Medical emergencies while underway

[Ryan L]

Nicole (my wife) needed emergency surgery while anchored at an island that had no doctors. So we made a video about it. If you're interested it includes footage of our E38-200 bashing into some "fun" waves. It's not major surgery but be warned there is some content that may disturb some people.

https://www.youtube.com/watch?v=OvWibTyPvg8&lc=z13ddph5wna1fht2s23xfprivq33yxbl2

In the video description there is a detailed list with links to the medical supplies, reference materials, and training we have for our ocean passages and voyages in the South Pacific. If you like the video it helps us a lot if you click the "thumbs up" and if you click "subscribe". Plus your comments are always welcome and appreciated here and on the video's page.

"Joliba" - how's my technique?

 

[Rick R.]

Nicole (my wife) needed emergency surgery while anchored at an island that had no doctors. So we made a video about it. If you're interested it includes footage of our E38-200 bashing into some "fun" waves. It's not major surgery but be warned there is some content that may disturb some people.

https://www.youtube.com/watch?v=OvWibTyPvg8&lc=z13ddph5wna1fht2s23xfprivq33yxbl2

In the video description there is a detailed list with links to the medical supplies, reference materials, and training we have for our ocean passages and voyages in the South Pacific. If you like the video it helps us a lot if you click the "thumbs up" and if you click "subscribe". Plus your comments are always welcome and appreciated here and on the video's page.

"Joliba" - how's my technique?

Important info Ryan!

Not something to be watched at lunch or dinner...lol

 

[Joliba]

Ryan,
You looked a little tentative but great result! When we sailed on Rhiannon, the only medical book we had was Advanced First Aid Afloat by Dr. Peter Eastman (who ran aground in Huahine when we were there.) None of us had any medical experience. We loved to read the chapter on how to perform a leg amputation at sea....So tell Nicole that it could have been worse.
Great video!
Mike

 

[bgary]

Great job!

Advanced First Aid Afloat

Prefacing this with the hope I never need it, but... is that a good reference? Are there others worth a look?

I have a copy of the SAS Survival Handbook in my truck (plus a copy of the Boy Scout manual, which is a surprisingly useful book) - I travel in and through mountains enough at various times of the year that I routinely carry the "stuff" I need to be able to survive if I get stuck somewhere and/or need to take care of basic medical needs. But most of that book is pivoted around wilderness survival, not survival afloat, so... open to recommendations.

 

[Joliba]

Bgary,
That book was from the 1970's. There are better books now. I have not looked into it recently. A good manual that my daughter used in remote South American villages 15 years ago is: Where There Is No Doctor. This has been updated. It is not specific to cruising, but is quite good. There are many suggestions for sailors if you search the Internet...but I don't know which books are best. Ryan L has some references. With the Internet, Satphones, and SSB, lots of good help for many situations is easily obtained quickly. Being well supplied is the key. Of course, many emergencies still cannot be treated to modern standards when days or weeks from a hospital. It is definitely still a risk one needs to accept in passage making.

 

[907Juice]

Strong work dude! Glad you had some forethought on supplies. Im a paramedic and carry a ditty bag with me whenever I travel. Only had to use it a few times but it was always nice to have! I'm glad it didn't get worse!

juice

 

[Vagabond39]

Medical afloat

Every ships officer is required to take some medical trainng. In serious cases, fadio communications to the Vatican would provide expert medical advice, and step by step surgical instructions.
While eating lunch, I was near the wall phone in the mess. A sailor came over dialeda number, and started talking: "Where is that thing we use to listen to the deisels. I need it, I have someone in sick bay."
So I figured that he was an officer.
Bob

 

[toddster]

Thanks for that. I don't know that I would be cool-headed enough to video the procedure!

Earlier this Fall, I was binging on solo sailing blogs and books and, as a bacteriologist, I found it really striking that almost everyone mentions getting serious staph infections. (Or at least they mention chronic "boils.") I did a bit of research (but have yet to find a definitive work on the subject) and found that Marine Mycobacteria and Vibrio vulnificans are also fairly common agents of fast-growing, potentially life-threatening infections among tropical sailors. (And these large wounds can then quickly become polymicrobial.) So, I was thinking, "Wow, why don't they tell people about this up front? There should be an in-depth discussion of this in all of those seamanship books!" Each person seems to have to discover it for themselves, the hard way. Maybe this wasn't so striking to historical sailors because a hundred years ago, everybody everywhere died of infectious disease anyway.

First, a quick inventory reveals that there is really nothing in the expensive "marine" first aid kit that I bought that would really help much with these infections. (And if you were alone, how would you work on your own backside?) Some careful supplementation would be needed before heading out on a long trip. And stocking antibiotics could be tricky. It's not easy to select the right ones, they might have short shelf-lives, and the oral ones might not be very effective.

Second, why is Staphylococcus (to begin with) so virulent on boats, and how might that be mitigated? I've found more conjecture than useful advice so far, but from what I know of the organism, I suspect chronic salt exposure -possibly in combination with sun exposure- may contribute. (High oxygen concentration can also make it go nuts, but that seems to be more of a problem on spacecraft.) Whether regular fresh-water bathing and fresh-water laundry would mitigate that, I don't know, but that's where I would start.

Third, as illustrated in Ryan and Nicole's video, calling in the cavalry may not always be an option. Just last month, there was that fellow with a fast-growing infection who called for medical evacuation near Fiji and it took four or five days for help to arrive. It turned out to be a very near thing for him. So anyone who is taking off for more than a week or so should be prepared to deal with infections.

 

[Ryan L]

Thanks for that. I don't know that I would be cool-headed enough to video the procedure!

Earlier this Fall, I was binging on solo sailing blogs and books and, as a bacteriologist, I found it really striking that almost everyone mentions getting serious staph infections. (Or at least they mention chronic "boils.") I did a bit of research (but have yet to find a definitive work on the subject) and found that Marine Mycobacteria and Vibrio vulnificans are also fairly common agents of fast-growing, potentially life-threatening infections among tropical sailors. (And these large wounds can then quickly become polymicrobial.) So, I was thinking, "Wow, why don't they tell people about this up front? There should be an in-depth discussion of this in all of those seamanship books!" Each person seems to have to discover it for themselves, the hard way. Maybe this wasn't so striking to historical sailors because a hundred years ago, everybody everywhere died of infectious disease anyway.

First, a quick inventory reveals that there is really nothing in the expensive "marine" first aid kit that I bought that would really help much with these infections. (And if you were alone, how would you work on your own backside?) Some careful supplementation would be needed before heading out on a long trip. And stocking antibiotics could be tricky. It's not easy to select the right ones, they might have short shelf-lives, and the oral ones might not be very effective.

Second, why is Staphylococcus (to begin with) so virulent on boats, and how might that be mitigated? I've found more conjecture than useful advice so far, but from what I know of the organism, I suspect chronic salt exposure -possibly in combination with sun exposure- may contribute. (High oxygen concentration can also make it go nuts, but that seems to be more of a problem on spacecraft.) Whether regular fresh-water bathing and fresh-water laundry would mitigate that, I don't know, but that's where I would start.

Third, as illustrated in Ryan and Nicole's video, calling in the cavalry may not always be an option. Just last month, there was that fellow with a fast-growing infection who called for medical evacuation near Fiji and it took four or five days for help to arrive. It turned out to be a very near thing for him. So anyone who is taking off for more than a week or so should be prepared to deal with infections.

I think you hit the nail on the head when you suggest chronic salt exposure (and presumably other common environmental factors present in offshore sailing) as being contributors to the seemingly higher incidences of staph infection. In our experience, and from what we see/hear from other cruisers out here, many staph infections begin during periods of high abrasion and low cleanliness such as during passage where you're constantly sliding around, sweating, getting coated in salt water, wearing dirty clothes, and not bathing as often as you otherwise would. The other most common causes seem to be minor cuts from reef, rocks, ladders, etc that maybe were not cleaned well or soon after they occurred. Nicole has had four staph infections so far. The most serious one, by far, was the one in our video. She had another on her other butt cheek that responded well to antibiotics and one under her arm pit that responded to antibiotics and a special waterproof dressing a doctor gave her called hydrocolloid dressing that sort of sucks out the puss from the wound while also protecting it. Expensive stuff but it worked extremely well. None of what I'm writing here is scientific or based on more than maybe a dozen examples we've come across in the past few years so take it for what it's worth...