The New Emergency Health Kit 98: Drugs and Medical Supplies for 10,000 People for Approximately 3 Months: Chapter 3: Composition of the New Emergency Health Kit 98: Supplementary unit (for 10,000 persons for 3 months)

The New Emergency Health Kit 98: Drugs and Medical Supplies for 10,000 People for Approximately 3 Months
(1998; 82 pages) [French] [Spanish]

Table of Contents

	Acknowledgments
	Introduction
	Chapter 1: Essential drugs and supplies in emergency situations
		What is an emergency?
		Quantification of drug requirements
		Contents of the kit
		Referral system
		Drug and supply management control
		Procurement of the kit
		Immunization in emergency
		Reproductive health
		Post emergency needs
	Chapter 2: Comments on the selection of drugs, medical supplies and equipment included in the kit
		Selection of the drugs
		Selection of renewable supplies
		Selection of equipment
		Major drug, equipment and supply changes since the 1990 edition
	Chapter 3: Composition of the New Emergency Health Kit 98
		Basic unit (for 1,000 persons, 3 months)
		Supplementary unit (for 10,000 persons for 3 months)
	Annex 1: Basic unit: treatment guidelines
	Annex 2: Assessment and treatment of diarrhoea
		Annex 2a: Assessment of diarrhoeal patients for dehydration
		Annex 2b: Treatment Plan A to treat diarrhoea at home
		Annex 2c: Treatment Plan B to treat dehydration
		Annex 2d: Treatment Plan C to treat severe dehydration quickly
	Annex 3: Management of the child with cough or difficult breathing
		Annex 3a: Child less than two months old
		Annex 3b: Child two months to five years old
		Annex 3c: Treatment instructions
	Annex 4: Sample data collection forms
	Annex 5: Sample health card
	Annex 6: Guidelines for suppliers
		Specifications for drugs and materials
		Packaging
		Packing list
		Information slips
	Annex 7: Other kits for emergency situations
		Immunization
		Nutritional support - feeding kits
		Reproductive health kits for emergencies
	Annex 8: Guidelines for Drug Donations⁴⁸
		Selection of drugs
		Quality assurance and shelf-life
		Presentation, packing and labelling
		Information and management
	Annex 9: Model Guidelines for the International Provision of Controlled Medicines for Emergency Medical Care⁵²
		Introduction
		Definitions
		Purpose and principle
		Scope of application
		Selection of suppliers
		Outline of standard agreement between suppliers⁵³ and control authorities of exporting countries
		Summary of the request procedure
		Model shipment request/notification form for emergency supplies of controlled substances
	Annex 10: References
		Drugs and drug management
		Gastrointestinal disease
		General public health
		HIV and STDs
		Immunization
		Laboratory support
		Malaria
		Materials
		Mental health
		Nutrition
		Reproductive health
		Respiratory tract infections
		Tuberculosis
	Annex 11: Useful addresses
	Organizations which have collaborated in the preparation of the New Emergency Health Kit 98
	Back Cover

Supplementary unit (for 10,000 persons for 3 months)

Drugs
*Anaesthetics*
ketamine, inj 50 mg/ml	10 ml/vial	25
lidocaine, inj 1%¹²	20 ml/vial	50
*Analgesics*¹³
morphine inj 10 mg/ml¹⁴	1 ml/ampoule	50
*Recall from basic unit:*
acetylsalicylic acid, 300 mg/tab	(10 x 3,000) 30,000
paracetamol, 100 mg/tab	(10 x 1,000) 10,000
*Anti-allergics*
hydrocortisone powder 100 mg	100 mg, powder for inj in vial	50
prednisolone, tab 5 mg	tab	100
epinephrine (adrenaline) see “respiratory tract”
*Antidotes*
naloxone inj 0.4 mg/ml¹⁵	1 ml/ampoule	20
*Anticonvulsants/anti-epileptics*
diazepam, inj 5 mg/ml	2 ml/ampoule	200
phenobarbital tab 50 mg	tab	1,000
*Anti-infective drugs*
amoxicillin, tab 250 mg	scored tab	3,000
ampicillin, inj 500 mg/vial	vial	200
benzathine benzylpenicillin, inj 2.4 million IU/vial (long acting penicillin)	vial	50
benzylpenicillin, inj 5 million IU /vial	vial	250
chloramphenicol, caps 250 mg	caps	2,000
chloramphenicol, inj 1 g/vial	vial	500
doxycycline, tab 100 mg	caps or tab	2,000
metronidazole, tab 250 mg	tab	2,000
nystatin, non-coated tab¹⁶	100,000 IU/tab	1,000
nystatin vaginal tab	100,000 IU/tab	1,000
procaine benzylpenicillin, inj 3-4 million IU/vial¹⁷	vial	750
quinine, inj 300 mg/ml¹⁸	2 ml/ampoule	100
quinine, sulfate, tab 300 mg	tab	3,000
sulfadoxine + pyrimethamine, tab 500 mg + 25 mg¹⁹	tab	300
*Recall from basic unit:*
mebendazole, tab 100 mg	(10 x 500) 5,000
cotrimoxazole, tab 400 + 80 mg	(10 x 2,000) 20,000
chloroquine, tab 150 mg base	(10 x 2,000) 20,000
*Blood, drugs affecting the*
folic acid, tab 5 mg	tab	1,000
*Recall from basic unit:*
ferrous sulfate + folic acid, tab 200 + 0.25 mg	(10 x 2000) 20,000
*Cardiovascular drugs*
methyldopa, 250 mg	tab	500
hydralazine, inj 20 mg	ampoule	20
*Dermatological drugs*
polyvidone iodine 10%, sol.,²⁰	200 ml bottle	10
silver sulfadiazine cream 1%	50 g. Tube	30
benzoic acid 6% + salicylic acid 3% ointment	40 g tube	25
*Recall from basic unit:*
tetracyline eye ointment 1%	(10 x 50) 500
gentian violet, powder 25 g	(10 x 4) 40
benzyl benzoate, lotion 25%, litre	(10 x 1) 10
*Diuretics*
furosemide, inj 10 mg/ml	2 ml/ampoule	20
hydrochlorothiazide, tab 25 mg	tab	200
*Gastrointestinal drugs*
promethazine, tab 25 mg	tab	500
promethazine, inj 25 mg/ml	2 ml/ampoule	50
atropine, inj 1 mg/ml	1 ml/ampoule	50
*Recall from basic unit:*
aluminium hydroxide, tab 500 mg	(10 x 1,000) 10,000
*Emergency contraceptives*²¹
ethinylestradiol 50 micrograms+ levonorgestrel 250 micrograms²²	(pack of 4)	100
*Oxytocics*
oxytocin inj 10 IU / ml²³	1 ml ampoule	200
*Psychotherapeutic drugs*
chlorpromazine, inj 25 mg/ml	2 ml/ampoule	20
*Respiratory tract, drugs acting on*
salbutamol, tab 4 mg	tab	1,000
aminophylline, inj 25 mg/ml	10 ml/ampoule	50
epinephrine (adrenaline), inj 1 mg/ml	1 ml/ampoule	50
*Solutions correcting water, electrolyte and acid-base disturbances*²⁴
compound solution of sodium lactate (Ringer’s lactate), inj sol., with giving set and needle	500 ml/bag	200
glucose, inj sol. 5%, with giving set and needle²⁵	500 ml/bag	100
glucose, inj sol. 50%	50 ml/vial	20
water for injection	10 ml/plastic vial	2,000
*Recall from basic unit:*
oral rehydration salts	(10 x 200) 2000
*Vitamins*
retinol (Vitamin A), caps 200,000 IU	caps	4,000
ascorbic acid, tab 250 mg	tab	4,000
Renewable supplies
scalp vein infusion set, disposable 25 G (diam. 0.5 mm)	unit	300
scalp vein infusion set, disposable, 21G (diam. 0.8 mm)	unit	100
IV placement canula, disposable, 18G (diam. 1.3 mm)	unit	15
IV placement canula, disposable, 22G (diam. 0.8 mm)	unit	15
IV placement canula, disposable, 24G (diam. 0.7 mm)	unit	15
needle Luer IV, disposable 19G (diam. 1.1 mm x 38 mm)	unit	1,000
needle Luer IM, disposable, 21G (diam. 0.8 mm x 40 mm)	unit	2,000
needle Luer SC, disposable 25G (diam. 0.5 mm x 16 mm)	unit	100
spinal needle, disposable, 22G (diam. 0.7 x 40 mm) black	unit	25
spinal needle, disposable, 20G (diam. 0.9 x 90 mm) yellow	unit	25
syringe Luer, resterilizable, nylon, 2 ml (diam. 0.9 x 90 mm)²⁶	unit	20
syringe Luer, resterilizable, nylon, 5 ml	unit	100
syringe Luer, resterilizable, nylon, 10 ml	unit	40
syringe Luer, disposable, 2 ml²⁶	unit	400
syringe Luer, disposable, 5 ml	unit	500
syringe Luer, disposable, 10 ml	unit	200
syringe Luer conical connector (for feeding), 60 ml	unit	20
feeding tube, CH 5 or 6 (premature baby), Luer tip,40 cm disposable	unit	20
feeding tube, CH 8, Luer tip, 40 cm disposable	unit	50
feeding tube, CH 16, conical tip, 125 cm disposable	unit	10
urinary catheter (Foley), no. 12, disposable	unit	10
urinary catheter (Foley), no. 14, disposable	unit	5
urinary catheter (Foley), no. 18, disposable	unit	5
surgical gloves sterile and resterilizable no. 6.5	pair	50
surgical gloves sterile and resterilizable no. 7.5	pair	150
surgical gloves sterile and resterilizable no. 8.5	pair	50
safety box for disposal of used syringes and needles 5L²⁷	unit	20
*Recall from basic unit:*
glove, examination, non sterile disposable	(100 units x 10) 1,000
sterilization test tape (for autoclave)	roll	2
sodium dichloroisocyanurate (NaDCC) tabs 1.67 g	tab	1,200
thermometer, Celsius, clinical, flat type	unit	10
spare bulb for otoscope	unit	4
batteries R6 alkaline AA size (for otoscope)	unit	12
*Recall from basic unit:*
thermometer, Celsius, clinical, flat type	(6 units x 10) 60
ballpens	(10 units x 10) 100
hardcover exercise book	(4 units x 10) 40
health card + plastic cover	(500 units x 10) 5,000
plastic bag for drugs	(2,000 units x 10) 20,000
small notepads (A6)	(10 units x 10) 100
urine collecting bag with valve, 2,000 ml	unit	10
glove, examination, latex non sterile large	unit	100
glove, examination, latex non sterile medium	unit	100
glove, examination, latex non sterile small	unit	100
mucus extractor, disposable	unit	5
suture, synthetic absorbable, braided, 70cm metric size DEC. 3 (USPu00), with cutting needle 3/8 circle, 30mm	(4 x 36 units)	144
surgical blade (surgical knives) no. 22 for handle no. 4	unit	50
tape umbilical non sterile 3 mm wide x 100 m spool	unit	1
razor blade	unit	100
tongue depressor (wooden, disposable)	unit	100
gauze roll 90 m x 0.90 m	roll	3
gauze compresses, 10 x 10 cm, 12 ply, sterile	unit	1,000
*Recall from basic unit:*
absorbent cotton wool	(1 kg x 10) 10
adhesive tape 2.5 cm x 5 cm	(30 rolls x 10) 300
bar of soap (100-200g/bar)	(10 bars x 10) 100
elastic bandage, 7.5 cm x 5 m	(20 units x 10) 200
gauze bandage with selvedge, 7.5 x 5 m	(200 rolls x 10) 2,000
gauze compress 10 x 10 cm, 12 ply, non sterile	(500 units x 10) 5,000
Equipment
apron, utility plastic reusable	unit	2
clinical stethoscope, dual cup	unit	4
obstetrical stethoscope (metal)	unit	1
sheeting, plastic PVC clear 90 cm x 180 cm	unit	2
sphygmomanometer (adult)	unit	4
razor non disposable	unit	2
scale for adult	unit	1
scale, hanging, 25 kg x 100 g (Salter type) + trousers	unit	3
tape measure (cm/mm)	unit	5
tape measure, mid-upper arm circumference, MUAC	unit	10
towel HUCK, 430 mm x 500 mm	unit	2
drum for compresses, lateral ellipses H: 10 cm, diam. 15 cm	unit	2
*Recall from basic unit:*
drum for compresses, lateral ellipses H: 15 cm, diam. 15 cm	(2 units x 10) 20
otoscope + set of reusable paediatric specula	unit	2
tourniquet	unit	2
dressing tray, stainless steel, approximately 30 x 20 x 3 cm	unit	1
kidney dish, stainless steel, approximately 26 x 14 cm	unit	2
scissors straight/blunt, 12/14 cm	unit	2
forceps Kocher no teeth, 12/14 cm	unit	2
*Recall from basic unit:*
kidney dish, stainless steel, approximately 26 x 14 cm	(1 unit x 10) 10
gallipot, stainless steel, 100 ml	(1 unit x 10) 10
dressing tray, stainless steel, approximately 30 x 20 x 3 cm	(1 unit x 10) 10
scissors straight/blunt, 12-14 cm	(2 units x 10) 20
forceps Kocher no teeth, 12-14 cm	(2 units x 10) 20
abscess/suture set (7 instruments + box)²⁸	unit	2
dressing set (3 instruments + box)²⁹	unit	5
delivery set³⁰	unit	1
*Recall from basic unit:*
dressing set (3 instruments + box)	(2 units x 10) 20
pressure sterilizer, 15 litres (type: Prestige 7503,double rack)	unit	1
pressure sterilizer 21 litres with basket	unit	1
kerosene stove, single burner, tank capacity 1-2 litres (type UNICEF 017. 0000)	unit	2
water filter with candles, 10/20 litres (type UNICEF 561.9902)	unit	3
nail brush, plastic, autoclavable	unit	2
*Recall from basic unit:*
plastic bottle, 1 litre	(3 units x 10) 30
syringe Luer, disposable, 10 ml	(1 unit x 10) 10
plastic bottle, 125 ml	(1 unit x 10) 10
nail brush, plastic, autoclavable	(2 units x 10) 20
bucket plastic, 12 litres	(2 unit x 10) 20
foldable jerrycan, 20 litres	(1 unit x 10) 10
MSF Clinical guidelines (diagnostic and treatment manual)³¹	unit	2

¹²20 ml vials are preferred, although 50 ml vials may be used as an alternative.

¹³Alternative injectable analgesics include pentazocine and tramadol which are considered inferior and are therefore not included in the WHO Model List of Essential Drugs. It is however recognized that these constitute a practical alternative to morphine in those situations where opioids cannot be sent.

¹⁴Import and export permits are normally required for shipment of morphine as it is a controlled drug coming under the UN Single Convention on Narcotic Drugs. Pentazocine (previously recommended in the NEHK) and tramadol (supplied by some humanitarian organizations), diazepam and phenobarbital are now controlled drugs in some countries and come under control measures additional to the UN Convention on Psychotropic Substances, resulting in the requirement for an import permit before authorization of an export permit. The Model guidelines for the international provision of controlled medicines for emergency care (see Annex 9) are designed to facilitate supply of all such controlled drugs in emergencies.

¹⁵Naloxone is an opioid antagonist given intravenously for the treatment of opioid overdosage and to reverse the effects of therapeutic doses of opioids. It has been added because morphine is in the kit.

¹⁶For the treatment of oral candidiasis; it may be replaced by an equivalent quantity of nystatin suspension.

¹⁷The combination of procaine benzylpenicillin 3 million IU and benzylpenicillin 1 million IU (procaine penicillin fortified) is used in many countries and may be included as an alternative.

¹⁸For the treatment of cerebral and resistant malaria cases. Intravenous injection of quinine must always be diluted in 500 ml glucose 5%.

¹⁹For the treatment of resistant malaria strains (check national protocols).

²⁰Polyvidone iodine has been chosen because the use of iodine tincture in hot climates may result in toxic concentrations of iodine by partial evaporation of the alcohol.

²¹A small quantity of emergency contraceptives is included in the kit for victims of rape. It is acknowledged that cultural and religious beliefs may preclude some women and health workers from using this treatment. It is strongly recommended that health workers assist the victim as much as possible in reaching an informed decision.

²²Women who seek help within 72 hours of rape and wish to use emergency contraception to prevent pregnancy should take two tablets of ethinylestradiol 50 micrograms + levonorgestrel 250 micrograms followed by two more tablets 12 hours later.

²³For treatment and prevention of postpartum haemorrhage.

²⁴Because of the weight, the quantity of infusions included in the kit is minimal. Look for local supply, once in the field.

²⁵Glucose 5%, bag 500 ml, for administration of quinine by infusion.

²⁶There is increasing international agreement to promote the use of disposable syringes and needles, and resterilizable syringes are likely to be phased out in the future. Disposable syringes should be substituted by autodestruct single use syringes as soon as proven practicable products become commercially available.

²⁷WHO/UNICEF standard E10/IC2: boxes should be prominently marked.

²⁸One suture set should be reserved for repair of postpartum vaginal tears.

Abscess/suture set (7 instruments + box):

• 1 stainless steel box approx. 20 x 10 x 5 cm
• 1 dissecting forceps with teeth, 12-14 cm
• 1 Kocher forceps with teeth, straight, 12-14 cm
• 1 Pean forceps straight, 12-14 cm
• 1 pair surgical scissors sharp/blunt, 12-14 cm
• 1 probe, 12-14 cm
• 1 Mayo-Hegar needle holder, 18 cm
• 1 handle scalpel, no 4

²⁹Dressing set (3 instruments + box):

• 1 stainless steel box approx. 17 x 7 x 3 cm
• 1 pair surgical scissors sharp/blunt, 12-14 cm
• 1 Kocher forceps, no teeth, straight, 12-14 cm
• 1 dissecting forceps, no teeth, 12-14 cm

³⁰Delivery set (3 instruments + box):

• 1 stainless steel box approx. 20 x 7 x 3 cm
• 1 scissors straight 14-15 cm B/B SS
• 1 scissors dissecting straight Mayo 16-18 cm SS
• 1 Forceps haemostat straight Rochester Pean 15-17 cm SS

³¹Clinical guidelines - diagnostic and treatment manual is available at cost price in English, French and Spanish from Médecins sans Frontières.