I have always found it interesting to ask sailors what they feel is the most important item of the on-board medical kit. The answers vary but most center on either having sufficient bandages or the appropriate broad-spectrum antibiotic. A few insightful souls say the most important item is a good medical reference.
It's kind of a trick question. Oddly, the most important component of on-board medical equipment is the one item not in the first-aid kit: adequate first-aid knowledge and training. While this may seem obvious, many sailors cast off daily with a knowledge of first-aid treatment that is as slim as their first-aid kits containing barely more than band aids and sunscreen.
I have often heard the excuse, If I have a problem, Ill call the Coast Guard. While this is usually an option, calling the Coast Guard from the water is not the same as dialing 9-1-1 on land. Even with picture-perfect weather and the exact location of your boat, it usually takes a lot of time for help to arrive and to get a suffering crew to treatment at an emergency center on land. During this time, what may have begun as a minor medical problem could have become a disaster for want of basic medical training on board. Some well-applied, emergency procedures instituted early can make all the critical difference.
The crew complement of many large sailing yachts today includes at least one crew member trained as a nurse or emergency medical technician (EMT). Though it would be nice, not all boats sailing coastal or offshore need to have this level of preparedness. But, as the first requisite, every sailor should be trained in CPR. While it may be a skill you will never have to use on board, the training prepares you psychologically for a myriad of small emergencies that will inevitably occur. CPR skills also teach you how to take a pulse rate, count respirations and roughly estimate blood pressure.
As the second requisite, sailors should take the American Red Cross advanced first-aid course. This course teaches wound management and stabilizing a sick or injured patient. Just think of learning the basics of advanced first-aid training as a lot like learning the basics of navigation, sail-handling, maintenance and repair, and general boat operation, which one does when first starting out sailing or after purchasing a new boat.
For sailors heading off on a lengthy offshore passage, more in-depth training should be considered. There are several companies that offer advanced medical training geared toward the voyaging sailor. These courses will familiarize you with handling emergencies like lacerations, burns and fractures. In addition, you will learn about common marine-generated emergencies, such as hypothermia.
Obviously, the more training and experience you have with emergencies, the better. The most extensive training available (short of medical school), is an EMT course. This course prepares you to handle most major and minor emergencies on board. The course is roughly 125 hours of study, both didactic and clinical training. In addition, you are exposed to real-life emergencies by riding on an ambulance. If nothing else, this experience will help prepare you to keep your cool in an emergency.
In addition to the appropriate level of training, an on-board medical reference is invaluable. Reference material is as important to safe passaging as having up-to-date charts. But an on-board emergency should not be the first time you pull out the medical reference. Even without formal medical training, if you have thoroughly read the medical references, you'll have a good minimal basis for emergency medical treatment.
There are a number of good marine medical reference books (a list is included at the end of this article). It is best to review several of them and choose the one that best suits your type of sailing. I don't recommend an emergency medical reference on CD-ROM. It is still much faster to pick up a book and check the table of contents or the index than it is to boot up the computer, get the CD-ROM going and scroll or search to the medical situation you need.
Finally, there are a number of commercial emergency medical advisory services that can help diagnose a problem and offer treatment recommendations while you are at sea. The most dramatic example of this service was the recent self-surgery performed by Viktor Yazykov, competitor on Leg 1 of the Around Alone race. The problem was diagnosed and the treatment relayed via e-mail from Boston to the South Atlantic. Some services will include case management of a medical problem in a foreign country, and in certain situations will offer repatriation via air ambulance if indicated.
Preparation is the foundation for proper safety at sea. Basic medical skills should be considered as important as basic navigational and boat-handling skills. If you have tooled yourself with the right combination of training and equipment, you are likely to be able to manage most on-board medical emergencies.
Marine medical references
Your Offshore Doctor: A Manual of Medical Self-Sufficiency at Sea, by Dr. Michael H. Beilan, Sheridan House, 11/96, (ISBN # 1574090135)
Advanced First Aid Afloat, third edition, by Dr. Peter F. Eastman, Cornell Maritime Press, 8/95 (ISBN# 0870334654)
The On-Board Medical Handbook: First Aid and Emergency Medicine Afloat, by Dr. Paul G. Gill, International Marine Publishers, 11/96 (ISBN# 0070242747)
First Aid for Yachtsmen: Emergencies and After Care, by Dr. Robert Haworth, Beekman Publishing, 6/80 (ISBN# 0846410958)
A Guide to Small Boat Emergencies, by John M. Waters, Naval Institute Press, 4/93 (ISBN# 1557509131)
The Ship Captains Medical Guide 21st edition, British government document, HMSO: Department of Trade, 1988 (ISBN# 0115121919)
International Medical Guide for Ships (including the ships medical chest) second edition, from the World Health Organization, WHO 1988 (ISBN#s 9241540184 or 9241542314)
I have not reviewed all of these books so I can't make any recommendations. Some of these titles are reviewed on Amazon.com and may help you chose the text that best matches your sailing needs. Watch for part II of this article which will feature my list of recommended on-board medical preparations and equipment.