Moving about a boat at sea often results in a few knocks and bruises, but if a crew member has a fall or major bump and is in serious pain, they should be examined and treated accordingly. The risk of this happening can be reduced by keeping one hand holding the boat at all times and by keeping knees bent and weight low.
There are two kinds of fracture, open and closed. An open fracture is where a broken bone has punctured the skin and is visible, whereas a closed fracture remains beneath the skin. An open fracture carries a high risk of infection and the casualty will most likely suffer bleeding and shock.
Sprains, strains, dislocations and closed fractures have similar symptoms and if in doubt it is best to treat them all as a fracture and to immobilize the injured limb and make the casualty comfortable.
The signs and symptoms of a fracture are:
- Swelling, bruising and deformity.
- Pain.
- Unnatural position.
- Grinding sensation.
- Difficulty in moving or leaning on the limb.
- Shock.
Treating a fracture:
- Check for levels of response and breathing.
- Control bleeding.
- Cover open fractures with a sterile dressing
- Gently straighten and support the limb.
- Treat with painkillers.
- Splint and support the limb with bandages to minimize movement. Splint an arm or leg to an uninjured part of the body. Splint a fractured finger to an adjacent finger.
- Do not over tighten bandage, padding helps.
- Apply a cold compress to closed fractures to reduce swelling.
- Seek medical advice.
- Monitor the casualty closely for swelling and signs of shock.
Head injury
The most common cause of head injury at sea is when a crew member gets hit by the boom. If this happens, the casualty should be examined straight away and you should send a MAYDAY immediately if the casualty has been knocked unconscious and is not responding. If the casualty quickly regains consciousness then assume they are suffering from concussion. Send out a PAN PAN and ask for medical help and the best course of action.
A blow to the head from the boom may result in a skull fracture or bleeding and might also cause a neck or spinal injury. A fractured skull is a very dangerous injury and can occur even if the patient regains consciousness. The casualty needs urgent treatment ashore and immediate evacuation.
Watch for:
- Signs of concussion, where casualty has been briefly knocked unconscious, followed by drowsiness, headache, loss of memory, double vision and dizziness.
- Depression on the scalp, bruising around the eyes, bleeding from ear or nose.
- Dilated or unequal pupil size.
- Irregular breathing, with slow pulse, less than 60 beats per minute.
- Flushed, dry skin.
- Convulsions.
- Deterioration, which might be gradual over several hours.
Treating a head injury:
- Check for AVPU levels of response.
- Check airway is clear if the casualty is unconscious.
- Send a MAYDAY and seek immediate evacuation if the casualty is unconscious.
- Send a PAN PAN and seek urgent medical advice if the casualty was knocked out but regained consciousness.
- Monitor breathing, pulse, level of response and pupil sizes.
- If the casualty is conscious, keep them awake but make sure they rest.
- If the casualty is unconscious, place in the recovery position.
