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MSN 1905 - 1 year on - Equipment!

Last week, we took a look at the ‘new’ drugs listed on the M1905 in March 2021. Shipping companies were given until March 2022 to update their medical kits onboard, so this week, we’re taking a look at the equipment introduced 12 months ago, as a quick reminder of what the equipment is, and when and how it’s used. 

As with anything, skill fade is a very real risk and we know that if you’re not using kit and equipment regularly, it’s easy to forget. Plus if you’re yet to complete a refresher, you might not be familiar with the updated equipment. Hopefully, this quick guide will help.

We’ve also listed the pages in your Ship Captain’s Medical Guide where you can find out more…

Pulse Oximiter (p202, listed in the index under airways)


A pulse oximeter is that handy little gadget that pops on to a patient's finger (or toe, or earlobe) and tells what the oxygen level or oxygen saturation (sats) are in the body. It’s non-invasive and can detect even small changes. 


It’s part of your examination and monitoring equipment and works by shining an infrared light through the finger to show how effectively blood is carrying oxygen to the extremities as well as giving you a pulse rate. If enough oxygen is getting to the fingers and toes, then the patient should have enough making its way to the brain and organs too, but if not, it provides a guide for oxygen therapy along with your shoreside medical support. 


For someone who is healthy, oxygen saturation should read around 92-98%. Don’t worry if it’s 99-100% though. Some people with lung (such as COPD) and heart conditions may have normal oxygen levels of 88-92%. They're unlikely to be working as crew on a ship, but could very easily be passengers. 


Of course a pulse oximeter does have limitations and you need to check the batteries regularly. It may not work effectively on cold peripheries or in the case of carbon monoxide poisoning, can pick up an inaccurate pulse in patients with atrial fibrillation (AF), can be affected by light and low blood pressure. It may not work on patients with painted or false finger nails but that’s easily resolved by turning it 90 degrees round the finger, or using a toe or earlobe. 

Blood Glucometer (p37)


A blood glucometer is used for testing the level of glucose (sugar) in the blood and is part of your examination and monitoring equipment.


It is invasive as it requires a small pin prick to break the skin, so there is a minor risk of infection. But, they are incredibly easy to use and can be invaluable in helping to work out what’s happening and whether it can be easily fixed, or required other intervention.


To test the blood glucose (sugar), first assemble the kit - the glucometer, testing strips, lancets and make sure you dispose of the sharp correctly afterwards.


Clean the finger and use the lancet to create a drop of blood. A tip from our tame Paramedic is to prick the side of the finger tip, slightly off centre, where it’s not quite so sensitive. Your patient will be grateful! 


Squeeze the finger until there is a drop of blood and then dip the testing strip into the blood. You’ll have to wait a few seconds for the result to display on the meter. 


Normal blood sugar readings will be between 4-6 mmol/l. If it drops below 4 or above 20, urgent treatment may be required under the guidance of your shoreside medical support. Taking a blood sugar reading is also a good way to rule out a potential cause of symptoms such as reduced consciousness, stroke symptoms, new confusion and diarrhoea/vomiting. 

Naso-pharangeal Airway - NPA (p200)


NPAs are an optional part of your resuscitation kit and both the 6mm and 7mm diameter NPAs are recommended. It’s simply a small tube with a wider section at one end, the flange. It can be used alone or with an oro-pharangeal airway and can be really useful if the casualty is suffering from ‘trismus’, where the teeth clench and it’s impossible to use an oro-pharangeal airway.


The right length/size is measured by holding one end at the side of the nostril; the other end should reach the ear lobe. Interestingly, the right nostril is normally slightly bigger than the left so most medics start there but either side will do just fine.


Lubricate the outside of the tube and insert it straight towards the back of the head, at a right angle to the face, not up towards the brain. Once inserted the flange will lie against the nostril.


The only caution is on the extremely rare occasion that a basal skull fracture is identified (by a wound, bruising around the eyes, bruising behind the ears, clear fluid coming from the nose), an NPA should not be used. 

Intravenous Access (p224-225 and p227)


Giving fluid and/or drugs through an intravenous (IV) route using a cannula is potentially a lifesaving technique, but must only be undertaken by trained personnel under shoreside medical team guidance. 


IV access means that the drugs or fluid can be introduced directly into the circulatory system and can work much more quickly and more effectively than oral medications. But, while inserting a cannula into a vein isn’t complicated, it needs training and regular practice to avoid skill fade. 


The cannula is a needle inside a fine plastic tube. The needle pierces the vein and the plastic tube advanced (or slid) over the needle to sit inside the vein. Then the needle is removed and disposed of and the cannula secured in place. 


Cannulas can be inserted into the back of the hand, the wrist or the inside of the elbow. This is an invasive procedure and comes with risks of infection and embolism from air or blood clots.

Intraosseous Access (p226-227)


As with the IV route, giving fluid and/or drugs through an intraosseous (IO) route is potentially a lifesaving technique, but must only be undertaken by trained personnel under shoreside medical team guidance. 


IO access sounds a bit gruesome as you are effectively drilling directly into someone’s bones to get to the marrow. But it is a fabulous way to get drugs or fluid into the circulatory system if you can’t gain IV access for some reason. 


It can work much more quickly and more effectively than oral medications and there are both manual and specialist options for firing or drilling the needle through the bone, normally in a site on the tibia that’s quite easy to locate.


IO is very similar to a cannula where a needle is used to introduce a plastic tube into the bone marrow.  The drill pierces the bone and is then removed, leaving the cannula tube in place to be secured. 


We also have it on good authority that practicing on a raw egg is ideal (as long as you don’t press too hard). It gives a really good ‘feel’ of pressing the needle against the bone, then the ‘give’ as it drills through into the marrow.


Of course there is a risk of infection and IO and while you can use IO on a conscious patient, it can be very painful, so steps would need to be taken to manage any pain. 


If you’re not of a sensitive nature, you may like to watch this US Marines film of an IO insertion but we warned… it’s not for the faint hearted! We recommend withdrawing a little of the marrow before flushing as it can reduce the pain dramatically be creating a space within the marrow first. https://www.youtube.com/watch?v=MgQJIsavbjI

Naso-gastric Tube (p13, 38, 65, 70, 148, 216, 220)


A naso-gastric tube is another advanced technique that should only be carried out under guidance from your shoreside medical team. 


It’s used to introduce fluid or food, or allow gas to escape from the stomach and can be used if your patient suffers from persistent vomiting, needs hydration and feeding but can’t swallow, has a distended or rigid abdomen or if they are unconscious - to deflate the stomach and reduce the risk of vomiting and aspiration (vomit getting into the lungs). But inserting and NG tube comes with a reasonable risk of the tube accidentally passing into the lungs instead of the stomach. This could have catastrophic results if not identified. 


The good news is that there are plenty of ways to check that the tube is in the right place (p216) and your shoreside medical team would be able to help you make totally sure it’s in the right place. 

We hope you’ve found our M1905 refreshers useful, and if you’d like any further information about the updates please get in touch.



Note: For the purpose of this blog, all measurements and techniques are in line with the 23rd Edition of the Ship Captain’s Medical Guide, but may vary slightly in other publications.

Guest blog: Jordan Lin

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!

That Lightbulb Moment!

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.

Worse Things Happen at Sea… a salty tale of dysentery, haemorrhoids, accidents, depression and death!

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!

How does the Easter Bunny avoid Diabetes?

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.

Reflective Practice and why it’s so important

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…

Guest Blog - Sam Kelly MSA

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’.

Dry January!

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!

12 months since I left the NHS

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.

Guest Blog - Rachel Smith

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!

Are they wearing a beer jacket??

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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