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Dive Site Medical Kit

Key Features
  • Designed & developed by expert offshore physicians
  • 3 Cases: Medical, Trauma and Resus Case
  • Includes Skippers Medical Emergency Handbook
  • Medical Case: First Aid, Analgesics, Antibiotics, Gut/Motion Sickness, Burns, Eye/Mouth/Skin, Patient Assessment
  • Resus Case: Emergency/Allergy, IV Fluids, Airway/Oxygen, Advanced Airway
  • Trauma Case: Wound Management, Dressings/Splints, Medical Equipment
Detailed Overview

The Dive Site Medical (DSM) Kit is designed to serve commercial diving operations, and also advanced sports diving activities. It can be configured to cover the requirements for saturation and air diving operations.

The kit complies with the recommendations of the Diving Medical Advisory Committee (DMAC 15-4).

The DSM kit provides dive site operators and medical staff the capability of dealing with both medical and trauma incidents when definitive care may be hours or even days distant. The kit also contains medicines and equipment to deal with specific diving-related life –threatening occurrences such as pneumothorax.

The DSM Kit is usually supplied in Pelicases, which keep the contents of the kit in excellent condition in the harsh marine environment. There is an alternate option to supply in soft bags if this is preferred.

The kit is split in to several sections, to enable appropriate deployment at the dive site. Each section is sub-divided in to modules, which enables intuitive use in the event of a medical emergency.

Technical Specification

Dive Site Medical Kit Contents List in accordance with DMAC-15 (alternatives with same fit, form and function maybe used)

Diagnostic Equipment

  • 1 Pencil torch
  • 1 Thermometer (electronic)
  • 1 Low range rectal thermometer – down to 28°C
  • 1 Stethoscope
  • 1 Aneroid sphygmomanometer
  • 1 Reflex hammer
  • 1 Tape measure
  • 2 Tuning forks (28Hz and 256Hz)
  • Pins for testing sensation (e.g. Neurotips)
  • Blood sugar testing equipment
  • Tongue depressors
  • Urine testing strips
  • 1 Otoscope (with spare bulb and batteries and
    disposable ear pieces)

Thoracocentesis

  • 2 Intercostal drain and drainage kits – preferably those without sharp metal ‘trocar’ introducers (e.g.
    Portex flexible introducer type)
  • 4 Devices for emergency needle thoracocentesis
  • 2 Heimlich Valves
  • Suitable strapping/fixing to secure the system
    appropriately

Urinary Catheterisation

  • 2 Urinary catheters (preferably non-latex) sizes 16
    and 18 (e.g. Foley type)
  • 2 Urine collection bags
  • 2 Catheter spigots (optional)
  • 2 x 20ml sterile water
  • 2 Urethral anaesthetic gel
  • Suitable strapping/fixing to secure the system
    appropriately

Dressings

  • 10 Packets gauze squares 10 x 10cm
  • 5 Packets cotton wool balls
  • 4 Triangular bandages
  • 4 Trauma care bandages
  • 12 Safety pins
  • 2 Adhesive bandage 75mm x 3m
  • 2 Adhesive bandage 25mm x 3m
  • 2 Crepe bandages 6 inch
  • 2 Crepe bandages 3 inch
  • 2 Large dressings
  • 2 Medium dressings
  • 40 Adhesive plasters
  • 2 Dressing bowls
  • 4 Eye pads
  • 1 Eye wash kit
  • 5 Soft silicone primary wound dressing (8cm x 10cm) (e.g. Mepitel)

Equipment to immobilise fractured/sprained limbs (e.g. a 36 inch Sam splint, which can be cut to size as required)

Sterile Supplies – General

  • 4 Universal containers
  • 2 Drapes 60 x 90cm
  • 10 Alcohol swabs or sachets of skin disinfectant (e.g. Cetrimide solution)
  • 10 Pairs of sterile gloves (selection of sizes, preferably non-latex)
  • 6 Sutures non-resorbable (e.g. nylon) (2/0 and 3/0), with cutting needles attached
  • Medium sized Sharps bin
  • Resorbable sutures (2/0 and 3/0), with needles attached
  • 5 x 20ml syringes
  • 5 x 10ml syringes
  • 5 x 2ml syringes
  • 10 x 18g needles
  • 10 x 21g needles
  • 1 Tube of antiseptic cream (e.g. Betadine)

Sterile Supplies – Specific

  • 1 Kidney dish
  • 1 60-100ml bowl (Gallipot)
  • 10 Sachets of skin disinfectant (e.g. Cetrimide solution)
  • 10 x 7.5cm 4-ply non-woven cotton swabs
  • 4 Dressing forceps
  • 2 Tissue backed drapes 60 x 90cm
  • 1 Yellow bag (for disposal of used items)

Sterile Instruments

  • 2 Spencer Wells forceps 5 inch
  • 1 Mosquito forceps
  • 1 Dressing forceps
  • 2 Disposable scalpels
  • 1 Forceps – fine toothed
  • 1 Dressing scissors
  • 1 Scissors – fine pointed
  • 1 Stainless steel ring cutter (for removal of rings and other piercings) – this does not need to be sterile

Intravenous Access

  • 3 Giving sets
  • 4 IV cannulae 16g
  • 4 IV cannulae 18g
  • 4 Butterfly infusion sets 19g (optional)
  • 2 Magnetic hooks
  • 4 x 3-way IV taps
  • Intraosseous (IO) infusion system (a minimum of 2 sets of devices are required)

Resuscitation

  • Resuscitator to include reservoir and connection for BIBS gas 
  • 3 Resuscitation masks with silicone face seals (varied sizes)
  • 1 Pocket resuscitator with one-way valve (e.g.Laerdal pocket mask with a silicone face seal and
    non-return valve) or face shield for mouth-to-mouth ventilation
  • 3 Supraglottic airways sized for adult males (e.g. IGel sizes 3, 4 and 5, or Combitube) with catheter mounts and filters – if female divers on board ensure there are correctly sized airways for them
  • (optional) Endotracheal tubes (ET tubes) (e.g. sizes 7, 8 and 9) with catheter mounts and filters**
  • (optional) Laryngoscope and batteries and spare bulbs. The use of Laryngoscopes with fibre optic disposable blades is encouraged. This is required if ET tubes are stored
  • 1 Automated external defibrillator (if this is to beused in the chamber it should either be
    appropriately tested for such use or it should be
    hard wired into the chamber)
  • 2 Oropharyngeal airways sizes 3 and 4
  • 1 Foot operated suction device
  • 1 Tourniquet to aid venous access
  • 2 Endotracheal suction catheters
  • 2 Wide bore suckers
  • (optional) 2 Nasopharyngeal airways (e.g. size 6 and 7 with flange)
    * Resuscitators may require modification to gas inlet to ensure adequate filling at pressure
    ** Endrotracheal tubes provided for use by doctors only

 

Drugs
Anatomical Therapeutic Chemical (ATC) codes are provided in brackets for guidance

Anaesthesia
Lidocaine injection without adrenaline (N01B B02)
Suggested: Lidocaine 10mg/ml or 20 mg/ml ampoules 5 x 10ml
Indication: Lidocaine is a useful local anaesthetic in concentrations up to 20%
Analgesia

Soluble aspirin tablets (N02B A01)
Suggested: Soluble aspirin, 20 x 300mg or 20 x 500mg tablets
Indication: Mild to moderate pain, pyrexia, chest pain of suspected cardiac origin
1 to 2 tablets every 4 to 6 hours

Paracetamol tablets (N02B E01)
Suggested: Paracetamol, 25 x 500mg tablets
Indication: Mild to moderate pain, pyrexia (fever)
1 to 2 tablets every 4 to 6 hours to a maximum of 8 tablets in 24 hour period

Codeine or dihydrocodeine tablets (N02A A08 or R05D A04)
Suggested: Codeine or dihydrocodeine, 20 x 25-30mg tablets
Indication: Moderate to severe pain
1 x 25 or 30mg tablet every 4 to 6 hours when necessary
DMAC 15 Rev. 4 December 2014 Page 7

Morphine injection (N02A A01)
Suggested: Morphine, 5 x 10mg ampoules
Indication: Severe and acute pain
Patients should be closely monitored for pain relief as well as for side-effects especially respiratory depression. It may be appropriate to consider the use of an antiemetic after administration of morphine

Naloxone injection (V03A B15)
Suggested: Naloxone, 0.4mg/ml ampoules – 2 x 1ml
Indication: Opioid (morphine) overdose, respiratory depression due to administration of opioid (morphine) analgesia
Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by naloxone. Naloxone will immediately reverse opioid-induced respiratory depression but the dose may have to be repeated because of the short duration of action of naloxone; however, naloxone will also antagonise the analgesic effect

The following drug is useful and acceptable as analgesia for moderate to severe pain where it is impossible to stock morphine:

Tramadol injection (N02A X02)
Suggested: Tramadol, 5 x 100mg ampoules
Indication: Moderate to severe pain
Resuscitation Drugs (refer to the appropriate resuscitation guidelines)

Adrenaline/Epinephrine injection (C01C A24)
Suggested: Adrenaline, 10 x 10ml ampoules. 100μg/ml ampoules (1 in 10,000)
Indication: Emergency treatment for cardiopulmonary resuscitation
Important: Intravenous route or intraosseous route to be used in resuscitation, during CPR only

Amiodarone injection (C01B D01)
Suggested: Amiodarone, 6 x 150mg ampoules
Indication: Amiodarone is used for the treatment of arrhythmias particularly during CPR
In some countries Amiodarone is sold as a powder – ensure the correct amount of the appropriate solute is included if this is the case
Important: Intravenous route or IO route to be used in resuscitation during CPR only

Furosemide injection (C03C A01)
Suggested: Furosemide, 5 x 40mg ampoules
Indication: Oedema, pulmonary oedema, resistant hypertension

Nausea and Vomiting
Fentiazin or prochlorperazine injection (preferred) or oral (optional) (N05A B)
Suggested: Prochlorperazine, 5 x 25mg ampoules or Prochlorperazine, 20 x 5 mg tablets
Indication: Severe nausea, vomiting, vertigo, labyrinthine disorders (not for use in motion sickness)
Where available, prochlorperzine in 3mg buccal tablets (dissolves sublingually) is a good choice as opposed to the tablets as such as there is no need to swallow a tablet; 10 x 3mg tablets

Hyoscine hydrobromide (Scopolamine) tablets/dermal patches (A04A D01)                               Suggested: Hyoscine, 40 x 300μg tablets (e.g. Kwells)
Indication: Short acting drug for sea sickness and hyperbaric evacuation. These tablets are chewable
Suggested: Scopolamine, 20 x dermal patches (e.g. Scopoderm plasters)
Indication: Long acting slow release drug for sea sickness and for hyperbaric evacuation. One patch to be placed behind one ear

Allergic Reactions

Antihistamine for injection (R06A B)
Chlorpheniramine, 2 x 10mg ampoules or dekschlorpheniramine, 2 x 5 mg ampoules
Indication: Symptomatic relief of allergy, urticaria, emergency treatment of anaphylactic reaction
Oral antihistamine (R06A E)

Cetirizine, 20 x 10mg tablets
Indication: Symptomatic relief of allergies – non-sedating
There are different types of non-sedating oral antihistamines that can be substituted as needs be
Corticosteroid for injection (H02A B)

Hydrocortisone 5 x 100mg ampoules
Indication: Hypersensitivity reaction e.g. anaphylaxis, angiodema, asthma
Adrenaline/epinephrine autoinjector (C01C A24)

Epinephrine autoinjector (EpiPen autoinjector) 0.3mg of 1 in 1000 (1mg/ml) adrenaline (giving 300mcg)
2ml auto-injector
Indication: Emergency treatment of acute anaphylaxis

Drugs Various
Atropine injection (A03B A01)
Atropine, 4 x 1ml ampoules (600μg/ml)
Although atropine is no longer recommended in the treatment of asystole or pulseless electrical activity in the

European resuscitation guidelines, it may be useful in the treatment of bradycardia

Glucose injection (B05B A03)
Glucose 2 x 500mg/ml 50ml
Indication: Hypoglycaemia

Glyceryl trinitrate sublingual tablets (C01D A02)
Glyceryl trinitrate sublingual tablets x 10 tablets
Indication: Cardiac chest pain

Intravenous fluids (B05B B01)
Crystalloid Infusion – 6 litres
Sodium Chloride Infusion 0.9% and/or Hartmann’s or Ringer’s lactate.
Company doctor to advise on exact make up

Antipsychotic drug for injection (N05A A)
Chlorpromazine, 2 x 50mg ampoules or levomepromazine, 2 x 25 mg ampoules
Indication: For relief of acute symptoms, schizophrenia and other psychoses, mania short-term adjunctive management of severe anxiety, psychomotor agitation, excitement, and violent or dangerously impulsive behaviour

Anxiolytics for injection (N05B A)
Diazepam, 5 x 10mg ampoules
Indication: Short-term use in anxiety or insomnia, status epilepticus and for muscle relaxant effect where indicated

Anxiolytics for oral use (N05B A)
Diazepam, 10 x 5mg tablets
Indication: Short-term use in anxiety or insomnia, status epilepticus

Anxiolytics for rectal use (N05B A)
Diazepam, 10 x 5mg suppositories
Indication: Short-term use in status epilepticus

Treatment of Burns

Sulphonamides for topical use (skin) (D06B A01)
Silver sulphadiazine cream, 1 tube of 1%
Indication: for example prophylaxis and treatment of infection in burn wounds, as an adjunct to short-term treatment of extensive abrasions; for conservative management of finger-tip injuries

Antibiotics
Broad spectrum antibiotics for oral use (J01C A, J01C F, J01C R02 or J01M A02)
Co-amoxiclav, 21 x 625mg tablets (1 tablet 3 times per day for 7 days) or dicloxacilline 30 x 500 mg
tablets
Indication: Broad-spectrum antibiotic
If this drug is not available the company doctor may choose to recommend a similar penicillinase resistant antibiotic

A quinolone, for example:

  • Ciprofloxacin, 20 x 750mg tablets (1 tablet 2 times per day for 10 days) OR
  • Levofloxacin, 20 x 500mg tablets (1 tablet 2 times per day for 10 days)
    Indication: A broad spectrum antibiotic useful in the treatment of Gram negative bacterial infections

Macrolide antibiotic for oral use (J01F A)
Clarithromycin 14 x 250mg tablets (1 tablet twice daily for 7 days) or erythromycin 30 x 250 mg tablets
(2 tablets twice daily for 7 days)
Indication: Susceptible infections in patients with penicillin hypersensitivity

Antibiotic ear drops with (S03C A) or without (S02A A) corticosteroids
Sofradex (framycetin sulphate/dexamethasone/gramicidin) ear drops or hydrocortisone/polymyxine B ear drops one bottle 2–3 drops 3-4 times daily. May be substituted by other ear drops containing combinations of antibiotics (e.g. Polymyxine B, Neomycine a.o.) and corticosteroid (hydrocortisone, dexamethasone a.o.)
Sofradex drops can also be used for eye infections

Ciprofloxacin ear drops (may also be useful in the treatment of ear infections in saturation divers)

An antifungal drug
Clotrimazole cream
Indications: For fungal skin infections