Just to offer up an opinion from an anaesthetist (not my opinion of course - I'm just the messenger) who has crossed the Pacific twice recently, and his view was an AED is only useful to keep someone alive for critical minutes until delivered to an intensive care unit. On a lighter side I asked him about putting people to sleep and his reply was that that was easy, but getting them to wake up was the hard part. Now I don't want to be greedy pushing my interests from this site, but I reckon any real passagemaker would seriously hold the subject of critical health up as a major obstacle to going to remote places. However I tend to think more about places where a helicopter can't go to provide help. I saw a heli evacuation off a cruise liner in Alaska recently, and was amazed at the efficiency of the USCG, and through the VHF we were beamed in on all the drama. Bob's comment about the skipper being responsible for the crew's state of health before embarking has hit a strong cord with me - thanks Bob. Bob's comment about dislike for "floatella" type trips. I read it as he is talking about the Baha HaHa types. You know the ones only half an hour by heli away for evacuation or a Tacos. I would imagine much comfort was had by the participants of the Nordhavn Atlantic Rally who enjoyed immensely the comfort of numbers, and I would be very surprised if the wife or partner would have participated in this adventure without it. However I circumnavigated Tasmania in company, then did the Australian continent without a soul in sight, and I agree, better to do your own thing from my experience. But then again only a short distance from help from the Australian Navy doing border patrols, or help from a heli on an offshore oil rig. When you are at half way point across the Puddle - 1300nm away from land on the east, the same to the west, nothing to the south, and Hawaii 2500nm to the north is a different matter, and to talk at least to someone close by just for some company must be a nice thing to do, even if they are hours away. Then again if you gotta die you gotta die, much prefer to have a cardiac arrest on the water and cark it, than going around a mountain bend for a head on with a car driven a women who has just picked up her three kids from school. Or survive a stroke for that matter, and dribble all over the rocking chair on the porch. Any further opinions would be appreciated (qualified particularly preferred) Peter Sheppard N55#38 SKIE -----Original Message----- From: passagemaking-under-power-bounces@lists.samurai.com [mailto:passagemaking-under-power-bounces@lists.samurai.com] On Behalf Of passagemaking-under-power-request@lists.samurai.com Sent: Friday, 10 September 2010 2:00 PM To: passagemaking-under-power@lists.samurai.com Subject: Passagemaking-Under-Power Digest, Vol 70, Issue 9 Send Passagemaking-Under-Power mailing list submissions to passagemaking-under-power@lists.samurai.com To subscribe or unsubscribe via the World Wide Web, visit http://lists.samurai.com/mailman/listinfo/passagemaking-under-power or, via email, send a message with subject or body 'help' to passagemaking-under-power-request@lists.samurai.com You can reach the person managing the list at passagemaking-under-power-owner@lists.samurai.com When replying, please edit your Subject line so it is more specific than "Re: Contents of Passagemaking-Under-Power digest..." Today's Topics: 1. Passage making Challenges (Bob Austin) 2. Passage Making Challenges (Rick MacClure) 3. Re: MV Kekada (Georgs Kolesnikovs) 4. The original "Passagemaker" is alive and well (Peter Quentrall-Thomas) 5. Passage making Challenges (Don Richards) 6. Re: Passage Making Challenges (ROBERT ZANUSSI) 7. The original "Passagemaker" is alive and well (Alan) ---------------------------------------------------------------------- Message: 1 Date: Wed, 8 Sep 2010 23:42:50 -0500 From: "Bob Austin" <thataway4@cox.net> To: <passagemaking-under-power@lists.samurai.com> Subject: [PUP] Passage making Challenges Message-ID: <EAE478FAB2E945BFBA27C013FC22DE43@bobPC> Content-Type: text/plain; charset="us-ascii" Specifically medical issues: Disclosure, I am a retired MD, Internist, Nephrologist, Athletic Medicine physician. I also spent about 10 years in my training working in some of the busiest trauma emergency rooms in the United States. I have put together several hundred medical kits for long distance cruisers and ocean racers, and have given advice via E-mail, WinLink, and Ham SSB/Marine SSB radio to many mariners, missionaries etc through the last 50 years for specific medical emergencies at sea. I would not pretend to practice medicine on the internet--and those who are not fully qualified should not either! For example--Oxygen can be very useful in certain circumstances, but generally I would not put it aboard a passage making small boat, unless there were specific medical conditions which might call for it. I would never put Nitrous Oxide aboard such a boat. Some on this forum, and many on T & T list have heard my lectures on Medicine at sea. First I would recommend that EVERY crew member be currently certified in CPR, and have at least an advanced first aid certificate--better yet, EMT training. Another good training course is through the Wilderness Medical Society. Although an automatic external defibrillator can be of use in very specific situations--they are best placed in public places or with public safety officers, where large numbers of people have access. If there is a history of cardiac disease, or risk factors, then aboard the boat might be a suitable place--but again--then everyone aboard that boat needs to be certified to use the AED. After defibrillation, there is the long term care of the heart attack victim. In most cities that would be in a cardiac intensive care unit supervised by cardiologists. Would I carry an AED?--yes, would I carry oxygen?--yes, but I have cardiac disease, and carry these items in both my boat and RV, because of that; however, crew mate and wife is an RN who has been advanced life support trained and is very experienced in emergency care. As for each crew member, I suggest that he or she have a comprehensive physical exam before leaving on the voyage, and if indicated cardiac stress tests, lab tests, and X rays. The skipper is responsible for the crew's well being! (For example one person I know of, took a diabetic as a crew member. That person went into diabetic coma about 5 days out of Los Angeles and died before Coast Guard assistance arrived) Vaccinations need to be up to date, and prophylactic medication be aboard for the areas you will be going into. (For example Malaria in parts of the world--and there are resistant varieties, so the drugs need to be tailored. I also suggest that the skipper establish a relationship with a physician who has the training to handle emergencies and can be reached via satellite radio, E-mail or other communication, such as SSB. That same physician should put together the first aid kit. Mention was made of a problem with Narcotics. I have personally sailed to over 50 countries--with narcotics aboard--in the ships medicine chest. This is under lock and key, with accounting by the master of the vessel. This is allowed under international law--and any ship making international voyages has the right to carry full medications which may be necessary for the health and welfare of the crew. (This is much different than illegal drugs!) Be sure and carry a copy of the original prescription signed by the physician and identified as for the ship's medicine chest. (see http://www.fas.org/irp/doddir/milmed/ships.pdf The ships medical chest and first aid at sea) WHO publishes the "The International Medical Guide for ships" (another must have)--which gives instructions for care and dispensing of narcotics and controlled substances. There are other primary medical and first aid books which should be carried, including a PDR or other pill identification and side effect book, a good first aid book and diagnostic manual, such as the Merc Manual. If the ship has adequate medication, and a line of communication, 99% of emergencies which arise at sea will be successfully handled. There is less than 1% which will not be--and even with a physician aboard--the patient might perish. Also be aware of AMVER, where a ship can be diverted to render assistance in the case of emergency. Not only are narcotics, but many sedatives, and some common medications are controlled substances, and the same rules of lock and key, under the care of the master/owner of the vessel, and accounting for their use and presence must be followed. A ships medicine kit needs to be made up with the specific knowledge of the crew members' medical needs, allergies and past history. I also have been leery of "convoy or floatella" type of voyages, even though I organized several going down the Coast of Baja in the late 1960's. The problem is that boats travel at different speeds, and it is often hard for them to stay together. I have also seen the floatella, abandon a vessel which was in distress. You need to be totally independent, even with other vessels near by. Foul weather may keep that person with the skill set you might need from reaching your boat. Or the critical person, might himself be a victim of an accident or medical problem. It is late--and I'll comment on the psychology of crew tomorrow. Bob Austin MD ------------------------------ Message: 2 Date: Thu, 09 Sep 2010 16:16:24 +1000 From: Rick MacClure <r-mack@bigpond.com> To: <passagemaking-under-power@lists.samurai.com> Subject: [PUP] Passage Making Challenges Message-ID: <C8AEB8D8.BA3%r-mack@bigpond.com> Content-Type: text/plain; charset="US-ASCII" Don you said " I would not pretend to practice medicine on the internet--and those who are not fully qualified should not either! For example--Oxygen can be very useful in certain circumstances, but generally I would not put it aboard a passage making small boat, unless there were specific medical conditions which might call for it". I thank you for your knowledge in these matters, just to let you and everyone else know, I was not "practicing medicine on the internet" when I suggested Peter carry oxygen on his boat, the advice I gave was in a personal email to a friend, and was in relation to using oxygen for treatments related to scuba diving. Disclosure, I am a Commercial Dive Supervisor and have over 35 years experience in this field. As I will be travelling on this boat and will be diving from it, I as a diving professional would like to have a supply of oxygen on board, if that's not going to upset to many people. Rick ------------------------------ Message: 3 Date: Thu, 9 Sep 2010 02:32:10 +0000 From: Georgs Kolesnikovs <gxk@earthlink.net> To: passagemaking-under-power@lists.samurai.com Subject: Re: [PUP] MV Kekada Message-ID: <EBC41943-E291-43D9-9443-4D8E068CCDA9@earthlink.net> Content-Type: text/plain; charset="us-ascii" Thanks very much, Don, for directing us to your fascinating site. You're in good hands with Bill and Stella at Seahorse Marine. We look forward to learning more about how you're equipping Kekada as the build continues toward launch next year. Once you're in the water and cruising, I know many here will be curious how your choice of the gyro for stabilization works out. Thanks, again, for sharing your experiences. --Georgs http://www.kekada.com/OurBoats/mvKekada.htm > > > SH54#33 (under construction) ------------------------------ Message: 4 Date: Thu, 9 Sep 2010 06:50:10 -0700 From: "Peter Quentrall-Thomas" <quentrall@gmail.com> To: <passagemaking-under-power@lists.samurai.com> Cc: gxk@earthlink.net Subject: [PUP] The original "Passagemaker" is alive and well Message-ID: <026d01cb5025$fa452a80$eecf7f80$@com> Content-Type: text/plain; charset="us-ascii" Just a quick note to let everyone know that the original, 30 ton, teak hulled, motor yacht "Passagemaker" as designed and built by Robert Beebe in 1963 is alive and well and currently on a one year circumnavigation of the Caribbean. I had the good fortune to purchase her from Charlie Baker in 1998 and after a year of hard work she is proving a very dependable live aboard. Drop me an e-mail at quentrall@gmail.com if you would like more news of her or if you can help me fill in some of her history such as voyages she made, previous owners etc. Have a great day............ Peter Quentrall-Thomas ------------------------------ Message: 5 Date: Thu, 9 Sep 2010 22:31:00 +0930 From: Don Richards <don_richards@hotmail.com> To: <passagemaking-under-power@lists.samurai.com> Subject: [PUP] Passage making Challenges Message-ID: <BAY156-w60E734B31D63457A268850E1730@phx.gbl> Content-Type: text/plain; charset="us-ascii" >> Don you said " I would not ...... Rick, just to clarify, those comments were made by Bob Austin. People have different opinions. I personally thought given your training your suggestion was quite reasonable and it was clear that your comments were made in a personal email to Peter. Don ------------------------------ Message: 6 Date: Thu, 09 Sep 2010 08:07:38 -0600 From: ROBERT ZANUSSI <rzanussi@shaw.ca> To: passagemaking-under-power@lists.samurai.com Subject: Re: [PUP] Passage Making Challenges Message-ID: <d027c44166af6.4c8895ca@shaw.ca> Content-Type: text/plain; charset="us-ascii" There is no hoodoo magic to delivering oxygen using a constant flow bottle in conjunction with an oral/nasal mask. As an instructor in the advanced delivery of O2 (and I probably am correct in saying Rick is also trained to teach this) it is something that can be learned faster than CPR. Furthermore used in conjunction with CPR might just save someone's life. Maybe not if you are in the middle of the Atlantic but if you are close enough to land that a SAR aircraft can reach your vessel it just might. And administring O2 is not practicing medicine any more than using an AED is. Rob Z > Don you said " I would not pretend to practice medicine on the > internet--and > those who are not fully qualified should not either! For > example--Oxygen > can be very useful in certain circumstances, but generally I > would not put > it aboard a passage making small boat, unless there were > specific medical > conditions which might call for it". > I thank you for your knowledge in these matters, just to let you and > everyone else know, I was not "practicing medicine on the > internet" when I > suggested Peter carry oxygen on his boat, the advice I gave was > in a > personal email to a friend, and was in relation to using oxygen for > treatments related to scuba diving. Disclosure, I am a > Commercial Dive > Supervisor and have over 35 years experience in this field. As I > will be > travelling on this boat and will be diving from it, I as a diving > professional would like to have a supply of oxygen on board, if > that's not > going to upset to many people. > Rick > _______________________________________________ > http://lists.samurai.com/mailman/listinfo/passagemaking-under-power > > To unsubscribe send email to > passagemaking-under-power-request@lists.samurai.com with the word > UNSUBSCRIBE and nothing else in the subject or body of the message. > > Passagemaking Under Power and PUP are trademarks of Water World > Productions. > Rob Hickory, dickory dock, three mice ran up a clock The clock struck one..... the other 2 escaped with minor injuries ------------------------------ Message: 7 Date: Thu, 09 Sep 2010 11:44:04 -0400 From: "Alan" <wagner.florida@verizon.net> To: <passagemaking-under-power@lists.samurai.com> Subject: [PUP] The original "Passagemaker" is alive and well Message-ID: <01f101cb5035$d527df80$7f779e80$@florida@verizon.net> Content-Type: text/plain; charset="us-ascii" From: Peter Quentrall-Thomas [mailto:quentrall@gmail.com] Sent: Thursday, September 09, 2010 9:50 AM To: passagemaking-under-power@lists.samurai.com Subject: The original "Passagemaker" is alive and well Just a quick note to let everyone know that the original, 30 ton, teak hulled, motor yacht "Passagemaker" as designed and built by Robert Beebe in 1963 is alive and well and currently on a one year circumnavigation of the Caribbean. I had the good fortune to purchase her from Charlie Baker in 1998 and after a year of hard work she is proving a very dependable live aboard. Drop me an e-mail at quentrall@gmail.com if you would like more news of her or if you can help me fill in some of her history such as voyages she made, previous owners etc. Have a great day............ Peter Quentrall-Thomas ------------------------------ _______________________________________________ Passagemaking-Under-Power Mailing List End of Passagemaking-Under-Power Digest, Vol 70, Issue 9 ********************************************************

> ----- Original Message ---- > > From: Peter Sheppard <peter@petersheppard.com.au> > > > > Bob's comment about dislike for "floatella" type trips. I read it as he is > > talking about the Baha HaHa types. You know the ones only half an hour by >heli > > away for evacuation or a Tacos. > I participated in the Baja Ha Ha three years ago, one of 4 power boats out of 600 participants. There was virtually no support while underway. The Grand Poobah of the Ha Ha emphasized that each boat was responsible for themselves. If a boat was damaged or a crew member was disabled, it was up to that boat to self rescue. There was no official or organized support from the Ha Ha organization. There was no designated medical personnel, no designated mechanics, no designated weathermen......although there were several along on the event who were participating as ordinary entrants. There was a lot more "hand holding" on the NAR than the Ha Ha. I may very well do the Pacific Puddle Jump (loosely organized by the Ha Ha people) from Mexico to Tahiti at some time in the future. This is a semi-organized event but each participant sets his on schedule and departure date. There might be 20 or 30 boats departing over a 3 month time span. Once out on the pond, you're on your own. I agree with Bob, each boat whether traveling alone or in company with another boat(s), needs to be completely self-sufficient. Will I ever be 100% prepared to handle any and every medical, mechanical, or weather mishap that might occur aboard my boat? I doubt it, but that's not going to stop me from going. Patrick Willard 40PH ALOHA La Paz, MX

I've truncated Peter's letter for brevity's sake. I'm an RN with 20 years experience working in third world countries and 20 years in a modern emergency room where I was an advanced practitioner leading a resuscitation team. Even on a vessel with the very best medical support including a physician in attendance, the best we can hope for is not far above what a GP in a rural practice would be able to provide. It's a sad fact that modern medicine's ability to save life is based in a massive urban infrastructure. We don't take that infrastructure with us when we voyage more than a few hours away from shore. It's a risk you choose to take or not. As for AED's, there is a lot of slick marketing pressure but the reality is, without that urban infrastructure they are useless, except to provide some comfort to those who can feel that they have' done all they can'. I don't want to get deep into the argument about oxygen on board, I'll just say that when it's needed, it's often for a considerably longer period than a cruising boat could provide from the cylinders they could conceivably carry. P. On 10/09/2010 06:40, Peter Sheppard wrote: > Just to offer up an opinion from an anaesthetist (not my opinion of course - > I'm just the messenger) who has crossed the Pacific twice recently, and his > view was an AED is only useful to keep someone alive for critical minutes > until delivered to an intensive care unit.