Surgical Intervention in the Field
	Date: Fri, 6 Sep 1996 20:26:46 From: John Trickett [thornbur@travel-net.com] While we are on the subject of surgical intervention in the field, in Ottawa we are currently discussing the availability of supplies for mass casualties in the field. Each of the paramedic vehicles carries sufficient tubes, drugs etc for 3 or 4 cases but once we start talking large numbers they are left with their hands,stethescopes and little else. We are trying to set up regional guidelines on where a large quantitiy of supplies should come from, how much is enough and who is responsible for supplies such as the narcotics.
	Date: Sat, 07 Sep 1996 18:37:30 From: DARRELL K. SCALES [SCALED@NEXTEL.NET] Probably the best way to prepare for a "Mass-Cal" is not to keep all of the supplies "up" on the paramedic vehicle. Design your own "Trauma Mass-Cal Push-Pak." This would be a large packet/pallet that could be sent to a site of a mass-cal and distribution from this packet could be organized/supervised by a trauma site coordinator. Each of the paramedic vehicles will never carry enough supply for a mass cal on the scale of,say, a jetliner crash. Each of these vehicles would possibly carry enough supplies together to provide for the casualties while awaiting the "push-pak." I haven't spent much time in a paramedic vehicle recently, but I don't recall much room for much more supplies. Also as often as a mass-cal occurs, it probably is not cost-effective to carry a lot of supplies to be prepared for one. The person responsible for distribution of medications/narcotics... would be in the mass-cal protocol for your area. I was with the 2d Armored Cavalry Regiment in Germany and in Iraq. We had separate boxes for regular field use: medical treatment, basic trauma. Packed in trucks ready to be broken open were our chests that contained loads of IV's, chest tubes, dressings, splints. Our mass-cal chests were not broken open except to change out expired items - this way we knew that we had enough supplies ready for when they were needed. Hope I gave you something helpful.
	Date: Sat, 7 Sep 1996 13:23:36 From: Arnaud Derossi [aderossi@pratique.fr] Such supplies has been prepared for a few years in France, and are stocked in the regional "SAMU" (french EMS system); it's called "Poste Sanitaire Mobile" (or PSM), and is located in the hospital where is settled the SAMU (i.e one SAMU per "departement" (state) -> one PSM per "departement"). There is enough material and drugs to take in charge around 500 wounded peoples. It is packed in special plastic boxes, with size and weight printed on it, so that it's easily and quickly available to be taken on-board aircrafts. It's therefore available 24 hours a day, in a very short notice (kit / 50 wounded peoples ready to leave within 10 minutes, and kit / 500 peoples within 45 minutes). Peremption of drugs is controlled by the hospital pharmacy. The only omissions are: - oxygen (for "real" disasters, whatever the stock quantity, it would'nt be enough... we are working on the idea of "chemical" oxygen); - blood products (replaced by colloids, for the haemodynamic part of it; future is the synthetic haemoglobin); - narcotics: only buprenorphine / nalbuphine; availability of fentanyl / sufentanil through the hospital pharmacy; Hope this helps...