Casualty Assessment and the Maritime Medical Environment

Why Maritime First Aid Is Different

On land, emergency medical services can reach most patients within minutes. At sea, you may be the only trained responder, the nearest hospital may be days away, and medical evacuation by helicopter or vessel is expensive, weather-dependent, and not always possible. The Ship Captain's Medical Guide and the STCW Medical First Aid syllabus both recognize these realities. Your job is not to replace a physician — it is to keep the casualty alive and as stable as possible until professional medical care becomes available, and to document everything so that care can continue seamlessly when it does.

The maritime medical environment has four defining constraints you must plan around:

1. Isolation — You cannot call for backup the same way a shore responder can. A designated medical officer aboard must make decisions alone or with radio guidance from a shoreside physician.

2. Limited supplies — The ship's medical locker is finite. Use supplies wisely and record everything you consume.

3. Delayed evacuation — A patient may need monitoring for hours or days. Written records are essential.

4. Duty to document — STCW and domestic regulations require a written patient record. Note the time, findings, treatments, and the patient's response to each intervention.

Scene Size-Up

Before you touch any casualty, stop and evaluate the scene. Rushing in without a size-up can create a second casualty — you.

• Hazard identification — Is the deck wet, is machinery still running, is there a toxic atmosphere, is there smoke or fire? Don your appropriate PPE (gloves at minimum for any contact with blood or body fluids) before approaching.
• Mechanism of injury (MOI) or nature of illness — How did this happen? A fall from height suggests spinal injury. A crush injury suggests internal bleeding. A drowning suggests hypoxia and hypothermia together. MOI guides the rest of your assessment.
• Number of casualties — Are there more victims? If there are multiple casualties and resources are limited, you will need to triage — sort by urgency.

Never enter a confined space to rescue a collapsed crew member until you have confirmed the atmosphere is safe. Toxic gas in void spaces and cargo holds is a leading cause of multiple fatalities aboard ships.

Primary Survey: ABCDE

The primary survey finds and addresses life-threatening conditions immediately, in order of priority. Use ABCDE every time, without skipping steps.

A — Airway

Is the airway open and clear? Unconscious casualties commonly obstruct their airway with the tongue. Use a head-tilt/chin-lift (jaw thrust if spinal injury is suspected). Remove visible obstructions. Look, listen, and feel for air movement.

B — Breathing

Is the casualty breathing adequately? Look for chest rise, listen for breath sounds, note rate and depth. Absent or inadequate breathing requires rescue breaths or assisted ventilation. A drowning victim or someone in a toxic atmosphere will often present with breathing problems as the first obvious sign.

C — Circulation

Check for a pulse. Look for and control major external bleeding — apply direct pressure immediately. Uncontrolled hemorrhage is one of the most common preventable causes of death from trauma. Signs of shock (pale, cold, clammy skin; rapid weak pulse; altered mental status) indicate internal or external blood loss that demands urgent action.

D — Disability (Neurological status)

Assess the level of consciousness using the AVPU scale: Alert, responds to Voice, responds to Pain, Unresponsive. Note pupil size and equality. A sudden change in neurological status is a red flag for head injury or stroke.

E — Exposure

Expose the body as needed to find hidden injuries — significant wounds can be concealed by clothing. In the maritime environment, balance the need to expose the casualty against the risk of hypothermia, especially after immersion. Cover the patient promptly once you have examined them.

After you address any life threat found at each step, move to the next. If the casualty deteriorates, return to A and reassess.

Secondary Survey: Head-to-Toe Assessment

Once the primary survey is complete and immediate life threats are controlled, perform a systematic head-to-toe physical examination. Work methodically: scalp, face, neck (check for tracheal deviation and neck vein distension), chest, abdomen, pelvis, limbs, and back. Look, feel, and note any tenderness, deformity, swelling, or abnormal movement. Record your findings as you go.

The secondary survey finds injuries that are serious but not immediately life-threatening — a closed fracture of the femur, for example — that will need treatment and careful monitoring during a prolonged period before evacuation.

Verbal Findings Report

In maritime operations you may need to report your findings to the vessel master or to a shoreside physician by radio. Use plain, organized language. State: who you are, who the casualty is, the mechanism of injury, your primary survey findings in ABCDE order, vital signs, treatments applied, and the patient's current status. Clarity and brevity matter on a radio channel.

Safety Points to Remember

• Don PPE before contact — gloves, eye protection if there is any splash risk.
• Never skip the scene size-up — a dead rescuer saves no one.
• Confined space atmospheres can kill in seconds — do not enter without confirmed atmosphere testing and appropriate respiratory protection.
• Document everything — time, findings, interventions, and patient response. The written record protects the patient and protects you.