Reality Check - Fractures Offshore

[ActiveCaptain]

Time spent on injury prevention is time well spent. But slipping, trauma, etc. are called accidents because they happen accidentally. Show me someone who can prevent all possible accidents on his boat and I'll show you someone who isn't on a boat.

I disagree about first aid and the care it provides. It saves lives. I've saved more than my share. Being a Red Cross instructor implies to me that you're a CPR instructor. While it's true that CPR revives only 2% of victims (as opposed to about 80% on TV), controlling bleeding, assisting with respiratory problems, and identifying and treating heat stroke -- all common possibilities on boats -- has a huge success rate. But only if you know how to do it fast.

Communications is really important. But being on a boat in a remote location doesn't allow any time for most professionals to get there. It's up to you.

I think it's a seriously bad idea to look unfavorably at first aid, wilderness medicine, or even and EMT course. Those things will give you the immediate know-how of what to do when an emergency strikes no matter how much you hoped to avoid it.

[eyschulman]

The communication link is important and would be more useful if the boat is well stocked with emergency medical aids such as strong pain meds-antibiotics- inflatable splint for extemities and large bandage materials. even with a physician aboard the things that can be done on a boat by a MD. alone are somewhat limited. I did a short tour in north atlantic as ships surgeon back in 60s and while I was able to put a splint on a non displaced Fx in a hurrican anything more complex like a compound fx would be hard to treat on a smaller boat(I had a sick bay and coorman)-I think there are some risks that come with the territory and getting sick or injured on a small boat out in the middle of an ocean is one of those inherent risks not much different than falling overboard. You do what you can to lessen risk but it's still there.

[Joli]

I've seen all sorts of mishaps on board but we've thankfully never been the recipienent of any serious one. Worse one was a crushed leg when the barging fleet was taken out by us, one unlucky sailor failed to get his leg out, his bones punctured the skin. The other bad one was a head wound on a J120 that was laid open in a jibe, funny it was the helmsman. We were dircetly behind when it happend, the guy was airlifted but I never heard what happened to him. One of our less experienced crew member decided we were of less then sound mind when racing and left the boat that day never to return as a racing crew. We won the regatta but he did not appreciate or understand setting the kite at the weather mark with breezes in the low 30's.

With or current boat we are extremely cautious, sheet loads are 16,000 pounds when the breeze is up, sails outweigh the crew and we have standing rules "no standing in the triangle of death, no hands resting on sheets or runners, and NO FENDING OFF". We work hard to be safe but still mistakes happen. We were sailing, my wife son and I, broad reaching with a kite. My wife was driving, my son was lounging and I was trimming in maybe 12 knots and maybe making 10. I asked my son to remove a wrap and instead of wrapping the drum and removing one wrap he flicked it. All the parts of the sheet jumped up and off the drum, knocking me down when I was standing forward of the shrouds, drug me 30 feet down the deck before I could get a wrap on something. I reminded him he wasn't on his 420.

Be careful out there.

[Stillraining]

Joli...what is the triangle of death?

[avril25]

I know you are talking about off shore events, but A long time friend recently passed away from a fractured scull/ head injury.
He was performing a some kind of flip off his boat and hit his head rather hard. was rushed to the hospital and sliped into a coma and later passaway. I saw a news clip on tv of a man rescued
from his disabled boat 300 miles off shore, he was wearing a helmet and at the time I wondered why was he wearing that helmet... This past summer I wacked my head when I went below
in not so rough seas. I have a hard head. Anyway my point is
be prepared for the worst, and Mr Murphy.

[Stillraining]

I had hopes Jessica Watson had a helmet on board as soon as I saw the configuration of her hard dodger...I later learned she indeed has one...
I wear my base ball cap reversed on board as I tend to hit my noggin on everything otherwise...a helmet would/will be required offshore gear on my boat.

[Hampus]

I fractured my right pinkie-toe (that's what it's called?) a couple of years ago. I know it's stupid but I just love the feel of the deck on my bare feet. I hit the toe on something when I scrambled from the cockpit to sort out the genoa. After that I had to walk barefoot. It hurt too much putting on the shoe.

Last year I came quite close a more serious accident, but luckily, it was only close. I was standing in the cockpit just after dawn and the admiral was downstairs getting her beautyslepp. I had promised her not to leave the cockpit without waking her and I thought she needed the sleep. I was however sooooo needing to wee-wee Looking around me I found a bottle that would just "fit". Fiddling with it I forgot about the steering wheel and out of the corner of my eye I saw the boom coming in an uncontrolled gybe. With just an inch to spare between the boom and my head I ducked and ended up smashing my forehead against the wheel Maybe should have been under "The sailors confessional"...

We no longer use the main downwind but rather the mizzen and double genoas. A safer and more comfortable configuration.

/Hampus

[SurferShane]

Working in personal injury litigation I saw more than a couple of boating cases. Most involved people negligently navigating powerboats causing passengers to fall or be thrown about. The most severe (and unfortunately not uncommon) were spinal crush style fractures.

I realise most people out there are not expecting to get sued and the post is more or less about offshore injuries you have caused to your own person. Regardless, the most bizarre case I witnessed was of the volunteer coastguard asking some old bloke on the dock to tie off their bow rope. The crew member threw him the rope and turned away. Neither the crewman nor the skipper admitted to be paying attention when the anchor on the bow was motored into the poor fellows head knocking him semi-unconscious into the water whereabouts he sustained a fracture to the leg when he was pinned against the wharf. The judge found in favour of the old bloke.

I note, I just bought a copy of the St John’s Ambulance first aid text to keep on board with my other emergency manuals, which covers all the common fractures. I missed a copy of a more complex emergency medicine manual from a local second hand bookstore and I would appreciate any recommendations of similarly useful texts for offshore cruising where immediate medical attention might not be practical/availible.

[rover88]

Originally Posted by bastonjock

How could you manage the pain?,its okay giving someone else diamorphine,but if you self inject then you would be incapacitated and unable to set the leg even if you had the nessesary medical knowledge.

When outfitting a boat for a long voyage, most family doctors will help you set up a medical kit and write prescriptions for emergency medications, including injectables, if they feel you are capable of administering them.

Pain control meds such as morphine have their place in your kit, but also dangerous side effects. "Narcan" reverses the affect of Morphine and should always be carried along with it (and made ready when morphine is administered). However, you can never self administer either.

"Toradol" (ketorolac tromethamine),is a potent NSAID (same class of drugs as Advil and Motrin) that controls pain without the side effects and is an option you can discuss with your doctor as part of an emergency medical kit.

This is not the place to list all recommended meds a well stocked first aid kit should have. However, any good doctor or nurse will sit down with you and advise on what emergency drugs your offshore kit should contain.

There are basic skills that augment first aid and can be learned by a layman. Administering IVs and injections are two that come to mind immediately.

[johnar]

About 2 years ago a friend and I was offshore about it pull in to the St Johns river so I got on deck to bring in the Spinnark while I was on deck pulling it in my friend let a sheet go and started the motor thinking it would help control the boat while I was on deck, what happen was a sheet got in the prop in turn the line had my fingers of my right hand, before it was all said and dune I was drug across the deck before he understood what happen, It took hours to make it to a hospital , while still on the boat I knew I had to limit the movement of my hand but my friend at the time could not control the boat himself. so I sent him below to find anything we could tape to my hand and fingers as a splint ( it did not look like a pro) but it really help with the pain and I was able to bring the ship in.

After this I decided to never sail or get myself into a spot where I could not handle/control myself even with injury. This was the second person I have sailed with that as it turned out they could not be counted on for help, the part that got me most I was sailing their boats not mine.

for any long trip I would love to take some medical training class and I have talk to my Doctor about a medical kit to have on board.

Sailing can be safe or it can hold alot of danger it all depends on the captain of the ship.


Dutch

[Livia]

Originally Posted by SurferShane

I would appreciate any recommendations of similarly useful texts for offshore cruising where immediate medical attention might not be practical/availible.

Funny coincidence because I was just writing about this issue this morning!

A free online copy of Where There Is No Doctor can be found here and Where There Is No Dentist here. On both of those pages you can either download individual chapters or the entire book at the bottom of the page.

[rover88]

Far better that the "Where There is No Doctor" (although that one is pretty good and free).

Amazon.com: Brady Emergency Care (9780835950732): Michael F. O'Keefe, Daniel Limmer, Harvey D. Grant, Robert H., Jr. Murray, J. David Bergeron: Books

Brady is the text used in most EMT courses. Easy to understand and full of good basic info. Also a good reference just to keep onboard.

[SurferShane]

@ Livia & Rover

Thanks for the advice – they are both exactly the type of texts/advice I need. Given the other complications that can occur with/due fractures, I suppose when you are out in the middle of the Pacific you need to know a lot more than basic first aid using a standard kit?

Anyway, I will have to have a read around the other threads to see if these issues are covered elsewhere.

[Ocean Girl]

Broke my toe on a beach in Mexico (the only rock for a mile, sticking slightly up out of the sand). My friend broke two of his ribs falling on a hatch board trying to get down below during an emergency. He ended up abandoning ship 6 hours later because of his inability to find and repair the leak. He watched her sink from his life raft (very very sad). He thinks, had he been able to dive overboard he could of found the leak and repaired it but with the broken ribs that was impossible.
While in Guatemala another cruiser broke his back in a cave we were exploring.

So during an emergency..keep calm, think before you act, be methodical, and above all protect yourself.
Erika