SUPPLIES
When available, generic medications are listed. Prescription medications and supplies are in bold. Always carry extra supplies of prescription medications and glasses or contact lenses that are normally prescribed for your passengers or crew. Remember to always check if someone has an allergy to a medication before administering it to them. All immunizations, both routine and for travelers, should be up to date for both children and adults, prior to leaving on an extended voyage. Check your supplies at least yearly and replace all materials past or approaching the expiration date printed on the package.

MEDICAL SEA CHEST
Typical supply check list for a recreational vessel with 4 to 6 passengers for an extended cruise.

RESCUE BREATHING

Life depends on oxygen rich blood reaching the brain. When a person is not spontaneously breathing, Rescue Breathing, previously called mouth-to-mouth resuscitation, is required. To assess if Rescue Breathing is needed:

LOOK at the victim's chest to see if it is rising and falling
LISTEN near the victim's mouth and nose for the sound of respiration
FEEL, using your cheek, for air moving from the victim's mouth and nose

When breathing stops, whatever the cause,
call for help and begin rescue breathing

Steps to Begin Rescue Breathing:
1. Lay the victim on their back on a firm surface. (A firm surface is required if CPR must be initiated.)

2. The rescuer should place the heel of his/her hand closest to the victim's head on the victim's forehead to tilt the head back. While head tilt is important, over extending the neck may restrict the airway. In general, adults need the greatest angle of head tilt, children less, and infants the least.

For victims with suspected neck injury, it is recommended to
limit head tilt to a minimum while opening the airway
by lifting the jaw and holding the chin.

3. Using the hand which is keeping the head extended, pinch the nostrils closed with the thumb and forefinger.

4. Lift the victim's chin with your hand nearest the victim's feet. (Not necessary to lift an infants jaw, although you may wish to support the chin while you are administering breaths.)

5. Take a deep breath. (For children and infants, reduce the amount of breath you administer. You are administering the right amount if you can see their chest rise fully when you exhale and breath into them.)

6. Open your mouth wide and seal your lips around the victim's mouth or around the mouth to mask breathing device. If you cannot get a good seal, close the mouth while keeping the head tilted and place your mouth over the nose of the victim to administer the breaths.

For infants and small children, you should seal your lips
around the victims mouth and nose.

7. Give 2 slow breaths. Breathe into the victim until their chest gently rises. If the breath does not go in, or if the chest does not rise, re-tilt the head, make sure you are lifting the chin appropriately, and try again.

8. If water or vomit begins to come out of the mouth, turn the victim's head or body to the side, sweep out the debris, re-position them on their back and continue.

If a neck injury is suspected, always roll the victim
keeping the neck and back in alignment

9. Check for a pulse. In adults, the carotid pulse in the neck just to the side of the midline is recommended. For infants, the brachial pulse located on the inside of the upper arm is recommended. Depress the area for 5-10 seconds using 2-3 fingers to feel for a pulse. (Do not use your thumb or you will feel your own pulse.)

If a pulse is present, count the rate for 15 seconds and multiply that number by 4. Normal pulse ranges are listed below.

Normal Pulse Ranges
Adult ...............................................60-80
Children .............................................80-100
Infants to 2 year olds ........................100-120

10. If a pulse is present, continue rescue breathing by giving 1 slow breath every:
-----5 seconds for an adult
-----3 seconds for a child or infant

11. Recheck pulse and breathing about every 1-2 minutes

12. Continue rescue breathing as long as a pulse is present, but the person is not breathing.

13. If the pulse stops begin CPR (Cardiopulmonary Resuscitation).

CPR (Cardiopulmonary Resuscitation)
--Before beginning CPR, rescue breathing should have begun. Chest compressions are only necessary if a pulse is not present.

--After two breaths are administered , begin chest compressions.

--Locate the sternum (breastbone) by following the curve of the ribs to the midline of the chest.

--Measure three finger breadths up from that point and place the heel of your right hand over the sternum. (For adults and children this is in the middle 1/3 of the sternum. For infants, place fingertips of one hand on the lower 1/3 of the sternum or between the nipples.)

--Place your left hand over the right. (For adults only. For children use only one hand.)

--Apply pressure vertically down from the shoulder, keeping your elbows straight and using your body weight as compressing force.

--Continue cardiac compressions and rescue breathing at the ratio of 15 cardiac compressions to 2 breaths.

--Recheck for pulse and respirations every 1-2 minutes.

--CPR should be discontinued when professional assistance arrives, the victim's condition is improved. or the rescuer is exhausted and unable to continue. CPR should continue while further recommendations are obtained from a maritime physician consulting service.
The rate, depth and hand usage to give compressions are as follows:

CHOKING

Conscious Choking Victim:

Assess if assistance is needed. Ask: Are you choking? Can you speak? As long as the victim can cough forcefully, stay nearby and encourage his coughing effort. If the victim's cough becomes weak or they can no longer breath, give abdominal thrusts.

Technique for Conscious Adults and Children in a Standing or Sitting Position:
--Stand behind the victim wrapping your arms around the victim's waist.
--Make a fist with one hand placing the thumb side against the victim's abdomen, just above the naval. Grasp your fist with your other hand.
--Administer 5 forceful and rapid upward thrusts. Be careful to remove pressure completely between thrusts. You may not need to thrust as firmly on a child.
--Repeat until the object is cleared or the victim becomes unconscious.

Technique for Infants (Either Conscious or Unconscious)
--Cradle the infant face down over your forearm with the head pointed down toward the floor.
--Administer 5 blows on the back between the shoulders.
--Turn the infant over, while balancing him or her on your arm and administer 5 chest thrusts (chest compressions 1/2 inch deep in the center of the breastbone) between the nipples.
--Lift the jaw and tongue to determine if the object causing the airway obstruction is present. If so, use your finger to carefully sweep it out. Be careful not inadvertently push the object back down into the airway.

Unconscious Choking Victim:

--Attempt rescue breathing as described in the section.
--If air will still not go in, place the heel of one hand against the middle of the abdomen just above the naval. Place the other hand over the hand on the abdomen and give forceful upward abdominal thrusts.
--Lift the jaw and tongue to check for the obstructing object. If seen, sweep it out with a finger. If you cannot see anything do not sweep.
--Tilt head back and attempt to give breaths again.
--Continue until breaths can be given.
--Once the object is removed, continue rescue breathing until the victim is spontaneously breathing. Monitor the victim closely. If the victim's airway has been blocked for more than a minute, it is advisable to contact a medical consultation service immediatley or an emergency medical service if in port.

NEAR - DROWNING

When lack of breathing is known to have been caused from near - drowning, it is helpful to place the victim's body at an angle in which the head is slightly lower than the body. This facilitates drainage of water from the lungs and reduces the risk of re-inhaling these fluids. Be prepared for water to sputter or gush from the victim. Turn the victim's head to one side so that it does not enter the lungs. (Again, remember to roll the head and body in unison if a neck injury is suspected.)

SPECIAL MARITIME MEDICAL CONSIDERATIONS

Hypothermia

Hypothermia results from the loss of body heat. Chances of developing hypothermia on deck are decreased by staying out of the wind, keeping dry, wearing layers of wool or synthetic clothing such as polypropylene, keeping active but not to the point of perspiration, and by not consuming alcoholic beverages. In the water, activity and maintaining the Heat Escape Lessening Posture (HELP) with the head out of the water, arms curled around the personal floatation device, legs crossed, bent at the knees and drawn up to the chest will help maintain body heat. Huddling with others in the water will slow heat loss as well. Early symptoms of hypothermia include: shivering, muscle stiffness, and lethargy which progresses to muscle rigidity, slow heart rate, confusion and later, loss of consciousness.

Once the victim is removed from the water their Airway, Breathing and Circulation (ABC) should be assessed. If neither pulse or respiration is present, CPR should begin immediately (refer to rescue breathing and CPR sections on p. 11). Medical consultation should be obtained to guide continued resuscitative efforts and for all unconscious victims of hypothermia. Victims should be brought into the vessel cabin while rescue breathing or CPR is continued, wet clothing removed, and their body wrapped in dry blankets. The only reliable method of determining their core body temperature is with a rectal hypothermic thermometer placed approximately one inch (2 cm) into the rectum. Since rewarming with a core temperature below 90.5ûF (32û C) is extremely difficult and risky, medical consultation is recommended. If a thermometer is unavailable and they are alert, or if the rectal core temperature is above 90.5ûF actively warming them by skin to skin contact with another crew member, wrapping both individuals in blankets, administering sips of warm liquid, and encouraging the victim to gently exercise is reasonable. Medical consultation for further recommendations is appropriate.

LIFE EXPECTANCY IN WATER

Seasickness

Avoidance of alcoholic beverages and eating small but frequent meals will help the susceptible mariner avoid the nausea that occurs with seasickness. It is very important to keep well hydrated with fluids such as fruit juice, soup broth, soda and commercially available sport drinks. For those known to develop seasickness, application of a scopolamine patch 24 hours before departure may be helpful. Once the symptons of seasickness have developed, exposure to fresh air and focusing one's vision on a distant object is recommended. Oral over-the-counter medications such as dimenhydrinate (Dramamine ®) or meclizine (Bonine ®) are useful before vomiting becomes recurrent vomiting, it may be necessary to administer a rectal suppository such as trimethobenzamide, promethazine, or prochlorperazine, if available. Injectable forms of anti-nausea medications are available and their use should be discussed with a physician before administration. Consultation with a physician should occur before the crew member develops symptons of severe dehydration such as fainting, confusion or a rapid heart rate.

Sun and Heat Exposure

Protective, light-weighted and colored, well ventilated clothing, a hat with a wide brim and sunglasses will minimize the risks of excessive sun exposure. Application of a waterproof sunscreen with SPF of 15 or greater to areas exposed to both direct and reflected sunlight will further reduce the risk of sunburn. Zinc Oxide ointment may be applied to the face if sun exposure is unavoidable. Special care should be taken to protect the skin of infants and children.

It is important to increase fluid intake when physically active in a hot environment to prevent dehydration and heat illnesses. In both heat exhaustion and heat stroke, the core body temperature is significantly elevated and must be lowered immediately. Moistening the skin with water and allowing evaporation or application of cool, not cold compresses will be beneficial. If the person is unconscious for longer than approximately 30 seconds as might occur with simple fainting, or their body temperature is greater than 104°F (40°C), memdical consultation should be obtained immediately.

Once sunburn has occured, the skin should be carefully protected from further sun exposure and irritation from poorly fitting clothing. A cool compress may alleviate the pain and swelling of small areas of skin that may have been burned. Oral administration of acetamenophen, aspirin, or ibuprofen will decrease pain. Soothing skin creams may be applied to intact skin. However, in areas with blistering, only an antibiotic iontment or burn cream such as silver sulfadiazine with sterile dressing covering the burned area should be applied. Blisters should be left intact, however, if a blister ruptures, the thin layer of loose skin can be gently removed with forceps and a new dressing applied. The dressing should be changed daily. A physician should be consulted at the earliest sign of infection.

Injuries fron Aquatic Animals

The treatment of choice for jelly fish stings remains debatable. Remaining tentacles can be gently brushed from the skin after application of a caking medium such as baking soda and water or shaving cream. Some authorities recommend soaking the wound in dilute vinegar to discharge any remaining nematocysts. Sponges may cause an abrasive injury producing a burning, weeping lesion which may also benefit from dilute vinegar soaks. Application of a topical steroid preparation such as 1% hydrocortisone cream or ointment relieves itching and burning.

Sea urchins, starfish, sea cucumbers and dirty coral produce puncture wounds which may contain irritating toxins. Cleaning the wound and removal or spines imbedded in the skin will help prevent later infection and pain. Infection can occur and antibiotics may be required.

Stings from venomous fish (lion fish, scorpion fish, cat fish, weever fish, stone fish, sculpins and others), sea snakes and stingrays may produce painful and potentially life threatening reactions. When handling fish, remember that the venom can remain potent for 24 hours aftern the animal's death. Fish envenomation may produce local redness, bruising, and severe pain which may be accompanied by weakness and paralysis. Soaking the injured part in warm water will partially deactivate the venom the decrease the pain. Severe reactions warrant medical assistance and possibly anti-venom. If a sea snake bite occurs, the a compressive dressing should be applied and the area immobilized, if possible, to delay spread of the venom while medical attention is sought. Removal of a stingray barb and deeply perforating fish or urchin spines can be difficult and is best done by a medical consulting service.

For a recommended reference list and further information, please contact the Maritime Health Services.

MEDICAL SUPPORT AT SEA   - 24 Hours, 7 Days a Week!   - VHF Marine Operators, Cellular  Phone or SSB!   - Services available on a per call basis  or by yearly contract (206) 781-8770  FAX: (206) 781-8771 Telex: 6838206 MHS UW Maritime Health Services, Inc.  2701 First Avenue, #105, Seattle, WA 98121.

U.S. Coast Guard Group Stations / Emergency Rescue Procedures/ Personal Flotation Devices / First Aid
Fire Extinguishers / Running Lights / Aids To Navigation / Inland Rules of the Road
VHF-FM Frequencies (Sponsored By Standard Communications) / VHF Radio Information
Preparation and Storm Advisories / Recommended Additional Equipment / Trailering Your Boat
Common Useful Knots / Marine Law Enforcement / Wind Determinants