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newSchoolWorks.com › VoTechWorks › Transportation › Maritime Crew (deck/engine) › Maritime First Aid: Emergency Care at Sea › Lesson 3
TRN-MARI24-05 · Lesson 3 · 10 clock hours · practice

Hemorrhage Control, Shock, and Wound Management

Objective. Students will control a simulated arterial bleed on a practice limb trainer using direct pressure, wound packing, and tourniquet application, completing all steps correctly within the time limit set by the instructor.

⚠ 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.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Why Hemorrhage Control Is a Maritime Priority

At sea, the nearest hospital may be hours or days away. When a crew member suffers a serious wound — from machinery, rigging, or a fall — uncontrolled bleeding can become fatal before any medical evacuation arrives. STCW Basic Training and the medical first aid standards that apply to merchant mariners require you to act fast, act correctly, and document what you do. This lesson teaches the three-step hemorrhage control sequence, shock recognition and management, and proper wound care in the shipboard environment.

Personal Protective Equipment First

Before touching any patient, put on nitrile gloves and eye protection. Blood-borne pathogens are a real hazard. If splash risk is high, add a face shield. Never skip PPE because the situation feels urgent — donning gloves takes only seconds and protects both you and the patient.

The Hemorrhage Control Sequence

Step 1 — Direct Pressure

Place a clean dressing or folded gauze directly over the wound and press hard with the heel of your hand. Maintain firm, uninterrupted pressure. Do not lift the dressing to check the wound; if blood soaks through, add more material on top and press harder. Two full minutes of sustained pressure is the minimum for most wounds. This step alone controls many bleeds.

Step 2 — Wound Packing

If direct pressure does not control a deep or cavity wound — common with puncture wounds from machinery or jagged metal — you must pack the wound. Take rolled gauze and push it firmly into the wound cavity with your fingers, starting at the deepest point and working outward. Pack tightly so no air space remains. Apply direct pressure over the packed gauze for at least three minutes. Wound packing is especially effective for junctional wounds (groin, axilla, neck) where a tourniquet cannot be placed.

Step 3 — Tourniquet Application

A tourniquet is indicated for life-threatening limb bleeding that direct pressure and packing cannot control. Use a commercial device such as a CAT (Combat Application Tourniquet) or SOFT-T Wide, not an improvised one, when a commercial device is available.

Application steps:

1. Place the tourniquet at least two inches (approximately 5 cm) above the wound, directly on the skin whenever possible — not over clothing if it can be avoided.

2. Secure the band snugly and route the strap through the buckle or clip.

3. Twist or ratchet the windlass or tightening mechanism until bleeding stops and there is no distal pulse in the limb.

4. Lock the windlass and secure it so it cannot unwind.

5. Write the exact time of application — hour and minute — on the tourniquet label or directly on the patient's skin with a marker. This time notation is not optional; it is a documentation requirement that guides hospital care.

Tourniquet pain is expected and does not mean the device is wrong. Never remove a tourniquet once applied unless directed by a physician or Telemedical Assistance Service (TMAS).

Recognizing and Managing Shock

Shock is a state of inadequate tissue perfusion — the body's cells are not getting enough oxygen. On vessels, the most common cause is hemorrhagic shock (blood loss), but you must also recognize obstructive shock (e.g., tension pneumothorax from a crushing chest injury) and distributive shock (e.g., anaphylaxis from a bee sting or medication reaction, or septic shock from an infected wound).

Signs of shock (any type): pale, cool, clammy skin; rapid and weak pulse; rapid breathing; altered mental status; low or falling blood pressure; extreme thirst.

Hemorrhagic shock management:

Obstructive shock: suspect if the patient has a chest injury with absent breath sounds on one side, distended neck veins, and worsening condition despite no major external bleed. This is a TMAS emergency — report immediately.

Distributive shock (anaphylaxis): sudden onset after a known trigger; hives, wheezing, throat swelling. Use the ship's prescribed epinephrine auto-injector per standing orders and TMAS guidance; position the patient supine with legs elevated unless breathing is labored.

Wound Care After Bleeding Is Controlled

Once hemorrhage is controlled, irrigate clean (non-cavity) wounds with clean water or saline if available. Apply a sterile dressing. Do not probe the wound or remove embedded objects — stabilize impaled objects in place with bulky dressings. Change outer dressings if they become saturated, without disturbing underlying packing. Monitor the wound site for signs of infection during prolonged care: increasing redness, warmth, swelling, pus, or fever.

Documentation Under STCW Standards

Standards of Training, Certification and Watchkeeping require that shipboard medical care be recorded. For any significant injury, complete a patient record that includes: time of injury, time each intervention was applied (especially tourniquet time), vital signs with times, medications given, and the name of whoever provided care. This record travels with the patient to shore-based medical facilities and may be required by port state authorities.

Safety Reminders

Key terms10

Hemorrhagic shockA life-threatening condition caused by significant blood loss that reduces the body's ability to deliver oxygen to tissues, producing pale skin, rapid weak pulse, and altered mental status.
Direct pressureThe first step in hemorrhage control: applying firm, continuous manual pressure over a wound with a dressing to compress damaged blood vessels and allow clotting.
Wound packingA technique for deep or cavity wounds in which gauze is pressed firmly into the wound space to fill dead space and apply internal pressure against bleeding vessels.
TourniquetA device placed around a limb and tightened until blood flow below it stops, used for life-threatening limb bleeding uncontrolled by direct pressure and packing.
TMAS (Telemedical Assistance Service)A shore-based medical consultation service that provides remote physician guidance to ships at sea; required contact point for serious injuries under many maritime regulations.
Obstructive shockShock caused by a physical blockage to circulation, such as a tension pneumothorax compressing the heart, rather than fluid loss or vessel dilation.
Distributive shockShock in which blood vessels dilate abnormally, reducing effective circulation pressure; causes include severe allergic reaction (anaphylaxis) and serious infection (sepsis).
Junctional woundA wound at a body junction such as the groin, armpit, or neck where a standard limb tourniquet cannot be applied; requires wound packing and pressure.
WindlassThe rod or stick on a commercial tourniquet that is twisted to tighten the band until blood flow in the limb is stopped; must be locked and secured after use.
Patient record formA written document required under STCW standards that records the time, nature, and treatment of a shipboard injury, including vital signs and tourniquet application time.
In class: Instructor demonstration using a commercial hemorrhage simulation trainer showing the progression from direct pressure to wound packing with gauze to commercial tourniquet application (e.g., CAT or SOFT-T Wide), with narration of the decision points and documentation requirements under STCW medical care standards. · Hands-on station rotation: each student performs direct pressure for two minutes on a bleeding simulator, then practices wound packing technique with rolled gauze on a foam wound prop, then applies a tourniquet to a practice arm trainer — instructor records time-to-control and technique errors on a checklist. · Shock management discussion and scenario: using case cards drawn from real maritime incident reports (de-identified), student pairs diagnose type of shock (hemorrhagic, obstructive, distributive), select appropriate interventions from a shipboard first aid kit inventory list, and document a simulated patient record form.
Materials: Hemorrhage simulation arm trainers, commercial tourniquets (CAT or equivalent) for training, rolled gauze, pressure dressings, nitrile gloves, eye protection, shipboard first aid kit (actual or replica inventory), patient record forms, STCW medical first aid syllabus, stop-the-bleed reference cards
Check: Student must achieve arterial bleed control on the arm trainer using correct sequence (pressure → packing → tourniquet if indicated) within the instructor-set time limit; tourniquet must be applied at least two inches above the wound with written time notation — correct sequence and documented time = pass; missed step or undocumented time = repeat.

Practice check8

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

STCW Basic Training — Basic first aid
1. A crew member's forearm is spurting bright red blood from a machinery laceration. You have applied firm direct pressure with a dressing for two minutes and the bleeding has not slowed. What is the correct next action?
STCW Basic Training — Basic first aid
2. You are applying a CAT tourniquet to a crew member's thigh. Where must the tourniquet be placed?
STCW Basic Training — Basic first aid
3. After applying a tourniquet, which action is required before moving the patient to the ship's medical locker?
STCW Basic Training — Basic first aid
4. A deckhand was stung by a wasp, and within minutes develops hives, wheezing, and says his throat feels tight. His blood pressure is falling. What type of shock is this?
STCW Basic Training — Basic first aid
5. Which combination of signs is most consistent with hemorrhagic shock?
STCW Basic Training — Basic first aid
6. A wounded crew member has a metal rod impaled in his abdomen. What is the correct wound management?
STCW Basic Training — Basic first aid
7. Under STCW medical care standards, which of the following MUST be included in the patient record when a tourniquet has been applied?
STCW Basic Training — Basic first aid
8. A crew member has a deep wound in the groin area from a line-handling accident with severe bleeding. You cannot apply a tourniquet to this location. What is the preferred hemorrhage control technique?
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