Thank you La Mer. Excellent information which combats the misinformation that started this thread.
Will note we compiled a med kit for our boat for voyaging and passage making. As part of our vetting crew we required a detailed past medical history and varied our kit in accordance to some extent. Features included
A separate store of all meds taking by crew. That additional 2 week supply was stored by us in hard shell waterproof containers.
List of crew specific allergies was held by us.
Beyond general surgical, trauma and burn supplies we carried separate modules for infection, vascular, shock, anaphylaxis/allergies, skin, etc.
My wife is an RN, I’m a physician who’s done internal medicine before doing neurology. My PCP is skilled in wilderness medicine. We collaborated on what’s feasible to do on a small boat following the principle of “first do no harm”.
This principle is important. In the absence of basic vital signs and a understanding of the differential diagnosis the indiscriminate use of a vasodilator like nitroglycerin can cause harm. Just like MI can mimic other ills other ills can mimic MI. Probably just fine with uncomplicated esophageal spasm but can envision scenarios where harm could be done. Yes, we did carry nitro. Fortunately like the epi pen never used. But in the absence of telemedicine input, prior training or prior directions from personal medical personnel would not endorse the blanket use of nitro in unsupervised settings by unskilled individuals.(LaMer please chime in with your opinion).
Inspite of the training of several members of our boat we also arranged for telemedical support on passage. This included access to our PCP (or his coverage) via satellite. For those who are or intend to be off grid would suggest.
Take a wilderness medicine course or equivalent. Make sure it’s relevant to your cruising grounds. Tropical medical concerns in the windwards is different than those of the inner passage.
Have 24/7 access to medical support. (We had prepaid formal arrangements and our PCP/coverage).
If you intend to carry paddles or run codes get educated so you know what your doing.
Don’t assume. Without a ECG, vital signs and a educated eye you maybe mislead. Yes, with stroke we say “time is brain” and cardiologists drill into you timely intervention is life. Still although I routinely gave thrombolytics on land I chose to not carry tPA in the absence of imaging. Realize your limitations. Even the best cardiologist will be limited in what they could do on a small, mid ocean boat.
In our litigious world none of the above is medical advice as each circumstance is different.
Wifey B: Excellent Hippo. No fair you and wife being med pros. :lol: Carrying your own doctor and nurse with you, in your selves.
We have done the best short of that we could. At our maritime school, we started with first aid and continued with both taking Medical Person in Charge course. I'd highly recommend it for anyone cruising, even if not interested in licensing. Now, clearly with 10 days training vs. your decades we're beneath novices. However, it did at least give us some training in the subjects I'll list below plus a training session in an ER.
Suturing & Wound Care, IV Therapy, Medication Administration & Injections, Pain Management, Infectious Diseases, Behavioral Emergencies, Eye, Ear, Nose & Throat, NG Tubes & Urinary Catheterization, Altered Mental States, Specific Diseases, OB/GYN & Infant Care, Complications of Drug & Alcohol Use, Poisoning & Overdoses, Rescue & Death At Sea, Legal Issues, Communication & Documentation, Anatomy, Patient Assessment, Respiratory Emergencies, Cardiovascular Emergencies, Defibrillation (AED), CPR, Bleeding & Shock, Burns, Environmental Emergencies, First Aid Kit, Sterile Techniques, Pharmacology, Toxicology, Muscular & Skeletal Injuries, Spinal Injuries, Lifting & Moving Injured or Ill Patients.
In addition to that, we subscribe to MedAire. This gives us immediate phone contact with a first responder type and ER type team. They helped us select what would be in our medical kit. We can get a webcam or other video call, all 24/7/365. Anything significant we would do based on their instruction, but feel we do at least have the exposure to carry out their instruction.
At the time we set this up, PC's weren't doing telehealth and I imagine there are other ways to do it. So, what we're doing does mirror your methods, just a very small level of experience compared to yours. Also, the service we use will assist in hospitals and doctors in other areas of the world and in evacuation from sea if necessary. (We do have travel policies on all on long range cruises).
One thing I was so happy to see on your list was requiring medical history. We require it of all cruising long distances or extended cruises with us. At this point, don't know of anyone cruising at all with us for whom we don't have it. They understand the purpose. I'm fully on board with HIPAA and protecting information but many don't know first what HIPAA doesn't apply to and second times they need their information known. Protect from employer abuse and others spreading information, but if you have friends you travel with on land or sea, please inform them. It may save your life. Among friends, it's not being nosy, it's looking our for each other.
This is far off from being alone and having attack as it involves others, but a little training might help one recognize better what they're experiencing and translate it to more usable descriptions for 911. I'd rather wait for the paramedic, but if 911 says to do something and it makes sense, I'll do it. I'd rather wait for the hospital, but the 911 operator and the paramedics are the key to me making it to the hospital. I think we're not far from the day we'd get patched through by camera to the paramedic and/or ER and they'd see us before they reached us.
I would encourage everyone with long times spent at sea to have a good medical kit, get some level of training, and follow your lead and ours and have arrangements with someone to advise us when an emergency arises, or in your case, to consult with you. They work together. We know heart attacks can kill, but we often forget the so called minor things that may not be minor, an infected wound, dehydration, an allergic reaction, a bite, a cut, a burn.
