Sailing Safety Website

[Foswick]

I'm an EMT, sailing instructor, wilderness medic, and former ER technician, and I am passionate about sailing safety topics. One thing I've noticed is the lack of a single reliable source of information about related topics. Most information is available, but you have to find it piecemeal and be able to discern good advice from bad.

In particular, there is very little available about emergency medicine for offshore sailing. Most widely-available first aid information is pretty useless in this context because it mostly written with the assumption that assistance is just a few minutes away. Your typical first aid guide won't, for example, tell you how to reduce a dislocated shoulder or suture a wound in a sterile field. These are things that you might really need.

Aside from shock, heat injuries, and cold injuries, most first aid information sources don't offer much that really matters. (Yet, they almost always include CPR ... which is very unlikely to make any difference. I've performed CPR over 100 times, and it has never saved a life, nor do I know anyone who has saved a life with CPR except when more aggressive interventions were forthcoming.)

I think that the assumption is that a) 911 is just a few minutes away, and b) most advanced interventions require training to do correctly without risk of additional harm.

The latter point is fair enough, but it kind of depends on the former point. If you are days from any kind of help, and even that is uncertain, and someone has a traumatic pneumothorax, you're a whole lot better off with a little bit of information/training than none at all. That axiom holds true in most aspects of remote medicine. Brain surgery is a notable exception.

There is a good source of info for remote medicine: The International Medical Guide for Ships.

OK ... that's my rant.

My question is, does anyone know of a good web resource for all/most things related to sailing safety and medicine? If not, I might just make one.

[Iron E]

Originally Posted by Foswick

I'm an EMT, sailing instructor, wilderness medic, and former ER technician, and I am passionate about sailing safety topics. One thing I've noticed is the lack of a single reliable source of information about related topics. Most information is available, but you have to find it piecemeal and be able to discern good advice from bad.

In particular, there is very little available about emergency medicine for offshore sailing. Most widely-available first aid information is pretty useless in this context because it mostly written with the assumption that assistance is just a few minutes away. Your typical first aid guide won't, for example, tell you how to reduce a dislocated shoulder or suture a wound in a sterile field. These are things that you might really need.

Aside from shock, heat injuries, and cold injuries, most first aid information sources don't offer much that really matters. (Yet, they almost always include CPR ... which is very unlikely to make any difference. I've performed CPR over 100 times, and it has never saved a life, nor do I know anyone who has saved a life with CPR except when more aggressive interventions were forthcoming.)

I think that the assumption is that a) 911 is just a few minutes away, and b) most advanced interventions require training to do correctly without risk of additional harm.

The latter point is fair enough, but it kind of depends on the former point. If you are days from any kind of help, and even that is uncertain, and someone has a traumatic pneumothorax, you're a whole lot better off with a little bit of information/training than none at all. That axiom holds true in most aspects of remote medicine. Brain surgery is a notable exception.

There is a good source of info for remote medicine: The International Medical Guide for Ships.

OK ... that's my rant.

My question is, does anyone know of a good web resource for all/most things related to sailing safety and medicine? If not, I might just make one.

Your wilderness medic training should cover most everything. Also:
HERE

Yeah, I'm familiar with CPR (un)success. Still, whenever I'm doing CPR I have the "You're gonna make it da**it!" attitude

[Foswick]

Originally Posted by Iron E

Still, whenever I'm doing CPR I have the "You're gonna make it da**it!" attitude

The common CPR advice is to perform until advanced care arrives or you can no longer perform. Unfortunately, in a remote setting, you have to know when to quit to avoid dangerously exhausting crew.

In truth, that is a complicated decision having to do with the cause of the cardiac arrest (if known), core temperature of the patient (colder is better), conditions at sea, and the state of the crew. I'm not even sure I would be comfortable offering guidelines for how much time is enough time, but I would say that it is important to know when to quit.

Even setting aside physical exhaustion, crew needs to know that CPR itself is unlikely to save a life when advanced care is more than a few minutes away. So, they need to be able stop without guilt that they did not try hard enough.

I want to be careful here, though. I am not saying that people shouldn't bother. Not at all. The current recommendation is for chest compressions only (no breaths), so even with absolutely no practice whatsoever, you can cause blood to circulate a bit and improve the patient's chances. It's just important to recognize that if their heart stops and advanced care isn't imminent, you are only shifting dire odds to slightly less dire, but still dire.

Not to get bogged down in CPR specifically, though ...

I am interested in finding or creating a one-stop resource that includes not only medical emergencies, but also topics such as MOB, emergency repairs, communications/signaling, equipment, supplies, etc.

I've just noticed that cruisers are kind of left to piece this information together from a variety of sources, and a lot of that information isn't great. When I talk to folks, they are all interested in being better prepared, but tend to get a little overwhelmed at the landscape of information/misinformation out there.

[5BTM]

Took it from one of the ships I worked on, when she was sold.

1967 edition.

[river]

Ship Captain's Medical Guide, and the STCW First Aid / Medical courses are probably the best thing.

[Foswick]

Yeah ... Ship's Captain Medical Guide is what I was thinking of. I misspoke when I said, "International Medical Guide for Ships".

[skipperpete]

The problem with the ships captains medical guide is assembling the medical kit, some of the stuff is expensive or has a limited shelf life. I have no medical training other than the advanced first aid certificate required for my licences but my personally owned medical kit for cruising has always been extensive including a set of inflatable splints, ampoules of xylocaine, tools to remove imbedded fish hooks and a course of oral antibiotics as well as the usual array of sterile dressings and bandages. I actually used one of the inflatable splints with great success on my youngest son, he broke his leg while in the whitsundays on the day he was to fly out to Melbourne and wore it all the way to the hospital…. In Melbourne!
Recently I was confronted with the cardiac compression/ resuscitation dilemma in a coffee shop when a nearby customer laid face first on the table near me, to my relief , another customer leapt into action with his CPR skills but to no avail, it was a suspected stroke…. He had died very rapidly……..But I actually had to think long and hard about applying my limited knowledge.

[grantmc]

With the relatively inexpensive cost of an Automated External Defibrillators (AED), wondering how many have one installed in their boat? Or are contemplating.

Obviously there are all manner of safety devices and gear we can buy, and most of it we at least hope is never used, but should an AED be on the list? It strikes me that perhaps it should, particularly if there are crew with a known cardiac issues.

And please I emphasise relatively inexpensive (compared to their cost say 10 years ago), so please don't hate on me for that statement.

[Foswick]

Originally Posted by skipperpete

The problem with the ships captains medical guide is assembling the medical kit, some of the stuff is expensive or has a limited shelf life.

Yeah, that's part of why I'm thinking of putting together this resource. You can actually get a lot of mileage out of a limited number of items, so long as you know what is worth spending money/space on, and what isn't really. For example, you can get a lot of mileage out of a pulse oximeter, stethoscope, and BP cuff, if you know how to use them to "troubleshoot". An AED would be very low on my list because of the narrowness of their efficacy, upkeep, and risks in a marine environment.

But ... this is the kind of thing that cruisers need to dig around, take courses, etc. to figure out and make educated decisions. I think there is room for improvement in how this information is distilled and presented to cruisers so that they can get good and practical advice that falls somewhere between how to remove a splinter and how to perform a triple bypass.

Really, I find a lot of people who want to do the "right" thing, but they aren't really sure what that is. I think there could be resources that says, "Hey, if you do x, y, and z, you've done your due diligence." If you really do your research, there is no end to what you could do.

But it's like this: Most people would consider it reasonable to carry a backup tiller, but not a backup mast. Both can fail and ruin your day, but at some point, you just accept certain risks because their likelihood is low compared to the burden of preparedness.

[Foswick]

Originally Posted by grantmc

should an AED be on the list?

I'm pretty much in the no-AED camp, but I wouldn't tell anyone NOT to carry one because, yes, in a narrow set of circumstances, they could save a life. It is just that I can think of dozens of other things I would rather do with that money and space that are MUCH more likely to improve outcomes.

It is important to understand that AEDs actually don't do very much. They will diagnose whether the patient is actually asystolic (no heart beat). This is useful because when things get crazy, it is easy to misdiagnose asystole and presume that a person's heart has stopped when it actually hasn't. This is exacerbated with hypothermia which can look a lot like death. (The saying is, "You're not dead until you're warm and dead.")

So, they are useful for that, which is no small thing, but also something that can almost be replaced (but not quite) with a little training to detect a faint, slow, or irregular pulse.

Also, they will diagnose v-tach and v-fib (VT and VF, which are only two kinds of irregular heart rhythms). They will not restart a stopped heart or treat any other irregular rhythm and will not treat a myocardial infarction (heart attack) unless it leads to one of those two rhythms.

In reality, if you attach an AED to an unresponsive patient, the chances are that it will not administer any shock whatsover because it will not detect VT or VF because something else is going on with the patient. This is what makes them a great frontline tool - it is pretty hard to misuse them. They are smart enough to only administer a shock if doing so would do any good.

And, granted, there is a long list of things that can happen on a boat that will put anotherwise healthy person into VF. So, it CAN be useful. If VT or VF occurs, it can resolve on its own, and frequently does. But ... if it occurs and would not otherwise resolve on its own, for every minute that passes, the chances of survival drops about 10%. To put this into perspective, the patient's odds already aren't great (well under 50% under normal conditions), not considering the original cause of the VT or VF, which may ultimately be fatal anyway.

Sorry to be grim, but that's the reality of it. Without getting into challenges of using an AED in a wet environment, in short, an AED is an excellent tool that slightly improves the odds of a better outcome in a relatively narrow set of circumstances. But, in those circumstances, there is really no suitable substitute for an AED.

In other words the chances of it being useful are exceedingly low, but the benefit of having it if you need it is exceedingly high.

In contrast, consider a sat phone and/or SSB. They will not help you with a VT/VF emergency ... not really ... but they do have a high likelihood of improving outcomes in a wide range of life threatening situations.

So, if money and space are no object, by all means, carry an AED. I just think about how I could instead spend that money on electrical or instrument redundancies, improved communications, a better life raft, etc ... any number of ways that I can think to make things safer and facilitate better emergency outcomes.

To be clear, I'm not anti-AED or advising anyone not to carry one. They are fantastic life-saving tools, for their purpose. I'm just providing my reasoning for why I am unlikely to ever do so.

[HankOnthewater]

You are right Foswick, every skipper does the best he/she can, but there is no formal repository of knowledge and common sense, that I know.
And even if there was, there might be confusion ie the opinion about AED is varied, ie to carry one on board or not. So, who makes the final decision in such repository, what is right, what could be right, and could be wrong and what is wrong?
And then there is information put together by professionals, who then assume advanced nursing, paramedical or medical skills. Such information is not really helpful either for the lay person.
And as was said, many items have an expiry date. quite expensive to update all that, just think of batteries in AED..... $$$.

But, happy to contribute.
But let us concentrate on the medical stuff first, as websites on other safety issues are abundant.
I am a nurse working in hospitals, mostly in management, often the lead for medical emergencies, I work at times clinically in remote nursing posts without a doctor, I work on events, often remote, for up to 500 people, for many weeks at a time, for first aid and medical issues. Hehehe, and in between all that, sail my boat or other people's

[Foswick]

Yeah, it is pretty hard to put out a single source of truth about most topics. But, I think about things like lists of backcountry essentials, i.e. "If you go into the backcountry, make sure you have these 10 essentials." No one I know carries all 10 items and nothing else, but it does give you a good "checklist" to know you are mostly covering the basics.

I think it should be possible to say, "If you go on the water, here is a basic list of equipment, supplies, and skills. If you go offshore, additionally carry these other items and train on these other skills. If you have more than two people, consider these things. Etc..."

And, for big-ticket items (like an AED), "Here are the pros and cons ... you decide."

I sailed a bit with a friend of mine who was also an ER doctor where I worked. We were sort of laughing at how, in the ER, we were able to perform miracles, but out on a friend's boat (with only a basic first-aid kit), there really wasn't very much we could do, despite our training. I'm surprised at how many offshore kits lack even a blood pressure cuff. There is a TON you can learn about a patient's condition with a BP cuff, and it is cheap and simple.

I think the real issue is that people don't know how to use these basic tools the way an emergency medical provider would - and it really isn't very difficult. I always tell people that if you can diagnose why an engine won't start, you can diagnose most emergency patient conditions. If it goes beyond fairly simple mechanics, there isn't much to do about it in an emergency situation anyway.