Medical emergencies

[pmagowan]

In another thread there was a discussion about medical emergencies and what to do. I am currently looking into a general medical kit and was looking for other's experiences of medical emergencies or first aid that they have needed on board. What problems did you have? Did you have kit to help you? Did you know what to do? Did you get assistance if required? What type of kit, if any do you have on board?

That type of stuff.

 

[AntarcticPilot]

In another thread there was a discussion about medical emergencies and what to do. I am currently looking into a general medical kit and was looking for other's experiences of medical emergencies or first aid that they have needed on board. What problems did you have? Did you have kit to help you? Did you know what to do? Did you get assistance if required? What type of kit, if any do you have on board?

That type of stuff.

Kit won't help without knowledge to use it; gaining the knowledge will tell you what you need. Obviously, if you're planning to cruise off the beaten track, as you've indicated elsewhere on here, you need to find a first aid course that will cater for your needs, which will include the likelihood of being several days from help, and being able to respond to radio instructions from a doctor. I suspect that means a course aimed at ship's officers. I've done such a course, aimed at people going to work in Antarctica, and it was three days with lots of simulated injury situations. It was WAY more intensive and higher level than the RYA courses, and I hate to think what it cost my employers! The first aid kit that went with that included pain relief up to and including morphine, and included lots of prescription-only drugs for use under instruction. Things like artificial airways, inflatable splints and much more were also included. Obviously, without appropriate training, an artificial airway can kill, and even with the training, I'd be very hesitant about using one!

Remember, First Aid is about keeping a patient alive until a doctor can intervene. It isn't about replacing the doctor's function, though it may include being able to respond to a doctor's instructions. What you need to do that obviously depends on how far from a doctor you are likely to be.

 

[sarabande]

The OP has rather more than minor qualification in the art of keeping people alive

 

[r_h]

Well worth checking out Medical Support Offshore:
www.msos.org.uk/home.html

 

[pmagowan]

Kit won't help without knowledge to use it; gaining the knowledge will tell you what you need. Obviously, if you're planning to cruise off the beaten track, as you've indicated elsewhere on here, you need to find a first aid course that will cater for your needs, which will include the likelihood of being several days from help, and being able to respond to radio instructions from a doctor. I suspect that means a course aimed at ship's officers. I've done such a course, aimed at people going to work in Antarctica, and it was three days with lots of simulated injury situations. It was WAY more intensive and higher level than the RYA courses, and I hate to think what it cost my employers! The first aid kit that went with that included pain relief up to and including morphine, and included lots of prescription-only drugs for use under instruction. Things like artificial airways, inflatable splints and much more were also included. Obviously, without appropriate training, an artificial airway can kill, and even with the training, I'd be very hesitant about using one!

Remember, First Aid is about keeping a patient alive until a doctor can intervene. It isn't about replacing the doctor's function, though it may include being able to respond to a doctor's instructions. What you need to do that obviously depends on how far from a doctor you are likely to be.

Hopefully I won't be that far from a doctor, being one. (I probably should have mentioned that) You never know it might be me that is in need!

I am really looking for other people's experiences of medical mishaps on board, minor and major. I want to look at organising a kit list for different levels of experience if I can find the time. I am currently reorganising my emergency medical bag and so I am looking at all this stuff anyway. It may be of use for others.

 

[Twister_Ken]

Only medical emergencies I've seen aboard, apart from minor cuts and bruises, have been sunstroke and severe seasickness. Oh, and a couple of badly bruised (almost crushed) fingers as a result of somebody hitting the windlass control whilst I was getting the chain back on the gypsy.

 

[AntarcticPilot]

Hopefully I won't be that far from a doctor, being one. You never know it might be me that is in need!

I am really looking for other people's experiences of medical mishaps on board, minor and major. I want to look at organising a kit list for different levels of experience if I can find the time. I am currently reorganising my emergency medical bag and so I am looking at all this stuff anyway. It may be of use for others.

Apologies to you; I didn't know that! But what is useful to you, with your knowledge and skill, probably won't be useful to A.N. Other without such skill, and in the worst case, might be dangerous in A.N. Other's hands. You will have trained responses that you may not be fully aware of, they are so ingrained, just as I almost automatically read charts and know where I am and can't understand why people have difficulty with navigation and charting!

My Antarctic course really homed in on three areas; wounds and broken bones; burns and hypothermia. Wounds included such things as pneumothorax. Of course, it also covered things like heart failure, drowning and epileptic fits, on the level of how to recognize them and what to do, but the former three were the things we were really taught how to manage. Heart disease was regarded as unlikely in the field; it was covered more for the ship's crews, who were less subject to stringent medical checks before deployment.

Obviously, you will have considered your response to physical injuries such as wounds, concussion and broken bones; those are eminently predictable in the unstable environment of a boat. From my Antarctic oriented course, I'd suggest that inflatable splints are a valuable resource, and also medication and dressings suitable for treating burns - plastic bags, cling film and "Flamzene" (not sure if that's the right name) were what was suggested. Beyond that, I suppose it depends on the medical history and age of the persons concerned. Of course, pain relief is something you will have access to, as well as antibiotics. Again, the Antarctic course mentioned emergency dental first aid; AFAIR there are temporary stopping materials, and such things as oil of cloves are still useful. As a doctor, suture material is something you can use; I'd hate to have to try, though we were shown how!

 

[tudorsailor]

In another thread there was a discussion about medical emergencies and what to do. I am currently looking into a general medical kit and was looking for other's experiences of medical emergencies or first aid that they have needed on board. What problems did you have? Did you have kit to help you? Did you know what to do? Did you get assistance if required? What type of kit, if any do you have on board?

That type of stuff.

I am not a doctor, I am a Mister (ie a surgeon!). I too wonder what kit to have on board when doing the ARC in 2017. As an orthopaedic surgeon, I guess I can deal with most musculo-skeletal injuries. But how much kit should I take with? Plaster cast, splints, local anaesthetic and suture kit? Intravenous catheters and fluids are probably of little value when mid atlantic. Help will take hours to arrive and one cannot take hours worth of IV fluids

Strong painkillers would be good. Not sure the process for acquiring them in the UK as the GMC frowns on self-prescribing.

I guess my fear is infections or appendicitis while offshore.

I asked people who had done the World Rally with Oyster what medical emergencies they had encountered, and a crushed finger was the main one. That would have been easy for me to deal with!

TudorSailor (AKA TudorDoc)

 

[prv]

Again, the Antarctic course mentioned emergency dental first aid; AFAIR there are temporary stopping materials, and such things as oil of cloves are still useful.

I have a large filling in one tooth, which fell out (actually, was pulled out by a toffee given to me by, ironically, a first-year dental student!) hours before departure on a square-rig voyage.

Since getting that properly fixed, touch wood it's been fine, but I do have an emergency dental kit on Ariam in case of similar problems for me or someone else. It's some kind of two-part filler which is meant to stay put for a couple of weeks, but which a dentist should apparently know how to remove cleanly in order to do a permanent repair. And I do have a small bottle of oil of cloves as well.

Most of the rest of the stuff is a fairly obvious combination of a standard first aid kit (various dressings and bandages including some specifically for burns, a Sam splint, steri-strips, tape, antiseptic, etc) and a family medical cabinet (various non-prescription painkillers, skin creams, diarrhoea and seasickness medications, indigestion tablets, rehydration sachets...). But I'm not expecting to be outside of lifeboat/helicopter range on this boat, so it's strictly treatment of minor accidents and ailments and stabilisation of major ones pending evacuation.

Pete

 

[sarabande]

apart from rope burns (damned great blisters on the palm of hands from a runaway spinnaker), and various cuts and bruises, the only accident I have had (so far, touch wood!) is a stellate fracture of the patella and severe concussion from falling down a hatch into the main saloon.


I am not sure what happened over the next few hours but I was first aided (trussed up like a chicken) by a young Royal Marine officer, and heaved up to the Royal Free for plastering.

I'd make very sure that any crew or guests had a good supply of personal medication, and shared the knowledge with other crew. Supplement the usual first aid with an airway, anaphylactic shock pens, suppositories for severe seasickness, something like Celox for major cuts /bleeding, inflatable splints, a neck brace. A really good knockout med for head injuries. Silly things like spare spectacles, too.


And some of those should find a home in the grab bag as well.

 

[Aurai]

Second

The dental emergency cover kit. The next step is to carry antibiotics for tooth challenges, to use under guidance, but useful if +20 hours from shore. Then the one that came up last summer was a severe allergic reaction to sushi and anti-histamine came in very useful.

Thanks

 

[prv]

suppositories for severe seasickness,

Personally I'm a fan of Buccastem here, having seen some impressive results on Stavros. It sticks to the gum inside the top lip to be absorbed through the skin, and should be safe from being vomited out.

Considerably easier to administer to a past-caring person in a pitching boat too. Persuading someone who's at the scared-they-might-not-die phase to try a suppository for probably the first time in their life seems like it could be challenging

Silly things like spare spectacles, too.

And some of those should find a home in the grab bag as well.

Got spare glasses in my grab bag :encouragement:

Pete

 

[Biggles Wader]

I am aware of a case of anaphalaxis that was reversed by a doctor admnistering adrenalin on a boat so that would be a useful addition to the kit.Otherwise,as a doctor you could carry kit to reverse a pneumothorax and maybe do a crico thyroid op?

 

[pmagowan]

I am aware of a case of anaphalaxis that was reversed by a doctor admnistering adrenalin on a boat so that would be a useful addition to the kit.Otherwise,as a doctor you could carry kit to reverse a pneumothorax and maybe do a crico thyroid op?

Just a bic pen!

 

[Biggles Wader]

Just a bic pen!

Be nice to have a suitable drill bit for a snug fit.

 

[sarabande]

I forgot to rcommend Animalintex, as a bandage.

http://www.vetpro.co.nz/Products/First+Aid++Veterinary/Animalintex/How+to+use+Animalintex.html

Very clever stuff used on, err, animals, where the physical challenge of keeping a bandage on in muddy/wet conditions is severe.

It's waterproof (in that it won't unravel if wet) sticks to itself with a clever adhesive, and is elastic.


Used on horses, sheep, cattle to cover wounds in the fields, and sticks like sh*t to their skin wihtout the tering feeling when you take it off. Nice bright colours as well

 

[rob2]

Hopefully I won't be that far from a doctor, being one. (I probably should have mentioned that) You never know it might be me that is in need!

I guess in your case as much as you can carry as you are already way beyond the normal first aid kit's capabilities. Trouble is when you take a survey of "most common" requirements sod's law dictates that it will be an uncommon one that you encounter! Run of the mill accidents as mentioned are fairly common and it's not that unusual for accidents to include serious breakages - plus of course all the ailments that can befall anyone with increasing certainty as we all get older. On the other hand, you can't hope to be as well equipped as an ambulance paramedic or you'll have nowhere to pack your undies away. With your knowledge, experience and contacts though it might be a good starting point to get the inventory for an ambulance and then delete what you can live withou or cannot get.

In a fatalistic way I don't envy your position of having the capability but maybe not the equipment to deal with a medical emergency. Whatever the outcome, I'm sure your crew will be in a better position than most - and sometimes there is no way things can be foreseen.

Rob.

 

[awol]

Had a crew dislocate a shoulder that he wouldn't let the retired doctor on board touch, never mind reduce - refused a helicopter so we dosed him with copious quantities of muscle relaxant* and Volterol, dumped him at the back of the cockpit and finished the race.
A razor and Steristrips have been used to close a head wound that showed bone.
No need for suppositories, normal Stugeron can be administered that way - if the victim is that bad.
Boat carries bandages, dressings, sterile water, umpteen pills, unguents, splints, tapes, tooth filling kit, spare sun cream, etc., but it's mainly stugeron, ibuprofen and plaster strips that get consumed.

*Portuguese brandy actually - I wasn't going to waste good whisky on the wretch.

 

[Yngmar]

You could check what fellow sailing doctors do (the book has a section on recommended kit for various cruising ranges at the end). Being not a doctor myself, I keep the book in the medkit, as it also has lots of handy illustrated descriptions of how to handle various medical emergencies specific to boats.

Other than the book and the usual packs of bandages and plasters, my medkit mostly contains pretty basic stuff. Lots and lots of Stugeron, some Immodium, rehydration packs, vitamins, Zinc oxide cream, over-the-counter painkillers and sore throat/runny nose things. Some dextrose tablets and in the galley is a jar of coffee for non-medical emergencies (definitely a drug if you ask me). Also hot/cold gel packs. Oh, and a wide brimmed hat. Heatstroke is a bastard.

The WHO publishes a rather thick book titled "International Medical Guide for Ships", but it really is for ships - carrying a print copy would sink most yachts.

I've also sailed on a boat with several GPs and a surgeon and their med kit contained some stuff I wouldn't know how to use without a briefing (which was given and quite interesting). The things I can recall were non pen-type epinephrine injections (the stuff you draw up from a glass bottle with a syringe) and an inhaler for something or other. I know of at least one boat on the ARC that even brought a portable defibrillator along.

My worst injury so far was a smushed toe (probably broken, foot turned all blue and green for a while and hurt like a ************). I put some ice on it and limped around for a week and a half. Luckily it was sandal weather.

And finally, here's an excerpt from the legendary Eric Forsyth:

One evening as we tacked, the boat gave an unexpected lurch and Kieron caught his hand between the barrel of the winch and the jib sheet. The top one inch of his right hand middle finger was just about amputated and was hanging by a shred of skin. There was blood everywhere. After packing the wound with paper towel and Neosporin I called a sailing friend, Charles, who is a doctor, for advice using the Iridium phone. He recommended an antibiotic which we had in the medical kit and gluing the part back with Krazy Glue, which fortunately I had on board. We were 300 miles from Fire Island Inlet. We found a plastic tube that would keep the parts together and dressed the wound two or three time a day. Fortunately the weather improved and we made good time to Fire Island Inlet under sail.
[..]
I dropped Denis off at the Port Jefferson ferry and a day later Kieron flew home. He later emailed to say the doctors thought his finger would be saved intact.

 

[prv]

Boat carries bandages, dressings, sterile water, umpteen pills, unguents, splints, tapes, tooth filling kit, spare sun cream, etc., but it's mainly stugeron, ibuprofen and plaster strips that get consumed.

That's a good point - I too have a bottle of factor 50 in the medical box, and after-sun foam stuff too for when it's too late.

The factor 50 is the cheap stuff that goes on like white paint, to encourage bringing and using personal supplies for day to day purposes. But the pusser's version is there if needed.

Last year I instigated a small ready-use box of stugeron, plasters, and ibuprofen to save digging into the main kit for these regular needs.

Pete