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Chapter 5. Basic Equipment

Basic medical equipment may not be available when needed. In developing countries, for example, even some of the largest hospitals lack basic medical equipment.1 Louis Pasteur reportedly said, "Chance favors the prepared mind." Be prepared to improvise. This book supplies ideas about how to make-do when faced with shortages. Problem-solving skills will take you the rest of the way.

"When improvising medical equipment, consider whether it (A) Will accomplish the purpose for which it is intended? (B) Is practical? and (C) May cause an accident or increase danger to the patient or clinician?"2

Health care resources, whether purchased, donated, or improvised, should be matched with the skills of the practitioners and the type of facility in which they are to be used. Table 5-1 describes the spectrum of health care facilities worldwide and is the basis for the "Essentials" tables in this chapter (Table 5-2) and elsewhere in the book.

Table 5-1 Spectrum of Health Care Facilities
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Table 5-1 Spectrum of Health Care Facilities

Basic

Village health posts

Clinics with nurses or medical assistants

Clinics with doctors

General Practitioner Hospital

General practitioner-staffed hospitals

General practitioner-staffed with surgical capabilities

Specialty Hospital

Hospitals with general surgeons

Hospitals with general and orthopedic surgeons

Hospitals with general and orthopedic surgeons and other specialties

Tertiary Hospital

Tertiary care facilities with limited range of specialties

Tertiary care facilities with full range of specialties

Adapted, with permission, from Mock et al.3

Table 5-2 WHO Basic Diagnostic/Monitoring Essentials
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Table 5-2 WHO Basic Diagnostic/Monitoring Essentials

Facility Level

Resources/Capabilities

Basic

GP

Specialist

Tertiary

Stethoscope

E

E

E

E

Blood pressure cuff

E

E

E

E

Flashlight (torch)

E

E

E

E

Thermometer

E

E

E

E

Fetal stethoscope

D

E

E

E

Urinary catheter and collection bag

D

E

E

E

Otoscope

D

E

E

E

Ophthalmoscope

D

D

E

E

Pediatric-length-based tape (Broselow)

D

D

D

D

Electronic cardiac monitoring

I

D

D

D

Central venous pressure monitoring

I

D

D

D

Right heart catheterization

I

I

D

D

Intracranial pressure monitoring

I

I

D

D

Abbreviations: D, desirable; E, essential resources; I, irrelevant.

Adapted, with permission, from Mock et al.19

Improvised (Safe) Medical Structures/Modification of Existing Structures

Any available site may be used to provide immediate health care when local facilities are overwhelmed. Generally, these will be buildings of convenience. Optimally, such buildings will be selected in advance and assigned a specific use (ambulatory care, hospital or nursing home overflow, minor acute hospitalization). Control (who runs and is responsible for it) and funding (who pays) for the facility, as well as the required supplies and equipment, should be predetermined. In most cases, a contingency contract with the building's owners will be necessary.

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