This is why the RYA insist that a MOB goes to hospital

[JumbleDuck]

The advice is about MOB - which is in itself very rare - and where the conditions that might lead to secondary drowning are more likely. If you read about the condition, you will see that not only is it rare in drownings as a whole, but the symptoms are observable and can take up to 24 hours to become apparent.

That is precisely my point. Secondary drowning is rare and has clearly observable symptoms. Treating every MOB as a medical emergency - lifeboats, helicopters, blue lights and all - is as silly as treating every capsized Laser the same way. You might as well call mayday every time someone skins a knuckle on board ... after all, tetanus can be fatal.

That is not, of course, to say that all MOBs can be lightly dismissed. In particular, if anyone thinks they may have inhaled water, we should take it very seriously.

 

[Jamesuk]

So should I go to hospital every time I've been for a swim.?

Yes of course ha if you have panicked say when a shark swims past and have taken water and chocked then yes go immediately.

Secondary drowning has been taught for years. A US service personel is often mentioned as an example

 

[duncan99210]

Thinking back to training as a dive supervisor, we were taught about the dangers of secondary drowning as part of the issues of a diving casualty. Now, we were mostly focused on casualties arising from diving incidents at depth but we also covered MOB situations from dive boats in transit. One of the points made about MOB casualties was that because they were unexpected they would often be accompanied by the cold water breath intake, which can easily lead to secondary drowning.

We discussed this in some detail with the medic taking the class. He pointed out that in a situation where you had a short period of time to think "I'm about to go into the water", then the probability of inhaling water was low. On the other hand, where you tripped whilst moving in a boat and pitched over the side, then the chances of inhalation of water increased dramatically. This, not every MOB was likely to have inhaled enough water for secondary drowning to be a possibility. However, the condition is not easy to spot for a layman, nor are the symptoms always self evident to the casualty. His recommendation was therefore to treat all MOB as potential casualties who should be referred to shore based medics for observation. Generally speaking, this meant aborting the dive trip, returning to shore and sending the casualty to A&E with a buddy to explain what had happened. He also recommended oxygen therapy until the casualty was in the care of medics.

OK. So what for the yachties? To my mind, anyone going over the side from a yacht is going to be a casualty, simply because of the time it will take to recover them. A dive RIB can easily recover a MOB within a very short period of time, not so for a yacht, where the problem of freeboard alone will make recovery difficult even for a conscious casualty. Close inshore, head for port and send the casualty to A&E via ambulance. Any further offshore, then ask for help in evacuation. I rather cause a bit of nause with the SAR people than see someone die because I didn't want to trouble anyone.

 

[Tranona]

That is precisely my point. Secondary drowning is rare and has clearly observable symptoms. Treating every MOB as a medical emergency - lifeboats, helicopters, blue lights and all - is as silly as treating every capsized Laser the same way. You might as well call mayday every time someone skins a knuckle on board ... after all, tetanus can be fatal.

That is not, of course, to say that all MOBs can be lightly dismissed. In particular, if anyone thinks they may have inhaled water, we should take it very seriously.

Nobody was seriously suggesting your first paragraph - so why bang on about it? Moral panic comes to mind - which diverts attention from the real issue, so your second paragraph is relevant. In the rare event of an MOB, watch out for symptoms of secondary drowning and call for help if you have any doubt - almost certainly there will be other symptoms anyway that need attention.

 

[JumbleDuck]

Nobody was seriously suggesting your first paragraph - so why bang on about it?

In response to

That's a bit of an ignorant reply. Sudden unexpected immersion as in an MOB often causes an involuntary in-breath when the head is under water, it's part of the shock process and is not the case when you jump in deliberately. That involuntary breath can suck water into the lungs, hence the sensible precaution of a hospital check.

and

It seems a sensible precaution to take a MOB in for obs, or even a proper check over by someone who knows what they are doing, which is not something you can do while sailing a boat.

and, though mitigated by

Good luck with that one. Assuming they get back on board I would call for the emergency service. At least call them and get their advice.

and

As the skipper it is your call, make sure you are happy with it as you sit at the inquest looking at the crew's wife and children as the Coroner states that the death was avoidable had you come into port.

I know of no lifeboat crew, helicopter crew, ambulance crew, A&E consultant, junior doctor, matron, staff nurse or hospital cleaner who will criticise you for getting your crew into their care, but hey ho I take it you have never lost close friends through an accident at sea or on the mountains.

and also noting

OK. So what for the yachties? To my mind, anyone going over the side from a yacht is going to be a casualty, simply because of the time it will take to recover them. A dive RIB can easily recover a MOB within a very short period of time, not so for a yacht, where the problem of freeboard alone will make recovery difficult even for a conscious casualty. Close inshore, head for port and send the casualty to A&E via ambulance. Any further offshore, then ask for help in evacuation.

not to mention posts on the other thread.

In the rare event of an MOB, watch out for symptoms of secondary drowning and call for help if you have any doubt - almost certainly there will be other symptoms anyway that need attention.

As so often, we are in complete agreement. Which is nice.

 

[Triassic]

Good luck with that one. Assuming they get back on board I would call for the emergency service. At least call them and get their advice. There is no way I would want a death, or even want to deny any medical attention to anyone on board a boat I was skippering. That's my rule. I would never want to answer the question: Why didn't call for help? YMMV.

Thanks for illustrating my point extremely well for me. The problem is that less and less people are prepared to take any personal responsibility for making a sensible decision based on the facts and information available. You you really think someone on the end of a telephone/radio is going to be able to make an assessment of a potential casualty based on what you tell them? All you are doing is trying to pass responsibility to someone else because as you yourself say, you don't want to have to answer any questions.

I'm not advocating taking unnecessary risk, all I am suggesting is that we act sensibly and act based on the circumstances present at the time. Sending someone to hospital simply because they have been overboard is just plain daft. What is you concern for their health based on? How long have they been in the water and how cold is it? Are they coughing and spluttering because you've just given them the kiss of life or are they laughing and joking about how you probably wouldn't have known what to do anyway? What's their physical and medical background, what are they telling you they want to do?

Oh, and to the poster who asked if I have ever had a crew member die on me, no I haven't. I have however held someone in my arms for 40 minutes and watch them slowly deteriorate because thats how long it took to get an ambulance to a busy town centre location.

 

[oldgit]

Keeping it relevant for the old salts who infest this forum.
You are standing on the quay with choice of two boats to send out your grandkids for a trip away.
You can either send them out with Tranona or Triassic.
Easy choice ?

 

[ronsurf]

You you really think someone on the end of a telephone/radio is going to be able to make an assessment of a potential casualty based on what you tell them?

Yes. Someone on the end of the phone knows exactly what they are doing, and knows exactly what questions to ask. Two weeks ago I called an ambulance after seeing someone fall and crack his head on the cobbles. I'm an old skateboarder, I know a good headbonk when I see one. The questions were incredibly specific and hard to answer vaguely: "Is he breathing?" "Is the breathing quiet or noisy, like he's snoring?" "Is he bleeding?" "The blood you can see, is there enough to fill a coffee cup?" "Is there enough to fill two coffee cups?" etc. I don't care what the answers mean - there is a paramedic on the way and he is trained to deal with this. I'm not. I'm helping my phoning the ambulance. So I would say yes, the person on the phone is able to make an assessment over the phone of the situation. By the time the paramedic arrived he knew the extent and seriousness of the injury, his name, whether his family was present and what medication he was on.

When my step father suffered a fatal heart attack, my sister was given instruction over the phone how to do CPR until the paramedic arrived.

So in answer to your question, yes, I would expect someone on the phone to make a medical assessment based on what they are told because that's been my experience so far.

 

[JumbleDuck]

Keeping it relevant for the old salts who infest this forum.
You are standing on the quay with choice of two boats to send out your grandkids for a trip away.
You can either send them out with Tranona or Triassic.
Easy choice ?

Doesn't seem easy to me:

In the rare event of an MOB, watch out for symptoms of secondary drowning and call for help if you have any doubt ...

... all I am suggesting is that we act sensibly and act based on the circumstances present at the time.

I can't see much difference, myself.

 

[mm42]

There are other dangers involved in immersion in the cold waters of the UK which many aren't aware of, for example hydrostatic squeeze which can kill, hence recovering casualties as horizontal as possible, heart failure caused by the immersion, all sorts.

The extra burden that would be placed on the NHS by yachtsmen being "overly" cautious with an MOB is miniscule and I would be amazed if you ever met a member of the emergency services who resented it.

 

[capnsensible]

http://www.beyondcoldwaterbootcamp.com/en/first-responders

 

[Triassic]

... The questions were incredibly specific and hard to answer vaguely: "Is he breathing?" "Is the breathing quiet or noisy, like he's snoring?" "Is he bleeding?" "The blood you can see, is there enough to fill a coffee cup?" "Is there enough to fill two coffee cups?" etc. I don't care what the answers mean - there is a paramedic on the way and he is trained to deal with this. .....

I think you have missed my point slightly.
Firstly, if he wasn't breathing, if his breathing was noisy, if he was bleeding enough to fill a coffee cup... etc etc you wouldn't be calling for "advice" you would have already decided he is in need of medical care and you would be calling for that help. I appreciate the person on the other end of the phone is able to offer first aid advice etc but that's isn't what we are asking here.

Would you make that call about somebody who is not displaying an signs of medical distress but has simply been over the side for a moment? My suggestion is that you should not. You should only be doing so if there is some reason for you having concern for their health.

 

[Triassic]

There are other dangers involved in immersion in the cold waters of the UK which many aren't aware of, for example hydrostatic squeeze which can kill, hence recovering casualties as horizontal as possible, heart failure caused by the immersion, all sorts.

The extra burden that would be placed on the NHS by yachtsmen being "overly" cautious with an MOB is miniscule and I would be amazed if you ever met a member of the emergency services who resented it.

Now that's changing the subject slightly. Clearly the water temperature and it's potential effect on the individual is one of the things you are going to consider when assessing what to do with them, but this thread is about a blanket policy of sending MOB's to hospital. Are you suggesting the RYA have different advice for those cruising the tropics?

"Resentment" is a powerful word. I think you will find quite a substantial part of the emergency services don't appreciate the unnecessary burden being placed upon them these days by the "just in case" brigade.

 

[mm42]

How many MOBs do you think there are causing this massive burden on the NHS?

I work alongside the emergency services and have not met one who would resent me sending a casualty who'd suffered an unplanned immersion in cold water to hospital.

 

[alant]

Thinking back to training as a dive supervisor, we were taught about the dangers of secondary drowning as part of the issues of a diving casualty. Now, we were mostly focused on casualties arising from diving incidents at depth but we also covered MOB situations from dive boats in transit. One of the points made about MOB casualties was that because they were unexpected they would often be accompanied by the cold water breath intake, which can easily lead to secondary drowning.

We discussed this in some detail with the medic taking the class. He pointed out that in a situation where you had a short period of time to think "I'm about to go into the water", then the probability of inhaling water was low. On the other hand, where you tripped whilst moving in a boat and pitched over the side, then the chances of inhalation of water increased dramatically. This, not every MOB was likely to have inhaled enough water for secondary drowning to be a possibility. However, the condition is not easy to spot for a layman, nor are the symptoms always self evident to the casualty. His recommendation was therefore to treat all MOB as potential casualties who should be referred to shore based medics for observation. Generally speaking, this meant aborting the dive trip, returning to shore and sending the casualty to A&E with a buddy to explain what had happened. He also recommended oxygen therapy until the casualty was in the care of medics.

OK. So what for the yachties? To my mind, anyone going over the side from a yacht is going to be a casualty, simply because of the time it will take to recover them. A dive RIB can easily recover a MOB within a very short period of time, not so for a yacht, where the problem of freeboard alone will make recovery difficult even for a conscious casualty. Close inshore, head for port and send the casualty to A&E via ambulance. Any further offshore, then ask for help in evacuation. I rather cause a bit of nause with the SAR people than see someone die because I didn't want to trouble anyone.

Whilst in the North Sea & transferring onto the mother ship, I lost my grip on the pilot ladder & plunged down, wearing heavy work gear, to some depth before my LJ saved me. Knowing it was happening, saved me from the shock response (it was also August) & never experienced any SD symptoms, having held my breath to prevent inhalation of sea water. Strangely, the Safety Officer didn't mention SD at the time, or take any precautions to observe my progress over the next 48 hrs, as is recommended.

 

[Triassic]

Very few I suspect, and hopefully it will stay that way if people use common sense and don't follow the RYA "advice" regardless of the circumstances.

Why do we keep making reference to "cold water"? This is about "Why the RYA insist that a MOB goes to hospital" and the risks associated with secondary drowning.

 

[mm42]

Very few I suspect, and hopefully it will stay that way if people use common sense and don't follow the RYA "advice" regardless of the circumstances.

Why do we keep making reference to "cold water"? This is about "Why the RYA insist that a MOB goes to hospital" and the risks associated with secondary drowning.

Maybe because we, and the RYA, are based in the UK, where we have cold waters. Cold water immersion increases the chances of secondary drowning due to the involuntary gasping and hyperventilation that occur as you enter cold water, often causing gulps of cold water to be taken in.

 

[alant]

Very few I suspect, and hopefully it will stay that way if people use common sense and don't follow the RYA "advice" regardless of the circumstances.

Why do we keep making reference to "cold water"? This is about "Why the RYA insist that a MOB goes to hospital" and the risks associated with secondary drowning.

When working as a commercially endorsed bod, I certainly would have no qualms about getting a mob casualty to hospital. Just the thought of possibly being quizzed by a Coroner, focussed any decision & I think few would behave otherwise. Duty of care, to crew/punters is paramount, crying wolf is not even considered, or should ever be.

 

[mm42]

When working as a commercially endorsed bod, I certainly would have no qualms about getting a mob casualty to hospital. Just the thought of possibly being quizzed by a Coroner, focussed any decision & I think few would behave otherwise. Duty of care, to crew/punters is paramount, crying wolf is not even considered, or should ever be.

Exactly.

My experience comes as coxswain of a rescue boat, our SOP is anyone who has entered the water is having an ambulance called. If the ambulance crew decides the casualty doesn't need further care then that is their call, but I'd be very surprised to see them just send someone on their way.

 

[JumbleDuck]

My experience comes as coxswain of a rescue boat, our SOP is anyone who has entered the water is having an ambulance called.

Golly. Last time I capsized a dinghy I was in 4' of warm water (I discovered the 4' aspect of it after swimming round for ten minutes, which was a little embarrassing). Would you have called an ambulance for me? How about the four kids I saw go over in Picos last weekend?

The trouble with all this "precaution never harmed anyone" stuff is that it does harm people. The time it takes to assess someone who has been send to A&E as an arse-covering exercise with no symptoms and no cause for concern is time that medical staff could have used to deal with someone who was actually in danger. On the other thread, someone suggests that anyone who falls overboard mid-channel could be taken ashore by helicopter ... which is fine, but rather tough luck on the guy who has a heart attack off Portland Bill and has to wait his turn.

I am absolutely not suggesting that we treat this matter lightly, just that we all show a bit of common sense and responsibility to the whole community. Secondary drowning is definitely something to be concerned about: we should know what to look for and what to do if we see anything perturbing.