First Aid Kit(s) for Cruising

Courtesy of  Rob Murray from SV AVANT

When we prepared Avant for offshore six years ago,  we looked carefully at what we would pack for first aid preparedness. We could easily imagine a wide range of scenarios where one or the other of us, or another cruiser or local, was injured (grievously), and needed first aid in an inconvenient, remote location. You know, unconscious bleeding from a compound fracture surrounded by crocodiles while darkness falls in some mangrove swamp, or something like that. We determined that:

  1. We needed to be able to react to a broad variety of potential medical emergencies quickly and comprehensively;
  2. That we would likely be short handed in responding (so the response would have to be easily transported by one person);
  3. That the emergency may happen aboard Avant, aboard another vessel, or ashore so we would need to be able to move the appropriate materials for response to the injured person, and then move the injured person from the site of the incident back to Avant or from the site of the incident to another place for treatment or evacuation;
  4. That we would be at least hours, and might be days or even weeks from professional medical facilities and professional medical help (so we would need enough supplies to treat issues for a prolonged period with instructions on how to use them);
  5. That there were ‘levels’ of response that would be appropriate, so segregating supplies into appropriate kits suited to different levels of response would make sense; and
  6. We would need reference materials suited to the kind of ‘medicine’ we would be practicing.

Before you carry on reading, please note that we’re over prepared. Period!

First, we looked for organizations that had worked systematically to solve this set of problems so we could emulate their methods and techniques. The military immediately came to mind, as they have applied science and rigour to responding to emergency medical situations in rustic locations (although they admittedly seem to focus on gunshot wounds and extreme blunt force trauma as the primary sources of injury). We also read up on mountaineering and other wilderness response experiences, and found the ‘prepper’ community had many guidelines, tips and resources that seemed useful. The Ministry of Transport in the UK also had relevant resources. While many sources suggested that buying supplies separately would be cheaper than buying a kit, we found the reverse to be true, and that the kits we looked at offered value as well as convenience.

So after our obsessive research, we equipped ourselves with a simple ‘boo-boo kit’ for day to day stuff.

Sample first aid kit.

This is the type of kit you see in a larger drug store, Costco, Walmart, or some other big box store. You can buy them online at Canadian Safety Supplies. They are also available from the Red Cross, St Johns Ambulance or similar organizations online. It’s portable, so we don’t have to drip blood on the way to the bandaids; soft sided so it’s easy to store, and reasonably comprehensive for small injuries. It unzips and flops open to display the contents when in use. There is plenty of room in the carry bag to augment the contents.

Kit Supplies

Supplies in this type of kit are usually similar to a list like this:

  • 12 plastic bandages, 1.9 cm x 7.6 cm (0.75 in. x 3.0 in.)
  • 10 junior plastic bandages, 1 cm x 3.8 cm (0.4 in. x 1.5 in.)
  • 6 fabric bandages, 2.2 cm x 7.6 cm (0.9 in. x 3.0 in.)
  • 2 large fabric bandages, 5.1 cm x 7.6 cm (2.0 in. x 3.0 in.)
  • 3 knuckle fabric bandages, 3.8 cm x 7.6 cm (1.5 in. x 3.0 in.)
  • 3 fingertip fabric bandages, 4.4 cm x 7.6 cm (1.7 in. x 3.0 in.)
  • 5 butterfly skin closures, 1 cm x 4.4 cm  (0.4 in. x 1.7 in.)
  • 4 sterile gauze pads, 7.6 cm x 7.6 cm (3.0 in. x 3.0 in.)
  • 2 sterile non-woven sponges, 7.6 cm x 7.6 cm (3.0 in. x 3.0 in.)
  • 1 sterile abdominal pad 12.7 cm x 22.9 cm (5.0 in. x 9.0 in.)
  • 2 sterile Telfa, non-adherent pads, 5.1 cm x 7.6 cm (2.0 in. x 3.0 in.)
  • 1 roll conforming stretch bandage, 5.1 cm x 180 cm (2.0 in. x 70.8 in.)
  • 1 roll conforming stretch bandage, 7.6 cm x 180 cm (3.0 in. x 70.8 in.)
  • 1 compress bandage, 10.2 cm x 10.2 cm (4 in. x 4 in.)
  • 1 Woundseal topical powder
  • 1 non-compressed, triangular bandage, 101.6 cm x 101.6 cm x 142.2 cm (40 in. x 40 in. x 56 in.)
  • 1 package of assorted safety pins
  • 4 sterile cotton-tipped applicators, 7.6 cm (3.0 in.)
  • 2 individually wrapped tongue depressors, 1.9 cm x 15.2 cm (0.7 in. x 6.0 in.)
  • 1 roll clear plastic tape, 2.5 cm x 140 cm (1 in. x 55.1 in.)
  • 1 roll elastic compression bandage, 7.6 cm x 170 cm (3.0 in. x 66.9 in.)
  • 16 antiseptic towelettes
  • 12 alcohol antiseptic swabs
  • 3 Bacitracin antibiotic ointment, 1 g (0.04 oz.) each
  • 2 Water-Jel, 3.5 g (0.12 oz.) each
  • 1 eye dressing pad
  • 1 large instant cold pack
  • 3 After Bite treatment swabs
  • 1 St. John’s Ambulance pocket guide, bilingual
  • 1 paramedic scissors
  • 1 pair of nickel-plated, blunt end splinter forceps
  • 1 package of splinter out
  • 2 Nitrile, medical examination gloves
  • 1 CPR face shield with filtered valve
  • 2 antimicrobial hand towelettes
  • 6 hand cleansing moist towelettes
  • Hand sanitizer
  • 1 infectious waste bag
  • 2 thermometers
  • 1 foil/Mylar emergency blanket, 142.2 cm x 203.2 cm (56 in. x 80 in.)
  • 2 candles
  • Waterproof tipped matches
  • Purified drinking water, 125 ml (4.3 oz.)
  • 2 plastic bandages, 1.9 cm x 7.6 cm (0.75 in. x 3.0 in.)
  • 5 junior plastic bandages, 1 cm x 3.8 cm (0.4 in. x 1.5 in.)
  • 2 fabric bandages, 2.2 cm x 7.6 cm (0.9 in. x 3.0 in.)
  • 1 knuckle fabric bandage, 3.8 cm x 7.6 cm (1.5 in. x 3.0 in.)
  • 1 fingertip fabric bandage, 4.4 cm x 5.1 cm (1.7 in. x 2.0 in.)
  • 2 sterile gauze pads, 5.1 cm x 5.1 cm (2.0 in. x 2.0 in.)
  • 2 antiseptic towelettes
  • 2 alcohol antiseptic swabs
  • 1 Bacitracin antibiotic ointment, 1 g (0.04 oz.)
  • 2 After Bite treatment swabs
  • 1 fist aid response card, bilingual
  • 2 hand cleansing moist towelettes

We added to the kit with:

  • Some tincture of Benzoin for pre swabbing where you want Bandaids to stick (that stuff is magic),
  • A big box of assorted Bandaids,
  • Extra medical tape, various widths,
  • Quality tweezers for dealing with slivers,
  • Extra antiseptic wipes,
  • Extra gloves,
  • Extra antibiotic ointment,
  • Saline and syringes for wound washing,
  • Eyedroppers.

This is stored within easy reach in the head, and we hope to never exceed the treatment these supplies will support.

This represents our first tier response. Small cut, burn, sliver, blister, ‘boo-boo’, something like that; everything we need to deal with it can be grabbed and delivered, to the person with the ouch, quickly.

Then, for when things get over the top, a major SHTF (SHTF is an acronym for ‘excrement – mechanized ventilator collision’) kit, similar to what you can purchase online at Live Action Safety, based on a medical bag designed and apparently used in the military. If you google for ‘m17 first aid kit’ or ‘fa110 first aid kit’ you will find something similar. Different vendors supply kits with different contents, so do shop around.

SHTF first aid kit

It can be carried by a shoulder strap or backpack style, and opens in three folds exposing six zippered compartments that allow access to contents in use. There is plenty of room in the carry bag to augment the contents. It’s about 13.5” long by 10”wide and 16” tall stowed or folded up for transport, and unfolded to expose the interior compartments, the bag measures about 36” long by 10” wide.

The contents of these typically look like this:

  • 5 – Bleed Stop Bandages
  • 4 – Sterile Pads, 4″x4″
  • 2 – Triangular Bandage
  • 2 – Ammonia Inhalants
  • 2 – Suture Sets
  • 2 – Stainless Steel hemostats
  • 1 – Tweezers
  • 10 – Abdominal Pads, 5″x9″
  • 2 – Airways
  • 10 – Butterfly Strips
  • 5 – Tape, Rolls, Adhesive, 1″
  • 1 – EMT Shears, 7.25″
  • 5 – Multi Trauma Dressings
  • 1 – EFA First Aid Book
  • 14 – Pain Relievers/Aspirin
  • 6 – Pairs Latex Examination Gloves
  • 15 – Antiseptic BZK Wipes
  • 2 – Burn Aid Packages
  • 15 – Iodine Wipes
  • 1 – Tourniquet (Basic Rubber Latex)
  • 12 – Elastic bandage 2”
  • 100 – Bandage Strips, 1”x3”
  • 2 – Elastic Bandages, 6″
  • 1 – Pen Light
  • 1 – CPR Mask
  • 1 – Hand Sanitizer 2 oz
  • 4 – Triple Antibiotic Packages
  • 1 – Scalpel Handle #3
  • 2 – Scalpel Blades
  • 2 – Eye Pads
  • 6 – Safety Pins
  • 1 – stethoscope
  • 1 -Skin and Eye Wash
  • 10 – Knuckle Bandages
  • 3 – Instant Ice Packs
  • 1 – Calamine Lotion, 6 oz.
  • 2 – Tongue Depressors
  • 6 – After Bite Wipes
  • 1 – SAM Type Universal Splint
  • 1 – Hand Soap
  • 15 – Alcohol Wipes
  • 10 – Sterile Pads, 2″x2″
  • 1 – Skin Probe
  • 1 – Burn Spray
  • 1 – Lip Treatment
  • 4 – First Aid Cream Packages
  • 3 – Petroleum jelly
  • 1 – Box of 100 Cotton Tips
  • 15 – Clean Wipes
  • 2 – Pill Bottles

We topped up/overfilled the kit with:

  • More gauze (lots more gauze),
  • More triangular bandages,
  • More safety pins (dollar store),
  • Extra medical tape, various widths,
  • More BZK and Alcohol wipes,
  • Package of ‘Wet-ones’ cleaning wipes (for cleaning around wounds),
  • Crazy glue (stitch substitute),
  • CAT tourniquet, similar to this one,
  • Several quick-clot stop bleeding bandages,
  • An extra SAM Splint,
  • A headlamp,
  • A flashlight,
  • Lots of extra gloves,
  • A couple of space blankets,
  • Duct tape (three or four 25’ lengths rolled on golf pencils),
  • Big orange garbage bags (ground cover/rain cover/blood catcher)
  • A few wound treatment/dressing change trays, similar to this one  (mostly for convenience, these are most everything you need for immediate treatment or re-dressing of a more than ‘boo boo’ issue in a single sterile kit, super easy to grab and use),
  • A couple of surgical staplers, similar to this one,
  • A ‘surgery’ kit, similar to this one,
  • Saline solution for wound cleaning,
  • Hydrogen peroxide,
  • 90% Isopropyl alcohol,
  • Syringes for wound cleaning,
  • Eyedroppers,
  • Eyewash bottle,
  • Cervical collar,
  • A selection of Catheters,
  • Some spray on ‘Bandage’ material,
  • Some ‘second skin’ for burns or blisters.
  • Finger splints,
  • Finger cots,
  • Other things we generally thought were a good idea while browsing in the first aid section.

All contents were repackaged as we saw appropriate in heavy duty Ziplock freezer bags. We made sure everything in the boo-boo kit was replicated in the SHTF list so we would not need to bring both.

We looked at the larger, upscale adventure medical kits and more current issue military kits (fa138 or fa140) for inspiration on what to add, although the price of these scared us off and there did not seem to be a huge difference in the actual supply of contents.

We also carry a couple of burn treatment kits like these ones you can get at Canadia Safety Supplies (two because they’re mostly consumables and the kits were cheaper than buying more of the contents). One in the SHTF kit, one in the head next to the boo-boo kit.

These contain burn specific treatments, usually a bill of materials something like this:

  • 1 Burn Dressing – 5.1 x 15.2 cm (2″ x 6″)
  • 1 Burn Dressing – 10.1 x 10.1 cm (4″ x 4″)
  • 1 Burn Gel Bottle 59gr (2 oz)
  • 6 Burn Gel Packet 3.5ml (1/8 oz)
  • 1 Conforming Stretch Gauze Bandage Roll – 10.1cm (4″)
  • 1 Vinyl Medical Examination Gloves, Powder Free (Pair)
  • 1 Paramedic Bandage Scissors 5.5″
  • 1 Roll of first aid tape – 1.25cm x 4.5m (1/2″ x 5yd)
  • 2 Cotton Tip Applicators, Sterile – 6″ [1]
  • 1 Nylon bag with carry handle

After getting the appropriate (we hope) response materials to the injured person, the problem then becomes getting the injured person to the appropriate place (aboard, ashore, whatever).

To solve this problem, we got a SKEDCO stretcher.  Basically a semi-flexible sheet of some kind of HDPE with straps that roll it over on the edges and foot to transform it into a surprisingly rigid stretcher that tightly controls and constrains the enclosed patient.

According to the Sked company, these are “equipped for horizontal hoisting by helicopter or vertical hoisting in caves or industrial confined spaces. When the patient is packaged, the stretcher becomes rigid. The durable plastic provides protection for the patient while allowing extrication through the most demanding confined spaces. The stretcher is rolled for storage in a tough cordura backpack, which is included with the system.” The design and materials allow it to be carried or dragged as terrain and personnel allow, and it stows in a very small space (about 30” long and 8” in diameter).

We packaged this with an Oregon Spine Splint (OSS). According to the company that makes it, the “OSS II provides for safe removal of patients from injury sites without doing further damage to the spine. The unique criss-crossing shoulder strap design provides superior immobilization without restricting breathing and, for clavical fractures, can be re-configured to retract and immobilize the shoulders. The OSS II is designed to provide easy access to the patient’s chest or abdominal area for treatment or diagnostic procedures. It can be used in place of a conventional short backboard and as a hip or leg splint.”

While these items cost a fortune new, they often show up as cheap army surplus on eBay. We got the Sked and OSS for less than ~$250 Canadian for the set on eBay. As an added bonus, the packaging was an attractive camouflage, and it was already dirty! The spine splint stores inside the stretcher. They are designed to be easy to transport when empty with a shoulder strap or backpack style and easy to carry or drag when loaded. We keep this stored under a berth.

We also considered modifying one or some of the under berth plywood supports to make traditional long boards and spine boards like those in the diagram, but decided to go the Sked route instead. (Pretty easy to do with a hole saw, jig saw, some epoxy and wood for the runners and time. Just add some straps and padding and you’re good to go. You can leave them wide as long as the holes for the straps are in the right places.)

So if we have to respond to an off-board emergency, everything is waterproof, floats, is man-portable and easy to transport. The Sked stretcher (with the Oregon Spine Splint inside) and SHTF kit carry bags also have six foot 1/2” three strand nylon lanyards and snaps spliced to them to augment their backpack style cases and shoulder straps for securing/transporting.

We don’t have a dedicated dental kit, but we do have OraGel topical painkiller, oil of cloves, 5 minute epoxy and crazy glue, so I think we can fake it. It’s stored in the head cabinet.

For medication, we have a list similar to what you see on the Safety and Seamanship Resources from the Cruising Club of America. We store it separately from the other stuff as it goes off after a few years and isn’t needed with the same urgency as, for example, a bandage or splint. I think you can always wait 30-60 min for antibiotics. We have found these types of antibiotic easily available over the counter and inexpensive in Mexico or other Central American countries. We don’t carry any serious pain killers, as opioids can cause trouble with customs. We’re strictly over the counter on pain medication.

While we have taken first aid courses over the years, they won’t have taught us everything we might need to know and we may have forgotten a few things over time, so we keep some reference materials at hand. We have e-copies of:

  • ‘The Ship Captain’s Medical Guide’
  • ‘Where there is no doctor’,
  • ‘Where there is no dentist’, and
  • a paper copy of ‘Marine Medicine, A Comprehensive Guide’, by Eric A. Weiss, M.D. and Michael Jacobs, M.D.
  • Military first aid manuals are surprisingly comprehensive, googling for the “Special Operations Forces Medical Handbook” or the “Ranger Medic Handbook” or similar titles can get you some very useful manuals that have comprehensive suggested packing lists for remote areas.

These are more suited to longer term or more remote care, as most first aid or medical books are written with the idea that you will be tended to by professionals within 20-30 minutes of injury. These books assume you’re under the care of your shipmates for hours or even days, and don’t assume a lot (or any) medical training.

Other goods we have now learned to carry include anti fungal creams (don’t ask, yes you want this aboard), a couple of extra litres of hydrogen peroxide and a couple of extra litres of 90% isopropyl alcohol for cleaning (while discredited in current practice as too aggressive, these traditional disinfectants work and have their place), iodine for disinfecting, and cortisone cream for bites/rashes.

Annual maintenance is simply changing the batteries in the flashlights and headlamps, and making sure nothing has burst or leaked. (Editors note: if using a zippered bag to store your first aid kit, clean and lube the zippers at least once a year.  Zippers tend to get crusty in the salty environment of your boat and the last thing you want is a first aid kit that won’t open when you need it).  While most supplies have expiry dates, on things like gauze, we ignore them, and on medication we are perhaps a bit liberal. We think that the efficacy of medication may decline a bit past the due date, but it doesn’t stop working, so we let most medications stay aboard longer than the best before dates suggest.

Worst problem so far? Pinched finger needing a bandaid. Ouch!