Ready, set, sail: Medical kit and health readiness

One of aims of our journey is to travel off the beaten path and to sail to remote locations. As much as my nature is to focus on what could go right, rather than on what could go wrong, there is a very real possibility that one or both of us could become ill or sustain an injury during our adventure. As such, I put a great deal of thought into preparing our medical kit, so that we will be as prepared as we can be to tackle the types of ailments that are most likely to occur.

Initially, I investigated prepackaged offshore medical kits that can be purchased online. After all, there is no reason to reinvent the wheel unnecessarily. However, ultimately, we opted to stock our own kit for two main reasons. First, pre-packed kits are extremely expensive. Secondly, we agreed that most pre-packed kits failed to include a large enough supply of certain items that we thought were important. After reviewing available kits and conducting some research independently, I completed a first aid at sea course. I also reached out to my professional network to get input from physicians who work with trauma patients and physicians who happen to be adventurers themselves and have had to provide (or receive) care in remote locations around the world. All of these were helpful in organizing a comprehensive kit.

Medical suppliesI organized our medical supplies in two containers, both of which are small coolers (one of which is from a cheesemakers company…reuse and recycle!). The larger (blue) one contains most supplies, while the smaller (orange) one includes medications. Items are generally grouped by categories (e.g., allergy, wound care) listed below and are labeled as such in ziplock bags. I created an inventory in Excel to monitor item use, so we know when to restock. In the list below, I’ve italicized items that a prescription was required to obtain. I’ve placed an asterisk next to items that I would like to obtain more of before we get too far off the grid. When all was said and done, supplies (including all prescriptions) totaled somewhere in the neighborhood of $600, which is a fair amount less than many of the prepackaged offshore kits.

Medical kits

Supplies inventory
Allergy
48   x    Benadryl
2   x    Epi-pens
1   x    Anti-itch gel

Burn
1   x    After burn gel
1   x    Aloe vera gel (without alcohol)
1   x    Aloe vera lotion

Cold/flu
10   x    Theraflu (daytime/nighttime)*
3   x    Alka-seltzer cold medicine (daytime/nighttime)*
1   x    Cough drops*
1   x    Thermometer

Eye care
4   x    Sterile eye wash (mini viles)
2   x    Multipurpose eye solution
1   x    Eye drops
1   x    Saline
1   x    Eye patch
1   x    Ofloxacin (eye antibiotic)
1   x    Polymyxin-Bac (antibiotic eye ointment)
1   x    Prednisolone (eye steroid)

Female health
15   x    Azo
2   x    Monistat

Gastrointestinal
30   x    Imodium plus
30   x    Gas-X
24   x    Pepto-Bismol
20   x    Ondansetron (nausea related to GI issues)
15   x    Ciprofloxacin (anti-diarrhea)
2   x    Exlax
2   x    Tums (bottles)
1   x    Enema

Hydration
20   x    Crystal Lite/Propel packets
10   x    Oral rehydration salts

Seasickness
16   x    Meclizine pills
16   x    Dramamine
15   x    Scopolamine patch

Pain
100   x    Aspirin
50   x    Aleve*
50   x    Hydromorphone (Dilaudid)
16   x    Instant icepack
1   x    Icy hot

Skin care
2   x    Chapstick (SPF 45)*
1   x    Gold Bond rash cream
1   x    Hand sanitizer*
1   x    Abreva

Wound/injury
40   x    Bandaids – Regular
20   x    Bandaids – Large
40   x    Gauze pads (4×4″)
20   x    Gauze pads (8×10″)
24   x    1/2″ steristrips
24   x    1/4″ steristrips
20   x    Latex gloves (pairs)
40   x    Cephalexin (Keflex; antibiotic)
30   x    Safety pins
8   x    Self-adhering bandage tape
5   x    Moleskin/blister bandages
2   x    Hydrogen peroxide
2   x    C-A-T tourniquet
1   x    Combat gauze
1   x    Israeli tourniquet (gray bandage w/coagulant)
1   x    Waterproof first aid tape
1   x    Ace wrap 2″
1   x    Ace wrap 3″
1   x    Ace wrap 4″
1   x    Sling
1   x    Medical stapler
1   x    Staple remover
1   x    Neosporin*
1   x    Plastic tweezers
1   x    Scissors
1   x    Hemostat

Vaccinations
We consulted with a travel nurse about the specific countries we intend to visit. Although we both had traveled a fair amount before we met, we each had to complete some extra vaccinations. In addition to routine immunizations (generally administered in childhood), we got the following vaccinations:

  • Tetanus
  • Typhoid
  • Hepatitis A&B
  • Yellow fever

At this point, we have elected not to seek medications for malaria prophylaxis. We will review Centers for Disease Control (CDC) updates regarding malaria in nations where we’ll be traveling throughout our voyage and obtain medications, as needed. Documentation concerning our vaccinations, particularly yellow fever, are stored with copies of documentation related to the boat.

Contraception
Although the topic of reproductive health may seem a bit too personal for some, Neil and I are in prime childbearing years, so this is a critical healthcare topic for us. Skip this section, if it strikes you as inappropriate or dull. Neil and I hope to add children to our lives in a few years, but for the time being, our goal is remain a crew of two. Contraception was an important discussion for us as we geared up for our journey. We have always used contraceptive pills, however, we encountered some obstacles to continuing to use that approach. I learned that my doctor can only prescribe pills in 3-month increments, which would have required me to have pills shipped to exotic locations and to pay for them out of pocket, as our health insurance was slated to end when we quit our jobs. The last thing I wanted to worry about was how I was going to get birth control pills shipped to the Pitcairn Islands. I also anticipated that I would lose track of days, as routines were loosened and or thrown out the window completely, especially on passages wherein sleep and wake schedules get funky. This lovely phenomenon is already happening just three weeks into our voyage! Lastly, what if the pills somehow got wet and dissolved (not totally out of the realm of possibility given the nature of our boat-based adventure) or were harmed by scorching conditions, such as those we’ll expect in Mexico?

After doing some homework and conferring with multiple gynecologists, we settled on an intrauterine device (IUD). IUDs are slightly more effective than oral contraceptives, I suspect at least in part due to greater human error involved in the latter. I had an IUD called Skyla placed in July to allow me sufficient time to get used to the device and to determine if I would have any undesirable side effects. So far, so good! Luckily for me, it was covered entirely by insurance. The Skyla will deliver a slow release of hormones with absolutely no necessary action on my part and will be effective in preventing pregnancy for three years.

Final thoughts

  • If you have health insurance, be sure to obtain any prescriptions you have before it lapses. Because we were both employed until the weeks (for me) and days (for Neil) before we departed, this was not a problem. For those who sever employment earlier, however, this is a hot topic to address sooner rather than later. With insurance, we spent $145 on prescriptions that would have otherwise cost upwards of $800.
  • At the urging of one of my mentors, we are also considering purchasing a fiberglass cast-making kit. We also wish that we would have gotten a prescription for Silvadene (silver sulfadiazine), a medication for treating burn wounds.
  • We are in the process of purchasing health insurance that will cover us after we leave the United States. Thanks to the recommendation from the crew of s/v Totem, we’ll be working with the International Medical Group (IMG) and plan to obtain Patriot Travel Medical Insurance.
  • In addition to the items inventoried above, we have two small, day medical kits. We also have a medical kit in our ditchbag. Items in those kits are not included here.
What else do you include in your medical kit? Are we missing anything?

19 thoughts on “Ready, set, sail: Medical kit and health readiness”

  1. Add a couple of bottles Pedialyte (Wal-Mart’s Equate brand is good) to your kit for dehydration. If you get sea-sick, your biggest danger is dehydration. If you sip on Pedialyte it will prevent this. It taste horrid but it works!

    I didn’t see anything for tooth aches. Wal-Mart pharmacy sells dental mirrors, numbing gel and temporary filling compound.

    Consider adding a blood pressure monitor, tracheotomy kit and stethoscope. These are also at Wal-Mart Pharmacy

    Get a script for antibiotics filled before you go (if you have a captain’s licence, this is an easier process). If not, buy some in the first country you arrive at outside the USA. Get cream and pills.

    How were you able to write a traveler’s health insurance policy when you are hopping from country to country? Most companies will write for specific countries only. I would like to know more about this. Right now, our plan is to pay as we go for insurance. We have discussed it with many cruisers and this is the most common. The of healthcare outside the USA is very good and the prices are about 1/5 of USA prices.

    Mark and Cindy
    s/v Cream Puff

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    • Hi Mark & Cindy,

      We keep Emergen-C and Propel/Crystal Lite handy, but adding Pedialyte is a great idea! We also agree that lack of any dental supplies is a problem. We are working on changing that. After speaking with two trauma surgeons and a physician who treats pediatric trauma patients, we elected not to get some of the other supplies you mentioned for a couple of reasons, namely our age, current health status, limited skills to use those devices, and inability to do much with the information they could provide. If we had more skills, we might feel differently. We also accept that there are certain ailments we will not survive if they were to occur in a remote location or during a passage, regardless of our knowledge or tools. For example, cardiac arrest or moderate to severe brain injury would almost certainly be fatal. Neither of us have a Captain’s License, but we did get our prescriptions filled before we left. Good call on that. As far as insurance, we were very pleased with IMG’s willingness to cover us from US to AUS for a low rate. We still haven’t officially signed up and keep going back and forth about it, for some of the reasons we mentioned above (i.e., age, few health issues), as well as for the reason you stated (i.e., low cost of healthcare outside the US).

      Thanks for your thoughts and ideas!
      Jessie

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  3. One thing I’ve found indispensable on our trips are butterfly bandages in a couple of different sizes. While I can do stitches thanks to the U.S. Army I prefer to use the butterfly. I actually attached a large piece of my wife’s heal back on with them. Kept it clean and fairly dry for a week and you couldn’t tell she had cut it off.

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    • Hi Lou!! YIKES, it sounds like your wife had one heck of an injury! We have steri-strips in multiple sizes, but we are going to get some butterfly bandages as well. One of my surgeon friends agrees that they are a bit stronger. Good call 🙂 ~Jessie

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  4. I’m sure you know this already but it’s always been a problem for us: It’s important to store your medications in a place where the temperature doesn’t exceed 77 F (25 C), which can be tricky on a boat. Somewhere down low along the waterline is best, but of course, it has to stay dry, too (watching out for humidity problems as well…). I second the suggestion of the butterfly bandages. Those are obligatory for offshore boats here in France. The other thing that is highly recommended here is some sort of mild anti-anxiety drug. We have an over-the-counter homeopathic thing (based on the plants Valeriana and Passiflora) that is normally given to hyperactive kids to help them sleep. It doesn’t make you sleepy or fog your brain, but just takes the edge off the nerves at times when you feel like you’re about to have a meltdown. Very useful for us !

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    • Maria, that is a really good point. That was one of my fears with using pills as our means of contraception…the last thing I wanted was to wind up pregnant because the pills got overheated in Mexico! Hooray for IUDs! Both of our storage containers are coolers, which I *hope* will help keep the temperature a bit lower. Right now, we are keeping them in our forward head, but I am going to keep your advice in mind and may need to move the supplies elsewhere as we get farther south. Thanks! We are also adding the butterfly bandages, thanks to you and Lou. Neither of us take anti-anxiety meds, but I am curious about the homeopathic remedy you mentioned… ~Jessie

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  5. Nice post. I liked that you got into some of those uncomfortable discussion areas. We had similar discussions but as we don’t want kids it was a little easier. I just got snipped.

    As others have pointed out, I didn’t see anything for dental health. We have these on our packing list for our med kit: http://www.amazon.com/dp/B0073H1UQQ/ref=wl_it_dp_o_pC_nS_ttl?_encoding=UTF8&colid=39MIX828ZRAEZ&coliid=I3O1VNV841G8KY&psc=1

    I noticed you had some things for stopping bleeding, I friend that is in the military suggested this stuff he carries in combat areas: http://www.amazon.com/dp/B001BCMLWQ/ref=wl_it_dp_o_pC_nS_ttl?_encoding=UTF8&colid=39MIX828ZRAEZ&coliid=IZMIVWHN1WGA0

    And then based on personal experience I would recommend some surgical blades and surgical lubricant. I have had the experience of having to cut my father’s thumb open with a pocket knife to get a hook out. Not a great time without a really, really sharp blade.

    Good luck. I hope you never have to use any of this and it’s just wasted money (one of the very few times you will hear a sailor/cruiser say that).

    Jesse

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    • Jesse,

      Thank you SO much for sending links! These are VERY helpful! I read the reviews of the dental kit, and there was one person who had to use it on two occasions. It worked well for them. In both the combat gauze and Israeli tourniquet there is quick-clot. Let me know if you want the links where I bought those. We had not thought of surgical blades, but that is a GREAT idea! Thanks so much…and yes, fingers crossed we don’t need any of it.

      ~Jessie

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  7. Ahoy The Red Thread, you guys are really doing it and having fun. I watch daily when you are sailing. I enjoyed the report on the first aid kit. And of course have a bunch of comments. Hopefully constructive. 1; hydrogen peroxide has been used for decades to cleanse wounds, but studies from the 1980s showed it did more damage than good. It kills human tissue. Thus there were several editorials in major medical journals to the effect “I hope I never hear of another doctor recommending hydrogen peroxide in human wounds.” Present recommendations for traumatic wounds are to cleanse with clean water, dry and dress. Betadine to cleanse is also useful, and easy to get, and probably more stable than H2O2. If a wound is infected antibiotic ointment can be of some benefit. Neosporin is popular, although allergy to neomycin is common, so we prefer polysporin. If you want silvadine let me know I can call it into a pharmacy near you in Ca. I don’t see an advantage to it, but no danger either.

    2; I think u need more Cipro, as well as some doxy and Septra DS. All good antibiotics. Doxycycline is the choice for malaria prophylaxis and travelers diarrhea, although for TD Cipro and Septra work very well. Allergies can be an issue esp with Septra, which is sulfa based. Sun sensativity is mentioned with doxy but is not that common and seldom limits it use. Again I would be happy to call those in to a pharmacy near you.

    3; you seem to know an ophthalmologist, so you might ask him or her about an eye band aid. It is a no correction contact lens and a God send if you get something in an eye. I did last winter which my ophthalmologist using a slit lamp could not find. The band aid saved my sanity. He gave me one for my first aid kit. If you need that called in I can try, but am unsure where to get them.

    4; I think you need a good topical steroid, like clobetasol cream, and a good anti fungal like econazole cream. Both are cheap and I can call them in as well. Clobetasol is a bit strong for use on the face, but otherwise great for itchy skin. Again I am very happy to call them in.

    Ondsaterone ,which you have,is good for motion sickness.

    None of these is expensive.

    I hope this is helpful. You can e-mail, or call me to discuss this. You are probably well advised to run this past another MD, and I would be very happy to discuss it with them or you or both. Cell 425 785-8012, home 425 454-6882

    Love you guys, Russ Caldwell MD Sailing dermatologist.

    Sent from my iPad

    >

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  8. Great post! I’ve got a prepackaged Medical kit, but you’re right – they don’t give you very much of the things you’ll most likely use most. Great suggestion on the cast kit, too. Never would have thought of that.

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  9. Some Dental stuff maybe nice, not being able to control an absess. There is some temp crown and filing products you might welcome.

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  10. Good post! Very comprehensive. We ended up with insurance through Divers Alert Network (dan.org) for traveling. The cost was very reasonable and covers boating related accidents far from home. Otherwise we were without insurance, but due to our age and relative good health and safety mindset we decided we could probably go without. No serious injuries to report after six months 🙂

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    • Thank you so much for your feedback and additional item idea. I’ll check out the link! It feels good to hear from people with extensive experience in the medical field that we are in decent shape in this domain! Cheers, Jessie

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