And the balms. And the bandages. And the allergy pills. And the antidiarrheals. And the splints.
Let’s talk about first aid kits. That’s right, you heard me –kits.
Before diving into the what, let’s briefly touch on the why. In my view, everybody should know basic first aid. Boaters and sailors should know more than the basics because there will be a longer delay in getting professional medical help. Those making a long passage should have even more advanced first-aid training because there is a high likelihood that there will be no trained medical follow-up for days.
The need for advanced first-aid training combined with anxiety about isolation tempted me to get an extensive first aid kit equipped for every contingency. But, knowing how to use that stuff is every bit as important as having it. During an emergency, we won’t have time to read the directions, and being under pressure will compound that problem.
So, I want to emphasize that Wild Rumpus’s first aid kit is built around the skill level of the passage crew and the eventual live-aboard/charter captains. One of our crew and charter captains is a Wilderness Emergency Medical Technician. Several of us are trained in Wilderness first aid, which is somewhat more than basic first aid and assumes that you will be in a remote area with no access to professional help. By the time of the passage, I’ll have added an advanced offshore first aid class as well.
In addition to the formal first aid training, I also consulted with doctors and nurses about various emergencies that might turn up offshore. As a result, we’ll have some additional meds on board (not listed here) with written instructions for when and how to use them. And finally, we have a satellite phone if we really need to talk to a medical expert.
With regard to purely onboard resources, we have several good medical references on board to refresh our recollection in an emergency– not to learn it for the first time! It is critical for the first aid responder(s) to have basic skills and knowledge. However, it is nearly as important to have good, easy-to-follow, and readily accessible reference materials for those rendering first-aid.
Automated External Defibulator
The AED is an excellent device for a heart attack victim. Per the Red Cross, successfully aiding a heart attack victim with CPR alone has about a 7% success rate. Successfully assisting a heart attack victim with an AED improves those odds to roughly 40%. Although the chances of survival still suck with an AED, the increase from 7% to 40% makes the decision to add an AED a no-brainer.
For those who haven’t used an AED, it is an entirely automated method of evaluating a potential heart attack patient and administering shocks if needed. The device literally talks you through the steps and then tells you to push a button if a shock is appropriate. If a shock is required, the AED will loudly announce “move away from the victim” and give you a count down. After the shock, it re-evaluates the patient and will talk the user through CPR. These are super easy to use and could save a life.
To the extent there is a debate about whether to have these onboard, the voices against argue that being far from follow-up medical care, which is critical to heart attack victims, renders the AED useless. But, for this argument to have any weight whatsoever, the cost and storage of the device must be hardships. Otherwise, the mere possibility of a cargo ship with a medical officer outweighs the storage and cost issues. Also, Wild Rumpus will eventually be taking limited charters in Grenada and the Virgin Islands, where medical assistance is well within reach. So, the potential safety benefit rules the day for Wild Rumpus, and we added an AED.
Our particular AED is the Phillips HeartStart. I did a lot of research, and ultimately I liked the ease of use and the “information” button -which will coach a first aid provider through CPR, including a metronome for compressions.
The Boo Boo Box
Life has its bumps, scrapes, cuts, and ouchies. For the most part, they require very little attention. On a passage, however, even a minor scratch or cut will get washed, loaded with antibiotic ointment, and a band-aid because it is critical that we avoid infections. Our daily use small first aid kit will be in an easy-to-reach spot, ready for life’s little issues. In addition to the contents provided, we are adding some high-quality waterproof bandages, triple antibiotic ointment, burn dressings, aspirin, Tylenol, cold meds, antidiarrheal pills, and allergy meds.
The Big First Aid Kit
We’ll be offshore and out of sight of land for 10 days or so at a time. As a result, we need to be prepared to encounter, assess, and treat a wider variety of problems without medical assistance than would be true at home. Shopping for this kit was trickier than I thought because the truly “offshore” kits were all designed for much bigger crews with a highly trained medical staff. For example, the larger kits included intravenous kits, which I simply don’t feel comfortable having on board as none of us are truly trained to be good (or licensed) to give an IV — particularly at sea.
Ultimately, I opted for the Adventure Medical Kits Marine 1000 (now replaced by the Marine 1500).
This kit comes pre-packaged with a good variety of medical necessities bundled into individual bags by medical necessity– Wound Care, Bleeding, Burns, Medications, Fractures and Sprains, and CPR tools. Overall, this kit’s equipment is sufficient for treating injuries we could actually treat with our level of training.
Additional Medical Supplies
After speaking to several medical professionals, I added additional tools and medicines to our first aid arsenal. Specifically, we will have onboard the following additional supplies: burn dressings, a temporary dental repair kit, earache drops, an anti-fungal cream, cortisone cream, adhesive wound closure strips, extra sterile bandage, extra bandage wrap, seasickness meds, diarrhea/constipation meds (not something anybody wants to think much about, but poop is an important issue), antacids, Tylenol, Advil, cold meds, additional gloves (not pictured) a sterile medical stapler, electrolytes, and two Aqua-C hydration IV hookups with two units of saline.
The two more advanced devices are the Aqua-C subcutaneous needle and the skin stapler. The Aqua-C is a lesser version of a true IV a doctor or nurse would give a patient. It is simpler, but the delivery of fluids is far slower. Instead of tapping into a vein, the Aqua-C hydrates through two tiny needles into the skin, making the application super simple and safe. The only real concern is cleaning the injection site to avoid infection. This will allow us to give fluids to somebody who cannot hold anything down or is unconscious.
The stapler is a true emergency medical device used instead of stitches to close a gaping wound of some sort. One danger of closing a large open wound is the significant chance of closing IN an infection, thus compounding the problem. On the other hand, closing an open would prevent further infection and promote more rapid healing. So, we will only resort to its use if and when instructed to do so by a doctor via Sat phone. I’ll be searching out emergency medical services phone numbers over the course of the next several months to supplement our first aid kit.
In addition to the above, we will pick up alcohol, hydrogen peroxide, and some over-the-counter wound cleaner once we are in Capetown.
I met with a travel doctor who gave me vaccinations for Typhoid and Yellow Fever, both required at some of our stops. The travel doctor also prescribed anti-diarrhea drugs and antibiotics appropriate for common stomach bugs with a set of instructions for when to use them.
In my manic attempt to protect the crew from almost every foreseeable medical emergency, I have considered what other medications could reasonably be necessary. One great article titled “Deep Ocean Medical Kit” was published by the Royal Cape Yacht Club in Capetown.
I was able to obtain a copy of a more in-depth article from the Royal Cape Yacht Club about appropriate medicines to keep on board. But I do not have permission to publish that article, so I mention it only to indicate that I relied on a medically trained source to determine the list of other medicines I will attempt to obtain for the passage. The possible ailments the list considers and recommends treatments for include sinus infections, urinary tract infections, pneumonia, skin infections, gum, and tooth-related infections, and eye infections.
Each crew member will be encouraged to bring enough of their personal medications (getting older just sucks) to last the entire trip with a wide margin for error. Additionally, at least one week’s worth of each persons’ meds will also be vacuum sealed and put in the ditch bag along with copies of passports and vaccination cards.
Knowledge is Power
As mentioned earlier, all the meds and first aid gear in the world won’t help if the crew doesn’t know how to use it. Luckily, Back Country Guides is giving an Advanced First Aid and CPR for Mariners course in April nearby. A couple of the crew and I will attend even though it is more likely to be a refresher than teach us anything new. Nevertheless, having the training fresh in our minds as we prepare to go offshore is far better than just buying first aid kits and books.