From tourniquets to chest seals, our community has been at the forefront of innovating, problem solving and improvising when not able to get a commercially tested and manufactured medical device. A purpose-made, evidence-based solution should always be primary in the PACE plan. After the primary manufactured and evaluated product is exhausted, what then? What is your alternate, contingency or emergency? Do you and the people that may potentially be treating you, fully grasp the principles behind all the fancy, expensive equipment that you use for the environment in which you are operating? The easiest example is the tourniquet. A tourniquet provides the user a secure mechanical advantage to apply pressure to the vessels of a limb or junction over what they would normally be able to reliably apply without something such as a windlass or ratchet system. It also incorporates materials that will not break a wide enough strap to disperse the pressure over a wider area to reduce the chance of iatrogenic injury from a narrow strap or cord. Same with a pad under the mechanism to reduce the incidence of pinching. Once the principles of these devices are fully understood, trial and error testing can begin. You must test what ever it is that you are planning to use in place of a vetted product.
Does it work?
Is it reproducible?
By your less trained partner force?
In the conditions that you will be contending with?
Once you have a plan and begin testing. Make sure you record your results, including tips and pearls so that the next person can duplicate what you did. Here is our post on bleach powder for disinfection and Dakins solution as an example. If you have something that has worked for you, please detail it in the comments below and perhaps we can add it here as an addendum or as a separate post in the future.
What if you have to improvise more than a tourniquet or IFAK contents though? Here is a list put together in the case that you find yourself in a situation where traditional MEDLOG channels cannot keep up with, you have limited budget with which to purchase purpose made supplies, or have extremely limited space with which to travel and transport equipment. This list is not comprehensive and should not limit your imagination. It should, however, help organize your thoughts and jog your memory while on your shopping trip to Walmart or Maxima. Other outlets that have some of these supplies are agricultural stores and, of course, drug stores or apothecaries.
Once you do this locally, even just by taking pictures and comparing items with others. Try doing it while traveling or on deployment to a developing country where there is no Walmart.
Some of the testing and evaluation mentioned above, may have already been done with evidence published in peer reviewed resources. Check back issues of the Journal of Special Operations Medicine. Once you sign up for a membership, either directly with a digital subscription or though a membership with SOMA, you can download all past issues via PDF and search through them. Another resource that every austere clinician should check out is the book, “Improvised Medicine 2nd Edition,” by Kenneth Iserson. I cannot recommend this book enough. As a testament to its popularity, each time I have purchased a copy for a course, it gets reappropriated. The kindle edition is a little cheaper and can’t just walk away. We probably need an Amazon Smile account with all the book recommendations I’ve made but we don’t receive money from any purchases… yet.
What would you add?
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