Slips, trips and falls

 The surfaces of a vessel may be wet, slippery, cluttered, moving and uneven. All these features increase the risk of slips and trips, which will commonly lead to falls to deck level. If they occur at an unguarded edge, such as the side of the vessel, an open hold or access opening on a container, or at the top of a companion way, they may result in a fall from a height that is likely to result in severe injury. Good housekeeping; removal of obstructions and slipperiness or the use of hand holds or safety harnesses will all reduce risks. Suitable footwear with good foot and ankle control and a non-slip surface will improve adhesion (13).

Overboard

 Falls from a vessel or between a ship and a quayside carry the additional risks of hypothermia, drowning and crushing, as does being swept off the deck by the sea. Rescue can be complex and involve other crewmembers in the risks of launching a boat and picking up the person. This is a particularly common risk in fishing as gear is handled over the side of the boat and, should entanglement occur while it is being run out, there is a risk of being drawn overboard with it. Work practice precautions are needed, crew members need to be required and motivated to wear a life jacket or suit with inbuilt buoyancy whenever in a part of the ship where this is a foreseeable risk. Crew procedures for rescue need to be in place with the rescue team trained and effectively led.

Historically, many of the falls between ship and quay arose when seafarers were returning to a vessel when affected by alcohol. This is less of a problem with current attitudes of alcohol use and seafaring, but nets at both sides of any exposed gangways can reduce the risk of such a fall.

Falling and swinging objects

 A ship is a multi-layered environment, where activities on upper decks, masts or derricks can pose risks to those below if, for instance, tools are dropped or if lifting tackle is swinging. Such risks are particularly common during cargo handling as loads are lifted and moved or fastenings are attached. Work practices that exclude crew from areas beneath working or lifting operations can eliminate such risks. The use of hard hats will reduce the frequency and severity of head injuries – the most serious sort if incident arising from such falling or swinging objects.

Work in enclosed spaces

 Enclosed spaces may pose risks from their lack of access and ventilation. They include cargo areas, such as the tanks on a liquid bulk carrier or spaces adjacent to cargoes that change the composition of the air. Spaces in the body of the ship, such as fuel stores, chain lockers and access routes to inspect the extremities of the hull pose similar risks. Atmospheres may be inflammable or explosive, deficient in oxygen or contaminated with toxic gasses. Hence, fire, explosion, asphyxiation and poisoning can arise. If a person is harmed in an enclosed space it can be a complex and dangerous task to remove them.The risks of different types of enclosed space and cargo are known. Detailed work practices have to be adopted such as tally systems for entry, the presence of a supervisor outside the space but in contact with the person within, and personal alarm systems. Gas checking for flammability, presence of oxygen and toxic substances is usually required. Protective equipment is needed, including breathing apparatus if there is a known risk or uncertainty about the presence of a hazard. Sets must also be immediately available for rescuers. Where there are flammable or explosive risks all lighting and tools used must be certified as flameproof and non-sparking.

Acute chemical incidents: eyes, skin, inhalation

 Chemical substances, both in cargo and those used on board as cleansing agents, scale removers and solvents, can cause acute injury. This may be by inhalation (gassing), often in a confined space, by corrosion of the skin and in particular by damage to the eyes. The risks should be known and documented in advance and crewmembers should be aware of them and of the precautions needed. The correct protective equipment must be provided and worn, in particular breathing apparatus if there is an inhalation risk or goggles or a full-face visor if there is a risk of eye damage. Careful consideration needs to be given to the fitness of those whose work may put them at risk; for instance those with asthma in response to irritants may be at increased risk if these are inhaled, while anyone with limited vision in one eye is at more immediate risk of permanent impairment if they suffer a corneal burn. There are specific antidotes for a few substances, such as sodium gluconate gel for the treatment of skin contamination with hydrofluoric acid. But for most conditions immediate decontamination of eyes by forcible irrigation with water or saline and skin decontamination with water are immediately possible and is the recommended treatment. Fresh air or oxygen may be used as supportive treatment after inhalation.

Burns, chemical and electrical injuries

 The commonest locations for thermal burns to occur on board are in the engine room (43%), where they are usually caused by flames, explosions or scalding, and in the galley (33%) where they result from contact with hot fluids or objects during cooking Preventative measures include good work practices and protective equipment. Clear labelling of hot objects can assist. Immediate treatment by cooling and by minimising the risk of infection is important. Burns affecting a significant proportion of the body require early specialist assessment and support for fluid replacement, pain relief and sometimes surgery to reduce blood supply restrictions secondary to eschar (contracted dead tissue and clot) formation.

 Chemical burns (5 above) from corrosives have many of the same features as thermal ones. Early irrigation is especially important for decontamination

 Electrical injury will be associated with power generation and use. In addition to superficial burns, deep and invisible burning can occur along the course taken by the current, especially at high voltages (>1000 volts). These lead to tissue necrosis and myoglobin breakdown with risks of kidney damage. Mains voltage alternating current can induce cardiac dysrhythmias and cardiovascular and ECG monitoring is advised where possible. Prevention is by work practices that ensure isolation of equipment before covers or insulation is removed.

 Work in port and other manual handling tasks

 The risks of slipping, tripping, falling and being struck by objects have already been noted. Some types of cargo handling such as securing containers are known to pose a high risk. Despite mechanical aids there is still much manual handling. Tasks include the movement of warps and springs when mooring and the loading of food and other requirements that is not done by the main cargo handling equipment. Movement of hatch covers may also involve hard physical work. Much of the damage is long term, but sudden strains and unexpected movements can cause acute musculoskeletal injury. Prevention is by attention to total weights and to expectations of how items should be moved as well as by training in lifting and handling techniques.

Hawsers and winches

 Both merchant and fishing vessels make extensive use of ropes, cable and hawsers. Particular risks include the parting of a hawser, especially a steel one, where the broken end may move around with high velocity, unspinning as it moves. This can result in major injuries to those who are in its path. Prohibitions of the presence of crew in areas where hawsers are under tension, for instance on tug towing decks, whenever they are inessential to the activity, can reduce risks.

Where cables are being winched in or out there will be pinch points between the winch or capstan and the coiled cable. These are often close to the locations where a crewmember is positioned and part of their task may be to ensure that the cable coils correctly – with the temptation of intervening by hand in the event of a problem. Such incidents are particularly common with the repetitive hauling tasks in fishing: often undertaken by a tired crew on a slippery and congested deck. Guarding of in-running nips and the provision of emergency stop buttons or wires where they can be reached, even during the course of entrapment, are essential precautions.

Fishing injuries and poisonings

 Personal injuries in fishing have many causes. A number have already been referred to. There is a high incidence of hand injuries; from fishing gear, marine debris and knives used in gutting. Because of prolonged wetting of the hands infection of injuries is common and a number of unusual or sea-specific pathogens may be present. Fish hooks readily penetrate the skin and, because they are on lines, can reach most parts of the body. Because of their barbs, cutters need to be to hand to remove them.

A number of sea creatures have defensive spines and these can cause penetrating injuries. Some inject venom and this can lead to local or generalised toxic reactions.

The postures adopted to perform tasks and maintain stability on small fishing vessels can lead to acute or long-term musculoskeletal injury.

The nature of the fishing sector with self-employment, risk taking to maximise catch or to fit into quota restrictions, fatigue during periods of catching and a macho culture, all combine to limit the effective adoption of safety precautions.

Diving accidents in crew doing ship inspections

 Diving to inspect and maintain a ship may be undertaken by a specialist contractor or by a crewmember who has, often limited training and skills as a diver. Common tasks include freeing debris from rudders and propellers and inspecting for damage after grounding or collision. In addition to the normal risk from diving, there are particular ones that arise from being adjacent to a ship, particularly in adverse weather conditions Sea movements may result in rapid changes in position leading to harm from contact with the ship, pressure changes, if not large, will take place very rapidly, disorientation can occur and propellers from the boat used for diving or from other vessels can cause severe lacerations. Crushing may also take place between vessels or between the vessel and a fixed jetty or quay. There are well-defined safe working practices for diving, which include the presence of a dive supervisor on the surface and rapid access to additional sets of diving equipment in case a rescue is needed. The dive plan needs to be agreed in advance and the diver should have the right training and competence to perform the task specified.

 The above list is only a selection of commonly encountered injury risks that have specific maritime features. Almost all of the range of injuries encountered ashore can also occur at sea, from eye injuries from flying projectiles when paint chipping or hammering, through knife wounds in the galley during food preparation, to falls from bed in rough weather. The feature common to all is the difficulty of access to treatment and care while at sea, and hence a higher risk of long term adverse outcomes than would be the case ashore. This places a premium on effective preventative action.