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post #70 of Old 01-14-2007
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I've been involved in emergency medicine for 15 years, first as an EMT, then paramedic, and now as an ER physician. If I ever have to take care of a seriously injured shipmate, it's not likely to be my advanced training or fancy procedures that'll make the difference. The most important factors that will contribute to a good outcome, in my opinion, are likely to be knowing the basics of medical care and being prepared. These are two goals that any interested non-medical person can meet.

Being prepared is essential and it boils down to what was said in previous posts above ie knowing where your equipment is, having it available, anticipating problems, etc. It's a very important point, but I won't belabor that point further as it was said so well above...

As for the issue of medical knowledge; Basic trauma care really boils down to very simple stuff. I'm often saddened by cases that come into the ER which end tragically, when simple maneuvers by bystanders or loved ones at the time of injury would have potentially saved life or limb. Many of these maneuvers are things that even a child can learn. Know basic CPR: be able to recognize when someone's airway isn't open, know how to keep it open for them or do rescue breathing. Know basic first aid: eg nearly all limb bleeding, even in cases of amputation or other massive injury, can be controlled effectively with firm direct pressure (as stated above, no tourniquets or fancy techniques needed). Know how to recognize and treat heat emergencies (cool them off) or cold emergencies (warm them up). Know basic spinal protection and limb splinting techniques (doesn't have to be pretty, just functional). Be able to recognize when someone is at risk for going into shock, so that you will undersatand the need to get them to shore ASAP, etc. This is the basic stuff, simple stuff that anyone can learn, its the stuff you need to know how to do immediately before you have time to get to shore, and it often works. It's true you are not likely to need these skills, as most of your sailing companions won't get their limbs cut off or suffer a near drowning. Most accidents will invovle minor cuts and bruises, simple fractures, etc, but keep in mind most of these more common things are not likely to be life threatening. Yes, it'd be nice to know how to start an IV for rehydration, give morphine for painful injuries, and administer antibiotics for that finger you sliced in the bilge, and if you are talking about weeks at sea I won't pretend that those skills wouldn't be useful. But for those of us who don't sail beyond a few days from medical care (the vast majority I'm sure), remember it's the basics that get the important jobs done. And the other stuff like "just starting an IV" comes with a lot of baggage: ie you have to safely store the fluids, they absolutely have to stay sterile, you have to know which fluids to use (ie not D5W in trauma as stated previously), you have to have IV catheters and know how to use them (takes practice to get it right). You aren't going to get injectible morphine very easily (legally), and IV morphine carries risk (low BP, allergy, respiratory suppression, etc). Antibiotics are rarely necessary in most limb lacerations if they are appropriately irrigated with fresh water. Etc, etc...

Anyway, you get the idea. Take some basic courses. CPR and Basic First Aid will take you a long way if you can gain confidence in those simple techniques. If you are really driven, a First Responder or basic level EMT course would be incredibly useful, but that's already beyond what most people will have the time to do. Will you be able to save someone who got bashed by the boom and is now bleeding into their brain? Or someone who's had a massive heart attack or penetrating thoracic or abdominal injuries or is in cardiac arrest? Probably not, but many of them wouldn't survive if their injury occured in the middle of an operating room at the best hospital, and if you do save them, it's going to be because you knew how to keep their airway open, not because you are a whiz at putting in stitches or doing brain surgery (a brain surgeon on the boat couldn't do much better, and might likely do worse, than a well prepared first responder). FYI, EMS trauma calls in my city (New York City) are, per city protocol, responded to by BASIC level EMTs, NOT by paramedics, because it is recognized that basic level providers (ie not the ones that wield IVs or medications) make the critical difference in trauma.

Ok, sorry I'm so long winded. You get my point...
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