Upgrading your Boats Medical Locker

[Davo1404]

Originally Posted by CassidyNZ

Which begs the question: what medical provisions (and how) do you carry in your grab bag? I’ve long been in the habit of immediately after departure, placing sign-out papers, passports and wallets/purses of all on board in the grab bag. You’re not going to need them until we reach our destination and it’s a bad idea being rescued from a disaster to be set down in a foreign country without papers/money.

Perhaps it is a good thing to have a seperate cache of med supplies in the first aid box that can quickly, without long deliberation, be transferred to the grab bag.

Must say, I’ve never really given that much attention. What would that cache look like (and please don’t include an AED [emoji3])?

You might need the AED after a few days use of the credit card!!,

[GarryD]

Sorry - meant to stress that "cruises" referred to times when we have been on vessels where they serve cocktails, someone to make up your bed each day, provide too many meals and someone else worries about the navigation!


Discussion on the contents of a boat's grab bag is likely to get the internet buzzing somewhat.

[Toys_with_time]

Originally Posted by joeelliott

Look up "Advanced Trama Life Support " ATLS 9th edition, It is put out by the American College of Surgeons, and was free to download when I did it about a year ago

Some sites want to charge up to $300 for it but can download for free from
https://viaaerearcp.files.wordpress..../atls-2018.pdf (very large file so can take a while)
Warning: has some graphic images so not for the squeamish and assumes a level of medical knowledge but IMHO would be a good reference if dealing with serious injury a long way from anywhere and as a back up to over the radio advice.

TwT

[Buzzman]

My father used to carry a First Aid kit when bushwalking. Usual stuff to repair cuts and scrapes. Then, on a trip to the south-west coast of TAS, he came down with what to him felt like flu, and was virtually bedridden in his tent. Fortunately, a passing doctor in another party had a suspicion it was bacterial pneumonia. A dentist in yet another group had, by sheer coincidence, chucked in his pack a few supplies from the cupboard at work, which included a course of penicillin. They left the drugs with Dad to take one per day. He survived, and was with us for another ten years. Nothing else would have worked on that occasion.
Moral is, take what 'might' be necessary - just in case.
I'd be including asthma medications and an epipen. Because I know I have 'allergic tendencies' and may inadvertently come across something I've not previously come across and have an adverse reaction.
One thing I've noted over the years that the commercial First Aid Kits never include is Elastoplast Fabric dressings. Originally, a continuous strip you could cut to whatever length, it was great for patching slashes and longer cuts and scrapes. These days owned by Beiersdorf, limited to 10cm long 'pieces' and a far cry from the original 'superglue adhesive' formula produced by Smith & Nephew (it would survive a shower without losing grip) this 'adhesive bandage' is SO useful for a wide variety of "just stop the bleeding and stitch the wound together" occasions that it simply astonishes me more don't include it.
The reason given, of course, is that it's not 'individually wrapped' and therefore 'non-sterile'.
Having worked in some out of the way locations, where a greasy, oily wrag was preferable to 'nothing at all', I suspect adverse litigation is the real reason 'non-sterile' products are no longer added routinely to "first aid" kits.
As an example - a few weeks ago I was knocking open a casement window that had jammed, and accidentally smashed a pane. A spear of glass penetrated the outer side of the 1st knuckle on my left little finger, which then bled profusely. And I do mean, profusely. Claret everywhere!
I applied pressure with the handkerchief from my pocket (nearest 'whatever bit of rag') and headed for the kitchen and the "First Aid Kit", which in my house includes Elastoplast Fabric. I pulled out a length, guesstimated what I'd need and scissored it off the end of the length, peeled back the paper tabs covering the glue section, whipped the 'rag' off my finger and replaced it with the Elastoplast. Changed daily for a week and no need for a visit to the hozzo. Once actual bleeding had ceased and the wound gummed up enough, I added BFI (bismuth formic iodide) powder and hey, presto, job done.
Now I can imagine a dozen (or more) scenarios where something similar might occur on a boat, miles from any assistance. You can't call out the Coast Guard, you need to 'manage'.
The key point to note (and which I've previously argued with nurses, doctors et al) is that the principal is "FIRST" aid. What's most important from a triage perspective. In this case, pressure on the wound to stop the bleeding, elevation of the limb to reduce flow, and something to 'stick' or 'close' the wound. Adhesive bandage.
In my experience, Johnson's Band Aids just don't work. They simply don't stick to me for some reason, so they are useless. So Elastoplast is the go to adhesive bandage, and the 10cm slabs make it a much more flexible solution for different-sized wounds. [The original continuous strip was even better!]
My First Aid kit also contains gauze and a roll of Elastoplast Tape (the kind that comes in the click-apart circular plastic container. Again, it's 'non-sterile', so First Aid Kit suppliers usually don't include it. Yet again, it's another 'must have' for that simple, "just stop the goddam bleeding" role that is essential in "first" aid.
To paraphrase Karl Malden, I wouldn't leave home without it/them.

[CaptFarmer]

Check out https://fas.org/irp/doddir/milmed/ships.pdf . My older hard copy is over 470 pages long and covers "Body, care after death" and much more.

[CassidyNZ]

Originally Posted by Davo1404

You might need the AED after a few days use of the credit card!!,

You might need an AED after seeing the charge for buying it on your credit card.

Sometimes when I see the extent that some sailors claim they go to with their medical kits, we should start seeing yachts with big red crosses painted on their topsides.

[NorthernMac]

Originally Posted by joeelliott

Look up "Advanced Trama Life Support " ATLS 9th edition, It is put out by the American College of Surgeons, and was free to download when I did it about a year ago

I’d that’s a bad idea.

Get the training or don’t try to play doctor.

https://www.nols.edu/en/coursefinder/courses/wilderness-first-responder-WFR/

[evm1024]

Originally Posted by NorthernMac

I’d that’s a bad idea.

Get the training or don’t try to play doctor.

https://www.nols.edu/en/coursefinder...responder-WFR/

Once upon a time there was a very famous doctor who died and went to heaven. At first he was content to wait in line with the others as St Peter allowed them through the Pearly Gates one at a time.

Soon he became impatient and marched right up to the gates and Said to St Peter: "St Peter I'm a very famous doctor and I've done so much good on earth. Surely, I do not need to wait in line. Please pass me through right away."

St Peter smiled down at the doctor and having experienced the arrogance of doctor replied in an even handed tone "Doctor I thank you for your service to humanity but no soul is more valuable than another. Please be patient and return to your place in the line."

Fuming, the doctor returned to his place and waited his turn.

After a while there came another doctor dressed in a white smock with a stethoscope draped over his shoulders. This doctor marched right up to St Peter, nodded and walked right on past him and through the Pearly Gates.

As you might suspect the Famous Doctor was beyond himself as he watched the other doctor just go right through the Pearly Gates. Stomping up to St Peter in a rage he shouted with obvious anger "St Peter you sent me to the back of the line and I waited patiently but you let that other doctor go right through, Just what is going on here?"

St Peter smiled at the doctor and said in a quiet voice:

[evm1024]

Oh, that? That was God. He likes to play doctor sometimes.

[evm1024]

There is a moral of the story.

Don't do medicine beyond your training and skills. And most certainly don't play God no matter what your training is.

[Pelagic]

Originally Posted by CaptFarmer

Check out https://fas.org/irp/doddir/milmed/ships.pdf . My older hard copy is over 470 pages long and covers "Body, care after death" and much more.

That's the book I remember reading so many years ago in marine college.

Those were the days of prolonged isolation, limited communication, weather advice and navigation based on visual observations.
The mindset then was all about self reliance

[s/v Jedi]

I have taken a couple of days away from this thread to think about this resistance to sailors closing wounds. Honestly, reading later posts, I still don’t know.

I do sense this “we are the doctors, leave it to the pro’s” attitude that has killed many when they find themselves in need of a doctor but find none around.
On the other hand, it may just be a miscommunication, although I still think it is deliberate.

So to be clear, my position is that offshore sailors should have an extensive on board medical kit that includes medical grade superglue (but use any kind when in need) and a stapler. When you end up with a wound which a doctor ashore would clean, irrigate, inspect and close, you should study or take a course to do that as well. The “inspect” part of that touches the “don’t close the wound” part as explained in all the courses available. “Leave it to the pro’s” is BS when out there alone and you need to learn to treat wounds like a pro even when you’re just an amateur. In the end, when in a bind, you probably have a satcom gadget to call a doctor and talk it through and get recommendations on treatment. Also, a deep or complex wound in that case probably disables the person for the most part anyway. And don’t forget medication to counter infection. For serious emergencies I would call a doctor no matter what, this is one of the reasons to get that Iridium Go.

About courses: do the first responder course. In some countries they don’t do tourniquets... if so study that on Youtube etc. because it is a life saver when used right. I got that pig foot course someone mentioned but was told they have artificial suture test objects nowadays

[Buzzman]

Jedi, I agree. The "pros" (no offence) hav etended to hav espent too long in 'medical emergency hospital training' where everything is about 'reducing the risk of later litigation'.
That's fine. For that scenario, I get that concern. It matters.
But, on a boat, in the middle of the ocean, faced with a deep tissue laceration and major blood loss, it's back to triage.
Stop the bleeding - whatever the heck works. If you're in the heads, grab a towel off a rack. On deck? Rip off that fleece pullover and use that.
Also, I think it's fair to point out that most of the advice being given assumes 'at least one other crew'.
So, what about solo sailors?
Say I've fallen on the foredeck, caught my foot between the samoson post and the anchor winch, and sustained a compound fracture of the fibula as a result. Bone penetration through skin. At the back of the calf. Right where I can't see it or get to it.
What do I do..???
Pad it. Wrap it. Stop the blood loss.
Get the cabing and get out the 'what do I do in this situation" book and look it up.
My uneducated giess is not much. But if I had SSB I might be able to reach a doctor and get better advice.
Bottom line is, ya do what ya gotta do.
Sometimes, it ain't pretty.

[s/v Jedi]

There’s also posts from (whom I think are) pro’s who agree that sailors should learn emergency medical procedures so it’s not universal. I suspect that some think the avg sailor too dumb to do it. For those who did not study this before leaving and/or who fell for the “offshore medical kit is all you need” meme they are probably right.

I did the first responder training while in the army and tourniquet technique was part of that, while it was not allowed for civilian use. When talking to civilian medics I got the same BS over tourniquet like you kill someone when you use a tourniquet. I believe they have come around and it’s now legal for civilian use as well... go figure.

That said, around the turn of the century when we were prepping to go full time cruising, we met many others who had no previous medical experience and they all did the specialized courses for sailors that included all of this (except no superglue at the time). So I think many are better prepared than we think.

[s/v Jedi]

On another note and more on topic: over the years of cruising we found that almost every (medical) problem aboard is minor and can be fixed with just a couple of items. This lead to our “mini comfort bag”. Since I wrote about this, we have started adding an alcohol prep pad and some antihistamine tablets to it, but here is the link to the original article. You can’t buy this but you can make them yourself
https://www.sv-jedi.org/sv_jedi/2017...ould-have.html