Medical Ditch Bag
by: Ben Bechard & Joan Lovell Kraemer
Nothing focuses the mind like being strapped on an ambulance stretcher with chest pain. While traveling from West End to Freeport Gran Bahama I was able to read through the rear window of the ambulance the road signs urging caution, such as “Undertakers love Overtakers” as the ambulance swerved into the passing lane on the narrow busy road.
In January 2010, while at West End, waiting out a gale to cross the Little Bahama Bank destination Boat Harbour, I experienced a sudden attack of chest/abdominal pain. I was taken to the local medical clinic by the kind manager of the resort and after a presumptive diagnosis of heart attack, was transferred to the hospital in Freeport. While this was going on, Margaret had to go back to the boat to get what we had forgotten. Soon after arrival, the emergency physicians were able to diagnose an acute pancreatitis caused by gallstones. After 5 days on intravenous, I was med-evaced to my hometown, Kingston Ontario where within a few days I had my gallbladder removed and was discharged home the next day. 3 weeks later we were flying back to Grand Bahamas to resume our boat trip.
Then came Wally’s and Joan’s experience in Marsh Harbour.
As many of you know, Wally was air evacuated out of the Bahamas due to what was thought to be a heart attack. We had the best that Abaco can provide-- a caring ER physician from the Auskell clinic accompanying us, an experienced and competent pilot, Sean Nixon, and friendly transport personnel from the local ambulance service. We had neighbors from Boat Harbor and Kevi from Abaco Beach Resort seeing us off on the plane. We could not have had kinder people surrounding us.
The following are some of the lessons learned because of these two episodes. Joan and I thought we should relate our experiences and highlight the points where we could have improved the ease of the contacts with the emergency services. Ben writes: This is what I have learned. I will try to focus my comments on what you need to do in the event of an emergency contact with the medical services in Abaco.
I used here, not only what I learned from the experiences in the Bahamas but also what I found useful in my contacts with patients when I was practicing Medicine in an Emergency Room in a small tourist town. It seems to me that emergency, contacts with the medical services in the Abaco should be viewed as a possible air evacuation every time since there is no hospital in Abaco to provide a definitive diagnosis. One should be prepared to go the clinic and not return to the boat. I like to think of this information and documents as “The Medical Ditch Bag”.
There are two levels of preparation that will help smooth things out: Before you leave home for the Bahamas and before you leave the boat for the clinic visit.
As we get older, it becomes more important to have an organized “medical history”. Not only do you take your medications to the Bahamas but you need to carry with you a resume of your past medical history, a list of the current diseases being treated, a copy of your recent blood tests and electrocardiogram (EKG) and any other recent tests results even if negative. Also any other information that your doctor would think would be helpful. Do not rely on being able to talk to your personal physician to sort out this information at the time of an emergency. This information should be kept with your health insurance papers.
If the time comes that you need to see somebody in an emergency, get your “medical ditch bag”. It should contain the information outlined above, plus all your pills (not only the name but the actual bottles)(for Canadians it is recommended that you get your pharmacist to add the most common brand for your medications since they normally put only the generic name and we found that the health personnel are generally not familiar with this nomenclature), your passport, credit cards and money and those of your companion. There may not be time or opportunity to go back to the boat to collect these items. Your companion should have some water and a snack since you can’t predict when it will be possible to access food, also toilet bag containing toothbrush etc. and a change of clothing. Cell phone, calling card, and computer to communicate with family and insurer are very useful.
The Medical Ditch Bag should be packed ahead of time as feasible just as the Boat Ditch Bag is prepared. The package should have a “list of contents” so that if you have to add something at the last minute, you will not forget it. Hopefully, you will not need it, but if you did, having this information for the physician will make the task of diagnosis and referral easier and more accurate. Also keep in mind that it is possible in Abaco, to pre-register at a clinic. This way, they would have all your details on hand in the event of an emergency.
Contrary to Joan and Wally’s experience, my insurance covered all the expenses including the flight by air ambulance except for the deductible.
Joan’s experience was somewhat different. She writes:
We found out the following:
1. We had signed up for a national medical jet evacuation service before coming to the Bahamas. They were unwilling to land a plane the day the emergency happened. The first reason was that it was becoming dark. Although the airport said that they would keep the lights on, the service said that the airport was not a place where they could land at night. This may also be because there is no radar for landing, and they rely on visuals to land. Therefore, if you have an evacuation service, don’t count on them being able to get there when you need them.
2. While at the clinic, we had arranged for admission to the Cleveland Clinic in Florida, assuming that the cardiac care there would be the best in the area. In fact, the ambulance transport meeting us at the West Palm Beach airport would only take us to the nearest hospital. It turned out to have a good emergency room and cardiac service. Don’t be surprised if you are transported to the nearest hospital regardless of your prior arrangements.
3. None of this transportation has been fully reimbursed by anyone-- not our private carrier, Medicare, or evacuation service. Expect that much if not all of it will be out of pocket.
4. What Ben said about a medical ditch bag is very true, since during an emergency you will not be able to remember things you need to take. If for some reason you can’t have a bag fully stocked and ready to go, I strongly suggest that you prepare now a typed list of items you need to take, and keep that list in a prominent place on the boat. Even if you have a medical ditch bag, make an evacuation check list so you can be ready to include those items you use daily and don’t want or can’t keep in a bag. Make sure you know where the bag, items or list are kept; neither a bag nor a list do any good if you don't know where you or your partner have stored them on the boat.
5. Securing the boat: Regardless of where you are, have a list of instructions for yourself or your partner, or to give to someone who may be closing the boat or watching over it in your absence.
We all hope that nobody will have to use the Medical Ditch Bag but, we believe that these precautions might be useful and prudent as the time they save could be critical in the event of an emergency.
Last Updated: September 1, 2012