Choosing a sea-going medical kit is a highly personal decision - as personal, perhaps, as choosing a style of clothing, a career or, most appropriately, a boat. And just as we all look for the vessel that best meets our needs, that boat seldom meets all of our wants. With most important purchases, what we end up with is often a compromise between our dream goal and what we can realistically attain.
With this in mind, the process of putting together a sea-going medical kit raises questions that must be answered before any purchases are made. Remember, though; think realistically - needs vs. wants.
- How long do you anticipate being totally self-reliant? Hours? Days? Weeks?
- What kind of environment are you preparing for? Cold? Heat? Predictably severe weather?
- Are there specific health problems that must be considered? Diabetes? Heart problems? Arthritis? Old sports injuries? Epilepsy? Handicaps?
- Will there be children aboard?
- What kind of radio/telecommunications do you have? VHF? SSB? Cell phone? Ham radio?
- What special skills do you have? First Aid? CPR? Medical? Nursing?
- What is your personal risk tolerance? High, i.e. willing to accept the trade-off between the economy of a simple kit and the risk of not having everything you might need? Or are you a 'risk-adverse' person who would carry a hospital if given the chance?
- Are you an improviser? Could you easily build a traction splint for a broken leg out of lee boards and duct tape?
- Are you more comfortable with 'alternative' medical practices than standard drugs and surgery?
- What is your age and general health status? Pregnant?
- Will your cruise take you to a developing ('third world') country?
- Are you primarily a daysailor? A coastal cruiser? A long-distance voyager? A racer? It makes a difference a big difference.
- Do you have the time, energy, inclination and expertise to custom-make your kit from scratch or are you looking for the most appropriate 'off-the-shelf' kit?
- Do you have 'inside' access to information, medications and supplies (friends or family in health care) or will you have to spend top dollar for your purchases?
- Do you have access to an experienced wilderness physician, or clinic willing to advise regarding supplies and medications, as well as prescribe antibiotics and narcotics?
- Are you planning to snorkel or scuba dive?
- Is anyone onboard taking prescription medications on a regular basis?
The list could go on, but you get the idea there is no such thing as the 'standard' medical kit for every boat. But there is probably a good one for your boat and your cruise based on your assessment of the above questions. So let's start with the most basic item in your kit, the medical guidebook.
There are now available literally dozens of publications which are considered 'wilderness' medical guides. Most are generic in the sense that their information is appropriate for not only the cruising sailor, but also for the backpacker, white water kayaker, mountain climber, or Himalayan trekker. In fact most volumes target land-based activities.
Nevertheless, some books specifically address the needs of the ocean voyaging community. I have included on my list books which are currently being used by many sailors (Eastman's Advanced First Aid Afloat, Gill's The Onboard Medical Handbook), or have been in use for many years by the commercial maritime community (The Ship's Medicine Chest). Others have specific applications (Werner's Where There is no Doctor - medical care in developing countries, Auerbach's Hazardous Marine Life for divers), or are recommended for medical professionals (Auerbach's Wilderness Medicine). Still others are particular favorites of mine: Cohen's The Healthy Sailor and Auerbach's Medicine for the Outdoors.
Finally, if you will be traveling internationally, the book entitled Health Information for International Travelers by the Center for Disease Control should definitely be somewhere in your onboard library. There are many other books of excellent quality I could mention, but time and space precludes mentioning all of them.
MEDICAL REFERENCE BOOKS
- Advanced First Aid Afloat, 4th Edition, by Peter F. Eastman, MD, Cornell Maritime Press, 212 pages, 1995.
For twenty-five years this has been the standard First Aid text carried aboard most sailing vessels. (First Edition, 1972). Dr. Eastman, a retired surgeon, writes in a folksy anecdotal manner and tells good sea stories. Describes procedures in a stepbystep manner, such as how to suture, how to give an injection, etc. This is a very readable book.
- Where There is no Doctor, by David Werner, Hesperian Foundation, 1992, 345 pages.
Originally written as a health guide for villagers in remote areas of the world, this text has now become a classic, translated into over forty languages. Useful for travelers who wish to be as selfreliant as possible.
- The Onboard Medical Handbook: First Aid and Emergency Medicine Afloat, by Paul G. Gill, MD, International Marine Pub., 1996, 208 pages.
A new addition to the shipboard medical library. Dr. Gill is an experienced emergency physician who has written a regular column for Outdoor Life and is an occasional contributor to Cruising World as well as other magazines.
- A Medical Guide to Hazardous Marine Life, by Paul S. Auerbach, MD, Best Pub. Co., 62 pages, 1996.
An excellent handbook for anyone who actually plans on going into the water. Richly illustrated with color photographs, this book is very practical and easy to use. Designed for scuba divers and others who explore the underwater environment and who may be stung, bitten or punctured by a marine creature.
- The Ship's Medicine Chest and Medical Aid at Sea, U.S Government Publication.
This is the standard text, used by the U.S. Merchant Marine. Detailed instructions on diagnosis and treatment for most illnesses and injuries experienced at sea. Written for the nonprofessional. The current edition is now somewhat outdated, especially the section on pharmaceuticals.
- Health Information for International Travelers, by Centers for Disease Control, HHS Publication #CDC958280.
This contains a global rundown of disease and immunization advice and other health guidance, including risks in particular countries. For additional health information, the Centers for Disease Control in Atlanta maintains the international travelers hotline at 4043324559.
- Wilderness Medicine: Management of Wilderness and Environmental Emergencies, Edited by Paul S. Auerbach, MD, C.V., Mosby Company, 1995, 1,529 pages
This is the text for medical professionals, highly recommended. It details the diagnosis, treatment and pathophysiology of virtually all emergencies encountered in remote/wilderness environments. The list of the contributing authors reads like a Who's Who of Emergency and Environmental Medicine.
- Medicine for the Outdoors: A Guide to Emergency Medical Procedures and First Aid, by Paul S. Auerbach, MD, Little Brown and Company, 348 pages, 1991 (hard to find).
Dr. Auerbach wrote this classic manual in the 1980s. Designed for the non-medical professional, it is written in easy to understand language, but with no skimping in the quality of advice. Currently out of print. Check used bookstores. There is a companion video, Medicine for the Outdoors (50 minutes).
- Dr. Cohen's Healthy Sailor Book, by Michael Martin Cohen, MD, International Marine Publishing Company, 257 pages. 1983 (hard to find).
Dr. Cohen has been one of the contributors to The Ship's Medicine Chest, and has produced an interesting companion to First Aid/Emergency texts. This book emphasizes prevention (an often neglected subject). It is written in language more suitable to a medical professional, but there is no reason an intelligent nonprofessional cannot glean many pearls of wisdom from this book. Currently out of print. Check used bookstores.
Sources of 'off-the-sheIf' Medical Kits
Adventure Medical Kits
5555 San Leandro St., Oakland, CA 94621
(800) 324-3517; (206) 746-1896; fax: (206) 746-3084
Chinook Medical Gear, Inc.
2805 Wilderness Place, Suite 700
Boulder, CO 94520
Medical Sea Pak Co.
1945 Ridge Road East, Suite 105, Rochester, NY 14622
Outdoor Research, Inc.
10001st Ave, So., Seattle, WA 98134
Travel Medicine, Inc.
351 Pleasant St., Suite 312, Northampton, MA 01060
West Marine Products
P.O. Box 50050
Watsonville, CA 95077
As a final note, do not forget that one of your most important medical resources is your ship's radio. With modern telecommunications your VHF, SSB, ham radio or cell phone can put you in direct contact with expert medical advice virtually anywhere in the world.
Remember that the MAYDAY distress call is reserved for the most dire of emergencies where there is a real hazard to life. For less critical situations it is advised to use the PAN distress call.
Marine Distress Communications
(Post Near Radio/Telephone)
Speak slowly, clearly, calmly...
1. Make sure your radio-telephone is ready.
2. Press the alarm signal on the radio transmitter for 30 seconds at least 1 minute before transmitting the Mayday distress call.
3. If within 20 miles of shore (or other vessels), transmit first on VHF channel 16 (156.8 MHz).
4. If offshore more than 20 miles, transmit first on SS13 frequency 2182 kHz.
5. Press the microphone button and say, "Mayday, Mayday. Mayday."
6. Say, "This is... (give your vessel name and call sign)."
7. Say, "Mayday, (name of your vessel)."
8. Tell where you are.
9. State the nature of the distress and/or the condition of the injured or ill person.
10. Give the number of persons on board.
11. Give estimate of the present seaworthiness of your vessel.
12. Briefly describe your vessel: (length and manufacturer; hull and trim colors).
13. Say, "I will be listening on channel 16."
14. End message by saying: "This is (vessel name and call sign), over."
15. If Mayday is not acknowledged within 30 seconds, reactivate the alarm signal of the radio transmitter and re-transmit, first on VHF, then SSB (preceded by the radio alarm signal) on any channel or frequency used in the area.
16. If still no answer, transmit again.
17. If still no answer, try VHF channels 21 (157.05 MHz), 22A (157.1 MHz), or SSB 2670 kHz primary Coast Guard working channels, or VHF channel 6 (156.3 MHz), SSB 2638 kHz, which at sea are used, as International shiptoship channels.
- kent benedict, md
Kent Benedict, MD, FACEP, is a board certified emergency physician who has been organizing and teaching courses on Emergency Medicine at Sea for over 17 years. He is the Chief Medical Officer for the Calfornia Maritime Academy's training ship, the Golden Bear. He's lectured nationally and currently holds two U.S. Coast Guard licenses, one as a Ship's Surgeon, the other as Ship's Master (100 tons).
This story was reprinted from the the September 1997 issue of Latitude
38. To order a copy (complete with black & white photos), use the subscription
order form, and specify the 9/97 issue, or just drop us
a note with a check for $7 to Latitude 38, Attn: Back Issues,
15 Locust Ave., Mill Valley, CA 94941.
Please note: If the actual issue may no longer be available, we will
still be able to make photocopies or PDFs of it.