Features January 15, 2002 Issue

Off-the-Shelf Medical Kits

If you need a ready-made kit for coastal cruising, the one from Adventure Medical is a Best Buy. Don't just grab and go, though—if you're going to be the onboard medic, you should take an active role in provisioning or at least familiarizing yourself with your kit.

Orion's Master Mariner Kit (left), Medical Sea
ûPak's Coastal Cruising Kit (back), and Adven-
ûture Medical's Comprehensive Aquatic Kit
û(foreground) are the three main ready-made
ûcontenders for moderately active cruisers.
Practical Sailor normally assigns articles among a sizeable squad of regular contributors. While all are experienced sailors, none is a doctor. (The editor, a former fire-rescue EMT, would have taken a crack at this evaluation, but luckily he was ushered into a quiet corner and told to settle down.) It was therefore logical to ask for an evaluation from Dr. Paul Gill, who is not only a sailor, but an emergency room physician and author of The Onboard Medical Handbook (International Marine Publishing). The following evaluation is Dr. Gill's.

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I keep a well-stocked medical kit on my sloop, not because I think it might save someone's life (although it could), but because it can, and has, saved me expensive and time-consuming trips to the hospital while I'm out daysailing or cruising.

On a recent cruise from Lake Champlain to Connecticut, we spent the first day motorsailing down to Whitehall, New York, at the southern end of the lake. The next morning I got up from my berth, took one step, and fell back into the berth with a loud "Yow." It felt as though I had a nail or a shard of glass in my heel. I didn't recall stepping on anything, but I had my shipmate shine a light on the tender area and we both took a good look. We could see a tiny puncture wound, but no glass or metal or any other foreign object. Don looked at me like I was crazy, but I assured him that there was something in my heel, and it hurt like the devil. There was no way I was going to be able to take Northern Light through the 12 locks of the Champlain Canal until it was removed. The problem was, the mystery object was invisible to the naked eye. I started calculating the distance to the nearest hospital (30 miles over country roads), and then decided to dig into my medical kit. I sent Don up into the forepeak to fetch it, and opened it up and started rummaging through it.

I extracted a small magnifying glass and a pair of very fine watchmaker's forceps. With Don again shining a light on the punctured heel, I examined the area with my magnifying lens. It took me only a few seconds to discover a tiny, lance-shaped object and remove it with my forceps. I held it up to the light, and realized instantly what it was. I had stepped on some zebra mussels the morning before while launching the dinghy, and a fragment of shell had apparently broken off and become embedded in my heel. Tiny as it was, it triggered enough inflammation overnight to make the area exquisitely tender by morning.

A few days later, as a brisk northerly was pushing us downriver toward Manhattan, Don developed a serious case of "the runs." I pulled out the kit again, went directly to the medication section, and found a couple of Imodium tablets. They did the trick, and saved us a visit to a busy New York City emergency department.

I can't tell you how many minor emergencies (sprained fingers, broken ribs, cuts, jellyfish stings, seasickness, swimmer's ear, etc.) I've treated with my medical kit. I've also used it to treat a few major emergencies (allergic reactions, broken bones), and every time both my patient and I were glad that I had a medical kit onboard.

My medical kit is home-made. I put it together from materials I purchased at my local drug store and one or two items I had to send away for. But there are some commercial kits on the market that are designed to meet the medical needs of cruising yachtsmen. I'll review three of them for you, make some comparisons, and tell you which of the kits I would want to have on Northern Light.

First, I'll list the supplies that I think you should have onboard if you are coastal cruising or making an ocean passage. Items marked with an asterisk are optional for coastal cruisers but are essential for offshore, and especially trans-oceanic, cruisers.

Wound Care Materials
I Wound preparation
A. antiseptic solution
B. bulb syringe
C. cotton swabs
D. irrigating syringe and needles*
E. Vaseline packing gauze*
F. latex gloves

II Wound closure
A. skin-closure tapes and tincture of benzoin
B. butterfly closures
C. stapler*

III Antibiotic ointment
A. Neosporin or Bacitracin
B. silver sulfadiazine

IV Dressings
A. transparent dressings
1. Bioclusive
2. Spenco 2nd Skin
B. non-adherent dressings
1. Tegaderm
2. Adaptic
C. bandage strips (Band-Aids)
D. gauze dressing pads
E. bulky dressings
1. ABDs
2. Surgipads
F. roll bandages (Kling, Kerlix)

Medications
I Pain medication
A. mild pain (aspirin, acetaminophen, ibuprofen)
B. moderately severe pain (oral narcotic)
C. severe pain (injectable narcotic)*

II Seasickness remedies
A. oral (Dramamine, meclizine, ginger)
B. Transderm Scop
C. wrist bands

III Gastrointestinal medicines
A. antacids
B. acid-blockers (Pepcid, Tagamet)
C. antidiarrheals (Imodium)
D. antivomiting
E. constipation

IV Sleep preparations

V Antibiotics*

VI Skin preparations
A. topical steroids (hydrocortisone, etc.)
B. antifungal ointment
C. aloe vera
D. isopropyl alcohol

VII Eye medications*
A. Tetrahydrozaline (Visine) drops
B. Antibiotic drops

VIII Ear medications
A. Otic Domeboro
B. Cortisporin Otic solution

IX Allergy medications
A. diphenhydramine (Benadryl)
B. prednisone*
C. epinephrine injection*

X Intravenous supplies*
A. IV tubing*
B. IV catheters*
C. normal saline solution*

XI Special needs
A. nitroglycerin tablets
B. estrogen tablets
C. pediatric rehydration solution

XII Personal medications

Miscellaneous
I Rubberized bandages (ACE)
A. 3"
B. 6"

II Instant cold packs

III Cravat

IV Safety pins

V Tongue blades

VI Tweezers
A. regular and fine.

VII Hemostats*
A. curved
B. straight

VIII Scalpel and blades*

IX Scissors

X Single-edged razor

XI Needle-nosed pliers

XII Moleskin

XIII Thermometer

XIV Penlight

XV Magnifying glass

XVI Splints

XVII Enema kit*

XVIII Blood pressure cuff and stethoscope*

XIX Foley catheters*

XX Surgical lubricant

XXI Nasal tampons and silver nitrate cautery sticks*

XXII Eye pads and shield*

XXIII Pregnancy test kits*

XXIV Compendium of medical history for every person aboard

XXV Medical Text/Merck Manual

These items should be organized and stored in a waterproof bag, a fishing tackle box, or some other suitable container that is compact enough to store in an out-of-the-way but easily accessible place on your boat.

Off-The-Shelf Kits
For these evaluations, the three companies were asked to submit medical kits that would be suitable for "coastal cruising," which could be defined loosely as sailing or motoring for several days at a time within relatively easy reach of expert medical help—a matter of hours, not days. These kits would be better stocked than rudimentary kits suitable for daysailing, but less involved than those that would be carried by offshore sailors beyond or at the extreme range of rescue craft.

The Medical Sea Pak "Coastal Cruising Kit" ($393.95) comes in a 13" x 19" x 7" red nylon bag with canvas handles. This container is perhaps a little larger than necessary but, being soft, it's probably easily storable in most cruising sailboats. I can think of several places I could store it on my 32-foot boat. Its ample dimensions allow for a degree of organization of its contents that would be impossible in a smaller, rigid container. Indeed, organization is the outstanding feature of the Medical Sea Pak. When you unzip the kit, it opens up like a suitcase, each half of which contains four plastic, removable zippered bags. The bags, or "modules," are numbered and labeled as follows:

1. Common Minor Problems
2. Minor Trauma
3. Major Lacerations
4. Sprains, Dislocations and Fractures
5. Burns
6. Systems/Problems
7. Resuscitation
8. Medications

Included in the Coastal Cruising Kit is a reference guide entitled First Aid by the Numbers. It contains a Table of Contents, an introduction that explains the problem-oriented design of the kit, 10 chapters that correspond to the numbered modules, and an appendix. Also included in the kit is a checkout pad to record items that have been used and need to be replaced.

With one glaring exception, the Coastal Cruising Kit comes well-stocked with the supplies I listed above. It has almost all of the wound care materials and miscellaneous items on my list, but almost none of the medications. In fact, the only medications you will find in the kit when you first open it are a bottle of aspirin tablets, a box of Peptic Relief Tablets, a bottle of calamine lotion, and 12 antacid tablets.

The bag labeled "Medications" is empty, which I found a little odd, although presumably the makers intend you to fill it yourself. While the reference guide does list a number of medications that they recommend you purchase for the kit, it's a very skimpy list that does not include such items as ear drops for swimmer's ear, diphenhydramine (Benadryl) for allergic reactions, isopropyl alcohol for treating jellyfish stings, or meclizine or Dramamine for seasickness.

The Coastal Cruising Kit gets high marks for the generous-sized, easily stowable bag that it comes in, for its easily accessible layout, and for its generally ample wound care and miscellaneous supplies. (They should include an irrigating syringe and more gloves, however.)

The fact that it contains almost no medications is a major drawback to the kit; however, the purchaser could pick up everything on my list of recommended medications in an hour or less at a neighborhood pharmacy for approximately $100 to $150.

The First Aid by Numbers reference guide that comes with the Coastal Cruising Kit provides succinct, if somewhat sketchy, instructions on how to deal with the more common injuries and medical problems you're likely to have to deal with on a voyage. It serves reasonably well as a guide to using the contents of the kit to treat medical problems, but anyone who purchased the kit would want to have a more comprehensive marine medical book onboard as a backup reference.

Although Medical Sea Pak's Coastal Cruising Kit has its virtues, the cost of medications and a medical reference book would bring the total price to $500 or more.

The Comprehensive Aquatic Kit from Adventure Medical Kits ($129.95 for organizer bag; $194.95 for Pelican box) promises to "prepare divers, sailors, and other mariners for most on and off-shore medical emergencies." In my opinion, it delivers on that promise.

This kit was designed by Paul Auerbach, MD, the Director of Emergency Medicine at Stanford University and a renowned expert in wilderness and marine medicine. His experience is reflected in this kit.

The kit I reviewed came in a crushproof Pelican dry box that measures 10.5" x 7" x 6". The Pelican Box is "absolutely airtight and watertight," according to the labeling. It even has a pressure control knob that allows you to purge air into the box and relieve any vacuum that may have developed during air travel. The Comprehensive Aquatic Kit is normally available in a water- resistant nylon organizer bag.

This kit is much more compact than Medical Sea Pak's Coastal Cruising Kit, and its organization is not as obvious on first inspection. However, the supplies are stored in logical groupings in see-through plastic bags, and I was able to quickly identify and retrieve medications, wound care materials, and miscellaneous items, such as thermometers, scissors, and a splint. Accessibility is not a problem.

As for contents, the Comprehensive Aquatic Kit is truly comprehensive. It contains most of the non-asterisked items on my list, plus a lot more. These extra items include a surgical sponge-scrub brush (excellent for cleaning dirty wounds), two packets of oral electrolyte powder (to make rehydration solution), four pill vials, duct tape, cold tablets, salt (to add to water to make saline solution for wound irrigation), a high-scale thermometer (for detecting hyperthermia), a low-scale thermometer (for detecting hypothermia), nasal decongestant spray, an accident report form, a tube of glucose gel (for treating insulin shock in diabetics), and a CPR MicroShield.

The kit does not come with prescription medications (prohibited by law) or many of the more esoteric items on my list which you might need on a long ocean passage. The only things it lacks to make it a complete coastal cruising medical kit are a cravat (which can be easily improvised), tongue blades, melatonin (for sleep), a 6" elastic bandage, a single-edged razor, and a magnifying lens.

Included in the Comprehensive Aquatic Kit is a concise but information-packed first-aid manual entitled A Comprehensive Guide to Wilderness and Travel Medicine. This book was written by Eric Weiss, MD, the Associate Director of Trauma at Stanford University Medical Center, and another respected authority on outdoor medicine. This 198-page book is well-illustrated and accessible. It covers the whole range of outdoor medicine, including hazardous marine life, marine and diving medicine, seafood poisoning, and travel diseases. It does not discuss seasickness, but otherwise it is indeed a comprehensive medical guide.

The Comprehensive Aquatic Kit gets high marks for its comprehensive contents and for Dr. Weiss' excellent medical manual. It's everything I would want in an onboard medical kit, and I consider it to be a bargain in either bag or box version.

The Master Mariner First Aid Kit from Orion ($99.99) comes in a 14.5" x 9.5" x 3" plastic container. It contains a few, but not many of the items on my Wound Care Materials list. Curiously, the kit includes three boxes of band-aid strips, but no antiseptic solution (only "antiseptic wipes"), cotton swabs, irrigating syringe, skin closure tapes, or transparent or non-adherent dresssings. It contains 12 aspirin tablets and two Dramamine tablets, but no other medications.

Of the items on my Miscellaneous list, it contains a cravat, a couple of safety pins, an instant ice pack, a pair of crude scissors, two eye pads, and plastic tweezers. Two items in the kit that are not on my lists are an emergency blanket and a fishhook removal device.

A few first-aid instructions are printed on a sheet affixed to the inside of the cover, but there is no manual or reference guide.

The Master Mariner First Aid Kit would be of limited use to coastal cruisers. You could treat sunburn, abrasions, minor sprains and small cuts with this kit, but it would prove wholly inadequate for most significant injuries or illnesses at sea. At $99.99 it's the least expensive of the three kits—priced to sell almost as an impulse item at the chandleries—but it's not an advantage that would count for much in a medical emergency.

Conclusions
Despite its grandiose name, Orion's Master Mariner kit is best-suited for daysailing, or perhaps as the foundation of a larger kit fitted out more thoughtfully by the owner.

Medical Sea Pak's Coastal Cruising Kit is good—as far as it goes. Its generous-sized nylon bag and its organization and accessibility are two of its strong points. But it comes with almost no medications, and at a retail price of $393.95, it's grossly overpriced, in my estimation.

I can recommend Adventure Medical Kits' Comprehensive Aquatic Kit without reservation. It's compact yet amazingly comprehensive for its size. Dr. Weiss' A Comprehensive Guide to Wilderness and Travel Medicine is a gem. I doubt that you could buy the contents of this kit and an equivalent container for less than $129.95— better simply to buy this kit, study its contents, then stow it in an accessible place and hope you won't have to use it too often.

Contacts- Medical Sea Pak, First Aid Pak, Inc., 1945 Ridge Road East, Suite 27, Rochester, NY, 14622, 800/832-6045, www.firstaidpak.com/. Adventure Medical Kits, P.O. Box 43309, Oakland, CA, 94624, 800/324-3517, www.adventuremedicalkits.com/. Orion Safety Products (Master Mariner Kit), 3157 N 500 W, Peru, IN 46970, 800/851-5260, www.orionsignals.com.

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