HOW TO: A simple open water swimmer’s first aid & medical kit

We put ourselves through torture, pain and injury and that’s a good day. And we do it obviously in and around one of the most dangerous environments on earth. So you need to be somewhat prepared.

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Obligatory IANAD (I am not a Doctor) disclaimer!

Warning: In this post I will using, with no shame, terminology picked up from TV medical programmes. It’s not Lupus.

We are a performance-aided sport, with no shame. For most distance swimmers, this means simple pain remediation. Watching a bunch of marathon swimmers swapping pain pills and advice and personal choice is one of my enduring favourite memories of 2010.

Prophylactic use of anti-inflammatories and analgesics for long swims is also very common, a stitch in time etc.

Pills

Generic Ibuprofen (an NSAI, non-steroidal anti-inflammatory) is popular here in Ireland as it is also an anti-inflammatory, as well as a mild pain-killer. Ibuprofen is however contra-indicated (medical speak for not advised or should be avoided) if you have asthma, or if you are on some other medications. Ibuprofen with Codeine added (Neurofen) is one of the big guns for serious non-prescribed pain relief. Not available over the counter here, the Pharmacist doesn’t seem to believe me when I tell her about my recurring period pains. Sexism!

Paracetamol is popular also, and it’s not unknown on long swims that swimmers will schedule to alternate paracetamol and Ibuprofen every three of four hours.

One friend uses Tramil brand paracetamol as it also contains some caffeine.

In my swim box I also carry an aerosol “Blood Control Spray”, to use for stopping bleeding from lacerations and abrasions (cuts!) we pick up from cutting too close to the reefs in Sandycove. I also have to admit I have never once remembered to use it. Some bandages and plasters also of course.

 

Homeopathy
Homeopathy

Ever at the sea and you get a toothache or worry that you will? Don’t want to ruin a swim because of that possibility, so carry a small bottle of Clove Oil in your kit. Rub it onto the gums to kill the pain. Old but effective folk remedy. No, IT’S NOT HOMEOPATHY. This is a Homoeopathy-free website. {By the way, if homeopathy actually worked, then as swimmers you should be immune to every ailment ever, since you are ingesting ultra-diluted fractions of EVERYTHING from the sea and you would be overdosing! Oh, that’s right, you can’t overdose on homeopatic treatments. You can overdose on the nonsense though}.

Abrasions and chaffing are a problem. Even when you are used to greasing up sometimes one area will be uncovered and get chaffed. I often forget/don’t bother to do the back of my neck for short swims and it flares up. Sometimes on a long pool swim I’ll chafe my fat gut from rubbing it with my knees during hundreds of tumble turns. The swimmer’s favourite is Sudocrem, properly pronounced Sudo-crem, but pronounced Sudo-cream by everyone. Take that, pharmaceutical giant! You all know it, it’s a zinc oxide used for treating nappy rash, spots, broken legs and brains tumours. Messy. Essential. Murhulin is a stronger version that I think has extra glue mixed into it.

I like and prefer Germolene, a topical (i.e. you rub it on) antiseptic anaesthetic over-the-counter cream. Very useful, and the item I use most often for small cuts on feet and hands.

I also have, still unopened and unused, a foil blanket/sheet of the type used by emergency services, for heat retention, just in case of severe hypothermia to myself or someone else. These are actually very small (postcard sized) and can be easily stored.

There are a couple of other handy-to-have items in the car also. Peppermint oil capsules to stop  intestinal cramps and some anti-diarrhoetic pills. And of course some vinegar for stings as we’ve discussed before.

All of that however only take a small amount of space. And as with all medical kits, better to have and not need that to need and not have.

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10 thoughts on “HOW TO: A simple open water swimmer’s first aid & medical kit”

  1. Great post, Donal. I’d add in anti-histamines too – I keep them in my pool bag to fight the chlorine snuffles, and in my OW bag in case of reactions to stings and bites.

      1. Generally, I don’t react, but one of the lakes I swim in has all these nasty little water lice things that nibble away while you’re in the water – cue some very attractive swelling and welts on occasions. Oh, the glamour.

  2. Sudocream – check. Thermal blanket – check. Vaseline – check. Plasters – check. Ibroprofen – check. Nurofen Plus – you can get it over the counter in the UK, they just ask you if you know what you’re doing! I’ve always been wary of paracetamol because of it’s potential impact on the liver, but then you’d probably have to take handfuls?

    As ever a useful and informative piece. Thanks.

    1. Carl, I had an email about this post that made me realise, that even though all this stuff is normal, for all of us, the person (a famous FINA swimmer, you would definitely know who it is) was utterly surprised! And so now I must go email him…

  3. Great post, Donal. I’m amazed to hear that people use codeine! In the US, that’s a controlled substance (one step past needing a prescription). Aside from the habit-forming-narcotic issue, I find it pretty tough on the stomach. If I get a prescription for it (dental work or something), I never fill it–the remedy is worse than the disease.

    Once thing I wish I could have in my swim bag is an epinephrine pen to treat allergic reactions to bee stings. I’m not allergic, but we have those Africanized bees here in Arizona, and I’m always worried that someone in the group will have a problem. But you need a prescription for those too–you can’t just go in and get one for your medical kit.

    1. Hey Katie, yes, the addiction is why they took off the counter here. I think you;d only need something that strong a long way into a big swim. I used Ponstan once during my EC, (which is a local variation of mefenamic acid, which is prescription only). I think the variation between us all wrt to analgesics is one reason we end up talking about it and swapping recommendations. One thing not on the list therefore, because I can’t recall any swimmer recommending it to me, & I’ve not tried on long swims, is aspirin.

      Karen also makes a point about simple antihistamines for jellyfish stings, (no killer bees here), which is something similar. I need to think about adding something.

  4. Hello LoneSwimmer,
    I’ve read your blog for a while now, but this is my first comment. Firstly, I want to say that I really enjoy your posts – I like the analytic approach you have to your swimming. Keep up the good work.

    My comment related to your “thermal foil blanket” – which I would argue is of very limited use in our cases (as open water swimmers).

    As you well know – and have got great images to show – our peripheries cool first – which includes our skin temperature and subcutaneous fat. As a result upon exiting the water, we are radiating very little heat.Evaporative heat loss is the big one that is attacking a swimmer once they are out of the water. Whilst swimming in the water it is conduction (directly to the water), and there’s not much we can do about that bar wetsuits & drysuits etc.

    Foil blankets work by reflecting radiated heat. This is very useful if you have just run the London Marathon, and your muscles are well perfused with blood, and you are radiating a lot of heat – this will help to stop you cooling down in the British drizzle/sleet/snow (as appropriate for the summer).

    There are three other routes to loosing heat – conduction, convection, and evaporation. The foil blanket does nothing for any of these, unless the individual is cocooned in it – with the edges all sealed to trap in the warmed & humidified air. It may even accelerate conductive heat loss if the foil is touching bare skin.

    As you have described very well on your blog – the key to getting warm again is to get dry, and get into some clothes – drying your body massively reduced evaporative heat loss (as there is no longer any moisture to evaporate) and the layers of clothes (and a hat) slow down the conduction and convection. This (as you know) is the most important things with getting warm.

    A foil blanket is possibly of use once you have got ALL of this sorted. If I’d got one, I’d use it last – and I certainly wouldn’t go out and buy one. However, for my money – I would go with an orange (the colour is unimportant, but all the ones I’ve seen are orange) survival bag. Basically a big thick plastic bag that you get inside. By getting in and tightly wrapping it around your head, so only your face is peeking out – you will start to warm & humidify the air inside it – and do a great job of speeding up the warming process.

    There is a company called Blizzard Bag who do foil blankets that do seal up into a cocoon, and even a jacket – they expand out like corrugated cardboard and trap air between multiple layers of foil to help to reduce the heat loss via conduction and convection. I’ve no link with them, I do have a couple of their products – but never used them in anger, and don’t take them with me when swimming.

    I hope all of that makes sense.
    Cheers, Dan

    1. Thanks for the compliments Dan.
      You’re obviously 100% correct, and I’m glad you mentioned it, I forgot that a lot of people wouldn’t know how or when to use a thermal blanket for swimmers. In fact, it’s not something I ever wish to use, but if I did it would probably be in a serious case, on an already covered person, possibly while awaiting EMS.

      I’m going to look into those bags, they sound like an ideal safety/backup option for both the Sandycove and Guillamene clubs to have for emergencies, thanks very much again!

  5. One supplement I’m a huge fan of: Methylsulfonylmethane (MSM for short)

    https://www.smartpowders.com/p-5337-msm-powder-1000-grams.aspx

    In a few double blind trials it’s been shown to be just as effective as NSAIDs for inflammation, it’s actually BENEFICIAL for seasonal allergic rhinitis, and healthy for the upper respiratory tract (it might even HELP with asthma). It’s basically a bioavailable source of sulfur. In one double-blinded trial the MSM group (1.5g/day) ended up taking significantly less painkillers for their inflammation than the placebo group

    It’s also not toxic (people have built up to taking ridiculously high doses of 30g/day without side effects). Generally the effective range for treatment of inflammation/allergic rhinitis is closer to the 1.5-3g/range a day. It’s relatively easily cleared in the urine/stool and the only known negative side effects are gastroinestinal upset and headaches if taking it at too high of a dosage, with some people experiencing a very mild stimulant effect if it’s taken too late at night (and too much). The headaches I imagine might be in part from dehydration, as a result of trying to clear out the excess MSM through the urine.

    It’s also relatively inexpensive. If taking 0.5g/dose per hour of intense swimming for 10 hours (seems like a good dosage… possibly 1g/hour?) It’s a bit more expensive in the UK:

    http://www.myprotein.com/uk/products/msm but I imagine it’s still cheaper than NSAIDs (hard to beat 8 quid for 500 doses)

    NSAIDs might actually also inhibit muscle protein synthesis, I don’t think the same effect has been shown for MSM. Sulfur is a key component of joints/cartillage/skin, by the way.

    ———————–

    You know I also always recommend consuming fatty fish (sardines, herring, atlantic mackerel, salmon), as Omega 3 fatty acids are also a great mediator of inflammation. Omega 3 ALA from walnuts/flax seeds aren’t terrible either, but not as good as from fish (primarily DHA+DPA+EPA)

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