First Aid [Updated Nov-2017]

This is about how we developed our strategies and philosophies, and what we did [and continue to do...] about it when it comes to self sufficiency- specifically with regard to being our own First Responders in this case. 

We prefer exploring remote areas- both on land and sea. [Or is it we prefer to stay away from crowds...?] Consequently, we lean toward self-sufficiency and focus on prevention as well as preparedness. 

This philosophy is also our approach for rescuing a person overboard; we focus most of our efforts on preventing it from happening– leaving rescue procedures for last.


As part of our safety briefing with guests we discuss accident prevention. To emphasize how important injury avoidance is to us, we warn everyone that injuries— no matter how minor— will be amputated. No exceptions...
Invariably this prompts questions about First Aid kits, preparation [training] and most importantly, prevention.

From my experience, the answers to questions regarding how much training [and kit content] depend upon where and how we will be traveling [e.g., sailboat cruising, kayaking, and hiking in this context] and how isolated the areas will be. [i.e., How self-sufficient do you need/desire to be in an emergency?] 


I personally believe proactive prevention, followed by reactive training is even more important than the first aid supplies onboard for ocean crossing and remote area coastal cruising. Proper training will help you deal well with emergencies and give you the knowledge to formulate [and evaluate...] your own concepts for what to carry in your kit(s). 


Training will also help you find your balance for risk tolerance vs. those associated with your planned adventure(s).


I believe proper training also facilitates efficient communication with remote medical support services in an emergency. [e.g., Working with medical specialists over a radio or phone. 
(i.e., Telemedicine) It also makes it easier to obtain prescription meds for your kit(s)...]

There are, however, those who feel specialized First Aid training is not useful because they believe those lacking a medical background will not benefit from nor retain unpracticed training. [e.g., Dr. Welch]  


Do you agree?


How our strategy evolved:


We are prone to traveling in fairly remote areas where it is often unusual to see another vessel [or person] for days, or sometimes weeks at a time.


Therefore, when pondering prevention, First Aid kits [and training...] the first question we ask ourselves is how long might we have to cope with an emergency situation before we could anticipate the arrival of qualified assistance? [Whether that be someone arriving on scene- e.g., an ambulance; or us transiting the patient(s) to medical facilities.]


In a big city, it might be 10-20 minutes or so before an ambulance arrives on scene. Much First Aid training is based upon this scenario. But what if it took 2 hours; or 10; or a day; or two days before you could reasonably expect qualified assistance? [Whether they are coming to you, or you to them...] 


Ask yourself if you are you prepared for that...

Delayed [or remote via voice call; e.g., Telemedicine] assistance is the more likely scenario for a cruising boat. [See the Yachting World article in Additional Reading section, below...]
Can't we just read a good First Aid kit and book and be prepared for most contingencies?  
Possibly... And you could possibly read a book about sailing or driving a car, and then just go do it... 

More questions to ask yourself: [or; what did we ask ourselves...?]

Could you stand to listen to someone you care about [or a stranger for that matter] moan and scream in pain while you to read [and interpret] a book, or use an app on your phone? [Will your hands be clean and dry enough to use either?] Can you keep pressure on that bleeding wound, and/or keep their spine immobilized while you search your reference materials for what to do next? 

If there is more than one injury and/or patient, are you comfortable deciding who to assist first and the priorities of treatment?


In a remote location scenario, are you prepared to converse effectively with medical professionals on a phone or radio, provide the feedback they request, and understand their advice and guidance? 

If you answered yes to all of the preceding questions, then there is no need to waste more of your time here...

So, what is our current strategy? 


We plan around hands-on medical assistance [on-scene or self-transport to assistance] always being a minimum of 1-4 days out. Even if we activate an emergency beacon [e.g., EPIRB, PLB] or make a sat phone or radio call. Therefore we try to be prepared to cope and manage for 4 days as our designated worse case scenario. 

Figure this out for yourself and it will help you decide how comfortable you are with your level of knowledge and preparedness... Because we figure we may have to be self-sufficient for up to 4 days in a medical emergency, we both obtained Emergency Medical Technician [EMT] and other training. 

A reasonable alternative for those who cannot commit one or two college semesters to EMT training [EMT levels 1 and 2 are all we felt we needed] is the NOLS Wilderness First Responder [WFR] course [80 hours in 9 full days in a row- mostly outdoors...]
 
Whether you have EMT, Paramedic, or NOLS WFR training, the NOLS Advanced Wilderness First Aid course [WAFA] is icing on the cake. [40 hours over 5 full days- time divided between classroom and outdoors...]



We really got a lot out of the NOLS WAFA course, and highly recommend it. But either of these courses will boost your knowledge and confidence immensely.

We have also heard very good things about the Offshore Emergency Medicine course by Wilderness Medical Associates International, but have not had an opportunity to attend one... yet... [Textbook included in book references, below.]

Do we really need all of this training?
   Hopefully not.


Have we had occasion to put it to use?  
   Unfortunately, yes. [More below...]

Do we need such diverse First Aid 'kits'? 

   Again, hopefully not. [But we don't normally need fire extinguishers either...]

Would lack of training or First Aid supplies prevent us from pursuing our adventures? 

   Not a chance. 

But if I have learned one thing about myself [with many requisite lessons in humility...] it is the more I delve into a subject, the more I discover I don't know... 
So, I have proved to myself more than once that ignorance truly is blissful– but not very useful in a pinch...
If you plan to always be close to first world societies and reliable means of emergency communication and transport, then you may be able to justify [rationalize?] less knowledge and training. 

It all depends on your personal risk tolerance, desired level of self-sufficiency, and the situations you may encounter on your chosen adventures. 


To help mitigate the risk of delayed response times in remote areas, we joined DAN Boater. 
This service [note: this is NOT insurance...] includes a 24/7 emergency medical hotline and worldwide emergency evacuation– among other related services– for US$100/year for a [US or Canadian] family [up to 5 individuals.]
This is a no brainer for us...


First Aid Kits


What supplies do we include in our First Aid kit(s)? [We found we were better able to formulate our own lists after some advanced training...]

A good initial reference [for boaters] is Practical Sailor's series of articles on this topic which includes evaluations of commercial First Aid kit offerings for various levels of need.

Independently, we decided upon the Adventure Medical [Marine] Kits line of offerings for our major kit. 

We have 4 levels of kits ranging from the usual stuff we need for minor, day-to-day issues, up to major trauma kits with neck braces, various splints, IV solutions, an AED in the near future, etc.
Adventure Medical Kits also happen to be what NOLS and many other organizations rebrand and sell.
We have amassed various levels of First Aid Kits, and carry what is appropriate for the adventure at hand. For instance, we have about everything you could need on the boat; carry a smaller subset of that in our kayaks, and an even less when exploring on land... [And no, we are not 'gram weenies'... Our kits are somewhat larger than many...]
For our boat ditch bag kit [and for grab-and-go and more extreme emergencies onboard] we chose the Adventure Medical Marine 3000 kit, and supplemented it with additional items we felt were worthwhile for our current risk factors. 


List of supplies included with basic kit



We added items like a traction splint, 4 neck braces in 3 different sizes, inflatable arm and leg splints, additional IV solutions, tooth/cap repair kits, Epi-pens [and spare ampules of Epinephrine and syringes...] fast dissolving [sublingual] antihistamines, prescription antibiotics and painkillers, high energy goo packs, and other specialty items. 
If you are wondering why we added some of these items [or what they are...] then you may be ready to augment your first aid knowledge...
We stow our kits in [truly waterproof] ditch bags made by Watershed[They also make military bags and rifle cases Navy SEALs swim with... These are not your typical roll-top 'dry' bags– which in our experience leak if left floating on water for a while; and definitely leak if submerged...] 


Here are a couple of our ditch bags: the yellow one is the typical non-waterproof floating bag packed mainly with waterproof signaling and communication devices, and a few survival goodies. 

The red bag is one of our Watershed ditch bags currently containing our near-shore survival gear. [e.g., tent, sleeping bags and pads, food, cooking supplies, etc.– all packed in waterproof bags within the ditch bag... Remember we are playing on the Inside Passage at present and ditching the boat would typically lead us to shore quickly...]


The black snake on top of the bag is a paddle board leash. We install bungee style leashes on all of our ditch bags to safely and easily tether them to us, the raft, dinghy, etc. in a hectic emergency situation...

And speaking of ditch bags— we have 3; not including the First Aid Kits— stand-by for a separate post on that topic...
Many cruisers choose to make up their own First Aid Kits. Using the list from the Practical Sailor reference, above, and/or one of these commercial offerings is a good starting point if you decide to do that. 
However, we have discovered there really isn't much savings building our own comprehensive First Aid Kit(s) [especially if you include your time...] We also feel that the organization and ease of refilling/reordering contents included with the commercial kits is a worthwhile added value for us.


What is in our medical library? 

[We are not including EMT and other specialty titles here...]

Emergency and general First Aid: [In alphabetical order- by publisher where applicable]

Other books worth considering include:

Have we ever been put to the test as a couple?


Yes, but luckily our personal worse injury to date [and here's hoping this record holds...] has been a fractured wrist; in inclement conditions at night in a remote setting on shore during a kayak trip. [Colles' fracture; very painful, but more inconvenient than life threatening...] Third-party water evacuation back to our vehicle– 20 kayak paddling miles away– was not possible until the next day [~16 hours- and one overnight- later] due to timing and inclement conditions. Subsequent ground transport and arrival at a medical facility occurred late on day 2. [~21 hours after the incident...] All-in-all not bad— unless you were the patient...


Lessons learned from that incident:

  • More powerful pain relief meds were needed. [Now in inventory. Otherwise the kit was more than adequate.]
  • Voice communication with rescue and transport resources [via sat phone in this case] is invaluable in an emergency requiring assistance. [Without that, it would have been 4 days before conditions abated enough where I could tow the patient- in their sea kayak- roughly 20 miles back to our vehicle, and then drive another 2 hours to medical facilities...
Is that the worst incident I have ever been involved with? Unfortunately, no...

I hope this explanation of how our strategies developed will help you continue your own discussions, and that you never have the occasion to test your First Aid skills or use your kit(s)!


Additional Reading and Viewing of Note:


Please leave a comment sharing your First Aid strategy [and philosophy if you like]; favorite preventative measures; books on this topic; and any unique inclusions in your kit(s), if any. 
[e.g., We don't need snake antivenom in our current latitudes...]

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