Initial Considerations in Planning the Voyage
Introduction - The Skippers Medical Emergency Handbook
The SMEH is a valuable compendium of knowledge on how to anticipate and mitigate medical risks of voyages at sea, whether coastal or transoceanic. It also provides an excellent resource on how to treat trauma and medical conditions if they arise when a sea. Some parts of the book should be read and assimilated prior to slipping lines, whereas other parts are for guidance on treatment if, despite the best planning, things go wrong, and action is required.
Initial Considerations in Planning the Voyage
Voyage planning is a complex affair and takes time, knowledge and experience. If you are lacking in any of these areas, get help and advice from someone who has the necessary expertise. Planning medical resource and support is a specialized part of this process. It is essential, because when the worst event happens, the planning process is irrevocably over, and the action must begin. If proper planning has not been undertaken, the action will be pathetically poor, and may further endanger life and limb. This is the rule of 6 Ps.
There are a number of main areas to be considered, which affect the medical planning for any voyage, whether it is a quick race around the cans on a cold winters day, a cruise in the Caribbean, or an exploratory voyage to the polar regions. These areas are considered below.
1. Length of voyage
This equates to time at sea, and therefore to the amount of medical supplies required. Also, the complexity of medical conditions that may require treatment increases in direct proportion. Generally, longer voyages require fitter crew, with fewer pre-existing medical conditions. Medical support on board and from onshore should be more comprehensive for longer voyages. Contingencies must be built in for unforeseen events and accidents that unavoidably significantly prolong the voyage.
2. Location and route
Availability of medical support and rescue facilities reduces rapidly as the route moves away from inhabited land and the working range of coastguard helicopters. Some areas of the oceans, such as the North Atlantic, are busy with commercial traffic, which may be a source of medical aid. Other areas, such as the Southern Ocean, are one of the last true wildernesses of the world, where rescue may be weeks away. Routes that venture in to the polar and equatorial regions bring special climatic medical risks. Ports of call may pose particular risks, in malarial regions for instance.
3. Type of voyage
Racing confers increased risk of trauma as the boat is driven forward on the edge of control, and sometimes beyond it. Cruising may be less directly injurious but the crew perhaps older with more medical baggage. Diving offers special risks of barotrauma, decompression sickness and gas problems.
4. The boat
It should be common sense that the boat is fit for purpose, but there are many examples where the boat has first injured, then drowned, the occupants. From the medical point of view, it is worth considering how an injured crewman would be evacuated from deck to below or to a helicopter, where simple ‘operations’ may be performed safely, where the medical kit and grab bag should be stored for rapid access in an emergency. Larger boats have the advantage of having dedicated space and weight carrying capacity for medical activities and stores.
5. The crew
More rigorous, remoter, longer, colder or warmer routes, require fitter crew and more comprehensive medical training for the skipper and medic. Short-handed crew work harder, become more exhausted, and consequently incur more injuries and illnesses.
Medical screening of crew may be considered necessary, particularly where the voyage is more onerous.
A crucial task is to identify a suitable candidate for the position of ‘medic’, who will support the skipper in dealing with medical problems aboard. The skipper must be up to date also, as the medic will need a plan B if they themselves are injured.
6. Ports of call
All possible ports of call should be identified, either as scheduled stopovers, or for use in an emergency. Facilities for rescue, definitive care, and medical re-supply require consideration.
Conclusion
The Rule of Six ‘P’s’ is paramount when venturing in to remote areas, whether at sea or on land.
Proper Preparation Prevents Pathetically Poor Performance.
A voyage should always be set up to succeed rather than to fail, and most actions, as discussed here, are straightforward and easy to achieve. They just require thought, insight, and knowledge. And that is why the SMEH is so useful!!