May 1998                                       113

Drowning - Immersion Casualties

Scilly Docs
In 1739 Tobias Smollett served as surgeon’s mate in HMS Cumberland. He vividly described his experiences in the novel Roderick Ransom. The following is an eye witness account of life at sea in bad weather.

”During such furious storms the spray of the sea, raised by the violence of the wind, is dispersed over the whole ship: so that people breathe, as it were, in water, for many weeks together.
The tumultuous waves incessantly breaking upon the decks, and wetting those who are on duty, as if they had been drenched in the sea, are also continually sending down great quantities of water below: which makes it the most
uncomfortable wet lodging. From the labouring of the ship, it generally leaks down in many places, directly on the Sailor’s bunks. There being no fire or sun to dry or exhale the moisture, and the hatches necessarily kept shut, this most stagnating confined air below becomes most offensive and intolerable. When such weather continues long attended with sleet and rain, as it generally is, you may figure for yourselves the condition of the poor men who are obliged to sleep in wet clothes and damp beds, the deck swimming with water below them, there to remain only four hours at a time ’till they are called up to hard labour, fresh fatigue, and exposed to the washings of the sea and rains.”

old ship in gale (9kb)Such descriptions of 18th century conditions at sea may be offset by improvements in 20th century engineering materials, clothing, navigation and meteorology. Nevertheless the description highlights the essential features of immersion casualties, exhaustion, hypothermia, and drowning. In a shipwreck situation, it is advisable to assume all survivors are suffering from hypothermia and drowning to varying degree. Initial treatment should therefore be aimed at the restoration of adequate circulation and breathing, with the prevention of further heat loss. The major problem is sudden collapse on, or within a few minutes of rescue with concommittant ventricular fibrillation and cardiac arrest. This may be due to hypothermia exacerbated by wind chill or fall in blood pressure with reperfusion of peripheries.

no drinking icon (5kb)Whatever the mechanism of post rescue collapse, great care should be exercised in the management of survivors, keeping them lying down, especially during the early phase of rewarming. Survivors who are hypothermic may be shivering, confused, semi conscious or unconscious. Removing wet clothing they should be placed in a warm bunk and insulated with blankets. During rewarming the conscious casualty may be given warm drinks but NO alcohol. All immersion cases should be admitted to hospital on return to port. Even those who initially appear to have made an uneventful recovery from their ordeal, may have inhaled water, and are at risk of infection.


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