MED-PIC Moment : Unconscious, But No Trauma?

As the medical person-in-charge (MED-PIC) onboard ships, there are any number of scenarios with which one could be faced.  Cuts, scrapes, bumps, bruises, broken bones and other assorted trauma injuries can reasonably be expected.  Mariners do live and work in an industrial environment, after all.  Normally, a mechanism of injury (MOI) is obvious – the seaman fell from the ladder, was struck by a parted mooring line, was snagged in a moving part, was burned by chemicals, had something caught in their eye, or any of a myriad of job-related hazards.  To a certain extent, the MED-PIC will be challenged by any of these situations, but can also be comforted by the fact that they are not unexpected.  Circulation, airway, breathing – plug the holes and keep the red stuff (blood) inside – treat for shock and, hey, life is good, right?  But, mariners all know to…..

Expect the unexpected.

Medical emergencies happen – crewmembers have pre-existing conditions, mariners are aging and develop problems and sometimes, someone takes a substance into their body that creates issues. These emergencies can be a MED-PIC nightmare – trying to diagnose a condition that may be life-threatening with a mere fraction of the training given first responders, nurses or doctors. So, where do we turn? Medical advisory services? Textbooks or medical guides? For some emergencies, though, having an idea of the appropriate protocol from the get-go is a good idea.

One such scenario is the unconscious victim/patient. A rapid trauma assessment or survey of any witnesses may offer a MOI. However, if no trauma is obvious and there are no witnesses, then the MED-PIC is truly challenged. The patient can’t offer any help and, aside from the vital signs taken, the MED-PIC has little information on which to act. So……

The following is excerpted from the World Health Organization (WHO) Medical Guide for Ships, 3rd Edition (pg. 122-123) (formatting added for clarity) :

Finding an unconscious person

Common causes of unconsciousness include:

– alcohol intoxication: remember that alcohol and trauma often go together, so be wary of singling out alcohol as the only cause of unconsciousness;

 -epileptic seizures;

– hypoglycaemia (low level of sugar in the blood), usually caused by insulin treatment;

– overdose of a narcotic drug, usually heroin, or a benzodiazepine (drugs with names ending in – azepam);

– compression of the brainstem by high pressure in the skull forcing part of the brain through the hole at the base of the skull through which the spinal cord leaves the skull: a common cause of this compression is bleeding in the skull caused by trauma or intracerebral haemorrhage (see Chapter 4, Head injuries).

What to do on finding an unconscious patient

If there is no evidence of major head injury, immediately give:

– glucagon at once, 1 mg intramuscularly; AND

– naloxone, 0.8 mg intramuscularly or intravenously, repeated twice if there is no response.

If the patient remains unconscious, seek medical advice.

 That could be pretty important information! However, to act on it quickly, the MED-PIC may need a few things; One, knowing whether this is a protocol that can be used independently or for which they need to get permission from their medical advisors. And if permission is necessary, being able to quickly contact those advisors; Two, knowledge of where in the ship’s hospital / medicine chest the appropriate drugs are located; and three, the knowledge and ability to properly administer those drugs.

Mariners are the first-responders in the maritime industry. They are the EMTs, firefighters, paramedics and emergency room personnel while on the water – and sometimes it’s all they have. Yes, there is help out there from Coast Guards and military vessels, but that help might be hours or days away. Check out the links below – take some time to read the medical guides – and expect the unexpected.

Additional Reading and Links

International Medical Guide for Ships – 3rd Ed – World Health Organization

UK MCA – The Ship Captain’s Medical Guide

Naloxone Training Program – State of Connecticut, Dept of Public Health