Master's responsibility in medical emergency

Anyone ever see this book with a ship’s medical kit anymore?

[https://www.amazon.com/Ships-Medicine-Chest-Medical-Aid/dp/1312782161]

When I served in the USPHS, as a medical officer at the now defunct Galveston Marine Hospital (1968-70), we used to be a go-to resource for medical advice for ships at sea.

Radio calls to the Coast Guard for medical assistance in the Gulf were patched to us and fielded by our OD. We also had a long range marine radio service station in Galveston (Mackey Radio) and we sometimes got medical calls from ships a long way away, like the S. Atlantic & S. Pacific! (Which could be incredibly hard to make out when patched thru the hospital phone system and to the OD quarters in the middle of the night!)

On those calls I was usually talking to the 2nd Mate, occasionally the Master. The ”Ships Medicine Chest” book was sadly out of date at that time and badly in need of an update. But it was often helpful as a communication aid if a copy was aboard, allowing a certain number of shortcuts if voice comm was seriously bad. (Eg: “Read page 35 & tell me if that fits! Repeat: read page….”)

It appears from that Amazon entry that the PHS has revised and kept that book up to some degree. Of course it’s a whole different world now with comm & access to advice, and even evacuation that we couldn’t even dream of in those days. Some calls left me with the feeling that the guy on the other end couldn’t have been more on his own if he was calling from the moon!

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I saw a copy of it when I was in school. I think it was an edition from the ‘80s. I’m sure someone could make some money publishing a new revision, not sure how that works though.

Seafarers only do 2-3 weeks of medical training in total. It takes Doctors and Nurses several years of training to become competent.

Seafarers are only fit to do very basic first aid.

It’s in the interests of the patient to get them to an actual medical professional as quickly as possible by any means necessary.

There’s an international guide published a year ago - International Medical Guide for Seafarers and Fishers.

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I’ve not spent a LOT of time with those kind of books for 50+ yrs because after my “draftee service” in the PHS, I specialized in eye surgery. But I’ve kept loosely in touch with it because, during my “prime”, I volunteered every couple of years for a tour with an overseas medical foundation, mostly in Mexico & Guatemala. In those kind of settings…planning to do eye surgery on someone whose language you don’t know and who hasn’t seen any kind of Dr. in forever…you have to fall back on your general medical knowledge and experience to assess the patient before, during and after surgery and to take steps to remedy other things that come up…or know when to get some help!

So, in that connection, working in Latin America, I became aware of this book that was widely used by community health promoters, back country nurses, etc, etc. “Where There Is No Doctor” (or “Donde no hay doctor”, the title the copies I would see had).

This book rose out of “3rd World” medical assistance experience of the kind sometimes provided by the Peace Corps and various UN & NGO organizations. It is perhaps a bit too slanted toward tropical diseases for the maritime world…but then again maybe not. The best thing about this book, IMHO, is that it was written by very experienced and well informed medical aid folks who were NOT doctors. They of course had professional advice and input, but the whole approach and viewpoint of this book is better suited to the non-medical person faced with something that is at least unpleasant and may be downright scary or repulsive.

So anyone who wants to perhaps make an addition to their ship’s slim medical library could not do better, again IMHO, than to add a copy of this book. Millions of copies have been distributed around the world by the Peace Corps and others. Dipping into it a bit in advance is not a bad idea either if you think you might actually have to take care of someone seriously sick or injured!

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I’ve had it onboard most vessels I’ve been on since leaving OSVs as a required publication. I’m not sure if it was required by US/IMO/SOLAS regulations or if it was only required by the company SMS.

International Medical Guide Cost: £225 ($280, oh how the mighty pound has fallen)

I guess I won’t order that ridiculously overpriced reference for my home library!

I cannot get over how everything from all these do-gooder organizations that are supposedly trying to help mariners is priced out of reach.

“Where There Is No Doctor”: $24.95 paperback

Admittedly you can skip some of the parts like “latrine building”, but the general approach to sick or hurt people for a non-medically trained person is excellent and pretty universal.

PS: Just to add why I think that: Most “First Aid” courses I’ve seen are indeed focused on the lay person but they’re usually limited to comforting and stabilizing the injured until transfer to a better facility, with the acknowledged exceptions of CPR & perhaps controlling severe bleeding. This book has the viewpoint of the back-country “barefoot doctor” who has minimal training and equipment but is sometimes faced with VERY serious problems for which there will be NO transfer available any time soon. So he is “IT” and he is going to have to do whatever he can to save a life. Not unlike the situations that can be encountered on blue water vessels a long way from a port.

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Thanks. I bought that one.

I agree. I had one case as master where the ship’s cook became very ill in the middle of the Pacific. I rang the number in Rome that is listed and was redirected to the Royal Flying Doctor Service in Australia.
On their advice I had to get the patient on a drip and the equipment to hand was last century compared to what I had trained on. I could have also done with one of those automatic blood pressure monitors. Trying to get a reading with a stethoscope and a mercury type monitor with the ship at max speed was very difficult. After 800 miles we landed the guy in Tahiti still alive and he made a full recovery.

Getting blood pressure manually is a practiced skill, even with a good quality stethoscope. Might seem easy for an EMT or Nurse, but they’re doing it every day, and most have nice equipment that they know very well. I would never trust someone who’s last attempt at reading BP, was back when they took first aid to get a good reading. First aid is a very important skill I think, but the vast majority of people don’t have the interest to learn or practice. Even with the EMS training I have, and having been First Aid/CPR instructor, there’s always new stuff that I’m learning. Stabilizing a patient with a traumatic injury, like bleeding, is probably one of the most important skills I think those of us in the maritime industry should learn. Though theres a whole slew of other conditions that we could commonly face as well.

Interested in the vessel size or configuration?
Number of Passengers? Overnight passengers?
What size and speed on the fast rescue? Enclosed?
Are there no other management level officers onboard the vessel that are assigned duties of medical care or bridge watch at sea?
Do you have a designated hospital onboard the vessel?
Are you carrying narcotic level meds?
AED and oxygen?
These answers will dictate the level of care any uscg or other authority might expect you to be able to provide.

These answers may help us better understand.

If patient is stable, USCG will not risk their personnel to do a helo evac. If patient is failing and within flight time of help they will come assess and decide if they can make a pick from your vessel, or from your tender.

My immediate thought is that the patients health matter would need to be very stable to risk transport in a fast rescue boat of any kind for any period of time, with less resources and less good working environment to call that a “do no harm” situation. On the other side of things, if they are failing rapidly and you feel that the rescue boat ride will not cause more damage to them, it is an option.

If you want a Free Ship’s Medical book, the IMO/WHO book is available as a PDF:

Not sure it is $255 better than “Where There Is No Doctor” but reviewing that IMO book, I’d say it IS the best book I’ve seen for offshore maritime use…based on my admittedly 60 yr old experience in consulting (by dodgy SSB radio) on some of those problems when was a PHS officer. So if you can get it for free, have it available digitally and be able to perhaps print out sections as needed, I’d say that’s the way to go.

By the way, the better quality, battery powered, automatic blood pressure measuring machines are the way to go. Readings more reliable and consistent and, if need be, you can leave the cuff on and recheck as often as you need to. And they can be fairly portable if needed. When I retired from doing eye surgery (almost 20 yrs ago!) anesthesiologists were shifting over to automated BP readings and that’s probably the standard now as they can have ones configured to make a digital record of time, pulse & BP and export it to the medical record. Along with automated body temp. readings and a host of other stuff. We’re not far from having robots that can assess multiple vital signs and other parameters and draw conclusions from them. Next step will be to eliminate the human and have the whole thing done by a robot including the surgery! So called “robotic” surgery now is not really fully automated and human control is still a significant part of it. But eliminating us is surely the next step.

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When a medical crisis occurs, the applicable legal duties may be very complex. The International Maritime Organization (IMO) is responsible for providing recommendations about the duty of the captain to assist and coordinate an evacuation as needed. Such hints are usually consistent with international treaties such as SOLAS and SAR, which override national laws. Nonetheless, one should seek advice from maritime lawyers or government representatives in order to understand how federal statutes pertain to their particular situation. They will answer if your choice of patients’ treatment options or evacuation would be covered by Federal Maritime Law. In this case it may be hard but it is recommended that you seek professional help.

Welcome AI

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Definitely reads like it!

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“Ok skipper. But the chain binder sticking out of my forehead…can I get a bandaid or aspirin or something?”

“Responsibility”? All you have to do is read the story of the MV Green Wave and its chief engineer to know that the CG really doesn’t care.