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We are planning an extended cruise this summer and would like some suggestions on what medical supplies to carry BEYOND the standard first aid kits.
Are there specific OTC meds or generic potions?
What are the most common on-board (on beach) medical ailments besides sunburn?
The crew will consist of two 40 something parents and 3 preteens. The cruising area will be Connecticut to Maine & back.
Time is of the essence in treating a severe allergic reaction. Offshore, you may not have the luxury of waiting for the Coasties to show up. Antihistamenes are good for an allergic reaction. Epi-pens are better, but you'll need to persuade your doctor to write a script for them.
If money is no object, a rechargable defibrillator would be nice to have around in the event someone has a coronary.
And from you, Dr. Jim? :rolleyes:
We have one of the new blood clotting agents, like about 3 lbs. of something like a sticky powder in an OD Green bag. It's what the US Army uses in Iraq, etc. to staunch really severe blood flow, like for a big gash. It's supposed to have saved hundreds of lives for the Army. I understand that the Navy has the same type thing but a different formula, different manufacturer (your tax dollars at work).
Doug Shuman
What's it called and where to you get it?Quote:
Originally Posted by Nonchalant1
It's called QuickClot and you can get it from the Army's supplier:Quote:
Originally Posted by SKYCHENEY
http://www.1starmy.com/quickclot-faq.asp There are some interesting articles on it, some say it's great (mostly Army) and some say it doesn't do what they wanted (mostly Navy/Marines). A friend of ours that did some contractor work for the pentagon says is really saved lives. I guess the pack we have is actually only 3.5 oz. as shown.
Doug
That's some interesting stuff. It sounds like something that should be included in every first aid kit. Doctors, what say you?Quote:
Originally Posted by Nonchalant1
Hey, if I fall off the bow underway and get manatee stripes from the props, maybe the admiral can save me with this stuff.
Doug
OK, here are a few suggestions, of a generic nature:
I would recommend that anyone who is interested in providing good first aid on board obtain a book first, and read it. There are two kinds of books that would be useful for this:
The first would be a book written specifically for the purpose of guiding first aid in the marine environment, and there are a few out there. They are written by doctors and as far as I know, they are just fine.
The second would be a good first-responder manual- in other words, a text or manual used by EMT-Paramedics. They actually provide more initial care than any other group of medical workers, as a class, and their textbooks and manuals are easy to read, well-illustrated, and cogent. Bear in mind that the book- any book- is only as useful as your ability to find stuff in it. You do not want to be meeting the book for the first time when someone's artery is squirting at you or your elderly guest just complained of chest pain and passed out. You will wish you had read the chapters on bleeding, chest pain, and loss of consciousness prior to those events.
I've seen reviews of various medical kits for boats. The last review I saw was in PBR, and they felt that the only one worth investing in was a modular kit that was rather expensive. The review was written by, or in consultation with, an emergency physician, and I thought was right on the money. If I were buying a kit, I would get the best one I could afford, and check its' contents regularly. For all the stuff I carry, a plastic tool box works a lot better, frankly.
As far as things to carry in addition to the kit, some suggestions:
-lots of wound dressing materials in various sizes. Often several people get injured at once. I would carry enough wound dressing materials to take care of six large wounds. What I have found useful are lots of four-inch square sponges, Kerlix to wrap them on, and ACE wraps to hold everything on. Keep in mind that medical professionals tend to put on very large dressings. You aren't going to have to care for six large wounds at once, but you won't run out of supplies.
-lots of clean water and soap to wash wounds with. The water in your FW system is NOT clean enough for this purpose. No one has ever shown that antiseptics such as alcohol, iodine, etc get wounds any cleaner than soap and water, but antiseptics DO kill tissue and make it harder for wounds to heal. The best agent for wound cleaning is bottled sterile saline with a SMALL amount of betadine mixed in. This will help kill bacteria and doesn't kill tissue. The amount of volume you use to wash a wound is as important as anything else, the more the better.
-splinting materials are important. The one maneuver that relieves the pain of an injured limb more than anything else is splinting it, applying an ice pack, and elevating it. The splinting materials we use are fiberglass sheets and strips vacuum-sealed in metal foil envelopes- you dip them in water and apply them and they cure. Splinting is enough for any injured part. You should not try to cast anything unless you know exactly what you are doing. Essentially any rigid material that is not heavy and can be padded and molded a bit can function as a splint. Padding is important to avoid pressure points and consequent skin damage- we use cast padding called Webril, but it should be widely available. Ace wraps go over that- not too tight. All this stuff comes in rolls and you should have several of all those. Clean rags can also be used to pad splints, and large clean rags can be used to make slings.
-if you are faced with the necessity of getting a badly injured or unconscious person off a boat, a litter may be invaluable. This is basically two poles and a cloth sling between them. Note that much of the equipment carried by EMS providers has to do with very basic tasks such as picking people up, moving them, immobilizing injured parts, and covering people up if they are hypothermic or in shock. Space blankets, which reflect heat back in, are useful to have.
-duct tape, several rolls, should be available. This is not a medical item. It is so useful that to describe it as a medical item only would demean its' utility. However, for example, I think a manageable litter could be made of poles, cloth and duct tape, if you needed to do it.
-you should have a list and supplies of everyone's prescription meds on board. Bear in mind that physicians are licensed by state, so, for example, I am not licensed to write a scrip in any states other than Virginia and Maryland. Likewise, if your doctor wrote a scrip with refills, and he is licensed in Florida, you may very well not be able to refill the scrip in any other state, even if you have the bottle, his phone number, etc. This problem is virtually guaranteed for any controlled drugs such as pain medicines and some seizure medicines. The lesson here is: bring as much of your own medicines with you as you will need for all the day you expect to be away, plus a few weeks to spare. Some drugs- notably insulin- must be kept cold. Plan for this. You do not want to run out of this drug especially, far away from home.
-specific meds I would carry are: Bacitracin ointment, aspirin, Tylenol, Motrin, lots of heavy sunblock, steroid ointment such as 1% HC, which is OTC, Benadryl, and, if you can get it, Silvadine, which is a burn cream that is very useful. I think it is available only by RX but it is worth the trouble to have. It can be used in anyone who is not allergic to sulfa drugs. I agree with your choice on the EpiPen- you should have at least one. Two would be better.
You asked about the most common on-board ailments: my feeling is that the most common ones would be burns (sun and otherwise), scrapes, contusions, lacerations, sprains, fractures, jellyfish and nettle stings, ray tails- minor trauma. Far less common is major trauma: head, neck, chest and abdomen injuries. Essentially for these you will have to provide field care as best you can while calling 911 (see below). The most common illnesses would probably be things like heat exhaustion and heat stroke, food poisoning, hangovers (not funny if you've had a bad one ever), and then the usual gamut of acute illnesses people can get anywhere, made worse by the fact that they are far from home. Also bear in mind that travel, although generally enjoyable, is stressful, and that the illness any person is most likely to suffer from is a worsening of the one they already have. So, for example, a patient with chronic well-controlled epilepsy who does fine at home may, in a travel situation where they haven't had enough sleep or have had too much alcohol, have a seizure. Frightening enough if they seize but stay on the boat- much worse if they fall overboard.
-certain illnesses and injuries are peculiar to the marine environment; most notably drowning or near-drowning. You should read the book on this. In ERs we tend to view this kind of injury as a composite of an airway problem, possible cardiac arrest, hypothermia, electrolyte disorder, and aspiration of foregin material into the lungs. We do not have a "drowning protocol"- this is an instance where the first-responder test is more useful to you than knowing what I as an ER doctor would do. The circumstances are somewhat different because of the field situation.
-seasickness is a topic that entire books have been written on. There are a variety of cures or preventatives. I don't know enough to comment on them authoritatively, but the wrist bands are reputed to work, ginger is reputed to work, and fresh air and being able to see the horizon is reputed to help. (in other words, being up and on deck at the exact moment that you crave nothing quite as much as lying in your bunk wishing you were dead). If you carry enough people in enough kinds of weather, it will happen. Prolonged vomiting, especially in the very yound and very old, can cause dehydration and electrolyte imbalances that are serious. The only option at that point is to get the patient off the boat and to an emergency room, unless you have the ability to intravenously rehydrate someone on board, and few of us do.
A few words about getting help: the process of getting first responders (EMS personnel) to a marine casualty is much more complex than that process is on land. It involves more steps and more people, is technically more difficult, and more dangerous to all concerned, not just the patient. Most inshore areas and coastal ones as well will have the ability to connect with land-based 911 services, but I don't know enough details on how this is done to advise you- plus there may be regional differences. In our area, I am fairly certain that if you can get cell service you can get a 911 call through. You also have the option of a radio call to the Coast Guard or local marine police or DNR. This is not something I am at all expert on. One of my colleagues who visits this forum is also a licensed captain and a police officer and may wish to comment on this.
Next: the first thing to do in any kind of emergency is take your own pulse. In other words, don't lose your cool. If you can keep your head while everyone else is losing theirs, you will either be viewed as a highly mature stable individual upon whom everyone else can depend in a crisis, OR an unsympathetic iceberg who could watch his pet cat expire without batting an eye. Kidding aside, approaching the sick and injured person calmly and methodically to do what you can to make them better or at least more comfortable while not doing any more harm is the best any of us can hope for, regardless of what we do for a living.
A few things I have found to be useful in my own work:
-I assume all injuries sustained in the marine environment are infected no matter how benign they may look. This generally means meticulous would cleaning, tetanus updates, antibiotics, splinting, elevation, and VERY close followup- no more than 24 hrs. And those are the patients that I don't admit to hospital.
-people on vacation tend to minimize their illnesses because they don't want to lose vacation time, upset their families, screw up plans, etc. Someone you know who does not look good- in other words different- is someone to be concerned about. I have found it pays for me to take family members seriously if they say their relative looks poorly, especially if that person has risk factors such as old age, diabetes, high blood pressure, etc etc. Your travel plans may be upset by having to put someone in the hospital. That, however, is better than losing them. It is essential, if you have ailing family or crew, not to stick to a schedule in defiance of their medical condition. Plans may need to be altered.
The basics of emergency care begins with "airway, breathing, and circulation". These are the fundamental and axiomatic truths on which rest all medical care given to terrestrial life forms. You should take a CPR course- not because you are likely to have to resuscitate someone on your boat, but because it will familiarize you with a few key concepts that you need to know.
And, if you are unfortunate to have someone arrest on your boat, if you have taken the course, you will have done everything you can reasonably do, which is all that can be expected of anyone. Regardless of the outcome.
No doubt this will generate other questions, some of which I may be able to answer. And probably differing opinions as well, which is good too.
Thank's Jim. That pretty much covers it.
I'll call our Dr. to see about getting a scrip for epi-pens & silvadine. Can prescriptions be written for the entire family - how does it work when you don't know who will need it?
Basically scrips have to be written for a particular person. However if the supplies are on board and you need them then you use them. The EpiPen should be reserved for use by someone who has a demonstrated history of serious allergy that may need it. The most common allergies for which they are written are peanut allergy (I have seen some horrendous peanut allergy reactions and thank God have had no deaths, but they do occur) and also beestings, which can be any of a variety of stinging insect called Hymenoptera. (wasps, hornets, bees, yellowjackets etc). Note that you should also familiarize yourself with this equipment.
Please feel free to ask anything else in this line. If I can't answer it or feel I shouldn't I will let you know. None of this stuff is secret, or ought to be.
Please explain about "Epi-Pens".
Thanks,
Doug
Epi-pens are automatic, intramuscular, injection devices containing a premeasured, single dose of adrenaline. Used for severe allergic reaction. Just remove the syringe cover and drive it into the victims leg.
My kids have not yet had a bee or jellyfish sting. Would hate to find out they're allergic while visiting some distant island.
Dr Jim...what do you recommend for relief of jellyfish stings if allergies are not an issue?
Adolph's meat tenderizer works well for this (believe it or not); the enzymes will dissolve jellyfish venom which is a protein. I also looked this up in Rosen's Textbook of Emergency Medicine; assuming a stable patient who does nor require airway support or any other life-sustaining measures, they advise washing the affected area with seawater (fresh water may cause the remaining stings to "go off"), neutralize the remaining undischarged stings with vinegar, which fixes them, and then covering the affected area with talcum powder or shaving cream which will remove the stings when scraped off. They advise antihistamines, steroid creams, and pain medication. They do not mention Adolphs' but it is well-known to work. They also advise a tetanus booster, which I should have mentioned earlier. Updating tetanus status before the trip is a good idea. Note that even dead tentacles from jellyfish etc can still sting and that you should be wearing gloves when you try to remove them.
Regarding allergic reactions to venomous marine animals: allergic reactions are more common when a person has been stung before. Most of the really toxic marine venomous animals are not found in our area- they are native to Australia and the Indo-Pacific region. Therefore, if a severe reaction occurs, it is likely to be in someone who has been stung in the past and/or is allergic and does not know it. Also, if a person is stung while in the water and reacts, it can increase their risk of drowning. So- remove the victim from the water, perform basic life support before anything else, glove up, and follow the measures outlined above. After that, the patient should be brought to an ER to complete treatment.
Jim,Quote:
Originally Posted by jim rosenthal
Since we have no history of serious allergies, should we forgo an EpiPen script? I always thought they were good to have "just in case".
Jim, thank you so very much for taking the time to respond to the questions asked in this thread and giving us the benefits of your knowledge. The info will be very useful to me and I’m sure to others as well.
And Passages, thanks for asking these good questions.:)
You have to read the label on the meat tenderizer. The ingredient to look for is papain, an extract of the papaya plant. Papain is an enzyme which, according to the Encyclopedia [does anyone else hear the Mickey Mouse Club song when spelling this?] Britannica, "catalyzes the breakdown of proteins by hydrolysis (addition of a water molecule)." I try to keep papain products on board, but many tenderizers use other ingredients which may not work as well.
Thing with an epi-pen is that if you need one, and don't have it, someone is likely to die on you.
In theory anyone who KNOWS they're severely allergic (to anything!) should have one on them. Reality is that many times people don't, or worse, they don't know they're severely allergic - the usual histamine reaction issue is that you don't get "nailed" with your FIRST exposure - its the second and subsequent one that gets you, as the first one sensitizes your system.
So if you're severely allergic to jellyfish stings, for example, you can get stung once. The SECOND sting, which might happen months or years later, is the one that causes the severe reaction.
Anyway, if you're going to be a significant distance away from EMS an Epi-Pen is a good thing to have in the med kit. It, like any other sort of actual medication though, has an expiration date if unused and so its another thing to check and renew from time to time.
That's exactly right, (as my former professor of pathology, John Murphy, would have said). The thing about an Epi-Pen, though, is the last instruction in it: "go immediately to emergency department"...well and good if you're on shore, not so easy if you are on land.
I think that unless you have a crew member with a documented history of allergy (in which case you should have an Epi-Pen on board) you are going to have a difficult time getting a physician to write a scrip for one. I write them for patients that I have seen who have had a serious allergic reaction, or one that I know has the potential to be serious. Peanut allergy is a great example. No one who has a history of peanut allergy, or beesting allergy, should be without an Epi-Pen. Period. I don't discharge anyone from the ER without a scrip for one, among other things. But if you don't have a person on board with a history of a severe allergic reaction, then your chance of someone having their FIRST serious allergic reaction to anything while on your boat is vanishingly small. Even less is the chance of that reaction, which is slim to begin with, being severe enough to require the use of an Epi-Pen.
Epi-Pens don't have a lot of downsides, although giving direct injections of adrenaline to people is not for the faint of heart when you see how some of them react to it. (think about how you feel when your adrenalin is way up and you'll get an idea- multiply that a few hundredfold).
So, to summarize: unless you know you are going to carry someone who you know should have one around, you don't need an Epi-Pen. Sorry for the long-winded post. :o
"It's the ennnnn...cyclopedia, E-N-CYC-LO-PEDIA!
Who's the leader of the club...
MICKEY MOUSE! donald duck! MICKEY MOUSE! donald duck!
Sorry - couldn't resist.
Thanks gentlemen for layman's advice of the med kit supplies and emergency medical attention.
Nick
Fabulous post by Dr. Jim R! Thanks much and will follow up, in the same manner as others have mentioned.
OK, w/the MM ref, I guess I can go slightly off point.
If you can, its best to have a good DO aboard. In the early sixties (use Excel to calculate how long ago that was), I deckhanded on a 118' steel yacht. When under way West of the Mackinaw Bridge, near Waugashance Pt., we encountered a 40' or so sail boat that had a damaged rudder and/or control and had lost its ability to maintain headway. So we agreed to take them under tow. We were in the process of backing down to throw a line to their bow, in about 1-2' seas, so they were bouncing slightly.
As we were backing, the other deckhand, George was his name, reached out to stop their bow from coming down and striking us on the fantail where the transom and aft deck joined; long story short, he was unsuccessful. His arm quickly looked like a broken bat single.
As luck would have it, we had one of the finest DO's from the Detroit area, most likely Grosse Pte. and he attended to the arm. When you're young, you don't notice all you should, so all I remember was that the Capt., Jim Mertaugh of the Mertaugh Boatworks family, (Great Lakes trivia) was a very unhappy camper about the arm. Towing...don't remember any of it and the splinted arm...don't remember. Oh, George didn't sail with us the next summer.