The ship’s medical kit, particularly aboard a small yacht, should be designed and stocked with products that actually work in the marine environment. Unfortunately, most retail marine medical kits are just more expensive versions of the first aid kit under the seat of your truck. To have your kit packed right, you may have to pack it yourself. Fortunately, new products make this easier than ever. Here are a few examples of supplies and gadgets that you might want to consider.
Bandages and dressings
Adhesive bandages, synonymous with the brand name Band-Aid, have been around for decades. And, for decades, they have not worked very well. Most Band-Aids do a good job of keeping wounds out of sight, but that’s about all. In fact, the phrase “put a Band-Aid on it” has become synonymous with all kinds of problems hidden but not fixed. However all that has changed for the better in the last few years, at least for wound care.
A good wound dressing should do what the skin over your knuckle was doing before you smashed it against the engine block: keeping blood and body fluids inside, and microbes outside. It should keep the wound safe from contamination and warm and wet enough to promote circulation and healing. You should be able to keep working on the engine with the dressing in place.
The new waterproof Band-Aid, and similar products like 3M’s Nexcare, do this beautifully and are now available in pharmacies everywhere. They use a semi-permeable membrane over sterile gauze that makes them waterproof but breathable. The adhesive is impressive and will keep the dressing in place without resorting to duct tape. You can even swim with them and still keep the wound clean. You can retire the 150 cloth or vinyl adhesive strips that came with your medical kit and buy the new stuff. They are roughly twice the price, but ten times as useful.
Semi-permeable membranes are also combined with colloidal dressings to absorb exudate and keep the wound at the appropriate level of moisture and warmth to promote healing. An easily available example for small wounds is the Band-Aid Advanced Healing Blister Cushion. They are impermeable to water from the outside but absorb moisture from the wound surface and allow the excess to evaporate. The result is better protection and faster healing, especially in wet and cold environments.
Similar products are available for larger open wounds in the form of Allevyn, Duoderm, and other comparable dressings. These can be applied once the wound has been cleaned and allowed to drain for a couple of days. They are expensive, but can be left in place for up to five days, even in harsh conditions. You won’t find these in the supermarket, but they are available from a number of online vendors.
You can also buy the semi-permeable membrane alone and put whatever you want under it. I sometimes use a layer of Xeroform gauze as an antibacterial agent in the wound and cover it with a Bioclusive or Tegaderm membrane. Since the membrane is transparent, the patient can watch the wound for signs of infection. Several days of Xeroform followed by an Allevyn dressing is very effective long-term wound management. The membranes can also be applied directly over a wound, which can be particularly useful for large abrasions. Again, look online for the bigger dimensions that are not available in drugstores.
Liquid dressings have also come a long way. You can abandon the toxic super glue for the wound-friendly products made for that purpose. White-water kayakers swear by New-Skin, a liquid bandage product. The doctor’s office version is called Dermabond and is included in some commercial marine medical kits but, in my experience, does not seem to stand up as well to water and activity.
Some adhesive bandages are now combined with clot-enhancing substances to control nuisance bleeding. Clotting powders and dressing were originally developed to stop life-threatening blood loss, particularly from gunshot wounds, but have not yet lived up to these expectations. The product has found a home in minor wound care and may be something to consider if you routinely take aspirin or other blood thinners.
Using the mucus membranes of the nose to absorb drugs is nothing new but the practice is becoming more popular, particularly in wilderness and rescue medicine. A simple atomizer is attached to a standard syringe and the liquid is sprayed up the nose. No intravenous line is necessary and the onset is almost as rapid as with intravenous administration. This is a good option for people who are unskilled or afraid of needles or for situations where starting and maintaining an IV would be difficult. We use this frequently for pain control in the ski patrol and search and rescue setting, and I now teach the same technique to offshore sailors.
Our choice for emergency pain control by the intranasal route is fentanyl, a potent narcotic with a short duration of action. In high-risk rescue work we don’t want the patient under the effects of a strong narcotic any longer than is necessary to complete the procedure or stabilize the problem. The same is true in many situations offshore. Intranasal fentanyl may be a better choice for your medical kit than morphine, which must be injected and lasts a lot longer. Needless to say, you will not find fentanyl or morphine on the shelf at Wal-Mart. You will need a prescription and instructions from your doctor.
As researchers gain experience with antibiotics and how they work, some of the recommended dosages have changed. Amoxicillin and cephalexin are two well-known antibiotics that are now often given twice a day rather than three or four times a day. The advantage in promoting patient compliance, particularly at sea, is obvious. When equipping your drug kit, be sure to ask your doctor about alternatives.
Some of the newer drugs are formulated to allow for a full course of treatment in one dose per day for as little as three days. Remind your doctor to consider ease of use as well as efficacy.
An otoscope is a handy device to have on board for examining anything small: small print, small electrical problems, small bugs, and small sea urchin spines in your toes. It is also good for looking in ears, up noses, down throats, and at small objects or abrasions in the eye. Every boat should have one. The new version sold by Dr. Mom is lightweight, cheap and best of all, stainless steel with an LED light. No rust and no spare bulbs.
The NuMask is a ventilation device for rescue breathing sold as an alternative to the typical pocket mask. It fits inside the victim’s mouth like a snorkel rather than over the face like a mask. I like it because it occupies only about a quarter of the space of a pocket mask and does not have an inflated cuff that can go flat. It’s also unaffected by facial hair.
For larger yachts carrying oxygen systems, the use of an Oxymizer nasal cannula will extend your supply of oxygen by three to four times. It is an inexpensive oxygen-powered reservoir device that uses no batteries. You adjust your regulator to deliver the lowest flow rate that keeps your patient comfortable. With an Oxymizer, a single E cylinder oxygen tank can last 24 hours.
For giving fluids to an ill and incapacitated crewmember the old technique of hypodermoclysis offers an easy and safe route. A hypodermic needle is used to infuse fluid under the skin instead of into a vein. The technique is easy to perform with a butterfly needle or IV catheter, and nearly idiot-proof using the new Aqua-C Hydration system from Norfolk Medical. A nurse can train you in just a few minutes.
If you are carrying epinephrine for the emergency treatment of anaphylaxis, and you should be, you are probably familiar with the EpiPen auto-injector. For long-term management you should be carrying at least three doses of epinephrine to cover rebound reactions and repeat offenders. This can get expensive, but the new Twinject auto-injector distributed by Verus Pharmaceuticals offers two doses in the same device. The package is slightly smaller than the single dose EpiPen and is about the same price. Auto-injectors are available over the counter in Canada and other countries, and by prescription in the U.S.
Jeff Isaac is a specialist in marine medical training and serves as president of MedicalOfficer.Net, Ltd.