Serious First Aid Kits for Offshore Adventures

by OCEAN Media on 10 Feb 2008 Two ex-SAS officers say they’d rather equip yachtsmen with medical supplies and emergency gear than stage a dramatic sea rescue

The Special Air Service (SAS) has an unrivalled reputation for selecting, training and deploying men whose physical fitness and mental toughness are second to none.

In 1996 two former SAS medics founded Yacht Lifeline and have since taken marine medical practice to a whole new level. Yacht Lifeline now employs a core team of specialists in New Zealand and Europe. Yacht Lifeline’s main priority is to train crew and ensure they are adequately prepared to avoid maritime incidents were medical intervention is required.

It also provides and monitors medical supplies and devices. OCEAN Magazine’s NZ Correspondent John Julian spoke with Yacht Lifeline’s managing director Tony Nicholson in Auckland.

JJ: Why did you set up Yacht Lifeline, and what were you doing beforehand?

TN: Brent Palmer and I were serving with the New Zealand SAS at the time and were approached by an offshore boat owner who was organising a regatta. He asked us to teach people how to suture, give injections, that type of thing, based on a limited amount of gear, a delayed evacuation, a limited amount of experience and skill and a hostile environment, using the type of logic we had been using in the military - out on the water versus in the jungle or on the ice.

What we did was look at the application of military standards and adjust them to commercial and recreational boating industries. We then moved into training and education for some of the rescue and SAR units.

The America’s Cup really exposed us to the larger yachts and their requirements. We did the first training courses in 1996/7 and, over the next three years, began to learn what the requirements were for vessels operating long voyages.

The 1999-2000 America’s Cup brought the spectator fleet down to New Zealand and exposed us to the higher-end requirements for large yachts.

JJ: Did you or Brent have any recreational seafaring experience?

TN: No, not at all but we were both divers and kayakers; not only in our jobs, but all our recreational pastimes are outdoors and exciting like skydiving, big wave surfing, sea and ocean kayaking.

We were really starting to push the limits on some of these sports as well. Again it all comes back to (situations) of limited resources and delayed evacuation.

The same key elements. Over the years we have put 5000 or so captains and crew through various training courses, and we’ve had a lot of feedback from them as to the type of instances that do occur. What we try to do is remove elements that are specific-scenario based. One of the difficulties about training people to deal with a specific scenario is how they might adapt when the situation changes.

So what we do is deconstruct things, right down to the most basic components so that, irrespective of the situation, they know what to do. That’s really the key to everything we do and it will work whether it’s midocean in 10-metre swells or in the middle of a desert.

JJ: You manage more than 4000 medical cases annually with nearly 1000 evacuations. Can you give an example that has used all your team’s skills and experience?

TN: We manage the 4000 medical cases with the medical advisory team we work with at AIG (a US travel insurer), which is one of the largest in the world.

When we set the 24/7-assistance service up we had to choose whether to do it ourselves, put it in a hospital environment or in a high-end communications environment.

The medical team we have here is made up of very skilled practitioners with the capability to deal with medical advice, coordination and evacuation. However we didn’t have the resources, especially the high-end stuff that’s required for evacuations in remote conditions.

So rather than reinvent the wheel we looked at two options and decided on a communications and co-ordination centre staffed with clinical people. So what we have is a medical team in a non-clinical environment, which is the best of both worlds. They are 100 per cent focused on the job they’re doing without the interruptions of a normal 24-hour emergency clinic where the victims of all sorts of accidents come through the door.

It’s difficult to think of one particular situation where the whole team has pulled together. Sometimes, however, you have to get a bit creative when managing things.

Recently we attended to a case involving a terminally ill guest on a charter vessel, who was fulfilling his lifelong dream to cruise the Pacific. His condition deteriorated quite significantly and the captain was worried that the passenger would not survive the cruise. We very quickly we had to co-ordinate a helicopter rescue from the closest point, to get the person off the vessel and provide medical escorts. That operation was arranged in 45 minutes.

There’s always remote work to deal with as well. Two years ago I was in Houston at the 24/7 Assist Call Centre, when they’d just finished coordinating an evacuation from Antarctica. The real issues arise when, no matter what plans you put in place, you simply can’t get someone off for three days.

We do try to keep people on board because a mid-ocean helicopter evacuation is dangerous for both the rescuers and the patient. It’s really important to have the baseline equipment and medications available on board, otherwise you’re going to force an evacuation and increase the risk. It then comes down to what key information the medical team needs to determine a safe course of treatment, and that requires some diagnostic tools.

This isn’t really about getting a captain to try to diagnose the situation, but to give him the wherewithal so he can effectively assess the patient by fact gathering, i.e. someone’s pupils are X, and his pulse rate is Y.

The medical team on the other end of the line can then determine a course of action. So long as the gear is on board, can say “Go to Blue Pack No. 1, select item No. 2, take one tablet three times a day and we’ll talk to you tomorrow.”

All of these pieces of the puzzle need to be in place. If a critical situation develops, those concerned need to be able to deal with it straight away – they must be able to ensure the patient has an airway, is breathing, has a pulse, and not be bleeding to death. If you can deal with those factors effectively then you may be giving yourself an hour.

JJ: Do your associates at AIG offer insurance plans for medical evacuation?

TN: When we launched Yacht Lifeline we had some insurance plans. But we found that, in most cases, medical evacuation and emergency medical expenses were covered under normal hull policies. So now if we discover that insurance is not in place for whatever reason, we refer people to one of the specialist organisations. We’re specialists in marine medicine and generally don’t attempt anything else.

JJ: Yacht Lifeline is now established in Australasia, Europe and the US. Does the bulk of your revenue come from procedural and preventive work, rather than reaction?

TN: Absolutely, I believe that we wouldn’t be doing our job if the majority of our revenue was coming from pulling people off boats. We don’t derive any revenue from evacuation. I like it that way.

JJ: Would you describe the type of service you provide to clients – those at the very early stage of a boat build, and those who have older boats?

TN: There are several components to our service including supply of the initial equipment, hardware and medicines and, as part of that, maintaining them on a day-to-day basis.

There should never be any expired medicines on board. We’ve seen some terrible examples where the most dangerous thing aboard has been the medical kit, medicines which, in some cases, expired before some of the crew were at primary school;