Textbook of Maritime Medicine

It is not unlikely that a ship’s doctor may be found confronted with medically demanding local humanitarian scenarios at sea, most of them will be humanitarian emergencies brought on by (civil) war, famine or natural disaster.

15.9.1  Rescue Situation

Rescue situation can be expected to vary according to the structure of the floating device, the grade of crowdedness; days stood at sea, basic supplies grabbed, environmental factors and pre-existing health problems of the displaced people. Among the effects that should be anticipated and assessed in preparing a response are the following inadequacies:

-        Fresh water supply is often inadequate and most likely to be contaminated, depending on the numbers of displaced persons and their means of floating devices.

-        On emergency platforms shelter may be inadequate.

-        Leading contributor to the spread of illness and disease is inadequate sanitation. This is common to displaced persons at sea.

-        Inadequate health and trauma care over a prolonged period of time.

-        New-born and minors care.

The unfortunate end result of many of the above factors is increased mortality. The most common causes of mortality in displaced people at sea are the same as in the developing world, especially in minors, even in the absence of humanitarian emergencies:

-        Diarrhoea and dehydration.

-        Measles.

-        Malaria.

-        Acute respiratory infections.

These can be aggravated by pre-existing malnutrition, wet and cold, and sea-sickness.

15.9.2  In-Processing Procedures Aboard

First priority is water, rest, food and emergency medical attention. Any persons requiring timely special medical assistance, whether seriously ill, injured, minors or disabled, must receive it.

However, everything done must be consistent with maintaining the safety of the ship and its staff. As a first step, everybody, except those requiring emergency medical attendance, must not come into contact with the crew. Non-urgent medical and personal needs have to be postponed after the basic in-processing procedures:

1. Take names, create individual identity and/or distribute registration numbers.
2. Separate all individuals at a dedicated place on deck, alternatively, considering weather situation, in a room without upholstered furniture or other textiles that can be easily disinfested or disinfected thereafter.
3. Collect all fabrics in plastic bags. For washing use hot water (60°C) and the hot cycle in the dryer.
4. Collect personal solid materials in tight closing plastic bags. Store in an extra room. All non-washable items should be kept in plastic bags then opened on shore.
5. Have all individuals taken a hot shower with the skin and hair thoroughly scrubbed with an abrasive cloth, brush or sponge.
6. Distribute overalls or other clean clothes.
7. Perform medical examination and group individuals according to the treatment required further.

Following this maximum access to the further processing process will be granted.

15.9.3  Mass Hypovolemia

Best treatment of choice against mass hypovolemia is oral rehydration therapy (ORT).

ORT is safe, effective, and cheap. Most important of all, it can be given by almost all auxiliary staff, enabling personnel to evaluate and institute therapy for far greater numbers. Only severe dehydration may require intra-venous treatment in single cases.

Hypovolemia can cause more than half the deaths early in a humanitarian emergency, but dramatic reductions in mortality have been made possible by ORT. Several alternative formulations have been found to be effective, using local available components such as corn or rice in place of sugar.