# Medicine at Sea advice



## captcore (Oct 23, 2011)

All,

I am an EMT/FF (and half of a paramedic...I finish the class in October), and I have been asked to give a presentation next weekend about medical emergencies at sea and their treatment. I was also asked that class be geared towards those who do not have access to medevac (air support), as they are heading offshore.

My question is this: Keeping in mind that I AM NOT A DOCTOR (I stayed at a Holiday Inn once....well ok, it was an express), what ailments or injuries would you like to hear about? So far, I have dehydration, dislocations, sprains, and burns. 

Any other suggestions?

Thanks

Capt Core


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## capttb (Dec 13, 2003)

Could be everything in "Emergency Care and Transportation of the Sick and Injured " but you need stopping bleeding and wound care, heat stroke/exhaustion and ABC basics, and choking.


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## Spirit of Freedom (Jul 24, 2012)

And broken bones and concussions. Unfortunately too common offshore.


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## killarney_sailor (May 4, 2006)

I would not ignore non-injuries at sea that require care. We have had no significant injuries in almost 30,000 miles offshore but some problems with infections and skin rashes. Had an infected boil that got larger than a golf ball and eventually required treatment in two different parts of French Polynesia and Fiji over more than five months. We did not an antibiotic that was really good for skin infections. Needed to add Keflex to the kit in addition to Cipro. My wife seems to have developed an allergic reaction to fish (and no we have not been eating reef fish, only mahi-mahi offshore and she has even had a reaction to canned salmon. Have to get that checked out while we are in South Africa. At sea, these things can be quite debilitating. With the boil I was only comfortable standing up, even lying down was not good. Try that when you are on a 1500 mile passage.


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## Minnewaska (Feb 21, 2010)

Anti-biotics, which to use and how to get them is often of interest to offshore sailors. Dentists are often accommodating with a ******, but can't get a good spectrum.

Having been certified as an EMT back in my 20s (never rode a bus), I learned the value of pure oxygen and would never be long offshore without it.

I think life preservation for heart attacks and shock are very concerning, particularly given the age of most cruisers.

Other than that, basic First Aid and CPR. Everyone should take that course, sailors or not.


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## msmith10 (Feb 28, 2009)

As an Emergency Physician for 30 years and sailor for much longer than that, I also serve as Fleet Surgeon for our club. I am almost daily pressed into service for boating related illness/injuries. My advice: keep it simple. The following list is one I use for this presentation.

Drowning
Cold exposure
Control of bleeding
Orthopedic injuries—sprains, strains, fractures
Laceration and wound care
Burns
Eye injuries
Seasickness
Insect bites and stings

This list would be augmented for offshore: advanced treatment of the above, and recognition and treatment of infections: pneumonia, urinary tract, skin, gastrointestinal, dental emergencies.

I also have a presentation discussing a proper first aid kit if you'd like that.
Preparation for offshore is very different from day-sailing/coastal cruising.
Offshore preparation requires that you have some prescription medications onboard and know how/when to use them. If you're going offshore, I'd recommend talking to your family doctor about writing prescriptions for some of the essentials to keep stocked on board.

Note that CPR/resuscitation is not on the list above. That's a topic all on it's own and should have a separate course. Every boater should know how to do CPR. While it's good to know more advanced stuff, there are limitations to what you can do offshore. Life-threatening illnesses offshore are exactly that, and your ability to intervene is extremely limited. While I don't want to be too cynical, a patient requiring CPR out-of-range of ground transportation (out of the marina) has virtually a 0% chance of survival. (please don't send me any Lazarus stories).
This is a huge subject- again, keep it simple.


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## jackdale (Dec 1, 2008)

I had a crew member who was medically evacuated mid way between Hawaii and Vancouver. I had prostate issues that could not be resolved. We contact CG Honolulu who arranged with AMVER for a rendezvous with a container ship which took him to Los Angeles.

The story is here http://www.sailnet.com/forums/pacif...edical-evacuation-maui-return.html#post929330

The thread also has some pictures.

Videos are at


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## zeehag (Nov 16, 2008)

DEHYDRATION is a large an d deadly problem with sailors. we die of it-- make sure this is made known. 
much of medicine at sea is similar to medicine in a hiking/camping/climbing situation in wilderness, away from help.
there is a book WHERE THERE IS NO DOCTOR--you may wish to acquire this book --it will be a help.
merck manual and handbooks of emergency medicine are also helpful. 
a medical kit that is complete, will take up an entire boat. i keep on board some few broad spectrum antibiotics, splinting materials, bandages, neosporin ointment, scissors, tweezers, "second skin" crazy glue and super glue, cervical collar(i know how to make a rigid collar/support from that for protecting necks after a fall)..and some other stuff....


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## jackdale (Dec 1, 2008)

A couple of items that might not be considered.

Sanitary napkins are great for bandaging wounds.

Vet wrap can be used for splinting, bandaging etc..










I will second the comments about advanced / wilderness first aid. Standard first aid is based on stabilizing and calling 911, who will be there in 10 minutes. That is unlikely even in coastal cruising.


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## emoney (Jun 2, 2010)

Default to the good Doctor above, of course, but I'd add "dealing with a concussion" to his list. That swinging boom in an accidental gybe is a real fear, and dealing with the aftermath is something every sailor should be prepared for.

On a side note, I think any discussion of "emergencies @ sea" should also include a conversation about preparing everyone on board for what to do "next". I wonder how many at-sea-rescues take place because the non-injured parties aboard aren't capable of handling the vessel after the captain gets injured?


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## msmith10 (Feb 28, 2009)

As an EMT, you will take for granted a lot of stuff that the layman won't comprehend. That's why I encourage you to keep it simple. First aid for daysailing, coastal cruising, and offshore becomes increasingly complex and trying to teach your audience too much will just lose them.
All of the advice above is good, but you've got to limit your discussion- maybe just a review of basic first aid kit essentials, recommending a good book and/or course, and how to summon emergency help- that would cover an hour presentation in itself.
Also, please don't take my lead-in to my first post as a "shut-out" to discussion or dissent. I just have had enough experience to know what you can and can't do out on the water. Even if you know what you're doing, dealing with emergencies on a boat are different from dealing with them in an emergency room with a million $ of drugs and equipment at your disposal, or even on shore where you can at least depend on a stable platform, electricity, heat and light, clean water, and access to supplies.


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## Minnewaska (Feb 21, 2010)

msmith10 said:


> .....While I don't want to be too cynical, a patient requiring CPR out-of-range of ground transportation (out of the marina) has virtually a 0% chance of survival....


I agree for most cardiac events. However, a cold water drowning could be resuscitated with success. Not all.


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## msmith10 (Feb 28, 2009)

You're right, Minne. That's a special case and one reason I think they still need to emphasize mouth-to-mouth as part of CPR. In a primary respiratory event, doing CPR without respirations is not really helpful. Anyone around water needs to practice the respiratory portion of CPR as well as compression.
The hard part of CPR offshore, or even coastal, is knowing when to stop, and not feeling guilty for not being able to continue when continuing is futile.


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## sailordave (Jun 26, 2001)

I've always said (and felt) that it's the simple things that are more likely to become a problem. Infection from a fish hook, a deep gash from a blow to the head (boom, flogging sail, etc.) a cut from a knife, concussion, etc. 

Emphasize the need to THOROUGHLY clean a wound. Should have on board sterile saline solution, squirt bottle and some Betadine. Flush the hell out of the wound and treat w/ Neosporin or its equivalent.

Years ago I saw a presentation about injuries at sea and read the handbook. The most common instruction was SEEK MEDICAL ATTENTION. Yeah, right.

And as an aside, and basic seamanship, I would say that "situational awareness" is very important for anyone that's going to be far from a safe harbor. Basically, where the hell are you and where would you go RIGHT NOW if you had to seek a port?


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## emt281101 (Mar 24, 2009)

msmith10,

About a year ago, I posted on this forum asking about doing a presentation about medical emergencies at sea. You said that you had a few presentations which I could borrow for reference. If you still have them, is there any way that I could have a peek? Perhaps you could email them to me at [email protected]. Obviously, I will not use your presentations in any way without your written permission.

Thanks

Capt. Corey


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## rgscpat (Aug 1, 2010)

Would it be appropriate to have a part of the discussion about forms of help that are available, i.e. communications with medical people ashore?


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## momoparagon (Jan 16, 2012)

I noticed someone mentioned this earlier, but I would strongly recommend talking about seasickness as well. As someone who suffers from this, sometimes in a quite debilitating way, prevention and treatment is always on my mind. 

Quite a few people have recommended different oral medications, Stugeron being the forerunner, but when I'm vomiting it can be impossible to keep pills in my stomach.

Recently I've discovered the Scopolamine Patches which have worked better than most things I've tried. I put the patch behind my ear the night before we leave and don't even have to think about it for three days. I've also found that, outside of the U.S., they can be purchased over the counter in most drug or grocery stores. 

I realize quite a bit of time has passed since your first post, but I was wondering if you filmed the presentation and put it up on a website or YouTube. If so, I would love to check that out!

Thanks so much!
Monique
s/v Paragon


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