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newSchoolWorks.com › VoTechWorks › Transportation › Maritime Crew (deck/engine) › Maritime First Aid: Emergency Care at Sea › Lesson 2
TRN-MARI24-05 · Lesson 2 · 10 clock hours · lab

CPR, AED, and Airway Management

Objective. Students will perform hands-only and ventilation CPR on an adult mannequin and correctly operate an AED through a full shock cycle, meeting current American Heart Association or Red Cross BLS skill standards.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a certified examiner or master technician in the trade or by a certification or approval body. It is a study draft and may contain errors. Do not use it as instructions for work on a job site or on live equipment. Always follow your instructor, your supervising professional, and current official references and regulations.

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Why CPR and AED Skills Matter at Sea

At sea, the nearest advanced medical help may be hours or days away. When a crewmember collapses from cardiac arrest, the people on board are the emergency medical system. Brain damage begins within minutes of cardiac arrest, and survival rates drop sharply with every minute that passes without effective chest compressions and defibrillation. STCW Basic Training requires proficiency in basic first aid, including CPR and AED use, because these skills are literally life-or-death tools for every mariner.

Recognizing Cardiac Arrest

Before starting CPR, confirm the situation is safe and the patient actually needs it. The BLS sequence begins with scene safety — on a vessel this means checking for electrical hazards, fuel spills, moving machinery, and deck motion. Never rush in and become a second casualty.

Check responsiveness by tapping the person's shoulders firmly and shouting. Look for absent or only gasping breathing. If the person is unresponsive and not breathing normally, assume cardiac arrest and act immediately. Gasping (agonal breathing) is not normal breathing — treat it as cardiac arrest.

Activating Emergency Communications

On a vessel, activating the emergency response system means two things: sound the ship's emergency alarm and make a radio call to the bridge with the location and nature of the emergency. One person should start CPR while a second activates communications and retrieves the AED. Never delay compressions to make the radio call yourself if someone else is available.

Chest Compressions: Rate, Depth, and Recoil

Place the heel of your hand on the center of the chest (lower half of the sternum). Place your second hand on top, fingers interlaced and lifted off the chest. Keep your arms straight and compress straight down. Current American Heart Association (AHA) and American Red Cross BLS guidelines call for:

Fatigue degrades compression quality quickly. Rotate rescuers approximately every 2 minutes (every 5 cycles of 30:2) when possible.

Rescue Breaths and Hands-Only CPR

For a trained rescuer willing and able to give breaths, the compression-to-ventilation ratio for adult BLS is 30 compressions to 2 breaths. Each breath should take about 1 second and produce visible chest rise. Avoid excessive force — over-ventilation can push air into the stomach and cause vomiting, which is especially dangerous in a confined engine room space.

If you are untrained, unwilling to give breaths, or conditions prevent safe ventilation, hands-only CPR (continuous chest compressions with no breaths) is acceptable and still effective, especially in the first few minutes. Always use a ventilation mask with a one-way valve when breaths are given — this is both an infection control measure and standard PPE.

Airway Management

Open the airway using the head-tilt chin-lift method: place one hand on the forehead and tilt the head back while lifting the chin with two fingers of the other hand. If a spinal injury is suspected, use a jaw thrust instead, though head-tilt chin-lift remains acceptable for a lone rescuer when a jaw thrust is not possible.

Using an AED

An AED (Automated External Defibrillator) is the most important link in the cardiac arrest chain of survival after compressions. Follow these steps:

1. Power on the AED — most units power on when the lid is opened.

2. Attach pads — one pad to the upper right chest (below the collarbone), one pad to the lower left side of the chest (below and to the left of the heart). Pads must contact bare, dry skin. Dry the chest if needed; in an engine room this is critical.

3. Clear the patient — before the AED analyzes and before any shock, ensure no one is touching the patient. State clearly: "I'm clear, you're clear, everybody's clear."

4. Follow voice prompts — the AED will advise shock or no shock. If shock is advised, press the shock button when instructed.

5. Resume CPR immediately after the shock — do not wait to check for a pulse. Continue CPR for 2 minutes, then allow the AED to re-analyze.

Engine Room Hazards and PPE

An engine room cardiac arrest presents specific hazards: oil on deck surfaces, noise, heat, and confined spaces. Before beginning care, don nitrile gloves to protect against blood and bodily fluids and to maintain grip. A face shield protects eyes during ventilation. Clear simulated oil-slick mats or hazards from around the patient before kneeling — a rescuer who slips and falls cannot help anyone. Use non-slip footwear whenever possible.

After the Emergency

Document the event as completely as possible: time of collapse, time CPR started, time AED applied, number of shocks, and patient response. This information is required for the ship's medical log and for any subsequent medical care the patient receives at port.

Key terms10

Cardiac arrestSudden cessation of effective heart pumping, resulting in loss of pulse and unconsciousness; requires immediate CPR and defibrillation.
BLS (Basic Life Support)The foundational level of emergency cardiac care including scene safety, CPR, and AED use, as defined by the American Heart Association and American Red Cross.
Compression rateThe speed of chest compressions; current BLS guidelines specify 100 to 120 compressions per minute for adults.
Full recoilAllowing the chest to completely return to its normal position between compressions so the heart can refill with blood; leaning on the chest prevents full recoil.
AED (Automated External Defibrillator)A portable device that analyzes heart rhythm and delivers an electrical shock to restore a normal rhythm in certain types of cardiac arrest.
Hands-only CPRContinuous chest compressions without rescue breaths; recommended for untrained bystanders and acceptable for any rescuer in the first minutes of adult cardiac arrest.
Head-tilt chin-liftThe standard manual technique to open an unconscious patient's airway by tilting the head back and lifting the chin forward.
Agonal breathingIrregular, gasping breaths that occur in the first minutes of cardiac arrest; not effective breathing — treat the patient as if not breathing.
One-way valve maskA ventilation barrier device placed over the patient's mouth and nose that allows the rescuer to deliver breaths while preventing backflow of the patient's air or fluids.
DefibrillationThe delivery of a controlled electrical shock through the chest wall to stop chaotic heart electrical activity and allow a normal rhythm to resume.
In class: Demonstration by instructor of adult BLS sequence on mannequin: scene safety, responsiveness check, activation of emergency communications (simulated ship's alarm and radio call to bridge), chest compressions, rescue breaths, and AED attachment — students observe and take notes on rate, depth, and recoil cues. · Repeated skills rotation: students work in groups of three, each taking a turn as rescuer while the other two observe and score using the program's CPR skills checklist; instructor circulates to correct hand position, compression depth, and AED pad placement in real time. · Scenario drill simulating an engine room cardiac arrest — one student is the rescuer, one plays a bystander with no training, one manages communications; team must locate the AED from a mounted cabinet, clear the area of simulated oil-slick mats (PPE: gloves), and complete a full AED cycle before the instructor calls time.
Materials: Adult CPR mannequins (minimum one per three students), AED trainers, ventilation masks with one-way valves, disposable gloves (nitrile), face shields, AHA or Red Cross BLS skills checklist, simulated engine room props (non-slip mats, dim lighting), program CPR skills checklist
Check: Instructor-scored mannequin skills check using the AHA or Red Cross BLS psychomotor skills sheet; student must achieve acceptable ratings on compression rate, depth, full recoil, minimal interruptions, and correct AED operation — any single critical fail (e.g., failure to use AED) = repeat required before moving forward.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

STCW Basic Training — Basic First Aid
1. You enter the engine room and find a crewmember collapsed and unresponsive. After confirming scene safety, what is your FIRST action?
STCW Basic Training — Basic First Aid
2. According to current AHA/Red Cross BLS guidelines, what is the correct compression rate for adult CPR?
STCW Basic Training — Basic First Aid
3. A trained rescuer is performing adult BLS with two-rescuer CPR. What is the correct compression-to-ventilation ratio?
STCW Basic Training — Basic First Aid
4. When attaching AED pads to a patient in the engine room, you notice the patient's chest is covered in oil and sweat. What should you do before placing the pads?
STCW Basic Training — Basic First Aid
5. The AED has analyzed the rhythm and is charging to deliver a shock. What must you do immediately before pressing the shock button?
STCW Basic Training — Basic First Aid
6. After the AED delivers a shock, what should the rescuer do immediately?
STCW Basic Training — Basic First Aid
7. A rescuer notices they are leaning slightly on the patient's chest between compressions. Why is this a critical error in BLS?
STCW Basic Training — Basic First Aid
8. During a simulated cardiac arrest scenario, your fellow crew member has no CPR training and asks if they can help. The AED is not yet available. What is the most appropriate task to assign them?
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