When we conduct used-boat inspections we look everywhere, including inside medicine cabinets. Especially on boats that are more than five years old, we are often surprised to discover that medicine kits share two common characteristics: The contents are often inadequate for the treatment of any injury more severe than a minor cut, and most of the contents are outdated.
Understandably, this condition exists because we tend to focus our energies on the recreational and social aspects of boating, as well as the obvious mechanical requirements such as changing engine oil and charging batteries. In the process, we may ignore the fact that a boat can be considered a hostile environment in which crews health is at risk.
With some exceptions, such as a head injury caused by an accidental jibe or fingers caught in a windlass, the risks inherent in boating are essentially the same as those found in a typical home. However, when operating in a marine environment, the need for proper, adequate treatment is exacerbated by the inability to jump into a car and head for an emergency room, or call an ambulance.
Consequently, it is incumbent upon a skipper to take two important precautionary steps to protect crew and guests. First, a careful evaluation of the contents of the ships medical kit should be conducted to assure that contents measure up to potential hazards. Second, aging contents, such as adhesive strips that have lost their adhesiveness or medications that have passed their expiration date, should be replaced with the newest available.
Risk Assessment
Your boats medical kit should reflect your sailing style, the composition of crew or guests, and the area in which you sail or cruise. Because of their proximity to treatment, boats used strictly during the day on calm waters within quick and easy reach of assistance require fewer medical supplies than those of a cruiser who spends nights on the hook in an isolated anchorage. Those who head more than one days distance offshore should be prepared to treat serious injuries for extended periods of time.
Medical risks fall into several categories, so the contents of your kit should match the types of injuries most likely to occur. Cuts, for example, may be closed with bandages, but lacerations-the tearing of skin-require a different treatment; both require an antiseptic and antibiotics to prevent infection. Abrasions require yet another type of treatment, often a cold pack.
In the kitchen, one of the most common injuries is a burn, from hot water, splattered grease, etc., and the same holds true for the ships galley. Burns, for example, can also occur when a rope running freely through the hands causes a blister or burn, when you touch your skin on a hot engine block or inadvertently create an electrical short-circuit.
Similarly, internal ailments occur whether you are on land or your favorite sailing grounds. That being the case, your onboard medical kits should contain the same types of remedies found in your home-drugs that will deter or eliminate nausea, vomiting and diarrhea, as well as a treatment for seasickness. Items most likely to be missing from a medical kit, we discovered, were those for the treatment of dental problems.
Within this context, we contacted several companies that specialize in putting together medical kits and obtained samples for evaluation.
Resources
In assessing the varied types of exposures we face and medical supplies necessary to combat them, we were assisted by Dr. William Forgey, author of Wilderness Medicine and a Board Member of the Wilderness Society. Though not specifically oriented to boat owners, Forgeys book incorporates comprehensive diagnostic and treatment recommendations with clearly defined guidelines for the evaluation of a medical kit. It contains a short section on aquatic animal injuries as well as a section on the treatment of hypothermia and heat-related injuries.
We also discovered that The Onboard Medical Handbook, by Dr. Paul G. Gill, Jr. provides information regarding the treatment of most medical ailments. It also includes sections discussing such problems as venomous marine animals, fish poisoning, and sharks and marine marauders.
Of the two, Gills is most relevant to boaters, and more readable. However, given a choice, wed have both onboard. Both practitioners agree on the basic approach to building or buying a boat medical kit, so we suggest you have a copy handy when you evaluate the kit for your boat.
On an elemental level, Forgey believes that a kit should be comprised of multi-functional components so as to reduce weight, bulk and simplify usage, especially if storage space or weight are considerations. For example, ibuprofen is a multi-purpose product which acts as a pain killer and reduces inflammation and fever, and so may replace aspirin.
He also believes a kit should be organized into modules and compartmentalized along specific lines of treatment. Modules include topical bandaging, non-prescription oral medication, orthopedic needs, field surgical needs, prescription oral medication and prescription injectables.
Most boat kits will be adequately prepared if they consist of the first two modules, he said.
Your primary objective when a minor injury occurs should be to solve the problem if you can. Failing that, you should stabilize the situation until help arrives, or you can return to civilization.
You should evaluate your skills as a care giver, he adds. In other words, theres no sense bringing sutures if youre too squeamish to stick a needle into someones skin. In the short run, butterfly bandages are an adequate substitute.
The kit should be easy to locate and recognize, so reflective tape on the outside is helpful, especially at night when you may be searching with a flashlight. It should be easily transportable without compromising on your boats specific needs.
In our evaluation of commercial medical kits, we discovered that components fall into four general categories. They include bandaging and splinting; instruments and hardware; lotions and cleansers, and medications. Within each category are 58 individual items. The most expensive kit contained all 58 items, the least expensive 12, with a small sample from some categories.
Most pre-packaged first-aid kits will include some form of first-aid instructional manual; however, a rule of thumb is that the more you spend for the kit, the better the publication. In most cases, those in the least expensive kits are woefully inadequate. Instructional manuals included in the kits ranged from a basic one-page chart cryptically describing treatment options, to The Comprehensive Guide to Wilderness and Travel Medicine, by Eric Weiss, MD, which is included in the REI Day Tripper kit.
The Basic Ingredients
Our recommendation is that every boats medicine kit include the following items (many will be contained in higher priced kits, though some name brand items must be purchased separately):
adhesive cover strip wound closures (i.e., Band-aids), in several sizes, including knuckle bandages, steri-strips, and butterfly bandages. Beiersdorf closures can be removed and re-applied to cover a wound. Asan alternative, tincture of Benzoin increases the adhesiveness of wound closure strips.
a roll of inch tape
a cold pack
3″ square sterile dressings
Tegaderm, which seals water from a wound, but which also allows the wound to breathe. The wound can be immersed following application
Spenco 2nd Skin, used for burns and blisters
Silvadene cream, for burns
Nu-Gauze Pads, super-absorbenttwo-ply pads
an antiseptic surgical scrub
a topical anesthetic like Dibucaine Ointment (1%)
otic drops, used for swimmers ear and ear infections
Percogesic tablets, used to reduce pain, fever, and muscle spasms
ibuprofen, for the relief of pain, fever, and inflammation
Meclizine, for nausea/vomiting
Ioperamide, an anti-diarrheal
antacid tablets or liquid
a topical antibiotic
Hardware should include at least one 6″-wide elastic bandage, waterproof tape (or duct tape), sutures, needle holder, bandage scissors, a thermometer (preferably digital), latex examining gloves, and cotton-tipped swabs. A headlamp will be useful after dark. A reflective-Mylar space blanket will assist with hypothermia or shock victims, and sealable plastic bags will protect components from the environment.
As generic supplies in the kit are exhausted, or age beyond their useful life, we recommend finding higher quality replacements at camping or outdoor stores, or your local pharmacy, since chandleries typically sell only complete kits.
The Container
In a marine environment susceptible to moisture, the risk of mold or fungus, and the corrosive affects of water and salt, its important that the storage vessel for your kit be strong enough to endure a pounding in bad weather and sufficiently watertight to protect its contents.
The primary difference between inexpensive kits with plastic storage containers and higher priced kits is that the less expensive are made of less impact-resistant plastic, and are likely to leak. Kits that we think are the most acceptable have tougher containers as well as gaskets on the lids that make them watertight (although they may not be totally waterproof). For example, we like Orions kits, which are built of strong plastic with watertight lids and plastic hinges and bolts.
Kits like those sold by Outdoor Research and REI store contents in waterproof pouches constructed of urethane-coated packcloth, which is less impact-resistant than plastic. The kits are equipped with varying numbers of mesh storage compartments which make it easy to see contents, and which lets them breathe. Modules snap to the pouch and elastic holds vials in place.
The same is true of Medical Sea Pak containers, which are compartmentalized and double-zippered.
In general terms, first-aid kits most suitable for day use and coastal cruising come in three flavors: Inexpensive ($10-$24) kits that are suitable only for dealing with minor cuts and scrapes; moderately priced ($25-$40) kits that have a greater selection of treatment aids; and higher-priced ($50-$90) sets with the greatest collection and quantity of aids.
The best commercial kits available for offshore use are manufactured by Medical Sea Pak, and range in price from $100-$900.
For comparative purposes, we evaluated kits manufactured by Johnson & Johnson, Healer Products, Orion Safety Products, Outdoor Research, and REI. The latter two companies were included because they enjoy excellent reputations as producers of products for use in the wilderness.
During our examination, however, we found that there are significant differences between products. In addition to the quality of the container, kits should be evaluated using two methods-the number of categories of medical aids (bandages, scissors, swabs, for instance), and the number of items in each category.
For example, the Healer Products Boat Medical Kit (#10206), has only 12 categories of items, with a total of 49 items, 16 of which are adhesive strips and 10 of which are aspirin; the kit has only a small first-aid instruction card.
By comparison, Orions Fish and Sail contains 69 items subdivided into 17 categories; however, 16 are adhesive strips, 12 are motion sickness pills, and 10 are non-aspirin tablets.
Johnson & Johnsons Marine First Aid Kit is superior in each category. It contains 100 items in 21 categories, and includes a first aid guide, scissors, thermometer, latex glove, survival blanket, signaling mirror and assortment of dressings, tapes and adhesive bandages.
Our second choice is REIs Hiker First Aid kit ($24), which is especially suitable for small boats since it is lighter and takes up less space than the Johnson & Johnson kit. The REI kit contains 70 different items. Unfortunately, it has a major drawback in that the container is a soft, zippered bag. If you buy this one, youll probably want to store it in a large, sealable plastic bag or box.
We think most boat owners should seriously consider the mid-priced kits, if not the more expensive ones. It is necessary to do your homework in this arena, however, or you may discover youre receiving little value for the additional expenditure. Healers Small Craft Kit (#10210, $44.25) and Orions Weekender First Aid Kit ($23.95) are examples. Though each has more categories of aids, the primary difference between these and the least expensive kits is an increase in the number of adhesive strips and alcohol pads-inexpensive items-rather than a greater selection of bandages of different sizes.
With this warning in mind, we recommend you take a more critical approach to this issue and opt for products in the $50-$90 range. Despite the additional cost, all of these kits have fewer adhesive strips than their less expensive counterparts; however, they all have a wider variety of treatment media.
Johnson & Johnsons #8172 Heavy Duty Kit ($50) contains 2″ gauze bandages, oval eye pads, a triangular bandage and burn cream-a total of 103 items.
Outdoor Researchs Saltwater Kit ($75) falls in the same category. It is more compact and lighter than other kits; contents are in a bright red soft bag.
Healers Marine Medical Kit (#10214, $59.95) adds both gauze and elastic bandages to its contents, along with an abdominal patch, an eye irrigator, an instant cold pack and first- aid booklet.
Similarly, Orions Sportfisher ($44.95) kit, which is packaged in a watertight plastic box, contains over 235 items, adding abdominal wound pads, adhesive strips in varied widths, cold pack, rescue blanket and a motion sickness wrist band.
We also evaluated Orions Master Mariner Kit ($99.95) and Medical Sea Paks Day Pak ($109.95) and consider the Sea Pak to be the superior product. The contents are compartmentalized in four waterproof containers by medical category: common problems, cuts and splinters, sprains and fractures, burns and CPR. The kit contains a CPR mask, a 15″ splint board, triangle sling, and 48″ roll of Ice Tape, a compression bandage. A waterproof first aid guide, entitled First Aid By the Numbers, provides step-by-step directions for the treatment of ailments and injuries, as well as a list of suggested prescription drugs that can be placed in a separate medication compartment.
Though the contents are enclosed in a zippered waterproof bag with a handle for hanging the kit, and the contents are enclosed in waterproof compartments, wed consider spending an additional $30 for a hard pack.
Recommendations
Because we are advocates of safe boating at all levels, we recommend the purchase of products in the mid- or upper-price range. In our opinion, the inexpensive $10-24 kits are suitable for use only at the dock when transportation to a medical facility is immediately available if a serious injury occurs.
Among the inexpensive kits, Johnson & Johnsons Marine First Aid kit is clearly superior to Healer, Orion and REI.
Of the mid-price products, we recommend the Orion Sportfisher. Its container is waterproof and shatterproof, and wont rust. The hinges and latches are plastic. The product contains more different types of aids and more of the important ingredients. Its major shortcoming is the lack of a first aid manual.
For boat owners contemplating an overnight trip beyond the sight of land, the Medical Sea Pak is the best choice. It is well organized, has an excellent guide to aid and the best assortment of medical products.
We also think your ships library should include a comprehensive, up to date, medical manual of the type we reviewed.
Is it possible to build your own kit at less expense than buying a commercial kit?
Probably not.
We were told by several manufacturers that, as a general rule, creating a personalized list of kit contents and purchasing components separately will cost more than purchasing a pre-packaged kit. The reasons are twofold: a) to maintain price competitiveness, the manufacturers may use generic or inexpensive products in their kits; b) manufacturers can buy large quantities of adhesive strips, for instance, and distribute them among several kits. As consumers, we may find ourselves purchasing larger quantities of a specific product than would be necessary for an average-sized boat. However, as specific items deteriorate with age or are used, we would recommend upgrading with higher priced components; adhesives that work well in saltwater, for instance, and more durable gauze pads.
Several manufacturers told us that marketing research indicates that the least expensive kits represent the majority of those sold because boaters tend to buy kits only after filling their shopping baskets with other items they consider more essential. That approach may impair your ability to deal with a medical emergency. We think that approach shows little consideration for the needs of crew or guests.
Contacts- Healer Products, Inc., 3 Rusciano Blvd. Pelham Manor, NY 10803; 914/738-9300; 800/223-5765. Johnson & Johnson, New Brunswick, NJ, 08903-2400; 800/526-3967. Medical Sea Pak Co., 1945 Ridge Road E., Suite 27, Rochester, NY, 14622; 716/266-3136; 800/832-6054. Orion Marine, Route 6, Box 542, Peru, IN; 765/472- 4375. Outdoor Research, 2203 1st Ave., Seattle, WA, 98134-1424; 800/421-2421. Adventure Medical Kits, 5555 San Leandro street, Oakland, CA, 94621; 800/324-3517. REI, 6750 S. 228th St., Kent, WA, 98032-4803; 800/426-4840. The Onboard Medical Handbook, Paul G. Gill, Jr., MD, International Marine, Box 547, Blacklick, OH 43004; 800/262-4729. Wilderness Medicine, Wm. Forgey, MD, ICS Books Inc., 1379 E. 86th Place, Merrilville, IN, 46410; 800/541-7323.
