating site. Secure with towel clips or tape.

Material Guidelines: For the Improvisation Engineer, care must be given to the selection of drape
material, and their preparation for use in the operating room.
• Sterile. In a disaster situation, very clean or near-sterile will suffice. For example, plastic table liners
sealed in original plastic, trash bags straight from their clean packaging, etc.
• Be as lint-free as possible.
• Resist tearing whether wet or dry.
• Must act as an effective, fluid-resistant barrier
(preventing strike-through contamination) - even when wet.

Draping Guidelines:
• The patient’s skin should be dry (after antiseptic solution application to incision site) before draping.
• Avoid excess handling of drapes.
• Always drape sterile to non-sterile.
• Use distance from your gown and the non-sterile table when draping.
• Cuff the drape over sterile gloves to avoid contact with patient or non-sterile surfaces when placing.
• Hold drapes high enough to avoid non-sterile touch.
• Never adjust a drape once placed.
• Sterile surgical team members must not come into contact with the contaminated undersurface of the
drape that has come into contact with a non-sterile surface.
• The portion of the drape hanging below the edge (operating table, back table, prep table) is considered
non-sterile. Repositioning the drape can bring the non-sterile portion of the drape into the sterile field,
causing contamination.

Improvised Portable Suction Pump


A small battery-powered air mattress inflator/deflator can make a gentle wound
and surgery suction pump. A wide-mouth canning jar with plastic freezer lid can be
converted to the receptacle, or regular disposable ones can be used. This pump runs off of
C batteries, and should only be run for increments of 10 minutes at a time. For light work
and fluids, this can gently slurp up fluids with corn syrup-consistency (in our tests).
Research and brainstorm other possible pump ideas that will suit your particular needs.

30
OPERATION THEATRE TENT

Unless you have a specific disaster that you have foreseen coming, and have adequately set up a capable medical
facility, you will not have much time to set one up from scratch. However, in humanitarian relief efforts, or even
military operations, mobile tent versions (illustration below) are set up to accomplish the same tasks.
You could quickly set up something similar to these to accomplish the same thing. Note that the traffic flow and
arrangement is different, due to the confines and environment.
Because these are set up to quickly process a large and constant number of seriously wounded, certain protocols
that would be followed under a serene, scheduled surgery are now set aside for expediency. Know what the high
levels and protocols of care should be, and strive to provide as much of it as you can under your circumstances.
Note that the Patient Prep Room, the Clean Utility Room, and the Soiled Utility Room are incorporated along
with the Operating Room in one tent or area. Even though they are close, they still retain some of their distinct
areas and barriers.

31
VENTILATION

While this may not be possible in your disaster situation, you should endeavor to keep outside air
pollutants (smoke, ash, dust, pollen, etc.) from being pumped into the operating room if at all possible.
The link between air quality and surgical-site infection is well established.
• Compensate for Intake. If using a cloth cover, standard filter, or other means to aid in filtering
the air, keep in mind that they will drastically cut down the air flow; you may have to make a boxed
opening at least twice the size of your air intake to double the opening due to the decreased intake
from the cloth.
• Clear the Air. The ventilation should remove, contain/dilute specific contaminants and fumes,
isolate contaminated air of one area from another, and flow from clean to a less clean area.
• Pressure. Ideally, you should have enough air pressure to prevent contaminates (dust, ash,
bugs, etc.) from entering the room even when the doors are fully open.
• Downward. The airflow should accomplish downward displacement, but also not disturb
the operating table contents and supplies.
• Monitor. Be aware of the room’s temperature and humidity if possible.

Improvised Air Handler


Supplies: Filter (20x25x4 3M Allergen Reduction filter 1550), old shipping crate with opening close in size to filter,
Harbor Freight 8” blower, small camping tent, aluminum tape, old 8” flex duct, 8” duct collars.

Scrub and clean crate (or Use aluminum tape to secure


similar size box). Disinfect filter to box opening, and seal all
from mold, mildew, etc. openings around filter. Be sure to
Remove doors. Cut 8” have extra filters and tape on hand
opening in side. for future filter changes.

Remove insulation from flex duct (if desired).


Remove grills from blower; use grill screws to
hold duct collars in place on either end. Use
tape to secure and seal duct collars to blower.
Slide flex duct on exit end of blower. Slide Place system in tent, making a hole
intake side duct collar into filter box. Test air for flex duct and cord. The tent
intake and draw. If your blower needs more screens serve to pre-filter bugs,
intake, connect another filter box in a daisy large dust, leaves, etc. The tent can
chain via duct collar (or large can, tin, etc.). also serve to protect from rain.

32
RECOVERY

Depending on your setup, you may have two post-operative recovery areas. The first area would be very close to the operating
room where the patient will be observed as they come out from anesthesia, looking for any complications from surgery or the
anesthesia that needs to be immediately addressed.
Once those concerns are satisfied, the patient can be moved to a more general recovery and care environment, depending on
their particular needs. In a disaster situation you most likely will not be able to give much long term care, but certain patients
will need more attention till their family or loved ones can take care of them or take them home.
The patient needs will vary, but (for forward planning purposes) cots, blankets, bedding, pillows, drinking containers, will go a
long way toward making them comfortable. Some patients may need several pillows to prop themselves up, or to elevate limbs,
etc. Other needs would include water and basins for sponge baths, access to bedside toilets or a restroom. Waterproof mattress
and pillow covers will help cut down on laundry.

• Use lounge chairs for patient beds, especially for patients needing slight elevation.
• Curtains help give patients a measure of dignity and also help relieve the stress and anxiety.
Keep the curtains well off the floor to allow for easy mopping. Opaque shower cloth curtains can
be used if need be, strung on a tight rope.
• Foldable vinyl-covered exercise mats make for easier resting and cleaning.
• In a tent environment, hanging cloth closet cubbies allow you to easily add off-the-floor
shelving for patient personal belongings, and their frequently needed supplies such as pads,
dressings, etc. These cubbies can be washed, and even trimmed shorter if needed.

33
QUARANTINE / ISOLATION
There are different times when patients have contagious diseases that could potentially affect others, and they need isolated
care and precautions. A pandemic flu would certainly qualify for needing isolation. Other times, a patient may have a
compromised immune system and need to be kept away from others until they fully recover.
An isolation room / tent should be minimally furnished. Keep in mind that all items in the room will need to be cleaned and
disinfected afterwards. An attached bathroom, or medical toilet will be desirable. Ideally, an anteroom (small room before their
room) would be useful, but not always available depending on your circumstances. Organization and attention to detail are
important to getting the maximum benefit from the isolation or quarantine condition; checklists will greatly help.

Suggested Supplies for Sick Room Suggested Guidelines


• Bed; mattress sealed in a waterproof cover • All items leaving the patient’s room should be
• Multiple sets of linens (fitted sheet, flat sheets, considered as having germs. Wash in hot, soapy
blankets, pillow cases, draw sheets, waterproof pads) water. Disinfect with a 10% bleach solution, or other
• Multiple pillows (6), each with plastic protectors disinfectant.
• Small trash can or bucket, with plenty of trash can liners • All trash should be bagged and closed before leaving
• Water pitcher / jug the room.
• Water basin • Use disposable dishes and utensils; bag in room.
• Small bucket or container for vomit • All linens should be gently bagged and closed before
• Large plastic tote or plastic laundry basket, with leaving. Shaking out the linens may mobilize germs in
appropriately-sized large plastic bags. Soiled linens the air. Wash in hot water and disinfect.
and clothing are bagged up before being washed. • Disinfect bathroom faucets, sink, and toilet
• Tissues after patient use.
• Hospital gowns • Elevate the bed on blocks or risers to a more
• Body wash comfortable height for the caregiver.
• Air freshener (not strong) • Disinfect the reusable gloves. Remove them
• Baby wipes in the room. Wash your hands afterwards.
• Hand / skin lotion • If you have an anteroom, have a trash can (with liner) to
• Talcum powder receive your disposable items (gloves, shoe covers, etc.).
• Drinking straws (for weak patients) • Keep door to sick room closed. Limit close contact with
• Bell / walkie-talkies to call for assistance the patient and others.
• Hand sanitizer (for patient) • When working with the patient in close contact, have
• Thermometer the patient wear a mask as well.
• Aprons / smocks / raincoat • Do not tuck the sheet and blanket under the mattress.
• Hair cover • Avoid frequent trips to and from the room. Plan ahead
• Shoe covers / small trash bags for what you will need, and what you might need.
• Reusable latex cleaning gloves • In the anteroom: trash bags from the patient’s room
• Disposable latex / nitrile gloves should be place within another bag, along with your
• N95 respirator masks. Use these when patient is disposable gloves, shoe covers, mask, hair cover - and
coughing or sneezing, and creating aerosols. then the bag closed up.
• Dedicated over-the-counter medications • Take notes and a simple record of pertinent information.
• Flashlight, with extra batteries This is useful if another caregiver assists or takes over.
• Pre-assembled kits / bags with supplies
to be used in the particular situation.

34
FOOD & KITCHEN

Consider your kitchen one of your key gateways; this can either spread disease
the fastest in your camp, or it can seriously prevent its spread. Disaster kitchen
responsibility is not “camping-cooking” - it must be given serious OCD to numerous details.
A “camping-cooking” mentality is guaranteed to give food safety lapses. It needs to be
overseen by someone familiar with food safety, food contamination, and preferably familiar
with food service and safety. A restaurant manager, or someone experienced in food service,
would be a great asset, especially in a volume setting. Many times classes on food safety are
All utensils and dishes must be taught by your community extension office.
sanitized between uses
Having a proper kitchen with clean water, surfaces, and means to cook will drastically
contribute to preventing disease and illness among your staff and patients.
Part of easing the work load, responsibilities, and worries by the medical professionals is
to be able to safely prepare needed meals, drinks, and comfort food in a safe manner. In a
disaster situation it doesn’t take much to get sick merely from improper and unclean food
preparation. The last thing you need is for the staff to get debilitatingly sick or constantly
worry about their drinking water and food.
Secondly, as part of your disaster medical care services, you will many times need to
All work surfaces and prepare nourishing drinks and soups for those suffering from malnutrition, dehydration,
tabletops and must be baby and infant needs, or special meals for recovering patients who need light and simple
sanitized regularly nourishment.

See the Washing Dishes Post-Disaster tutorial, Disaster Crash Course Digest Vol. 1

This basic kitchen setup provided: 1) convenient handwash station, 2) clean work surfaces,
3) multi-step dish washing, 4) clean water, 5) solar hot water, 6) sanitizing solutions, 7) air dry space.

“...they found an Egyptian in the field ...and gave him bread, and he did eat; and they made him drink water;
And they gave him a piece of a cake of figs, and two clusters of raisins: and when he had eaten, his spirit came
again to him: for he had eaten no bread, nor drunk any water, three days and three nights ...my master left me,
because three days agone I fell sick.” - I Samuel 30:11-13

35
“And he put them all out, and took her by the hand, and called, saying, Maid, arise.
And her spirit came again, and she arose straightway: and he commanded to give her meat.”
Luke 8:54-55

Improvised Stoves
Stacked cinder block, rubble, or rocks can quickly make little stoves for heating water, soup,
laundry water, keeping cleaning water hot, etc. Having a L-shaped stovepipe inside (like a
rocket stove) can make more directed and efficient use of wood or charcoal. Multiple stoves
or heating spots can be added and scaled up. Note the use of blocks to help keep the fire heat
near and around the pot. The pot rests on two bricks so the pot does not impede air movement.
In my rocket-stoves, I like to start a small fire in the bottom, then when that is good and hot,
move the pot out of the way, and add larger pieces of firewood that I’ve split. This gives a
longer burn time so I’m not having to constantly feed the fire with smaller sticks. Every now
and then, use a poker below to make sure coals and ash are not blocking the airway.
You may want one stove more suited to heating smaller pots (for cooking foods), and a larger
firebox for heating large amounts of water or food.

Waste Water
Kitchen water from the handwash station or rinse steps can be considered Gray Water, and
could possibly be used elsewhere (laundry pre-rinse, disinfecting tubs, etc.) if water is scarce.
Water that has organic material in it (food residue, etc.) should be considered Trash Water,
and should be disposed of properly, at least away from camp.
Have any intermediate storage buckets clearly labeled to avoid confusion and misplacement.
Also, keep the containers lidded to avoid attracting flys and bugs. Empty containers daily.

Solar Hot Water


Depending on your setup, you could place a black water hose on your roof, and run it into the
kitchen area, with an inline valve and garden sprayer head at the service end.
You could have the water line gravity fed from a nearby bucket that can be easily refilled as
needed, or have the hose connected to your main water tank or source.
The hot water makes it much easier to remove grease from the dishes and utensils, as well as
providing a mild sanitizing effect if very hot. It also makes washing dishes in colder climates
much more tolerable.

36
Kitchen/Food Safety Guidelines
While this list is not all encompassing, it does provide many of the safeguards that you should practice at all times with food, especially in a disaster
situation. It is highly recommended that you research your state’s health department food safety guidelines for more compressive overview. Post this
page in your kitchen for reference.

• All kitchen staff must wash their hands with soap and water before handing food, and after possible contamination.
• Food must be protected from sun, dust, and flies.
• No animals in kitchen area.
• Anyone recently experiencing diarrhoea, has an infected cut, or has a disease that can be transmitted through food
(cold, flu, etc.) is prohibited from entering the kitchen or preparing food.
• Uneaten portions of food, and other kitchen waste, is to be disposed of quickly - in separate areas from medical waste
to prevent human or animal scavenging.
• Kitchen utensils should at least be cleaned and boiled for disinfection after each meal.
• When possible, kitchen solid waste should be buried or incinerated. Kitchen waste water should be emptied into a pit.
• Ice for consumption must be separated from ice used for other purposes (chilling food, etc.).
• Food must be kept below 45°F, or above 140°F at all times. Rapid bacteria incubation and growth can occur between
those ranges. When storing hot foods, cool them down as quickly as possible beforehand (immerse pot in cool water, etc.).
• All water containers should be boiled or scalded each week.
• Crock pots, steam tables, and other hot holding devices are not a safe means for reheating chilled food. Too much time allows
for rapid multiplication of bacteria that causes food poisoning. You should use reheating methods (grill, stove, etc.) that can
bring the entire food temperature up to at least 165°F within 30 minutes.
• Hot foods for serving should be maintained at 140°F and above.
• If possible, in a large camp, maintain a supply of boiling water for immediately washing dishes and utensils.
• A bleach sanitizing solution (no soap) and cloths should be used to wipe down counters and table tops. The cloths should be
rinsed in the solution frequently, and not used for any other purpose. Typical solution: 1 capful bleach to 1 gal cool water.
Coolers & Containers
Coolers can make great food storage containers, even when ice is not available. Keep them
well in the shade, and they can be used to keep food stuffs safer from insects and vermin.
Other containers, such as Rubbermaids, with lids, can serve a similar purpose. In winter
conditions, coolers can be used to help keep certain items from freezing.

See the Keeping Food Cool tutorial, Disaster Crash Course Digest Vol. 1

Washing Hands
The kitchen needs to have a convenient place and way for the staff to wash their hands.
This station is only for the kitchen staff.
• Very easy to use; it should not be a hassle, or it may get skipped.
• Individual hand cloths for drying of hands available (disposable paper, or single-use cloth).
• Have a nearby trash receptacle or linen bin for the hand cloths.
• Best health practice is to use your hand cloth to turn off the water once you have dried your
hands. This prevents your clean hands from being contaminated by the faucet.
• Liquid soap in a dispenser. Foaming dispensers will cut down on soap waste. These can
be refilled by adding filling them a quarter of the way with dish soap, and adding water.
Optional: adding a half drop of green and yellow food coloring to the soap will make the
container more visible and appealing.
• Having hand lotion available is recommended.
• Hands must be washed after handling raw meat.
• Wash hands before and after using gloves.
• There should be another handwash station available for those using a dinner area.

38
RESTROOM

A restroom should be accessible, with as many handicap considerations as possible.


Remember that even a healthy person can be temporarily handicapped by illness or injury.
That person may one day be you.

• If possible, separate restrooms for staff and patients can contribute toward the staff
staying healthier and morale.
• In a planned facility, an RV-style toilet (shown) can save a lot of water, but they will take
more effort to clean. This may be a better solution for the staff restroom.
• If you expect any significant volume of patients, possibly have an exterior restroom /
outhouse to reduce the loads and use of the in-building restrooms.
• Keep in mind that some sick patients may spend quite a while in there.
• The restroom will also provide privacy for urine samples and other tests.
• While a flushable toilet does use a lot of water, it can also provide the cleanest way of
disposing of bodily fluids, especially diarrhea, vomit, bedpan contents, etc.
• The latrine / outhouse / restroom should be far away from your kitchen area.
• Keep the area and equipment free from flies.
• Buckets / bedpans / bedside toilets for waste should be emptied regularly and kept lidded
to avoid flies. Bedpans can be emptied into lidded buckets with sawdust temporarily.
• Do not use bleach or formaldehyde for odor control in the outhouse / trench / etc.
It will interfere with the biological breakdown of sewage.
• Do not pour chlorine bleach into outhouses / porta-potties, etc. It will chemically react
with the ammonia in the urine.
• Wood ash, sawdust, or lime can be sprinkled over waste in outhouses / latrines
to control odors and reduce flies.

39
JANITORIAL

If you can keep your facility clean, water clean, food areas clean, and bathrooms clean,
you can do more to keep people healthy than a physician can do during a disaster situation.
Maintaining a clean environment will be the significant difference between contributing toward a
patient’s well-being - or making it worse. Not only does it contribute toward the staff’s health and safety,
but it also magnifies the efforts and aid provided.
Because of the attention-to-detail required to keep the entire medical system working well, the staff
and assistants need serious OCD and as many resources as possible to accomplish their task. While your
situation may not allow for all that you would like, those in charge of janitorial and sanitation should not
have the excuse to cut corners if resources are available. The janitorial staff should always ask what is the
highest level of cleaning that can be provided, and strive to provide it.
The job of the janitorial and sanitation staff is just as important as the medical providers. If it is not
done right, it can undo a lot of the good that the medics labored for, and can contribute to a even worse
condition than they started with. The cleaning staff needs to be constantly open to special needs and
criteria that the medical professionals need accomplished.
• Mopping. Mops should be marked, and only used in their designated area to prevent cross-
contamination. The mop heads should be laundered and turned upright for proper air drying. Have
multiple mop heads available if possible. Buckets should be emptied, washed, and stored upside-down
after use.
• Detergents. While your situation may severely limit what is available, floor cleaners with Pine Oil
(Pine Sol) can be used for disinfecting floors, and are more commonly available. Lysol Concentrate
would be another option. Make sure any container has instructions for disinfecting floors and follow
accordingly (usually requiring 10 minutes contact time).
• Surgical Suite. The Operating Room, related Utility rooms, Patient Prep areas, and Scrub area, should
be cleaned daily, including mopping the rooms twice (start and end of day).
• Trash. Medical care waste must be disposed of in a way that prevents people from accidentally
being exposed to the contents - now or some time in the future. In many disaster situations, you will
have to dig a deep hole and accumulate it there with alternating layers of dirt. Be sure the site is not
conducive to scavenging animals or vermin. Always carry trash bags away from your body to prevent
contamination or accidental puncture by sharp objects within the trash. Medical care waste can be
safely stored for short durations until final disposal is possible.
Trash storage in moderate climates: 3 days in winter and 2 days in summer.
Trash storage in warm climates: 2 days during cool season, and 1 day during hot season.
• Safety. The materials you are working with will usually constitute biohazard (blood, bodily fluids, etc.).
Depending on the task, you must wear appropriate protective clothing (gown/apron, masks, gloves,
cap/bouffant, safety goggles, etc.). After each task or shift these must be cleaned for the next person
or series of tasks. Always evaluate the tasks to be completed, examine the potential risks, and protect
yourself accordingly. Proper training for all assistants is paramount to keeping the safety equipment
clean and serving its purpose.

See suggested Janitorial Supplies List in back

40
PERSONAL PROTECTION

Working in a medical environment exposes many of the staff to situations


involving potential contamination. Whether one is a caregiver, laundry
staff, or sanitation engineer, the risks are great and demand constant
attention to proper personal safety, and the safety of others.
The configurations shown below are average levels of protection;
the specific needs or situations may involve less or more of the kit.

Regular Involved
Supplies: Supplies:
• Goggles (not always needed) • Goggles (not always needed)
• Mask (not always needed) • Mask (not always needed)
• Reusable Gloves • Reusable Elbow-length Gloves
• Water-resistant/proof Apron • Water-resistant/proof Apron

Typical Usage: Typical Usage:


• Soiled Utility Room • Certain janitorial
• Certain janitorial • Tasks involving handling
• Tasks involving minor potential of grossly contaminated
splashing and/or contact with materials (linens, volume
minor contaminated materials/ body fluids, etc.)
surfaces

Patient Higher Risk


Supplies: Supplies:
• Bouffant Cap • Bouffant Cap or Tyvek Hood
• Mask (various) • Goggles
• Barrier Gown • Mask (various)
• Gloves • Tyvek suit
• Shoe Covers • Gloves
• Rubber Boots / Tyvek Shoe Covers
Typical Usage:
• Patient care when prevention Typical Usage:
of introducing contaminates • Risk from highly contagious
to the patient, or when pathogens via body fluid contact.
preventing contamination • Additional configurations
from patient to caregiver. depending on severity of
• Tasks involving negligible risk contagion and means of
of mobilized fluids. transmission.

41
Eye Protection
Contamination from body fluids can happen when liquids are splashed,
squirted, or aerosoled toward the eyes. While for most caregiver tasks, this risk
is low, sometimes a particular treatment or care may involve recognized fluid
mobilization risks (projectile vomit, watery diarrhea, major hemorrhaging, etc.)
that warrant appropriate eye protection. A face shield provides greater facial
protection and increased vision. The overall key is to prevent contaminated fluids
from reaching the eyes.

In certain situations involving potential high-risk fluid contamination


or contact, all seams, zippers, and openings should be sealed with duct
tape to prevent fluid seepage and cross-through contamination.

Improvised Barrier Gowns


For situations where water-resistant aprons are not available,
trash bags can be used for similar minor tasks. For fuller
protection, individual bags could also be used for the arms. Improvised Caps
Elbow-length gloves could also make them more complete. Vinyl shower caps can cheaply
Note: wearing the trash bags will get warm, and they will substitute for disposable bouffant
retain user moisture; moderate air holes in the back side will caps. Depending on the type, these
help air flow. could be disinfected and reused.
Due to the tight folds, it would be
best to disinfect these in their own
batch, and agitate the solution to
ensure proper coverage.

Improvised Shoe Covers


Regular shopping bags or small trash bags can be
easily donned over outside shoes. Tie behind the
ankle. A container with these bags could be available
30 gallon 42 gallon outside key areas to avoid people tracking in dirt or
household heavy-duty contractor contaminates from other areas.
trash bag trash bag

42
PERSONNEL

The people on your team are just that - people. In a disaster situation many stresses will be weighing on
individuals. Frustrations about uncertainties, personal loss, property loss, status loss, control loss - compounded by
the roller coaster of emotions working in a medical setting can quickly burn out both the hardened and the best.
Your staff will need time and place to vent some of their frustrations, have some quiet time, pray, get away from
patients - and many times simply cry. If you do not make a regular practice of getting apart from the chaos and
getting a breather, then you will come apart - and possibly hard and at the worst moment.
Recognize the limits of your team’s professional and personal capacity and well-being. You can’t adequately help
others if you aren’t in a healthy condition yourself. Set mandatory breaks. Be flexible enough to reschedule if a
team member is barely holding it together and needs some time. Don’t make them feel guilty about taking a
break, crying, or taking a few minutes alone. They need it, and you will need it.
Pamper your staff. This will be hard during a disaster situation, but keep in mind that they are being pushed
beyond their capabilities, and will feel many frustrations from not being able to help people in a way that they
know is possible, or that just all seems senseless and hopeless at times. Make sure you do all you can to provide
them conditions for a restful and rejuvenating sleep: small fan, cot, mosquito net, portable music player, privacy,
security, etc. Little things like coffee, candy, personal hygiene items, prayer, cards, etc. can go a long way toward
boosting morale in trying times.

Stress
• It is quite normal for people (survivors and responders) to experience strong emotional aftershocks or physical
reactions after an horrible event. These have the potential to interfere with your ability to function normally.
• A stress reaction is not a sign of weakness; always be understanding and supportive of the person.
• Do not disregard it. Do not call their emotions into question (“You have no right to feel that way...”),
nor try to minimize them (“It’s not as serious as all that...“).
• Listen carefully to them; many times they just need someone to hear them. Talking is very therapeutic.
• Avoid numbing the stress and pain with substance abuse (drugs, alcohol) at all costs
• Do not make major life changes during times of stress

Stress Management
• Get enough sleep
• Get enough to eat and drink - even when you don’t feel like it
• Do some light exercise or stretching
• Spend time with others - sometimes even when you don’t want to
• Vary the type of tasks that you are doing
• Focus on what you did well
• Support and encourage a coworker. Make sure they are eating and drinking like they should, and taking breaks
• Do not take things personally - others will be stressed as well.
Recognize the expression of their frustration, guilt, or worry.
• Give coworkers recognition and appreciation for a job well done.
• Force yourself to take a break when your stamina and patience start wearing thin.
• Keep a journal; write your way through sleepless hours

43
SUSTAINABILITY
The scope of your disaster will alter how much you need to focus on being able to continue for as long as possible with little
or no chance of quality resupply of vital materials. There are a number of things that can be obtained even in war or strife
situations, mainly from the surrounding populace. However, in any dire situation, goods will become scare either through lack
of resupply or people storing up due to anticipated times of scarcity.
Evaluate your situation, or potential situation, and try to get an idea of what supplies and methods you will need to make
reusable, and which ones you might be able to get resupplies for. Many times, this also takes into account your location and
access to various networks, groups, and nationalities.
Have a running list of items that you absolutely must have (critical medicines, filters, instruments, etc.), which items would be
very nice to have, what would be convenient to have, and also what you have that other might want in the way of trade.
Keep in mind that some items that are reusable have additional work (disinfecting, laundry, etc.) and quality control to get
them usable again (cloth towels vs. paper towels, cloth gowns vs. disposable gowns, etc.).

Brainstorm & Evaluate


Evaluate what your greatest needs will be, and whether you should invest your time and resources going one way or the other.
For forward planning, it is always best to have a batch of disposables on hand for the surge that comes at the beginning of a
disaster, when you are stretched thin on a variety of fronts. Less work, more focus.
Some situations, needs, or problems are better solved by heading them off by Prevention, instead of trying to mop up
afterwards. For example, many health conditions are a result of poor sanitation and unclean water. Instead of trying to focus
mainly on treating the results, spend time and resources to correct what is causing the problems. Brainstorm on what would
normally be used to mitigate later problems. Once a solution is considered, evaluate whether disposable or reusables would be
better for your situation, or available at all. Sometimes, a disposable solution may be best, but you may have to brainstorm on
an alternative form of it, if the certain disposable is not readily available.

Example 1: Prevention: providing clean, easy-to-use hand washing stations would greatly improve sanitary
conditions, and reduce disease spread. Disposable paper hand towels are not available. Reusable cloths
could be used. Problem: no access to bulk wash cloths. Alternative: cut up clean second-hand clothing.

Example 2: Unavoidable: we need to disinfect patient linens. Disposable/resupply purchases of bleach are
extremely limited and remote. Invest some time to create reusable/renewable bleach generator.
As a close fallback, we have the Alternative of limited Lysol Concentrate supplies, or boiling the linens.

44
SEWAGE

Warning:
Under disaster situations, human waste will be the greatest danger to your health,
and practically always contains the germs of transmissible diseases.

City Septic
Usually in a disaster of large enough scope to render your local hospitals unfit, the water treatment and septic mains will also
not be functional. The septic mains may also backflow as people try to dump their waste into the lines anyway.

Septic Tank
Depending on your disaster, you might be able to dispose of your black water (toilet use, water containing medical waste, etc.)
in a manner that breaks it down over time and leaches it underground. This would be a short-term solution. Depending on your
water use volume, you might overwhelm smaller septic tanks.

Transport
In some situations, there may be locals who normally pump septic tanks, and who can transport the waste elsewhere.
This would only be a viable solution if you have a holding or septic tank.

Covered Leach Pit


Temporary. Dig a large hole in the ground, far away from any water sources and also away from your facilities. Cover/fence it
sufficiently to prevent people from falling in. Discharge your black water here, allowing it to leach into the ground.

Open Pond
Not ideal. Depending on your situation, you may just have to dig a large shallow pond where the waste water can be diverted
to. Make sure it is in a place that will receive full sun all day. The sunlight will help quickly break down the waste. Construct it
as far as your piping will allow, since it will not smell great.

Grey Water
Because of the health concerns, there will be little water that will be reusable in a medical clinic setting. Grey water should
always be used the same day that it is generated to prevent it getting stagnant and creating health concerns. Because of the
potential for contamination, do not use grey water from this type of facility for growing food, gardens, fruit trees, dishes, etc.
Some limited options would be using laundry water for flush toilet water, mopping floors, water for disinfection buckets, etc.

“...Thou shalt have a place also without the camp, whither thou shalt go forth abroad:
And thou shalt have a paddle upon thy weapon; and it shall be, when thou wilt ease thyself
abroad, thou shalt dig therewith, and shalt turn back and cover that which cometh from thee...”
Deuteronomy 23:12-13

45
POWER SYSTEM

In a disaster situation, one of your greatest electrical needs will be


adequate lighting - not only in surgery, but also to safely navigate
the camp and perform tasks after sunset. Also, you may need lights
during the day, especially if set up in a shipping container, basement,
dark building, trailer, etc. Your second largest power need may be
air movement (fans, blowers, etc.) to keep things cooler during the
summer, or circulate warm air during the winter.

Generators
These are generally procurable during a moderate disaster (hurricane), but may
be almost impossible during a catastrophic disaster (tsunami aftermath, Haiti
earthquake, etc.). The advantage of a generator is that it can produce significant
amounts of power for equipment (depending on size of generator) including high
load items such as refrigerators and air conditioners. The downside is that they
can use quite a bit of fuel, which is often scarce during said disasters. They are also
noisy, and can draw unwanted attention. Propane generators are significantly
quieter and unobtrusive; though, propane may be harder to obtain than gasoline.
All generators would need to be chained down and kept in a secure outdoor area,
and away from living quarters and people (due to carbon monoxide). The fuel
would also need significant attention to safety and theft concerns. Definitely read
up on proper ways to handle and store volatile fuels such as gasoline.

46
Solar Power
The ability to have relatively free power definitely makes it
a plus when resources and fuels are scarce. Oftentimes, even
small solar panels can recharge batteries, laptops, etc. and
provide for basic power needs. There are different ways and
styles of rigging up a temporary solar power system. Much
more could be said about solar power, so definitely do your
research; but, here are some of the basic supplies:

Solar Panels - these come in a variety of sizes, and convert the


Solar panels feeds into charge
direct sunlight into small amounts of power. The more panels
controller (upper left), which you have, the greater collective amount of power you have.
charges two marine batteries
(lower), which combine power
to small inverter (middle) Batteries - while you can use normal car batteries in a pinch,
deep-cycle RV Marine batteries (often used in RVs and boats)
will give you more life out of them. These will require regular
maintenance, checking to make sure they are not being
drained, damage being done to the batteries, and occasionally
refilling with distilled water. Definitely research best battery
practices.
Batteries hooked
to 1000 watt inverter

Charge Controller - makes sure the batteries are


charging properly at a good rate and efficiently
without overcharging. You will get what you pay
for; don’t go for a cheap controller.

Inverter - converts battery power (12 volt) to common use (120 volt). Again, you will get what
you pay for. Because of what it does, it is one of the important parts of the system; it is also
the part most likely to break or burn up due to misuse. Sometimes fixing them is as simple as
replacing a fuse; other times they are toast. If forward planning, you should have at least two
spare inverters in addition to your current one. You will need to swap it out quick until the bad
one can be more thoroughly troubleshooted.

Portable Panels - these make great ways to affordably recharge


small devices such as compatible walkie-talkies, rechargeable
batteries for flashlights, pulse oximeters, and pen lights.

47
Conserving Power
Regardless of the system that you use, conservation of energy is important and very critical. Wasted energy means more fuel
required, and perhaps unnecessary wear and tear on vital power equipment (batteries, inverter, etc.). It also means that other
options or equipment that could have been run will not be used.

Conservation Tips:
• Have signs reminding staff to turn off lights, and only use what is necessary for safe work.
• Have signs with specific instructions for certain uses (e.g. only run the ventilation blower sparingly)
• Use manual timer switches to prevent heavy load items from inadvertently being left on (e.g. the
blower). These can give options for the amount of time, but also have the signs or labels stating what
should normally be used (e.g. 15 minute increments).
• LED light bulbs. These use significantly less energy than incandescent. A LED bulb that produces as
much light as a 40 watt incandescent may only use 8 watts of energy. This means you can run 5 LED
light bulbs for the same amount of power as 1 incandescent. Five times the light! Although they can be
pricey, they will quickly pay for themselves when you compare obtaining generator fuel or additional
batteries or solar panels. Definitely have extra bulbs!
• Spread the work out. Find ways to lesson the load on your main power supply and use. Things like solar
attic fans are a self-contained solution to reduce heat, lessening the need and use of a fan or blower.
• At night, if nothing is running, turn off the inverter since it will consume power throughout the night.

Outlets with covers provide a way to put a label over the


outlet, warning about what should not be used, and to
double check whether the load should be used or not (e.g.
check with maintenance before using). The physical barrier
can keep them from absentmindedly using it.

48
WATER TREATMENT

Important Keys
• Access to water (more than medicine), and the means to filter
and purify it, will make or break your medical facility.
• Invest in a durable water system before any other infrastructure.
• You will go through a LOT of water to maintain proper care.

Major Water Demands


• Hydration - especially when working hard during a disaster situation. This is also important because major
medical concerns during disasters are usually related to diarrhea and its rapid dehydration effects on the body.
• Wound Irrigation - washing out of wounds requires clean water.
• Food - preparation with unclean water is one of the leading causes of illness and disease during a disaster
situation - hence the amount of diarrhea.
• Laundry - you will be surprised at the amount of linens, staff clothing, staff scrubs, surgical gowns, patient
gowns, hand cloths, etc. that will need to be washed (thoroughly) on a daily basis.
• Sanitation - Large amounts of water will be used in disinfection and sterilizing procedures. This is in addition to
the constant cleaning and mopping of facilities, cleaning of equipment and furniture, and cleaning of patients.

Normally, 1 person can get by with (at minimum) 1 gallon of water use per day for their various needs; however, in a
medical facility situation, much more water is used per person per day due to the water-involving tasks.
• FYI - When the Red Cross set up their General Field Hospital in Haiti after the earthquake, it required on average
26 gallons of water per bed per day. In better conditions, 100-200 gallons per bed per day would be standard.

See the tutorial, 25 Tips to Filtering Water Short-Term in Digest Vol. I

“And whosoever shall give to drink unto one of these little ones
a cup of cold water only in the name of a disciple, verily I say
unto you, he shall in no wise lose his reward.”
Matthew 10:42

49
Sand Filter
A sand filter, utilizing a biolayer, is a great non-mechanical way to filter
large amounts of drinking water.
The biolayer is a natural ‘slime’ that takes about two weeks to develop,
and is a critical player to breaking down organisms in the water. It will
form on the surface of the sand, and must be kept wet to keep it alive.
Use cleaned ingredients when building the filter.
Best practices call for a disinfection step after the manual filtration
process. See our tutorial, 25 Tips to Filtering Water Short-Term in
Digest Vol. I for more on disinfecting water.
Note: the pre-filtering and straining stage (Step 1) is so simple, but
most people will overlook it; do not skip!

The sand filter should be refreshed with new charcoal every year. The barrel can also be back-flushed by running
clean water through the hose in reverse (with pressure). Back-flushing may use 300-500 gallons of clean water.

50
Large Volume
Ceramic Filtration
There are a thousand different ways to rig up a
large-volume ceramic filtration system. However,
they will all follow the same basic steps:
• Prefilter - make sure bugs, rocks, leaves, etc.
do not enter the process.
• Reservoir - ability to hold water that is about
to be filtered.
• Ceramic Filters - some of the very best filters.
There are different brands, but many of them
function the exact same way. Ceramic filters
that utilize activated carbon (such as the Black
Berkeys) are the best.

• Holding Tank - a reservoir where the filtered water is held until stored.
• Main Tanks - usually tanks capable of holding several hundreds of gallons of water. These are
usually mounted on towers for gravity-fed pressure. Pumps are needed to get the water from the
holding tanks up into the main tanks; these can be manual or electric pumps, often depending on
height of tower, etc.

The setup shown above uses an inline strainer (bottom center) for incoming rain water (from separate
rain water tank), a manual hand pump (center) to fill up the two blue reservoirs (connected via
overflow) which have ceramic filters (Black Berkeys) installed in their bases. We used two so that one
filter can be serviced if need be, while still being able to filter some water. Each blue tank holds 15
gallons. Water trickles through the filters and hoses (not visible) down into the black holding tank
(black barrel). When we see that it is sufficiently full via an external clear hose, a manual timer switch
is turned to the appropriate amount of time for a 12 volt water pump to lift the water to the adjacent
main tank on a 15’ high tower adjacent to the filter house. A small solar panel on the roof, along with
a small charge controller, keeps the battery charged and ready to go.

Carts
Water is very heavy; let a garden cart do most of the
back-breaking work when you transport water around.

51
Hoses
Depending on your setup, you will need a variety of hoses to transfer water to containers, barrels,
wash tubs, laundry stations, etc. For drinking water locations, use white RV hoses made specifically
for drinking water.
Regular garden hoses are not made to convey drinking water, and can leach chemicals into the water.
In a temporary disaster situation, using a clean garden hose may be necessary, but look soon to
switch to other means of conveying water. If your water tastes or smells like rubber hose, that’s not a
good sign.
Regular garden hoses would be good for conveying utility water to laundry sites
and other utility purposes.

Rain Water
There are a few ways that you can use fresh, clarified rain water for tasks to ease the filtration load.
Clarified rainwater has been run through cloth or a strainer to remove bugs, leaves, etc. As long as the
water is fresh and clear (not stagnant with algae, etc.) then it should be fine, although you might treat
it with some bleach to freshen it up a bit. Depending on collection site (near a lot of pine trees, etc.),
pollen may be extra heavy in the spring, making the water sour and yellow.
Have a dedicated rain water barrel that only supplies your clinic flush toilet. Clean rain water could also
be used in initial laundry washes, and even when boiling linens, etc. Regular clinic mopping as well.
Do not waste filtered water on utility tasks. Just make sure the rain water is fresh and not contaminated
(pollen, fallout, ash, etc.)

Quick Temporary Towers


In some situations, you will need water elevated to either
provide better water pressure, or to serve as a distribution
point for hoses to point of use stations.
A ladder with paint tray can elevate a 5-gallon bucket, while
also making it easy to climb the ladder with a water pail and
refill the main bucket. Rest a lid on top to keep out bugs and
such, while still allowing air in for best drainage.
Use straps or rope to secure the bucket from moving.
If hooking up a hose to a faucet bib on the bucket, tie your
hose to the ladder for strain relief - in case someone trips on
or yanks the hose.
3-4 ladders can be made to hold a barrel of water - if proper precautions are made.
Use boards or pallets to make a distributed platform. Tie or screw it down. Do not climb on.
Caution: one gallon of water weighs 8.34 pounds (3.78 kilograms). 55 gallons = 459 lbs.

52
IMPROVISED SINKS
There are a variety of simple designs for improvised hand washing stations (tippy tap, etc.). However, many of them require
frequent refilling, and may not be best for the volume and regular use that we may experience in a medical setting. Here are
some simple ways to make heavier-duty, portable wash stations that are easier to maintain.

Handy Supplies... Faucet caps


(plastic easiest) Garden hose wands

Hose faucets
(3/4” best)

Hose barb

Conduit Inline hose valve Spray head


Drill several small holes (also available
locknut (3/4”) in the caps to make a separately)
simple spray head

Barrels = Great Water Pressure


For the most part, your water gets its pressure from the drop in elevation (hence why
water towers are high), not necessarily from the water itself. However, a barrel of
water will exert more weight pressure than a 5-gallon bucket of water will.
Some faucet heads will work better with different size water containers or pressures.
A spray head from a garden hose wand (for example) gives a much wider spray and
coverage with a barrel than it does on a bucket. Match and test the heads according
to your needs. If not properly matched up, you may be wasting water, when a more
efficient head may work.
A barrel-sourced sink would be best where the public will be washing their hands.

Different Setups
Your improvised medical situation will require a variety of different sink setups. Some
sinks will need to conserve water, and will serve just for washing hands. Others may
need to deliver a good spray for washing dishes. Others, such as a scrub sink, may just
need a good steady stream of water. On the other hand, some sinks such as the soiled
utility room sink must only be a stream of water, not a spray, to avoid mobilizing
contaminates in water particles. Assess your needs, and realize that one sink type will
not address all your needs. In many cases, though, you will only need to adjust the
faucet spray head.

53
Both Hands
Sinks specifically for hand washing need to be set up so that the user can wash both hands
at the same time, without having to press or hold something with either hand. This allows
them to make sure both hands have major debris and soap rinsed without transferring some
between hands due to one not being under the rinse water. Make sure your faucets and valves
are turn-based, not push-based.

Wide Spray Head


This type works best under greater pressure than a 5-gallon
bucket can provide; however, it can still give an adequate
spread to wash hands with. This type of head will use more
water than others, but is good for situations where a wider
spread is needed, such as kitchen and showers.

Flexible Spray
This uses the spray head from a solar shower. This moderate
spray amount is good for washing regular amounts of kitchen
work. If the kitchen needs have greater volume, a larger spray
head may be needed.
Note, the lid on the blue water container in this setup.
We unscrewed the manufacturer’s nozzle, and merely replaced
it with a more robust metal one. Also, the swing handle makes
it much easier for kitchen tasks, where they will be constantly
turning on and off the water.

Water Conservation
This setup is ideal for simple hand washing stations in exam
rooms, cafeteria areas, etc. This design uses an inline valve as
both an extender (out and away from the buckets) and easier
valve than the main one. The small holes in the cap allow
adequate flow for hand washing, while minimizing water
waste. When using the inline valves, get the ones with the
larger knobs, as they are easier to use, especially when your
hands are wet.

54
WASHING HANDS

THIS IS SOME OF THE MOST IMPORTANT CARE YOU WILL BE ABLE TO PROVIDE
Even though you are in the midst of a disaster, unwashed hands will dramatically increase your infection and mortality rate.
It is in these situations that attention to hand washing takes much greater precedence. You may not have many other resources
at your disposal, but your care should not make a situation worse.
• A secondary infection is the leading cause of death in a hospital - and many times it was avoidable.
• Remember that most people are sick before they come to a hospital. Surfaces they touch must be sanitized regularly.
• Ask all guests and visitors to wash their hands, especially if visiting patients.
• Staff must wash hands before and after every procedure, and between each patient.
• Short fingernails are a must.
• Items that medical staff regularly touch must be sanitized between patients (stethescopes, pens, etc.).
In conjunction with that, attention needs to be on staff clothing that they are touching throughout the day. Staff should
change into clean scrubs when they arrive for work, and then change out of them back into their street clothes at the end
of the day. The scrubs should be considered contaminated at the end of the day, and sent to laundry.
• Always keep in mind that the outside of the gloves touch the patients - as well as whatever the outside of your gloves have
been in contact with. The gloves are to protect both the caregiver and the patient; but only proper attention will keep the
outside of the glove from passing on an infection to the patient.
• Do not share cloths used for drying hands - even within family; the individual use greatly hinders disease spread.

YOUR TOP PRIORITY


One of your top priorities as the Improvisation WASHING
Engineer is to ensure that staff have an easy
and accessible means to wash their hands HANDS
with clean water and soap, ideally at multiple (See Reference
locations. The easier it is for them to wash their Sheets Section)
hands, the greater use of it will take place.

Hand Rub
• Alcohol-based hand rubs will aid in convenience, but plain water and soap is just as effective with
proper hand washing technique. Alcohol-based rubs will not remove the contaminates from off your
hands like water and soap.
• When using alcohol-based rubs, be sure the fingertips get cleaned well, since this area (more than
the palm) is where potential contaminates and pathogens will be picked up and spread.
• Use a dime-sized amount to avoid hand irritation over time. Have hand lotion available.

“...he set the laver between the tent of the congregation and the altar, and put water there,
to wash withal. And Moses and Aaron and his sons washed their hands and their feet thereat...”
Exodus 40:30-31

55
LAUNDRY

This section assumes water and power are unavailable, and a washing
machine is not an option. Given time, running one from a generator
would save a considerable amount of time.

See our Washing Laundry Post-


Disaster tutorial in Digest Vol.1.

Although linens should be disinfected prior to cleaning, the medical facility should have its own dedicated laundry
equipment that is used only for soiled medical laundry, and not everyday laundry use. Avoid creating potential cross-
contamination due to accidental safety lapses. If possible, have dedicated equipment for surgical linens and supplies.
The laundry chores will go through a lot of water, especially if you have to use reusable items such as towels, drapes, etc.
Make sure your infrastructure and sources can meet the laundry water demands.
One way to lighten the water filter load is to use clarified rain water for the laundry initial washes.
Depending on quality, it could also be used for the final rinses, especially if boiling the laundry.
If you reuse hand drying towels, I would recommend cleaning them separately, since they have a light use load, and it is more
important to keep them as clean as possible. Reusable towels for the Operating Room must be sterilized as well.
Dressings and textiles can be disinfected by a few different options: A) Hanging in full sunlight for 6 hours per side. B) Wash and
boil for 10 minutes. C) Wash, rinse, and soak for 30 minutes in 0.1% chlorine solution or 5% Lysol solution.

Sorting
Laundry will be sorted and processed slightly differently according to their use and purpose.
Operating Room Linens - must be the absolute cleanest you can get, including sterilization.
This includes towels, gowns, drapes, etc. These must be totally clean and free of contaminants
(lint, blood, oil, grease, etc.). Visually check these and reprocess or discard as needed.
Patient Use - gowns, bedding, pillowcases, etc. Disinfect and wash as normal.
Incontinent Care - these are more soiled, and need additional pre-rinsing and disinfecting.
Private clothes - Disinfect and wash as normal, but separately.
Reusable Hand Towels - Disinfect and wash as normal, but separately.

LAUNDRY
CYCLE
Whether you use disposable paper towels or reusable cloth hand towels, make (See Reference
sure they are the cleanest that you can get, and give careful attention that the Sheets Section)
ones in storage are sealed in plastic bags or sealed containers until ready for
use. If using uniform washcloths as drying cloths, have a special bin where used
cloths are placed. Each cloth is used only one time before the cloths go through
disinfection and laundry. Once dry, they are folded once, stacked, and bagged.
Hand towels used in the Operating Room must be sterilized as well.

56
Boiling Disinfecting
Wear as much personal protection to prevent contamination by bodily fluids, pathogens, etc.
If need be, rinse any excess
soiling from linens Wring out excess water Boil for 10 minutes

Wash as normal

Minimize splashing

Bleach Disinfecting
Wear personal protection - from pathogens and chemicals.
If need be, rinse any excess Immerse in bleach Wring out excess
soiling from linens. Wring. disinfecting solution disinfecting solution
Note that any linens prior
to finishing some form
of disinfection are to be
considered biohazard!

Bleach Disinfecting
Solution:
5 tbsp bleach : 1 pt. water
1 tbsp bleach : 1 qt. water
Any stirrers should be 1/4 cup bleach : 1 gal. water
used for that task,
and only that task

Surgical / Hand Cloths


Wear personal protection when handling - for pathogens and hot surfaces.
If need be, rinse any excess Transfer to Wash as normal, using
soiling from linens. Wring. Boil for 10 minutes dedicated area dedicated equipment

57
Heating Water
Depending on your circumstances and resources, you will likely need to heat large amounts
of water for boiling linens. Have a dedicated stove and area just for this purpose. Use a metal
grate, rebar, rocks, etc. to prop up the pot. Do not plan on moving the pot when it is full of
boiling water - it will be too dangerous. Build up some form of wind shield to keep the heat
around the pot and make more efficient use of fuel. You can use firewood to get the fire going,
and then switch to charcoal (if possible) when the water is at a rolling boil. This will greatly
reduce smoke, and fire smell on the linens. Keep a lid on the pots to conserve heat, and keep
them at boiling temperature, especially after adding wet linens.

Containers
Large pots commonly used for steaming seafood, tamales, etc. are great for laundry. Usually
these have either a removable inner sieve, or have a raised, removable plate on the bottom for
steaming. The removable baskets make it easy to drain and transfer cloths without having to
move a pot of boiling water. The plate can keep linens from scorching on the hot bottom. Note
that aluminum containers should not be used for bleach disinfecting. Use stainless steel or
plastic containers when using bleach. Exercise care that disinfected linens are not placed back
into a dirty, contaminated container. Disinfect your laundry hampers and tubs daily.

Folding
Have a clean surface; use a plastic tablecloth or tarp if need
be. For items such as hand cloths and surgical, try to fold
and package them in the cleanest area possible - in a tent if
need be. Store items in closed containers or plastic bags.

As best as possible, your laundry center should have separate areas and equipment for regular
patient-related linens and surgical. Hand cloths should be washed in the surgical area.

58
HOW TO MAKE BLEACH

In your medical setting, bleach will be used for many critical processes, including disinfecting
drinking water, kitchen ware, sterilizing linens, cleaning floors and walls, disinfecting medical
waste, restrooms, wounds, and surgical instruments.
In a major disaster (or even remote situation) you may not have the resources to obtain a
commercial source of bleach. With this simple, improvised method, you can generate fresh
bleach with minimal supplies.
Materials Needed:
• Water • Iron/Steel
• Table salt, or fine-grained salt • 12-24 volt source
• Carbon rods • Wire and clamps

How It Works
A moderate 12-24 volt current is run through a salt water brine solution for 1 hour. The carbon rod (+)
produces chlorine gas (the bubbles). The iron rod will produce sodium hydroxide (the hydrogen bubbles).
The chlorine gas reacts with the sodium hydroxide to produce sodium chlorate, and the iron liberates the
excess oxygen from the chlorate to make sodium chloride (bleach).

WARNINGS
• This produces toxic chlorine gas - only use in a very well-ventilated area.
• This produces flammable hydrogen gas - so keep away from open flame, sparks, etc.
• This uses DC electricity near water. Keep your hands out of the water during the process.
If you don’t know basic safety about batteries, electricity, 12 volt, etc. - then do not attempt this.
• The solution will get very hot - protect yourself from burns when handling.
• The bleach produced will be a stronger oxidizer than regular commercial bleach. Wear gloves and
protective goggles when handling and using.

This is only an improvised solution. There are commercial chlorine generators available that are much more
efficient and faster than this method. If you foresee the need for them, I highly suggest you check out
WaterStep (waterstep.org), Safe Water International Ministries (swimforhim.info), or Antenna (antenna.ch).

Getting Carbon Rods


Large 6v lantern batteries can quickly be taken apart to obtain the carbon rods
needed. Each battery will yield 4 rods. Wear gloves when taking them apart, and
have a rag to wipe each rod off with. The top connectors can usually be twisted off.
The carbon rod will be used only for the positive (+, red) connection. An iron/steel
bolt or scrap will be used for the negative (-, black) connection. Do not use iron for
the positive, as that will not work for our purposes, and will make a mess.
During the process, the carbon rod will flake off small amounts each time and
gradually wear out after several batches. Have replacements in mind.

59
Salt Water Timers
Mix 1/4 cup salt with 1 liter of water. With a fully charged 12v battery,
Dissolve well. If you make it in large the process takes 1 hour. Have
batches, it is easier to put it in a container timers so you do not forget about
and shake it up. it, and damage your battery.

Batteries & 12V Sources


Any 12-24 volt source can be used (batteries, 120v>12v converters, battery
chargers, solar panels, etc.). From our tests, the sealed gel batteries will give you
one batch before needing to be recharged, while a marine deep-cycle battery can
give you several batches. Make sure you have a way to recharge your batteries.

Simple Improvisation
Using a sharp knife, cut 4 stars into a scrap piece of
plastic. Push the carbon rod and metal rod through
the holes. This simple safety keeps them about 1”
apart, and prevents them from touching. Immerse in
the brine solution, leaving the two ends above the Testing
waterline. Connect the carbon rod to the positive (+) At the end of the hour, dip a piece
wire, and the iron rod to the negative (-) wire. of colored paper (construction
Wait one hour. Disconnect. Test. paper or post-it notes) for about a
minute. It should bleach the paper.

More Efficient Improvisation


Since the chlorine is generated by the chlorine gas interacting with the negative
electrode and hydrogen, I took a thick-walled plastic cup, and drilled two holes so
that the carbon rod (+) would be under the steel (-) rod, giving greater interaction
between the two as the chlorine gas would bubble up right along the negative
electrode. For testing, I just used a glue gun to seal around the electrodes; however,
since the solution does get very hot, after a few tests it started leaking. I would
suggest sealing around the electrodes with silicone, gum, or marine epoxy.
For safety reasons, I would also suggest having one end poke out on either side of
the container, instead of both near each other. In tests, this stacked arrangement
appeared to produce a stronger and darker chlorine.

Filtering
The carbon rod will wear away slightly during each use.
To filter out the black carbon flecks, secure a clean cloth rag
around a container, leaving an indention. Place a coffee filter
or paper towel in the indention, and pour the bleach solution
through it. This will result in the clean bleach. Store the final
bleach in a container with a tight lid, in a dark place.

60
Larger, Faster
Using rubber bands, bind the four carbon
rods tightly together. Do the same for the
negative rods as well, making sure they
have equivalent volume and surface area.
The rubber bands keep the carbon in
contact with each other, even if they shed
a bit. Increasing the size of the positive
and negative rods will increase the
production rate; use pool testing strips to
determine the best time for your setup.

Chlorine Tips
• When mixing chlorine with water for disinfecting solution, or to purify water, make sure that the
solution is stirred or mixed. Chlorine tends to float to the surface; because of this, it is important
for true readings that water samples drawn are not only from the surface.
• When using chlorine to disinfect drinking water, remember that it needs at least half an hour of
contact time with the water.
• When preparing bleach from a dry or granular form, always mix up a small slurry batch with
water, then apply the batch to the main water supply to aid mixing and dissolving.
• Do not use chlorinated water in a charcoal-based water system or sand filter system. The chlorine
will absorb into the charcoal, limiting it’s absorptive qualities; the chlorine will also kill beneficial
bacteria in a sand filter system. Apply chlorine after those filtration steps.
• Chlorination is not effective if the water pH is above 7.2 or below 6.8.
• Drinking water should be between 2 and 5 ppm when treated. At 5ppm the water has reached the
recommended chlorine level; two hours after applying, the water should still have 2 ppm chlorine
level, and the waterborne pathogens are killed.
• Bleach manufacturers typically add a small amount of lye to their bleach water to raise the pH.

Calcium Hypochlorite
• The granular form of bleach can be used for drinking water disinfection if it is 65-70% calcium
hypochlorite, with no additional anti-fungals or water clarifiers.
• If it does have additional additives, it could possibly be used for non-drinking disinfection purposes.
• Mix 1 heaping teaspoon calcium hypochlorite for 2 gallons of water to make bleach solution.

61
POTASSIUM HYDROXIDE (LYE)

Potassium Hydroxide and Sodium Hydroxide are recognized disinfectants often used in pharmaceutical
facilities, food preparation facilities, and veterinary applications, especially used in controlling livestock
outbreaks by disinfecting barns, stalls, etc.
• Lye can be made with soft water (rain water) and hard wood ash. Do not use pine.
• Commercially prepared lye is Sodium Hydroxide, and is more caustic than Potassium Hydroxide; both have
equivalent cleaning and disinfecting abilities. When used for soap making, though, you will generally use
1.4 times more potassium hydroxide than sodium hydroxide. Check your soap recipes carefully.
• For our improvisation purposes, sodium hydroxide makes an effective disinfectant for cleaning hard
surfaces, floors, latrines, and some equipment.
• It should be applied in a solution with hot or boiling water for best disinfection.
• Be sure to rinse the surface with cold water afterwards.

WARNINGS
• Lye is very caustic and a strong oxidizer, and can chemically burn your skin. Use goggles and gloves.
• Always pour lye into your water, not the water into the lye.
• Adding water to lye will create an exothermic reaction (heat).
• Lye is made active with hot water.
• If liquid lye gets onto your skin, wash off with water, then use a vinegar wash to neutralize.
• No aluminum containers or utensils should be used with lye.

Obtaining Potassium Hydroxide (KOH)...


Pour boiling water
Fill bucket with packed slowly into ashes;
hardwood ashes, leaving use about 1.5 times
some room for water. the ash volume.

Drill a number of The resulting dilute


holes in the bottom lye solution will look
of a 5-gallon like strong tea.
Put a layer of clean
bucket. You will get most
rocks in the bottom
of the KOH on the
to aid drainage. Place (optional) The lye solution will first pour.
straw, pine straw, or A little bit of lime can slowly drip down
cloths over the rocks be added to the ash 1 gallon dilute lye
into a lower bucket. typically will produce
for a filter. to make the potash I used bricks to hold
more soluble. 3/8 cup concentrate
the top bucket up. solution.

62
Processing Potassium Hydroxide...
Over a hot fire, you will need to boil your dilute For strength consistency,
lye solution down to about 50% of its volume you can boil it down
to drive off excess water. Your final intended to crystal form and
use will determine how much you boil off. store, or boil down to
This will take several hours, depending on soap-making strength
the size of your batch and heat source. and store. Always store
in glass, earthenware,
Once you get close to crystal plastic, stainless steel,
form, the solution will start to enamelware, ceramic, or
resemble wet sugar. In a sunny arid bare wood containers.
environment, you could place this in Note the use of a plastic
pans to further dry out more slowly. lid on the canning jar
instead of metal.
Boiling the water completely out will
result in brown-sugar looking lye
crystals. Note that the color will be
slightly influenced by the straw or Have proper,
pine you use in the filter. designated containers
and measuring cups,
I used a wooden spatula to scrape and utensils, etc. set aside
break the hardened lye off the pot, for lye production,
then used a flat-end piece of firewood transfer, mixing, etc.
to smash it into a more powder form.

For Soap Making


For soap-making use, the strength of lye is tested for by seeing if a fresh egg or potato floats in
it, with just a dime-sized portion of the egg floating above the surface. You can boil the solution
further or slowly add more water to get it to the proper strength.
KOH soap recipe: 18.2 ounces of potassium hydroxide powder, 2.5 pints of water, 6 pounds fat
NaOH soap recipe: 13 ounces of sodium hydroxide powder, 1.5 pints of water, 6 pounds fat
Follow soap-making procedures as normal (not covered here).

For Disinfecting Purposes


Lye should be applied as a 2% solution. Use goggles, gloves, and face mask.
• 1 lb crystals (2 cups) to 5.5 gallons of hot or boiling water (or 1 cup to 2.75 gals b.w.).
• Apply to surface; let sit 10-15 minutes, then rinse with water.
• Use only plastic spray bottles or sprayers, not metal sprayers.
• Use a course, wet spray, not a fine mist. Lye is caustic, and you don’t want to breath it.
• Lye solution will damage painted or varnished surfaces if allowed to remain in contact with
them for very long.

63
REUSING GLOVES (NON-STERILE)

Note:
While reusing gloves has been used in the past, and is still being used in developing countries and under
austere situations, the practice is not recommended, but it is a recognized appropriate reuse of disposable
items. Under dire disaster circumstances, reprocessing of gloves may become necessary to prevent the
spread of disease or contagion. Always wash your hands before and after using gloves.

Drying Cleaning Gloves


• Glove Tree. Use several pvc pipes, broom handles, clean sticks, etc. to create a drying rack
for the gloves. Insert these at an angle into a bucket (or the ground), and fill the bucket
with sand or dirt. This makes it easy for the gloves to drain and dry, while keeping them at a
convenient height. Have taller rods for elbow-length chemical gloves. You will probably need
several of these buckets, depending on how many gloves you have to dry at a time.

• Smooth Ends. You can rub the pvc pipe up against concrete blocks or
sidewalks to sand off the end where the glove is going to go. You want to avoid
having hard edges that might promote tearing or grabbing of the glove.

• Shady Spot. Even though sunlight can be a great disinfectant, it will tend to break
down the latex gloves. Use chemical methods to disinfect the gloves, and only use
this drying rack in a shady place.

• Careful Placement. When placing the gloves, just rest them on the rods. Do not force
the rods into the fingers. Gently placing the glove in different spots on the rod end,
though, will tend to make the glove prop up better than other spots, and promote the
best interior draining and drying.

• Elbow Gloves. For long-sleeved gloves with elastic cuffs, use metal cans open at both
ends (or large diameter 2-4” diameter pvc pipe sections) to help prop open the elastic
sleeve so air can circulate. This can then be hanged up on a clothesline, or the glove can
be propped up on the glove tree.

• Clip the Cuffs. If you ever need to clothespin the cleaning gloves
(or any gloves), do it by the cuffs to prevent possible tears and
unnecessary wear and tear on the critical parts.

64
Cold Disinfecting Gloves (for non-sterile use)

• STEP 1. Before removing soiled gloves, immerse hands briefly in a container with 0.5% chlorine
disinfecting solution (1 tablespoon to 1 gallon of water).

• STEP 2. Carefully remove gloves by turning them inside out and putting them in the solution.

• STEP 3. Make sure the gloves are fully immersed, and that the solution is inside of the gloves.

• STEP 4. Let gloves soak in disinfecting solution for 10 minutes.

• STEP 5. With clean cleaning gloves, wash gloves in soapy water, cleaning inside and out.

• STEP 6. Thoroughly rinse gloves in clean water until no soap or detergent remains. Rinse well at
least 2-3 times. Residual soap can interfere with later sterilization or high-level disinfection.

• STEP 7. Test gloves for holes by inflating them by hand and holding them under water,
checking for air bubbles.

• STEP 8. In a clean room or area, hang up the gloves to dry. Handle them very gently. A small fan may
help them dry out quicker. You may have to adjust them, and make sure they have as little water in
them as possible. Do not leave gloves wet for long periods of time, as they will become tacky.

• STEP 9. Wearing clean gloves (and preferably hair cap and apron/gown) gently remove the dried
gloves and store them in clean containers.

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STERILIZING GLOVES

Note:
Gloves used in surgical procedures must be sterile. However, modern gloves are thinner than past
gloves to allow more tactile sensitivity. In the past, the surgical gloves were generally thicker to
survive the strain of reprocessing. The high incidence of infection (primarily Staphylococcus aurous)
led to the practice being discontinued. They will not stand up to multiple reprocessing steps that
past gloves have, although you should be able to get some reprocessing out of them (3Xs for latex).
In a dire disaster circumstance, if push came to shove:
• Non-sterile gloves (new or reprocessed) can be cleaned with alcohol to render them near-sterile.
• If you are going to autoclave gloves for surgical use, it would be recommended to start with new,
unprocessed gloves.
• If using re-processed surgical gloves, double gloving is recommended.

AUTOCLAVING GLOVES
• STEP 1. Be sure that you are first wearing clean gloves, and that you are in the cleanest room or area
that you can get, with a disinfected work surface. Then, start with brand-new, non-sterile gloves
- or non-sterile gloves that have been decontaminated, cleaned, and dried.

• STEP 2. Fold the cuffs of the gloves out toward the palm so that after sterilization they can easily be
put on without contamination.

PACKING GLOVES
• STEP 3. Pack gloves.
FOR STERILIZATION
(See Reference Sheets Section)

• STEP 4. Place packs in the autoclave on their sides (do not stack in piles) to ensure
optimum steam penetration.

• STEP 5. Process as normal for 30 minutes. Dry in the absolute cleanest area possible.
See How to Sterilize Instruments, Disaster Crash Course Digest , Vol. I.

• STEP 6. Do not use the gloves for 24-48 hours after sterilization. They will be extremely fragile
after sterilization, and need time for their elasticity to return, and to prevent tackiness.
Store them in a dry, clean, cool place, away from direct sunlight.

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FORMS
Collecting and maintaining records is vital, especially if patients are expected to return frequently or
have the potential to need medical care. Different types of conditions can have different types of forms
for better organization. However you record it, make sure it is quickly accessible, and easy for the care
provider to find the recorded information.
In austere conditions, electronic forms and records may not be the best route. Paper records are much
more reliable if stored in a dry place, or sealed container, depending on your situation’s condition.
Everyone in your group, including staff, should have their own records on file in case of emergency or
accident. Keep as careful and accurate records as possible, and be sure to update regularly, especially
with major health changes. The forms included here represent samples of common form types. Small
forms for photocopying are included at the end of this chapter.

Simple Inventory
A basic way to keep track of inventory and usage is a simple spreadsheet. This could also be done
with regular lined paper by hand if need be. Once the list is written out, the tracking will last for
a while. This tracks usage and amount. Location can refer to rack letter and shelf number (B4).
A new sheet is made by copying the old inventory item list and continuing.

Medical Report

Appointment Sheet
For regular clinic-style use, you can assign people various time slots, and also have alternates
available for quick, routine checkups.

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S.O.A.P.
SOAP stands for the four types of information recorded: Subjective, Objective, Assessment, and Plan.
This simple form is used to record condition, and provide the latest condition at examination.
A new record is filled out and maintained over time to compare progress. For patients receiving
constant care, this information would be updated more frequently (at least four times daily) than
one coming in only for checkups. These forms are added to the patient’s main file and kept as
needed.

The staff records their Caregiver Name (who performed the assessment),
the Patient Name, and the Date, and Time (if needed).
Subjective: Covers thoughts and general observations. What the patient describes their condition to be.
Mainly patient-provided information describing what they are experiencing.
Example: Joe became weak and faint today after experiencing achy joints and muscles over the past several days.
Gets dizzy standing up. Nauseated and complains of head ache and sore throat. Urinating, but not as much as usual.
He is trying to stay hydrated but too busy to be consistent. He has not gotten much sleep for the last two weeks.
Objective: Data and condition. The cold hard facts. What’s their temperature, heart rate, etc. - measurable and
statistical information, not subjective.
Example: Vital signs: Temp: 102 F, Pulse: 110/min and regular, Resp Rate: 22/min, BP 100/60.
Skin pale and mildly moist. Looks tired but is awake and alert. His mouth is moist.
Assessment: Conclusions - what the medical professional considers the condition to possibly be.
Example: Flu with mild dehydration and fatigue.
Plan: Future care or action needed.
Example: Push fluids (ORS), ibuprofen 800 mg every 4hrs as need for temp > 101 or pain. Bed rest.
Take VS and check hydration, fluid input/output, and 4 times daily. Use anti-nausea meds if available.

Wound or Injury Care Tracker Chart


Keep track of ongoing wound treatment and progress.

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PERSECUTION

Sometimes, a disaster comes in the form of religious or ethnic persecution. Many times, individuals find
themselves unable to flee from the region, and must shelter in place. During Hitler’s Germany, the Jewish
people and political dissidents had to go into hiding. When a community has to go ‘underground’, they still have
regular and emergency medical needs that arise. Sometimes, individuals fear to go to established hospitals for
legitimate fears that their children will be taken away, or that they themselves will be euthanized.
As you prudently foresee your situation, certain steps may need to be discretely taken to ensure a level of
medical care can be provided in a persecuted environment. Doing so reduces exposure and falling into traps
where persecutors will be prone to investigate. If you think there is a growing chance of persecution in your
area, you should either move now, or start stockpiling medical supplies before such activities come under
additional scrutiny and scarcity.

Having easily-transportable supplies and ready-to-go supplies keeps you available for quick
emergencies or quick relocation. Sometimes it may be easier to take what you need to the
patient’s location, especially if they will need to be there a while for recovery.
Have your supplies transportable in nondescript containers, or smuggled within other boxes.
If you have to set up in a place that is more secure than anything else, use tarps, washable
tablecloths, shower curtains, or cut up trash bags as a floor cover, table covers, and to wrap
any nearby supports or items that the medical crew may potential bump into.
Storm shelters, basements, large attics, etc. can provide workable setup areas. For some areas,
if time permits, you may want to use a hand-held pump sprayer and spray the interior surfaces
with a disinfectant before setup. Be careful not to breath the fumes while applying.
Oftentimes these areas will be cramped, and will get hot quickly, especially the more people
you have present. Also, be careful about using candles, propane lanterns, etc. in an enclosed
area if the air is not constantly exchanged. Also be mindful if using oxygen. A blower can help
change out the air; having several feet of flexible ducting on either end of most blowers will
significantly quiet them down.

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REFERENCE SHEETS

The following pages contain reference sheets that can be printed off and used for training, area
signs, and quality control. It is recommended that they be laminated, put in plastic page protectors,
or placed inside a wall picture frame / wall mounted sign holder for durability.

DEPLOYMENT IMPROVISED
LAYOUTS SUPPLIES

SOILED PACKING GLOVES


UTILITY ROOM FOR STERILIZING
PROCEDURES

LAUNDRY WASHING
CYCLE HANDS

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PEP TALK
• You are the Improvisation Engineer - not the Doctor. Your job is to make their job easier and more
effective. Respect their expertise, responsibilities, and knowledge. Do not try to do their job. Respect and
commend their role, and they will respect and commend your role; together, you are a team.
• A large investment. You will need much prayer, wisdom, and advice before you implement forward
planning, depending on what you see coming down the pipe. If you move forward in planning and pre-
stocking for an impending disaster (natural, social, political, etc.) realize that it will cost far more than you
may expect. I would not recommend you attempt this by yourself, or you may bankrupt yourself. As a planned
community or group project, though, it could be accomplished. Have a plan for different stages, and what will
be invested in.
• Have a Plan. You should accomplish any project in steps. You eat a whale one bite at a time. Your first step
may be a well-equipped first aid kit, then medical closet, then room, then portable building, etc.
Each expansion stage is also going to have much larger amounts of learning and practice that goes with it.
The more complex a system becomes, the easier it is to become dysfunctional. Even as you grow in knowledge
and supplies, have checklists, manuals, policies, etc. to keep the quality control in place.
• Update Your Plan. As you probably know, most plans are thrown out the window when the rubber meets the
road. Once your disaster situation starts, and you get a working plan, make certain you take opportunities to
revisit that plan and re-orient yourself and efforts if need be; don’t get stuck in an unnecessary rut.
Have frequent plan updates, and invite constructive criticism.
• Practice, Practice, Practice. There is a lot of great internet knowledge about first aid, survivability, disasters,
etc. - but if you never practice it and perform a dry run, you will find out the hard way that there is a lot of
unmentioned tidbits in between the lines. Also, what works for one person in a similar situation may not work
at all for you under yours because of some minor detail. Example: evaporative water pots are a great idea for
summer use in arid Arizona, but won’t work hardly at all in humid Florida.
• Stress Test. Practice scenarios under ideal conditions, but also (later) test the procedures by throwing various
monkey wrenches into the system. Examples: what if we have a winter week of continually overcast skies? How
will we dry a lot of laundry when its raining? What if we had quadruple the soiled laundry load due to everyone in
our family having food poisoning?
• Have a Backup. And Backups of your Backups. Two is one, and one is none. When a critical part of your
infrastructure breaks, have a replacement - and a replacement to take the place of your standby. Sometimes
something may fail and you not realize what caused it to fail until it does it again. Example: wrong wiring
polarity somewhere fries your inverter. Start with things that have a high degree of probability in failing
(inverters, light bulbs, pumps, etc.) but then also keep in mind parts that are absolutely vital, but have a lower
chance of failure (charge controllers, medical equipment such as meters). You should also consider that some
items might get stolen (generator, gasoline, etc.).
• Have an alternative. Part of having a backup is knowing an alternative way to perform a task or function if
Plan A fails or is no longer available. Example: Volcanic ash now covers your sky and solar panels - what now?
We just ran out of bleach... The dog chewed through the main tank water hose and drained it overnight...

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• Your Family. Much of this may seem overwhelming, I agree; but do not let that hinder you from taking
some steps toward improving the medical response that you can provide. When a member of your family
gets hurt out on the farm, you shouldn’t have to wait for the ambulance to start giving them critical first aid
and care. Invest in quality first aid kits as an investment in your family’s health - prevention is always the
best medicine.
• Consider and Appreciate. While there is a lot of heavy stuff here, I hope it makes you appreciate what you
do have now, and also makes you more aware of what many in other countries right now do not have. Pray
for your missionaries and friends in developing countries who do not have good access to quality medical
care. Their concerns for their family’s well-being is much more on their shoulders than it would be perhaps
in our circumstances. Pray for their safety, health, strength, wisdom, and grace - especially when you know
they are facing a medical crisis. Let your prayers be quickly coupled with action when possible. Ask them if
there is anything specific that they need or want that would improve their situation or contribute toward
their health.
• Murphy’s Law. Keep in mind that everything that can go wrong in a situation - just might. Everything is
subject to change. Sometimes it can be physical changes or spiritual - or both. Regroup, and with the Lord’s
help and strength, keep pressing on (Psalm 68:28).
• Take Time to Train. Even when things are busy and crazy, try to work in staff training. The time lost in
training new staff will be more than adequately replaced by a gain of time and efficiency in the following
days and weeks.
• Simplify, simplify. Keep it simple; everything doesn’t have to be over-engineered. Get the basic,
improvised systems working first, then revisit them later for greater efficiency if need be.
• Spontaneous Planning. Prudently examining potential situations and alternatives helps merge both
planning and spontaneity. The pre-planning and preparing greatly helps reduce the chaos of a situation.
Learn to be prepared so that you can be flexible.
• Always seek professional medical help when it is available!

“And Jesus said, ...She hath done what she could...”


Mark 14:6-8

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SUPPLY LISTS

Diamonds () indicate items that you will want in quantity, especially if you see the chances of
resupply as being very remote or rare.
These lists are not exhaustive, but provide many of the basic supplies, consumables, and alternatives that a
medical facility will go through, especially in a disaster situation. These do not cover actual medical tools and
equipment. For your particular needs, you may not need all of them, or you may need additional items.
You will not be able to purchase all of these supplies at once, so start acquiring them in batches as you are
able. Start with collecting a well-rounded first-aid kit and a comfortable inventory of medical supplies.
Once you have that, then you can start on infrastructure investments. It is always better to have at least some
medical supplies without a facility, than a facility without hardly any supplies.
Put some wise thought and planning with how far you are able to go, realizing that the larger you scale up,
the greater the supply needs will be (and maintenance tasks).
If you have any form of advance warning (social chaos, war, etc.), you may want to have a buffer of disposable
items to lessen tasks and cleaning chores during the initial wave surge of patients. These would include
foldable paper towels (dispensable) instead of wash cloths, disposable surgical gowns and other personal
protection clothing, disposable common instruments, etc.
You will need to keep regular inventory to allow time to adapt to sudden shortages, allow time for resupply,
or to find alternatives.

Personnel: Pharmacy / Lab: Protection:


• Patience • Spoons (tsp. & tbl.) • Disposable latex gloves
• Kindness • Large spoons • Procedure masks
• Compassion • Tongs • Dust masks
• Humbleness • Slotted spoons • Caps / shower caps
• Honesty • Pot holders • Safety goggles
• Willing to share • Metal tea balls • CPR masks
• Non-complaining • Mesh strainers • Waterproof aprons
• Willing to learn • Kitchen timers • Large trash bags
• Trust & Dependability • Small glass mixing containers (improvised gowns)
• Professionalism • Disposables: dixie cups, plastic • Elbow-length gloves
• Meekness spoons, medicine cups, stirrers, etc.
• Willingness to work hard • Various basins and bowls
• A positive attitude • Canning jars
• Supportive • Plastic zip bags (sm, md, lg)
• Measuring cups (plastic & glass)
• Funnels (various sizes)
• Kettle

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Maintenance: Medical Supplies: • Ipecac Syrup
Suggestive list. Your needs may vary. • Activated Charcoal
• Spare LED light bulbs
(capsules & powder)
• Garden cart • Sterile 8”x10” surgical pads
• Eye drops
• Tool kit • Sterile 5”x9” surgical pads
• Contact Lens Saline Solution
• Water containers • Sterile 4”x4” gauze pads
• Talcum Powder
• Garden & RV water hoses • Non-sterile 4”x4” gauze pads
• Diaper Rash Cream
• Duct tape • Non-sterile 3”3” gauze pads
• Zinc Oxide
• Zip ties (lg & sm) • Lap sponges
• Suntan lotion
• Baling wire • Lg maxi pads (100)
• Aloe
• Rope • 1” wide surgical tape
• White sugar (for sugardyne)
• Twine / Cord • 2” Ace style bandages
• Glass thermometers (4 oral)
• Tarps • 3” Ace style bandages
• Glass thermometers (4 rectal)
• Tarp clips • Vet wrap
• Sphygmomanometer
• Bungee cords • Strong nylon thread
(blood pressure cuff, manual)
• Large plastic sheets • Stainless sewing needles, curved
• Stethoscopes (good ones)
• Large tents • Safety pins, medium
• Otoscope
• Shovels, Pick, Post-hole digger, etc. • Enema bags, hose and accessories
• Space blankets
• Basic electrician tools & supplies • Industrial Burn Kit
• Bedpans & urinals
• Extension cords (regular, and heavy • Surgical and Suture Kit
• Superglue
gauge) • Emerg. Dental Repair Kit
• Portable lights • Eye patches, medium
• Adhesive bandages Feminine Care:
• Butterfly bandages
Laundry: • Snakebite kits
• Feminine napkins (washable)
• Pregnancy test kits
• Plastic tubs and buckets for rinsing • Razor blades, single edged • Intimate lubricant
and disinfecting • Cotton swabs • Menstrual pain relief pills
• Large metal pots for boiling water • Rubbing alcohol • Menopausal supplements
and linens • Hydrogen Peroxide 3% • Vinegar
• Laundry soap • Pain creams - menthol based • Enema/douche bags
• Mop bucket(s) with wringer • Pain creams - capsicum based • Tincture of iodine
• Buckets • Antibiotic ointment • Cranberry pills
• Clean toilet plungers • Ibuprofen - 200mg
or laundry plungers • Acetaminophen - 250mg
• Clothespins • Aspirin - 200mg
• Drying rack(s) • Benadryl (Diphenhydramine)
• Soft bristle scrub brushes • Antidiarrheal
• Washboards • Antibiotic pills
• Foot Powder
• Nail Fungus Treatment
Miscellaneous: • Petroleum Jelly
Clean bed sheets and pillow
• Smoke detectors cases can be easily ripped
• Laxatives, various into roll and triangular
• Fire extinguishers • Milk of Magnesia
• Fly traps bandages. Flannel sheets
• Bismuth Subsalicyclate (Pepto) can be made into reusable
• Clinic-only tool kit • Toothache Pain Gel feminine pads.
• Calamine lotion / generics

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Admin / Office: Janitorial: Operating Room:
• Pens / pencils • Vacuum (12v or 120v) • Transfer sheet
• Paper pads (large & small) • Brooms / dust pans • Stretchers
• Copy paper • Mops • Huck towels
• File Folders • Mop heads • Reusable surgical gowns
• Inner-office envelopes • Flyswatters • Disposable isolation gowns
• 3-ring binders • Small Trash bags (3 gal) • Large trashbags (improvised
• Index cards / pads • Medium Trash bags (13 gal) gowns)
• Scissors • Contractor Trash bags (50 gal) • Disposable bouffant caps
• 3-hole punch • Spray bottles or shower caps
• Stapler / remover / staples • Cleaning caddies • Reusable caps
• Highlighters • Pump sprayers (lg & sm) • Shoe covers
• Sharpie pens • Air fresheners • Surgical masks
• Post-it notes • Bleach (liquid,granular, tab) • Vinyl tablecloths
• Various envelopes • Floor disinfectant • Plastic liners / drop cloths
• Hanging folder organizers • Reusable rags • Disposable plastic tablecloths
• Paperclips • Paper towels • Disposable plastic-backed
• Binder clips (large & small) • Hand cloths paper tablecloths
• Small photocopier / supplies • Reusable latex gloves • Hand scrubbers
• Laptop / Printer / Typewriter • Chemical gloves • Hibiclens
• Clocks (wall & small) • Disposable plastic gloves • Stands / folding lap desk
• Misc batteries • Hand sanitizer / refills • Laptop podium
• Organizers • Liquid hand soap / refills • Toolcart w/ball bearing drawers
• Clipboards • Hand lotion • Main light
• Calendars • Wet floor cones • High power flashlight
• Bulletin board / tacks • Mop bucket w/wringer • Blower, flexible ducting, and
• Rubber bands • Small buckets means to filter the air well
• Binder plastic sleeves • Toilet scrubbers • Oximeter
• Solar calculators • Vinegar • Clock
• Clear tape (large & small) • Bleach (liquid, granular, tabs) • Timer
• Paper organizers / boxes • Pine Sol • Trashbins / buckets
• Wall sign holders • Lysol Concentrate
• Label maker & refills • Disinfectant cleaners
• Walkie talkies

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Survival for the Soul
How can I know that I will go to Heaven?
It is sobering to think that one day we will all have to give account
for our lives, and the decisions that we have made toward eternity.
“And I saw the dead, small and great, stand before God; and the books
were opened: and another book was opened, which is the book of life:
and the dead were judged out of those things which were written
in the books, according to their works. ...And whosoever was not
found written in the book of life was cast into the lake of fire.”
Revelation 20:12

“...all have sinned, and come short of the glory of God.”


Romans 3:23

“...the wages of sin is death.”


Romans 6:23

“For by grace are ye saved through faith; and that not of yourselves:
it is the gift of God: not of works, lest any man should boast.”
Ephesians 2:9

“But God commendeth his love toward us,


in that while we were yet sinners, Christ died for us.”
Romans 5:8

“...whosever believeth in him should not perish, but have eternal life.
For God so loved the world, that he gave his only begotten Son,
that whosoever believeth in him should not perish,
but have everlasting life.”
John 3:15-16

“...if thou shalt confess with thy mouth the Lord Jesus,
and shalt believe in thine heart that God hath raised him
from the dead, thou shalt be saved.”
Romans 10:9

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