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Go Back   SailNet Community > General Interest > General Discussion (sailing related)
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  #61  
Old 01-13-2007
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Q...
Here's a link which gathers up some of the already available medical resources for cruisers. I don't know if what you are thinking about is substantially different but hopefully this will give you some things to look at.
http://www.geocities.com/TheTropics/5471/health.htm
I don't think any cruising authors ever plan to make a lot of bucks from their writings...there are probably only a few that can make eveough to cruise on...but most of the booksare labors of love and provide the personal satisfaction of adding something worthwhile for the community. Good luck to ya!
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  #62  
Old 01-13-2007
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Q, I'd suspect that the market for "offshore cruisers medicine" is 1000 sailors worldwide and you might sell your book to 100 of them before the market saturated. Add another couple of hundred interested people and if you are lucky, 200-500 per year, which means no publishing house can afford to print it and if you self-publish or demand-publish, that might bump the price to $50 and slow down sales even more. Which is not to say you shouldn't do it as a labor of love--but don't expect something targeted to that market to be profitable.

I have read books on offshore medicine, wilderness medicine, etc. and while I can't remember the name I know there are a couple of good ones out there oriented to a more general survivalist/wilderness audience. You might find some references at www.equipped.org, Doug Ritter's site. I guess the big question is, do you want to encompass appendectomies and trepanning, or stop somewhat short of that.
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  #63  
Old 01-13-2007
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Cam and Hellosailor,
Thanks for replies. I had suspected that the issue of a small market for such a book would raise itself, which is why I have not already started the huge task of writing a book. I just wanted to throw out the idea to see if active interest was manifested. I'll keep my eyes open. I do enjoy writing.
Q
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  #64  
Old 01-13-2007
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Quote:
Originally Posted by hellosailor
Q, I'd suspect that the market for "offshore cruisers medicine" is 1000 sailors worldwide and you might sell your book to 100 of them before the market saturated.
I don't know, how many copies of Jimmy Cornell's "World Cruising Handbook" have been sold ? I'm sure a lot more have been sold than there are world cruisers to use them. I suspect there are a lot of wannabe's buying these books, I know I am one of them!
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  #65  
Old 01-13-2007
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Why write a book?

Just for the sake of the discussion, I was not thinking of writing a cruising medicine book for the profit. It's more about a sense of accomplishment and rendering a service. And, of course, if as a result of such a book, even one life is saved, that would make it worthwhile.
Q
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  #66  
Old 01-13-2007
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Where I would not want to proceed would be if my effort found no interest, and the effort found itself unpublshed and neglected. For that reason, there must be at least enough interest (as in "market") to justify a publisher's taking it on.
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best deals i have seen

are on 'army surplus' FAKs

google for m-3 or m-17 -- they have a ton of supplies, are well equipped for 'really bad things' happening, and are usually pretty well priced.
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Old 01-13-2007
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"If you have a nursing friend, perhaps you can talk them into showing you how to start an IV. In my class, we practised on each other! It's really not hard to get the knack of it. If you have that skill, it is worthwhile to carry Ringer's lactate, and other IV administered fluids. In severe trauma/sickness simply getting a dextrose solution into the blood stream can be invaluable."

This is my point about having training. Just an ability to start an IV does not mean you know what to do with it. Thats why most EMTs can not start them, it takes more than to know how, you need the what and when and how much.
Case in point. RL aka Ringers lactate is NOT a dextrose solution, nor do you want to use a hypertonic glucose solution in a trauma case. Further most trauma is not treated with fluid challenge any more. It just blows the forming clots out.
First do no harm.
I would also strongly advise aganst ever using a tourniquet. In 20 something years of EMS I have never seen one used when it was needed or used correctly. Direct pressure, elevation and pressure points will do the trick. We dont even teach them anymore. In anything short of an amputation they are over kill and can kill someone who just needed basic care.
Get some real training and do only what you know or can be directed to do via radio.
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Old 01-14-2007
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wild-you're argueing specific treatments all of which are moot points if you are not capable of administering an IV.

In your years of experience as an EMT, did you ever have a patient under your care for five or more days? That's why my training was different than yours.

Your last statement I agree with entirely. It is a little short sighted though as the maritime industry has had to develop their own training programs due to lack of help from the medical community. The medical community has trouble seeing over the horizon and seems to fear law-suits more than a patient death. Many though, when confronted with the realities of life at sea, come to realize why it is important to know how to administer an IV or a catheter. EMT training focuses almost exclusively on stabilization and presumes hospitilization. Remove the latter and you must take a different approach in your training.
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I've been involved in emergency medicine for 15 years, first as an EMT, then paramedic, and now as an ER physician. If I ever have to take care of a seriously injured shipmate, it's not likely to be my advanced training or fancy procedures that'll make the difference. The most important factors that will contribute to a good outcome, in my opinion, are likely to be knowing the basics of medical care and being prepared. These are two goals that any interested non-medical person can meet.

Being prepared is essential and it boils down to what was said in previous posts above ie knowing where your equipment is, having it available, anticipating problems, etc. It's a very important point, but I won't belabor that point further as it was said so well above...

As for the issue of medical knowledge; Basic trauma care really boils down to very simple stuff. I'm often saddened by cases that come into the ER which end tragically, when simple maneuvers by bystanders or loved ones at the time of injury would have potentially saved life or limb. Many of these maneuvers are things that even a child can learn. Know basic CPR: be able to recognize when someone's airway isn't open, know how to keep it open for them or do rescue breathing. Know basic first aid: eg nearly all limb bleeding, even in cases of amputation or other massive injury, can be controlled effectively with firm direct pressure (as stated above, no tourniquets or fancy techniques needed). Know how to recognize and treat heat emergencies (cool them off) or cold emergencies (warm them up). Know basic spinal protection and limb splinting techniques (doesn't have to be pretty, just functional). Be able to recognize when someone is at risk for going into shock, so that you will undersatand the need to get them to shore ASAP, etc. This is the basic stuff, simple stuff that anyone can learn, its the stuff you need to know how to do immediately before you have time to get to shore, and it often works. It's true you are not likely to need these skills, as most of your sailing companions won't get their limbs cut off or suffer a near drowning. Most accidents will invovle minor cuts and bruises, simple fractures, etc, but keep in mind most of these more common things are not likely to be life threatening. Yes, it'd be nice to know how to start an IV for rehydration, give morphine for painful injuries, and administer antibiotics for that finger you sliced in the bilge, and if you are talking about weeks at sea I won't pretend that those skills wouldn't be useful. But for those of us who don't sail beyond a few days from medical care (the vast majority I'm sure), remember it's the basics that get the important jobs done. And the other stuff like "just starting an IV" comes with a lot of baggage: ie you have to safely store the fluids, they absolutely have to stay sterile, you have to know which fluids to use (ie not D5W in trauma as stated previously), you have to have IV catheters and know how to use them (takes practice to get it right). You aren't going to get injectible morphine very easily (legally), and IV morphine carries risk (low BP, allergy, respiratory suppression, etc). Antibiotics are rarely necessary in most limb lacerations if they are appropriately irrigated with fresh water. Etc, etc...

Anyway, you get the idea. Take some basic courses. CPR and Basic First Aid will take you a long way if you can gain confidence in those simple techniques. If you are really driven, a First Responder or basic level EMT course would be incredibly useful, but that's already beyond what most people will have the time to do. Will you be able to save someone who got bashed by the boom and is now bleeding into their brain? Or someone who's had a massive heart attack or penetrating thoracic or abdominal injuries or is in cardiac arrest? Probably not, but many of them wouldn't survive if their injury occured in the middle of an operating room at the best hospital, and if you do save them, it's going to be because you knew how to keep their airway open, not because you are a whiz at putting in stitches or doing brain surgery (a brain surgeon on the boat couldn't do much better, and might likely do worse, than a well prepared first responder). FYI, EMS trauma calls in my city (New York City) are, per city protocol, responded to by BASIC level EMTs, NOT by paramedics, because it is recognized that basic level providers (ie not the ones that wield IVs or medications) make the critical difference in trauma.

Ok, sorry I'm so long winded. You get my point...
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