As an instructor, I challenge students to truly understand the physiology behind the treatments, rather than just memorizing a set response to a particular problem. A shipboard medical officer must be able to improvise and adapt to an unstable and sometimes hostile environment and be able to continue care for days or weeks if necessary. Mariners, who are used to understanding and fixing integrated mechanical and electrical systems, relate well to the body-systems and principles-oriented approach of this type of training. The marine version of the WFR course includes details on specific topics like diving injuries, envenomation by marine organisms and infections by saltwater bacteria. The curriculum also gives added attention to routine medical care, with an emphasis on prevention, early intervention and patient education. Medical issues that are considered minor ashore can become major problems at sea. A major goal of the Marine WFR course concerns the ability to distinguish between a true medical emergency requiring evacuation and a less serious medical problem that can be managed onboard. The presence of blood, pain and deformity can cloud judgment, leading to needlessly heroic, high-risk evacuations for low-risk medical problems. Students are intensively drilled through case studies and simulations until they can identify the few conditions that are life threatening and the vast majority of situations that are not. Prolonged evacuation times may require medical officers to use techniques and medications not available to their terrestrial colleagues. Communication with medical advisory services or other authorizing practitioners is essential. To help prepare for this, students run scenarios over the radio, practicing the role of the medical officer calling for advice, as well as the practitioner offering it. This exercise quickly reinforces effective medical communication techniques as students attempt to describe the physical exam and environmental conditions to each other. Eight days of intensive training are required to achieve the full Marine WFR certification. (See www.wildmed.com for more info.) Those looking for less of a time commitment but the same approach to marine medical training can sign up for the two-day version, available through the Ocean Navigator School of Seamanship. I will be teaching Introduction to Offshore Emergency Medicine, scheduled for March 9 and 10 in San Francisco and April 20 and 21 in New York.Jeff Isaac, PA-C
