11/21/2020 – Initial post
ON THE WATER, FOR ANYONE HAVING CHEST PAIN OR DIFFICULTY BREATHING, A “M’AIDEZ” CALL SHOULD BE MADE IMMEDIATELY. LIKEWISE, MENTAL CONFUSION, SLURRING OF WORDS OR DROOPING OF FACIAL EXPRESSION, HEAD INJURIES WITH OR WITHOUT CONFUSION AND SERIOUS FALLS REQUIRE IMMEDIATE, URGENT EVALUATION AND CARE. Plan and drill ahead of time for the possibility of a “m’aidez” call. Know what you will need to be able to tell the USCG and rescue personnel about your location and the nature of your emergency. Emergencies don’t care about the weather or seastate, so consider how you would handle the boat while caring for your spouse’s chest pain BEFORE an emergency happens. Plan and drill for the sudden and unexpected possibility of being “Suddenly Alone.” Plan for sudden disability of the Captain; plan for sudden disability of the First Mate or visiting crew member.
Prescription Medications and Medical Devices: Always do your own due diligence! My Admiral and I take over-the-counter vitamins and aspirin, and prescription statin anti-lipid drugs. I take prescription eye drops, and she takes several cardiac medications. Well in advance of cruise departure, order a 3-month supply of all prescription medications and personal care needs. With the proper documentation, customs and immigration officers (Bahamas, Canada) will clear them. Without documentation, check-in delays are possible, if not likely. It can be a problem to ship some medications across international borders, so medications that you absolutely cannot be without must be transported with you.
In the past several years, we have dealt with several different mail-order pharmacies. They are not very good at supporting travelers. (No, it’s worse than that; they are a superb pain in the posterior.) We know that they can accommodate travelers, so stay calm, but be persistent. Order early, and order only when you’re going to be in one place for long enough to wait them out. Different medications will come from different warehouses in different parts of the country. Be sure to update your delivery address a couple of days before you actually place the medication order.
Expect surprises. We have gotten to the point that we call the pharmacy company a day or two ahead of placing the order just to update our shipping address. That allows time for the updated delivery address to propagate across the pharmacy company’s computer server farm. We have had parts of our medication orders go to several different, random delivery addresses. The pharmacy companies will always blame that on you. They will want to use up one of your refills and will threaten to charge you full price for a re-do of the order. We can scramble through all that, but it’s time-consuming and annoying. If you change your permanent address before you place the order, there is a better chance they’ll get fulfillment and delivery right. But, it’s on you to manage the process and your pharmacy company.
When cruising, be sure to have documentation aboard for any injectable medications and injection supplies that you transport. What particularly comes to mind is diabetes medications and needles, and epinephrine injectors for anaphylactic allergic reactions. Sanctuary’s Admiral uses a medical device called a “TENS unit.” It’s electrical; it runs on batteries and needs electrode wires. Carry spare batteries, and if you need/use rechargeable batteries, carry a spare charger. Carry spare electrodes. Get a copy of the prescription from the doctor to keep in your onboard file. Consumable supplies for CPAP, BPAP, infusion pumps, catheters and ostomy supplies, glucose test strips and INR measurement test strips should be secured in advance of cruise departure.
Talk with your doctor before departure about having a 10-day supply of antibiotics and pain killers aboard for use in emergent situations. If you’re cruising in some remote place, it may be a day or two or three before you can get to see a nurse, let alone a doctor. Assuming no allergies to the antibiotic, starting an antibiotic right away may be/can be the right thing to do. Your doctor can advise products suitable to your personal needs. We were traveling in the salt marshes of the US southeast when the Admiral came down with an abscessed tooth. Having a pain killer at hand definitely made us both more comfortable until we could locate a dentist. I nicked a finger with a screwdriver, and within 18 hours, the finger was three times normal size and very painful. I caught the wheel of a shopping cart at Walmart with my ankle. By the next morning, my ankle was several times normal size. Things happen. Having a supply of Cephalexin/Ciprofloxacin was a really wise exercise in planning ahead, but it does not replace seeing a doctor as soon as you can.
Emergency Care: many pharmacies offer emergent care services intended to manage relatively minor health incidents. They also administer flu, pneumonia, tetanus and shingles shots (shingles with a prescription, of course). Walgreens and CVS are two national pharmacy chains we have used successfully. These facilities are typically staffed by a Nurse Practitioner. The ARNP will be able to prescribe antibiotics, and handle simple conditions like skin rashes, bruises, splinters, cuts with simple stitches, burns, sprains, and similar types of injuries. Depending on state law, an ARNP may not be able to prescribe opiate pain medications. For initial assessment of an emerging situation, these facilities are very helpful, if available.
Free-standing emergency care facilities are also available in many areas. These usually have on-site staff physicians. Obviously, they can handle a wider range of health problems, including x-rays, simple blood and urine labs, and EKGs.
If you are taking responsibility for minor children (grandchildren, for example), make sure you understand any medications they need to take and whatever condition(s) those medications are intended to treat! For minor children in the absence of their parents/legal guardians, have written and notarized parental permission to seek and request medical treatment if that should become necessary. As we Boy Scouts are fond of saying: “Be Prepared!“