|From Ocean Navigator #84 |
The story concerned a delivery crew of two men who took on a third at the request of the owner. This third crewmember was a heavy drinker who decided to go cold turkey for the duration of the delivery run. Three days out of port he became confused. By the fourth day he was hallucinating and had to be strapped down to his bunk. His level of consciousness deteriorated further, and his fellow crew had to make an emergency diversion to offload him. This was costly, and the stress of the medical emergency took a severe toll on an already fatigued crew. The third crewmember was hospitalized, and though he lived he could have just as easily died. His unknown alcoholism put him at risk for DTs (delirium tremens) and alcohol withdrawal seizures, both very serious medical emergencies.
The good news is that this case was preventable. A little medical diligence can prevent this from befalling your crew. What does it take? Here’s a list of what to do to make your crew’s health an asset, not a liability.
A summary medical record is needed for each crewmember. It should note the following:
1. Name, address, and whom to call in case of an emergency.
2. The name and address of the crewmember’s doctor and/or dentist.
3. A list of the crewmember’s active medical problems and any serious medical problems in the past.
4. Any medications. Note the medications the crewmember requires and whether they must be taken daily, weekly, or monthly. Plan to have enough for the duration of the voyage. Pack a short-term emergency supply in your medical locker. Encourage all crew to comply with taking their regular medications. Don’t be hesitant to check on their compliance.
5. Allergies. Note any serious medication, food, or contact-type allergies. Especially note the type of reaction and how it’s been managed in the past.
6. Blood type. In many foreign countries it is advisable to not undergo transfusion for blood loss unless absolutely necessary. In such a crisis, transfusion from a known person, free of disease, is preferable.
Look for problem areas: crew with the following problems should be noted, as these common ills should be planned for in advance:
1. Hypertension. Daily medication is a must; have what you need plus a backup supply and an emergency supply in the medical locker, too. Any person with hypertension should know how to take his or her own blood pressure or spend the $80 to $120 for a simple automatic machine.
2. Back pain. Chronic back pain is the most common source of physical suffering among sailors of all ages. Plan to manage a flareup with the right medications and crew task reassignment. Think preventively and you can avoid it almost entirely. Remember that your back is most prone to injury immediately after arising from your bunk. Stretch and go slow for the first hour or so.
3. Heart disease. The risk factors for heart disease are hypertension, cigarette smoking, obesity, diabetes, high cholesterol, and a family history of an early heart attack in a parent or sibling. If you have even one of these risk factors, it’s not a bad idea to see the doctor for a exercise stress test before you go.
4. Dental problems. During the Vietnam War, the most common reason for medical evacuation from the field, not related to combat injury, was because of bad teeth. Intense, debilitating pain, serious infections, and the possibility of dental surgery without anesthesia or proper sterilized instruments are all good reasons for taking care of your teeth before you depart.
5. Smokers and drinkers: smokers have higher disease rates of heart attack, strokes, bleeding ulcers, chronic heartburn, and respiratory infections like bronchitis and pneumonia. Additionally, they are a mobile source of unmonitored flame on board. Have a declared policy on smoking on board your vessel.
As noted in our opening anecdote, drinkers also present a problem. The biggest problem comes with an abrupt withdrawal of alcohol while underway. A heavy drinker’s brain has adapted to a daily dose of alcohol. Its fundamental cellular chemistry is altered as a result. Abrupt withdrawal can provoke seizures, hallucinations, and severe agitation. As a general rule, if you decide to quit, do it on land, where help is more easily available. This in no way should be read as free license to pursue an intoxicated state while at sea. Nothing could be more stupid or dangerous.
6. Seasickness: As skipper, you should know who is prone to it and prepare accordingly. Every sailor at one time or another will experience seasickness. Have all at-risk crewmembers take their chosen seasickness remedy the day before you set out. Note that sleepiness is a common side effect of most oral medications. Last, be aware that person with seasickness will not be able to take daily medications with effect. This is particularly important for crew taking blood pressure medication.
7. Immunizations: Everyone on board should have had a tetanus shot in the last five years. Also, if you are heading to the tropics, it’s a good idea to have a yellow fever immunization. In the tropics you will also encounter malaria. Have a malaria prevention plan centered on limiting mosquito exposure and an assigned day of the week to take preventive anti-malarial medicine.
All of the above cautions apply to the captain of the vessel too. He or she is not immune from illness or injury. Though everybody on board is affected if a single crewmember is lost, the loss of the skipper can put the entire vessel in jeopardy.
Dan Carlin is an ER doctor in Maryland and the founder of Voyager Medicine.