3.7 First Aid, Survival & Cold-Water Immersion

First Aid Is Part of Deck Safety

Q161 mixes procedural seamanship with medical and survival knowledge because the master is often the senior person present when a passenger bleeds, collapses into shock, or enters cold water after an MOB. You are not expected to replace a paramedic, but you are expected to stop major bleeding, support shock care, manage hypothermia, and run survival priorities until Coast Guard or EMS takes over. Separately, federal credentialing requires approved first aid and CPR training before an original Master officer endorsement is issued — the exam and the application package both care.

Shock

Shock is inadequate tissue perfusion — a life-threatening state after blood loss, severe trauma, burns, allergic reaction, or cardiac events. Signs include pale/cool/clammy skin, rapid weak pulse, rapid shallow breathing, anxiety or confusion, nausea, and thirst.

Master-level care (within training):

• Ensure scene safety and call for advanced help (radio Mayday/Pan-Pan medical as appropriate; 911 via cell when coastal).
• Control obvious bleeding.
• Keep the person lying down if no breathing/spinal contraindication to that position; elevate legs only if your training and the injury pattern support it.
• Maintain body temperature — blankets under and over; protect from wind and spray.
• Do not give food or drink if surgery or decreased consciousness is likely.
• Reassure and monitor continuously; be ready for CPR if circulation fails.

Bleeding Control

Priority order taught across standard first-aid courses:

1. Direct pressure on the wound with a clean dressing; add more dressings without removing the first if blood soaks through.
2. Pressure bandage once bleeding slows.
3. Tourniquet for severe limb hemorrhage when direct pressure fails or is impractical (e.g., mass casualty, arterial spurting) — place high on the limb per current training, note the time, and do not loosen casually.
4. For embedded objects: stabilize, do not yank out on deck.

Glove up when possible; passenger vessels should carry a stocked first-aid kit matching COI/company standards and know its location cold.

Hypothermia (General)

Hypothermia is core temperature drop from cold air, wet clothing, wind, or water immersion. Early signs: shivering, poor coordination, confusion, slurred speech. Later: shivering stops, severe confusion, unconsciousness, cardiac risk.

Field care principles:

• Remove from cold/wind; gentle handling (rough movement can trigger cardiac events in severe cases).
• Replace wet clothes with dry insulation; use blankets, sleeping bags, survival craft canopy.
• Warm the core (trunk) preferentially; avoid focusing only on rubbing extremities hard.
• Provide warm sweet drinks only if fully conscious and your protocol allows.
• Severe hypothermia needs professional medical care ASAP — treat as urgent medical distress traffic if needed.

Cold-Water Immersion — Three Stages

Cold water kills in a predictable sequence. Exam stems love these stages:

1. Cold Shock (roughly first 1–3 minutes)

Sudden immersion causes gasp reflex, hyperventilation, and panic. Victims can inhale water and drown in the first minute even if strong swimmers. Survival actions:

• PFD on before entry when possible (why throw flotation immediately in MOB).
• Keep airway clear; float on your back; do not try a long swim in the first minute.
• Focus on controlling breathing for about a minute before assessing swim options.

2. Swim Failure / Short-Term Immersion (about 3–30 minutes)

Cooling of muscles and nerves causes loss of coordination — the person cannot swim or grasp effectively even though core temperature may not yet be critically low. They may slip out of a ladder or fail to hold a ring.

• Get them to flotation and rescue quickly; do not expect a long self-rescue swim in cold water.
• Rescuers should use lines and gear, not assume the person can climb unaided.

3. Hypothermia (after roughly 30+ minutes, variable with temperature/gear)

Core cooling progresses to classic hypothermia. Survival time depends on water temperature, body size, clothing, PFD, sea state, and behavior. Stay still with insulation and flotation beats thrashing, which dumps heat.

HELP Position and Group Huddle

With a PFD on and rescue not immediate:

• HELP (Heat Escape Lessening Posture): draw knees toward the chest, arms tight to the sides/chest, head out of the water — reduces heat loss from groin, armpits, and chest.
• Group huddle: several people in PFDs face inward, chests close, arms around each other — shared warmth and easier visual target for searchers.
• Never discard a PFD to "swim faster" in cold open water.
• If you have a liferaft or buoyant apparatus, get out of the water as soon as possible — air is colder but water conducts heat far faster; out of water always wins when the craft is available.

Survival Craft Priorities

Once in a raft, buoyant apparatus, or floating wreckage:

1. Account for people and stream a sea painter/drogue as designed if it helps keep the craft from the sinking vessel safely.
2. Dry off / insulate — close canopy, use blankets/space bags, huddle.
3. Inventory signaling gear: EPIRB/PLB, VHF handheld, flares, mirror, dye, whistle.
4. Signal when it can be seen or heard — do not fire all pyrotechnics into empty fog.
5. Ration water; do not drink seawater. Food is secondary to water and heat.
6. Assign a lookout/watch rotation; fight despair with structure and hope grounded in SAR practice.
7. Stay with the craft — it is a larger target than a lone swimmer.

First Aid Training Requirement — Original Master

For an original officer endorsement as Master (including Master Less Than 100 GRT pathways), the Coast Guard requires completion of an approved first aid course and CPR training meeting current National Maritime Center standards (commonly including adult CPR and AED familiarization as the approved course outlines specify). This is a credential prerequisite documented with the MMC application, not a suggestion for after you pass Q161.

Practical implications for candidates:

• Complete first aid + CPR at an accepted provider before or during the application process.
• Keep cards/certificates available for evaluation.
• On the vessel, that training is why the master is expected to lead bleeding, shock, and drowning/hypothermia care until EMS arrives.

Raise-of-grade or renewal rules can differ by transaction; the exam-level takeaway for this section is: original Master expects documented first aid/CPR competence, and Q161 expects you to apply the survival and immediate-care concepts above under stress.

Bridge-card: medical vs survival decision

• Bleeding/shock on deck: pressure, warmth, radio for help, monitor ABCs.
• Person in cold water: flotation, rapid recovery, treat cold shock then hypothermia — do not force a long swim.
• In the raft: out of water, insulated, signaling ready, group together, master sets the watch and the calm.