Challenge: Medical Treatment at Sea

[Slinger]

I would consult my onboard medical book, which would hopefully give me enough information to determine the seriousness of the injury and what to look for to indicated it was getting worse (or better). I would then consult with Chris (odd nobody else has mentioned this), explain that I wasn't a doctor, explain as best I could what the medical book indicated, and explain our various options: return to Cape Town, press on, call for help (which of course you would be able to do — who would go cruising without at least an SSB?) or divert to the closest port possible. I'm thinking if Chris is a regular guy, he will downplay the injury and defer to the skipper. As a sailor, he would also understand that the prospect of returning to Cape Town could be more dangerous than continuing on to Oz. I would then tell him that, considering that his injury does not look life-threatening, my decision would be to press on and to monitor his situation closely for several days, during which time he's out of the watch system and all duties except bedrest. I would impress upon him my concern for his well being, and tell him that if his condition worsened in any way, either outwardly or according to the med book — even if he said he 'felt okay' — I will not hesitate to call for help and alter course or heave to to expedite a rendevous with a ship or helicopter.
If his decision at this meeting was that he felt his injury was serious and he needed medical attention ASAP, I would request that from any party I could reach by SSB, Satphone or, if all else failed, EPIRB.

[Pblais]

Head trauma is a very serious issue, especially in a remote setting.

John Rousmaniere recalls a story where he was aboard with a group of sailors. A crew member was struck to the head in an accidental gybe. He was dead when he hit the deck. The rest of the crew were all surgeons. If you read much by John you'll get a sense he has a passion for gybe preventers. That would be the reason. It's worth sharing since it's not a hypothetical. To have gone through that and not feel otherwise would be more unbelievable. It is something all boats could prevent if they tried. Stuff really happens but not all of it has to.

[Slinger]

Years ago I was racing on a boat and the traveler let go just as our bow guy was coming back aft on the leeward side. The boom hit him square in the face. The impact sent him flying into the lifelines, which caught under his knees. He managed to grab them also and hold on until we dragged him back inboard. It was pretty obvious from the gushing blood that he had (at the least) broken his nose. We stopped racing and returned to the club (which was close). Although he looked pretty bad in the days following — two shiners and a nose brace thing — he was okay and recovered fully. However, the incident always stayed with me as it was horrifying to witness and the outcome could have been much worse. We didn't wear lifejackets in those days and I've always wondered what would have happened if he'd gone overboard. Was he too dazed to tread water until we returned? Anyway, so I guess because of that (and a couple other head bangers on other boats) I've always been interested in reading or hearing about what other people have done when head injuries occur. All these incidents deserve serious attention and healthy respect.

[donw_s11]

Okay, several people have brought up preventers here. That was my first thought when I read the very first post--Why did an accidental gybe result in a head injury??

It's a little too late when you've got the dead body of your crew laying on the cabin sole to decide that a preventer would have been a good idea.

Several MD's have already responded to the treatment of the head injury, so there is not much to add there.

The scenario does point out the importance of long distance communication capability to help you deal with the unexpected situation with which you are unfamiliar and need expert advice. Communicating early will also help you deal with the aftermath of arriving in port with either a dead body, or a missing crewperson. It is also possible that an air evac could be made even 800 to 1200 miles offshore if the authorities have air refueling capability.

Got to go, but I'll add my thoughts on dealing with the body later.

Don W.

[Tempest245]

ok, I'll make irish coffee ....

[Pblais]

Irish coffee and a body to be named later works. The head injury was preventable, but there is the issue of advanced first aid treatment. Unless you care to invest in a full medical education you ned to cosider what you can prepare for and that includes the entire crew. Suppose you invest in all the training and you take one in the head. Out in the middle of no where you have what you have and know. You could have known more.

[Therapy]

Originally Posted by Pblais

Irish coffee and a body to be named later works. The head injury was preventable, but there is the issue of advanced first aid treatment. Unless you care to invest in a full medical education you ned to cosider what you can prepare for and that includes the entire crew. Suppose you invest in all the training and you take one in the head. Out in the middle of no where you have what you have and know. You could have known more.

Investing in a full medical education will not help much.
Things are too specialized now.
Basic first aid with a reference book is all that is needed.
If you want to go whole hog take an EMT course, but then that education is geared toward stabilization for transport.

[donw_s11]

Okay, this is a tough one.

No matter what you do it is probably going to be second guessed as wrong by the authorities and family of the deceased. The less you communicate, the more trouble you are going to be in. For example, doing a burial at sea without consultation could be construed as destroying evidence of a murder. It is after all just you and your spouses version of how they came to be dead, and no body for an autopsy. Of course, there is no evidence of foul play either, but expect that the authorities are going to separate you and the missus, and give both of you a really good (possibly harsh) separate interrogation to try to get at the truth. What if your wife was asleep when the crewmember got hit by the boom, and you are really the only person who knows for sure what happened. The crew never remembered getting hit, your wife was asleep, you just assume that they got hit by the boom. Are you for sure that your testimony and that of your spouse is going to come off as credible? Remember, that in addition to the police interrogation, there is probably going to be a formal inquest as well. You may possibly be remanded into custody and forced to fly back to the home country to testify in a coroner's inquest depending on the laws of the home country.

Not having the body is going to make everything a little less cut and dried. It is also going to possibly raise suspicions in the surviving family members which may lead to a civil lawsuit for wrongful death. Ugh!

Well, that leads to another scenario which is that you try to keep the body until landfall. If you have a freezer and can make ice, that may not be too bad. Otherwise.... ugh! Use multiple plastic garbage bags to make a makeshift body bag. Seal the seams of the garbage bags with tape to try to make them airtight. Wrap the plastic enclosed body up in a blanket or sleeping bag, and put them in a cabin that can be closed off, with a plastic sheet or garbage bags under them. None of your options here are pleasant, but at least you will have a body to present for autopsy, and corroboration of your story.

If you have long range communications, try to arrange a rendezvous with a freighter that has a freezer that the body can be stored in. This is your best option. The body is preserved for autopsy, and you do not have to deal with it on your small boat. You still may have to face a lawsuit from the crew's family, but at least there is some evidence on your side.

I feel for anyone that finds themselves in this situation. And to think a simple preventer could have prevented _all_ of this...


Don W.

[Tempest245]

Don,

excellent analysis.....a good argument for having long distance communications too.

[Christian Van H]

Hey Docs, would the administration of Ibuprofen (Advil), or some other anti-inflammatory drug be of any benefit here? After taking in the early symptoms, and seeing no immediate threat...

[Wotname]

Nicely summarized Don although I am not sure if the average freighter would be willing to take the body on board and watch his "only" live evidence sail away. He might be willing to take the body along with all the crew and yacht's log etc.

Would I abandon ship in this instance, not likey especially as I would then be committed to going to whatever port the freighter was bound for.

A cruise ship would be better and they would be more accustomed to dealing with these matters; but not likely to find many cruise ships in that part of the oceans .

[NW Craig]

Don W,

be careful with the body in the plastic bag.

depending on the heat and number of days, there's going to be some gas building up in there and I bet it's not going to be pretty when that bag blows!

craig

[Wotname]

Depending on the time of the year but we should assume the southern summer, I expect the temps. to be in the low teens (C) and the time to be say 3 weeks.

Anyone know what would happen to a body in those conditions?

[Sparohok]

Do what they did with Nelson on the HMS Victory -- put the body in a cask of brandy till you make port.

What, you don't have enough brandy? Sounds like time to rethink that emergency medical kit.

Martin

[Wotname]

Not sure if I could use the brandy like that unless it still works after a single pass through a live body