Upgrading your Boats Medical Locker

[s/v Jedi]

For anti-biotics you need to cover every possible infection but have specific attention to the high occurrence of things like cuts from reefs etc. When you work on this with your doctor, explain you want to carry as little different medications as possible, with is not too bad when using broad spectrum antibiotics. We carry two, but for complete coverage you would need three I think.

When you don’t have a doctor willing to help, you can often find them in places like hospitals for seafarers, tropical disease institutes etc. Last case you can just buy them on-line for use on pets (aquaria) but best after initial prescriptions from doctor. Much harder are opioids like Vicadin but with a doctor helping, it’s possible.

When they expire, in 3rd world countries, we take the old pills and our cruising permit and have always been successful in replacing them with new.

Besides medications, offshore cruisers need to take much more basic supplies than they do. Unfortunately it’s often only understood after an accident. Take plenty of (Google it) Israeli battle dressings, in different sizes. Not just for that accident, but also enough to renew the dressing a number of times.

We also carry medical grade superglue to use instead of stitches, but also a stapler (and the tool to take staples out again). When you are willing to study things, you also want a good tourniquet; we carry two different kinds. Clotting agents, chest valves for lung penetration, chemical cold packs for burns, splints, one of those green tubes to bypass breathing obstruction etc. You must have the tools to treat life threatening conditions, not just a headache.

[Valyn]

I thought this was a pretty good video from Delos:

https://www.youtube.com/watch?v=xBb6LOmQbwc

[CassidyNZ]

We consulted with a doctor at our local medical centre who also happened to be an ex-cruising sailor. Not only did he have an excellent understanding of what meds needed in remote locations looked like, he also knew the pitfalls of antibiotics for “random” use. He made up a list and the pharmacy alongside issued.

We carry penicillin as our primary anti-infection med as none of us is allergic, avoiding antibiotics unless specifically prescribed. We also carry a range of pain killers including Tramadol, right up to injectable morphine and local anaesthetic. Sounds extreme but if someone should, for example, break a limb three days from land, no amount of paracetamol is going to help. Having had two fingers pass over between the chain and windlass gypsy, I can attest to their value.

We carry a range of off-the-shelf meds for things like seasickness, runny tums, burn treatments, constipation, sunburn and so on. Oil of cloves for toothache. I allow no sleeping tabs of any sort (last thing I want on a sinking ship is a comatose crew member). If you can’t sleep, an extra watch or two will help and someone else can get more sleep .

We carry a suture set as well as those little wound-closing plasters, a full inventory of plasters, bandages, dressings, splints and routine first aid stuff.

This is not unlike flares, liferafts and EPIRBS - carry them in the hope you’re never going to need them but will be pleased if you do.

[Singularity]

Frankly a lot of infections that people treat with antibiotics would go away on their own without antibiotics and a lot of trauma can be treated with items from around the boat (presumably with the capacity to boil water making things easier). At the same time, some of the more serious concerns that require antibiotics need to be evacuated anyway, thus a sat phone would be ideal...

I'd suggest an ample supply (i.e. several days worth...maybe 10L+) of IV fluids and training to administer (which can be difficult in a dehydrated person, or someone who has already bled a lot) would be part of a well founded medical plan, as with a satellite phone with #s of docs to call in cause of an issue. If $/space not an issue, adding a portable oxygen generator, AED, and some type of cardiac monitoring device (EKG-like).

If the CF overlords would permit it we could start some individual posts to provide some medical gestalt on different topics that would be high-yield for cruisers to review. If such posts, though, were allowed to be infiltrated with anecdotes of pseudoscience then it gets tedious to address the pseudoscience while simultaneously trying to educate the basic points.

[slug]

Hard to justify complex medical first aid kits

Anything above standard offshore kit is extremely expensive and must be professionally supervised and assembled by area of operation

The complex medical emergencies that Ivd had onboard could only be addressed by a hospital and a medivac helicopter

Septicemia , stroke , broken bones ...

To accomplish this you need communications

This is The most important piece of your medical kit

[evm1024]

Our cruise has been postponed by a year (at lease I hope only a year).

In regards to medical my experience is mostly based on climbing expeditions. Karakorum, Aconcagua, Corderia Blanca et al.

I had myself trained as an EMT at the local community college and of course had advanced first aid and Mountaineering first aid. Plus some specific instruction from my friendly local phlebotomist, dentist and so on.

The expedition first aid kit was originally designed by the expedition doctor and was later passed to other expeditions. We focused on trauma, high altitude issues, major infections and exposure issues (sun, cold etc).

We saw cases of just about everything - Going through villages there were things I've only read about in books (tuberculosis!). In other teams as well as our own we saw everything from Legionnaires' disease to simple sprains.

I expect that any of the insurance programs that get you back to you home country is a cornerstone (DAN for example) of your medical response but we are talking about point-of-contact medical support.

I am so far out of date (no expeditions since '95 or so) that it is not funny. I would really like to see a recommended medical kit list that covers a few levels of skills (ER doc level to NOOB level) that would for the basis for your medical locker. I know that such lists exist on various websites.

One thing that we found valuable was silver nitrate sticksfor cold sores, compazine for control of vomiting etc and chloroquine for malaria prophylaxis in areas subject to malaria. Chloroquine - yuck, perhaps the most bitter thing I've ever put in my mouth!

I'll be interested in seeing where this thread goes.

[Navicula]

we like to crusie in remote location and have witnessed a couple of medical emergencys that we could do nothing about....and noboday in the surrounding area had any help or knowledge.....

beside splints and bandaids we have added a defribulator....not for us I hope, but maybe I can help some else....for us we carry medical evacuation insurance as well.....it tough out there and anything can happen

you cant be prepared for everything, its the life we choose

[Paul L]

Originally Posted by RobertoD

While radio etc and on-line advice is available, in an emergency situation that can be time consuming, if even available. I (first responder) recommend "On-Board Medical Emergency Handbook" - First Aid at Sea. ISBN 978-0-07-154857-1, or MHID 0-07-154857-2. And should you think a crew member may need one, get an AED - Automatic External Defibrillator - and learn how to do CPR (easy to find on-line). And lots of Band Aids, various sizes-thats what are missing whenever I do a boaters emergency supplies check

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.

[CarlF]

My GP (who travels a lot himself) has me carry these prescriptions:

Azithromycin
Doxycycline
Cipro
Methyprednisolone "Metpack"
Hydromorphone
Tramadal
Hydrocodon-acetaminophen
Desodine cream
Nystatin
Eye antibiotic

Non prescriptions:

Benedryl
Allegra
Hydrogen peroxide
Betadyne
Amerigel Hydrogel Wound Dressing (especially good for slow to heal skin problems)
Naproxen, Ibuprophen, Tylonol, aspirin
Loperamide (diarrhea)
Metamucil
Colace
Several antifungals

I expect you already have a DAN policy. It does seem that DAN Boater has better repatriation terms (after you've been evacuated to a hospital and stabilized you can then go to the hospital of your choice in your home country on request - assuming it is safe for you to travel)

The DAN emergency call center is also available for less urgent medical needs such as locating a doctor or pharmacy as well as advising on how serious something is. They have far more experience dealing with tropical issues than most GP's.

https://danboater.org

[CassidyNZ]

Originally Posted by Navicula

beside splints and bandaids we have added a defribulator....not for us I hope, but maybe I can help some else....for us we carry medical evacuation insurance as well.....it tough out there and anything can happen

you cant be prepared for everything, its the life we choose

For me, a defibrillator is financially out of reach. Neither my wife nor I have any record of heart issues in our family backgrounds in living memory nor do we have any issues commonly associated with heart disease (e.g high blood pressure). So we don’t believe a defibrillator is a valid requirement on our boat. I applaud you for buying in case someone else needs it.

Some of the recommendations above almost reflect a full-on paramedic presence - most sailors I know (incl. me) would have no idea how half that stuff works. I reckon if ever I need an ECG unit and intravenous drip kit on my boat, there is a Mayday in my future.

[Discovery 15797]

Lots of great advice here.

I have 1 first aid kit (small injuries, cuts, minor burns, non-prescription meds) and an offshore kit.

I do carry sutures of various sizes, but I have also 6 Zipstitchs, and skin staples, and 'surgical super glue' (that I will probably get rid of because it is crap in a wet environment when applied to an area that is not immobile). I also carry catheters that I hope I will never never never never use (and I pray every day I'm offshore I never ever have to use one). And last year I added an AED.

Now...the real important thing that hasn't been mentioned yet...

While having books onboard are good, they have little value if you have not read them. When someone falls seriously ill /injured onboard is not the time to go flipping through a medical book.

Secondly, inserting an IV, or suturing a deep wound requires training. If you're going to carry advanced med kits onboard get some hands-on training on how to use that equipment.

BTW....this is a great thread...thanks!

[CarlF]

I was considering a defibrillator for the boat but an EMT told me that post AED shock survival rates are very low without prompt hospital followup care. It buys you "hours but not days" he said.

If that's true, it could still help at anchor or in a marina - but perhaps not at sea or in remote areas.

Thoughts?

[BigAl.NZ]

Those bloody cuts you get in the tropics and take forever to get better (if they don't get infected) are best treated with:

flucloxacillin

Some other good suggestions in here too.

[RobinNZ]

The NZ cat 1 list is great and we have this onboard, however there are three important additions, particularly for the tropics:

Flucloxacillin - this is an antibiotic suited to skin infections. I have heard of small scratches and cuts leading to medevacs and amputations. This is great if a cut goes septic.

Ural - great for treating urinary tract infections

Duoderm - waterproof wound dressings, there really aren’t enough of this kind of product in the cat 1 med kit.

I hope this is useful!

[Paul L]

Originally Posted by CarlF

I was considering a defibrillator for the boat but an EMT told me that post AED shock survival rates are very low without prompt hospital followup care. It buys you "hours but not days" he said.

If that's true, it could still help at anchor or in a marina - but perhaps not at sea or in remote areas.

Thoughts?

I posted the same concerns a few posts up in post #23