2 Week Sailing Race

[jbrynels]

Hi All,

I have been selected to join a crew that will be racing from Victoria, British Columbia, to Maui, Hawaii that will take (hopefully, as we are racing) under two weeks. I have also been selected to be in charge of medical equipment for the race. What would you guys take on the a sailing race of this caliber. We will be up to 2000 miles off-shore at some points and therefore extended care could be expected. In addition there are some older (65 is the oldest) I think, so I am bringing an AED with me. Any suggestions for other equipment? Also, do you think that I should be asking the crew to email me (confidentially of course) or the skipper, their relevant medical history/allergies etc. to have on file?

Any advice would be appreciated and if this is in the wrong place please do let me know.


Thanks,
Johnny

 

[bigbaldguy]

You're limited by your scope of practice and training. I would expect lots of minor scrapes cuts sprains ect. Most ships of this type generally carry a fairly comprehensive on board EMK with all the basic BLS stuff. Maybe some c spine stuff in case of a bad fall from rigging. Remember you can get in trouble going beyond your scope regardless of the situation so just stick with the basics.

I know there are some exceptions to the scope of practice when you are in international waters but you can still only operate to your level of training.

 

[jbrynels]

Yes, I realize that, but also understand that I have been charged with stocking the vessel. Meaning, that there is nothing on it regarding medical supplies, and now it is my job to stock it. I want to stock it within my scope of practice, just wondering if anyone has any suggestions for long term treatment that may be helpful.

 

[bigbaldguy]

Yes, I realize that, but also understand that I have been charged with stocking the vessel. Meaning, that there is nothing on it regarding medical supplies, and now it is my job to stock it. I want to stock it within my scope of practice, just wondering if anyone has any suggestions for long term treatment that may be helpful.

Fair enough, I imagine in terms of long term treatment the hardest thing to do on a boat (and I'm not a sailor so don't hold me to this) would be to maintain C spine especially in a rough sea. So back board and collar. Might be a good idea if you suggest to the captain that all crew get the basics of two man cpr under their belt. If you do have to pump on a guy for any length of time you will all be taking turns. As for medical conditions and allergies if crew is willing to give it to the captain I think that would be good info to have. Might wanna stock a good supply of instant cold packs for sprains.

 

[NomadicMedic]

The Adventure Medical Kit folks make kits for sailing. You could go off of that inventory list... http://www.adventuremedicalkits.com/products.php?catname=Marine&cat=8

Also, I know a lot of what is in the AMK "super-modo-gigantic first aid kit" is geared toward those with MPIC training. You'll find dental repair stuff, foleys (yikes!) and some other stuff that's most likely outside your scope.

 

[bigbaldguy]

The Adventure Medical Kit folks make kits for sailing. You could go off of that inventory list... http://www.adventuremedicalkits.com/products.php?catname=Marine&cat=8

Also, I know a lot of what is in the AMK "super-modo-gigantic first aid kit" is geared toward those with MPIC training. You'll find dental repair stuff, foleys (yikes!) and some other stuff that's most likely outside your scope.

Actually throwing a couple of temporary dental filling kits in is and excellent idea. I know folks who have had trips ruined because of a lost filling.

 

[firetender]

Scope of practice and 2,000 miles from home?

This is NOT to be construed as giving medical or legal advice, not is it an official opinion of EMTLife.

Unless you have an escort with an MD on board be prepared to do surgery and everything leading up to it -- within your ability to handle it.

Let's get real; There are innumerable possibilities for trauma or illness on such a trip (think appendicitis) and if a life hangs in the balance and there's a possibility you -- and you're the only one -- can successfully intervene, then have a damn good instruction manual available with all the basic tools at your fingertips.

At the very least assure you have ship-to-shore communication and access to a Physician who can talk you through a nightmare AT ANY TIME DURING THE JOURNEY. I'm talking someone you've already taken the time to establish a relationship with who would be willing to act as your support.

What is more difficult to live with, an unlikely lawsuit or your conscience?

If NO OTHER OPTIONS ARE AVAILABLE and you do not make a maximum effort to prepare adequately for the unknown then YOU are the one that carries the weight if someone dies on your watch, it's that simple.

Perhaps that M.D. will prescribe anitibiotics and whatever for you to carry, to be administered on his/her order so there are options available until you can swing a medivac.

You won't sink the ship by stocking it well, and it won't hurt you to seek out and find MD's or other practitioners with experience in this and have a long talk about what the essentials would be and how they would be willing to back you.

Once you leave drydock, you're under the auspices of a different God, and that's the one you have to answer to, lawyers be damned.

 

[bigbaldguy]

This is NOT to be construed as giving medical or legal advice, not is it an official opinion of EMTLife.

Unless you have an escort with an MD on board be prepared to do surgery and everything leading up to it -- within your ability to handle it.

Let's get real; There are innumerable possibilities for trauma or illness on such a trip (think appendicitis) and if a life hangs in the balance and there's a possibility you -- and you're the only one -- can successfully intervene, then have a damn good instruction manual available with all the basic tools at your fingertips.

At the very least assure you have ship-to-shore communication and access to a Physician who can talk you through a nightmare AT ANY TIME DURING THE JOURNEY. I'm talking someone you've already taken the time to establish a relationship with who would be willing to act as your support.

What is more difficult to live with, an unlikely lawsuit or your conscience?

If NO OTHER OPTIONS ARE AVAILABLE and you do not make a maximum effort to prepare adequately for the unknown then YOU are the one that carries the weight if someone dies on your watch, it's that simple.

Perhaps that M.D. will prescribe anitibiotics and whatever for you to carry, to be administered on his/her order so there are options available until you can swing a medivac.

You won't sink the ship by stocking it well, and it won't hurt you to seek out and find MD's or other practitioners with experience in this and have a long talk about what the essentials would be and how they would be willing to back you.

Once you leave drydock, you're under the auspices of a different God, and that's the one you have to answer to, lawyers be damned.

AMEN Testify brother

 

[wandering_idiot]

Look at the International Maritime Organization (IMO) and see what the MINIMAL requirements are for a first aid kit for a vessel of your size, and crew, and build on that.

 

[Lozenger19]

I go sailing frequently and I'm also one of the first aiders/ medics for the club. I recommend the following:

AED (be careful near water)

airway management kit

Burns kit (rope burn)

c spine equipment

plasters

bandages

wound glue / steri strips (if trained)

wound cleaning equipment

foil blankets

paracetamol & aspirin

map (so you know your location)

WORKING radio with charger

list of local coast guards/ life boats

It would also be a good idea to get people's medical history (most recent) & any allergies

Hope this helps



Sent from my iPhone using Tapatalk

 

[JPINFV]

WORKING radio with charger

If you're doing an open water race, you better have a working maritime radio AND be comfortable with standard radio practices, including hailing and emergency procedures.

 

[Lozenger19]

If you're doing an open water race, you better have a working maritime radio AND be comfortable with standard radio practices, including hailing and emergency procedures.

Good point


Sent from my iPhone using Tapatalk

 

[wandering_idiot]

Look at the International Maritime Organization (IMO) and see what the MINIMAL requirements are for a first aid kit for a vessel of your size, and crew, and build on that.

Just a quick expansion on this and re-reviewing your initial post. You should have every member of your crew fill out a crew survey regarding meds, allergies, etc. so you have a quick reference in case no one can provide that info.

The IMO requirements are a CYA and, after you've filled those, you're set to pack as you see fit.

And Scopalomine patches and/or Promethazine... carry plenty of that.

 

[Steam Engine]

Lots of good advice here. While this too should not be considered medical advice, here's my take:

*You mentioned requesting a medical history...personally, I would demand it if I were being asked to take on this responsibility. Make sure all information is reasonably recent, and includes a full list of medications. If possible meet with everyone on the crew prior to the race to review, or at the very least contact them via phone or email to do the same. Make sure they bring a list of all necessary medications, clearly labeled in original bottles, and with more than they expect to need. Also, this is more on them than you, but I'd encourage them to get cleared by their PCP prior to embarking on a trip like this. I might also consider some sort of waiver / treatment consent form. I also second finding a physician

*A few standard jump kits with all the normal BLS supplies you'd carry on the ambulance, plus the extras you may need. Spread these around the boat so that they can be accessed easily, and have them in waterproof, floating containers if possible.

*Designate one of the above mentioned bags as a ditch bag, and have it readily available if you need to jump ship. Keep a few days worth of everyone's necessary meds in this kit as well.

*Diphenhydramine (Benadryl) and epinephrine if you're trained and comfortable with its use.

*Dramamine or something similar, and something suitable for rehydrating.

*SAM splints, cardboard splints, etc., and plenty of cravats or webbing. Also finger splints and lots of waterproof tape.

*Books and field guides (and preferably certification) from an organization that specializes in wilderness or offshore medicine (I like Wilderness Medical Associates, but there are a number of other quality organizations).

*Functioning EPIRBs (not really your responsibility, but I wouldn't set foot on that boat without them.)

*Satellite phone

*Working radio...remember that just because you have a radio, there is no guarantee that there will be anyone around to hear you, especially if you'll be 2000 miles out as stated.

Hopefully this gives you some direction...I'll try to get back to you with more once I have some time to think it over. Good luck!

 

[jbrynels]

I go sailing frequently and I'm also one of the first aiders/ medics for the club. I recommend the following:

AED (be careful near water)

airway management kit

Burns kit (rope burn)

c spine equipment

plasters

bandages

wound glue / steri strips (if trained)

wound cleaning equipment

foil blankets

paracetamol & aspirin

map (so you know your location)

WORKING radio with charger

list of local coast guards/ life boats

It would also be a good idea to get people's medical history (most recent) & any allergies

Hope this helps



Sent from my iPhone using Tapatalk

Keep in mind that we are going 2000 miles off shore. So we will have a Ham Radio etc. A regular VHF wouldn't do anything out there. Also there aren't any local CG boats out there. I have a kit content list made up out of that list that someone (sorry I can't remember who at the moment) suggested earlier on in the thread:


Bandage Material
Bandage, Adhesive, Fabric, 1" x 3" x 30
Bandage, Adhesive, Fabric, Fingertip x 15
Bandage, Adhesive, Fabric, Knuckle x 15
Bandage, Conforming Gauze, 3" x 5
Bandage, Elastic, Self Adhering, 2" x 4
Bandage, Waterproof Assorted, 30 pc. x 10
Dressing, Gauze, Sterile, 2" x 2", Pkg./2 x 16
Dressing, Gauze, Sterile, 3" x 3", Pkg./2 x 10
Dressing, Gauze, Sterile, 4" x 4", Pkg./2 x 15
Dressing, Non-Adherent, Sterile, 3" x 4" x 6
Dressing, Transparent, 2 3/8" x 2 3/4" x 2
Dressing, Transparent, 4" x 4 3/4" x 2
Eye Pad, Sterile x 2

Bleeding
Gloves, Nitrile (Pair), Hand Wipe x 14
Trauma Pad, 5" x 9" x 2
Trauma Pad, 8" x 10" x 2

Blister/Burn
Aloe Vera Gel with Lidocaine, 4 oz x 1
Dressing, Hydrogel, 2" x 3" x 2
GlacierGel (Large Oval) x 2
GlacierGel (Small Rectangular) x 2
Moleskin, Pre-Cut & Shaped (11 pieces) x 11

CPR
CPR Pocket Mask, Laerdal x 1
Automated External Defibrilator x 1 (plus extra battery)
Nasopharyngeal airways x 1 Full set
Oral-pharyngeal airways x 1 full set
Bag-Valve-Mask x 1

Dental
Cotton Pellets x 10
Cotton Rolls x 4
Dental Floss x 1
Dental Medic Instructions
Dental Mirror x 1
Dental Spatula x 1
Oil of Clove, 3.7 ml x 1
Temporary Cavity Filling Mixture x 1
Wax Rope x 1

Fracture/Sprain
Bandage, Elastic with Velcro, 4" x 1
Bandage, Elastic with Velcro, 6" x 1
Bandage, Triangular x 3
Cold Pack (Lots, depending on the ice that is kept on board.)
SAM® Splint, 4" x 36" x 2
SAM® Splint, Finger x 4

Instrument
Blood Pressure Cuff
EMT Shears, 4"
Pencil
Safety Pins
Scissors, Stainless Steel, 5"
Splinter Picker/Tick Remover Forceps
Stethoscope
Thermometer, Digital
Tongue Depressor, Wooden x 4

Suture/Syringe
Angiocatheter, 18G x 1 1/4" x 1
Gloves, Surgical Sterile, Size 8 (pair) x 2
Hemostat Forceps, Kelly Straight, 5.5" x 1
Mayo Heger Needle Holder, 5" x 1
Needle, Disposable, Sterile, 18G x 1 1/2" x 2
Needle, Disposable, Sterile, 21G x 1 1/2" x 2
Needle, Disposable, Sterile, 25G x 5/8" x 2
Scalpel with Handle, Sterile, Disposable, #11 Blade x 4
Skin Staple Remover, Disposable x 1
Skin Stapler (15), Disposable x 1
Surgical Lubricant, Sterile x 3
Suture, Nylon, 3-0 x 2
Suture, Nylon, 5-0 x 2
Syringe, Luer Lok, 3ml x 2
Syringe, Luer Lok, 5ml x 1
Thumb Tissue Forceps, Mouse-Tooth, 4.5" x 1
Towel Drape, Sterile x 1

Wound Care
After Cuts & Scrapes Antiseptic Wipe x 30
Alcohol Swab x 20
Cotton Tip Applicator, Pkg./2 x 3
Povidone Iodine, 1 oz x 3
Scrub Brush, Sterile x 1
Tape, 1" x 10 Yards x 2
Tincture of Benzoin Topical Adhesive, Vial x 8
Triple Antibiotic Ointment, 1 oz x 1
Triple Antibiotic Ointment, Single Use x 12
Wound Closure Strips, 1/4" x 4", Pkg./10 x 4

 

[mycrofft]

Looking pretty darn thorough above

A satellite phone will probably be better than a ham radio, but if the HAM can be "sandwiched in"...
Duplicate your acute emergency stuff in a waterproof floatable situation, and maybe a vest or belt with what you would need STAT in a killer situation like airway, TK, 4X4. Lots of pocket lights and some cyalumes too, it is somewhat dark more than half the time and if you can't see, you're fubar.
Try to set some hours for you to be able to sleep. They can get you if it's bad, but sniffles or headache...later.
Have an OTC meds box available, get the captain to impress that you need to know if anyone's taking stuff regularly, and not to hoard.
I believe there are maritime laws regulating the minimal qualification of medical crew and contents of kits ("Ship's Captain's Medical Chest At Sea" was the old standard for USA). No idea what's in force now.
Oh, and 2,000 miles? If my old unit is still in operation, or their brother unit on the East Coast, they can do it. You just get them there, then arrange for fairly decent weather.

PS: an assistant or three. What if you fall ill or are injured?

 

[Steam Engine]

Keep in mind that we are going 2000 miles off shore. So we will have a Ham Radio etc. A regular VHF wouldn't do anything out there. Also there aren't any local CG boats out there. I have a kit content list made up out of that list that someone (sorry I can't remember who at the moment) suggested earlier on in the thread:


Bandage Material
Bandage, Adhesive, Fabric, 1" x 3" x 30
Bandage, Adhesive, Fabric, Fingertip x 15
Bandage, Adhesive, Fabric, Knuckle x 15
Bandage, Conforming Gauze, 3" x 5
Bandage, Elastic, Self Adhering, 2" x 4
Bandage, Waterproof Assorted, 30 pc. x 10
Dressing, Gauze, Sterile, 2" x 2", Pkg./2 x 16
Dressing, Gauze, Sterile, 3" x 3", Pkg./2 x 10
Dressing, Gauze, Sterile, 4" x 4", Pkg./2 x 15
Dressing, Non-Adherent, Sterile, 3" x 4" x 6
Dressing, Transparent, 2 3/8" x 2 3/4" x 2
Dressing, Transparent, 4" x 4 3/4" x 2
Eye Pad, Sterile x 2

Bleeding
Gloves, Nitrile (Pair), Hand Wipe x 14
Trauma Pad, 5" x 9" x 2
Trauma Pad, 8" x 10" x 2

Blister/Burn
Aloe Vera Gel with Lidocaine, 4 oz x 1
Dressing, Hydrogel, 2" x 3" x 2
GlacierGel (Large Oval) x 2
GlacierGel (Small Rectangular) x 2
Moleskin, Pre-Cut & Shaped (11 pieces) x 11

CPR
CPR Pocket Mask, Laerdal x 1
Automated External Defibrilator x 1 (plus extra battery)
Nasopharyngeal airways x 1 Full set
Oral-pharyngeal airways x 1 full set
Bag-Valve-Mask x 1

Dental
Cotton Pellets x 10
Cotton Rolls x 4
Dental Floss x 1
Dental Medic Instructions
Dental Mirror x 1
Dental Spatula x 1
Oil of Clove, 3.7 ml x 1
Temporary Cavity Filling Mixture x 1
Wax Rope x 1

Fracture/Sprain
Bandage, Elastic with Velcro, 4" x 1
Bandage, Elastic with Velcro, 6" x 1
Bandage, Triangular x 3
Cold Pack (Lots, depending on the ice that is kept on board.)
SAM® Splint, 4" x 36" x 2
SAM® Splint, Finger x 4

Instrument
Blood Pressure Cuff
EMT Shears, 4"
Pencil
Safety Pins
Scissors, Stainless Steel, 5"
Splinter Picker/Tick Remover Forceps
Stethoscope
Thermometer, Digital
Tongue Depressor, Wooden x 4

Suture/Syringe
Angiocatheter, 18G x 1 1/4" x 1
Gloves, Surgical Sterile, Size 8 (pair) x 2
Hemostat Forceps, Kelly Straight, 5.5" x 1
Mayo Heger Needle Holder, 5" x 1
Needle, Disposable, Sterile, 18G x 1 1/2" x 2
Needle, Disposable, Sterile, 21G x 1 1/2" x 2
Needle, Disposable, Sterile, 25G x 5/8" x 2
Scalpel with Handle, Sterile, Disposable, #11 Blade x 4
Skin Staple Remover, Disposable x 1
Skin Stapler (15), Disposable x 1
Surgical Lubricant, Sterile x 3
Suture, Nylon, 3-0 x 2
Suture, Nylon, 5-0 x 2
Syringe, Luer Lok, 3ml x 2
Syringe, Luer Lok, 5ml x 1
Thumb Tissue Forceps, Mouse-Tooth, 4.5" x 1
Towel Drape, Sterile x 1

Wound Care
After Cuts & Scrapes Antiseptic Wipe x 30
Alcohol Swab x 20
Cotton Tip Applicator, Pkg./2 x 3
Povidone Iodine, 1 oz x 3
Scrub Brush, Sterile x 1
Tape, 1" x 10 Yards x 2
Tincture of Benzoin Topical Adhesive, Vial x 8
Triple Antibiotic Ointment, 1 oz x 1
Triple Antibiotic Ointment, Single Use x 12
Wound Closure Strips, 1/4" x 4", Pkg./10 x 4

Looking petty good...I'd throw in a few c-collars, standard OTC's including Benadryl, Dramamine and Zofran (if you can), epinephrine (if you can), and perhaps some physician-supplied local anesthetic and an order to use it (again, if you can).