First Aid

Wondering what type of first aid kits people keep aboard for extended cruises (Bahamas....etc...)

Ron, I looked at many different commercial first aid kits and found that none of them had all of the things I was looking for. Rather than buy several kits to get what I wanted, I bought a fishing tackle box and filled it with the things I thought I should have on board, the HOPED I'd never have to use it.

+1

Ditto here on making up you own kit. Our kit is in a waterproof Rubermaid bin.

Probably more important, is to take a marine first aid training. I emphasis the "marine" part because there will likely be more emphasis on hypothermia and handling of hypothermic patients. Also, many other first aid courses teach how to stabilize a patient for 10-15 minutes until the ambulance arrives. In the marine world, it may be many hours before paramedics can reach the scene or a patient can be transferred to a higher level of care.

I have been fortunate to acquire Advanced Marine First Aid training through the marine search & rescue that I volunteer with.

Might be a bit of overkill, but dont tell the Admiral that! She built this bag herself! Even has IV Drips, LOL. Hope to never need that. That medical background has paid off a few times
We store it in the bathtub of the forward head along with the ditch bags.

We had a Fieldtex Trans-Ocean Medical Sea Pak (soft case) for 10 years and used it. The burn and the laceration kit were worth the cost alone. They also make a coastal kit which may work for you. Lena and I had both taken advanced first aid and other classes. We also had a doctor who helped us with the prescription list which included lidocaine and pain meds. Even in the Bahamas, medical care can be a day plus away.

Fieldtex Trans-Ocean Medical Sea Pak (soft case) - OceanMedix

Thanks Folks. I have my TRAUMA KITS from my former job with the PD. But, I think I need less trauma and more specific like the OCEANMED.

Here’s a reference that we’ve used. It’s a nice gut check to see if you’re on the right track or waiting for the return phone call when something’s not medically right. Here’s a downloadable pdf.

https://fas.org/irp/doddir/milmed/ships.pdf

Following! (been wanting to talk about this for a LONG time)

Well lets keep it going. How many of us know how to start a saline or ringers IV? Very important to know basics.

For boats we run offshore we have the Medaire Global Medkit. We have added a few extra things, such as medications we felt could be needed and a Defibrillator.

https://www.medaire.com/products-services/yacht-pages/yacht-medical-kits-equipment

As an active duty critical care paramedic I put together a pretty comprehensive kit, and have a defibrillator onboard (AED). I teach Advanced Cardiac Life Support (ACLS) and Advanced Pediatric Life Support (PALS) to teachers, RN's, and occasionally an emergency room MD who missed the same class but taught by other MD's and who needs it to work in the ED. I will inventory my kit when I get a chance, although that might not be for another month or so, and make the inventory available to anyone interested. Gotta have a couple of tourniquets, for example. I have IV's but frankly you don't need to have IV equipment and it is after all a relatively complex skill. Also, the idea of fluid "boluses" for shock is falling out of favor. Turns out they probably do more harm than good in MOST instances. If a person goes into cardiac arrest on board it is helpful to have an AED, which only works in two instances, and NOT if a person is "flatline", although you won't know that. But, don't worry, the AED will know when to shock and when not to shock. And, again depending on where you are, but if after a reasonable length of time you do not achieve ROSC (return of spontaneous circulation), you basically just have to quit, unless you are in an area where medics are responding. Interesting subject.

Sub.d

Great topic!

I have an AED onboard. Of course, I live alone so I have to be hooked up all the time, just in case. SMIRK

If one thinks about the contents of your first aid kit, dont forget a supply of aspirin. That is a very versatile over the counter drug.
I keep nitro-pills in my front left pocket, just under my wallet. Come on folks, leave the wallet alone. Dig deeper for the pills. LOL
I used to have lots of other things but, they disappeared with my LAST wife, now ex-wife.

I bought a waterproof, generic Pelican case and stocked it myself. I shopped various exepedition-grade first aid kits and built a list from the contents of those kits. I then bought the items individually. It turned out to be much cheaper than buying a kit.

I'm not starting IV drips, however, over the years we've needed stitches 3 times while at anchor. That's about where my kit ends (broken bones and stitches).

Rondalw1 said:

Wondering what type of first aid kits people keep aboard for extended cruises (Bahamas....etc...)

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Prior to going cruising my late skipper & I took a 2 semester Medicine at Sea class from Dr. McGillis (the actress Kelly McGillis' dad) in Newport Beach. We carried a complete EMT kit + a burn kit + an emergency dental kit + snakebite & suture kits. We practiced suturing on raw chicken parts as class homework. (A cruising friend, who was luckily an EMT himself once had to suture his own artery when his inflatible flipped him into his outboard prop.) In addition to extra-long prescriptions (we made special arrangements w/prescription insurance carrier, which was then Medco, now Express Scripts), we had special prescriptions for likely emergencies. We carried a couple of relevant books, including one on emergency dentistry. (I did break a crown off the coast of Nicaragua & had to wait until Costa Rica for a real dentist. The burn kit wasn't needed, but I considered it important because offshore burns can quickly turn deadly from infection (which is why when I taught provisioning I emphasized that cooking naked is extremely dangerous--don't laugh unless you've cruised in the tropics). I also had certain supplies, including prescriptions & extra contact lenses packed in our liferaft, + special items in the floating abandon ship bag. There was a pair of crutches in a forward locker, just in case. Remember, over-preparation is not a problem.



Fly Boy, who once in his years in the jungles of SE Asia had to perform an emergency appendectomy on one of his men with just a Swiss Army knife & a doc on the other end of the radio, came into the room while I was typing the above, & when I told him the topic he responded, "Be sure to carry an ace bandage & a bottle of rum." It was a bottle of whiskey in the helicopter that got him to medical care in a happy state when a bullet at close range from an AK47 nearly cost him a leg. (Yes, I do know that alcohol is contraindicated in some medical situations.) Bahamas-bound we will now plan backup refrigeration for insulin. We live on the mid-Atlantic coast, so have a whole-house generator for just that reason; last fall we were several days without power when we got hit by back-to-back hurricanes.

You mentioned that "...we will now plan backup refrigeration for insulin." Is one of your crew, or you, diabetic? If so, that is a good idea. But I wouldn't want others thinking it should be part of their medical kit if there were no diabetics aboard, because it should not be.

Rondalw1 said:

Wondering what type of first aid kits people keep aboard for extended cruises (Bahamas....etc...)

Click to expand...

Medic said:

You mentioned that "...we will now plan backup refrigeration for insulin." Is one of your crew, or you, diabetic? If so, that is a good idea. But I wouldn't want others thinking it should be part of their medical kit if there were no diabetics aboard, because it should not be.

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Yes, one of us is diabetic. Forgot to mention that I carry Epipens. Yes, I have allergies, but they are also useful when one steps on a ray (happened to 2 different friends + had a diving companion stupid enough to try to pick up one). Also useful in an encounter with killer bees, as friends discovered when the mast on their sailing dinghy took out a hive when they were literally up a creek in southern Mexico. They had to jump in the water to escape. It may sound silly, but the bees were enough of a problem for sailors on the Pacific Coast of Central/South America at the time that I stowed hats with head screens for the crew on my boat.

I have epinephrine in ampoules, but EpiPens are best for most people because they have the correct dose. An ampoule could kill a person, you need to draw up the correct amount. ONE PROBLEM...Unfortunately, many, even most anaphylactic reactions outlast the epi in one or even two EpiPens. I would start an epi drip after using intramuscular (IM) epi, but that is a pretty advanced procedure with the drug dosages, drip rates, etc being critical. Epinephrine is an incredibly potent drug.


Good luck in your travels.

Medic said:

I have epinephrine in ampoules, but EpiPens are best for most people because they have the correct dose. An ampoule could kill a person, you need to draw up the correct amount. ONE PROBLEM...Unfortunately, many, even most anaphylactic reactions outlast the epi in one or even two EpiPens. I would start an epi drip after using intramuscular (IM) epi, but that is a pretty advanced procedure with the drug dosages, drip rates, etc being critical. Epinephrine is an incredibly potent drug.


Good luck in your travels.

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Just curious who you administer these drugs? Standing orders? Protocols which cover you working off duty? I get that you know what you are doing and it will no doubt help but It's going to be a stretch to call it good under Good Samaritan.

Whatever you buy, add a package of DECENT band-aids. The adhesive on most of them is crap. That and be prepared to throw out any portion that has adhesives after about 3 years, tops. The adhesive just dries out, and ends up even less useful than it was from the start. Other stuff like gauze, pads and the like, that'll last a bit longer.

The Band-Aid brand "Flexible Fabric" or "Tru-Stay" ones are about the best. They stick and stay stuck. The fabric ones are more comfortable but the fabric, as you'd expect is a dirt magnet.

That and keep a fresh supply of hydrogen peroxide on hand. I like the spray bottles, as it avoids wasting it for simple cuts & scrapes.

I say this because I've got a 11 year old with friends, and it seems like our house is 'first aid central' for bike, skateboard and other crashes.

IM Epi (such as from a typical auto-injector) does wear off in 10-30 minutes. And, it can sometimes take more than one dose to work, even initially. But, that doesn't mean that, if one is at sea (or in the woods, or, or, or...) and away from other medical care, the typical person needs IV Epi to treat anaphylaxis effectively, even potentially definitively.

Instead, one can typically use the initial dose(s) of IM Epi to buy time to fix the root cause of the problem. For example, as soon as the patient is able, a heavy oral dose of Diphenhydramine (Benadryl) or similar old-school antihistamine can be taken to relieve an underlying allergic reaction. If Albuterol (such as by prescription for Asthma) is available, it might be of help in relieving wheezing and other elements of respiratory distress. If a bee sting is causing the problem, removing the stinger might help, as might other measures to slow absorption from the site of the sting (if you happen to be familiar with them). Note: Inducing vomiting doesn't usually work for food allergies, especially after symptoms have started and can lead to //death// by choking, especially when respiratory distress is a concern as it is in the case of anaphylaxis -- so it is not usually recommended.

IV or IM Epi, although essential and lifesaving, does have some potentially deadly or life-changing risks, e.g. MI, CVA, arrhythmia, etc, and, overall, doesn't have nearly as good a safety profile as antihistamines, Albuterol, removing the stinger, etc. So, although Epi should be given as early as needed, and as often as needed, the patient is generally safer if less is needed. (Note: Epi by inhaler, such as the new OTC "Primatine Mist" doesn't seem to work well enough to be of use for anaphylaxis).

IV Epi is generally considered less safe than IM Epi. Of course, when extended treatment is needed, repeated IM injections have their own risks and aren't well tolerated by the patient or practical to manage. And, an IV is often indicated, anyway, to provide fluid to counteract the fluid shift often associated with anaphylaxis and associated risk of hypovolemic shock.

So, I guess all I am saying here is that not being able to give Epi by IV doesn't mean one can't give effective, possibly definitive treatment if it comes down to that (professional help is always way best). Just keep giving IM as needed, for as long as needed, while working to resolve the root cause by removing the allergen (except don't induce vomiting for food allergies), treating the allergy (antihistamine), and using other treatments for specific symptoms, e.g. Albuterol inhaler.

Also, be cognizant of how much IM Epi is available. It can be expensive, but keeping more is always better. I'd rather throw a bunch away than not have one when someone's life depends upon it. But, if it is in short supply, one might have to make decisions I don't envy about when to give the first dose or how long to wait before repeated doses.

(EMT-B, AWLS, WEMT)

We vary what we carry by boat, depending on where the boat is likely to cruise. The medical kit for a boat that is never more than 3 hours from shore is much different than one that crosses oceans.

I'm sure we go far beyond what is necessary but we are members of MedAire. It gives us immediate access to doctors and trauma specialists who can advise us as we administer medical treatment. It's a recognition that as well as we've been trained, we're still far from doctors and their training and even doctors are not always expert outside their specialties.

They also advise on health and travel risks and can provide advice on local facilities and medical translators. They've reviewed out medical kit and compared it to our guests and cruising areas. They are primarily in aviation, hence the name.

I know HIPAA was important as persons needed their medical privacy, especially those with certain diseases. They needed protection from employers who would misuse the information. However, I'd encourage everyone to either have a flash drive or have a cloud location with their entire medical history and, if you travel with friends, inform them. We require disclosure from our guests. People show up at ER's all the time with no information. People die from those treating them not being aware of their conditions, sometimes simple things like allergies and drug reactions or being on blood thinners. We have a healthy 22 year old who travels with us, but nearly died from a bee sting years ago, something that most people casually dismiss. She was lucky the school nurse didn't. It's a shame circumstances have led us to feel we need to hide our medical conditions, that people, including employers, will use them negatively. We're primarily a very healthy family and extended family, but many of us have something in our history or profile that is very important to know.

Imp said:

Prior to going cruising my late skipper & I took a 2 semester Medicine at Sea class from Dr. McGillis (the actress Kelly McGillis' dad) in Newport Beach. We carried a complete EMT kit + a burn kit + an emergency dental kit + snakebite & suture kits. We practiced suturing on raw chicken parts as class homework. (A cruising friend, who was luckily an EMT himself once had to suture his own artery when his inflatible flipped him into his outboard prop.) In addition to extra-long prescriptions (we made special arrangements w/prescription insurance carrier, which was then Medco, now Express Scripts), we had special prescriptions for likely emergencies. We carried a couple of relevant books, including one on emergency dentistry. (I did break a crown off the coast of Nicaragua & had to wait until Costa Rica for a real dentist. The burn kit wasn't needed, but I considered it important because offshore burns can quickly turn deadly from infection (which is why when I taught provisioning I emphasized that cooking naked is extremely dangerous--don't laugh unless you've cruised in the tropics). I also had certain supplies, including prescriptions & extra contact lenses packed in our liferaft, + special items in the floating abandon ship bag. There was a pair of crutches in a forward locker, just in case. Remember, over-preparation is not a problem.



Fly Boy, who once in his years in the jungles of SE Asia had to perform an emergency appendectomy on one of his men with just a Swiss Army knife & a doc on the other end of the radio, came into the room while I was typing the above, & when I told him the topic he responded, "Be sure to carry an ace bandage & a bottle of rum." It was a bottle of whiskey in the helicopter that got him to medical care in a happy state when a bullet at close range from an AK47 nearly cost him a leg. (Yes, I do know that alcohol is contraindicated in some medical situations.) Bahamas-bound we will now plan backup refrigeration for insulin. We live on the mid-Atlantic coast, so have a whole-house generator for just that reason; last fall we were several days without power when we got hit by back-to-back hurricanes.

Click to expand...

As part of our Captain's training we took a 3 day Medical First Aid Care Provider course and then a 7 day Medical Person in Charge course. My wife was a natural. My first lab time in the hospital ER I thought I'd pass out. I adjusted though and may be the most valuable course I've ever taken. I may not save a life at sea but at least I can now try. Worst things we've encountered at sea have been food poisoning from something ashore and allergic reactions to bites or stings ashore plus minor cuts in the galley. However, we've encountered life threatening incidents at marinas with people panicking and we didn't panic and helped until EMT's arrived. I was so brave because I was trained. They didn't see me crying and shaking after. We had the equipment and the know how. Still not like those whose careers trained them, so many on this forum. But better than we were. Once was a leg which had been ripped by a propeller and once was a heart attack. One marina, the EMT's arrived in about 8 minutes and the other it took over 15 minutes. Here I was a man who couldn't stand the sight of blood, who didn't even know CPR and instead of running away, I ran to the need. Not because of me, but because of training.

We have now sent quite a few non-boaters or just local boaters for the training. The best we've found locally. Don't profess to learn in 10 days what it takes a career to learn but here were the subjects and it was an intense 10 days.

I.V. bags and meds are 99% overkill. The IV solutions go out of date and they will probably never get used. They teach in Paramedic school that getting an IV drip started has never saved a life. The possible exception may be a severe burn patient but the chances of survival if you are at sea is pretty dismal.

Basic Life Support consists of maintaining an airway, keeping circulation going and controlling bleeding.

A first aid kit should consist of bandages, antiseptics, slings, pain medication, NSAIDS,(either OTC or prescription) and anti nausea. Some simple tools, tweezers, clamps, scissors, magnifying glass, If you want to go a little advanced, a suture kit. If you are qualified some injectable morphine, muscle relaxant, anti emetic, maybe some ativan.

pete

Pete Meisinger said:

I.V. bags and meds are 99% overkill. The IV solutions go out of date and they will probably never get used. They teach in Paramedic school that getting an IV drip started has never saved a life. The possible exception may be a severe burn patient but the chances of survival if you are at sea is pretty dismal.

pete

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If you're midway across the Atlantic, your perspective might change. I hope to never use anything we have. Hoped to not use the AED but did at a marina.

You make a point about paramedic care and the IV drip but paramedics get people to ER's where IV drips are critical. If one never boats more and a couple of hours from shore then the paramedic parallel holds, but when boating hours or days from a hospital then it's both paramedic and ER. So what might be the most frequent use of an IV on a boat? Dehydration, a very common problem while boating. Not the emergency type you normally think of and not impossible to address in other ways.

As to becoming outdated, we keep records and replace.

So, I recognize not needed for your boating and likely not for the OP, but we do consider important for ours.

I have done 2 difficult and friends of mine nearly died flying MEDEVACs of "appendicitis" patients that turned out to be severe dehydration from seasickness.


Medical problems at sea can become larger issues for not only the patient.


Be careful and be the best you can be.....

wkearney99 said:

Whatever you buy, add a package of DECENT band-aids. The adhesive on most of them is crap. That and be prepared to throw out any portion that has adhesives after about 3 years, tops. The adhesive just dries out, and ends up even less useful than it was from the start. Other stuff like gauze, pads and the like, that'll last a bit longer.

The Band-Aid brand "Flexible Fabric" or "Tru-Stay" ones are about the best. They stick and stay stuck. The fabric ones are more comfortable but the fabric, as you'd expect is a dirt magnet.

That and keep a fresh supply of hydrogen peroxide on hand. I like the spray bottles, as it avoids wasting it for simple cuts & scrapes.

I say this because I've got a 11 year old with friends, and it seems like our house is 'first aid central' for bike, skateboard and other crashes.

Click to expand...

LOL
Don’t give him a key to the boat or use the liquid ‘bandaiid’

OldDan1943 said:

LOL
Don’t give him a key to the boat or use the liquid ‘bandaid’

Click to expand...

Heh, thankfully, now 14, he's grown past the regular injuries stage. And has taken two years of boat captain courses. Ran the dinghy on his own all last summer. This summer will probably see him starting to do some docking of the EB47.

You should build a first aid kit to suit your own abilities. Why have a trach kit if you don't know how to use it, same for various I.V. supplies and medications. You might be thinking that a paramedic or Dr. might also be on the scene and ask "Does anyone have a tracheotomy kit and a number 3 scaple"? Probably never happen, If there happens to be a paramedic on the next boat who does know what this stuff i=s for they probably have their own supplies.

Also..Your stuff will be out of date.

Keep it simple stupid (KISS) . bandaids, iodine, gauze, butterfly bandages, tape and several ointments.

pete

pete