Cruising medicine chest on board

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Cruising medicine chest on board

Postby seadago » Mon Aug 22, 2016 11:23 am

Onboard Medicine Chest

A few years ago my wife and I went scuba diving in Pemba (amazing spot, BTW!), a little island off the coast of Tanzania. We were on a small liveaboard anchored in a shallow cove on the west coast of the island, and diving on the reefs offshore off a rubber duck. To cool off during the hottest hours of the day, we would just jump over the side, and climb back onboard up the ladder. On the first day, the poor girl developed an allergic reaction to... something! It started on the inner side of her forearms; no blisters, but blotched and discoloured skin, quite ugly looking really. Within 12 hours, it had extended to her torso and neck, and she was was a bit feverish. I had some antihistamines on my travel bag, over the counter stuff for hay-fever, which did not help. She was very uncomfortable, and the prospect was to abort the trip and go back to Dar-es-Salaam (via Zanzibar) to seek treatment there.

We searched for the culprit everywhere on the boat; bedding, food, any potentially toxic materials or products on board she may have come into contact with. There was no distinctly localised lesion on her skin, so I deduced it could not be a sting from a marine organism, and being anchored in the middle of the bay, there was little chance of a biting insect getting to us. I even checked carefully the inside of our wetsuits, just in case we had picked something up from the ocean in the previous dive. Nothing!

As luck would have it, that day came onboard a couple from the UK. A medical doctor and his wife that were trekking across Africa on a sabbatical. The guy (shame, can't remember his name!) looked a my wife, produced two innocuous looking pills from a bag, and presto....the following morning she was feeling well enough to dive again!!

This episode impressed upon me the importance of having a well equipped medicine chest on board when cruising.

The long story above comes into context because I am now planning a long cruise, and need the help of experienced long distance cruisers (particularly those with a medical degree/training) to put it together, beyond the regular content of any first aid kit, or pre-existing conditions of the crew.

Constraints as follows:

Geographic area: tropical and sub tropical (i.e. unlikely I will ever have to treat for frostbite).

Specific conditions and/or medicine groups:

# Topical antiseptics (powder or cream form) for skin lesions, abrasions, burns, sweat itch, etc.
# Stings and bites; anything from blue bottles to horse flies, not shark attacks!
# Antihistamine and general anti-allergenic compounds (as per the story above).
# Dehydration, sunstroke, sunburn.
# Food poisoning, diarrhoea, nausea/vomiting, constipation.
# Digestive track cramps, period pains, etc.
# Products that will keep me awake – something stronger than caffeine... Not asking for advise on mind-altering substances. Rationales is having to stay awake and alert for 24 hrs to cope with unexpected bad weather.
# Topical and/or internal anti-inflammatory compounds – sprained ankles, damaged knees, twisted thumbs, tendinitis, that sort of thing, short of a downright bone fracture
# Antibiotics/antibacterials. This is a very wide topic, I know, so I'll try to narrow it down with a few conditions: (1) eye, ear, sinus infections, (2) fungal infections – wet skin, finger nails, etc, (3) infected wounds from coral, rock, shell cuts, sea urchin spines, fish hooks, etc, (4) urinary track infections, (5) tooth infections/abscesses
# Pain killers – not necessarily opiates, but stronger than paracetamol.

Ok, above but a few. Any other out of your experience that I have not thought about, please instruct me!

Repeat, the purpose of this exercise is not to equip a bush clinic, but to put together an emergency get-me-out-of-trouble, mostly symptomatic, medicine kit that will allow me to get to where I can seek qualified medical care if required.

Many thanks in advance for your input and advise on this topic!!!

And now, the conclusion of the story..... Eventually, I found out who the culprit was. In time, I too developed a rush, exactly in the same place my wife did at the beginning, the inside for my forearms and wrists!! It was only a slight skin rush on me, but too much to be a coincidence. I was evidently reacting to something. I tracked it down to climbing up the boat ladder after one of my cool-off dips. Sure enough, encrusted on the side bars of the ladder was a covering of orange coloured sponge. In grabbing the side bars and pulling myself upwards on the ladder, the inside of my forearms was rubbing against the sponge, right in the place were the rush developed!!
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Re: Cruising medicine chest on board

Postby mike cunningham » Tue Aug 23, 2016 12:40 pm

This is a good topic. I just completed the singlehanded transpac and struggled to put together a med kit. Not so much the content but actually obtaining the drugs. My HMO would not prescribe painkillers. I did not request stimulants. I was able to obtain antibiotics. Any ideas on strategies for obtaining the drugs you need for the kit?

With regard to painkillers, I fell across the cockpit and badly bruised my ribs. There we are couple of days I could have used something more than tylenol.

Regarding Antibiotics, a story. A few SHTPs ago a fellow developed a skin infection on his butt. It got so bad he had to be pulled off his boat about 500 miles from Hawaii. The skipper of the CG Cutter that pulled him off was a sailor and set up the sick guy's AP to steer a course for Oahu. A transmitting "Yellow Brick" tracker was left on board with a warning the CG would sink the boat if it got closer than 30 NM to land without a human aboard. Shoreside members of the SF Bay Single Handed Sailing Society flew from Kauai to Oahu, found a boat, sailed up, boarded this guy's sailboat and delivered it safely to Kauai. After hearing this one, the antibiotics went to the top of my list.
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Re: Cruising medicine chest on board

Postby rvivian » Fri Aug 26, 2016 1:36 am

There was a presentation at this year's Seattle Boat Show entitled "Medical Preparedness for the Recreational Boater" by Denny Emory

He also wrote a valuable treatise on the topic at http://www.bwsailing.com/bw/cruising-ne ... dical-kit/.
Heart's Desire
Freedom 30
Shelton, WA
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Re: Cruising medicine chest on board

Postby Castaway » Sat Aug 27, 2016 6:06 am

I have advised several long distance cruisers on medical supplies for small boats: for many years I have been an instructor for Maritime and Coastguard Agency approved medical care courses for professional seafarers.

In the UK, there is a guidance note (MN 1768), freely available online at mcga.gov.uk, which lists various medicines which can or should be carried aboard British registered ships. So far as I know, it can be applied to boats on the Small Ships Register, and it explains how medicines and supplies may be obtained from a pharmacist, even including morphine. Find a pharmacist in a port with lots of fishing boats; they will be familiar with the regulations. Additionally, this list is internationally accepted and is useful if ever medical advice by radio is required (annotate your own copy so that you can discuss with the doctor what supplies you actually carry). There are also companies which sell comprehensive first aid kits for sailors, but they are very expensive, though nicely presented. They can be found at boat shows. Although I know nothing of obtaining medicines outwith the UK, in many countries a wide range is freely available to purchase.

There is no substitute for having had some good professional teaching in First Aid, and perhaps even Medical Care Aboard Ship, especially if you will be far from land or civilization. However, the UK 'Ship's Captains Medical Guide' is also available online, free of charge, and can be downloaded as .pdf files suitable for use with a laptop. This is invaluable, even though aimed at commercial vessels, and I would recommend it to any long distance sailor.

As to what you should carry, don't be put off strong analgesics, of which morphine is the best, and fairly safe to use, too. Paracetamol just won't be adequate for a heart attack or major limb fracture. Anti-infection medication of several sorts is necessary (for bacterial, fungal or protozoal bugs), and an EpiPen for major allergic reaction. Some treatments are available as suppositories (used where the sun doesn't shine?); don't be put off by this idea, as it is a safe and effective route of medication, particularly for severe sea-sickness. Most doctors will be sympathetic to reasonable requests for prescription only medicines if presented with the M Notice 'authorising' their supply; they have the discretion to provide them if they choose.

We carry a modest medical kit, and also a doctor and nurse on board, which has been useful; the nurse had to stitch a wound in my scalp on a remote island in the Baltic four years ago, and it healed well with no other attention. Well worth the board and accommodation, and she shares my cabin!
Gerald Freshwater,
s/y 'Castaway', (UK F35 cat ketch)
Lerwick Boating Club
Shetland Isles, Scotland
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Re: Cruising medicine chest on board

Postby Castaway » Sat Aug 27, 2016 6:11 am

Seadago:- are there any fishing boats left in Lowestoft? Do try a discussion with a local chemist, armed with a copy of the M notice.

The links for the M notice and the Guide are:-

www.gov.uk/government/uploads/system/up ... sn1768.pdf

www.gov.uk/government/publications/the- ... ical-guide

They are, obviously, Crown Copyright, but there is no restriction on downloading them for personal use.

Gerald Freshwater
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s/y 'Castaway', (UK F35 cat ketch)
Lerwick Boating Club
Shetland Isles, Scotland
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Re: Cruising medicine chest on board

Postby seadago » Tue Oct 04, 2016 5:22 am

Hi Gerald
Many thanks for the info and links. Very useful document. Will definetely use a guide.
I also have the British Medfical Association "New Guide to Medicine and Drugs" (Dorling Kindersley Editor, ISBN 0-7513-0444-1) which I recommend as a must-have in any household book rack, let alone a cruising boat. Info is organised by groups of medical conditions, and drug advise includes active compounds, most common commercial brand names worldwide (very, very useful if having to buy over-the-counter abroad!), posology, as well as much info on treatment, simptoms, possible side effects, etc.
Have engaged a MD friend to help me put together, and will report progress.
many thanks to everyone for input!
Rafa
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Re: Cruising medicine chest on board

Postby seadago » Wed May 10, 2017 1:40 pm

Partial update on this topic.
Slow progress I'm afraid -hec!, the thread is a year old...- and mostly self propelled....
Came across a very good resource:
"Where there is no Doctor" by David Werner (with Carol Thurman and Jane Maxwell). There are several editions: Macmilan Education; ISBN 978-0-333-51612-2 (2010), available in paperback from Amazon for 40 quid. Used cheaper. Also in Kindle format but not latest edition.
There are editions in other languages and for specific regions. I have the Spanish version (just for the fun of it, and funny it can be at times! :D); Ediorial Pax Mexico ISBN968-860-503-4
PDF English version can be downloaded from:
http://hesperian.org/books-and-resources/

The book is intended for rural environments in the developing world, with bush clinics manned, at best, by a practical nurse or a school teacher. Touches on most conditions of human physical suffering, with lots of practical advise and very useful diagnostic decision-making trees. Lots of line illustrations. Of particular interest I found advise on the use of local/natural/traditional remedies for common ailments, as substitute for an industrial pharmacopoeia. This is of necessity regional (my Mexican edition focuses on central and south America).

Worth having IMHO
Cheers
Rafa
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Re: Cruising medicine chest on board

Postby seadago » Mon Sep 11, 2017 7:48 am

Update on this topic

OK, attached (.XLS) an attempt to synthesise an structure the list of drugs for a medicine chest by condition. It follows roughly the categories I identified in opening the thread.
A few observations:

Commercial names refer to the name the drug is marketed by. Different laboratories offer exactly the same drug under different names in different countries, or for very slightly different presentations. Not all names I came cross are included!! The ones that are, correspond to popular brands mostly in Europe and LatAm respectively. There are others in other parts of the world.

I included the name of the active principle(s) for each drug. Many market names to one active principle. This, IMO, is a critical bit of info. I have received commentary to the effect that it is best practice NOT to use anything we are not already familiar with. Whilst I wholeheartedly agree with this, it does not help if we are in a foreign country looking for a brand name the pharmacist or clinic nurse is not familiar with. Knowing the active principle helps a lot. It will also allow us to identify generics, which will work just as well.

Mind everyone! this is only a list of medicines, and what pathology the are normally used (or intended) for. How you use them however, is your own affair.

Finally, there is a wealth of advise on medicines and drugs on the web (drugs.com, ndrugs.com, medicine.net, etc, etc) with more info that be readily digested. When in doubt, google!

Please contribute to the list with your own experience and insight. Thanks!
Rafa
Attachments
cruising medicine chest WIP1.xls
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Re: Cruising medicine chest on board

Postby northerncole » Sat Oct 07, 2017 9:50 pm

When I was doing a lot of long trips I picked up an emergency dental kit somewhere to add to the medical chest. Best thing I ever bought. Nothing worse than toothache or a lost filling weeks from shore. Not to mention trying to find a dentist in some ports. Good thread.
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Re: Cruising medicine chest on board

Postby seadago » Mon Oct 09, 2017 8:04 am

northerncole wrote:When I was doing a lot of long trips I picked up an emergency dental kit somewhere to add to the medical chest. Best thing I ever bought. Nothing worse than toothache or a lost filling weeks from shore. Not to mention trying to find a dentist in some ports. Good thread.

Hi Northerncole
Indeed! it is one of the most obvious gaps in the above list. Would appreciate details of the contents of your dental kit. Thanks!
Rafa
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