MEDICAL EMERGENCIES:
Gilbert Park advises on identifying the symptoms of the most pressing medical conditions that might occur when at sea, and what kind of emergency call should be made
Averting clinical disasters afloat
Radio courses today teach three emergency call types: Mayday, Pan-Pan and Securité. Some readers will remember when there was a fourth, Pan-Pan Medico, designed for medical emergencies.
This was dropped when BT Coast radio stations closed. BT Coast stations were able to use the telephone network to get direct medical advice to the vessel. ‘Medico’ was the keyword for them (rather than the coastguard) to take the call and patch it through to a doctor. When the duties were transferred to the Coastguard all Pan-Pan calls would automatically go to them, medical or otherwise, and the term became obsolete. However, HM Coastguard will still respond to a Pan-Pan Medico and treat the call accordingly.
Today, any vessel or person contacting HM Coastguard with a medical problem will speak to the duty doctor. The coastguard will put the caller into a ‘connect’ call with one of the two contracted radio medical advice service hospitals (Aberdeen Royal Infirmary and Queen Alexandra Hospital, Portsmouth). The coastguard monitors the call between the casualty and the doctor so they are aware of the situation. If deemed necessary for evacuation, the coastguard will arrange the UK Coastguard search and rescue helicopter or lifeboat to transfer them to a hospital or trauma centre on shore. If evacuation is not deemed necessary, then medical facilities will be arranged to meet the vessel on its arrival.
HM Coastguard has undergone significant changes in the last two years: the remaining stations are linked electronically so that all information is available to all officers. The service now works in a single ‘virtual’ operations room: if anyone is in doubt about which coastguard operations centre to call, just say ’UK Coastguard’ and you will be answered. All the existing telephone numbers and MMSI numbers have been redirected into the new network, and a single national number for routine telephone calls will be issued in 2017.
Skippers tend to be naturally reluctant to use the Mayday, but are there instances when it should be used? It is clear that Mayday should only be used when there is a situation where, ‘in the opinion of the master, a vessel, aircraft, vehicle or person is in grave and imminent danger and requires immediate assistance‘. Any Mayday call will take priority over all other calls.
Immediate help
unforeseeable medical situations that might be encountered where delay in starting treatment may worsen the condition, resulting in permanent disability and possibly death. In medicine, the term ’golden hour‘ is applied to all of these, implying that treatment should be started within the hour (although the exact time frame varies) from the onset of the condition as irreversible worsening may occur thereafter.
The first is major trauma. This is easy to identify as there is usually an injury with significant blood loss, increased pulse rate, pallor and a reduced consciousness level or even coma. The next three are all medical conditions – and the relevant condition, implications and need for urgent treatment are often poorly recognised.
Septic shock
Septic shock occurs when you have a serious infection somewhere in your body: a neighbour of mine developed it while his boat was moored on a visitors’ pontoon in a river. At first the infection is localised, but as time progresses it starts to affect the whole body with loss of fluid from the circulation and dilation of the blood vessels, resulting in low blood pressure. The heart compensates at first by increasing the pulse, but if the infection continues it cannot keep up and the blood supply to vital organs reduces to a level where at first they don’t work normally, then they start to get damaged. (See panel, ‘Recognition of septic shock’.) Prompt treatment at the failure stage reverses shock before damage starts.
The mooring my neighbour was on is surrounded by deep water with no walk-ashore facility. As he couldn’t even stand up, another sailor on the pontoon took the boat to a marina about a mile away where his wife called 999 and requested an ambulance. My neighbour was taken to hospital where he was treated for his septic shock. This took some time, delaying the start of treatment. A Mayday call would have resulted in him being taken off his boat much more quickly and saving time in getting him to hospital. He was lucky in that he made a full recovery.
Stroke and heart attack
The next two emergencies, stroke and heart attack (officially called myocardial infarction, or MI), also depend on rapid diagnosis involving special tests followed by swift treatment. On one occasion, I thought I was suffering from one