SANDRA ROBERTS from 2nd edition
Working on board has its own occupational risks with variations due to the nature of the work and the type of vessel. Care of the injured or ill seafarer is usually the responsibility of a deck officer, often the first officer, but ultimately the ship’s Master has final responsibility.
The officer responsible for medical care on board may handle many minor injuries and ailments. He should keep good records of all consultations and this is discussed further in Ch 2.8. He may seek advice from a TeleMedical Assistance Service (TMAS) as there are limits to the capabilities of ships’ officers to diagnose and treat. Improvements in technology and communications make obtaining TMAS advice easier. (Ch. 5.7). In addition, the limitations of equipment and medicines on board, together with the medical experience and training of the officers, influence care provided (Ch. 5.3). Publications such as the International Medical Guide for Ships[1] or a national equivalent cover the practical treatment of such cases and this is beyond the scope of this text.
D.6.1 Minor injuries
The nature of the work on board may result in minor injuries due to, for example, slips, trips and falls, falling or swinging objects, chemical incidents, and manual handling. Burns are more likely to occur in the engine room or galley environments. The types of minor injuries seen may be lacerations, bruising, sprains and strains, burns including sunburn, head injury, eye injuries or simple fractures. Improvements in risk assessment of on board procedures, and the correct use of safety equipment, should reduce the number of minor injuries sustained. Please see Ch. 6.2 for additional information on risk assessment.
All those working at sea will have rudimentary knowledge of first aid to enable them to initially treat injuries and get help. Mandatory training in first aid is focused on lifesaving techniques rather than, for example, simple wound cleaning and dressing. Even the more advanced medical care training is limited to immediate actions rather than long-term care, for example, the assessment of wounds and ongoing management. The availability and choice of wound dressings is limited in the mandatory equipment to be carried on board and additional equipment carried by choice will vary. (Ch. 5.5). Simple supplies and medicines readily available ashore for managing small wounds, insect bites, and superficial burns, may not routinely be kept on board. Provision of these items should be considered and based on the type of injuries sustained on board a vessel. This will make the management of minor injuries easier to fulfil.
D.6.2 Minor illness
The clinical knowledge of the officer dealing with the patient may be very limited as will the accuracy of monitoring the patient’s observations and clinical signs. Without the assistance of TMAS, symptoms may not be recognised, incorrect diagnosis made and inappropriate treatment given.
Minor illness may not even be notified to the officer responsible for medical care on board and may be self-managed. Reasons for this will vary but it is important that all illness is reported in case the situation worsens and becomes an emergency to be dealt with. In particular, some early signs and symptoms may indicate a higher risk of serious underlying problems for example, any decline in consciousness after a bang on the head, or a raised temperature with signs such as photophobia, stiff neck or headache.
D.6.3 Major illness and Injury
Major illness may develop slowly or be sudden in nature. Medical advice should always be sought from TMAS, as the officer responsible for dealing with the problem with not have sufficient knowledge to manage the situation appropriately. Misdiagnosis, or delay in treatment, may have serious consequences for the sick crewmember. Any delay in getting advice from TMAS may also affect how quickly evacuation from the ship may be achieved.
When serious injury occurs rapid first aid will be required. As with major illness, help should be sought as soon as possible, but there should be no delay in applying first aid to the casualty.
[1] International Medical Guide for Ships. ISBN-13: 978-9241547208 ISBN-10: 9241547200