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10 Tips for First Aid at Sea.

If your position on First Aid at sea has always been to let someone else get stuck in, you might need to think again if you’re planning to be more than a couple of miles offshore. Remember that at sea, first aid knowledge could be the difference between someone you love living, or dying! Scary stuff!

Firstly, the good news is that you can get your training from a specialist, such as Red Square Medical, where all of our instructors understand boats and the ocean and can tailor the course to your specific requirements. We can even teach it onboard your boat! We do recommend a basic level of knowledge such as the RYA First Aid at Sea course to give you a good start, but it’s not essential. 

There are 3 main issues when you’re trying to carry out first aid onboard any boat:

1. Lack of space.
2. A potentially unstable environment - picture bad weather and rolling seas.
3. The potentially long time period to wait for definitive care - it will take a lot longer to get help than when you’re on land and you may have to wait hours, days or in extreme cases, weeks.

So here’s a list of 10 things that you might like to consider for first aid at sea…

1. It’s only a bump on the head! - How many times have you bumped your head on a boat? You probably can’t remember but hopefully haven’t ever done too much damage. 

The thing to remember about head injuries is that you can’t see what damage has been done inside. It can take hours or days for symptoms to appear, so it’s important to write down the details of the accident and monitor the casualty closely as changes can creep up over time.

Immediate red flags after a head injury are any obvious skull deformity, loss of consciousness, unequal pupils, cerebrospinal fluid (CSF) or blood leaking from the ears, nose or mouth. Other warning signs either immediately or later include confusion, behavioural changes, loss of balance, changes to speech, headaches, numbness or pins and needles, vomiting or visual disturbances. 

2. There are quick fixes to keep someone alive in an emergency, make sure you know what they are!

You also need to have the equipment in your medical kit and know how to use it. If you choose to carry medication that is normally only given on prescription you will need to work with an authorised supplier to acquire it and have training, plus telemedicine support, in order to use it. 

Haemostatics (blood clotting agents) are great to have around for major hemorrhages and they are available in different presentations suitable for all kinds of wounds. Just put in contact with the bleed, apply pressure and the you can leave the rest up to the clotting agent.

Epipens can be handy and should be essential if you have anyone on board who suffers from allergies. Epipens deliver a shot of adrenaline to counteract anaphylactic shock (extreme allergic reaction) and buy a bit of time to get help and administer longer acting drugs.

Know your crew and work out what kind of lifesaving items and quick fixes you want to have onboard.

3. This brings us nicely to knowing your crew! Make sure you have a record of the medical history of the crew and any guests on board. Be proactive rather than reactive. 

If someone has a health issue – perhaps a respiratory condition, allergy, diabetes, epilepsy or a heart condition it’s much better to know that from the start rather than finding out during an emergency. 

Also, illness, seasickness and dehydration can cause normally sensible people to forget to take medicine or even take too much. Vomiting can be serious if it leads to dehydration or means the casualty can’t keep oral medications down. Ask those who take regular drugs or inhalers to keep them in a known location so that others can access them easily in an emergency. 

4. Take spares! Anyone can get seasick or a vomiting bug that means they can’t keep medications down. Your boat could be stuck somewhere, or delayed, for any number of reasons, and now you may have to isolate or quarantine due to COVID-19 regulations. Your destination country may have different rules on prescription medications which means you can’t get hold of regular meds quite as easily.

Remind everyone onboard to bring sufficient medication for a period longer than your voyage. For those who require emergency medications such as inhalers for asthma or Epipens for anaphylaxis, make sure they are stored in a central location where everyone can find them easily.

5. You want me to leave the glass in the wound? Foreign bodies that get stuck in the body need to remain in the body. If a crew member gets a large piece of glass stuck in their body, or a piece of metal through the leg or any foreign body larger than specks, it’s very important to leave it in! 

The foreign body could be near to, or partially through an artery, so pulling it out could cause a larger problem. When you consider that help might be hours or days away, it’s important to prevent a more serious issue. Don’t make more work for yourself! Stop blood loss, clean the wound and bandage it up as best you can, protecting the body and the foreign object. They will need to go to hospital.

6. Burn, baby, burn! It’s important to know that burns keep on burning underneath the skin until they are completely cooled down. The best remedy is running under cold water for at least 20 minutes, though this may not be practical on a boat. 

Alternatives include wrapping cold packs in a tea towel to apply, or even putting a burn in a bucket of water is better than doing nothing. Gels and some burn dressings can be useful short term but will have to be scraped off in hospital, so the initial relief may not be worth the longer term pain and many hospitals prefer you to avoid them. Once cooled, wrap loose strips of cling film over the burn to protect it, or a paraffin dressing and top with a light bandage to hold it in place. Be aware that burns can cause a loss of fluid and even blisters mean body fluid isn’t where it should be so avoiding dehydration is an important consideration.

7. Packing for a medical evacuation? When a casualty is Med Evac’d (most likey by air) make sure you pack all the essentials… medical notes, detached body parts, their passport and some money! The following items can be really useful:

- Written record of events - what happened, how, when, for how long, etc.
- First Aid given – any vital signs/observations taken such as blood pressure, temperature, etc. and any drugs administered with the amount and time of administration.
- Any missing parts, like fingers, need to be put in a bag with a little trapped air, wrapped in cloth and kept cold but not frozen in a fridge or cooler. Keeping detached body parts cold will massively increase the chances of the parts being saved.
- Pack the casualty with their passport, money/credit card and a mobile phone. When they are discharged from hospital they may not be able to get back to the boat easily and may have to make alternative arrangements. 

8. It’s going to take how long? Although a 999 call on land may take some time for non life threatening emergencies could take several hours these days, you can guarantee they will be aiming to get to you within 8 minutes for something that is life threatening. Not so at sea!

If someone stops breathing it could take up to an hour for help to arrive. If they’re bleeding out, and help is 6 hours away, what will you do? Onboard any kind of boat, YOU need to know how to keep someone alive for hours and/or days, not just a few minutes. It’s also important that everyone is medically trained - because who’s going to look after you if you’re the one that’s ill or injured?

9. Stay on deck! Sometimes you want to instinctively get someone down below for comfort and safety. But, it could make the extrication ridiculously complicated and force you to work in an even more confined space.

This is really important if your casualty is unconscious. For Med Evac by air, it’s far easier to work with them on deck than trying to lift them up the companionway when they’re a dead weight. 

10. Think. Then act. 

Remember the basics of DRSCABCDE. Just because someone looks like they can’t breathe doesn’t mean it’s life threatening asthma, it could be a panic attack. Chest pain doesn’t always mean a heart attack. If they’re talking, they’re breathing and you can relax a little. If not, then follow the algorithm and get help running sooner rather than later. Take observations/vital signs and build up the information that will help you when speaking to either emergency services on land, or your Telemedicine provider.

The sand on the beaches near boats is not the place to stick your head! The ocean is a harsh environment and you need to be prepared.

Lots of people worry about things like ‘what if I do CPR and the casualty still dies?’. Well, it might sound brutal, but the statistics show that they probably will despite your best efforts. But what if they were in the 10% who survive? What if you did CPR and saved a life, or at least gave it your all to give them the best chance possible. How good would that feel?

So, get some training, know your medical kit, keep some reference materials on board (we can recommend), know how to use your communications equipment to get help. Speak to the team at Red Square Medical and we can help to put together the best possible training and support package so you can enjoy your boating worry free. 

If your position on First Aid at sea has always been to let someone else get stuck in, you might need to think again if you’re planning to be more than a couple of miles offshore. Remember that at sea, first aid knowledge could be the difference between someone you love living, or dying! Scary stuff!



by Rachel Smith 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!
by Rachel Smith 24 Apr, 2024
At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.
by Rachel Smith 03 Apr, 2024
You might wonder about the title of this month’s guest blog, as Worse Things Happen at Sea is also the name of our monthly newsletter. But this month, we’re delighted to introduce Andrew Edwards as our Guest Blogger, and we felt his amazing story about life at sea really deserved a dramatic headline… Dysentery... In the summer of 1966, I was a cadet on a cargo ship that loaded in the UK for 9 ports in West, South and East Africa. Our first port of call was Luanda, the capital of Angola – which was then a colony of Portugal. Next, 300 miles down the coast we called in to Lobito – also in Angola. In Lobito two of the ship's company contracted dysentery; myself and a big Irishman called Reg. The shoreside Doctor we saw simply diagnosed the condition (amoebic dysentery) and said, ‘sorry but I have no antibiotics for this!’. Thankfully the ship’s purser stood our corner and demanded that the Doctor find some. The following day the antibiotics were flown in from the Belgian Congo. The Doctor gave us no advice as to how to deal with the condition, not a word about how contagious it was, not a word as to the importance of thoroughly washing our hands and maintaining scrupulous personal hygiene. Thankfully both Reg and I were quartered just a short sprint from the heads, and we were left to get on with it by our shipmates. It took about a week to get over the dysentery, by which time I had lost several stone in weight and was as weak as a kitten. By the time we arrived in Walvis Bay, South West Africa (now known as Namibia), a further 1000 miles south, I was just about fit enough to play football for the ship against a local team. Their football ground had a main road going right through the middle of it which made for some challenging moments, but they still beat us comfortably and they were playing in bare feet!
by Rachel Smith 20 Mar, 2024
As it’s Easter, we thought that it would be a very appropriate time, what with all that chocolate around, to take a closer look at the subject of Diabetes and why it’s such a huge problem in the UK and across the world. The Easter Bunny always looks so cute and cuddly, but is he a diabetes case waiting to happen? Or does his diet of grass and all that hopping around for the rest of the year make an important difference? According to the WHO, diabetes is a chronic, metabolic disease which is characterised by elevated levels of blood glucose (or blood sugar). Over time, this leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, and it usually develops with a late onset in adults. It occurs when the body becomes resistant to insulin or doesn't make enough insulin. Worryingly, in the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels and is closely linked to obesity, poor diet, and an unhealthy lifestyle. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes (need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue), but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Normal onset is in younger people, but can also be in adults. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 1 diabetes cannot currently be prevented. It’s thought to be caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin. It can also be caused by genetics, viruses, trauma, tumours, removal of the pancreas or other damage to the pancreas. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. But the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The starting point for living well with type one or type 2 diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications. A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet to facilitate early treatment.
by Rachel Smith 21 Feb, 2024
Well, we’ve made it to February! How are your goals for the year going so far? As you’ll know, we do love a bit of goal setting at Red Square Medical HQ. But, we also understand the importance of Reflective Practice too. Especially in relation to setting goals. Want to know more? Please read on…
by Rachel Smith 07 Feb, 2024
Today we start the first in a series of blogs in conjunction with our friends at the Maritime Skills Academy, and kicking it all off is a Guest Blog from MSAs Head of Training, Sam Kelly. Sam is 37 and lives in southeast Kent, in the quaint seaside town of Deal with with his wife, two children and a ‘Golden Doodle’ called Pringle. He has lived in the area ever since his father, a serving Royal Marine at the Deal Depot, and mother decided this was the place to raise their family. And it is, quite frankly, an excellent place to live. Here is his story… I’m the Head of Training for the Maritime Skills Academy, based in our head office in Dover. I oversee a team of Maritime Safety Instructors who deliver all STCW training for seafarers. Outside the Dover base, we have MSA Gibraltar. This location is operated in partnership with the University of Gibraltar and delivers Basic Safety Training and most recently Operational Firefighting, We are actually in the process of building a state-of-the-art Fire Training Module on ‘the Rock’.
by Rachel Smith 17 Jan, 2024
So Christmas seems like years ago, and we’re all well into the New Year now. Did you make any resolutions? Some love to, some don’t. At Red Square Medical HQ, we love a goal or two and think the turn of the years can be a good prompt to make some positive changes. But, it’s well known that New Year resolutions don’t last. Forbes magazine tells us that 21% don’t make their resolution stick for even a month. While 34% state that it lasted for between one and three months. Is that a failure though? Or could it be all it takes to make some small changes that have a lasting impact? We thought it would be good to take a closer look at one of the most popular resolutions… Dry January! Now, let’s get one thing straight, the Red Square Medical team are not averse to a tipple or two! But as medics, we’re very aware of the short and long term benefits of giving our livers a little breather every so often. Of course, everyone responds differently to stopping drinking for a month, so the timeline below is just a guide. But it might help you to decide whether it’s a good idea to give the booze a break for a while, or work towards reducing your intake - we know it’s easy for it to creep up over time!
by Rachel Smith 03 Jan, 2024
What I miss most about the Ambulance Service… It’s been 12 months since I left the Ambulance service after 8 years of working frontline, and to be honest it’s flown by. A few weeks ago the team at Red Square Medical HQ were chatting about how life has changed in that time and what, if anything, I was missing from my former life! The list might just surprise you… Most of all, I miss my old colleagues and I definitely miss the patient contact. And driving on blue lights… that was one of the best parts of the job! Working in the ambulance service with regular partners who you get on well with really does create friendships for life. Or even doing a tricky job with someone you don’t know well provides a common bond forever. Every day you’re facing stressful situations and sometimes split second, life changing decisions. You rely on each other totally and make sure you keep each other safe in some difficult and challenging situations. I worked with 3 very different partners most of the time for my last few years and I miss them all. Happily though, I have some great new colleagues at Red Square Medical and Outreach Rescue, the other company that I work for.
by Rachel Smith 03 Jan, 2024
I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding. Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me. I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel. I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!
by Rachel Smith 20 Dec, 2023
Christmas is coming and the season of parties is upon us. Of course this means that most of us will overindulge in large amounts of luscious food and, of course, a tipple or two. At Red Square Medical HQ, we have a method of categorising drunk people. During our combined careers, we’ve dealt with more drunks than we can remember; it’s easily running into several hundred. What we’ve learnt, amongst other things, is that most people who are drunk fall into one of these categories. Now please don’t judge as it is purely observation and also makes for an interesting chat when delivering the STCW Medical training, because we all know at least one person from each category and sometimes… a person can be in multiple categories depending on many other factors, or, we might even have been there ourselves! Once we have established these categories there is a serious note to this blog so please do keep reading.
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