Medicine at Sea advice

captcore · #1 10-31-2012

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

capttb · #2 10-31-2012

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.

Spirit of Freedom · #3 10-31-2012

And broken bones and concussions. Unfortunately too common offshore.

killarney_sailor · #4 10-31-2012

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.

Minnewaska · #5 10-31-2012

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.

msmith10 · #6 10-31-2012

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.

jackdale · #7 10-31-2012

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 Medical Evacuation on Maui Return

The thread also has some pictures.

Videos are at

evacuation sailboat to container ship august, 2012 part 1 - YouTube

evacuation sailboat to container ship august, 2012 part 2 - YouTube

evacuation sailboat to container ship august, 2012 part 3 - YouTube

zeehag · #8 10-31-2012

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....

jackdale · #9 10-31-2012

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.

emoney · #10 10-31-2012

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?