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William Mahaffy 12-18-1998 07:00 PM

The Onboard Medical Kit, Part Two
<HTML><!-- eWebEditPro --><P>Now that everyone has rushed out and taken advanced first-aid courses, you need to equip your boat with the first-aid kit that has all the right articles necessary to handle any medical emergency that may arise. Your marine first-aid kit should be tailored to the specific needs of the crew and the general type of sailing you do.</P><P>If you are mainly a Chesapeake Bay sailor, for example, you would probably not need the sophisticated medical kit that a sailor making extended passages would have aboard. Consider, also, the varying needs of crewmembers. Do you or any of your crew have a preexisting medical condition? And, think about the waters you frequent. Do you routinely sail in an area with known local hazards, such as fire coral or jellyfish? Being aware of these contingencies and planning for them in the first-aid kit can be the difference between taking care of a minor medical problem and facing a disaster.</P><P>Marine medical kits can be categorized into 3 types: inland, near-coastal and voyaging. Each type kit is created around the expected needs of that sailing. If you choose to move from inland- to voyaging-type sailing, for example, it's a matter of simply augmenting the kit with the additional necessary items.</P><P><B>The inland kit</B></P><P>The inland kit contains articles used to treat the small, more common on-board injuries, such as; cuts, abrasions, contusions, minor burns, etc.</P><P>Here are the items that should be in an inland-type marine first-aid kit: bandages, dressings (include non-stick dressings, e.g. Telfa), gauze rolls, tape, Ace wraps, isopropyl alcohol, Betadine solution, hydrogen peroxide, sterile saline for irrigation, burn dressings and over-the-counter medications. Include a thermometer (oral and rectal), some sterile gloves, bandage and trauma scissors, tweezers, cold packs, eye-wash solution and antibiotic ointment packets.</P><P>The medications for the inland-type first-aid kit should include: aspirin and a non-aspirin pain relievers (Tylenol or Motrin), Maalox, Pepto-Bismol, Calamine lotion, Imodium, Benadryl, decongestant, sore-throat lozenges, hydrocortisone ointment, sunscreen and after-sun lotion. As for prescription medications, these need to be specific to any known problems. <P>To round out the kit, I would include a blood-pressure cuff and stethoscope. Even if you are not an expert at using them, someone on board may be and you will find them to be a useful diagnostic tool. They will also be essential equipment if you upgrade to a more sophisticated kit.</P><P><B>The near-coastal kit</B></P><P>The near-coastal kit, designed for use by sailors with some advanced first-aid training, contains, in addition to the items of the inland kit: splinting materials (a ladder splint, padded arm board and finger splints), an emergency dental kit (commercially available as a complete set), tongue depressors, Insta-glucose, petrolatum gauze, Steri-strips and/or butterfly bandages, K-Y Lubricating jelly, a naso-gastric tube, some large trauma dressings and an emergency space blanket.</P><P>The medications in the near-coastal kit include those in the inland plus: Lomotil, Dulcolax or Senekot, glycerine suppositories, Lotrimin antifungal cream and Monistat cream and vaginal suppositories. I recommend Silvadene cream for more severe burns (it is rather expensive but well worth it for second-degree burns). Oral antibiotics include Ampicillin 250 mg, Augmentin 500/125 mg, Keflex 500 mg, Ciprofloxacin 500 mg, Erythromycin 500 mg, Tetracycline 150 mg and Bactrim DS. You should have sublingual nitroglycerine 0.4 mg, Darvocet N-100 or Percocet.</P><P>The near-coastal kit should also contain intravenous and suturing supplies. You should carry 1 or 2 1000 cc bags of Lactated Ringers solution with tubing, an IV start kit and some 18- and 20-gauge IV catheters. For suturing, you will need a surgical scrub brush, surgical instrument tray (containing sterile scissors, hemostats and clamps), Lidocaine 1% without epinephrine (20 cc multi-dose vial), a needle "driver", disposable scalpel, syringes (5, 10 and 20 cc), needles (18-, 21- and 25-gauge), some Vicryl (2-0) and Ethilon (3-0, 4-0) suture. Obviously, these items require training over and above advanced first-aid, but the skills are not difficult to learn and you needn't be a surgeon to get the job done.</P><P><B>The voyaging kit</B></P><P>The voyaging kit, with still more items added to the kit, is the highest level medical kit. It should augment the dressings and bandages with more bulky and trauma dressings, roller gauze, sterile eye pads, a burn sheet, fiberglass cast material and padding. More Betadine solution, saline irrigation solution, Burrow's solution (for fungal infections), isopropyl alcohol and alcohol wipes, sterile gloves, suturing materials, IV fluids and syringes. You will need a Foley catheter (16 French) and some gauze drains.</P><P>Medications will include Mannitol 25% (IV), Lasix 20 mg (IV and oral), Atropine sulfate 1 mg (IV), Ceftriaxone 1 gm vials with Diluent (IV antibiotic), Demerol 50 mg/ml, Morphine sulfate 10 mg/ml, Medrol 40 mg vials and Epinephrine 1:1000 30 cc vial, Prednisone 5 mg tablets, Compazine suppositories, Albuterol inhaler, Auralgan ear drops, 10% sulfacetamide eye ointment and Garamycin topical antibiotic.</P><P>There are other items that, given the medical history of the crew and the specific cruising grounds, your health care provider may recommend.</P><P>In my future articles covering minor and major trauma, illnesses and infections, I will refer back to these supplies. Hopefully, this will help clarify the reason for carrying this equipment.</P><P>Your boat's medical first-aid kit is as important as your sail inventory. As with a storm trysail, it is far better to have it and not need it than to need it and not have it at all.</P>1/99<P></P></HTML>

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