Being able to provide emergency first aid is often a vital part of the seafarers’ skill set and is a must do to promote health and medicine tradition at sea. From the most basic of bandaging, through to being able to follow the Shipmasters Medical Guide, the trauma care provided at sea can make all the difference when it comes to saving lives. We look at how medical care and health at sea have evolved, and look at a future of connected ships which can save lives.
Seafaring has always been a dangerous occupation. Whether from accidents, fire or sinking, those who go to the sea in ships have always been at high risk. The problems are not limited to dangers – there can be massive issues with health and medicine at sea too. For centuries even eating and drinking at sea carried a risk of illness and disease.
Scurvy, rickets, all manner of nasties – and food which was fit for weevils but not so hot for people, this was the way of the seafarers’ life. Rum to wash down the evil mess of fetid salty meat and hard tack.
It took the Royal Navy to try and find solutions to the problems of people at sea. Their sailors were dying, and that can be expensive and rather tiresome – so they sought answers.
A Scottish Naval surgeon, James Lind, first proved that citrus fruit could tackle scurvy. In his 1753 book on the matter he described the ways in which fruits could help. A lot of trial and error later, and finally sailors were downing lime juice and avoiding the open sores and paralysis which scurvy brought. This practice led to the American use of the nickname “limey” to refer to the British.
For commercial, merchant vessels, good owners made sure their Captains understood the need to keep a happy, healthy crew – but the decisions were theirs and theirs alone. There were few rules in place. Thankfully most voyages were relatively swift, and even sailing vessels raced over the surf to ports which provided fresh sustenance.
There were many attempts by Governments, both to improve the seafarer’s lot , to increase efficiency and to develop health and medicine at sea. One of the earliest was a charter of Richard I (the Lionheart) which set out rates of pay, conditions of service and levels of punishment for sailors. Five centuries later, one of the greatest reformers was Samuel Pepys, Secretary to the Navy Office.
Health and physical wellbeing were all major parts of this focus. Not necessarily out of any namby pamby notions of nicety, but dead seafarers are not much help with the sails or swabbing the decks, so the focus was on trying to keep them alive.
A seafarer’s life was hard back in the day, and they had to be tough to survive. There was a great deal of sickness at sea. Seamen were often cold and wet, rats carried disease, and the poor diet caused problems too. Eating too much salt with the ship’s meat was a real problem, and so seafarers were not the healthiest of lots.
As well as injury from shipboard accidents, there was risk of death or maiming from falling from rigging, or having cargo drop on unsuspecting crew below. There was little in the way of health and safety, just a reliance on common sense and seamanship. There were many injuries and deaths.
Over on naval vessels, times of battle caused untold damage to sailors. Ships’ surgeons worked in cramped and filthy conditions with no anaesthetic for patients having amputations. Infection and gangrene was commonplace.
In 1694, Queen Mary was so horrified at the amount of suffering caused to men in the Navy by the battles of the time that she persuaded her husband, King William, to found a hospital for seamen. The Greenwich Hospital was therefore built, and the navy later provided hospital ships as well.
Over the centuries the provision of medical care and assistance onboard has improved, but it has been more a case of improvements to life style, machinery, safety and awareness which have been used to limit and reduce accidents and injury, rather than any incredible leaps forward in care onboard.
Even today, there is only so much that can be done onboard ship to deal with sick or injured crew. If someone is severely ill or hurt, then the best option is to get them airlifted or transferred as quickly as possible to shore.
Obviously seafarers are not expected to be surgeons, but sometimes there is a life or death need to be able to respond quickly and effectively. STCW requires certain levels of medical and first aid attainment.
There are basic levels of elementary first aid, and this level of training gives all seafarers a basic knowledge of the immediate action to be taken upon encountering an accident or other medical emergency on board ship.
For more senior officers, then there is a need to build on the basic foundations of first aid. This is where the higher level, “Proficiency in Medical Care on Board Ship” comes into play. It is designed for seafarers designated to take charge of medical care on board ship.
The training is based on the advice and procedures contained in the Ship Captain’s Medical Guide, which is the go to guide for anything which can go wrong onboard. ‘The Ship Captain’s Medical Guide’ contains a wide range of authoritative advice – from birth to death, from first aid, general nursing, hygiene and the prevention of disease, to the treatment of injuries and diseases.
But in the 21st Century is it right that we are still relying on books and officers to avoid being squeamish. What will the future hold for health and medicine at sea? Even today we are seeing more remote medical care being given. Doctor’s surgeries are not necessarily the first port of call, it can be done online.
In the future, we will likely see medical care provided through an app and smartphone – officers onboard will be able to use a phone to take images, to check pulses and vital signs, and to send data to a physician or paramedic ashore.
Suddenly far from being isolated and remote, medicine onboard can be connected to professionals and the very best advice available. Of course until we have robots onboard who can stitch or manipulate fractures, there remains a hands on element – but the future is coming fast, and it seems that it will be safer than ever.