Being Prepared For The Likely Medical Emergencies At Sea

This is a four-step talk that I have given to help sailors prepare for the most common medical problems when cruising.

1. Assessing yourself
2. Preparing your medical kit
3. Reviewing the most likely emergencies at sea
4. Looking at my Medical Kit

Assessing Yourself

Assess your type of cruising:

• coastal cruising and developed countries require less preparation 
• offshore or to third world countries requires maximum self-sufficiency
• you can stock up easily and cheaply on prescription and OTC medications in many undeveloped countries
• determine how long you will be away
• consider the climate and season you are sailing in (temperature, sun, insects, etc.)
• research your destination's medical precautions at Travel Health ONLINE and at the Centers for Disease Control and Prevention 
• research other cruising perspectives, such as Darrel Wyatt, MD, author of the Cruising Guide to the Abacos and Northern Bahamas

Assess yourself:

• what diseases you have now
• what ailments you are likely to come down with based on your history

Example:

Current Disease:	Allergies
Current Treatment:	Antihistamine pills (ie. Claritin)
Being prepared for the likely emergencies:	1. Antihistamine eye drops (ie. Opticrom) 2. Antihistamine ointment/cream (ie. Caladryl) 3. Injectable antihistamines (IM Benadryl) 4. Ventolin inhaler 5. Prednisone tablets 6. Injectable adrenaline (ie. Ana-kit or Epi-pen)

Preparing your Medical Kit

Have Reference Materials on board:

• The Merck Manual (There is now a layman's version called the Home Edition)
• A good medical dictionary, such as Taber's
• "Where there is no doctor" by David Werner et al

Have the right attitude:

• Avoid using medicine. Most things get better with time.
• No medicine is without a side effect
• "At first, do no harm"
• When in doubt, get help

Setting up your medical kit:

• Ask for expiration dates for all prescriptions
• Ask for expiry dates as far in the future as possible
• Get more than you think you will need of regularly used medicine
• Avoid medications that need refrigeration
• Separate "trauma" from "medicines"
• Use water-tight and air-tight plastic boxes
• Keep an inventory log with supplies and names of medicines (generic and trade), and expiration dates. Recheck your list every 6 months
• Avoid prepackaged kits - DIY is better

The Most Likely Emergencies

SKIN

1. Cuts, scrapes and blisters: These are caused caused by coral, boat jobs, objects on shore and shoes

Prevention:	very important because all cuts will get infected in the tropics wear gloves, wetsuits, protective clothing, socks, moleskin avoid jewellery
Treatment:	stop the bleeding - pressure x 15 minutes clean the wound (hydrogen peroxide, Betadine, Savlon, saline or just fresh water)
Other Supplies:	tweezers, scissors, ring cutter steri strips versus sutures bandaids - esp. fingertip, and lots of the regular size (Elastoplast) dressings - include telfa or sofratulle, gauze pads, cling, good tape (3M Transpore or Leukoplast waterproof tape)

2. Infection

Prevention:	Antibiotic ointment prophylactically Bactroban or Fucidin are more effective than Polysporin
Treatment:	Antibiotic ointment Oral antibiotics (ie. Cloxacillin, Keflex, or Biaxin)
Other Supplies:	Scalpel, sterile packing

3. Burns (Sunburn and Thermal)

Prevention:	Sunscreen, clothing, hat, sunglasses, awning or bimini Swim with wetsuit or shirt Get pot holders and avoid heeling or rolly anchorages (or buy a catamaran)
Treatment:	Aspirin for severe sunburn apply cold water or ice to burn immediately Flamazine (Silver sulfadiazine) or Bactroban/Fucidin Dressing (gauze, etc.)

4. Bug Bites

Prevention:	insect repellant (DEET 99% Muskol), clothing, avoid shore at night Citronella candles, coils, mosquito netting or windy anchorages
Treatment:	Antihistamine ointment/cream (Caladryl) Antihistamine pills (Claritin)

GUT

1. Seasickness: Everyone is prone.

Prevention:	learn what you can and can't do worse if tired or hungry, so eat starchy bland foods regularly and get proper rest premedicate if possible, or as soon as symptoms develop (fatigue, apathy, irritability, nausea, hangover feeling, vomitting, diarrhea)
Treatment:	Gravol - oral, suppositories and/or injectable Cinnarizine (Stugeron) - not available in Canada or U.S. Meclizine/ Marzine Scopolamine - Kwells or Transderm patches

2. Dehydration: This can be a result from vomitting, diarrhea and/or sweating caused by seasickness, food intolerance/poisoning, or heat stroke.

Prevention:	drink a lot of water - intake in tropics 2L pp/day safe water - chlorine bleach, bottled large jugs, rain water
Treatment:	fluid replacement (Gastrolyte,Gatorade, sugar water) IV fluids not practical If diarrhea, "wait and see" - clear fluids for 24 hours, then bland, low fat foods avoid Imodium at first have antibiotics for traveller's diarrhea on board (Cipro, Noroxin or Septra) consider having Flagyl or an antihelmintic on board for parasites (not emergency medicine)

3. Indigestion, Constipation and Hemmorhoids: Bring Zantac and a hemmorhoid preparation.

HEAD

1. Headache

Prevention:	sun - sunglasses, hat, awning, drink lots of water stress - good charts, good communication, being prepared alcohol - drink water before going to bed
Treatment:	ASA, Ibuprofen, Tylenol extra strength Codeine - Tylenol #1, Tylenol #3

2. Eyes

Problem:	Treatment:
Infection (pink eye)	Antibiotic drops (Sodium sulamyd 10 % drops)
Foreign body	local anaesthetic drops, Q-tips, antibiotic drops, anti-inflammatory drops
Contact lenses	disposable with cleaning solution/saline

3. Ears

Problem:	Treatment:
Swimmer's Ear	antiseptic drops (Bur-o-sol) antibiotic drops (Garasone)
Ear Wax	don't use Q-tips Cerumol, mineral oil (Cerumenex)
Middle Ear Infection	Amoxil 500 mg capsules, or Biaxin 500 mg capsules, or Zithromax

MUSCLES AND BONES

Prevention:	sail in good weather, sail on a catamaran know your limitations "one hand for you, one hand for the boat"
Treatment:	muscle relaxants (Robaxisal) anti-inflammatories (Naprosyn) analgesics (Tylenol #3) injectable analgesics (Demerol)
Supplies:	instant cold packs tensor bandages - large and small splints triangular bandage (sling)

My Medical Kit

This is what I initially packed for my three-year circumnavigation with my husband. We set out in 1992, and you should keep this in mind. There are certain new medications that would be better choices if I was leaving now. However, the CATEGORIES would remain the same. I would take more of certain things, and less of others. But one never knows what will happen out there, and it is better to err on the side of caution.

We restocked as needed along the way, as medication expired and as our destinations changed (ie. anti-malarial medication). Topical antibiotic ointment was used daily to prevent nicks and scapes from getting infected in the tropical climate. Topical steroid creams were also important due to Alec's sensitive, eczema-prone skin. I would probably take more oral steroids too, as this has become a more recognized short-term treatment for a wide range of ailments.

This is just a sample. You must build your own list based on the first steps outlined above. You must take into account your skills as well. Please remember that I was an Emergency Room doctor and the kit reflects this. Outside assistance may help you choose the correct medication when in doubt, and in some countries it may help to take your own medicines and needles to the hospital.