In an earlier post on Katrina and preparing for an emergency, a commenter asked an excellent question:

As a doctor, what would you recommend [for an emergency medical kit] for usually healthy laymen?

The answer: it depends. (don’t you just hate answers like that ?)

But it does–it depends on a number of different things:

• Where are you located geographically?
• What sort of emergency or emergencies are you likely to encounter?
• How many people are likely to require medical care?
• What is the health or health problems of those affected?
• What is your level of medical expertise?
• What kind of injuries or medical problems would you expect in a disaster?

Your medical needs in an emergency will vary–at least to a degree–based on where you are located, and what type of disaster you are likely to encounter. For example, the Southeast, the Gulf and Florida are at obvious risk for hurricane. Wind and structural damage are likely, but flooding risk will depend on whether you are near a body of water (and don’t underestimate the potential for a small creek to become a raging river). Out West, earthquakes are much more likely, which tend to result in structural damage and fire (from electrical and gas line disruption). If you live in a major urban area, large-scale terrorism (biological, chemical, or nuclear) are more likely than in a small midwest town–where tornadoes, flash floods, or severe snow conditions might be a far greater risk.

Your climate may also have an influence on your medical needs–dehydration being more likely in hot climates, hypothermia in cold.

Your medical condition–and that of those in your family–should also be considered. While most people will not be at risk missing routine prescriptions for hypertension, high cholesterol, or many other conditions for short periods (1-2 weeks), people with diabetes (especially those requiring insulin) can get very sick very quickly without their medication and monitoring equipment, for example. If you are unsure how critical your prescription is in such an emergency, ask your doctor.

It is worthwhile considering (unpleasant though it may be) to consider what might happen, in terms of possible injuries, during a disaster. Some are obviously worse than others, but all should be thought through when preparing:

• Lacerations–breaks in the skin, minor or severe, which pose a risk of infection, or in some cases serious bleeding;
• Fractures (broken bones)
• Sprains–injured and painful tendons which can limit mobility
• Burns–usually from fire, electrical, or chemical injury–although severe cold (frostbite) is similar in many ways
• Temperature-related dangers–hypothermia, heat prostration
• Infection–usually a risk from other injuries, although contaminated food and water are a risk as well.

Some basic medical supplies should be in every emergency medical kit. The most important which come to mind are:

• Wound dressings. These come in a variety of forms, and gauze bandages (separate squares, typically 4 x 4 inches) or rolled in 1 to 3 inch width are the most common, and should be available. Another excellent wound dressing is Tegaderm–a clear adhesive film dressing, which has the advantage of being waterproof, and which will remain adherent for many days. It is excellent for small lacerations, burns, or blisters.
• Compressive dressings. This includes Ace wraps in several widths, and elastic bandages which can conform to irregular areas. These are very useful for sprains or for keeping pressure on wounds to control bleeding.
• Antiseptics. Cleaning a burn or open injury early is the best preventive measure for preventing infection. Iodine-based solutions (such as Betadine solution–not the scrub, which has soap), hydrogen peroxide, and rubbing alcohol are all excellent disinfectants and readily available.
• Topical antibiotics. Neosporin, Polysporin, Triple antibiotic cream or ointment.
• Surgical tape. Paper and cloth tape to hold dressings or splints in place. Paper is easier on the skin but adgeres poorly when wet.
• Bandage scissors. These heavy scissors are invaluable for cutting tape and dressings, or cutting off restrictive clothing.
• Instant cold packs. Reduce swelling and pain with early injuries.
• Survival blankets. Even in warm climates hypothermia can be a risk with prolonged exposure. These blankets can be lifesavers. A sleeping bag is an alternative, although it may be difficult to get an injured individual in and out of these.
• Latex exam or surgical gloves. These come in various sizes. Sterile gloves are a luxury but clean latex gloves will serve well in most circumstances, and don’t need to be rotated.
• Simple surgical tools. Tweezers, hemostats, small iris or similar surgical scissors, can be very useful for extracting wood, metal, or glass fragments, cleaning dirty wounds, or performing open heart or brain surgery (just joking about the last). They can be sterilized by boiling or with rubbing alcohol to a safe degree of sterility for an emergency.
• Splints. These are important to stabilize fractures or severe sprains.
• OTC Drugs. Aspirin, ibuprofen, Benadryl or similar antihistamine, hydrocortisone cream.

There are no doubt other things (which my medical readers or others may suggest), but this would seem to cover the basics pretty well. Most of these items are inexpensive and can be easily purchased at local stores or over the web.

Store these items in a sturdy container, such as a toolbox, tackle box, or similar container that will survive some banging around. Consider a waterproof container if you are at risk of floods or water damage. And consider where you are going to keep this kit: if your house is destroyed by fire or collapses, and your medical supplies are inside, all your preparation is for naught. Duplication is a good idea, at least for the most critical items–keeping one in a structurally safe place in your home, one in your car–and don’t forget about work.

Most of the items I’ve mentioned above are quite stable over time, and shouldn’t need replacing often. Peroxide and the OTC medications can probably be rotated every few years and remain safe and potent. If you need to store critical prescription medication, you will need to be much more proactive on keeping these up to date, as most medications outdate in a year. Plan to rotate these on your birthday or some other easily-remembered date.

Such an emergency kit will cost you less than average Seattlite spends on mochas a week, and can be assembled in very little time. Take the time and effort to get one of these together–it may save your life.

Update: A little sleep has brought to mind several more items:

• Normal saline for irrigation, and a syringe (an ear bulb will work fine)
• A tourniquet–actually something of a mixed bag. It can be lifesaving in severe bleeding from an extremity, but you have to have have some idea how to use it. A length of latex rubber hose will work fine.

And everyone should get the basic skill of CPR–both for disasters and general safety.