Dual Standards of Care in Humanitarian Ops: Effective Treatment in Limited Resources, Slides of Pediatrics

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Changing Your Frame of Reference

Standards of Care in HA Operations

“Two Standards of Care”

Understand “Two Standards of Care” Empiricism - relying on hunches more than hard data Medical Supplies

• WHO Emergency Health Kit

Who Provides Health Care?

Nurses and community health workers Little to no supervision by a physician

In an HA op, there will not be the HM/MO to patient ratio we are used to:

• train refugees/IDPs as community health workers
• train Marines, soldiers

The Best Thing for Medical

Training Others to perform medical tasks is the most valuable use of our time

• Oral rehydration
• Health education
• Disease surveillance

How do you treat?

IV therapy is extraordinary treatment

• expensive (man-hours, sterile supplies) Greater reliance on oral and intramuscular medications Convenience and ease of administration are forsaken for cost and durability of medicines No lab or X-ray; no time for in-depth diagnosis (up to 60-100 patients per day per doc) docsity.com

What is Used to Treat?

No comfort meds (cold and cough remedies) Low cost, low glamor antibiotics

DRUG PENICILLIN^ ROCEPHIN(high-speed, low-drag) Pneumococcal Resistance 20 %^ 5 %

Cost per person per treatment $ 1^ $ 100

The WHO Emergency Health Kit

Developed by UNHCR, London School of Tropical Medicine, UNICEF, Doctors without Borders, International Red Cross) Driven by prior failures Reliable, standardized, proven, durable, inexpensive, appropriate Packaged for durability (can be air-dropped) Inventory used as model for whole nations’ drug supplies docsity.com

WHO Kit Set-up

Designed to support 10,000 patients for 3 months 10 Basic Units: oral and topical medicines 1 Supplementary Unit: injectables 1000 1000 1000 1000 1000

10,

1000 1000 1000 1000 1000

Supplies in the WHO Kit

(selected list) Antibiotics (very basic) Oral Rehydration Salts Pressure Sterilizer Kerosene Stove Weight / Height Charts Clinical Guidelines

The Antibiotics

Penicillin V Penicillin G IM Penicillin G IV Ampicillin Septra Chloramphenicol Tetracycline

Penicillin G and Bicillin IM

Procaine IM only (1000 doses)

• child: 25-50 k units / kg / d divided q 12 h
• adult: 300 - 600 k units q 12 h Bicillin (50 doses)
• depot shot q 15-30 days Indications
• Mild-moderate versions of:
• respiratory infections
• head & neck infections
• oral anaerobes, strep docsity.com

Ampicillin PO / IM / IV

Ampicillin PO (2000 tabs)

• child: 50 - 100 mg / kg / d divided q6h
• adult: 2 - 4 g / d divided q6h Ampicllin IM / IV (200 doses)
• child: 100 - 400 mg / kg / d divided q4-6h
• adult: 6 - 12 g / d divided q4-6h Indications
• moderate-severe respiratory infections
• neonatal sepsis / meningitis
• better gram-negative coverage than PCN docsity.com

Chloramphenicol

Oral: 250 mg tabs (2000 doses) IM / IV 1 g injections (500 doses) Doses:

• < 1 wk: 25 mg/kg/day

• 1 wk: 50 mg/kg/day div q12h

• 4 wk: 50 mg/kg/day div q6h

• child/adult: 100 mg/kg/day divided q6h

Chloramphenicol continued

Indications

• Excellent penetration of all body fluids
• Use for all serious infections
  • sepsis
  • meningitis
  • respiratory infections
  • bone / joint infections
  • typhoid, cholera, dysentery