SECTION 2, FIRE FIGHTING & SELF RESCUE

General causes of offshore installation fires are:

x Welding
x Electrical causes
x Fuel leak
x Galley accidents
x Overheating / friction
x Laundry accidents
x Smoking
x Poor housekeeping
x Static electricity
x Collision
x Helicopter incidents

The danger of fire can include

x Panic
x Heat
x Smoke
x Poisonous gasses
x Lack of oxygen
x Dangerous goods
x Fire spread

Fire Triangle

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The fire triangle or combustion triangle is a simple model for understanding the ingredients
necessary for most fires.
The triangle illustrates a fire requires three elements: energy, fuel, and oxygen. The fire is
prevented or extinguished by removing any one of them. A fire naturally occurs when the
elements are combined in the right mixture.
Without sufficient energy, a fire cannot begin, and it cannot continue. Energy can be removed
by the application of a substance which reduces the amount of energy available to the fire
reaction.
Without fuel, a fire will stop.
Without sufficient oxygen, a fire cannot begin, and it cannot continue. With a decreased
oxygen concentration, the combustion process slows.

Fire Spread

Conduction:
x Touching a stove and being burned
x Ice cooling down your hand
x Boiling water by thrusting a red-hot piece of iron into it

Convection:
x Hot air rising, cooling, and falling (convection currents)
x An old-fashioned radiator (creates a convection cell in a room by emitting warm air at
the top and drawing in cool air at the bottom).

Radiation:
x Heat from the sun warming your face
x Heat from a lightbulb
x Heat from a fire
x Heat from anything else which is warmer than its surroundings

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CLASSIFICATION OF FIRES

Class A
Burning process with flames and glowing characteristics.
Solid fuel:
x Wood
x Paper
x Textile
x Rope
x Plastics

Class B
Burning process with flames only.
Liquid fuel:
x Oil
x Petrol
x Methanol
x Paints

Class C
Burning process with flames.
Gases:
x Natural gas
x Propane
x Acetylene

Class D
Burning process with flames and glare symptoms.
Light metals:
x Aluminium
x Magnesium
x Titanium

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 Class E
Fire involving electrical equipment
x Poor isolation
x Over load
connection

Class F
x Fire involving cooking oils or fats
x Differ from conventional liquid fires due
to the high temperatures involved

Fires involving electrical installations, they need special attention. Pay attention to:
x Is a class A fire; solid matter: plastics (PVC)
x Will cause poisonous and corrosive gasses
x Electrically conductive: do not use water
x If possible: switch off electricity

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Extinguishing media
The principle of extinguishment is based on disturbing the combustion process by:

x Reducing the level of oxygen

x Removal of the fuel
x Lowering the temperature
x Disturbance of the mixture
x Adding a negative catalyst (breaking chain reaction)
x The next slides are going to be the extinguishers. So by explaining this you can ask
with each extinguisher wat does it do with the triangle.

Water
Principle:
x cooling
x smothering
x changing mixture
Advantage:
x unlimited availability
x cheap
Disadvantage:
x electrically conductive,
x water damage
x freezing below zero °C
Fire class: A
x Distance 2-3 Metres

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Dry powder
Principle:
x covering (class A and D)
x inhibits flames (negative catalyst)
Advantage:
x rapid flame knockdown
x usable for all classes *
Disadvantage:
x corrosive
x obstructs visibility
x causes additional damage
Types of powder:
x BC
x ABC
x D
Distance 4-5 metres

Foam

Principle:
x vapor suppression
x cooling
x radiation resistance
Advantage:
x no re-ignition of liquid fires
x good isolator
Disadvantage:
x can freeze below zero °C
Fire class: A, B
Distance 3- 4 metres

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CO2

Principle:
x smothering
Advantage:
x almost no additional damage
x will totally disappear
Disadvantage:
x burns on physical contact
x hard to use in windy conditions
x weight of gas cylinder
x short jet throw
Fire class: A (no smouldering nor glowing parts), B, electrical fires
Distance 1,5- 2 metres

Fire blanket

Principle:
x covering, smothering
Advantage:
x no damage
x can be used on people
Disadvantage:
x close proximity to flames
Fire class: A (persons), B

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Colour Code

Detection And Fixed Fire Fighting

Installations

The purpose of fire detection systems. An automatic fire alarm system is designed to detect
the unwanted presence of fire by monitoring environmental changes associated with
combustion. In general, a fire alarm system is classified as either automatically actuated,
manually actuated, or both. Automatic fire alarm systems are intended to notify the
installation occupants to evacuate in the event of a fire or other emergency, report the event
to an off-premises location in order to summon emergency services, and to prepare the
structure and associated systems to control the spread of fire and smoke.
Manually actuated devices; Break glass stations, buttons and manual fire alarm activation are
constructed to be readily located (near the exits), identified, and operated.
Automatically actuated devices can take many forms intended to respond to any number of
detectable physical changes associated with fire: confected thermal energy; heat detector,
products of combustion; smoke detector, radiant energy; flame detector, combustion gasses;
CO detector and release of extinguishing agents; water-flow detector. The newest innovations
can use cameras and computer algorithms to analyse the visible effects of fire and movement
in applications inappropriate for or hostile to other detection methods.

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These systems are commonly used in shipping, on- and offshore installations and in
mechanical buildings. The purpose of fixed extinguishing media is to automatically
extinguish the fire without any personnel needed in the room or area. Two different types are
known:.
x Fire-fighting systems based on water
x Fire-fighting systems based on gas

Installations based on water

x Deluge
x Sprinkler
x Hi-fog
x Foam

Deluge
Purpose: providing cooling to the installation and construction. A deluge provides a huge
amount of water

Sprinkler
Purpose: early detection and suppression of an indoor fire

Hi-fog
Purpose: early detection and suppression of an
indoor fire. High fog has a double effect; the fog has Example of high fog nozzle
a smothering effect next to cooling.

Foam
Purpose: early extinguishment of a liquid spill fire.

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Installations based on gas
x CO2
x FM200
x Inergen
x Argonite
x Halon (partially banned)
x Novec 1230 (new)

When you are in the area where fixed fire-fighting

systems are present and activated are deployed , leave
the area immediately and proceed to your muster Gas buffer tank for sire suppression system

station. With a few exceptions, fixed suppression

systems oppose a serious risk to health once activated.

Actions to take when discovering a fire

Your duty
x Raise the alarm, alert co-workers
x Press fire alarm button
x Call control room
x Shout for help
x Extinguish fire if possible

Typical locations of extinguishers

x Kitchen
x Corridors
x Hotspots
x Hotwork areas
x Small rooms

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SECTION 5, SURVIVAL FIRST AID
‘First Aid’ is the immediate assistance or treatment given to someone injured or suddenly taken
ill before the arrival of a medic/doctor or other appropriately qualified person. The person
offering his help to a casualty must act calmly and with confidence and above all must be
willing to offer assistance whenever the need arises.

Prioritising actions
How to approach and help a casualty who is responsive? If a casualty is aware, the first aid
provider at the scene will try to reassure and help the casualty at the same time. If a casualty
needs assistance of a first aid provider, mostly a certain level of stress will be reached which
may turn into panic. Panic can especially happen if the casualty is losing a lot of blood or if
the casualty is disabled due to the incident or accident. In case of blood loss, fractures, loss of
vision or disabilities a medic needs to come to the scene.

Immediate actions should be carried out by all personnel on board when discovering a
casualty. Assessment the environment for hazards and dangers to yourself, make sure you
don’t end up being the next casualty. Raise alarm and make sure you know your First Aid
do’s and don’ts when attending to the casualty.

Appropriate behaviour at the first aid scene

If an accident did happen and there are casualties, safety of everyone else will be important
in order to prevent more casualties. If a first aid provider wants to help a casualty at the
accident or incident site an assessment of safety is necessary. To avoid more casualties the
alarm will be raised and everyone in the area will be asked to help. If the incident or accident
site is not safe the area should be made safe before anyone will help the casualty. If the scene
can’t be made safe by the layman at the scene an emergency response team will arrive at the
scene to make the area safe and to attend to the casualty. If the area also can’t be made safe
by an emergency response team or a first aid provider the casualty must be left without any
help.

If the area seems to be safe, a casualty can be approached by a first aid provider. The situation
will be assessed while approaching the casualty. The assessment will be done to make sure
that the situation will be safe or remain safe. The assessment also will be done to look for
indications about the incident or accident. Each indication also can be used as a pointer of
injuries to the casualty.

If the casualty is conscious, the first aid provider should ask about the incident or accident.
The first aid provider should also ask the casualty about his/her injuries. Important
information about the injury will help the first aid provider at the scene to determine if a medic
is required.

During the verbal investigation the casualty will be reassured by the first aid provider. The
first aid provider needs to explain the casualty about the first aid which will be administered.
The first aid provider will also try to create some protection against preheating or cooling
down. An important part of reassuring a casualty will be remaining close and visible to the
casualty.

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After the first examination of the casualty, a medic or doctor must be informed about the
situation. Important information for a medic or doctor are the casualty’s vital signs. Vital signs
are: the level of consciousness, respiration, circulation, blood loss, exposure to high and low
temperature and exposure to dangerous goods or substances.
To make sure that the physical situation will not become worse, the casualty must be helped
at the incident or accident site. Only if the situation is changing to a hazardous situation the
casualty must be moved as soon as possible but this has to be done carefully and preferably
using a suitable type of stretcher.

Assess all casualties

x Make priorities in helping casualties

Five points,
Call professional help/medic and tell:
x Accident
x Location
x Amount of casualties
x Which kind of injuries or diseases
x First aid provided by you

First aid: casualty not responding but still breathing normal

x Safe Approach
x Speak and shake
x If no response the casualty is unconscious
x Check breathing 10 seconds
x Call for help or raise the alarm
x When the casualty is breathing

Recovery position
x Do not leave the casualty until the medic arrives
x Check breathing regularly

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Principles of handling
Danger
Response
Chest Compression
Airway
Breathing

Danger
Ensure area is safe for:
x Rescuer
x Others
x Victims
Remember, don’t become the next victim!

Response
Check for the level of response:
To check level of consciousness, use the AVPU method:
x Alert
x Voice
x Pain
x Unresponsive
Shout and shake
If Unresponsive
x Call / shout for help
x No breathing or no normal breathing (only gasping or labored)
x Start CPR

Chest Compressions
CPR management includes: 30 chest compressions as fast and as hard, push at least 2” for
0
adult with 100-120 rate per minutes, straight hand position 90 to the chest, please let
completely recoil each compression.

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Airway Open
Use head tilt chin lift method to
give rescue breath and clearing
the airway of non-trauma victims.

Breathing
Give two breaths after 30
compressions (1 second for each
breath), it’s mandatory to use mouth
seal protector.

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Types of injuries

External Bleeding

Three types of external bleeding:

Arterial
x Oxygenated and bright red blood
x Often profuse and spouting from the wound
Venous
x Dark deoxygenated blood flowing from a vein
x Slow stream
Capillary
x Result of an abrasion also known as a scrape.

Internal Bleeding
x Discoloration of the skin.
x Rapid swollen

Treatment of bleeding

Prevention of further blood loss

x Put a dressing on the wound, apply direct pressure on the dressing.
x If the bleeding does not stop, add more dressing on top the first and press harder.
x Keep pressure on the wound until it stops bleeding.
x Wrap a bandage firmly but not too tight over the dressing.
x Elevate the wound above the heart or higher.

Prevention of contamination
x Clear water and soap
x Disinfectant
x Prevention of wound infection by covering the wound with sterile dressing
x Use of gloves

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Burns Injuries

Commonly caused by:

x Sun
x Heat
x Extreme cold
x Electrical
x Radiation
x Chemical
x Friction

Classification of burn injuries

st
1 degree burning
Superficial
x Slightly swollen
x Red discoloration
x Painful

Severity of burns:
x Will become lethal if body surface area affected > 75%

Treatment
x Cooling down with water 20-30 minutes.
x Cold tap water.
x Drink more of water.

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 nd
2 degree burning

Partial thickness
x Blistered
x Red or pale discoloration
x Very painful

Severity of burns:
x Will become lethal if body surface area affected > 30 %

Treatment
x Cooling down (minimum 20-30 minutes)
o Flushing with cold tap water
o Specially first aid cooling means
x Cover with
o Sterile gauze
o Metal mesh line
x Do not break the blisters

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 rd
3 degree burning

Full thickness
x Permanent tissue damage
x Black, white, yellow, brown, charred and leathery skin
x Painless
Severity of burns:
x Will become lethal if body surface affected >10%
Treatment
x Cooling minimal 30 minutes
o Flushing with cold tap/shower water
o Special first aid cooling means
x Do not touch the burn area.
x Cover by
o Sterile gauze
o Separate each body fold affected
x Check for signs of circulation

Total Body Surface Area Measurements

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Hazardous substances
x Explosives
x Gasses
x Flammable liquids
x Flammable solids
x Spontaneously combustible
x Substances which in contact with water emit
flammable gases
x Oxidizing substances
x Organic peroxides
x Toxic substances
x Infectious substances
x Radioactive substances
x Corrosive substances
x Miscellaneous dangerous substances and articles
x Medicine

Exposure to chemicals can be by: contact to the skin (dermal), trough the respiratory system
and trough the digestive system. If a casualty has been exposed to a hazardous substance, at
all times the packaging or the material safety data sheet must be handed over to the medic.

Dermal exposures
If a casualty has been exposed to some hazardous substances, the most important step as a
first aid provider will be to take care of your own safety. Avoid any contact with solids, fluids
or fumes.
Try to create a safe area or stop the exposure to hazardous substances. In most situations, tell
the casualty how to stop the exposure or tell the casualty to leave the affected area. Tell the
casualty also to take the material safety data sheet or the packaging of the hazardous
substances with him/her.
In a situation of an unconscious casualty, the casualty should be taken to a safe area. The level
of consciousness and respiration must be checked immediately during the assessment of the
situation and the casualty. If the casualty seems to be unconscious, sometimes the casualty
also may be dead. SAFETY FIRST! The first aid provider should leave the affected area
immediately.

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If the casualty is out of the affected area, all of the affected clothing should be taken off by
the casualty itself. As soon as possible rinse the affected body parts of the casualty for at least
30 minutes. If water is used to rinse the affected body-parts, then water in the first moments
should be cold so no hazardous materials will be absorbed by the skin. After 2 minutes use
lukewarm water. If information about treatment on the material safety data sheet explains to
use a neutralizing agent than don’t use water. Also on the permit-to-work some information
about a neutralizing agent should be specified.
If a hazardous substance was spilled over the face of a casualty make sure that water or
neutralizing agents are not flushed over nose and mouth. If a hazardous substance came in
contact with an eye treatment should be the same but make sure that there won’t be any contact
with the other eye, mouth or nose by water or a neutralizing agent if the face is rinsed.
In some cases, chemical contact might will be rapidly reaction with water, clearing the skin
by sweep and brush are needed as vigorously.

Exposures through the respiratory organs

If a casualty has been exposed to hazardous fumes, intoxication of the airway of the first aid
provider must be prevented. The first aid provider must avoid any contact with the hazardous
fumes. If the casualty is conscious tell the casualty to go to a not affected area, preferably in
fresh air. If the casualty is unable to leave the affected area by himself, then only take the
casualty to a safe environment if the affected area is without fumes or if the first aid provider
is protected by breathing apparatus. After the casualty has been relocated successfully,
provide medical oxygen. If medical oxygen is used, the flow of oxygen should at least be 10
to 15 liters per minute.
As soon as possible call the medic to come to the scene. Try to find the packaging or Material
Safety Data Sheet.
While the casualty is under treatment continuously check the status of consciousness. Also,
be prepared to start Cardio Pulmonary Resuscitation.

Infection through the digestive system

If a hazardous substance has been swallowed by the casualty the first aid provider must avoid
any contact with the hazardous substance. If a hazardous substance has been swallowed the
first aid provider must find out what kind of substance has been swallowed. As a first aid
provider it is important to divide substances into three groups. Corrosive substances,
hydrocarbon products and solids.
If a corrosive substance has been swallowed, make the casualty drink some water. At the most
two cups of fresh water must be swallowed to decrease the effect of the corrosive substance
to the intestines.

After drinking some water, the mouth must be rinsed. Vomiting must be avoided to keep the
effect of the corrosives as low as possible. The casualty should be referred to the medic.
If hydrocarbons have been swallowed no water should be used and vomiting must be
prevented. Hydrocarbons will float on water in de stomach. If the casualty is vomiting the
fumes of the hydrocarbons can be inhaled into the lungs.

If a casualty swallowed solid hazardous substances, the wrong or too much medication, no
water should be used to dilute the substance. Water will make the effect of most solids even
worse. The casualty who swallowed solid hazardous substances must vomit if he/she is
conscious.

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In all situations where casualties have been exposed to hazardous substances, the medic must
be consulted for further treatment and monitoring.

Infection through the digestive system in case of hydrocarbon products.

If a hazardous substance has been swallowed by the casualty the first aid provider must avoid
any contact to the hazardous substance. If a hazardous substance has been swallowed the first
aid provider must find out what kind of substance has been swallowed. As a first aid provider
it is important to divide substances into three groups. Corrosive substances, hydrocarbon
products and solids.
If a corrosive substance has been swallowed the casualty make the casualty drink some water.
At the most two cups of fresh water must be swallowed to decrease the effect of the corrosive
substance to the intestines.
After drinking some water also, the mouth must be rinsed with some water. Vomiting must
be avoided to keep the effect of the corrosives as low as possible.
The casualty should be treated by the medic.
If a product of hydrocarbons has been swallowed no water should be used and vomiting must
be prevented. Hydrocarbons will float on water in de stomach. If the casualty is vomiting the
fumes of the hydrocarbons can be inhaled into the lungs
If a casualty swallowed solid hazardous substances, the wrong medicine or too much medicine
no water should be used to dilute the substance. Water will make the effect of the most solids
even worse. The casualty who swallowed solid hazardous substances must vomit if the
casualty is conscious.
In all of the situations of being exposed to hazardous substances the medic must been seen
and checked by the medic.

Infection through the digestive system in case of solids

If a hazardous substance has been swallowed by the casualty the first aid provider must avoid
any contact to the hazardous substance. If a hazardous substance has been swallowed the first
aid provider must find out what kind of substance has been swallowed. As a first aid provider
it is important to divide substances into three groups. Corrosive substances, hydrocarbon
products and solids.
If a corrosive substance has been swallowed the casualty make the casualty drink some water.
At the most two cups of fresh water must be swallowed to decrease the effect of the corrosive
substance to the intestines.
After drinking some water also, the mouth must be rinsed with some water. Vomiting must
be avoided to keep the effect of the corrosives as low as possible.
The casualty should be treated by the medic.
If a product of hydrocarbons has been swallowed no water should be used and vomiting must
be prevented. Hydrocarbons will float on water in de stomach. If the casualty is vomiting the
fumes of the hydrocarbons can be inhaled into the lungs
If a casualty swallowed solid hazardous substances, the wrong medicine or too much medicine
no water should be used to dilute the substance. Water will make the effect of the most solids
even worse. The casualty who swallowed solid hazardous substances must vomit if the
casualty is conscious.
In all of the situations of being exposed to hazardous substances the medic must been seen
and checked by the medic.

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Exposure to the Elements

Heat exhaustion
If a casualty has been exposed to a warm or hot environment the inner body temperature can
rise above a normal inner body temperature of 37⁰C. This physical condition is known as heat
exhaustion. Before the signs of heat exhaustion occur, the casualty will have a reddish
coloured skin and is sweating. After that signs of a pale clammy skin will occur and if the first
aid provider feels the skin it will be warm. Other signs will or can be profuse sweating,
headache, dizziness and headache. If the vitals are checked respiration and pulse will be rapid
but weak. Respiration and pulse will be fast so the body will do it’s best to lose some of its
higher inner body temperature.

If the casualty, whom has been exposed to a warm or hot environment, must be taken to a
cooler area. Due to the higher than normal inner body temperature fluids from to body has
been vaporized by exhaled carbon dioxide and lost as sweat. Copious amounts of cool water
must be drunken by the casualty. Another solution can be found by isotonic sports drinks.
Isotonic sports drinks also include some necessary minerals and salt.

Make sure that the casualty will be at rest and continuously check the level of consciousness
and respiration.

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Heat Stroke
If the situation has been changed to the worst a heatstroke does occur. The physical condition
can become a life-threatening situation.
The skin will feel warm or hot and shows a red tinted colour of the skin. The skin also feels
dry like a leathery skin and if the skin is squeezed it will remain the squeezed position.
The casualty will complain about headaches and dizziness. Vision of the casualty also can be
less than normal. Due to the sudden increased (inner) body temperature the level of
consciousness also will change. Furthermore, due to the increased (inner) body temperature
and the changes in the level of consciousness the response of the casualty will change.
Suddenly the casualty can become confused or restlessness. The inner body temperature may
increase above 40c and cause unconsciousness. Circulation can be felt in de carotid artery and
will be a very strong or heavy pulsation.
Treatment of the casualty. Remove the casualty from the warm area to a cool environment.
After the casualty is in a cooler environment remove the outer clothing. Try to cover the
casualty by wet towels or blankets to take the temperature from the body. The warm body will
evaporate the cooling water from the blankets or towels, so the temperature might drop to a
temperature below 40⁰C.

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Effects of cold temperature

The graph of exposure to cold water can be used to explain the increasing inner body
temperature in the first few minutes if a casualty is fully or partially submerged.
After a few minutes the body will cool down again.
In the first part of the graph cold (water) shock is visible. After 2 to 5 minutes on the graph
cooling down and how to recognise some signs of hypothermia can be explained.

Cold (water) shock: inner body temperature 36,4⁰C to 38,0⁰C. After a few moments the bod
will re-establish until the inner body is cooled down till a temperature of 35,5⁰C. If the inner
body temperature is 35,5⁰C hypothermia is a fact.

If the inner body temperature will continue to decrease until temperature of approximately
33,0⁰C the body can recover itself by its own metabolism.

If the temperature will decrease below 33,0⁰C metabolism cannot rewarm the body. If the
inner body temperature is close to 28⁰C the casualty will become unconscious.

If decreasing of the inner body temperature still will continue the casualty can die if the inner
body temperature is close to 26⁰C.

Cold shock
Cold (water) shock can occur if the temperature of water is below 15⁰C even if a person is
protected by an immersion suit or anti exposure suit. If the face of the casualty was
underwater, especially as the eyes and the temples have been exposed to the cold water.
Within the first 2 to 5 minutes the casualty will have to deal with cold (water) shock.
The response to the cold environment will be a fast and uncontrolled respiration, an increased
heart rate, high blood pressure, disorientation and panic. The cold (water) shock response is

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meant to get the inner body temperature higher so the body will remain warm.
Due to the cold (water) shock effect in water the casualty has been in panic and was
disorientated. If the eyes were immersed in cold water visibility is nil or nothing. Breath
holding time is also nil or nothing because of the panic but also because off the great need of
oxygen which is required for digestion. Due to the increased need for oxygen for
metabolism breathing may be significantly accelerated. The accelerated respiration can be
increased from 5 up to 10 times the normal rate. If the demand for oxygen is greatly increased
the circulation of blood also greatly accelerates and the pressure of blood can become
extremely high. The increased heart rate can cause heart failure.
The extremely high blood pressure also is a response of the cold water over de skin. This
extremely high blood pressure haemorrhage can occur.

Hypothermia (treatment)
The first aid provider constantly will check the airway if it is open and free. Also, every minute
respiration must be checked. The level of hypothermia must be checked every minute. The
assessment will be done constantly so changes for the good or the worse can be reported to
the medic. If no medic is available, the first aid provider will advise the first provider how to
help to casualty. At all times the casualty must be protected against further cooling. Protection
can be applied by a thermal protective aid or a blanket. At least the head and the body past
the groin area must be covered. Another option can be, remove the casualty from the cold
environment into an enclosed compartment. Circulation of air must be prevented. The
temperature in the enclosed compartment should be between 18⁰C and 20⁰C. If the
temperature is above 20⁰C rewarming can cause an aftershock.

Hypothermia (beginning stage)

Treatment of a hypothermic casualty if the first aid provider recognizes signs like mental
confusion, pale cold and clammy skin, goose bumps, shivering, restlessness and tiredness
should be:
Vertical elevation from water can still be done. Circulation probable is still fine so no
unexpected change in the level of consciousness will occur. Although a horizontal lift might
be a better solution if the casualty stayed more than 15 minutes in water. If the casualty has
been taken to an enclosed compartment drought must be prevented. If the vital signs of the
casualty are not changing for the worse warm drinks can be used for rewarming the casualty.
The casualty should only drink in sips.
The casualty may take of its own clothing if the clothing will be replaced by dry clothing or
will be protected against cooling. Rewarming by a shower or a bathtub in lukewarm water
can be an option but the physical and mental situation should be observed by the first aid
provider. If rewarming of the hypothermic casualty is to fast an aftershock can cause a life-
threatening situation so rewarming by lukewarm water only will be used by a medic.

Hypothermia (severe stage)

If the situation has been changed for the worse sings like disorientation, drowsy, loss of
memory, exhaustion, lowering of consciousness, a weak pulse, rigid limbs (arms and legs) or
even worse like unconscious and respirational and circulation difficulty’s or clinically death
the casualty preferably must be rescued horizontally out of the water. If the lift is too
complicated or taking too much time, the lift can also be done vertically. During the elevation
from water and if the is in a safe area nothing of the casualty should be moved. A sudden
movement even the slightest movement will cause a change in circulation and cause a

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decrease of the inner body temperature. Knowing those problems and dangers if a
hypothermic casualty hopefully the rescue of a hypothermic casualty from cold water will be
prepared by the man overboard team, the first aid provider, the medic and all of the who will
be involved.

Frostbite
If a part of the body has been exposed to a sub-zero temperature parts of the body can become
frozen. If the temperature is becoming cold the casualty will complain about pain what may
feel like pins and needles. If the temperature is less than 6⁰C numbness in the extremities will
occur. The colour of the skin will change to a pale or waxy colour. This decolourization is the
same as seen in shock. If the is touched it will feel hard and leathery. Flexibility of the skin
will be the same as mentioned in heat stroke. Due to a lack of circulation of blood less oxygen
will be in the skin and can cause some bleu decolourization or the skin will be (bleu) spotted.
Treatment by the first aid provider always will start by taking the casualty to a warm
environment or area. If circulation in the extremities starts swelling can occur. To prevent
suspension jewellery must be removed before the affected body parts will be rewarmed.
Rewarming of body parts can be done by the warmer body parts of the casualty. After
rewarming damaged tissues can appear. The same degrees as burns also can be seen after
rewarming of frozen body parts.

First aid arrangements

On board there a many different first aid items to use in case of an emergency. First aid boxes
are designed different even provided in different colors. The first aid box is needed for many
different kinds of injuries.
The AED must be used as a help during the CPR proces. If a shock advised stay clear and the
AED will try to bring the heart in the correct ritme again.
There are different kind of stretchers, some needs to be build and put together. The stretcher
is a big help if the victim needs to be transported. Bigger platforms do have a hospital with a
medic. The hospital is equiped to keep the victim stable for 1,5 hour untill a helicopter does
arrive.

LTJ Jakarta, version 3, 2017 75