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Elementary First Aid (EFA)

Course Topics

  • General Principles
  • First Aid Symbol
  • First Aid Kit
  • Location of first aid kits
  • Contents of lifeboat first aid kit
  • Situations Requiring First Aid
  • Actions for Accident or Illness on board
  • Heart Attack
  • Stroke
  • Examination of patient
  • Observations of a casualty
  • Forming Diagnosis
  • Drugs on board
  • Injections IMIVSC
  • Test dose for penicillin
  • Radio Medical Advice
  • Using GMDSS
  • Helicopter evacuation
  • Body structure and functions
  • Structure of the human body
  • Functions of important parts and systems
  • Skeletal System
  • Muscular System
  • Cardiovascular System
  • Respiratory System
  • Nervous System
  • Digestive System
  • Positioning of Casualty
  • The Unconscious Casualty
  • Resuscitation
  • Cardio pulmonary Resuscitation (CPR)
  • CPR with Help of Second Person
  • Special Situations
  • CPR for Children and Infants
  • Use of Oxygen resuscitator
  • Airway Obstruction
  • Bleeding
  • Management of Shock
  • Burns and scalds and accidents caused by Electricity
  • Burns
  • Scalds
  • Rescue and transport of casualty
  • Fractures, dislocation and muscular injuries
  • Apply practical first aid procedures
  • Describes types of fracture
  • Open (or compound) Fractures
  • Closed (or simple) Fractures
  • Complicated Fracture
  • Treatment for injured parts
  • Immobilization of injured pats
  • Pelvic and spinal injuries
  • Joint Dislocation
  • Pneumatic splints
  • Accidents caused by chemicals
  • Hazards of Transport of dangerous cargo
  • Use of Medical First Aid Guide
  • MATLV levels
  • Poisoning
  • Acid and caustic burns
  • Sterilization
  • Disinfection of surgical instruments
  • Dressing wounds, Care of cuts, wounds, burns and scalds
  • Suturing
  • Intravenous Therapy
  • Hypothermia
  • How Heat is Lost from the Body
  • How the Body defends itself against Cold
  • Survival in Cold Water
  • Frostbite
  • HIV AIDS
  • Prevention of AIDS
  • About the Virus
  • HIV Life Cycle
  • HIV Transmission
  • Signs and Symptoms
  • Diagnosis
  • Treatments
  • Drug Abuse
  • Amphetamine
  • Anabolic steroids
  • Cocaine
  • Heroin
  • Inhalant
  • Marijuana
  • Morphine
  • Alcoholism
  • Complication of Alcoholism
  • Effects of Chronic Alcoholism
  • Central nervous system
  • Treatment of Alcoholism
  • Nutrition and Diet
  • Staying healthy
  • Maintaining Good Health
  • Eating Disorders
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Norovirus
  • Recognize the dangers when entering enclosed spaces
  • Recognize danger from blood and other excretion from persons suffering from infectious disease
  • Rules for Maintaining Personal Health and Hygiene on a Ship

General Principles



General Principles

 

This course covers immediate care to be given in life threatening situations involving sudden illness or injury at sea, including techniques for adult CPR. This component fulfills the requirements of STCW Section A-VI, Table A-VI/1-3.

 

First aid is the provision of initial care for an illness or injury. It is usually performed by a lay person to a sick or injured casualty until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and, in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.

 

The person giving first aid, deals with the whole situation, the injured person, and the injury or illness. He/she know what should to do as well as what should not to do in the emergency situation. And he knows, too, that his first aid knowledge and skill can mean the difference between life and death, between temporary and permanent disability, and between rapid recovery and long hospitalisation.

 

First Aid is the immediate and temporary basic medical care provided to an ill or injured victim, until more advanced care arrives or the person recovers. It is a life-saving medical technique that a non-medical person or a lay person can be trained to perform with minimal equipment.

 



 

between temporary and permanent disability, and between rapid recovery and long hospitalisation.

 

Aim of First Aid

The key aim of first aid can be summarized in three key points.

 

Preserve life

The overriding aim of all medical care, including first aid, is to save lives.

 

Prevent Further Harm

To prevent the condition from worsening. This covers both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, e.g. applying pressure to stop bleeding from becoming excessive and dangerous.

 

Promote Recovery

  • First aid also involves attempt to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound or a tourniquet to prevent bleeding or a splint to immobilize a fracture.
  • First aid training also involves the prevention of initial injury and responder safety, and the treatment phases.

 

First Aid encompasses DRABCD. That is:

  • Danger
  • Response
  • Airway
  • Breathing
  • Compressions/Circulation
  • Defibrillation

 

 

IMGS (International Medical Guide for Ships)

All ships should carry medical instruments, a medical chest and a copy of medical guide, as required by the International Labour Organisation's Maritime Labour Convention 2006.

 

The International Medical Guide for Ships gives guidelines on how to diagnose, treat and prevent health problems in seafarers, mainly focusing on the first 48 hours after injury.


In addition to giving guidelines to diagnose and treat a patient onboard, the Medical Guide also gives guidelines on preventing various health problems those may be faced by the seafarers. Illustrations in the book make it easier for the medical officer onboard to get the information for treatment.


It covers from simple injury to many types of diseases, pregnancy, child birth, death and caring of rescued persons

 

It endeavours to give the seafarer the treatment and health protection that is available ashore.

 

World Health Organisation 2007

According to the specifications of the International Labour Organisation (ILO) Maritime Labour Convention 2006, all ships must have a medicine chest, medical kit and medical guidelines. The main principles of International Medical Guide for Ships are to make sure that:

  • The mariners are given proper health protection and medical care.
  • The mariners are given necessary medicines without any delay.
  • Medical equipment and facilities for analysing and for doing treatment are available.

 

The ILO Maritime Labour Convention states that ships engaged on international journey for duration of more than three days and having 100 persons or more must have a well-qualified medical doctor to provide medical care. Ships without a medical doctor can have any of the following:

  • At least one mariner on board taking charge of all the medical care and administering medicine as part of their usual duties 
  • At least one mariner skilled in providing medical first aid on board.

 

Mariners who are not medical doctors but take in-charge of medical care on board must have finished training in medical care meeting all the needs of the International Convention on Standards of Training, Certification and Watch keeping for Seafarers. The International Medical Guide for Ships acts as a standard guide for such training courses. The ILO Maritime Labour Convention 2006 specifies that the skilled authority must make sure that the medical advice given (via radio and satellites) to ships travelling in sea is available for 24 hours a day. 

 

IMGS explains when it is necessary to seek such medical advice. By having IMGS on board ships and following the given instructions, the countries can do the following:

  • Fulfil their responsibilities under the sections of the Maritime Labour Convention 2006
  • Make sure the finest possible health outcomes for their maritime population. 

 

IMGS (International Medical Guide for ships) contains the following:

  • First aid treatment
  • Shock
  • Pain management
  • Head injuries
  • Eye injuries and illness
  • Injuries in bone, joint, and muscle 
  • Injuries in abdominal and chest 
  • Wounds
  • Burns, chemical splashes, smoke inhalation, and electrocution
  • Heat disorders like heat stroke
  • Poisoning
  • Examination of the sick person
  • Paralysis, weird behaviour and unconsciousness
  • Heart disorders like chest pain, circulation problem etc
  • Respiratory problems
  • Gastrointestinal and liver illness
  • Kidney disorders and other urinary infections
  • Pregnancy and childbirth
  • Infections transmitted by sexually activities
  • Skin diseases
  • Disorders in bone, joint and muscle
  • Usage of tobacco, alcohol and drugs
  • Transmittable diseases
  • Dental problems
  • External aid
  • Nursing care and medical actions
  • Fatality at sea
  • Medical care for mariners at sea
  • Environmental control and cleanliness
  • Preventing illness and promoting health in mariners
  • Anatomy and physiology
  • International Health Regulations (abbreviated as IHR)
  • Medicine chest of ship
  • Annex A: Forms for case reporting, referral and clearance

 

Training of Seafarers

As per IMO requirements, there are three levels of first aid training for seafarers.

  • Before starting work at sea, all seafarers are required to undertake elementary first aid training, which is a short course designed to provide a basic knowledge of what to do when faced with an accident or medical emergency.
  • Ships’ officers are required to complete proficiency in medical first aid training, covering the provision of immediate first aid in the event of an accident or illness on board.
  • The ship’s Master and anyone who is designated to be responsible for the medical stores on board is required to complete proficiency in medical care training, covering provision of medical care to the sick and injured while they remain on board.
  • Each of the courses includes the use of the medical stores which are required to be carried on board. Organizations providing the training have to be approved by the flag state administration and details of approved training providers can be obtained from them. Syllabus of these courses is as per the STCW Code.



 A ship's owner is obliged as per Merchant Shipping laws to provide care to a seaman who becomes ill or injured while "in service". Every ship owner needs to pay for care of its seaman.



 The Duty to Provide Cure

Maintenance and care is a contractual form of compensation given by general maritime law to a seaman who becomes ill while in service to his vessel. The ship owner's obligation is deep-rooted in maritime law and is an incident or implied term of a contract for maritime employment.



 Care is a Contractual Obligation

The obligation of the ship owner to provide for the maintenance and care of seamen becoming ill or injured during the period of their service is an implied contractual obligation imposed by general maritime law as one annex to the employment.



 Who is Entitled to Care
 

All persons who are members of the ship's company are entitled to maintenance and care when ill or injured in the ship's service and without culpable misconduct on their part. A Master, although not coming within the many protective wage statutes covering seamen, is regarded as a seaman for purposes of the Jones Act and is also entitled to maintenance and care. Any member of the crew, including the Captain of a vessel, is entitled to maintenance and care and therefore entitled to have the ship owner pay for all reasonable and necessary medical expenses.



 In the Service of the Ship

The phrase "in the service of the ship" has had a liberal interpretation throughout history. Presently, it encompasses virtually all of the seaman's activities from the time he first boards the vessel to the time he departs from her after signing off, and perhaps, for a reasonable time thereafter, till his repatriation to hometown, should any illness manifest itself traceable to his activities while in the ship's service.A ship's owner is obliged as per Merchant Shipping laws to provide care to a seaman who becomes ill or injured while "in service". Every ship owner needs to pay for care of its seaman.

 

Methods to Raise a Medical Emergency Alarm

 

PA System Announcement: Call for medical assistance using a clear and loud announcement (e.g., "Medical Emergency in Engine Room, immediate assistance required!").

 

General Alarm (if required): Some ships may use the General Alarm (continuous ringing of the bell/buzzer) followed by an announcement. On a ship, the General Alarm Button is strategically placed in multiple key locations to ensure quick access in case of emergencies. The exact locations may vary depending on the ship type and design, but the most common places include:

 

  1. Bridge (Wheelhouse)
  2. Engine Control Room (ECR)
  3. Accommodation Area (Captain’s and Officers’ Cabins)
  4. Fire Control Station / Emergency Station
  5. Muster Stations
  6. Cargo Control Room (for Tankers and Large Ships)
  7. Emergency Escape Routes / Public Areas

 

Radio Communication: Contact the bridge using VHF/UHF radio or the internal telephone system.

Emergency Call Points: Some ships have designated emergency call buttons or telephones to notify the duty officer.

 

Raising an alarm 

 

To raise the general alarm on a ship if you find someone injured, immediately activate the nearest alarm station, which typically involves pulling a lever or pressing a button, and then announce over the ship's PA system that there is a medical emergency, stating the location of the injured person and the nature of the injury; the standard general alarm signal is usually seven short blasts followed by one long blast on the ship's whistle and internal alarm system. 

 

 

 

 

Raising an alarm in case of a medical emergency on a ship is a critical and systematic process to ensure the situation is promptly addressed. The following steps outline how to raise an alarm for medical emergencies onboard:

 

1. Assess the Situation:

Check the severity of the medical emergency. Is it life-threatening (e.g., heart attack, severe bleeding, unconsciousness), or is it a less critical issue (e.g., injury, fainting)?

Ensure safety by checking the environment. Make sure there is no further danger to the patient, such as fire, chemicals, or moving machinery.

 

2. Alert the Bridge (Captain and Crew):

Use the ship's internal communication system (intercom, radio, or phone) to contact the bridge.

Say: “Medical Emergency on (location of the ship), [specific area]. Immediate assistance required.”

Give clear details about the patient's condition, location, and the type of emergency.

Alternatively, you can use the emergency alarm button, if the ship is equipped with such systems, which automatically alerts the captain and crew.

 

3. Activate the Ship's Emergency Medical Response:

Call for assistance from the ship's medical officer or the nearest qualified crew member.

Utilize the onboard medical team (doctor or trained medical personnel) to attend to the injured or ill person. In many ships, this is a designated role such as the "ship's doctor" or a nurse.

Depending on the severity, ask for assistance to prepare medical equipment, stretchers, or first aid kits.

 

4. Use the Ship’s Public Address (PA) System if Needed:

Announce the emergency using the ship’s PA system if necessary.

Example announcement: "Attention, medical emergency on Deck 3, near the cafeteria. Medical team, please report immediately to the scene."

Make sure that the alarm or announcement is loud enough to alert all personnel in the vicinity.

 

5. Inform Nearby Crew Members:

Inform crew members in the immediate vicinity, including those responsible for specific areas like engine rooms, decks, or cabins, so they can be prepared to assist or clear the area if needed.

Notify security or safety officers for coordination, especially if there is a need to help manage the situation with crowd control or evacuations.

 

6. Follow Emergency Procedures:

Activate any available emergency procedures such as contacting nearby ports for medical support or arranging evacuation if required. Many ships have established protocols to deal with medical emergencies, including contacting medical professionals via radio or satellite communication.

 

7. Provide Medical Aid:

Until help arrives, provide first aid or basic medical care to the patient if you're trained to do so.

Monitor the patient and provide reassurance. Administer CPR, control bleeding, or perform other emergency medical interventions based on your training.

 

8. Coordinate Medical Evacuation if Needed:

If the emergency is severe and requires evacuation to a hospital, arrange for a helicopter or boat evacuation. This typically requires coordination with the coast guard or medical evacuation services.

 

9. Document the Incident:

Record the details of the medical emergency, including time, nature of the emergency, actions taken, and outcomes. This documentation is essential for both medical and legal purposes.

 

 

 

Own safety

 

In an emergency aboard a ship, the first consideration must always be for your own safety. This includes ensuring you follow established safety protocols and procedures. Secure your personal safety by wearing the necessary protective equipment, assessing your environment, and moving to a safe location. Once your own safety is ensured, you can then assist others and take appropriate action in line with the ship's emergency protocols. Adhering to these protocols is critical to maintaining order and ensuring the effective handling of the emergency situation.

 

Personal safety measures when the general alarm is sounded on a ship, here are key steps to ensure your own safety:

 

1. Acknowledge the Alarm:

  • When you hear the general alarm (usually seven short blasts followed by one long blast), stop any work you are doing immediately.

 

2. Wear Proper Safety Gear:

  • Put on your life jacket and hard hat (if available).
  • Wear protective clothing, including gloves, safety shoes, and other Personal Protective Equipment (PPE).

 

3. Secure Work Area:

  • If you are working with equipment, shut it down safely if time allows.
  • Secure loose objects to prevent them from becoming hazards.

 

4. Follow Muster Instructions:

  • Go directly to your assigned muster station as indicated in the ship’s muster list.
  • Use the safest and nearest route, avoiding elevators and potentially dangerous areas.

 

5. Account for Others:

  • Ensure that your coworkers or team members are accounted for.
  • Report your presence to the designated officer at the muster station.

 

6. Stay Informed:

  • Listen to announcements from the ship's command or emergency team.
  • Follow the instructions given by the officers and crew.

 

7. Emergency Duties:

  • If you have specific emergency duties assigned (like firefighting, assisting passengers, or handling lifeboats), carry them out efficiently and safely.

 

8. Stay Calm and Alert:

  • Stay calm and assist others who may need help.
  • Be alert to changing conditions and possible hazards, such as smoke, fire, or water ingress.

 

 

 

Sequence of immediate actions to be taken in emergency

 

In the event of a medical emergency aboard a ship, the sequence of immediate actions should be as follows:

 

Ensure Personal Safety: Before taking any action, make sure you are in a safe position and assess the surrounding environment for any potential hazards. Your safety is the top priority.

 

Alert the Crew: Immediately notify the ship's medical team or the designated first aid responder. Use the ship's communication system to inform the captain and other crew members about the situation.

 

Assess the Situation: Quickly assess the condition of the injured or ill person. Check for signs of breathing, consciousness, and any visible injuries. Determine the severity of the situation to decide the urgency of medical assistance needed.

 

Provide First Aid: Administer basic first aid according to the nature of the medical emergency. This may include CPR, controlling bleeding, treating shock, or providing any other necessary immediate interventions.

 

Stabilize the Patient: Keep the patient calm and still, and provide comfort to reduce stress. Ensure that their airway is clear, and monitor vital signs (breathing, pulse) if possible.

 

Prepare for Evacuation (if necessary): If the situation requires evacuation (e.g., for a more serious condition), prepare the patient for transfer to medical facilities on land or arrange for helicopter or boat evacuation.

 

Maintain Communication: Keep the captain and medical team informed about the condition of the patient and any actions taken. Coordinate with the medical team on board for further guidance.

 

Record the Incident: Document all actions taken, the patient’s condition, and any medications or treatments administered. This will be vital for any future medical care or investigation.

 

By following these steps, you can help ensure that the medical emergency is handled promptly and efficiently while maintaining the safety and well-being of the affected individual.

 

 

OWN SAFETY WHILE ENTERING TANKS OR ENCLOSED SPACES ON A SHIP

Entering tanks or enclosed spaces on a ship is one of the most dangerous tasks due to risks like oxygen deficiency, toxic gases, and explosion hazards. Always follow proper safety procedures to prevent accidents.

 

1. PRE-ENTRY PREPARATION

 

Obtain a Permit-to-Work (PTW):

  • Never enter without a signed Permit to Work (PTW) from the Chief Officer or Safety Officer.
  • Ensure all safety measures are in place before starting the job.

Conduct Risk Assessment:

  • Identify potential hazards (low oxygen, toxic fumes, flammable gases).
  • Ensure emergency escape routes and procedures are clear.

Check Gas Levels Using a Gas Detector:

  • Oxygen (O₂) level: Should be 19.5% to 22%.
  • Hydrogen Sulfide (H₂S): Must be below permissible limits.
  • Carbon Monoxide (CO) & Hydrocarbons: Should be at a safe level to avoid toxicity/explosion.

Ensure Proper Ventilation:

  • Use mechanical blowers or forced ventilation before and during entry.
  • Keep ventilation running throughout the work.

Wear the Correct Personal Protective Equipment (PPE):

  • SCBA (Self-Contained Breathing Apparatus) if gas levels are unsafe.
  • Chemical-resistant coveralls, gloves, and boots if dealing with chemicals.
  • Hard hat, safety goggles, and harness with lifeline for confined space work.

 

2. ENTRY PROCEDURE

 

Never Enter Alone (Always Follow the Buddy System)

  • At least two people must be present – one inside and one outside as a standby.
  • Standby personnel should maintain constant communication with the entrant.

 

Use a Lifeline & Communication Equipment

  • Always wear a safety harness with a lifeline for quick rescue if needed.
  • Use walkie-talkies or an intrinsically safe communication system.

Avoid Naked Flames or Electrical Sparks

  • If flammable gases are present, do not use mobile phones, torches, or tools that can cause sparks.
  • Ensure all equipment is explosion-proof.

 

Monitor Gas Levels Continuously

  • Keep checking for oxygen levels and toxic gases while working inside.
  • If gas levels become unsafe, exit immediately.

 

 

3. EMERGENCY PROCEDURE

 

 If You Feel Dizzy or Breathless, EXIT IMMEDIATELY!

  • Do not ignore headaches, dizziness, or difficulty breathing.
  • Signal to the standby person and evacuate at once.

 

Rescue Procedure (DO NOT Enter Immediately!)

  • The standby person must not enter without SCBA and proper rescue gear.
  • Call for emergency assistance and follow rescue procedures.

 

First Aid & Medical Help

  • Move the affected person to fresh air.
  • Provide oxygen and CPR if needed.
  • Inform the bridge and medical officer for further assistance.

 

4. POST-EXIT SAFETY CHECKS

  • Secure the area after work
  • Close all openings safely
  • Log the operation details in records
  • Review the process for safety improvements

 

KEY SAFETY RULES 

  • Always follow Permit-to-Work procedures.
  • Test atmosphere before & during entry.
  • Ensure proper ventilation at all times.
  • Use correct PPE (SCBA if needed).
  • Never work alone – always use the buddy system.
  • Keep lifeline & emergency rescue ready.
  • If in doubt, DO NOT ENTER!

 

 

If someone falls ill during tank cleaning on a ship, it could be due to toxic gas exposure, lack of oxygen, chemical fumes, or physical exhaustion. Immediate action is critical to prevent a fatal incident.

 

IMMEDIATE ACTION SEQUENCE:

 

1. Raise the Alarm

  • Call for help immediately using the ship’s PA system, radio, or emergency alarm.
  • Inform the Bridge and Duty Officer about the incident.

2. Do NOT Enter the Tank Alone

  • NEVER enter the tank without proper safety precautions.
  • The rescuer must follow proper Enclosed Space Entry Procedures to avoid becoming a victim.

3. Stop Tank Cleaning Operations

  • Halt all tank cleaning processes to prevent further exposure to dangerous gases or chemicals.
  • Shut off ventilation, pumps, or any operations that might worsen the situation.

4. Assess the Situation

  • Determine if the affected person is conscious or unconscious.
  • Check if they are breathing and responsive.
  • If unconscious, assume they may be suffering from oxygen deficiency or toxic gas inhalation.

5. Ventilate the Tank

  • If safe, increase ventilation using mechanical blowers or fresh air supply.
  • Use the gas detection meter to check for oxygen levels and toxic gases (O₂, H₂S, CO, hydrocarbons).

6. Follow Safe Rescue Procedures

  • If the atmosphere is dangerous, rescue must be done by trained personnel with SCBA (Self-Contained Breathing Apparatus).
  • Use a lifeline and safety harness before entering.
  • A standby team must be ready with first aid and oxygen supply.

7. Administer First Aid

  • If the victim is breathing but dizzy, move them to fresh air and monitor closely.
  • If not breathing, perform CPR (Cardiopulmonary Resuscitation) immediately.
  • Provide medical oxygen if available.
  • Keep the victim warm and in a comfortable position.

8. Inform the Master and Shore Authorities

  • Report the incident to the captain and log all details.
  • If serious, request medical evacuation (MEDEVAC) or diversion to the nearest port.

9. Conduct an Investigation

  • Identify the cause (e.g., toxic gases, lack of PPE, equipment failure).
  • Ensure proper gas checks and ventilation procedures before resuming work.
  • Conduct a safety briefing to prevent recurrence.

Key Preventive Measures for Tank Cleaning:

  • Always conduct gas checks before and during tank entry.
  • Use SCBA or an airline respirator if working in a hazardous atmosphere.
  • Follow Permit-to-Work (PTW) and Enclosed Space Entry Procedures.
  • Ensure continuous ventilation and oxygen monitoring.
  • Have a rescue team on standby before starting operations.