Sea survivors will suffer from additional health- and life-threatening problems as (13):
A major contributory factor in the aetiology of cold injury.
Non-freezing cold injury
Tissue temperatures between about 17 °C and -0,55 °C (freezing point of tissue fluid) lasting for a protracted period can result in a non-freezing cold injury. If feet are in water, the colder the water, the higher the risk of injury.
Freezing cold injury
After exposure to cold temperatures below freezing aggravated by high wind chill factor the temperature of the exposed peripheral tissue may drop below the freezing point of -0,55 °C.
Dehydrated, resting survivors in a hot, humid environment are at risk. Prevention is good hydration.
Survivors in open rafts or boats are at risk of severe burns by direct and indirect UV rays, especially in equatorial waters.
Skin broken by abrasions and boils will not heal in the environment of a life-raft, wound cleansing can be done with fresh water if no antiseptic is available.
Despite medications many occupant will still feel seasick and vomit. This will most probably cause a chain-reaction. If available, vomiting should be done in plastic bags. New medication (tablets) may be administered by absorbing through the lining of the mouth instead of being swallowed. Morale and discipline will be affected.
May develop following swallowing of large amounts of salt water before entering the life-raft.
Displaced People and Refugees at Sea
It is not unlikely that a ship’s doctor may be confronted with medically demanding local humanitarian scenarios at sea, most of these will be humanitarian emergencies brought on by (civil) war, famine or natural disaster.
Rescue situations can be expected to vary according to the structure of the floating device, the degree of crowdeding; days spent at sea, water and food supplies, environmental factors and any pre-existing health problems in the displaced people. Among the effects that should be anticipated and assessed in preparing a response are the following:
- Fresh water supply is often inadequate and is likely to be contaminated, the risk will depend on the numbers of displaced persons and their means of staying floating.
- On improvise platforms or open boats shelter may be inadequate.
- The 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.
- Care for the new-born and minors.
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.
- Acute respiratory infections.
These can be aggravated by pre-existing malnutrition, wet and cold, and sea-sickness.
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, should not come into contact with the crew. Non-urgent medical and personal needs have to be postponed until after the basic processing procedures:
Take names, standardise unique identity titles for each and/or distribute registration numbers.
- Separate all individuals on a dedicated place on deck. Alternatively, considering the weather situation, use a room without upholstered furniture or other textiles that can be easily disinfested or disinfected thereafter.
- Collect all fabrics in plastic bags. For washing use hot water (60°C) and the hot cycle in the dryer.
- 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.
- Have all individuals taken a hot shower with the skin and hair thoroughly scrubbed with an abrasive cloth, brush or sponge.
- Distribute overalls or other clean clothes.
- Perform medical examination and group individuals according to any further treatment required.
Following this initial stage access to the further processing process will be granted.
The best treatment for 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 will require individual intra-venous treatment.
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.