Lt christian’s little blue book
MEDICAL EQUIPMENT PURCHASES
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- EMERGENCY EQUIPMENT AND SUPPLIES
MEDICAL EQUIPMENT PURCHASESMedical equipment items that cost over $5,000—X-ray machines, whirlpools, operating room tables, etc. —are managed through a central funding system. If you want an item that is expensive, you need to put your order in at least a year in advance. Even then, you may not see the equipment you ordered, but your relief is counting on you to look out for the department. These purchases do NOT come out of your OPTAR. They are centrally purchased and separately funded. To plan for large ticket purchases, you must maintain a listing of all your equipment and their life expectancies. This is maintained as part of the 3M system (more on this later). When equipment reaches the end of its life expectancy and is no longer usable, the biomedical repair techs certify this and permit it to be surveyed. You can then order a new one. To further track your equipment needs, you must submit your medical equipment requirements (those over $5,000), through the chain of command to the TYCOM by 01 MAY every year. The reporting requirements are spelled out very nicely in BUMEDINST 4235.7 series. This same instruction tells you how to request an emergency equipment purchase, i.e., if a vital piece of equipment breaks and can’t be fixed. Also, items that are under the $5,000 ceiling come out of your OPTAR and must be budgeted. EMERGENCY EQUIPMENT AND SUPPLIESIn addition to the equipment in the BDSs, there is emergency equipment in portable medical lockers, first aid boxes, boat boxes, gun bags, corpsman response bags, and stretchers. Every piece of emergency equipment is located in a specifically designated location, outlined in the Medical Department’s Battle Bill (another instruction you need to make sure is in place). Each piece of emergency equipment comes with an AMMAL stating exactly what items are present and the quantities required. For the BDSs and other emergency equipment, the AMMAL requirements are sufficient, but you can always augment them as you see fit and if your budget allows. All emergency items must be inventoried quarterly. This is a Medical Department evolution. There are many ways to accomplish the inventory, but putting different corpsmen in charge of different items seems to work best. Your supply petty officer has the AMMALs and keeps the master list once the inventory is complete. Each item—e.g., a first aid box—has an inventory AMMAL inside. These must contain the location of the equipment (tack number of the space), and the inventory list must be signed and dated by the person who performed the inventory. When they are done, the outside of the item must be sealed and labeled with a “do not tamper” seal, which is also signed and dated by the person who did the inventory. After that is done, they must sign the master inventory list maintained by the supply petty officer. It is a good idea for you or your senior khakis to spot check the equipment (particularly first aid boxes) to ensure accuracy of the inventories. Also in your travels about the ship, it is a good idea to inspect the first aid boxes specifically looking for tampering, to see if they need replacement or re-inventory. The NSN (stock number) on the AMMAL list must match the NSN on the item in the emergency equipment. If the NSNs do not match, but they are descriptively the same—e.g., both 7 ¼ inch bandage scissors—then write in the correct NSN for the item and put a star next to the NSN on the AMMAL list. CONTINGENCY SUPPLIES A number of storerooms located in various parts of the ship are designated for your medical supplies and equipment. Some of these will be readily accessible from your medical spaces; others will be so out of the way they require a navigational chart and sextant to find. One of the first things you should definitely do during the turnover time with your predecessor is to get a tour of all the Medical Department spaces, including the storerooms. This will not only better acquaint you with the ship in general but will allow you to find supplies later. The first time you venture out on your own, leave a trail of breadcrumbs. Another good reason for touring the storerooms is to get a visual idea of the material for which your department is responsible. You will be pleasantly surprised by the abundance of supplies at your disposal. Some of it will be unavailable for every day Sick Call. There should be gynecological instruments and empty bottles (by the thousands). Most of this equipment is earmarked for disaster relief or evacuation of civilians during wartime operations. You will also find some miscellaneous items you’ve never heard of and others you thought you would never see. It is a good idea to inspect the storerooms throughout the year to see that spaces are kept neat and clean, properly stocked, and in good condition. You will occasionally find surprises: personal gear belonging to corpsmen, bicycles, radios, tapes, woodcarvings and various other souvenirs purchased at foreign ports. Make sure non-medical items are removed. One important supply function is stocking the Medical Officer Response Kit, which is normally kept in the designated trauma area. These are often overlooked by the corpsmen who update medicinals and during preventive maintenance of equipment. This bag should hold most medications necessary for advanced cardiac life support and trauma situations. At least once a month you should inspect the kit, checking the dates of all medications and replacing those that have expired. If your chief and LPO are on their toes, this will be done for you automatically, but don’t assume that it will be. You don’t want to get caught short in a true emergency. Other than AMMAL items and supplies, ordering any additional medical supplies will be up to your personal preferences. Keep in mind that the AMMALs cover almost everything that you will need to supply your Medical Department. They contain all the basic materials, including a wide variety of cold medications, anti-inflammatories, antibiotics (both PO and IV), some plaster for rolling casts, metal splints for fingers, and a variety of suture material and needles. The department AMMAL also includes professional books. The TYCOMs have a list of required books, publications and instructions you must maintain on board. Anything else you want is up to you. When you get on board, look over the AMMALs and talk to the person you are relieving about what may be missing. You can then decide what medications and items you simply cannot live without and order appropriately. While you can order anything that you have money for, be cautious with ordering non-AMMAL items. The AMMALs are intended to be standard minimal types of supplies that you will need as a GMO on a ship. AMMALs were developed as consensus standards by panels of Medical Officers, are intended to cover the types of contingencies you can expect to face, and should supply the needs for what you expect to treat on your type of ship. They will not and should not replace what is available in the local hospital. Don’t waste your OPTAR on the latest and greatest medications, when the older, more cost-effective medications work just as well. If you have only one or two patients on a “special” non-AMMAL medication, have their doctor at the hospital write prescriptions to be filled at the hospital pharmacy. The shore-based docs are usually very good about giving the patient enough medication for a deployment as long as you ask. A penny saved may save your bacon at the end of the quarter. A few words on AMMAL limits. The AMMAL levels are conservative, low quantities. For medications and supplies not often used, they are fine, e.g., antihypertensive medications, and surgical instruments. But for commonly used medications like antibiotics, OTC cold medications, non-steroidals, birth control pills, antifungals, antiemetics, and sunscreen, they can be woefully short. Discuss your ship’s dispensing history with your pharmacy tech and the person you are relieving. Then you will have an idea what medications you may need in higher quantities. Keep in mind that you are the corner drugstore for the crew, since the ship’s store can’t sell medication. Realize also that some medications are seasonal. You may need to order more cold medicines during cold and flu season and more antifungals and non-steroidals during hot weather and sports tournaments. The AMMALs are planned for the same numbers year round. You have to plan two to three months in advance to ensure your order makes it through the supply system. 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