International Medical Guide

INTERNATIONAL MEDICAL GUIDE FOR SHIP’S

( 2nd  EDITION )

WORLD HEALTH ORGANIZATION, GENEVA

Over 20 years have passed since the first edition of the International Medical Guide for Ship’s (IMGS) was published by the World Health Organization. During this time, it has served the International seafaring community well.

Medical first aid guide for use accidents involving dangerous goods published by the International Maritime Organization (IMO ) on behalf of ILO, IMO, and WHO.

The three functions of this guide are :

1. To enable users to diagnose and treat injured and sick seafarers.
2. To serve as a textbook on medical problems for those studying for a certificate in medical training.   
3. To help in giving crews some training on first aid, and on the prevention of diseases.   

GENERAL PRINCIPLES OF FIRST AID ABOARD SHIP

First aid must be administered immediately to:

1. Restore breathing and heart-beat
2. Control bleeding.
3. Remove poison.
4. Prevent further injury to the patient (for instance, his removal from a room containing carbon monoxide or smoke).

Never underestimate and do not treat as minor injuries:

1. Unconsciousness.
2. Suspected internal bleeding.
3. Stab or puncture wounds.
4. Wounds near joints.
5. Possible fractures.
6. Eye injuries.

Note.  Never consider anyone to be dead, until you and others agree that:

1. No pulse can be felt, and no sounds are heard when the examiner’s ear is put the chest.
2. Breathing has stopped.
3. The eyes are glazed and sunken.
4. There is progressive cooling of the body (this may not apply if the surrounding air temperature is close to normal body temperature).

  

UNCONSCIOUS CASUALTIES

The causes of unconsciousness are many and are often difficult to determine. Treatment varies with the cause, but in first aid it is usually not possible to make diagnosis of the cause, let alone undertake treatment.

The immediate threat to life may be:

1.      Breathing obstructed by the tongue falling back and blocking the throat.

2.      Stopped heart.

Not breathing, heart stopped

A trained first-aider must begin heart  compression at once. Unless circulation is restored, the brain will be without oxygen and the person will die within 4-6 minutes.

1.      Lay casualty on a hard  surface.

2.      Start heart compression at once.

3.      Give artificial respiration, since breathing stops when the heart stops.

The necessary aid can be given by one person alternately compressing the heart and then filling the lungs with air, or –better still- by two people working together.

Not breathing, heart not stopped

1.      Open mouth and ensure the airway is clear.

2.      Begin ARTIFICIAL RESPIRATION at once.

Basic life support: artificial respiration and heart compression

Basic life support is an emergency life saving procedure that consists of recognizing and correcting failure of the respiratory or cardiovascular systems.

Oxygen, which is present in the atmosphere in a concentration of about 21%, is essential for the life of all cells. The brain, the principal organ for conscious life, starts to die if deprived of oxygen for as little as four minutes.

Basic life support comprises the “ABC” steps, which concern the airway, breathing, and circulation respectively.

Its prompt application is indicated for:

A.    Airway obstruction

B.     Breathing (respiratory) arrest

C.     Circulatory of cardiac (heart) arrest.

  

Airway (Step A)

Establishing an open airway is the most important step in artificial respiration.

If patient is unconscious, open the airway, thereafter make sure it stays open.

-          Lift up neck

-          Push forehead back

-          Clear out mouth with fingers

Breathing (Step B)

-    Mouth-to-mouth respiration

-          Mount-to-nose respiration

-          Alternative method of artificial respiration (Silvester method)

If patient is not breathing, begin artificial respiration.

-        Before beginning artificial respiration, check carotid pulse in neck. It should be felt again after the first minute and checked every five minutes thereafter.

-        Give four quick breaths and continue at rate of  12 inflations per minute.

-        Chest should rise and fall. If it does not, check to make sure the victim’s head is tilted as far back as possible.

-         If necessary, use fingers to clear the airway.

Heart Compression (Step C)

If pulse is absent, begin heart compression. If possible, use two rescuers. Don’t delay. One rescuer can do the job.

-          Locate pressure point (lower half of sternum).

-          Depress Sternum 4-5 cm, 60 to 80 times per minute

-          If one rescuer   - 15 compressions and two quick inflations.

-          If two rescuers  - 5 compressions and one inflation.

Pupils of eyes should be checked during heart compression. Constriction of a pupil on exposure to light shows that the brain is getting adequate blood and oxygen.