By Bob Currie, Vessel Examiner
United States Coast Guard Auxiliary Flotilla 081-06-08
As a boat operator, you are responsible for your safety and the safety of your passengers. Today we will talk about recognizing and treating shock and about controlling severe bleeding, both of which occur in boating accidents and need immediate treatment.

Flotilla 081-06-08 is based at Coast Guard Station Galveston. The Coast Guard Auxiliary is the uniformed civilian component of the US Coast Guard and supports the Coast Guard in nearly all mission areas. The Auxiliary was created by Congress in 1939. For more information, please visit www.cgaux.org.

Shock
Shock is a depressed physiological or mental state. Shock can occur at anytime during first aid and should be assessed first and monitored throughout treatment. There are four common symptoms of shock that you should memorize:

• Restless
• Faint
• Thirsty
• Nauseated

Causes of Shock

• Trauma (Bleeding, falls, struck by object, fractures and burns)
• Allergic reactions
• Hypothermia
• Drugs
• Toxins
• Heart attack
• Illnesses such as diabetes
• Emotional

Symptoms of Shock

• Restlessness
• Fainting
• Thirst
• Nausea
• Weakness
• Anxiousness
• Fright
• Dizziness

Signs of Shock

• Pulse – weak and rapid
• Breathing – shallow, rapid, and irregular
• Skin – cold, clammy (sweating)
• Pupils – dilated
• State of consciousness – alert (may be deceiving) to unconscious

Treatment for Shock
Initial treatment for shock includes limiting a patient’s activity, ideally having the person lie down and remain alert for the signs and symptoms of shock. If unconscious, appropriate treatment is to activate EMS and institute resuscitation procedures. If CPR is not necessary, the victim should remain lying down, should be kept warm, if not already overheated, and should be checked for other injuries.

Additional procedures must be followed and completed in order to control the effects of shock upon the victim:

• Check for “medic alert” or other information tags.
• Obtain history for medical problems (heart disease, diabetes, allergies, medications).
• If on the water, notify the Coast Guard to obtain help and transport as advised.
• Provide specific treatment if advised and trained to do so.
• If there is not a head injury or breathing trouble, place victim flat on back and elevate the lower extremities about 8 to 10 inches. Be careful of any other injuries.
• Perform cardiopulmonary resuscitation (CPR) if indicated and trained to provide.
• Warm with blankets. If the patient is hot, do not warm.
• If conscious, moisten lips, if requested.
• Do not allow patient to eat or drink.
• Never give alcohol.
• Handle gently.

Anaphylactic Shock
Anaphylactic shock is a rapid and extreme allergic reaction. Causes include allergies to fish, shellfish, berries, drugs, insect stings, exercise, cold, pollen or dust.

Symptoms of Anaphylactic Shock

• Skin: itching, hives (raised rash), flushing (redness)
• Swelling of lips, tongue, feet, throat, hands
• Respiratory tract: wheezing, shortness of breath, coughing
• Gastrointestinal: nausea and vomiting, abdominal cramps, diarrhea
• Headache
• Altered mental status, sense of impending doom
• Loss of consciousness
• Onset of symptoms may be rapid, within seconds, or delayed (up to two hours).

Treatment of Anaphylactic Shock
Anaphylactic shock requires medication to counteract the allergic reaction to the substance. If the victim carries an epinephrine kit, crewmembers may assist them in administration, if trained. Notify the Coast Guard of this extreme medical emergency by activating the Rescue 21 System (pushing the “Distress” button on your marine radio). The victim should be treated for shock and, if necessary, administered CPR. All that is observed or performed should be recorded while keeping the Coast Guard appraised of the situation so that appropriate medical resources can be activated. Medical attention should be obtained regardless of patient’s response. Anaphylactic shock can be very serious resulting in death within a few minutes.

Control of Severe Bleeding
Severe bleeding requires the use of direct pressure, pressure points, a tourniquet, or a combination of these methods. As mentioned, a person who is bleeding severely most likely will also require observation for or treatment for shock.

Direct Pressure Control of Severe Bleeding
To apply direct pressure, the palm of a gloved hand should be placed over the wound. Sterile, disposable gloves should be used. An ungloved hand should never be placed onto an exposed wound. To reduce the flow of bleeding, the injury should be raised so that it is at a level higher than the heart. This should only be done if a change in position will not cause additional harm to a victim. If immediately available, or if direct pressure does not control the bleeding, a thick pad of cloth held between the gloved hand and the wound may be used.

Pressure Point Control of Severe Bleeding
If direct pressure alone does not control the bleeding, then the use of pressure points can be added to the direct pressure method to reduce the blood pressure at the wound. Severe bleeding that cannot be controlled by direct pressure is most surely due to bleeding from an artery, and holding pressure on that artery above the wound can help stem the blood flow enough for direct pressure to be effective. The chart below shows the pressure points that may be used to help stop arterial bleeding.

Using Tourniquets to Control Severe Bleeding
Tourniquets can be extremely dangerous. Tourniquets should only be used when a victim is in danger of bleeding to death. A tourniquet should only be tight enough to stop the bleeding. Never hide a tourniquet with a splint or bandage.

1. Place the tourniquet two to three inches above the wound, but not touching the wound edges. If the wound is in a joint area or just below a joint, place the tourniquet directly above the joint.
2. Wrap the tourniquet band tightly around the limb twice and secure it in place.
3. Attach a note to the victim giving the location of the tourniquet and the time that it was applied. Always leave the tourniquet exposed to view. If it is not possible to attach a note, write the letter “T” on the patient’s forehead with a grease pen, lipstick, or other suitable marker, and show the time it was applied.
4. After making the decision, and applying a tourniquet, DO NOT LOOSEN IT.
5. Continue to treat for shock and obtain medical attention IMMEDIATELY.

Part of your job as a boat operator is to perform a pre-trip risk assessment. This assessment should include checking your first aid kit for supplies mentioned in this article. Could you encounter a situation where a passenger might go into shock? If so, do you have a blanket to cover them to keep them warm? Do any of the passengers have allergies? If so, do they carry an epi pen, and who on board knows how to use an epi pen if it is needed? Do you have gloves to use to help control severe bleeding? What about bandages and a tourniquet? The further away from land and help you go, the more you should think about having such equipment aboard your boat and about asking your passengers about any medical problems they have. Be sure to show everyone where the first aid kit is located and how to use your marine radio in an emergency.

For more information on boating safety, please visit the Official Website of the U.S. Coast Guard’s Boating Safety Division at www.uscgboating.org . Questions about the US Coast Guard Auxiliary or our free Vessel Safety Check program may be directed to me at [email protected]. I am available to perform free Vessel Safety Checks, and I will come to your location to perform them. SAFE BOATING!

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