Ships Hospital

[cap10ed]

I thought this might be a good place to discuss what we have done to assist in first aid. Also talk about health issue’s and general malaise and possible solutions. I’ll start.

I have heard that infections of the urinary tract can also effect mental health well being. Is this a wives tale?

I have a generic First AId kit aboard because I sail coastal and not off shore. Curious how stocked up are Scantling members when it comes to 1st aid supplies.

On the bigger vessels sailed here are the medicine chests proportionately sized to accommodate the larger crew. Ships I sailed had 23 crew and a comprehensive array of equipment. Oxygen, blood pressure monitors, back boards etc. Much of it mandated.

Beau mentioned using duct tape has a make shift bandage. What other devices have people found to make a serious event into a controlled one?

How many people have current First aid training ?

[BeauV]

I'm happy to see this here, it's a serious issue.

First Aid:

Clearly this depends upon where one is going and what one is up to. I try to think of how far away from help I am, rather than offshore vs inshore vs lake etc.... For example, a lake in the middle of nowhere could be farther away from help (in time) than a boat that is a hundred miles off the coast of Oregon. In addition, some boats are simply more dangerous than others. As a result, a different sort of injury can occur, based upon the type of boat. As a young guy I remember being hit by a spinnaker pole that was as heavy as I was, a lot of modern boats don't have gear like that. Thus, the First Aid kit that one should have aboard needs to be based upon the sorts of equipment one has and the damage it can do to the crew. Obviously, there are constants, like water in which one can drown; but there are many boat specific and location specific items to consider. My recommendation is that one sit down and come up with a list of injuries that could happen on your boat, assign a probability and severity number to them, and be certain you've got a good way of dealing with the most sever and probably of them.

Regarding the First Aid kit, there are a lot of good lists of things to take. Have a look here:
http://www.westmarine.com/webapp/wcs/st ... sYY83npgxI
(Chuck Hawley, who is also US Sailing Safety at Sea Chairman, does a great job)

Because most injuries I've seen happen in clusters, because something breaks or goes badly wrong, I stock a lot more bandages and splints than the typical recommendation. BTW, splints and backboards don't have to be dedicated devices, you just have to know how to make them from what's already aboard. My thinking is based upon a specific problem, like a broken rig that hits three people as it comes down, and what I'll need to address that problem. For major bleeding injuries, I have a bag full of unused rags that I can use for an injury or a major oil leak, they work equally well for both. Tape is really useful, but don't use stretchy tape (like electrical or rigging tape) because it can cut off circulation. Duct tape is useful because it sticks well and doesn't stretch.

Finally, I can't recommend advanced First Aid training enough. It is useful ashore as well as afloat and it is amazingly helpful to know what something like a butterfly closure is supposed to do (that's what I did to Big Bill's face with duct tape.). Similarly, how to address heart attacks, strokes, broken bones, breathing issues, hyperthermia, etc... are all much better learned in a class than "on the job" when they happen.

As to a urinary tract infection I'm sure if I had one my mental health would be disturbed, geesh!!!

[Olaf Hart]

UTI's and mental health are not related, but you have to check for sepsis in recent onset of dementia.
UTI is the most common cause of sepsis in older women, so that is probably where the idea came from.

From recent experience, it is possible to splint most fractures with things lying around on a boat, but not an ankle.
A blow up ankle splint is a good idea on a boat.

Plastic urine bottles with a lanyard are life savers on a lone watch.

The best offshore setup I have seen is on the VOR. Several crew members have to do paramedic training, they have a standardised comprehensive medical kit, and real time access to medical assistance.

I will see if I can track down the medical kit inventory

[Orestes Munn]

In my youth, I saw countless nursing home patients comatose from urinary tract infections and pneumonias. They usually got back to their baseline demented state after a few days of IV antibiotics. If you add a little dehydration, an otherwise uncomplicated UTI can turn even a healthy 70 year-old sailor into a disoriented and dangerous emergency situation.

I'm pretty minimalist in my own first aid preparations. I want to be able to clean and close a laceration and treat mild infections, gastroenteritis, and acute pain. For anything serious, I'm going to plan on evacuation in under 24 hours, because that's where I sail. If I were going further away, I'd take all kinds of shit.

As Beau points out, the most important piece of kit is between your ears. Anyone can stop bleeding with almost anything and a monkey can suture, but it takes some judgment to tell who's really sick and who isn't and when to call for remote expert support or an evac. A basic first aid course is a very good thing.

Always use Duck tape sticky side out!

[Olaf Hart]

Just on dementia, many older folks skate on the edge for some time, and it doesn't take much to make it florid.
This really hit home during the GFC.
I had a few patients who appeared normal and rational suddenly become demented when their retirement savings, which were in listed property trusts, we're frozen by the government.

[BeauV]

...snip...

Always use Duck tape sticky side out!

OM, sorry I forgot that. Yes! You don't want to stick things to people with duct tape just use it as a construction material. I made precisely this error on Big Bill and the doctors lectured me on it. Sorry I forgot.

[Orestes Munn]

...snip...

Always use Duck tape sticky side out!

OM, sorry I forgot that. Yes! You don't want to stick things to people with duct tape just use it as a construction material. I made precisely this error on Big Bill and the doctors lectured me on it. Sorry I forgot.

And as long as we're talking tape, use caution closing a ring of tape around anything that might swell. Electrical tape does indeed make nice functional dressings. Just ask Tim Ford and Audrey about how I opened up and then closed my finger on the first day of a 3-day regatta this summer. There's probably still some blood on the boat.

[cap10ed]

Fire and burns are my fear. The littlest burn hurts like hell. We always tacked so our galley was on the lee side when cooking offshore so no liquids would spill down on the cook. What is the best burn ointment to carry aboard ?

[Orestes Munn]

Fire and burns are my fear. The littlest burn hurts like hell. We always tacked so our galley was on the lee side when cooking offshore so no liquids would spill down on the cook. What is the best burn ointment to carry aboard ?

The goal in burn treatment is to prevent infection. I was brought up on silver-sulfadiazine, but I'm not sure if it's still doctrine-—maybe Olaf knows. A significant burn, especially in a place that's hard to keep clean, e.g., the crotch, is a potential abort or evac and that's a situation where I would err on the side of caution. Actually, I would do that in a lot of situations.

[Olaf Hart]

Silvazine is still the standard. A bit expensive and best stored in the refrigerator.
Use a thin layer and non adhesive dressings for the first three days (Melonin).

By then you will know if it is a full thickness burn, or partial thickness.

In a full thickness burn, the nerves are damaged so there is an area of lost touch sensation.
See a burns unit, may need grafting.

There are water gel dressings available now which seem to work for mild to moderate burns.

Don't forget that first aid is to immerse a burn in cold water for a few minutes, makes a big difference to the extent of skin damage.

[Lin]

Fire and burns are my fear. The littlest burn hurts like hell. We always tacked so our galley was on the lee side when cooking offshore so no liquids would spill down on the cook. What is the best burn ointment to carry aboard ?

The goal in burn treatment is to prevent infection. I was brought up on silver-sulfadiazine, but I'm not sure if it's still doctrine-—maybe Olaf knows. A significant burn, especially in a place that's hard to keep clean, e.g., the crotch, is a potential abort or evac and that's a situation where I would err on the side of caution. Actually, I would do that in a lot of situations.

I recently was treated for a burn and they still use Silver sulfadiazine (Flamazine in Canada) Bear in mind that that the cream is not stable for very long, once opened. In most cases however I think you guys are discussing situations here where someone can be evacuated if need be. The trips that are over 2,000 miles (or so) and med evacuation is not imminent, I prep First Aid supplies differently.

Burns need to be cooled immediately (with clean, cold water if possible) and kept clean. Agree completely with Olaf.
I am not keen on using anything like polysporin, or the like.

Women often show signs of confusion and symptoms similar to dementia when they have a urinary tract infections. (as already mentionend) Rarely do elderly people spike high fevers and often confusion is the first sign of a UTI or pneumonia.

When we were sailing back from Hawaii to Friday Harbour last year, there was another boat that was also sailing back from Hawaii (Post Pac Cup race) a number of miles away (? 5 - 25 miles) from our boat, and we were about 700 miles from home. One of their crew got a UTI and he had an underlying prostate problem. They managed it very well, did wonderful assesments including BP's, heart rate montoring, temperatures, was put on the correct antibiotics, and lots of fluids etc. He got great care and I commended the acting skipper, afterward. We maintained radio contact with them for a couple days to ensure he was improving and that they had enough appropriate antibiotics to treat the UTI. They also had Sat phone coverage with a nurse in their home town, to ensure he was getting the right treatment.

[BeauV]

Lin, if I have an accident afloat can you be sure to be there. You've got a magical way about you. BV

[Soñadora]

Going under the knife.

Finally getting around to having that umbilical hernia taken care of. Going in first thing tomorrow morning.

I would be lying if I said I didn't mildly enjoy anesthesia.

[BeauV]

...snip....

I would be lying if I said I didn't mildly enjoy anesthesia.

Seriously?!? I always wake up with a terrible hangover and crying like a baby.

[cap10ed]

When you go under and see the Scantlers there. I would be the bald one with the Ray-bans. Quick recovery Rick.

[Orestes Munn]

Going under the knife.

Finally getting around to having that umbilical hernia taken care of. Going in first thing tomorrow morning.

I would be lying if I said I didn't mildly enjoy anesthesia.

We'll be thinking of you.

When I had my spine thing, where they keep you light and wake you up immediately and ask you to move your extremities, the surgeon came out, smoking his cigar and wiping his hands on his bloody apron. My wife jumped up and said "Doctor! How's he doing?". The laconic answer was, "A little too well". Never did find out what I said.

[Soñadora]

You're a unique induhvidual, OM.

Never had the hangover thing. Usually just groggy and relaxed.

[Slick470]

You're a unique induhvidual, OM.

Never had the hangover thing. Usually just groggy and relaxed.

OM is unique in person too. Best wishes Rick.

[Rob McAlpine]

I hate anesthesia, and loathe morphine. Unfortunately, I've had far too much experience with both in recent years.

The longer offshore races require current first aid certs, and it's a good idea in the oilfield, as well.

I keep this first aid kit aboard, plus a round of antibiotics and some pain killers:

http://www.firstaidneeds.com/product/999PCC-219

[Lin]

I hate anesthesia, and loathe morphine. Unfortunately, I've had far too much experience with both in recent years.

The longer offshore races require current first aid certs, and it's a good idea in the oilfield, as well.

I keep this first aid kit aboard, plus a round of antibiotics and some pain killers:

http://www.firstaidneeds.com/product/999PCC-219

Morphine is a drug that is poorly tolerated by many due to the nasty side effects -nausea, vomiting, hallucinations. Yuck

Wishing you a quick recovery Rick!

[Orestes Munn]

I hate anesthesia, and loathe morphine. Unfortunately, I've had far too much experience with both in recent years.

The longer offshore races require current first aid certs, and it's a good idea in the oilfield, as well.

I keep this first aid kit aboard, plus a round of antibiotics and some pain killers:

http://www.firstaidneeds.com/product/999PCC-219

I like that kit, especially now that I know what's in it. Looks about right for the ≤ 24 hrs to definitive care range.

[BeauV]

I hate anesthesia, and loathe morphine. Unfortunately, I've had far too much experience with both in recent years.

The longer offshore races require current first aid certs, and it's a good idea in the oilfield, as well.

I keep this first aid kit aboard, plus a round of antibiotics and some pain killers:

http://www.firstaidneeds.com/product/999PCC-219

Rob, a guy I know has converted one of those bags to carry all the requisite parts of a good cocktail party: Shaker, wand, glasses of all types, gin, vermouth, etc..... He left the back just as is so he doesn't get "the look" while hauling 15 lbs of booze aboard a boat. B-))

[Orestes Munn]

Rob, a guy I know has converted one of those bags to carry all the requisite parts of a good cocktail party: Shaker, wand, glasses of all types, gin, vermouth, etc....

OK, OK, don't pass out on me; I know it looks ugly, but you're going to be fine. Here, hold pressure right there while I go below and get the med kit...

[BeauV]

Rob, a guy I know has converted one of those bags to carry all the requisite parts of a good cocktail party: Shaker, wand, glasses of all types, gin, vermouth, etc....

OK, OK, don't pass out on me; I know it looks ugly, but you're going to be fine. Here, hold pressure right there while I go below and get the med kit...

OM, amongst some of the sailors I sail with the DTs are a serious medical issue

[Orestes Munn]

Rob, a guy I know has converted one of those bags to carry all the requisite parts of a good cocktail party: Shaker, wand, glasses of all types, gin, vermouth, etc....

OK, OK, don't pass out on me; I know it looks ugly, but you're going to be fine. Here, hold pressure right there while I go below and get the med kit...

OM, amongst some of the sailors I sail with the DTs are a serious medical issue

No shit. I've haven't heard of a case of frank DTs or seizures, but I have heard about several guys who picked the wrong time to quit drinking.

The first delivery I crewed on, the first question I was asked by the skipper, a well known offshore sailor and retired Navy O-6, was "what kind of beer do you drink?". I thought he was just going to the store to get a six pack or two, but we set off in the morning with a 75 qt cooler filled with beer in the cockpit and the two watch captains drank steadily the entire time, watch in, watch out, without showing the slightest evidence of intoxication.

[Rasp]

Reading this thread brought to mind a sailing mishap on a BVI Spring Regatta race. I had lucked into the local knowledge 'rock pilot' position on a well organized visiting Swan 60. Two owners who were as unalike as could be, the asshole lawyer was a good helm and tough on the crew and usually drove upwind and the laid pack partner pretty much balanced out the karma and drove downwind. A couple of semi-pros in the crew and a competitive boat overall.
The week before at Rolex in St Thomas it was all guys and lots of ego and testosterone in abundance. We did so well that the owners decided to invite the 'girls' down for the Tortola event. I figured it was wives and girlfriends and sure enough there were 6 or 7 nice ladies on the rail when racing resumed. The cutest of the bunch ended sitting right next to me at the back of the rail meat row as I had to be able to convey my vast local knowledge to the skip and tactician. I couldn't decide if the girl was the lawyer owners girlfriend or daughter. There was something between them but I couldn't quite get the gist of it. At Rolex the guys were all peeing over the stern rail but when I had to go I figured it best to consider the ladies and pee in the head down below. As I returned to my place on the rail, the cute significant something of the skipper asked why I had gone below. I told her that I didn't want to pee off the stern with a mixed crew and her reply was something to the effect of 'Don't be silly, once you have seen one penis, you have seen them all!' I later asked her when she had to be back in school and what college she attended. She laughed and said that she was in residency at Johns Hopkins as a urologist, more specifically as an andrologist. I was unfamiliar with that term and she gave me the definition and I then understood her earlier comment about penises.

Andrology focuses on the male reproductive system. It is mainly concerned with male infertility, erectile dysfunction and ejaculatory disorders. Since male sexuality is largely controlled by hormones, andrology overlaps with endocrinology. Surgery in this field includes fertilization procedures, vasectomy reversals, and the implantation of penile prostheses. Vasectomies may also be included here, although most urologists perform this procedure.

I mentioned this comment to the skip that night at the party and asked if she was just pulling my leg, and with a wink he said that she was indeed all she claimed to be, and more! He said that if she were to pull my leg, that it would probably be the proverbial third leg.

I apologised to her the next day about mistaking her for a mere college girl and asked more about her field of study. She was eager to talk and I learned stuff about my own junk that day that I never knew. She then claimed to have been on the team that restored John Wayne Bobbitt to his original genital configuration and I once again got the impression I was being made a fool of. I had to mention her outrageous claim to the skip again that evening and he once again backed her up and said that he was a personal injury lawyer and that he had used her as an expert witness on cases where guys had been rendered impotent for one reason or another. He said that she was very dear to him as she had made him a lot of money with her expertise.

The last day of the regatta, I was doing guy/sheet in the cockpit on the spi runs and the runner tender didn't take up slack and I got the big runner fiddle block right in the face. I was stunned and saw stars for a couple of seconds, but managed to keep hold of my sheet and stay on my feet. The lawyer skip cussed the hell out of the runner tender and came to take the sheet but I waved him off. My sunglasses had broken and left a cut across the bridge on my nose and I had blood running down both sides of my face. Skip motioned for the girl to take me below and tend to my wounds and relieved me of the sheet. She knew right where the well equipped first aid kit was and was prepping to give me sutures right on the spot. I insisted on returning to my post so she cleaned me up and put a butterfly on it but told me that she would deal with me properly once we got to shore. My heart soared!

I was a real stud as I came back and resumed my role in the cockpit and the Skip gave my Doc an 'atta girl' and we went on to do well in the race and regatta. After the dockside routine of stowing sails and tidying up the boat and the first 'real drinks' got passed around, my new Doc grabbed the first aid kit and a fresh bottle of rum (anesthesia she said!) and started to hustle me off to the hotel room for surgery but not before the Skip pulled me aside and gave me a fresh Crew shirt and the key to his room and told me to go shower and get cleaned up before reporting to the ER. I sort of stammered something about her being his 'date' and he said that she was a free agent and that if I didn't fully submit to her talents and medical skills that I would never crew on his boat again! You can just barely see the scar to today... (The one on my nose, not the one on my heart)

The boat returned to BVI Spring Regatta the next year and I went looking for the pretty Doc but she was not to be seen. The Skip knew just what I was up to and let me fret for a while before telling me that she had gotten married to the bowman from the year before! So it is true what they say about bowmen, the bastards...

[JoeP]

You do have the best stories Rasp.

[Tucky]

My god, yes you do. Thanks.

[cap10ed]

I think we can look at a TV version of Scantlings now. There seems to be enough talent around to write scripts. Great story Rasp.

[Soñadora]

ain't that how it is? I wonder if andrology is anything like drafting was for me. After doing it for a dozen years it wasn't fun any more.