---
module: 074-03
language: en
chapter: 74
title: "Disaster, Remote, Rural, and Resource-Limited Medicine"
module_title: "Management, monitoring, prevention, safety, ethics, systems issues, and longitudinal care"
source_sha256: 84ab45d44f61d86858b74eab3b9b6077087f4e6d50ba818863374a10359b40f2
---
# Managing care under scarcity

## Essential resuscitation
### Airway: positioning, suction, bag-mask first
#### Two-person mask may beat early intubation
### Oxygen is a finite drug
#### Concentrators need power, vary with altitude
#### Titrate, fix leaks, monitor supply
### Haemorrhage control before crystalloid
#### Walking donors need advance protocols
### Fluid plans separate shock and dehydration
#### Oral rehydration scalable if gut works
#### Reassess after small volumes

## Infection prevention and treatment
### Water and sanitation beat broad antibiotics
### Separate clean and contaminated flow
### Empirical protocols reflect local resistance
#### Indiscriminate courses promote resistance
#### Source control remains essential
### Proportionate, feasible isolation
#### Coercion drives concealment

## Evacuation and retrieval
### Stabilise airway, bleeding, splints, analgesia
### Transport physiology: cabin pressure, noise
### Destination by capability and capacity
#### Direct transfer versus nearest resuscitation
### Transfer record survives electronic failure

## Ethical allocation
### Protocols developed publicly before crisis
### Exclude social worth, wealth, race
#### Age not an unexamined exclusion
### Triage teams separate allocation from advocacy
### Withholding and withdrawing can be equivalent
#### Withdrawal emotionally harder
### Disability assessed by clinical prognosis
#### Audit tools for structural bias

## Responder protection and workforce
### Protective equipment, vaccination, rest, security
### Duty to care has limits
#### Institutions owe reciprocal protection
### Rosters respect sleep and circadian physiology
### Confidential support over compulsory debriefing
### Adapted scope still needs supervision
#### Unintegrated volunteers create risk

## Medicines, equipment, supply
### Essential-medicine lists
#### Track consumption, expiry, cold chain
#### Substitution protocols prevent improvised conversion
### Equipment must be maintainable locally
#### Incompatible donations burden systems
### Pre-positioning reduces delay, risks expiry
### Logistics data are clinical data

## Chronic, maternal, and mental care
### Simplify regimens, avoid abrupt withdrawal
#### Steroids, insulin, antiseizure drugs, opioids
### Refill points and paper summaries
### Maternal care and reproductive services
#### Violence and unintended pregnancy may rise
### Psychological first aid and severe illness continuity
#### Strengthen, not replace, local supports

## Recovery, resilience, equity
### Recovery restores more than buildings
### Humanitarian data minimum and purpose-limited
#### Breach exposes people to violence, detention
### Find who aid systematically misses
### Local procurement over parallel systems
### After-action review with funded owners
### Build back better
#### Recovery funds should not reproduce inequity

## Accountable flexibility
### Altered standards formally activated and ended
#### Document why usual care was impossible
### Scarcity never justifies discrimination
### Consent and confidentiality persist
### Preparation reduces improvisation