First aid and medical problems at sea.
Occasionally i write a serious post and this will (mostly) be a serious and factual one. This started off as a single post which came about purely due to the poor design feature i found on the boat next to mine. It also reminded me of an actual incident i was involved in during the Whitbread race and then after that when i was thinking about boats and stoves the whole subject got to the point where there were multiple topics to write about. This post is the also the first in a series that i have already written about first aid and medical problems and that i have scheduled to appear on the blog while i am away for a couple of weeks of actual sailing.
In the Uk it’s that time of year when many sailors are either just getting their boats in the water or messing around in boatyards*. Yesterday down at the yard when i nearly tripped over one owner’s badly organised extension cable, head-butted a boat as i tripped and all-but face-planted into another owner’s tool kit i was suddenly and inexplicably reminded about first aid. This time last week i was getting the benefit of morons on jet-ski’s and on the same day, in the same area of the same quiet river there were canoeists, kayakers, rowboats and even an intrepid pair of wildswimmers. Now i have a horrible imagination and to me the combination of careless early season idiots on poweful waterborne motorbikes and barely visible wetsuited swimmers gave me the shudders. I bet that not one of the jet-ski arseholes had even the most remote notion of first aid had they caused an accident…..and they are exactly the kind of stupid that will cause an accident.
I also promised to talk about this.
That by the way is my partner Jackie modelling the latest in ankle-wrecking bridgedeck design on the boat that i am moored next to. Now, as a good and polite kind of sailor i would normally cross the other guys boat by walking around the foredeck….except that this one is an all but impassable assault course so we have little choice but to cross via that boat’s cockpit. The horror-show above is basically someone’s idea of a really neat rope stowage solution, except that it’s also a perfect foot trap. Imagine if you will stepping accidentally into that while the boat is being thrown around…..and then fallin sideways with your ankle in more or less a vice. Well, something like that is exactly what happened in the worst accident that i ever dealt with at sea. Always up for a sea story i will explain what happened.
Some of you may know that i sailed legs of the Whitbread race in 1989-90, in fact i joined Creightons Naturally as medical officer one leg after their disaster in the southern ocean in which 2 crew members were lost overboard. I wasn’t there for the disaster but did have to deal with the aftermath. After one leg with CN i got a transfer to another older Maxi, Atlantic Privateer/Liverpool Enterprise and sailed the last 2 legs of that race with that crew. During the final leg i was continually busy with medical problems as i think now that the crew were generally just getting chronically tired and possibly a bit careless….we also had newbie ‘leggers’ on board. Somewhere in mid Atlantic we had days of watches when all we did was continuous sail changes : light 1 to heavy 1, heavy 1 to 2, 2-3, reef in and reef out. If you have ever done big manual sail changes with masthead maxi headsails then you will know just how much physical work that is. At some point during one watch something went wrong at the mast during a reef and one of the new guys enthusiastically clambered up onto the boom at the gooseneck to ‘assist’ with the problem. In the next moment he was thrown off the boom and landed with his ankle between the huge spinnaker pole and the low coachroof side….and then fell sideways. The first i saw or knew about the accident was him screaming in pain on deck. Here i won’t go into the first aid action except to say that immobilising him and getting him below was technically challenging but then i had to manage him and is injury until we got back to the UK. The medical outcome was that he had not only broken the bottom bones in that leg but trashed the ankle joint as well.
After the Whitbread race i dropped out of sailing circulation for a while mainly to pick up my career again but within the same year i was back aboard a maxi preparing to take paying guests on a complete circumnavigation. I guess i was there primarily to be the boat’s medical officer and rigger but that i also ran a watch and usually cleaned up after the skipper’s galley disasters. In between the race and the voyage i had done some thinking and come up with the startling conclusion that accidents and incidents on board requiring first aid were actually a failure on our part : and the failure is that of not thinking ahead and preventing the accident. Now it isn’t always possible to predict what some of the idiots will do but generally it was possible to set things up such that potentially dangerous situations just don’t happen because we have a better way of doing things. The most simple example goes back to the Enterprise accident and a crewmember falling off the gooseneck. During the circumnavigation a simple tack downhaul line removed any need for anyone to be off the deck during a reef. At the time i had never heard of the term ‘risk management’ but by thinking through each thing that we did aboard the boat and working out better systems and procedures that was exactly what i was doing.
Today i’m not actually here to tell sea stories although i have plenty more where that came from, rather i would like my readers and visitors to think about 2 things : firstly their level of first aid knowledge and onboard equipment and secondly their own boats as potential accident zones.
Up until about 10 years ago i had never done a formal first aid course although even then i had done at least 20 years of healthcare as a nurse including a couple of months in the emergency department as a student nurse. That’s as good a grounding in first aid medicine as anything that can be had. Add to that the day-in day-out stuff that we routinely do as nurses and i was reasonably skilled enough to be a decent boat medic. I didn’t know as much as i should have and sometimes had to improvise so when i came home i actually went on a first aid course myself and later became a first aid instructor in the outdoors industry. For several years i ran first aid courses myself and just before some major job problems was on the cusp of becoming a recognised RYA first aid instructor. Today i find it disturbing how few boat owners that i know have ever done a first aid course or even picked up a basic book about the subject.
I’m not here to preach the good word…..although i would like my readers to honestly think whether or not they have the skills and equipment to deal with the level and duration of problems that they could encounter during their own sailing. I specifically mention duration (of problem) because it is my experience that few first aid courses create any sense of having to deal with problems for an extended period. The usual assumption here is that when the problem occurs the first aider does their stuff, calls 999 and then the boys in green magically appear and whisk the body away. Well….on the mountain, on the river and lake, in the forest and on the sea that just doesn’t happen. On the mountain it can take hours for a mountain rescue team to muster and get to the casualty. Even in the local woods an ambulance can’t actually get to you, my experience there for example has been having to act as the person who can organise an evacuation of a casualty to the road. At sea the problem can be even worse given that once you have put out your ‘help’ call the RNLI crew have got to muster, launch their boat, get to your position, find you, get aboard maybe in a seaway and then decide what to do.
Imagine then the kind of places that Pascale and Troy (free range sailing) go to and how far they might be from serious medical assistance. As it is they seem to have a very positive attitude towards medical emergencies and a very keen sense of risk awareness around crocs, sharks, box-jellyfish, stonefish and big sharp fish-hooks for example.
Free range sailing..Troy talking about medical emergencies with the good doctor.
Now, i’m not here to endorse anything in the video and i want to add that that the video doesn’t show the total procedure for assessing, cleaning and managing a wound but the message here isn’t that….its about learning this stuff yourself and/or being a good reminder that skills fade and need to be updated. Good for Troy by the way to have a go at suturing, something i think is a crucial ocean-sailors skill.
As i write the post i was making a quick note of everything that i can remember having to deal with in terms of first aid and medical problems at sea. I won’t add them here but just for fun included them in a postscript at the end.
So, if you sail coastal or offshore and have never done a first aid course then i would just ask 2 things : first, why not ? and secondly why not ?. Here in the UK there are plenty enough ways to get some basic teaching, i know that most RYA recognised sailing schools will often run or organise a first aid course as do many good outdoor centres. For a premium first aid learning experience i would actually suggest stepping outside the sailing world and making a trip up the national mountain centre and doing one of their level 2 courses. For sailors their first aid course for paddlers would be a good choice. Beyond sailing centres and outdoors activity centres there are lots of other ways of getting on a first aid course except be advised that not all of them are good. My experience as an instructor was that many people have sat through theoretical and video based courses that have almost no hands-on learning time. To do first aid you HAVE to get hands-on and preferably in the same environment that you might need to practice in. Here for a moment i would like to put you back in my shoes aboard Liverpool Enterprise improvising the immobilisation and getting-below of a potential spinal injury.
Now i’m sorry if that was a bit preach-y so here endeth the lesson for today.
PS. Chest pain, abdominal pain (potential ulcer). Unconscious diabetic. Hypothermia. Dehydration needing IV fluids. Cuts and lacerations. Rope-burn, thermal burns and chemical burns. Coral sting injuries. Abcesses requiring incision and drainage. Broken bones. Dental abcesses. Gunnel-bum. Conjunctivitis. Potential renal failure. Sunburn. Alcohol and drug abuse. Psychological problems including depression and drug/alcohol dependency.
*As i wrote the post we had another gas explosion aboard a boat in Plymouth.
Some time remind me to tell you about a young lady and her cute but coral-stung derriere…..