EQUIPMENT GUIDE

We recommend a good quality 3M Littman cardiology 2 or 3, and if you have the budget, try to include an Eko-CORE or ECG DUO module to take with you. We recommend a cardiology 2 or 3 simply because those reach max analog performance. Anything more doesn’t get you much and any model lower starts to reduce quality. When working with limited resources and limited diagnostic ability, having an audio waveform (Eko CORE) can be really helpful in evaluating murmurs. If you have extra resources, the ECG module is also very useful for doing point-of-care electrocardiography. You can move it over different leads in order to take your own 12 lead EKG.

We have extensively tested and reviewed multiple stethoscopes over the years. We don’t recommend the Think Labs One digital stethoscope or even the well-known Littman electronic stethoscope. Both are neat devices, but don’t justify the utility to cost ratio. For missions, a simple stethoscope will do, but we also like the Eko-CORE and ECG DUO as useful gadgets, if the budget allows.

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Summary: Cardiology III with both Duo ECG / Eko-Core. The company often gives out nice promotions so we recommend waiting for one of those to save a few dollars.

Fundoscopy is a difficult task for most physicians. However, in the mission field it is important to be equipped with all the tools should a need arise. Most medical clinics lack a non-mydriatic camera and other advanced imaging resources. We recommend the Welch Allyn Panoptic, as there is no close second device in performance for manual fundoscopy. It is also important to note that you can use a 20 mm optical lens with chemical dilation and achieve roughly the same or better results. In the past we have used iPhone attachments in order to take video and pictures while using the Welch Allyn Panoptic. It is still very difficult to get good visualization without dilation.

While we think an iPhone attachment is neat and useful, there are currently no compatible devices and attachments for newer phones. We may explore 3D printing custom phone attachments in the future.

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Summary: Welch Allyn Panoptic with dilating drops. Devices are common and inexpensive.

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.

In the past we also used to recommend an iPhone attachment otoscope which allows video and pictures to shared with patients. The cell scope photo for clinicians has since been discontinued, however we are exploring options in 3D printing for bringing this back for modern phones. As there are no current iPhone attachment or digital scopes in the market, we recommend using the scope listed under our ENT scope section.

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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 extremely useful tool for diagnosing skin lesions and pathologies. Regardless of specialty, we recommend the incorporation of this practice for rural medical missions. We recommend the Dermlite II Pro or higher. We currently use the Dermlite II extensively as it is relatively inexpensive and has all the performance needed. A purchasable magnetic ring can be mounted to a Dermlite II to allow it to attach to your smart phone. If budget is an issue, there also exists a 3GEN Dermlite HUD which attaches to a smartphone and is very decent in quality. We recommend picking up any Practical Atlas or Guide to Dermoscopy and bringing that into the mission field. We believe a little intentional preparation and consideration can bring so much ability and utility to rural medicine.

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Lastly, we also recommend picking up an application called VisualDx DermExpert. This is a powerful AI diagnostic tool which allows a clinician to take pictures of skin lesions and to have a computer-generated differential to assist in confirming diagnoses. Even with little to no knowledge in dermatology, combining a little tool, one book, and a powerful application, you can be equipped to handle dermatology in the middle of nowhere.

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Summary: The 3Gen Dermlite HUD can be purchased anywhere between $50 – $100. We recommended Dermlite II Pro, which can usually be purchased for $500 – $1000. You should spend only around $100 for a guide or Atlas. VisualDx often has discounts for membership prices, and if you are a student, they have a significant discount as well.

While we use formal sinuscope tools for more specialized procedures, a full ENT setup is not needed for field usage. Nowadays, many USB sinuscope devices can be purchased inexpensively on Amazon and provide great utility for examining the ear, nose, and throat. Although there are many brands, we tried to use a smaller diameter for the ear, and primarily purchase from a company called ScopeAround.

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You can use several different brands and they all are quite inexpensive. If you’re looking for a medical grade sinuscope/auriscope, just make sure to pick up a portable LED light source. If you don’t need a medical grade scope, Amazon has Scopearound along with other Borescopes for your laptop or phone.

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

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

Our current recommendation is the MIR Spirobank II, which is a lightweight portable and reusable spirometry device that you can take on the go. It is both convenient and accurate with reporting features. It is much farther ahead than its competitors (NDD EasyOne.)

Make sure patient expiratory technique is good, and we also recommend always carrying a separate peak flow device and incentive spirometer in your mission bag.

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Summary: You can purchase a MIR Spirobank anywhere between $700-$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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Summary: Portable Omron blood pressure cuff. Purchasable on Amazon.

We believe every mission hospital should have one full-size slit lamp. There are many brands to choose from, but for the most part, a slit lamp is a slit lamp. We recommend against spending large sums, as slit lamps are numerous and frequently donated. Newer slit lamps with LEDs and the gold standard Haag Streit 900 can cost several thousands of dollars and are not worth the cost for the performance.

In terms of field use, a portable hand-held slit lamp is extremely useful. We recommend several models such as the Topcon SL / Kowa / Keeler / and a new Chinese unit that has just come out. Being able to put a slit lamp into a backpack or suitcase adds tremendous ability to diagnose eye complaints on the go.

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

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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. 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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At the end of the day, even little disposable ones, a keychain flashlight, or even smartphones will work.

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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.

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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. Make sure you have in date strips when using the machine.

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. 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 simple yet an essential tool to have on the mission field. Nowadays, high-quality microscopes are very inexpensive. A small portable microscope will allow you to perform wet mounts, KOH preps for both genital and skin pathology, as well as give you a gross diagnosis of hematologic disorders. We recommend any OMAX microscope with at least 100x magnification, a universal cell phone adapter mount in order to take pictures of your slides, a box or two of slides and cover slips, KOH, a small bottle of saline, and also a small bottle of immersion oil for 100X magnification. Avoid buying a microscope that comes with a digital camera, as cell phone cameras with an adapter are actually much more powerful than these.

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Summary: OMAX Microscope with an iPhone microscope attachment. Make sure to bring immersion oil, KOH, saline, and cover slips. You should not have to spend more than $100 – $300 on an OMAX compound microscope, $30 on a universal cell phone microscope adapter, and the rest of the accessories are common and can be purchased cheaply.

Epocrates, UpToDate, BiliBaby, VisualDx, MDCalc. Let us know if we missed any.

A simple list for reference: webril, plaster, cast Saw, colored cast, cheap shears. Bonus is a stockinettes if you really want.

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.

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.

Best tool for point-of-care hemoglobin is the HemoCue HB 201+. Unlike most point-of-care testing, the HemoCue is 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.