Question 1

A crew member has suspected appendicitis — right lower quadrant pain, fever 38.9°C, guarding and rebound tenderness, and has been deteriorating for 6 hours. Your examiner asks how you assess the need for MEDEVAC and how you initiate it.

Accepted Answer

MEDEVAC decision: signs and symptoms strongly suggest acute appendicitis with possible early perforation — this is a surgical emergency that cannot be treated at sea. Indications for MEDEVAC: surgical emergency requiring operation, deteriorating condition, no surgical capability on board (none available on merchant ships). Initiate MEDEVAC: (1) Contact MRCC (flag state or nearest coastal MRCC if in a traffic area) on VHF Ch 16 or DSC distress — request medical evacuation; (2) Provide: vessel position, speed, course, closest port ETA, weather/sea state, description of patient condition (MIST — Mechanism, Injuries/Illness, Signs, Treatment given); (3) Divert towards nearest port with appropriate medical facilities if MRCC advises; (4) Prepare the casualty — secure IV line if trained, keep NPO (nil by mouth) as surgery may be imminent, monitor vitals; (5) Prepare hoist or transfer area if helicopter MEDEVAC; (6) Contact ship manager and P&I Club. MEDEVAC decisions at sea are made in consultation with medical radio advice — the OOW/master should not make this decision alone. However, the OOW must be able to: (a) recognise that the clinical picture (6 hours of worsening RLQ pain + fever + peritoneal signs) indicates a surgical emergency; (b) contact MRCC and relay the MIST report accurately; (c) initiate diversion decision in consultation with medical authority. Analgesics in appendicitis: historically there was a concern that analgesics would mask symptoms — current medical guidance (UK NICE, RCSE) states that appropriate analgesics can and should be given to patients with suspected appendicitis. Antibiotics: some evidence supports antibiotic treatment of uncomplicated appendicitis (non-perforated), but the at-sea clinical assessment cannot reliably distinguish complicated from uncomplicated — surgical evaluation is required. MRCC medical advice: UK MRCC coordinates MEDEVAC using HM Coastguard helicopter assets within UK SAR area; international SAR regions are covered by respective national MRCCs who can also coordinate fixed-wing MEDEVAC for vessels on oceanic passages.

Question 2

At 0300 a crew member collapses on the bridge. He is unresponsive and not breathing normally. You are OOW. Describe your immediate actions.

Accepted Answer

Immediate actions: (1) Call for help — shout to activate emergency response, ensure the master and medic/person with medical training are alerted; (2) Lay the casualty on a firm surface — the bridge deck; (3) Check airway — head tilt/chin lift, look for obvious airway obstruction; (4) Begin CPR — 30 chest compressions to 2 rescue breaths (ratio 30:2), compressions at 100-120 per minute, depth 5-6cm, allow full recoil; (5) Deploy AED (automated external defibrillator) as soon as available — apply pads and follow AED voice prompts without interrupting CPR except for shock delivery; (6) Contact CIRM (Italian Maritime Medical Centre) or flag state designated MRCC medical service for medical advice; (7) Do not abandon the bridge — delegate CPR if qualified crew arrive; alert watch and autopilot. STCW VI/4 (Basic Safety Training — first aid) and the IMO Model Course 1.13 (Medical First Aid) are the framework for OOW medical competency. CPR protocol: the Resuscitation Council UK 2021 guidelines (applicable at sea) specify 30:2 compressions:breaths. Compressions should not be interrupted for more than 10 seconds for breaths. AED: all ships covered by SOLAS are required to have AEDs (MSC.1/Circ.1396). The AED provides voice guidance and the OOW is trained to use it under STCW Basic Safety. Medical Radio Advice: the MCA's International Maritime Organisation recognised medical advisory service operates via the MRCC radio network — CIRM (Italy), Falck (Denmark), and other national maritime medical services are available 24/7. The master should be woken, but CPR must start immediately — every minute without CPR/defibrillation reduces survival by 10%. The OOW should not leave the bridge unmanned but should delegate CPR immediately on arrival of other crew.

Question 3

A crew member sustains burns to both arms and hands from steam escaping from a burst pipe. The burns cover approximately 20% of body surface. Describe your assessment and immediate treatment.

Accepted Answer

Assessment using Rule of Nines: both arms = 9% each = 18%, hands included in arm total — approximately 18-20% BSA. This is a significant burn requiring urgent medical advice and likely evacuation. Immediate treatment: (1) Cool the burn — pour cool (not cold, not iced) water over the burns for minimum 20 minutes; this is the single most important first aid intervention — reduces depth of burn and pain; (2) Remove clothing and jewellery in the burned area before swelling occurs, unless stuck to the skin; (3) Cover with clean non-adherent dressings or cling film (do not burst any blisters); (4) Monitor for shock — burns cause fluid loss; elevate burned limbs; (5) Give oral fluids if conscious and not vomiting; (6) Contact medical radio advice immediately — burns >15% BSA in adults require IV fluid resuscitation (Parkland formula); (7) Prepare for possible MEDEVAC — 20% burns with airway involvement requires hospital. Burns management is in the MCA Ship Captain's Medical Guide (SCMG) Chapter 10 and the STCW VI/4 first aid syllabus. The 20-minute cooling rule is evidence-based and critically important — cooling within 3 hours of injury significantly reduces burn depth. Common errors at sea: (a) using ice or very cold water — causes vasoconstriction and paradoxically worsens burn depth; (b) applying lotions, creams, or butter — these retain heat and cause infection; (c) removing cling film or dressings unnecessarily — causes further tissue damage. Rule of Nines for adults: head 9%, each arm 9%, each leg 18%, front trunk 18%, back trunk 18%, genitalia 1%. Burns thresholds: >10% in children or elderly, >15% in adults = major burns requiring IV fluids; >20% adults with significant risk = likely MEDEVAC. At OOW level, the examiner expects knowledge of cooling, dressings, shock recognition, and when to request MEDEVAC via medical radio advice.