Medical Kit, Medical Training for Transatlantic

[goboatingnow]

Sheesh , I’m sure you’d take lathes to re bore the cylinder heads too

As to an AED. The “ casual “ advice I received from a cardiac paramedic was it’s useless. AEDs are largely designed under the assumption that a major trauma hospital is available pretty quickly thereafter. This is not the case far off shore.

I think a decent medical kit for typical cuts and bruises , some typical treatments for hot humid country rash’s bites etc. some Re hydration , non prescription painkillers etc. Are sufficient

As I said for longer journeys over a week and out of range of rescue I carry some prescription barbiturate based pain killers ( fast and slow release and a broad spectrum antibiotic . These are primarily because of the potential time at sea.

While full Medicals are great I find it’s never done and would be seen by many as an invasion of privacy in a non commercial setting.

Hence you have to normally rely on people telling you in private if they have relevant medical histories. Most crew realise why you are asking and will respond with generally truthful answers, after all they are the only ones that will suffer if they lie.

Note that access to Tele medicine is fantastic. Set this up in advance but Falmouth MRCC will have access to all this. Have their number preprogrammed into the sat phone.

[Mara Mae]

Originally Posted by goboatingnow

Sheesh , I’m sure you’d take lathes to re bore the cylinder heads too

As to an AED. The “ casual “ advice I received from a cardiac paramedic was it’s useless. AEDs are largely designed under the assumption that a major trauma hospital is available pretty quickly thereafter. This is not the case far off shore.

I think a decent medical kit for typical cuts and bruises , some typical treatments for hot humid country rash’s bites etc. some Re hydration , non prescription painkillers etc. Are sufficient

As I said for longer journeys over a week and out of range of rescue I carry some prescription barbiturate based pain killers ( fast and slow release and a broad spectrum antibiotic . These are primarily because of the potential time at sea.

While full Medicals are great I find it’s never done and would be seen by many as an invasion of privacy in a non commercial setting.

Hence you have to normally rely on people telling you in private if they have relevant medical histories. Most crew realise why you are asking and will respond with generally truthful answers, after all they are the only ones that will suffer if they lie.

Note that access to Tele medicine is fantastic. Set this up in advance but Falmouth MRCC will have access to all this. Have their number preprogrammed into the sat phone.

Why can't you simply answer the OP's question without making disparaging comments about other members' responses? Perhaps the crustiness of your first line grants you "full old salt" status?
Personally I find your responses somewhat casual that tend to equate a Trans Atlantic crossing to a hop across the Chesapeake where sunburn and nausea will be the extent of medical issues. When I ask a question on this forum I am looking for experiential data that I will mine for my purpose. I am never seeking editorial critique of other members answers. Respectful diivergence of opinion sure, but sarcastic hyperbole is useless in answering my question. When I answer a question I try to contextualize my level of experience and offer an,"if it was me" type of answer and let the OP judge the value of the response. As far as the confidentiality of medical information, as a crew member on an ocean crossing I want to know the health of my fellow crew it could potentially be a liability for all. However recreational the voyage may be it is not a democracy and hurt feelings should not factor into overall crew safety. But my background is in commercial aviation where a medical exam is mandatory every two years for license retention.

[goboatingnow]

Originally Posted by Mara Mae

Why can't you simply answer the OP's question without making disparaging comments about other members' responses? Perhaps the crustiness of your first line grants you "full old salt" status?
Personally I find your responses somewhat casual that tend to equate a Trans Atlantic crossing to a hop across the Chesapeake where sunburn and nausea will be the extent of medical issues. When I ask a question on this forum I am looking for experiential data that I will mine for my purpose. I am never seeking editorial critique of other members answers. Respectful diivergence of opinion sure, but sarcastic hyperbole is useless in answering my question. When I answer a question I try to contextualize my level of experience and offer an,"if it was me" type of answer and let the OP judge the value of the response. As far as the confidentiality of medical information, as a crew member on an ocean crossing I want to know the health of my fellow crew it could potentially be a liability for all. However recreational the voyage may be it is not a democracy and hurt feelings should not factor into overall crew safety. But my background is in commercial aviation where a medical exam is mandatory every two years for license retention.

Jeepers it was a one line “ quip “ in a post filled with useful comment ,get a grip.

Listen up and read all my posts. I clearly set out based on my experiences what I would bring and why. I mentioned specific drugs and equipment and critiqued why I would not choose what others suggested. I opined my views based on the body of water I have crossed and my experiences while doing it.

As for medical information , as a delivery skipper for many years , I can tell you demanding medical records etc simply doesn’t happen no mater what you personally think. Crews are in demand and selected for their good abilities as sailing crew not just because they are medically perfect. Demanding official medical records or tests without extremely good prior reasons will just likely get you a “ f#€k off “ response. These people are not paid staff and good crew are hard to come by.

[goboatingnow]

T

Originally Posted by Mara Mae

?..Personally I find your responses somewhat casual that tend to equate a Trans Atlantic crossing to a hop across the Chesapeake where sunburn and nausea will be the extent of medical issues. .....

By and large for the vast vast majority of crossings , sunburn might be about the height of it. Occasionally nausea , usually by letting the wrong crew cook. This is a trade winds crossing at the most benign time of the year for such an undertaking. The med could give you more hassle. It’s a big and no doubt well equipped boat to boot.

The trouble is newbies and armchair sailors overthink and overcompensate by trying to cover all bases , as if you can be a floating trauma hospital , rather like long keels and rudders can save the incompetent sailor.

Extensive medical supplies are only useful if you have good appropriate medical training , and can understand what’s appropriate and what’s not ( like the AED issue. ) no amount of medical supplies put an old head on young shoulders , a situation where I lost someone I knew on a crossing.

Equally someone with the training may be incapacitated or they might not be very good at “ medical “ matters or their training may have been poor , rendering much of what you have useless or next to useless

As I said a reasonable medical supplies with over the counter medicines , typical tropics treatments for the common ailments , backed by some prescription pain killers and a broad spectrum antibiotic is typically sufficient in my experience. Anything more serious will need evacuation and if that’s not possible or timely bad things may happen

People die on the ARC crossings that’s a fact of life , people are evacuated on such crossings and i personally know one women , who is alive today thsnks to a cruise ship diverted.

[Hoodsail]

Sounds like an excellent trip. Not a physician but a pharmacist so I am going to focus on the drugs. Would recommend all aboard complete a health history, allergies (food/drugs) & current list of meds, to be held by the skipper. I handed my primary care physician a list of meds, directions for use, & quantity. Explained my plan to sail off shore and all meds were prophylactic (no not condoms), she thanked me profusely as this made her job easy. Just called prescriptions into local pharmacy, all drugs were generic, avoid brand name unless only available. Definitely recommend a book, will have to look for mine, if noone on board is a healthcare professional (physician, pharmacist, nurse). My thinking - what possibly could happen on board & then what prescription medications could be helpful: trauma, infection, aches/pains, unrelenting seasickness, allergic reaction.
1. Trauma (cracked ribs from a fall)= potent analgesics (pain killers) = acetaminophen with codeine (15 or 30 mg) tablets , #30 (1-2 every 4-6hr as needed for pain). In current climate highly unlikely you could get more potent combination (oxycodone with acetaminophen).
2. Infection (urinary tract infection, appendicitis, trauma-compound fracture) = ciprofloxacin 250/500mg tabs (1 every 12 hrs) #20 and/or amoxicillin/clavulanate 500mg/125mg (1 tab every 8 hrs) #30.
3. Aches/pains = over the counter your choice of; acetaminophen/paracetamol (in the EU), ibuprofen/naproxen.
4. Seasickness = ondansetron 4mg tabs as needed(1 every 12 hrs) #15.
Also effective is scopalamine topical patches, oral antihistamines (eg meclizine/ or other agent of choice per country)
5. Allergic reaction = diphenhydramine 25mg caps (1 every 6 hrs as needed for rash) - this is a non-prescription med. Very effective and much easier to give than an epi-pen. If crew has significant allergy history that requires an epi-pen, that person should be carrying their own.
6. Unrelenting diarrhea = loperamide or lomotil 1 tab every 4-6 hrs to stop pooping #20-30. non-prescription med

Key is reading through whatever book you take with as a reference to familiarize yourself with the directions & if possible review those unclear with your/a physician...would agree that an AED is not needed... if a crew members needs to be shocked into cardiac rhythm highly unlikely he/she will survive off shore...CPR (post drowning) is always good training as well as basic 1st aid... thanks

[goboatingnow]

To add further based in my experience of this body of water

1. Safety first , no alcohol
2. Careful night time deck procedure or in heavy weather
3, conservative sail plan especially at night and during expected squall periods, you’re not in a race.
4. Long distance comms , preferably satphone
5. Chafe prevention
6. Good watch schedules
7. Good cooking and regular meal times.
8. Emphasise staying on board , over any form of MOB.

You arrive sun tanned , rested , likely have gained a little weight and look forward to sailing the Caribbean

[Mara Mae]

Originally Posted by Hoodsail

Sounds like an excellent trip. Not a physician but a pharmacist so I am going to focus on the drugs. Would recommend all aboard complete a health history, allergies (food/drugs) & current list of meds, to be held by the skipper. I handed my primary care physician a list of meds, directions for use, & quantity. Explained my plan to sail off shore and all meds were prophylactic (no not condoms), she thanked me profusely as this made her job easy. Just called prescriptions into local pharmacy, all drugs were generic, avoid brand name unless only available. Definitely recommend a book, will have to look for mine, if noone on board is a healthcare professional (physician, pharmacist, nurse). My thinking - what possibly could happen on board & then what prescription medications could be helpful: trauma, infection, aches/pains, unrelenting seasickness, allergic reaction.
1. Trauma (cracked ribs from a fall)= potent analgesics (pain killers) = acetaminophen with codeine (15 or 30 mg) tablets , #30 (1-2 every 4-6hr as needed for pain). In current climate highly unlikely you could get more potent combination (oxycodone with acetaminophen).
2. Infection (urinary tract infection, appendicitis, trauma-compound fracture) = ciprofloxacin 250/500mg tabs (1 every 12 hrs) #20 and/or amoxicillin/clavulanate 500mg/125mg (1 tab every 8 hrs) #30.
3. Aches/pains = over the counter your choice of; acetaminophen/paracetamol (in the EU), ibuprofen/naproxen.
4. Seasickness = ondansetron 4mg tabs as needed(1 every 12 hrs) #15.
Also effective is scopalamine topical patches, oral antihistamines (eg meclizine/ or other agent of choice per country)
5. Allergic reaction = diphenhydramine 25mg caps (1 every 6 hrs as needed for rash) - this is a non-prescription med. Very effective and much easier to give than an epi-pen. If crew has significant allergy history that requires an epi-pen, that person should be carrying their own.
6. Unrelenting diarrhea = loperamide or lomotil 1 tab every 4-6 hrs to stop pooping #20-30. non-prescription med

Key is reading through whatever book you take with as a reference to familiarize yourself with the directions & if possible review those unclear with your/a physician...would agree that an AED is not needed... if a crew members needs to be shocked into cardiac rhythm highly unlikely he/she will survive off shore...CPR (post drowning) is always good training as well as basic 1st aid... thanks

Excellent advice.

[goboatingnow]

I will say in the Eu , having tried everything , sturgeron ( cinnizarine ) I found to be most effective

I never had issues getting things like fast and slow relief tramadol , Ive personally Had to take this and its very effective. It tends not to dull the mind as bad as some others.

[goboatingnow]

By the way this is a useful paper to read

“Medical kit for single-handed offshore yacht races”

https://journals.viamedica.pl/intern...019.0035/49796

[Mara Mae]

Originally Posted by ChrisJHC

I did a Marine First Aid course here in Aus.

One of the items recommended to be carried was the “Morning After Pill”.

Given we regularly have 8 of us on board a 30-footer, I’m not sure how you would get the privacy to carry out the activities needed to require its use

Back on track - the course was mostly a standard first aid course with a few extra items for remote circumstances - suturing, administering morphine, rectal rehydration and so on.

8 on a 30 footer. Way too much information and way not enough room! lol

Suturing excellent point and skill for remote medicine. We carried Demerol not morphine.

[Dockhead]

Thanks for all the exellent advice! Has given me a lot to think about.


I think my next steps will be (a) buy the book and read it; (b) take the advanced first aid course.


And I need to find among my acquaintances a doctor who can help with the prescription items in the kit. Antibiotics are no problem; I can buy those over the counter in Russia or Kazakhstan, but effective pain stuff is going to be harder in this post-opiod crisis world. We had morphine with us in the Arctic, but I think this is easy to get for a yacht skipper only in the UK. With my yacht out of UK waters, I'm not sure how I would do that.

[fivecapes]

Surprised noone's mentioned Advanced First Aid Afloat,

and the pretty good (and free) Offshore Medicine: What You Need To Know (and Nothing More).

[Paul L]

Originally Posted by Dockhead

Thanks for all the exellent advice! Has given me a lot to think about.


I think my next steps will be (a) buy the book and read it; (b) take the advanced first aid course.


And I need to find among my acquaintances a doctor who can help with the prescription items in the kit. Antibiotics are no problem; I can buy those over the counter in Russia or Kazakhstan, but effective pain stuff is going to be harder in this post-opiod crisis world. We had morphine with us in the Arctic, but I think this is easy to get for a yacht skipper only in the UK. With my yacht out of UK waters, I'm not sure how I would do that.

Most of the first aid courses are oriented about short term dealing with a problem till you can get through to 911 (or whatever the emergency number is in your country). If you can find a marine offshore medical course or a remote medicine course I think you will find it much more meaty and useful of your time. I went to a 2 day Offshore medical course taught by an ER doc in Seattle. He was very practical in taking us through the actual things we could do to save lives and brutally honest about the heroic efforts that were useless.

A good drug list is the New Zealand Cat 1 offshore list. A non official version here
https://www.google.com/amp/s/astrola...ores-list/amp/

[Dockhead]

Originally Posted by Paul L

Most of the first aid courses are oriented about short term dealing with a problem till you can get through to 911 (or whatever the emergency number is in your country). If you can find a marine offshore medical course or a remote medicine course I think you will find it much more meaty and useful of your time. I went to a 2 day Offshore medical course taught by an ER doc in Seattle. He was very practical in taking us through the actual things we could do to save lives and brutally honest about the heroic efforts that were useless.

A good drug list is the New Zealand Cat 1 offshore list. A non official version here
https://www.google.com/amp/s/astrola...ores-list/amp/

Thanks; that's helpful.


Yes, I understand that the typical recreational first aid courses will be of little value. I was actually thinking about doing the STCW course, like this one: https://chieftain.training/stcw-medical-first-aid/


It's four days, unfortunately, but this looks like the real business.

[Mara Mae]

Originally Posted by fivecapes

Surprised noone's mentioned Advanced First Aid Afloat,

and the pretty good (and free) Offshore Medicine: What You Need To Know (and Nothing More).

Excellent! Thanks