medical

Most city-centers will have a hospital. Ones out in the islands—South Pacific for instance—tend to be good and cheap, but in most cases you must be self-sufficient. That includes a well-stocked medical supply, and the know-how to fix yourself up.

Before going offshore, if you can, we recommend doing a first-aid course. Knowing what to do in the event of severe bleeding, choking, or severe allergic reactions, could save your crew's life.

In a marine environment, it may not be possible for EMS personnel to come to your assistance in an emergency. You may need to contact a doctor and request advice on providing care, even if it is outside of your training. Read about calling for help on a boat. Document the doctor’s orders carefully.

You should prepare the following information and present it to the doctor:

• Routine information about the ship
• Routine information about the person
• Details of the illness/injury
• Care rendered and the person’s response to that care

MALARIA

If travelling into Malaria endemic areas, we carry rapid diagnostic tests. The test is 90% accurate and quickly diagnoses if Malaria is present, and if so, which one you have, so that treatment can commence quickly if needed. We relied on tests because we were close to hospitals, but if traveling to islands with no facilities it might be a good idea to also carry antimalarials (e.g., malarone).

For medicine like Malarone, it's important to start this medication 1-2 days before you enter the malarious area, to continue while in the area and for 7 days after leaving.

The best protection is prevention. Use screens on windows and doors, if you must go out in the evening or after a big rain wear long-sleeved shirts and pants and wear insect repellents that contain diethyltoluamide (DEET).

Malaria symptoms: fever, chills, headache, other flu-like symptoms.

See malaria information by country.

JELLYFISH STINGS

Stings from marine life can range from painful, to life-threatening.

If stung by a jellyfish:

• Flush the injured area with vinegar for at least 30 seconds, if vinegar isn't available mix baking soda and water into a paste and apply it to the area for 20 minutes.
• Remove any pieces of the animal, while protecting your hands,
• Immerse the affected area in water as hot as the person can tolerate for at least 20 minutes, or until the person feels less pain

Seek medical attention if there is an infection, or if the person has trouble breathing. Always flush with vinegar FIRST, before removing any part of the animal, the tentacles can continue to fire even after they're detached so you must neutralize the poison before touching them or they could inject more poison into the person.

SUNBURNS

The following precautions will help prevent sunburns:

• Limit sun exposure between 1000-1500, if possible.
• Wear light colored clothing that covers the arms, neck and legs.
• Use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 and apply it 15-30 minutes before going outdoors. Reapply sunscreen at least every 2 hours, as well as after being in the water and after sweating.

Take a cool shower to relieve pain. Treat mild to moderate sunburns with aloe vera gel. Apply it a few times a day to the sunburnt area.

If you have blisters, leave them. The liquid in the blisters will ensure that the skin heals well, while protecting it from infection. While the sunburn is healing, stay out of the sun, and keep the area covered if outside.

HYPOTHERMIA

There are four levels of hypothermia, from mild to severe life-threatening symptoms:

• Cold stressed, not hypothermic: conscious, normal movement, shivering, and alert.
• Mild hypothermia: conscious, impaired movement, shivering, alert
• Moderate hypothermia: conscious, impaired movement, little or no shivering, not alert
• Severe hypothermia: cold, unconscious.

• Cold-Shock Response: Rapid cooling of the skin causes a gasp followed by hyperventilation (lasting 1-2 min).
• Cold Incapacitation: Further cooling of nerve and muscle fibres causes weakness and a loss of coordination, leading to incapacitation within approximately 15 minutes.
• Hypothermia: A person dressed appropriately for the weather conditions will take 30 minutes + to become mildly hypothermic.
• Circum-Rescue Collapse: Can occur just prior to, during, or after rescue. The signs and symptoms range from collapsing, to fainting, to cardiac arrest. When rescuing a person from cold water, monitor the person’s condition carefully and be prepared to provide emergency care.

If you are in OPEN WATER you can increase your survival time while waiting for rescue by doing the following:

• With a PFD, adopt the Heat Escape Lessening Position (HELP):
• Press your arms against your armpits.
• Place your forearms across your chest.
• Squeeze your thighs together and raise your knees toward your chest.
• If several people are in the water together, adopt the huddle position:
• Face each other
• Have each person squeeze their thighs together
• Form a circle and hug each other. Each person should place one arm above and one arm below the arms of those adjacent, and pull the sides of the chests together
• Sandwich any children or persons without a PFD inside the huddle.
• Get out of the water as much as possible by using a capsized boat or other floating object as a flotation device.

Caring for hypothermia

Care for hypothermia varies depending on the severity of the symptoms mentioned earlier (cold stressed/not hypothermic, mild hypothermia, moderate hypothermia and severe hypothermia):

• Cold stressed, not hypothermic
• Reduce heat loss, add dry clothing.
• Give high-calorie food or drink (warm, sugary, non-alcoholic)
• Increase heat production (exercise, e.g., run in place)
• Mild hypothermia
• Handle person gently, keep horizontal
• No standing/walking for at least 30 min
• Insulate the person/vapor barrier (hypothermia wrap, see below)
• Give high-calorie food or drink (warm, sugary, non-alcoholic)
• Monitor until improvement for 30 min
• Moderate hypothermia
• Handle person gently, keep horizontal
• No standing/walking
• Insulate the person/vapor barrier (hypothermia wrap, see below)
• No drink or food
• Apply heat to upper torso, by applying warm water bottles, or heating pads (i.e., the armpits, chest, and upper back). Body heat from yourself can also work in an emergency
• Severe hypothermia
• Treat as moderate hypothermia
• If no obvious vital signs, do 60-second breathing check
• If not breathing, start CPR

HYPOTHERMIA WRAP

Applying a hypothermia wrap, or hypothermia 'burrito', is an excellent way to reduce the heat lost by a person with hypothermia.

It consists of layering insulation and heat-reflecting material. If help is more than 30 minutes away (common on offshore boats), protect the person from the environment, remove the wet clothing and put them in a hypothermia wrap.

To apply a hypothermia wrap:

• Insulation pad. Place it between the person and the ground/floor.
• Sleeping bag/blanket. Wrap the person, apply as much insulation as possible.
• Hat or hood. Cover person's head/neck with a toque, heavy hat, or hood.
• Vapour barrier. If the person is dry, place the vapour barrier outside of the insulation wrap. If the person is wet, place the vapour barrier inside the insulation wrap. If two vapour barriers are available, place one inside and one outside the insulation wrap. A vapour barrier can be a plastic tarp or foil blanket.

DAN BOATER

In case of a serious injury, you must have the means to get yourself to the nearest clinic. We use DAN Boater, a repatriation insurance that covers helicopter/transportation fees.

MEDICAL RESOURCES

We find that medical apps for mobiles, and FM army field manuals, are helpful when dealing with minor burns, cuts and various aches. If you have a smart phone, the Canadian Red Cross app is free, works offline, and is very good.

We also recommend:

• The downloadable guides by Riot Medicine
• A Barefoot Doctor’s Manual: The American Translation of the Official Chinese Paramedical Manual(an excellent general health manual)