Mcga-shs Capt Guide Chap13

8/10/2019 Mcga-shs Capt Guide Chap13

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Rad io med ical a dvice

Med ivac service b yhelicopter

Ship-to -ship tran sfer o fdoctor or pat ient

Communicat ing w ithdoctors

CHAPTER 13

209

Radio medical adviceThis is available by ra dio teleg raphy, or by direct contact w iththe doctor by radio telephon y from a number of ports in allparts of the w orld. Deta ils of w orld wide services can befound in the Admiralty List of Radio Signals (ARLS) Vol 1.Satellite telecommunicat ions using fa csimile a nd voice h avefacilitat ed this direct conta ct. Additiona lly, i t may, onoccasion, be o bta ined from o ther ships in the vicinity whohave a doctor on board. In either instance it is better if theexchang e of informat ion i s in a languag e common to bo thparties. Coded messages are a frequent source ofmisunderstanding and should be avoided a s far as possible.

However, the medical section of the Internationa l Code ofSigna ls should be used wh enever appropriate.

Telemed icine systems are in develo pmen t, exploitingdigital image handling a nd t elecommunications technology.As yet they are experimental, expensive and of limitedbenef it , how ever, in the nea r future robust, well supported,effective and a fforda ble systems will emerge.

It is very important that all the information possible ispassed on to the doctor and that all his advice andinstructions are clearly understood and fully recorded. Acomprehensive set of notes should be read y to pa ss on to thedoctor, preferably based on the appropriate format below (one is for illnesses; the o the r for injuries). Have a pencil andpaper available to make notes and remember to transcribethese notes to the patients and to the ships records afterreceiving them. It is a good idea to record the exchange ofinformation b y means of a ta pe recorder if one is available.This may then be playe d ba ck to clarify w ritten note s. Somecountries may not be aware of the contents of your shipsmedical chest and it w ill save time an d bot her if you have alist of drugs and appliances available (MSN 1726). Whencontac t ing Br i t ish or o ther doctors who ma y be a wa re of thestandards required in British ships, be prepared to notifythem of the ca teg ory of medica l stores car r ied a nd w hetherthere are any deficiencies likely to affect treatment in theparticular case.

It may be necessary, under certain circumstances, towi thhold the name of the pa t ient when o bta in ing medica ladvice in order to preserve confidentiality. In such cases thepatient s nam e and ran k may be submitted lat er in writing tocomplete the d octor s records. Age, sex and ethnic origin aremore impor tant tha n the pat ient s name.


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210 THE SHIP CAPTAINS MED ICAL GU IDE

A. In the case of illness1.0 rout ine part iculars about the ship 1. 1 n a me o f sh ip1.2 call sign/MMSI/INMARSATnum be r1 .3 d a t e a n d t i m e (G M T)

1.4 posi t ion , course , speed1 .5 l a st p o rt o f ca l l

1. 5. 1 p o rt o f d e st in a t io n is a n d i s h o urs/d a y s a w a y

1. 5. 2 n ea re st po rt is a n d i s h o urs/d a y s a w a y

1. 5. 3 o t h er po ssib le p or t is a n d i s h o ur s/d a y s a w a y

1 .6 l o ca l w e a t h e r (i f r el ev a n t )

2.0 rou t ine p a r t i cu la r s abou t the pa t i en t 2 .1 n a m e o f c a su a l t y (o p t io n a l )2 .2 e t h n ic o r ig i n2.3 ra nk2 .4 jo b o n b o a r d ( o ccu p a t io n )2.5 a ge

3.0 part iculars of t he i l lness 3.1 when did the i llness f i rs t begin?3.2 how did the i llness begin (suddenly,

slo w ly, )?3 .3 w h a t d i d t h e p a t ie n t f i rst c o m pl a in o f ?3 .4 l is t a l l h is compla in ts and symptoms3.5 descr ibe the course of h is present

illness from the b eginning t o thepresent time

3.6 give any impor tant pas t i llnesses /injuries/op era tio ns

3.7 give par t iculars of know n i l lnessesw hich run in t he f amily (family history)

3.8 describe any social pursuits oroccupat ions w hich may be importan t(social an d occupat ional h istory)

3.9 list a ll medicines/tab lets/drugs w hichthe pat ient wa s taking before thepresent il lness bega n a nd g ive thedose(s) and how of ten t aken(see 6.1 below )

3 .1 0 l ist a n y k no w n a l le rg i e s3 .11 h a s t he p a t ie n t b e e n ta k in g a n y

alcohol or do you t hink he is on drug s?

4.0 results of examination of t he i l l person 4.1 tempera ture , pulse and respi ra t ion4 .2 d e scr ib e t h e g e n e ra l a p p e a r a n ce o f

the pat ient4 .3 d e scr ib e t h e a p p e a r a n ce o f t h e

affec ted par ts4 .4 w h a t d o y o u f in d o n e xa m i na t i o n o f

the a ffected pa rts (sw elling,tend erness, lack of movemen t, and soon)?

4 .5 w h a t t e s t s h a v e yo u d o n e a n d w i t hw hat result (urine, other)?

5.0 diagnosis 5 .1 w h a t d o y o u t h i nk t h e d ia g n o s is is?5 .2 wha t o ther i llnesses have you

considered (the differentialdiagnosis)?

6.0 t r ea tment 6.1 list ALL the me dicines/ta blet s/drug s

which the pat ient has taken or beengiven since the illness bega n a ndgive the dose(s) and t he times givenor how ofte n given (see 3.9 above).Do not use the term stan da rdant ibiotic treat ment. Name theant ibiotic given.

6 .2 h o w h a s t h e pa t i e n t re sp o n d e d t othe t rea tment g iven?

7. 0 p ro b le ms7 .1 w h a t p r o b le m s a r e w o r ry in g y o u n o w ?7 .2 w h a t d o y o u t h in k y o u ne e d t o b e

ad vised on?

8. 0 o t h er co m me n t s

9 .0 c o mm e n t s b y t h e ra d i o d o ct o r

Information to be ready when requesting RADIO MEDICAL ADVICE

Complete the appropriate form or notes before asking for assistance. Give the relevantinformation t o your radio medical adviser. Get a ny advice you are given dow n in writing as youreceive it , and repea t ba ck to your a dviser to a void misunderstanding .


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Ch a pt er 13 EXTERNAL ASSISTANCE 211

B. In the case of injury1.0 rout ine part iculars about t he ship 1. 1 n a m e o f sh ip1.2 call sign /MMSI/INMARSAR nu mbe r1 .3 d a t e a n d t i m e (G M T)1.4 course , speed, posi t ion1 .5 l a st p o rt o f ca l l

1. 5. 1 p o rt o f d e st in a t io n is a n d is h o u rs/d a y s a w a y

1. 5. 2 n ea re st po rt is a n d is h o u rs/d a y s a w a y

1. 5. 3 o t h er po ssib le p o rt is a n d is h o u rs/d a y s a w a y

1 .6 l o ca l w e a t h e r (i f r el ev a n t )

2.0 rou t ine p a r t i cu la r s abou t the p a t i en t 2 .1 n a m e o f c a su a l ty (o p t io n a l )2 .2 e t h n ic o r ig i n2.3 ra nk2.4 job on board (occupation)2.5 a ge

3.0 history of th e injuries 3.1 exact ly how did the in jur ies ar ise?3. 2 h ow l o ng a g o w a s t ha t ?3 .3 w h a t d o e s t h e pa t i e n t co m p la i n o f ?

(list the com plaint s in order ofimportance or severity)

3.4 give important pa st il lnesses/injuries/opera t ions

3.5 list ALL med icines/ta blets/drug s whichthe pat ient wa s taking before thepresent injury (injuries) an d g ive dosesa n d h o w o f t e n t a k en

3 .6 l ist a n y k n o w n a l le rg ie s3 .7 h a s t h e p a t ie n t b e e n t a k in g a n y

alcohol or do you think he is on drug s?3.8 does the pa t ient remember everyth ing

that happened, or d id he loseconsciousness even for a short t ime?

3.9 if he lost consciousness, describe w hen,or how long, and the depth ofunco nsciousne ss. Use AVPA (seeChapt er 4) or GCS

4.0 results of examin ation 4.1 tempera ture , pulse and respi ra t ion4.2 descr ibe the genera l condi t ion of the

pat ient4 .3 l ist w h a t y o u b e li ev e t o b e t h e

pa tient s injuries in order ofimportance an d severity

4 .4 did the pa t ient lose any b lood? If so ,how much?

4 .5 w h a t t e s t s h a v e yo u d o n e a n d w i t hw hat result (urine, othe r)?

5.0 t r ea tment 5.1 descr ibe the f i r st -a id and o t her

treat ment w hich you have carried outsince t he injuries occurred

5.2 list ALL the me dicines/ta blet s/drug swhich the pat ient ha s taken or beengiven, and give the do se(s) and thetimes given or how o ften g iven. Donot use the term standa rd antibiotictreat ment. Name the ant ibiotic given

5. 3 h o w h a s t h e p a t ie n t r esp o nd e d t o t he

t rea tment?

6.0 prob lems 6 .1 w h a t p r o b le m s a r e w o r ry in g y o u n o w ?6 .2 w h a t d o y o u t h in k y o u n e e d t o b e

ad vised on

7.0 other comments

8.0 comment s by the radio do ctor

Medivac service by helicopterDo no t a sk for a he licopter unless the pa tient is in a serious situation and never for trivial i l lnessor for your convenience. Remembe r that , apa rt from the expense of h elicopter evacuat ion, the

pilot and crew ofte n risk their l ives to render a ssistan ce to ships at sea a nd t heir services shouldbe used only in a genuine emerg ency.

The no rma l procedure is as follow s.Conta ct the coa st radio sta tion (det ails in ARLS Vol 1), ask for medica l advice and the y w ill

normally transfer your call to a d octor. Give the do ctor all the information you can so tha t he canmake a n a ssessment of the seriousness of the situa tion. He w ill normally give advice onimmediate care of t he pa tient. After the link call is over, the d octor w ill advise the Search a ndRescue (SAR) authority on th e best met hod o f evacuat ion and , should helicopter evacuation b ethoug ht de sirable, the SAR authority will make the necessary arrang ements and w ill keep intouch w ith the ship.


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Do not expect a helicopter to a ppear right aw ay. There are certain operationa l matters toconsider and a lthough the service is alw ays manned, d elay may e nsue. Remember that the rang eof a helicopter is l imited, de pending o n the t ype in service, and you ma y be a sked to rend ezvousnearer land. In bad w eather and a t ext reme ranges it may b e necessary to a r range for anotheraircraft to overfly and escort the helicopter for safet y reasons and this aircraf t ma y have to b ebrought from a nother base. Arrangements may ha ve to be mad e for a refuelling stop to be ma deat say an o il rig so that the helicopter can ma ke the pickup and t hen fly back without further stops.

All this takes time, and , as it is done w ith the utm ost efficiency, do no t keep calling to a skw here the helicopter is.

More deta iled informa tion is ava ilab le from the Merchant Ship Search and Rescue Manual(MERSAR) or Volume 3 of the International Aeronautical and Maritime Search and RescueMa nua l (IAMSAR).When h elicopter eva cuation is decided upon:

It is essential t hat the ships position should be given to the rescuers as a ccurately a spossible. A fix plus the bea ring (magn etic or true) and distance from a fixed object, l ike ahead land o r light house, should be g iven if possible. The type of ship and colour of hullshould be included if t ime a llow s.

Give details of your patients condition a nd report a ny chang e in it immediately. Details ofhis mobility are especially important a s he may req uire to be lifted by stretcher.

Inform the bridg e and e ngine room w at ches. A person w ho is capab le of communicat ingcorrectly and eff iciently by radio should be nomina ted t o communicate w ith the he licopter.

Helicopt ers are f itte d w ith VHF a nd/or UHF RT. They ca nno t no rma lly wo rk on th e MFfreq uencies, altho ug h certain larg e helicopters can commun icate on 2,182 kHz MF. If directcommunicat ion betw een the ship and the a ssisting helicopter cannot b e effected on e itherVHF or 2,182 kHz, it ma y be po ssible to d o so via a lifebo at if one is in the vicinity.Alternat ively a me ssag e ma y be pa ssed via a Coast Radio Station o r Rescue Co-ordinationCent re (RCC) on 2,182 kHz, or on VHF.

Passeng er ships are required to carry rad io equipment opera ting on the a eronaut ical

freq uencies 121. SMHz and 123.1 MHz. These freq uencies are reserved f or distress an durgency purposes and can be used to communicate w ith the helicopter.

The ship must be on a steady course g iving minimum ship mot ion. Relat ive w ind should bemaintained as follows:

For helicopter ope rating area

Aft 30 o on Por t Bow.

M id sh ip s 3 0 o on Starboard Bow.

Fo rw a r d 30 o on Starboa rd Quarter.

If this is not possible the ship should remain stationary head to wind, or follow theinstructions of the helicopter crew.

An indication of relat ive wind direction should be g iven. Flag s and penna nts are suita blefor this purpose. Smoke from a g alley funnel may a lso give an indication of t he w ind but inall cases where a ny funnel is making exhaust, the w ind must be at lea st two po ints off t hepor t bow.

Clear a s large an a rea of d eck (or covered ha tchwa y) as possible and ma rk the a rea w ith a

large letter H in w hite. Whip or wire aerials in and a round the a rea should, if a t allpossible, be struck.

All loose articles must be securely tied dow n or remo ved from the transfer a rea. Thedow nw ash from the helicopter s rotor w ill ea sily lift unsecured covers, ta rpaulins, hoses,rope and ga sh etc., thereby presenting a severe flying h aza rd. Even small pieces of pa perif sucked into a helicopter eng ine, can cause the h elicopter to crash.

From the air, especially if there is a lot of shipping in t he a rea, i t is difficult f or the pilot ofa h elicopter to pick out the particular ship he is looking f or from th e ma ny in sight , unlesstha t ship uses a distinctive distress sign al w hich can be clea rly seen b y him. One such signa l


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Ch a pt er 13 EXTERNAL ASSISTANCE 213

is the o ran ge colo ured smoke signa l carried in th e lifebo a ts. This is very distinct from th e air.A well trained Aldis lamp can also be seen, except in very bright sunlight w hen the lifebo atheliograph could be used. The d isplay of these signals will save va luable time in thehelicopter locating the casualty, and ma y mean a ll the diffe rence betw een success andfailure.

On no account must the winch wire be allowed t o foul any pa rt of the ship or rigg ing, orthe helicopter be ma de fa st to the ship.

The w inch w ire should be han dled only by personnel w earing rubb er gloves. A helicoptercan build up a cha rge of static electricity w hich, if discharged through a pe rson ha ndlingthe w inch wire, can kill or cau se severe injury. The he licopt er crew w ill norma lly discharg ethe sta tic electricity bef ore commencing the o peration by d ipping t he w inch w ire in the seaor a llow ing t he ho ok to touch the ships deck. How ever, under some conditions sufficientstatic electricity can build up during t he ope ration t o g ive unprotected personnel a severeshock.

When co-operating w ith helicopters in SAR operations, ships should no t a ttempt to providea lee w hilst helicopters are enga ged in winching operations as this tends to createturbulence.

The survivor is placed in the stret cher, strappe d in such a ma nner t ha t it is impo ssible fo rhim to slip or fall out, a nd bo th stretcher and crew man are w inched up into the helicopter.If the pa tient is already in a Neil-Robertson t ype stretcher this can either be lifted straightinto the aircraft or placed in the rigid frame stretcher.

At all t imes obey t he instructions of t he he licopter crew. They ha ve the expertise to d o t hisjob q uickly a nd efficiently.

Preparation of the patient for evacuation:

Place in a plastic envelope t he pa tients medical records (if any) tog ether w ith an y necessarypapers (including pa ssport), so th at they can be sent w ith him.

Add to the medical record, in the envelope, note s of a ny treatme nt given to the pa tient.See that he is ta gg ed if morphine has been given to him.

If possible ensure tha t your patient is wea ring a lifejacket befo re he is moved to t hestretcher.

Ship-to-ship transfer of doctor or patientThis is a seam anship problem w hich dem and s high standa rds of competence for its safe a ndefficient performance. There should be no ne ed t o a dvise professiona l seam en concerning thisoperat ion, but this guide may occasiona lly be in the ha nds of yachtsmen or small craft operato rsto w hom a few reminders may be a ppropr ia te .

A very larg e ta nker or other ship under wa y at sea ma y require 30 minutes or more to bringher ma in propulsion ma chinery to stand-by, so use your da ylight signa lling a pparat us or VHF assoon as possible. Loa ded, larg e ta nkers require several miles to take off their headw ay a nd a redifficult to m ano euvre close to small craft.

Light (unload ed) ships of a ny type and high-sided pa ssenge r ships will make considerableleeway w hen s topped and must be approached wi th caut ion . Some ships may have to turn the i rpropellers very slow ly during the operat ion.

Keep clear o f the overhang of b ow s or stern, especially if there is any sea running. Alsobew are of a ny permanent fende ring fitted a t sides. The gen eral rule is tha t the ship with thehigher freeboa rd will provide illumination and fa cilit ies for boa rding an d w ill indicate the b estposition.

Do not linger a longside for any rea son; as soon a s the operation is completed use full powerto g et your craft clear. There may b e a suction effect tha t w ill hold you along side a nd w hich ma ybe da nge rous if you do not use full pow er. For your own saf ety, make sure you are seen a nd youractions are communicated t o the Master of t he large r ship and act promptly on h is instructions.

See section above: Preparation of th e patient f or evacuation


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Communicating with doctorsAs a ma tter of courtesy as w ell as of informat ion, a letter or form should alw ays be sent with an ypatient w ho is go ing to see a do ctor. The crew membe r will be a strang er to the do ctor andthere may be a language difficulty. A written communication in a foreign language is ofteneasier to understand tha n a spoken one. The letter should include routine particulars about thecrew member (name, da te of b i rth) and a bout the sh ip (name o f sh ip , por t , name of a gent ,ow ner). The med ical content of t he letter should follow a systema tic approach and should givethe do ctor a synopsis of all that is know n ab out th e person which may b e relevant, includingcopies of any information from d octors in previous ports. This is why the use of a form f or thispurpose is particularly valuab le because the doctor can the n be req uested to w rite back to theMaster on the form.


Mcga-shs Capt Guide Chap13

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