Deep ocean medical kit intro, by Dr John Roos.

We are enthusiastic yachties, going about the business of sailing.   We don’t look for trouble, but unfortunately, spending time on the open sea, and especially in the cold seas of the Cape of Storms, means it’s very likely that trouble will seek us out, sooner or later…

We know that we need to be prepared – as responsible yachtsmen-and-women we pay enthusiastic attention to the safety advice on offer.  We follow the guidelines of SAS, SAMSA and other authorities in whom we trust.  We adhere to the minutiae of the prescripts of our COF inspections, and we willingly subject ourselves to the rigours of all aspects of crew and skipper training, including the basic first aid courses on offer.  We equip our boats with all the stuff we’re advised to, including commercially prepared first aid kits – and more.

So, we should be well prepared and equipped to manage medical emergencies at sea, right…?

Wrong!   You don’t need to be sunk by a whale to find yourself in a spot of bother – and you don’t need to venture too far from the breakwater for that ‘bother’ to find you…

Ask Paul Morris, of Savannah fame who, along with his crew, was fairly recently jolted into the real world by unexpectedly having to rescue and manage two severely hypothermic kayakers, right on our doorstep, so to speak.

Let’s consider Savannah’s hapless kayakers for a moment.  If one falls into water of 15oC or below, one could be dead within 15 minutes due to a phenomenon known as the cold shock response.  Our water temperatures drop as low as 12oC at certain times of the year.

Alternatively, one could still be alive after two hours (not happily alive, but alive nonetheless), depending on what one either does or doesn’t do.  There are also certain things one should and shouldn’t do whilst rescuing severely hypothermic people from the water.   Paul and his crew had a happy outcome and must be congratulated on doing an incredible job.   What an incredibly fortuitous privilege it is to save someone’s life!   But who teaches us the really important things that we need to know?

While we’re on the subject, let’s explore hypothermia just a little further.   The onset of hypothermia, for the yacht crew in heavy weather, is a slow, progressive and insidious process – hardly recognisable for what it is.   Signs and symptoms are nebulous and non-specific, and unless we are specifically aware of what to look for, we may miss the signs completely.

For example, moderate hypothermia results in introversion, irritability to the point of aggression, progressively impaired decision-making, confusion, disorientation, amnesia, apathy, loss of fine motor skills, impaired balance, slurred speech and eventual clouding of consciousness.

Would the warning lights of ‘hypothermia’ flash through your mind when one of your normally care-free, boisterous crew members becomes uncharacteristically quiet, irritable and disinterested, or would you put it down to a sense-of-humour failure owing to the sea conditions?   Of course, it could be either or both – but the situationally-aware skipper and crew would consider all possibilities.

Have you noticed that the physiological effects of moderate hypothermia are precisely those of extreme alcohol intoxication – would you want to sail your boat with a ‘drunk’ skipper and crew, through a raging storm?

We can’t recognise a problem if we don’t know what to look for, and again, who teaches us the really important things that we need to know?

The uncomfortable truth is that we are generally ill-prepared to understand our own physiology, and to manage medical emergencies at sea, despite our training, and through no fault of our own – even if fairly close to home.   Which begs the question: what do we do when we’re two weeks into a deep ocean crossing and we’re faced with a real medical emergency?

Our first aid courses, and our medical kits, are designed for landlubbers, not ocean sailors, and as such are woefully inadequate and really not fit-for-purpose.   The knowledge and equipment lists imparted to us, notwithstanding the best intentions, are designed to provide only the briefest temporising relief whilst waiting for the ambulance, or whilst we undertake the rushed trip to the emergency unit or the GP’s rooms.

We need to rethink medical emergencies at sea.   We need to think out of the (first aid) box, and ‘re-engineer’ our ocean-going medical training.   Our training needs to be a whole lot more meaningful, goal-directed and purpose-built – for all types and categories of sailors heading offshore – and even for those small craft crew confining themselves to the inshore traffic zone.

We need to re-define what constitutes an emergency.  On land, an infected skin rash may be no more than an annoying irritation ahead of the visit to the GP, and would hardly constitute an emergency.  On the deep ocean it may become an incapacitating, life-threatening condition.   Similarly, doing CPR that may be appropriate on the beach, may be an exercise in futility in the deep ocean.   We need to consider these things.

Cold water, big seas, high winds, a mixture of alcohol, cooking stoves, accidental gybes and complacency may present a toxic milieu to the unwitting sailor, and can turn an exhilarating sail into an excruciating nightmare in the blink of an eye.   We need to be appropriately prepared for all eventualities.

There is an overwhelming amount of medical information ‘out there’, and a bewildering array of medical kits available.   There are a lot of well-meaning people (and organisations), giving well-intentioned advice.   Some of it is spot-on, some of it inadequate, some of it inappropriate, some of it completely wrong and some of it is downright dangerous.   So what do we take and what do we leave?

The challenge for us lies in how to take evidence-based practice and make it manageable, accessible, meaningful and digestible for non-medics, whose primary passion is sailing and not emergency medicine.  And how to keep the focus on sailing without creating prescriptive regulatory hurdles for those men and women wishing to engage primarily in their sport and the passion of yachting.

We are very well-positioned here in the “fairest Cape in all the world”, at our Tavern of the Seas, to draw upon our internal resources, our own ingenuity, and to engage with organisations such as SAS, SAMSA, the NSRI and others, in order to build – one step at a time – a meaningful body of knowledge, skills and appropriate equipment.   Thus providing world-class medical training to the world-class crews of our world-class sailing events, such as the iconic Cape to Rio and St Helena yacht races.

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