Factors beyond the crew’s control – such as an unhealthy guest or owner with a high blood-pressure and cholesterol or a guest who believes he is Michael Phelps when in reality he can’t swim a lap – can cause potentially life-threatening problems on board. These two types of people are at high risk for the top two medical emergencies yacht crew are likely to encounter: heart attacks and drowning.
Heart Attacks
According to the World Health Organization (WHO), cardiovascular disease (CVD) or heart disease accounts for about 30 percent of deaths worldwide. WHO also reports that CVD is the leading cause of death in Europe and the U.S. In a recent Dockwalk.com article, Kelly Sanford reported that “a man over the age of 40 has a one in eight chance of sudden cardiac death.” However, it is not only men who are at risk. WHO claims, “CVD causes 8.5 million deaths among women annually. It’s the largest single cause of mortality among women, accounting for one-third of all deaths in women worldwide.”
The likelihood of a captain, guest, owner or even a fellow crewmember with CVD – or at least the precursors: high blood pressure, high cholesterol, diabetes, smoking, stress, obesity and the list goes on – is high. While CVD can take many forms, the two main forms are coronary heart disease (CHD) and stroke and the main form of CHD is a heart attack.
If faced with a possible heart attack, crew must know the symptoms. According to 2009 article on Dockwalk.com by Paulo Magalhães Alves, M.D. of MedAire titled “Treating Chest Pain at Sea” these are the symptoms of a heart attack:
· Chest pressure
· Tightness or heaviness in the center or slightly to the left associated with nausea
· Shortness of breath
· Cold sweats
· Radiation of the discomfort to left shoulder and arm.
Once crew have assessed that someone is indeed having a heart attack, they must act quickly. If near land, the first duty is to call emergency services. If the yacht is not near land, call a telemedicine company such as MedAire. Immediately follow this with cardiopulmonary resuscitation (CPR), which all crew should be familiar with from their STCW training. If no pulse is found, the victim is unconscious or is not breathing, a defibrillator can be used. Raising the legs of the victim can help circulate the victim’s blood. Keep the victim as comfortable as possible until you are able to get them professional medical help.
Drowning
Drowning and near-drowning accidents are also a risk on board. According to WHO, hundreds of thousands of people drown each year.
While drowning can happen to anyone, the International Life Saving Federation says that three particular age groups are the most susceptible. Children under five years old, 20- to 25-year-olds and those over 60 have the highest percentages of drowning deaths. Also, WHO says, “Males have the highest drowning-related mortality rates worldwide. Studies suggest males have higher drowning rates than females due to increased exposure to water and riskier behavior, such as swimming alone, drinking alcohol before swimming alone and boating.”
A previous article that ran on Dockwalk.com by Kelly Sanford titled, “Responding to a Drowning Victim,” explains the proper way to respond to a drowning victim.
The ABC’s for drowning:
Airway
The idea that lungs fill completely with water in a drowning incident is a bit of a misconception. Ginger Bartos, RN, of MedAire/MedLink says, “Most often, there is a small amount of water inhaled and an involuntary spasm of the epiglottis that prevents the lungs from being completely filled.” Therefore, attempting to execute a Heimlich or other maneuver to rid the lungs of water is not recommended; instead, it is important to assist the victim in breathing as soon as possible. Lift the neck and tilt the head backward. Open the victim’s mouth to check for any noticeable obstruction.
Breathing
If the airway is clear and the victim is still not breathing, keep the head positioned with the neck up and head back, pinch the nose and deliver two full breaths. Each breath should take one second. If the victim is a child, use a shallower breath.
Circulation
If the victim is still not breathing, coughing or showing signs of resuscitation and you cannot find a pulse, then begin chest compressions. Hands can be quickly positioned by placing them in the center between the two nipples. Push down on the chest from 1.5 to 2 inches 30 times at the rate of 100 times per minute (which is faster than once per second – count one-and-two-and-three…). Check for breathing and a pulse and repeat the 30-to-two, compressions-to-breaths as necessary.
Kelly writes that alcohol or drug use is attributed to about 50 percent of adult drowning deaths. It is important to keep this in mind when responding to a victim.
According to an article published by Dipak Chandy, MD, assistant professor of medicine at New York Medical College, ‘If you were to rank, by importance, the risk factors that contribute to drowning and near-drowning, the list would look like this:
· Inability to swim or overestimation of swimming capabilities
· Risk-taking behavior, including the use of alcohol and illicit drugs
· Inadequate adult supervision of children
· Trauma (such as a physical injury), seizures, stroke, heart attack or heart arrhythmia
· “Shallow water blackout,” in which swimmers hyperventilate in order to swim longer under water. This can lead to a lack of oxygen in the brain and loss of consciousness.
· Hypothermia, or lowered body temperature. This can lead to heart arrhythmia and rapid exhaustion.
Both heart attacks and drowning are serious emergencies on board a yacht, but if crew are prepared, lives can and will be saved – vigilance and knowledge are key.