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Medical Matters at sea.

A death at sea Messages in this topic - RSS

Daria Blackwell
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4/8/2016
Daria Blackwell
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Forty-year-old Sarah Young was buried at sea after being swept overboard in the Clipper race. At least we know now that burial at sea is possible. May she rest in peace.

http://www.practical-sailor.com/blog/Clipper-Fatality-Highlights-Adventure-Sail-Risks-11988-1.html?ET=practicalsailor%3Ae31880%3A125771a%3A&st=email&s=p_waypoints040616#post

http://www.latitude38.com/lectronic/lectronicday.lasso?date=2016-04-04&dayid=1351#Story4

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Daria Blackwell - Rear Commodore, PR Officer, Editor OCC Digital Comms & Port Officer, West of Ireland s/v Aleria http://www.coastalboating.net
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Simon Currin
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1/27/2016
Simon Currin
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Caroline,

Unfortunately there is no way of predicting who or when someone will develop this condition. The NHS Choices website does give good advice on recognition etc and I am sure it is covered in the various handbooks. http://www.nhs.uk/conditions/Appendicitis/Pages/Introduction.aspx

The important thing is to be able to recognise the symptoms and distinguish them from less serious conditions. I would thoroughly recommend having access to reliable long range communication such as email, Iridium, SSB etc so that Falmouth can connect you through to real time advice. It is very unlikely that any of us would carry enough iv fluids and antibiotics to cope with a perforated or gangrenous appendix so the emphasis will need to be on seeking outside help via Falmouth if you are a UK citizen.

If it is any consolation appendicitis seems to be much rarer than it used to be for reasons that I don 't think anyone understands.

Simon

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Simon Currin
S/V Shimshal simon@medex.org.uk
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aragorn
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1/27/2016
aragorn
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Simon
A question - how can the likelihood of appendicitis be done/assessed?
Sorry for the rather delayed interest in these subjects, but we are working up to an Atlantic crossing and whilst we undertaken a 2weeks non stop cruise, we were probably only 2/3 days from land. This issue of appendicitis is probably the one that causes us most sleepless nights
Thanks
Caroline & Robert
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Daria Blackwell
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7/14/2015
Daria Blackwell
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"jgbailey" post=1817 wrote:
Where can you buy a body bag?


You can buy just about anything online. http://www.extrapackaging.com/bodybags/

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Daria Blackwell - Rear Commodore, PR Officer, Editor OCC Digital Comms & Port Officer, West of Ireland s/v Aleria http://www.coastalboating.net
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Simon Currin
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7/1/2015
Simon Currin
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No we don 't carry a defib.

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Simon Currin
S/V Shimshal simon@medex.org.uk
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Daria Blackwell
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6/26/2015
Daria Blackwell
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Sadly, there has just been a death reported aboard a vessel in the Marion to Bermuda race. http://www.bwsailing.com/cc/tragedy-and-triumph-during-marion-bermuda-race/

Out of curiosity, does anyone have a defibrillator aboard?

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Daria Blackwell - Rear Commodore, PR Officer, Editor OCC Digital Comms & Port Officer, West of Ireland s/v Aleria http://www.coastalboating.net
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jgbailey
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2/13/2015
jgbailey
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Where can you buy a body bag?
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Blackie
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11/16/2014
Blackie
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The only reason for calling to Falmouth is if you are about to step UP into your liferaft.
Once out on the ocean, you must rely on your own experience and common sense, with possible help from nearby yachtsmen.
Julia and I were on the '99 crossing and heard the complete story on the SSB of how two crew plus a nurse were transferred to the casualty, the nurse assessed the patient and called for advice, a sailing doctor 500 miles away prescribed treatment, a further yacht transferred the necessary drugs, the hospital in St Lucia could not cope with the seriousness so he was flown to Martinique where a leading French heart specialist just happened to be on holiday...three months later the patient was drinking gin in our cockpit...a most fantastic story of co-operation and sheer common sense from fellow yachtsmen.
My family have always known that if the worst happened, I would not return and they would assume that I was enjoying myself with the mermaids.
When Julia and I were preparing for our first long passage together, I made the point forcefully to her children that should she die at sea, I would give her the smartest burial I could and they would have to trust me...I do not care a damn for officialdom and their rules. However, in view of the questioning expected, I would have made for the nearest British Consulate downwind where I could have explained in my own language, though I do think that Frances 's idea of saying they fell overboard has merit!
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Daria Blackwell
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11/3/2014
Daria Blackwell
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I just located two references about death at sea. Both pertain more to merchant vessels but give some useful guidance I believe. One is the WHO Medical Guide for Ships (pdf attached). And the other is a blog entry. See text below.

Note that the WHO document does provide instructions for burial at sea.


[attachment=170]WHOMedicalGuideforShips3rdEdition.pdf[/attachment]



What to Do in Case of Death of a Person Onboard Ship?

NOVEMBER 9, 2012 BY RAUNEK 1 COMMENT

Death on board ships as a result of any kind of adversity is an extreme form of emergency situation. In case of such unfortunate event, the crew and master of the ship must take all the necessary steps that are mentioned in WHO’s International medical guide for ships or according to the procedures given by the radio medical personnel.

The master of the ship would inform the company about the deceased person along with other necessary details that are required in the form of evidence.

Death in Ship

Important details required as evidence are:

Date, time, and position of the vessel when the death occurred
Location of the death if it occurred because of an accident
Record of the working hours of the deceased
Details of the condition of the body
Complete eye witness statement that is taken immediately after the incident
Type of medical treatment given to the person before death
Details of the person who gave medical treatment
Details on indication of intoxication, if found
Details of tools, wires, equipment etc. which was the cause of death
Timed photographs of the place where deceased was found
Details of telemedicine assistance, if available and provided
Any other information asked by the company
The company is responsible to inform the next-of-kin of the deceased person. Also, it is to note that in case the incident occurs when the ship is at port or anchor, the procedures according to the laws of that particular country needs to be followed.

If at port, the master should inform the local agents, medical personnel, and concerned persons of the P & I club. The local agent would guide the master regarding the procedures to be followed as required by the authorities of that particular country.

Death of a Person Onboard Ship

If the accident has taken place at the sea, the procedures and guidelines as provided by the company are followed. The company might ask to preserve the body in an emptied refer compartment. Also, the agent of the next port of call must be informed beforehand so that the necessary information is provided to the local authorities, the consulate of the ship’s flag state, and the correspondence of P & I club.

As per the rules, all the belongings of the deceased person should be packed and handed over to the agent to be sent to the company, which would eventually forward it to the next-of-kin along with a copy of inventory list of belongings.

All the details are to be noted in the official log book for later reference.

Kindly note that this is just a general overview of the practice that is followed in such situations, the full procedures/guidelines to be followed in case of death on board ships would vary according to the company policies and laws of country in which the death occurred.

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Daria Blackwell - Rear Commodore, PR Officer, Editor OCC Digital Comms & Port Officer, West of Ireland s/v Aleria http://www.coastalboating.net

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Daria Blackwell
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11/1/2014
Daria Blackwell
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I suppose that laws may differ in different jurisdictions relative to a body and declaration of death at sea, or is there a provision in Admiralty Law that prevails? Do we have any law specialists here? Is there a place one might plan to make landfall that would serve best? Does a Master Mariner have any special requirements or legal obligations?

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Daria Blackwell - Rear Commodore, PR Officer, Editor OCC Digital Comms & Port Officer, West of Ireland s/v Aleria http://www.coastalboating.net
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David Tyler
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11/1/2014
David Tyler
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"simoncurrin" post=1618 wrote:

So if it comes to a decision between a defibrillator and an extra anchor I think my vote is for the latter which has more uses on board Tystie than I would ever have imagined.
Simon


Alternatively, you could carry a couple of cannon balls, if you prefer a more traditional solution to the problem, but they don 't have so many other uses ;)

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David Tyler "Weaverbird" weaverbird22@gmail.com
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Simon Currin
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10/29/2014
Simon Currin
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Great contribution David. Particularly like the Captain Oates bit. I think you make well the point that common sense must prevail if the 'official advice ' is so out of touch it may be dangerous to the survivors. I am not at all sure that the medics patched through at such times have any real conception of what it is to be on a small boat mid ocean.

So if it comes to a decision between a defibrillator and an extra anchor I think my vote is for the latter which has more uses on board Tystie than I would ever have imagined.
Simon

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Simon Currin
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David Tyler
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10/29/2014
David Tyler
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Yes, an interesting discussion.
I 'm in my late 60s, and my greatest fear is ending up in a geriatric ward, not dying at sea. I hope I go "with my boots on".
If I were aboard a crewed yacht, and a death occurred, I would gather all available evidence, in the form of signed statements and photos, tie an anchor to the corpse and bury it respectfully in deep water. At the end of the passage, the evidence to be handed to the competent authority. That 's been done since folks have been going to sea - can 't be wrong.
If I 'm on passage alone, and know for sure that that I 'm not going to make it (a bad injury, or an infection, perhaps), then I would attempt self-burial - tie anchor to foot, drink bottle of whisky, slip over side when sufficiently smashed. The only downside is that my daughters would have to wait seven years before they could administer my Will, I believe, if there is no body as evidence of death. That 's one of the stronger reasons for carrying an Iridium device, so that I can say "Goodbye, World", and supply a lat and long where the wreath should be dropped. Not for bleating for help. Self-reliance should be the name of the game, and where that fails, I for one am "prepared to drown like a gentleman", as Blondie Hasler put it.

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David Tyler "Weaverbird" weaverbird22@gmail.com
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Simon Currin
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10/23/2014
Simon Currin
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Frances,
Under UK law the only person able to issue a death certificate would be a Coroner after an Inquest to determine the cause of death.His verdict would be dependent on the evidence available but obviously they don 't have to have the body if it was genuinely lost at sea in order to issue the certificate. I have no idea how this is applied in other Jurisdictions. The point you make about being accepted at your destination is very interesting. Presumably Falmouth would make those arrangements if it were a UK boat?
Simon

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Simon Currin
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fgrennie
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10/23/2014
fgrennie
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I would think that you would be required to keep the body, this rule applies to cruise ships who have on average 200 deaths a year.

other questions to consider will the Port Authority accept you when you arrive at your destination and who will issue death certificate or you will have difficulty with insurance and bank accounts etc.

Daria yes the wearing of shoes would have prevented a broken toe but the circumstances were that it was 90F, no wind and mid Atlantic and I was off-watch and lying stretched out in the cockpit doing a bit of sunbathing, albeit with life jacket on and line attached. The Skipper was coming out through the hatch, stumbled and fell on my upturned foot.

Accidents happen even although you may take all the necessary precautions. A friend who was crossing at the same time but further North was hit by a large wave and the boat suddenly heeled over and one of the crew asleep inside was thrown out of their berth over the lee cloth and cracked two ribs.
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Simon Currin
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10/23/2014
Simon Currin
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Daria,
Thanks for the links and I agree a survey would be a good idea once everyone has got over the regalia survey. My hunch is that the cruising community is somewhat older than the racing community so the nature of the problems encountered would be different. Maybe we could do our own bit of comparative research over the next year and get a paper out of it? On second thoughts I leave that to someone else!

Another thought is how do long term cruisers replenish their kits. Easy at home to stock up with drugs but they will be out of date by the time you get to the more distant spots. Do "we" ignore those dates, ship out replacements or try and buy them locally or get them prescribed locally? Moving controlled drugs around the world is very difficult so what do you do if you do have morphine aboard when you get to Thailand where possession may be a capital offence?

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Simon Currin
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Simon Currin
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10/23/2014
Simon Currin
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Bill,
I am not aware of any legal imperativeto bring the body to shore. My comment to Frances was really about pretending someone went overboard rather than being honest at the inquest (for there inevitably would be one) and saying the person died in these circumstances, this is the advice we received and this is what we did and why. I really would caution against presenting anything other than the truth at an inquest not least because you are on oathe and to otherwise could land you in gaol.

Lugging bodies is around is a very serious consideration for sailing couples and I know that even with 4 survivors on that boat they struggled to get him to the forepeak.
Simon

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Simon Currin
S/V Shimshal simon@medex.org.uk
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Daria Blackwell
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10/23/2014
Daria Blackwell
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Simon, perhaps a survey of ocean voyagers would prove useful. I just found a couple of studies focusing on racing sailors but nothing on distance sailors.

http://www.wemjournal.org/article/S1080-6032(10)00204-8/pdf
http://www.wemjournal.org/article/S1080-6032(08)70170-4/pdf

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Daria Blackwell - Rear Commodore, PR Officer, Editor OCC Digital Comms & Port Officer, West of Ireland s/v Aleria http://www.coastalboating.net
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Daria Blackwell
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10/23/2014
Daria Blackwell
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Before we crossed the first time in 2008, we took every precaution. Had medical checkups, ticked off every vaccination box (we had intended to keep going but family responsibilities and other factors made us take a break), took CPR and first aid courses, and put together a very extensive medical kit which my sister (an ID physician) and my doctor (a cardiologist) helped me put together. I had surgical equipment, IV fluids, antibiotics for every type of infection, bandages and stabilizers for every type of break or fracture, aspirin, nausea preps of every kind, electrolyte replacement and so on. I am not a doctor or a nurse, but I 've been involved with medicine and pharmaceuticals for my entire career. I also had very reliable wilderness medicine books and other books on board to assist with diagnosis and management. We tried to anticipate major injuries and illnesses and have what we needed onboard.

In 2006, a review article about sailing injuries appeared in the BJSM and I wrote an article for our website in which I also summarised the medical report Beth Leonard had compiled from their circumnavigation aboard Silk. http://www.coastalboating.net/Cruising/Seamanship/Medicine/ShipboardMedicine.html

Afterwards, I also compiled a list of items that might be useful in a medical kit and references to have onboard. These served me well as repositories of information that I could go back to for reference over time. http://www.coastalboating.net/Resources/Safety/medicalkit.html

I have to concur with Beth that we never experienced colds or flu during our year sailing and I came back with my full reserves of medicines. That makes sense as you really come across fewer people and certainly do not take on any new foreign microorganisms while underway at sea. I had terrible difficulty with heat rashes and allergies. I also became extremely ill with most likely a streptococcal infection in Martinique after going for a swim in the anchorage at Trois Islets. I treated myself with amoxicillin/clavulanic acid and improved rapidly. I managed to replace the antibiotics with amoxicillin alone in Dominica without an Rx.

Alex was hit by a flailing sheet and knocked unconscious. Fortunately, I was right there, he was not out for long and he fell into the cockpit. I was able to support him as he collapsed. We have strict rules about not coming up on deck without being clipped in and we both were. Staying on the boat is the number 1 priority.

We pay careful attention to hypo and hyperthermia. Alex is highly susceptible to hypothermia and I to hyperthermia. We watch for signs of irritability, irrationality, change of coloration, etc and correct it before it gets out of hand. That 's very important because it affects judgement and people don 't realize it 's happening.

We did think about what would happen with a heart attack or stroke, both of which are in our family histories. I had a good supply of aspirin on board but other than that, we know that relying on CPR is unrealistic. We have thought about a defibrillator but so far have not gone for it. As we age, perhaps... or perhaps going quickly would not be such a bad thing at some point in time.

Just before we left there was a story about a woman winched to the top of the mast by her husband to replace a bulb. While she was up there, he had a heart attack and died. I do not remember how she got down but she must have because she was alive to tell the story. We now always use two halyards if at all possible: one for climbing/winching, one as a fail safe rigged for getting down as well. And we always have a knife handy when doing any kind of deck work.

Our different crossings were very different and had completely different challenges. in the first we sailed through 6 gales and avoided one strong storm across the northern N Atlantic. There injury and hypothermia were the risks. I was black and blue but managed to avoid breaks. As I recall, we did not have any significant injuries. The other two crossings were benign, but we had minor injuries. So I always wear shoes on deck to prevent breaking toes. We have both had knee surgery and have back problems. So we carry knee braces and back braces.

In short, we tried to prepare for things that were likely. You cannot prepare for everything. There are medical services that provide remote medical consultation which would be useful to hear about from anyone with experience.

We don 't have a body bag. We both would prefer to be buried at sea. But I do not know how we would deal with the situation when faced with it in reality.

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Daria Blackwell - Rear Commodore, PR Officer, Editor OCC Digital Comms & Port Officer, West of Ireland s/v Aleria http://www.coastalboating.net
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Bill Balme
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10/23/2014
Bill Balme
Posts: 143
Interesting discussion...

Can I get clarification: if someone dies, does the law require you to keep the body aboard? Why?

Seems that if one goes out for a hike and over does it, someone might keel over and die - they 're basically in the same spot. I don 't imagine there are many defibrillators in hiker 's back-packs - so no, I would not want to have one on board and then suffer the consequences of dealing with a very sick patient afterwards.

When we crossed last year, Laurie kitted the boat with all sorts of medicines and medical books - to deal with less than life threatening emergencies. (Would have been fun lying there in pain trying to work out what was wrong!) We figured that after that, perhaps an overdose of something could be taken! This brings us back to the legal requirements for keeping a body aboard - it had been our plan to chuck it over - but I suspect that would have been wrong. (We 're lucky that we have a watertight bulkhead up front to store a body - but I seriously doubt that Laurie would have been able to lug my dead weight up from the saloon and all the way forward.)

I think Laurie 's concern was more centered around how she would be able to manage the boat when suddenly alone - but that 's another whole discussion...


Bill
s/v Toodle-oo!

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Bill Balme
s/v Toodle-oo!
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