Grid Down Hospital – Part 1 & Part 2
Grid Down Hospital Introduction
Welcome to the first of what I hope will be many (or at least a few) articles on running a Grid Down Hospital.
For the purposes of these articles, I will use the term Grid Down Hospital to refer to any medical care facility put into service when normal facilities and services, for whatever reason, are not available. Hopefully, such care facilities will be established and staffed by medical professionals, but one can never be certain.
Some of this information will not be useful for you. Some will. Take what you can use, and leave the rest. If you have any specific questions, or concerns, please let me know and I’ll do my best to answer your concerns.
Be forewarned: I am not a traditional kind of physician. I have my own opinions about what works and how things should be done. I also don’t tolerate any ‘woo’ – that is ‘alternative medicine’ that has no basis in science. I may say things you don’t like. You may say things I don’t like. That’s called a discussion.
Right now, I have some articles that I wrote for another website, that hasn’t been updated in more than a year. These include Hygiene and Sanitation, the Grid Down Hospital Library, Medical School (medical education), Grid Down Hospital Central Supply, Grid Down Hospital Pharmacy, Basic tools for the Grid Down Hospital Staff, and the Grid Down Hospital Lab. I have already planned a couple of articles on equipment and techniques for the pre Grid Down Hospital care provider.
Grid Down Hospital – Part II: Hygiene & Sanitation
Trauma is cool…
Patching bullet holes can be exciting.
But this will be a very small part of what you need to prepare for. Grid down, more lives will be saved by the application of basic sanitation steps than all the CLS bags in the world. Being able to find clean water, disinfect or sterilize it, treat sewage and infectious waste (or at least keep it away from anything that will spread it) is far more important in the long term.
In fact, garbage collection and clean water supplies have done more to keep society healthy than all the doctors and hospitals in the world, and for far less cost. Disease, rather than trauma is what kills most people, grid up or down. If you can minimize disease you will have done more to save lives than treating a bullet wound or broken bone.
How to sterilize water? Simple:
You don’t need to ‘sterilize’ water. Sterilization is the destruction of all microorganisms in, on and around an object. What is needed, assuming the water has no other chemical pollutants in it, is disinfection (killing of pathogenic (disease causing) organisms). If the water is polluted with chemicals, you have a very serious problem on your hands.
Disinfection can be done many ways, including filtration, heat, ozonation, and chemical disinfection. Despite many stories to the contrary, simply boiling water will disinfect it. At any elevation you’re likely be at the boiling point of water is high enough to kill (or denature) anything in the water. You don’t need to boil it for any particular length of time, just get it boiling at a good rolling boil.
Filtration is a good method, you should use a filter that has an absolute rating of 0.2 micron diameter or LESS (0.1 micron). Personally, I use iodine crystals (Polar Pure™) first, then filter the water.
Chemical disinfection is the use of various chemicals (usually a halide like chlorine or iodine) in the water. It’s usually a quick, economical and effective method.
Here is a summary of water disinfection chemical usage based on the Wilderness Medical Society Practice Guidelines 2nd Edition, edited by William Forgey MD (page 63):
For chemical disinfection, the key is the concentration of halogens (halogens are a group of elements like Chlorine, Bromine or Iodine), in parts per million (halogen to water):
How to get the desired concentration of halogens, for various products:
Iodine tablets, also known as: tetraglycine hydroperiodide; EDWGT (emergency drinking water germicidal tablets); USGI water purification tablets; Potable Aqua (trade name); Globaline (trade name):
4 ppm – ½ tablet per liter of water 8 ppm – 1 tablet per liter of water.
NOTE: These tablets should be gunmetal gray in color when used – if rust colored, they are useless:
The free iodine has combined with atmospheric moisture. The bottles should be kept well sealed and replaced often. Checking the tablets in the bottle just exposes them to moisture in the air.
For 2% iodine (tincture of Iodine) (gtts=drops)
4 ppm – 0.2 ml (5 gtts) 8 ppm – 0.4 ml (10 gtts)
NOTE: Tincture of Iodine should NOT be used as a wound treatment, so this is not a good option for a ‘dual use’ item.
10% povidone-iodine solution (Betadine™)
NOTE: Solution only, NOT SCRUB – Scrub has soap in it
4 ppm – 0.35 ml (8 gtts) 8 ppm – 0.7ml (16 gtts)
Saturated (in water) Iodine crystals (Polar Pure™)
4 ppm – 13 ml 8 ppm – 26 ml
Iodine crystals in alcohol
0.1 ml / 5 ppm 0.2 ml / 10 ppm
Halazone tablets (Monodichloroaminobenzoic acid)
4 ppm – 2 tabs 8 ppm – 4 tabs
NOTE: The old Vietnam era chlorine tabs are decades out of date. Chlorine tabs decay even more rapidly than iodine tabs. Not recommended.
Household bleach (Clorox™)
4 ppm – 0.1 ml (2 gtts) 8 ppm – 0.2 ml (4 gtts)
Note: Bleach offers a relatively economical method of treating large (gallons) of water at a time. 4 liters is approximately 1 gallon.
For very cold water contact time should be increased.
If drinking this water after disinfection, flavoring agents (drink mixes, etc) can be added: This must be done AFTER the period allocated for disinfection (the disinfecting agent will bind to the organic material and not work).
Bleach offers the easiest and most economical method of disinfecting water, especially in large quantities. Unfortunately, liquid bleach does not store well, and will lose potency over a relatively short time (months to year).
It is possible to make ‘bleach’ from products that are more stable…in particular calcium hypochlorite, also known as ‘pool shock’ or ‘HTH’ (which stands for “high test hypochlorite”). You can buy 1 lb plastic bags for a couple of dollars, and make thousands of gallons of water from it.
Unfortunately, the plastic bags it normally is sold in are not well suited for long term storage. I keep mine in 2 liter Nalgene™ lab flasks similar to these:
which I then keep in 5 gallon sealed buckets. I then keep this bucket well away from anything that may react to it, including metal, brake fluid or water.
Directions for calculating how much HTH to use can be found here:
https://www.scribd.com/doc/266122449/2006-09-14-Faq-Fs-Emergency-disinfection-drinkingwater-2006 (retrieved 1 October 2016) or here:
http://www.who.int/water_sanitation_health/hygiene/emergencies/fs2_19.pdf (retrieved 22 June 2015)
General guidelines on water and handwashing:
(Accessed 16 May 2015)
Guidelines for Drinking Water
(Accessed 16 May 2015)
(Accessed 16 May 2015)
Sterilization of Medical Supplies
Face it, disposables won’t be, but they have to be sterile. Here is some guidance on how to sterilize medical instruments in an austere environment
http://www.moljinar.com/page6/files/Sterilization%20v1-2.pdf Accessed 23 June 2015
Everyone goes, and we need to deal with it. If you’re out of cities, there is a good chance your home is on a septic system, which is great! When was the last time you had it pumped out (not everything is processed in it) and inspected to make sure the leach field is in good shape? It’s easier to fix it now than later.
If you need to dig a hole and build an outhouse, here is a compendium of information:
http://inspectapedia.com/septic/Outhouse_Latrine_Construction.php Accessed 23 June 2015
Accessed 23 June 2015
http://www.weblife.org/humanure/pdf/humanure_handbook_third_edition.pdf (retrieved 22 June 2015)
Medical waste needs to be handled differently than regular garbage, since it is oftentimes more infectious and is always ‘ickier’.
Method for incineration of medical waste: https://www.icrc.org/eng/assets/files/publications/icrc-002-4032.pdf retrieved 22 June 2015
Unfortunately, it will be necessary to deal with the dead. Here are some guidelines:
https://www.icrc.org/eng/assets/files/other/icrc-002-0880.pdf Accessed 23 June 2015
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