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Chemical and Electrical Injuries
Next week, we're going to be welcoming Krissie Stiles as our fabulous guest blogger. Krissie's specialty is burns and plastics and while writing the blog with her, it prompted some questions about what to do if the injury is due to chemicals or electricity, rather than thermal.
So, that’s a really interesting question and one we haven’t really looked into before even though it’s really relevant to our environment, whether you’re cleaning on a Superyacht or working on a vessel carrying something quite toxic!
Chemicals
Chemical burns or injuries can be caused by acid, alkaline or caustic chemicals. They can be very damaging and need immediate medical attention. You will need to raise the alarm as soon as you suspect a chemical incident so that everyone is aware. It may mean certain safety protocols are triggered.
As with every first aid scenario, safety is paramount and you MUST
make sure it is safe for you to approach the casualty. Be very wary of gases that could be inhaled, liquids or powder that could make contact with you too - if possible, ask the casualty to move away from the source to a safer area.
- Use gloves or something protective to cover your hands.
- Try to carefully remove the chemical and any contaminated clothing without contaminating yourself or the area you’re in.
- The aim is to remove the chemical and clothing from contact with the skin and eyes, but being careful not to touch or spread it.
- Carefully cutting clothing off is more effective than pulling it over the casualty’s head and body.
- If the chemical is dry, pat it with a dry towel and gently brush it off the skin. Then rinse with lots of water.
- If the chemical is wet, rinse the affected area with as much clean water as possible.
- Rinse the affected area continuously with clean water as soon as possible.
- Try to make sure the water runs off the affected area without pooling on the skin or in the eyes.
- Only use water. Don’t rub or wipe the affected area.
Your vessel should have ‘Data Sheets’ for any chemicals used onboard. They may be called something different, but they contain crucial information about the different chemicals, how they act and react, and any special treatments that are needed. Make a point of finding out where this information is kept so that you can access it quickly in an emergency.
Any chemical burns or injuries must be assessed in hospital so you would need to plan for a medevac or to come ashore as soon as possible.
Once the casualty gets to hospital, treatment will include more washing, to make sure the substance is completely removed. Then cleaning and dressing the burn or injury and managing pain. Dressing will need to be checked and changed regularly until the burn has completely healed, in order to prevent infection.
Minor injuries that only affect the outer layer of skin, or a small section of the underlying layer of tissue normally heal well and leave minimal scarring. As with superficial or partial thickness thermal burns, good ongoing burn care can make a big difference.
More severe burns may need referral to a specialist burns unit where an entire medical team including occupational therapists, physiotherapists and mental health professionals work together to support recovery. Treatment could include skin grafts and the more severe or deeper burns can take months or years to heal. In the worst cases it can leave significant scar tissue, plus issues like sight loss and reduced or restricted movement.
Electrical
Electrical injuries happen when high-energy current travels through the body due to contact with an electrical source. Injuries occur due to either the flow of current through the body, arc flash, or from clothing that catches fire.
Most body tissues, except bone, conduct electricity very well and the highly developed human nervous system is very sensitive to even small electrical currents. Skeletal muscle and peripheral nerve tissue are particularly susceptible to injury. Some casualties show little sign of external injury, but extensive muscle and nerve injury internally.
One of the unique aspects of electrical injuries are that there should be an entrance and exit wound. The electric current injures the tissues where it enters, but also where it exits. So these wounds may look fairly innocuous, but the damage caused by the current as it tracks through the tissues from the entrance to the exit, through the body, can be extensive.
Low voltage currents passing through the body have well defined, but normally reversible physiological effects including muscle contraction, respiratory paralysis and ventricular fibrillation.
At higher voltages, strong muscular contractions can actually cause fractures and/or dislocations and throw the victim away from the electrical circuit. This in itself can cause traumatic injuries.
Some currents will ‘freeze’ the casualty, making them unable to let go of or move away from the electrical current, leading to a frightening and painful struggle, even for short periods.
- As with every first aid scenario, safety is paramount and you MUST make sure it is safe for you to approach the casualty.
- Turn off the power source and if you do need to recover the casualty, you may need to wait for specialist equipment.
- For lower voltage incidents, you can consider using something non conductive, such as a wooden pole, to move the casualty from the source.
- Check the airway and breathing - as electrical damage to the brainstem can cause respiratory arrest and you may need to start CPR.
- Likewise, the current may cause the casualty’s heart to stop beating normally, and you may need to carry out CPR.
- Electrical burns can be cooled with water, but it will only really make a difference to the entry and exit wounds, it won’t help the internal damage.
- Have handy, or attach a defibrillator if you have one. Then you can activate it quickly if needed.
All electrical injuries or burns, however minor they may seem, need urgent assessment in hospital so you would need to plan for a medevac or to come ashore as soon as possible.
We hope you’ve taken away a couple of new points from this slightly more in depth look at chemical and electrical injuries, compared to standard burns. As always, please feel free to get in touch if you have any ‘burning’ questions! (Sorry, we couldn't resist that one!)
Finally, we have a few blogs on related topics that you might find interesting, and the links below are for anyone (and their families) affected by burns.
https://www.redsquaremedical.com/and-it-burns-burns-burns
https://www.redsquaremedical.com/lightning-strikes-at-sea
- Changing Faces provides support for people whose condition or injury affects their appearance
- Victim Support provides help and advice to victims and witnesses of crimes
- Katie Piper Foundation provides specific help for victims and families of acid attacks and other burns
This is super useful and a must read for all working at sea - go on share it!
We are big fans of free resources and information sharing. Good quality, evidence based first aid and medical care information should be available to everyone and we provide it in a number of different ways:
Annual updates - this lets you know what has changed in the last year with the regulations and new techniques.
Salt Water Solutions - this is a monthly learning resource that helps you stay on top of your knowledge and skillset
STCW validation - This is done every 6 months and is your way of telling us whether your STCW First Aid and Medical Care training is actually useful and relevant to life onboard your ship.
Worse Things Happen at Sea! - a monthly resource that hones in on something current and pertinent to the maritime industry.
Just click on the images below to sign up for one or all of them!!
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!
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.
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!
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.
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…
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’.
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!
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.
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!
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.