Our healthcare systems are strained beyond capacity. From healthcare worker shortages to increase in patients visiting the emergency rooms, to medication shortages our fragile healthcare system is reaching, and in some instances has reached crisis mode.
Our medical supplies and medications are in jeopardy
We rely on other countries for the materials to make our medications
According to the council on foreign relations “It is believed that about 80 percent of the basic components used in U.S. drugs, known as active pharmaceutical ingredients (APIs), come from China and India, though the exact dependence remains unknown since no reliable API registry exists.”
(API refers to active pharmaceutical ingredients)
Considering the current healthcare crises, along with the political and social climate of our world, that is a very scary statement.
Our global economy, which virtually shut down over the past months has placed our healthcare system in jeopardy. Even those we rely on during a crisis- our firefighters, EMTs, paramedics are in short supply, or in some areas of the United States they are nonexistent. In many ways we are on our own.
Are you prepared to handle a medical emergency?
According to the CDC there are 130 million visits annually to the emergency room.
Some of the most common reasons for these visits were cough, headache, fever and vomiting.
Many of these visits could be avoided with proper education, supplies and medications on hand.
Medical emergencies come in many forms
- Natural disaster– earthquake, tornado, hurricane, fire, flooding
- Health emergency– heart attack, uncontrolled diabetes, choking
- Illness– fever, vomiting, diarrhea, cough, severe allergic reaction, etc.
- Injury– Motor vehicle crash, household injury such as falls resulting in fracture or sprain,
Etc.
- Supply chain disruption– limited or lack of necessary medications and supplies
What can you do?
First identify your own situation and medical needs
- Are you in an area that is prone to natural disasters?
- Do you live in an area where medical attention may take a long time coming?
- Given the current shortage of EMTs and paramedics you may have a very long wait, even if you live in the city. Be prepared for the fact help may be long in coming or not at all
- Are you or those in your household on medications that would be life threatening if you/they ran out?
- How is yours and household members mobility?
- Do you live alone or with others? If so, would they be able to provide medical assistance if you needed help?
Each household will have a different set of priorities. However, there will still be many common areas to prepare
ACTION PLAN
ACT, NOT REACT
Medical preparedness, just like any preparedness topic has a learning curve. But armed with knowledge, practice, and the necessary medications and supplies you will be able to handle many medical emergencies and avoid a trip to the hospital or clinic.
Get out a notebook and start your action plan if you haven’t already
Start a checklist with the following information:
- Accumulate the necessary food (according to diet -low sodium, diabetic, allergy free foods- and clean water. Goal is to start with a months’ worth of food and build from there. There are several online resources that can help you with this. This may not seem like a medical prep, however without adequate clean water and food you aren’t able to maintain health.
- Discuss with your primary care provider about prescribing several months’ worth of medications AND OBTAIN THOSE MEDICATIONS.
- Schedule a consultation with a Jase medical provider and purchase the antibiotic kit on this site.
- Purchase an adequate first aid kit (It is advisable to have one for each vehicle and a home kit) A recommended website for your first aid kit and other emergency supplies is https://mymedic.com/ Be familiar with what is in the kit, don’t just buy it and put it on the shelf for when emergency arises.
- Along with a first aid kit make sure you have adequate pain relievers, creams, bandages, ace wraps ice packs, etc.
- Post important phone numbers in a place that all in your household know where to find it (911, fire, police, trusted neighbors, family to contact in case of emergency) A self-laminating pouch is a good idea to store this in. The refrigerator or inside a cupboard are common areas these are posted.
- If you and able-bodied members of your household haven’t already attended first aid and CPR classes, sign up and get that done. There are many CPR and first aid course out there. Either find a reputable one locally or the Red Cross has many options to choose from
- Start a first aid library and read the books. Apply what you learn in practice scenarios if able. A few recommended books are American Red Cross First Aid-Responding To Emergencies and The Survival Medicine Handbook- The Essential Guide When Help is NOT on the way
The most important step you can take is to take that first step.
- Get educated
- Obtain supplies
- Practice and get familiar with your supplies.
Next week we will be starting a series on various medical conditions and when to call the doctor.
Our expertise at JASE is focused on providing our patients with the more difficult to obtain prescription medications for their emergency preparedness. Specifically, antibiotics and medications for chronic conditions. Our five specially selected antibiotics can all be found on the WHO’s Model List of Essential Medicines. However, when putting together a useful first-aid/med kit you should include much more than just prescription antibiotics. Here are a few other important medications to consider:
Acetaminophen (Tylenol): Everyone is familiar with this medication. It is a great option for mild to moderate pain. It is safe for those who may have kidney or GI problems as it is processed mainly by the liver and doesn’t cause the same kind of stomach/intestinal issues that ibuprofen can cause.
Ibuprofen (Advil): Another very common and effective medication to treat mild to moderate pain and inflammation. Ibuprofen is processed in the kidneys so caution should be exercised in people who have kidney disease. It can also be hard on the stomach and has been known to cause GI bleeds (although this is rare).
Loperamide (Lomotil): Not all diarrheal causes are from bacteria. Most of the time a diarrheal illness will be self-limited (meaning it will go away on its own without any treatment). Having some loperamide on hand is great when stopping every few minutes to go to the bathroom just isn’t an option. You may be traveling, on a bus or plane, hiking, or at work when you don’t have quick access to a bathroom. Caution when taking this medication as it can sometimes work too well and you will end up with constipation instead! Take as directed and follow the dosage guidelines.
Diphenhydramine (Benadryl): This medication should be in everyone’s first-aid kit. It is an antihistamine and can be used for minor allergic reactions or even as a sleep-aid.
This is just a very small list of over-the-counter medications to consider when putting together a first-aid/med kit. And don’t forget those daily chronic medication needs such as medications for high blood pressure, thyroid disorders, seizure disorders, antidepressants, asthma, etc. Our physicians can determine which medications would be appropriate to prescribe in long-term amounts. Have any questions? Don’t hesitate to reach out to us at answers@jasemedical.com.
A common concern we get from patients is their penicillin allergy. Penicillin reported allergy is the most common drug allergy in the United States. Estimates range from 10%-25% of the population have a penicillin allergy reported on their medical record.
However, even though you might have a penicillin allergy reported on your medical record it doesn’t necessarily mean you have a true allergy. In fact, over 90 percent of patients with a reported penicillin allergy are found to not actually have any allergy when formally tested.
LESS THAN 1 in 10 of reported penicillin allergies are truly allergic
WHY ARE THERE SO MANY FALSE PENICILLIN ALLERGIES?
One of the more common reasons that a penicillin allergy might be posted on a medical record is if a patient took penicillin as a baby and a rash appeared. Rashes are common in sick children and there is a good chance that it was unrelated to the medication. Also, many patients outgrow this kind of sensitivity.
80% of patients who may have once been allergic lose their penicillin sensitivity after 10 years
WHY DOES IT REALLY MATTER? I CAN JUST USE A DIFFERENT KIND OF ANTIBIOTIC.
There are a few reasons why a false penicillin allergy matters. Using the right first-line-directed therapy is in the best interest of the patient. Other medications may be more prone to secondary complications like causing an overgrowth of bacteria in the gut called clostridiodes difficile. C. diff infection causes a difficult to treat diarrheal illness. In addition, other treatments may not be as effective resulting in worse outcomes, longer hospital stays, and higher costs.
HOW DO I KNOW IF MY ALLERGY IS REAL OR NOT?
Your primary care provider can provide a referral to an allergy specialist. The specialist can perform tests including skin testing and even potential treatments like desensitization. If the skin test is negative, then you can safely remove the penicillin allergy from your medical record!
Check out these additional resources:
Is it Really a Penicillin Allergy?
Think You’re Allergic to Penicillin? Why You May Be Mistaken
Some people may feel that it is irresponsible for physicians to prescribe antibiotics for emergency use. They favor withholding these critical medications due to a fear of creating antibiotic resistance if inappropriately used.
Let’s turn to the evidence. Studies over the years have looked at so-called “pocket prescriptions” and their effect on antibiotic use amongst pediatric and adult populations. A “pocket-prescription” is when your health care provider is unsure whether antibiotics are appropriate for your infection, so they write you a “just in case” prescription. They tell you that if the symptoms worsen over the next 24-48 hours, you should fill the prescription and begin taking the prescribed antibiotics. It turns out that this type of care leads to LESS antibiotic use by the patients. This is because they feel empowered to decide the best course of action for their own care. They don’t have to go to the next primary care office, urgent care, or emergency department until they find someone willing to give them antibiotics. Instead, they keep the prescription, knowing that they can fill it if needed—most of the time they don’t.
Antibiotic stewardship is not simply withholding antibiotics from patients. It is also prescribing and using antibiotics when appropriate. It is part of a wholesome physician-patient relationship. One where patient and physician work together to make the best decision on behalf of the patients’ wellbeing. It is also why anyone seeking a prescription through Jase Medical is first evaluated to ensure they are appropriate candidates. In addition, they can contact us any time to follow up with their prescribing physician should they have any questions about the use of the medications prescribed.
A few of the studies referenced above:
Martin Edwards, M. E. (2003). Patients’ responses to delayed antibiotic prescription for acute upper respiratory tract infections. British Journal of General Practice, Nov(53(496)), 845–850. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314726/
Del Mar CB. Delayed prescription reduced antibiotic use in the common cold. ACP J Club. 2002 Nov-Dec;137(3):116. PMID: 12418856.
American Family Physician POEM. (2014). Delayed Prescription Strategies Decrease Antibiotic Use. American Family Physician. Published. https://www.aafp.org/afp/2014/0715/p110.html
According to many scientists and clinicians, antimicrobial resistance is one of the greatest threats to human health worldwide. However, without a clear understanding of the vital role of antimicrobials, and more specifically, antibiotics in modern life, a statement like ‘antimicrobial resistance is the greatest threat to human health worldwide’ may seem like hyperbole.
The discovery of antibiotics in the 1930s fundamentally transformed the way physicians care for patients. Treatment-focused approaches based on antibiotic use allowed physicians to save countless lives.
Since then, we have seen the top causes of mortality in humans change from things like kidney disease, gastrointestinal infections, and pneumonia to cancer and heart disease. More than eight decades later, the medical advances enabled by antibiotics are now threatened by rising antibiotic resistance. Without effective medications to treat infections, many fields of medicine will be hindered. Care of the critically ill, surgery, transplant medicine, neonatology, and the treatment of cancer patients, among others. Our ability to respond to national security threats like bioterrorism or pandemics will also be affected.
The causes of antimicrobial resistance are multifactorial and complicated. Chief among them is the lack of antibiotic stewardship. According to the Centers for Disease Control and Prevention (CDC), antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.
The CDC lists four primary efforts to address antibiotic stewardship in an outpatient setting. They are: 1 – a means to measure antibiotic prescribing, 2 – improve antibiotic prescribing by clinicians and use by patients so that antibiotics are prescribed and used when needed, 3- minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics, and 4- ensure that the right drug, dose, and duration are selected when antibiotics are needed.
Over the last 10-20 years, the medical community and general public in developed nations worldwide have made considerable gains in the implementation of antibiotic stewardship. For example, there has been a concerted effort to increase awareness about the inappropriateness of prescribing and using antibiotics to treat viral infections. At JASE, we strive to continue this trend while empowering our patients to care for themselves when access to appropriate and timely medical treatment may not be available.
The effectiveness of antibiotics is a limited resource, and we must treat them as such. Nevertheless, they are crucial to our health and well-being, and we should respect them as powerful medications that save lives but can cause significant harm when misused.
Trying to find a silver lining to the cloud of the coronavirus pandemic can be challenging. However, one such silver lining is how the pandemic highlighted our fragile supply chain here in the United States, if not the world’s global supply chain. The world’s supply chain issues existed before the pandemic, and they have only grown worse since. There doesn’t seem to be an industry that isn’t affected in one way or another.
Before the pandemic, our health care industry was experiencing shortages regularly of basic medical supplies, including pharmaceuticals. The problem is now even more severe.
The FDA’s Center for Drug Evaluation and Research director said, “Historically, the production of medicines for the U.S. population has been domestically based. However, in recent decades, drug manufacturing has gradually moved out of the United States.” Now nearly 3/4ths of the active ingredients used in medicines sold in the United States are produced overseas. Today, the majority of pharmaceutical production takes place in China and India.
In an interview Senator Chris Coons, D-Del said, “If we have another global pandemic that leads to the world to close borders and leads global supply chains to shatter or to break down, we are distinctly vulnerable because we are now dependent upon globally integrated supply chains.”
Many will remember donning their mask and venturing out into the eerily quiet streets to visit an essential business such as the grocery store only to see bare shelves. We have lived through supply chain shortages caused by a global pandemic, but many other potential causes may disrupt our fragile supply chain. Other causes include local disasters in the countries or cities of pharmaceuticals factories or a terror attack on infrastructure anywhere along the supply chain.
At JASE Medical, we are on a mission to help our community prepare for the worst. We want to empower our neighbors to be self-sufficient and not have to rely on others when it comes to their well-being. We are starting that mission with emergency use antibiotics.
