Upgrading your Boats Medical Locker

[GordMay]

... Think about what you are comfortable using. There is no point in carry supplies for procedures you would not be able to do. I carry what I need to set and splint a long bone fracture but it is not something you want to be learning from the book while at sea so unless you have experience as a first responded there would be little point...

Except, if you have them, others, qualified to use them, might; just as an African clinic might use your sterile sharps.

BTW, the same applies to spare parts & tools.

[kas_1611]

Be very very careful about medications when travelling overseas. What maybe an OTC medication at home could land you with a drug smuggling charge somewhere else.

For instance Paracetamol & Codeine is an OTC in the UK but a Prescription only drug in the US. I found this out when the Medic on an oil rig confiscated my personal supply as I did not have the Px to have them, despite me having the receipt from the UK store I'd purchased them from.

Codeine is an Illegal Drug in some countries, Greece and Egypt for instance, so transporting them into country is considered the same as smuggling Cocaine or Heroin. Even if you have a prescription from your Doctor they can still seize your medication and possibly arrest you.

Commercial Vessels with a proper Sickbay and fully qualified Medic onboard can carry such medications in a properly defined, bonded and secured Medical Bay but your average First Aid kit or "medical locker" on a private cruiser will not qualify neither will your medical certification (unless you are a fully, state registered, medical doctor). Simply put it is not worth the risk to transport medications based on or containing Opiods, Cocaine or any other controlled medications.

[Michael Cobbe]

We did a first aid course and they gave us a list of drugs and medical kit to carry. We went our doctor and said were going long distance sailing and he gave most of the drugs free. Medical kit included blood presssue. The most interesting things are for cuts use kitchen roll it is sterile out of the pack, and hold it tight until the bleeding stops. For burns use Flamzene cream, and cling film which is also sterile out of the pack.


Appendisitis, if you press the area it is in won't hurt, let go and it will hurt. There are two drugs that stop the Appendix bursting for 24 hour so you can call for help.

[HankOnthewater]

About AED, anyone, just try to get data on hoe many patients are saved by using AED.... let me know if you find reliable data, other than data from interested biased parties.
Even though I work in a hospital and attend every medical emergency, including cardiac arrest, I do not know the official figures on the number of patients it saves.

Yes, I have my own AED, and can use it in automatic mode or manually with a cardiac monitor (ECG trace) and qualified to do so, but....... to save a person from a arrhythmia, apart from the shocks, one needs mostly IV (intravenous) access and IV medication like adrenaline and amioridone, and then a prompt transfer to a tertiary hospital for further treatment.

My AED is not on my boat currently. And if I were to start traveling/cruising, not sure, if I will bring it along.

Reason for my AED: at times I travel remotely (on land ) with 50-80 others for up to 6 weeks, me as a paid medic/nurse. And yes, the most important tool in emergencies is the satellite phone. A plane of the RFDS (Royal Flying Doctor Service) might be only 3 to 6 hours away. If help beyond AED is more than 24 hours away, I doubt if that tool is very useful.
Just my take on AED.

On sutures... how many sailors can suture? Suturing without an local anaesthetic is near impossible, unless the victim is extremely stoic or unconscious.

On antibiotics: yes skin infections can become nasty and cuts from coral/fish takes a long time to heal. The antibiotics mentioned are good (flucloxacillin). Hmmm, azithromysin was mentioned. I see that mainly used in respiratory disaeases; hehehe, dare I say Covid-19?

Diverticulitis is an illness often pops up intermittently, particularly in older people (I guess our target audience). Discuss with your doctor and likely amoxillin and metronidazole tablets will be offered.

[slug]

Originally Posted by kas_1611

Be very very careful about medications when travelling overseas. What maybe an OTC medication at home could land you with a drug smuggling charge somewhere else.

For instance Paracetamol & Codeine is an OTC in the UK but a Prescription only drug in the US. I found this out when the Medic on an oil rig confiscated my personal supply as I did not have the Px to have them, despite me having the receipt from the UK store I'd purchased them from.

Codeine is an Illegal Drug in some countries, Greece and Egypt for instance, so transporting them into country is considered the same as smuggling Cocaine or Heroin. Even if you have a prescription from your Doctor they can still seize your medication and possibly arrest you.

Commercial Vessels with a proper Sickbay and fully qualified Medic onboard can carry such medications in a properly defined, bonded and secured Medical Bay but your average First Aid kit or "medical locker" on a private cruiser will not qualify neither will your medical certification (unless you are a fully, state registered, medical doctor). Simply put it is not worth the risk to transport medications based on or containing Opiods, Cocaine or any other controlled medications.

Yah be very careful with drugs

Important to have a doctors prescription for each drug and the person covered by this drug must be stated on the prescription

When the crew , with the prescription , leaves the boat the drugs must go with him

[Paul L]

Originally Posted by slug

Yah be very careful with drugs

Important to have a doctors prescription for each drug and the person covered by this drug must be stated on the prescription

When the crew , with the prescription , leaves the boat the drugs must go with him

Prescriptions can be written for the ships medical kit along with the masters name. The drugs do not have to be for a particular person. It is a generic medical kit to be used at the discretion of the master or the ships medical officier - in our case my wife, a trained nurse practioner. The wording might sound formal and for large ships, but that is exactly what CIQ is expecting and used to. We've cleared into close to 30 countries and never had an issue.
Sometimes we just list the ships medical kit on customs forms. For countries that are known to be picky, like Indonesia, we list each drug in the kit.

[DanCan]

Originally Posted by HankOnthewater

About AED, anyone, just try to get data on hoe many patients are saved by using AED.... let me know if you find reliable data, other than data from interested biased parties.
Even though I work in a hospital and attend every medical emergency, including cardiac arrest, I do not know the official figures on the number of patients it saves.

Yes, I have my own AED, and can use it in automatic mode or manually with a cardiac monitor (ECG trace) and qualified to do so, but....... to save a person from a arrhythmia, apart from the shocks, one needs mostly IV (intravenous) access and IV medication like adrenaline and amioridone, and then a prompt transfer to a tertiary hospital for further treatment.

My AED is not on my boat currently. And if I were to start traveling/cruising, not sure, if I will bring it along.

Reason for my AED: at times I travel remotely (on land ) with 50-80 others for up to 6 weeks, me as a paid medic/nurse. And yes, the most important tool in emergencies is the satellite phone. A plane of the RFDS (Royal Flying Doctor Service) might be only 3 to 6 hours away. If help beyond AED is more than 24 hours away, I doubt if that tool is very useful.
Just my take on AED.

On sutures... how many sailors can suture? Suturing without an local anaesthetic is near impossible, unless the victim is extremely stoic or unconscious.

On antibiotics: yes skin infections can become nasty and cuts from coral/fish takes a long time to heal. The antibiotics mentioned are good (flucloxacillin). Hmmm, azithromysin was mentioned. I see that mainly used in respiratory disaeases; hehehe, dare I say Covid-19?

Diverticulitis is an illness often pops up intermittently, particularly in older people (I guess our target audience). Discuss with your doctor and likely amoxillin and metronidazole tablets will be offered.

On sutures....
I don’t have any medical training (except regular first aid). I heard that we should be very careful with sutures. One thing is a superficial cut we can glue but a different story is a deep cut. If we don’t know what are we doing we could be doing more harm than good because of blood vessels. I remember they said an absorbent pad and pressure is the best for the initial aid.

[olaf hart]

A couple of things to take offshore.
A sterile urinary catheter is useful, especially a stiffer silicone one, urinary retention in old guys is an emergency, much more common with seasickness meds.
I also managed to break my ankle on an island, had to get the boat off anchor and back home, was able to do most things sitting and kneeling, but the pain was excruciating trying to sleep.
Used to run ED’s, so can jury rig most things, but can’t splint an ankle. I would have given anything for a blow up ankle splint.

[slug]

Originally Posted by Paul L

Prescriptions can be written for the ships medical kit along with the masters name. The drugs do not have to be for a particular person. It is a generic medical kit to be used at the discretion of the master or the ships medical officier - in our case my wife, a trained nurse practioner. The wording might sound formal and for large ships, but that is exactly what CIQ is expecting and used to. We've cleared into close to 30 countries and never had an issue.
Sometimes we just list the ships medical kit on customs forms. For countries that are known to be picky, like Indonesia, we list each drug in the kit.

My experience had been the drug inventory on arrival must match drug inventory at departure

If it doesn’t you must document what happened to the missing inventory

[olaf hart]

Other things that are useful are gel dressings, make managing any sort of skin ulcer a breeze.

The urinary catheter is also useful for severe dehydration due to sea sickness, it is a simple thing to make up a rehydration solution boiling then cooling water with salt added to body temperature, then use the catheter to give it as an enema.

[Sojourner]

I don't have my inventory in front of me but when we moved onto the boat, I went to a sympathetic private doctor and explained I was putting together a ship's med kit. He prescribed a dozen or two items, including antibiotics suitable for seven or eight types of issues (skin, uti, lung, etc), antivirals, pain meds (not all are always legal everywhere but they're locked in a safe and I'm a fast talker), stapler kit for deep cuts, dressings, etc. I walked out of the pharmacy with a garbage bag of goodies. So far, haven't touched any 😅 But good to have, until they expire anyway...

[Paul L]

Originally Posted by slug

My experience had been the drug inventory on arrival must match drug inventory at departure

If it doesn’t you must document what happened to the missing inventory

Never been asked on exit anywhere. But the drugs are there to be used when needed, so I don't see why they need to be the same on exit as on entry.
Customs is usually a lot more concerned about alcohol and tobacco, even those are not normally monitored closely.
Having prescription meds onboard is not a big deal. Customs officiers around the world expect you to have a well equiped yacht.

[AiniA]

Lots of good info here. Someone will have to go through it to come up with a kit that makes sense for them. Some general comments based on our experience before taking off and during four years of cruising.
- You don't have to be going around the Horn or somewhere really exotic to be a long way from medical help. Passages of 20+ days are not that rare. You need to think beyond the concept of just first aid. Even in a fairly busy part of ocean you can be out of contact. We had someone fall onboard and had two puncture wounds just above the eye, from breaker switches on the main panel. This was about 150 nm NW of Bermuda. We made a Pan-Pan call on VHF every half hour until we got within range of Bermuda radio without success. On our return home I asked a doctor to critique my care for this injury. She was pleased with what I had done except that I should have kept a written record of everything and checked blood pressure. We now have a BP cuff.
- Before departing we did a weekend wilderness first aid course offered by Columbia University. It was very useful, although when I got my hand crushed in South Africa I remembered what needed to be done while my wife forget everything because of stress
- I had a staph infection on my leg between Easter island and Pitcairn. We were in SSB range of Canadian doctor heading from Easter to Chile and he described treatment that involved the use of many sterile pads with hot water and for dressings. We had a standard pack of 30 or but they did not last. We ended up using pieces of t-shirt boiled after the pads and sanitary napkins ran out. At our first opportunity I bought a pack of something like 200 pads and of course, have not used one since.
- Broad spectrum antibiotics do not work on skin infections. We eventually ended up with four antibiotics for skin, dental, gastro, and respiratory. Other than the ineffective use of Cipro (the only one we had at first) for the skin we did not use any of them.
- We had pain killers ranging from mild to Percocet. We declared drugs on country entry as requested but never had a problem or even a question.
- Our dock mate before we left was an orthopaedic surgeon. He suggested a skin stapler rather suturing. Many unused, sterile skin staplers are thrown away in hospitals so if you know a surgeon you probably can get a freebie. Didn't use this either.
-He also recommended Silvadene for treatment of burns, said it was the next best thing to a wonder drug for this. Did not use it.

[AiniA]

Originally Posted by oleman

If you are in the USA or Canada, make sure all prescription required medications have a proper Medical Doctor authorized prescription. Your Family Doctor is where you start!

Travel clinics are also useful since the folks there have more experience than regular MDs. Travel clinic can also make sure you have all of the vaccinations you need.

[Discovery 15797]

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?

That is why I recommend hands-on training. Buying kits and books are not very helpful if a person is not properly trained.

The AED is used to shock a heart that is beating erratically (ventricular fibrillation or ventricular tachycardia) because CPR on a patient in this situation is ineffective. The AED shock attempts to stop this irregular heartbeat, and in some (rare) cases the heart rhythm may return to a weak but normal pattern, but in many cases will require immediate CPR. In either case hospitalization is required.

The question then becomes, if you are near-shore sailing, or in an anchorage, or at a marina and someone on the boat has a sudden cardiac arrest, could an AED and CPR potentially save that life? (IMHO, a small chance is better than no chance.)