For Clinicians | Appropriate Medical Preparation 

The Clinical Category We’ve Been Practicing Without a Name

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Patients have been asking us a version of the same question for years. “What’s reasonable to have on hand,…… just in case?” Most of us don’t have a clean answer.

• The toddler spiking a fever past 11pm after the only instacare in town just closed. 
• The UTI that announces itself Friday at 6pm with a weekend ahead.
• Pink eye Sunday morning with school Monday. 
• Strep in a rural county where the nearest ER is three hours away and urgent care closed at 6. 
• The pharmacy that’s open but out of stock on the antibiotic the prescriber just called in
• The cruise-ship UTI on night three. 
• A traveler’s fever in a hotel in a country where nobody at the front desk speaks English. 
• A national pharmacy chain offline for two days after a ransomware attack. 
• A maintenance refill backordered the week of a long-planned trip. 

Different sizes of disruption, same shape underneath: a moment when primary care isn’t reachable, and the patient doesn’t have what they need on the shelf.

Our patients have been living in this middle for years without a word for it. We are giving it one: appropriate medical preparation. A clinically grounded buffer to primary care, not around it.  Common, predictable medical disruption that ends with an avoidable ER bill, a missed dose, a ruined vacation, or just a really bad week.

Between full healthcare and full prepper

Right now, patients are choosing between two answers. Full healthcare, available when you’re close to the doctor and the pharmacy and the schedule is cooperating. Or full prepper, where the assumption is help isn’t coming. Neither was built for the life they actually live. The institutional advice in between (FEMA’s 72-hour kit, the written medication list every family is told to clear) is what everyone’s told to have, but in practice almost no family does.¹

Patients are hungry for something better. Access. Travel. Geography. Timing that doesn’t fit a normal clinic schedule. The things that go wrong on a Friday night don’t wait for Monday morning. When healthcare doesn’t fill the gap, patients fill it themselves, often from dubious sources online, because they need a real answer and someone has to give them one.

The disruption doesn’t even need to be exotic to be miserable. My brother-in-law spent an hour and a half in a seemingly neverending line at 9pm on a Friday at the only 24-hour pharmacy in his county (and at 750K+ people, it’s not a small, rural podunk county). Just Friday at 9pm, not even a holiday weekend. The whole evening was gone for something he should’ve been able to have on his own shelf ahead of time.

Survival medicine has its place for the long-term disruptions where help really isn’t coming. But for the disruptions that fill most families’ calendars, the question isn’t whether help is coming. It’s whether the family already has what they need on the shelf, before the wait causes major inconvenience and perhaps deterioration in their condition. That’s what we’re building into: a clinical bridge that meets patients where they are, instead of asking them to work around healthcare hours that aren’t always in their best interest.

What’s actively short in summer 2026

In Q1 2026, ASHP counted 223 active national drug shortages, the second consecutive quarter the count has risen⁵. The mix isn’t the headlines you might remember.

ADHD stimulants: amphetamine mixed salts (IR and XR), lisdexamfetamine, and methylphenidate ER are in their fourth year of active shortage. Specific strengths of amphetamine XR had release dates as recently as mid-May and early-June 2026.

Sterile injectable chemotherapy: vinblastine, methotrexate, and cisplatin are all currently short. Vinblastine is the most-shorted oncology drug, reported in shortage at 57% of surveyed centers⁶.

Injectable opioids: morphine sulfate (on the FDA shortage list since 2017) and fentanyl citrate (since 2012) remain chronically short. Acute pain, surgical anesthesia, palliative care.

Estradiol and progesterone: added to the shortage list in January and February 2026. Demand is up; manufacturing capacity hasn’t caught up.

The guidelines that haven’t been written

Naming the category is half the work. The other half is writing the clinical guidelines that define it: what patients can safely have on hand before a clinical event arrives, and how to use it well when it does. Clinicians love guidelines and frameworks, and the ones for this category have not been written yet. We are building them.

Appropriate medical preparation is, in no way, a replacement for primary care. Chronic conditions and the long-term continuity that primary care exists to provide belong in the exam room. We are here for the moments primary care isn’t, not for the moments primary care is. The line is sharp and we hold it.

What it actually is: a clinically grounded model of preparation, built by a team of board-certified physicians, physician assistants, and pharmacists. Protocols are reviewed. Decisions are cross-checked. Medications are matched to common and predictable conditions where the clinical decision is well-understood. When something changes after the patient has the medication on the shelf, the team is reachable by call or email, no runaround. The work is structured around preparation, before symptoms arrive.

And it is not fear-based stockpiling dressed up in clinical language. The doomsday posture sold as health care is a different category. Ours stays in the lane of common, predictable conditions where the clinical evidence is settled.

The work the literature already supports

Any clinician in practice more than a few months has seen this conversation in a dozen different costumes. The patient calling Friday at 4:55pm…….the colleague who watched a UTI hijack a family’s vacation……the pharmacist taking the 9pm phone call asking about an antibiotic shortage with no known arrival date for the backordered amoxicillin² and the parents are really upset because the other pharmacy that can get it in is closed for the weekend……the provider who got the late-night text from a friend traveling abroad asking how he can get an antibiotic for strep overseas. We have been navigating this informally for years, one patient at a time, with no shared language and no defined framework.

The reason is partly that we were trained for a different system. Pharmacy school, medical school, PA school all assumed a closed loop: one patient, one prescriber, one chart, one local pharmacy that knew about all three. That loop is gone. Patients now have access to direct-to-consumer telehealth, mail-order chains, foreign pharmacies, cross-border purchasing, online communities, and TikTok dosing advice³. The job is harder than the one we trained for: guiding patients toward appropriate access in a landscape where access is everywhere and quality is uneven.

The frame for this kind of work already exists in the literature. The Patient Activation Measure⁴ has documented for two decades that clinical outcomes improve when patients are activated and prepared to participate in their own care. Appropriate medical preparation is clinician-supported patient activation, not patient autonomy alone. The category needs both halves; neither one works on its own.

Charting the gray area in public

Public knowledge gets better when clinicians chart the gray area in public, instead of leaving the internet to do it. Patients today can get almost anything they want from an online pharmacy. Without a clinical voice in that conversation, they will keep filling the gap themselves, more often and with less guidance. We’re choosing to do that work in the open.

What we are doing right now is defining what is safe to have on hand and what is not, and edging out the boundaries of the category as we go. We are confident doing this work. We are also finding it is more complex than it sounds. A UTI workup is straightforward. Building a complete framework for the range of conditions a reasonable family could face is a different scale of clinical work. Not impossible. Just hard to do well in the cracks of an office visit. If you are doing this work for your own patients, we champion that. If you would rather refer or follow along, both options are here. You can refer at Jase.com, or follow our work as we share how we are thinking about it.

What we are sharing going forward: how we make clinical decisions, where we draw the lines, what the evidence supports, what we’re still working through. The category is new. The protocols are being written at the highest clinical standard we know. We want medical professionals at the table while we build, not after.

Building this in the open

This article is one of many we are writing. The category needs a clinical framework, written and revised in public, and we are starting that work here. Each week we will be sharing a piece of it: a condition we are working through, a protocol, a decision we made and why, a question we are still chewing on, and current news stories and how they relate to appropriate medical preparation.

If this is interesting to you….follow along! We are publishing a few times a week, having a lot of fun building this in the open, and we would love to have you join us. 

Sources

1. FEMA. 2023 National Household Survey on Disaster Preparedness: Key Findings. Federal Emergency Management Agency, Individual and Community Preparedness Division, 2023. https://community.fema.gov/PreparednessConnect/s/article/Results-from-the-2023-National-Household-Survey-on-Disaster-Preparedness
2. Brewster RCL, Khazanchi R, Butler A, O’Meara D, Bagchi D, Michelson KA. The 2022-2023 Amoxicillin Shortage and Acute Otitis Media Treatment. Pediatrics. 2023;152(3):e2023062482. https://pmc.ncbi.nlm.nih.gov/articles/PMC10895544/
3. Trilliant Health. Telehealth Demand: An Update Four Years After the Onset of the COVID-19 Pandemic. Trilliant Health Market Research, 2024. https://www.trillianthealth.com/market-research/studies/telehealth-demand-an-update-four-years-after-the-onset-of-the-covid-19-pandemic
4. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Services Research. 2004;39(4 Pt 1):1005-1026. https://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2004.00269.x

For Clinicians | Off-Grid Health Care

A Guide to Medical Preparation When the System Fails (aka SHTF)

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Edited and approved by Kristen Carpenter, PA-C — Clinical Advisory Board Member

Your patient has already Googled “SHTF medical” at 11pm. They didn’t bring it up at the visit because they don’t think you’ll know what to say. They might be right.

They are not alone. Behind every shortage story (saline, Adderall, Ozempic, amoxicillin liquid, the two weeks of hurricane evacuations that emptied a region’s pharmacies), patients are running a quiet clinical question through their head: “What’s reasonable to have on hand,…… just in case?”
Most of us were never trained to answer it. Yet, when we hedge, the prepper internet doesn’t. It tells them to buy fish antibiotics and trust no one. Our silence on the subject isn’t helping our patients: it’s giving them only extremes to turn to for answers.

Today we’re talking about this question. The category is appropriate medical preparation, sized to the disruptions families actually face, not a doomsday-world-is-ending scenario.

The framework breaks into five modules: medication, trauma and wound care, water and sanitation, power and continuity, and household-specific layers. A sixth, capability, makes the rest work or not.

Medication: chronic supply, contingency supply

This is where preparation actually starts, and where the bulk of the work is. The hurricane Katrina chronic-disease data is dated but still the cleanest evidence we have on what happens when a region’s pharmacies go offline, settles the question of priority. Of medications dispensed to evacuees in San Antonio, 68% were for chronic disease. Cardiovascular alone was 39%. The federal stockpile supplied 9%. Retail pharmacies covered 73%¹.

What we don’t really recognize here is that the patient’s own medicine cabinet is the primary line. Federal caches and DMAT formularies are backstops, not plans.

So the first tier is the chronic supply, patient-owned. A 90+ day on-hand supply of every prescription the household can’t go without, paired with a written list any pharmacist can act on (drug, dose, prescriber, pharmacy). You might object that this isn’t preparation, it’s just well-managed primary care. Yep. That’s the point. The category isn’t separate from primary care. It’s primary care that takes evacuation, supply chain disruption, and Friday-night closures seriously. Ready.gov anchors a 3-day baseline kit². Disaster medicine literature pushes 30 to 90 days for chronic meds³. What actually holds up in a big disaster is closer to 90 days to have on hand.

The trickier prescriptions to navigate are controlled substances. Schedules III through V are workable. During a governor’s declaration, pharmacists in most states can dispense an emergency supply (typically up to 30 days) without a new prescription on file⁵. Coverage varies by state but typically includes medications like benzodiazepines, tramadol, and codeine combinations, the prescriptions most likely to surface in a sheltered population.

Schedule II is the cliff. Stimulants and most opioids. A declared disaster does not, by itself, authorize a Schedule II refill. That takes a fancy, specific DEA waiver, and the waivers are inconsistent. We don’t endorse stockpiling. We also don’t have a clean way to tell a patient on a Schedule II to save some each month, because clinically that’s the opposite of how these medications are supposed to be taken. There is a gap. They should just know ahead of time, and so should we, that navigating this one is inherently just going to be very tricky.

The second tier is the contingency supply. The prescription half: short-course antibiotics, antifungals, rescue inhalers, oral rehydration salts, basic wound care. The OTC half: acetaminophen, ibuprofen, diphenhydramine, loperamide, antacids, electrolyte tablets, meclizine, loratadine, bismuth subsalicylate. The clinical logic for the prescription half is the same one telehealth platforms already use for the same conditions, with the same prescribing patterns and the same evidence base. The only difference is timing. Same medications, same standards, prescribed before symptoms arrive instead of after.

This is the gap JaseCase is built to close: amoxicillin-clavulanate, azithromycin, ciprofloxacin, doxycycline, metronidazole, a methylprednisolone dosepak, ondansetron, triamcinolone topical, plus the OTC backbone.

Trauma: bleeding control, wound care, burns

The medication layer is what you have when the pharmacy is gone. The trauma layer is about what you do in the minutes before EMS can get there. Hemorrhage is the only category of injury where a layperson can credibly outperform “wait for the ambulance,” and that’s the core of this section.

Stop the Bleed has been around long enough that most clinicians know the program by name, but the kit itself doesn’t follow most patients home. The core list is short and CoTCCC-vetted: a CoTCCC-listed windlass tourniquet, hemostatic-impregnated gauze (kaolin-based is the canonical mechanism), a 4 to 6 inch pressure dressing, nitrile gloves, trauma shears, and a permanent marker for time-of-application⁶. Skill-retention data argue for refreshing training every 1 to 2 years⁷. The fact that a tourniquet is in the kit doesn’t mean a patient knows when to reach for one.

That set, plus a pair of vented chest seals, a space blanket for hypothermia prevention, and a casualty card, is what separates a real household IFAK from a box of band-aids. NPAs and needle decompression are training-dependent. They belong in the kit when a household member has been trained to use them, and they don’t when no one has.

Most calls to use the kit aren’t going to be trauma though. They’ll be wound care, and the Wilderness Medical Society’s 2014 austere wound care guidelines are the cleanest reference⁸. Irrigate with at least 1 liter of potable or disinfected water at pressure (a 30 to 60 mL syringe with an 18 gauge angiocath does the job). No additives in routine wounds. Close clean, low-tension wounds within 8 to 12 hours, up to 24 for the face, with adhesive closure strips or tissue adhesive. Sutures and staples belong in trained hands, not a kitchen. Pack contaminated wounds open and watch them. AAFP evidence is clear that plain white petrolatum is equivalent to triple antibiotic ointment for routine wound aftercare, with less contact dermatitis and less selection pressure on resistant flora⁹. The kit version: petrolatum, non-adherent dressings, gauze rolls, adhesive strips, tissue adhesive, sterile gloves. Teach the household what infection actually looks like: spreading erythema, streaking, purulence, fever, increasing pain.

Burns are the injury most under-prepared for, and the field guidance has changed. The American Burn Association and the 2025 Annals of Emergency Medicine literature now support 20 minutes of cool running water (not ice, not butter) within 3 hours of injury, with measurably better outcomes¹⁰. Cover with a non-adherent dressing or plastic cling wrap. Hydrogel burn dressings are a field-acceptable third option per ABA, distinct from the older silver sulfadiazine cream that’s no longer first-line. The household version of “what to do with a burn” is simpler than what most of us grew up teaching: water, time, clean cover.

Splints, briefly. One 36-inch SAM splint covers the realistic home use case. Radiolucent, reusable, immobilizes wrist, forearm, ankle, and cervical spine when folded. Add a triangular bandage and a couple of ACE wraps. 

One frame to hold through the rest of this: kits scale with capability. A household with a trained member can credibly carry a higher-tier kit. The category is appropriate medical preparation, sized to capability.

Water and sanitation

Back to fundamentals here. In austere medicine, dehydration is the leading preventable cause of death, and sanitation failures drive much of the rest. The kit answer for both is cheap and simple.

Start with safe water. Ready.gov’s anchor is 1 gallon per person per day¹¹. Treat the source with whatever you have available. Boiling for 1 minute (3 minutes above 6,500 feet) is the gold standard. Unscented household bleach (5 to 9% sodium hypochlorite) works at 8 drops per gallon of clear water or 16 drops per gallon of cloudy water, 30 minute contact time¹². For filtration, the spec that matters is “≤1 micron absolute,” which screens out Giardia and Cryptosporidium; viruses still need chemical disinfection on top.

Then rehydration. The WHO low-osmolarity oral rehydration salt formula (75 mEq sodium, 75 mmol glucose, 20 mEq potassium, 10 mEq citrate per liter) is the standard¹³. Commercial ORS packets are cheap to stock; the home recipe in a pinch is 1 liter of clean water, 6 level teaspoons of sugar, and half a teaspoon of salt. One thing worth telling patients over and over again: adult sports drinks are not pediatric ORS. The sodium is too low and the sugar is too high to treat clinical dehydration in a child, and this really matters when the household has small kids and no power.

Infection prevention is the third leg, and it’s mostly about hand hygiene and a few pieces of PPE. CDC guidance: soap and water for 20 seconds, 60% alcohol hand rub as backup, nitrile gloves (not latex), N95 respirators for smoke and infectious exposure, household bleach for surface disinfection¹⁴. Gloves don’t replace handwashing. We all know to wash our hands. This is the reminder: scrub them, and scrub them well. As basic as it gets, and as load-bearing as anything in the kit.

Power, monitoring, documentation, communication

Four things beyond the supplies themselves. Power: durable medical equipment needs a backup plan. CPAP and BiPAP units run off a portable battery overnight; oxygen concentrators draw too much for that, and the answer is standby tanks, not bigger batteries.

The refrigerator is the harder problem.  I know you’re already thinking about insulin, because the idea of a disaster panics any diabetic patient. Insulin is stable at 59 to 86°F for up to 28 days unopened, per FDA emergency guidance⁴. Do not freeze. Use it warm before going without.

Beyond the insulin window, GLP-1 agonists run 14 to 56 days at room temperature depending on product (Ozempic 56 days at up to 30°C, Trulicity 14)¹⁵. Most injectable biologics fall in a similar window. The point a patient needs to hear in the office, before a hurricane forecast lands: check the package insert for the room-temp tolerance of their specific medication, pack a cooler with ice packs (not direct contact), and don’t freeze any of it.

Monitoring: a thermometer, a validated home blood pressure cuff, a glucometer for diabetics, and a pulse oximeter cover the household use case, with the FDA Safety Communication caveat that pulse-ox devices overestimate true saturation in darker-skinned patients¹⁶. Skip the otoscope; non-clinicians can’t reliably interpret what they see. 

Documentation: the patient’s kit should include a written med list with doses, an allergy list, photos of every pill bottle (the label itself is a functional clinical document), insurance and immunization records, an advance directive, and recent labs on a thumb drive. HIPAA doesn’t block emergency disclosure¹⁷. 

Communication: four pre-emergency setups worth pushing at a routine visit. Patient portal credentials stored somewhere accessible, the prescriber’s direct line saved, a regional telehealth fallback identified before the season, and a backup ER chosen if the usual system is overwhelmed.

Pediatric, mental health, household specifics

A generic kit doesn’t fit a specific household. Here’s a few specific populations who need specialized resources in an emergency. 

Pediatric. Weight-based dosing for acetaminophen, ibuprofen, diphenhydramine, and ondansetron printed on a card the household can read at 2am¹⁸. Pediatric ORS, not adult sports drinks. Ready-to-feed formula in any household with an infant; powder requires safe water that may not be available. Children’s medication doses can be improvised from adult bottles sometimes if truly needed, but beware your numbers: the math is the most common error in field pediatric care.

Mental health. Continuity of psychiatric medications is the under-discussed half of disaster planning. SSRIs, mood stabilizers, antipsychotics, and benzodiazepines: discontinuation syndromes and decompensation are the predictable failure modes when an evacuation runs longer than the on-hand supply. The Schedule II hardship from Module 1 lives here too; stimulants and opioids are the gap. Brief acute insomnia in a sheltered population is expected and self-resolves; eye masks and earplugs are kit items worth recommending.

Pregnancy. A pregnant patient needs an earlier evacuation trigger, a clean emergency birth kit, and prenatal vitamins added to the chronic supply per ACOG¹⁹.

Older adults on polypharmacy need indications named on the med list, not just drug names, plus spare hearing-aid batteries and glasses.

A dental emergency kit (Dentek temporary filling, clove oil, ibuprofen-acetaminophen combo) covers most field dental needs; antibiotics for systemic signs only, ER for swelling extending under the tongue or to the eye.

Capability, and the cliff

A kit you don’t know how to use is decoration. The previous five modules describe the contents of a household’s medical preparation; this one describes what makes that preparation actually work.

Capability is training. Stop the Bleed certification, a basic wound care class, comfort with the medications in the kit, a household conversation about who in the family knows what. Most of this is free or close to it. None of it gets done if we as the clinician haven’t said it out loud during a routine visit.

Which brings us to the cliff.

Patients are figuring this out themselves. They are Googling at 1am and going down Reddit rabbit holes. They are taking dosing advice from prepper forums because the clinical voices have stayed quiet. Healthcare’s collective response to “what should I reasonably have on hand?” has been to hedge or say, ‘you can’t have any prescription on hand ahead of time. That’s not responsible. You’ll be treated only after you need it”. 

The void doesn’t stay empty; somebody fills it.

The failure is at the category level. We never named the thing the patient was asking about, so we never built the framework for thinking about it. The category has a name now: appropriate medical preparation. The framework is the five modules above. The work is making sure the patients in our practices encounter our voice in this space before they encounter someone else’s.

A few of us are charting the grey area in public. We are publishing the criteria, the dosing thresholds, the kit composition, the indications, and the limits, week after week, so that what a curious patient finds when they search is a clinician’s framework rather than a forum’s. This is the work Jase exists to do. If you have patients asking the SHTF question and you want a clinically rigorous resource to point them to, we work with HCPs directly. The goal is not to sell to your patient. It’s to make sure your patient has the guidance of clinical help in this emerging area.

Sources

1. Greenough PG, Lappi MD, Hsu EB, et al. Chronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees. American Journal of Preventive Medicine. 2007;33(3):207-210. PubMed: 17826580.
2. Ready.gov, Build A Kit (3-day baseline). ready.gov/kit
3. Healthcare Ready, A Review of State Emergency Prescription Protocols; supporting disaster medicine literature on 30 to 90 day chronic-medication supply.
4. FDA, Information Regarding Insulin Storage and Switching Between Products in an Emergency.
5. DEA Pharmacist’s Manual; Healthcare Ready, Review of State Emergency Prescription Protocols (Schedule III through V emergency dispensing coverage varies by state).
6. American College of Surgeons / Stop the Bleed, kit composition and CoTCCC-listed contents.
7. Goolsby C, et al., skill-retention data on Stop the Bleed training (the underlying evidence base for the 1 to 2 year refresh recommendation).
8. Wilderness Medical Society, Basic Wound Management in the Austere Environment (2014 practice guidelines).
9. American Academy of Family Physicians, wound care evidence: petrolatum vs. triple-antibiotic ointment.
10. American Burn Association field guidance; Annals of Emergency Medicine (2025), Cool Running Water as a First Aid Treatment for Burn Injuries. PubMed: 40985917.
11. Ready.gov, Build A Kit (water anchor: 1 gallon per person per day). ready.gov/water
12. CDC, Making Water Safe in an Emergency; CDC water filtration guidance (the ≤1 micron absolute filter spec for Giardia and Cryptosporidium).
13. World Health Organization, Oral Rehydration Salts: Production of the new ORS.
14. CDC, Guidelines for Personal Hygiene During an Emergency; supporting CDC respiratory protection and wildfire smoke guidance for N95 use.
15. GLP-1 manufacturer prescribing information (Novo Nordisk for Ozempic, Eli Lilly for Trulicity, current US labeling).
16. FDA Safety Communication: Pulse Oximeter Accuracy and Limitations (2021, updated 2022).
17. ASPR-TRACIE, HIPAA and Disclosures in Emergency Situations fact sheet.
18. AAP pediatric dosing charts (acetaminophen and ibuprofen); Lexicomp Pediatric and Harriet Lane (diphenhydramine and ondansetron weight-based dosing).
19. American College of Obstetricians and Gynecologists Committee Statement No. 15 (January 2025): Preparing for Disasters: Addressing Critical Obstetric and Gynecologic Needs of Patients.