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newSchoolWorks.com › VoTechWorks › Transportation › Maritime Crew (deck/engine) › Maritime First Aid: Emergency Care at Sea › Lesson 5
TRN-MARI24-05 · Lesson 5 · 8 clock hours · field

Immobilization, Patient Movement, and Medical Documentation

Objective. Students will correctly apply a SAM splint to a simulated lower-arm fracture, log-roll and secure a simulated spinal-injury casualty onto a backboard, package the casualty in a Neil Robertson stretcher, and complete a STCW-compliant patient record ready for radio transmission to a medical officer.

⚠ 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.

Immobilization, Patient Movement, and Medical Documentation

At sea, you may be hours or days from a hospital. When a crewmember suffers a fracture or a potential spinal injury, your job is to stabilize the patient, move them safely, and hand off accurate information to the medical officer ashore. Every step you take — and every step you skip — will be visible in the patient record.

Applying a SAM Splint

A SAM splint is a thin aluminum core wrapped in foam. It conforms to any limb when bent into a structural curve. For a forearm fracture:

1. Check distal CMS first — Circulation (capillary refill, pulse at wrist), Motor (can the patient move fingers?), Sensation (can they feel light touch?). Write down your findings before you splint.

2. Measure the splint from the palm to just below the elbow, or elbow to just below the shoulder depending on the injury site.

3. Bend a gentle C-curve or T-bar into the splint to add rigidity.

4. Pad bony prominences (wrist, elbow) with the foam side against the skin.

5. Apply the splint to the injured side and secure with roller gauze or self-adherent wrap — snug, not tight.

6. Check distal CMS again immediately after securing. If circulation has worsened, loosen and recheck.

7. Support the arm in a sling and swathe if the shoulder allows.

For a lower leg, the same logic applies: measure palm-to-knee equivalent (heel to just above the knee), pad the heel and ankle prominences, and check CMS before and after.

Safety point: Never straighten an angulated fracture unless circulation is absent and evacuation is delayed — follow your training protocol and medical officer guidance.

Spinal Injury: Log-Roll and Backboard

Suspect a spinal injury after any fall from height, blow to the head, neck, or back, or when a casualty is unconscious after trauma. The rule is: keep the spine in neutral alignment until a physician clears it.

Team of four positions:

Log-roll sequence:

1. Head person takes inline stabilization and announces the plan.

2. Apply a properly sized cervical collar — measure from the bottom of the chin to the top of the shoulder to select size.

3. Position the team. On the head person's count, roll the casualty as one unit ("Roll on three — 1, 2, 3").

4. Foot person slides the backboard under the casualty.

5. Roll back down onto the board on command.

6. Center and align the casualty. Strap at chest, hips, and legs — not across the neck.

7. Secure the head last with foam blocks or rolled blankets and forehead tape. Maintain inline stabilization until head is secured to the board.

Safety point: In a narrow passageway, do not rush. A broken spinal alignment cannot be undone. Move only when every team member is ready.

Neil Robertson Stretcher: Packaging and Moving

The Neil Robertson stretcher is a tubular canvas-and-wood-slat device designed for confined spaces on ships — vertical hoists, narrow ladders, and passageways. The backboard-packaged casualty is placed inside it, the flaps are folded, and the straps are buckled in sequence from feet to chest. The handles allow vertical or horizontal carries.

Moving through confined spaces:

STCW Patient Record and Radio Medical Report

STCW requires ships to maintain written records of all medical treatments. The patient record must include at minimum:

When you radio the shore-based medical officer (CIRM in the US or a TMAS provider internationally), use a structured format:

1. Identification — vessel name, call sign, position, ETA to port

2. Patient — name, age, sex, rank

3. Mechanism — how the injury occurred

4. Vital signs — current, with times

5. Care given — what you did and when

6. Current status — conscious, pain level, CMS findings

7. Request — what you need: advice, medication authorization, evacuation request

Speak slowly, use plain language, and confirm each item with the medical officer. Record the name of the officer and the advice given on the patient form.

Safety point: Radio communications about patients are confidential. Limit open-channel broadcasts to essential information.

Competency Standard

For this lesson you must pass all three parts of the checklist: correct SAM splint with CMS documented, log-roll without spinal misalignment, and a complete patient record with a structured radio report. Any one part not met means you repeat that component before the course moves on. These skills directly support your STCW Basic Training certification requirement for elementary first aid.

Key terms9

CMS checkAssessment of Circulation, Motor function, and Sensation distal to an injury site; performed before and after splinting to detect neurovascular compromise.
SAM splintA flexible aluminum-core, foam-padded splint that is shaped by the rescuer and conforms to any limb to immobilize a fracture.
Manual inline stabilizationHands-on technique where the rescuer at the head holds the casualty's head and neck in neutral alignment, preventing movement until secured to a backboard.
Log-rollA coordinated team maneuver that turns a suspected spinal-injury casualty as a single rigid unit to place them on a backboard without twisting the spine.
Neil Robertson stretcherA tubular canvas and wood-slat evacuation stretcher designed for ship confined spaces; allows vertical or horizontal movement through hatches and ladders.
Cervical collarA rigid foam-and-plastic device placed around the neck to limit cervical spine movement in a patient with suspected neck injury.
STCW patient recordA written medical documentation form required under STCW conventions that captures patient identity, vital signs, interventions, and medications for every onboard medical event.
Radio medical reportA structured verbal report transmitted to a shore-based medical officer that provides patient identification, mechanism, current vital signs, care given, and a specific request for guidance or evacuation.
TMASTelemedical Assistance Service — shore-based medical consultation centers that provide remote guidance to ships' officers managing medical emergencies at sea.
In class: Instructor demonstration of SAM splint application to forearm and lower leg, followed by a four-person log-roll with manual inline spinal stabilization, backboard application, and full packaging in a Neil Robertson stretcher — students rotate through each position (head, left, right, foot) so every student practices the lead and support roles. · Simulated ship's passageway move: fully packaged Neil Robertson stretcher (with a consenting student inside) is carried by a four-person team through a narrow doorway mock-up and up a single step, requiring communication, coordinated lifting, and proper body mechanics; instructor observes and coaches PPE use (gloves, back mechanics). · Documentation station: each student independently completes a printed STCW-format patient record for the scenario casualty (name, time, mechanism, vital signs, interventions, medications given), then composes and delivers a structured radio medical report to the instructor playing the role of the shore-based medical officer — report is recorded and played back for self-assessment.
Materials: SAM splints (forearm and lower leg sizes), cervical collars (assorted sizes), long backboards with straps, Neil Robertson stretcher, passageway mock-up props, nitrile gloves, STCW patient record forms, radio handset (or training radio), scenario vital signs cards, Ship Captain's Medical Guide
Check: Instructor uses a three-part competency checklist: (1) SAM splint applied with distal CMS check documented — correct; (2) log-roll completed without breaking spinal alignment as judged by instructor at the head position — correct; (3) patient record complete with no missing mandatory fields and radio report includes patient ID, mechanism, vitals, and care given — all three parts correct = pass; any single part incorrect = that component repeated.

Practice check8

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

STCW Basic Training — Elementary First Aid
1. When applying a SAM splint to a suspected forearm fracture, which action must be completed BOTH before and after securing the splint?
STCW Basic Training — Elementary First Aid
2. During a four-person log-roll of a suspected spinal-injury casualty, who calls every movement and maintains spinal stabilization throughout the procedure?
STCW Basic Training — Elementary First Aid
3. After the log-roll is complete and the casualty is centered on the backboard, in what order are the head blocks and forehead tape applied relative to the chest and hip straps?
STCW Basic Training — Elementary First Aid
4. Which feature of the Neil Robertson stretcher makes it the preferred device for moving an injured crewmember through a ship's vertical hatch or narrow ladder?
STCW Basic Training — Personal Safety and Social Responsibilities
5. A student is carrying the head end of a Neil Robertson stretcher down a narrow passageway and is walking backward. What is the MOST important safety measure at this moment?
STCW Basic Training — Elementary First Aid
6. Which of the following items is a MANDATORY field on an STCW-compliant patient record?
STCW Basic Training — Emergency Procedures
7. When transmitting a radio medical report to a shore-based medical officer, which item should be included in your opening transmission?
STCW Basic Training — Elementary First Aid
8. A crew member falls from a ladder and is unconscious. During the SAM splint assessment you notice the fingers on the injured arm are pale, cold, and the patient cannot move them. What is the CORRECT next action regarding the splint?
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