Where to get medicine for ships medicine chest?

[matt357]

I plan to sail around the world with several people and regulations state that I have to have a stocked medicine chest. I have a book by the world health organization called "International medical guide for ships" that has a list of the different medications I need to have and when to use them and the dose ect. but it does not say where to get these medications, many of which are normally prescription in the US. Where do you get them?

[chuckr]

pardon the question -- but what regulations require you to have medicines on board?

just a question
chuck patty and svsoulmates
in port yasmine hammamet tunisia for the winter

[matt357]

I'm not quite sure, it says it in the book.

[SunnySky]

The International Medical Guide for Ships is a GREAT reference to have onboard, but it doesn't take the place of real life experience, especially as it related to taking responsibility both legally and ethically for the health of other people onboard. All prescription meds are going to need a prescription for the patient that they are intended for, or someone onboard with legal authority to dispense them. In life or death situations things do change a little bit (hypothetical example like someone with anaphylactic shock clearly about to die but without an Epi pen and no definitive medical care making use of someone elses Epi pen is clearly the right thing do do if available BUT taking on a lot of liability if things don't go right.. and did person giving Epi consider giving the patient diphenhydramine for when the epinephrine wears off? did they accidently use an adult epi on a child? etc etc).
Even though I usually sail alone and am in first stages of sailing around the world (only WA to AK and down to Cali so far as shake out cruise to date..) it was important to gain additional medical experience to be better able to patch myself up plus when I do have guests I take captain's responsibility for all onboard very seriously (despite being a very laid back person..) so I took a wilderness EMT/MPIC course. Two really good schools for such training are NOLS Wilderness Medicine Institute and Remote Medical International - Solutions for Wilderness & Remote Area Medicine. There are other schools but those are the two I would recommend, whatever school you choose make sure the emphasis is on WILDERNESS medicine and/or Medical Person In Charge skills because while regular EMT training is beneficial it always concludes every serious health problem with the same solution: "diesel" (meaning pedal to the metal getting the person to definitive medical care in a hospital setting, which works great when one has the luxury of a hospital nearby but not so great when that's all you have training in and medical evac is simply not possible in a timely manner, if at all...).
As side note, to supplement the above answer, Chinook Medical Gear, Inc - Your Source for Medical Kits, Tactical Combat Casualty Care Items, Emergency First Aid Supplies including hemostatic, bandages, personal protection, iv supplies, tourniquets, evacuation and more! is a supplier of outdoor focused medical supplies and they (among others) carry the Marine 3000 Adventure Medical Kit which is a good base kit to then customize based on your skills, expected needs and experience (in my case, since I play rugby whenever and wherever possible I added a few bottles of sterile saline solution for wound irrigation (which any pharmacy has for contact lens wearers) and sterile staple kits (easy to use one handed..) for patching myself up because it's a contact sport that I love.. But if crew are divers then that would add more focus on ear injuries and decompression sickness than simple sailing related injuries, tropical local dehydration and heat stroke, cold climate hypothermia, etc etc etc :-)
Good luck in your endeavors, learning how best to take care of your own health and the health of others is a great life skill to have :-)

[s/v Moondancer]

Matt,

I think that having some basic medicines on board, antibiotic for chest or urinary infection, benedryl and steroids for allergic reactions etc is a good idea.

All crew members should declare any medical problems and medications taken.

We have a significant 'medical chest' prescribed by a medically qualified sailor. But the were prescribed for personal use not "Captain's Medical Medicine."

Once out of the US many countries will sell you what is reasonably needed. Interestingly Mexico had such a problem with everyone taking antibiotics that they will sell you an epi-pen but not antibiotic.

In one country the local public health clinic gave us a prescription for anti-malarial drugs even though they would be used in another country.

It is a good idea to take a 'course' if you can find one. Some Brits we know took a UK course that came with medications and a body-bag!

Kits

[lorenzo b]

Take an EMT course. You need to know how to stabilize someone who is injured and how to stop bleeding. Medicine is pretty useless without the knowledge to use it properly.

[MBLittle]

I'm still curious what regulations the OP is talking about...

[s/v Moondancer]

I think the OP is referring to the requirement, per individual nations, that require a Captain to have taken a 'Captain's Medical' course. British ships are required to carry an entire pharmacopeia of medicines and someone has to know how to use them.

Ships Captain's Medical Guide

Chapter 6.1 has an excellent description of how to treat syphilis and the possible complications. It mentions the antibiotic doxacycline, possible the most versatile antibiotic for cruisers...It treats a whole range of medical problems including: syphilis, malaria, anthrax and the plague.

Doxycycline Dosage - Drugs.com

We actually carry more doxacycline than any other antibiotic, mostly for malaria prophylaxis but it treats many other problems, and yes, I do have a medical degree but talk to your doctor before you buy anything.

[Teknav]

I don't believe there are regulations in stocking medicines while crossing the seven seas; for non-commercial boats. Even though you may have a well stocked medicine cabinet, using its contents depends on how much you know about drug interactions. Someone who undergoes a seizure or insulin shock can be very difficult to treat while at sea.

While you can call out for a physician or a pharmacist "out there" for guidance, it would be best to screen your passengers and make a decision about their health needs prior to going underway. On the other side of the coin, remote islands will welcome your gift of unused medications; band-aids, gauze, aspirin, antibiotics, antiseptics, suture kits and such.

Mauritz
Pharmacy - Board Certified

[JPA Cate]

Originally Posted by matt357

I plan to sail around the world with several people and regulations state that I have to have a stocked medicine chest. I have a book by the world health organization called "International medical guide for ships" that has a list of the different medications I need to have and when to use them and the dose ect. but it does not say where to get these medications, many of which are normally prescription in the US. Where do you get them?

Locate a doctor who is an offshore sailor in your area of origin. Discuss the issue with him/her. Pay for this person's time, and get the Rxes you need. Fill them for the first time in your local area. This needs to be kept in a labeled, lockiing bag, and probably with a spare list for Customs in foreign countries.

You will need to update it as meds expire, and as better meds become available. In Australia, the chemist's shops (pharmacies) that service big ships can also service your prescription list. Generally speaking, crew are responsible for their own meds, unless there is a local regulation requiring it to be locked.

Good luck with it.

Ann

[Hud3]

Our doctor had taught field medicine to Marines at Camp Lejeune, so he knew a bit about the best complement of drugs for us when we went off cruising. We also set up email communications with him so we could contact him for advice on which drug to use and proper dosage if any needs arose while we were out there. For example, we had three different antibiotics.

Our prescription drug insurance had limits on amounts we could order at one time (3 months worth), so he contacted them to get their agreement to pay for larger quantities of the drugs my wife was taking on a regular basis.

[Stumble]

Matt,

There is a lot of good info here but some common misconceptions too.

Generally in the US a doctor can write a prescription for a ship or vessel's captain to carry onboard to be dispensed as needed. Assuming you follow the doctors/books recommendations for doing so there is very little or no liability incurred.

There are a few things I think everyone should have, and my doctor has basically written me a standing script for when I go to sea for all of them. He and I have a nice relationship where if I use one I must document it, and when I replace them for age/refrigeration issues I bring them back unopened to him so he can confirm they were not used.

This is primarily an issue for the steroids like prednisone which is great for all sorts of things on board, epi pens which are the go to for allergic shock (but must be refrigerated and only are good for 3 months). You also want to have some major knock out pain killers (I like to have mepregan forte which is Demerol and fennergan mixed) in case of major injury. It is also a good idea to have one of the suppository sea sickness medicines since they are the only thing that works once someone is already sick.

I am sure there is a longer list, but these are the things I keep coming back to. However since they are all controlled, and some seriously so, you need to work closely with a doctor about what to carry.

Other ideas
1) try and find drugs that don't have complications with any drugs someone aboard is already taking, just to minimize possible effects
2) I have two sets of instructions for drug use. The first is the bible for marine medicine. The second is on all the labels a single word, possibly two indicating use. This is in case in an emergency an inexperienced person has to be the one looking. So the Demerol says MAJOR PAIN on it, the Eppi pen has ALLERGIC REACTION, ect.
3) for maintenance drugs most insurance companies will allow you to fill more than three months worth under a doctors orders. Or some docs will double write your script. So instead of taking 1/day the script will say 2/day, again it depends on your relationship.
4) see ISAF 4.08.1A found http://www.sailing.org/tools/documen...s1to605012012-[11791].pdf for recommendations on medical literature to have on board. Have a hard copy, and put it in a zip lock bag...

[roverhi]

Find a good doctor who knows a bit about backwoods medicine to give you some pointers. Worth it even if you have to pay them for their time. Quite often Doctors have a good supply of sample drugs or can get samples to stock a medicine chest. Otherwise, you could spend big bucks for medicine you will probably never use. On top of anti bionics, anti diarrhea, etc, you have to be ready to and know how to deal with injuries. Severe cuts requiring stitches are relatively common. Wear the examples of my wife's seamstress skills to prove it. Inflatable splint or other ways to immobilize an injured limb. etc. Much beyond that and you will be way out of your league and have to hope for quick transport of the sufferer.

AFAIK, there are no requirements for medical supplies for a private yacht. Common sense for situations where you can often be 10 or more days away from help should be your guide. Remember reading the British Sea Captains Medical Guide before venturing south. Wife and I got a big kick out of it as it seemed everything in it resulted in death. Especially enjoyed the section in identifying if somebody is really really dead other than by smell.

If you are serious about dealing with emergencies, Lorenzo B's advice to take an EMT course is good. Take the PDR and pay especial care in any medicine's side effects and reactions with other drugs, should you need to use any of them.

[Paul Elliott]

I started with a doctor who had done some extensive sailing, including soloing to Hawaii. We discussed my plans (and my crew) and he prescribed a bunch of medicines for the boat. We also discussed when and how to use them. As the years progressed I would consult with him for prescriptions to replace expired medicines, and to make minor changes (for example, the recommended drugs for treating MRSA infections have been changing).

This doctor has now retired, and I've found that any doctor with whom I've had a relationship will prescribe for my ship's medicine chest, even the heavy-duty painkillers. We usually try for the less-controlled or non-narcotic painkillers, to keep the process simple. I think if I would be shown the door if I just walked in off the street and asked for this stuff, but if the doctor knows me it's not been a problem.

Fortunately, we've never needed to use any of these prescriptions. Unfortunately, the full kit can be pretty expensive, since I pay out of pocket.

[Bestathook]

With all due respect for the magnificence CF Members vessels, I doubt that any of them are "ships". The traditional definition of a boat is" a vessel that can be carried on another vessel.

Legally, ships fall into a different legal category than boats, particularly non-commercial pleasure boats. It is well to keep the legal differences in these vessels in mind. They have different requirements and different privileges.

It is certainly wise to exceed the basic first aid kit for extended cruises, particularly to sparsely inhabited regions. But in inhabited areas, many modern drugs and medical supplies are available. often much cheaper than in the US.

For example, the identical pairs of eyeglasses cost $265 in San Diego, $45 in Mexico, and $12 in India. same lenses by same manufacturer.

In Dakar, Senegal,for example, I have had a clerk in a pharmacy hand me the inventory list, and have me list what I want. A doctor was available if I wanted a prescription. The Meds were incredibly cheap.

In Ecuador I bought in date, sealed, tetracycline off a blanket in the market from a 10 year old kid, whose Mom was selling vegetables on another blanket. Again they cost a fraction of US prices.

I suggest you contact cruisers in the first few countries you will enter and find out what is available for how much $. Then build an adequate medicine chest for the trip, and fill out your wish list in the first place with better prices. Prescriptions are usually easily available.

This may not be so in Europe, but in Latin America, Africa, and much of Aisia I have found it to be so.