Yachting holidays are always a unique experience, but how do you deal with the more unpleasant moments and how do you administer first aid?
The captain often has to administer first aid as it’s a long way to port and medical aid, so it’s good to be prepared. In the first part of our series we dealt with on-board illnesses and their treatment. Today we’re focusing on accidents and injuries.
We’ve prepared tips and advice on how to deal with them effectively, as well as several principles which are worth following. First aid on a yacht is then easier to manage.
What kind of injuries do we come across most often on a boat and how do we deal with them?
Injuries caused by marine wildlife
Most injuries are caused by carelessness or ignorance. It is reassuring to know that no sea creature considers humans as natural prey, so they typically will not attack unless they feels threatened.
Wounds caused by sea urchins are probably the most common example of these injuries. Luckily they are also the least serious. So how do we deal with these injuries and what other dangers are lurking beneath the waves?
Injuries are caused by spines or jellyfish tentacles, which are covered in small spines and stinging cells (nematocysts) which release venom. Contact with lionfish, scorpionfish or stonefish can cause more serious injuries which require rapid treatment from a doctor and can cause permanent complications.
In more exotic countries you can come across the most venomous species of jellyfish or cone snails, which can result in death or long-term issues.
Contact can cause itching, intense burning, pins and needles, sometimes pain, rash or swelling. It can also cause nausea, vomiting, fatigue and malaise. Coming into contact with the most poisonous types can result in a very serious reaction and ultimately lead to paralysis of the central nervous system - extreme pain, breathing problems, difficulty swallowing, including the possibility of respiratory arrest and unconsciousness.
First aid for stings and injuries from spines
It’s important to prevent the further spread of toxins, which have entered the body. You can try and use an implement such as a razor or credit card. Parts of the creature (tentacles, spines etc) can be removed with tweezers. Rinse the affected area with sea water or alcohol solution.
Toxin is made of protein and it’s necessary to disrupt and denature it so it can no longer fulfil its function and stop it from poisoning the affected area. A hot water rinse helps. As hot as the injured person can handle (be careful to avoid scalding), an acidic rinse, with vinegar for example, or heating it with a hairdryer. You can administer analgesics, antihistamines such as a topical cream like Benadryl and disinfectant.
Beware of freshwater. If you use it, it may cause the toxin to release further.
In the event of a serious and sudden reaction with the possibility of respiratory arrest, it’s imperative to administer cardiopulmonary resuscitation and get the casualty to a doctor as soon as possible.
Prevent unwanted contact by wearing thin Neoprene or Lycra t-shirts and snorkelling suits. The best prevention is to never touch marine wildlife and just admire it in its natural habitat from a safe distance.
Being careful pays off - some species of venomous creatures are skilled camouflagers and have an uncanny ability to blend in with their surroundings. For example, a stonefish looks just like the rock it’s resting on, which is where it gets its name from.
Fish or marine animal bites
As we’ve mentioned already, no marine creature will attack unprovoked. You can set yourself up for a bite if you disturb their territory or you try to provoke a fish by handling it or tugging it, etc.
First aid for fish bites
Injuries are treated in the usual way – cleaning, disinfecting and dressing the wound.
Minor accidents and injuries
Snorkelling injuries (retracted or perforated eardrum, etc.)
When snorkelling or diving to the anchor your eardrums may become retracted or damaged if you don’t equalise pressure in time. If the eardrum ruptures, it may cause dizziness or even vomiting, which is very dangerous underwater. Damage can then result in constant tinnitus or even hearing loss.
Always equalise in time, even if it hurts. The simplest and most common method is the Valsalva manoeuvre (pinch your nose and gently exhale through it). It’s often enough to just swallow or move the jaw from side to side.
Minor injuries, abrasions and wounds
There is no shortage of minor injuries and abrasions on board a boat. With minor abrasions it’s good to prevent constant contact with seawater and further mechanical damage, which is hard to avoid entirely when sailing. Otherwise the wound does not heal as well and inflammation or ‘encapsulation’ can occur.
First aid for minor injuries
It is advisable to disinfect the area (Betadine, iodine solution, hydrogen peroxide H2O2), or cover with a bandage or plaster. In certain parts of Europe you can buy a green solution called Novikov, which creates a waterproof film and is a very effective antiseptic treatment.
Head injuries are amongst the most serious injuries and usually require medical assistance. How can you spot them?
Concussion can cause confusion, memory loss, nausea or vomiting, brief loss of consciousness and headache. More serious injuries can make a person sleepy and lose consciousness. A skull fracture can result in cerebrospinal fluid leaking from the ear or nose.
First aid for head injuries
There’s not much a first aider can do except get the injured person expert medical help as quickly as possible. In the case of mild concussion, reclining in a semi-recumbent position in the shade or and administer painkillers if needed. The recovery position should be used for more serious injuries. Head injuries can result in damage to the cervical spine, so proceed carefully when giving assistance.
Spinal injuries from jumping into water
Falls on the boat, violent impact or an ill-judged jump into water can lead to serious spinal injuries. Damage to the first five vertebrae can even cause cessation of breathing.
First aid for spinal injuries
If spinal injury looks likely, don’t move the injured person and wait for help. If you need to move them, try and do it as sparingly as possible and with enough people to help you. Lay the casualty on a firm mat and stabilise sufficiently. Make sure the injured person doesn’t get too hot or cold (even if it doesn’t seem like it, the body can lose heat very quickly).
If the patient is not breathing, start resuscitation with the patient on their back as in this instance securing vital functions takes precedence.
A fracture or dislocation may be the result of a fall or slipping over on the boat. Apart from standard fractures, more serious compound fractures or complex fractures of the jaw or pelvis may occur.
Fractures may cause pain, bruising, distinct changes in the shape of the limbs and unnatural range of movement. Complex or compound fractures can be accompanied by vascular damage and bleeding. Injury to the pelvis especially can be serious as it may result in extensive blood loss.
First aid for fractures
The priority is always to splint the limb perfectly, as well as immobilise the two surrounding joints. With a compound fracture it’s also essential to treat and disinfect the wound. You can help the injured person find a comfortable position, administer pain relief and ice the limb if needed.
It doesn’t matter if the bleeding is from a vein or artery, but if the blood loss is massive the priority is to stop it. How best to staunch blood flow?
First aid for bleeding
- Stick fingers in the wound. The fastest and most basic technique to stop massive blood loss. Actually pressing on the vein is most effective. It’s even better if the injured person can hold the wound, leaving your hands free to help with other things.
- A pressure bandage ideally over the wound. How do you make a pressure bandage? Take a whole roll of bandage and place it directly on the wound to make a pressure layer. Then unroll a second bandage and wrap it firmly around the wound, criss-crossing tightly over the first bandage to hold it in place. It’s essential to cover the first bandage completely. If blood is still seeping through, add another layer of bandage in the same way. If blood soaks through, don’t remove the bottom layer as this could reopen the wound, but just keep replacing the outer layers.
- If blood is soaking through 2 layers of pressure bandages, it’s time to use a tourniquet. This is definitely a last resort, though! Tourniqueting limbs is advisable only in extreme trauma cases and it’s not a long-term solution as you risk losing the part of the limb that has its blood supply cut off.
- In the case of massive blood loss, put the casualty in the ‘shock position’ and elevate the extremities. The affected limb should be raised as much as possible as this reduces the blood pressure in that part of the body.
The most important consideration is the safety of the rescuer. A drowning person can muster huge strength and pull the rescuer beneath the surface of the water. It sounds cruel, but if the drowning person is in shock and active, it’s a good idea to stay at a safe distance and wait.
Pull a passive drowning person to the shore or onto the boat and if they’re not breathing or not breathing normally, begin resuscitation. With drowning, it’s advisable to administer 5 rescue breaths. Every drowning casualty must be monitored, even when they feel better.
That’s due to so-called secondary drowning. This is a problem particularly associated with drowning in saltwater, which then ‘pulls’ water back into the lungs and can result in pulmonary swelling (oedema). That’s why every drowning episode should be assessed by a doctor.
Other accidents and injuries
Eye injuries, foreign body in the eye
It’s relatively easy for a foreign body to penetrate on a boat (staples, fragments...) causing chemical burns and mechanical injuries.
You can try and remove a foreign body from the eye using a corner of a handkerchief or tissue, but don’t persist if it doesn’t work as you run the risk of pushing the foreign body in deeper or damaging the cornea. Flushing the eye out can help (boric acid, topical antibiotic ointment at night) and covering the eye with a soft dressing.
With chemical burns, flush the eye out with running water for 20 minutes in such a way that the water drains over the smallest area possible and doesn’t contaminate other parts of the eye. In the case of serious injury, it’s essential that a doctor check the eye afterwards.
Be careful when doing repairs or handling flares. You can protect your eyes with clear safety glasses.
When judging the severity of a burn and deciding on a course of treatment, its depth (degree) and extent are the decisive factors.
Depending on the depth and impact on tissue we classify burns according to a three-grade scale:
1st degree: redness, pain
2nd degree: blistering
3rd degree: damage to deeper tissue and charring
The majority of burns continue to deepen and won’t reach their final form until around the third day.
Severity also depends on the extent of the burn. Life-threatening burns cover 10 to 15 % of an adult’s body and 3 to 5 % of a child’s. To give you an idea, 1 % is roughly equivalent to the palm and fingers of an injured person, while the whole arm is about 9 %.
First aid for burns
A burn retains a very high temperature, that’s why it’s good to cool it immediately to prevent the residual heat deepening the burn.
Minor burns can be treated with panthenol, deeper ones should be disinfected and covered with sterile dressing. You can administer analgesics. Don’t burst blisters and if clothing has been burnt onto the skin, don’t try and pull it off.
How to administer cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) may need to be initiated in more serious cases. Always begin CPR if the casualty is not breathing or not breathing normally (for example, gasping, wheezing, irregular breathing).
How do you deal with breathing issues? Lay the casualty on their back and tilt their head back. This is best achieved by pushing on the forehead and ‘lifting’ the chin. That’s how you ensure the airway is open . Never put anything under the head. This is the best way to check whether the casualty is breathing normally or whether it’s necessary to begin CPR. If they’re not breathing normally, begin CPR:
- Chest compressions should be carried out on the centre of the chest (midway between the nipples, at the base of the ribs). Uncover the chest, so it’s easier to find the correct place.
- Ideally, you should do chest compressions on an adult to a depth of around 5 cm and never more than 6 cm.
- You should maintain a speed of 100 to 120 compressions a minute (if you’re not sure, you should aim for two compressions per second).
- Don’t stop and don’t take breaks, take turns (CPR is tiring).
A trained and experienced first aider will administer 2 rescue breaths after 30 chest compressions (15 chest compressions for children), but if you are inexperienced focus only on the chest compressions and leave out the breathing.
Heart massage can save lives and anyone can do it, but you’ll feel better if you get to practice beforehand on a course or lecture.
Principles of first aid - not just for boats!
The safety of the rescuer and others is always paramount. Firstly, asses risk for the rescuer and for the safety of the boat. When administering first aid it helps to remember a few basic principles:
- Don’t panic, keep yourself and others calm, only then can you offer the casualty real assistance.
- First make sure the boat is secured - put someone in charge of the boat and surroundings and only then deal with the casualty.
- Calm the casualty, try and prevent them getting stressed.
- Always choose a simple and effective course of action.
- Have a well-equipped medical kit on board, which the whole crew knows about.
- Take a first aid course, ideally one where you participate and which will then make first aid a breeze.
- In the event of a serious accident, decide on a course of action as quickly as possible. Do not delay in cancelling the charter or calling for help if need be.
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