As this second edition goes to press, the need for improvisation among health care workers has become more evident. Natural and human-made disasters have overwhelmed many of the world’s resource-poor regions; local and international health care workers have stepped in to assist—with excellent skills, but often with less than adequate supplies and equipment. Health care workers in more developed countries also experience these shortages, even under “normal circumstances,” but generally to a lesser degree. The information in this book should help to overcome some of these difficulties.

Improvised medicine 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 prevailing 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.

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 other 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 flood will inundate their facility, 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.

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 work, innovate, and provide leadership in resource-poor environments, especially when others are panicking, often requires superior knowledge and greater understanding. Improvised Medicine provides this.

Exemplifying the need to innovate and to manage limited resources is the performance of Dr. Lin and his colleagues of the Israel Defense Forces Medical Corps after the 2010 earthquake in Haiti. Just 89 hours after the massive quake struck Port-au-Prince, the IDF Medical Corps Field Hospital was fully operational. Despite having highly trained personnel and equipment adequate for prior humanitarian missions, “the vast dimensions” of the crisis forced the Corps to find creative solutions “to several problems in a variety of medical fields: blood transfusion, debridement and coverage of complex wounds, self-production of orthopedic hardware, surgical exposure, and managing maxillofacial injuries.” “Under these hectic conditions,” Lin wrote, “lack of specific medical equipment is expected and requires improvisation using available items.”¹

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 supplies (e.g., IV fluids, medications) and having difficulty with a procedure (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.