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Immediate medical problems aboard survival craft
Trauma
Injuries should be handled as outlined in Chapter 4. However, a prepared medical survival kit might not be available, so the rescuers will have to improvise. The following measures are suggested.
The first objective in caring for any injured person is to provide life-saving treatment. Without equipment this may be accomplished by:
· controlling haemorrhage with direct pressure;
· giving mouth-to-mouth artificial respiration when needed, by heart compression
· treating shock by placing a survivor's head lower than the rest of his body, and keeping him warm
· treating fractures by strapping the extremity to the opposite side, if nothing is available that can be used for splinting (for example, splint one leg to the other, one arm to the chest, or one forearm to the other with hands touching elbows);
· relieving pain by simple reassurance and giving medicines, if available.
Persons rescued from drowning
Those rescued promptly, from drowning usually recover spontaneously, if they have not spent too much time in cold water and their body temperature has not been abnormally lowered.
Treatment
Treatment for persons who have almost drowned should consist of immediate mouth-to-mouth artificial respiration, and heart compression, if needed.
If the person has trouble breathing, mouth-to-mouth artificial respiration may be helpful, even though he is breathing on his own. Efforts to drain water from the lungs of those rescued from drowning are not generally indicated or helpful, and should not be attempted. However, victims tend to swallow large volumes of water and their stomachs may become distended. This distension impairs ventilation and circulation, and it should be alleviated as soon as possible. The water may be forced out and distension relieved by turning the victim on his side and compressing the upper abdomen. Also, the victim may be turned over into a face-downwards position and lifted under the stomach with the rescuer's hands to force the water out.
Generalized hypothermia due to immersion
As already mentioned, generalized hypothermia is the leading cause of death among shipwreck survivors.
In a cold environment, body-heat production will automatically increase in an effort to balance heat loss. But, if the rate of heat loss exceeds the rate of heat production, then the body temperature must fall and hypothermia will result.
Generalized hypothermia commonly occurs in most survivors extracted from cold water. The victims are strikingly pale, frequently have generalized muscular rigidity, are shivering, and exhibit varying levels of consciousness and shock. In addition, death by drowning is a frequent consequence of weakness caused by hypothermia, supervening before death from hypothermia alone would have occurred.
Treatment
The treatment for hypothermia will depend on the condition of the survivor. Generally speaking, survivors who are rational and capable of recounting their experiences, although shivering dramatically, merely need to have all their wet clothes removed and replaced with dry clothes or blankets. However, always bear in mind that even conscious survivors can collapse and become unconscious shortly after rescue. Alcohol should be avoided at all costs.
In more serious cases, in which the survivor is not shivering and is semi-conscious, unconscious, or apparently dead, immediate first aid measures will be necessary to preserve, life.
The following measures are recommended for dealing with such a survivor:
· On rescue, always check the survivor's breathing.
· If the survivor is not breathing, ensure that the airway is clear and start artificial respiration immediately (mouth-to-mouth or mouth-to-nose).
· Attempts at providing basic life support should be continued for at least 30 minutes (if medical advice is not available).
· If the survivor is breathing but unconscious, lay him in the unconscious position. This is necessary to ensure that his breathing is not obstructed by his tongue or by vomit.
· Avoid all unnecessary manhandling; do not even remove wet clothes; do not massage.
· Prevent further loss of heat through evaporation and from exposure to the wind. Wrap the patient in blankets, preferably keeping him horizontal with his head slightly down.
Emotional factors
Under ideal conditions the healthy uninjured person may be able to survive 3 days at sea in a lifeboat or raft. However, survival for more than a month is not uncommon. The single most important factor in castaway survival is the will to live.This has been proved time and again in sea disasters and "ditchings".
The actions and emotional stability of the castaways depend first upon the morale and psychological strength of both the group and the individual. A group of experienced seamen, for instance, will be psychologically stronger than a group of shocked passengers.
As time is spent on the survival craft awaiting rescue, the group's morale may weaken seriously. Keeping survivors active is important. An assignment to various tasks - nursing care, supply tally, rescue watch, among other activities - will divert and occupy the mind and may help to keep hopes high. Lone survivors should make every effort to conserve energy and resources. They may imagine that they hear voices or see things that are not really there. Keeping the mind active with mental exercises may help to prevent this development.
Mental derangement may appear at any time before orafter the rescue.
It is the duty of all survivors to recognize and treat mental disturbances, but the ultimate responsibility rests with the captain of the survival craft. Anxiety is most contagious and can destroy chances of survival on the open sea.
The best treatment for anxiety is to reassure patients and other people in the lifeboat and assign small tasks to keep them occupied. Acute agitation should be treated promptly, as the situation demands. For some victims forcible restraint may need to be applied. Morphine sulfate, 10 mg intramuscularly, repeated every 4 hours as needed, may serve to calm the anxious.