Making sure everyone on board is safe is a captain’s number-one priority. But sometimes things can go awry when help is very far away. The right preparation will allow you to embark on long cruises with confidence.
Whether out for a spin on the bay, on an overnight cruise, making an ocean passage, or heading out past The Wall in pursuit of the big one, being prepared to cope with a medical emergency may be the most significant factor in having a sucessful trip. The distance from professional medical care should be considered in preparing for the inevitability of any medical situation that could arise, be it large or small.
Practical Patient 1:
A Shoulder to Cry On
“Marianne, this is Fireball II, over.” It was Mack on the VHF. We had partied the night before while anchored in a beautiful and isolated bay on the south shore of Viti Levu in the Fijian Islands. I could hear the tension in his voice and responded. He said, “I need your help.” I didn’t need more details and sprung into action, grabbing the first-aid kit en route to the dinghy. When I arrived at Fireball II, I found that one of his crew members, Betsy, had slipped going down the companionway and hurt her shoulder. To be honest, I was relieved that it wasn’t a life-threatening situation. As a former whitewater kayaker and trained Wilderness-EMT, I always had an interest in the subject of shoulder injuries and paid special attention during advanced training. Professional medical care was at least 24 hours away and she became the focus of my attention. After an evaluation, I determined that she dislocated her shoulder and was able to successfully reduce it. Although she had some discomfort for a few days, it was a happy ending. The outcome was the result of proper training and preparation for the inevitable—a medical emergency where access to professional medical assistance was not an option.
Statistics indicate that of all medical emergencies encountered by boaters, 40 percent are due to injury while a startling 60 percent are due to illness. Yes, there will be the stubbed or broken toe, sprain, dislocated shoulder, laceration, fishhook incident, or head trauma, yet it is more likely you will face sickness, an infection, or an aggravated existing medical condition. A great many of these, if properly addressed at the onset, can be dealt with and, as often as not, stopped from escalating into a true medical emergency and the possible need for outside assistance.
Being as self-reliant as possible should be the goal of every prudent mariner. There is no single source of information for the outfitting of a boat and no perfect way to prepare for a first-aid or medical emergency while onboard. It is vital to consider all of the information and advice available, update equipment as required, and continue the learning process through experience and training.
Your medical kit should include a first-aid manual and prescription medications, particularly those that may be germane to your crew. Consideration should be given to the number and age of those onboard, the durations of your cruise, and the time and distance you’ll be from professional medical care.
Two highly regarded first-aid manuals that you should consider adding to your kit are Marine Medicine, A Comprehensive Guide, written by Dr. Eric Weiss and Dr. Michael Jacobs (The Mountaineers Books, $15.95), now in its second edition, and Advanced First Aid Afloat, written by Dr. Peter F. Eastman (Cornell Maritime Press, $16.99). The latter manual, first published in 1972, has become widely accepted and is now in its fifth edition. Both of these books address injuries and illnesses, and include information about first-aid kits, prescription medications, and medical support. Each is written in plain language complete with diagrams and photographs to aid in the evaluation and treatment of a patient onboard.
Practical Patient 2:
Taking it on the Chin
Tied up in a slip on a remote island in the Bahamas, it was low tide when Bob took the giant step down to the toerail and his foot slipped. In a split second his chin was bouncing off that very same toerail as he disappeared into the gap between the finger pier and the boat. We fished him out of the water, quite groggy, and with a substantial gash across the bottom of his chin. We were able to determine that his jaw was not broken and he still had all of his teeth. The wound was flushed out with fresh water using an irrigation syringe and we also let it bleed for a short while to insure that it was as clean as possible. Direct pressure was then applied until the bleeding stopped. As we were going to be back in civilization in a couple of days it was decided not to suture the substantial gash. We applied a few wound-closure strips to keep the edges in alignment and to allow it to drain if necessary. We then bandaged him up. Infection was avoided and the injury was properly addressed in the ER when we reached port.
A first-aid kit can be assembled from scratch, and, although doing so can be a worthwhile task, it can also be expensive and difficult as many items may not be readily available, or in the appropriate size or quantity desired. In addition, you must consider the many contingencies and organize and package all of the items in such a way that they are secure and readily available when needed. There are two well-designed, nicely organized, and well-stocked lines of first-aid kits developed specifically for recreational boaters. These are the Medical Sea Pak product line by Fieldtex Products, Inc. and the Marine Series Medical Kits developed by Adventure Medical Kits in consultation with Dr. Michael Jacobs, the previously noted sailor and marine medical authority.
These two product lines do vary somewhat with regard to specific items, yet each comes in a full range of kit sizes, with the contents organized by category and contained in clearly marked pouches. Medical Sea Paks are available either in a rugged nylon soft case or in a hard case, while the Marine Series kits are available in padded foam cases with water-resistant zippers. The selection of a specific kit is based upon the number of persons onboard, the duration of time spent offshore, and the anticipated time and distance away from professional medical assistance.
Another option is to have a custom medical kit assembled for the requirements of the specific cruise or special circumstance. A number of vendors provide this service including OceanMedix (www.oceanmedix.com) [Editor’s Note: Full disclosure, the author of this article is a cofounder of this company], Remote Medical International (www.remotemedical.com) and World Clinic (www.worldclinic.com).
Prescription medications are a necessary component of any vessel’s medical inventory, and are carried in anticipation of a wide range of illnesses and injuries that might be encountered while boating. Developing an appropriate list of prescription medications can be done in consultation with a physician, or by referring to one of the lists found in the appendices of the manuals noted above.
Practical Patient 3:
Wretched and Retching
We were entering the Gulf Stream en route to Bermuda. An otherwise smooth passage changed rapidly as a crosswind whipped the opposing current into a lumpy mess. Avery had been doing well standing watch, yet, that was all about to change. Seasickness took hold quickly and she was incapacitated. For more than 24 hours she was unable to hold down anything. I was able to get her to tolerate small sips of water and little more. Just as I was getting concerned about the potential ramifications of severe dehydration, the seas calmed. In retrospect we should have been more proactive in anticipation of the significant change in sea state, and the need for all onboard to utilize the most effective seasickness remedy of choice prior to the inevitable.
An alternative for the recreational boater is the product line of Prescription Medical Kits developed by OceanMedix (www.oceanmedix.com) . These kits come in three sizes ranging from the Individual Prescription Kit designed for one or two people heading out on an extended adventure to the Voyager Prescription Kit designed for a vessel with a crew size of one to 12 people embarking on an extended voyage of up to 28 days. Each kit is assembled to order, with medications and supplies selected and provided in adequate quantities, and then organized in a custom fabricated, rugged nylon case with internal removable pouches.
To complete your inventory of medical equipment and supplies, you might consider a few more specialty items such as an automatic external defibrillator (AED), medical oxygen, IV fluids for extreme dehydration, QuikClot Advanced Clotting Sponges to control extreme bleeding, a portable extraction stretcher, and a neck brace.
A complete supply of over-the-counter products should not be overlooked. In addition to those items used on a regular basis, you should consider everything from sunscreen to Imodium, from Milk of Magnesia to Meclizine, from Q-tips to lip balm. A complement of seasick remedies ranging from ginger root, the aromatics, over-the-counter tablets, Relief Band, and prescription medications should also be included.
At least one member of every crew should be trained in basic first aid and CPR. Courses are regularly provided in almost every community by the American Red Cross. The American Heart Association also provides CPR training, and both organizations provide training in the use of an AED. Higher levels of training are available from NOLS Wilderness Medicine Institute and Wilderness Medical Associates, which also offers an advanced, three-day course in offshore emergency medicine presented by the noted instructor Jeffrey Isaac, a certified physician’s assistant.
Before heading out, make sure someone on your crew is completely familiar with the first-aid manual and the contents of the medical kit carried onboard, and is able to address the existing medical conditions of any crew member as well as any others that might arise. Also, the crew as a whole should be prepared to communicate any situation to an outside professional medical provider by radio or satphone if necessary.
Even in home waters, getting outside professional medical assistance or direct intervention in a timely manner may not be possible. Prior planning, proper training, and a complete medical kit will provide peace of mind and prepare you to best cope with a wide range of medical emergencies at sea.
Capt. Denny Emory is a licensed yacht captain, holding a U.S. Coast Guard 100-ton master’s license. He founded Emory / Yachting Services and cofounded OceanMedix LLC. A former certified Wilderness EMT, he has voyaged more than 100,000 nautical miles on both sail and power vessels and is a member of the Ocean Cruising Club, Cruising Club of America, U.S. Sailing, the U.S. Power Squadron, and the Seven Seas Cruising Association.
This article originally appeared in the September 2015 issue of Power & Motoryacht magazine.