5.6 Common Shipboard Medical Emergencies & Poisoning
Key Takeaways
- STCW Table A-VI/1-3 covers action on encountering an accident 'or other medical emergency', so non-traumatic illness is squarely within the Elementary First Aid competence.
- Suspected heart attack: sit the casualty up, keep them still, and if there is no allergy or contraindication give a single 300 mg aspirin tablet to be chewed slowly, then contact the telemedical service.
- Stroke is recognised with FAST — Face droop, Arm weakness, Speech difficulty, Time to act — and the casualty is given nothing by mouth.
- A drowning casualty is resuscitated with 5 initial rescue breaths before chest compressions, because hypoxia rather than a primary cardiac event is the cause of the arrest.
- The adult intramuscular adrenaline dose for anaphylaxis is 500 micrograms from an ampoule, or the 300 microgram dose delivered by a standard adult auto-injector, given into the outer thigh and repeated after 5 minutes if there is no improvement.
5.6 Common Shipboard Medical Emergencies & Poisoning
Core Principle: Column 1 of Table A-VI/1-3 is take immediate action upon encountering an accident or other medical emergency. Ships carry an ageing, largely male, shift-working population thousands of miles from a hospital. Illness, not injury, is the most common reason a ship diverts.
1. Cardiac Chest Pain
Recognition
- Central, crushing or heavy chest pain or tightness, often radiating to the left arm, the jaw, the neck or the back.
- Sweating, pallor, nausea, shortness of breath, a sense of impending doom.
- Angina is provoked by exertion and eases with rest within minutes. A heart attack (myocardial infarction) does not ease with rest.
- Presentations are often atypical, particularly in people with diabetes: indigestion-like discomfort, breathlessness alone, or sudden collapse.
Action
- Stop all activity. Sit the casualty up, supported, knees bent — do not walk them to the ship's hospital.
- Reassure and keep them still. Exertion increases cardiac oxygen demand.
- Aspirin: if the casualty is conscious, able to swallow, has no aspirin allergy, no active bleeding disorder and no other contraindication, give a single 300 mg aspirin tablet to be chewed slowly — chewing gets it into the bloodstream faster than swallowing whole.
- Oxygen if the casualty is breathless or their saturation is low.
- Assist with the casualty's own prescribed medication (for example a glyceryl trinitrate spray) if they have it.
- Contact TMAS immediately with a full set of vitals. Be ready for cardiac arrest: have the AED at the bedside.
2. Stroke
FAST is the recognition tool:
| Letter | Test | Positive Finding |
|---|---|---|
| F — Face | Ask them to smile | One side of the face droops |
| A — Arms | Ask them to raise both arms and hold | One arm drifts down or cannot be raised |
| S — Speech | Ask a simple question | Slurred, jumbled, or no speech |
| T — Time | Note the time of onset | Treatment options depend entirely on this |
Action: lie the casualty down with the head and shoulders slightly raised, support the weak side, give nothing by mouth (the swallow reflex may be impaired and aspiration is a real risk), record the exact time symptoms began, and contact TMAS urgently. Stroke is time-critical, so evacuation is discussed early.
3. Diabetic Emergencies
| Hypoglycaemia (low blood sugar) | Hyperglycaemia (high blood sugar) | |
|---|---|---|
| Onset | Minutes — sudden | Hours to days — gradual |
| Skin | Pale, cold, sweating | Warm, dry, flushed |
| Behaviour | Confused, aggressive, uncoordinated — often mistaken for drunkenness | Drowsy, lethargic, progressing to coma |
| Other | Hungry, trembling, rapid pulse | Very thirsty, passing large volumes of urine, deep sighing breathing, acetone (pear-drop) smell on the breath |
| Action | If conscious and able to swallow: 15–20 g of fast-acting sugar — glucose gel, sugary drink, glucose tablets. Repeat after 10–15 minutes if no improvement, then give a longer-acting carbohydrate. | Give nothing by mouth if drowsy. Recovery position if unconscious. Urgent TMAS contact. |
The safe default: if you genuinely cannot tell which one it is and the casualty is conscious and swallowing, give sugar. Sugar corrects a hypo within minutes and will not meaningfully worsen a hyper in the time before you get advice. An untreated hypo causes brain injury far faster.
4. Seizures
During the seizure:
- Do not restrain the casualty and do not put anything in the mouth — you will break teeth or lose fingers, and the tongue cannot be swallowed.
- Protect the head with padding; clear hard, hot and sharp objects away — on a ship that means deck fittings, steam lines and machinery guards.
- Note the start time. A convulsion lasting more than 5 minutes, or repeated seizures without recovery of consciousness, is status epilepticus — a medical emergency requiring urgent TMAS contact.
After the seizure: place in the recovery position, check the airway and breathing, allow the drowsy post-ictal period to run, keep them warm and undisturbed, and look for injuries sustained during the fit. A first-ever seizure always warrants medical advice.
5. Asthma and Anaphylaxis
Asthma
Wheeze, difficulty breathing out, difficulty speaking full sentences, use of the neck and shoulder muscles to breathe. Sit the casualty upright and leaning slightly forward, help them use their own reliever inhaler (typically blue), stay calm and reduce anxiety, and give oxygen. Warning signs of a severe attack are exhaustion, a silent chest, cyanosis and confusion — contact TMAS at once.
Anaphylaxis
A rapid, generalised allergic reaction — commonly to shellfish, nuts, insect stings or drugs. Look for swelling of the lips, tongue and throat, stridor or hoarse voice, widespread rash, wheeze, and collapse.
- Adrenaline is the treatment, and it is time-critical. The adult intramuscular dose is 500 micrograms from an ampoule, or the 300 microgram dose delivered by a standard adult auto-injector, given into the outer aspect of the mid-thigh — through clothing if necessary.
- Lie the casualty flat with the legs raised if there is circulatory collapse; sit them up if breathing is the dominant problem. Do not stand them up — sudden standing in anaphylaxis has caused cardiac arrest.
- Repeat the adrenaline after 5 minutes if there is no improvement.
- Oxygen, continuous monitoring, and urgent TMAS contact. Anaphylaxis can rebound hours later, so the casualty is observed.
6. Drowning and Near-Drowning
Drowning arrest is hypoxic, not primarily cardiac, and the resuscitation sequence is modified accordingly:
- Remove from the water — horizontally where the casualty has been immersed for any length of time (Section 2.2).
- If unresponsive and not breathing normally, give 5 initial rescue breaths before starting chest compressions.
- Then continue standard CPR at 30:2 with the AED attached as soon as it arrives (Section 5.3).
- Do not attempt to drain water from the lungs, and do not perform abdominal thrusts to expel water — it wastes time and provokes vomiting.
- Expect regurgitation; be ready to turn the casualty and clear the airway.
Every near-drowning casualty needs medical assessment, even if they seem completely recovered. Inhaled water, and especially inhaled seawater, can produce pulmonary oedema hours later. Contact TMAS and observe for at least 24 hours.
7. Gas and Chemical Poisoning
| Agent | Where It Is Met on Board | Recognition | Action |
|---|---|---|---|
| Carbon monoxide | Fires, faulty heaters, incinerators, inert gas | Headache, nausea, confusion; pulse oximeter reads falsely normal | Remove with SCBA, high-flow oxygen, TMAS (Section 3.5) |
| Hydrogen sulphide | Sewage tanks, sour crude, bilges | Rotten-egg smell at low levels, then olfactory paralysis; rapid collapse | Rescue team with SCBA only; oxygen; TMAS |
| Refrigerant / CO₂ / nitrogen | Machinery spaces, CO₂ room, inerted tanks | Simple asphyxiants; no warning; collapse | Ventilate, rescue with SCBA, oxygen |
| Solvents, thinners, cleaning chemicals | Paint locker, workshops | Dizziness, nausea, headache; skin and eye burns | Fresh air, remove contaminated clothing, irrigate skin and eyes for 20 minutes, consult the Safety Data Sheet |
| Dangerous goods in cargo | Container and tank cargo incidents | Varies by substance | Consult the Medical First Aid Guide (MFAG) with the substance's UN number |
Universal rules for any poisoning: protect yourself first — over half of enclosed-space fatalities are would-be rescuers (Section 6.1); remove the casualty from exposure only with the correct breathing apparatus; give high-flow oxygen; keep the container, label or Safety Data Sheet to hand for the TMAS call; and never induce vomiting after swallowing a corrosive or a petroleum product.
8. When to Call TMAS
Telemedical Maritime Assistance Service advice is free, available 24 hours a day, and there is no threshold that must be crossed before you use it. Call early for any chest pain, any altered consciousness, any suspected stroke, any anaphylaxis, any significant poisoning or smoke exposure, any first seizure, and any casualty you are simply unsure about. Have a full set of vitals, the time of onset, the casualty's medical history, their regular medications and their allergies written down before you make the call (Section 5.5).
A 52-year-old engineer develops central crushing chest pain radiating into the left arm, with sweating and nausea. He has no known allergies. What is the correct immediate first-aid action?
A crew member has been pulled unresponsive from the water and is not breathing normally. How does the resuscitation sequence differ from a standard collapse?
A rating is found confused, sweating, pale and behaving aggressively. Nobody knows whether he is a diabetic having a hypoglycaemic episode or a hyperglycaemic one, and he is conscious and able to swallow. What should be done?
A crew member develops rapidly swelling lips and tongue, a hoarse voice, widespread rash and wheeze after eating shellfish. What is the correct immediate treatment?