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A comment I often get is: “I’m only ever a day’s sailing from help and thus no more than six hours from medical support.” This supposes that the conditions are good and, if required, a helicopter is available. But what happens if the conditions deteriorate, or the helicopter is on another job, down for maintenance or is unable to fly due to weather conditions? Considering these potential obstacles, let’s use six hours as our maximum time to evacuate a patient from the yacht.

Every situation is different but we have to make some assumptions. The first is that, with trauma, if you get to hospital alive you have a 99 per cent chance of staying that way, assuming that you are a fit and healthy person before you were injured. Unfortunately age works against you; the older you are, the less chance you have of survival.

Coming back to the six-hour window, with severe bleeding it takes from between 15 minutes and one hour to bleed to death, therefore the “six hours to help” is not a lot of use for either crew or guests. In the worst-case scenario, if you sever the femoral artery you can bleed to death in just five minutes.

Unfortunately because of either incorrect training or panic, we let casualties bleed far longer than need be, making it harder to keep them alive until evacuation to hospital is possible. However, with or without the advantage of proper training, the answer is simple: direct pressure – a lot of it, for a long time. And better still, if you have a haemostatic agent onboard such as Celox, this agent will help promote blood clotting in conjunction with the direct pressure. It also works with casualties who are on blood thinners such as warfarin. But if all else fails, use a tourniquet.

PREVENTING A CASUALTY FROM BLEEDING TO DEATH

If someone has a life-threatening bleed the ABCs procedure always takes priority: airways, breathing, circulation. When you get to C, locate the site of bleeding and provide direct pressure; at this stage gloves are part of the safety assessment. If gloves are not available use the casualty’s own hand, a plastic bag or clothing against the wound and apply the pressure over the top or to the sides.

The amount of pressure required is far more than you would expect. In the second, compensatory phase of shock the blood pressure (BP) starts at or near the
normal level,

so direct pressure has to be at least or more than the BP (120–135mmHg). For most people this is their entire body weight and the pressure has to be maintained for at least 20 minutes.

Twenty minutes is the average time it takes for a healthy person to drop their BP as part of the secondary phase of shock. If at all possible, elevate the limb; this helps reduce the pressure needed to control the bleeding. Combine pressure dressings and bandages are found in most emergency onboard trauma kits. Ensure all crew know where the closest kit is on the vessel.

During or after the 20 minutes of pressure, apply between one and five combine dressings, place the plastic packaging over the dressings and bandage in place. Do not bandage too tightly – the role of the bandage is to hold the dressings in place, direct pressure is what is needed to stop the bleeding. Check for circulation (pulses, colour, warmth) past the bandage, for example in the hand or foot. Make sure you contact a remote medical adviser for further advice.