mcga-shs_capt_guide_chap1.pdf

CHAPTER 1

Introduction

When a ship is in port, or near to port where hospital and

other expert medical attention are available, the first aid

treatment necessary aboard ship is similar to that practised

ashore. At sea, in the absence of these facilities, trained ships’

officers are required to give types of treatment beyond that

accepted as normal first aid.

The content of this chapter covers the knowledge of first

aid necessary for the safe and efficient immediate treatment

of casualties before they are transported to the ship’s

hospital or to a cabin for any necessary definitive treatment

of the type described in Chapter 4.

However, anyone aboard ship may find a casualty and

every seaman should know three basic life-saving actions to

be given immediately while waiting for trained help to

arrive. These are:

to give artificial respiration by the mouth to nose/mouth

method;

Introduction

Priorities

General principles of first

aid

General assessment of

the situation

Dressings, bandages,

slings and splints

First aid satchels and

boxes

Severe bleeding

Unconscious casualty

Burns and scalds

Suffocation (asphyxia)

Strangulation

Choking

Epileptic fits

Shock

Bleeding

Wounds

Fractures

Dislocations

Head injuries

Chest injuries

Blast injuries

Transportation

to place an unconscious casualty in the unconscious

position;

to stop severe bleeding.

Priorities

On finding a casualty:

n ensure your own safety;

if necessary, remove the casualty from danger or danger

from the casualty (but see the note below on enclosed

spaces);

give immediate treatment to the casualty who is not

breathing and/or whose heart has stopped, is bleeding

severely or unconscious – others can be treated later;

send for help.

If there is more than one unconscious or bleeding casualty:

send for help;

n treat the most serious injury first in the order of:

• not breathing and/or heart stopped;

• unconsciousness.

• serious bleeding;

If the casualty is in an ENCLOSED SPACE:

n DO NOT enter the enclosed space unless you are a trained

member of a rescue team acting under instructions;

n send for help and inform the master.

It must be assumed that the atmosphere in the space is

hostile. The rescue team MUST NOT enter unless wearing

breathing apparatus which must also be fitted to the casualty

as soon as possible. The casualty must be removed quickly to

the nearest safe adjacent area outside the enclosed space

unless his injuries and the likely time of evacuation makes

some treatment essential before movement.

THE SHIP CAPTAIN’S MEDICAL GUIDE

General principles of first aid on board ship

The general principles are:

make a rapid examination of the patient to assess responsiveness and the extent of the

injury;

check breathing, heart and look for serious bleeding;

• if breathing has stopped, give artificial respiration;

• if the heart has stopped, give heart compression and artificial respiration;

• arrest serious bleeding;

handle the patient as little and as gently as possible so as to:

• prevent further injuries; and

• prevent further shock;

see that the patient is put in the most comfortable position possible and loosen tight

clothing so that he can breathe easily;

do not remove more clothing than is necessary and, when you do, remove it gently. With an

injured limb, get the sound limb out of the clothing first and then peel the clothes off the

injured limb, which should be supported by another person during the process. If cutting

clothes is indicated to expose the injured part, do so. In removing a boot or shoe remove the

lace and, if necessary, cut the upper down towards the toecap; keep onlookers away.

always remember that shock can be a great danger to life and one of the main objects of

first aid is to prevent this;

you may have to improvise splints, bandages etc. (Figure 1.23);

do not give alcohol in any form;

do not move the patient until he is fit to be moved. Bleeding should be arrested, fractures

immobilised and shock treated. See that the necessary personnel and equipment for

smooth and efficient transport are available;

never consider anyone to be dead until you and others agree that:

• breathing has stopped;

• no pulse is felt and no sounds are heard when the examiner’s ear is put to the chest;

• the eyes are glazed and pupils are dilated;

• there is a progressive cooling of the body.

(For a further description of the diagnosis of death Chapter 12).

General assessment of the situation

Once it has been established that there is no immediate threat to life there will be time to take

stock of the situation. Reassurance and quick and effective attention to injuries and

compassionate treatment of the injured person will alleviate his condition. Remember:

a calm and systematic approach should be adopted;

give nothing by mouth;

protect the casualty from heat or cold, remembering that in the tropics open steel decks can

be very hot;

never underestimate and do not treat as minor injuries:

• unconsciousness

• suspected internal bleeding

• stab or puncture wounds

• wounds near joints (see fractures);

• possible fractures

• eye injuries

Chapter 1 FIRST AID

Dressings, bandages, slings and splints

Standard dressing

A standard dressing consists of a thick pad of gauze which is attached to a bandage, leaving

about 30cm of tail. The dressing is packed in a paper cover and is sterile. Therefore, when the

package is opened, it is important that the gauze pad should not be allowed to touch anything

(including your fingers) before it is applied to the wound.

Standard dressings are available in three sizes:

Small Gauze pad measures 7.5 cm by 10 cm.

Medium Gauze pad measures 10 cm by 15 cm.

Large Gauze pad measures 15 cm by 20 cm.

Always select a dressing with a pad which is larger than the

wound which you have to cover up.

In use the pad is placed upon the wound, the tail is taken

round the limb and held, the bandage is held taut as it is

taken round the affected part so as to `lock’ the tail in

position. The bandaging can then be continued to hold the

dressing firmly in place by making turns above and below

the pad so that they overlap it (Figure 1.1).

Figure 1.1

Bandages

Bandages are required to apply and maintain pressure on a wound to stop bleeding, to keep a

dressing in place, to provide support, and to prevent movement. Wherever a standard dressing is

not used it is customary to cover a wound in the following ways:

dry dressing – sterile gauze or lint covered by a layer of cotton wool and held in place by a

roller or triangular bandage;

non-stick dressing – sterile paraffin gauze covered by sterile gauze or lint and cotton wool

and held in place as above.

NOTE: Never use cotton wool as the first layer of a dressing. When using lint always put the

smooth surface next to the skin.

Tube gauze finger bandage

Cut off a piece of tube gauze bandage

60 cm long. Lay this on a flat surface and

make a longitudinal cut at one end

10 cm long through both thicknesses of

the bandage (Figure 1.2). The tails so

formed, ‘B’, will be used to secure the

bandage.

Insert the applicator into the

bandage at end ‘B’, then push all the

bandage on to it. Then pull 2.5 cm of

the bandage off the end of the

applicator (Figure 1.3). Tuck this inside.

Hold the finger dressing in place.

Insert the finger into the applicator and

push it gently towards the base of the

finger. Hold the bandage in place with

your thumb and withdraw the

applicator with a slight turning motion.

The bandage will slip off the applicator

and will mould firmly to the finger

(Figure 1.4).

60 cm

B 1

B 2

10 cm

Figure 1.2

Figure 1.3

B 1 B 2

Figure 1.4

THE SHIP CAPTAIN’S MEDICAL GUIDE

Figure 1.5

Figure 1.6

Figure 1.7

When the applicator comes off the finger, hold the bandage and the applicator firmly and

turn through 360 degrees (Figure 1.5).

Re-insert the tip of the finger into the applicator and push it once again to the base of the

finger (Figure 1.6).

Repeat the complete manoeuvre until the bandage is all used up. Then tie loosely at the base

of the finger (Figure 1.7). Tape the base of the dressing avoiding encircling the finger.

Triangular bandage

This is the most useful bandage in first aid. It can be used as a broad or narrow fold bandage to

hold dressings in place. It can also be used for immobilising limbs or as a sling. It is made from

calico or similar material by cutting diagonally across a square of material having 1 metre sides.

The ends should always be tied with a reef knot.

(a) Triangular bandage laid flat.

(b) Folded once.

(d) Folded three times – narrow fold bandage.

Figure 1.8 Broad and narrow fold bandages.

Broad and narrow fold bandages

Figure 1.8 shows how to make a broad and a narrow fold bandage.

The main ways in which a triangular bandage can be used, either as a temporary dressing or

to secure or cover a proper dressing, are as follows:

Hand bandage

See Figure 1.9

Wrist and palm bandage

Place palm on the middle of a narrow fold bandage. Take the ends and cross the bandage at the

back of the hand, leaving out the thumb. Take turns of the bandage round and round the wrist

and tie off at the back (Figure 1.10).

Chapter 1 FIRST AID

(a) Place the hand on the

bandage. Bring down point ‘C’

over the back of the hand to the

wrist

(b) Turn ‘A’ over the back of the

hand, under ‘B’ and half around

the wrist.

hand, over ‘A’ and half around

the wrist.

(d) Take turns with ‘A’ and ‘B’

round the wrist and tie off.

(a)

(b)

(c)

(d)

Figure 1.9 Hand bandage

Elbow bandage

Fold over the base of the bandage and place the back of the

elbow in the middle of the bandage so that the point lies at the

back of the upper arm. Take the ends of the bandage round the

forearm, cross them in the bend of the elbow, and then take

them round the upper arm – to make a ‘figure of eight’. Tie off

at the back of the arm about 10 cm above the elbow. Fold down

the point and fix it with a safety pin (Figure 1.11).

Figure 1.10

Shoulder bandage

Stand facing the casualty’s injured side. Place the centre of an

open bandage on his shoulder with the point running up the

side of the neck (Figure 1.12a). Fold a hem inwards along the

base, carry the ends round the middle of the arm, cross and tie

them on the outer side (Figure 1.12b). This will secure the lower

border of the bandage. Apply an arm sling. Turn the point of the

shoulder bandage already applied down over the knot of the

arm sling. Pull it tight and pin it in place (Figure 1.12c).

Figure 1.11

(a)

(b)

(c)

Figure 1.12

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