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Casualty management

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zippyRN View Drop Down
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Topic: Casualty management
    Posted: 12 Jan 12 at 9:34pm
In the light of  incident in Aus discussed here http://www.yachtsandyachting.com/forum/forum_posts.asp?TID=8905&title=unfortunate-event-at-australian-youth-championship maybe it's time for another 'rescue' topic 

my first question  primarily to  those who advocate single crew rescue boats or rescue crews where the 'crewman' is not dressed to enter the water   - how would you deal with this especially if it were a single hander or the crew of the casualty vessel was not 'together' enough  ( or in the case of club racing  where the crew might be a child and the helm a parent - physically capable of assisting )?

with my Health Professional Head on - my  first thought and the first thought of marshals and first aid / ambulance personnel at a motorsport even where you have a competitor knocked out  would be the possibility of spinal injury 

How many clubs  even possess Spinal immobilisation kit  never mind routinely  carry it on rescue boats  and have crews trained to use it 

- use of a long extrication board is a core part of the pool lifeguard qualification in fact Ferno make a specific   model of board for aquatic use  http://www.ferno.co.uk/product/aquaboard

although the majority of long extrication boards are buoyant  and water proof ( being either rotomoulded or GRP ) while straps and head restraints might not be .

You can't rely on the Ambulance service being able to assist in a timely manner as  ordinary crews aren't water rescue trained - so we'd be relying on HART or the the Fire and Rescue service inland and the RNLI / Coastguard  in coastal waters 

I have visions of spending 30 or 40 minutes 'on scene'  with a hypoxic head injured patient  who is being handled poorly , and becoming more and more hypothermic because of a lack of preparation 

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sargesail View Drop Down
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Post Options Post Options   Quote sargesail Quote  Post ReplyReply Direct Link To This Post Posted: 12 Jan 12 at 10:26pm
Zippy,

I'm puzzled by this.  I get the fact that they might have a spinal injury.  However surely in the majority of the conditions in which an injury would occur they would not only be at risk of drowning and hypothermia as you mention but would also have a very mobile spine due to the waves and the requirement to support them.

Next someone will be suggesting that I shouldn't lift their face from the water if they are wearing a BA not a lifejacket because thee might be spinal damage.

Surely the speeds and impacts are much less than motorsport an the risks of spinal injury much reduced.

Totally agree that rescue boats must have 2 crew.
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 12 Jan 12 at 10:41pm
Originally posted by sargesail

Zippy,

I'm puzzled by this.  I get the fact that they might have a spinal injury.  However surely in the majority of the conditions in which an injury would occur they would not only be at risk of drowning and hypothermia as you mention but would also have a very mobile spine due to the waves and the requirement to support them.


unless it was some horrid short chop an inert, 'relaxed' body  in the water wouldn't be undergoing a lot of violent movement  and is supported fairly evenly along their length by being semi immersed  ( assuming they are in BA, wetsuit / drysuit  +/- trap harness )

rather than ragging them about and them flopping all over the place as they are dragged from the water over the the side of a rescue boat and dumped in a heap on the floor ... 

Next someone will be suggesting that I shouldn't lift their face from the water if they are wearing a BA not a lifejacket because thee might be spinal damage.

 the gold standard would be to roll them while trying to keep them in line 

Surely the speeds and impacts are much less than motorsport an the risks of spinal injury much reduced.

still fairly high energy - and stuff like BMX (racing rather than the stunt / freestyle stuff)) still has the same sort of marshalling and medic-ing considerations  despite lower  energies 

it's a fair old whack to knock someone out 

Totally agree that rescue boats must have 2 crew.

if you look at previous  debates   on here it's suprising  that there isn't  consensus on this or that  you need to be ready to go in the water as rescue crew  to save life or limb 
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Post Options Post Options   Quote sargesail Quote  Post ReplyReply Direct Link To This Post Posted: 13 Jan 12 at 8:57pm
Originally posted by zippyRN

Originally posted by sargesail

Zippy,

I'm puzzled by this.  I get the fact that they might have a spinal injury.  However surely in the majority of the conditions in which an injury would occur they would not only be at risk of drowning and hypothermia as you mention but would also have a very mobile spine due to the waves and the requirement to support them.


unless it was some horrid short chop an inert, 'relaxed' body  in the water wouldn't be undergoing a lot of violent movement  and is supported fairly evenly along their length by being semi immersed  ( assuming they are in BA, wetsuit / drysuit  +/- trap harness )

rather than ragging them about and them flopping all over the place as they are dragged from the water over the the side of a rescue boat and dumped in a heap on the floor ..

Is that you're professional opinion (I'm guessing that the RN might mean Navy)...because I am entirely unconvinced by that.  Especially as I am imagining a desperate helm/crew supporting the casualty and remaining contact with their boat - the refuge of safety.

Next someone will be suggesting that I shouldn't lift their face from the water if they are wearing a BA not a lifejacket because thee might be spinal damage.

 the gold standard would be to roll them while trying to keep them in line 

I'll buy that - but I just can't bring myself to forget that breathing comes first.  Nor do I understand why this has never been taught/considered in any of the many water based first aid courses I have attaneded.

Surely the speeds and impacts are much less than motorsport an the risks of spinal injury much reduced.

still fairly high energy - and stuff like BMX (racing rather than the stunt / freestyle stuff)) still has the same sort of marshalling and medic-ing considerations  despite lower  energies 

it's a fair old whack to knock someone out

Yes - but in 30 years in the sport I have no recollection of hearing about a single spinal injury on a dinghy.  By and large impacts are between boats and boats - on the rare occasions that they are not I can not see a correlation between a BMX racer at 30 mile an hour with plenty of air, and a dinghy at 20knots (closing speed).

So can you cite any dinghy sailing spinals?  I'm just interested because it's not a risk I have really factored in - and I'm not sure that I buy into all of your arguments but if it is then I want to ask some questions about techniques etc.

Totally agree that rescue boats must have 2 crew.

if you look at previous  debates   on here it's suprising  that there isn't  consensus on this or that  you need to be ready to go in the water as rescue crew  to save life or limb 
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 14 Jan 12 at 12:40am
Sarge  i found your last reply  hard to read 

i'm not sure of any SCIs  from Sailing but given the fact Tess Lloyd was knocked clean out and  needed Neurosurgery and is still  anaesthetisted on ICU ...  

boat to boat collisions is not necessarily the issue  ,although someone  on the wire  thrown forward  in a collision  or someone struck by a boom with the full force of a crash gybe  is getting a lot of energy exchange in a short period of time 

as for the point about an unconcious crewmember and their partner holding on to them and the boat  the unconcious person is either going to be on their back being held / towed in the classical lifeguarding  'chin tow'  or semi erect  pulled up again their crewmate  with one of their crewmates arms under their axilla 'hugging' them to keep their head out of the water ( resting on their crewmates shoulder )  and the other arm treading water or holding on to the boat .

wrong guess on the RN ... given the topic is casualty management what else might it mean ?  ( to save people from further puzzlement I'm a registered Nurse and my clinical  background is in three main areas - prehospital care, Emergency departments and Spinal injuries rehab)
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Post Options Post Options   Quote sargesail Quote  Post ReplyReply Direct Link To This Post Posted: 15 Jan 12 at 9:29pm
OK - I'll park my concerns.  Had you been an RN waterborne medical specialist I'd maybe have seen it differently, but without any evidence of spinal injuries and with just one case where I don't htink we we even know the mechanism of injury I'm not going to worry about equioment or training.
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Post Options Post Options   Quote jeffers Quote  Post ReplyReply Direct Link To This Post Posted: 16 Jan 12 at 12:38pm
The simple answer is make sure you club mandates all boats with a 'safety'role to have 2 able bodied people on board, one of whom is dressed to enter the water.
 
It is common sense if you ask me but should be written down.
 
We have the rule at Hunts and we are a small inland club where the shore is never much more than 30 secnds way by powerboat at full throttle.
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Post Options Post Options   Quote radixon Quote  Post ReplyReply Direct Link To This Post Posted: 16 Jan 12 at 8:30pm
The RYA Safety boat course or first aid course do not deal with spinal boards. I dont think it is something that should worry us. Hyperthermia and drowning are more of an issue with sailing than having a back injury.


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zippyRN View Drop Down
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 16 Jan 12 at 10:46pm
Hypothermia is a significant consideration,  but cold shock is more likely to kill you 

and why might people sailing drown ?  because of head and neck injuries   from the boom striking them  or being struck by another boat ... 

 the " it'll never happen " has happened  with the unfortunate incident in Aus , will it take a fatality for attitudes to change ?





Edited by zippyRN - 16 Jan 12 at 10:48pm
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Post Options Post Options   Quote zippyRN Quote  Post ReplyReply Direct Link To This Post Posted: 16 Jan 12 at 11:42pm
For those asking aobut injury prevalence etc  - a  very quick and dirty literature review throws up a variety of discussion in professional literature as well as general news items and specific information from sailing clubs 








part of the problem is drilling down through all the over use vs acute trauma and the fact that 'sailing' as a whole  can  cover a variety of disciplines - including  windsurfing and kiteboarding at times as well as dinghy / keelboat/ yacht
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