Page 27 - Journal of Special Operations Medicine - Summer 2014

http://www.welchallyn.com/), Level 1 H-1025 rapid in- Equipment/Supplies
fuser (Smiths Medical, Dublin, OH; http://www.smiths- A major hurdle was the lack of proper equipment to con-
medical.com/), and an inexpensive piped-oxygen system duct medical or trauma resuscitations. It is difficult to jus-
using two H-cylinders was installed. Cricothyrotomy tify the purchase of new major items of durable medical
and tube thoracostomy setups were staged similar to equipment for a facility that is not intended to be a pri-
the SAMMC ER. Intubation supplies, to include a fiber- mary receiving site for the critically injured or ill. The Tri-
optic laryngoscope with disposable blades, were stored Service Medical Excess Distribution System (TRIMEDS)
in a Flambeau box with break-away seal. An ear/nose/ is an excellent resource allowing units to obtain a wide
throat/ophthalmology box was added with epistaxis array of expensive medical equipment that is otherwise
catheters, Wood’s lamp, and other supplies. A com- going to be disposed by the offering unit as surplus. Ac-
mercially available emergency dental box was obtained. cessible online by all DoD personnel using a Common Ac-
Blanket/fluid warming cabinet, urinalysis machine, and cess Card at https://medlog.us.af.mil, this program allows
a working 12-lead electrocardiograph machine were in- a user to view all “excess” equipment in DoD facilities
stalled in the facility. Figure 2 displays the current state worldwide. Requesting the equipment requires the unit
of the trauma bay, Figure 3 shows the inpatient ward. establish a Defense Medical Logistics Standard Support
(DMLSS) account with the Defense Health Agency—or
coordinate with a supporting MTF. Use of the DMLSS
Figure 2 Current state of the trauma bay. system is almost universal within Military Health System
facilities. As a general rule, this equipment may be several
years old, but is in functional condition. With patience
and a keen eye one can obtain whatever is needed. As an
example, the authors obtained a 2-year-old LIFEPAK 20
®
Defibrillator/Monitor (Physio-Control, Redmond, WA;
http://www.physio-control.com/) as excess from an Air
Force facility that had recently “upgraded” to a different
brand. The requesting entity need only pay for shipping
of the item to their location. Tutorials and updated points
of contact for this process are easily found online.

Another option is the Reutilization Program of the De-
fense Logistics Agency (DLA) whereby vast quantities
of medical (and all other classes of supplies/equipment)
that are turned in by “line” units can be requested by
Figure 3 Inpatient ward. another unit. DoD “customers” have the highest prior-
ity for requesting property. Durable medical equipment,
bulk quantities of disposable supplies, even complete
field Medical Equipment Sets are turned in to DLA all
the time. Often, no one requests the property within the
45-day window and it is sold to surplus dealers at bulk
auction by DLA’s contractor. A tutorial to this process
can be found at https://www.dispositionservices.dla.mil
/change/RTD-DOD.pdf.

Other concerns are the small stock of disposable sup-
plies and pharmaceuticals necessary for resuscitation.
Agreements should be made with parent/supporting or
neighboring large MTFs to exchange these items as ex-
piration dates approach and prevent waste.

Areas for continued improvement include the addition of Training
a portable slitlamp and electronic tonometer to better as- While the first hurdle one encounters may be the lack of
sess eye complaints, reestablishing the basic radiographic “the right stuff,” even the most well-equipped facility is
capability that was removed during the 2009 remodel, useless without the knowledge to use it properly. Even
as well as a Broselow Pediatric Resuscitation System cart if technically competent in emergency procedures, per-
(Armstrong Medical, Lincolnshire, IL) in the event of a sonnel also require confidence in their own abilities to
critical pediatric patient presenting to the facility. perform advanced skills in an emergency situation.

Preparedness for Resuscitation at an Isolated Army Troop Medical Clinic 17