Question 1

A crew member is recovered from the water after being in the sea at 8°C for approximately 40 minutes. He is conscious but confused, shivering severely, and his skin is pale and cold. Describe your treatment.

Accepted Answer

This is severe hypothermia risk — core temperature likely 28-32°C (moderate hypothermia). Treatment: (1) Get the casualty out of the cold environment immediately and into shelter; (2) Handle VERY gently — cardiac muscle in hypothermia is irritable and rough handling or excessive movement can trigger ventricular fibrillation; (3) Remove wet clothing by cutting if necessary — do not rub the skin (vasodilation risk); (4) Apply warm dry blankets, foil emergency blanket, or Helly Hansen bag around the torso — warm the core not the periphery first; (5) Warm, sweet drinks only if fully conscious and able to swallow; (6) Do NOT give alcohol; (7) Monitor for cardiac arrhythmia — if cardiac arrest occurs, begin CPR and continue (hypothermic cardiac arrest is reversible if core temperature is raised); (8) Seek medical radio advice; (9) Check blood sugar. Hypothermia treatment at sea is in the STCW first aid syllabus and the SCMG. The critical point: "afterdrop" — when cold blood from the periphery returns to the core during rewarming, the core temperature can paradoxically drop further. This is why: (a) rough handling and vigorous massage are dangerous (stimulates vasodilation and afterdrop); (b) hot baths cause rapid peripheral vasodilation and massive afterdrop; (c) alcohol causes vasodilation — exactly what is not needed. Core rewarming before peripheral: wrap trunk and head (where most heat loss occurs) in insulating material — the extremities rewarm naturally as the core temperature rises. In maritime hypothermia, the Helly Hansen or "Hibler pack" (a casualty placed in a sleeping bag with another warm person) is the recommended at-sea method. After drop VF: a hypothermic heart in VF must have CPR continued until the core temperature reaches 30°C+ — "you're not dead until you're warm and dead" is the clinical principle. This has resulted in full recovery from apparent death in cold water drowning.

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.