Hypothermia, Again.

When I come across someone’s story about how an emergency was handled I always try to keep the story in perspective since I know that even when we drill for an emergency, it will seldom follow the  course we expect.  Many decisions are made in the heat of the moment and only a well drilled team will overcome the tendency to shoot from the hip.

Reading these accounts is always enlightening but  most times it’s downright scary.  And even though the facts about hypothermia are well documented and the shortcomings regarding field treatment recognized, there is still a lot of mis-information regarding how to treat someone who has fallen into cold water.

The recently released newsletter from the N.M.A. contains a letter from a mariner describing a late night-cold water M.O.B. situation on a Western Rivers towboat and the efforts expended to recover a very large, cold, and wet individual.  There are many facets to the story but the ones of immediate interest to me included how the habit of many deckhands wearing a P.F.D. too loosely can have a dangerous consequence. Additionally, the lack of rescue training could have killed this man after he was safely back aboard his boat.We all regard a man-overboard situation as a priority emergency.

Time is always “of the essence”, cold water makes it even more so.  The small window of opportunity available to find, recover, and maybe revive a victim is quite small and training needs to reflect a higher level of awareness as to what can and cannot be utilized during a rescue.  The last thing we need is to manage the first three steps successfully and fail in the end because we didn’t follow the course of action that may have saved the victim’s life.

The N.M.A Newsletter’s story relates how a large individual (5’9″ at 260 lb.s) is recovered from 39*F water.  The efforts expended by 2 large men to pull this soaking wet victim from the water was nearly a failed effort due to the loosely fitted P.F.D. and girth of the man.  He was too cold to assist in his rescue, and more to the point, too heavy to be pulled from the water, he was waterlogged and the one thing that may have aided his rescue was in danger of slipping off.  Until more help arrived, this man was not getting out of the water.

As the story continues, the help arrives and he is pulled aboard only to be put into another life threatening situation by his rescuers.  He was stripped of his clothing and put in a shower to be rewarmed.  The absolute wrong thing to do! His next trip may very well have been to the morgue, the swift rewarming in the shower may well have caused a dump of the colder blood in his arms and legs and caused cardiac failure in moments.  This is not what should be done to assist a hypothermia victim.  The victim’s body mass may have protected his core temperature for a longer time, but his extremities were cooling quickly.

The link provided here has a few of the methods used by professionals when treating a hypothermia victim and none of the methods listed allow for a quick rewarming in any situation.  The most effective means includes warmed and moist oxygen and wrapping the victim in layers of blankets.  The method of sharing body heat from a rescuer is NOT considered the proper method to rewarm a cold water victim..

Basic First Aid training seldom goes far enough when it comes to hypothermia.  Beyond describing its effect and how to recognize it, there are too many remedies passed along like “old wive’s tales” that are potentially deadly in a real world situation.  Here’s a fact, if the cold blood in the limbs is dumped into the core by a rapid rewarming, a heart-attack is nearly guaranteed, regardless of the victims age.

The most important phase of treatment is the prevention of post-rescue collapse during the first 30 minutes following rescue, and during transportation to a medical facility.

Some recommended methods of treatment are difficult to apply in the workplace.  The lack of enough crew to actually pull the victim from the water.  Handling the victim to keep them oriented horizontally will be problematic since most victims will not necessarily be all that co-operative.  They may try to help, but in doing so will force cooled blood into their core and risk further complications.  Moving limbs will pump cold blood, this is a bad thing until the victim is properly rewarmed.  Warm sweet drinks (hot chocolate is a good one, not coffee) will help but the real answer lies in getting professional help as quickly as possible and minimizing the further cooling of the victim.  Wrap them in blankets, but don’t try to get them warmed up all at once.

IN NO CASE SHOULD HOT SHOWERS OR BATHS BE USED

It can’t be emphasized enough how we need to understand cold water immersion and prudent prevention and rescue methods.  The link to Cold Water Boot Camp was very useful for illustrating the effects of cold water, but it fell short when it comes to after the rescue.  If you’re going to wear a Personal Floatation Device, why wouldn’t you wear it correctly?  It takes 30 seconds to properly fit the device, and it will be of use when someone tries to pull you from the water.   Bear in mind that although Spring is here in the Northeast, the surface water temps won’t rise above “bone chilling cold” until August.

Mario Vittone, a name known to most of us these days has put himself into the water, suffered the effects of hypothermia and recovery in highly controlled experiments for our benefit.  The lessons learned have been freely shared and we can be grateful he suffered in our place for the cause of educating rescuers to the reality of the effects of cold water.

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The New and Improved Merchant Mariner’s Credential

The new format

The final rule for the consolidation of the MMC (Merchant Marine Credential) has been published and caused a great uproar from mariners across the country including license holders within the ranks of the USCG.  The subsequent comment period was ignored by the rule-makers when it came to the actual license itself.  The issue that is contested, almost to a man, concerns the proper format of the “traditional” license.  The new M.M.C. abandons the old style license in favor of a passport style booklet.  It’s understandable that the need for consolidation can and should be accommodated but the traditional license should have never been left out of the mix.  It was apparent during and after the issue was proposed that the MMC was going to happen, the surprise for the Coast Guard came when the unholy din arose surrounding the diploma style license we all know and respect.   After the final rule was published, Capt Joel Milton ran an article on his blog displaying a response from a Mr. Jeffrey Lantz who was apparently caught in the crosshairs and forced to give an explanation of our feckless Coast Guard’s behavior and failure to address this issue as part of the final rule, and he sounded surprised that there was an uproar.

I won’t go into the entire letter, I’ll just take this opportunity to “cherry pick” a gem from within said response.  In their haste to accomplish their main goal of reducing the number of documents we need to carry,(by the way, thanks for that) and the numerous appearances said documents require, the Coast Guard demonstrated an incredible lack of concern regarding the document we all recognize as our ticket.  When it comes to the Office of Marine Inspection the USCG may spout tradition and honor as a mantra, but it certainly falls by the wayside in a hurry when it suits their needs.  And as I read Mr. Lantz’s letter, it seems it’s being denigrated as quaintly sentimental and a hokey kind of traditional.  What a pair!

The issue of maintaining a proper diploma style license was supported by every mariner asked, not a few but all.

MERPAC was generous and accommodated the issue of the new MMC but also recommended the traditional license be offered as an optional issue.  I submit the license is more important as a badge of honor than a credential.  By the way, how does one post the new passport style booklet?

I noted a patently ridiculous statement in the response from Mr. Lantz, specifically; “There are numerous factors to consider in deciding whether or not to also provide a “suitable for framing copy of the license.” These include the availability of Coast Guard resources, including personnel, paper stock, hardware, software and equipment, and the process for determining and collecting fees.”

Is he kidding me? One piece of paper?  Doesn’t that infrastructure already exist? Is it too much of a reach to tack a fee on the application to include the “traditional framing copy” and process it along with everything else. What issue would any of us have with a note on the document stating it is “for display only”.   How many lawyers do you need to consult regarding those three words?

The next time you walk into your doctor’s office, take note of how many diplomas he  or she has on the wall.  Does it inspire confidence to see proof out in the open that your practitioner is well qualified to handle your situation, or would you rather ask to see some ID just as you’re disrobing for an examination?  C’mon Doc, let’s get out the wallet.

The time it would take to send the data to a printer and the ink it would require wouldn’t amount to 2 minutes or cost more than a dime. The paper adds a quarter, and the personnel time load would be an additional 10 seconds to enter the check mark and push enter. Paper, equipment, personnel? I’m sure there will be about 200,000 license blanks going to a landfill if these folks don’t come to their senses.  Talk about a waste.  Hey, think green!

Enough with the bullshit already….charge another $5.00 and issue the license we all want.  If we have to cough up a couple of bucks it’ll be worth it to you to keep us quiet and you’ll have pin money for the next budget shortfall.

Don’t thank me now, but feel free to drop me a line if you need any more help.

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Are You Here?

We all have stories of the climb through the ranks remembering the good, the bad, and the ugly of it all. The long cold watches we stood pulling hawser, stacking the tow for the downriver transit, or just hanging on for dear life while rough weather tried to claim our stomachs and all that was in them.  Perhaps the most difficult adjustment to be made within ourselves and our loved ones was making peace with the time spent away from home for extended periods of little or no contact.  At first a very difficult mindset to abide.  It was a given that you’d have to deal with it, but few of us ever really had any instruction as to how to handle it.  It was and probably still is, learn as you go.

I’ve given many a new crew-member the regular talk about cell phones, Ipods, and laptop computers.  But of all the realities to be faced, the big one that must be acknowledged is; you’ve got to let go of what’s happening at home.

If you’re waiting to hear if your heavily pregnant wife is on her way to the hospital to deliver, get off the boat. You’re not here.  Or perhaps the house needs a plumber, or the car has broken down once again. Or maybe, your significant other is driving you to distraction with heartache or that pining “I miss you so much” thing.   Or maybe she’s been seen in the company of a rival, go home if you can’t shut it off (Please don’t leave an apprentice mate alone to cover for you).

The fact remains that a life aboard demands your attention, and for short periods of time all of your attention. If you’re burdened with heartache, health concerns for loved ones,  or maybe just homesick, you need to either learn how to shut it off or go home.  It’s not because we consider it unmanly, it’s because if you’re distracted by anything other than what you’re doing, it will surely get you or your shipmates killed.

Oh yes Virginia, there was a time I can recall before cell phones were everywhere:

This is what a pay phone looks like kiddies!

It wasn’t so long ago on the boats that when you needed to call home, you waited in line while 4 or 5 other guys called their spouse, girlfriend, lawyer, or whatever. There was a certain code you were expected to follow if you were part of that gang. Don’t talk too long, and please talk low enough so we don’t have to hear it. It could have been last night or last week that you got to a pay phone in port, but that is how it was.  If it was an emergency you had to use the Marine Operator and broadcast your situation to everyone else waiting to make a call, a very public call.

The days at sea with no phone or communication with home are no more, really getting away from it all doesn’t happen unless you turn the phone off.  And turn it off you must, while you’re on watch.

I have the good fortune to be married to a woman who is self sufficient and capable.  In all my years at sea I have  only had 3 emergencies I’ve had to get off the boat to address.  She has handled preparing for hurricanes, sick children, broken furnaces and dying relatives.  I am blissfully ignorant of many issues that would otherwise be my concern were I at home. I’m lucky, my wife and I think alike in many ways and she’s well aware of how bad it could be if I’m not paying attention at work.

She and I speak twice a day if I’m in range and we tend to keep it short and sweet. It’s unnecessary for me to direct the business of the house since that is her milieu not mine. I’m asked for my opinion and perhaps preference, but the last word concerning the house, her house, is hers.  Something one would be wise to face right up front.

I have a small support network of friends on call that will assist with any issue that may need muscle, transportation, or repair. Otherwise, she’s got it under control. If I had to worry about the boat and home at the same time, neither would be in very good order.  It’s imperative that your head is here, not worrying about (insert problem here).

This brings me back to my advice;  You’ve got to leave what’s at home, at home. If your head is 500 miles away, you’re going to step into a swinging boom, an open hatch, or maybe over the side. It’s necessary to be here.

Try and educate you’re significant other as to what your day is like at any given time and set aside an off-watch time to catch up.  It helps if your S.O. is a grown-up, not in years so much but in mind.  If they recognize what you face everyday, they will avoid the temptation of putting a burden on you that you can only worry about.

It easy to say, but not the least bit easy to do.  None the less, your life may depend on it.

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