EQUIPMENT GUIDE

We've put countless stethoscopes to the test over the years. The Think Labs One digital stethoscope and the Littmann electronic stethoscope? Not worth the cost. They’re cool gadgets but don’t offer enough bang for your buck. The bottom line is that good listening skills and a solid understanding of physiology are all you really need. A Cardiology II or III stethoscope will do the trick. If you're venturing into the middle of nowhere and want to dig deep into waveforms to confirm your suspicions of different types of murmurs, an Eko CORE can be incredibly useful. Plus, the audio boost is a big help in noisy environments.

For those with a bit more budget, consider the upgraded Eko 500, which includes a spot lead ECG. It’s sensitive to artifacts and not as precise as a standard 12-lead ECG, but it's a handy, portable tool for diagnosing atrial fibrillation and ventricular tachycardia. It's the preferred choice over other portable ECG gadgets like the Apple Watch, ThinkLabs, or Kardia. To get the best deal, look out for promotions, often available during Black Friday and Christmas specials.

Special Notes:

Would avoid apple watch, thinklabs, or Kardia, etc.

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Summary:

Basics, a Littmann II/III is all you need to get the job done.  A EKO 500 is the best option to have a portable ECG, and the noise cancelling is helpful.

Fundoscopy can be quite challenging for many physicians, but in the mission field, it's crucial to be prepared with the right tools. Most medical clinics lack advanced imaging resources like non-mydriatic cameras. Our top recommendation for manual fundoscopy is the Welch Allyn Panoptic—it’s unrivaled in performance. You can also achieve excellent results using a 20 mm optical lens with chemical dilation.

In our experience, using iPhone attachments to take videos and pictures with the Welch Allyn Panoptic is possible, but getting good visualization without dilation is tough. While these attachments are handy, attachments for newer phones are quite limited.

Currently, handheld IR cameras don’t offer the image quality to justify their price. Larger non-mydriatic cameras need more advancements before becoming practical portable options.

Special Notes:

Using regular dilating agents like Tropicamide with a 3D-printed rig allows you to use your iPhone to capture spectacular fundus images that would impress any ophthalmologist. The bottom line: if you need a device for non-mydriatic fundoscopy, go with the Panoptic. Otherwise, dilation with a 3D-printed rig is an outstanding tool for the field. If you need a custom rig for the panoptic, or for a rig with the 20D lens, we can make you one.​

Summary:

Panoptic with a compatible phone rig with dilation is ideal. 20D lens with compatible phone rig and is also fantastic.

Our top recommendation is the Welch Allyn Macroview Otoscope. It is a very common otoscope and familiar to most physicians. Just make sure to purchase the macro view instead of the traditional metal otoscope. We find the Macroview gives a much better view.

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Special Notes:

We also recommend buying an insufflation bulb to test TMs.

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Summary: Welch Allyn Macroview Otoscope. Devices are common and inexpensive.

Dermoscopy is an invaluable tool for diagnosing skin lesions and pathologies, and we highly recommend incorporating it into rural medical missions, regardless of your specialty. Our top pick is the Dermlite II Pro or higher. We use the Dermlite II extensively because it’s affordable and performs exceptionally well. You can mount a purchasable magnetic ring to the Dermlite II, allowing it to attach to your smartphone.

If budget is tight, the 3GEN Dermlite HUD is a good alternative, offering decent quality and smartphone compatibility. Bringing a Practical Atlas or Guide to Dermoscopy into the mission field is also highly recommended. A little preparation and these tools can significantly enhance rural medical practice.

Special Notes

For additional support, we suggest the VisualDx DermExpert app. This powerful AI diagnostic tool lets you take pictures of skin lesions and receive computer-generated differentials to help confirm diagnoses. Even with minimal dermatology knowledge, a combination of this tool, a guidebook, and the app equips you to handle dermatology cases effectively in remote areas.

A third alternative is a DE550 wireless dermatoscope which is reasonably priced as well and can project to a large tablet or phone. With these recommendations, you’ll be well-prepared to provide top-notch dermatological care, even in the most remote locations.

Summary:

3Gen Dermlite HUDII or DL1: $100-200, Dermlite II/II/IV Pro: $500-1000

While we use formal sinuscope tools for specialized procedures, a full ENT setup isn't necessary for field use. Nowadays, many affordable USB sinuscope devices are available on Amazon, providing great utility for examining the ear, nose, and throat.

like with many of our systems, we like to add that extra technology and special touch that brings futuristic and modern medicine closer to those who are most underserved. Therefore, we also recommend several good USB or iPhone scope attachments that can broadcast a patient’s ear canal, mouth, or nasal canal to your phone and be shown to the patient. This can subsequently be cast to a compatible television for an enhanced patient experience.

Special Notes:

Also with a bigger budget there is also a wireless casting device called the Firefly DE1270, which can connect to flexible and rigid endoscopes and project them wirelessly to a tablet or phone device. This is especially powerful when using more official rigid and flexible bronch/laryngoscopes, and large screens.

Summary: Any USB or smartphone borescope on Amazon can get the job done.

For a more robust system consider a Firefly.

Not too long ago, spirometry required large, complicated machines. Even three years ago, our primary portable devices were the PC-based Midmark IQ Spirometer and Welch Allyn SpiroPerfect. These worked well at the time but were cumbersome with disposable transducers, computer cabling, and clumsy software.

Our current recommendation is the MIR Spirobank II, a lightweight, portable, and reusable spirometry device that's perfect for on-the-go use. It's both convenient and accurate with excellent reporting features, far surpassing its competitors like the NDD EasyOne. It's amazing that we can now perform a full PFT with just a phone and a small handheld device.

Special Note: Ensure that your patient’s expiratory technique is good, and always carry a separate peak flow device and incentive spirometer in your mission bag.

Summary: You can purchase a MIR Spirobank for anywhere between $700 and $1300.

A blood pressure machine is a blood pressure machine. In our long history of trying different brands such as LifePak, Welch Allyn, and Omron, they are all relatively the same. In our experience, the consumer grade and inexpensive Omron blood pressure cuffs perform very closely with medical grade devices. While it is important to always have at least one medical grade vital sign machine, these retail blood pressure cuffs perform very well. It is recommended to make sure you get a device that can be used while plugged in to make sure it is given adequate power for greater accuracy.

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Special Notes:

- Critical care situations should use a hospital grade monitor over even a retail BP cuff, or even a medical grade spot monitor. Both are unreliable. And obviously, should avoid ankle, thigh, or wrist BP machines due to gross inaccuracies.

Summary: Portable Omron blood pressure cuff. Purchasable on Amazon.

We believe every mission hospital should have at least one full-size slit lamp. There are many brands to choose from, but generally, a slit lamp is a slit lamp. We advise against spending large sums, as these devices are often donated. High-end models like the newer LED slit lamps and the Haag Streit 900 can cost several thousand dollars and are not worth the extra expense for the performance they offer.

For field use, a portable hand-held slit lamp is extremely useful. We recommend models such as the Topcon SL, Kowa, and Keeler. Being able to pack a slit lamp into a backpack or suitcase adds tremendous capability for diagnosing eye complaints on the go. Our top choice for portable slit lamps is the SL2, a Chinese LED portable model. This is ideal if luggage and transportation are concerns. However, for procedures like foreign body removal, a stationary slit lamp is still necessary.

Special Notes: You can find used older slit lamps for a couple of hundred dollars that will work just fine. If you opt for a cheaper model, ensure you have several spare bulbs on hand. Sometimes, you can carefully disassemble the top portion, pack it into a suitcase, and assemble a wheeled desk on-site overseas.

Summary: Many options exist for standard slit lamps, so make sure you have extra bulbs. Your target price should be between $500-$1000. For portable options, brand names can be purchased for between $2000-$4000.

While sort of a medical luxury, we believe having at least one CO-oximeter is important for any mission hospital. In this area there is really only one device that is available for point-of-care co-oximetry. It’s very handy to have this available to check for carbon monoxide and methemoglobin. It is very useful to have in places with lots of wood or trash burning. The Masimo Rad-57 Co-oximeter is the device of choice.

Please note: make sure the device you purchase includes the rainbow patient cable, as they are very expensive and are more cost-effective when purchased together. Also, there are many Masimo Rad-57 devices that do not have the carbon monoxide or methemoglobin features activated, so absolutely make sure that these features are activated before purchasing.

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Summary: Devices with all the features unlocked are much rarer. Expect to pay anywhere between $400 to $700 for a good device.

Audiometers are extremely useful in the mission field, and yet so underutilized. The technology is quite old and simple, and therefore perfect for mission budgets. We recommend any of the older units like the Maico 27/40 or Beltone 119 and if you are looking for a newer device the Ambco 650AB.

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At the moment, digital and USB based audiometers are overly expensive and unreasonable when it comes to the simple necessity to test hearing frequencies. We don’t recommend using these due to cost.

As far as tympanometers go, these are useful devices, however maybe more a clinical luxury given the price ranges and utility. If you are seeing a lot of pediatric or Ent cases this could be a good investment long-term, and it does provide very nice tympanogram data, which are easy to learn and interpret.

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Summary: Try to buy a used audiometer for around $50-$250 and no more. A brand-new audiometer can be purchased for around $600-$800.

It’s always good to have a set of quality trauma shears. The top choice is the widely known and popularized Leatherman Raptor. We reviewed and tried many different types of shears and they remain the highest quality and best performing. In reality though, any standard or normal set of shears will get the job done just fine. But if you do plan on doing an emergency thoracotomy or sternotomy and need to cut through bone, make sure you have a pair of Leatherman Raptors on hand.

It is important to note that you should make sure to pay to sharpen them every once in a while, as they will dull. Also, it is best to avoid using them for splinting, as you will quickly dull the blade.

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Summary: You can find a brand-new pair for $60-$80.

With the advancement of technology, most finger pulse oximeter’s purchased on Amazon are just as good as any hospital grade pulse oximeter.

Special Notes:

Our personal favorite is the Contec CMS50D which also allows you to record 24 hour oxygenation charts and see visual waveforms. This is very useful for performing gross studies for sleep apnea with finger taping overnight. We believe it is a vital piece of equipment that can also be used in resuscitation, as well as checking for ROSC. 

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Summary: Many of the basic pulse oximeters can be purchased for around $25-$50. The 24 hour recording Contec CMS50D model is usually around the $50 range as well.

Penlights are penlights. But we don’t simply leave it there. Our preferred penlight is the Streamlight Stylus. However, you should be warned that it is extremely bright and can often be a little uncomfortable for patients. We choose this as our preferred penlight as the batteries are interchangeable, it is extremely durable and rugged, and can also double as a very bright flashlight. It is an excellent penlight that we’ve tested and have used extensively in trauma and emergency situations.

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Special Notes: Can even use an iphone, which the modern style of medicine.

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Summary: Few models exist, but the Stylus Pro can be purchased on Amazon for between $20 – $30.

Urinalysis does not get any simpler than bringing a bottle of UA strips and maybe some paper towels. For short-term mission trips, this is the  ideal and most portable option. For field hospitals and longer trips, it’s worthwhile to bring a urinalysis machine just for convenience. Urinalysis machines simply do the observation and print the results rather than you having to look at the different colors. They are quite inexpensive and our top recommendation is the McKesson Consult. Bear in mind that you will need to have non-expired strips in order to use the machine, otherwise it will not work.

Special Notes: Avoid expensive Clinitek Status, Consult is just as good. Make sure you have in date strips when using the machine, or you’ll be back to manually reading.

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Summary: Bottle of strips for convenience and short-term trips. The McKesson Consult is our top pick at only around $80-$120.

Although we’ve been actively searching for consumer options for temperature measurement, we still cannot recommend any consumer options for medical testing. It would not be a bad idea to carry around a simple Amazon probe temperature device for everyday carry, but for precision measurement we recommend the Welch Allyn Sure Temp or LXI etc. It is simple and reliable.

We recommend avoiding purchasing anything much more expensive, such as the LXI vital machine. Just make sure to bring extra probe covers with you.

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Summary: Welch Allyn Sure Temp is the most accurate, inexpensive, and reliable. Don’t forget probe covers.

Glucometer devices are so common and widely used that they are easily affordable. Pretty much any reputable retail brand will provide accurate blood glucose levels and are usually sold in all-in-one kits including blood sugar monitor, lancing device, lancets, and controls. They are a must-have for any medical missions bag.

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Summary: Accu-Chek all-in-one kits can be purchased on Amazon for as little as $14-$25.

A microscope is a simple yet essential tool for the mission field. High-quality microscopes are now very affordable. A small portable microscope allows you to perform wet mounts, KOH preps for both genital and skin pathology, and provides a gross diagnosis of hematologic disorders. We recommend any OMAX microscope with at least 100x magnification, a universal cell phone adapter mount to take pictures of your slides, a box or two of slides and cover slips, KOH, a small bottle of saline, and a small bottle of immersion oil for 100x magnification. Avoid microscopes with built-in digital cameras, as cell phone cameras with adapters are more powerful.

Special Notes: Ensure you have all necessary accessories, including immersion oil, KOH, saline, and cover slips. These items are crucial for comprehensive diagnostic capabilities in the field.

Summary: An OMAX microscope with an iPhone microscope attachment is recommended. You shouldn't spend more than $100-$300 on an OMAX compound microscope, $30 on a universal cell phone microscope adapter, and the rest of the accessories can be purchased cheaply.

Epocrates, UpToDate, BiliBaby, VisualDx, MDCalc. We also highly recommend a EMRA medical handbook and a Pediatric Handook by Dr. Clark Sleeth. These are pocket guides that cover a wealth of information even offline.

Basic list to take includes webril, plaster, cast Saw, fiberglass, and cheap shears. Stockinettes in our experience is optinal if you have webril. If you simplify your kit or inventory it helps with sustainability and long-term consistent care.  

Difficult venous access is as prevalent in the states as it is overseas. We recommend having a stash of ultrasound IV kits ready in case of emergency. Gel packets, Tegaderm (probe cover), long angiocatheters, tourniquet, chlorhexidine swabs, IV pigtails, and flushes. We bundle each kit in a baggie. A large IV in the internal jugular can serve as a trauma line, and standard US catheters can be used as arterial lines as well.

Special Note: US access is something anyone can learn, and vitally important in the mission field. Here one of many good videos that give a good tutorial. This also prevents the need to use expensive double or triple lumen kits. Here is another video on how to make your own gel models to practice on.

Summary: US IVs provide a tremendous skill for gaining access in adults, children, and replace the need for expensive and large triple lumen trays.

Keep a nice set of gold handle instruments. You can use our checklist: needle driver, rat-tooth and Adson forceps, Iris scissors, Metzenbaum scissors, multiple scalpel handles, disposable blades. Variety of sutures, gauze, large band aid kit, Kerlix, Aquaphor, Tegaderm, and Tourniquet. Don’t forget your anesthetics.

Special Notes: Paired with a small ultrasonic cleaner, enzymatic, and autoclave you can run your own small procedures anywhere anytime. For smaller surgical kits we recommend shopping on ebay, however for larger OR or surgical trays we have a great charity network for stocking larger procedures and theaters.

Summary: Dealer choice for your surgical missions.

Best tool for point-of-care hemoglobin is the HemoCue HB 201+ or the Cliawaive HgB Test System. Unlike most point-of-care testing equipment, the HemoCue and cliawaived HgB are pretty inexpensive and the reagents are easily purchasable as well. The HemoCue is a great device and a handy inexpensive tool to have in any missionary arsenal. These both can be purchased for under 400 dollars including reagents.

Special Notes: There is a Hemocue HB 801 with a bigger screen but in our experience its best to go with a simpler system.

Summary: Having a point of care HgB is a tremendous tool when chemistry analyzers are limited. Options for POC Hgb are good, and highly cost effective.