Upgrading your Boats Medical Locker

[Discovery 15797]

Originally Posted by NorthCoastJoe

As an x paramedic and ACLS instructor. Defibrillator = Done ... As a paramedic in the SF bay area and over 200 codes, saves 2. In the middle of the ocean hopeless even with full ACLS resources.

I can think of more valuable things.

Hmm...here is a paper that contradicts your experience.

I suspect you are right. If someone suffers a SCA onboard in the middle of the ocean they won't survive. But, I sure as hell don't want to be the one to tell their family..."yep, I knew they were a goner, so I didn't even try because my ACLS instructor told me "deregulator = done"."

BTW...with an attitude like that, I'm glad you weren't my ACLS instructor.

[Paul L]

Originally Posted by evm1024

Perhaps we all should review our remote medical knowledge in the light of (ever) changing protocols. I know that I am out of date and can always use a refresher.

I'm sure that no one advocates for closing dirty wounds and that good cleaning of wounds is SOP. Here is a reference RE wound management in the wilderness that may be useful.

https://www.wildsafe.org/resources/w...ical-protocol/

One of the reasons that I am interested in this thread is that we are planning a 5 year cruise and it is time for me to get a remote medical refresher and to update/upgrade the med kit.

Likely I'll take a wilderness medicine class this fall. I would recommend like to all who will be in out of the way places.

Your referenced article in bold says do not suture serious wounds. That was the point both myself and Singularity made.

[evm1024]

Originally Posted by Paul L

Your referenced article in bold says do not suture serious wounds. That was the point both myself and Singularity made.

The article uses the term High risk. High risk and serious are not the same but why not for this discussion. In any case let's be precise with our quotations. We do not want to lose meaning.

It says:

DO NOT close any high risk wounds with sutures or tape

Having already defined high risk as:

High-risk wounds (embedded debris, devitalized tissue, bites, open fractures, deep structure involvement or any wound which gapes > ½ inch wide)

It appears to me that those who have said that they carry superglue, a stapler or a suture kit all indicate that the wound needs to be clean, and that they have training and that they have received these supplies from their doc.

I can understand how one would get their back up if it was implied that they would close up an un-clean wound, that they were unskilled and incapable of making sound choices in wound management, that this should be left to the pro's and in general you will shoot your eye out (reference to an old movie for those who don't know).

Be that as it may I don't have a suture kit in the boats med kit. It might come in handy to have a stapler someday for closing a head gash.

I don't advocate for or against would closures beyond steri-strips and the like for small cuts.

I do advocate for training, staying withing your skills and training, getting "expert" advise over the SSB or Phone and a focus on stabilization and life preservation.

As a climb and expedition leader I spent 40 hours a year in wilderness first aid along with the 80 hours full course every 4 years. I would recommend something similar for all venturing far afield.

More on the topic of upgrading your med locker is the book (and training to match): Oxford Handbook of Expedition and Wilderness Medicine

Regards

[Nicholson58]

If you are in the US you will need a friend doctor who can obtain prescription or controlled substances for you or give you a script. This is so illegal no sane doc would do it. The US so called emergency kit contains band aids, tape, scissors, sunburn cream, topical antibiotic and other over the counter stuff you can get at Walmart Or Costco for about 1/4 or less.

In many foreign countries the stuff you might want is available. Over the counter or with a minimum of “please”.

We are in our fourth season in the Caribbean. Currently under C19 lock down in Antigua. Mostly, cruisers don’t get sick. We naturally are isolated, mostly don’t hang out in crowds. We take extra care to avoid physical injury, don’t touch plants you don’t know, don’t touch the coral. DeFib in board, splints, tape etc. Seeing a doctor is not expensive except now, we want nothing to do with anyone who sees patients.

[SRQsailor]

One item often overlooked but that come in handy twice while cruising in remote locations is ophthalmic ointment. Antibiotic is good, but even better is a combo antibiotic and cortisone. Hiking onshore at Cooper island in BVI my crew scratched a cornea on a manchineel bush leaf. Was in agony. Wouldn't let me treat it and we were about to haul anchor for Roadtown. Coincidentally, there was an ophthalmologist on another boat in the anchorage who had the antibiotic version but I had the combo and he said that would be even better. Once he let me apply it, he had almost instant relief.

M.L. Trautman, DMD

[Exctyengr]

Stocking a med kit is one thing, knowing how to use it is quite another. Take a Wilderness First Responder course and learn what you are doing.
Then, build your first aid kit.

[Adiona]

Cruising is a risk and to prep properly and reasonably, take a quick step back. Write these down. Not to scare anyone away from exploring, I offer my opinion on what questions that need to be addressed, and why.
What medical issues and conditions does the crew have and what meds do they take routinely. How old are they. List these. Have enough onboard and sealed properly from the elements for the duration. Don’t rely on getting them anywhere else but your locked Med locker.
How long are you away from medical care, both emergency and available on the coast.Have some splints and rolls of elastic bandage to accommodate a bone break or sprain or just keep on a gauze pad.
Burns are a real threat. Salves, splints, dressings are a necessity to prevent further damage.
The big one is shock from pain or injury. You need to discuss this with a doctor, preferably one who has boating or emergency medicine background because these meds will probably need an Rx, at least in the US. Or your family doc can help.
And please take a first aid course anywhere, online. I agree that you need to be realistic about your crews capability to handle an emergency and recognize that the treatment is being done correctly, so that more damage is not being done or limbs or lives being lost. And in extreme conditions, how would handle a death onboard. In case.
This might sound morbid, but being prepared is what cruising is about, and the answer might be that you and your crew are not capable, or unwilling, to handle a severe emergency where you are going then the wise thing is to reassess whether it is safe to go/be there. What would be foolish is to assume nothing will happen.
For years I have carried far more medical supplies that a small hospital, including suture kits and meds. And it was a source on comfort to know they were aboard if needed. It’s was also amazing to me when we had injuries, how much of those supplies I used up on simple cuts, scrapes, burns, keeping them clean and dry and infection free till they healed. Also, it was useful to share these, when others ran short, or needed meds.
Being safe while exploring was important to us, just my two cents, like the grocery lion.

[Tudorsailor]

As an Orthopaedic/Hand surgeon I find that too little attention is given to wounds in most first aid kits. Firstly many cuts that would be stitched if you were in an ER will heal very nicely without sutures. Big cuts left open will heal eventually but may take weeks. Remember that nature was able to heal cuts before sutures were invented!


If you can bring the edge together then they will heal more quickly. If you do not have anything better, gaffer tape can be used but its not ideal. It is worth stocking up and steristrips. The most useful size is 1/2". Surgical glue is also good but requires the edges to be dry. Ordinary superglue apparently stings a lot but can be used if necessary

For the cuts and grazes that we all get on our hands the best dressing is a compeed https://www.compeed.us/ THey are intended for feet but a perfect for fingers. They promote healing in a moist environment so no scab. THey are very waterproof and stay on better than almost all other dressings. They are best left on as long as possible. When removed the would will be soggy but the edges will creep in nicely.
Should you ever slice the pulp of a finger tip, then compeed will perform a miracle. After several weeks the pulp regrows including the fingerprint. You certainly do not need to see a plastic surgeon to put the skin back on

Lastly, if you fish, then look up the techniques for getting a hook out. Be aware that you generally cannot cut the end off with ordinary pliers. There are some good youtube videos on how to remove hooks. For a big hook its best to break the barb off and pull back through. For the small hooks the string technique looks good https://youtu.be/fOoardRmtSU

TS

[PapaLulu]

The survival (as measured by discharge from hospital) for out-of-hospital use of AED is quoted in this study as 47% but this is in Denmark with BLS-trained civilians and tertiary care hospitals: Changes in automated external defibrillator use and survival after out-of-hospital cardiac arrest in the Nijmegen area; J. Was, et al Dec 2018

[BoatBumm]

As a now retired Board-Certified Emergency Physician with 33 years of full-time experience and a semi-long distance sailor, I’ve given talks about being prepared for self-medical care for the cruising sailor. But specifically regarding this post, I would worry less about medications than being prepared for physical injuries. Research has shown that falls leading to sprains and fractures are the sailors’ biggest risk. I also encourage people to learn about proper wound care, including carrying skin staplers for lacerations. You practice on a pigs foot from the butcher shop to learn how to do it. (Pssst - it’s not that hard to do). I also encourage true out-in-the-blue sailor to learn how to start an intravenous line and carry a few bags of saline and the needed equipment to give i.v. fluids. Again, pretty easy to learn. Your local EMTs will likely be willing to train you if you agree to practice poking each other. Sailors are at risk for serious dehydration, and that can kill. Mother Nature is pretty protective in most of her responses to illness & injury. BUT her response to dehydration is definitely counter productive. Dehydration itself tends to make you nauseated, which can quickly start this rapid downhill spiral since you don’t want to drink and therefore get more dehydrated and then even more nauseated, etc., etc. You’d be amazed how much a liter or two of i.v. fluids can improve a seriously ill person. They can perk up like a wilted plant given water.

Back to medications. Carry a good supply of whatever routine meds you and your crew take. Carry several kinds of over the counter pain meds: Tylenol (acetaminophen) Advil (ibuprofen), Aleve (naproxen), etc. it would be nice to have a small supply of narcotic pain meds but at least in the USA they have really cracked down on supplying people with narcotics, so legally getting any could be an issue. Antibiotic wise I would recommend ciprofloxacin for urinary tract infections, azithromycin for potential pneumonia, and cephalexin for soft tissue infections. All these with the general proviso that antibiotics are, in the USA at least, massively over used (Oh, it can’t hurt! (Yes, it can)). And finally make sure you know your crew’s drug allergy history, and make sure everyone is up to date on current and appropriate vaccinations. If your crew is older it’s likely a good idea for each crew member to speak with his/her own primary care provider to see what specific medical issues might apply to that crew member and then how to be better prepared to deal with those issues.

I could go on for many pages, but this is enough for now.

[TomThumb]

OP is asking about the latest medications. All the advice on references and other med kit contents are valid in themselves, as is the idea you need stocks much larger than for those in a first aid situation close to help. But the question on meds is more complex than just a list of advanced drugs.

The key question for the OP is their level of comfort and intent. If you only know basic first aid, what you can achieve will be limited and so are your needs. If at the other end you undertake courses like the US-based Wilderness First Aid then First Responder and beyond into 'paramedic' levels, you will both have the capacity to do more and a commensurate need for more advanced supplies. My own training has included inserting canulas, catheters (yup), IV injections, suturing and a swag of things Navy had decided small ships COs (with no doctor or medics) needed to have in order to sustain life of both crew and those we encounter (refugees, fishermen, adversaries etc). That also came with authority to hold advanced / scheduled drugs in a safe.

So, the trick with advanced medications is that they require advanced diagnosis (incl both skills and tools) and the ability to safely administer the advanced meds and monitor effects (intended and side). If you do more training, you might wish for advanced meds but as others have noted, you will want to consider the legality of holding them as you travel. Some might be bonded while you visit, others might be seized and others might constitute a crime. A weird example is that in Australia I can but the NSAID diclofenac over the counter and need a doctor to prescribe it in the US. So in Oz, it lives in my toiletries bag, but in theory as I cross a US border I need a doctor's script for it. In some countries what we thin of as even basic meds are illegal.

I'd suggest building your list, considering which fit your essential and desired needs using a risk-based process for the full spectrum of possible and probable accidents (injury) and incidents (ilnesses) factor in how long you need to last (how remote) and add in any pre-existing conditions to that risk.) Then get scripts from a GP for ALL of them so you have at least some legal coverage.

[GarryD]

Yes GTN spray on boat, in car and in med cupboard at home. Follows two MI's!


Also always carry two weeks worth of regular med with copy of doctor's prescription - don't want to nip away for a couple of days at the last minute and have to go home to collect.


In passing also carry copies of passports on board. On one occasion we were inspected by the French authorities - quite happy to get the details of the copies although we were carrying the originals.


Change of tack - after the Costa Concordia disaster a few years ago, we decided that once off the ship the survivors would need to rely on outside help to survive and get home. So on cruises we now each carry, as well as our ship's ID card, a credit card, 20euros and a reduced size copy of our passports, not "legal tender" but a starting point.

[Pelagic]

I was surprised that we got off on a tangent about the pros and Cons of suturing .
It has always been a part of wilderness medical training courses .
Complicated or Simple, if there is no help around, you should know how.

https://youtu.be/KuQ38nN481E

https://youtu.be/z8oWv-nVO6g

And staples

https://youtu.be/RAVane1yvyU

[Davo1404]

Originally Posted by Paul L

In a remote cruising area the efficacy of an AED is pretty doubtful. It is unlikely that the patient will see advanced medical care within a few days, let alone the needed few hours. The results of AED use when the patient receives advanced care within a few hours is not that high. And even in those cases the success is defined as released from the hospital, often with significant disability. So in a remote cruising situation they are unlikely to end in a successful outcome.

Exactly. Early defibrillation is only one part of the chain of survival. The last part is early access to a Coronary care unit. In layman's terms,using an AED actually stops the heart from being in a rhythm called VF "ventricular fribulation ". Not conducive to life. After the shock has been administered & with good CPR, oxygen & drug therapy, and early transport to a ccu. If all the links aren't available then the AED is of little help.

[CassidyNZ]

Originally Posted by GarryD

Change of tack - after the Costa Concordia disaster a few years ago, we decided that once off the ship the survivors would need to rely on outside help to survive and get home. So on cruises we now each carry, as well as our ship's ID card, a credit card, 20euros and a reduced size copy of our passports, not "legal tender" but a starting point.

Which begs the question: what medical provisions (and how) do you carry in your grab bag? I’ve long been in the habit of immediately after departure, placing sign-out papers, passports and wallets/purses of all on board in the grab bag. You’re not going to need them until we reach our destination and it’s a bad idea being rescued from a disaster to be set down in a foreign country without papers/money.

Perhaps it is a good thing to have a seperate cache of med supplies in the first aid box that can quickly, without long deliberation, be transferred to the grab bag.

Must say, I’ve never really given that much attention. What would that cache look like (and please don’t include an AED )?