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post #11 of 27 Old 09-26-2016
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Re: Prescription medications in your kit

Sure, you can get medical advice, but that's only based upon the information provided by the person on the other end of the communications device. If you do not possess the knowledge and continued training in the medical field(s), it would be indeed difficult to provide even the most preliminary, basic information to a qualified physician on the other end of the line. Sure, you might get lucky, but I wouldn't want to bet my life on it.

Additionally, the vast majority of pleasure craft do not have the necessary diagnostic equipment on board to even make an educated guess, let alone a definitive diagnosis. It takes an EKG machine to determine if someone is having a heart attack - otherwise you could be giving dangerous drugs to someone that merely is suffering from indigestion, and vice-versa. Most boats don't even have a simple stethoscope or blood pressure cuff onboard. How about a pulse oximeter? I didn't notice any nitroglycerine in that kit either. Treat an infection with the wrong antibiotic and you make that bug immune to not only that antibiotic, but often many others of the same ilk. Then of course, some antibiotics, when combined with others, cause C-diff, which can easily kill you - (ask me how I know this!)

I talked with Paul McElroy a few minutes ago, and he said that there are a lot of CFR subsections pertaining to this, and you have to read them all. He also said, "keep in mind that a medical doctor or PA cannot provide themselves with a prescription - it must be provided by another medical doctor or PA, and that PA has to be working under an MD. They cannot do it on their own. As for walking into a drugstore with your recreational boat's documentation papers and filling a bag with prescription drugs, Paul said "Absolutely NOT!" He also said that on all commercial vessels, the drugs are under the control of both the captain and a certified, trained medical officer. And, every drug on that commercial vessel must be accounted for, and documents containing the number dispensed, who they were dispensed to, expiration dates, and number remaining in stock must be reported annually, or upon demand by the USCG during even a routine boarding or inspection.

Paul also said that the kits that are available may have to have a prescription in some jurisdictions in order to be supplied to the consumer. I found this to be true when I ordered an oxygen generator for myself a few months ago. Keep in mind the O2 generator is not a dangerous device, or drug - just a machine that helps be to be able to breathe. The manufacturer could not ship the oxygen generator, which I desperately needed, until my pulmonary doctor sent him a prescription. Ironically, my pulmonary doctor was one of my students when I was technical director of the Cardio-Pulmonary Division of Johns Hopkins Hospital.

Now, I realize that some folks wish to have every safety item at their disposal aboard their boat, especially while cruising. And, I agree to a major extent. I carry a military (US Army) first aid field kit, which mainly consists of adhesive bandages, tapes, a suture kit, various antibiotic salves, sterile gauze, rubber gloves, eye wash system, aspirin, scissors, and a box of various sized Band-Aids. I also have a blood pressure machine (electronic), a stethoscope and a pulse oximeter, which tells me when it's time to go onto supplemental oxygen. I also carry my oxygen generator, which stays in the cabin, but I have a line long enough to reach my anywhere on the boat. It will run on the house batteries for about 72 hours. My second kit contains all my prescription drugs that I take on a daily basis, and they are in the prescription bottles, which is mandated by federal law. These include: Nitroglycerine (just in case), Albuterol (rescue inhaler), Metatoprolol (beta Blocker), Hydro-Morphine, Hydrochlorathiazide, an over the counter antihistamine, Zantac 150, 5,000 USP Vitamin D and regular aspirin. I also have a good supply of sunblock onboard, which every boater should have available for themselves and the crew.

Now, I do not, by any means, have all the bases covered if I encounter many medical problems while cruising. And, despite working the medical field for 15 years at two of Maryland's most prestigious hospitals with some of the top physicians and surgeons in the region, and extensive training at NIH and both hospitals, without having the proper diagnostic equipment at my disposal, and consulting with various specialist in the field, would not want to treat myself or others for anything other than minor cuts and scrapes. From what I've seen in that kit, it does not really address this without first having a rudimentary first aid kit onboard.

Good luck upon whatever you decide,

Gary
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post #12 of 27 Old 09-26-2016
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Re: Prescription medications in your kit

Gary,

What you are saying is true... But.

Sometimes you have to do the best you can with what you have. No one wants to have to set a crew members broken limb, or treat an underway suspected heart attack. But if my option is to watch someone die, or spend two weeks with a broken unset arm, I really want a doctor on the phone to walk me thru what my options are.

Even something as simple as an allergic reaction can be dangerous, and while I may have the right drugs onboard, and may even have a rudimentary knowledge of how to use them. If it really comes down to needing them, I am calling a doctor for advice not because I want to use them, but because I know how sketchy my knowledge is.


As for antibiotics and pain killers... I am more hesitant about using anti-biotics than I am pain killers. If someone breaks an arm, or gashes themselves, it's generally pretty clear that they are going to need something for pain. Anti-biotics are harder I agree and I would be hesitant about using them, but serious punctures and serious tooth aches generally require them, not to mention infections. But then having them on board doesn't mean you have to use them.
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post #13 of 27 Old 09-26-2016
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Re: Prescription medications in your kit

When my father, a surgeon, put together a medical kit for my circumnavigation in 1970, he gave me an older Merck Manual and butterfly bandages, as well as some antibiotics, Lomotil for food poisoning and some speed for emergencies where I might need to stay awake for a prolonged period, among other things like bandages and tape.
When I asked why no sutures he stated that it was likely we wouldn't be able to clean the wound sufficiently to close the wound and the butterfly bandages would allow the wound to seep without containing an infection.
The older Merck Manual was actually a stroke of genius as it recommended medicines available in the 3rd world at the time, not cutting edge meds that we would find only in the US. This book actually enabled us to diagnose and save the lives of a few people, including several children on islands without medical personnel, using the meds available in their clinic.
I'm pretty good at sewing sails but frankly, I doubt I'd have been able to suture a wound properly in heavy weather, anyway.
Medications have a definite shelf life, especially in the tropics, and stocking up on the latest and best may not be all that helpful when they go out of date and can't be replaced when you need them. Stick with a simple, basic kit that doesn't take skilled medical personnel to use.

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post #14 of 27 Old 09-26-2016
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Re: Prescription medications in your kit

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Originally Posted by travlin-easy View Post
Sure, you can get medical advice, but that's only based upon the information provided by the person on the other end of the communications device. If you do not possess the knowledge and continued training in the medical field(s), it would be indeed difficult to provide even the most preliminary, basic information to a qualified physician on the other end of the line. Sure, you might get lucky, but I wouldn't want to bet my life on it.Gary
Well said, Gary.
Just like the rail on our boat is the edge of a 900 foot cliff, injuries on a passage are not acceptable. There's no cure needed if one is thoughtful, cognizant of their surroundings/actions and always cautious.
Again, sh*t does NOT have to happen!

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post #15 of 27 Old 09-28-2016
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Re: Prescription medications in your kit

I'm a retired physician. Between the wife (RN) and I we can just about run a code on the the boat and treat sepsis as well as treat most fractures or shock. Still although I set up the kit and had the luxury of getting stuff from my hospital or office I did not. Used a friend to write 'scripts for me. That said
if you are searched while clearing in or stopped in foreign waters and you don't have the name of the person on the supplies on the boat you're probably going to be in a whole lot of hurt. No real purpose to have meds written to the boat for cruisers. Think it would be a hassle if searched and easier to just write meds to owner.
What's OTC in other countries tends to be much more extensive then what's OTC in the US. This decreases exposure for some things. There is much argument about how far out you can use meds past their expiration date. Our current med kit has gone back and forth from carribean and is two years old. In spite of being just past due everything is being replaced. We are leaving for a year on the 20th. They will remain in their orginal packing with my name on it although that's inefficient to prevent difficulties with authorities in the the future.
A more common hassle is that many daily meds come as 3 month supply. Difficult when you are out the your home country and moving for more than three months.
Most insurance requires an "indication" documented if they are going to pay for meds. Difficult for the meds usually placed in a Med kit so very expensive to replace.

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post #16 of 27 Old 09-28-2016
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Re: Prescription medications in your kit

Check out Seaside Marine Int’l Drug Co, in Los Angeles. They have complete first aid kits and can sell individual supplies.
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post #17 of 27 Old 09-28-2016
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Re: Prescription medications in your kit

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Originally Posted by outbound View Post
I'm a retired physician. Between the wife (RN) and I we can just about run a code on the the boat and treat sepsis as well as treat most fractures or shock. Still although I set up the kit and had the luxury of getting stuff from my hospital or office I did not. Used a friend to write 'scripts for me. That said
if you are searched while clearing in or stopped in foreign waters and you don't have the name of the person on the supplies on the boat you're probably going to be in a whole lot of hurt. No real purpose to have meds written to the boat for cruisers. Think it would be a hassle if searched and easier to just write meds to owner.
What's OTC in other countries tends to be much more extensive then what's OTC in the US. This decreases exposure for some things. There is much argument about how far out you can use meds past their expiration date. Our current med kit has gone back and forth from carribean and is two years old. In spite of being just past due everything is being replaced. We are leaving for a year on the 20th. They will remain in their orginal packing with my name on it although that's inefficient to prevent difficulties with authorities in the the future.
A more common hassle is that many daily meds come as 3 month supply. Difficult when you are out the your home country and moving for more than three months.
Most insurance requires an "indication" documented if they are going to pay for meds. Difficult for the meds usually placed in a Med kit so very expensive to replace.
In 17 years years of cruising, no official ever checked our extensive medical equipment, including prescription drugs for my name, the boat name or my wife's name. In Mexico we were able to get USA style prescription drugs just for the asking at the pharmacy. The Australians were most interested in the sudafed...we had to record the amounts on hand and if any were consumed, it had to be recorded in the log book. A customs seal was placed on each OTC package. They didn't bother with the injectible morphine ampoules or the other opiate based pain killers. Have been replacing various items here in Asia, all available at the pharmacy, for the asking. I'd tell you the price, but it may give most of you a coronary due to the absolute low cost.

We found a cruiser friendly Doctor in Seattle who provided what we asked for and also suggested some we did not. All paid for by my company sponsored insurance program. My gal was an RN and trauma nurse, so were really well prepared. But, I'll guess 99 percent of the prescription drug items were never used. Seems we go through ibuprofen the most.

You may find once you are offshore that obtaining the meds you require is quite easy and at a fraction of the cost back home. Good luck and stay healthy!


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post #18 of 27 Old 09-28-2016
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Re: Prescription medications in your kit

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....Surely there must be some kind of training standard before a physician would hand out these kind of drugs for the expressed purpose of use on a third party?
In the US, the easiest path to this credential is to become a Paramedic. These are professionals that typically work in advanced care ambulances, a step above Emergency Medical Technicians. The Paramedic may administer medication upon instruction from a physician, there may even by a few drugs they can administer on their own. This would be an ideal resource to have aboard, along with a satellite phone connection back to a tele-medicine service. I was a certified EMT-D many years ago, although, it was not my occupation. Still, I've found the life skills that I learned in that course to be invaluable.

Paramedic training requires just about a full year of class study and hundreds of hours of clinical experience. Although, it's still not what the OP is asking, as the Paramedic can't prescribe meds, they are simply trained and licensed to evaluate and administer. One still needs to figure out how to have these meds aboard in the first place.


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post #19 of 27 Old 09-28-2016
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Re: Prescription medications in your kit

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.....A doctor may require somebody to demonstrate that they know how to properly administer medications before writing a script for the boat.
Some may, but I don't think that's a regulatory requirement. I know there are docs that will write the script for cruisers and I believe it's perfectly legal.

Your previous scenario was administering to a third party. For cruisers, they would be administering to themselves. Yes, one could administer to another, but I think that's form over function, especially between spouses.

Quote:
Big time liability involved for both parties here, the ethics of first aid dictate that you not perform any treatments that you aren't adequately educated in.
Liability and ethics are far apart. Liability is a matter of jurisdictional law. Ethics are a matter of personal boundaries, which vary greatly.


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post #20 of 27 Old 09-29-2016
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Re: Prescription medications in your kit

Too far off the intended topic here to get into a discussion on ethics. Suffice it to say that it's pretty unlikely that a drug is going to be administered aboard a recreational vessel to an unconscious person. Therefore, the infirmed is going to participate in the decision to take the medication. In that case, I don't see much potential for either legal or ethical violations, unless the jurisdiction specifically disallows the circumstance. Indeed there are some jurisdictions that would not permit the use of a narcotic by one other than that to which it was prescribed. However, that liability is upon the infirmed themselves and they may be quite willing to accept it, in the circumstance.


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