Boat Gear & Outfitting | Offshore Emergency Medicine

Offshore Emergency Medicine – When There is No Rescue

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We have just wrapped up a 3-day course through Med Officer and Wilderness Medical Associates called Emergency Offshore Medicine. The class was phenomenal, and while I’m not going to go over all the details we learned, I hope that a brief overview of the course will convince anyone planning to cruise to take it.

Audience

Our class consisted of 14 students. Here is a breakdown to the best of my memory:

A father and daughter with a monohull in Lake Champlain preparing for a 2-ish year trip
A couple from Toronto in the process of buying a monohull in Grenada for 2-ish years of cruising
A couple from CA on a 44′ monohull getting ready to retire and cruise down the west coast
A skipper and crew member of a Hinckley preparing to embark on Jimmy Cornell’s Blue Planet Odyssey
A woman having her and her husband’s cat built in South Africa
3 solo guys – racers and/or EMTs
Us!

Everyone was really nice and we loved getting the chance to talk to so many people about the trips they are taking and what they have done to prepare.

This class was primarily cruisers and a lot of the scenarios involved levels of cruising. For example, more of the scenarios were if this happens, and you are halfway between the Galapagos and Marquesas, here’s what you do…

Instructors

Our instructors were Jeff Issac and David Johnson. Jeff has an extensive background with Outward Bound, Wilderness Medical Associates International, and sailing. David Johnson is the owner and president of Wilderness Medical Associates International and is an Emergency Room Doctor. They took turns presenting and wrote the book we read as our pre-requisite, Wilderness and Rescue Medicine.

3 Main Systems

David and Jeff taught us that there are 3 systems to be concerned about: Pulmonary, Respiratory, and Nervous. We were taught how to look at a scenario we find on board and identify which system is affected, and therefore what is the anticipated problem. For example, dehydration leads to volume shock, which is a pulmonary problem. A swelling throat leads to respiratory distress and is a respiratory problem.

We did several exercises where we find people in various states of distress and evaluate what anticipated problems might exist. This is helpful in making sure that you cover all your bases and can communicate effectively to any rescue operation.

Evaluating Risk for Problems and Solutions

There were a few really good basic principals taught in this course, and one of them was to learn how to identify risk and emergency levels. This is especially relevant when offshore due to the risk of evacuation. We learned how to identify problems that could not be fixed aboard and what the best solutions are at the time.

For example, a potential problem on board would be someone falling and hitting their head. We have a laceration, so anticipated problems are bleeding and infection, plus a head injury that needs to be evaluated. If the laceration is clean and you can not see bone, it is low risk.   When the person remembers their injury and is in a good mental state, it is a low-risk injury. If there is bone showing in the cut or the patient is incoherent, it is a high-risk injury. In this example, if you don’t know how to evaluate the patient, a high-risk evacuation may be done, such as helicopter rescue in stormy weather, resulting in risk to crew and rescuers. We learned to evaluate head injuries for a TBI (traumatic brain injury) with a risk of ICP (inter-cranial pressure).

Another example would be a broken bone. Broken bones could cut off circulation and cause ischemia (a pulmonary problem). In the real world, no damage would be caused by the time you get to a hospital, but if you are hours or days from help, reducing the broken bone would be a low-risk solution to a high-risk problem. That involves gently pulling the bone back into place.

I think this was the best part of the class. Even at home, I waver on going to the doctor when something is wrong, and the risk of that is so low – just a bit of money and time. So knowing when things are going wrong and will not get better, that is good to know.

Labs

We had some lab time where we got to play with medical stuff! No needle sticks, of course, but we took pulses and blood pressure, learned how to split, practiced PPV (Positive Pressure Ventilation), practiced working with needles on meat, and tested out bandages. We were free to ask lots of questions.

Medical Kits

All through the class, we talked about the proper supplies and how to use them. Jeff had emailed us a list of supplies to have in our med kit, everything from forceps and bandages to splints and antibiotics. We have some shopping to do!

For prescription items, we had put some thought into this already.  It’s usually suggested to find either a cruising sympathetic primary doctor or a travel doctor to help you get the items needed (like pain medication and antibiotics). Some people have had trouble getting prescriptions, so we need to start working on that.

In Case of Emergency

Fortunately, most cruisers never have a problem out at sea. We will spend most of our time on land anyway, but for that small amount of time that we are far from help, we feel much more prepared. As Jeff often said, you will never have this happen, but if you do…..

Thank you to Jeff and David! We really enjoyed the class!

4 Comments

  1. I’m so glad you guys took this course. Makes me feel better! Hmmm….”gently pulling the bone back into place”, ouch!!!!

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