Excerpt from Doctor On Board. Page reference numbers point to more in-depth treatment and self-reliant care available within the book.

 

Many maritime regulations, including the country of your ship’s registry and the ports at which you call, can influence the content and your management of the ship’s medicine chest. U. S. Federal legislation had been enacted in 1790, which required every American flag vessel over 150 tons with a crew of 10 or more to carry a medicine chest. In many jurisdictions, there are exclusions for private boats not accepting paying passengers or crew members in certain categories regarding the design and contents of the ship’s medicine chest. If you are visiting foreign ports of call, you must be cognizant of these regulations.

In this section we will be looking at the most practical development of a compact medical chest to serve the purposes of both offshore and extend cruises in a private ship, generally with a crew ranging from 3 to 25. Medical care and medicine chest recommendations for commercial ships are subject to specific requirements of the country of their registry. This book would provide a valuable guide as far as diagnosis and provide treatment plans that would be of value to commercial concerns as the official publications developed for the merchant marine are not symptom-based.There are expanded discussions of this topic available at www.doctor-on-board.com.

The most appropriate ship’s medicine chest would be compact, containing both multifunctional and cross-functional components. This requires the minimal number of medications but provides in-depth coverage when a medication is consumed.

Taking the above into account, study the potential first aid material requirements, anticipate the most likely serious events that could conceivably occur, but also tailor the kit to the medical skill level of the participants. Additional factors to consider are the weight, cost, bulk, and availability of components. Take into consideration the number in the party, length of survival situation, degree of risk anticipated, and whether or not there is a potential that other people beyond those of the immediate shipboard party will be treated.

When companies design commercial kits, two additional factors must also be considered. One is what real estate agents call “curb appeal.” It must look impressive at first glance. The other is to plan for various price points to target different markets. These constraints give commercial kits a disadvantage over the kit you put together yourself. They always contain a shallow amount of multiple line items to look impressive.

While commercial kits are usually an anathema to practical use, they can prove to be a necessity to the commercial ship master due to convenience of acquisition and to match complex requirements of some maritime laws.

The ship’s medicine chest includes state-of-the-art items that will provide ideal treatment. As this book has been written for those who may be isolated without ready access to professional medical care, the treatments discussed go beyond normal first aid. The kits described in this chapter go beyond what would be considered a “first aid” kit, but many components are easily usable under first aid conditions. The ship’s medicine chest consists of 7 units: Topical Bandaging Kit, Non-Rx Oral Medication Kit, Rx Oral/Topical Medication Kit, the Rx Injectable Medication Kit, the Rx Cardiac Medication Kit, the Dental Kit, and the Lifeboat Survival Kit.

As a minimum, the Topical Bandaging Kit and Non-Rx Oral Medication Kit will generally fulfill the vast majority of emergency treatment requirements. The prescription kits are designed for longterm and more advanced patient care. All items listed in the kits can be obtained without a prescription, except in the kits clearly marked “Rx.”

All nonprescription medications have packaging that describes the official dosages and appropriate warnings or precautions concerning their use. Prescription medications usually have elaborate package inserts with this same information. When obtaining a prescription drug for your medical kit, request this insert from your physician or copy the information from the Physicians’ Desk Reference or from the Tarascon Pharmacopoeia©, available at libraries and even as smartphone apps.

The quantities of all items can be split into minimal amounts that would be included in a special kit, which you would want to repack for your lifeboat, to last 2 to 3 weeks. Due to the suggested list having items with multifunctional capability (the item can be used for more than one purpose) and items with cross-functional uses (one condition can be treated by several of the items), the quantities of items in the kit can be reduced. Cost is also a factor in recommending products. When significant treatments are required, such as implementing the use of antibiotics, the patient should be evacuated if possible. A patient with any injury, symptom, or infection that does not improve within 48 hours should be evacuated to definitive medical care. For those of you preparing for a situation where evacuation is unlikely or impossible, evaluate the stock requirements and plan accordingly.

Most medications will have an expiration date of 1 to 5 years from the date of purchase. The expiration dates have been calculated to guarantee the product will not have degraded more than 3% of the active ingredient. A study has reported that an evaluation of 8 products stored in their original containers for 28–40 years past their expiration date retained greater than 90% of their potency. Storage affects shelf life—generally heat and sunlight degrade products, but a study release in 2019 in the Journal of Wilderness and Environmental Medicine evaluated a wide range of items that were stored in very unfavorable conditions over a year beyond expiration date and were found to have lost none of their potency. Commercial ships must pay stick attention to medication expiration dates by law. Many countries you may enter will require that all medications brought into their jurisdictions have at least a 6-month period until expiration.

All items should be obtained in stock bottles, which usually come in 90 or 100 count. In stock bottles, the items listed should last at least 5 to 10 years beyond their expiration date. Some medications listed are too expensive for a stock bottle or need to be ordered individually, such as the injection medications. Obtain what you can—having more than you require could prove useful during a voyage as these items will be invaluable and might be useful in barter circumstances (which is frankly illegal in most jurisdictions but sometimes necessary in isolated circumstances).

Aspirin does degrade rather fast and will soon smell like vinegar, indicating it is losing potency. Epinephrine solution turns brown as it degrades into norepinephrine, which fortunately is an active metabolite but works to a lesser degree in treating anaphylaxis. Avoid capsules and choose tablets, since the former are very sensitive to heat and dampness. Liquids usually degrade faster than solids.

There can be variations in generic names among American, Canadian, and British sources. Professional vendors for stocking the ship’s store are listed as “ship’s chandlery in yellow pages listings. And always give the Internet search engines and major online supply sources a look.

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ALTERNATIVE IMPROVISATION
Alternatives to the use of the medications listed below are outlined in the treatment discussions for various problems throughout the book. Alternatives to medical supplies are also discussed below and are indicated by a check mark. Granted, resources at sea will be limited on your ship, but many galley items and other assorted materials can substitute for standard medical supplies in a pinch.





LIFEBOAT KIT VERSUS SHIP’S MEDICINE CHEST
The ship’s medicine chest should have routine inventories made and rotation of medications to prevent expirations being exceeded. The Lifeboat kit should be sealed, located, and attached within the lifeboat and not disturbed. The outside should be marked with an expiration date of the shortest dated medication inside. Figuring that the ambient temperatures the kit will be exposed to will be severe at times, this kit should be repackaged and updated yearly. Beside the medications suggested below, the lifeboat will obviously require signal equipment, water, food, environmental protective and other survival gear. This book concentrates on the medical/surgical supplies only. Familiarize yourself with discussions on hydration, environmental injuries such as heat and cold, and eye and skin protection and have necessary gear and supplies for protection prepacked in the lifeboat.

Regarding both the lifeboat and the ship supplies, the medical items have been divided into subgroups, primarily responding to their being prescription or not, but also oral, topical, or injectable.

While it is not feasible to think you will need an automatic external defibrillator (AED)prepacked aboard a lifeboat. A portable AED should be on every boat and readily available to transfer to the lifeboat if appropriate and possible during evacuation.

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