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Old 28 May 2009, 10:44   #11
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Interesting point that, about having a doctor on board.

I instruct my crews it makes no difference - in such an example, which we ran through at this mornings meeting, the procedure is exactly the same - pan call, head for nominated landing point. The only difference is you mention to CG that a doctor is attending, after all a doctor on a boat can only do a limited amount without backup, and for spinal cases early immobilsation is the key.
Dunno about that - I would rather a doctor without equipment than an idiot with a whole hospital behind him. Remember that case where a surgeon on a BA flight used a coathanger and some cling flim to save someone with a collapsed lung???

http://www.independent.co.uk/news/uk...s-1308095.html
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Old 28 May 2009, 18:10   #12
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Two things I found really worrying in that report - one was the length of time from reaching a safe haven to an ambulance attending (around 1 hour), but the other was the total disregard both owner and skipper had for their own operating procedures immediately after the incident. ANY spinal injury causing extreme pain to the casualty is at minimum a case for a pan call - mayday if severe pain around the upper back or neck. But a mobile phone call bypassing the Coastguard totally - I notice in the MAIBs usual coded language they raise the possibility of this being due to the company not wanting adverse publicity. For the MAIB to even raise this "possibility" usually means they're pretty damn certain that was the reason!
There was no excuse in this case - the company couldn't even say the skipper (who appeared woefully underqualified) ignored procedures - the boss was on board!
Given the amount of these injuries on this type of boat, there is a very strong case for a specific "fast passenger craft" coding annexe, part of which I believe should be for the boat first aid kit to include O2 and at the very least a KED (short spinal board) and crew training to use both - a one day course usually.
Shock absorbing seating is a desirable, but not something you're going to achieve without pricing a lot of operators out of the business.
I think if you need O2 and a KED on board you have got your risk assessment/risk management all wrong - that is responding to the risk by expecting casualties and treating them rather than reducing the risk.

Since we weren't there we can only assume the conversations on board. But I note that it was another passenger rather than the doctor treating the casualty that prompted the 999 call. And that the doctor waited a long time before recalling. That suggests to me that perhaps the doctor had not suspected the severity of the injury (or shared that with the skipper/owner).
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Old 29 May 2009, 03:50   #13
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Given the amount of these injuries on this type of boat
I haven't seen any reliable stats, where do you get your information from? I don't get the impression from the operators I work with (and I accept all the arguments about "they would say that wouldn't they") that this is a regular occurence. In fact, the number of injuries seems very small from what I can see

I'm with Polwart on this. I do recognise there is a risk and the potential injuries are serious, but I think we have to be careful not to over-react. We will never remove risk from operations at sea, and we need to be sensible about how we manage the risks that do exist. In this situation, better briefing and better boat-handling would probably have mitigated the risk fairly well. Yes, there may still be occasions when accidents happen - but we don't carry spinal boards and 02 in our cars, and I suspect there is a greater likelihood of being involved in a situation where that equipment would come in useful on the road than on the water. If and when an unusual accident happens, we call for specialised help - we don't expect to have to manage every eventuality ourselves.

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Old 01 June 2009, 10:08   #14
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As a paramedic a few of my own opinions:

O2 is of precious little use in the vast majority of injuries. In fact there are a lot of things that recent evidence shows may be made worse by the administration of O2, for example stroke and heart attack.

Having a doctor, or anyone else qualified is useful, but where and what they practice is very relevant. I'd rather have a RYA safetyboat instructor with a really good first aid qualification than a surgeon who last practiced outside of hospital 20 years ago. In my experience it is often the people with the most knowledge of the environment they are in that can foresee potential problems in managing and moving a casualty.
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Old 03 June 2009, 12:23   #15
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I think if you need O2 and a KED on board you have got your risk assessment/risk management all wrong - that is responding to the risk by expecting casualties and treating them rather than reducing the risk.
We do that - but then most of the jobs we're at, we're there for the specific contingency of something going wrong, for example one of our main jobs is sitting under cables over rivers whilst they're being worked on.

Large passenger vessels carrying a KED is mitigating an assessed risk - yes, the "mechanism of injury" risks should be addressed and if possible removed first, but inevitably there will be times when with the best will in the world a situation may occur beyond the normal planning. Dynamic RA is more important here that written, but it doesn't mean the situation will never happen.

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but we don't carry spinal boards and 02 in our cars, and I suspect there is a greater likelihood of being involved in a situation where that equipment would come in useful on the road
Absolutely, but in all but the most rural of areas two things change this reasoning - time to appropriate care, and improvised stability - for example, someone injured in an RTC can be kept still where they are in most cases until appropriate care arrives, but at sea this is not possible.

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I haven't seen any reliable stats, where do you get your information from?
I was using the instances quoted by MAIB - maybe small in terms of the number of passengers carried successfully, but it would appear to be a higher ratio of injuries sustained than would be expected.

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In fact there are a lot of things that recent evidence shows may be made worse by the administration of O2, for example stroke and heart attack.
Yep - agree, and we've changed our response to reflect the new JRCALC findings, although the research around this is far from definitive yet.

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Having a doctor, or anyone else qualified is useful, but where and what they practice is very relevant
Again, agree totally, The doctor on the plane example was lucky - there is a gulf of knowledge of emergency care between, say, a rural GP and a BASICS trauma doctor although on paper the quals may be similar. The fact that someone is a doctor does not make them any more experienced in hostile environment medicine than someone with lower quals.
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Old 03 June 2009, 17:52   #16
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We do that - but then most of the jobs we're at, we're there for the specific contingency of something going wrong, for example one of our main jobs is sitting under cables over rivers whilst they're being worked on.

Large passenger vessels carrying a KED is mitigating an assessed risk - yes, the "mechanism of injury" risks should be addressed and if possible removed first, but inevitably there will be times when with the best will in the world a situation may occur beyond the normal planning. Dynamic RA is more important here that written, but it doesn't mean the situation will never happen.
but it sounds like you work in quite different circumstances from typical passenger vessels. To use a KED effectively and properly you need to practice with it regularly - that time would probably be better spent training in boat handling to avoid the risk!

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Absolutely, but in all but the most rural of areas two things change this reasoning - time to appropriate care, and improvised stability - for example, someone injured in an RTC can be kept still where they are in most cases until appropriate care arrives, but at sea this is not possible.
you assume that the time to appropriate care is significantly different at sea. Actually since most of these trips are only about 1 hour long they are never more 30 minutes from the launch point - and I would suggest probably a similar time from a lifeboat and possibly chopper. Whilst that is longer than you would hope for in a RTC it is not inconceivable, and certainly possible in mountain bike, rock climbing, horse riding, hang/para gliding, etc. Not withstanding the inevitable problems of carrying gear - it would not be considered normal to carry that sort of gear in those, probably higher risk activities, nor would it even be normal to have that sort of gear at any "base camp" for those activities - relying instead on calling professional help.

My instinct would have been that heart attack was a greater risk - and not easily mitigated ? Do you think all passenger vessels should carry AEDs?
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Old 04 June 2009, 04:50   #17
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Polwart - if you look at the post, you'll see I'm talking about the potential to immobilise during the wait for immediate care - I've been on mountain rescue teams as well as lifeboat crews, and yes, sometimes these can be protracted waits for the casualty -but - and it's a key but - at sea it is extremely difficult in smaller passenger vessels to prevent casualty movement, even if due purely to the sea conditions. Any other type of land accident, except where the need to move the casualty away from further danger prevails, the casualty can be kept still to prevent further damage. in the Celtic Pioneer example, the journey to shore could have quite probably increased the damage from the original wedge compression injury - and it is at this point that good spinal care would have been more important.

Yes, KEDs require training - but so would an AED, and indeed anyone thinking that any form of first aid means getting the ticket then not revisiting for 3 years until a requal is needed should look long and hard at their operating procedures!
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Old 04 June 2009, 05:31   #18
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This is a matter for the operator, and I hope it stays that way (at this level of risk assessment, anyway)

If the owner/operator feels that there is a significant risk, and wishes to carry specialist extra equipment (and has the space to accomodate it), he's free to do that.

For most operators, I think they should review their procedures and perhaps some will make changes, but I expect most will take the view that the Celtic Pioneer incident was an isolated though regrettable accident and doesn't justify the level of change that would require them to train crew and carry KEDs or similar

My opinion
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Old 04 June 2009, 07:33   #19
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Agree totally Ian, it is a matter for the operator - but - given that this operator had clearly defined emergency procedures which promptly went over the side when something actually happened, it is likely to prompt the MCA towards more heavy-handed regulation to justify a few jobs at Spring Palace.

After all, they've got to find a new role for the guy who used to buy the white paras
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Old 04 June 2009, 14:16   #20
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Any other type of land accident, except where the need to move the casualty away from further danger prevails, the casualty can be kept still to prevent further damage. in the Celtic Pioneer example, the journey to shore could have quite probably increased the damage from the original wedge compression injury - and it is at this point that good spinal care would have been more important.
but my guess is that nobody on board appreciated the severity of the injury anyway, otherwise a Mayday would have been declared etc, the 999 call would have probably resulted in an ambulance quicker etc.

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Yes, KEDs require training - but so would an AED, and indeed anyone thinking that any form of first aid means getting the ticket then not revisiting for 3 years until a requal is needed should look long and hard at their operating procedures!
well I am glad we agree about something. I wasn't advocating routine carrying of AED's either (just that if you are going to enforce bits of kit, that would be higher up my list). If you work in the "rescue services" its fine to train with all this kit all the time, but actually if you are in the boat driving business its probably not realistic.

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but - given that this operator had clearly defined emergency procedures which promptly went over the side when something actually happened, it is likely to prompt the MCA towards more heavy-handed regulation to justify a few jobs at Spring Palace.
I don't see the logic there: Emergency procedures were in place (which met the requirements and were probably suitable and sufficient for the circumstances). Those procedures were not followed. So do you change the regulations to make it harder for everyone (i.e. increased training and equipment requirements) OR focus your efforts on ensuring the basic existing procedures are followed "next time"?
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