Medical First Aid
Study Guide for Seafarers
Aligned to the topics of STCW Regulation VI/4 (Medical First Aid)
Mercantile Marine Academy, Kolkata
E-learning | www.mmatrust.com/e-learning
A revision aid. It does not replace an approved STCW course, the ship's medical guide, or radio medical advice. In any real emergency, follow your training and call for help.
Contents
- Why first aid matters at sea ... 3
- Immediate action: the first minutes ... 4
- The body in brief ... 5
- Examining the casualty ... 5
- Cardiac arrest, CPR and the AED ... 7
- Choking ... 8
- Bleeding and shock ... 9
- Burns, scalds, heat and cold ... 10
- Bones, joints, muscles and the spine ... 11
- Toxic hazards on board ... 12
- Common medical emergencies ... 13
- Rescued persons ... 14
- Radio medical advice ... 14
- Medicines, hygiene and mental health ... 15
| 15. Quick revision sheet | ... 17 |
|---|---|
| 16. Practice questions ... 18 |
Answers ... 20
How to use this guide Read one chapter at a time, then close the guide and say the steps aloud from memory. The revision sheet and practice questions at the end test what you have learned. First aid is a practical skill: practise CPR, bandaging and recovery position with a qualified instructor on a manikin.
1. Why first aid matters at sea
A ship can be days from a hospital. Until a doctor can help, the people on board are the medical team. Medical first aid is the immediate, correct care given to a sick or injured person using what is on board, so that life is saved, the condition does not get worse, and recovery is helped.
The three aims of first aid
| • | Preserve life: keep the airway open, support breathing and circulation, stop serious bleeding. |
|---|---|
| • • | Prevent the condition getting worse: do not move the casualty unnecessarily, keep warm, protect injuries. Promote recovery: reassure, relieve pain where trained and permitted, and arrange medical help. |
What the STCW Code expects
STCW Regulation VI/4 sets the standard for seafarers who are designated to provide medical first aid on board (and, at a higher level, medical care). The usual topics are listed below; check your own course syllabus for the exact list.
| Topic area | What you must be able to do |
|---|---|
| Immediate action | Assess the scene, raise the alarm, start life-saving first aid |
| Body structure and function | Name the main body systems and what goes wrong with them |
| Patient examination | Check responsiveness, airway, breathing, circulation; take pulse, breathing rate, temperature; take a history |
| Cardiac arrest, drowning, asphyxia | Give CPR, use an AED, treat choking and drowning |
| Bleeding, burns, fractures, spinal injury | Control bleeding, treat burns and scalds, immobilise fractures, protect the spine |
| Toxicological hazards on board | Recognise and treat poisoning, gas and chemical exposure |
| Rescued persons | Care for survivors: hypothermia, distress, cold exposure |
| Radio medical advice | Describe the casualty clearly to a doctor ashore and follow the advice |
| Pharmacology, sterilisation, psychological problems | Handle medicines safely, keep equipment clean, support someone in mental distress |
Help available on board
• • • • Ship's medical chest and first-aid kit: contents are set by flag-state rules. Know where they are and check expiry dates. International Medical Guide for Ships (WHO) or the national equivalent: the book you follow for diagnosis and treatment on board. MFAG (Medical First Aid Guide for Use in Accidents Involving Dangerous Goods) and the cargo's safety data sheet: for chemical exposure. Radio medical advice: free 24-hour telemedical help from a doctor ashore (see chapter 13).
2. Immediate action: the first minutes
Always work in the same order. A calm, fixed routine stops you freezing and protects you from becoming a second casualty.
DR ABC: the order of action Danger: is it safe for me, the casualty and others? (fire, gas, moving machinery, heavy seas, live electricity) Response: shake the shoulders gently and shout. Do they answer or move? Shout / send for help: raise the alarm, tell the bridge, ask someone to bring the first-aid kit and AED. Airway: open it (head tilt and chin lift; jaw thrust if neck injury is possible). Breathing: look, listen and feel for no more than 10 seconds. Normal breathing? Circulation: severe bleeding? Start CPR if not breathing normally.
Step by step
| 1 2 | Check danger. Do not rush into an enclosed space, a smoke-filled area or near live wires. Make the area safe or wait for trained help. Check response. If they respond, find out what is wrong and keep checking them. If not, shout for help. |
|---|---|
| 3 4 | Raise the alarm. On a ship this means telling the bridge/officer of the watch, who informs the Master and arranges radio medical advice. Give the exact location. Open the airway and check breathing for up to 10 seconds. |
| 5 | Not breathing normally? Start CPR at once (chapter 5) and send for the AED. |
| 6 | Breathing normally but unresponsive? Place in the recovery position and keep checking breathing. |
| 7 | Control severe bleeding and treat other life-threatening problems before minor ones. |
| 8 | Keep a record: times, what you found, what you did. This is passed on to the doctor and the next port. |
Protect yourself Wear gloves and eye protection if available. Wash hands afterwards. Treat all blood and body fluids as infectious. Never put yourself in danger: a second casualty doubles the problem.
Priority of treatment (triage)
With several casualties, treat first those who are unresponsive and not breathing normally and those with severe bleeding, because these are the ones who will die soonest without help. A quiet casualty who is not breathing is more urgent than a loud one who is.
3. The body in brief
You need only the basics, but they explain what you are seeing when something goes wrong.
| System | Main parts | Job | When it fails |
|---|---|---|---|
| Respiratory | Airway, lungs | Takes in oxygen, removes carbon dioxide | Choking, drowning, smoke inhalation, asthma |
| Circulatory | Heart, blood vessels, blood | Carries oxygen to the whole body | Cardiac arrest, bleeding, shock, heart attack |
| Nervous | Brain, spinal cord, nerves | Controls thinking, movement, feeling | Head injury, stroke, spinal injury, seizure |
| Skeletal and muscular | Bones, joints, muscles | Support and movement | Fractures, dislocations, sprains, strains |
| Skin | Skin layers | Barrier, temperature control | Burns, wounds, infection, heat and cold injury |
| Digestive and urinary | Stomach, bowel, kidneys | Food, water balance, waste | Poisoning, dehydration, severe vomiting, kidney stones |
Why oxygen is everything
Brain cells begin to be damaged within about 3 to 4 minutes without oxygen. That is why first aid is built around the airway, breathing and circulation: a clear airway lets air in, breathing and CPR move the oxygen, and the heart and blood carry it to the brain.
Normal adult values to remember Pulse: 60 to 100 beats per minute at rest Breathing: 12 to 20 breaths per minute at rest Temperature: about 36 to 37.5 degrees C (below 35 is hypothermia; above 38 is fever) Skin: normally warm, pink and dry. Cold, pale, clammy skin can mean shock.
4. Examining the casualty
Primary survey: look for life threats (about 1 minute)
| Letter | Check | Act if there is a problem |
|---|---|---|
| A: Airway | Is it open and clear? Noisy breathing, gurgling or no air movement? | Head tilt and chin lift (jaw thrust if neck injury). Clear visible blockage. |
| B: Breathing | Rate, depth, effort, blue lips | Rescue breaths or CPR; give oxygen if available and trained |
| C: Circulation | Pulse, skin colour and temperature, severe bleeding | Stop bleeding; lay flat and keep warm for shock |
| D: Disability | Level of response using AVPU (below); pupils; blood sugar if able | Recovery position if unresponsive but breathing |
| E: Exposure | Expose only as needed to find injuries; stop them getting cold | Cover with a blanket after checking |
AVPU scale: Alert; responds to Voice; responds to Pain; Unresponsive. Any change toward the U end means the casualty is getting worse: report it.
Secondary survey: head to toe (when life threats are dealt with)
| • | Head and face: wounds, swelling, blood or fluid from ears or nose, pupils. |
|---|---|
| • | Neck: tenderness, swelling. Chest: pain on breathing, shape, wounds. Abdomen: pain, rigid, bruising. |
| • • | Pelvis and back: tenderness (do not roll if spine injury is possible). Arms and legs: deformity, swelling, can they move and feel? Skin: colour, temperature, rashes, burns, medical alert bracelet or card. |
History: ask SAMPLE
| S | Signs and symptoms: what do they feel, when did it start? |
|---|---|
| A | Allergies: to medicines, foods, stings |
| M | Medication: what do they take, when was the last dose? |
| P | Past medical history: heart, diabetes, asthma, epilepsy, operations |
| L | Last food and drink: when and what? |
| E | Events: what happened leading up to this? |
Record, then repeat Write down pulse, breathing rate, level of response and temperature with the time. Repeat every few minutes. A trend over time (improving or worsening) tells the doctor more than a single reading.
5. Cardiac arrest, CPR and the AED
In cardiac arrest the heart stops pumping effectively. The casualty is unresponsive and not breathing, or only gasping. Without CPR and a shock from an AED if needed, death follows within minutes. Start immediately.
Adult CPR
| 1 2 | Check danger, response, then shout for help. Open the airway; check breathing for no more than 10 seconds. Not breathing normally: send someone for the AED and make sure the alarm is raised. |
|---|---|
| 3 4 5 6 | Kneel beside the casualty on a firm surface. Place the heel of one hand on the centre of the chest (lower half of the breastbone), other hand on top, fingers interlocked and off the ribs. With straight arms, push down hard and fast: about 5 to 6 cm deep, at 100 to 120 compressions per minute. Let the chest come fully back up each time. After 30 compressions, give 2 rescue breaths: tilt head, lift chin, pinch the nose, seal your mouth over theirs, and blow steadily for about 1 second until the chest rises. Use a pocket mask or face shield if you have one. Continue 30:2 without stopping. Keep any pause for breaths or pad placement under 10 seconds. |
| 7 | Swap with another rescuer about every 2 minutes if possible, as compressions are tiring. |
| 8 | Carry on until the casualty shows clear signs of life, a trained person takes over, the AED tells you otherwise, or you are too exhausted to continue. |
If you cannot or will not give breaths Give hands-only CPR: continuous chest compressions at 100 to 120 per minute. CPR with breaths is the most effective, but compressions alone are far better than doing nothing.
Using an AED (automated external defibrillator)
| 1 | Switch it on and follow the voice prompts. Keep doing CPR until it is ready. |
|---|---|
| 2 3 | Expose the chest. Dry it if wet. Remove medication patches. Apply the pads as shown on the pad pictures (one below the right collarbone, one on the left side below the armpit). Let the AED analyse. Nobody touches the casualty while it does. |
| 4 5 | If a shock is advised, make sure everyone is clear, then press the shock button when told. Restart CPR immediately. Continue as the AED instructs, usually a new analysis every 2 minutes. |
AED safety Do not use in standing water: move the casualty to a dry area first. Do not touch the casualty during a shock. Leave the pads on even if you do not need another shock, and hand over with the AED still attached.
Children and infants
| Adult | Child (1 year to puberty) | Infant (under 1 year) |
|---|---|---|
| Compression 5 to 6 cm depth | About one-third of chest depth (around 5 cm) | About one-third of chest depth (around 4 cm) |
| Hand position Heel of both hands | Heel of one or two hands | Two thumbs encircling the chest, or heel of one hand |
| Rate 100 to 120 per minute | 100 to 120 per minute | 100 to 120 per minute |
| Ratio 30 compressions : 2 breaths | 30 : 2 (some courses use 15 : 2 with two rescuers) | 30 : 2 (some courses use 15 : 2 with two rescuers) |
| First breaths Go straight to compressions | ERC-style courses start with 5 rescue breaths; AHA starts with compressions | As for a child; cover the mouth and nose with your mouth |
Guidelines are updated from time to time (the American Heart Association updated its guidance in 2025, for example, removing the two-finger technique for infants). Always follow the technique taught on your current approved course.
Recovery position
For an unresponsive casualty who is breathing normally and has no suspected spinal injury:
| 1 | Kneel beside them. Place the arm nearest you at a right angle, palm up. |
|---|---|
| 2 | Bring the far arm across the chest and hold the back of that hand against their near cheek. |
| 3 | Bend the far knee up with the foot flat on the floor. |
| 4 5 | Pull on that knee to roll them toward you onto their side. Tilt the head back slightly to keep the airway open. Adjust the top leg so the hip and knee are at right angles. Check breathing often. Roll to the other side after about 30 minutes if they stay there. |
Drowning
• • • • Drowning is first a breathing problem, so oxygen matters. Make sure you are safe: reach or throw, do not go in unless trained and equipped. Once out of the water, check response and breathing. If not breathing normally, give 5 initial rescue breaths, then CPR 30:2, and use the AED (dry the chest first). Do not try to drain water from the lungs. Vomiting is common: turn them to the side, clear the mouth, then carry on. Every near-drowning casualty, even if they seem to recover, needs medical assessment because lung problems can appear later.
6. Choking
Mild choking: the person can speak, cough and breathe. Encourage them to keep coughing. Do not slap the back. Watch them closely.
Severe choking in an adult or child (over 1 year)
Signs: cannot speak, cough or breathe; silent; hands to throat; turning blue; may become unconscious.
1 Shout for help. Lean the casualty forward, supporting the chest with one hand.
2 3 4 5 Give up to 5 sharp back blows between the shoulder blades with the heel of your other hand. Check after each one if the blockage has cleared. If not cleared, give up to 5 abdominal thrusts: stand behind them, put your arms around the waist, make a fist just above the navel with the thumb side in, grasp it with the other hand, and pull sharply inward and upward. Keep alternating 5 back blows and 5 abdominal thrusts until the object comes out or the casualty becomes unresponsive. If they become unresponsive, lay them down, make sure help is called, and start CPR. Look in the mouth before each set of breaths and remove any object you can see.
Special cases Pregnant or very large casualty: use chest thrusts (same hand position as CPR) instead of abdominal thrusts. Infant (under 1 year): lay face down along your forearm, head lower than the body, and give 5 back blows; then turn face up and give 5 chest thrusts using the heel of one hand (not fingers). Never use abdominal thrusts on infants. Alternate until clear or unresponsive, then CPR. After successful abdominal or chest thrusts, the casualty should always be checked by a doctor (internal injury is possible).
7. Bleeding and shock
Severe external bleeding
Bleeding that is spurting, soaks through dressings, or will not stop can kill within minutes. Control it first, before many other things.
| 1 2 | Put on gloves if available. Press directly on the wound with a clean pad or dressing (your gloved hand if nothing else is available). Keep pressing firmly. If blood soaks through, add more pads on top; do not remove the first one. |
|---|---|
| 3 | Raise the injured limb if there is no fracture. Lay the casualty down. |
| 4 5 | Secure the pad with a firm bandage. Check that the fingers or toes beyond it are still warm and pink (not too tight). Call for help, treat for shock, and monitor. Do not give food or drink. |
Tourniquet: only for life-threatening limb bleeding If direct pressure cannot stop severe bleeding from an arm or leg, apply a commercial tourniquet if available: about 5 to 7 cm above the wound (never over a joint), tighten until the bleeding stops, write the time on the casualty or the tourniquet, and do not loosen it. Tell the doctor the time it was applied.
Wounds and bandaging
• • • • Minor wounds: wash hands, rinse with clean water, pat dry, cover with a sterile dressing. Check tetanus protection. Embedded object: do not pull it out. Pad around it, press on the sides, and bandage without pressing on the object. Amputated part: wrap in clean, moist material, place in a bag, keep it cool but not touching ice, and send with the casualty. Nose bleed: sit up, lean forward, pinch the soft part of the nose for 10 minutes. Seek advice if it will not stop.
Shock
Shock here means the circulation is not delivering enough blood to the organs, often after blood loss, burns, severe infection or a heart problem. Signs: pale, cold and clammy skin, fast weak pulse, fast breathing, thirst, restlessness, then confusion and unresponsiveness.
| 1 | Treat the cause (for example, control bleeding). |
|---|---|
| 2 | Lay the casualty down and raise the legs about 30 cm if there is no suspected fracture or spinal injury. |
| 3 | Loosen tight clothing, keep them warm with a blanket, reassure them. |
| 4 | Nothing to eat or drink. Monitor breathing and pulse. Be ready to start CPR. |
8. Burns, scalds, heat and cold
Burns and scalds
A burn comes from dry heat, fire, hot metal, chemicals or electricity; a scald from hot liquid or steam. The engine room, galley and hot pipes make these common at sea.
| 1 2 3 4 | Stop the burning: remove the casualty from danger. Switch off electricity before touching an electrical victim. Cool the burn under cool (not ice-cold) running water for at least 20 minutes. Seawater is acceptable if nothing else is available. Gently remove rings, watches and clothing near the burn unless stuck to the skin. Do not remove stuck clothing. Cover loosely with a clean, non-fluffy dressing or cling film laid lengthways (not wrapped round a limb). |
|---|---|
| 5 | Keep the casualty warm elsewhere in the body, treat for shock, and call for advice. Give small sips of water only if conscious and able to swallow, as advised. |
Never Never apply ice, butter, toothpaste or creams. Never burst blisters. Never put adhesive dressings or fluffy cotton wool on a burn.
| Type | Look like | Needs radio medical advice? |
|---|---|---|
| Superficial | Red, painful, no blisters (like sunburn) | Usually not, if small |
| Partial thickness | Blisters, wet, very painful | Yes if bigger than the casualty's palm, or on face, hands, feet, joints, genitals |
| Full thickness | White, leathery or charred, may be painless | Always: this is serious |
Size estimate: the casualty's own palm (with fingers) is about 1 percent of body surface. Rule of nines for adults: head 9, each arm 9, front of trunk 18, back of trunk 18, each leg 18, groin 1.
Chemical and electrical burns
• • Chemical: brush off dry powder, remove contaminated clothing, flood with water for 20 minutes or more. For eyes, irrigate for at least 15 to 20 minutes holding the lids open. Check the safety data sheet and MFAG. Electrical: make the supply safe first. There may be a small entry and exit wound with deep damage and heart rhythm problems. Check breathing and give CPR if needed. All electrical burns need medical advice.
Heat illness
| Heat exhaustion | Heat stroke (emergency) |
|---|---|
| Signs Heavy sweating, pale and clammy, headache, dizziness, nausea, cramps | Very hot skin, high temperature (about 40 or more), confusion, fits, may collapse |
| Action Rest in a cool place, lie down, loosen clothing, sip cool water or oral rehydration solution, cool with a wet cloth and fan | Call for help at once. Cool rapidly with wet sheets and fanning or cool-water immersion. Treat as life-threatening. |
Cold: hypothermia and frostbite
Hypothermia is a core temperature below about 35 degrees C. Signs: shivering (which may stop in severe cases), pale cold skin, slow speech, clumsiness, drowsiness, then unresponsiveness with a slow, faint pulse.
| 1 | Move them out of wind and water. Handle gently, keeping them horizontal where possible. |
|---|---|
| 2 3 4 Frostbite: pale, hard, numb skin on fingers, toes, ears or nose. Rewarm gently in warm (not hot) water, do not rub, protect the area with loose dry dressings, and get advice. Do not rewarm if it might freeze again. | Remove wet clothing and dry them. Wrap in blankets or a sleeping bag; insulate from the cold deck and cover the head. If alert and able to swallow, give warm, sweet drinks and food. No alcohol, and do not rub the arms and legs. Check breathing and pulse for up to a minute. If there is no sign of life, start CPR and continue while warming. Seek radio medical advice. |
9. Bones, joints, muscles and the spine
Fractures
Signs: pain, swelling, bruising, deformity, loss of movement, a grating feeling, or a wound with bone visible (open fracture).
| 1 | Do not move the casualty unless there is danger. Support the injured part in the position found. |
|---|---|
| 2 3 4 5 | Control any bleeding. For an open fracture, cover the wound with a sterile dressing and pad around the bone; do not push it back. Immobilise: support the joint above and below the break with padding and a splint, sling or bandage (an uninjured leg or the body can act as a splint). Check the circulation beyond the injury: colour, warmth, feeling, movement, and the pulse. Recheck every 10 minutes. Give cold packs for swelling (wrapped, 15 to 20 minutes). Treat for shock, and ask for advice. |
| Injury | Key points |
| Dislocation | A joint out of place. Do not try to put it back. Support in the position of comfort and |
immobilise.
| Sprain and strain | Rest, cold pack, gentle compression with a bandage, and elevation. Seek advice if they cannot use the limb. |
|---|---|
| Rib fracture | Pain on breathing. Support the injured side with a sling or pillow. Watch breathing closely. |
| Pelvis, thigh bone | Can cause severe internal bleeding. Keep still, treat for shock, send for help urgently. |
Head and spinal injuries
Suspect a spinal injury after a fall from a height (ladders, hatches, gangways), a blow to the head, diving, a heavy object falling, or if the casualty complains of neck or back pain, numbness, tingling or weakness.
• • • • Keep the head, neck and back in line. Hold the head steady with your hands on both sides and tell the casualty not to move. Do not move them unless in danger or the airway needs clearing. If the airway is blocked, use a jaw thrust; breathing comes first. If you must move them, do so with several trained people, log-rolling in one piece onto a rigid stretcher with the head supported. Watch for worsening: drowsiness, vomiting, unequal pupils, fits, or fluid from the ears or nose after a head injury. Report these at once.
10. Toxic hazards on board
Ships carry chemicals, fuel, refrigerants and cargoes that can poison or burn. Gases and vapours are the most dangerous because they are often invisible.
| Hazard | Where | Effect and action |
|---|---|---|
| Oxygen shortage | Tanks, holds, cofferdams, voids, enclosed spaces | Collapse without warning. Never enter an enclosed space without a permit, testing and breathing apparatus. Never go in to rescue alone. |
| Carbon monoxide | Engine exhaust, fires, poorly ventilated areas | Headache, dizziness, collapse. Move to fresh air, give oxygen, check breathing. |
| Hydrogen sulphide | Sewage, some cargoes and tanks | Rotten-egg smell (it quickly numbs the nose), then collapse. Fresh air, oxygen, CPR if needed. |
| Refrigerant, ammonia, CO2 (fixed fire system) | Refrigeration plant, CO2 rooms | Choking, burns to eyes and lungs, cold burns. Fresh air; flush eyes and skin with water. |
| Chemical cargo, paints, solvents | Decks, stores, cargo areas | Check the safety data sheet and MFAG. Remove contaminated clothing; flush skin and eyes with water for at least 15 to 20 minutes. |
General rules for poisoning
| • | Remove the person from the source (only if safe for you) and into fresh air. |
|---|---|
| • | Identify the substance: keep the container, label or sample for the doctor. |
| • • • | Do not make them vomit unless a doctor or the medical guide tells you to. Do not give drinks or home remedies unless advised. If breathing stops, give CPR; avoid mouth-to-mouth contact with contaminated casualties and use a pocket mask. Get radio medical advice early and give the name of the substance. |
11. Common medical emergencies
Not all emergencies are injuries. These can happen to anyone on board.
| Condition | Recognise | First aid |
|---|---|---|
| Heart attack | Crushing chest pain spreading to arm, jaw or back; sweating; breathless; nausea | Sit them in a comfortable position (usually half sitting), keep calm, call for help and radio advice. Follow the medical guide about aspirin. Be ready for CPR and the AED. |
| Stroke | FAST: Face drooping, Arm weak, Speech slurred, Time to act | Note the time symptoms began, keep them safe and calm, nothing to eat or drink, urgent radio medical advice. |
| Asthma attack | Wheezing, difficulty speaking, distress | Sit upright and leaning forward, help them use their reliever inhaler, keep calm. Seek advice if it does not ease. |
| Severe allergic reaction (anaphylaxis) | Swelling of face or throat, rash, difficulty breathing, collapse | Use the adrenaline auto-injector on the outer mid-thigh if available, call for help, lie down (sit up if breathing is difficult). A second dose may be needed. |
| Low blood sugar (diabetic) | Shaky, sweaty, confused, aggressive, drowsy | If conscious and able to swallow, give fast-acting sugar (glucose tablets or a sugary drink), then a snack. If unresponsive, recovery position and urgent help. |
| Seizure (fit) | Sudden collapse, stiffening, jerking movements | Protect from injury, cushion the head, do not restrain, nothing in the mouth, note the time. Afterwards place in the recovery position. Emergency if over 5 minutes. |
| Fainting | Brief loss of response, pale, quick recovery | Lay flat, raise the legs, give fresh air. Treat as unresponsive if they do not recover quickly. |
| Severe vomiting or diarrhoea | Dehydration, dizziness, dark urine | Small frequent sips of oral rehydration solution. Isolate if infection is suspected, wash hands, ask for advice. |
12. Rescued persons
Survivors from the sea or a lifeboat are often cold, exhausted, dehydrated and frightened. Their care starts as soon as they are on board.
| • • • | Handle gently and keep as horizontal as possible when lifting someone from the water, especially after a long immersion. Standing up suddenly can drop the blood pressure and trigger collapse. Check airway, breathing and circulation first. Then treat hypothermia: remove wet clothing, dry, insulate, give warm sweet drinks if alert. Look for injuries and signs of near-drowning, swallowed seawater, and sunburn or dehydration. |
|---|---|
| • • | Give psychological support: stay with them, speak calmly, give simple information, and avoid forcing them to talk about the event. Keep a record of names, condition and treatment. Seek radio medical advice for the whole group. |
13. Radio medical advice
Doctors ashore can advise any ship, free of charge, through Telemedical Maritime Assistance Services (TMAS) reached through the nearest coast radio station or by satellite. The advice is only as good as the information you give.
Have this ready before you call Ship: name, call sign, position, course and speed, next port and ETA, nearest port. Patient: name, age, sex, rank, how long on board. Problem: what happened, when, what the pain or complaint is, and where. Readings: response (AVPU), pulse, breathing rate, temperature, blood pressure if you can measure it. History: SAMPLE (allergies, medicines, past illness, last meal). Treatment given so far, and the medicines and equipment available on board.
| • | Describe what you see and measure; do not guess a diagnosis. |
|---|---|
| • | Write down the instructions and repeat them back. Ask if you do not understand. |
| • | Record the call, the advice and the follow-up. Report back if the condition changes. |
| • | The Master decides on diversion or evacuation, usually with the doctor's advice. |
14. Medicines, hygiene and mental health
Giving medicines safely
Only give medicines as taught on your course, as laid down in the ship's medical guide, or as advised by a doctor over the radio. Never give a medicine you have not been advised to give.
| The 5 rights | Check before every dose |
|---|---|
| Right person | Check the name; ask about allergies and other medicines |
| Right medicine | Read the label and the expiry date; never use unlabelled medicine |
| Right dose | Follow instructions exactly; do not guess |
| Right route | By mouth, injection, skin or inhaler: only as directed |
| Right time | Note the time given and when the next dose is due |
| • Store medicines in the medical chest as laid down, and keep controlled drugs locked under the |
Master's responsibility, with a record of every use.
• Record every medicine given: what, how much, when, by whom. Watch for side effects and allergic reactions.
Cleanliness and sterilisation
| • | Cleaning removes dirt. Disinfection reduces germs. Sterilisation destroys all germs, including spores. |
|---|---|
| • • | Wash hands before and after treating anyone. Wear gloves. Use sterile dressings straight from the sealed pack. Clean and sterilise reusable instruments according to the equipment instructions and the medical guide. |
| • | Dispose of sharps in a sharps container and contaminated waste as required. Clean spills of blood with disinfectant while wearing gloves. |
Psychological and psychiatric problems
Isolation, long contracts, fatigue, loss and worry about home can affect anyone on board. Stress, anxiety, depression, alcohol or drug misuse and sleep problems are real health problems.
• Warning signs: withdrawal, big changes in mood or behaviour, not eating or sleeping, talk of hopelessness, giving belongings away, heavy drinking, anger.
• • • What to do: find a private place, listen without judging, and take what they say seriously. Do not promise to keep it secret. If someone talks about harming themselves, do not leave them alone, remove obvious means if it is safe, and tell the Master at once and get radio medical advice. Encourage them to seek help. Many seafarer welfare organisations run 24-hour helplines.
15. Quick revision sheet
| Situation | Remember |
|---|---|
| Any emergency | DR ABC: Danger, Response, Shout, Airway, Breathing, Circulation |
| Not breathing normally | CPR 30:2, 5 to 6 cm deep, 100 to 120 per minute, use the AED |
| Unresponsive but breathing | Recovery position; keep checking |
| Severe choking | 5 back blows, 5 abdominal thrusts, repeat. Unresponsive: CPR. Infant: 5 back blows, 5 chest thrusts |
| Severe bleeding | Direct pressure; add pads; raise; bandage. Tourniquet only if pressure fails |
| Shock | Lie down, raise legs, keep warm, nothing to eat or drink |
| Burn | Cool with running water 20 minutes; cover loosely; no ice, creams or burst blisters |
| Fracture | Support, immobilise above and below, check circulation |
| Spinal injury | Keep head, neck and back in line; do not move; jaw thrust if airway blocked |
| Hypothermia | Gentle handling, remove wet clothes, insulate, warm sweet drinks, no alcohol |
| Heat stroke | Emergency: cool rapidly |
| Poisoning or gas | Safety first, fresh air, identify the substance, MFAG, do not induce vomiting |
| Enclosed space casualty | Never enter alone or unprotected. Raise the alarm |
| Stroke | FAST: Face, Arm, Speech, Time |
| Radio medical advice | Ship, patient, problem, readings, history, treatment given, medicines available |
16. Practice questions
Choose the best answer. The answers and short reasons are on the next page.
- What is the first thing to do on finding a collapsed crew member in an engine room?
- A) Start chest compressions
- B) Check that it is safe for you and others
- C) Call the Master
- D) Give them water
- An unresponsive adult is not breathing normally. What is the correct CPR ratio?
- A) 15 compressions : 2 breaths
- B) 30 compressions : 2 breaths
- C) 5 compressions : 1 breath
- D) 2 compressions : 30 breaths
- What is the approximate adult compression depth and rate?
- A) 2 to 3 cm, 60 per minute
- B) 5 to 6 cm, 100 to 120 per minute
- C) 8 to 10 cm, 150 per minute
- D) As deep as possible, slowly
- A conscious adult is choking and cannot speak or cough. What do you do?
- A) Give water
- B) Give 5 back blows then 5 abdominal thrusts, and repeat
- C) Lay them flat and wait
- D) Put your fingers blindly in the mouth
- Which is NOT used for choking in an infant?
- A) Back blows
- B) Chest thrusts
- C) Abdominal thrusts
- D) Checking the mouth for visible objects
- Blood is soaking through the dressing on a leg wound. What should you do?
- A) Remove the dressing and look
- B) Add more pads on top and keep pressing
- C) Wash the wound
- D) Loosen the bandage
- For a minor burn, cool it with cool running water for at least:
- A) 30 seconds
- B) 2 minutes
- C) 20 minutes
- D) 2 hours
- Which should NEVER be put on a burn?
- A) Cool running water
- B) Clean cling film laid loosely
- C) Butter or ice
- D) A non-fluffy dressing
- A casualty fell from a ladder and complains of neck pain. The best action is to:
- A) Sit them up and walk them to the mess
- B) Keep the head, neck and back in line and do not move them
- C) Roll them onto their side quickly
- D) Give painkillers and let them rest
- The correct response to someone showing signs of hypothermia is to:
- A) Rub their limbs briskly
- B) Give alcohol to warm them
- C) Handle gently, remove wet clothing and insulate
- D) Place them in a very hot bath
- You find a crew member collapsed in a closed cargo hold. What is the safest first step?
- A) Run in and drag them out
- B) Raise the alarm and do not enter without proper protection
- C) Hold your breath and enter
- D) Shout from the entrance and wait for hours
- What does the F in FAST (stroke) stand for?
- A) Fainting
- B) Face drooping
- C) Fever
- D) Fracture
- Which information is most useful to give a doctor on a radio medical call?
- A) Your opinion on the diagnosis only
- B) Ship position, patient details, readings, history, treatment given
- C) The ship's cargo
- D) The weather forecast
- Before giving any medicine you should check:
- A) Person, medicine, dose, route and time
- B) Only the dose
- C) Nothing, if it is a common medicine
- D) Only the colour of the tablet
- After the AED analyses and says no shock advised, you should:
- A) Remove the pads and stop
- B) Continue CPR as the AED instructs
- C) Wait for the casualty to wake
- D) Turn the AED off
Answers
| No. | Answer | Why |
|---|---|---|
| 1 | B) Check that it is safe for you and others | Danger comes first so you do not become a second casualty. |
| 2 | B) 30 compressions : 2 breaths | Adult CPR is 30 compressions followed by 2 breaths. |
| 3 | B) 5 to 6 cm, 100 to 120 per minute | About 5 to 6 cm at 100 to 120 compressions per minute, allowing full recoil. |
| 4 | B) Give 5 back blows then 5 abdominal thrusts, and repeat | Alternate back blows and abdominal thrusts. Start CPR if they become unresponsive. |
| 5 | C) Abdominal thrusts | Abdominal thrusts are not used in infants; use back blows and chest thrusts. |
| 6 | B) Add more pads on top and keep pressing | Never remove the first pad; add more and keep firm direct pressure. |
| 7 | C) 20 minutes | Cool for at least 20 minutes. |
| 8 | C) Butter or ice | Ice, butter and creams can make the injury worse. |
| 9 | B) Keep the head, neck and back in line and do not move them | Suspected spinal injury: keep them still and supported. |
| 10 | C) Handle gently, remove wet clothing and insulate | Gentle handling and gradual insulation. Alcohol and rubbing are harmful. |
| 11 | B) Raise the alarm and do not enter without proper protection | Many deaths happen to would-be rescuers. Raise the alarm and use the enclosed-space rescue plan. |
| 12 | B) Face drooping | Face, Arm, Speech, Time. |
| 13 | B) Ship position, patient details, readings, history, treatment given | Facts you can see and measure, plus ship and patient details. |
| 14 | A) Person, medicine, dose, route and time | All five rights (person, medicine, dose, route, time) must be checked every time. |
| 15 | B) Continue CPR as the AED instructs | Carry on with CPR and keep the pads attached. |
Keep learning Reading is only the start. Take an approved STCW Medical First Aid course, practise with a manikin, keep your certificate and refresher training up to date, and know where the medical chest, AED and ship's medical guide are kept on every ship you join.
Sources used to check the technical content: American Heart Association 2025 guideline updates (CPR rate, depth, ratio, choking and AED changes), STCW Regulation VI/4 course syllabus topics, and widely taught first-aid practice. This guide is a general study aid. Medical practice and guidelines change; always follow your approved course, flag-state requirements, the International Medical Guide for Ships and professional medical advice.