Challenge: Medical Treatment at Sea

[Wotname]

Originally Posted by Spammy

<snip>Sorry, this hypothetical incident is serious and could only be treated conservatively in the field until getting access to specialized medical care.

Exactly but specialized medical care is not quickly available in this challenge. Part of the challenge is deciding whether to spent time and divert to possible medivac via shipping lanes. How do we access the injury to warrant such action. What are dangers of that decision?

The injury is not immediately life threating but it could become so. Many people get a wack on the head from a boom and continue on - what are risks and how do we access them given the locale.

[AK_sailor]

I shouldn't have said "idiot sailor". Sorry, I didn't mean to insult anyone.

Originally Posted by MarkJ

The person ain't gunna get a Neurosurgeon or anyone else! Thats the point in this exercise. They are 4 days solid running South East of Capetown that puts them about 600 - 800 miles into the deep blue.

If someone gets injured half way between South Africa and Australia or between New Zealand and the Horn in the Southern Ocean then they are going to have to survive with just the people on board helping.

My point in this excercise is that in that situation, a person with a severe head injury is very likely going to die. It happens....sometimes people die and there is little we can do about it. With or without the Black and Decker.

On the other hand, sometimes they get lucky. The one time I've dealt with a serious head injury was not at sea, but while I was a Ski Patroler, at a small hill way out in the boonies. A young kid hit his head hard, was lapsing in an out of conciousness, was combative while concious, and was bleeding from the ears with a halo (not a good sign). We did what we could (backboard, oxygen, etc) and called a helicopter. The feedback that we got later from the hospital was that about the time he got there, he started to get better. The neurosurgeon later told us that the last few patients he'd seen with this kind of injury (basal scull fracture as I recall) had all died. This kid recovered, more or less on his own.

If an MD like Spammy doesn't think he can treat the injury in the field, even a well trained (EMT, WFR, and OEC) layperson such as myself would be foolish to attempt more, with or without HF radio or Sat phone. If you want to travel to remote places beyond easy reach of rescue (afloat or ashore), you take some risks. If I'm on the boat with you I will do what I can, but I'm not a brain surgeon, and I won't try to pretend I am.

[Wotname]

Originally Posted by AK_sailor

OK, I'll chime in here. Before going tangental on pregnant females, I'd like to make a few comments about the original scenario. Head trauma is a very serious issue, especially in a remote setting.

Agreed but how do we determine if it is serious head trauma? I see you have answered this below - thanks.

Originally Posted by AK_sailor

Wotname left out a key peice of information: When the original accident happened, did Chris loose conciousness, and if so, for how long (seconds? minutes? hours?)? And/or did she have any amnesia after the event.

Sorry but Wotname didn't leave out any critical info. Wotname is a pedantic kind of guy and if there was any initial loss of conciousness or amnesia, he would have told you. Only the smyptons mentioned in the OP were observed.

Originally Posted by AK_sailor

The first question to ask is did Chris sustain a significant traumatic brain injury? It would be quite rare for a bump on the noggin to cause a serious brain injury without causing at least some loss of conciousness, or amnesia. (Not impossible, but rare, and in a remote setting with limited resources we have to play the odds.)

So it is unlikely there was serious brain injury (but possible) and yes we play the odds due to limited options .

Originally Posted by AK_sailor

We are interested in early signs of increasing ICP. These would be chages in mental status, severe or increasingly severe headache, or severe vomiting. These are "Red Flag" signs of increased ICP.

OK, we have one sympton here but is that enough to warrant a very difficult possible (not certain) medivac in a couple of days time. I don't know but it is part of the challenge to come up with what we might (would) do. Besides a severe headache would be common after any wack on the head and it did go away.

Originally Posted by AK_sailor

Except maybe prayer to whatever deity you subscribe to.

Can't hurt, might help and it would make some feel better at least

Originally Posted by AK_sailor

Several people have mentioned looking for unequal or unreactive pupils. Unfortunately, these tend to be a late sign of increased ICP.

Thanks, this has added to my meager medical knowledge - even if only internet advice - no slur intended AK .

Originally Posted by AK_sailor

Don't give aspirin for a known or suspected head trauma.

Likewise

[Wotname]

Originally Posted by MarkJ

......If someone gets injured half way between South Africa and Australia or between New Zealand and the Horn in the Southern Ocean then they are going to have to survive with just the people on board helping....

And any pre-knowledge picked up on a CF challenge . Only half joking as I have already learnt a couple of things here and there on these challenges.

[David_Old_Jersey]

Originally Posted by Wotname

I have already learnt a couple of things here and there on these challenges.

Me too

And I think this was a very useful one, if for no other reason than reminding (informing?) folk that stuff that could be survivable ashore (in a 1st world country) won't always be onboard or abroad. It's a risk to be considered and chosen.

[Wotname]

OK, time moves on (although anyone is still free to comment on the earlier situation).

You are now midway between Africa and Australia and have moved south towards the great circle route mainly because Chris seems to be fully recovered and the sailing is tough but doable. You want to reach Fremantle as soon as possible (within normal safety margins) and the great circle is the fastest (due distance and wind). BTW, Chris is really not sure if she is pregant but thinks it is a distinct possibility given her last few weeks ashore.

You relieve Chris at midnight and she goes below to sleep. Your wife is also sleeping below and you are alone on deck. Due to the changing weather, you remain on deck until 0400 when you go below to wake your wife for her watch.

You find Chris on the cabin sole - dead. No apparent wounds or injury. All you know is she was OK 4 hours earlier.

What do you do?

[Tempest245]

Make Coffee

[Talbot]

Place body in the body bag that you thoughtfully included as an essential piece of kit.

Place in dinghy and stream astern (unless wind from astern). seek nearest merch to transfer body.

feel great sense of relief that you will no longer be threatened by a paternity case.

start checking on wife's life insurance and stand her in same position as Chris at game start.

[Therapy]

LOLOLOL

[nautical62]

If I were doing blue water passage making, I would have a satellite phone and would use it to get professional advice and professional evacuation/treatment if warranted.

[Talbot]

Originally Posted by nautical62

If I were doing blue water passage making, I would have a satellite phone and would use it to get professional advice and professional evacuation/treatment if warranted.

Tha a bit late when they have already died!

[David_Old_Jersey]

Skipping back a bit in the story - IMO would have been sensible to record the accident in the log book and the symptoms / concerns and plan.....and the fact that she seemed better - just in case things later went badly.......and as they have gone badly I would mention that in the log book as well.

Although I do not have a great deal of experiance dealing with dead bodies onboard boats, I would favour landing with (or without) one in a 1st world country. Preferably one speaking my own lingo for coping with the legal possibilities.

In the interim I would try and contact any passing ships to communicate the situation onshore (the authorities of the dead Crew and those of my intended destination). I might also shoot some video.

As my own boat does not have the refrigeration to cope with a body I would commit her to the deep in the morning rather than try and keep her onboard.....in accordance with whatever religion she subscribed to on a "best effort" basis. Also would pack her personal gear up ready for collection by the authorities.

[Spammy]

The initial challenge in this thread had initial blurring of vision which improved, leaving a severe headache. In that case I would opt for rest and careful observation until the person could get to a medical facility. The point was made that the Southern Ocean is too remote for this to be possible. I understand.....But I cannot think of an intervention that would be possible for a layperson on an ocean passage. I have actually had some field experience. On two occasions in the field (highway accidents), I rendered assistance to patients with severe head injuries. There was nothing I could do to improve the injury, but on one occasion, the patient had experienced a cardiorespiratory arrest (a very grave sign in a head injury). I assisted another person on the scene with CPR, then cleared the airway, and assisted breathing as a pulse and respirations resumed. The patient had fixed and dilated pupils, and was unresponsive to stimuli. I stayed until EMS arrived and assisted in stabilizing the patient for transport. There was nothing else I could have done in the situation. i considered the prognosis very poor for survival, even with rapid transport to a hospital. There are a number of miraculous "believe it or not" interventions that have worked once in an emergency, but these are anecdotes, and should not be considered as reliable solutions to severe emergencies.

[Spammy]

Originally Posted by Wotname

Exactly but specialized medical care is not quickly available in this challenge. Part of the challenge is deciding whether to spent time and divert to possible medivac via shipping lanes. How do we access the injury to warrant such action. What are dangers of that decision?

The injury is not immediately life threating but it could become so. Many people get a wack on the head from a boom and continue on - what are risks and how do we access them given the locale.

Sorry, Wotname, I did not directly answer your question. In a head injury, deteriorating mental status is always a bad sign and should be taken seriously. Confusion that is worsening, stupor, coma are all to be taken as signs that getting the patient to medical care is a first priority. Dilated and unreactive pupils or unequal pupils are of similar importance, and can be easily assessed without a lot of training. Bleeding from the ears or "raccoon eye" bruising around both eyes may be signs of a basilar skull fracture, as may drainage of watery fluid from the nose (spinal fluid). Initial clear mental status followed later by increasing confusion and/or stupor may suggest an evolving intracranial bleed. Hope this helps.

[Wotname]

Yes I think "make coffee" is about the best thing one could do initially.

I can't see transferring the body to a towed dinghy is going to work. Too hard, too dangerous and probably simply result in the loss of the dinghy (and body) sooner or later.

Can't see any merchant shipping being willing to take a body on board from strange yacht - why would they want to get involved - there is no life in danger.

Burial at sea - well it is technically possible and probably legal but what a fuss when you finally get to port. As DOJ observes, make for a 1st world country.

Keeping the body on board doesn't seem to be an option either being as you will have it for a week or two in this part of the world.

I can only think of making contact (via HF / Satphone / patched VHF via merchant ship) with some land based authority to get advice. Let someone else make the decision . Log everything, take as many photos as (if) possible and remain aware that the first priority is the safety of the vessel and remaining crew (the Admiral in this instance).

It would be really hard to explain the loss of all your crew (wife and other woman - possibly pregnant) .

FWIW, I did have a friend who died in similar circumstances (but not on a boat). He was hit on the head with a bit of roofing timber on a Sunday afternoon. He drove 100 miles home and went to work on Monday. He seemed to be perfectly OK. On the following Friday afternoon, he went home and collapsed in his garage. His girlfriend found him dead about 10 minutes later. He was about 40 at the time, the shock was profound to all who knew him.

While this challenge is unlikely to occur to most cruisers, the possibility of someone dying on board (heart attack, food poisoning etc) is always with us.

What would you do?