Medical Emergencies at Remote Cruising Destinations

[Saleen411]

Originally Posted by MarkJ

1) if they were not in the water they couldn't see much sea life.

2) the circuit they did began with areas without much marine life... so by the time they got to the Caribbean or the Pacific they had probably made up their minds there was nothing to see.

3) I am anchored next to a large rock reef. When I meet people I say snorkel on the outside of the reef. But they always snorkel on the inside of the reef. What's the difference? On this reef there is no life on the inside and an abundance on the outside. So you gotta get advice where to go and TAKE THE ADVICE!

Mark,

Bit of thread drift here.....In GENERAL, they say......many areas they visited had been over fished, and some areas were completely decimated by the locals. Just passing on what they said.....Again, I don't think their priority was diving.

[quandary]

Its a good question. I try to rely on the statistics. You probably have less chance of dying while cruising, diving etc than you have when driving at 70mph or flying in an aircraft or getting taken out by a terrorist bomb or criminal...obviously provided you take sensible precautions. Its amazing how scare stories can frighten people even though the odds on the same happening to you are almost zero!
(a few thousand people get killed in 9/11 and the whole western world of 100's of millions spend a fortune on defence and security?)

[Saleen411]

Originally Posted by quandary

Its a good question. I try to rely on the statistics. You probably have less chance of dying while cruising, diving etc than you have when driving at 70mph or flying in an aircraft or getting taken out by a terrorist bomb or criminal...obviously provided you take sensible precautions. Its amazing how scare stories can frighten people even though the odds on the same happening to you are almost zero!
(a few thousand people get killed in 9/11 and the whole western world of 100's of millions spend a fortune on defence and security?)

In my OP I expressed a concern because of what recently happened to my gal. I was extremely concerned that she was heading towards anaphylaxis after her apparent allergic reaction to stingray venom. As I previously mentioned my ex wife almost died from a severe seafood allergic reaction. A reaction so severe that I'm not sure an epipen would have been of much help.

Anyway, bottom line is...I was extremely thankful the other day that we were near an emergency room and NOT in the middle of nowhere.

As to statistics.......I have to take them with a grain of salt. For instance, I read that my job has recently been listed in the top 5 of "most dangerous" due to fatality statistics. I find that ludicrous as i consider DRIVING my car and riding my motorcycle about the most dangerous things I do. Not because of ME, but because of the other DH that's trying to kill me.

Not that anybody cares since nobody here knows me....but I've enjoyed a lifetime of activities that many consider risky or even foolhardy. I don't consider ANYTHING I've done as such because there is ALWAYS a plan B should things go awry......multiple redundant systems/ engines, reserve chutes, ejection seats etc.

However I still have my concerns about offshore cruising with my gal because of her allergy issues. Plan B on a boat for a serious medical emergency in a remote location is a medical kit, a medical book and a radio/sat phone. Possibly an AED. Evidently in most cases this seems to be adequate. I haven't read anything about a high mortality rate amongst cruisers.

So it is what it is...if cruising offshore were easy and risk free, then everybody would be doing it. I think my cruising friend said there's usually no more than 300 or so boats circumnavigating at any given time....a ridiculously small percentage of the world population. A GRAND ADVENTURE as my friend puts it.

I think this thread has pretty much run it's course.....thank you again for all the informative replies.

[Muckle Flugga]

Originally Posted by Paul L

In the context of remote medicine, such as cruisers out in remote areas, you are overstating the stats. While those stats are based on time to getting initial help they also include getting the patient quickly to an equipped trauma center. Without the additional treatment given in the immediately following hospitalization, the stats would look much, much worse. In addition stats are usually based on a success being the patient was discharged from the hospital -- those that go to a nursing home, with limited mental or physical capabilities are all put in the success column.

On the OPs subject, When cruising in remote areas you certainly take some additional cautions. We tend to try and have another dinghy with us when we are in sketchy diving areas. We always try and find out what nasties are in the area, land and sea, before we show up. Excellent book on inderstanding specifically what dangers lurk in the tropical sea and treating them is All Stings Considered.
For me I think our biggest risk is taking third world (and some 2nd world) taxis.

to the taxis/traffic thing. Absolutely. By far the most dangerous thing here in SE Asia.

Also my Ship Captain's Medical and Medical Care Aboard Ship training (UK MCA) would have me agreeing with you about defibrillation in remote areas. The advice is to carry nitroglycerine (nitrolingual), morphine, aspirin and antiemetics for acute cardiac care, but defibrillators are considered essentially pointless if no chance of arrival at a well equipped hospital. That advice I am sure is debatable, but it is the policy I was taught.

[Muckle Flugga]

Originally Posted by Saleen411

In my OP I expressed a concern because of what recently happened to my gal. I was extremely concerned that she was heading towards anaphylaxis after her apparent allergic reaction to stingray venom. As I previously mentioned my ex wife almost died from a severe seafood allergic reaction. A reaction so severe that I'm not sure an epipen would have been of much help.

Anyway, bottom line is...I was extremely thankful the other day that we were near an emergency room and NOT in the middle of nowhere.

As to statistics.......I have to take them with a grain of salt. For instance, I read that my job has recently been listed in the top 5 of "most dangerous" due to fatality statistics. I find that ludicrous as i consider DRIVING my car and riding my motorcycle about the most dangerous things I do. Not because of ME, but because of the other DH that's trying to kill me.

Not that anybody cares since nobody here knows me....but I've enjoyed a lifetime of activities that many consider risky or even foolhardy. I don't consider ANYTHING I've done as such because there is ALWAYS a plan B should things go awry......multiple redundant systems/ engines, reserve chutes, ejection seats etc.

However I still have my concerns about offshore cruising with my gal because of her allergy issues. Plan B on a boat for a serious medical emergency in a remote location is a medical kit, a medical book and a radio/sat phone. Possibly an AED. Evidently in most cases this seems to be adequate. I haven't read anything about a high mortality rate amongst cruisers.

So it is what it is...if cruising offshore were easy and risk free, then everybody would be doing it. I think my cruising friend said there's usually no more than 300 or so boats circumnavigating at any given time....a ridiculously small percentage of the world population. A GRAND ADVENTURE as my friend puts it.

I think this thread has pretty much run it's course.....thank you again for all the informative replies.

Very sorry indeed to hear about your wife. Very sad.

i used to date a girl with extreme allergy issues, which in particular were an intense allergy to sesame seeds or anything that had ever even touched them. This allergy developed suddenly. We always had an EPIPEN or other epinephrine injector handy, and also found that powerful antihistamines helped, even ordinary ones were useful… Onboard in the CAT A kit are Epipens, oral and injectable antihistamines. These are all excellent frontline defenses. The thing is it is hard to know who may suffer an extreme anaphylactic reaction to this or that foodstuff or stings, and previous non reaction is no guarantee at all of future non reaction. Extreme allergies can develop very suddenly to previously tolerated stimuli. In your case I have absolutely every sympathy with the anxiety you must be feeling, given your previous experience. It is the anxiety of a prudent mind. As to your attitude towards redundancy, that is precisely the right attitude to have and is excellent seamanship.

With regard to stingers, I always have a high acidity vinegar in my dinghy wherever I go, particularly if swimming or diving. It is excellent at preventing cnidoblasts (jelly stinging cells) from firing, by, it seems, neutralising the chemical trigger, one of the two they have, which in turn disarms the mechanical hair trigger.

[JPA Cate]

Originally Posted by zeehag

and no one hears your radio call for assist. ok.. someone hears but is 2 days away?? same bucket as not having damn machine on boat to suck up all your boat electricity . yeah they have battteries but for how much time will they function as you wait for assistance and extrication ??
cruising, long term and out of range of allegedly normal places to receive delivery of health care?? you sign on for the death at sea, sorry, not up for that?? donot go.
chances are the individual suffering cardiac arrest in ocean has experienced the problem of angina or vertigo or intractible heartburn or other symptom before the big one. dehydration causes electrolyte imbalances not tolerated by many with cardiac history, especially arrhythmias.
it might be a better idea to prevent the need for the aed than to feel a need to carry it on board for whatever purpose.

I confess I haven't read all the posts, but I really think zeehag's got this one nailed, spot on. You --anyone-- can't defend against all possible bad things that may happen to you as you age. Give it a break, get on with enjoying life, your enjoyment will add far more to your longevity than worrying does.

Ann

[DumnMad]

I agree, and in any case when on the boat away from fast-foods, lazy-boy chairs, and too much red meat heart issues are much less likely.

However **** happens: Solo yachtie's miracle survival tale | Stuff.co.nz

[jackdale]

I have only had one real medical emergency when one of my crew had prostate issues about half way from Maui to Vancouver. VHF and SSB were useless in making any contact so I used the sat phone to contact RCC in Honolulu. The flight surgeon recommended an medical evacuation.

The RCC contacted AMVER who arranged a rendezvous with a container ship to which we transferred our crew member. I became a very big fan of sat phones and now carry the phone numbers of RCCs.

It is reassuring to know that a resource like AMVER is available.

For who want to know more about the rescue and AMVER:

http://www.slideshare.net/JackDale/rescue-me-30496650

[GoingWalkabout]

Originally Posted by Muckle Flugga

to the taxis/traffic thing. Absolutely. By far the most dangerous thing here in SE Asia.

Also my Ship Captain's Medical and Medical Care Aboard Ship training (UK MCA) would have me agreeing with you about defibrillation in remote areas. The advice is to carry nitroglycerine (nitrolingual), morphine, aspirin and antiemetics for acute cardiac care, but defibrillators are considered essentially pointless if no chance of arrival at a well equipped hospital. That advice I am sure is debatable, but it is the policy I was taught.

This is not the advice of the American Heart Association regarding defibrillators.

[Muckle Flugga]

Originally Posted by GoingWalkabout

This is not the advice of the American Heart Association regarding defibrillators.

As I said, debatable, but does the AHA specifically indicate that defibrillators in remote locations with no acute/extended care facitility within a couple of days or more is recommended? I somewhat doubt that, but would be interesting to know, certainly. I should also have included oxygen in my list. Oxygen is very important in acute cardiac care. And yes, I do carry it. (Also for diving related problems.)

[Muckle Flugga]

Originally Posted by jackdale

I have only had one real medical emergency when one of my crew had prostate issues about half way from Maui to Vancouver. VHF and SSB were useless in making any contact so I used the sat phone to contact RCC in Honolulu. The flight surgeon recommended an medical evacuation.

The RCC contacted AMVER who arranged a rendezvous with a container ship to which we transferred our crew member. I became a very big fan of sat phones and now carry the phone numbers of RCCs.

It is reassuring to know that a resource like AMVER is available.

For who want to know more about the rescue and AMVER:

http://www.slideshare.net/JackDale/rescue-me-30496650

I agree on Satcomms. I have HM Coast Guard Falmouth on sat speed dial. They have 3 radiomedically qualified doctors on standby 24/7 for all UK registered or flagged shipping, worldwide.

[GoingWalkabout]

Originally Posted by Muckle Flugga

As I said, debatable, but does the AHA specifically indicate that defibrillators in remote locations with no acute/extended care facitility within a couple of days or more is recommended? I somewhat doubt that, but would be interesting to know, certainly. I should also have included oxygen in my list. Oxygen is very important in acute cardiac care. And yes, I do carry it. (Also for diving related problems.)

A defib is not a cure for all. However it has a high success rate for certain heart events. Agree on the oxygen. I have a portable oxygen tank in my EMT kit. On an ocean crossing I would train one other person than myself on how to stick and run a saline drip. I was trained to do all one can no matter how slim the chances. By the way if off the USA coast the amazing USCG will do an airlift straight to a hospital. GD bless them. If your in the middle of the Atlantic well all I can say is do all you can and pray. Not everyone can make it but I'm never going to be the one not prepared and never the one to give up.

[Muckle Flugga]

Originally Posted by GoingWalkabout

A defib is not a cure for all. However it has a high success rate for certain heart events. Agree on the oxygen. I have a portable oxygen tank in my EMT kit. On an ocean crossing I would train one other person than myself on how to stick and run a saline drip. I was trained to do all one can no matter how slim the chances. By the way if off the USA coast the amazing USCG will do an airlift straight to a hospital. GD bless them. If your in the middle of the Atlantic well all I can say is do all you can and pray. Not everyone can make it but I'm never going to be the one not prepared and never the one to give up.

Sounds good, though I personally would be very careful with saline. I have drips, but they can be really dangerous. If there is a major bleed, the body will respond by constricting blood flow to the bleed area. If the bleed is internal there may be few or no outward signs of the fact. In either case, a saline can raise blood pressure artificially, causing a failure of the constriction response and relaxing the arteries in the vicinity of the injury, causing the casualty rapidly to bleed out. This effect was first noticed when the casualty to death ratio was analysed between the Vietnam and Korean wars. In Korea, the use of saline dramatically improved the chances of surviving a battlefield injury, but many of the casualties died on the way to MASH units, which were where the drips were located. In Vietnam, drips were issued to all the troops or at least to a Corpsman, with instructions to insert a line as soon as a soldier was injured. The result was a catastrophic RISE in battlefield casualty mortality, the precise opposite of what was expected. It was only subsequently understood why. Salines, deployed at the wrong point and without proper monitoring equipment, can kill. A better alternative unless in extremis and specifically indicated, is a "bum tube". Just a beaker or funnel up the bum, which absorbs saline at the rate the body can handle, without bypassing the gut, straight into the circulatory system. The latter tricks the body in various ways, many of them potentially catastrophic.

As to being prepared

As a quote runs from an old western (Unforgiven, I think) one deputy ridicules another's stockpile of weapons as they wait to confront a famous outlaw, and the reply comes:

"If I'm going to get shot, it's not gonna be for lack of shooting back!"

[zeehag]

Originally Posted by GoingWalkabout

This is not the advice of the American Heart Association regarding defibrillators.

the american heart association lost its credibility with me, a cardiac care rn, when they allowed pfizer to build their brand new headquarters building just to be able to bribe the heart assoc into use as a first line drug, a poison named amiodarone, as a front line drug in acls. we had tested that , as did 3 other arrythmia centers in usa in 1986. we came to conclusion, as 10 out of 10 patients on that drug who went to surgery DIED because they could not be removed from ventilator. we studied this and found amiodarone, with its over 2 week half life was causing interstitial pulmonary fibrosis in all of the patients we sentenced to using it. very not a decent drug to use as a first line anti arrhythmic. to make this poison we deemed unusable for any but last ditch efforts to save a soul not able to survive without it. poison, no surgery after administering even a few doses.
and so WHAT do you think heart ass has to say about WHAT!!??? allowing a poison with 2 week plus as a half life, and because of BRIBE!!!--not appropriate for first line defense against v tach, sorry.
they lost me as an advocate with that murderous move'

[rwidman]

We all increase our risk of death when we leave the dock. Even just cruising the US ICW, if someone has a stroke or heart attack or serious injury, getting medical attention will take far longer than if you're on land. If you are in a boat away from a dock, you can't just call an ambulance.

It's a calculated risk we all take and we have to decide how much risk is acceptable.