Medical Kit Contents for Ocean Cruising?

[Dockhead]

I know this question has been chewed over a few times on CF over the years.

I'm getting my boat ready for some long passages this summer and I'm thinking about the medical kit.

As a UK registered ship, we have access to radio medical consultation by the UK Coast Guard -- a grand thing in case of need (the UK Coast Guard is a very fine institution, as we find out more and more every year). But having a doctor on the line might be no good if we don't have the right medicine or bit of equipment we need to deal with a problem.

I will have my 83 year old father on board, a hard core sailor and still very fit -- will fight off other crew for the chance to go up the mast, for example. But I worry about his heart, with which he has had some trouble -- mild, but at that age, a heart attack is a serious risk.

So although I don't think I would put together a complete MCA-recommended medical kit with all the bells and whistles (http://www.dft.gov.uk/mca/1768.pdf), I think I would definitely want decent meds and tools for cardiac situations. That's one kind of medical emergency which won't wait until you can get turned around and back into port.

What do you guys think?

I was thinking that a good, basic medical kit good for passages not more than a day or two from land (Category "B" according to the MCA system), for a large cruising yacht with 6 - 8 people on board, including possibly elderly people, might emphasize the following:

1. Plenty of stuff to deal with trauma -- most likely problem, correct? So all kinds of bandages, splints, suturing gear, antiseptics, scalpels, scissors, forceps, local anaesthetics, etc., etc.

2. Analgesics -- aspirin, ibuprofen, codeine (I think I can even get morphine sulphate injections in the UK if I promise to keep them under lock & key) -- seems like being able to deal with pain would be a high priority.

3. Antibiotics of several types to deal with bacterial infections -- another likely problem, right?

4. A cardiac kit, not going so far as defibrillation gear. The cardiac section of the MCA guide includes: adrenaline/epinephrine injections, GTN spray, Frusemide tablets, and Atenolol. What about nitroglycerine and aspirin?

5. Dental kit -- temporary fillings, local anaesthetics, mirror, etc.

6. General pharmacy: seasickness, gastric, anti-diarrheal, antifungal, condoms, sleeping pills, cough medicine, etc.

Then some other selected items from the MCA list according to what problems are most likely and most urgent.

Does this sound about right? What do you guys think?

[foolishsailor]

Most likely issue to deal with is actually shock associated with trauma. Stopping the bleeding is usually the easy part...

The below items assume one is trained in assessing an individual and medical training. One also assumes you have a Physician at the other end of a phone or radio when administering injections to give guidelines and dosages where required. The items below are only what to have in the kit that may be needed in addition to what you have listed - Im NOT saying they are required for a given situaiton. Also there is alot of overlap in terms of what itesm treat what issue - so i wont repeat items assuming one would know what to use.

Also - Im not a Doctor, I just play one on TV. This would be from our kit and the guidelines from the Ships Captain Medical Officer training that we took.

A good kit addresses these forms of shock:

General items:

• Blood pressure cuff
• breathing bag with child, adolescent and adult size masks

Hypovolemic Shock
shock associated with dehydration usually do to vomiting and or diarhhea from sea sickness etc.

• Suppository based sea sickness or anit-naseua meds.
• IV kit and Saline Bag
  
• Powdered Electrolyte

Hemorrhagic Shock
Most common one people think of - shock due to rapid blood loss

Solution:

• Ability to stop bleeding using pressure and bandages in your kit
• IV kit and Saline Bagto keep blood pressure up

Cardiogenic Shock
Heart losing its ability to pump without actual loss of blood or fluid - like a heart attack


Solution:

• Injectable Nor-Epinephrine
• Glyceryl trinitrate spray

Neurogenic Shock
Usually caused by severe spinal cord trauma or head injury.


Not alot in the bag to deal with this other than keeping blood presure up using fluids


Anaphylactic Shock
Allergic reaction


Think you have this covered - epineprine shots "epi-pens"


Hypoglycemic Shock
Blood sugar issues

• Glucose Syrup (juice usually is adequate
• Insulin - we dont carry this as we assume anyone who has insulin issues is aware and provides thier own medication...

we also carry 4 containers of chemical oxygen that will provide 20 minutes of supplimental oxygen each they are very small containers and you just add water to them - brilliant! Designed to keep someone alive until the experts arrive - not really gonna do much on a passage



You might want to consider a set of oropharyngeal airway (OPA) devices to assist in airway management...


Also if you are going to kit out - get a paramedic jump bag. We have stuff onboard not just for ourselves but to help others and we have used it to help others twice...


there are also tons of sites and info for cruiser kits and jump kits online


just a brain dump hope it helps.

[foolishsailor]

Newt comes to mind as someone who would have the anawers

[sarafina]

I have, in addition to many of the items listed, the bandages that stop the bleeding and lidocaine.

Lots of times there are small injuries aboard that need debris removal and sutures, and doing that is a bitch without something to numb it up. Injectable lidocaine for local anesthetic makes that job easier.

QuikClot is one brand of the bandages.

I keep sanitary supplies also, NOT for the ladies, but because they make good bandages.

Also silver sulfadiazine for burns. Wonder stuff. Works on chemical burns from coral and jellyfish as well.

Valium for mild sedation in case of panic attacks.

Oxycodine and Perc for pain.

Enema set up for dehydration.

[avb3]

Originally Posted by sarafina

............

Oxycodine and Perc for pain.

Enema set up for dehydration.

All good stuff, but one better insure a prescription for some of the drugs; they maybe consider illegal otherwise in some countries.

[foolishsailor]

Originally Posted by avb3

All good stuff, but one better insure a prescription for some of the drugs; they maybe consider illegal otherwise in some countries.

We found it easier to source morphine sulphate ampules for the high level analgesics amd the doc gave us a signed perscription. We keep all our scheule 1s and equivilent, most countries have similar enough regulations, in a seperate lockable box with all documention inside. To our surprise we have never been asked to surrender the meds or even been hasseled.

However we havent been to the states yet...curious what my fellow countrymen at customs will do...

[s/v Beth]

I'm impressed. You have covered almost everything I would bring. I am in the OR right now but will address this thread when I get home.

[foolishsailor]

Umm i totally forgot Septic Shock. You defo want dehydrated injectable antibiotics as well antibiotics that address various strains of bacteria. These can also be used to deal with the great fear of appendicitis. A tip our GP gave us who specializes in expedition medicine is that massive doses of injectable antibiotics can prevent an appendix from rupturing for many days allowing extra time to seek help...

Newt, cant wait for your input...

[JanetGroene]

Your pressure cooker can be used as a sterilizer. Sanitation is a key, and often difficult, so how about a supply of hospital-strength antibacterial soap for a scrub before you go to work on the patient? Urine retention in an elderly man can be a problem and can quickly create a crisis. Could you learn to insert a catheter? Or maybe just have your dad's plumbing thoroughly checked before you go?

[sy_gilana]

I commend your thinking. When we left we had ages from 9 to 78 with us and planned accordingly.

Some pointers, an AED might be a good idea, and also a Pulse Oximiter. An electric or manual Sphigmomanometer, or PB measuring device. We have drips, giving sets, Ringers, Saline, Dextrose, etc

See the way we think of it is, if you're talking to a doc via radio, then having the vital signs will help them immeasurably to make a diagnosis, then the treatment windows all open when you DO have the stuff on board. Imagine the Doctor saying, "I don't suppose you have "X" on board" and you actually DO! it increases the chances of survival until medical care is reached.

As far as a dental kit goes, we have the real deal from dentist friends, BUT we have been most successful with Superglue and Bicarbonate of Soda.
Dry the hole or broken tooth with an alcohol soaked q-tip or ear bud. Apply a drop of good quality Cyanoacrylate (Loctite or similar) then press in dry bicarb, repeat as required, finally a drop of glue. Then shape with nail file, or sharp knife point. It takes on the colour of the substrate, is incredibly strong, expect a life of more than 2 years.

For jellyfish stings, we have found nothing better than hot seawater (the same water that you were swimming in) heat a cloth in the microwave, on the exhaust manifold, whatever, as hot as possible. DO NOT change the PH, the Salinity, or any chemical stimulus (urine, ammonia etc) in 20 million years they have evolved to exist in water up to 25 degrees, heat the area to 40+ and it all turns to protoplasm, no more sting, the proteins become a soup...trust me this works. NOT fresh water, the cells (nematocycsts i think) will all fire with a chemical stimulus.

I would rather carry something I never needed than need something I never carried when it comes to medical emergencies......

[s/v Beth]

Wow- lots of different lines of thought here. I don't think your going to carry everything I keep on a crash cart in a hospital. You probably can, but the outdating of drugs, knowing what and when to administer, and just the bulk of it probably will get too out of hand. To address the OP question- what would you bring for a cardiac emergency- A monitor-AED combines two things in one and is largely automatic. A non medical person can train in these things and be efficient quickly. I would(will) bring in the future:
BP cuff and things to take heart rate and resp rate. Pulse ox- some of the new finger fitters are cheap and give you both the SaO2 and the HR. You need to give the person over the radio a brief history and physical, and this is part of it.
Oxygen: a small e tank is easy to transport, and will give you a few hours of oxygen via mask or nasal canalue. Useful for shock, bends, seasickness, stroke, mi, etc.
IV: bag, tubing and access- useful for everything from dehydration to shock to almost anything. There is a reason why EMT's establish access almost immediately.
Then we get into Pharmacy- yes many of the drugs suggested above would be useful in certain situations. I can see one or two broad spectum antibiotics, antiemetics, and perhaps some pain killers- but we have to be careful. All drugs have the ability to both help and kill- that is why I trained for so many years as a MD. Nitroglycerin paste or sublingual might be useful for the OP. His dad should know how to use it.
Also carry a short manual on sea medicine. You cannot be expected to remember it all unless you do it everyday. Even I look up stuff on occasion. I would also take a course in common emergencies and how to handle them. In my years on the water (even just weekend boating) it is amazing how often I really do use my medicine for people I meet out there.
In summary: I would get trained in the most common emergencies and then bring stuff to handle them. I apply an IV and Oxygen on most people I am trying to transport to the hospital. Just food for thought.

[Astrid]

Another thing to look at is what kind of injuries would one anticipate on a boat--probably the most common would be blunt force trauma, broken bones and abrasions; followed by dehydration, sunburn. Once you have a general idea of what to expect, you can plan around what you need to deal with the situations if they arise.

[mangomuffins]

Originally Posted by s/v Beth

Wow- lots of different lines of thought here. I don't think your going to carry everything I keep on a crash cart in a hospital. You probably can, but the outdating of drugs, knowing what and when to administer, and just the bulk of it probably will get too out of hand. To address the OP question- what would you bring for a cardiac emergency- A monitor-AED combines two things in one and is largely automatic. A non medical person can train in these things and be efficient quickly. I would(will) bring in the future:
BP cuff and things to take heart rate and resp rate. Pulse ox- some of the new finger fitters are cheap and give you both the SaO2 and the HR. You need to give the person over the radio a brief history and physical, and this is part of it.
Oxygen: a small e tank is easy to transport, and will give you a few hours of oxygen via mask or nasal canalue. Useful for shock, bends, seasickness, stroke, mi, etc.
IV: bag, tubing and access- useful for everything from dehydration to shock to almost anything. There is a reason why EMT's establish access almost immediately.
Then we get into Pharmacy- yes many of the drugs suggested above would be useful in certain situations. I can see one or two broad spectum antibiotics, antiemetics, and perhaps some pain killers- but we have to be careful. All drugs have the ability to both help and kill- that is why I trained for so many years as a MD. Nitroglycerin paste or sublingual might be useful for the OP. His dad should know how to use it.
Also carry a short manual on sea medicine. You cannot be expected to remember it all unless you do it everyday. Even I look up stuff on occasion. I would also take a course in common emergencies and how to handle them. In my years on the water (even just weekend boating) it is amazing how often I really do use my medicine for people I meet out there.
In summary: I would get trained in the most common emergencies and then bring stuff to handle them. I apply an IV and Oxygen on most people I am trying to transport to the hospital. Just food for thought.

You can't get much better advice than this re: Your dad should have a nitro Rx already. I would just add that nitro pump spray might stand up to sea conditions better. In case of a heart attack, nitro will be your lifeline till you can get the patient to a hospital or rescue team. From my own natural medicine perspective, you might also want to keep a tube of capsacin (pepper) cream handy for external application to the chest in case of heart attack or angina attack. This can save lives esp. if nitro is unavailable or expired. Pluss you can use it on sore muscles!!

Best of health.

Dr. MM

[arielle24]

Don't forget medications for fever, cough or allergies.

[ZenithOcean]

Where I presently work we kit all of the boats that will operate away from the main yacht with a SOLAS Cat C Kit (Including the Glycerol Trinitrate Spray) and an AED.

A kit like this Force 4 Cat and a dental kit like this Force 4 Dentanurse First Aid Kit - Only £13.95 - Force 4 Chandlery would probably cover most of the emergency stuff, in addition to a daily use first aid kit.

The AED is going to be more costly, but if you've got people aged 40+ onboard it would be a sensible move to have one.

SOLAS Category-C First Aid Kit (Cat-C)