Beyond STCW: First Aid Advice from a former Royal Marines Medic
This blog has been written by a Deckhand Medic Quay Crew recently placed. This particular candidate spent 11 years in the Royal Marines before spending 6 years as Team Medic for UK Special Forces and taking part in multiple tours of Iraq and Afghanistan. He was the first responder to dozens of serious, life threatening injuries and often was the sole medic on hand for hours. As part of his extensive training, he worked as a Paramedic with the Ambulance Service in the UK and spent several weeks in the Trauma Unit at Camp Bastion, Afghanistan.
Will a short blog make you into a medical professional? No of course not, but it might help having a systematic guide with a bit of realism added if you ever need it. Let’s face it, the last time you did any medical training was on the Friday of your STCW95 after a few beers the night before and it was delivered by Sandra, who although was lovely, she didn’t really have any experience and you were not that interested anyway, as you were more worried about the increasing M6 traffic. (Sandra is a made up lady, but we all know the type of person I am talking about.)
So where do I come in? I was asked to give a little input using my previous experience as a medic in the Royal Marines and I figured if I can write an easy guide to help you out in if the situation arises, I would be glad to help. However please bear with me as I am not much of a writer, I tend to eat the crayons.
Be it on the battlefield or on a yacht, the stages of treatment should not differ, regardless of injury. What I mean by this is, whether a person has been shot or a deckhand has crushed his hand in the anchor chain, we still go through our treatment the same (I promise it will become clearer). HOWEVER, what is helpful is, if you know what the incident is I.e. a fall from height or someone has caught their hand in the anchor chain, then before you even arrive on the scene you can start to think what injures may be associated with the incident: – Hand + Anchor = Lacerations, breaks etc. etc.
Do you understand so far? Basically, the better the information you receive about the incident, the better you can arm yourself for the mayhem that is about to ensue. We call this Mechanism of injury (MOI). Easy…right?!
You have just grabbed the medical kit and made your way to the foredeck. When you arrive, you see a rib swinging on the crane, there is a deckhand on the floor bleeding and another 18-year-old deckhand looking at you like a rabbit in the headlights. What do you do?
You follow this easy guide.
(**This guide is a very simple version of what is taught on STCW95, and is meant as something to consider only. It will not make you a medic.)
TAKE A BREATH!! There is no point rushing in a blind panic. Take a breath and assess the situation properly.
What do you assess? You firstly need to look at possible dangers to yourself and anyone else. That rib swinging on the crane, we should probably get it out the way. And who better to move it than the young lad in a state of shock looking at you for guidance. Give him the job and it will focus him for a short while. That’s the danger sorted.
Is the casualty responsive or unconscious? In addition to this, has there been a response from the Bridge? What I mean by this is, is anyone else aware of the situation, is further help coming. Have you had a RESPONSE? It will put you at ease if you know someone else is on their way to help you.
3. Catastrophic Haemorrhage
Now, this is probably going to differ from what you have been taught previously. The human body requires blood for various reasons. If someone is bleeding they are losing that blood. You need to STOP the blood loss. (That’s not the bit that’s different from what you’ve been taught, it’s the next bit). Tourniquets are the quickest and most effective way of stopping catastrophic bleeds from limbs. I know there is the “fear” of applying tourniquets as people say there are lots of risks associated with applying tourniquets. I understand the argument but what’s the risk if you don’t apply one? They will potentially bleed out. Remember, life over limb! If you think the bleed is catastrophic put on a tourniquet. How do you know it’s working? Well, the blood will stop coming out and I guarantee you they will forget the pain of the injury and start complaining about the tourniquet (sometimes a bit of “tough love” is required).
Are they shouting at you in pain?? Perfect, their airway is clear! If they can talk/shout at you then it means they have a clear airway and have air in their lungs. However, you still need to check in the mouth and remove anything like chewing gum. They may be ok now but they may go unconscious later and choke. Check it and check it thoroughly. Remember you may be treating an elderly guest. Anything loose like dentures need to come out. There are lots of methods you can use to maintain airways but I can’t teach you that in a blog. Just make sure it’s clear for now.
We need to ensure the patient has no injuries to their respiratory system. An easy and quick way is to ask the patient to count to ten aloud in one breath (in trauma we want a respiratory rate of between 10-20 breaths per minute. If they can count to ten aloud in one breath…awesome they are within those parameters).
Recheck your tourniquet. Make sure it’s doing the job of keeping the red stuff inside. At this point stand up, take a step back and have a look at your situation. Are you still safe, has further help arrived? Now is a good time to quickly reassess your situation. All good? BOOM get stuck back in! Firstly you want to check their radial pulse (that’s the one in the wrist). The pulse rate should be between 60-120 per minute. If it’s weak and rapid it’s usually a sign of blood loss. Then this is where I would check for internal bleeding using various methods that I spent months practising on my then girlfriend, but a simple way is to have a look for further bleeding on the deck. Are there any major lacerations you have missed, then have a feel of the stomach, is it hard (could indicate bleeding). Then have a feel of the long bones (femur and humerus) is the muscle mass around them solid (again could indicate a bleed). You won’t be able to diagnose a bleed but you can certainly make someone aware that it’s a possibility.
This is where we check the responsiveness of the patient. You would of no doubt been chatting away to them anyway but a more formal way is what we call AVPU.
Alert– is the patient alert (are they having a chat with you).
Voice– Is the patient alert to voice commands (are they quiet but responding to you).
Pain– is the patient alerted to painful stimulus (patient is quiet, eyes closed but as you pinch their ear they try to brush it away).
Unresponsive– is the patient unresponsive (like it says on the tin).
8. Environment and exposure
Time to patch up any smaller wounds, splint any breaks, get them on a stretcher and out of there. There is no point sorting a patient out and then leaving them exposed to the elements. Get them wrapped up or shaded and get them to professional help ASAP.
And there you have it, you just saved their life. Time for a cup of tea before you grab that window blade and start over on windows, scuppers, and rails.
In all seriousness, it can be daunting when faced with a real casualty. Just stay calm, reassure the patient and yourself, stay within the boundaries of your medical knowledge and you will be fine. Medical training takes years to learn and a lot of practice. You continue to learn something new everyday. Have a look around your yacht and run some scenarios, it’ll only take ten minutes but it’ll be well worth it should you ever need it. As I said at the start, this blog is in no way intended to teach you to be a professional medic but will hopefully give you some tips if you need them.