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Old 28-09-2010, 17:06   #16
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"Sugar is..." Put it in context. You are on a boat, offshore. Or a backwoods camp, or a car/plane crash site. You need something to encourage clotting.
What are your choices? If someone packed food or drinks, the odds are you have sugar and salt and maybe pepper. And dirt. Given the normal range of choices--sugar is an excellent one.
Given a proper trauma kit and clotting agents, save it for the coffee.
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Old 28-09-2010, 17:21   #17
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When we told her we were going off cruising for a couple of months, our doctor was happy to write us scripts for an epi pen and a couple of different antibiotics.

We didn't need any of them, but it was good to know we had them when we were off in some of the more remote spots, where help might be a day away or more.
Ditto, on the antibiotics. I also carried pain meds and suture materials.
And silvadene...in addition to the regular supplies..
The most used item in my bag for guests seems to be Motion-eze
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Old 28-09-2010, 18:20   #18
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Store-bought "first aid" kits usually translate into "inconvenience kits" full of aspirin and odd-shaped bandaids, with little if any contents aimed at TRAUMA and injury that must be dealt with differently.
Big difference I suppose between putting a bandaid on a kid’s finger too having to stop the bleeding after someone’s limb has been bitten off by a shark? You should see the size of the good old shark trauma kits kept in most Australian beach first aid rooms. After you loose a few limbs it could conveniently double as a coffin.

Don’t think I am starting shark hysteria; more to the point just agreeing with your post about the size and cost of real first aid trauma kits. The generic kits will also NOT contain the vital prescription only medicines you will require in remote locations. These really require the advice of specialist travel Doctors?
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Old 28-09-2010, 18:49   #19
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Sugar is great for fighting established infections (seriously), but not so good for blood clotting.
On the alternate medicine the “hippies” will argue the same about honey and probably with good cause?

Regardless, the one thing I really do trust for the same is the good old methylated spirits. I am sure Tom this old GP and Navy Doctor who lived across the road from me and held the stuff in high esteem said it was once called St Vincent’s spirit? I realise it does cause a bit of pain, but it is nowhere near as sadistic as how he told me in WWII it was standard practice to order enemas for tough but misbehaving Able Seamen.

Good thing is that I have a metho stove onboard so it is another incidental item that can be of assistance in an emergency. I find it good for drying sea ulcers and ear infections.

If you are cruising in the topics around Australia in summer gallons of vinegar for instant application on stinger bites – box jellies and irrigangi – is an absolute necessity. I keep one bottle on the floor of the cockpit for instant access and application.
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Old 29-09-2010, 04:42   #20
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..............
If you are cruising in the topics around Australia in summer gallons of vinegar for instant application on stinger bites – box jellies and irrigangi – is an absolute necessity. I keep one bottle on the floor of the cockpit for instant access and application.
Good point about keeping it in the cockpit - why didn't I think of that
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Old 29-09-2010, 09:36   #21
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Maybe you can buy a small hospital and take it with you?

I would say buy the medicine you need (because of your health issues). Then buy the medicine that you know how to apply (e.g. strong pain killers).

I do not think buying a 'kit' gives any benefit over a well thought-over collection of actual necessities.

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Old 29-09-2010, 12:14   #22
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The pre-made kits are a convenience, and you can no doubt put together your own for less money. I bought the kit (Oceanmedix: Trans-Ocean Medical Sea Pak). For the prescriptions, I use a doctor who understands the needs of the cruiser/racer on an ocean passage, and make sure I know any medical issues my crewmembers might have.

The kit has a pretty good collection of supplies, but you should review the contents and add stuff as appropriate. We've added antibiotics, anaesthetics, epi-pens, burn treatment, heart meds, nausea meds, etc. It's not cheap. We've never needed any of it.

I also carry everyday minor first-aid supplies in a drawer. Sometimes we use a band-aid. Training is good, and I should have more. I have basic first-responder training from my time as a volunteer firefighter, but that is oriented towards stabilization while waiting for the medics to arrive. Being a week from outside help is a much different situation. Having radio or satphone access to medical advice is also a good thing.
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Old 29-09-2010, 14:21   #23
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Originally Posted by hellosailor View Post
"Sugar is..." Put it in context. You are on a boat, offshore. Or a backwoods camp, or a car/plane crash site. You need something to encourage clotting.
What are your choices? If someone packed food or drinks, the odds are you have sugar and salt and maybe pepper. And dirt. Given the normal range of choices--sugar is an excellent one.
Given a proper trauma kit and clotting agents, save it for the coffee.

Well, lets see. Absent decent medical equipment, and direct pressure, elevation, packing the wound with paper towels and/or clean towels, pressure points and if applicable a tourniquet aren't working, what will?

How about instant potatoes? Rolled oats? Both will work better than sugar. Sugar is a crystal, there's not much room in it's lattice for water molecules to be adsorbed. Further, it's lattice isn't very stable, mix it with water and it falls apart. Not good characteristics for something thats supposed to concentrate blood clotting factors. If real hemostatic agents are a '100' on the clotting scale, instant potatoes are maybe a 20 and sugar is maybe a 2. So, the right stuff is at least 50x more efficacious, and other improvised agents may be 10x better. Test this yourself: How much water will a sugar cube absorb vs. the same weight of salt (same issues as sugar, btw), pepper (which doesn't really absorb water, I've found - it floats), or something like instant potatoes or oatmeal?

I don't have a problem with improvised medical equipment - I teach wilderness medicine and have been an expedition physician and before that paramedic. However, if you're going to improvise do a good job, while understanding the science, chemistry, physics, physiology and biology involved.

BTW, horse ranchers I know use the potatoes on their horses when they get cuts. Seems to work OK for them, although frankly I'd rather carry the right gear.
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Old 29-09-2010, 14:29   #24
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Big difference I suppose between putting a bandaid on a kid’s finger too having to stop the bleeding after someone’s limb has been bitten off by a shark? You should see the size of the good old shark trauma kits kept in most Australian beach first aid rooms. After you loose a few limbs it could conveniently double as a coffin.

Don’t think I am starting shark hysteria; more to the point just agreeing with your post about the size and cost of real first aid trauma kits. The generic kits will also NOT contain the vital prescription only medicines you will require in remote locations. These really require the advice of specialist travel Doctors?
The value (this year) of the kit I routinely carry (on land) is $4136.85, plus $2405.14 in drugs (kept in a locked refrigerator in my truck) and $974.57 for airway and oxygen. $7516.55 total, according to my insurance inventory.

That doesn't include, btw, an AED, evacuation/stabilization gear, or radios. It fits into two backpack sized bags and is intended to be used to stabilize and manage up to two major trauma patients for 1 day (any longer than that and I'd need more drugs and fluids).

When I did my last circumnavigation, I had more than that, based on the crew and route. When I raced, I carried a lot less, but then we were never far from shore. I used more of it racing, too.
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Old 29-09-2010, 14:31   #25
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Maybe you can buy a small hospital and take it with you?

I would say buy the medicine you need (because of your health issues). Then buy the medicine that you know how to apply (e.g. strong pain killers).

I do not think buying a 'kit' gives any benefit over a well thought-over collection of actual necessities.

b.
Yeah, pretty much. I'm really interested in the new, very small, ultrasound units. Or McCoy's tricorder...
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Old 29-09-2010, 17:19   #26
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I don't have a problem with improvised medical equipment - I teach wilderness medicine and have been an expedition physician and before that paramedic. However, if you're going to improvise do a good job, while understanding the science, chemistry, physics, physiology and biology involved.


Thanks for your serious posts based on obvious experience. It certainly sounds like you are the kind of fellow adventurer who I would feel secure either trekking or sailing with!

I totally agree with the above statement. Regardless, I have just picked up a bit of first aid over the years through stuff like scouts, army cadets, surf-lifesaving, martial arts and my own wilderness and aquatic activities. I have also worked in personal injury litigation, which requires some understanding of anatomy and medicine.

To further my understanding I would really like to know what books you would recommend on the above topics you mentioned. On the fringes I really enjoyed Kenneth Kamlers’s “Surviving Extremes” and as far as knowing how the human body and mind reacts to extreme punishment I am a big fan of Sir Ranulph Fiennes. Then while I have the standard St John’s first aid manual and a dedicated diving medicine text on board, I would really like to know what slightly more specialized texts you would recommend keeping close by the medical kit? Like you mention these kits, medications and/or alternate practices are of no real use if you don’t know how to use them.

I note this topic has been covered in other threads, I just thought while on the point it might not hurt to get some advice that compliments those kits!
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Old 29-09-2010, 17:46   #27
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I don't have a problem with improvised medical equipment - I teach wilderness medicine and have been an expedition physician and before that paramedic. However, if you're going to improvise do a good job, while understanding the science, chemistry, physics, physiology and biology involved.
The one thing you did forget to mention – NO DOUBT AN INADVERTANT OVERSIGHT – was the psychology of remote/wilderness medicine. No use having any understanding or amount of equipment if you are totally freaking out around a patient who is slipping into severe shock? I am sure with your experience you could rephrase what I have said much more eloquently whilst adding some well-founded advice?
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Old 29-09-2010, 21:19   #28
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The one thing you did forget to mention – NO DOUBT AN INADVERTANT OVERSIGHT – was the psychology of remote/wilderness medicine. No use having any understanding or amount of equipment if you are totally freaking out around a patient who is slipping into severe shock? I am sure with your experience you could rephrase what I have said much more eloquently whilst adding some well-founded advice?
As Aristotle said, we become brave by doing brave things....in other words, experience counts for a lot.

But as I teach paramedics and EMT's, in an emergency look around: Most everyone except your partner around you will be scared as well, and even more clueless. Anything you do will probably be an improvement over nothing at all, since nothing at all will result in the victims death.

And you don't have to be perfect, just average. Do the best you can, take a deep breath and apply the knowledge you have. As a general rule, air is supposed to go in and out, blood goes around and around, and anything that interrupts those two is a bad thing. Blood all over the deck? Plug the hole. Air not moving? Move it. Thats 90% of the things that you can fix, right there.
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Old 29-09-2010, 21:38   #29
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Ditto vinegar...google it's multitude of uses..

Didn't read the whole thing..but i'd add a set of airways to what has been mentioned..can't do much if the esophagus swells shut...

Take some first aid courses..you don't really need the whole EMT course..but it can't hurt..I'd personally prefer a really cute bartender/nurse aboard..

what?
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Old 29-09-2010, 21:41   #30
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Thanks for your serious posts based on obvious experience. It certainly sounds like you are the kind of fellow adventurer who I would feel secure either trekking or sailing with!

I totally agree with the above statement. Regardless, I have just picked up a bit of first aid over the years through stuff like scouts, army cadets, surf-lifesaving, martial arts and my own wilderness and aquatic activities. I have also worked in personal injury litigation, which requires some understanding of anatomy and medicine.

To further my understanding I would really like to know what books you would recommend on the above topics you mentioned. On the fringes I really enjoyed Kenneth Kamlers’s “Surviving Extremes” and as far as knowing how the human body and mind reacts to extreme punishment I am a big fan of Sir Ranulph Fiennes. Then while I have the standard St John’s first aid manual and a dedicated diving medicine text on board, I would really like to know what slightly more specialized texts you would recommend keeping close by the medical kit? Like you mention these kits, medications and/or alternate practices are of no real use if you don’t know how to use them.

I note this topic has been covered in other threads, I just thought while on the point it might not hurt to get some advice that compliments those kits!
Thanks for your kind words.

I generally recommend books, equipment, study and whatnot based on peoples interest and skills, and what is realistic and practical - not everyone can do surgery, most people who have suture materials shouldnt attempt closing wounds so why do they have them?

Diving is an interesting topic. I have the US Navy Diving Manual (all 4 volumes, printed and e-copy) and the NOAA diving manual, and Kindall's Hyperbaric Medicine Practice, but I have a subspecialty in Hyperbaric Medicine, and dive medicine. I also taught hyperbaric medicine, and am a diver myself. None of them I think would particularly useful for a first aider, or diver, unless you're in a chamber - and if you are, someone will know more about whats going on than the patient does, I hope.

For general first aid books there is Eastman's Advanced First Aid Afloat, or Forgey's Wilderness Medicine. There is also the classic Auerbach's Wilderness Medicine (get the Field Guide, the textbook itself is bigger than Bowditch and weighs more), or the US Military's Special Operations Forces Medical Operations Guide (1st or 2nd edition). The current 2nd edition is available from the US Government Printing Office, is printed on waterproof paper, and has sections on everything from trauma to dive medicine to high-altitude medicine to tropical medicine to....

One book I recommend for people delving into 'professional' medical texts is a professional (not home) medical dictionary. I like Stedmans, but there are others - Dorlands, Taber's and Mosby's. Go to a bookstore that has all three and find the one you like - they're essentially the same.

The classic big ship texts seem to be too concerned with goldbricking and STD's to be useful for a cruiser - at least the cruisers I hang with (I'm boring, I guess).

Jay Keystone's Travel Medicine is always good, as is Jongs, and my first stop in consulting with a patient travelling (I've done travel medicine as well) is the CDCs travellers web page.

HTH,
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