HomeMedical matters at sea

Medical Matters at sea.

IS CRUISING A SAFE ACTIVITY? Messages in this topic - RSS

Dick
Posts: 376


18 days ago
Dick
Posts: 376
Hi Phillip,
I applaud your efforts to disseminate information pertinent to the cruising sailor. Thanks.
The just mentioned medical book, “YOUR OFFSHORE DOCTOR: A Manual of Medical Self-sufficiency at Sea”, is available on Kindle for free (I believe in the UK as well as in the US.)
I know you plan to review it and that is appreciated and anticipated.
A few words:
Most of us will have only one, possibly two, “how to” books on dealing with emergency medicine for sailors on board and, hopefully, we will have actually read them and practiced their diagnostic and treatment suggestions and procedures.
In the interests of the above caveat, and the importance of the subject, I will wade in with a couple of preliminary observations. (In the following, I am speaking only to blue water sailors: those who spend time where there is no access to first responders or hospitals.)
For lay sailors, the one or two books you have on board and the training you choose, will pretty much dictate your response to a medical emergency and your response’s effectiveness, so these choices, often made in early years of cruising, are very important. This is not an area where there is much “continuing education” among the cruising community (although I would argue that it should be).
Given the importance of the book(s) and training chosen, and in a responsibility to our members, we should review the choices with a critical eye.
I would wish to propose a couple of over-arching considerations. The first that the book be written with “wilderness medicine” clearly dictating procedures and considerations. By that I mean diagnostics and procedures where there is no hands-on access to first responders, Drs. or hospitals: you are on your own. And written by people who have been out there dealing with wilderness emergency medicine issues of a wide range for long periods.
I suggest this as wilderness medicine people have been doing this for decades and have worked out the details in actual field experience. They are also often working under an “umbrella” organization who has to answer to a higher authority: insurance companies (monetary considerations often being a very good motivator to generate best practices). And their writing comes directly out of these actual hands-on experiences, and is often reviewed by a “team” of trained people who review and critique these actual events. Cruisers are far more loosely structured and independent, but can benefit from the accumulation of medical emergencies that have taken place in back country hiking/camping, and learn from those whose lives have been dedicated to managing these situations and have used their many experiences to inform their writing.
Following that: the first diagnostic order of business is whether the event is life threatening (where evacuation is considered necessary for saving a life) or something you are going to have to deal with. A mangled finger where the bleeding has stopped will likely not demand evacuation, but a head wound with possible concussion and a certain vital signs picture may.
After determination of the life-threatening aspects of the event, then and only then does one move on the treatment: the cleaning and bandaging of the wound, the administration of anti-biotics etc.
My best, Dick Stevenson, s/v Alchemy

--
Dick Stevenson, s/v Alchemy
0 link
Philip Heaton
Posts: 33


19 days ago
Philip Heaton
Posts: 33
Not sure how widely publicised this gas been but OCC member Michael Beilan has recently had published the book "YOUR OFFSHORE DOCTOR: A Manual of Medical Self-sufficiency at Sea. I have one on order so no review yet but knowing Michael it should be invaluable ...
0 link
Dick
Posts: 376


24 days ago
Dick
Posts: 376
Hi John,
I suspect that one should distinguish different sailing activities: racing and cruising. As we are a cruising club. I will focus on cruising. Racing is a competition and any competition will be more dangerous no matter what the sport.
In my writings on safety, I believe (and readers have supported this in their feedback) that my most important piece of advice is to never move faster that 2/3rds speed when sailing. Rarely is one called upon to move fast: so just do everything at 2/3rds pace always and your safety will increase dramatically. Similarly, do not sail your boat at more than 75-80% of its potential. You are cruising after all and I guarantee you that the potential for injury to person and the potential to damage the boat go up exponentially as one pushes one’s boat that last 20% towards the edge of its potential.
It has been my experience that cruisers have a wide range of preparedness: and I believe preparedness to be the most important ingredient to safe sailing (just after luck). A well-prepared boat run by a safety-thoughtful skipper is generally a boat where injuries are rare. Bad luck can happen to anyone of course, so nothing is in any way guaranteed, but that has been my observation.
As to sailing being safe or not: this has to be seen in the context of a self-selected population who appreciate spending lots of time outside, and enjoy being quite active, curious and adventurous. To my mind, they may be, overall, much better off health-wise in the long run than more sedentary folks.
Bottom line, for me, is preparedness: skipper, crew, and boat. If you work your way into cruising incrementally with a good foundation and experience in the basics, I do not see cruising as in any way injury-inducing. That said, I think many boats leave shore poorly prepared and I think the media (and perhaps also clubs, associations, schools etc.) do a poor job of making clear the kinds of skills/experience one should develop in the pursuit of safe cruising.
My best, Dick Stevenson, s/v Alchemy

--
Dick Stevenson, s/v Alchemy
0 link
Daria Blackwell
Administrator
Posts: 764


24 days ago
Daria Blackwell
Administrator
Posts: 764
IS CRUISING A SAFE ACTIVITY?
JOHN DUGGAN, PO Cascais

All sensible cruisers take seriously the issue of safety on board. The horrors of a man overboard situation, sinking or fire on board are the subject of endless discussion but how safe is cruising under sail, when seen through the respective of personal injury, below the level of life-threatening?
I’m prompted to reflect on this, based on my own impressive list of afflictions suffered over the past five or six seasons:
· Bruised ribs and a badly twisted shoulder, due to slipping while ascending the companionway
· A busted Anterior Cruciate Ligament (the one that stops your knee from folding like a collapsed marionette) caused by a bare-footed slip on a wet deck
· Further damage to my shoulder, from winching in a bad position
· Pneumonia!
· Sea sickness and sundry rashes.
I’ve since come across a surprising number of people with bad shoulders, due to over-extension of the arm when winching. One cardinal rule – don’t winch with one arm only; get over the top of the winch in a stable position and use both arms. The shoulder is a complex joint and surgery may be the only solution to a bad tendon injury. While shoulder injuries are a “sore point” with me, they are far from the only common injury, as may be seen in the following extract from a study by Wilderness & Environmental Medicine:
“From 1188 respondents, a total of 1715 injuries and 559 illnesses was reported. The top 3 injuries for keel boats were leg contusions (11%), hand lacerations (8%), and arm contusions (6%), and in dinghies they were leg contusions (13%), knee contusions (6%), and leg lacerations (6%). The most common mechanisms of injury were “trip/fall,” “hit by object,” and “caught in lines.” Tacking, heavy weather, and jibing were the most common factors contributing to injury. The rates of injury and severe injury in this internet-based survey were 4.6 and 0.57 per 1000 days of sailing, respectively. Of the 70 severe injuries, 25% were fractures, 16% were torn tendons or cartilage, 14% were concussions, and 8% were dislocations. The median rate of lifejacket use was 30%, and median rate of sunscreen use was 80%. Sixteen percent of sailors reported sunburn over the prior 12 months. Seven percent of sailors reported use of alcohol within the 2 hours preceding injury. Conclusions.—The most common injuries in both keel boats and dinghies are soft-tissue injuries to the extremities. Severe injuries and illnesses in sailing are uncommon in this study population.”
The full study report may be seen here https://www.wemjournal.org/article/S1080-6032(10)00204-8/pdf

The following was contributed by my friend and experienced sailor, Dr Geoff Chadwick:

1. Trauma. Rib fractures are a common consequence of being thrown around by sudden motion. These are painful but require no specific treatment except in the emergency situation of tension pneumothorax where the lung is punctured and inexpert intervention will do more harm than good. Fingers are the other common injuries so ordinary band aids are vital for cuts and adhesive tape for fixing an injured finger to the one next to it.

2. The first aid kit should be visible in the saloon not stored in a rarely used locker. The contents should be reviewed annually as commonly used items like bandaids run out first.

3. Seasickness. Puke in a bucket not over the side. Although sufferers tend to stay on deck for fresh air, in my experience they are better off in a bunk to keep warm, with a bucket beside them. Electrolyte salts or simply sugar in water are useful but not if they cause distress.

4. Skin problems. Skin infections and irritations are common. Most ailments will respond to alcohol gel hand cleaner which is now widely available. Of the proprietary skin creams E45 is good.

5. Teeth. Simple emergency dental kits are inexpensive and safe to use for broken teeth or lost fillings.

6. Medical help. There are online resources which can evaluate symptoms and help deciding whether evacuation (dangerous in itself) should be considered

I invite readers to share their experiences and recommendations.

Posted on behalf of:
John Duggan
February 2019

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






Powered by Jitbit Forum 8.3.8.0 © 2006-2013 Jitbit Software