Chapter 4 – Marine Advanced First Aid

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4.1 Number of Trainees in a Course

The number of trainees in a course must not exceed 12, under the supervision of one accredited instructor.

4.2 Course Goal

Every seafarer who is designated to apply immediate advanced first aid in the event of an accident or illness on board must demonstrate competence to undertake the tasks, duties and responsibilities described in the subjects listed below.

4.3 Course Criteria

Marine Advanced First Aid is required by:

  1. Any person who wants to obtain a Master's or Officer's certificate or endorsement;
  2. The person designated to provide first aid on board a vessel engaged on a near coastal voyage, class 1 or unlimited voyage.

4.4 Instructor Qualification

  1. The approved instructor must be:
    1. an experienced emergency professional;
    2. an approved instructor certified by an approved agency.

4.5 Course Outline

Course outline Time (Hours)
Subjects Lectures, demonstrations and practical work
1. Immediate Action 2.0
2. First-Aid Kit 1.5
3. Body Structure and Function 2.5
4. Toxicological Hazards Aboard Ship 3.5
5. Examination of Patient 1.5
6. Spinal Injuries 3.0
7. Burns, Scalds and Effects of Heat and Cold 3.0
8. Fractures, Dislocations and Muscular Injuries 3.0
9. Medical Care of Rescued Persons, Including Distress, Hypothermia and Cold Exposure 2.0
10. Radio Medical Advice 1.0
11. Pharmacology 2.5
12. Sterilization 0.5
13. Cardiac Arrest, Drowning and Asphyxia 2.0
14. Psychological and Psychiatric Problems 2.0
15. Assessment 1.0
TOTAL 31.0

Note: Teaching staff should note that outlines are suggestions only as regards sequence and length of time allocated to each objective. These factors may be adapted by lecturers to suit individual groups of trainees depending on their experience, ability, equipment and staff available for training.

4.6 Knowledge and Competencies

Methods of demonstrating the competence are by assessment of evidence obtained from practical instruction, lectures, tests, demonstrations and practical instruction

Competence Knowledge, Understanding and Proficiency Criteria for Evaluating Competence
1. Immediate action (2 hrs) Revise as necessary, important aspects of the Marine Basic First Aid training course;
  1. Identification of probable cause, nature and extent of injuries is prompt, complete and conforms to current first-aid practice.
  2. Indication of risks of harm to self and others is minimized at all times.
  3. Treatment of injuries and the patient’s condition is appropriate, conforms to recognize first-aid practice and international guidelines.
Trainees must be able to apply immediate first aid in the event of accident or illness on board.
2. First Aid Kit (1.5 hrs)
  1. Describe and list the contents of the first-aid kit required by national regulations and the international convention.
  2. List location of first-aid kits on board.
  3. Describe contents of lifeboat kit.
  4. Demonstrate use of the first-aid kit in appropriate medical situations.
  5. Importance of routine checks.
Trainees must be able to describe and list the contents of the first-aid kit required by regulations.
3. Body structure and functions (1 hr)

Use a chart, dummy, human body or other suitable medium, such as audio-visual aids, to describe and explain the structure of the human body and functions of the important parts and systems; in particular;

  1. For the skeletal system:
    • lists the major parts of the skeleton.
    • describe the different kinds of bones.
    • explain the function of the skeleton.
  2. For the muscular system:
    • list the major muscles of the human body.
    • explains their operation and function.
  3. For the cardiovascular system:
    • identify main organs of the chest and the location of the heart.
    • describe the distribution of arteries and veins.
    • describe the physiological function of the blood.
    • describe the heart as a pump.
    • explains how the circulatory system operates.
    • state the location of the arterial pressure points and explain how they can be effectively used in an emergency involving bleeding.
  4. For the respiratory system:
    • state the location of the lungs.
    • explain the function of the lungs in terms of gas exchange.
    • state the importance of respiratory rate.
    • explain the importance of the composition of inspired and expired air.
  5. For the digestive system and abdomen:
    • describe in simple terms the digestive system and its operation.
    • list the abdominal organs and describe their function.
  6. Identify parts of reproductive system and functions of each.
  7. Identify structures of the skin and related elements.
Trainees must be able to describe and explain the structure of the human body and functions of the important parts and systems.
4. Toxicological hazards aboard ship
  1. State that there are important regulations to be observed for the transport of dangerous cargo aboard ship as required by the IMO/IMDG Code;
    • knowledge of potentially toxic substances.
    • WHMIS Class identification system and the information available.
    • Material Safety Data Sheets MSDS, their location and the type of information available.
    • proper safeguards to be followed in the use and storage of dangerous goods carried on board.
  2. Apply first-aid in accordance with the International First Aid Science Advisory Board or its national equivalent;
  3. Use, in particular, the appropriate First Aid techniques for:
    • identifying the symptoms and clinical aspects of poisoning.
    • applying first aid in cases of poisoning by ingestion, inhalation, or skin/eye injuries.
    • applying first aid in cases of acid and caustic solutions that have been swallowed.
    • identifying the symptoms of and treatment for acid and caustic burns.
  4. Use of oxygen administration:
    • components of the delivery system
    • operation of the delivery system.
    • changing cylinders.
    • CPR with supplemental oxygen.
    • after use care and servicing.
  5. Entry in confined spaces:
    • characteristics and dangers associated with confined spaces.
    • limitations of responsibilities and abilities when dealing with confined spaces.
    • appropriate precautions and procedures for incidents in and around confined spaces.
Trainees must be able to evaluate toxicological hazards aboard ship.
5. Examination of patient
  1. Conduct a systematic and complete:
    • primary assessment (airway, breathing, circulation);
    • and secondary assessment (history, vital signs, head-to-toe examination);
    • including appropriate record keeping of findings and action taken.
  2. Provide assessment from a large variety of individual facts based on:
    • information derived from medical history;
    • general appearance;
    • answers to specific questions;
    • physical examination.
  3. Draw conclusions by process of elimination and comparison;
    • recognize feigning of illness.
    • recognize airway obstruction and provide appropriate care for obstructed airways.
    • recognize breathing emergencies and provide artificial respiration for casualty without suspected head/spinal injury; for casualty with suspected head/spinal injury; and oxygen administration including an overview of endotracheal intubation.
    • recognize signs and symptoms of angina/heart attack.
    • recognize signs and symptoms of cardiac arrest.
  4. Demonstrate one rescuer CPR, two rescuer CPR.
Trainees must be able to make detailed observations of casualty and provide assessment.
6. Spinal injuries
  1. Recognize the signs and symptoms of spinal injury;
    • recognize signs of possible head/spinal injury based on mechanism of injury.
  2. Identify the complications, which may be caused by unconsciousness.
  3. Apply appropriate first aid measures, including:
    • take precautions to avoid further damage where head/spinal injuries are suspected.
    • appropriate rescue transport and treatment for cases of suspected fracture of the spine.
  4. Head injuries;
    • levels of consciousness or unconsciousness.
Trainees must be able to recognize the symptoms of spinal injury and provide suitable care.
7. Burns, scalds and effects of heat and cold
  1. Recognize the signs of: burns, scalds, heatstroke, hypothermia, frostbite and identify them according to type (heat, electrical, chemical, radiation).
  2. Apply appropriate first-aid measures including;
    • the definition, complications and treatment of the general condition of burns.
  3. Distinguish between burns and scalds.
  4. Describe the differences between partial thickness and full thickness burns.
  5. Classify burn and apply the correct first-aid procedures according to the seriousness of the burned area.
  6. State the importance of sterile dressings.
  7. Describe the effects of heat and state the importance of positioning the patient in the shade, providing the increased fluid requirement and careful cooling of the body.
  8. Distinguish between hypothermia and frostbite and apply the correct first aid procedures, including rewarming and attention to possible tissue damage
Trainees must be able to recognize signs of burns, scalds and effects of heat and cold and provide suitable care.
8. Fractures, dislocation and muscular injuries
  1. Apply practical first-aid procedures for the assessment and treatment of fractures, dislocations and muscular injuries.
  2. Describe types of fractures as;
    • open or compound, closed or simple, complicated
    • assess from indications that a bone is broken
  3. Describe the treatment for injured parts;
    • stop bleeding from open fracture
    • relieve pain and treat fractures
  4. State the importance of immobilization of the injured part.
  5. Describe the special requirements for the treatment of pelvic and spinal injuries.
  6. Describe the signs, symptoms and treatment of sprains, strains and dislocations;
    • recognize dislocations from signs.
    • prevent movement in affected area by suitable immobilization and take precautions during transportation.
  7. Demonstrate the correct procedures to be used in cases of fractures, dislocations and muscular injuries.
  8. Recognize and treat muscular injuries.
  9. State the necessary precautions while using splints.
Trainees must be able to apply practical first-aid procedures for the assessment and treatment of fractures, dislocations and muscular injuries.
9. Medical care of rescued persons, including distress, hypothermia and cold exposure
  1. Apply appropriate skill in the care of rescued persons;
    • handle immediate medical problems
  2. Recognize the special problems in cases of;
    • hypothermia, applying the correct treatment and taking precautions against heat loss and taking into account the effects of wind and humidity.
    • frostbite, applying the correct treatment for cold injury, immersion foot, etc.
    • treat for oil contamination, dehydration and malnutrition.
    • treat for sunburn, heat exhaustion, cramps and sunstroke.
    • seasickness, describing the cause and provide treatment.
    • sunburn, describing the cause and providing the correct treatment and prophylaxis (prevention).
    • dehydration and nutrition in rescue situations, describing frequent errors and hazards.
    • rewarming.
  3. Provide follow-up care.
Trainees must be able to apply basic medical skill in the care of rescued persons.
10. Radio medical advice
  1. State that radio medical advice is available using GMDSS Bmed 1.
  2. Describe the methods used to obtain radio medical advice;
    • prepare information before asking for advice.
    • provide information to advisor and record exchange of information.
    • repeat information to advisor.
  3. Interpret advice obtained from external sources.
  4. Maintain all records on board.
  5. Make all arrangements for helicopter or ship to ship transfer.
Trainees must be able to describe the methods used to obtain radio medical advice.
11. Pharmacology
  1. Drug list on board;
    • usage.- dosages.
    • side effects and precautions related to specific medications available on board
  2. Describe how injections (sc/im) are given.
  3. Describe how a test dose for penicillin is given.
  4. Describe what qualifications are required to administer each medication.
Trainees must be able to list medications carried on board.
12. Sterilization
  1. Discuss disinfection of surgical instruments.
  2. Apply knowledge of universal precautions.
  3. Take precautions against infecting the wound.
Trainees must have knowledge of methods of disinfection and of universal precautions.
13. Cardiac arrest, asphyxia and drowning
  1. State the cause of and apply the appropriate treatment for;
    • recognize a stroke/TIA and provide first aid.
    • recognize signs and symptoms of congestive heart failure (CHF).
    • provide immediate first aid to casualty in a drowning emergency.
    • recognize asphyxia and provide first aid.
  2. Explain how mouth-to-mouth resuscitation is applied and state under what conditions it cannot be used.
  3. Explain how chest compressions are applied and state the limiting factors related to the use of cardiopulmonary resuscitation CPR practice on a mannequin.
  4. Demonstrate the correct procedures for mouth-to-mouth resuscitation and chest compressions using a practice mannequin.
  5. Provide CPR.
Trainees must be able to apply the appropriate treatment for cardiac arrest, asphyxia and drowning.
14. Psychological and psychiatric problems
  1. Explain that situational disturbances may be influenced by;
    • psychological characteristics of seafarers.
    • psychological consequences of separation.
  2. State that these may be contributory factors for psychological malfunctioning.
Trainees must be able to recognize contributory factors for psychological malfunctioning.

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