Medical Problems Afloat
Care and Avoidance
Each year, numerous stories circulate through the club regarding injuries to members, disasters, or near disasters while cruising through our favorite waters along the shores of Washington and British Columbia. Of course the same illnesses and accidents occur afloat as onshore, but with concerns peculiar to boating. Over the years, many of us have witnessed maladies from a fishhook in a finger, simply remedied, to life threatening illnesses requiring the mobilization of a helicopter rescue team. Boating compounds these problems in that delays by weather or location may distinctly alter the outcome.
One cannot discuss the specific treatment of injuries or illnesses in three or four pages, nor are the concerns of the day sailor the same as those of the offshore cruiser. One may call 911, while the other must be self sufficient in the event of major injuries. Many boating injuries will have occurred while someone was underway, or in rather remote areas, either by distance or rendered so by navigational difficulties. Hence, for our purposes, this text will treat first aid afloat as care when help or medical facilities may be as much as 24 to 48 hours away.
A skipper is clearly responsible for the preparedness of the vessel, and safety of the crew, whether family or guests. A basic knowledge of first aid is necessary, as well as specific needs of any crew members, along with steps for prevention of injury. There are common denominators in all injuries, which will be discussed under the headings of PREVENTION, (including preparation to avoid more serious injury or loss of life), GENERAL PRINCIPLES for care of the injured person, and an adequate FIRST AID KIT (commensurate with the areas to be cruised).
A number of hazards are always present in the marine environment that are inseparable from boating safety, such as Fire, Drowning, Hypothermia, and Carbon Monoxide Poisoning.
Carbon Monoxide (CO) is aptly known as the “silent killer”. Under normal circumstances, oxygen inhaled into the lung attaches loosely to the hemoglobin of the blood and is carried to the tissues such as the brain, organs and extremities where it is released. Carbon Monoxide, however, forms a tenacious bond with hemoglobin, preventing the blood from carrying oxygen, which ultimately results in death.
CO Poisoning is far more common with gas engines and generators, since diesel fumes are so noxious and diesels operate with more complete combustion. The following preventive suggestions are offered:
- Never run with aft curtains or doors open, without very adequate ventilation forward. We always close aft doors when underway.
- Check exhaust lines and engine manifolds for leaks, regularly.
- Do not run a generator when sleeping.
- Obtain a Carbon Monoxide Detector, with an active sound alarm. The color change of a passive detector may well be missed.
Coast Guard safety requirements are well known, mandatory and followed by all prudent skippers.Yet drownings occur that are almost always preventable. Ensuring that all guests know the location of life jackets, wearing life jackets with emergency lights or strobes at night while on deck and using safety harnesses where appropriate are common sense requirements. Particular caution is needed while handling and boarding dinghies, since hitting one’s head during a fall while boarding has caused drowning.
In the event someone does go overboard, one should throw an unattached life ring (that won’t be pulled away by the boat), assign a lookout to keep an eye on the person in the water (easy to lose eye contact in any kind of chop), and maneuver the boat back to the victim. So easy to say, but it must be practiced, particularly to avoid injury by the propellers. It must be practiced by skipper and mate separately, since it may save your life.
For those cruising beyond Vancouver Island, or to its west side, a life raft and exposure suits are obvious safety measures.
The 50 degree temperature of our inland waters becomes extremely unforgiving to a victim in the water. Depending on clothing worn, average survival before severe hypothermia sets in may be 2-1/2 to 3 hours. The importance of a life jacket becomes apparent by studies showing that treading water rapidly increases the onset of hypothermia. Even “drown-proofing” by placing one’s head under water, raising it for a breath every thirty seconds, effective in warmer climates, increases the rate of onset of hypothermia. Children lose heat even faster, hence, the importance of life jackets, or exposure suits where longer immersion may occur.
Probably the most feared event on board is fire. Most skippers will add to the standard complement of fire extinguishers, with at least one or more in each area of the boat and an automatic engine room unit. Again, one needs a plan. In an engine room fire, diesels left running will simply aspirate and exhaust the flame retardant, leaving the fire to burn anew. In gasoline driven boats, explosions often follow engine room fires so that it may be prudent to stand off in a dinghy until certain that a fire/explosion risk has passed. One should also be reminded that Carbon Monoxide and Flame retardants displace the oxygen, and one should exercise extreme caution on entering a closed space after discharge of a fire extinguisher.
Prevention includes constant vigilance for fuel line integrity, proper stowage of oily rags in sealed metal containers (to avoid spontaneous combustion), survey of propane lines and connections and care with alcohol stoves or primers for kerosene stoves to avoid fires from the nearly invisible alcohol flames.
Burns are an exceedingly painful and dangerous injury aboard a boat. Boiling water in a seaway is a dangerous practice, and proper fiddles should be in place on any stove used while sailing or powering in seas. Similar caution should be observed around hot engine manifolds.
Each of us has known a friend who has had a hatch fall on their head or hand, or worse has fallen into an open hatch. The simple experience of rigging a preventer, to keep the hatch from falling closed, and a simple banner to prevent others from happening upon an open hatch, could save a major injury from occurring. This preemptive approach can be applied to a number of areas in any boat to prevent accidents, and can be as simple as non-skid, an extra lashing, a safety rail, padding or whatever is deemed necessary when surveying your boat for potential danger areas.
General Principles: Care of the Injured
Fortunately, most “emergencies” can be dealt with in a logical manner, marshaling the information, personnel and facilities to solve the problem. However, what does one do when an accident causes a life threatening injury? A good place to start is the ABC’s of life support:
A = Airway
B = Breathing
C = Circulation
In an unresponsive person, check that the airway is clear, that the patient is breathing and that there is a pulse (carotid pulse in the neck). The absence of any one of these will result in death within a few minutes. In an apneic person (not breathing) or where no pulse can be found, begin C.P.R. (Cardiopulmonary Resuscitation). If this were a real emergency and one had to look this up, it would be too late. Take a course and get certified in C.P.R.! And while you’re at it, learn the Heimlich maneuver to force aspirated food from the airway in a person choking while eating.
Control severe bleeding. Usually this can be accomplished by direct pressure over a wound If you’ve run out of gauze in the first aid kit, a freshly laundered towel will work. Blood takes eight to ten minutes to clot, so continuous pressure for ten minutes by the clock should bring most bleeding under control. In massive bleeding from an extremity, not controlled by direct pressure, a tourniquet may be life saving. Preferably, a tourniquet should be padded, and tightened only enough to stop arterial bleeding (pumping). Excessive tightening can cause permanent nerve injury. Also, tourniquets must be released periodically (e.g. every 30 minutes) to avoid muscle damage.
Protect from further injury. Remove the person from the source of injury, but take particular care with possible neck injuries to avoid movement that could cause further damage to the spinal cord. With major fractures, avoid movements that could cause bone to puncture the skin or do internal damage. Protect the injured person from weather by blankets or whatever is at hand.
Fine! Our patient is breathing, has a pulse, bleeding is under control and we’ve taken steps to avoid further injury. Relax, and read the manual.You don’t have one??? Every boat must have a good first aid manual aboard. I would recommend Advanced First Aid Afloat by Peter Eastman, M.D.While it may give you more information than you want to know, it will serve you well on a trip to Alaska. Besides, it doesn’t cost much more for a really good reference than for an adequate one.
First Aid Kit
The first aid kit for inland cruising will be very different from that of the offshore sailor. The latter may have to deal with dental problems, major lacerations or internal concerns such as bladder obstruction for which no help is forthcoming. What follows is a basic kit for inland cruising that presumes that one could be 24 to 48 hours from professional care.
Some would argue that it contains too much, while others would suggest a more comprehensive package. This list is a starting point. Items marked with an asterisk (*) require a prescription, and their use should be discussed with your physician before departure. In fact, with cellular phones active throughout the Puget Sound, Georgia Strait and Johnstone Strait areas, one can contact their own physician, local hospital or poison control center directly. (See “Important Phone Numbers” in this book, or make a list before departure, including your doctor’s office and exchange numbers.) PREVENTION!
- Keflex 250 mg. (30) Antibiotic for infections, or severe wounds until medical care*.
- Amoxicillin 250 mg.*
- Tetracycline or Erythromycin.* Antibiotic if allergic to Penicillin or Keflex. Good for shellfish vibrio infection.
- Compazine Suppositories 25 mg. (3) For intractable vomiting or severe sea sickness.
- Tylenol with Codeine 30 mg. * Pain reliever (or substitute if allergic to codeine). Benadryl 50 mg. For severe allergic reactions.
- Lomotil. For severe diarrhea.
- Neosporin Ointment. One ounce tube. For cuts, abrasions and minor burns.
- Sea Sick Medication. Scopolamine Transderm again available.
- Zinc Oxide Ointment. Major sun protection for nose and lip.
- Bee Sting Kit.* Where crew member has serious allergy to bee venom.
- Adolph’s Meat Tenderizer. For bee stings.
- Silvadene Ointment. For burns.
- Scissors, Tweezers.
- Ace Bandage 3” (e.g. “Kling” Bandage) (2) For bandaging head or extremity.
- Gauze squares 4” (12).
- Vaseline gauze 4”x 8” (2) Non-adhesive dressing for burns or wounds.
- Steri-strips 1/2” wide. Several for wound closure.
- Betadine soap. For cleansing wounds (less harmful to wound tissues than Tinctures of Iodine
- or Merthiolate).
- Splints. Cardboard, blow-up or padded material for splints.
First Aid Manual
As we have seen, first aid is a matter of prevention and preparation. For the serious boater, first aid is inseparable from routine vessel maintenance. May we all enjoy safe cruising.
John Brunzell, MD
Monday, June 13, 2016