I hear many stories of crew having to be the first responder in a medical incident.
Only last week a crew member retold to me the story of three crew members hit by a spinnaker pole, one knocked unconscious, and the very next day a captain sent an email to the MSOS team to say that after attending the proficiency in medical care course he used a SAM splint technique he learnt for a friend who was involved in a mountain bike accident.
Whatever the medical scenario, there are a few facts that remain true when you are the first responder to a medical incident:
-The stress response will kick in, and it will likely be stronger in a medical incident than in other stressful situations.
-You will struggle to learn new skills when it does
-If you can manage your stress response, and recall your training, you may save a life and importantly, provide a better long-term recovery.
So what can we do help get our stress response under control quickly and provide prompt action? It is always the same answer – training. If your training is recent and was effective, as your body goes into the stress response and shuts off your decision-making powers, your brain will search for the skills you learnt and practiced in the muscle memory, which will immediately reduce the rising panic.
So what are the actions that we need to train on regularly so that we have them in the back pocket of our brain, ready to go?
I am going to briefly cover them here, highlighting some considerations for the maritime environment.
We must initially perform a quick thirty second check for safety and life-threatening injuries. You have most likely heard the assessment referred to as the Drs ABC or ABCDE or primary survey (military). The environment in which they are being performed or who is training you usually determines the name utilised.
I consider the maritime environment unique – non-medical professionals performing medical care far from outside support – therefore I like to include four medical first response actions:
- CONTROL THE STRESS RESPONSE
- CALL FOR HELP
- CHECK FOR SAFETY – YOU THE CASUALTY & THE VESSEL
- CHECK THE CASUALTY – RESPONSE, AIRWAY, BREATHING & BLEEDING
These are four simple to learn & practice actions, with the last action having four parts. Here is a little more detail on each action:
You witness a person thrown across the deck violently and hit a winch, or retrieve them from the water with a gash from a jet ski propellor, or you hear the ominous ‘medical emergency’ over the radio and it kicks in – a huge dose of hormonal mediators like a jug of espresso is dumped into your blood stream, revving up your sympathetic nervous system – raising heart & breathing rate, and getting more oxygen to your muscles, making you stronger and more ready to ‘fight or flight.’ The primeval system designed to protect your life is in full flow, you get a mind blank, and the abilities you really need to treat a casualty are shut off. I have heard many stories of people momentarily walking away from a casualty and not calling for help during the peak of the response.
So how can we combat this natural response?
Awareness – acknowledging that this response will happen will in itself will help you cope better, and sometimes even verbalising the feeling (I feel panicked and overwhelmed right now) even silently, strangely reduces panic.
Training – as outlined above, panic will reduce if your brain can recall recent training.
Simulation – running medical drills where crew first vigorously jog on the spot for a minute and then go and then treat a casualty will simulate that raised heart rate and breathing.
IMMEDIATELY CALL FOR HELP
‘ALL CREW ALL CREW, MEDICAL EMERGENCY IN THE (YOUR LOCATION)’
A simple message which alerts your crew to work as a team to secure the vessel & get the medical kits to you as fast as possible. On a vessel not using radios, a loud shout.
CHECK FOR SAFETY – DON’T BECOME A SECOND CASUALTY
Take a breath, look around you, up and down and consider how the accident happened as you approach. Think about removing hazards to you first, wether that be a circuit break in the engine room, throwing a flotation device to someone drowning before swimming out, or considering moving a casualty off an unstable platform.
Also consider the overall safety of the vessel, there is a tendency in a medical incident for everyone to be head down, focused on the casualty, but if the casualty is the captain, who is at the helm, organising the bringing down of the sails, or navigating the vessel back to port? To highlight this, I spoke recently with a first officer who recounted the story of when his captain started having a major heart attack whilst entering the marina, leaving him to take control of the yacht for the first time and support crew through the medical incident, a daunting task, but handled heroically.
CHECK THE CASUALTY FOR LIFE THREATENING ISSUES
- Are they responding? Shout and clap loudly, strongly squeeze the earlobes
2) Do they have an airway – a clear passage from the lips to the lungs?
Put one hand on the forehead, then firmly tilt the chin up slightly with two fingers and look in mouth, or if in a confined space and you are behind the head, put fingers under the jaw to tilt the chin up.
3) Are they breathing?
Look for movement in the chest/abdomen for 10 seconds. If you don’t see any movement, they are not breathing, you must immediately start high quality CPR and get the defibrillator.
(Note: If they are not responding, and you hear snoring sounds (google agonal breaths) this is not normal, we count this as not breathing.
4) Are they bleeding to death?
Scan the body from head to toe, if you find a bleed apply direct pressure where the blood is coming out with a cloth or dressing and your body weight and be sure to finish scanning for other bleeds. Place heavy pressure on the site that blood is coming out, and if possible, raise the legs (move warm oxygenated blood around the body i.e., reduce shock which is lack of oxygen). If you are crew coming to the scene and CPR has started, look for bleeding and put pressure on the bleed site.
Once we have identified & treated any life threatening issues with our quick assessment, we can slow down and look at the scene, and consider whether we suspect a head or spinal injury – fall from height, visible injury, or we saw them hit on the back or head – and if suspected, leave them in position or on the back and put in a guedel airway or nasal airway, and if not suspected put them into the recovery position (either from the front or the back, as we practice in training) and monitor.
We then go onto to our secondary response actions which would be calling your telemedical provider if they are not already on speaker phone or via a telemedicine monitor such as the MSOS Themis unit; reassess first response actions, take vital signs, and identify and treat burns, broken bones and any other medical causes, giving oxygen and fluids as per your telemed providers advice.
We must as a medical team onboard also consider taking notes including: timings, what you are seeing, what you are doing, and if the captain or relatives are aware, the casualties history, allergies and medications to relay to telemedical doctors for diagnosis, and supporting the relatives during this traumatic time.
This is a brief look at the first and second response actions onboard a yacht, I hope it has refreshed your memory, however to build that muscle memory and cement the skills to memory, a training filled with hands on practice and true to life scenarios is required.
MSOS can train you and your crew onboard your vessel anywhere in the world, for a pre-season training or STCW courses, putting all your crew through different levels of training concurrently. Or you can book onto our many fun and engaging classroom based MCA courses for more advanced training.
I hope to see you on a training day soon.
Sara Paterson DTN Bsc RN
MSOS trainer, freelance yacht medic