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post #1 of Old 01-13-2004 Thread Starter
William Mahaffy
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Treating Common Onboard Injuries

When you're miles away from the nearest ambulance or hospital, you and your crew become the ER on call.
Most of the injuries that occur on board come under the category of minor trauma, or of damage to the soft tissue. Treatment of these injuries usually requires just basic first-aid training, an inland-type medical kit, and a healthy dose of common sense.

While minor-trauma injuries can frequently be painful, they're rarely life-threatening. Typically, they include abrasions, avulsions, and minor lacerations. Here is how these injuries should be handled.

Contusions     A contusion is basically a bruise. It's defined as an "injury that causes bleeding in or beneath the skin but does not break the skin." Contusions can range from a painful whack on the shin from a winch handle, for example, to more extensive trauma, like big bruises to the hip or thigh. Contusions happen readily on a boat, large or small, on oceans or inland lakes. I remember examining some impressive contusions on crew who went through a night's battering on squall-tossed seas. They were very battered and bruised but none had serious injuries.

The treatment for contusions is easy to remember with the mnemonic ICE, or Ice, Compression, and Elevation. Following this treatment reduces pain, swelling, and further hemorrhage.

First, apply ice or a cold pack to the injury. As the blood vessels constrict, pain eases while bleeding and swelling decrease. But remember: Do not place ice directly on the skin; this may cause damage to the skin itself.

Next, apply direct manual pressure, or compression, to the injury. An Ace bandage or an air splint might work, too. Elevation is self-explanatory. By keeping the injury above the level of the heart, swelling is reduced.

The most important component of onboard medical equipment is the one item not in the first-aid kit: adequate first-aid knowledge and training.
Abrasions     Abrasions (denuded epidermis) seem to happen all the time on sailboats. One common abrasion-causing situation is when forearms and nonskid decks come into unexpected contact. Superficial abrasions may be red and painful, while deeper abrasions will exhibit capillary bleeding. The ICE approach works well for this too, but remember to also thoroughly clean the scrape. Use hydrogen peroxide and saline irrigation. Then apply a nonstick (Telfa) dressing to the wound, tape in place and apply the cold. You may also cover the wound with a thin layer of antibiotic ointment before applying the dressing.

Avulsions     An avulsion occurs when a piece of tissue is partially or completely torn away from the body after hitting a metal or other hard object. Glancing blows to the binnacle, a stanchion, the boom, or the sail track often result in this type of injury.

The first order of business is to control the inevitable bleeding that will occur with these deeper wounds. Applying direct manual pressure to the wound for several minutes using some form of clean (preferably sterile) dressing. Once the bleeding has stopped, the wound should be bandaged securely and then employ the ICE technique. If there is any gross contamination of the wound, it should be cleaned with a dilute Betadine solution (mix one part Betadine solution with 10 parts saline irrigation). Do not use hydrogen peroxide to clean the wound because this will destroy the fibroblast cells in the deeper layers and delay healing.

Minor lacerations are an ongoing hazard on a sailboat. To manage these, keep in mind: control bleeding, clean the wound, dressing, bandage, and ICE. Depending on the size and location of the laceration, you may also choose to place a Steri-Strip or butterfly bandage on the wound. Generally, minor lacerations heal on their own without difficulty. Lacerations requiring surgical removal of skin and more advanced management will be discussed in a future article.

Like sailing itself, as you become more comfortable handling common medical situations, the better you'll be at handling more complicated situations that may arise.
Finally, a word about control of hemorrhage: None of these injuries should bleed profusely unless the patient has some clotting disorder or is taking anticoagulant medication (remember: aspirin hinders blood clotting). Be patient. You may need to hold pressure for several minutes. Sometimes this can seem like an eternityespecially if the patient is a screaming child.

If the bleeding seems excessive, reinforce the pressure dressing instead of completely changing it. If it is changed frequently, the beginning stages of clot formation may be disrupted and the clotting mechanism will have to start over again. It is better to just supplement gauze over the existing saturated dressing until the bleeding has stopped. At this stage you could then carefully replace the initial dressings with a new one and bandage securely.

Minor injuries are common on board. With an inland medical kit, good common sense and these treatment fundamentals, they should be easily manageable. And like sailing itself, as you become more comfortable handling these medical situations, you'll be better at handling more complicated situations that may arise.

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