One of the most worrysome occurrences during a short-crewed long passage is having a crewmember in urgent need of medical care, be it due to a sudden illness or, even worse, an accident, when the nearest port is many sailing days away.
The two longest passages in a circumnavigation take more than 20 days each and, unless in the very first few days, sailing upwind back to the starting point is not a feasible option as it is also the case for diverting to an intermediate destination.
Even when in or near port, this does not necessarily mean that adequate medical care is readily available or that the required medicines are available.
Therefore, a certain degree of self-sufficiency is needed, both in terms of being able to administer basic medical care as well as in terms of having available on-board all the required tools and medicines, possibly to be used by a local doctor or, in extreme emergency, upon advice from a remote doctor contacted by radio or satphone.
CHECK-UP and pre-departure PROPHYLAXIS:
Every year stories are heard of boats that had on-board medical emergencies due to pre-existing (and, quite often, previously known) medical conditions. A pre-departure medical check of all crew-members is really a basic precaution, and this does not mean that a person with a medical condition should not undertake such enterprises, but this should be thought out seriously with one’s MD.
Another important aspect is the prophylaxis against endemic diseases which are common in many tropical areas: specific medical advice is easily available, and the problem must be addressed well in advance of departure because some vaccinations require more than one inoculation and/or cannot be performed simultaneously.
ON-BOARD MEDICAL KIT:
The list in pdf format that can be downloaded from our web-site at this address: http://www.webalice.it/gianfranco.balducci/Shaula/images/Medical%20Kit.pdf has been prepared by some Doctors participating in the Rally and is an excellent starting point. This list is a subset of the official “A” table that prescribes the medical stuff for seafaring ships.
Note: quite a few of the listed medicines can be purchased only with a doctor’s prescription or being the holder of a “Medical Care aboard Ship” proficiency certificate (but only through dedicated suppliers of ships’ medical provisions – more about that in a minute).
Another note: the list intentionally does not include strong painkillers (e.g. morphine) because in many places they are rated as illegal drugs and their possession without being an MD (or holding the above-mentioned certificate) is a criminal offence that may land you in jail! Still, even some of the milder painkillers in the list must be stored in the “Captain’s safe” and in some Countries even they may be looked-upon with suspicion.
The commonly-available “First-Aid” courses are of almost no use because they are actually meant to “keep alive” a casualty for the few minutes before an ambulance arrives, and possibly avoid “doing damage” through good-willing but clumsy practices. These skills are useful, but fall far short of what you need in the middle of an Ocean!
What you actually need is the skills to provide “emergency medical care” over an extended period of time and, as nobody can become a Doctor in one week, this is achieved by learning the PROCEDURES to be followed and how to consult MANUALS (first and foremost the “Ship Captain’s Medical Guide”) and, if at all possible, consulting a Doctor by radio or satphone: you learn how to search for SYMPTOMS and then use them to look into the Manual or to report them to a doctor, and then apply the medicaments according to the advice received.
All this is taught in the “proficiency in Medical Care aboard Ships” training courses, that are available to professional mariners and to leisure sailors as well in several places around the UK.
You MUST have on board the “Ship Captain’s Medical Guide”, and another useful document is the international rule MSN1768, which lists all the medicines of the official medical kit and indicates purpose, dosage and side-effects, if any.
I made a short version of this document, which can be downloaded here: http://www.webalice.it/gianfranco.balducci/Shaula/images/Medicine%20Usage%20Guide.pdf and which is limited to the medicines which are in the recommended on-board medical kit.
HELP FROM OUTSIDE:
In the Rally there were several Doctors, so obviously our first option would have been to talk to one of them: we did not have the need, but others did – luckily not for any really serious illness!
The Italian CIRM (International Radio-Medical Centre) provides medical consultancy to ships worldwide and can be contacted by SSB, Satphone or e-mail: it’s one of the few such services existing in the world, and in case of need we would certainly have given them a call.
The US Coastguard reportedly has a similar service.
Do NOT count on the possibility of an air-lift: unless very close to the shore of an advanced Country, both helicopters and float-planes will be out of range or plain simply not-existing.
There IS the possibility of help from nearby SHIPS: passenger ships as well as naval vessels normally have doctors and medical facilities on board, and even merchant ships may not have a doctor but would be able to carry the casualty to a port in a matter of few days!
Transferring a sick or wounded person would be a dangerous operation in anything other than a calm day, and should be considered only for seriously-ill patients. Another consideration is the handling of the boat by the remaining crew, expecially if only one is left: here being in a Rally may be of help, as another boat may be able to lend a crewmember.
European citizens when traveling around the Union are entitled to free medical care, but this does not extend even to European Countries’ overseas territories, let alone other Countries (although there may be some bilateral agreements in place, e.g. with Australia).
A Traveller’s Medical Insurance would be highly advisable, but unfortunately that’s very hard to find, and prices may be prohibitive.
Unfortunately, this is not a low-probability risk: in the Rally there were at least 3 or 4 cases of people who ended-up in hospital and at least in one case (in Australia) this was quite expensive.