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Improvised medicine, as described in this book, encompasses a spectrum of ad hoc equipment and special methods and knowledge for advanced health care practitioners who already work capably within their own areas of expertise. Use Improvised Medicine when, due to the circumstances, you must reach beyond your comfort level and provide medical care usually provided by other specialists—or without the medications, equipment, and milieu to which you have become accustomed.

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In the context of a disaster or a resource-poor environment, frustration may be defined as understanding what can be done, what needs to be done, and how to do it, but not having the necessary tools. Unlike paramedics, who are trained to expect the unexpected, most health care professionals (including physicians, dentists, podiatrists, physician assistants, and nurse practitioners) who work in high-tech health care systems don't expect that the power will fail, a fire will ignite, the computer system will crash, a facility will flood, or an epidemic will erupt. Yet these events occur on a routine basis and, given the state of the world, it is likely they will occur more frequently in the future.

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How do you practice medicine in a disaster when you are confronted by increased numbers of patients, the need to extend your scope of practice beyond your comfort level, and the need to work with limited or alternative methods, equipment, and staff in unusual, often makeshift, locales? When a disaster's scope is regional or national, knowing what to do and how to improvise becomes even more crucial. For a health care provider to innovate, work, and provide leadership in resource-poor environments, especially when others are panicking, often requires superior knowledge and greater understanding. Improvised Medicine provides this.

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In selecting material for this book, I have tried to anticipate both short-term and long-term resource deficiencies. Therefore, some improvised techniques in the book can be used immediately in sudden critical situations; others are long-term solutions for use when equipment and facilities will be lacking for some time. The most mundane, everyday occurrences include the lack of necessary equipment and difficulty with procedures (e.g., airway, IV). If this book's improvised methods help in these situations, great; but the real emphasis is on opening your mind to ways of solving problems in a crisis and providing options for you (and your patients) when alternatives seem limited or nonexistent.

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Farley wrote in 1938 that "original ideas for improvising equipment have been pretty well exhausted."1

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This book is essentially an argument against Farley's thinking. Improvised Medicine represents both exploration and discovery. My adventure took the form of a search through the world's medical literature, both past and current, for procedures that can be used and equipment that can be improvised in resource-poor situations. Many techniques were tested to see if they actually work; some that exist in medical lore did not work when tested. Three major techniques that, initially, seemed like ...

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