Upgrading your Boats Medical Locker

[Discovery 15797]

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.

US data here from NIH

Survival was 9% (382 of 4,403) with bystander cardiopulmonary resuscitation but no AED, 24% (69 of 289) with AED application, and 38% (64 of 170) with AED shock delivered.

Agree with comments regarding suturing. Topical lidocaine hydrochloride putty is about as effective as injected lidocaine. But, again...a class such as Mastering Fundamentals of Skin Laceration Repair is important.

[Singularity]

Even suturing wounds closed has pros and cons. Worst case scenario you encapsulate a concentrated nugget of bad guys that overwhelems your immune system and/or doesn't respond to your available antibiotics. Sometimes it is more optimal from a health/safety standpoint to leave some wounds open (the body is well-equipped to heal in such circumstances, depending on wound size/type).

So are we suturing the wound to ultimately protect health, or are we suturing so as to make a better looking wound? We can always accomplish the latter with a little plastic surgery.

[s/v Jedi]

Originally Posted by Singularity

Even suturing wounds closed has pros and cons. Worst case scenario you encapsulate a concentrated nugget of bad guys that overwhelems your immune system and/or doesn't respond to your available antibiotics. Sometimes it is more optimal from a health/safety standpoint to leave some wounds open (the body is well-equipped to heal in such circumstances, depending on wound size/type).

So are we suturing the wound to ultimately protect health, or are we suturing so as to make a better looking wound? We can always accomplish the latter with a little plastic surgery.

Are you saying that people would close wounds without cleaning and disinfecting them? For most short handed crews there is no staffed sick bay and a couple of staples (or some superglue for small cuts) can get you back in action. I believe most offshore sailors have read enough to know how to do this

[dannc]

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....

While AEDs and CPR have very low likely hood of patient survival, without CPR or AED usage, the patient has zero chance of survival. With CPR and/or AED there is at least some chance.

The other argument against AED usage is that if one is not close to a decent hospital, it is of limited/no help. That is true. While one could have a cardiac event on a long passage, that is a small part of the cruising for most people. The rest of the time one is in an anchorage, marina or coastal passage where help can be close by. In those cases, which is far more likely than using a AED in a remote area, the AED could save a life. The odds are still low for survival but better odds than no AED.

It seems like whenever we are in a marina we are at the end of a pier. Way out. Even in little marinas. The last marina we were at was small and we were at the end of the farthest pier. If the marina had an AED, it was a good 10 minute RUN from the end of the pier to the office and back. Just by chance, there was a fire station within a few hundred yards of the marina, but even that close, by the time the 911 call got out, and the FD got to us, at least 10 minutes would have gone by. 10 minutes of CPR is a work out. An AED on a boat close to the person would be a good thing.

In other marinas we have been in, the time to get an AED would have been much longer. If an AED was even available and who knows how long it would take emergency services to get to us. The AED and/or CPR would buy some time.

I was watching some random sailing video. Not sure how or why I was watching that channel but I was for some reason. I think they were near Granada. I think. Anyway, there was some small, barely above sea level island, that cruisers would go to and hang out. There was a bar on the island and people were drinking and chilling when a call went out on the VHF that there was a health issue on one of the boats. There was a doctor on another boat who went to assist the man who had gone down. There was not anything the doctor could do and the man died.

Would an AED have helped that man? I have no idea there were any airlift capability in that area. If there was not, the end result would have been the same. However, if there was a possibility of airlifting that man to a hospital, an AED would have given him a chance. As it was, he died six months into his dream of cruising.

Should every boat carry and AED? Certainly not. There are far more important things one should use limited funds to buy in regards to safety and emergency gear. BUT, if one has the money, and has the space, why not have an AED? They are simple to use and they might save a person one day. Or the AED could just sit on the boat and never be used like a PLB or EPIRB. In the US, on Amazon, an AED is $1,400ish.

Later,
Dan

[Singularity]

Originally Posted by s/v Jedi

Are you saying that people would close wounds without cleaning and disinfecting them? For most short handed crews there is no staffed sick bay and a couple of staples (or some superglue for small cuts) can get you back in action. I believe most offshore sailors have read enough to know how to do this

I'm saying that surgeons who know better working in a sterile environment with all the wound cleaning access and supplies and skill (such as an operating room/theatre) will often leave wounds open, or partially open, because they understand what types of wounds ought not to be closed and why.

[Singularity]

How to maybe look at AEDs differently...how they may have more utility on a boat than just great-grandpa keeling over. The logic below is sound; the metaphorical interpretation is loose:

First, consider that the everyday synchronized electrical activity in the heart is maintained by electrical wires running about the heart. In a healthy heart, none of the wires are crossed (or shorted against one another).

Next, consider that the wires transmit signals slowly, as in meters per second or something.

Next....understand that the wires are not wires, but really a bunch of capacitors connected in mostly series, but a little bit in parallel. They are capacitors that have a tendency to discharge on their own, and they're very sensitive to oxygen levels, electrolytes, stress levels, etc.

Next, with normal oxygen, the capacitors discharge/recharge per routine and all signals go in the normal series (synchronized) fashion.

IF there is inadequate oxygen*, then the capacitors don't fire/recharge per routine and all hell breaks loose. When this is so, we call this fibrillation. The normal "cyclical cascade of electrical" current is lost; insofar as these ~currents are what stimulates the individual cells that comprise the heart pump to squeeze in a coordinated manner...the heart just jiggles. Little clusters of capacitors doing their own thing, ~telling/causing little segments of heart muscle to squeeze at relatively random (unsynchronized) times.

*scar tissue in the heart (age-related, from previous heart attack, or gross structural changes from chronic hypertension, plus lots of other stuff) outright may effectively be thought of as offering lowering of fibrillation threshold...people don't per se get tested for this stuff in normal cardiology visits...but to some degree it can be tested for (i.e. electrophysiology studies)

So some AED scenarios:
1) Great-great grandpa gets a sudden occlusion of a major coronary artery such that a large segment of wiring gets an immediate loss of oxygen producing fibrillation, and grandpa goes down. If this isn't occurring within a few minutes of a well equipped hospital, this is a bad deal. You can shock the heart back maybe, but because of the un-fixed oxygen-to-wiring problem, it'll just go back into fibrillation.

2) Grandma has had some progressive loss of blood flow (over her lifetime) that either caused a silent heart attack in the past, or, just overtime enough coronary artery occlusion has resulted in enough damage to the wiring that....even without a new heart attack...or angina or heart attack symptoms...can "lower the threshold" that in certain circumstances (e.g. stress, dehydration, mineral efficiency [capacitors run on minerals], etc, etc, etc) she can go into fibrillation. Shocking her back may buy her a heck of a lot of time to get on a helicopter to a doc or something. Sure, the stress/electrolyte/whatever perfect storm that immediately prior triggered an arrhythmia is likely there...putting her at high risk of ~fibbing again, but this is a much more salvageable situation than #1 above. And with adequate meds/training/phone/IV on board...this really helps in the #2 scenario.

3) Healthy coronary arteries, healthy wiring, but random bad event like electrocution, drowning, random drug reaction (normally all the capacitors in the wiring system has some ability to re-synch, but this isn't 100% reliable and is less so with age). Otherwise, like the "rogue wave" phenomenon...some people come from the factory with electrical issues that will cause a ~random rogue/fatal rhythm every so often.

I have an AED for the rare events (#3), and maybe #2 events. #1 events (most common) are typically bad, but like the controversy about parachutes in small planes goes...the AED gives you something to play with on the way to a certain death...it can't hurt anything, besides the pocket book.

**All the above references to fibrillation refer to ventricular fibrillation. Atrial fibrillation causes it's own separate problems, but also can push people into category #1 above (and/or exacerbate category #2 and #3 issues as mentioned above).

[lhuff35204]

World Travel Medical Kit (that I use)

First Aid:
Bactine skin wash (more lidocaine than any other brand)
Gauze sponges
Surgical pads
X-large Band-Aids
1” Band-Aids
Steri Strips
Israeli Bandage
Blister pads
SAM splint
Triangular bandage & safety pins
4” & 2” Coban bandage
Pocket mask
Duct tape (small roll)
New Skin liquid bandage
Triple antibiotic ointment
Benadryl cream
Antifungal cream
Hydrocortisone spray
Burn ointment (anesthetic)
Hemorrhoid cream
Surgical Instruments Kit
Sterile syringes
Tweezers sharp point
EMT Scissor
Stethoscope / Sphygmomanometer
Thermometer (electronic)
Nitrile gloves
Hand wipes

Sundries:
DEET repellant
Permethrin
Hydropel ointment

Over-the-counter:
Antacid (chewable Pepcid)
Pepto-Bismol caplets (4 per day)
Flavored oral rehydration salts
Pseudoephedrine 24hr (decongestant)
Nasal spray (decongestant)
Benadryl (antihistamine)
Primatene mist (asthma or anaphylaxis)
Imodium (4 per day)
Coated aspirin (as an anti DVT or chest pains)
Naprosyn
Ibuprofen
Tylenol
Polysporin eye drops
Redness eye drops

Prescriptions or buy in country:
Ambien (for sleep)
Alprazolam (anxiety)
Scopolamine (sea sickness)
Donnatal (for abdominal cramps or sea sickness)
Ultram (for pain)
Fluoroquinolone antibiotic 14+ days
Doxycycline 14+ days
Lariam or Malarone (malaria)
Zofran (for nausea)
Butorphanol tartrate nasal spray (severe pain if available)

[Singularity]

Some ideas added below. I sincerely don't mean to be critical, just offering alternative ideas using the list that's there..maybe for a boat with less space or stranded for an extended period:

Originally Posted by lhuff35204

World Travel Medical Kit (that I use)

First Aid:
Bactine skin wash (more lidocaine than any other brand) = in a pinch, most any soap + boiled water
Gauze sponges =Boiled linen/socks; apply this to skin, back with paper towel, toilet paper, more linen/socks)
Surgical pads = boiled linen/socks, again backed up as above
X-large Band-Aids = consider that old school is to let wounds breath, leak, maybe benefit from UV sunlight; boiled linen covered by cleansed compressive wrap "ace bandage" as alternative
1” Band-Aids = as above
Steri Strips = good alternative to sutures; alternatively leave wound open, or cover with boiled linen and held in place by ace wrap
Israeli Bandage = good to have a few on-board; linen/sock/ace wrap alternative/back-up
Blister pads = moleskin? yes please; can ~create with quality duct tape or quality medical tape +/- rubber gasket material, dining place mats, etc
SAM splint = must have onboard; can replicate with scavenged thin sheet metal from somewhere on board
Triangular bandage & safety pins= +/- cut up linen/shirt + any fastener or knot
4” & 2” Coban bandage= nice, would invest in re-usable compression bandages assortment first (i.e. ace-wrap)
Pocket mask
Duct tape (small roll) = high-quality, consider replacing all tapes on a regular basis
New Skin liquid bandage
Triple antibiotic ointment = consider mupirocin 2%...mupi usually kills MRSA, triple doesn't
Benadryl cream
Antifungal cream
Hydrocortisone spray = never, ever allow in eyes
Burn ointment (anesthetic) = try to scrounge up silver impregnated dressing pads if nothing better to do with a little extra change
Hemorrhoid cream = witch hazel works too, while hazel helps with other stuff; sitz baths in warm fresh water, etc
Surgical Instruments Kit
Sterile syringes
Tweezers sharp point
EMT Scissor
Stethoscope / Sphygmomanometer =practice listening to clear lungs and to the belly...to hear the normal belly sounds gurgling around...so that you get an idea, maybe, of bad lungs sounds and/or zero belly gurgling sounds (in an emergency just compare to asymptomatic person)
Thermometer (electronic) = consider adding mercury type in a stout tube for backup
Nitrile gloves
Hand wipes

Sundries:
DEET repellant
Permethrin
Hydropel ointment

Over-the-counter:
Antacid (chewable Pepcid)
Pepto-Bismol caplets (4 per day) = note can/will cause ~black stool
Flavored oral rehydration salts = can exacerbate nausea if used inappropriately; can make OTC w/2 tablespoons sugar, 1/2 teaspoon table salt per liter water
Pseudoephedrine 24hr (decongestant)
Nasal spray (decongestant)
Benadryl (antihistamine)
Primatene mist (asthma or anaphylaxis)
Imodium (4 per day)
Coated aspirin (as an anti DVT or chest pains)
Naprosyn
Ibuprofen
Tylenol
Polysporin eye drops = make sure the eye drops do not have any steroids in them
Redness eye drops
Consider antibiotic eye drops with steroids to have on board, but don't use unless talking with someone by phone who agrees that they should be used

Prescriptions or buy in country:
Ambien (for sleep)
Alprazolam (anxiety) hesitant to mention this, but if seasickness is bordering on dehydration that is a severe risk to health, this may help symptoms enough to get some fluid in
Scopolamine (sea sickness)
Donnatal (for abdominal cramps or sea sickness)
Ultram (for pain)
Fluoroquinolone antibiotic 14+ days
Doxycycline 14+ days
Lariam or Malarone (malaria)
Zofran (for nausea)
Butorphanol tartrate nasal spray (severe pain if available)

There are some other antibiotic considerations...not sure if acceptable to mention them here...maybe moderator can comment?

[Pelagic]

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.

Exactly, have been doing that for years. Controlled drugs kept in a well presented bondable container with detailed printed update to be part of our entry formality.

While some study hard and inspect contents on departure, most just accept as legitimate ships inventory

[BigAl.NZ]

Anyone here carrying GTN/Nitrolingual spray?

[Pelagic]

Great input from many with real "remote" world experience and advanced understanding of medical emergencies.

Today with SATCOM or even SSB you can get help from a USCG Fleet Surgeon to try and save a life.

I've had to do that twice when evacuation in the middle of the Pacific was not possible.

First case was a burst appendix where we managed to diagnose and maintain vitals for 3 days in order to get permission and a very sick crew to Kwajalein Atol where the military base hospital immediately operated on him.

They complimented our crew on keeping him alive long enough to get to Kwaj, with the use of our available Meds.

That one reminded me of an old British ships masters book I read in marine college teaching you how to remove an appendix at Sea. So glad I've never had to try that...

The 2nd emergency was a heart viral infection in Yap atol.

With the help of Yap divers and their unlimited oxygen supply we kept him alive overnight so that a Med Evac at low altitude could be organized to get him to Guam.
(In intensive care, they managed to stabilize him after two weeks, so that he could be Medivaced to Miami via Hawaii). Where he eventually recovered after a year

My point, while Medivac is the best solution, sometimes you need to be able to stabilize with what you have onboard in communication with remote Dr's advice.

Carrying onboard what a Dr. needs to try and save or stabilize patient, is how I look at the medical emergency ships inventory.

[Paul L]

Originally Posted by Discovery 15797

US data here from NIH

Quote:
Survival was 9% (382 of 4,403) with bystander cardiopulmonary resuscitation but no AED, 24% (69 of 289) with AED application, and 38% (64 of 170) with AED shock delivered.

.....

Not sure the stats listed here have much application to remote cruising. In the study the EMS shows up on average in less than 6 minutes. Then the patient is whisked to a trauma center. Any patients that didn't have an EMS show up were excluded.
The definition of survived is discharged from the hospital. Many of those discharged will be to nursing homes with significant disability, aka a major reduced quality of life.

An AED used in a remote cruising environment is very unlikely to end with a good outcome. For most cruisers, you'd probably get a lot more benefit spending the AED initial cost and maintainance cost (expiring battery, pads and unit) on remote medicine courses for all the crew.

Having an AED onboard may give you a comforting feeling that you are addressing all risks. At usd1,400 plus maintainance costs it isn't that much in the scope of running a cruising boat.

[slug]

Originally Posted by Paul L

Not sure the stats listed here have much application to remote cruising. In the study the EMS shows up on average in less than 6 minutes. Then the patient is whisked to a trauma center. Any patients that didn't have an EMS show up were excluded.
The definition of survived is discharged from the hospital. Many of those discharged will be to nursing homes with significant disability, aka a major reduced quality of life.

An AED used in a remote cruising environment is very unlikely to end with a good outcome. For most cruisers, you'd probably get a lot more benefit spending the AED initial cost and maintainance cost (expiring battery, pads and unit) on remote medicine courses for all the crew.

Having an AED onboard may give you a comforting feeling that you are addressing all risks. At usd1,400 plus maintainance costs it isn't that much in the scope of running a cruising boat.

It’s all about the “ comforting feeling “

Best to only protect against known medical challenges While cruising

I just heard from a mate ... cut his foot when He took his going into town shoes off while beaching the tender

stepped on a sharp piece of metal

nasty cut

Not sure what he had in his medic kit , but this wound good easily spiral into an emergency

[s/v Jedi]

Originally Posted by Singularity

I'm saying that surgeons who know better working in a sterile environment with all the wound cleaning access and supplies and skill (such as an operating room/theatre) will often leave wounds open, or partially open, because they understand what types of wounds ought not to be closed and why.

Yes, of course. This thread however is not about shoreside medical facilities but about short handed, offshore cruising. Cleaning and disinfecting a wound as good as possible, then closing it with superglue, suture or staple to enable sailing on is afaik the best way to deal with it.

More problematic is stopping bleeding. Very few boats are equipped for this while it is often needed. You bleed out before help arrives if the bleeding can not be stopped. This is why I always stress to carry plenty Israeli battle dressings in several sizes, quick clotting agents like Celox or even Celox impregnated gauze and, if willing to study it’s use, a tourniquet.

In all the years of cruising I only once needed a small battle dressing for crew aboard, but we have assisted others many times, both cruisers and local people. The most used items were bandages, insect/sea-creature bite/sting treatment (StingKill ampules), antihistamines and broad spectrum antibiotics.

[Paul L]

Originally Posted by s/v Jedi

Yes, of course. This thread however is not about shoreside medical facilities but about short handed, offshore cruising. Cleaning and disinfecting a wound as good as possible, then closing it with superglue, suture or staple to enable sailing on is afaik the best way to deal with it.

....

Closing a wound that could be dirty or have forgeign material with sutures or staples is certainly not the advice I've received from remote medicine docs.
WHO states
"Do not close contaminated and infected wounds, but leave them open to heal by secondary intention"
https://www.who.int/surgery/publications/WoundManagement.pdf