© 2005 Jeffrey Isaac, PA-C
the problems associated with contaminated sharps. With appropriate medical
supervision, field medical personnel who may not be authorized to perform
injections could administer these medications.
IV fluid replacement, taken for granted in the urban setting, presents
some real challenges to the SAR medical team. The market has responded with
various forms of pressure infusion systems, warmers, and carrying systems.
Infusion Dynamics offers a battery-powered infuser only twice the size of a pack
of cards retailing for about $1800. It can be set to deliver a precise flow rate
regardless of gravity.
The evolution of this example also offers a lesson in practical design. The
original product used a specialized and expensive battery pack. The newer
version uses standard AAA batteries available anywhere, perhaps even stolen
from your headlamp in a pinch.
As appealing as the various new devices for IV therapy are, the
justification for their use is limited. Rather than spending thousands of dollars on
warmers and infusers, consider a bolus system utilizing a 60cc syringe and a
three-way stopcock. For less than $5, you can infuse fluids through a peripheral
or IO port in periodic boluses rather than try to maintain a gravity flow or
monitor an electronic system. It is simple to set up and purge, requires no
batteries, can be packaged and warmed with the patient, and is under direct
control of the medic whenever in use.
Another frequently carried medical technology is the Epi-Pen Autoinjector.
Its obvious benefit is ease and safety of use, but the cost runs about $80 retail
for one dose with a shelf life of only 1.5 years. Medics working in remote settings
will need to carry two or three of the devices to allow for repeat doses.
A less expensive alternative is to carry a 1 mg ampoule of epinephrine and
a 1cc syringe, which costs about $2 and provides 3 doses. The combination
weighs a fraction of the Epi-Pen, and occupies much less space. In freezing
weather, it can be easily carried inside insulated clothing. In this case the
reduction in technology requires an increase in training and competence, but the
trade-off is worth it.
Since you're going to provide the extra training, you might also train your
team to use diphenhydramine and prednisone. The stand-alone EpiPen is fine for
the few minutes that it takes the ambulance to arrive in town. But for prolonged
evacuations in the backcountry, epinephrine alone is incomplete treatment.
