Question 1

A crew member falls from a gangway onto the quay and is conscious but in severe pain. You suspect a fracture of the right femur (thigh) and cannot exclude a spinal injury. Describe your management.

Accepted Answer

Management: (1) Spinal precautions — maintain inline stabilisation of the head and neck; do not move the casualty until the spine is protected — use log roll technique with four or more helpers to place on a spinal board or stretcher; (2) Femoral fracture — this is a high-energy injury with significant blood loss potential into the thigh (up to 2 litres); apply traction splint (Thomas splint or improvised) to immobilise and reduce blood loss; (3) Treat for shock — lay flat (not in recovery position if spinal injury suspected — maintain supine unless airway threatened), monitor for signs of hypovolaemic shock (tachycardia, hypotension, pallor); (4) IV access if trained and kit available; (5) Pain relief per medical radio advice; (6) Notify MRCC — significant trauma with possible spinal injury requires hospital-level care; (7) Log all vital signs every 15 minutes. Trauma management at sea follows PHTLS (Pre-Hospital Trauma Life Support) principles at Basic Life Support level. Femoral fracture blood loss: the femoral shaft can absorb 1-2 litres of blood into the thigh compartment — a bilateral femoral fracture can cause fatal hypovolaemic shock from closed fractures alone. Traction splints (Thomas splint or Kendrick Traction Device — often in ship medical kits) reduce the volume available for this blood loss by pulling the fracture ends into alignment and reducing the thigh diameter. Spinal injury management: the principle of inline stabilisation and log roll is taught in all trauma courses and applies at sea. A fall from height (gangway) with significant mechanism of injury requires spinal precautions until excluded by clinical assessment or imaging. The OOW at exam level must demonstrate knowledge of: (a) fracture types and their associated complications; (b) hypovolaemic shock signs and management; (c) spinal precautions; (d) when to request emergency assistance.

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.