I was recently speaking with a captain at an MSOS Medical Care course, who described what he referred to as the worst moment of his 30-year yachting career. A tender was not starting in a moderate sea and he asked a deckhand to jump from the main vessel to the tender, to assist. But as he jumped, the tender lurched away from the yacht and he fell in between the two vessels. This captain recounted with disbelief how fast the crew member drifted away from the vessel, fighting with the sea conditions. This story had a positive outcome as the crew member was rescued, but it is a good reminder that drowning incidents can happen when least expected. The statistic that most children drown whilst two adults well-known to them are close by, is sad proof of this fact.
Some other drowning statistics:
- Worldwide, 1000 people die every day from drowning; 2 every 3 minutes; 41 per hour.
- It is the world’s third leading cause of accidental death
- 64% of people who drown are under 30 years old
- Male to female ratio of drowning is 2:1
- In 40% of drowning victims, alcohol was on board.
There is a risk when entering cold water, particularly, unexpectedly (falling at night after heavy drinking or jumping in from a height). Your cold sensors trigger a gasp reflex and if you are submerged or have a wave breaking over your face, you can immediately inhale the 22ml/kg of saltwater required to completely fill your airway and drown. After the initial cold water shock, the possibility of heat loss and exhaustion reducing your swimming ability is the main risk. And those with smaller body surface area (children) or less fat (older adults) can struggle more quickly.
Drowning is a form of suffocation, the airway is filled with water meaning air & oxygen cannot enter the body. Without oxygen going to the brain, the person will quickly fall unconscious. In most cases, within 10 minutes of being unconscious, there will be irreversible damage due to lack of oxygen. Previously, there were many different terms for drowning – dry, saltwater, freshwater, passive and secondary. Today, however, drowning is simply described as a process and there are three outcomes; survival with complete recovery; survival with disability; or death. How quickly and effectively a drowned person is responded to and cared for can have a significant impact on the outcome.
So What are the Considerations for Yacht Crew?
Prevention:
Keep a close eye on all those in the water, particularly children and older adults. Look out for the signs of someone just about to drown a person just about to drown cannot call for help. They are expending all their energy keeping their airway above the waterline, head flopped back, hands under the water thrashing, and focused on survival. Drowning is a silent killer.
Response to Drowning:
Tell someone struggling in the water to rest, relax and float. Focus on safe rescue by getting them a flotation device. If they are unconscious, quick and safe retrieval is vital. Outcomes improve dramatically if lifesaving is commenced within 10 minutes.
If there is a lot of water or foam in the mouth, quickly clear with a suction device; 10-15 seconds only. Start continuous breaths and chest compressions as soon as possible, preferably using a bag valve mask with oxygen or a demand valve system. If you cannot start compressions during rescue, start with the breaths and then start compressions as soon as they are on a hard surface. Give 10-20 breaths per minute and 100-120 compressions per minute (hard and fast) at a depth of 1/3rd of the chest. As soon as possible, dry the casualty and the area, connect them to a defibrillator and ensure no water contact between casualty and rescuers. Apply pads and turn on, follow shock prompts and continue CPR, looking for signs of life in between.
If a person has survived a drowning, there is still a risk their lungs will react to the ingress of water. They should be monitored closely for the first 6 hours when it is most likely they will deteriorate, and treated for shock as required; reassure; raise legs; keep warm; give oxygen & fluids – as directed by a telemed doctor. Continue to monitor for the next 24 hours and get them to a health facility at the earliest opportunity.
Equipment:
You must know what equipment you have onboard for in-water rescue, and how to use it. Train regularly with your man overboard equipment, build brain-muscle memory on where the equipment is located around the deck, and how to deploy it. If you are swimming with guests or children and you are unsure about their ability, take a flotation device.
Jason’s Cradle:
A device that is deployed from the vessel or tender to remove a casualty from the water quickly.
Water Rescue Stretcher:
We recommend the ‘Ferno Aquaboard’ due to its simple strapping system and spinal immobilisation straps (keeping the spine fixed in position and head in-line with the body. Spinal immobilisation is required for anyone who has a suspected injury to the head or spine. For example; jumping off a high inflatable and hitting the water or hitting the seabed after a shallow water dive. Practice the strapping system on the vessel, and in a safe location practice an in-water rescue with your device.
Medical Kits & Telemedicine:
If the casualty is not breathing, they need to receive breaths and oxygen as soon as possible. MSOS provides an advanced tender medkit (which includes an oxygen delivery system), and additional oxygen kits for swim platforms. Locate the trauma and oxygen kits you have on board and ensure you can retrieve them quickly and that they are checked regularly.
STAY SAFE IN THE WATER. DON’T UNDERESTIMATE THE CONDITIONS – OR OVERESTIMATE YOUR ABILITIES!
By Sara Paterson RN DTN Bsc
Training Instructor & European Sales
Medical Support Offshore Ltd
