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Medical Matters at sea.

A death at sea Messages in this topic - RSS

fgrennie
Posts: 109


10/23/2014
fgrennie
Posts: 109
Yes we crossed in 1999.

Agree that the burial at see is probably unethical and we would have followed the rules which are to keep the body with you or you could possibly be charged with murder. It is alright for large cruise ships when this happens as they have refrigeration so maybe it it something that has to be discussed and possible solutions sought for yachtsmen.

On medical matters the unexpected will usually happen and sat phone and SSB I think are important items to have on board and keep your fingers crossed that nothing serious happens, if it does then you have the means to contact someone for help.

Look forward to seeing other members thoughts on this thread.
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Simon Currin
Administrator
Posts: 728


10/23/2014
Simon Currin
Administrator
Posts: 728
Frances thank you very much for your thoughtful comments. This is exacactly the type of discussion I was hoping to encourage.

We crossed in '99 so yes we must indeed have listened to the same medical emergency evolve on the SSB.

Interestingly bin liners and duct tape were used to augment the small body bag but neither prevented the contamination of the rest of the boat. Your idea of using the tender is an excellent one. I wonder if anyone has actually done that?

Intersting too to hear that you sought out individual 's wishes upon their demise.

I wouldn 't though over estimate the value of pre-departure medicals as I think there is very little evidence to support their worth. We have organised a lot of mountain adventures in our time and it is almost always the most unexpected person that falls victim to an accident or illness and our pre-trip medicals have been useless as a way of predicting. This doesn 't mean that they are a bad idea but it does mean they should not be relied upon. I am sure some will want to challenge this.

Of course medical kit is important and the training to go with it as well as the Captain 's Medical Handbook but how many of us actually tick all those boxes? To cope with appendicitis you would need intravenous antibiotics, fluids and strong pain killers. Could, or should, we all skill and equip up to this level. Do we all now have sat phones to summon advice and is the quality of that advice as good as it should be? What do you do if you don 't like the advice received? Frances I think you would have been very brave to pretend that that demise had been caused by a "man over board". Would that have been legal or ethical? It would have been a pragmatic solution but would it not have been better to have sought and received pragmatic advice rather than falsify the cause of death?

Simon

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Simon Currin
S/V Shimshal simon@medex.org.uk
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fgrennie
Posts: 109


10/23/2014
fgrennie
Posts: 109
Simon thank you for starting this discussion and I am sure you will get a lot of personal views from our members.

On the question should every yacht carry a defibrillator and should everyone be trained to use it. These days every defib machine carries simple instructions on how to use it the biggest question would be how do you look after the patient until help arrives which would probably be anything from 3 to 5 days or longer the most critical period for a person to survive is 24 hours, so are we all to train as medics before we take to the high seas. On land when you have to use one of these machines you also call for an ambulance to get the person to hospital.

The next question would be supposing someone had a burst appendix in the middle of the ocean. In other words anything unexpected could happen when you are on a long voyage. I think the best advice would be before departure have a complete medical check-up, have a well-stocked medical kit and medical book, and make sure everyone has completed a first aid course and prey that nothing serious will happen but at least you are semi prepared for any emergency.

I think we must have crossed the Atlantic at the same time because I remember listening to the radio and the drama of the wife whose husband had a heart attack and feeling very helpless at not being nearer but relieved when we heard that a nurse had managed to get aboard to help. On that trip the only illness or injury received by the crew was to myself when I broke a toe. Got a bit worried when it went black and the discussion on the net was whether to cut it off with a knife but someone said a chisel would be better. Needless to say I did not take their advice and bound the broken toe to the next one with duct tape. Worked a treat.

Lastly if someone dies at sea. We had an elderly gentleman crewing with us and this question came up before we set sail. The gentleman himself said that if he died at sea we were to bury him at sea. To be on the safe side of the law we packed large black bin bags and duct tape and would put him securely in the dinghy and tow with a long rope off the back of the boat until we reached land. On the other hand I would like to think we granted him his last wish to be buried at sea and probably tell Falmouth that a crew member had fallen overboard and that we had carried out a search but could find nothing.
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Simon Currin
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Posts: 728


10/22/2014
Simon Currin
Administrator
Posts: 728
I usually steer clear of addressing medical issues as it is too close to the day job but it is an obvious omission from this Forum thus far. It occurred to me that amongst our members we, collectively, must have vast experience of the medical issues a cruiser might confront in the course of their sailing lives. I am certainly aware of some very challenging problems that have arisen on board member 's vessels in recent years. The aim of this thread is to get people thinking about the unthinkable and reflect on how things might have been done better. Who knows it might even save a life one day?

So my first case report is an account drawn from my knowledge of what happened to a member during her OCC qualifying passage. It may not be entirely accurate as this is obviously written third hand but it raises many issues worthy of comment.

On passage from Las Palmas to St Lucia a 40 ' yacht with a paying crew of 4 and a professional skipper were a 1,000 miles from Rodney Bay when one of the crew, a male in his late 60 's, suddenly died at the saloon table. There was no warning, no symptoms. One moment he was alive the next moment he was dead. A retired doctor was on board who led a fruitless attempt at resuscitation. What is not taught in first aid courses is that the success rate of a resuscitation attempted in the community is in the region of 5%. It 's how quickly to being defibrillated that really makes the difference and even in the best equipped centres the success rate is not much more than 50%. Though my figures might be out of date they do give an idea that the odds of successfully reviving someone in cardiac arrest mid ocean are poor. If the resuscitation had been successful then how would that crew have coped with a critically ill patient who would have presented a challenge to any fully equipped coronary care unit or ITU? Should a charter yacht taking ageing clients across an ocean carry a defibrillator and train their skippers to use them. I think not but it is worthy of debate.

Anyway the man was dead and the latitude was about 17 degrees north with 1,000 miles to a safe haven. The boat was making about 130 miles a day but the wind was declining and they only had enough fuel to motor for 2 days. For some reason (I am not sure why) the SSB couldn 't be coaxed into action but fortunately the OCC member had borrowed an Iridium phone and a mini solar charger so that she could ring home from time to time. The call was made to Falmouth and the advice received was to keep the corpse on board and continue towards St Lucia. Was that good advice? Hot climates and decomposing corpses are not a good combination and the risk of infection to the survivors is very significant. Again comment very welcome.

Charter boats crossing oceans apparently carry body bags and this was no exception. The trouble is the bag was too small to be sealed so the crew tried their best to use other plastic bags to wrap the remains before placing them in the forepeak and duck taping around the doors in an attempt to seal off that part of the boat. I don 't want to be too gruesome but this did not work and of course the bilge drained the forepeak so the boat soon became a floating hazard to health. Meanwhile the ARC controllers coordinated other boats to standby and supply fuel in case of calms. The boat forged on and made reasonably good time to St Lucia where it was immediately quarantined and the traumatised crew were brilliantly supported by the ARC organisers.

A sad tale of a probably unique qualifying passage but it does for me raise all manner of questions and I would be grateful for comment not least because we will soon be sailing over the horizon and want to prepare, but not over prepare, for the worst that might happen. So here are some suggestions for discussion.

Should we all carry defibrillators and insist that everyone is trained to use them?
If we are all going to be equipped for advanced life support then how are we going to care for that critically ill survivor for the following week and what additional kit should we carry?
I am reminded of our first Atlantic passage when a cruising couple sought advice from Falmouth for the husband who had had a heart attack mid ocean. A cargo ship was diverted and an attempt made to transfer the critically ill gent from yacht to ship in rolling seas. Thankfully the attempt was quickly abandoned and he survived on board his own yacht with the help of a nurse and some additional crew scavenged from yachts in the vicinity. My guess is that the advice issued came from some medical registrar on call who hadn 't any idea of the consequences of his advice. So should common sense have prevailed over 'official advice '?
Again should official advice have been ignored and the body disposed of at sea in a dignified fashion? Would that have been the safest option? Should we be writing down such advanced directives when we put to sea in good health to make it simpler for those left behind?
If they had disposed of the body what would have been the legal consequences of ignoring Falmouth and should the relatives back home have contributed to that decision to sail on? Were they even consulted?
Should we all be carrying bomb proof-ways to communicate across the water or should we stay in blissful isolation and just get on and do what ever needs to be done? I think there is no question that skipper
There is no doubt that skippered charter yachts must have very robust and reliable communications that must work and the skills must be on board to use them. However should all us amateurs be similarly equipped.
What would you have done differently and why?
Should the OCC provide a panel willing to advise in such situations to avoid crass rescue attempts etc?

If there is interest in this thread I will, from time to time, post similar case stories for comment but would very much welcome contributions from any member with their own first hand experiences.

Simon

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Simon Currin
S/V Shimshal simon@medex.org.uk
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