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First aid involves immediate measures to assist an injured or ill person, aiming to save lives, prevent further harm, and alleviate health issues before professional help arrives. It addresses conditions like suffocation or severe blood loss, where prompt action is crucial for survival. Certain injuries allow for a brief delay in treatment to locate a crew member skilled in first aid or gather necessary supplies. All crew members must be prepared to administer basic first aid and understand when to act and when to wait for trained personnel. Untrained individuals should acknowledge their limitations to avoid causing harm inadvertently.

THE STRUCTURE AND FUNCTIONS OF THE ORGANISM

Skin

The skin serves as a protective barrier against mechanical damage, temperature effects, chemicals, and microorganisms. Comprising three main layers—epidermis, dermis, and subcutis—it undergoes constant change. Skin features, including follicles and glands, contribute to its functions. Careful examination of skin conditions, injuries, rashes, and overall appearance aids in assessing the individual’s general health.

Bones

The skeleton provides essential support for the body, facilitating movement and functionality. Bones comprise hard surface bone tissue with a sponge-like interior filled with soft bone marrow, some producing blood elements. The periosteum surrounds bone surfaces with nerve endings. Joints connect bones, forming the skeletal structure categorized into head, trunk, and limbs. Head bones include the skull and facial bones with mucous-lined sinuses. Trunk bones comprise the spine and ribcage. Limb bones are divided into upper and lower limbs. During casualty examination, signs of pain, swelling, deformity, or bone alterations are assessed.

Joints

They allow the bone to move for movement, exercise, breathing, and other functions. Joints are the head and cup of bone that fit into each other, coated with cartilage. They consist of the articular cocoon, articular fluid, and ligaments. When examining casualties, we look for joint pain, deformity, and swelling.

Muscles

Muscles are categorized into transverse striped (voluntary), smooth, and cardiac. Transverse striped muscles consist of myofibrils, forming tendons at their ends, connecting to bones. Smooth muscles control involuntary bodily functions found in internal organs. The heart muscle, uniquely adapted for heart function, consists of specialized tissue. During casualty examination, signs of pain, deformity, and swelling are assessed in muscle injuries.

Respiratory system

The respiratory system includes the nose, larynx, windpipe, and lungs. Air travels through these airways, reaching the alveoli in the lungs, where oxygen is exchanged with red blood cells. Breathing is driven by the diaphragm and rib muscles, with a normal rhythm of about 16 breaths per minute. Oxygen is distributed throughout the body, producing carbon dioxide expelled through exhalation. The sense of smell in the nose is crucial for danger detection. Breathing emergencies may arise from various causes, requiring assessment for breathing existence, rhythm, airway obstructions, secretions, bleeding, and respiratory muscle use in casualties.

Cardiovascular system

The circulatory system comprises the heart, lungs, and arterial and venous vessels, working together to circulate blood throughout the body. The heart, a central pump, consists of atria and ventricles with valves preventing blood backflow. The pulse reflects the left ventricle’s contractions, typically beating 60-80 times per minute at rest. Arteries carry oxygen-rich blood from the heart to the cells, while veins return deoxygenated blood. Blood loss from arteries is characterized by jet-like spraying. The circulatory system includes 5-6 liters of blood, composed of plasma and blood cells (red, white, and platelets). Hemorrhagic shock, categorized by blood loss classes, can be fatal if exceeding 40%. Circulatory problems encompass aneurysms, atherosclerosis, heart disease, high blood pressure, and varicose veins. A heart attack results from blocked blood flow to the heart, causing muscle damage. Prompt medical intervention reduces heart damage and mortality.

Digestive system

The digestive system, from the oral cavity to the large intestine, involves organs like the liver and pancreas. Food undergoes chewing and salivary soaking in the oral cavity while the stomach digests it with gastric juices. The duodenum further aids digestion with liver and pancreas juices, and the small intestine absorbs nutrients. The large intestine absorbs water, forming stool. Gastrointestinal emergencies, often causing severe pain, may require surgical intervention for issues like intestinal obstruction, organ perforation, hernia, blood flow blockage, or abdominal abscess. Immediate medical attention is crucial for suspected appendicitis or related conditions.

Urinary system

The urinary system comprises kidneys, ureters, bladder, and urethra. In men, the urethra, which passes through the prostate gland, participates in seminal fluid formation. The kidneys filter blood, removing harmful metabolic products. Filtered components form urine, which travels through the ureter to the bladder. An adult typically urinates 1 to 2 liters daily. Urinary emergencies involve uncontrolled renal bleeding, urine accumulation in the peritoneal or retroperitoneal space, and urine outflow obstruction.

Nervous system

Nerve cells, or neurons, are fundamental to the nervous system, featuring numerous branches and fibers forming nerves. The nervous system comprises the central (brain and spinal cord) and peripheral (nerves outside these structures) systems. The skull and spinal column protect the central system, with cerebrospinal fluid circulating through it. The brain interprets our environment, controls body movement, and houses thoughts. The peripheral system facilitates communication between the central system and the body’s organs. The autonomic nervous system involuntarily regulates organ functions. Various conditions, from degenerative diseases to trauma, can lead to nervous system emergencies, including heart attacks, seizures, strokes, and head or spinal injuries.

Senses

Humans possess five senses: vision, hearing, taste, smell, and touch. Vision relies on the eyes, with the image projected through the lens onto the retina, which sends signals to the brain. Hearing involves the outer, inner, and middle ear, capturing sound waves and transmitting them through the auditory system to the brain. The smell is perceived by cells in the nasal mucosa, acting as a chemical analyzer. Taste resides in the tongue, featuring thousands of taste buds. Touch and warmth sensations are felt through the skin, particularly the fingertips. These senses collectively contribute to our perception of the surrounding environment and play essential roles in maintaining our well-being by identifying potential dangers and providing enjoyment through sensory experiences.3.3. Medical First Aid on Board a Ship.

MEDICAL FIRST AID ON BOARD A SHIP

Priorities

When encountering a casualty, prioritize safety to avoid harm. Remove the person from danger or eliminate the danger. For a single unconscious or bleeding casualty, provide immediate aid and seek help. With multiple casualties, send for assistance and prioritize treatment based on severity: severe bleeding, respiratory/heart issues, and unconsciousness. In enclosed spaces, refrain from entry unless trained in rescue and equipped with breathing apparatus. Summon help and notify the master. If entry is necessary, promptly fit the casualty with a breathing apparatus and relocate to a safe area, considering immediate treatment if vital.

General principles of first aid abroad ship

Emergency conditions pose immediate threats to life and require urgent first aid intervention to prevent death or lasting consequences. Immediate actions include restoring breathing and heartbeat, controlling bleeding, removing poisons, and preventing further harm. In cases of compromised breathing and heart function, reanimation procedures are crucial, addressing conditions like drowning, subcooling, foreign body airway obstruction, electric shock, poisoning, severe wounds, and hanging. If these vital functions aren’t restored within 3-5 minutes, brain death occurs. Terminating travel and seeking the nearest port or helicopter transport may be necessary depending on the situation and coordination with onshore health services.

Important notes when providing first aid

In encountering an unconscious person, initial actions involve assessing consciousness and following the ABC principle: ensuring airway patency (A), checking for breathing (B), and verifying the existence of a heartbeat (C). Immediate measures include stopping severe bleeding. For an unconscious but breathing casualty, the recovery position is applied; artificial respiration is initiated for no breathing. If there is no heartbeat, cardiac massage is performed after removing clothes. Seating is allowed only if spinal injuries are ruled out. Signs of death, such as the absence of a heartbeat, glassy eyes, and body cooling, must be present. Brain death occurs in 3 to 5 minutes without oxygen, emphasizing the urgency of revival measures in cases like accidents, poisoning, hanging, drowning, and heart disease.

ABC principle

The ABC principle, Airway, Breathing, and Circulation, guides vital function assessment and procedures for injured individuals. For Airway, if unconscious, ensure unobstructed airways by lifting the neck, pushing the forehead backward, and clearing the mouth. Breathing involves initiating artificial respiration if the person isn’t breathing, checking the cervical artery pulse, and administering rescue breaths. Circulation protocols include checking the cervical artery pulse, starting external heart massage if there is no heartbeat, applying pressure to the pectoral bone, and coordinating chest compressions and rescue breaths. Optimal resuscitation involves two rescuers, one for artificial respiration and the other for heart massage. Continuous revival efforts are crucial, with effectiveness assessed regularly. Resuscitation persists until spontaneous pulse and respiration return or up to one hour if not restored.

Artificial respiration

During resuscitation, attention is first directed to inspecting and clearing nasal and oral cavities, removing potential obstructions. A finger, wrapped for protection, is used to clear blockages. The tongue, prone to obstruction, is pulled forward and secured until normal breathing resumes. Artificial respiration methods include mouth-to-mouth, mouth-to-nose, Sylvester, or Holger Nielson methods, with the first being most suitable for maritime conditions. After clearing airways, the head is tilted backward, and rescue breaths are administered 16 to 20 times per minute. When the mouth can’t be opened, the mouth-to-nose method is applied. Sylvester’s method involves laying the injured person on a hard surface, tilting the head backward, and using specific arm movements. Larger ships should have basic aids like an AMBU mask or respirator for establishing breathing function onboard, incorporating oxygen when necessary.

Cardiac massage

In cardiac arrest, closed-chest cardiac massage becomes crucial to provide the necessary oxygen to the brain until the heart resumes beating. The individual should be undressed and laid on a hard surface for effective external massage, with the pressure point at the middle-lower sternum determined. Care must be taken not to break ribs or cartilage. Performed with two hands, the lower hand’s palm rhythmically presses the sternum’s root. The compression depth should be 4–5 cm, and the release must be complete. For adults, the rate is 90 to 100 compressions per minute, while children require adjusted techniques.

Cardiopulmonary resuscitation (CPR)

If the injured person is not breathing and shows no heart activity, a combined external cardiac massage and artificial respiration should be initiated. For a single rescuer, the sequence involves 15 chest compressions followed by two rescue breaths. The rescuer kneels on the side of the injured for seamless execution. For two rescuers, the rhythm is five chest compressions followed by one rescue breath, ensuring continuous cardiac massage with minimal interruptions. A single rescuer aims for at least four cycles per minute (15 compressions each), while maintaining a preferable rhythm of six cycles per minute (90 compressions). Immediate action is critical to effective resuscitation.

Evaluating the effectiveness of CPR

The effectiveness of resuscitation is assessed through various indicators. Pupillary response to light is crucial; narrowed pupils signify sufficient brain oxygenation, while dilated and unresponsive pupils indicate severe brain damage. Checking the pulse, expanding the thorax with rescue breaths, palpating the pulse during chest compressions, and returning normal skin color are additional markers of success. The termination of resuscitation is considered if the injured person remains deeply unconscious, lacks spontaneous breaths, and exhibits fixed dilated pupils for 15 to 30 minutes, indicating brain death. In the absence of a doctor, artificial respiration and cardiac massage should persist until spontaneous breathing and heartbeat resume or the person is transferred to medical care or until the rescuer discontinues due to fatigue, with drowning cases requiring resuscitation efforts for at least one hour.     

BLEEDING

External bleeding – pressure, compression, and elevation

External bleeding can be controlled through various methods. Direct pressure on the wound using the palm or sterile gauze is the simplest and most effective approach. Digital compression at arterial pressure points with fingers can be applied temporarily if direct pressure is insufficient. This method preserves the injured person’s life until professional care is available. When direct pressure or improvised compression isn’t feasible, a compression bandage is a long-term solution. This involves placing a thick gauze pad over the wound, covering it with sterile gauze, and firmly tightening the bandage. Limb elevation, though not sufficient on its own, aids in reducing blood flow and pressure, complementing other bleeding control methods. When a compression bandage proves insufficient, additional layers should be added without removing the initial bandage. Sterile gauze and plain bandages can be improved without specialized first bandages. Properly fitted compression bandages should not be removed for 24 hours.

External bleeding – hemostat, Esmarch bandage and tourniquet

Based on severity and location, external hemorrhage can be addressed using hemostat clamps, Esmarch bandages, or tourniquets. Like Pean à demeur, the hemostat clamp is highly effective, squeezing the bleeding blood vessel without damaging secondary blood flow or uninjured tissue. It’s preferable in ship conditions. The clamp’s handles prevent spontaneous loosening, and it should be transferred to the hospital with sterile gauze protecting the wound. When other methods fail, the Esmarch bandage and tourniquet are reserved for limb amputation or near-amputation. The Esmarch bandage, made of elastic material, interrupts limb circulation, while the tourniquet, improvised from fabric or a kerchief, prevents bleeding. A tourniquet on an incomplete amputation should be released slowly every twenty minutes to prevent tissue damage. Any applied bandages require immediate radio consultation with a doctor and must not be covered or forgotten.

Nosebleed

For a nosebleed, squeeze both nostrils continuously for 10 minutes with the head tilted forward. If bleeding persists, continue squeezing the soft parts of the nostrils for 20 minutes before gradually releasing the pressure. Avoid touching the nose afterward. If bleeding persists, consult a doctor via radio for advice on creating a nose tampon. This involves inserting a 1 cm wide, 1 m long strip of gauze (preferably Vaseline-soaked or iodoform-soaked) into the bleeding nostril, leaving it for 48 hours. Carefully remove the tampon to prevent new bleeding. Early removal may cause the tampon to adhere to the mucous membrane, leading to further bleeding.

Internal bleeding

Internal bleeding, occurring in conditions like injuries or gastrointestinal issues, can be visible or hidden. Signs of hidden bleeding include swelling around a closed fracture or the appearance of blood in vomit, stool, or spit. Serious internal bleeding may result from seemingly harmless abdominal injuries. Blood loss can lead to shock, with symptoms such as a fast, weak pulse and dropping blood pressure. Monitoring blood pressure changes every 10 minutes for about an hour helps assess internal bleeding. If blood pressure remains stable, internal bleeding is less likely. In suspected cases, seek a doctor’s advice via radio. Elevating the injured person’s legs 30 cm aids blood flow to the lungs and brain, and morphine can be administered for pain and discomfort, with infusion under radio consultation.

Ear bleeding

Ear bleeding often follows head or blast injuries, typically from a ruptured eardrum. It involves drainage with blood, pus, wax, and fluid. Initial care involves placing a wide bandage over the ear and tilting the head toward the injured side. If the person is unconscious, the recovery position is recommended, with the injured ear facing downwards. Avoid inserting anything into the ear canal. Seek medical advice via radio for further guidance.

SHOCK

Signs, causes, and types of shock

Shock is a serious condition resulting from weakened vital functions due to impaired circulation and reduced oxygen delivery to tissues. Common causes include extensive bruising, major burns, fractures, fluid loss from bleeding, severe diarrhea, vomiting, allergies, infections, and stroke. Severe shock is life-threatening, presenting signs like pallor, rapid shallow breathing, thirst, nausea, vomiting, weak and rapid heartbeat, and restlessness. In people with black skin, paleness is checked on mucous membranes. Act preventively if the casualty is badly injured. Lay them on their back, lift their legs, and seek immediate medical attention, as severe shock poses a serious threat to life.

First aid and shock treatment

Shock management involves addressing its causes, replenishing fluids, and ensuring warmth. Causes, such as bleeding, compromised breathing, and intense pain, should be addressed by positioning the injured person horizontally with raised feet (30 cm), except in specific injuries. Warming is essential to avoiding overheating. Pain relief, crucial for preventing shock deepening, may include morphine if there are no contraindications. Oral fluid replenishment is natural, given every 15 minutes unless contraindicated. After consulting a doctor, intravenous infusion is an option when oral intake is not feasible. Solutions like saline, Glucose 5%, or Dextran 6% are administered as directed. Alcohol is strictly avoided. Always consult a doctor via radio in case of suspicion or doubt.

FIRST AID FOR BURNS

How to treat a burn

Prompt cooling with cold running or submerged water for at least 10 minutes is crucial for any burns. Gently remove stuck clothing without force. The burned area should then be covered with dry sterile or Vaseline gauze, avoiding shed materials. Severe burns require consultation with a doctor via radio, considering the affected area, degree of burn, and potential shock.

FIRST AID FOR ELECTRIC SHOCK  

Electric shock treatment

For electrical burn victims, immediate removal from the circuit is crucial. Switch off the power source or interrupt the electrical flow if possible. Use rubber gloves and shoes or non-metallic objects to address the situation safely. Ensure no one else is at risk before assisting. Administer artificial respiration if the victim is not breathing and initiate cardiac massage if the heart is not functioning. Send for help concurrently. Cool burnt areas with cold water for breathing patients and gently cover them with sterile material. Treat electrical burns similarly to heat-induced burns, addressing pain, shock, and infection prevention. After initial aid, hospital supervision is necessary, with onboard monitoring of respiratory and cardiac functions to ensure they are stable.

BROKEN BONES AND FRACTURES

General principles

Bone fractures result from mechanical force, causing the bone to split into fragments. These fragments can be contained within the tissue (closed fractures) or pierce the skin (open fractures), posing higher infection risks. Infections prolong the healing process, emphasizing the need to minimize infection risks. Depending on vessel size, sharp bone fragments cause pain, tissue damage, and potential bleeding. Immobilization is key in fracture management, alleviating pain, and minimizing soft tissue damage. Signs of closed fractures include a history of trauma, audible bone cracking, visible swelling and deformity, and impaired, painful limb movement. Immediate attention and proper immobilization are crucial for fracture management.

Principles of fracture management

For complicated fractures or injuries to critical areas, seek immediate medical advice via radio. Avoid moving the injured person until the bleeding stops and the fracture is immobilized. While awaiting professional help, take these steps: control bleeding with sterile gauze or clean cloth, immobilize the fractured area without attempting realignment, apply ice packs wrapped in cloth to reduce swelling, and address shock symptoms by laying the person down with the head lower than the trunk and elevating the legs if possible. Seek professional medical assistance promptly for comprehensive care.

Bleeding in fractures

Standard methods like sterile gauze, pressure, compression bandages, and blood clamps manage bleeding from an open fracture. Bleeding stems from surrounding tissues, not the broken bone. Elevating the limb reduces blood flow and bleeding intensity. Stopping bleeding is crucial, as fatalities result from exsanguination, not broken bones. Rest minimizes further bleeding, preventing additional injury and pain. Once the bleeding stops, treat the wound by cleaning and disinfecting it with warm water, soap, and 1% Cetavlon solution. Avoid letting water, soap, or disinfectant enter the wound. Cover the wound with sterile gauze and remove foreign bodies with sterile tweezers. Do not immediately remove the blood-soaked bandage; consult a doctor via radio for further guidance.

Pain management

Severe pain should be suppressed by administering 1 ampoule (10 mg) of morphine hydrochloride to the muscle. For fractures of smaller bones, milder painkillers (analgesics) may be given in tablets or injections.

When administering morphine, the advice of a physician via radio should be sought before repeating the dose. To avoid intense pain, the broken part must be handled with care.

Immobilization

Different splints are used for immobilization, covering the bandage that stops bleeding and tends to the wound. The splint’s length should span both adjacent joints of the broken bone. Pneumatic splints are ideal for transporting injured individuals but shouldn’t remain for more than 4 hours to avoid circulation issues. Immobilization aligns with the natural position of the body part, ensuring comfort with relaxed muscles. For instance, a broken forearm is bent at the elbow unless an elbow fracture restricts movement, warranting a stretched position. Careful stretching of broken arms or legs is suitable, avoiding violent or forceful actions. Without a dedicated immobilizer, a wrapped wooden strip/board suffices. Spinal injuries require immobilization on a wide plank or door, while folding a jacket or cloth triangle can secure smaller body parts.

Circulation check

In the case of a broken limb, circulation should be assessed by checking the pulse and pressing the nails. Normal circulation manifests as pale nails turning pink when pressure is released. Warning signs of circulatory issues include an absent pulse, blue or pale fingertips, cold peripheral parts, and loss of sensation. Immediate radio consultation with a doctor is vital to prevent amputation. Internal bleeding signs should be monitored in fractures. For upper jaw fractures, maintaining airway patency is crucial, stopping bleeding and immobilizing the jaw. Oral wounds may require antibiotics. Lower jaw fractures may cause deformity, tooth loss, bleeding, and swallowing difficulty. Managing a fractured jaw includes pulling it forward for breathing and immobilizing it with bandages. Seek radio advice for an unconscious, injured person, ensuring breathing and preventing suffocation.

Fractured collarbone and shoulder

Clavicle fractures typically result from falls on the shoulder or arm. If only the collarbone is broken, the arm should be held close to the body with a sling or the other arm, elevating the hand above the elbow. Minimal arm movement is advised, and an ice pack should be applied. A homemade sling using a handkerchief or triangle bandage is suitable. Certain shoulder bone fractures may require immobilization with a triangular bandage. Most scapular body fractures are treated without surgery, using ice for swelling and pain medications for pain control.

Fractures of the upper arm, elbow, and forearm

Upper arm and elbow fractures result in an inability to raise or bend the elbow. Potential complications involve injury to nearby arteries and nerves. Treatment includes immobilizing the upper arm and elbow with a pneumatic mold or classic Kramer joint in a flexed elbow position. In the case of a broken elbow, immobilization in the extended position is necessary due to pain and complications. Forearm fractures (radius and ulna) usually result from a fall on the arm. Treatment involves carefully stretching and immobilizing the broken bones using inflatable splints, classic Kramer splints, or improvised immobilizers, with pain management through analgesics.

Fractures of the wrist, hand bones, and fingers

Wrist fractures typically occur when falling on an outstretched fist. Caused by direct impact or bruising, symptoms include swelling, pain, an unnatural appearance, and impaired function. Treatment involves immobilizing the fist on a straight splint and inserting cloth or bandage into the fist cavity. Avoid pulling the fractured joint; instead, immobilize it. If severe pain is present, provide analgesics and elevate the injured fist to reduce bleeding and swelling. Forearm immobilization is achieved with a bandage. For finger fractures, immobilize only the broken finger after gently pulling it out and use a wooden stick for support.

Spine and neck fractures

A spinal fracture is a severe injury that demands immediate attention. Suspected cases require the injured person to lie on a hard surface, avoiding any movement that might intersect the spinal cord, potentially causing lifelong paralysis. If the person cannot lie down independently or is unconscious, three people should carefully lay them down on a rigid base, securing their feet and body. This minimizes both vertical and horizontal movement. When transporting a person with a suspected spine fracture, six people should carry them, preventing additional harm. Severe analgesics or morphine may be administered, but seeking medical advice via radio is crucial. The same principles apply to neck injuries or fractures, and a dedicated Schanz collar or newspaper layers can be used for immobilization.

Chest injuries

Rib injuries and fractures commonly result from falling onto sharp objects or strong impacts to the chest, causing severe pain intensified by breathing. Lung damage may occur, presenting as difficulty breathing and coughing with bloody sputum. Sharp rib fragments can puncture the pulmonary pleura, leading to lung collapse (pneumothorax). Immediate attention is crucial, especially for open chest wounds. Closing the wound promptly is vital to prevent air entry and lung collapse. This involves covering the wound with Vaseline gauze, aluminum or plastic foil and securing them with Leukoplast tape. Monitoring signs of internal bleeding, pulse, and breathing frequency is essential. The injured should rest semi-upright, and in cases of suspected chest injuries, particularly pneumothorax, seeking radio medical advice is imperative. Pneumothorax demands urgent radio consultation and helicopter transfer to a hospital, with precautions taken during transport to minimize altitude-related complications.

Injuries and fractures of the pelvis

Pelvic fractures result from a forceful impact on the pelvic bones, causing pain in the hips, lower abdomen, groin, lower back, or thighs. A simple test involves gentle pressure on both pelvic bones to detect increased pain, confirming a fracture. Bladder and urethra injuries may lead to urine leakage into surrounding tissues, requiring testing for blood. Pelvic fractures can cause severe internal bleeding, necessitating regular pulse checks and monitoring for signs of internal bleeding. Suspected pelvic injuries demand immediate radio medical attention. When transporting the injured, ensure a supine position, immobilizing with splints or a plank. Administer strong painkillers or morphine, regularly measure pulse, and address shock symptoms if present.

Fracture of the femur

In a femur fracture, severe pain prevents leg movement, with the broken leg appearing shorter and twisted. Shock may occur due to bleeding and pain, warranting immediate radio medical advice. For a suspected closed fracture, gently immobilize the leg with splints, wrapped in soft material, and tied together. If both legs are affected, insert fabric between them, use splints on the sides, and secure with ties. Femur fractures may cause significant bleeding, requiring urgent attention to prevent life-threatening complications.

Fractures of the lower leg, ankle, and foot

Fractures of the lower leg bones (tibia and fibula) result from severe impacts or falls, causing swelling, deformity, impaired function, and pain in closed fractures. For immobilization, gently pull the leg straight and use classical or inflatable splints. Inflatable splints are advantageous for open fractures as they assist in controlling bleeding. When using a classic splint, wrap it with soft material and place one on the back, with two on each side of the broken leg. Connect the joints around the knee and ankle for stability. Ankle and foot fractures, caused by falls or twists, present with pain, swelling, and reduced function. Immobilize with inflatable splints or, if unavailable, use classic splints, ensuring they cover the foot and sides of the ankle. Improvisation with a blanket or pillow is an option without classic splints.

FIRST AID FOR CHOKING AND SUFFOCATION

Heimlich’s maneuver

Choking, resulting from airway obstruction, may be triggered by food, unconsciousness-induced vomiting, insect bite swelling, allergic reactions, or tongue blockage during fainting—partially obstructed airways prompt coughing for self-expulsion. For food-induced choking, immediately perform Heimlich’s maneuver by clasping hands on the abdomen and applying strong, repeated pressure. Unconscious individuals require a modified maneuver, with pressure on the abdomen above the navel. Remove the expelled obstruction, place the person in the recovery position if breathing, or initiate CPR if not. If airway obstruction persists, repeat the procedure until successful, indicated by normal chest inflation during artificial respiration attempts. Seek medical advice via radio for further guidance.

ONBOARD POISONING

The most common poisoning hazards

Poisoning can be acute or chronic, with severity determined by poison type, amount, and entry method. On ships, potential poisons include everyday substances (alcohol, paints, solvents), offshore-generated substances, and toxic cargoes (petroleum, acids, alkalis). Common workplace poisons are carbon monoxide (CO), carbon dioxide (CO2), ammonia (NH3), and freon, with additional hazards from pesticides like methyl bromide. Fermentation in organic cargoes (cereals and fruits) can deplete oxygen and release CO2. Prompt identification and proper response are crucial, and radio consultation with a doctor is essential for effective treatment and guidance in poisoning emergencies.

General signs of poisoning and first aid

Signs of poisoning include headache, nausea, vomiting, behavior changes, drowsiness, fainting, pain, cramps, and poor general condition. Severe poisoning signs include bluish skin, difficulty breathing, rapid pulse, vomiting, and consciousness disturbance. First aid principles involve quick and calm action, identifying the poison, removing it from the body, administering antidotes, catheterizing if needed, maintaining vital functions, providing oxygen, keeping the poisoned person warm, not inducing vomiting in specific cases, monitoring the condition, and seeking medical advice via radio. Warnings include avoiding mouth-to-mouth resuscitation in certain cases, refraining from milk in insecticide or gas poisoning, and not administering certain drugs in gas poisoning. Protective measures for skin exposure are emphasized, emphasizing prompt clothing removal and washing with soap and water.

Carbon monoxide poisoning

Carbon monoxide (CO) is a combustion gas produced during incomplete burning, common in engine exhaust. Symptoms vary based on exposure duration and concentration. Signs include unconsciousness, irregular breathing, muscle twitching, and potential death. At lower concentrations, symptoms include headache, dizziness, nausea, vomiting, and fainting. First aid involves moving the victim to fresh air, assessing consciousness and vital functions, administering artificial respiration or cardiac massage if needed, providing oxygen through a mask for conscious victims, and considering Diazepam for convulsions under medical guidance via radio. Diazepam should only be administered into the muscle based on radio consultation with a doctor.

HYPOTHERMIA AND HEATSTROKE

Signs of hypothermia

The greatest threat to survival at sea is the rapid loss of body heat, as water cools the body much faster than air. Even in relatively warm seas, hypothermia can set in. Hypothermia, marked by a core body temperature below 35°C, progresses through stages, initially causing shivering, cold and pale skin. Fatigue, confusion, and slowed bodily functions occur as the temperature drops. Severe hypothermia leads to unconsciousness, slowed heart rate, and breathing. Without prompt help, hypothermia can be fatal, causing respiratory failure and cardiac dysfunction. Full body cooling can slow metabolism, increasing the chances of successful resuscitation compared to victims of apparent death from other causes.

First aid for hypothermia  

First aid for severe chilling involves preventing further heat loss and gradually raising the internal body temperature. Maintaining a horizontal body position is crucial to prevent heart strain and potential heart attacks when removing chilled individuals from the sea. Reanimation should be initiated if the person is not breathing. First aid should be administered even if the rescued individual shows no signs of life, with priority given to those without tremors during triage. Avoid excessive movement, alcohol administration, overheated rooms, or baths, as these can enhance heat loss and strain the heart. Wrap the casualties in blankets, including the head, and provide a warm drink. Replace wet clothes with dry ones if the person has not been in the water for a long time. After tremors cease, place the casualty in a bed, maintain warmth, and keep the room temperature between 15-20°C. Specific first aid procedures include Hibler’s thermal envelope and a hot towel, changed hourly, for internal warming. Blanket wrapping alone without a heat source is ineffective.

First aid for different body temperatures

Hypothermia assesses the person’s condition based on consciousness and rectal temperature. At 37°C, normal body temperature is maintained. At 36°C, feeling cold prompts replacing wet clothes, protection, and hot drinks. Shivering appears at 35°C, and at 34°C, slow motion and confusion set in. Muscle stiffness occurs at 33°C, requiring warm drinks, heating, and monitoring. Shivering stops at 32°C, and at 31°C, a semi-conscious state arises. Fainting occurs at 30°C, followed by a slow heart rate at 29°C. At 28°C, heart and breathing cessation prompt artificial respiration and heart massage, continuing as long as possible. Below 28°C, there are no signs of life.

Frostbites – local effects of prolonged exposure to cold

Limited freezing of body parts can occur in extreme cold, especially for seafarers in cold areas. Affected areas are typically feet, hands, ears, and nose. Frostbites have three stages: first-degree with pale, cold, and swollen skin; second-degree with pale blue skin, swelling, blisters, and bleeding fluid; and third-degree with scabs, skin breakdown, and insensitivity to pain. While there is little shock, third-degree frostbites risk amputation of affected parts. First aid involves warming, removing wet clothes, avoiding skin contact, not opening blisters, and seeking medical advice via radio for second and third-degree frostbites, which require prompt medical treatment.

Effects of heat

High temperatures can lead to heat-related issues such as heat exhaustion, cramps, sunstroke, sunburns, and dehydration. Sunstroke results from prolonged sun exposure without head protection, causing the body’s cooling mechanism to fail. Symptoms include headache, dizziness, vomiting, cramps, stomach pain, and fever. First aid involves removing the person from the sun, cooling with cold compresses, removing excess clothing, avoiding swimming, and providing rehydration solutions or water with salt. Further, cooling measures, rest, and limited activity for at least 48 hours are recommended.

DROWNING

First aid in drowning

Drowning is characterized by fluid suppression, where the primary cause of death is hypoxia (lack of oxygen) rather than the fluid introduced into the airways. Timely and generous delivery of oxygen through mouth-to-mouth resuscitation is crucial. Respiratory failure often precedes cardiac arrest during drowning, emphasizing the importance of prompt artificial respiration. Revival should commence after bringing the person to a solid surface, considering specific challenges such as water expulsion and decreased lung elasticity. Cardiac function detection may be challenging, and rescuers should persist with resuscitation for at least 60 minutes. Cooling of the drowned person requires careful heating to raise internal body temperature. Unlike other cases, the established limit of apparent death does not apply to drowning, with successful resuscitation reported even after prolonged periods in cold water.

Dehydration and malnutrition

Survivors adrift on rafts or lifeboats at sea for extended periods may face dehydration and malnutrition. Quick solutions are not viable. For rehydration, survivors can be given oral rehydration salt solution or sweetened non-alcoholic beverages to encourage initial urine production. In warm weather, larger fluid amounts may be permitted. If fasting is prolonged, avoid solids for the first two days, providing nutritious fluids like soup, sugary drinks, and milk. Gradually reintroduce a mushy and normal diet. Seek radiotherapist advice, aiming to transfer the survivor to a hospital promptly.

Prevention of drowning

Depressed individuals on board require constant surveillance due to the risk of suicide by drowning. These individuals may neglect personal safety, increasing their vulnerability even without suicidal intent. Alcohol consumption impairs motor skills, coordination, and accelerates heat loss. Drunk or hungover individuals are prone to falling or intentionally jumping into the sea, especially at night. Swimming under the influence of alcohol or drugs is highly perilous, necessitating restrictions on individuals under their influence from swimming or entering the water for “refreshment.”

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