MEDICAL EMERGENCIES AT SEA. SIX PRACTICAL CASES

As many of you have unfortunately experienced, the boat is an inexhaustible source of minor and major incidents which are not comparable with any other “category” of situations. Different types of possible negative events are indeed concentrated in the same (beloved) place: our boats. Every “domestic incident” can occur on board, especially if facilitated by the motion of the boat. And many other misadventures can result from a fall overboard, insect bites, heat and cold strokes and everything resulting from a direct contact with the marine environment. On board, therefore, everything takes on a statistical significance absolutely different from what can normally happen on the ground.

In the light of this, the boat consequently might appear as a dangerous place people should avoid. However, of course, that’s no true. Careful precautions and a healthy dose of common sense are sufficient to avoid almost all accidents on board. Running on the deck barefoot, instead of wearing closed non-skip shoes, is, for example, a potentially dangerous behaviour. Even the least experienced person knows that but might not be able to avoid it if caught off guard. Experienced careful boaters, on the contrary, perfectly know that those shoes should be put on “before” any event suddenly causes us to “run”. If this attitude was correctly applied to any situation on board – as any good captain normally does – our statistics about on-board accidents would significantly drop.

However, the imponderable lies beyond all these considerations. The first-aid kit – compulsory on board – alongside some first-aid notions (which can be acquired thanks to qualified courses) will certainly allow to solve any little problem easily or stabilize more serious situations until medical professionals’ intervention.

The following are just some practical examples. Without any pretense of being exhaustive, they are written by a simple journalist, with no specific experience as a doctor. They must be therefore integrated by participating, at least once in your life, to one of the numerous courses that health organizations (often gratuitously) propose to both general workers and yachtsmen.

Abrasions: as we know, abrasions are wounds consisting of superficial damage to the skin. They are less serious than lacerations since bleeding and damage are really minimal. When you notice an abrasion, the first step you should take is to wash the wound with some fresh water  attempting to gently remove any dirty particles or debris. Saltwater is absolutely not recommended in this case. In order to prevent infection, it is important to disinfect the wound with little aggressive agents: denaturate alcohol is not a good idea. Once the wound is dry (a piece of gauze or sterile bandage can be applied), the abrasion should be covered and protected. In the event of a small wound, a plaster will be sufficient. If the wound is deeper and more serious, the use of a gauze fixed with some plasters or an elastic bandage is highly recommended. Of course, dressing needs to be changed whenever the bandage becomes wet or dirty. In the event of a serious abrasion, steps are always the same but you should call the C.I.R.M.

Minor and major cuts: in this case, the first step you should take is to wash, disinfect and cover the wound. Cuts, in fact, always cause tissue damage alongside the separation of two or more tissue portions that consequently need to be repaired. It will be probably difficult for us to suture a wound on board; however, adhesive plasters, always present in the first-aid kit, will certainly come in handy. In the event of a severe wound or some difficulties with the previous step, it is important to apply firm but gentle pressure on the cut with a sterile piece of gauze. The latter mustn’t be removed until medical help in order to prevent bleeding to start again. How to clean a cut in case of emergency? A large sterile syringe in the first-aid kit could be a good solution since it will enable us to flood the wound with water with very precise moves. Furthermore, in order to prevent the emotive situation of both the patient and his caregiver from getting worse, you’d better have some towels to contain the “product” of the abundant washing. If the cut is large or bleeding heavily and the wound is on an arm or leg, vessels have been probably seriously damaged. In this case, you should apply a tourniquet or a belt on the portion of the arm/leg above the cut, being careful not to compromise blood circulation. In this case, especially if the cut is serious and associated with a contusion ( head injuries), it is highly recommended to call the C.I.R.M. as soon as possible.

Trauma: this general definition includes a large group of injuries, ranging from muscle sprains, dislocations and fractures. If a bone fracture is suspected, immobilization is the first step to take also because we are not able to assess the scale of the damage. Consequently, the part of the body that has got injured should be immobilized (in the event of a dislocation, we can use a bandage) without attempting any strange medical manoueuvres. A painkiller can be useful to relieve pain while ice can contribute to slow the inflammation: we can use dry ice or, as an alternative, the ice we have in our on-board fridge. A call to the C.I.R.M is highly recommended especially in case of serious trauma.

Heatstroke: high temperatures and excessive moisture, especially if suffered within narrow spaces like boats or if due to an excessive sun exposure, can cause a temporary increase in body temperature. First symptoms can include excessive sweating, difficult breathing, accelerated heart beats, dizziness, cramps and even faint. Rapid reduction of the core body temperature is the cornerstone of treatment. Consequently, the patient diagnosed with heat stroke should be moved out of the sun, preferably in a shadowed ventilated place; then, it is necessary to apply ice packs to his groin, neck, back and armpits to lower his body temperature. If the situation is more serious ( lack of sweating is a symptom), you’d better remove clothes, fan and sponge with a wet cloth. If the person has passed out, please make sure that his breathing is regular and then seek medical care.

Burn injuries: characterized by degrees – based on the severity of the tissue damage – burns generally represent a serious problem which can easily turns into an infection. Burns should always be treated with sterile gloves and any possible precaution. Even a simple sunburn is a first-degree burn and should not be underestimated.

The presence of blisters or dark parts on the skin are the first symptoms of a serious burn. In the event of a first-degree burn, the wound can be gently cleaned with some fresh water and treated with a moisturizing cream. Major burns, on the contrary, should be washed with fresh water and covered with cool wet compresses or sterile gauzes. Blisters should not be broken. Serious burns, of course, should be treated at the hospital. Please remember that the severity of a burn injury is always directly proportional to its extension.

Hypothermia: this is a condition that occurs more frequently than you can imagine, especially on sailboats. It is a potentially dangerous drop in body temperature usually caused by prolonged exposure to cold temperatures. The risk of cold exposure increases as the winter months arrive. But if you’re exposed to cold temperatures on a spring hike or capsized on a summer sail, you can also be at risk of hypothermia. Symptoms include torpidity, drowsiness, lower capacity of reaction, stumbling steps and slow breathing. If the person at the wheel shows those symptoms, he must be immediately replaced by another crew member. In water, of course, the situation is more dramatic.  Body temperature must be increased but slowly. The first step to take is to remove all wet clothes and begin rewarming the person with hot dry clothes, bottles of hot water and warm blankets. If the hypothermic person is unconscious, or has no pulse or signs of breathing, call for emergency help right away. Alcoholic drinks must be absolutely avoided.

In this article, of course, we haven’t talked about many other common or even more serious situations, such as CPR techniques and other emergency treatments. After all, subjects are many and all deserve to receive equal attention. However, what is important is a conscious full approach to our common passion.