USCG Exam Focus Areas — Medical Emergencies
The USCG OUPV and Master exam tests medical emergencies primarily in the Deck Safety and Vessel Safety sections. The most frequently tested topics are:
The Captain's Medical Responsibility
Duty of care, medical logs, and 46 CFR 160.041
A vessel master has an absolute duty of care for all persons aboard. This duty extends to providing reasonable medical assistance to any person in distress, including crew, passengers, and persons in the water. The duty exists whether or not the captain has formal medical training — the standard is to act reasonably given the resources and training available.
The ship's medicine chest for inspected vessels is governed by 46 CFR Part 160.041, which specifies minimum required medications, equipment, and supplies based on vessel type and operating area. Offshore vessels (those sailing beyond 12 nautical miles from shore) have expanded requirements. All items in the medicine chest must be within their expiration date; an expired EpiPen that fails during an anaphylaxis emergency is a legal and practical failure of duty.
Medical logs are required when a patient is treated aboard. At minimum the log should record: date and time of the incident, patient name, symptoms observed, vital signs taken and at what times, all treatments and medications administered (with dosages and times), and the outcome including any transfer to medical care. These records are critical if the incident leads to legal proceedings and are required to be available to USCG inspectors.
The USCG First Aid and CPR certificate must be current for all licensed captains operating passenger-carrying vessels. The certificate is valid for two years from the date of training. Accepted providers include the American Red Cross, American Heart Association, and USCG-approved equivalents. Renewal requires a full recertification course, not just a review — skills must be demonstrated to a certified instructor.
Chain of Survival — Cardiac Arrest at Sea
The four-link chain determines whether your patient lives or dies
Recognize the cardiac arrest: unresponsive, no normal breathing, no pulse. Call for help immediately — assign someone to radio the Coast Guard on Ch 16 and retrieve the AED. Every second without circulation is brain cells dying.
Begin chest compressions immediately: 30 compressions at 2-inch depth, rate 100–120 per minute, then 2 rescue breaths. Allow full chest recoil. Push hard, push fast. Do not stop until AED arrives or relieved.
Attach the AED as soon as it arrives. Turn it on and follow voice prompts exactly. Clear all personnel before delivering the shock. Resume CPR immediately after the shock — do not wait to check for a pulse.
Advanced care includes IV access, airway management, and medication. At sea this means: continue CPR and AED use, request Coast Guard medivac, provide ongoing vital signs updates, position patient in recovery position if pulse returns, and prevent hypothermia.
Adult CPR — Step-by-Step Protocol
30 compressions : 2 breaths — at least 2 inches deep — 100–120/min
AED Use — PACS Method
Attach the AED as soon as it arrives. Resume CPR immediately after every shock.
Open the case and press the power button — or lift the lid (some models auto-power on).
Attach adhesive pads as shown on the diagrams: one below the right collarbone, one on the left side below the armpit. Ensure skin is dry; wipe if wet.
Tell everyone to stand clear — do not touch the patient. Press Analyze if prompted. The AED analyzes the heart rhythm and determines if a shock is needed.
If the AED advises a shock, confirm all crew are clear, press the Shock button. Resume CPR immediately — do not wait for a pulse check.
Choking — Recognition and Response
Heimlich maneuver, back blows, and unconscious victim protocol
Signs: Can speak, cough, or breathe — wheezing or coughing
- 1Encourage the victim to keep coughing
- 2Do NOT perform abdominal thrusts if the victim can cough effectively
- 3Stay with the victim and monitor — mild obstruction may resolve spontaneously
- 4Call for help if obstruction does not clear promptly
Signs: Cannot speak, cannot cough, cannot breathe, choking hand signal
- 1Ask: 'Are you choking?' — if they cannot speak or cough, act immediately
- 2Give 5 firm back blows between shoulder blades with the heel of your hand
- 3If back blows fail: give 5 abdominal thrusts (Heimlich maneuver)
- 4Alternate 5 back blows and 5 abdominal thrusts until object is expelled
- 5If victim is pregnant or obese: use chest thrusts instead of abdominal thrusts
- 6Continue until object is expelled, victim becomes unconscious, or help arrives
Signs: Victim collapses during choking episode or found unresponsive
- 1Lower the victim carefully to the ground
- 2Activate your emergency response: radio Coast Guard, get AED
- 3Begin CPR starting with chest compressions
- 4Before giving rescue breaths: look in the mouth for a visible object
- 5If object is visible: remove with a finger sweep — never do blind finger sweeps
- 6Attempt rescue breaths after each set of 30 compressions
- 7Continue CPR cycle — compressions may dislodge the object
- 8Do NOT delay CPR to repeatedly search for the object
Drowning and Near-Drowning
Recognition, rescue, and the secondary drowning warning every captain must know
- ›Victim is vertical in the water, not swimming
- ›Head low in water, mouth at or below surface
- ›Arms pressing down on water (not waving)
- ›No crying out — airway at or below surface
- ›Eyes glassy or closed
- ›Pull victim from water horizontally when possible
- ›Assess for breathing immediately after removal
- ›If not breathing: begin rescue breaths while still in the water if possible
- ›Get to a stable surface for CPR if needed
- ›All drowning victims who inhaled water must be transported to a hospital
- ›Secondary drowning can occur 1–24 hours after the event
- ›Watch for: persistent cough, breathing difficulty, chest pain, fatigue, altered mental status
Cold Water Immersion — Critical Concepts
In 50-degree F water, useful physical activity is incapacitated within 5 minutes due to cold shock and muscle cooling. Swimming ability is lost within 30 minutes. Unconsciousness occurs within 1–2 hours. The '1-10-1 Rule' is a memory aid: 1 minute of cold shock breathing difficulty, 10 minutes of useful swimming, 1 hour before unconsciousness.
Entering cold water triggers an uncontrollable gasp reflex and hyperventilation lasting 1–3 minutes. If the head is underwater during this gasp, immediate drowning can result. Wearing a life jacket prevents this by keeping the head above water during the initial shock.
Heat Escape Lessening Position: draw knees to chest, cross arms over chest, keep life jacket on. This reduces heat loss from the groin, armpits, and chest by up to 50 percent compared to treading water, which circulates warm water away from the body rapidly.
When a hypothermia victim is removed from cold water, cold blood from the extremities returns to the core as the body rewarms — causing core temperature to continue falling for 30–60 minutes after rescue. This is afterdrop. Handle all hypothermia victims horizontally and gently; exertion and position changes increase afterdrop severity.
Passive rewarming (insulating from further heat loss) is appropriate for mild hypothermia. Active external rewarming (heat packs, warm water immersion, warm environment) is used for moderate hypothermia. Active internal rewarming (warm IV fluids, warm humidified oxygen) is hospital-based treatment for severe hypothermia and should not be delayed by attempting inadequate field rewarming.
Hypothermia — Stages, Signs, and Treatment
A patient who is cold and appears dead is not dead until warm and dead
- ›Shivering — active and vigorous
- ›Slurred speech
- ›Poor coordination
- ›Confusion or irritability
- ›Pale, cold skin
- ›Move patient to shelter — out of wind, rain, and cold water
- ›Remove all wet clothing — gently to avoid afterdrop
- ›Wrap in dry blankets, sleeping bags, or space blankets
- ›Apply heat packs to neck, armpits, and groin — not directly on skin
- ›Warm sweet drinks if fully conscious and able to swallow
- ›Handle gently — avoid any exertion by the patient
- ›Shivering stops — thermogenic mechanism exhausted
- ›Muscle rigidity and stiffness
- ›Severe confusion or semi-consciousness
- ›Heart rate and breathing slow
- ›Skin appears bluish (cyanosis)
- ›Handle with extreme care — rough movement can trigger V-fib
- ›Keep patient horizontal — do NOT allow to stand or walk
- ›Active external rewarming: warm water bottles to core areas
- ›No food, drink, or oral medications — aspiration risk
- ›Oxygen if available
- ›Continuous monitoring for cardiac arrest
- ›Medivac required for rewarming in controlled setting
- ›Unconscious or unresponsive
- ›Pulse may be absent or undetectable
- ›Breathing absent or agonal
- ›Pupils fixed and dilated
- ›Muscles extremely rigid
- ›Appears dead
- ›Begin CPR if no pulse detectable — hypothermia patients survive CPR better than normothermic cardiac arrests
- ›Attach AED — shock only if advised (V-fib common in severe hypothermia)
- ›Handle with absolute gentleness — any jostling can trigger cardiac arrest
- ›Keep horizontal at all times
- ›Aggressive in-hospital rewarming (warm IV fluids, warm humidified O2, cardiac bypass if needed) is required
- ›Declare dead only after warming to normal temperature with no response
Heat Emergencies — Exhaustion vs. Heat Stroke
Heat stroke is a life-threatening emergency. Cool first, transport second.
| Feature | Heat Exhaustion | Heat Stroke |
|---|---|---|
| Core Temperature | Below 104 degrees F | Above 104 degrees F |
| Skin | Pale, cool, moist — still sweating | Hot, dry (classic) or hot, wet (exertional) |
| Mental Status | Alert or mildly confused | ALTERED — confusion, seizures, unconscious |
| Sweating | Heavy sweating present | Sweating may have stopped (classic type) |
| Severity | Serious — treat and monitor | LIFE-THREATENING — immediate cooling required |
| First Action | Move to cool area, hydrate | Cool aggressively FIRST, then transport |
- ›Move to cool, shaded area — out of direct sun
- ›Lay down with legs elevated (if no nausea/vomiting)
- ›Remove excess clothing
- ›Cool with wet towels, fans, or cool water spray
- ›Oral rehydration with water or sports drinks if conscious and not nauseated
- ›Monitor for progression to heat stroke
- ›COOL FIRST — this is the priority, not transport
- ›Immerse in cool water or ice bath if available
- ›Apply ice packs to neck, armpits, groin
- ›Wet patient and fan aggressively
- ›Do NOT give oral fluids — aspiration risk in altered mental status
- ›Evacuate immediately — this is a true life-threatening emergency
- ›Request medivac — call Coast Guard Ch 16
Bleeding Control — Direct Pressure, Packing, and Tourniquet
The USCG recommends commercial tourniquets be carried on all offshore vessels
Apply firm, continuous direct pressure to the wound using the cleanest material available — ideally sterile gauze. Do not lift the dressing to check the wound. If blood soaks through, add more material on top and press harder. Maintain pressure for a minimum of 10 minutes without releasing.
For deep or cavity wounds (stab wounds, gunshot wounds, amputations) where direct pressure over the top is insufficient: pack the wound cavity tightly with gauze — hemostatic gauze (Combat Gauze, QuikClot) if available. Pack as deep as possible, then apply firm pressure over the packing for at least 3 minutes.
For life-threatening extremity bleeding that direct pressure cannot control, or for amputations: apply a commercial tourniquet (CAT, SOFTT-W) 2 to 3 inches above the wound — never over a joint. Tighten until bleeding stops. Record the time of application on the tourniquet or the patient's skin. Do NOT remove at sea. The USCG recommends tourniquets be carried on all offshore vessels.
Applying pressure to a proximal artery (brachial artery for arm wounds, femoral artery for leg wounds) can reduce blood flow to the wound site as an adjunct to direct pressure. This technique is difficult to maintain and has largely been replaced by tourniquet use for arterial bleeding.
Burns — Depth, Rule of Nines, and Treatment
Rule of Nines estimates the percentage of total body surface area (TBSA) burned
| Body Region | TBSA % | Note |
|---|---|---|
| Head and Neck | 9% | Combined front and back |
| Each Arm (entire) | 9% | Upper + lower arm + hand |
| Chest (anterior trunk, upper) | 9% | Front, above navel |
| Abdomen (anterior trunk, lower) | 9% | Front, below navel |
| Upper Back | 9% | Posterior trunk, upper half |
| Lower Back and Buttocks | 9% | Posterior trunk, lower half |
| Each Thigh | 9% | Front and back combined |
| Each Lower Leg and Foot | 9% | Below knee to toes |
| Genitalia | 1% | Perineum |
| Total | 100% | Superficial (1st degree) burns are not counted in TBSA |
- ›Partial-thickness burns greater than 20% TBSA in adults
- ›Any full-thickness (third-degree) burn requiring skin grafting
- ›Burns involving face, hands, feet, genitalia, or major joints
- ›Inhalation injury or burns to the airway (hoarseness, singed nasal hairs, carbonaceous sputum)
- ›Circumferential burns of the chest or extremities
- ›Chemical or electrical burns (extent may be deceptive)
- ›Burns in patients with significant medical comorbidities
Cardiac Emergencies — Recognition and Treatment
Aspirin (chewed), nitroglycerin, AED, and medivac — the cardiac response chain
Classic presentation: crushing, squeezing, or heavy pressure sensation in the center of the chest lasting more than 10–15 minutes. May radiate to the left arm, jaw, neck, or back. Not all heart attacks are 'textbook' — some present as mild discomfort, indigestion, or jaw pain only.
Dyspnea at rest or with minimal exertion, especially when combined with chest pain or discomfort, indicates a possible cardiac event. Congestive heart failure (CHF) presents as difficulty breathing when lying flat (orthopnea).
Women, diabetics, and elderly patients more commonly present with atypical symptoms: nausea/vomiting, fatigue, jaw or arm pain without chest pain, lightheadedness, or simply 'not feeling right.' Do not dismiss cardiac history because there is no chest pain.
Pale, cool, clammy skin; rapid weak pulse; drop in blood pressure; altered mental status — these indicate cardiogenic shock from a massive cardiac event. This is immediately life-threatening. Begin CPR if pulse is lost.
Cardiac Emergency Treatment Protocol
Have the patient sit or lie in the position most comfortable for breathing — usually semi-reclined
Loosen any tight clothing around the neck and chest
Administer aspirin (325 mg non-enteric-coated) — have the patient chew it, not swallow whole — if not allergic and no contraindications
If the patient has been prescribed nitroglycerin: assist them in taking their own prescribed nitro tablet sublingually (under the tongue) — do NOT give someone else's nitroglycerin
Administer oxygen if available — 4–6 LPM by nasal cannula or 10–15 LPM by non-rebreather mask
Radio Coast Guard Ch 16 with PAN-PAN or MAYDAY depending on severity — request medivac or urgent escort
Monitor vital signs every 5 minutes and document
Have AED ready and attached — cardiac arrest can occur rapidly
Keep the patient calm and still — exertion increases cardiac oxygen demand
Do NOT give nitroglycerin if systolic blood pressure is below 90 mmHg, if patient has taken ED medications in past 48 hours, or if right-side infarction is suspected
Head, Neck, and Spine Injuries
Mechanism of injury, spinal precautions, and the log-roll technique
- ›Fall from height to a hard surface
- ›Dive into shallow water
- ›Head-on collision at speed (vessel strike or allision)
- ›High-speed fall during rough weather that includes head/neck impact
- ›Ejection from vessel
- ›Any blow to the head causing loss of consciousness
- ›Neck or back pain at the injury site
- ›Numbness, tingling, or weakness in arms or legs
- ›Loss of bladder or bowel control
- ›Inability to move extremities
- ›Patient reports 'electric shock' sensation with neck movement
- ›Tenderness to palpation of the spine
- ›Position one rescuer at the head to maintain in-line stabilization throughout the roll
- ›Two additional rescuers along the body to roll as one unit on command
- ›The head controller calls the commands: 'Ready — roll'
- ›Roll the patient as a single rigid unit — no twisting of the spine
- ›Slide the backboard under the patient while in the rolled position
- ›Roll back onto the backboard on command
- ›Secure with straps: head immobilizer, torso, hips, and legs
Requesting Medical Assistance — SEACOS and Medivac
When to call, what to say, and how to prepare for a Coast Guard helicopter
Medivac is appropriate when: (1) the condition is immediately life-threatening and cannot be managed aboard, (2) the patient will deteriorate significantly before the vessel can reach port, or (3) a telemedical physician advises evacuation. Common indications: cardiac arrest or ongoing cardiac emergency, severe hypothermia, uncontrolled bleeding, head injury with altered consciousness, signs of stroke, anaphylaxis, airway compromise, severe trauma.
Before requesting medivac, contact a maritime medical advisory service for physician guidance. Available 24/7 via satellite phone or SSB radio. United States: contact USCG Sector, which can patch you to an on-call physician. International waters: MedAire (commercial service), CIRM (Italy), or TMAS (various nations). Provide: patient age, gender, vital signs, symptoms, time of onset, medications administered, and current medications.
Radio on VHF Ch 16 (or SSB 2182 kHz). Begin with MAYDAY MAYDAY MAYDAY if life is at immediate risk, or PAN-PAN PAN-PAN PAN-PAN for urgent but not immediate. State: vessel name, position (latitude/longitude), number of crew and patients, nature of emergency, vessel description, current weather at location, and whether you can receive a helicopter.
Clear the largest open deck area of all lines, canvas, and loose gear. Secure all antenna whips that could contact the hoist. Identify wind direction — the helicopter will approach into the wind. Illuminate the landing zone at night with deck lights. Do not touch the rescue basket or hoist hook until it has contacted the vessel or water to discharge static electricity.
Prepare a written patient report: time of incident, vital sign trend, all treatments administered and times, medications given, known allergies, and any relevant medical history. This report goes with the patient. Have a crew member ready to accompany if requested.
Ship's Medicine Chest — 46 CFR 160.041
Required and optional medications and equipment for offshore vessels
- ›Aspirin (non-enteric-coated) — cardiac emergencies and pain
- ›Epinephrine auto-injector (EpiPen) — anaphylaxis
- ›Nitroglycerin tablets or spray — cardiac chest pain
- ›Diphenhydramine (Benadryl) — allergic reactions
- ›Antacid tablets — GI distress
- ›Antiseptic solution (Betadine/povidone-iodine)
- ›Sterile gauze pads and bandage rolls
- ›Adhesive bandages (assorted sizes)
- ›Elastic bandage (ACE wrap)
- ›SAM splints (padded aluminum)
- ›Tourniquet (CAT or SOFTT-W)
- ›Oral airways (assorted sizes)
- ›Bag-valve mask (BVM)
- ›CPR face shield/mask
- ›Trauma shears (scissors)
- ›Medical gloves (nitrile, multiple pairs)
- ›Thermometer
- ›Blood pressure cuff and stethoscope
- ›Current first aid manual
- ›Ibuprofen or naproxen — anti-inflammatory/pain
- ›Loperamide (Imodium) — diarrhea control
- ›Prochlorperazine or ondansetron — nausea/vomiting (especially sea sickness)
- ›Antibiotic ointment (bacitracin/Neosporin)
- ›Eye wash saline
- ›SAM finger splints
- ›Hemostatic gauze (QuikClot/Combat Gauze)
- ›Cervical collar (adjustable)
- ›Oxygen delivery system with mask and cannula
- ›Pulse oximeter
- ›Glucose tablets or gel — hypoglycemia
USCG First Aid and CPR Certificate
High-Yield Exam Facts — Do Not Forget These
30 chest compressions, then 2 rescue breaths. This is the adult ratio. Compression depth: at least 2 inches. Rate: 100–120 per minute. Full recoil after each compression — do not lean on the chest between compressions. The USCG exam tests this number directly.
The distinguishing feature of heat stroke is altered mental status combined with a high core temperature. Skin is hot and dry (classic) because sweating has stopped. Heat exhaustion: still sweating, mentally normal. If in doubt, cool aggressively — you cannot over-cool a heat stroke victim at sea.
When a tourniquet is applied, the time must be written on the tourniquet or on the patient's skin (forehead or limb). Do NOT remove a tourniquet in the field. Tourniquet time is critical information for the receiving surgeon. The USCG recommends commercial tourniquets be carried on all offshore vessels.
Afterdrop is the continued drop in core temperature after rescue as cold peripheral blood returns to the core. Rough handling, standing the patient up, or making them walk all worsen afterdrop and can trigger ventricular fibrillation. Hypothermia patients are carried horizontally and handled gently at all times.
After every AED shock, the AED will instruct you to resume CPR immediately. Do not stop to check for a pulse — the AED's rhythm analysis is more reliable than a pulse check and any delay wastes perfusion time. Resume compressions within 10 seconds of the shock.
A near-drowning victim who appears fine after rescue can develop respiratory failure hours later from water-induced lung inflammation. Every person who was submerged and inhaled water — even briefly — must be seen by a physician. No exceptions. This rule is tested on the OUPV exam.
Know that 46 CFR 160.041 is the federal regulation governing the contents of the ship's medicine chest for inspected vessels. Required contents include epinephrine auto-injectors, aspirin, nitroglycerin, bandages, tourniquets, oral airways, and a CPR mask. All medications must be in date.
Non-enteric-coated aspirin 325 mg should be chewed by the cardiac patient — this speeds absorption significantly compared to swallowing whole. Enteric-coated aspirin is NOT appropriate for acute cardiac use because absorption is too slow. Do not give aspirin if the patient is allergic or has active GI bleeding.
Practice Questions — Medical Emergencies at Sea
A 45-year-old passenger collapses and is unresponsive. You check for breathing and find no normal breathing. You have one crew member available and an AED on board. What is the correct sequence of actions?
Have your crew member radio MAYDAY on Ch 16 and retrieve the AED while you immediately begin CPR at 30:2. When the AED arrives, attach it while minimizing interruptions to compressions, follow its prompts, deliver a shock if advised, and resume CPR immediately after the shock. Continue until advanced medical help arrives or the patient shows obvious signs of life.
A crew member is pulled from cold water after 20 minutes of immersion. His core temperature is estimated at 88 degrees F. He is confused and shivering has stopped. What stage of hypothermia is this and what is the immediate treatment priority?
This is moderate hypothermia (82–90 degrees F). Shivering stops because the thermogenic mechanism is exhausted — this is a worsening sign. Treatment: handle with extreme gentleness and keep the patient horizontal to minimize afterdrop. Remove wet clothing carefully. Apply warm packs to neck, armpits, and groin. Give oxygen if available. Do NOT give oral fluids. Request medivac — active internal rewarming requires hospital resources.
During a charter trip, a passenger develops headache, cessation of sweating, hot dry skin, and becomes confused and combative. Core temperature appears to be 105 degrees F. What is the diagnosis and what do you do first?
This is heat stroke — a life-threatening emergency. The first priority is aggressive cooling, not transport. Apply ice packs to the neck, armpits, and groin; wet the patient and fan aggressively; immerse in cool water if available. Do NOT give oral fluids. Radio PAN-PAN or MAYDAY on Ch 16, request medivac. Document vital signs every 5 minutes during cooling.
A passenger receives a scalding burn to the right arm and chest from a spilled pot of boiling water. The arm shows blisters; the chest area is red but no blisters. Using the Rule of Nines, estimate the TBSA of partial-thickness and superficial burns.
Right arm (entire): 9% TBSA, partial-thickness (second-degree — blistered). Anterior chest: 9% TBSA, superficial (first-degree — red, no blisters). Only partial-thickness and deeper burns are counted in TBSA for treatment decisions; the superficial chest burn is not counted. Total second-degree TBSA = 9%. Cool the blistered arm with cool water. Do NOT break blisters. Evacuate — a 9% partial-thickness burn requires physician evaluation.
You are offshore and a crew member falls and strikes his head on a winch drum. He is alert but reports tingling in his fingers. What do you do and what regulation governs your medical equipment?
Assume a cervical spine injury based on mechanism (head strike with neurological symptoms). Manually stabilize the head and neck in a neutral position immediately. Apply a cervical collar from the medicine chest. Log-roll the patient to a backboard using the three-rescuer technique. Keep horizontal. Radio for medical advice and request medivac. The medicine chest is governed by 46 CFR 160.041 for inspected vessels.
A near-drowning victim is pulled aboard. He is conscious, coughing, and reports he is fine. He wants to return to fishing. What should you do?
Refuse to allow normal activity. The patient is at risk for secondary drowning — fluid-induced lung inflammation that can cause respiratory failure 1 to 24 hours after the event. The patient must be monitored continuously and transported to a medical facility for evaluation regardless of how well he appears. Document the incident time, submersion duration, water temperature, and any symptoms for the receiving medical team.
Which federal regulation governs the ship's medicine chest for inspected passenger vessels, and what is one required item?
46 CFR 160.041 governs the ship's medicine chest for inspected vessels. Required items include (but are not limited to): aspirin (non-enteric-coated), epinephrine auto-injector (EpiPen), nitroglycerin tablets or spray, tourniquets, bandages and dressings, oral airways, CPR face mask, and a current first aid manual. All medications must be within their expiration date.
What is the correct technique for performing abdominal thrusts on a conscious choking victim who cannot speak?
Stand behind the victim. Make a fist and place the thumb side against the abdomen, just above the navel and well below the breastbone. Grasp your fist with the other hand. Deliver firm inward-and-upward thrusts — each thrust should be distinct and forceful. Alternate 5 back blows with 5 abdominal thrusts until the object is expelled. If the victim is pregnant or obese, use chest thrusts at the same rate and alternation.
Pro Tips — What Experienced Captains Know
At the start of each charter, brief your crew: who calls the Coast Guard, who retrieves the AED, who monitors passengers. In a cardiac arrest, role confusion costs seconds and seconds cost lives. A pre-assigned crew transforms a chaotic emergency into a coordinated response.
Even trained rescuers misplace AED pads under stress. Every AED has a diagram showing exact pad placement. Look at it. Place one pad below the right collarbone, one on the left side below the armpit. If a patient has a pacemaker scar, offset the pad 1 inch from the device.
Tourniquet time is the most critical piece of information for the surgeon receiving your patient. Write it on the patient's forehead, on tape on the tourniquet, or on the skin above the tourniquet. Do this immediately after application — in a stressful event, you will not remember the exact time an hour later.
Ice water can cause vasoconstriction and worsen tissue damage and hypothermia in patients with large burns. The correct agent is cool (not cold) running water for 10–20 minutes for partial-thickness burns. Do not apply ice packs directly to burns. For full-thickness burns over large areas, avoid prolonged water cooling due to hypothermia risk.
A life jacket provides three critical protections in cold water: it keeps the head above water during the cold shock gasp reflex (preventing immediate drowning), it enables the HELP position to reduce heat loss, and it keeps an unconscious victim face-up to maintain an airway. Enforcing life jacket wear is one of the highest-impact decisions a captain makes.
Before transmitting a medivac request, a 5-minute call to a maritime medical advisor can clarify whether evacuation is necessary, what vital signs to monitor, and what field treatments to start. USCG Sector can connect you to an on-call physician. Commercial services like MedAire are available 24/7 via satellite phone for offshore passages.
Related Study Topics
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