How long has it been since you were last trained in First Aid? When you passed your driver’s license? In the army? For me, it was over 20 years back, so I very much looked forward to refreshing my knowledge and learning about the specific challenges of medicine at sea.
Due to COVID, the course had to be changed from two days onsite to one full day online and a short practical slot onsite which, given the epidemiological situation in Switzerland, is not to take place before February.
Martin Fischle of sailadventures.ch [German] did a fabulous job introducing us to the basics of medicine at sea based on his immense experience as both an ER nurse/instructor and a sailor.
The biggest challenge of medicine at sea is how long it takes until you can put a sick or injured person in the hands of a professional. I had never realized this before although it’s pretty obvious. In large cities, an ambulance may be 10-15 minutes away. Make this an hour in remote areas, and it still doesn’t compare to what you have to deal with on a boat. In one situation Martin described, it took more than five hours before a patient with a heart attack could be loaded into an ambulance. And that was from a boat just off Helgoland, an island near the German coast. One can only imagine what this means for a crew.
Among the many takeaways from the day, these were the most enlightening to me:
- You may have to go on for hours with cardiopulmonary resuscitation. Even the best trained people can only do this for 15 minutes at a time. So look at the size of the crew and do the math.
- Pain reduces the effect of life-saving measures, which means pain management is actually one of the most important activities by itself. On this topic, I also finally understood why my doctor brother always recommends combining two or three painkillers. There are three categories, acting at the injured location, on the communication to the brain, or on the brain itself.
- People can get into serious trouble and die 24-48 hours after you pull them out of the water. Even small amounts of water in the lungs can cause them to get irritated and swell to a point where they will no longer work. Knowing this, one should be extremely attentive to breathing problems after near-drowning incidents, and always have a strong diuretic at hand that will eliminate water from the body quickly.
- “No-one is dead before they’re warm and dead.” Would you have known that you can kill a person that has remained in cold water for a long time by merely moving them, or warming them up too quickly? In a severely hypothermic patient that doesn’t shiver anymore, pumping cold blood from the extremities into the relatively warmer heart can easily lead to deadly cardiac arrythmia. This means such patients must be handled with extreme care, and not given up on too soon. The lowest core temperature someone survived was 13 degrees Celsius.
I learned so much more in this course than in any first aid training before. Martin’s course is accepted as a Medicine at Sea training for the SYA bluewater license. I can only recommend it.
