Fears of a major medical emergency

You want to know what keeps me up at night? I know this is a dark subject, but it has been a long off-season and I think about this a lot. So... why not share it with the group.

I am so scared that I won't be able to help Bess if she had a major, or even semi-major, medical emergency.

By far, my worst boating fear would be to lose my wife due to my own ignorance. Yes, I know I should take a course, but would that even prepare you for seeing your wife lying in a pool of her own blood with a tibia sticking out of her skin? I feel like I would only be able to cry and vomit at the sight, only being able to maybe try to control the bleeding, but no more.

Let's pretend, for a moment, that I would even HAVE all the necessary medical equipment onboard (and we don't), I still seem to have such a queezy stomach that a compound fracture or major tissue trauma would make me incapable of rendering proper medical care. There is, of course, a book onboard that came with the med kit, but seeing a 2D line drawing of a broken femur looks easy to fix on paper. I just don't know what to do should something like a fall cause sufficient damage and blood loss.

I guess the short version is: I know enough to know that I don't know enough. Any suggestions? Anyone else in my dark place too?

I need a drink---

I would have the same reaction. I can't handle blood from humans. I've skinned and gutted deer and can handle that, but for some reason human blood\trauma freaks me out.

Relax guys, even for me, a qualified medico, there is little above basic first aid I could do out at sea either...and you are not expected to..!

It is therefore not worth spoiling the pleasure of boating to worry about something that might, but is very unlikely, to happen.

Unless, of course, the boating involves someone who is severely debilitated from existing medical conditions. In which case one decides either it is time to call boating quits - or, being philosophical, accept the fact that if they died out boating, they couldn't think of a better time and place to do it.

Just remember, all it takes is to activate the EPIRB, (which it is wise to have) and wait for help to come to you, even if outside areas covered by Coastguard or other Marine Rescue services. If within one of those areas just make sure all crucial crew, (including wives), know how to send a MayDay via VHF. With many VHFs now it is just the pressing of the red button, right..?

Seriously, we are all going to die of something - eventually. This came home to me recently when I diagnosed, with some trepidation re his reaction, a probably fatal tumour in a 71 yr old man. But he had, and still has, a great attitude. His response when advised by me of this was to say..."oh well doc, I guess at my age I was going to develop something to die of eventually - I guess this might be that..?" What can you say? - he had me at a loss for words because he was so right...

As Art would say, happy boating dayze - just enjoy, and not worry about things we have little control over...that's my take on it after 50 years in the health business.

Many years ago I was an EMT, and I definitely saw my share of things, and you're right, it's entirely different when its a loved one. Well at first anyway, but after that initial reaction, knowing what to do can go along way to helping the situation. I'll admit that having confidence in your actions based on experience really helps in those situations, but You can't go wrong by learning more about what to do.

One of the things I'd suggest concentrating on learning is when is someone in an immediate life threatening I situation vs. when they're in a lot of pain but not in immediate danger, which is way more common in my experience. It'll be easier for you to remain calm if you KNOW this will turn out ok.

Stabilizing a compound fracture of the tibia is not that hard and you can surely learn how to do it and what to do to minimize blood loss.

What would be the best place to go learn? I don't know. Somewhere there must be a course specific to boaters. Of course the difference is the amount of time you could be the only medical help.

Know anyone in the medical profession? Ask them to help you out. I actually got my old partner (now nurse) to come out for the day and give my wife a crash course on what she can do if I get hurt. She's been looking forward to stapling me ever since

Consider More Training

Great thread!

Perhaps some medical training would ease your concern a bit? First aid and "field care" has advanced greatly as a result of (unfortunately) many years of combat experience. For example, the thinking regarding tourniquets has changed from "last resort" in the late 1990's, to get one on and NOW in current times.

There are traditional classes for first aid, first responder, and EMT. You'll also find courses for the outdoors crowd, who may venture many hours/days from professional help. There are also combat lifesaver courses for trauma. Sure, a bomb blast while underway on your passagemaker is unlikely, but there are many things aboard that could cause a traumatic injury.

After some training you will have more confidence and know what gear you want to have aboard. You can make a kit yourself and not break the bank. We keep gear aboard IRENE for addressing things that are very serious (we do not carry the off-the-shelf first aid kit). Serious bleeding, obstructed airways, and tension pneumothorax can and should be addressed immediately...and you CAN do it and save a life. For us, this gear is just like the spare fuel filters and fire extinguishers.

Hopefully we look after each other well, exercise good risk management, and remain safe through prevention. We are coastal cruisers now, and that means we are usually an hour or more from obtaining care from an EMT/Paramedic. We want to be prepared for that hour or more if it's something we can manage.

Best Wishes

Spot Messenger (or the like) with an SOS button gives peace of mind. Also, unlike an EPIRB, a Spot lets your family and/or friends know your exact position whenever you send an "OK" message, which means if you both become incapacitated or separated from your boat a search can start from there instead of "somewhere between Port Hardy and Ketchikan".

A great reference book in case you're in an isolated area and it could be hours or a day before help arrives is Medicine for Mountaineering;

Medicine for Mountaineering & Other Wilderness Activities: James Wilkerson: 9780898863314: Amazon.com: Books

Statistically, crosswalks scare me more.

Fortunately, "there's an app for that":




Keith

Keith

(Dupe post courtesy of bug in TF app)

After many years of work as a cop and being at countless accident scenes, I'm just a little bothered by the sight of blood, but not much. I have found in an emergency that I revert back to the training I received and do what is needed by rote, not stopping to think about what I'm seeing.


I think Peter nailed it--there's only so much one would be able to do if faced with a serious injury such as a compound fracture. Your response would likely be limited to making the injured person comfortable and getting them to an ambulance ASAP.

It may sound extreme, but given that a cardiac event may be your last event, I don't think having a defibrillator onboard is unreasonable. I see them on planes as well as in many public buildings. It would require some training to be used effectively but well worth it. Check Ebay for an idea of prices and selection. Like our EPIRBs we would hope to never need it.

Tom, I am not familiar with where you cruise so I don't know how remote you tend to be. As others have mentioned, taking a basic first aid course is always a good idea but you are not expected to do much but keep someone stable until trained personnel arrive.

More importantly, try and do a realistic assessment of the risk. Do you have the same fears if you and Beth are out for a remote walk in the woods, or a road trip, etc...? Boating is generally a pretty safe endeavor. Don't let borrowing trouble spoil the fun. Easy to say, hard to do.

Blood doesn't bother me too much. However when I had to take my 4 year old son to the ER because he ripped his big toenail off, I was fine until I was leaning up against the exam table holding him while the ER doc was cleaning up the mess of tissue. When I started to get light headed I swapped places with my father-in-law (he was a surgeon) and I had to sit down. The fact that it was my little boy got to me. However, it didn't phase me until after I had done what I needed to do which was assess, stabilize, and transport. Once the responsibility was not mine, then it got to me.

I think that you would find that you would be able to do what needed to be done at the time.

So suck it up and take a high quality set of Red Cross first aid courses, and get the appropriate medical supplies on board. If one of you has a heart condition of any kind, get an AED. Those things and a Mayday are all you need. We were very conscious of the possibility, especially since we are clumsy and like to anchor in somewhat remote spots. So we did something about it instead of worrying.

If I'm in any of your boats when I get a fracture please do not get me to an ambulance ASAP. Slow down and don't pound into the waves. Thank you.

I had that same fear so we followed Medical First Aid up with Medical Person in Charge training. Both were at a Maritime School as part of our training but could be taken as stand alone. We also carry a very full medical kit and have access to a medical service. If you're not going well offshore the medical service is probably an unnecessary expense. Many would say the other items are. However, they give me peace of mind.

Do I believe I can definitely save my wife from a heart attack or stroke or anything that happens? No. Not even people far more trained than me can do that. But I'm by nature very squeamish when it comes to blood and gore and I'm not confident that I can step in and perform to the best of my abilities. The time spent training in an Emergency room as part of the course was very tough for me, but I soon found myself thinking rationally there as opposed to struggling to deal with what I saw.

I do know I'm far more capable than I was without the training. I'd never taken any first aid course. My wife had some training as part of her teacher training prior.

I would at least take some good first aid training. At least then you'll feel like you've prepared the best you can.

Tom.B; said:

I am so scared that I won't be able to help Bess...

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So turn it around, Tom.

Is Bess also scared Tom won't be able to help her?

Is Bess scared she won't be able to help Tom?

Needless worries.
Get together on this and take even some basic courses, together.
Talk about it, together.

Here's the funny part...IF scenario 1 happens, Beth might be the calm one and guide YOU through what to do.

Tom.B said:

I guess the short version is: I know enough to know that I don't know enough. Any suggestions? Anyone else in my dark place too?

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caltexflanc said:

So suck it up and take a high quality set of Red Cross first aid courses, and get the appropriate medical supplies on board. If one of you has a heart condition of any kind, get an AED. Those things and a Mayday are all you need. We were very conscious of the possibility, especially since we are clumsy and like to anchor in somewhat remote spots. So we did something about it instead of worrying.

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What would you do if at home, on the road, etc...
Probably call for help the only difference is how to call for that help when aboard.
Agree response time may also be different so what to do in the interim will depend on the condition.
The good news is whatever you learn will help you & Bess whether on or off the boat

Agree w/ cal...
Best place to start is Red Cross - they have many courses and avenues to learn including some online options.

Like they say... worrying is like a rocking chair -
It will fill your time but won't get you anywhere!

Take the step to learn and you & Bess will sleep better.

petdoc4u said:

It may sound extreme, but given that a cardiac event may be your last event, I don't think having a defibrillator onboard is unreasonable. I see them on planes as well as in many public buildings. It would require some training to be used effectively but well worth it. Check Ebay for an idea of prices and selection. Like our EPIRBs we would hope to never need it.

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We carry one. Prices have really dropped.

The things I would expect to use most would be treatment for cuts including closure of wounds, medication for allergic reactions, antibiotics, immodium and laxatives, treatment for sun burn, bags for infection control (boat is small area and infections or viruses spread quickly), airway kits, stethoscope and blood pressure equipment, oxygen, test kits for things like malaria. So far we've never needed more than basic first aid and hope we never do. We know if we're 50 miles offshore and someone has a heart attack they may die, but we do know what to do plus we have ER doctors to call who can further supervise us and make sure we're doing what we should be.

If our cruising was on the ICW our emphasis would be different.

A bit off topic, but this is a first-person account of a recent medical emergency in a major Laser Masters event in Mexico.

Please share to help others.
Okay, I just thought I would let you all know that I am very much alive, but a little weak.
After finishing the practice race on Saturday at the Laser Radial World Masters in Mexico I had slight chest pain as I crossed the finish line?
I decided to stay out and practice in the 20 to 25 knot winds and sailed back up to the top mark so I could reach back to the club. At the top mark the pain went away and I thought nothing was wrong.
When I got back to the club the pain came back and I knew things weren't right, I relaxed and slowly made my way up the ramp but was unable to take my boat out of the water and required help to get to my position in the boat park.
I lay down next to my boat and someone jokingly called out, sailor down, sailor down,thankfully this got the attention of Andy from the club who helped me get to the clinic where they immediately wired me up to a cardio machine. I am eternally grateful to Andy for saving my life, for if it wasn't for his quick action getting me to the clinic I wouldn't be here now.
I said to the doctor I am feeling tingling in my hands, he said, well Sir, we can see that you are actually having a heart attack as we speak.-------------------- I was dead for 3 1/2 minutes had heart, chest massage and was zapped twice to bring me back and placed in a medical induced coma for 24 hours.
I would like to personally thank the sailing staff, the medical clinic staff and the doctors who operated on me and put a stent in the 99% blocked artery.
The upside is that there is no permanent damage, and I am still just as crazy as ever but will wait awhile to go sailing.
The down side is that I have missed the opportunity to compete in 2 World Laser regattas this year, but there's always next year in Europe.

Hate to say it...but at the other end of medical emergencies at sea.....

Accept that something bad might happen and the outcome unthinkable.....tthe price we pay to boat.

15 feet from a dock is the equivalent to the wilderness....if an ambulance can't get to you....you might as well be on a mountain top.

Take some courses...but squeemish or not...you can't do a lot so get help coming your way, sustain life and head toward the rescuers.

I just went to a class run by an ER doctor and it was interesting because he contacted the Coast Guard to ask their opinion of things and they said they would rather be hailed for a non-emergency than for someone to be afraid to call them in an emergency. Let them be the ones who decide if you need help or not. Give them a call.

Thanks everybody... This has been helpful.

I am a surgeon who spends a good deal of time taking care of trauma patients, with also an extensive background in cardiology/cardiac surgery. A few observations about medical emergencies.

The great majority of mishaps I see are preventable. Obviously alcohol or drug impairment leads the list, but let's assume most boaters have the sense to drink after the engines are shut down. The next traumatic injury on the list would likely be related to docks and docking. Drilling into everyone that no hull or any boat part is more expensive than a human part is important. Never extend any limb, jump, or otherwise attempt any heroic boat saving maneuver. Same with anchors or mooring balls--they are responsible for mangling hand injuries. Again, just let it go.

If seas are rough, find a secure place and stay put. Walking around on a heaving vessel isn't smart, and virtually any trauma victim will regret an error in judgment at some point. Let the dishes break, the cabinets fly open, and the boat become a yard sale before venturing on an unstable surface.

Maintain your flexibility as flexibility avoids falls, which produce the open fractures Tom alluded to earlier. I highly recommend yoga or something similar. As we age the balance and flexibility diminish, and falls increase. Falls are probably the most morbid, and most preventable events of the mature demographic.


Medical emergencies are also avoidable, although not completely. There is nothing like a vigorous and negative cardiac stress test to put your mind at ease. Have your friendly family practice or cardiology doctor run you on a treadmill and follow it with an echo. It costs about 1200 bucks and is worth the piece of mind. I would second idea of purchasing an AED if there is a history of coronary disease. Pay assiduous attention to things like blood pressure and blood sugars in the case of diabetics and you can avoid all those troubles.

Get rid of your gut and exercise every time you are close to shore. An elevated body mass index (BMI) is a predictor of medical events, so lower that risk. There is no reason to avoid cruising, even off shore, if you minimize your risk ahead of time.

Your body is no more than a vessel that transports your soul through your life journey. It isn't much different than a boat. A well maintained boat has few problems, a neglected one a lot. Careful attention to detail and risk mitigation will reduce your risk of a medical event to below that of what you would experience on land.

You're going to get your adrenaline flowing, and the will to survive - and help your loved one survive - is going to kick it. It may take a few seconds - perhaps even a full minute - for your brain to kick you in the butt, however it WILL kick in.

So now that your body has done it's part ("get back in the fight, Maverick!") it's now up to you to do so.

1. Take a CPR course.
2. Learn how to clear the airway.
3. Learn to stop the bleeding
4. Learn how to treat for shock.
5. Practice getting your first-aid kit out ("where the hell did I store that again?")
6. Know how to activate your PLB/EPIRB. Don't wait for an emergency to read the instructions.
7. Wash, rinse, repeat.

Think about this: the first word in any checklist (including the one above) is a verb. TAKE/LEARN/PRACTICE/KNOW. They are designed to remove any thought process. The thought goes into the planning of the checklist. You just EXECUTE on the plan. Same here.

Do it over and over so that you DON'T have to think. This will also help you overcome the fear/paralysis when something happens.

You'll do fine.

An AED is a must for older cruisers or anyone diagnosed with heart problems or high blood pressure. They are becoming more affordable yearly and they are "idiot proof" If there is a situation that requires one and you don't have one, then the person WILL die.

Control the bleeding - there are many easy to use tourniquets and blood clotting gauzes and bandages available on the market. Top that with a good compression bandage and you are set.

QuikClot® Advanced Clotting Gauze

SWAT-T Tourniquet

Those are probably the main items needed for the more serious problems an average person can assist with. I do not endorse these specific web sites or products, I am just provide a research tool for you.

petdoc4u said:

It may sound extreme, but given that a cardiac event may be your last event, I don't think having a defibrillator onboard is unreasonable. I see them on planes as well as in many public buildings. It would require some training to be used effectively but well worth it. Check Ebay for an idea of prices and selection. Like our EPIRBs we would hope to never need it.

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While the above could be considered a reasonable thing to do, especially if money is no object, like EPIRBS, they have a finite battery life. To put things in perspective, in terms of likelihood it will be used, as a family physician now for about 40 years, we have never had to use one, even in a busy medical surgery, in that time. Our defibrillator's battery died and had to be replaced several times in that period, then finally, somehow, it walked, so we did not replace it. It is not mandatory, even for a medical surgery.

I won't say it can't or won't happen, but thus far it hasn't, so the chances of it out boating are slim indeed. Unless, that is, the person is already one who has an established heart condition where it is much more likely, in which case they could - maybe make that should, (and usually are) - already fitted with an implanted automatic pacemaker/defibrillator. But, yes, by all means do a first aid and CPR course.

As a footnote, having now seen a few other posts above, including other medical people, it is worth noting that if someone suffers from a condition serious enough to suffer something like a cardiac arrest, such that a defib. might retrieve a pulse, (excluding maybe an electric shock), unless one has the necessary equipment, IVs, drugs, oxygen, monitor, etc, to sustain them after the defib, and able to get them to a hospital asap, it will likely be in vain. I also worked as an anaesthetist and emergency room doc, so sadly, I know these things. I mention it not to frighten you, but to reassure you it is not being silly or negligent if you elect to not have a defib on board, just sayin'...

Peter B said:

To put things in perspective...

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Aside from us getting away from the original question of alleviating Tom's fear, it's nice that you put it in perspective, Peter. Just far too many "what ifs" to ponder so, as long as we have something more than no basic knowledge, experience and assistive equipment, we could give ourselves an infarct just from worry.

If I can get silly for a moment, something others think I do with ease; slamming into a big wave, breaks a waterline which sprays on whatever to cause a total power failure resulting in a joker valve seizing in skipper's built in fuel pump. He goes down, the only crew at the time is a nine year old granddaughter who faints getting a worm on a hook and has zero knowledge of anything boat or body.

Whoops.

So, how far do we go to cover it all? Stay home I guess and hope the aerobics nut upstairs doesn't cause the chandelier to fall at the very moment we're under it.

Now I understand why that 48 OA had a helipad.

Tom; just keep on Skinny Dippin'.