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Thank you James,
I always felt the bringing the MOB on board as quickly as possible was the thing to do.
Kimberlite Amel Super Maramu #376
From: amelyachtowners@... [mailto:amelyachtowners@...]
Sent: Monday, April 02, 2018 3:29 PM
Subject: Re: [Amel Yacht Owners] Re: Rescueing method of casualty (Person Over Board)
I would like to add to this discussion with respect strictly to medical management and considerations.
The vast majority of you have far greater sailing experience than me, and I think this is an engaging discussion.
In the case of severe hypothermia (below 30 C core temp), the primary risk of death is from cardiac dysrhythmia, and specifically ventricular fibrillation.
The risk of this is particularly high when actively rewarming the patient from an even lower temperature through that critical range around 25 a 30 centigrade.
Another risk of causing cardiac dysrhythmia is from excessive manipulation of the patient - that is, moving the patient.
The idea that placing the patient vertically predisposes to dysrhythmia is not accurate. Indeed, placing a hypotensive patient in a head up position may cause loss of consciousness, but not cardiac arrest necessarily.
The act of extricating a severely hypothermic patient from immersion - in any manner - may trigger a dysrhythmia. Position is not a primary concern. In fact, there is higher likelihood of addition trauma in a horizontal position.
The fundamental principles, therefore, should still be performing the most expeditious method of extrication with the least amount of trauma or jostling, maintaining safety of the other crew, and immediate attempts at rewarming.
For those who have experience, bretyllium given intravenously can possibly help control a possible dysrhythmia. However, this is no longer available in the US. And only a physician should administer this. In that case, prolonged CPR is your only option for salvage in the field. You do not stop until body temp is normalized or you meet exhaustion.
As we say in medicine, “you’re not dead until you’re WARM and dead.”
Soteria SM 347
I must say that I support entirely your thinking.
In my case this is based upon a very limited experience (once only) retrieving a windsurfer who had drifted away in a squall and be separated from his board. The water was relatively warm, probably around 18° C, and the man had been drifting for 20 to 30 minutes. He was already starting to suffer from hypothermia and our only objective (3 on board) was to get him out of the water as soon as possible and down below to warm him up. Very fortunately we succeeded without even giving a thought to the lifting position.
Last year in its September issue, Yachting Monthly had a very informative article, based upon actual MOB retrieval exercises in calm waters. Their objective was to debunk various myths propagated by well intentioned souls. I am quoting here directly from this article:
MYTH 14: The MOB has to be lifted in the horizontal position...There is no increased risk of heart attack if the MOB is lifted vertically. ln most waters of the world, death from hypothermia occurs long before any dangerous peripheral vascular bed failure develops. The whole concept of peripheral vascular failure being caused by surface-type immersion is a myth. At the surface, it would take days to develop.
My halfpenny worth,
Formerly SM 232
I stand by my thinking that the horizontal lift is impractical recommendation for a shorthanded cruising boat. For demonstrating in a class with 5 or 6 students and an instructor, that's a different story. There are not very many places where I disagree with the smart and thoughtful people of the RYA, and this is the only one I can think of that is of real importance.
Any person at REAL risk of cardiac arrest in cold water will be totally unable to help with rigging anything themselves. Putting another person in the water is VERY dangerous in and of itself, and would require a yacht crewed by at least 4 or, more likely, 5 people to justify the increased risks. As the captain of a boat, I would be very, very reluctant to put a second crew member in the water. I might do it...but only as a last possible resort.
If the person in the water is coordinated enough to rig their own horizontal lifting harness they are not yet hypothermic and do not need it. Get them out of the water NOW before they do!
Rigging a leg lifting strap as shown in that video when you are in the water is a LOT harder if you are not in a full survival suit, with your legs floating at the surface. If you ARE in a full survival suit, you are (most likely) not hypothermic, and do not need it...
When we did our testing, I was in a wetsuit. It was important for us to keep in mind that some things were much easier in a wetsuit because of the buoyancy, and others were more difficult.
Even for a victim who is fully conscious, if they are lifted horizontally they are now unable to usefully fend off from the rolling hull themselves, and you need another crew member dedicated to that task. A person lifted vertically, with a halyard (not a boom!) between hull and face will not hit the hull in a dangerous way short of extreme rolling conditions.
I do understand the rational for the RYA's suggestion, and I still think it is unrealistically complicated for use in the real world on a yacht with sailing with only 2 or 3 people. The extra time required for it in most cases I believe INCREASES risks of all kinds to both victim and crew.
That's all I have to say on the matter, except for... whatever you plan on doing, you should try it in warm calm water first. In the testing we did we found LOTS of suggestions including many that have been widely published were marginally practical--at best.
Moraine Cay, Abacos, Bahamas.
---In amelyachtowners@..., <philipp.sollberger@....> wrote :
Many thanks to all for your clear answers and experience.
For me it is still important to precise, that a horizontal lift up of an unconsious person from the water is better than a vertical one. The risk of a heart stop is bigger, if the warm blood circulates down to the extremities as legs and the cold flows back to heart. This can end in a cardiatic arrest.
The method to do a horizontal lift up is not so complicated as mentioned. I have learnt it at the UKSA in Cowes. Use the lifeline of the person in the water and put it under his or her bottom and clip it either to the lifesling hook or to the halyard directly.
With big waves you have to protect the casualty that he or she is not bashing to the hull and for this reason you lower a crew member which is fixed to the yacht by lifeline and halyard. Afterwards you can lift them up both. The casualty in a horizontal way and the crew member vertically. With this method you have the most possible protecting method to get both back on deck..
The lifeline method you can test yourself very easily and with no risk. lie down on deck with your lifewest on and your lifeline.. Take the halyard, fix it on the hook of the lifewest and take the lifeline, put it under the bottom through and take it and fix it to the halyard shakle or the lifewest hook. If all is fix, then lift up for half to one meter and you will get the proof, that you are hanging quite horizontally on the halyard.
Thank you very much Bill Rouse for your confirmation about the strength of the halyards.
Person over board is a subject, that nobody wants to happen. But unfortunately it happens on the rally round the world race as VOR and Clipper Race last time.
There are different videos on youtube which show, that you should lower a rescuer for getting the casualty fixed to the yacht.
Try to avoid such situations with being attached to the boat if you a leaving the central cockpit area in foul weather or night. Clip you on as early as possible.
Fair winds and never an overboard case.