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Preparation for Cruising Medical Emergencies

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  1. Preparation for Cruising Medical Emergencies Dr Kathy DeGaris Dr Rosie Colahan

  2. Before you leave..... Planned Voyage Crew Considerations Boat Equipment Legal Compliance - Drugs

  3. Before you leave.....CREW • Personal Fitness • GP Visit • Travel Consult • Dental check up • Crew Confidential Medical Questionnaire • Medications including for seasickness • Allergies • Action Plans for chronic disease • Own Water bottle

  4. Before you leave.....BOAT EQUIPMENT • YA Blue Book Special Regulations Section 2 • Medical Guides • Injury/Illness Chart • Apply First Aid Certification • Medical Kits – Contents, storage • Simplified ‘Day’ Medical Kit • Accessing Drugs for Ships Supplies

  5. Before you leave.....BOAT EQUIPMENT • Medical Kits • Contents • Medication • Storage • Simplified Day Medical Kit • Accessing Drugs for Ships Supplies

  6. Before you leave.....BOAT EQUIPMENT • Drugs for Ships Supplies • S4 (antibiotics, pain killers, prescription drugs) • S8 (restricted drugs, opiates) Legal requirements • DHS Drugs & Poisons (Victoria) • Customs • Storage • Record of Supply & Administration

  7. Before you leave.....BOAT EQUIPMENT Contact details and coverage for Emergency Medical Assistance • Communications HF/VHF Radio, Satphone, Mobile phone Authorities Organising Authority SAR (Search & Rescue) - AMSA Water Police Ambulance - Local 000 or International 112 (GSM) Hospital

  8. On the Water Medical Emergencies requiring Advice • Before administering prescription drugs • Cardiac emergency • Eye injury • Severe pain • Diarrhoea with fever • Severe burns

  9. On the Water Illness / Injury Chart • Monitor patient over time • Record admin of medication • Fluid balance • Hand-over to SAR, ambulance, hospital Next of Kin • Notify and keep them posted

  10. Medical Emergencies First Aid Priorities Head Injuries Fractures Dislocations

  11. First Aid Priorities Danger Response Send for Help Airway Breathing Circulation

  12. First Aid Priorities DANGER RESPONSE SEND AIRWAY BREATHING CIRCULATION REMOVE FROM DANGER • EXPOSURE • Sunstroke / Sunburn • Hypothermia • DROWNING • MOB

  13. First Aid Priorities DANGER RESPONSE SEND AIRWAY BREATHING CIRCULATION ASSESS CONSCIOUS STATE (Shout and squeeze hand) Unconscious Needs constant supervision Conscious Record obs over time ? MOVE CASUALTY Safe protected area No risk of falling Observer access Observation over time

  14. OBSERVATION SHEET

  15. First Aid Priorities DANGER RESPONSE SEND AIRWAY BREATHING CIRCULATION SEND FOR HELP On the boat Emergency Authorities

  16. First Aid Priorities DANGER RESPONSE SEND AIRWAY BREATHING CIRCULATION AIRWAY Clear Airway of obstructions (loose teeth, tongue, vomit) Lie Casualty on their side ? Oral airway

  17. First Aid Priorities DANGER RESPONSE SEND AIRWAY BREATHING CIRCULATION BREATHING Disposable face shields or CPR mask +/- hand operated breathing bag Ventolin puffer if wheezing

  18. First Aid Priorities DANGER RESPONSE SEND AIRWAY BREATHING CIRCULATION CIRCULATION • Pulses Wrist (Radial) Groin (Femoral) Neck (Carotid) Chest (Cardiac) • Skin Colour White - blood loss Blue- Hypothermia Green – Seasickness Red – Sunburn / hyperthermia

  19. Injuries • Head Injuries – Open / Closed • Fractures • Dislocations • Fish Hooks • Wounds

  20. Head Injuries • Open • Closed Observation - Modified Glascow Coma Scale (GCS)

  21. Fractures

  22. Fracture Management - Limbs Immobilisation of joint above and joint below the fracture site

  23. Fracture Management

  24. Dislocations - Fingers • Face the patient, both in standing positions. • Firmly grasp the end of the dislocated finger. • Request the patient to lean backwards while maintaining the finger in a fixed position. • As the patient leans back sudden painless reduction should occur.

  25. Dislocated shoulder • Hang affected arm over back of seat. • Grasp the patient’s wrist with one hand and exert a steady downward pressure. • Place the other hand in the armpit exerting a direct outward pressure against the upper part of the upper arm. • When appropriate muscle relaxation is achieved, the head of the upper arm slips back into the shoulder joint.

  26. Removal of Fish Hooks

  27. Removal of Fish Hooks

  28. Removal of Fish Hooks

  29. Removal of Fish Hooks

  30. Wounds • Assessment • Dressings • Suturing • Splinting /slings

  31. Wound Assessment Site Size and depth ? Under tension ? Skin loss Complicating factors

  32. Wound Assessment

  33. Suturing - Instruments TISSUE FORCEPS TOOTHED FORCEPS NEEDLE HOLDERS SCISSORS

  34. Wounds • Get the patient comfortable ? Analgesia • Get yourself comfortable Non skid mats Tray for instruments Elbows braced on the table

  35. Sharps Disposal • Do not re-use syringes, needles or suture material. • Dispose of needles into impervious screw top container

  36. Burns

  37. Burns • Cold water immersion for > 20mins • Cool compresses • Analgesia • Rehydration • Severe burns • Antibiotics • Medical evacuation

  38. Burns

  39. More information www.orcv.org.au