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2013-03-28

The ship's orderly will see you now

Come for the course, stay for the gruesome anecdotes
My wife has a science degree in biology and is qualified to be a high school science teacher. More to the point, she spent about a dozen years as a wildlife rehabitator at the Toronto Wildlife Centre. This centre, as are most similar organization, is a charity that cares for wild animals where they are on the losing side of interactions with humanity.
This scene has been enacted at our home. Less likely to happen aboard.
This can include treating all sorts of injuries, from concussed birds who've run into tall buildings, to turtles with guts full of fishhooks, to motherless mammals due to cars, cats or disease. The missus's job was frequently concerned with triage, deciding which animals would survive both the initial injury and the frequently long period of care required until they could be released as close as could be known to their original location.
Green is "I'm feeling much better!"

Imagine something between an emergency room nurse and about 75% of a vet's skills, only with animals from field mice up to deer and large birds of prey. Most of whom, upon first encountering my wife, were in considerable pain and probably mortal terror.

Designating her as "the ship's doctor" aboard Alchemy was therefore logical. Her medical skills, while somewhat unorthodoxically acquired, are largely transferable from the critter to the jumped-up, seafaring primates with whom she will be travelling.

Mine, however, were pretty well non-existent. Short of obtaining a few "fix my owie" merits in various children's organization, I had very little formal knowledge. And my wife, who will happily douse a No. 1 several times her size on a pitching foredeck in a part-gale, finds the engine makes her nervous. So, following the fairly successful model of our separate delivery crew trips, this winter, she has taken a diesel maintenance course and I have taken Transport Canada's Marine Basic First Aid Course. While it took some bureacratic running around to arrange, I found it a worthwhile expansion of my quasi-medical knowledge, as much for dispelling some medical myths or abandoning old-school ideas of first aid that probably got retired after World War II. (Hint: Tracheotomies are right out. Something you saw on M*A*S*H* when you were a kid has likely gone the way of the buggy whip these days.). The certification arrives in the form of a card and is good for three years. Even if taught by Vinnie Jones.


The goal of myself and my wife, of course, is to create a sort of Venn diagram of each other's skill set. If I break an arm on deck, she can service the diesel to get us to shore safely; if she does the same, I can render first aid in the marine setting, which has some special considerations, particularly in rough conditions. And of course, we can both educate our son in the basic basics, such as wound compression, splinting and treating things like jellyfish stings, which we aren't likely to avoid, and, contrary to what you might have heard, don't require someone to pee on you.
Our course instructor, Craig Hamilton, looking both nautical and uninjured.

The course, which was held last weekend at our boat club, was run by a former television producer turned charter skipper turned marine safety instructor, Craig Hamilton. He runs with his associations an outfit called Boaterskills.ca. He possesses a thick wad of certifications and teaches boat handling, docking, boater safety and the training needed to get the various marine licences required to operate a boat in Canada. Teaching the "terrestrial" Red Cross Basic First Aid course with added information pertinent to boats (like "how do you get an unconscious large person tied to a back board up the companionway stairs?" Answer: Maybe you don't, or maybe you rig the mainsheet...it depends.) There was a focus, driven in part by participants' questions, on the sort of injuries more likely to occur about a boat, like drownings, burns, and blunt force trauma from being thrown into things.

It's a shocking business, I know.

A large proportion of the course time is spent learning CPR and the use of Automatic External Defibrillators (AEDs). These are the portable, rechargeable, automated versions of the "clear! ZAP!" devices that have been a staple of medical dramas since the '70s. As they are now sold for about $1,500, they are falling into the same class of safety devices as EPIRBs, satphones, SOLAS-grade flares and liferafts: expensive, but very hard to justify ignoring.

Several trenchant facts emerged during the training: if you are not breathing and your heart has stopped, you are dead; chest compressions will only keep you from being really dead by literally pushing minimally oxygenated blood to your brain. The current thinking is that the CPR rhythm should be 30 compressions, followed by two breaths with the airway kept clear. It's real work; the CPR manikins have "sternum-strength" spring pads inside them to simulate the average chest, and you must compress a fairly small target area to have any hope of actually pushing the blood through a stopped heart. Think "unprimed Whale Gusher foot pump in the galley" and those of you familiar with those devices will sense the type of physicality involved.
You bet I can now do this. Your sternum won't thank me, but you might live to curse me.

We learned that the AED is for when you still have a heartbeat, but it is dodgy, racing or otherwise compromised. This could be from shock, fever, poisoning of some description, blood loss, a head injury...whatever. The point is to restore the normal rhythm until help can arrive. And help needs to arrive; at the level of Basic First Aid, you are merely trying to keep the person alive, and if not in immediate danger of death, to keep them from going into shock, to keep them safe, warm and confortable. It's Better Than Nothing, not Pretend Doctor. The limitations of the first aid renderer are considerable, but there is still scope to preserve life itself, to keep people hydrated and nourished (unless internal bleeding is suspected!), and to rig splints and dressings for the smaller, but probably quite distressing, injuries and maladies that can befall sailors.

We're going to need a bigger head.

At this point, I ruefully stare at my hands, which have been blistered, scorched, stapled, cut with tools blunt and scapel-like, and which sport a number of interesting cosmetic modifications. Boating for me has not been without incident or injury, but it's really part of the game to endure a few examples of the sea's rough embrace.

I like this one, as the doctor-authors are themselves sailors.

Should I wish to take further instruction, there's an advanced course in Marine First Aid. I'm thinking it may make sense. Thanks to an alert reader who sent along a link to a free (and very comprehensive) PDF from the World Health Organization entitled International Medical Guide for Ships. Good to know and better to read.

In a later post, and in consultation with the Ship's Doctor (Not a Real Doctor But Pretty Damned Good), we shall discuss the ship's medicine chest and its mysterious contents. Which, thanks to the expert instruction of Mr. Hamilton, who was not shy of offering a usually vivid anecdote in order to illustrate a course point, is slightly less mysterious now. Go ahead: Injure yourself in front of me. Odds are I won't just stare at you waiting for someone to do something, or perhaps smother your screams with a nearby pillow or callously suggest you rub rum into it.

Instead, I will render aid.


4 comments:

John NYC said...

Great description, so lively, I feel like I've attended the course.

I wonder where to get the first aid kit, though.

Here's a short film on CPR from the British Heart Foundation:

http://www.youtube.com/watch?v=ILxjxfB4zNk

Rhys said...

Thanks, John. I put that video in the body of the post...it's too good to miss a Vinnie moment.

Re: kits. Because I am leaning toward the "purpose-built" kit, plus a "sub-kit" made just for the liferaft ditch bag, I am leaning away from the professionally assembled ones. I think to a certain extent you should tailor them to one's own health needs/history, age and known issues. You need very little beyond what you can assemble at Shoppers' Drug Mart for Lake Ontario, for instance, plus some splints or even spare sail battens.

I'm going to reduce several old jerseys and worn flannel blankets to those large triangular bandages, however. Even I can see their utility.

Other places you would need Cipro, epi-pens and other expensive, single-use devices. Assuming you are going for a comprehensive medical kit, you have to consider a relationship with a doctor here who will write scrips for unusual drugs, plus one who will provide the inoculations needed for the tropics. Your GP is not going to keep the cure for yellow fever in her fridge.

That said, the expiry dates of certain drugs plus the cost of "exotics" here means it's best, assuming you know the time needed for vaccines or tablet regimes to become effective, to get them abroad. Some quite powerful medicines are over-the-counter in other places, and there's also the matter of needing to show vaccination records in certain places.

Assembling the appropriate medical gear is, like devising the right ground tackle, a fairly complex topic I will broach in a future post. I certainly don't yet know everything I need to on the topic, but it's safe to say that the ship's doctor has some pretty unusual drugs, instruments and salves she thinks should be aboard. She's quite capable of stitching, wound debridement and other messy but minor repairs that might require a visit to a perhaps dubious shoreside clinic. We also have had horrible warnings in the form of friends left with reduced limb function because a bad break was set improperly and they turned down the chance to load up on happy juice and fly back to Canada...so maybe the truly comprehensive first aid kit should include an open-ended return ticket?

dbostrom said...

Be sure also to see the WHO "International
Medical Guide for Ships" which includes comprehensive information for sailors including where to store the bodies (you'll need a large reefer).

http://apps.who.int/iris/bitstream/10665/43814/1/9789240682313_eng.pdf

More comprehensive than most any other "first aid" guide, also completely free.

Rhys said...

Thanks for the tip and the link, although I certainly hope I'm never on either end of that particular decision. I'm afraid there's no provision for installing a Grunert big enough to hold a corpse. Nobody would use the ice cubes!