Preparing for Medical Emergencies at Sea
Step 1: Preparation
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
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) |
| 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) |
Get 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
Prepare your 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
Prepare 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
Step 2: Prepare for the mostly likely emergencies
SKIN
1. Cuts, scrapes and blisters: These are caused caused by coral, boat jobs, objects on shore and shoes. This is very important because all cuts will get infected in the tropics.
| Prevention: | Make sure to wear gloves, wetsuits, protective clothing, socks Avoid jewellery |
| Treatment: | Stop the bleeding – pressure x 15 minutes Clean the wound with 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 Bring 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 (buy a catamaran) |
| Treatment: | Aspirin for severe sunburn Apply cold water or ice to burns 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. Symptoms may be mild to severe and include fatigue, apathy, irritability, nausea, hangover feeling, vomiting, diarrhea.
| Prevention: | Learn what you can and can’t do Worse if tired or hungry, so eat starchy bland foods regularly Get proper rest Premedicate if possible, or as soon as symptoms develop |
| Treatment: | Gravol – oral, suppositories and/or injectable Cinnarizine (Stugeron) – not available in Canada or U.S. Meclizine/ MarzineScopolamine – 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 anti-helmintic 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) |
Step 3: Assemble your medical kit
This is what I initially packed for my three-year circumnavigation with my husband in 1992. This was a long time ago, 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.
| CATEGORY | DESCRIPTION – brand name | DESCRIPTION – generic name | QUANTITY |
| Anaesthetic | Xylocaine 1% w Epi | lidocaine hydrochloride | 90 ml |
| Xylocaine 1% w/o Epi | lidocaine hydrochloride | 40 ml | |
| Analgesics – injectable | Demerol – 50 mg/ml | meperidine | 30 ml |
| Toradol | ketorolac tromethamine | 1 x 30 mg | |
| Analgesics – oral | Bayer aspirin | ASA (acetylsalicylic acid) | 100 x 325 ng |
| Ponstan | mefenamic acid | 30 x 250 mg | |
| Tylenol #1 | acetaminophen/codeine | 100 x 325mg/8mg | |
| Tylenol #3 | acetaminophen/codeine | 50 x 325mg/30mg | |
| Analgesics – oral | Tylenol Extra Strength | acetaminophen | 100 x 500 mg |
| Tylenol plain | acetaminophen | 100 x 325 mg | |
| Antibiotics – oral | Amoxicillin | amoxicillin | 100 x 250 mg |
| Bactrim (Septra) | sulfamethoxazole/trimethoprim | 14 x 800/160 mg | |
| Biaxin | clarithromycin | 28 x 250mg | |
| Ceftin | cefuroxime | 28 x 250 mg | |
| Cipro | ciprofloxacin | 28 x 500mg | |
| Clavulin | amoxicillin/clavulanate | 42 x 500mg | |
| Cloxacillin | cloxacillin | 40 x 500 mg | |
| Doryx | doxycycline | 14 x 100mg | |
| Eryc | erythromycin | 60 x 333mg | |
| Flagyl | metronidazole | 4 x 500 mg | |
| Lariam | mefloquine | 16 x 250mg | |
| Noroxin | norfloxacin | 42 x 400mg | |
| Antibiotics – topical | Bacitracin cream | bacitracin | 60g |
| Bactroban ointment | mupirocin | 100 g | |
| Fucidin cream | fusidic acid | 15 g | |
| Neosporin burn cream | gramicidin/neomycin/polymyxin B | 1 x 90 mg | |
| Silvadene (Flamazine) | silver sulfadiazene | 1 x 50 g tube | |
| Antidiarrheal – oral | Imodium | loperamide | 12 x 2 mg |
| Antifungals – topical | Canesten vaginal inserts | clotrimazole | 6 x 200 mg |
| Loprox | ciclopirox olamine | 30 g | |
| Monistat cream w applicator | miconazole | 1 x 85 g | |
| Terazol w applicator | terconazole | 1 x 9 g | |
| Antihistamines – oral | Benadryl capsules | diphenhydramine | 40 x 25 mg |
| Claritin | loratadine | 100 x 10 mg | |
| Antihistamines – topical | Caladryl lotion | calamine/diphenhydramine HCl | |
| Anti-inflammatories – oral | Advil | ibuprofen | 100 x 200 mg |
| Anaprox DS | naproxen | 30 x 550 mg | |
| Naprosyn SR | naproxen | 18 x 750 mg | |
| Toradol | ketorolac tromethamine | 80 x 10 mg | |
| Anti-inflammatories – supp | Feldene suppositories | piroxicam | 6 x 20 mg |
| Antilice | Kwellada shampoo | lindane | 50 ml |
| NIX Creme Rinse | permethrin | 59 ml | |
| Antiseasickness | Gravol suppositories | dimenhydrinate | 10 x 100 mg |
| Gravol tablets | dimenhydrinate | 100 x 50 mg | |
| Transderm Scop. Patches | scopolamine | 12 | |
| Antiulcer | Cytotec | misoprostol | 20 x 200 mcg |
| Zantac | ranitidine | 42 x 150 mg | |
| Anxiolytic | Ativan sublingual | lorazepam | 12 x 0.5 mg |
| Ativan tablets | lorazepam | 50 x 1 mg | |
| Xanax | alprazolam | 9 x 0.25 mg | |
| Asthma treatment | Ventolin inhaler | salbutamol (albuterol) | 2 inhalers |
| Bandages | Bandaid Plastic Strips | 10 small, 30 regular | |
| Elastoplast adhesive tape | 2.5 cm x 4.5cm – 1 roll | ||
| Elastoplast Airstrips | 10 small, 30 large | ||
| Elastoplast cont. strips | 1 roll of each – 1″ & 2″ | ||
| Elastoplast cont. strips | 6 cm x 33″ | ||
| Elastoplast plastic – pink | 3 x 5 cm – 3 m | ||
| Mini/band bandaids | 10 small | ||
| Tensor bandages – 2″,3″,6″ | 1 of each | ||
| Tensor bandages – 4″ | 2 | ||
| Triangular bandage | 1 | ||
| Decongestants | Dristan Nasal Mist | pheniramine/phenylephrine | 4 x 3 ml |
| Sudafed | pseudoephedrine | 60 x 30 mg | |
| Dressings | Abdo. Pads, 5″ x 9″ | 3 | |
| Abdo. Pads, 6″ x 8″ | 8 | ||
| Abdo. Pads, 8″ x 10″ | 5 | ||
| Bactigras – 10cm x 10 cm | chlorhexidine acetate | 5 | |
| Bactigras – 5cm x 5cm | chlorhexidine acetate | 4 | |
| Gauze – 4″ x 4″ | 80 | ||
| Gauze – 5 cm x 5 cm | 10 | ||
| Kling, nonsterile | 4, 2″ rolls | ||
| Kling, nonsterile | 4, 3″ rolls | ||
| Kling, nonsterile | 4, 4″ rolls | ||
| Kling, sterile | 4″ x 4.5 m – 4 rolls | ||
| Large fingertip dressing | 10 | ||
| Sofra-Tulle – 10cm x 10 cm | framycetin sulfate | 15 | |
| Telfa – 3″ x 4″ | 18 | ||
| Ears | Garasone ear drops | betamethasone/gentamicin | 4 x 2.5 ml |
| Eyes | Eye pads | 12 | |
| Eye patch tape | 4 x 1″ roll | ||
| Opticrom drops | cromoglycate | 2 x 10 ml | |
| Sodium Sulamyd 10 % drops | sulfacetamide | 2 x 8 ml | |
| Sofracort drops | framycetin/gramicidin/dexamethasone | 2 x 8 ml | |
| Tetracaine drops | tetracaine | 5 ml | |
| Vasocon-A | antazoline/naphazoline | 10 ml | |
| Visine | 1 x 15 ml | ||
| Hemorrhoid treatment | Anusol – HC ointment | hydrocortisone/zinc sulfate | 15 g |
| Miscellaneous | alcohol swabs-disposable | 80 | |
| EpiPen | epinephrine | 1 | |
| Gastrolyte sachets | dextrose/electrolytes | 10 | |
| Vaseline | petroleum jelly | 3 x 50 g | |
| Vaseline nasal packing | 2 of 1″ x 36″ | ||
| Muscle Relaxant | Robaxacet | acetaminophen/methacarbamol | 12 |
| Robaxisal | ASA/methacarbamol | 12 | |
| Muscle Relaxant – oral | Flexeril | cyclobenbenzaprine | 40 x 10 mg |
| Robaxisal | ASA/methocarbamol | 28 x 325mg/400mg | |
| Needles | IV Quik-caths:22G & 18G | 2 | |
| needles-18G, 1 1/2″ | 6 | ||
| needles-19G, 1 1/2″ | 2 | ||
| needles-22G, 1 1/2″ | 2 | ||
| needles-23G, 1″ | 5 | ||
| needles-25G, 5/8″ | 8 | ||
| needles-25G, 5/8″ | 2 | ||
| needles-27G, 1/2″ | 14 | ||
| scalpels-disposable | 3 sterile | ||
| syringes-1cc w 27G 1″ needle | 4 | ||
| syringes-20cc w/o needles | 2 sterile | ||
| syringes-3 cc w 21G 1 1/2″ needle | 7 | ||
| syringes-3 cc w 25G 1″ needle | 9 | ||
| syringes-3 cc w 25G 1/2″ needle | 3 | ||
| syringes-3cc w 22G 1 1/2″ needle | 2 | ||
| syringes-3cc w 25G 5/8″ needle | 3 | ||
| syringes-6 cc w/o needle | 1 sterile | ||
| Other | absorbent cotton balls, sterile | 4 balls/pk, 5 pks. | |
| blood pressure cuff | sphygmomanometer | 1 | |
| cautery – disposable | 1 | ||
| chemstrips | 35 | ||
| Gloves, latex – nonsterile | 1 box | ||
| Gloves, latex – sterile | 4 pairs | ||
| Gloves, vinyl – sterile | 1 pair | ||
| Instant Cold Packs | 3 | ||
| Instrument – Coker clamp | 1 | ||
| Instrument – hemostat, curved | 1 | ||
| Instrument – hemostats, straight | 1 large, 1 small | ||
| Instrument – tissue forceps | 1 | ||
| Instrument – towel clamp | 1 | ||
| Iodide tablets | 50 | ||
| IV Administration Set | 1 | ||
| magnifying glass | 1 | ||
| measuring tape | 1 | ||
| Minor Laceration Trays – sterile | 2 | ||
| moleskin | 16″ x 7″ | ||
| moleskin | 3″ x 2″ | ||
| ophthalmoscope | 1 | ||
| otoscope | 1 | ||
| pregnancy kits | 3 | ||
| Q-tips | 1 large box | ||
| Splints for fingers | 2 med,1 long | ||
| splints-malleable | 2 | ||
| stethoscope | 1 | ||
| surgical scissors | 2 pair | ||
| surgical tubing | 1 lg. piece | ||
| thermometer | 1 | ||
| tongue depressors, nonsterile | 40 | ||
| Packing | 5% iodoform packing – 1 jar, sterile | 1.2cm x 4.5cm | |
| plain packing – 1 jar, sterile | 1.2cm x 4.5cm | ||
| Steroids – topical | Hydrocortisone cream | hydrocortisone 0.5 % | 30 g |
| Hydrocortisone cream | hydrocortisone 1 % | 30 g | |
| Kenacomb cream | gramicidin/neomycin/nystatin/triamcinolone | 30 g | |
| Kenalog cream | triamcinolone acetonide 0.1 % | 120 g | |
| Topicort cream | desoximetasone 0.25 % | 30 g | |
| Topicort Mild | 120 g | ||
| Westcort cream | hydrocortisone-17-valerate 0.2 % | 45 g | |
| Prednisone | prednisone | 200 x 5 mg | |
| Sutures | steri-“suture”-strips | 40 x 1/4″x3″ | |
| steri-strips | 40 x 1/8″x3″ | ||
| sutures-abs. Dexon ll | 2 x 4-0 | ||
| sutures-abs. plain gut | 1 x 2-0 | ||
| sutures-Dermalon | 12 x 6-0 | ||
| sutures-Dermalon | 4 x 4-0 | ||
| sutures-Dermalon, lg. needle | 8 x 5-0 | ||
| sutures-Dermalon, sm. needle | 7 x 5-0 | ||
| sutures-Novafil | 6 x 4-0 | ||
| Tape | Cloth tape | 2 x 2″ rolls | |
| Cloth tape | 1 x 1″ roll | ||
| Dressing tape – Curasilk | 3 x 1″ rolls | ||
| Heavy duty stretch tape | 1 x 4″ roll | ||
| Heavy duty stretch tape | 2 x 3″ rolls | ||
| Leukoplast waterproof | 5.5 yds x 1″ – 2 rolls | ||
| Paper tape | 1 x 2″ roll | ||
| Transpore 1/2″ roll | 2 |
Mainsailing 