Medicine on Board

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By the time you’re looking for your medical kit, it’s already too late to start getting prepared  (published July 2012)

Racing around the world in the 1998-99 Around Alone Race, singlehanded Russian sailor Viktor Yazykov faced a potentially life-threatening situation—the abscess on his elbow required draining. Even to a former Russian paratrooper, it was painful, and a resulting infection could kill him. Lancing the abscess would be excruciating. He drank some vodka to dull the pain. Perhaps that wouldn’t be enough, he thought, so he took some aspirin before proceeding to lance the abscess. It wasn’t a good situation, as he sat on the cabin sole, watching his arm bleed continuously. With the blood beginning to form a lake in the bottom of his little boat, Viktor passed out, facing the prospect of potentially bleeding to death.

While I felt a great deal of sympathy for the solo sailor, even as a non-medical person with a minimal amount of first aid training, his approach seemed to miss a few important considerations. Alcohol is a vasodilator. The blood vessels will all be opened up. Aspirin is a blood thinner. The blood will flow through the widened blood vessels like a torrent. And as he passed out, his arm wasn’t even elevated to use gravity to slow the flowing blood. As a former U.S. Marine, I was left wondering what kind of first aid training was provided to the Russian military.

The medical kits that are available to wilderness travelers and offshore sailors are fantastic. In some cases, they provide extensive equipment for a wide variety of medical emergencies—everything from toothaches to broken limbs. But they are not all-inclusive, and even the ones that contain medical books and are organized in a thoroughly logical way lack something very important: knowledgeable training. There are, however, ways to at least partially remedy that. Many courses are offered in wilderness first aide training. See www.nols.edu/wmi/courses/wildfirstaid.shtml for one example. In most cases, first aid is meant to temporarily patch people up long enough to get them to qualified medical attention. In the wilderness, that time might be quite lengthy. And the middle of the ocean is as much wilderness as anywhere on the planet.

Of course there are alternative means of getting medical help. Viktor Yazykov was fortunate enough to be able to contact a physician by phone. Whether you’re using a satellite communications phone or SSB, it’s possible to patch through to a doctor and get remote advice. The website www.telemedicine.com/directory/resources.html offers a partial list. When Rich Wilson and I set a double-handed speed record from New York to Melbourne, Australia, we attended a refresher class with a doctor in Boston who was later available by phone if an emergency presented itself. Unfortunately, having the ability to get medical advice by phone doesn’t absolve one of the responsibilities of being self-reliant. Planning ahead and having someone onboard dedicated, trained and equipped for medical emergencies is a huge step in the right direction, but even that has its limitations in some cases.

During the 1993-94 Whitbread ‘Round the World Race, our doctor onboard Winston was a French bowman. During a couple of maneuvers, he was alternately slammed into the boom vang and later banged his forehead on the spinnaker pole during a spinnaker peal. He wasn’t having a very good day. At 4:30 am, his forehead required stitching, so his backup, a young New Zealander, had to do the deed. Confronting the situation with focus and good humor, they got through the minor emergency, but the fact that it could have been far more serious wasn’t lost on us. Even the boat’s doctor sometimes gets sick. Plan your backups.

Whether you’re getting ready for a transatlantic crossing or a day sail on the bay, it’s a good idea to have two separate first aid kits. One is the “major kit,” in which you can find equipment to help in almost any situation from broken bones to bad burns. Life Raft & Survival Equipment offers several: www.lrse.com/store/page8.html. For long trips, you should also be prepared for things like appendicitis, which requires treatment with extensive antibiotics. EpiPens may save a life if one of the crew is allergic to bee stings or peanuts. It’s a simple enough solution, but if you don’t have it or it’s not handy, tragedy can result. The “major first aid kit” should be kept in a secure location that everyone knows about, but only the responsible medical person on the crew should access it.

The other first aid kit is the “minor kit.” This kit has band-aids, seasickness medicine, small burn ointment, suntan lotion, aspirin, antibiotic cream and a few other commonly used treatments. It’s kept in the head or another location that’s convenient for everyone and can be quickly accessed. Additionally, a third kit should be kept in the emergency grab bag. If you have five minutes to get off a burning, sinking vessel, you may not have time to get the comprehensive medical kit. You’ll be lucky to get the grab bag, satellite phone and a few extra bottles of water. Make sure the grab bag is well stocked with things you might very well need. You may want to augment the minimal first aid kit that is already a part of the supplies stowed in the liferaft.

Even a well thought out and comprehensive medical kit needs to be augmented for long passages. If members of the crew take regular medications, such as blood pressure pills, migraine medication or other pharmaceuticals, some of those medications should be put in the grab bag as well as other locations for emergency use—perhaps even in the liferaft. Passages get delayed or diverted from time to time, and planning ahead can help avoid a cascading set of problems. Similarly, for long passages, you may need extra painkillers or antibiotics.

During one ‘round the world race, we had a crewmember dislocate his shoulder and another crewmember break his arm. The doctor pulled on the man’s arm to reset the dislocation, and the broken arm was set using a sort of medical prepreg Kevlar that was kicked off when exposed to fresh water. Having that kind of training and equipment made a huge difference to those crewmen.

Burns, of course, are one of the major causes of medical problems while offshore. One group we came across while taking a boat from Cape Town, South Africa to the Caribbean had an extremely unfortunate incident. The cook was preparing Thanksgiving dinner while sailing in a large seaway, and a pot of boiling water was tossed off the stove and onto her. She suffered for three days while they made for St. Helena Island in the South Atlantic. She was then confined to the hospital for another three days while she healed. The incident might have been avoided if she had not been boiling water in an unsuitable sea state or had been wearing a set of foul weather bib pants while cooking. And her pain while still underway could have been lessened if they had sufficient painkillers and burn ointment.

There are even tricks that can be employed to lessen the effects of seasickness. Whether you use medication, pressure point wristbands or other kinds of prevention, you might want to keep a case of Pedialyte onboard to help rehydrate those afflicted with seasickness. Seasickness can be a very serious malady over time, and should be treated with due respect.

As it turned out, Viktor Yazykov didn’t bleed to death as a result of his abscess or his self-inflicted therapy. He managed to survive, because he was strong and determined. But there are other approaches that you may find somewhat more convenient, and those approaches begin with training. A phone number or a good medical book can provide a start toward resolving medical issues onboard your boat, but they’re unlikely to provide the answer you really need in an emergency. Put yourself in front of the information, and be prepared before it becomes a necessity.

Bill Biewenga is a navigator, delivery skipper and weather router. His websites are www.weather4sailors.com and www.WxAdvantage.com. He can be contacted at billbiewenga@cox.net

Author: Bill Biewenga

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