First Aid Training, Knowledge, & Supplies

This post has now been added to our list of Stuff we have and use [and do...] sidebar where we will keep it up-to-date in the future.

Please read that updated version.

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Original Version:

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]

• Hesperian Health Guides:
• Where there is no Doctor
• Where there is no Dentist
• Marine Medicine: A comprehensive guide 
• Included with Adventure [Marine] Medical Kits
• NOLS: [Not a DIY resource; requires the training...]
• Wilderness Medicine
• Wilderness Medicine Field Guide
• Wilderness Medicine Pocket Guide 
• Helps get you past 'brain freeze' in an emergency...
• Where there is no Pet Doctor  [If you have pets onboard as we do...]

Other books worth considering include:

• Merck Manual(s)
• Various titles of interest; great for diagnosing and treatment
• Don't forget the Veterinary version if you have pets...
• Physician's Desktop Reference [PDR]
• Various titles; useful if you need to understand medications in remote situations
• Wilderness and Rescue Medicine 
• Offshore Emergency Medicine course textbook referenced above

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 of Note:

• Attainable Adventure Cruising: Medical Emergencies eBook
• Modest membership fee required, and so worth it to us...
• DAN Boater: member stories 
• Yachting World: Telemedicine at Sea

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...]

Preparing to go south... [Or: South is relative...]

We have enjoyed a summer in central interior Alaska, but that entails being away from the boat. [However, the 24 hr daylight makes it a bit easier to be away...]

We had to prepare our modest Fairbanks home for sale, and have now found the new owner. 

Now to get back on the boat and get back to our chosen lifestyle... [and build a cabin on Wrangell Island on our awesome tent site...]

Our crew heard we are preparing to move further south again, and while they hate the commute, they enjoy the results...



Perhaps out of misinformation or misunderstanding, Gus, our junior crew member, thought it best to start working on his tan since everyone knows it is typically sunnier the further south you go... [And we are loosing almost 10 degrees of latitude after all...]

Gus in the morning sun under his birdie bait station... which he says he will miss...
But we refuse to feed any birds near the boat... something he doesn't understand...

Elsie, on the other hand, is her usual nonplussed self about it... [in a North-American feline sense...]  

Elsie claiming she doesn't require a tan... 

As for the rest of the crew, we just go with the flow, which is south, and soon we hope, as this is what it looked like in Fairbanks the end of September last year:

 

We hope to see you on the water soon...

More February meanderings

When we returned to Seattle, our plan was to drive the truck/camper out of the backyard, and head out to see friends in multiple locations.  Yay! Road trip! Our first attempt at getting the truck out didn't go so well.

 

Bill tried to drive out our truck, and it kept slipping on the water logged green grass and weeds.  He was trying not to slide into Ralph's truck, and felt like he needed to move it first.  That was also a no-go, as it did the same thing, and neither truck could get traction to move the way we wanted them to go.  Bill decided that the best course of action, was to call a local towing company, and winch both vehicles out.

 

As it turns out, the owner of this company lives just down the road, so the technician was motivated to do a good job, not that he wouldn't have, but just sayin'.  He winched out Ralph's truck first, since it was the easiest, and in the way of the big Ford.

This was the hole left behind by the silver truck.

Then they repositioned the tow truck and connected up to the Ford.

 

Here we go.... I sped up the movie so it wouldn't be too long, and I obviously did not stand still. (sorry)  He winched it up till all tires were on on more stable ground, and Bill drove it out.

Read to drive it out

And then what we left behind, I apologize to my brother and sister-in-law for the mess.

Add caption

We are out, thanks to MAC towing,  ready to go visit friends.  We left the trailer behind with hopes that the yard would dry out in our week absence, and if not made contingency plans with the tow truck to come back and help get the trailer out.

Our adventure begins: part lll

It really felt like we were living the cruising life when we left Ladysmith.  We were living off of our provisions, anchoring in a different bay every night, and voyaging through waters I had never been in.  This included the security that both Bob and Bill had been there/done that, many times, so they were experienced, and Polly who had lived the cruising lifestyle with Bob, was a competent and understanding partner to give advice from a female point of view.

The weather cleared up and was wonderful almost all of the way up the Canadian coast.  A typical day would begin with coffee, putting the oats and hot water in an insulated mug.  Bill would begin the "flight plan", (keep in mind the previous owner who left us with INCREDIBLE complete documentation was a fighter pilot in the Air Force, and a commercial jet pilot for Continental).  The plan starts with the engine checks that are made before every startup, and my job is to secure cabins and turn on instruments.  Once the anchor was pulled, or the lines cast off, we would get underway, get comfortable, and eat our oatmeal with the various nuts and twigs added.  The rest of the day was spent enjoying the scenery, watching for wildlife, checking out the other vessels on the water, and reading up about the area in the cruising guide.  Bob, whose trawler is a bit faster than us, would usually arrive at the prearranged bay first, set his anchor and when we arrived, we would tie up to Vahalla's side.  Polly, who is a Canadian citizen, could fish, and would usually have her line out, which would sometimes provide the evening meal.  Yum, fresh halibut and crab direct from the ocean, nothing better.  Thanks Polly.

After an excellent meal, we would take out the charts, and books, and discuss the route and destination for the next day.  A day's milage would be anywhere from 20-60 miles a day, depending on tides, currents, weather, and the best place to anchor in safety for the night.

Rafted up for the night

Bob and Polly relaxing on their stern deck

This boat is using their asymmetrical spinnaker sail.

Denali Rose motoring along, picture courtesy of Bob.

Someone's vacation home on an island

Bill put the dinghy in the water for the first time, and the engine started on the first pull..YAY!

We stopped in Shearwater, Canada for fuel, and have a day off of the boat on land.

It was very crowded, with boats 2 deep at the dock.  We tied up to Vahalla again.

About a half an hour out of Shearwater, Bill discovered that the regulator on the engine alternator was not working, and the batteries were not being charged.  He pulled out the list of spares, and YAY, we have another one on board, (thanks to Jack), and we have a map to where it is stored.

Under the lower dinette, a warehouse of spares, everything perfectly in it's place.

So, while we are underway, Bill is in the engine room connecting the spare regulator, that worked perfectly after installation.  

We spent a couple more days with Bob and Polly.

Vahalla underway next to us.

Because I had a plane reservation for Anchorage out of Ketchikan, we say goodbye, and we head north right away.  Vahalla will try out some more fishing spots before meeting back up with us in Ketchikan.  We anchored in this calm little bay for 2 days, the wind/weather dropped in on us, and we had other boats come and join us until it lifted.

Kumealon Inlet

Looking out towards Grenville Channel

Next we headed for Dundas Island, and Brundige Inlet, which is the last stop before leaving Canadian waters and entering back into the US.  Many boats stop here, because they have to transit Dixon Entrance, which is open to the Pacific Ocean, and everyone waits for the best weather window to cross.

Passing large ships at anchor outside of Prince Rupert.

Canadian weather station on Green Island.

We pick the BEST weather day ever for our crossing Dixon Entrance! Absolutely calm except for a little swell coming in from the Pacific Ocean.  I was very glad, since I was feeling a little bit apprehensive about this.  The good news: it was no problem at all, the bad news: it can only go downhill from here. (unless it is always like this...fat chance)

Looking out on the Pacific Ocean.

We head into Ketchikan with a few days to spare.

Ketchikan ahead. Notice the BLUE SKY! It was 75 degrees.

The view from our slip in the harbor.

I'm back in Alaska, it's a celebration!

While I am spending 10 days in Anchorage, and Fairbanks catching up with family, Bill is installing a new battery bank in Denali Rose.

New batteries are good to have.

And celebrating the batteries....

Ketchikan is a very busy place during the summer.  They have docking facilities for up to five large cruise ships at a time, and others anchor out.  When the ships are in, it's like you are trying to walk in downtown Disneyland, instead of a small community in Southeast Alaska.  To help the tourists enjoy themselves, there are float plane tours of the area, and starting at 6:30am they take off and land every 15 minutes or so, and this doesn't stop till 10:00pm.  Vrooom vrooom vroooom, all day long, whew. By the time I returned back to Denali Rose from my trip north, Bill was OH SO READY to get out of there!  The next morning, we cast off our lines, and headed to Wrangell, our new home.

Headed north to Wrangell from Ketchikan

Heritage Harbor Wrangell, Alaska

Denali Rose, in her home slip, Wrangell.

Mission accomplished, we made it to Wrangell.

Our adventure begins: part II

Ahoy: The first in a series of four-letter words commonly exchanged by skippers as their boats approach one another...   (Sailing Pocket Dictionary by Henry Beard & Roy McKie)

So, after settling our truck/camper/trailer in my brother's back yard, we returned to our new home, Denali Rose in Anacortes. We are very grateful that Ralph and Gloria graciously offered us that option, it means that we don't have to think about the security of the Wagon Train.

It was now time to leave Washington, we had spent enough time, effort, and money, and we were arranging to "buddy-boat" with our good friends from Fairbanks, who now live on Gabriola Island, Canada. We joined 50 of our closest boating "friends" for the night, in Prevost Harbor, the last bay before crossing into Canadian waters.  It was the first anchorage using our new windlass and chain, and we were very pleased with how nicely it ran.

The next day we head to the closest customs office for cruisers, Bedwell Harbor, and with passports in hand, we check-in for our stay in Canadian waters.  It was a beautiful day, but a long afternoon.

The customs officers said that since the boat was new to them, and we to the boat, they would need to do a thorough search this time, and then we would be in the data bank, for subsequent visits.  (We are applying for our Nexus cards, to make it easier on everyone in the future...)

They found one [out of 6...] can of bear spray, that wasn't labeled correctly, and we voluntarily gave it up to the officer. After the paperwork was completed, they did comment on how organized, and well prepared the boat was.  My efforts at putting items in rubbermaid tubs of various sizes, and labels on the front paid off.

They released us into Canadian waters, and off we went to Gabriola Island, Silva Bay, and Bob/Polly's house.  It was Canada Day, and we heard over the radio at the bay, someone razzing us because our U.S. flag was so big and our courtesy Canadian flag was so small.  It just happened to be the largest one we could find, and it was better than not flying one at all. (we thought) There are rules about Maritime Flag Etiquette, most of them date back to early sailing days, and they are very specific about what flags, where to fly them, how big, etc.  We bought a bigger one in Canada, as (duh) they have a larger selection than the US stores.

The view from the deck

A tug (on the left) pulling a raft of logs, called a log boom.  Something to watch out for when navigating Canadian waters.

After the weeks of hustle and bustle, it was really nice to relax with good friends, Bob and Polly, and enjoy their comfortable, spacious, and beautiful home for a few days.  Gabriola Island is a delightful place to visit or live.  It is filled with farms that sell produce and meat, lovely scenery, and windy roads that seem to take you "over hill and dale".  We provisioned up with local foodstuff, and took Denali Rose over to Ladysmith Harbor at Nanaimo to meet up with the Vahalla.

In Ladysmith Harbor, note our large Canadian flag. (Especially next the the dinky one that Vahalla has. Hey Canadian friends, whats with making fun of us anyway?)

Since Bob was on the docks to help with the lines, Bill was behind the wheel, steering us into the slip. We had some difficulties, (read: very tense moments), getting into place when the engine died on us several times as Bill was getting the boat to turn into the slip.  We had everyone who was nearby, helping to fend us off from bumping into other boats, and grabbing lines to pull us into the dock.  I was VERY glad not to be at the wheel that day.  Bill later found that the idle on the engine was too low, he adjusted it up, and the engine has purred obediently since.

We finished our shop for groceries, and boat items in Nanaimo, packed it all into our lockers and holds, and headed north with our ultimate joint destination of Ketchikan Alaska.

Cool store front.

Motoring by a log boom, as we leave Nanaimo, watching carefully for stray logs.

New barbecue, a necessary item on a boat.

Leaving Ladysmith, it was a rainy day.

Large Canadian flag waving in the wind. (just wait till you see my new Alaska flag)