Medical Kit, Medical Training for Transatlantic

[redhead]

I recommend a book "Where There is No Doctor".

Written for missionary/peace corps people out of touch (no phone, internet etc.) and stationed in remote villages. It covers a lot of the most common medical problems, from diagnosing fever, to tooth extraction, to sutures, to fashioning a splint/cast for a broken limb.

I bought a hard copy and keep it right in the first aid bag.

[Godshalk]

For our transatlantic, we bought a kit here:
https://www.adventuremedicalkits.com...ts/marine.html

Here's the medical requirement from the 2019 Transatlantic Race:
https://www.transatlanticrace.org/20...notice-of-race

[Cheechako]

The Seattle Fish Expo (Everything about commercial fishing including boats and engines etc) Used to give various medical classes. I took one about first aid and they even taught you suturing etc. We practiced sutures on Pig Legs, the skin etc being similar to human.
It was good stuff, a lot better than your typical first aid or cpr class.

[dannc]

Originally Posted by goboatingnow

There is never “ weeks to port” ( on a trans Atlantic) if the injury is in any way severe the medical advice you will get is to evac. AMVER and GMDSS will typically have a ship present within three days. ( you may have to change course ) you will also have helicopter access upto 600 km from land depending !!

A serious back injury or bad breaks needs evac in my opinion and that is what the advice will say.

Depending on an evacuation does not seem prudent to me. One should be prepared as best as one can be.

There is a line, maybe not so fine line, between severe and not severe.

What if one had burn victim on board but ran out of the supplies to handle the injury? What could be a sorta easily managed issue might not be if one runs out of the right supplies, which could force a call for a evacuation. Or one had enough supplies for one person but two people got burned. Then one would have to call for a evacuation which would not be a good plan as far as I am concerned.

I have had back and neck injuries, too many , and one sent me to the ER, and most to the doctor. With what I know now, I could handle them without needing a doctor, much less an evacuation, as long as I have the supplies on the boat and enough of them. Not sure all bone breaks would require an evacuation, certainly a compound fracture of a major limb but a broken toe, finger, or stress fracture?

I have also had a painful shoulder injury. The doctor's did not fix the injury, they just confirmed it was an inflammatory injury which I fixed, not them. One just has to know what to do, what you need, and have enough of it. Enough of "it" is what needs as much thought as what you need as well as the knowing how to use what you have.

Later,
Dan

[Cpt Mark]

40+ years ago I had to be certified as an advanced red cross 1st aide instructor. College course and our training was right below EMT. In basic 1st aide and advanced we actually taught 1st aid. About 10 years ago I needed a current 1st aide certification. Took the class. I'll teach you the class here.

If anything happens, call 911.

That was the extent of the class for 8 hours. They didn't teach anything anymore. Very sad. So if you want to take a class to learn, look carefully into it and probably find a private course geared for the outdoors or long distance sailing. It won't be cheap but you'll actually learn something.

[Dockhead]

Originally Posted by goboatingnow

There is never “ weeks to port” ( on a trans Atlantic) if the injury is in any way severe the medical advice you will get is to evac. AMVER and GMDSS will typically have a ship present within three days. ( you may have to change course ) you will also have helicopter access upto 600 km from land depending !! . . .

Thanks for this -- three days from a ship is very different from the parameters for our Arctic trip, where there were normally no ships within much further than that, and query whether a ship would even be willing to divert considering icebergs, sea ice, etc.


I guess a trade winds transat is actually much less remote. This is a relief.

[goboatingnow]

Originally Posted by Dockhead

Thanks for this -- three days from a ship is very different from the parameters for our Arctic trip, where there were normally no ships within much further than that, and query whether a ship would even be willing to divert considering icebergs, sea ice, etc.


I guess a trade winds transat is actually much less remote. This is a relief.

Ships are under SOLAS obligations to assist end of story

On one crossing the same oil tanker diverted once 300 miles south and on his return crossing he was diverted nearly 500 miles both times to pickup a sick yachtsman. They reckoned it cost the ships company 50K

Anything looks serious get on the blower straight away. Either push back towards the canaries ( not easy ) if you can get into chopper range or arrange the meeting point with the ship.

Don’t think youre a hospital , lives depend on it.

And yes you can depend on the ship appearing in as much as you can depend on anything

It’s foolish in the extreme to not use the services that are made available. Forget all this self help macho BS. The person alive afterwards will thank. you.

Clearly I’m not talking about a case of jock rot here !!

Anyway that needs major pain relief has the potential to be fatal.
Anything that has accompanying severe dizziness can be fatal

Don’t dither first get advice ( sat phone is best ) then act on that advice , if evac , evac as quickly as you can. Tear up the voyage plan and just seek to get the person help.

In my experience ailment on long oceanic voyages is rare. The environment is quite sterile , crew are generally careful and you’re much more likely to have illness issues in port or coastal sailing. ( people let their guard down )

In several crossing we hadn’t anything more then a few minor cuts

By the way ensure you understand the crews medical history. Hopefully you don’t get surprised. !!

[goboatingnow]

To mention a few issues.

Salt water boils in general completely avoidable on a big cruising yacht. You’ll have lots of clothes , you can wash and dry , water rations may be generous. Little swimming happens anyway. With conservative sails you should (a) never have water on the deck and (b) the AP will steer the whole way across. Salt buildup is not abnormal , In fact it’s by and large dull sailing. You really just all become boat repair experts as the main issue is chafe prevention and repairs ( make sure all your halyards and sheaves are in good order )

So the opportunity for insect bites tends to be either side , clearly if you have crew that react to bites you need to be prepared. A good crew medical briefing is useful. Women especially pre menopausal often react badly to bites.

In our cases all crew didn’t suffer any jock rash , bites or stuff until they got to the Caribbean !

Don’t overthink it. ( too much ) in a boat that big she will cover ground. It will be over faster then you think.

[goboatingnow]

I’m amused at the carry condoms . I’m the skipper I’m not their father and I presume they are all adults. !!

Mind you condoms have many uses. Very handy for impromptu water fights.

By the way I know you know your eggs. But on deliveries it was a zero absolutely zero alcohol policy underway for me as skipper.

[goboatingnow]

Originally Posted by Dockhead

Thanks for this -- three days from a ship is very different from the parameters for our Arctic trip, where there were normally no ships within much further than that, and query whether a ship would even be willing to divert considering icebergs, sea ice, etc.


I guess a trade winds transat is actually much less remote. This is a relief.

It’s quite remote the nearest humans were in the space station! And it’s outside the commercial shipping lanes these days.

But it benign temperatures and generally easy conditions for a big boat with a strong crew. Sail her conservatively and she’ll pop put the other end with no drama.

[Dockhead]

Originally Posted by goboatingnow

. . .By the way I know you know your eggs. But on deliveries it was a zero absolutely zero alcohol policy underway for me as skipper.

I'm the skipper, but the owner is a fine sailor (and old shipmate of mine) himself, and he likes his wine!! I am "zero absolutely zero alcohol" underway on my own boat, but the owner has overridden this policy for this voyage.



We shall see.

[Mara Mae]

Originally Posted by Dockhead

All the sailing I've done more than a week or two away from civilization, I've done with a doctor on board. We'll be doing a transat in January, and none of the crew has any medical training other than some first aid courses.


I know it's been discussed before, but what do people think is an appropriate medical kit for such a voyage, large vessel with 6 to 8 people on board?


And some one of us probably needs to get first aid cert updated, no?



We will have working SSB and a robust satellite system so we will be able to do tele-medicine if, God forbid, someone gets sick or injured, but we will need to have appropriate supplies and equipment on board.


Tips?

Excellent question. I have been in a life saving/preserving situation twice as first respondent (NOT First Responder) One was a cardiac arrest where I had to perform CPR and another was a broken tibia on a wilderness cross-country ski trail in -20C.

To minimize risk and maximize emergency heath care. Many of the earlier comments are pertinent. This is my thinking.

1. All crew members should have CPR cert. All because CPR performed correctly is incredibly demanding physically and people will need to be spelled.

2. Comprehensive wilderness/marine/remote location first aid kit with prescription pain meds. Consult with an emergency physician trauma specialist.

3. Full physicals for all crew prior to departure. Including EKGs. The location and administration of all personal meds must be known by crew. There should be duplicates stored separately.

4. Detailed and practiced operational procedures in inclement weather to minimize likelihood of traumatic injuries.

5. Select crew members skipper plus 1 obtain Emergency Marine Medical cert. for serious injuries like head, arterial bleeding, hypothermia, fractures, choking, burns and pain relief.

6. Personally I would not rely very much on TeleHealth.

[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.

[rmlarson1098]

Originally Posted by Dockhead

All the sailing I've done more than a week or two away from civilization, I've done with a doctor on board. We'll be doing a transat in January, and none of the crew has any medical training other than some first aid courses.


I know it's been discussed before, but what do people think is an appropriate medical kit for such a voyage, large vessel with 6 to 8 people on board?


And some one of us probably needs to get first aid cert updated, no?



We will have working SSB and a robust satellite system so we will be able to do tele-medicine if, God forbid, someone gets sick or injured, but we will need to have appropriate supplies and equipment on board.


Tips?

We keep it fairly simple.
Good, fabric/waterproof fabric (not plastic) band-aids.
Gauze - make it 'Cling' or similar.
Surgical tape.
Sterile pads, sanitary napkins. The later do the same thing and are much less expensive.
Rubbing alcohol. Neosporin.
Rum.
Butterfly tapes/bandages, with several tubes of Super/Crazy glue to close lacerations.
Q tips.
A quality sling (double straps over the shoulders) with a padded band to immobilize the arm. Great for shoulder injuries as well as some broken arms.
Neck pillow, like for sleeping on aircraft.
Ace bandage.
Knee compression sleeve.
Flexible finger splint.
Flexible limb splint.
Tums/Mylanta. Preparation H and a donut pillow. Hey, there's a lot of sitting on a boat!
Imodium/Lomotil for diarrhea, Dulcolax for constipation.
Eye wash with a cup. Eye patch.
Lubricating eye drops.
Ear drops.
Hydrogen peroxide, with ear irrigation kit.
Dental repair kit.
Ibuprofen (pain) acetaminophen (fever) aspirin (cardiac issues)
Thermometer.
Motion sickness meds (over the counter) plus prescription patches.
Epipens (2)
A few 'Z Packs', with a course of broad spectrum oral antibiotics.
We carry no syringes, or 'narcotic' pain meds. Have to make due with Advil, rum, and a stick to bite on in worse case scenarios.
We don't carry a suturing kit; see butterfly tapes, Super Glue above.
Know CPR, and concentrate on chest compressions. We don't do respirations anymore, which seems to be the (not so new) thing.
We carry, and can use, an AED. Our big splurge. The last one went belly-up after 3 years (never used it, thankfully) and we decided to pay the big bucks for a new one. But for cardiac arrest it's pretty much essential.
For non-specific chest pain, we chew an aspirin, and take a Tums.
Ok, so this isn't such a simple list! But there may be a few good ideas in there that could prove helpful.
It's not difficult or terribly time-consuming to complete a First Responder course. To be able to use direct pressure to stop bleeding, (hopefully!) bandage and dress a wound, and splint a broken limb are important. Remember, unless the boat is on fire splint 'em where they lay.
Our only communications (other than cell phones) are a the VHF.
But it's just the 2 of us usually, and we understand the risks of ocean passage-making.
If you've a boat full of family/crew, your results may vary!
All the best.
PS: We also carry a modest but helpful First Aid Kit in a tidy little box.
We never open it. It's to show - and hopefully please - coast guards and other government agencies that may be concerned.

[StoneCrab]

In the 90's Cruising World worked with an ER doctor who put on a first aid and medical training seminar that took place over a Saturday and Sunday. It was very thorough. We got to practice suturing on pigs feet. A surprise but a great experience.

He went over all the medicines and things that belong in a kit. A Sam Splint was top of the list as well as a catheter. He went into detail about the situations that call for a catheter and there were many. We didn't practice inserting those but there are a range of sizes and techniques.

He stressed the importance of getting a physician who was willing to work with us in getting the kit prescriptions. Very important to have official written prescriptions. Having the drugs can be illegal without the Rx.

I'd take the class again if it were offered. It was a confidence booster and a reminder of all the basic First Aid that is easy to pick up and just as easy to forget. Go with a partner who will be on the trip. You can't suture one handed if you cut your hand badly. The other person could be a life saver.