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