Introducing the Marine Medical Blog

We’ve all done it. You are blithely chopping veggies for a gourmet dinner with your prized chef-grade knife, and your attention wanders. Suddenly you’re spurting blood and, although you can’t quite feel it yet, you realize that you have deeply sliced your finger.

You holler at whomever is in the next room, they come running, and (after much drama) you and your partner-in-panic wrap the traumatized digit in a T-shirt and drive to the nearest Emergency Room. After an interminable wait during which you almost pass out from pain, the doc checks for nerve damage and stitches up the cut, the nurse applies a bandage, you’re handed a prescription for antibiotics, and you undergo a radical cashectomy. At least you feel secure, knowing that experts have decided you will probably not lose the finger...

Now picture the same scene on the water, where the decision to visit the ER could involve the Coast Guard and a rescue helicopter. Traumatic injury takes on a whole new dimension when you are far from professional help... and this is the point where you need to become reasonably self-sufficient. We all have different experiences and abilities, and unless you have extensive medical training, it is easy to panic, scramble for supplies, and second-guess yourself about whether you’re doing it right (my partner jokes about staunching blood flow with one hand and Googling with the other). Even if you are a medical professional, it’s a different experience when you are looking at your own blood spurting from a fresh wound... and if you have to repair yourself in the cabin of a pitching vessel... well, it can be a challenge.

So we had an idea. How can I put 17 years of nursing experience (including ER) to best use as I make the transition to water, not only helping my sailing partner but bringing something to the cruising community? I have patched many a cut, assessed countless traumas, changed innumerable complicated dressings, given thousands of injections, started a plethora of IV’s, assisted with surgeries, sutured many incisions and generated a few trees’ worth of documentation... perhaps I can offer useful tidbits to fellow sailors, and even a much-needed product or two.

One of my basic philosophies is that we must take responsibility for our own health, and this is not even optional in the cruising setting. We have to educate ourselves, stock the best tools and supplies, and take a deliberate approach to on-board health management. With this blog I will attempt to move us toward that goal.

But lets not be boring! This is not a textbook; it’s interesting stuff, and should be treated that way. I will use this blog to present case studies of marine medical “adventures” as learning tools. Please consider this an invitation to send me your war stories of trauma aboard... if it’s a fit, I’d love to follow up with an interview and provide credit (if it’s not too embarrassing!) as well as a link to your website. We’ll also throw in a discount on your next order for medical supplies as a “thank you” for sharing your tales.

The first module in our Expedition Medical Chest line is focused on wounds and burn care. Since lacerations, abrasions, punctures, and burns are common injuries on a boat, we decided to focus on those for our initial offering. Steve told me how he shopped for his boat’s expensive medical kit, and as I browsed the contents with a critical nurse’s eye, I found myself surprised at what was (and was not) included. I realized that if I were called upon to take care of someone who had just cut themselves badly at sea, I would not want to reach for that kit... which is a high-end and well-marketed product.

This brings me to the reasoning behind our first Medical Chest module (available here), which reflects my nursing experience as well as Steve’s colorful career of adventure on land and sea. I have specific preferences in the items I reach for when I enter the hospital supply room, so here is an inventory of the contents packed in a logical sequence in our gasketed Lexan cases, along with some commentary on my rationale behind each:

• Ten non-latex gloves - gloves are second only to washing your hands as a huge step in preventing wound infection, as well as protecting the person who is doing the care. We chose vinyl since many people are allergic to latex (including some who are not aware of it).
• Two 8” X 10” high absorbency ‘Abdominal’ pads - these dressings are extremely absorbent and generous enough to cover a large wound. They can also be doubled over to increase their absorbency for a smaller wound. You can use them to initially stop the bleeding, for dressings after the wound has been closed, and as a pressure bandage. They are sterile, individually wrapped, and very versatile.
• 25 4” X 4” gauze sponges - when someone is really bleeding, pressure is the first thing to think of to stop it. Gauze 4x4’s are great to just grab and hold on the fresh wound. They are absorbent, and easy to maneuver. They can also be used as dressings, although they do tend to stick to the site. We chose not to make these sterile to cut down on individually packaged waste. Since they are included with the intended purpose of stopping bleeding, that’s not a problem; aseptic technique will happen later.
• 10 stretch fabric knuckle/fingertip bandaids - first, I love the stretch fabric approach to bandaids as opposed to the plastic ones. They feel better, stay on longer, and their adhesive is more water resistant... a much needed quality at sea. The other quality these bandaids have is their special contours for maneuverability in tight places (like fingers and knuckles).
• 20 stretch fabric 1” X 3” bandaids - again, love the stretch fabric. These are the staples we need to have in stock for all those miscellaneous cuts and abrasions.
• One roll Micropore paper tape - this is my favorite tape for applying and changing dressings (and I’ve tried them all). It is easy to manipulate in tight spots, the adhesive lasts a long time, and it seems to cause the least irritation.
• Two 100mL bottles of sterile water - sterile water or saline is a very good thing to have on hand for flushing a fresh wound. Boiled sea water works well also... but this is quicker.
• One 12mL syringe - when you are flushing a wound with the sterile solution, a syringe helps to get some pressure going. This can be very helpful with displacing debris and microbes.
• One tube of triple antibiotic ointment - a good broad-spectrum topical antibiotic ointment can mean the difference between quick healing and a painful infection. Indispensable stuff.
• One pack of 10 3M Steri-strips - To close a gash, these are my tool of choice. I have patched up thousands of wounds (including some really big, ugly ones) with these amazing little strips. One of the things I like to do is to cut them in half before applying them, so they go twice as far. This is useful since they are expensive and are used up quickly with one big procedure.
• 5 Povidone Betadine swabs - iodine (betadine) is really an amazing substance.  It will nearly sterilize skin around a wound and is used in surgical prep as well as complicated dressing change protocols.  Use it liberally on the skin surrounding the wound but really endeavor not to get it into the wound itself as it can damage open tissue.
• 20 Alcohol wipes - alcohol will also nearly sterilize skin as well as instruments (such as forceps) before use. It will also de-fat an area of skin, which will make tape and/or Steri-strips stick better.
• 5 Telfa 3”x5” non-adherent pads - these dressings will help prevent ripping off a newly formed scab (your body’s natural protective layer). But if you do have a problem with a sticking bandage, soak it in sterile water or saline and let it sit for five minutes. Peel it off slowly and carefully, and your scab will remain intact. Then you can clean, medicate and reapply the dressing.
• Two rolls of Kerlix gauze wrap - I really like this stuff for keeping a dressing in place in a spot like an elbow or wrist where there is a lot of motion or friction, but where you don’t need moisture protection. It offers a bit of extra padding as well.
• Two sterile eye pads - if you have an eye injury it is extremely important to protect it...these pads are contoured for this area.
• One roll of 3M Coban wrap - this is the wrap to use when you need to secure a dressing, further protect the area, and/or give some support to a joint. It has a little bit of stretch, gives some moisture protection and (the best thing) sticks only to itself so you don’t need those pesky anchors you need with traditional Ace bandages. I don’t know about you, but I always lose those! Coban is wonderful.
• One 2”x2” 3M Acticoat burn dressing - these dressings are impregnated with a silver antimicrobial substance which is particularly effective. Leave this on for 3 days immediately after a burn and you will have protection, pain relief and significantly better healing.
• One Instant Ice Pack - not just for burns or bruising... if you have inflammation along with your wound (which often happens) ice is very helpful for the pain and swelling.
• One disposable razor - before you tape a dressing on an area, if you remove the hair it is much easier to achieve cleanliness as well as much less painful dressing changes. Pulling tape off of a hairy area does not contribute to comfort!
• Self-published instruction manual and starter medical log - To tie all this together, I've written a set of procedures for dealing with typical lacerations, presented in a logical sequence that matches the grouping of supplies within the chest.

As I mentioned earlier, we were deliberate in our choices with these materials, and the quantities we included. Some other kits we have examined include inadequate quantities of supplies you can grab at your local drugstore, packaged in cases that won’t withstand a puddle, much less a flooded dinghy. Maybe I am spoiled, but I know there is a huge difference in the quality and usability of these items. Lower grade bandages will fall apart as soon as they get wet or you bend your elbow to hoist a line... better ones last longer, are easier to work with, and give you a better chance to heal.

The supplies in our kits are the same ones I am used to grabbing when I run into the supply room in hospitals, and the quantities reflect my experience with first aid as well as ongoing care. The gasketed polycarbonate box is completely waterproof and will keep your supplies dry... a must in the marine environment. I took some time to sit down and write out a step-by-step instruction book in clear language (with a font big enough to see), then followed that with a starter medical log to get you in the habit of keeping records about this important subject.

We believe that the combination of these elements yields a marine medical kit that meets the needs of cruisers and others who need a reliable stock of supplies in a harsh environment. This Medical Chest is what Steve and I would like to have available if we find ourselves dealing with an injury at sea.

Future blog posts will look at such topics as what to stock in your onboard medicine cabinet (both over-the-counter and with a prescription from your MD), antibiotics (broad spectrum and others), to Tourniquet or not to Tourniquet, the proper way to do dressing changes and wound assessments, shock, hypothermia, aseptic technique, burns, how to wrap, how to give an injection, how to document incidents in a medical log, use of epinephrine pens and so on. I expect it to be interesting and fun... especially with the added color of your stories about medical adventures at sea!

Welcome, and thanks for dropping by...