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  Topic Review (Newest First)
03-10-2013 05:22 PM
Se'id Meis
Re: 1st Aid at Sea & Important Like Items to Carry

Thanks to the Doc'(s) and the original poster! This was some invaluable stuff.....once we got past the omni-present naysayers! By trade I'm an Engineer. I know what makes the boat work but, with threads like this, I hope to understand what makes the experience work! I can't help but think that this is what this site was meant to be!

Thanks again, y'all, and keep it coming!

Gary & Jennifer Hunt
P-30'ing on SV Se'id Me'
11-07-2012 09:09 AM
Re: 1st Aid at Sea & Important Like Items to Carry

For First Aid? Have an ER Nurse sailing with you or the ER Doctor, One on the either or both. And let them handle the bloody details.
11-06-2012 10:04 PM
Re: 1st Aid at Sea & Important Like Items to Carry

Aren't we all always looking for another boat?
11-06-2012 09:59 PM
Re: 1st Aid at Sea & Important Like Items to Carry

at least the lac wasn't on your scalp... "Hand me that stapler..." Now THAT would've been fun to watch, "hey doc... you ummmm need a hand with that?"

I think the self-sufficiency aspect touches home with a lot of us and I think you make a great point. Going back to the original post, we want to prepare for the potential unseen that comes our way. But it's not always a matter of how much stuff you can shove aboard to overcome poor cognitive preparedness.

For me sailing is as much a thinking game as it is playing by feel.... like a riddle that's fun to solve. Trying to sail close to wind that keeps fluctuating between soft air and strong gusts, finding yourself in changing conditions or situations that require problem solving.... and knowing you (with your crew if you have one) have to figure it out.

Qualified medical crew isn't easy to come by... if you also become a diesel mechanic you could probably hitch so many rides you'd circumnavigate.

btw, my uncle used to have a boat slipped in Lorain, not too far from you. He let it go and is apparently in the market for another (nearing a slightly early retirement selling his periodontal surgery practice)
11-06-2012 09:40 PM
Re: 1st Aid at Sea & Important Like Items to Carry

Suturing myself in a mirror was kind of like that Ginger Rogers quote - backwards in heels. Upside down and backwards. I'm not brave, though; I had local anesthetic on board.
What I like best about knowing medicine is that it feeds into a strong drive I have for self-sufficiency. I think most sailors have this same goal- we like to be able to handle situations on our own, without outside help. Knowing medicine allows me to spend my time learning the stuff I don't know as well. It's also, of course, a desired skill that I can offer among a crew that are better sailors, or navigators, etc- it gives me a niche.
11-06-2012 09:12 PM
Re: 1st Aid at Sea & Important Like Items to Carry

Originally Posted by msmith10 View Post
I even stitched a cut to my chin using a mirror in my cabin one time so I wouldn't have to cut my sail short.
FRANKENSAILOR!! that would've been fun to watch... self-suturing on a (I'm assuming) rocking boat. I can only imagine you've used that since with apprehensive patients in the ED, "Don't be a baby, I had to suture my own face on a moving sailboat before. You've got it easy here..."
11-06-2012 05:28 PM
Re: 1st Aid at Sea & Important Like Items to Carry

Yeah, I'm a residency trained and board certified Emergency Physician for 28 years in a very busy urban ER and level 1 trauma center with between 130-140,000 patients I've personally cared for in my career. I've intubated and resuscitated a few people. I won't hold myself out as an expert on law or even sailing, but I will hold my ground on emergency medical care.
Your analysis of drowning is correct, from a physiologic standpoint. Dry or wet, salt water or fresh doesn't make much difference in resuscitation, you've got to get them breathing, get their heart started, and get their tissues perfused, and once they're stabilized, then you start putting out fires.

You're right about common sense, but isn't that a rare commodity- it's really the application of knowledge and experience, eh?

You're absolutely right. Very few will ever have to resuscitate a person. But we'll all be called upon to treat a burn, a cut, seasickness, even as a coastal cruiser or day sailor, and that's what people should read up on and prepare for. I had a similar episode as yours in the BVIs when my wife sustained a nasty 2nd degree "lap" burn from spilled hot water. Knowing how to handle it turned a painful and potentially trip-ending injury into an inconvenient but tolerable nuisance. Being able to help seasick crew allowed me to finish more than one race that I otherwise would have had to scrub. I even stitched a cut to my chin using a mirror in my cabin one time so I wouldn't have to cut my sail short.
11-06-2012 05:05 PM
Re: 1st Aid at Sea & Important Like Items to Carry

Originally Posted by biology View Post
I'd go with a SAM splint (the longest one that comes rolled up). Pretty cheap ($10-15), easy to use, compact, and lots and lots of splinting uses.

Dunno about the BVM (ambu bag). That's a bulky (and more expensive $20) item that could be remedied with a simple pocket mask ($5). Plus the person would have to be trained for how and when to use a BVM. The pocket mask is easier to use and works fine. Current AHA guidelines support ventilationless chest compressions ("compression-only CPR") with evidence of high efficacy anyway for out-of-hospital cardiac arrest management. Isolated respiratory arrest without cardiac compromise is rare and most likely exacerbation of a pre-existing medical condition such as asthma or COPD. In that case, it takes us back to crew-specific Rx meds and a face mask.
Yes, the pocket masks are what I have. The only reason I'd maybe choose something bigger like a bag is the yuk factor. Having been on a number of situations away from immediate help, continuing CPR for any length of time can be a messy proposition. Training is definitely needed to use an airway but they can mean the difference... I've been out of FA for a long time and am sure there are lots of things I'm not up to date on. In the 12 years I spent as a full time first-aider, I learned the common sense is the main thing needed in any FA kit. Unfortunately you can't put that in a sterile wrapper.

The ladder splint I mentioned sounds like the SAM splint. It's just a rolled-up flexible wire splint, about 4" wide and maybe 4' long when unrolled.

Sailing is not a particularly safe thing to do. There are ample opportunities for cuts, lacerations, head injuries, compound fractures, etc. A good FA kit, not just the WalMart variety of band-aids Hellosailor referred to, really should be a priority.
11-06-2012 04:55 PM
Re: 1st Aid at Sea & Important Like Items to Carry

@Smith; I assume you're a Paramedic, Nurse Anesthetist or Physician considering you seem to have experience intubating. The near-drowning is an interesting thing to consider. I would imagine the person went overboard and you were able to retrieve them and get them back on deck to find them in respiratory/cardiac arrest. I think the likelihood of survival would be based on a few factors: (this info is for general public and not directed at you smith since you seem to have your finger on the pulse of things)

1. water temperature. As you know (but perhaps others don't) cold water survival rates are much higher than warm water, especially in younger populations, usually due to the mammalian diving reflex that slow metabolism upon dropping into cold water. This usually means longer resuscitation times to allow for warming before determining death. Some may say, "they're not dead, until they're warm and dead." Basically year round along the coast of New England would always count as cold water, and along Florida always warm water due to consistent temperatures. Soooooo fall overboard up north?!

2. laryngeal spasms. A "dry drowning" is due to laryngeal spasms, which still causes asphyxiation by submersion (the definition of drowning); water does not enter the lung. A "wet drowning" is absent of laryngeal spasms and allows water into the trachea and thus lungs. An intubation kit with suction (a meconium aspirator works like a champ to turn your ET tube into a laryngeal suction device) come in very handy here. Usually wet drownings are associated with intoxication or head injury as normal physiological responses are hindered (assuming you got them back aboard quickly).

3. Age. The younger you are the more likely you'll survive a near-drowning. Kids tolerate transient hypoxia a bit better (especially in cold water, as mentioned above).

4. salt vs fresh. This is usually only important is the person is revived after a wet-drowning. In fresh water the surfactant is washed away and causes the alveoli to collapse (atelectasis). When you ventilate with positive pressure you're actually forcing more fluid into the capillaries causing hemodilution (decreasing the concentration of your red blood cells is the key factor here). With salt water, if the person is revived, salt stays in the alveoli and (due to osmotic pressure) draws fluid out of the capillaries back into the alveoli. So a person can wind up with pulmonary edema hours after they've been revived and still have serious respiratory compromise.

5. distance to rescue. Can't do CPR or ventilate forever. Gotta get to definitive care: hospital.

Side note: usually "drowning" is considered death by asphyxiation within 24 hours of submersion, and "near drowning" is death by asphyxiation after 24 hours of submersion. So if you fell in the water and were revived and lived... it wasn't actually a "near drowning" (it would only be called that if you died the next day!).
11-06-2012 04:36 PM
Re: 1st Aid at Sea & Important Like Items to Carry

Originally Posted by tdw View Post
Smith, you are probably correct that drowning or near drowning are major or the major concerns on board overall but out cruising away from immediate medical care burns, sprains/fractures and stomach/intestinal upset are probably more of an issue.
Of course you're right, and my post was essentially didactic. We've strayed a long way from the OP, which was a shotgun full of "I'm gonna blue water cruise, what do I need?"
I was addressing one point with which I disagreed.
I find it difficult to tell someone what they need in their "first aid kit" without knowing their capabilities and what they're going to be doing. I did, in fact, recommend a first aid kit via private message a few days ago to a man who's a pharmacist with several other qualifications, and who's going to be the medical officer on an offshore race. In that case, I know what he's capable of doing and what he may be called upon to do, and I know what he'll need to do this. In a case like that, I can make specific recommendations. In his situation, this really isn't first aid, but may become definitive treatment.
There have been a lot of subsequent posts addressing CPR, cauterizing wounds, treating shock, and a lot of suggestions that are just plain nonsense.
The best thing the OP can do is learn some first aid, decide what he's capable of handling and is likely to be treating, and prepare a kit accordingly.
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