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Old 29-09-2010, 21:54   #31
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Thanks for your kind words.

HTH,

No problems I have Mosbys medical dictionary and will have to keep an eye out for the other titles. I have to admit the Special Ops manual sounds interesting especially considering I did a bit of time playing the wounded for the First Field Ambulance Reserves. I will probably see what else I can pick-up at the next Uni book sale.

Thanks, Shane
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Old 30-09-2010, 00:21   #32
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Kits are good, but what's in your head is crucial.

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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..
Any training (at least any training from a competent instructor) is better than being totally clueless. I'm partial to Wilderness First Responder, but there are other good classes. In WFR I like the training using realistic scenarios, and the emphasis on learning to improvise with what is available. I also like that WFR tries to give you at least some basic tools to make evacuation/rescue decisions. "Do we need to call a helo right now, or can we wait till daylight and calmer weather?" (Risk vs reward.)

WFR is a 70-80 hour class, and costs about $5-600, so it may be a bit much for many people. There are shorter/cheaper courses that might fit your needs or budget better. Get the best training you can, where ever you can. A good medical kit is great, but what is in your head is always most important. Also, consider that you may be the one laying in the puddle of blood with no airway. Is there someone else in your crew that can take care of you if need be?

As for the cute bartender/nurse....you'll need to arrange that yourself! I don't know any place they teach that in a class?
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Old 30-09-2010, 02:02   #33
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To George's list I would add:

--SAM splints (1 each--sized for arm, leg and finger)
--several 10-day courses of 750 mg ciprofloxacin, at least 2 courses per crew member
--Injectable lidocaine to deaden open wounds for cleaning (& syringes to drizzle the lidocaine into open would to numb the field)
--xeroform dressings to pack over open wounds with loose gauze dressing over all

I have used SAM splint and painters duct tape to stabilize a broken arm until could reach medical care. Used ciprofloxacin to treat bladder infection once, a kidney infection once and bronchial infection twice during our Pacific crossing. This is the best all-round antibiotic. We also carry ciprofloxacin eye drops and ear drops, but have had no need of these yet.

Before we left the USA I took the offshore medical preparedness course sometimes offered by Landfall Navigation. This is a good course for sailors because they teach you what to do for medical emergencies when no help will be arriving. The normal paramedic and first aid courses focus on providing care with the idea that you will receive proper medical treatment within 20 minutes to an hour. These 2 concepts are entirely different. I would recommend the offshore course for anyone anticipating long-distance cruising.

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Old 30-09-2010, 05:17   #34
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Originally Posted by svBeBe View Post
To George's list I would add:

--SAM splints (1 each--sized for arm, leg and finger)
--several 10-day courses of 750 mg ciprofloxacin, at least 2 courses per crew member
--Injectable lidocaine to deaden open wounds for cleaning (& syringes to drizzle the lidocaine into open would to numb the field)
--xeroform dressings to pack over open wounds with loose gauze dressing over all

I have used SAM splint and painters duct tape to stabilize a broken arm until could reach medical care. Used ciprofloxacin to treat bladder infection once, a kidney infection once and bronchial infection twice during our Pacific crossing. This is the best all-round antibiotic. We also carry ciprofloxacin eye drops and ear drops, but have had no need of these yet.

Before we left the USA I took the offshore medical preparedness course sometimes offered by Landfall Navigation. This is a good course for sailors because they teach you what to do for medical emergencies when no help will be arriving. The normal paramedic and first aid courses focus on providing care with the idea that you will receive proper medical treatment within 20 minutes to an hour. These 2 concepts are entirely different. I would recommend the offshore course for anyone anticipating long-distance cruising.

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Whole heartedly agree on antibiotics and lido... As I said in my post I thought that was the minimum for coastal cruising assuming the crew has little formal training.

Mine has all sorts of extra goodies, including a dozen injectable meds, as many more in tablet or liquid form, IV solution and drip sets, an AED, BVM, Airways, surgical set, suture kit, oxygen, and a dental kit. It DOES NOT fit in a peanut butter jar! LOL
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Old 30-09-2010, 07:14   #35
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The nice thing about SAM splints is that you can very easily cut them up to fit whatever you need. A regular pair of scissors will do, so-called 'EMT' shears work fine.

Need a finger cot or splint? No problem, trim it out. Got a small person? Trim that big SAM down. No need to carry different sizes, carry a couple of the biggest you can get.

I'd also recommend a full-leg splint of some sort. For laypeople, cardboard or inflatable might be best, I carry a small traction splint (KTD) for midshaft femur (thigh) fractures, but diagnosing and using a traction splint requires advanced first aid / First responder skills.

And wilderness FR or EMT is great training for sailors.
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Old 30-09-2010, 07:22   #36
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Whole heartedly agree on antibiotics and lido... As I said in my post I thought that was the minimum for coastal cruising assuming the crew has little formal training.

Mine has all sorts of extra goodies, including a dozen injectable meds, as many more in tablet or liquid form, IV solution and drip sets, an AED, BVM, Airways, surgical set, suture kit, oxygen, and a dental kit. It DOES NOT fit in a peanut butter jar! LOL
Yeah, mine has a lot of extra items as well.

While ciprofloxacin is a good general purpose antibiotic, it's not good for everything. As a basic armamentarium I'd include a sulfa drug like trimethoprim/sulfamethoxazole double-strength (TMP/SMX DS) or metronidazole (Flagyl).

As with any drug, you need to verify that the patient isn't allergic to it.


http://www.cruisersforum.com/forums/...tml#post530904
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Old 30-09-2010, 08:27   #37
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boomp: unfortunately, here in Azerbaijan, checking with my local paramedic isn't much of an option
Oh, it should be an option. They will have the Soviet system of "skoraya pomosh'" or "rapid aid", where doctors come out in a Gazelle or Mercedes van carrying a medical bag.

I just googled it and here is what their vans look like:

Скорая помощь Баку готова к любой ситуации в праздники | Здоровье | Trend Life

Here's the address and phone number of the main office of Skoraya Pomosh' in Baku:

2
РЕСПУБЛИКАНСКАЯ СТАНЦИЯ СКОРОЙ МЕДИЦИНСКОЙ ПОМОЩИ г. Баку, ул. Шарифзаде 212 телефон (99412) 431-62-91
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Old 30-09-2010, 08:39   #38
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Oh, it should be an option. They will have the Soviet system of "skoraya pomosh'" or "rapid aid", where doctors come out in a Gazelle or Mercedes van carrying a medical bag.

I just googled it and here is what their vans look like:

Скорая помощь Баку готова к любой ситуации в праздники | Здоровье | Trend Life

Here's the address and phone number of the main office of Skoraya Pomosh' in Baku:

2
РЕСПУБЛИКАНСКАЯ СТАНЦИЯ СКОРОЙ МЕДИЦИНСКОЙ ПОМОЩИ г. Баку, ул. Шарифзаде 212 телефон (99412) 431-62-91

And the default treatment was Valium (diazepam) or some other benzodiazepam, IM to quiet the patient down. If they got another call to the same location that day, they'd actually treat.....

Not so good if you're having an MI....
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Old 30-09-2010, 09:03   #39
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And the default treatment was Valium (diazepam) or some other benzodiazepam, IM to quiet the patient down. If they got another call to the same location that day, they'd actually treat.....

Not so good if you're having an MI....
But spot on for a seizure!
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Old 30-09-2010, 09:23   #40
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And the default treatment was Valium (diazepam) or some other benzodiazepam, IM to quiet the patient down. If they got another call to the same location that day, they'd actually treat.....

Not so good if you're having an MI....
The medical system in the former Soviet Union is generally horrible. I would hate to end up in one of their ghastly hospitals.

But the paramedical care is pretty good. I've been treated for trauma in that system (foot split open by an axe), and it was superb for that. The paramedics are actually real doctors and they have quite good kits. They do quite a lot of treatment on the spot. I think it's actually better than our system of making urgent care patients get to a hospital somehow. We don't have it, I suspect, because it would be too expensive to have so many doctors tied up in traffic all the time.

The protocol for an MI is to rush you to a cardiac center, just like in the US. The only difference is that they send special cardiac ambulances with real doctors, instead of paramedics. You'd still rather have your MI (god forbid) in the US, because the cardiac center, once you get there, is going to be better.
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Old 30-09-2010, 09:48   #41
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Dockhead: I'm in Nigeria now.

In Baku we used the "SOS" clinic. The local system generated a lot of horror stories (including children being deliberately kept unwell to milk their parents of funds).

In Lagos we also use "SOS".

I did the diving medics course in LA 35+years ago. It was an option in the commercial diving course and it was great. Days at USC med school and nights either in the E.R. at LA General or with the paramedics in various fire stations (I pulled somewhere in Hollywood)

It was very serious course that lasted the best part of 2 months if I remember.

I can still remember attending the autopsy of some kid (c. 18 y.o.) who'd had his throat cut in an argument over a parking space - go figure!! The pathologist was the famous Dr. Naguchi and he congratulated us on having being delivered of "such a great specimen. Not an ounce of fat".

There were two LAPD detectives there. They were like something out of a James Ellroy crime novel with violent plaid sports jackets and wiping Vicks Vapor-rub under their noses.

I've never forgotten it.

We ended up being registered as EMTs in California.

Happily never had to use the training in anger. Carrying out serious trauma management or, God forbid, surgery in a saturation chamber was not something to be entertained lightly.
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Old 30-09-2010, 09:49   #42
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The medical system in the former Soviet Union is generally horrible. I would hate to end up in one of their ghastly hospitals.

But the paramedical care is pretty good. I've been treated for trauma in that system (foot split open by an axe), and it was superb for that. The paramedics are actually real doctors and they have quite good kits. They do quite a lot of treatment on the spot. I think it's actually better than our system of making urgent care patients get to a hospital somehow. We don't have it, I suspect, because it would be too expensive to have so many doctors tied up in traffic all the time.

The protocol for an MI is to rush you to a cardiac center, just like in the US. The only difference is that they send special cardiac ambulances with real doctors, instead of paramedics. You'd still rather have your MI (god forbid) in the US, because the cardiac center, once you get there, is going to be better.
The standard of care in the US is field diagnosis of an MI, and if appropriate direct transport to a cath lab - MI to cath times of less than 90 minutes are the goal.

That is, if you're near a cath lab...but the capability is becoming ubiquitous in hospitals in the US.
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Old 30-09-2010, 09:52   #43
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Dockhead: I'm in Nigeria now.

In Baku we used the "SOS" clinic. The local system generated a lot of horror stories (including children being deliberately kept unwell to milk their parents of funds).

In Lagos we also use "SOS".

I did the diving medics course in LA 35+years ago. It was an option in the commercial diving course and it was great. Days at USC med school and nights either in the E.R. at LA General or with the paramedics in various fire stations (I pulled somewhere in Hollywood)

It was very serious course that lasted the best part of 2 months if I remember.

I can still remember attending the autopsy of some kid (c. 18 y.o.) who'd had his throat cut in an argument over a parking space - go figure!! The pathologist was the famous Dr. Naguchi and he congratulated us on having being delivered of "such a great specimen. Not an ounce of fat".

There were two LAPD detectives there. They were like something out of a James Ellroy crime novel with violent plaid sports jackets and wiping Vicks Vapor-rub under their noses.

I've never forgotten it.

We ended up being registered as EMTs in California.

Happily never had to use the training in anger. Carrying out serious trauma management or, God forbid, surgery in a saturation chamber was not something to be entertained lightly.
LOL. My exposure to the 'Mission' (the LA County Morgue used to be on Mission) was the day they autopsied the late porn star, John Holmes.....
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Old 30-09-2010, 10:33   #44
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Healer-
"Both will work better than sugar." I don't know, I'm just following perhaps too unquestioningly the advice from an ex-military medic. I *suspect* the advantage to sugar over your absorbent foods, is that they will form a culture medium for all sorts of critters, whereas nothing really grows in dried sugar. His emphasis was that it is relatively sterile to being with, and stays that way, forming a "scab" that stays relatively sterile so questions of infection don't get in the way.

WRT Honey, there has been extensive investigation of it. Aside from keeping it away from infants (because it often has botulism contamination in a very small degree) it has also been proven to be anti-bacterial and moisturizing, so it can be a good thing to apply to some wound surfaces.

After all, what is penecillin? The mold from a canteloupe.

Shane-
"No use having any understanding or amount of equipment if you are totally freaking out around a patient who is slipping into severe shock?"
Well, if the captain of a vessel is panic-prone you might want to not sail with that captain. There are some places where you want calmer heads, and if you are choosing crew, it is a good idea to consider that as well. Obviously if you are taking your family, you take what you have and work with it.
There's no question that "deal with it and react afterwards" is not something everyone can be taught, but you can try to install it and lead by example. And at least IF you have the proper equipment on site, there's a chance that SOME one there, or someone responding there, will be able to make use of it--even if everyone at the site was a casualty.
You do the best you can, that's why it is called "first aid".
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Old 30-09-2010, 12:30   #45
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Healer-
"Both will work better than sugar." I don't know, I'm just following perhaps too unquestioningly the advice from an ex-military medic. I *suspect* the advantage to sugar over your absorbent foods, is that they will form a culture medium for all sorts of critters, whereas nothing really grows in dried sugar. His emphasis was that it is relatively sterile to being with, and stays that way, forming a "scab" that stays relatively sterile so questions of infection don't get in the way.

WRT Honey, there has been extensive investigation of it. Aside from keeping it away from infants (because it often has botulism contamination in a very small degree) it has also been proven to be anti-bacterial and moisturizing, so it can be a good thing to apply to some wound surfaces.

After all, what is penecillin? The mold from a canteloupe.

Shane-
"No use having any understanding or amount of equipment if you are totally freaking out around a patient who is slipping into severe shock?"
Well, if the captain of a vessel is panic-prone you might want to not sail with that captain. There are some places where you want calmer heads, and if you are choosing crew, it is a good idea to consider that as well. Obviously if you are taking your family, you take what you have and work with it.
There's no question that "deal with it and react afterwards" is not something everyone can be taught, but you can try to install it and lead by example. And at least IF you have the proper equipment on site, there's a chance that SOME one there, or someone responding there, will be able to make use of it--even if everyone at the site was a casualty.
You do the best you can, that's why it is called "first aid".
I'm (still) a reserve military officer, currently in the US Army Reserves as a medical officer (quite a letdown for a USAF fighter pilot.....). A great deal of my time as a physician in the Army is explaining to medics why their urban legends, conventional wisdom and 'thats what my Sergeant taught me at AIT' is a bad idea. For example, tampons are not good blood-stoppers, and if you're going to carry them why not carry the right stuff, that actually works, instead?

As far as people who were military medics, there has been a huge change in the training medics have received, even in the recent (last 5 year) past. Someone trained as a medic prior to Desert Storm? They'd lack even common EMT skills today. Just because someone is a medic doesn't mean they were any good at it, either: I prescribed hemorrhoid cream (Preparation-H) for one soldier (we were in the field at the time) and a 'medic' (a senior Non-commissioned Officer, an E-7 no less) gave him linament ointment (Ben-gay), and claimed 'they were the same thing'.

Not quite.

Many medics in the military, and in civilian life, are very anxious to get more knowledge and training. Unfortunately the training they receive is minimal at best (unless they are special forces medics), and so they go and try and find more knowledge on the internet. As do we all.

The problem with internet medical knowledge is that a) there's no validation of it, and b) knowledge thats out there may be horribly out of date, no matter how valid it might appear. There is a publication that has been floating around for at least 30 years now, purporting to be the "Green Berets Medic Handbook". It even has a number - ST-31-91B. Woo-hoo! It must be 'official'!

What it is is a reprint of the class handouts that Green Beret medics were given in the immediate post-Vietnam era, written by Green Beret medics, and based on pretty much old wives tails, folklore, and other less than stellar sources. Much of the advice in that book is nonsense, and the former Command Surgeon of the US Army Special Operations Command, had this to say about it:

Quote:
That manual is a relic of sentimental and historical interest only, advocating treatments that, if used by todays medics, would result in disciplinary measures, wrote Dr. Warner Anderson, a U.S. Army Colonel (ret.) and former associate dean of the Special Warfare Medical Group. The manual you reference is of great historical importance in illustrating the advances made in SOF medicine in the past 25 years. But it no more reflects current SOF practice than a 25 year-old Merck Manual reflects current Family Practice. In 2007, it is merely a curiosity. Readers who use some of the tips and remedies could potentially cause harm to themselves or their patients.


Or worse, people will hear 'war stories' from people who may or may not be what they purport to be. The 'plug the hole with a tampon' story seems to have come from a science fiction writer, and has spread all over the EMS world - in and out of the military. But they'll all say that a buddy who was a (insert military force) (insert special operations team) medic told them they did it....

These days, we (military physicians) occasionally see things that just don't make any sense, performed by medics. OK, whatever. Most of the time it doesn't have any impact (good or bad) on the outcome: Those that would live still lived, those that unfortunately won't, don't, no matter what.

But, salt is bad for many reasons, as I indicated. For example, the sodium in salt (it's sodium and chloride ions in an octahedral molecular matrix) is very reactive - those ions will pop off the chloride ion and do something, with something else. Usually not a good thing in the body (sodium ions are used for LOTS of important things in the body, adding more of them willy-nilly is a bad idea). Dumping salt into a wound isnt going to have the same effect as (say) administering saline solution, either - the saline solution goes into the vasculature (plumbing), and has specific and not always benign results. Likewise the now free chloride ion is in the wrong place at the wrong time, and can cause trouble. Even if the ions bind to something innocuous, they are now not doing what they're supposed to and neither is that salt absorbing any water. It's just diminished.

The way that sugar, and honey, work as an antibacterial is by absorbing water from the bacterial cell, killing it. Cells are (kind of like) baggies full of wet stuff (cytosol) that has smaller parts floating around in it doing important (for the cell) things. In order for the organelle (the smaller part) to get whatever it needs into it, or move whatever it's doing out of it, the cytosol environment has to be correct: Making it much drier stops that from happening. Get the cell dry enough and the cell starves/suffocates, or crystals growing inside of it from the dehydration puncture the cell membrane, which lets wildly different pH components in to wreck havoc.

In practice, in treating wounds, the sugar or honey has to be replaced several times a day, after it's absorbed enough water to turn into a syrup. The patient also has to be well-hydrated as well.

The commercial products like quikclot, celox, or things like instant potatoes have the same effect: They cause the water (only) inside the blood sloshing around outside of the vasculature to be absorbed, which increases the concentration of the blood components including clotting factors. Its not perfect, but it's frankly better than most other things (including injecting clotting factors directly, it turns out).

The reasons that physicians usually don't have much patience for so-called alternative medical procedures (or techniques) is because they fail to have any plausible mode of working, based on the science that we (physicians) learn. Even before medical school we have to study general and organic chemistry, biology, physics, so that in classes like biochemistry or physiology we understand not only what is happening, but the basic scientific principals that MAKE them happen. If there is no plausible reason that something CAN happen, it probably doesn't and it takes more than urban legend to make it true.

And if you think that a mouldy cantalope is the same as a drug, try it yourself.

Now, I can't afford (as a physician) to spend the time to explain to each patient that comes in that what they heard from some dude who was a military medic is nonsense.
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