No small boat should cross an ocean without one or more crew members trained as medical officer.
This is different from basic CPR or the first aid training of the 3 Cs: Check, Call 911, Care until ambulance arrives. At sea, you are the ambulance and the hospital. That extraordinary responsibility requires bravura mixed with humility.
Fortunately, excellent training is available. The cool result of training is getting to correct thinking. That means knowing you can do much more to help than you might have imagined.
Correct thinking also means knowing you can do much less to help than you might have wished. The resolution of this paradox is learning to distinguish one from the other. The process is a journey into medicine and into your own psyche to distinguish fear from arrogance.
The course to take is "Offshore Emergency Medicine" taught by Jeffrey Isaac, PA-C, of Medical Officer, Ltd. http://www.medofficer.net Look under Courses. Also look under Articles for thoughtful opinions. The course is designed for home study followed by three days of class practice. The course book, Wilderness And Rescue Medicine by Jeffrey Isaac, is available from Amazon. http://a.co/c3I2Zbn
I took the course years ago. To be relied upon, I would need to take it again. This is what impressed me about the experience:
Think of the human body as a machine. With plenty of clean water, warmth, food, sleep and good social vibes, the body will work well most of the time. But In extremis: No oxygen = no life -- only minutes.
Think methodically and keep notes about the whole system: Air goes in (not if under water) through nose and mouth to lungs (not if obstructed or muscles not working) into the blood (not if pressure too low –- causes?) bringing oxygen to (1) the brain (which tells heart and lungs to keep working) and (2) the muscles (which pump the blood and move the lungs). Understand the big picture so you can ask the right questions to methodically go through a check list to see what is wrong.
Observe the crew. A talking active person who drinks enough water, eats and defecates, is not shivering, is coherent, and is within their own personality range is probably OK -- at least for awhile.
Often in class a student would ask how long a human could live with some condition. Answer: “Five.” Next question: “Five what?” Answer: “I don’t know, minutes, days, years” meaning it depends on factors beyond your control and outside your knowledge. Other conditions were separated between deadly if not air lifted, and those not warranting the danger of an air lift.
Keep the obvious in mind, but do not let it blind you from considering unexpected causes or multiple causes. If you do not know how something should look, compare right side with left. While people come in different shapes, they are normally symmetrical.
Remember, you are not the patient: (1) The pain of cleaning a deep wound is not your pain, but do not flinch from doing it properly while still comforting your patient. Your stress will only magnify the patient’s fear and pain. (2) With a conscious coherent patient, you may not do anything without permission.
“I see you are in pain. I have some training, may I check your body for wounds?” If the patient says “no” explore why, but do not act without permission.
Perhaps the patient wants to be examined by someone else. Say what you are going to do. Try to get to a “yes” answer.
“I am going to put your dislocated shoulder back into its happy place, I will not start until you say go, and I will stop if you command me, but together we can do this. Do you need more assurance? Do you want a small glass of whisky? Are you ready to get this done now?”
When you have permission, give yourself permission to let go of your own inhibitions. Focus on your purpose. No one wants a death because you were too embarrassed to do a complete exam. While you lack most medical tools and are neither trained nor licensed as a doctor, you can certainly gently and quickly pat a person from head to toe to disclose hidden injuries.
You must also let go of your own revulsions. Learn to accept the sight of blood. Some wounds are messy, but if blood is not spurting out, blood is not by itself an immediate threat to life.
Think mechanically. Stop spurting blood with hand pressure. Use washed hands, gloves and sterile gauze pads, if available. Loss of a little blood isn’t the larger concern, it’s the loss of blood pressure.
Consider whether the patient is a danger to care givers because of Hepatitis C or other viruses transmitted by blood. Have this discussion before leaving the dock. Being at sea requires frank realism.
With a week of home study before the three-day course, you learn that you can do a lot to save lives, offer comfort and a stronger recovery.
You can handle many problems with limited resources. Others require years of medical experience and the machines and medications of a hospital. A goal of the Medicine at Sea course is to avoid unnecessary air evacuation at sea.
Learn the difference between life threatening and scary looking. If possible, make radio contact with a medical doctor but know they may not understand your conditions at sea.
Know that evacuation personnel thrive on the heroic thrill of doing their job. Your job is to provide dispassionate thought for your patient’s well being.
In addition to response to trauma, Emergency Medicine at Sea teaches sailors to assess illness, including: infections of eyes, ears, teeth; abdominal pain; chest pain; gastrointestinal problems; respiratory infections.
Air evacuation to hospital may not be possible or fast enough to save a patient’s life. Understand those life and death consequences.
Encourage the crew to stay well with healthy eating, hydration, sleep, and proper clothing as well as remaining alert to danger and physical trauma.
Those who will not or can not follow the prescription of the last sentence should not go offshore on a small boat. That would be unfair.
You can handle many problems with limited resources. Others require years of medical experience and the machines and medications of a hospital.
From the admiral's chair
John Berol is the husband of Captain Diane. He commissioned Celtic Song in 2005, has sailed extensively and maintains an active interest in both the boat and her captain. He believes the more you know, the better you will sail. The term “Admiral’s Chair” is a family joke. For just as every writer needs an editor, so every captain needs an admiral.