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Old 10-30-2008, 01:52 PM   #1
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I am considering taking the following EMT class at Florida Community College (FCCJ) next semester.

The class is First Responders: Emergency Care Training

Brief course description:

Designed specifically for non-medical individuals who wish to learn basic life saving skills, this course provides students with the basic skills necessary to save a life, minimize patient discomfort and prevent further injury. Upon successful completion of this course, students are qualified in basic life support and prepared to enter Fundamentals of Emergency Medical Care, as prerequisite skills are a part of the course content.

Is this worthwhile and what EMT training and medical skills are recommended and are necessary. I have done the basic CPR classes, but do not believe that I am equipped to deal with medical issues on board my vessel. I understand that any training is better than none but there may be a class or course that is better targeted to the requirements. Things I really feel are necessary that I did not see in the class curriculum, though they may be there as I have only given it a very brief look, are suturing.

I would really like those that have taken EMT classes, paramedics / Doctors and those that have needed medical skills while at sea or in places where medical facilities are limited at best, to have a look at the course content that I am attaching as a PDF file and pass their opinions and definitely suggestions.

EMS1059.pdf
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Old 10-30-2008, 03:32 PM   #2
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I think you would need to break it down at least in two subcatrgories. Close enough for additional emergency response, ie Coast Guard and out of range of emergency response.

If someone is requiring CPR on a boat and are actively trying to die, you are probably not going to intervene. Hypoxic brain injury occurs in about 6 minutes unless circulation is restored. My thought is if you want to be safe, stay at home and move close to a major emergency center. Don't feel to good about the move though. I read once where resucitations under the best of conditions is about 5% nationally. That's with people who know how to do CPR, a little shock or two via the AED, a boat load of various medicines, fluids, O2, and lots of highly paid people. The 5% has been close to my expereince from what I have seen.

With that said I would focus on prevention of the bad stuff and focus on the stuff you can do something about. I can elaborate on that if you want.

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Old 10-30-2008, 05:17 PM   #3
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Related to things that one can do something about...

One of the things that can really do incredible harm is dehydration. If someone is ill, injured, etc, frequently simple dehydration can become the main issue facing their recovery and even their survival.

In addition to having drink mix available with electrolytes aboard and the possibility of using a rehydrating enema, I've always been surprised that the use of subcutaneous fluids isn't really considered. It seems it would be easy to carry needles and IV bags of appropriate solution for use in emergency (even if one is not a medical professional who can easily administer fluids via IV). I just did a google search on this method of re-hydration and it seems to be not popular in medical settings perhaps simply because the medical professionals can just use an IV instead. Its something I'm further looking into--there is some research and it seems that its use in elderly patients (probably at nursing homes or home care) is a major area where it is being studied.
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Old 10-30-2008, 06:20 PM   #4
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[QUOTE=duckwheat;27276]I think you would need to break it down at least in two subcatrgories. Close enough for additional emergency response, ie Coast Guard and out of range of emergency response.

Hey DW thanks for the reply, and elaborate ahead. I come from a Medical family but had no desire to persue that line of work (though my son hopes to) and did medic training in the SA military. Have treated the odd soldier who ate a bullet and treated my daughter after she was shot and MISSED at close range by some IDIOT with a 30-06, and the damage you see is from the barrel blast. Nearly lost her leg and I had to treat that open wound under (specialist supervision of course) for nearly 3 months prior to skin grafts, but that is another story...

Here is the gruesome picture, and there is nothing worse IMO than being helpless and unable to help. I have the time and the inclination so I would like to position myself where I may just be able to help.
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Old 10-30-2008, 08:55 PM   #5
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HERE GOES...

I tried to stay out of this!

Disclaimer: I am NOT a physician!

First, GOOD FOR YOU, for looking into taking care of yourself and others.

You asked basically about the class you posted about... MOST classes that you will find are predicated on the Golden Hour concept that you will be able to get the injured or ill to advanced medical facilities within an hour. The class that you mentioned is basic (to me) and if you are coastal cruising may be of some benefit. However it is not in any way sufficient for offshore emergencies.

All of the posters before me have very valid points which I shall try to expound upon.

Redbopeep: Norfolk Medical Products make a hypodermoclysis kit called the Aqua-C Hydration System (get the high-flow version). They are great offshore, but do not allow as much fluid to be infused as a normal IV which is why they aren't commonly used. (Except at the vet'). I do IV's daily in the back of a moving ambulance and may find IV access difficult in an active seaway! They are also offering Nasal Nebulizing Drug Packaging now for intranasal dosing which may benefit offshore, but I would still want a means of hydration intact.

Duckwheat: Solid point! Your medical decisions (and training) hinge on two questions: Is advanced medical care available to me in a timely manner? Or... Am I on my own?

I will try to illustrate Duckwheat's point...

Many people with the means may opt to take an AED (Automated External Defibulator) used to interrupt a heart dysrhythmia in certain rhythms in the hopes of it restarting in a normal rhythm. Even in the most successful circumstances most people who are resuscitated require near immediate advanced cardiac care and drug therapy to live with any quality of life. So if you are near shore and a cardiac center and have all of the training and the drugs you "may" be able to save someone. (Personally, if I had a cardiac history I wouldn't leave home without one!). The reality is: No physician is going to give you a prescription for those medications unless they are confident that you know what you are doing, and even then... The drugs involved require care to keep them fresh and viable. Some distance offshore the chances are smaller that advanced care could be found so the viability (and expense) of taking this treatment may negate doing so.

In nearly every medical decision you make, or plan to make, the availability of advanced care is a factor.

One course will seldom prepare you to care for yourself and others offshore. There are some good options:

JeffreyE Isaac PA-C used to teach for the Wilderness Medical Associates and offers a good course tailored for offshore sailors.

I teach Wilderness Medical classes for desert, mountain, and cold climates but I have not yet developed a Marine based class (I guess I had better work on that).

Other programs are listed in the back of sailing magazines though I cannot recommend them only because I know nothing about them.

Taking a course or two is a good start. I recommend finding a sailing physician as he can better understand your needs and write 'scripts for what you need. Plenty of good books abound. Go to Barnes and Noble, or your local major bookstore and look through :

"Wilderness Medicine" by Paul S. Auerbach (The best "Forward" of ANY medical book!)

Warning: It is over 1000 pages and has 78 chapters to include 9 on marine medicine. Should you decide to purchase this book accompany it with a good medical dictionary unless you are well trained medically already!

The subjucts that you will need to "really" understand (under stress if you don't know it well you won't remember it), include, but are not limited to:

CPR

Basic First Aid

Forms of Hydration and Rehydration(For Hypovolemia)

Medication Administration

Vital Signs...Taking them & the equipment to do so, What they are telling you, or how to describe them to a physician on the radio

Anything and Everything about Sea-Sickness

Exposure injuries...From Sunburn to Hypothermia

Splinting and Bandaging

Shock

Suturing (And when NOT to)

Controlling Bleeding

Drowning and Near-Drowning(salt & Fresh Water)

Handling injuries and Illnesses caused by MarineLife

Handling Anaphylaxis

Eye & Dental Injuries

Diving Injuries

Aquatic Skin Disorders

I have missed a lot here, this is really the tip of the iceberg! That said: I have seen basics save many lives. Let me say that again... I HAVE SEEN BASICS SAVE MANY LIVES!!! Often just the act of opening the airway of a person who has stopped breathing is enough to restart them. I have seen just that MANY times! There are proper ways to open an airway depending on the mechanism of injury though... Learn them!



I don't want to try to teach a class here, but I do want you to know that there are people hear capable of doing just that "On many subjects".

Be aware that a good HF Radio (and the skill to use it), will often get you in contact with a doctor. The ability to convey the actual situation, injuries, and health status of the patient is not as easy as it sounds. Practice it with a friend to see just how difficult it can be... Now, ADD STRESS. And please do NOT assume that all doctors can help you with remote medical problems... Some are not capable of thinking "out of the box" and will be lost without their staff and facilities. If you are able to explain the situation well and the physician is able to tell you what you need to do, try to have the appropriate medication or equipment aboard. If the Doc' says, "That will need antibiotics" and you haven't any shame on you. But again, get on the radio and see if someone just over the horizon has what you need. Some ships at sea have great medical facilities aboard. Better yet, prepare to care for yourself.

I hope that some of this has made sense, as I just finished a 24 hour shift, and another starts in the morning. Normally, I would say to PM me if you want to converse more, but I feel that this subject matter is best kept on this site for all to view. I am NOT a physician and CANNOT give medical advice, but I will be happy to answer "what would you do if" questions here if it will help anyone. The Pelican Cases that hold my many varied wilderness and offshore kits are packed and ready, and even what to take with you is an often stressfull exercise (Please see the forward to the above mentioned book).

Hope this helps someone,

David NREMT-Paramedic, I/C, C/C, WEMT-P/ Instructor

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Old 10-30-2008, 09:48 PM   #6
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Quote:
Originally Posted by Wildernesstech View Post
Disclaimer: I am NOT a physician!

Taking a course or two is a good start.

"Wilderness Medicine" by Paul S. Auerbach (The best "Forward" of ANY medical book!)

Hope this helps someone,

David NREMT-Paramedic, I/C, C/C, WEMT-P/ Instructor

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Thank you so much for this post, this is EXACTLY what I was hoping for. Even though I personally thought that the course would be beneficial I figured that it would be incorrectly targeted for what I need. I was hoping that some alternative training would be suggested. I actually looked at doing a full on paramedic course but I am too old (not physically, just too damned hard to jam stuff into my head these days) and the time available to me is not sufficient, though I may again explore some level of paramedic training. You guy are not paid enough, actually they could pay you double and that would not be enough. Firefighters, nurses and school teachers fall into that category as well, however I digress.

I will look at the recommended reading and see what courses I can find here in JAX that I can do at night that is better targeted at what I need. Once I reach that point I will revisit this post or re-open the topic with more pertinent questions.

Thanks again for the time trouble and sacrificed sleep time to answer my questions. I applaud you ....
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Old 10-31-2008, 12:40 AM   #7
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If it teaches you basics that you don't already know then it is a step in the right direction...

David

Edited by Nausikaa. Unecessary quote of the entire foregoing post deleted.
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Old 11-03-2008, 02:26 PM   #8
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I would get a basic first aid course. I think the thing that should get your attention is how to respond to minor to moderate trauma. Fractures, lacerations, etc................ Major trauma is probably not going to be survived. Cruise vs living next to a trauma center, life is about choices and managing the risk to an acceptable personal level.

Wound care: Pressure to a bleeding wound. Know how to clean a wound and apply a dressing. Hydrogen peroxide is good on a dirty and infected wound then lose it. It will damge granulating tissue. Do not be afraid to debride a wound. Do not ignore or underestimate a scalp wound, they bleed a lot. Staples work best and get it closed up. Dont trim the hair, it will just end up in the wound. Increases the risk of infection.

Repair: Glue it, Staple it, or suture it. There are lots of how to guides on the internet. Grab some pigs feet and practice on them. It is not rocket science. If you have tendon damage that is evident it will need to be repaired later. The fewest number of sutures the better, less inflammation from the suture material.

I would take some antibiotics: Keflex is good for simple to moderate infections and cheap, Doxycycline would be in there as well, covers MRSA which is becoming more and more prevalent. How about a little Cipro, works good. Chance of a parasite, Flagyl is cheap as well. I would get some hydrocodone based pain medications in case your break something.

Remember, you have an immune system and you need to give it a chance. The public as a whole wants an antibiotic for everything, including the runny nose that has had them on deaths doorstep for the past 4 hours. Most of the stuff we come in contact will not kill you. Just be patient!!

Dehydration: I would not take IV fluids. That just sounds absurd. If you got a gut that works, you sould be able to rehydrate with water. Fancy water with electrolytes not really a necessity. I have dripped water in to a infant that was so dry we could not get a line started. Were about to do an interosseus (IV in the bone) and we took the time to try orally. In 15 minutes it was as if you blew up a ballon, lusty cry with tears.......... So don't get to worried about getting IV fluids, just use a the obvious. A teaspoon at a time will work.

An AED, another thing I would not take. So you shock them, now what. There was some underlying reason why they went into a nonviable rythm. All the shock in the world is not going to fix that underlying reason. You do not have the ACLS (Advanced Cardiac Life Support) meds with you, no pump to deliver them accurately, so don't take it. Again risk for being where you are at on a sailbaot far from that ER. Just remember the ER will not significantly increase your survival rate, so enjoy the boat.

I was in a village in the Aleutians in October and was told the story about a person who had come into the clinic and complaining of feeling weak. Within 30 minutes that had collapsed. No pulse, no breathing present. They started CPR and mouth to mouth................................How long do you go? They continued for 5 hours. YOu could make a good case for 3 cycles of CPR and Mouth to mouth. No pulse? Say a prayer for everyone involved and understand you did what you could.

Take care of chronic health issues prior to departure. A new diabetic should wait until they get it controlled. High blood pressure, 120/70 is ideal. If you are not there ask your provider why not. I would not start any new meds shortly before starting out, but that is just me. Take accurate records and history with you. I always ask people why they are taking the various drugs. It is rare that I have a person who can tell me why they are taking each medicine and what they are suppose to do. RARE.

Be smart. When I was young I lived in the Bush in Alaska placer mining. It took about a week to realize just how far away I was from everything. I thought about how I walked and looked for the potential for injury in everything. We get pretty casual about our personal safety living in society. Think twice about jumping. You are not as nimble as you use to be. Jumping will probably increase the energy to the fall, so a broken bone is now possible. DO NOT GET IN A HURRY, unless you absolutley have to.

There is more, but I need to go and safely walk the dogs. By the way any practitioner should have no problem getting you set up for your cruise. You get the list together and ask them to prescribe the items. I would do it in a heart beat for any patient that organized. Don't ask them to come up with the list for you.

DW in Idaho
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Old 11-03-2008, 09:00 PM   #9
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Quote:
Originally Posted by duckwheat View Post
I would get a basic first aid course. I think the thing that should get your attention is how to respond to minor to moderate trauma. Fractures, lacerations, etc................ Major trauma is probably not going to be survived. Cruise vs living next to a trauma center, life is about choices and managing the risk to an acceptable personal level.

Wound care: Pressure to a bleeding wound. Know how to clean a wound and apply a dressing. Hydrogen peroxide is good on a dirty and infected wound then lose it. It will damge granulating tissue. Do not be afraid to debride a wound. Do not ignore or underestimate a scalp wound, they bleed a lot. Staples work best and get it closed up. Dont trim the hair, it will just end up in the wound. Increases the risk of infection.

Repair: Glue it, Staple it, or suture it. There are lots of how to guides on the internet. Grab some pigs feet and practice on them. It is not rocket science. If you have tendon damage that is evident it will need to be repaired later. The fewest number of sutures the better, less inflammation from the suture material.

I would take some antibiotics: Keflex is good for simple to moderate infections and cheap, Doxycycline would be in there as well, covers MRSA which is becoming more and more prevalent. How about a little Cipro, works good. Chance of a parasite, Flagyl is cheap as well. I would get some hydrocodone based pain medications in case your break something.

Remember, you have an immune system and you need to give it a chance. The public as a whole wants an antibiotic for everything, including the runny nose that has had them on deaths doorstep for the past 4 hours. Most of the stuff we come in contact will not kill you. Just be patient!!

Dehydration: I would not take IV fluids. That just sounds absurd. If you got a gut that works, you sould be able to rehydrate with water. Fancy water with electrolytes not really a necessity. I have dripped water in to a infant that was so dry we could not get a line started. Were about to do an interosseus (IV in the bone) and we took the time to try orally. In 15 minutes it was as if you blew up a ballon, lusty cry with tears.......... So don't get to worried about getting IV fluids, just use a the obvious. A teaspoon at a time will work.

An AED, another thing I would not take. So you shock them, now what. There was some underlying reason why they went into a nonviable rythm. All the shock in the world is not going to fix that underlying reason. You do not have the ACLS (Advanced Cardiac Life Support) meds with you, no pump to deliver them accurately, so don't take it. Again risk for being where you are at on a sailbaot far from that ER. Just remember the ER will not significantly increase your survival rate, so enjoy the boat.

I was in a village in the Aleutians in October and was told the story about a person who had come into the clinic and complaining of feeling weak. Within 30 minutes that had collapsed. No pulse, no breathing present. They started CPR and mouth to mouth................................How long do you go? They continued for 5 hours. YOu could make a good case for 3 cycles of CPR and Mouth to mouth. No pulse? Say a prayer for everyone involved and understand you did what you could.

Take care of chronic health issues prior to departure. A new diabetic should wait until they get it controlled. High blood pressure, 120/70 is ideal. If you are not there ask your provider why not. I would not start any new meds shortly before starting out, but that is just me. Take accurate records and history with you. I always ask people why they are taking the various drugs. It is rare that I have a person who can tell me why they are taking each medicine and what they are suppose to do. RARE.

Be smart. When I was young I lived in the Bush in Alaska placer mining. It took about a week to realize just how far away I was from everything. I thought about how I walked and looked for the potential for injury in everything. We get pretty casual about our personal safety living in society. Think twice about jumping. You are not as nimble as you use to be. Jumping will probably increase the energy to the fall, so a broken bone is now possible. DO NOT GET IN A HURRY, unless you absolutley have to.

There is more, but I need to go and safely walk the dogs. By the way any practitioner should have no problem getting you set up for your cruise. You get the list together and ask them to prescribe the items. I would do it in a heart beat for any patient that organized. Don't ask them to come up with the list for you.

DW in Idaho
DW,

From the "Forward " that I referenced above, relating to the Lewis & Clark Expedition... How little they took with them in medical supplies and training... What they went through and all but one survived:

"looking back, one can only be amazed at the medical success of the expedition, which returned with the loss of only one man. Was it skill? Was it luck? Was the trip a tribute to the endurance and resistance of the human body to cold, heat, starvation, insects, injuries, and medications that could have done more harm than good? ...

The medication chest contained little of therapeutic value except opium and laudanum...

Could a modern doctor have done better? Not much. Some illnesses may have been shortened, some pain relieved, but many more medications would have been dispensed, more lacerations sutured, and perhaps snakebite antivenom administered."

That is the long and short of it... We concur that when offshore we take our own responsibilty, and we are certainly limited in what we can take, and the outcome may be different from getting sick right next to the hospital, BUT; Seldom the out come will be much better. I stumbled right past it, and DW has hit the nail squarely on the head. Doctors, nurses, and paramedics are fine people, but it is the human body and common sense that will get you the most mileage out of your life.

David
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Old 11-03-2008, 09:19 PM   #10
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Here is a good link for the types of injuries most common on cruising yachts: www.cruisingclub.org/seamanship/seamanship_surgeon.htm

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