To treat or not to treat

[Craig]

From a medical point of view Im fairly well stocked up. However one person with a major trauma who required say 1-2 weeks of intensive treatment ( fluids, antibiotics, pain relief, you can easily get through 20-30 L of fluid in a week ) would wipe me out. Now there is no way that I can afford or spare the space to stock more than I currently have. So what do you do - close relative suffers several GSW's to various parts of the body or suffers from a severe pneumonia that will use up all your IV antibiotics. Do you blow everything on perhaps a 50% chance of saving them ? Or do you let them die and use your stuff more prudently.

On one hand the reason you stocked up was so that your nearest and dearest would have medical care in a crisis - but surely you dont want to blow everything at once.

What would others do ? Go all out or accept there time was up ? Hard call. Do you just apply your standard disaster triage seive?

Craig

[tangent]

hmmm... triage screening varies, but generally implies you have multiple patients and can't save all of them. Here you are flipping that to assume that you WILL have future patients needing your limited supplies. Can you imagine how you'd feel if you let them go, and then your stuff went bad on the shelf?

a possibly better tact might be a heroic initial intervention, and then see how things are looking for recovery before commiting all your supplies.

from another point of view, you are making what are possibly some bad assumptions.
1) when it's gone you won't be able to get or make more.
2) reliance on stockpiled products vs means to produce alternatives.
3) alternative treatment stratagies in this case or future cases are not possible.

more later...

[Craig]

Tangent,
You would feel awful and guilty. Thats the problem. The classical problem limited resources vs. greater need. Im just trying to get my head around this issue when its close to home, ie family.

I dont think my assumptions are false - you are obviously just more optimistic than I am :smile:. It depends on what sort of disaster we are talking about - a big natural disaster with help on the way Id go all out - but what about a bigger disaster with no prospect of help ? To date most alternative or improvised treatments Ive come accross are not as good as currently available, so IMO you wont be replenishing your stock with like - ie you may be able to replace your stock of ketamine with ether (perhaps), but not with ketamine.

cheers

Craig

[RESQDOC]

This really is the core question, isn’t it? Limited resources, limited capability to resupply, how much do you use, when do you use it, when do you withhold it?

In a worst case scenario there will be terrible injuries, horrible pain, poor survival rate from serious illness/ injury, early death, misery all around. For most of us it is not possible to afford or store adequate supplies for extended, multiple patient operations. As much as we would all like to have a prepackaged disaster hospital standing by, it just isn’t possible. Thus we must prepare for care of our immediate, on a fairly short term basis in terms of consumable supplies.

Let me through these questions out, just thinking out loud:

1. Who has the highest priority? Is it YOU? Are you the only medical provider? If you go belly up, will the prepackaged disaster hospital do anyone else any good? Should you save back supplies in case you need them?

2. Are you willing to provide aggressive comfort care for those too seriously injured to be saved, and no other treatment? What about your spouse? What about your children? Can you make a rational decision about their potential for survival? Will you use anything, do anything, irregardless of their potential for survival? Would you consider euthanasia for them if terminal, or just comfort care until nature takes it’s course?

There is of course, no correct answer, and in fact no way to really know unless you find yourself in that position. We ALL die. Prolongation of life at any and all costs in any and all circumstances is not the goal, in my opinion. It is how we live, and how we die, that is important. There are things worse than death, I have seen them, I fear them worse than death, for my family and myself.

Our family’s position is this: every effort will be made to conserve consumable supplies and use conservative management techniques, etc. The majority of straight forward illness
and injury can be managed with sanitation, nutrition, pain control, and adjunctive measures. Maybe not as quickly, maybe not with as good an outcome, maybe with more
pain, but the majority of our ancestors survived under such conditions, we can also. However if there is a reasonable chance of survival only by using a drug, whatever, it will be used. I will not let my children die from a pneumonia that would be survivable,
probably, with treatment.

The problem at hand is more important than the potential problem in the future. Yes, supplies might be used up and not available in the future, that’s the nature of the beast. I will not look at a bottle of antibiotics on the shelf and wonder why it was there and my child was in her grave.

Clearly non-survivable conditions will be kept comfortable in any fashion necessary. My
wife (a nurse) and I have discussed euthanasia for each other, should that be the only option, and are prepared to do so if necessary. My wife does not feel capable of doing so for our children so we are prepared to use any supplies necessary to keep them comfortable until the end. Not the logical decision perhaps, but that is our choice and I am comfortable with it.

_________________
Do No Harm. Do Know Harm.

[jagdkampf]

One other possibility is renewable resources. Modern hospital use a very high percentage of non renewable resources, i.e. disposable syringes, needles, iv solutions, etc, etc. The most basic of IV fluids are either .9% NACL or D5W, both of which can be easily manufactured and sterilized. Glass syringes and needles without plastic hubs can also be sterilized. Instrumentation can be readily resterilized as well. Suture materials can be obtained from some other unorthodox sources. Probably the most difficult thing to come by would be medications. We certainly overuse antibiotics in the modern world but they also don't have an easy replacement. Aseptic technique and sterility goes a long way along with good hygenic measures in preventing infection and disease but we will never be able to replicate a modern hospital in the worst case scenario and a higher mortality rate is inevitable. Perhaps we should talk more about how to invest in renewable supplies and how to make IV solutions.
JAG

[tangent]

I'm splitting this thread out into two, this one for the moral side of the issue, the new thread, titled: "Extended Medical Care w/ No chance of Resupply" in the same forum.

as to the moral issues. you stockpiled the supplies, it's your family and your skills - of cource they get treated first. In a group situation, and maybe it's not your medical supplies - the equasion shifts a little... if there is another medical person with equivalant or better skills in the froup that is NOT related to the patient, mabey the best thing you could do is pass treatment and the decisions on to them and stay out of it, unless you are needed.

other considerations: considering the survival of the group/family as a whole, how old is each member? what skills do they bring to the table? can anyone else do what they can? (ie: loss of one member could threaten survival of whole group - a bad situation to be in!) What is their condition, otherwise? A 67yo male diagnosed w/ lung cancer and given an estimated 2-3 years to live is not going to be a high priority in my book if I have a wife, brother, sister and half a dozen kids underfoot. OTOH - if that person is the only one that knows how to store food, is an encyclopedia of doing things the old ways, is a machinest or a chemist, or a doctor...

every situation is diffrent.

[Reasonable Rascal]

Morality vs. austere conditions. A subject of serious consideration. Consider the trek in the backcountry when you encounter a native of the region in need of serious attention, for which you also have need of the meds for a member of your group owing to misfortune.

Split the supplies and make them stretch, perhaps increasing the disability of your fellow trekker, toss what you have at the misfortunate because after all you are presumably on your way out towards civilization and your fellow trekker has you and others to assist them, or curse their misfortune on top of your own and continue on?

RR

[cayoung]

The big question is knowing what challenges will spring up in the future. And knowing for sure that you've reached the end of your medical restock. You also don't know if someone else (govt, or mobs) will move in and take what you have.

On the chance that resupply comes over the hill, or that you don't have more patients, I'd be tempted to treat agressively. Especially myself or family.

The two negative outcomes seem to be
1) You treat agressively and someone later needs the supplies more
2) You don't treat agressively, and you regret being stingy.

What with the odds of confiscation and mobs and further problems, I'd lean towards treat agressively, now.

There is no good answer, but this may be useful to some of us.