Dive boat first aid kits

[novicediver]

A previous thread got me thinking (dangerous thing I know!). Since many nurses, doctors, and paramedics, also happen to dive, what would you like to see if you opened up a first aid kit? As I mentioned in the other thread, airlines now often have AED's, IV fluids, and first line cardiac drugs. Also items such as BVM's, and oral airways are carried. My point is, if something happens, even with advanced training, we are still limited by what tools we have access to. I know there are issues such as cost and liability involved but there are ways to resolve them. Just a brainstorm to see what you would want available in a med kit if it hit the fan on board.

 

[GIFCo147]

First Aid Kits vary greatly in their style and supplies. I have seen anything from a small waterlogged bandaid box to a kit that would rival an Advanced Life Support Ambulance.
This said, My kit is fairly robust. It is an orange soft sided bag. It stays in the cabin of my boat, but most of the contents have been vacuume sealed to keep everything clean and dry.
This is from memory, so it may not be complete, but it contains:

BSI:
Gloves, gown, goggles, mask, N-95 resp., CPR Microshield, sm red bag

Diagnostic:
Cuff, Scope, Penlight, shears, paper, pen, Patient Care Reports, plastic survey tape (red, yellow, green, and black)

Airway:
O2, Oral airways (ad/ped sizes), Nasal airways (ad/ped sizes), Bulb suction, Tongue Blades, L'scope and ET Tubes (2 each 3.0-9.0), Magill Forcepts, tube restrints, end tidal CO2 detector, tube check (bulb style)
BVMs (ad/ped) with assorted masks

Trauma:
Bandaids, 2x2s, 4x4s, 5x9s, Trauma Dressings, Burn Sheet, 2" Kling, 4" Kling, SAM Splint, hot packs, cold packs, triangle bandages, two adjustable C-Collars

Medical:
Oral Glucose paste

Other:
OB Kit (has useful items like sterile drapes, scalpel, clamps, sponges, cover gown, chux pads, plastic bag and twist tie). This is a handy kit to have for many different medical/surgical type events, not just birthin' babies.

I also have some allergy issues, so I usually have epi-pens around.

I'm sure there is more, but that's what I could remember off the top of my head.

It should probably be stated that you should not carry anything that is outside of you level of training, or that you are not authorized to carry.

Stephen

 

[erparamedic]

Stephen...

I, being a Paramedic, think you have a GREAT kit! Are you trained to use everything? For example... shouldn't intubate, if you don't know how... it's easy to accidentally get the tube into the esophagus, or if you don't secure it right, you can lose the airway. Do you routinely check the expiration dates on epi-pens and glucose?

The only things I would add would be 4-6 1 L bags of 0.9% NaCl IV fluids, and some angiocaths, 3 each, sizes 16, 18, 20, and 22. IVF can be very important in certain emergencies. I don't know how hard it would be to get cardiac drugs... 1:10,000 Epi, Lidocaine, Atropine, Amiodorone... are the big ones. Cardiac drugs of lesser importance, would be Mag Sulfate, Calcium Chloride, Sodium Bicarb. (This is NOT an all-inclusive list of cardiac drugs). Of course... ONLY trained folks.... docs, medics, etc should be the ones to administer such drugs.

Also, the last thing that would be nice, but out of range for many dive ops, is an AED. The price on them are coming down, and they are stupid-proof now. They have pictures on the pads that show where to put them, and you hook the pads to the machine, and follow what the machine says... mainly charge, clear, and shock.

I'll have to say again, though, that you have a great kit! I just gave a few options to think about adding.... of course, ONLY if you are trained and legally allowed to carry said things.

 

[novicediver]

Just speaking from what we carry on the airline, all kits are inventoried and sealed. There is no guarantee that a doc, nurse, or medic, will be on board but it is available just in case. Maybe some of the larger liveaboards can explore expanding their kits. Much of the liability is still covered in the United States under Good Samaritan acts as long people act within their training level. Of course I am not an attorney so that is an issue that would have to be explored as well.

 

[GIFCo147]

Hi erparamedic,

Sorry, I didn't start off stating my background. I'm an RN, EMT-P in New York State.

I am a firm believer in checking tube placement by several different means. That is why I check tubes with a stethescope, tube check, and end tidal CO2 detector. I use the screw- down type tube restraint. They really do work great in the field.

I make it a habit to check the epi pens and glucose dates regularly. I also replace the epi every 6 months or so, because the boat does experience a wide temperature range (Great Lakes- Cold Spring/Fall, Hot Summers!).

I carry saline bags for irrigation, but I have stayed away from angios and meds for my personal kit. Maintaining it would be time consuming, and the expense would not be insignificant.

AEDs are getting cheaper and New York State has done a good job of keeping up with Public Access Defibrillation changes. As the prices come down, AEDs will certainly become more wide spread.

I will have to get in touch with you if I get to FDIC next Spring.

Take care,

Stephen

 

[Scottri]

I'd love to see a kit like that and the training to use it all. I was involved in a rescue attempt 2 weeks ago where an AED and the cardiac meds may have saved a life but we did not have access to them. We had a paramedic diving with us in our party but he could only do so much with what we had. I can't say if the vicitim would have lived but it would have given him a better chance.

 

[erparamedic]

Hi erparamedic,

Sorry, I didn't start off stating my background. I'm an RN, EMT-P in New York State.
I am a firm believer in checking tube placement by several different means. That is why I check tubes with a stethescope, tube check, and end tidal CO2 detector. I use the screw- down type tube restraint. They really do work great in the field.
I make it a habit to check the epi pens and glucose dates regularly. I also replace the epi every 6 months or so, because the boat does experience a wide temperature range (Great Lakes- Cold Spring/Fall, Hot Summers!).
I carry saline bags for irrigation, but I have stayed away from angios and meds for my personal kit. Maintaining it would be time consuming, and the expense would not be insignificant.
AEDs are getting cheaper and New York State has done a good job of keeping up with Public Access Defibrillation changes. As the prices come down, AEDs will certainly become more wide spread.
I will have to get in touch with you if I get to FDIC next Spring.
Take care,
Stephen

Stephen... I'd love to hear from you if you come down for FDIC. We haven't been able to make it there the last couple years, but did so for every year, for about 10 years prior. It's a fun convention. We've also been to the Firehouse Expo in Baltimore, MD.(PARTY!! Hahaha!!).

Great to know your background. Your're right... keeping meds would be quite expensive.

Jamie

 

[Thalassamania]

My only addition would be some inflatable splints. Perhaps it's just the luck of the draw but I've needed splints more often than anything else except sudafed, asprin and bandaids.

 

[Tom Smedley]

There is also the question of licensure. In Panama City Florida if a diving accident happens and a physician or nurse or paramedic from Alabama or Tennessee or Georgia happens to be on board would they be legally covered to tube a victim or to order drugs to be used or to even start an IV????

 

[erparamedic]

There is also the question of licensure. In Panama City Florida if a diving accident happens and a physician or nurse or paramedic from Alabama or Tennessee or Georgia happens to be on board would they be legally covered to tube a victim or to order drugs to be used or to even start an IV????

I am a Nationally Certified Paramedic. If you hold a NREMTP card, then yes, you would be allowed to provide care with IVs, intubation, drug therapy, defib, whatever is in your scope of practice.... and be covered under good samaritan laws. (Unless you carry your own malpractice insurance, then good sam will be there for you.) I know my employer carries my malpractice insurance. (Around here, it's the employer that provides the insurance... not the medic themselves.) If one carries national certifications or licensures, it shouldn't be an issue.

** I should add... I'm not an attorney, and don't claim to be one on tv either. I'm just a lowly under-paid medic and this post is a matter of opinion! LOL