RESQDOC
12-04-01, 09:24
OK, lets press on. The take home points from Part 1 were these:
- Medical care basics are a priority
- You must understand far more than a simple indication or normal value for a test to be of value or meaningful for patient care
- While it is possible to do a wide variety of tests, given adequate resources, you must select the tests of greatest value under remote/disaster conditions
- The highest priority tests are those that are relevant for your current medical problems
- Other tests should be focused on the most common survivable/treatable conditions, including infections of various types, anemias, pregnancy, and metabolic problems
To this I would add, “learn a few things very well.” I think that you would be better off to limit your focus to those tests that give you the most bang for your particular situation rather than try to develop a broad based capability to start with. Later, when feasible, you can expand as desired. This is not easy material to learn or stay current on, some of it requires on-going practice to be accurate and consistent, and some simply can’t be learned on the fly in the middle of chaos. Better that you learn in detail the parameters of a 10 test urine dipstick than put a book on the shelf about malaria smears and fool yourself into believing that you can learn to ID smears if you need it someday.
The concept of “sustainability” needs to be discussed also. Many of the newer lab techniques are dependant on electricity, technology, limited shelf life materials, or relatively fragile components. This makes them difficult to use without a regular resupply of materials, availability of service & repair, etc. The usual answer to this problem is “well, lets do it the way they did 50 years ago.” That’s fine, except that many of the older techniques are based on availability of extensive, very diversely equipped laboratories with dozens if not hundreds of chemical reagents and pieces of labware/equipment available. Yes, it’s quite nice that you can perform a urine glucose test without relying on a limited shelf life dipstick – but to do that you have to have several chemicals available, which have their own storage problems and are of limited general use and somewhat expensive to stock. So, what is really sustainable? For an experienced chemist a well set-up lab might be reasonable. Ditto an experienced medical technologist. These people are literally worth their weight in gold, and should be cultivated and protected if they are a part of your planning. For the rest of us I suggest that it is not feasible or reasonable to plan to equip an extensive medical lab. Too much stuff, too much money, especially if you plan to use the older methods. Too fragile, too much resupply if you plan on using the newer methods.
So, I guess we’re just SOL, huh? No, not at all. I think that the “average” medic can learn to perform useful medical tests, with a reasonable accuracy & safety, using a reasonable amount of equipment in a “blended” approach of both older and newer methods. Some of this requires electricity – if you want these capabilities, you’ll have to plan on a method of producing the juice. Some of this requires use of limited shelf life material – if you want these capabilities, you’ll have to plan on rotating stock to keep fresh material on hand and accept that you might run out someday. Some of this requires practice and experience – if you want these capabilities you’ll have to plan on spending the time. But we never said it would be easy, did we?
So what are the take home messages tonight? I would suggest these:
- Learn a few high priority things very well to start with
- Be rational in assessing your needs & capabilities, don’t assume that you can learn everything out of a book without prior study and practice
- Recognize that neither “old” nor “new” methodologies provide entirely satisfactory solutions for our purposes, compromises will need to be made, and some things may not be possible at all
I think that lab capability can be broken down into two general categories: those tests that do not require microscopy, and those that do. This is not a traditional separation, yet it makes sense to me, as use of a microscope adds both a quantum leap in complexity and capability. I suggest that we begin by discussing testing that can be performed without a microscope, and without complex, multistep chemical processes and build from there. Other opinions, perspectives, and criticisms of this approach are encouraged, everyone with an interest please contribute!
First up: simple blood testing
Take care,
Keith
- Medical care basics are a priority
- You must understand far more than a simple indication or normal value for a test to be of value or meaningful for patient care
- While it is possible to do a wide variety of tests, given adequate resources, you must select the tests of greatest value under remote/disaster conditions
- The highest priority tests are those that are relevant for your current medical problems
- Other tests should be focused on the most common survivable/treatable conditions, including infections of various types, anemias, pregnancy, and metabolic problems
To this I would add, “learn a few things very well.” I think that you would be better off to limit your focus to those tests that give you the most bang for your particular situation rather than try to develop a broad based capability to start with. Later, when feasible, you can expand as desired. This is not easy material to learn or stay current on, some of it requires on-going practice to be accurate and consistent, and some simply can’t be learned on the fly in the middle of chaos. Better that you learn in detail the parameters of a 10 test urine dipstick than put a book on the shelf about malaria smears and fool yourself into believing that you can learn to ID smears if you need it someday.
The concept of “sustainability” needs to be discussed also. Many of the newer lab techniques are dependant on electricity, technology, limited shelf life materials, or relatively fragile components. This makes them difficult to use without a regular resupply of materials, availability of service & repair, etc. The usual answer to this problem is “well, lets do it the way they did 50 years ago.” That’s fine, except that many of the older techniques are based on availability of extensive, very diversely equipped laboratories with dozens if not hundreds of chemical reagents and pieces of labware/equipment available. Yes, it’s quite nice that you can perform a urine glucose test without relying on a limited shelf life dipstick – but to do that you have to have several chemicals available, which have their own storage problems and are of limited general use and somewhat expensive to stock. So, what is really sustainable? For an experienced chemist a well set-up lab might be reasonable. Ditto an experienced medical technologist. These people are literally worth their weight in gold, and should be cultivated and protected if they are a part of your planning. For the rest of us I suggest that it is not feasible or reasonable to plan to equip an extensive medical lab. Too much stuff, too much money, especially if you plan to use the older methods. Too fragile, too much resupply if you plan on using the newer methods.
So, I guess we’re just SOL, huh? No, not at all. I think that the “average” medic can learn to perform useful medical tests, with a reasonable accuracy & safety, using a reasonable amount of equipment in a “blended” approach of both older and newer methods. Some of this requires electricity – if you want these capabilities, you’ll have to plan on a method of producing the juice. Some of this requires use of limited shelf life material – if you want these capabilities, you’ll have to plan on rotating stock to keep fresh material on hand and accept that you might run out someday. Some of this requires practice and experience – if you want these capabilities you’ll have to plan on spending the time. But we never said it would be easy, did we?
So what are the take home messages tonight? I would suggest these:
- Learn a few high priority things very well to start with
- Be rational in assessing your needs & capabilities, don’t assume that you can learn everything out of a book without prior study and practice
- Recognize that neither “old” nor “new” methodologies provide entirely satisfactory solutions for our purposes, compromises will need to be made, and some things may not be possible at all
I think that lab capability can be broken down into two general categories: those tests that do not require microscopy, and those that do. This is not a traditional separation, yet it makes sense to me, as use of a microscope adds both a quantum leap in complexity and capability. I suggest that we begin by discussing testing that can be performed without a microscope, and without complex, multistep chemical processes and build from there. Other opinions, perspectives, and criticisms of this approach are encouraged, everyone with an interest please contribute!
First up: simple blood testing
Take care,
Keith