Medical/First Aid Training for the Cruiser

[shipofools]

Join a volunteer fire/rescue squad and get some practical experience. Classroom teaching is no substitute for actual doing.

Get the book - "where there is no doctor".
http://www.hesperian.org/publications_download_wtnd.php

Cheers,

[schoonerdog]

When creating your course I would love to see hypodermoclysis discussed. It's a technique meant to be administered by a family member in a at home setting for a patient who needs to be rehydrated. In other words, its ridiculously simple technique. It's common in nursing homes as the patients become more agitated with intravenous administration of fluids and has far fewer potential complications. Most medical evacuations I've heard of are do to dehydration. Unfortunately it can still take several days to reach a hospital in many areas of the world even if you do hit an epirb. And treating simple dehydration seems like a much better alternative than abandoning your boat and your life investments and dreams.

Here's a discussion of the technique.

Hypodermoclysis: An Alternative Infusion Technique - November 1, 2001 - American Family Physician


I'm also not knocking wilderness EMT courses at all, I'm just stating that shipboard EMT course would be better. Obviously you think the same as you are creating a specific course for cruisers. The ones offered up in Baltimore for the merchant marine are also geared specifically for our situations, but I think yours could even be better as the one up in Baltimore is geared to people who've been chosen to be the shipboard medical officer because of a certain aptitude toward the task. You could take it more slowly than they do and provide more individual attention. You might want to contact the people who teach this class though as they would have extensive knowledge of treating conditions at sea through years of giving this class and getting feedback.

Originally Posted by 42AFJ

Having worked in EMS for 6 years I can tell you that an EMT course and Paramedic for that matter is fantastic only if backed by real experience and the care enroute many times is the difference between life and death. These providers start long term care before you even reach the hospital. My wife is an ICU RN. That being said we teach First Aid and CPR and package custom medical kits for companies and cruisers. As already mentioned First Aid only goes so far. Knowing how to prevent/manage infection, fractures, and worse, is not provided in many classes. Working with MD's we are in the final stages of developing a specialized course that will concentrate on long term treatment until port or evacuation. First Aid is the backbone. Blood goes round and round, Air in and out. Any deviation fix it.

[Cheechako]

The Fall Fisherman's Expo used to have a training class that included suturing etc. You actually got to inject with a syringe and suture a pigs foot in the class. I took it twice. The fee was really low like $20-40 as I remember. Not sure if they still do this and the show is now called something else, but it is in the Wa State Convention center, in the fall. Any other shows that go into this detail on survival first aid when Doc's aren't available...?

[nautical62]

Schoonerdog: Very good points on dehydration and courses designed to specific applications.

[s/v Beth]

Being an MD in acute care medicine and looking to cruise in the future, I have thought a lot about this. My concerns are not so much first aid, I think with a little coaching most of us could sew lacerations and split broken bones. I worry about appendicitis, dehydration with kidney failure, near drowning with unconsciousness and needing life support. I just don't know how your going to train for the bigger stuff.
Then again, we are purposely leaving civilization behind. Maybe dying is something that we will not escape out on the ocean. I know what I would prefer the last moments in my life.

[Spammy]

Another MD weighing in here....Most courses are aimed at first aid to either treat for minor issues or attempt to stabilize things until the patient can be delivered to a place where trained professionals can give definitive care. EMT's can triage patients and render basic care, CPR, etc, but they are "First Responders", whose primary role is to deliver patients efficiently to emergency rooms. While I think a wilderness first aid course would be helpful to a degree, there is not likely to be any training course that would allow a person to be self sufficient in a broad range of medical emergencies. I have a fair bit of experience in managing trauma. on another forum, I expressed interest in participating in authoring a text designed to be a resource for medical emergencies for oceangoing cruisers ( I am already in print as a contributor in a medical textbook). After reviewing some well-thought-out replies and doing a good bit of thinking, I decided that this idea was simply not practical, short of producing a heavy tome of some 500-1000 pages and with perhaps twenty contributors, all for a very small audience, and likely limited interest. It seemed like a good idea at first... Bottom line: true competence in a variety of remote emergency circumstances is very likely beyond the reach of the average cruiser.

[GordMay]

Originally Posted by Spammy

...there is not likely to be any training course that would allow a person to be self sufficient in a broad range of medical emergencies...

I disagree.
You, yourself, probably undertook just such a training regime - at Medical School.


I know, it's a feeble joke.

[ess105]

Originally Posted by perchance

A tip of the hat to the bee gees. Apparently while administering cpr you should use the beat of "Stayin Alive by the B Gs Do they get royalties for for this?

"Another one bites the dust" has a similarly useful bear. Just don't sing it aloud when the victims relatives are near.

[Talbot]

A very useful resource is the Ships Captains Medical Guide

This can be downloaded from this link for free or purchased elsewhere as a hard book or ebook.

This is designed for merchant ship captains and is an excellent tool

Highly recommended

[GordMay]

The latest American Heart Association guidelines specify a rate of 100 compressions/minute when doing CPR on all patients.

HEALTHCARE PROVIDER SUMMARY of STEPS OF CPR for ADULTS, CHILDREN and INFANTS
http://www.socpc.ca/pdf_aed/Summary%...eps%202006.pdf

[Scottie2]

One of the primary things needed for offshore cruisers would be knowledge in the proper administration of relevant medications. Be it antibotics for inflammed coral scrapes, heart meds in case of fibrilation, antifungals for tropical infections, narcotics for severe injuries, insulin for diabetic issues ...

I'm not a medic, so I'm sure one could quickly point out other examples where quick in-place administration of meds would be applicable until such time proper medical attention could be obtained - which could be days or even weeks.

I've seen somewhere a list of meds that should be included in a cruiser's first aid kit .. it would be relevant to know how to administer each properly.

Back to the original thread question - is anyone aware of any such provider?

[schoonerdog]

MITAGS.org would probably be the best precanned program. Again, it's meant for ship board medical officers, which are just lay people who being a captain have typically the responsibility of also being the ships medical officer. It can't cover every medical emergency, but lets face it, if someone is choking you have seconds to respond, anywhere. If someone is bleeding severly you have a minute or two to respond, anywhere. The point is to allow you to provide LONGER transitive care than would otherwise be the case, not trying to be a full MD with a fully equiped hospital. As to the real world utility of this, here are some quick statistics from the National Institute of Health.

43% of ER visist are seeking emergency care would be due to dehydration from diarrhea or vomiting. This you can resolve at sea with some minimal training until you reach medical care.

Fever is responsible for 36% of the rest of the visits. Again, there are simple courses of treatment that can help someone cope with fever until they reach medical care, especially if they have an SSB to communicate to a MD and have a good general broadbased antibiotic already onboard and know how to do things like take a pulse and monitor BP.

Injuries are responsible then for 34% of ER visits. Again, with training, you can figure out how to help mitigate these for longer transitive care by preventing infection and immediate blood loss, helping to prevent shock, etc.

27% of the ER visits are due to respiratory disease. Again, you can easily learn to administer oxygen. You can easily how to administer a resue inhaler.

(note these are often overlapping conditions, so the statistics don't add to 100%)

Simply taking the courses can also help you assess your needs. If you are a parent with small children are you carrying activated charcoal in case of poisoning so if you do call 911 and you are anchored offshore you have an immediate treatment possible? It can also help you assess the difference between something which can afford to wait 24-48 hours until you reach port and having to abandon ship. It can also help you know how to provide stabilization and how to transport someone who is critically wounded. Think it through, you decide to be apathetic and not take the training and instead want to rely on a SSB. You activate it when you have a spinal injury and are now looking at a tanker coming at you with a deck 6 stories high. How are you going to move that person? Things that we would have particular needs to address such as drowning and hypothermia would be covered and are things which even anchored out you wouldn't be able to wait for onshore assistance.

Also, you should learn this even if you're never travelling offshore. I go gunkholing in the Chesapeake all the time. A kid falls through the hatch of the boat and need bleeding contained immediately and assessed for concussion. You can do that. Very easily. And the simple fact of being on a sailboat pretty much anywhere even in industrial countries means the time for you to transition that patient from the boat to the shore probably will be at least 30 minutes more than if you were ashore, even in an urban setting.

Will this cover everything? No, but it has a very good chance of being able to help more than 90% of the injuries you are likely to encounter. Again, the point isn't to state that you will never need a doctor again. It's to allow you to react quickly until you reach that doctor. And as every doctor here knows, in critical conditions, seconds count, so a first responder course which helps in containing bleeding, treating choking, etc will be very helpful even if you never leave the suburbs. Also it goes without saying that professionals will be at levels far exceeding that of our competence. But knowing vaguely what to do, and having a medical book on board, can help that person move more quickly to a good transitive treatment plan. In the merchant marine there is no choice, you're going offshore, you're a captain, you are legally obligated to have this training. We should hold ourselves to this same responsibility. Actually I think this should be covered as mandatory training for every highschool student out there.

[schoonerdog]

Scottie, you bring up a very good point. Perhaps one of the best things to learn from this course is how to treat an injury at it's onset, such as preventing infection, so that you can avoid complications which then may make emergency care necessary. It would also teach how to assess a dangerous situation to prevent more than one person being injured.

Originally Posted by Scottie2

One of the primary things needed for offshore cruisers would be knowledge in the proper administration of relevant medications. Be it antibotics for inflammed coral scrapes, heart meds in case of fibrilation, antifungals for tropical infections, narcotics for severe injuries, insulin for diabetic issues ...

I'm not a medic, so I'm sure one could quickly point out other examples where quick in-place administration of meds would be applicable until such time proper medical attention could be obtained - which could be days or even weeks.

I've seen somewhere a list of meds that should be included in a cruiser's first aid kit .. it would be relevant to know how to administer each properly.

Back to the original thread question - is anyone aware of any such provider?

[waverider]

Marine First Aid Training

St John Ambulance offers Marine first aid training designed specifically to meet Transport Canada regulations. Effective September 1, 2008, training will be available to meet the revised TC requirements. (The training requirements for the Marine Advanced First Aid program are found in the Transport Canada document, TP 13008E: Training Standards for Marine First Aid and Marine Medical Care.)
Under the new regulations, Marine Basic training will involve two days of training. Course participants will receive training according to the St John Ambulance standard along with a Marine specific supplement approved by Transport Canada.
The Marine Basic First Aid program is designed to train individuals working aboard ships. It is required by:

1. 1. <LI class=MsoNormal style="COLOR: black; tab-stops: list 1.0in">Any person who wants to obtain a rating certificate or endorsement or who wants to obtain a Master or Chief Mate Limited certificate;
   2. The person designated to provide first aid on board a vessel engaged on a near coastal voyage, class 2 or sheltered waters voyage.

Marine Advanced training is also available. This program requires 40 hours of training and is based on the St John Medical First Responder program, again integrating supplemental information specific to the Marine environment.
The Marine Advanced First Aid program is designed to train individuals working aboard ships. It is required by:

1. 1. <LI class=MsoNormal style="COLOR: black; tab-stops: list 1.0in">Any person who wants to obtain a Master's or Officer's certificate or endorsement;
   2. The person designated to provide first aid on board a vessel engaged on a near coastal voyage, class 1 or unlimited voyage.

For more information on Marine programs in your area, contact the local St John Ambulance

Hope this helps our Canadian Members

[Spammy]

In my last post on this subject, I didn't mean to leave the impression that trying to obtain knowledge and training in first aid and emergencies such as choking, fractures and lacerations is a hopeless pursuit. Quite the contrary: more knowledge is always better. What I meant to suggest was that I'm not aware of one source of comprehensive training that exists to allow a layperson to be confident in all emergencies at sea. A number of the resources suggested by other posters are a good start.