Improvised Medicine: Providing Care in Extreme Environments (AMAZON)

Improvised Medicine: Providing Care in Extreme Environments (AMAZON)

Product Code: 479832

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Deliver quality healthcare in the most challenging field conditions

Full of practical clinical pearls and proven strategies, this indispensable guide shows you how to operate outside your comfort zone and devise effective treatment solutions when the traditional tools (medications, equipment, and staff) are unavailable—or when you need to provide care outside of your specialty. Improvised Medicine is a must for anyone who plans to work in global, disaster, or other resource-poor settings.


  • Simple-to-follow directions, diagrams, and illustrations describe practical techniques and the improvised equipment necessary to provide quality care during crises.
  • Contains improvisations in anesthesia and airway management, dentistry, gynecology/obstetrics, infectious disease/laboratory diagnosis, internal medicine, otolaryngology, pediatrics and malnutrition, orthopedics, psychiatry, and surgery.
  • Also includes basic disaster communication techniques, post-disaster forensics, a model hospital disaster plan and innovative patient-transport methods.

Learn how to:

  • Make an endotracheal tube in seconds
  • Perform digital-oral and blind-nasotracheal intubations
  • Make plaster bandages for splints/casts
  • Give open-drop ether, ketamine drips, and halothane
  • Use subcutaneous/intraperitoneal rehydration/transfusion
  • Make ORS and standard nutrition formulas
  • Clean, disinfect, and sterilize equipment for reuse
  • Warm blood units in seconds inexpensively
  • Take/view stereoscopic x-rays with standard equipment
  • Quickly and easily stop postpartum hemorrhage
  • Fashion surgical equipment from common items
  • Evacuate patients easily for high-rise hospitals
  • Make esophageal and precordial stethoscopes
  • Quickly improvise a saline lock
  • Make ECG electrode/defibrillator pads and ultrasound gel

Kenneth V. Iserson, MD, MBA, FACEP, FAAEM
Fellow, International Federation of Emergency Medicine
Professor Emeritus, Emergency Medicine
The University of Arizona
Tucson, AZ
Founder/Director, REEME (
Publisher :  McGraw Hill
Published   2011 
Pages :  578
Format :  Soft bound
Dimensions :  8.9 x 5.9 x 0.9 inches
Kenneth V. Iserson, M.D., MBA, FACEP, FAAEM, FIFEM (1949- ) born in Washington, DC, migrated to the American Southwest at his earliest opportunity. After nearly three decades as a teacher, clinician and bioethicist at The University of Arizona in Tucson, he is now Professor Emeritus of Emergency Medicine at The University of Arizona, Medical Director (Emeritus) of the Southern Arizona Rescue Association (search & rescue), a Supervisory Physician with Arizona's Disaster Medical Assistance Team (AZ-1), and a member of the American Red Cross disaster response team.

The author of hundreds of scientific articles on emergency medicine and biomedical ethics, he has also authored numerous books. His most popular book, "Iserson's Getting Into a Residency: A Guide for Medical Students," is now in its 7th edition. Another, "Death to Dust: What Happens to Dead Bodies?" was cited as one of the best reference books by the New York Public Libraries. His latest book, "Improvised Medicine: Providing Care in Extreme Environments," will appear in December 2012 (McGraw-Hill).

Dr. Iserson now limits his medical practice to global and disaster medicine. In the past few years, he has practiced or taught on all seven continents, including 6 months as Lead Physician for the US Antarctic Program, and work with NGOs in rural areas of Central and South America, Zambia, Bhutan, Ghana and South Sudan. He also runs the Project that freely distributes more than 700 Spanish-language PowerPoint presentations on Emergency Medicine.
Family Medicine Vol 46

Improvised Medicine: Providing Care in Extreme Environments
Kenneth V. Iserson
New York, McGraw-Hill, 2012, 578 pp., $56, paperback

Dr Iserson has given us a most remarkable book. Many readers may be familiar with David Werner’s lay healthworker book, Where There Is No Doctor; this new volume could be titled Where There Is a Doctor–But No Stuff. Drawing from his experience providing care in international, wilderness, and disaster settings, he has compiled an impressive collection of bare-bones equipment and work-around strategies to provide the best possible care in resource-poor settings. While presenting many creative examples, the purpose of the book is not to offer an exhaustive list of solutions to missing resource challenges but to inspire creativity in readers who may find themselves needing to improvise. The approach to medical resource problem solving is applicable to providing care in isolated, remote (ie, wilderness and rural) locations, global health activities in developing nations, and in post-disaster settings.

The book starts with addressing essential infrastructure: communications, water, sanitation, and refrigeration. Without these basics, medical care beyond the simplest first aid is futile. Next, basic equipment, supplies, and sterilization are discussed. Creative means of overcoming shortages are offered, including reuse, repair, adaptation, and even manufacture of rudimentary equipment. Similarly, creative sources of consumable supplies are presented. Throughout this section (as well as the rest of the book), important details are presented in tabular form, providing information that physicians may not often encounter. Examples of this include sterilization methods, constitution of important solutions, and anesthesia/sedation drugs and strategies.

Moving on from the basics, the remainder of the book is a pragmatic guide to patient assessment, stabilization, and treatment (both surgical and nonsurgical). Ranging from height and weight estimation strategies to estimating laboratory values from physical exam to improvised analytical techniques (eg, urinalysis without strips), a wealth of assessment tricks are presented. Among the hints are historical techniques for assessment, stabilization, and treatment that have been long forgotten in our technologically dependent era.

Among the more interesting sections to this reviewer were the Critical Care sections. Although modern ICUs blur the line between reality and science fiction, quality critical care can often be provided with less technology and still save lives. Some of the improvisations presented in this section are not merely relevant for chronically resource-limited settings; for example, the technique for using a single ventilator for several patients simultaneously has clear relevance to the most modern facility in the event of a respiratory pandemic. Another valuable section is Dental Care. As physicians, we have limited experience in this area, yet in many settings, the ability to treat basic dental problems alleviates a tremendous amount of human suffering. Very practical, step-by-step procedural descriptions are included and are well illustrated.

The volume closes with an appendix presenting a model Hospital Disaster Plan. This template is focused on well-resourced facilities that may suddenly become resource-poor environments. It offers an excellent guide to disaster preparedness.

While concise, the work uses an almost “folksy” style, making for an easy read. Concepts are presented via engaging anecdotes, and the ideas are amply illustrated. While easy to use to find specific topics of interest, it is no mere dry reference book; I found myself reading it cover to cover.

Reasonably priced, this book is also available for KindleTM. Given the harsh environments in which it is most likely to be of value, the paper-and-ink version is recommended. Too bad the publisher didn’t follow the example of some, such as The Washington Manual, and include an electronic version with purchase of the bound one.

The appeal for this book is broad. Obviously, it should be required reading for those involved in disaster response or global health activities (including medical students doing electives abroad). It would be a valuable read for any physicians who leave the confines of their medical center and may encounter the words “Is there a doctor in the house?” Also, it should be in every hospital library, in case a disaster reduces them to an “extreme environment.”

Improvised Medicine is a remarkable compilation of concepts and contraptions, both innovative and historical, that can improve medical care in the most difficult situations. MacGyver would be proud!

Mark K. Huntington, MD, PhD
Sioux Falls Family Medicine Residency and
University of South Dakota Sanford School of Medicine


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