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thataway



Joined: 02 Nov 2003
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City/Region: Pensacola
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C-Dory Year: 2007
C-Dory Model: 25 Cruiser
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PostPosted: Thu Nov 12, 2015 6:48 pm    Post subject: First Aid Kit Reply with quote

Marco Flamingo has asked about a first aid kit in the thread on EPRIB.

None of the below should be considered to be specific medical advice, and is only for first response and emergency treatment, until an injury or illness can be evaluated at a medical facility. I have intentionally avoiding some issues, but welcome questions.

I have made several hundred offshore custom first aid kits (Including RX and Narcotics) for offshore sailors and voyagers during my over 30 years of practicing medicine (Mostly in Long Beach CA). What is needed for a day trip, will be different from a trip in a remote area, such as Alaska for a month, and that is different to what you will carry if crossing an ocean.

My philosophy is that anyone who is smart enough to afford a boat to voyage, is smart enough to handle medical crisis, as long as they have supplies at hand, some basic knowledge and have a good communication system (Ham Radio, Satellite phone, or text message via satellite) to contact a shore side physician. I used to offer this aid thru ham radio and Winlink. We shut this down because of potential liability. There used to be several coastal hospitals who had a ham set, with a patch to the ER and could give this advice, and there are currently services which give this for a fee, but you have to subscribe before you leave on the voyage. This includes vetting the skipper/and being sure that they have adequate basic training and gear.I

One wonders how much room this takes up? For 7 years I was director of Athletic Medicine at a large Division I university, and carried all emergency gear I needed in a large fanny pack--this included gear not on this list, including laryngoscope, endotracheal tubes, 3 suiture kits, and several injectables including a 50 CC syringe with dextrose solution. A cardiac monitor, AED, Oxygen and extra dressings were carried by one of the trainers--all of this gear was personally carried on aircraft.

What I present here would be for a C Dory on a week end to several week coastal trip where they could get to a hospital setting in 12 hours if necessary.

Training. I highly recommend that at least 2 people aboard have CPR certification, have at least basic first aid knowledge, and training as given by the American Red Cross. For ocean voyages, I recommend that a paramedic course be taken--at least for the basic level.

Books

I recommend a basic first aid book aboard--such as the AMA, or Red Cross First aid and Safety book.

Marine Medicine, by Dr. Eric Weiss (there is also a Kindle Edition)

"Doctor on Board" by Dr. Hauert

A PDR or "The pill book" are also handy.

American Wilderness Society has an excellent book on Wilderness medicine:
Wilderness Medicine beyond first aid.

Kits

The basic kid can be obtained in the Walmart Johnson and Johnson $7 first aid kit for day trips. We keep a number of these in cars, RV, Boat etc, all with supplements.

If you want something very organized, then the kits from Adventure Medicine: There are lists of the kit contents--if you want you can assemble for less.

https://www.adventuremedicalkits.com

Medication:

No medication, including Generic should be taken without a doctors's advice. Be sure that a person is not allergic to a medication before giving it.

Bonnie (Meclizine 25 mg) chewable for motion sickness can be chewed or dissolved under the tongue after a person has motion sickness--also mild anti histamine.
Benadryl; (25 mg anti histamine.)
Advil / ( Ibuprofen ) ( 200 mg x 2 Tablets )
Tylenol / ( Acetaminophen ) ( 500 mg x 2 Tablets )
Aspirin ( 325 mg x 2 Tablets )
EpiPen (Epinephrine, for severe allergic reactions--injected RX)
Medrol Dose Pac (for severe allergy, oral, tapering decrease dose of steroids RX)
Peptobismol
IMODIUMŪ(loperamide hydrochloride)
Metamucil
Ducolax tab
Antacids


Cleaning

It is extremely important to clean well any wound which has been in the water, or from beach/coral sand/marine life, or rock.
Scrub brush It sounds harsh, but scrub out a wound, to get any debris out.

hexachlorophene or solution.
Betadine, or Povidine (can be in swabs--or pads)
Benzalkonium Chloride Antiseptic pads
Saline rinse (in bottles or pressure cans) to irrigate the wound

There is some controversy about using potential toxic chemicals on wound edges. Our experience is that one time initial application doe snot delay healing, and gives far less infection. We do not use alcohol. But alcohol can be used to sterilize instruments.

Instruments:

Head lamp (several times I had to suiture folks when no lights available)
Splinter forceps--we often use those on the handle of our Swiss Army knife, but we also have small dental picks, and larger sharp pointed forceps

#11 Knife blade (X-acto) and handle
Scissors--bandage, and small cuticle type
Gloves, Nitrile Gloves extra thick, disposable --I keep a box of 50 aboard.
Sterile gloves, for suiture and exam--this is elective.
Diagonal wire cutters for fish hooks.

Wound closure:

Most wounds will do well with just pressure, and not suiture, but when it is necessary:
Also this is a point to mention "quick Clot" It is life saving--but rarely necessary, unless massive trauma. If you want it or not--is elective.

For the most part, we used steri strips (CVS) or butterfly bandages: You can make your own, if necessary, here is some technique on use of skin closure strips:
http://www.firstaidguide.net/skin-closure-strips/

Suiture sets--not recommended for short near shore--clean, dress and use pressure dressing, until you get to medical care.
I carried several sterile packets with 4 different types of suitures, and needles, hemostats, scissors, probe, suiture holder, etc. You can buy sets from "Duluth Trading co".

Small suitures, and needles hurt less than injection of Xylocaine for a small wound.

If you want to know all of the suiture types and stitches:
http://www.uphs.upenn.edu/surgery/Education/facilities/measey/Wound_Closure_Manual.pdf

Bandages and dressings:

An assortment of Band aids: I prefer the cloth "Tough Strips" by J & J.
Get: everything from small spots, to the 3 x 3" pad for knees and elbows.
At least several dozen assorted.

Telfa pads (non stick dressingsI). 2 x3 up to 3 x 6 inches. You can cut if you need smaller

Gauze pads: At least a dozen 2 x 2, 2 x 3, on up to 4 x 4 size.

Roller Gauze--several rolls of 1" and 2".

Eye bandage: several pads

Kerlex dressing: 4.5" x 4 yards (at least one)

Muslin 36" square--washed and clean. This can be cut for a sling, head dressing etc--basic "bandage"

Israel war dressing: 4 x 6"-- not necessary, but something that more are carrying for massive trauma. Can make one out of telfa pads, 4 x 4 and Kerlex. But handy for compression dressing.

Tape:

1" cloth x 6 yards min.
1" micro pore clear tape x 3 yards
Athletic wrap (4" is most handy size), self adhering, elastic
"Ace" bandage: 2" 3" and 4"

ointment and skin

I am an advocate of using antibiotic ointment if a wound can be contaminated, after the cleaning and irrigation But this is also controversial.
I carry at least one tube of triple antibiotic ointment.

Cortisone 1% ointment.

Air way
Although the most recent CRP does not require rescue breathing, I feel that establishing a good airway is essential, and at times the only way is to have an airway device.

Fractures or dislocations:
If compound keep wound sterile and cover with a dressing--immobalize until you obtain medical care.

SAM splint, along with Ace bandage. (4.25" x 36")

Inflatable splint

Casting material--only on longer voyages

fingers and toes are more common, and taping to adjacent digit often is all that is necessary. There is also a SAM finger splint--excellent.

Burns

Minor burns, cool water may help--do not use ice, or put butter etc on the burn.

A 3rd degree burn, cover with sterile material (if you have sterile saline, you can put this on the first layer of dressing material, avoid pressure, put no ointment on the burn, and get medical attention.

Be safe, and avoid injury and illness.

_________________
Bob Austin
Thataway
Thataway (Ex Seaweed) 2007 25 C Dory May 2018 to Oct. 2021
Thisaway 2006 22' CDory November 2011 to May 2018
Caracal 18 140 Suzuki 2007 to present
Thataway TomCat 255 150 Suzukis June 2006 thru August 2011
C Pelican; 1992, 22 Cruiser, 2002 thru 2006
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BrentB



Joined: 15 Jul 2006
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PostPosted: Thu Nov 12, 2015 10:45 pm    Post subject: Reply with quote

Thanks Bob

very helpful

What do you use to cut fish hook shaft from a finger or hand"

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thataway



Joined: 02 Nov 2003
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City/Region: Pensacola
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C-Dory Year: 2007
C-Dory Model: 25 Cruiser
Vessel Name: thataway
Photos: Thataway
PostPosted: Thu Nov 12, 2015 11:23 pm    Post subject: Reply with quote

Thank you Brent,
Under instruments,
"Diagonal wire cutters for fish hook"

Actually I have two pair aboard--a large one is in a net case right under the helm, and is heavy duty, enough to cut a 12/0 hook, which is the largest I have, in an older genuine bone jig (from the 1930's). There is a smaller pair of diagonal cutters in my electrical kit. If you get a hook in the finger, or worse, you want to get it out ASAP I have also had dog noses in fish hooks, as well as a few birds along the way.
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BrentB



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PostPosted: Thu Nov 12, 2015 11:25 pm    Post subject: Reply with quote

Hi Bob

I read that and assume you didnt buy them at Harbor Freight LOL or liked a small bolt cutter
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hardee



Joined: 30 Oct 2006
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PostPosted: Fri Nov 13, 2015 2:17 am    Post subject: Reply with quote

Thanks for that write up Dr Bob. That is very helpful, and quit a list and shows I need to do some updating. I have carried the "basic required" up until last spring when I was preparing for my extended cruise time on Vancouver Island. I did a kit for that, but because of the room involved I took the big one off the boat when I got back and went back to the smaller one which, for my local cruising is probably adequate, but the larger kit needs some revision.

Thanks for your excellent work here.

Harvey
SleepyC Moon


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thataway



Joined: 02 Nov 2003
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City/Region: Pensacola
State or Province: FL
C-Dory Year: 2007
C-Dory Model: 25 Cruiser
Vessel Name: thataway
Photos: Thataway
PostPosted: Fri Nov 13, 2015 8:44 am    Post subject: Reply with quote

Brent,
You like to get down as close to the wound as possible. The dikes allow getting closer than a bolt cutter, and are handy. My bolt cutters are left over from sailboat racing days, and substantial. (Along with rigging cutters--different types of jaws).

Harvey, certainly this is a "base"--and for shorter trips, one could pear this down. The true offshore kits have a lot more prescription medication, burn treatment material, catheters, etc, but not a lot more of bandages etc. For example for a short trip, I would definitely eliminate the suiture set, inflatable splint, & items which I marked as "elective"

The bare minimum would be the J & J $7 - $9 across the counter kit. I would add the Bonine, and some tylenol or Advil to that as min. meds. I would have at least one good "Ace" bandage, and several 4 x 4 telfa, and 4 x4 gauze pads, and beef up the basic bandages and tape for any day trip.
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SGIDave



Joined: 16 Jun 2008
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PostPosted: Fri Nov 13, 2015 12:17 pm    Post subject: Reply with quote

Thanks Bob for posting this information.

Something I would add would be a "Coban" (that's a brand name) product which acts as a tape replacment. It is GREAT in that it sticks to itself - not your skin. If your patient is elderly or has thin skin, using lots of normal tape will cause further injury when your remove the tape for dressing changes...the Coban doesn't do this since it doesn't stick to the skin.

In a marine environment, the wound wound needs to be DRY for normal tape to work...not so with COBAN.

It comes in colors, widths to suit, and doesn't 'break down' (get gewy) like old rolls of tape will over time. If you are careful when removing it, you can reuse it too. This stuff is handier than velcro!

Looks like this
Most pharmacies sell some version of it - maybe not the Coban brand.

dave
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BrentB



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PostPosted: Fri Nov 13, 2015 1:29 pm    Post subject: Reply with quote

Eye injuries occur.

Any comments on the following?

1. Scratched Eye (Corneal Abrasion). Flush with saline, bandage and head to ER?

2. Chemical burn, Flush well, bandage and ER visit

3. Eye swelling or black eye. Cold compress and ER


4. Foreign objects (metal, sand, etcc) Rinse, Would you try to remove?

Thanks
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hardee



Joined: 30 Oct 2006
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PostPosted: Fri Nov 13, 2015 1:47 pm    Post subject: Reply with quote

SGIDave wrote:
Thanks Bob for posting this information.

Something I would add would be a "Coban" (that's a brand name) product which acts as a tape replacment. It is GREAT in that it sticks to itself - not your skin. If your patient is elderly or has thin skin, using lots of normal tape will cause further injury when your remove the tape for dressing changes...the Coban doesn't do this since it doesn't stick to the skin.

In a marine environment, the wound wound needs to be DRY for normal tape to work...not so with COBAN.

It comes in colors, widths to suit, and doesn't 'break down' (get gewy) like old rolls of tape will over time. If you are careful when removing it, you can reuse it too. This stuff is handier than velcro!

Looks like this
Most pharmacies sell some version of it - maybe not the Coban brand.

dave


Dave, I love Coban and have used it since it's inception. Bob did include in his list, "Athletic Wrap" which is close, and Coban is expensive. Try "Vet Wrap" from a farm and feed store. Same stuff, colors and less expensive.

Bob, You are right about the pain med addition. I do carry Aspirin, but an ibuprofen and/or tylenol addition is on my list. Case in point: My first launch on my 2 month Vancouver Island trip, at the ramp in Port Alberni, I slipped on the trailer, fell against the spare tire and cracked a couple of ribs. No question, I have had broken ribs before so knew the sound and feel. I had aspirin, but chose not to use that because I didn't want to increase any chance of bleeding so....... I changed which way I slept, and how I got into and out of that Vee birth. Lots of deep breathing and stretching for a few days. For a while, it was pretty sore, but oh well, live and learn.

Thanks again for your input here.

Harvey
SleepyCMoon

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thataway



Joined: 02 Nov 2003
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PostPosted: Fri Nov 13, 2015 4:48 pm    Post subject: Reply with quote

Harvey, You did catch the "Athletic wrap (4" is most handy size), self adhering, elastic " I happen to have the "Coban" brand (by 3M, and labeled "Athletic Wrap") , but intentionally did not include it because there are some cheaper alternatives, including by generics by CVS etc.

Brent--yes, eye/ear also have many different injuries. Again, in the more advanced kits (more than 12 hours from a hospital), I do include both medication, (drops and ointment) and further materials. The list for the full kit is 4 typed pages single spaced, so I had to make some cut offs in what to say for a C Dory specific kit.

I should have put in "Q" tips, since you can use that, both to invert the eye lid. and the sterile cotton end to sweep debris out of the corner of the eye. Many people are not comfortable doing this.

Other items would include an eye cup for washing and ear syringe, Boric Acid drops for swimmer's ear. etc. The saline will do for a good irrigation fluid. I also carried fluorescein strips for corneal abrasions with the athletes and in our long distance kits. Today we can buy cheap LED UV flashlights (labeled "NCIS, or CSI" ) which are in the UV spectrum. Again, having an ophthalmoscope makes the corneal exam much better.

I did not specifically go into treatment for specific issues, because that is what the first aid books are for. I have removed a few foreign bodies from the cornea, when in remote areas. But I have an ophthalmoscope, which allows me both a magnified view, but also ability to look further into the eye, and see if there is more injury. For the most part, embedded eye foreign bodies are best treated by an ophthalmologist, especially if the foreign body goes into the anterior chamber of the eye.

I also intentionally left off the use of "Crazy Glue for skin closure, AED and oxygen on board, and a few other topics/gear. For example, I have heart disease, and elected to have an implanted defibrillator/pacemaker, rather than carry an AED, and hope that sone was with me would could use it. I also carry a finger pulse oximeter, oxygen/oxygen concentrator, because of my personal need for it due to heart disease. Some ladies carry antibiotics because they are susceptible to bladder and kidney infections.
If you have specific medical needs one needs to discuss with their personal physician what medications are wise or essential to carry when on the boat.
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C-Hawk



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PostPosted: Fri Nov 13, 2015 5:00 pm    Post subject: Reply with quote

I would also recommend a good course in First Aid.
I am certified in Wilderness First Aid through NOLS.

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thataway



Joined: 02 Nov 2003
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PostPosted: Fri Nov 13, 2015 10:12 pm    Post subject: Reply with quote

Roger,
Good point--I had just mentioned Red Cross or AMA approved course--up to EMT training (often offered thru junior colleges.(

The NOLS is a great resource--and I had not visited their web site for some time. I used to be a member of the Wilderness Medical Society (I found out yesterday, my membership had expired and they wanted more money!) This is more of medical professional organization and National Outdoor Leadership School offers a lot of courses and some fantastic expeditions.

The courses are from 16/20 hours on Wilderness First aid, 40 hour Advanced First Aid, 80 hour First Responder, 200 hour Wilderness/EMT.
All of the courses appear to be very comprehensive.

We used to give one and two day courses on marine medicine and first aid at sea. There are a lot of injuries which can happen in the "normal course" of our boating--like Harvey's broken ribs (Been there, and we have "flack jackets to prevent that!)
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