Emergency Care Textbook Professional Responders-part-23 PDF

23 Marine Environment Key Content Maritime Occupational Health and Safety Regulations (MOHS)................................. 384 Sterilization Techniques.......... 385 Managing Dangers at the Scene.................................... 385 Toxicological Hazards on Board a Ship...........................

23 Marine Environment Key Content Maritime Occupational Health and Safety Regulations (MOHS)................................. 384 Sterilization Techniques.......... 385 Managing Dangers at the Scene.................................... 385 Toxicological Hazards on Board a Ship......................... 386 Psychological Well-Being of Seafarers............................... 387 Medical Care of Rescued Persons................................. 388 Radio Medical Advice............. 390 Transfer and Transport........... 396 Marine Pharmacology............. 396 Medications and Health Supplies Carried on Board................................. 396 Drugs Requiring Medical Advice................................ 397 Introduction This chapter references the need for specialized training for responders who are responsible for the medical care of seafarers. Although this chapter outlines procedures intended for those with specialized training, as a marine first aid attendant, you may be requested to gather supplies and/or assist a ship’s physician or more advanced medical personnel with procedures. This information is being provided to familiarize you with the necessary equipment and safety precautions. MARINE ENVIRONMENT As a marine advanced first aid attendant, you are required to hold a marine first aid certificate specified by Transport Canada, Marine Safety. While most of the principles and techniques described in this text are applicable in a marine environment, some unique considerations or modifications are necessary for this context. 383 As a marine first aid attendant, it is important for you to be aware of the location of the following items on your ship: First aid station(s), which are found in the wheelhouse, engine room, galley, and lifesaving equipment (e.g., lifeboats) First aid kits (Figure 23–1) and equipment Medical supplies MARITIME OCCUPATIONAL HEALTH AND SAFETY REGULATIONS (MOHS) The Maritime Occupational Health and Safety Regulations (MOHS) of the Canada Labour Code specify the legal requirements around first aid and medical care in a marine environment. The MOHS is a living document that is updated regularly, so you must ensure that you have familiarized yourself with the most recent version. It is available for free online from the Government of Canada. The following section summarizes key points from the MOHS, but you must ensure that you are familiar with this important legal document. Part 6, Section 114 of the regulation covers legislative requirements for the following topics: First aid providers on board Medical care ashore First aid kit, medicine chest, and medical guide Transportation of injured employees Posting of information Records MARINE ENVIRONMENT First Aid Kit, Medicine Chest, and Medical Guide 384 The tables in the MOHS regulations specify the type of first aid kit that must be on board a vessel based on the number of employees on the vessel, and the type and quantity of items that must be included in each type of kit. The MOHS regulations also specify which vessels must carry a medicine chest and what it must contain. First aid kits and medicine chests must be accessible to employees on board and clearly marked with conspicuous signs. It is the Figure 23–1: A first aid kit. responsibility of the employer to ensure that the ship is equipped in accordance with these regulations. The first aid kit and its contents, along with the medicine chest, other medical equipment, and the medical guide, must be properly maintained and inspected by a qualified person at regular intervals, at least once every 12 months. Any employee responsible for medical care or first aid must be instructed in the use of the medical guide by his or her employer. Records Whenever an injured or ill employee reports for first aid to a person, or if a person who holds a first aid certificate renders first aid to an employee, the person must complete and sign a first aid record with the following information: The date and time of the reporting of the injury, disabling injury, or illness This record must be kept by the employer for 2 years. Unless there is a qualified person (e.g., a registered nurse or doctor) on board the ship, the ship’s captain is ultimately responsible for the administration of medicine. However, the decision as to whether to administer medicine is made after consulting with the medical advisor. Also, the captain must maintain a log book of all medicine administered during the voyage and for which type of illnesses. An official entry in the ship’s log book must also be made. STERILIZATION TECHNIQUES It is important to understand and follow the proper procedure for sterilizing surgical equipment and work surfaces. Sterilizing surgical instruments is essential for decreasing the risk of disease transmission. Currently, the most common methods of sterilization are: 1. Steam sterilization (autoclaving). 2. Dry heat. 3. Chemical antiseptics. Steam Sterilization Steam sterilization (also known as autoclaving) is the preferred means of sterilizing instruments. Prior to beginning the sterilization procedure, disinfect all instruments and cleanse them of all organic materials. This will significantly decrease the risk of exposure to the persons handling the instruments. All viruses become inactive with steam sterilization if the following protocols are followed: 20 minutes at 121°C to 132°C (250°F to 270°F) or 30 minutes in the same temperature range if wrapped in packs. There are indicators that show whether sterilization has been successful. For example, wet spots on a pack of instruments after the procedure has finished indicates that sterilization was not successful and therefore must be repeated. Dry Heat If autoclaving is not possible, another fairly effective method of sterilization is the application of dry heat for a period of 1 to 2 hours at a temperature of 170°C (338°F). For this to be effective, the instruments must be free of grease or oil contamination. This method is only effective on metal instruments and a few natural suture materials. Chemical Antiseptics Most surgical instruments are no longer stored in liquid antiseptics. However, chemicals such as glutaral (glutaraldehyde), formaldehyde, or chlorhexidine can be applied to sharp instruments, as well as certain catheters and tubes, to effectively sterilize them. If you have chosen to use glutaral, ensure that you follow the manufacturer’s instructions. This chemical is very effective against several contaminants, including bacteria, fungi, and a wide range of viruses. If you have chosen to use formaldehyde for cleaning, you must also expose the instruments to vapour from paraformaldehyde tablets. This is done in a closed container that must be sealed for a minimum of 48 hours. MANAGING DANGERS AT THE SCENE When arriving at an emergency scene in a maritime environment, the following items should be evaluated: 1. Location of the emergency 2. Extent of the problem 3. Apparent dangers 4. Apparent number of ill or injured people MARINE ENVIRONMENT The full name of the injured or ill employee The date, time, and location of the occurrence of the injury, disabling injury, or illness A brief description of the injury, disabling injury, or illness A brief description of the first aid rendered, if any A brief description of arrangements made for the treatment or transportation of the injured or ill employee 385 5. Behaviour of ill or injured people and bystanders 6. Need for additional assistance 2. Safety Data Sheets (SDSs) 3. Worker education Responders should ensure their safety by: 1. Evaluating present and potential dangers. 2. Wearing proper protective gear. 3. Doing only what they are trained to do. 4. Summoning additional resources. If you are required to work with or near controlled products, you must receive training in the following areas: Use of WHMIS labels and SDSs Location of SDSs (they should be easily accessible) Procedures for safely using, storing, handling, and disposing of the hazardous materials on site Procedures to follow in case of an emergency that involves hazardous materials Specific codes that are used on your vessel (pipes, pumps, and large containers that carry hazardous materials should be marked with these codes) Different types of emergencies present different degrees of danger. Examples of emergencies that are more dangerous include those involving water and ice, high winds, hazardous materials, natural disasters, or confined spaces. If the scene is unsafe, retreat. Notify appropriate personnel and wait for their arrival. Never enter a dangerous scene unless you have the training and equipment to do so. If you are being called to a cabin or sleeping quarters, ensure your safety by: Having ship personnel clear you to enter the cabin. Standing to one side of the door when knocking. Asking how many people are in the cabin at that time. TOXICOLOGICAL HAZARDS ON BOARD A SHIP Global Harmonized System (GHS) MARINE ENVIRONMENT Many workers are exposed to chemical hazards in the workplace. To help protect employees, the federal, provincial, and territorial governments have legislated WHMIS, a nationwide class identification system that provides Canadian workers and employers with information on the hazardous materials they use on the job. 386 WHMIS regulations require employers to: 1. Clearly label hazardous materials, including all toxic substances. 2. Inform employees about risks and precautions. WHMIS uses the following three approaches to help identify and handle hazardous materials safely: 1. Labels (risks, precautionary measures, and first aid to be given in case of exposure or poisoning) To minimize safety and health risks, workers should observe all warning labels, tags, and placards in the workplace and follow the required precautions. When both employer and employee follow these government guidelines, hazardous-materials injuries in the workplace can be prevented. Safety Data Sheets (SDSs) contain important technical information for workers on the work site. An SDS must be available for every hazardous material on the work site. More information on SDSs can be found on page 32. Inhalation is the most common method of poisoning in the shipping industry. A toxic substance may consist of vapour, gas, mist, spray, dust, or fumes. It is recommended that copies of all relevant SDSs be kept in a location where the first aid attendant will have ready access to the information. For worker reference, appropriate SDSs must also be available at all locations where the products are used. Potentially Toxic Substances Toxic substances can cause death, illness, or serious injury. They can be harmful when they are swallowed or inhaled or when they come into contact with skin. Toxic substances can be gases, solids, or liquids. Certain refrigerated cargoes, including fruit, vegetables, and cheese, generate carbon dioxide during normal storage. After the failure of a refrigerating plant, food cargoes, especially meat, may generate poisonous and inflammable cargo space. This can be particularly dangerous if the cargo space is flooded. Carbon monoxide, ammonia, hydrogen sulphide, and hydrogen may be generated in addition to carbon dioxide. In any great concentration, these gases are extremely poisonous, and some are explosive. Never enter a confined space without the authorization of the master or a responsible officer. Storage of Dangerous Goods on Board Every hazardous substance stored, handled, or used in a workplace must be managed to ensure that the potential hazard to workers is minimal. This is accomplished by clearly marking and labelling packages and by placing warning placards on containers and transport units as indicated by national and international regulations. Confined Space: Characteristics and Dangers Crew members may be risking injury or death when entering confined spaces in which air cannot support life. Some confined spaces may lack oxygen content; some may even contain asphyxiating or toxic gases. Pump rooms or tanks that previously contained petroleum or chemicals are a particular risk for toxic gases. Rust, fire, and bacteria present in any enclosed space, such as shipping containers or holds, can also use up and deplete oxygen content. Only specially trained personnel are permitted to work in a confined space. When respiratory protection is required, workers in a confined space must wear a safety or body harness securely attached to a lifeline. Never enter a confined space without the permission of the master or a responsible officer who has ensured that the space is safe to enter. A safety watch is a worker who must be stationed outside the confined space to provide constant watch and maintain communication with the worker inside. The safety watch must activate a suitable alarm if a rescue in a confined space becomes necessary. If a responder is on safety watch outside the space and sees a worker collapse inside, he or she should raise the alarm immediately and wait for help before entering the confined space. If a responder needs to work in a confined space, he or she must make sure to have: Proper respiratory protection. Communication with people outside the space. Safety/first aid equipment. Proper training. PSYCHOLOGICAL WELL-BEING OF SEAFARERS Marine environments create unusual social conditions. A seafarer may be in extremely close quarters with his or her colleagues for weeks or months, yet still feel isolated and alone. Separation from loved ones, monotonous environments, and long work hours can all contribute to mental health concerns. Suicide is a serious problem in marine environments. Seafarers should be attentive to their own mental states, as well as those of the people around them. If you find yourself experiencing depression, anxiety, or other mental health conditions, there may be resources available to you. Speak with someone that you trust about your experiences. MARINE ENVIRONMENT Carbon monoxide gas can occur in hold fires, as the product of an explosion, in the waste gases of petroleum and oil-driven engines, and when refrigerated meat cargoes decompose. Refrigerant gases such as ammonia vapour, carbon dioxide, or Freon will displace oxygen, making the air unsafe to breathe. In the presence of an open flame, the properties of Freon change, producing a toxic substance. 387 MEDICAL CARE OF RESCUED PERSONS Immediate Care of Survivors Survival in a rescue craft (lifeboat or raft) is one of the most strenuous ordeals a person can face (Figure 23–2). Rescued survivors must receive immediate care. Rescued survivors may be found suffering from various injuries and conditions, including the following: Drowning Hypothermia and other cold-related injuries Emotional conditions Seasickness Sunburn Heat exposure (heat cramps, heat exhaustion, and heat stroke) Contamination with oil Dehydration and malnutrition Immersion foot (trench foot) Medical Care of Rescued Persons from Sea Under ideal conditions, a healthy, uninjured person may be able to survive for at least 3 days at sea (and even as long as a month, depending on available resources) in a rescue craft. Survivors may need emotional support and/or crisis intervention in addition to care for any physical conditions. Keep the person quiet and warm and let him or her sleep. Dry foods, such as crackers, may help settle the stomach. Figure 23–2: A survival rescue craft. Abdominal cramps. Vomiting. Exhaustion. Dry mouth. Patients who are not accustomed to the sea are most susceptible to seasickness, but even experienced seafarers may be affected in rough water conditions (Figure 23–3). To treat seasickness: Keep the patient quiet and warm. Provide dry foods, such as crackers or toast, in small portions to help settle the patient’s stomach. Offer cracked ice to help relieve the patient’s thirst. More severe cases of prolonged vomiting may be managed with over-the-counter preventive medications in dosages recommended by the Many injuries and illnesses that occur in the marine environment are described elsewhere in this text, but the following are more specific to this context. MARINE ENVIRONMENT SEASICKNESS 388 Seasickness (motion sickness) is an acute illness largely due to the motion of the ship or vessel. Signs and symptoms of seasickness vary but include: Loss of appetite. Headaches. Nausea. Cold sweat. Dizziness. Figure 23–3: Vomiting is a symptom of seasickness and can affect even experienced seafarers. manufacturer. It is very important to note the contraindications and side effects of these medications before drug administration (see Chapter 22). In mild cases, the condition will gradually wear off and no specific treatment may be necessary. CONTAMINATION BY OIL Oil can cause breathing difficulties if inhaled, or nausea and vomiting if ingested. DEHYDRATION AND MALNUTRITION Survivors who have been adrift for several days may be found suffering from dehydration. If they have been adrift for several weeks, malnutrition may also have developed. To care for dehydration and malnutrition: Give food and water in small amounts at first. Seek radio medical advice on how to treat the patient. Provide a diet of nourishing liquids (sugar and water combination, milk, or soup), as this will help satisfy nutritional requirements. This diet should continue until the survivor can be transferred to medical care ashore. IMMERSION FOOT (TRENCH FOOT) Immersion foot is caused by exposure of the lower extremities to water above freezing temperatures, but usually below 10ºC (50ºF), for more than 12 hours. It typically occurs in shipwrecked sailors who have survived in lifeboats or rafts in adverse weather conditions and with wet and constrictive clothing, especially in combination with a poor diet. Figure 23–4: A sign of immersion foot is swollen, waxy feet. Preventing Immersion Foot To prevent immersion foot: Keep your feet clean and dry. Wear proper-fitting boots. Wear wool or synthetic socks. Sleep in dry socks or barefoot. Dry and massage your feet twice a day. Signs and Symptoms of Immersion Foot Initial signs and symptoms of immersion foot include: Swollen, cold, waxy feet (Figure 23–4). Peeling skin. Reduced sensitivity to touch. Wooden feeling in feet. Delayed capillary refill time (nail beds stay white after being squeezed). After the foot warms up, it may present the following signs and symptoms: Warm, dry, red skin Blisters Pain Tingling or itching Increased sensitivity to cold MARINE ENVIRONMENT Survivors of shipwrecks are sometimes covered in oil. If a patient has suffered oil contamination, follow these guidelines: Clean the skin only after the patient is warm and comfortable (clean the areas around the mouth and eyes immediately). Wipe the skin with a soft cloth or strong paper towels. Have the patient take a warm shower using regular hair shampoo and body soap. If the patient has any signs of burns, do not wipe the affected areas directly. 389 Care for Immersion Foot When caring for immersion foot, handle the area gently and warm it slowly. Raise the foot (or feet), and continue to monitor the patient as well as the affected area. from a medical advisor will depend on the severity of the situation and the supplies and medical personnel available on board the ship. You should prepare for the medical advice by having the list of available medications and supplies on hand during the call. RADIO MEDICAL ADVICE Preparing Information for Radio Medical Advice As a general rule for a marine first aid attendant, procedures beyond your training and ability should not be attempted. However, you should be aware that medical advice is available, especially in cases in which more advanced medical procedures are required. A vessel is required by law to carry a complete and up-to-date list of radio stations from which medical advice can be obtained. When seeking radio medical advice, provide as much information as possible to the medical advisor. Remember to repeat the information back to the advisor to ensure that the information exchanged is accurate. You may want to record the exchange on tape to help clarify any written notes. Medical advice can be accessed from a physician by: Mobile phone. Direct radiotelephone contact with a shore radio station using a prearranged radio frequency (e.g., Rescue Coordination Centre [RCC]/Maritime Rescue Sub-Centres [MRSC] or the Marine Communications and Traffic Services Centre [MCTS]). You should request to speak to a physician. Contacting a nearby port or nearby ship with a physician on board. The advice received For legal reasons, it is important to write down any exchange of information. Afterwards, copy the notes, including the actions that were taken, into both the patient’s and ship’s records. Examples of specific forms are: The Ship Master’s Report form. The Patient Health Status form. The Medical Advice form. Prior to seeking radio medical advice, you should prepare key information about your ship, the ill or injured person, and the treatment required or rendered (Table 23–1). TABLE 23–1: FORMS TO BE USED IN COMMUNICATING TO A DOCTOR INFORMATION ABOUT A PERSON’S ILLNESS (PART A) OR INJURY (PART B)1 (A) IN THE CASE OF ILLNESS 1. Routine information about the ship MARINE ENVIRONMENT 1.1 1.2 1.3 1.4 1.5.1 1.5.2 1.5.3 1.6 390 Name of ship Call sign Date and time (GMT) Course, speed, position, and cargo Port of destination _____________ which is _____________ hours/days away Nearest port _____________ which is _____________ hours/days away Alternative port _____________ which is _____________ hours/days away Local weather (if relevant) 2. Routine information about the person 2.1 2.2 2.3 2.4 2.5 Surname Other names Rank Job on board (specify kind of work, not just the trade) Age and sex (A) IN THE CASE OF ILLNESS 3. Details of illness 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 When did the illness first begin? Has the illness occurred before? If so, when? How did the illness begin (suddenly, slowly, etc.)? What did the person first complain of? List all the person’s complaints and symptoms. Describe the course of the present illness from the start of the illness to the present time. Give details of past illnesses/injuries/operations. List serious illnesses of parents, brothers, sisters, if known (family history). List social pursuits and previous occupations, including hobbies (social and occupational history). List all medicines/tablets/drugs that the person was taking before the present illness began and indicate the dose(s) and frequency of administration. Does the person smoke? If so, how much and how often? Does the person drink alcohol? If so, how much (on how many days a week, on average, and how many drinks a day, on average)? Does the person take any herbal or folk medicines? If so, how are they taken? Does the person use recreational drugs? If so, how are they taken? 4. Results of examination of person 4.1 Note temperature, pulse, blood pressure, and respiration. 4.2 Describe the general appearance of the person (healthy, obviously ill, pale, etc.). 4.3 Describe the appearance of affected parts of the body (consider faxing or emailing a digital photograph). 4.4 Describe your observations about the affected parts of the body (swelling, tenderness, lack of movement, etc.). 4.4.1 What tests have you done (urine, blood, other) and what were the results? 4.4.2 Give the results, if available, of any previous blood tests, X-rays, or other investigations. 5. Diagnosis 5.1 What is your diagnosis? 6. Treatment 6.1 Describe care you have administered since the illness began. 6.2 List ALL medicines/tablets/drugs that the person has taken or been given, and indicate the dose(s), the number of times given, and the frequency of administration. 6.3 How has the person responded to the treatment? 7. Problems 7.1 7.2 What problems are worrying you now? What do you need advice about? 8. Other comments 9. Comments by the physician (B) IN THE CASE OF INJURY 1.1 1.2 1.3 1.4 1.5.1 1.5.2 1.5.3 1.6 Name of ship Call sign Date and time (GMT) Course, speed, position, and cargo Port of destination _____________ which is _____________ hours/days away Nearest port _____________ which is _____________ hours/days away Alternative port _____________ which is _____________ hours/days away Local weather (if relevant) 2. Routine information about the person 2.1 2.2 2.3 2.4 2.5 Surname Other names Rank Job on board (specify kind of work, not just the trade) Age and sex MARINE ENVIRONMENT 1. Routine information about the ship 391 (B) IN THE CASE OF INJURY 3. History of the injury or injuries 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Exactly how did the injury or injuries occur? Did the person lose any blood? If so, how much? When did the injury or injuries occur? How long before the incident did the person last eat or drink? What does the person complain of? (List the complaints in order of importance or severity.) List all past illnesses/injuries/operations. List all medicines/tablets/drugs that the person was taking before the present injury or injuries occurred; indicate the dose(s) and frequency of administration. 3.8 Has the person been taking any alcohol? 3.9 Do you think the person might have taken narcotic drugs, amphetamine, etc.? 3.10 Does the person remember everything that happened? If not, how long before the accident is his or her last clear memory? 3.11 Did the person lose responsiveness, even for a very short time? If so, for how long and when in relation to the injury? 4. Results of examination of person 4.1 4.2 4.3 4.4.1 4.4.2 Note temperature, pulse, blood pressure, and respiration. Describe the general condition of the person. List what you believe to be the person’s injuries in order of importance and severity. What tests have you done (urine, blood, other) and what were the results? Give the results, if available, of any previous blood tests, X-rays, or other investigations. 5. Treatment 5.1 5.2 5.3 Describe the care you have administered since the injury or injuries occurred. List ALL medicines/tablets/drugs that the person has taken or been given, and indicate the dose(s), including the number of times given, and the frequency of administration. How has the person responded to the treatment? 6. Problems 6.1 6.2 What problems are worrying you now? What do you need advice about? 7. Other comments 8. Comments by the physician Radiotelephone Procedures MARINE ENVIRONMENT Transport Canada provides a reference regarding radiotelephone procedures (TP 9878E: Safety and Distress Radiotelephone Procedures), which should be displayed next to your vessel’s radiotelephone. The procedures in this reference advise that safety and distress radio messages should be made on Channel 16 (156.8 MHz) or on frequency 2,182 kHz, MF. 392 The normal procedure to obtain radio medical advice is as follows: 1. Make contact with the shore radio station and request medical advice (Figure 23–5). 2. Give the physician all the information you can so that a medical assessment of the situation can be made. 3. The physician will give advice on the immediate care of the patient. Figure 23–5: Obtaining radio medical advice. 4. After the link call is over, the physician will advise the Search and Rescue (SAR) authority or coast guard service (e.g., RCC) on the best method of evacuation. 5. If helicopter evacuation is necessary, the coast guard will keep in touch with the ship. Communication With Physicians A written letter or form should always accompany any patient seeing a physician. A clearly written communication in a foreign language is sometimes better understood than a spoken one (see Table 23–2). The phonetic alphabet (see Appendix C) may be useful when clarifying important details over the radio. TABLE 23–2: MEDICAL REPORT FORMS FOR SEAFARERS SHIP MASTER’S REPORT FORM Date of report _________________________________________________________ ✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵ Ship’s Identity and Navigation Status Name _________________________________________________________________________________ Owner _________________________________________________________________________________ Name and address of on-shore agent _________________________________________________________ ______________________________________________________________________________________________ Position (latitude, longitude) at onset of illness ________________________________________________ Destination and ETA (expected time of arrival) _________________________________________________ ______________________________________________________________________________________________ ✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵ The Person and the Medical Problem Surname and first name ________________________________________________ Gender: Male Female Date of birth (dd-mm-yyyy) ___________________________________________________________________ __________________________________________________________________________________ Seafarer registration number Shipboard job title _________________________________________________________________ __________________________________________________________________________ Hour and date when taken off work Hour and date when returned to work __________________________________________________________ ________________________________________________________ MARINE ENVIRONMENT Nationality 393 Injury or Illness Hour and date of injury or onset of illness ____________________________________________________ Hour and date of first examination or treatment Location on ship where injury occurred Circumstances of injury ______________________________________________ ______________________________________________________ ______________________________________________________________________ ______________________________________________________________________________________________ Symptoms ___________________________________________________________________________________ Findings of physical examination ______________________________________________________________ ______________________________________________________________________________________________ Findings of X-ray or laboratory tests ___________________________________________________________ Overall clinical impression before treatment ____________________________________________________ ______________________________________________________________________________________________ Treatment given on board ____________________________________________________________________ ______________________________________________________________________________________________ Overall clinical impression after treatment _____________________________________________________ ______________________________________________________________________________________________ ✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵ Telemedical Consultation (on-line medical control) Hour and date of initial contact _______________________________________________________________ Mode of communication (radio, telephone, fax, other) Surname and first name of telemedical consultant Details of telemedical advice given _________________________________________ ______________________________________________ ___________________________________________________________ ______________________________________________________________________________________________ MARINE ENVIRONMENT ✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵✵ 394 N.B. Attach all relevant medical reports to this report form. Person Health Status Form (To accompany person being evacuated) Surname and first name Age (years) Gender _______________________________________________________________ _______________________________________________________________ Time (hour) and date Vital signs ________________________________________________________________ _______________________________________________________________ _______________________________________________________________ Blood pressure (systolic/diastolic) ____________________________________________ Pulse (beats/min.) ____________________________________________ Body temperature (oral), note F or C ___________________________________________ Presenting medical problem: symptoms, site(s) of pain or injury, time of onset, duration of problem, contributing factors _________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Treatment given (medication, dressings, etc.) __________________________________________________ ______________________________________________________________________________________________ Telemedical advice (on-line medical control) received __________________________________________ ______________________________________________________________________________________________ Other current medical problems ______________________________________________________________ ______________________________________________________________________________________________ Past history of significant medical problems ___________________________________________________ ______________________________________________________________________________________________ Current medication being taken (generic and brand names; dosage; time of last dose) MARINE ENVIRONMENT ______________________________________________________________________________________________ 395 TRANSFER AND TRANSPORT Medical Evacuation From a Ship People who require rapid transport to a hospital facility due to severe trauma or medical emergency require medical evacuation from a ship. This decision is the responsibility of the vessel’s chief officer. Wear  rubber gloves to handle the winch wire because a helicopter can build up a significant charge of static electricity. Point search lights vertically upward to aid in locating the ship if the hoist is being carried out at night. Light the pickup area as much as possible. Be sure not to blind the pilot by shining any lights directly on the helicopter. Obey the helicopter crew’s instructions at all times. Evacuation by Helicopter If helicopter evacuation is determined to be necessary, the following measures should be taken: Give the ship’s position and description, and details of the patient’s condition. Advise the bridge and engine room watches that someone should maintain direct communication with the helicopter. Send a message via a shore radio station or coast guard station on 2,182 kHz, MF, or on VHF (if direct communication with the helicopter cannot be made), and follow all instructions provided. Clear as large an area as possible on the deck and mark the area in white with a large letter “H” to identify the hoist area. If possible, take down whip and wire aerials in and around the area. Ensure that all loose articles are securely tied down. Identify the ship to the flight crew with a signal (orange-coloured smoke, for example, which is often used in lifeboats). This is helpful in heavy shipping areas. Never hook the hoist cable of the helicopter to any part of the ship. MARINE PHARMACOLOGY Medications and Health Supplies Carried on Board In the International Medical Guide for Ships, 3rd Edition (2007) (Table 23–3), the World Health Organization (WHO) has recommended a list of medications and health supplies in the ship’s medicine chest. This list can be found in Chapter 33 of the guide. In the International Medical Guide for Ships, Quantification Addendum 2010, the WHO updated the list of recommended medications in the ship’s medicine chest section of the International Medical Guide for Ships to include recommended quantities of medicines required to be held by ships. This addendum also provides recommended stock holdings for the medicines listed in the International Medical Guide for Ships. The listing is standardized to quantities per number of crew. TABLE 23–3: CATEGORIES OF SHIPS MARINE ENVIRONMENT CATEGORY A 396 International Medical Guide for Ships, 3rd Edition (2007) Ocean-going merchant vessels without a physician on board CATEGORY B CATEGORY C Merchant vessels engaged in coastal trade or going to nearby ports, and not more than 24 hours away from port of call Fishing boats or private craft that are never more than a few days from home port, or only a few hours from a port of call Crew Sizes and Trip Durations The WHO has chosen to calculate quantities per 10 crew members. Trip durations have been based on 3 to 4 weeks. Medical supplies and medications are most likely located in the ship’s sick bay (ship’s hospital). Cabinets and drawers in the sick bay should hold a working quantity of the recommended medications and should be clearly labelled. The contents of the ship’s medicine chest should be inspected annually by a pharmacist. During the first assessment, question the patient to find out if he or she has allergies, medical conditions, or medications. This will allow you to find out whether the patient has a medication that may be helpful for the situation. It will also allow you to discover any contraindications or situations that may change the choice of medication or the way a medication is used. If someone develops a pronounced side effect from a medication, obtain radio medical advice. Drug administration requires specialized training and is intended for those who provide advanced medical care. The following section—which describes medications found on ships, and their side effects—is intended to provide a basic overview only. Drugs Requiring Medical Advice Safe drug therapy requires clear communication between the ill or injured patient and medical Figure 23–6: Nitroglycerin spray. professionals. In some situations, first aid attendants must access radio medical advice before administering medication (see Radio Medical Advice in this chapter). For example, nitroglycerin spray (Figure 23–6) is a medication restricted to “on the advice of a doctor” in DFO/5758. The International Medical Guide for Ships, 3rd Edition (2007), gives advice on other specific medications, with precautions stating: “Give only on radio medical advice from a doctor.” “Should the patient be allergic to the drug, radio medical advice should be obtained for an alternative anti-infective treatment.” “Do not administer this drug before obtaining radio medical advice.” In a marine environment, refer to the drug guide stored on your ship, or check with local standards and protocols for clarification. For some medications, first aid attendants are likely to assist a patient in taking medications from his or her own supply. Assisting a patient with his or her medications may include: Finding the medication bottle. Getting water for pills. Helping the patient hold a glass or read a label. MARINE ENVIRONMENT It is important to be familiar with the list of medications on the ship and know where to find them. Some medications can’t be given without the approval of a physician. They should be labelled “Give only on radio medical advice from a physician.” A drug guide outlines the side effects and precautions of the medications carried on board. It is important to know the location of this guide on board the ship. Before and after administering medication, check the patient’s signs and symptoms, as well as the patient’s vital signs. 397 USE (INDICATIONS) AND PRECAUTIONS (CONTRAINDICATIONS AND SIDE EFFECTS) MARINE ENVIRONMENT The three essential characteristics of each medication are indications, side effects, and contraindications. The name, strength, dose, and directions are printed on the label of each drug container (see Chapter 22 for more information). In a marine environment, the International Medical Guide for Ships, 3rd Edition (2007), provides a drug guide in the following format for each medicine: dosage, indications, contraindications, and side effects. 398 Before administering or assisting with a medication, read the precaution(s) (contraindications and side effects) and note(s) relating to each drug. The process for drug administration may include: Obtaining authorization to administer the drug. Knowing the drug’s use. Knowing the precautions of the drug. Assessing a patient before and after a medication is taken. SUMMARY RECORDING FIRST AID—INFORMATION REQUIREMENTS Date and time of the reporting of the injury, disabling injury, or illness Full name of the injured or ill employee Date, time, and location of the occurrence of the injury, disabling injury, or illness Brief description of the injury, disabling injury, or illness Brief description of the first aid rendered (if any) Brief description of arrangements made for treatment or transportation of the injured or ill employee MANAGING DANGERS AT THE SCENE Evaluate the following upon arrival: 1. Location of the emergency 2. Extent of the problem 3. Apparent dangers 4. Apparent number of ill or injured people 5. Behaviour of ill or injured people and bystanders 6. Need for additional assistance GENERAL METHODS TO ENSURE YOUR SAFETY METHODS TO ENSURE YOUR SAFETY WHEN ENTERING SLEEPING QUARTERS Evaluate present and potential dangers. Have ship personnel clear you to enter the cabin. Wear proper protective gear. Stand to one side of the door when knocking. Do only what you are trained to do. Ask how many people are in the cabin at the time. Summon additional resources. HANDLING HAZARDOUS MATERIALS Required Training for Working With or Near Controlled Products Use of the Workplace Hazardous Materials Information System (WHMIS) and Safety Data Sheets (SDSs) Location of SDSs Procedures for safely using, storing, handling, and disposing of the materials on site Procedures to follow in case of an emergency that involves the materials Specific codes that are used on your vessel Requirements for Working With Hazardous Materials in a Confined Space Proper respiratory protection Communication with people outside the space Safety/first aid equipment Proper training 1. Make contact with the shore radio station and request medical advice. 2. Give the physician all the information you can for a medical assessment of  the situation. 3. The physician will give advice on the immediate care of the patient. 4. After the link call is over, the physician will advise the Search and Rescue (SAR)  authority or coast guard service on the best method of evacuation. 5. If the helicopter is necessary, the coast guard will keep in touch with the ship. MARINE ENVIRONMENT Obtaining Radio Medical Advice—General Procedure 399 400