Emergency Protocols

Case-Based Learning

Maritime Case Simulations

Practice the clinical decisions, command communication, and documentation that maritime medicine demands.

Case Simulations

Tap any case to expand the full scenario. Each case progresses through phases of assessment, audit, communication, and documentation.

Initial Call

0230 — Nurse calls. 62-year-old male passenger, crushing central chest pain, diaphoretic, onset 40 minutes ago.

First 5 Minutes

  • ABCDE assessment
  • ECG shows ST elevation in leads II, III, aVF
  • Aspirin given
  • GTN given
  • IV access established

First 30 Minutes

  • Pain score improving but not resolved
  • BP stable
  • Repeat ECG shows persistent ST changes
  • Consider thrombolysis decision

Osolika Endurance Audit

  • Oxygen: 6 D-cylinders at 4L/min = approximately 6 hours
  • Staff: 1 doctor, 1 nurse
  • Drugs: Aspirin, heparin, morphine available; tenecteplase available
  • Diagnostics: ECG only, no troponin POC
  • Weather: Calm
  • Evacuation: Helicopter range exceeded
  • Transit to port: 18 hours

ORS Score

Level 3 — Capability gap. Oxygen may not outlast transit at current flow.

Bridge Phrase

“Captain, we have a patient with a suspected heart attack. Our oxygen supply may not last until port arrival. I recommend we explore diversion options to reduce transit time.”

Documentation

“ST-elevation MI suspected. Thrombolysis considered. Oxygen endurance audit shows potential shortfall over 18-hour transit. Master informed. Diversion discussed.”

Learning Points

  • Thrombolysis decision at sea
  • Oxygen sustainability
  • When to request diversion

Initial Call

1400 — 35-year-old crew member, engine department. Fever 39.8°C, rigors, confusion developing. Abdominal pain right lower quadrant for 2 days, worsening.

First 5 Minutes

  • ABCDE assessment
  • HR 125, BP 88/52, RR 28, SpO2 94%, GCS 14 (confused)
  • Abdomen: guarding RLQ with rebound

First 30 Minutes

  • IV fluids started — 1L crystalloid bolus
  • IV antibiotics (ceftriaxone + metronidazole)
  • Paracetamol for fever
  • Second fluid bolus planned
  • Urinary catheter if available

Osolika Endurance Audit

  • Oxygen: Adequate
  • Staff: 1 doctor, 1 nurse (crew member as helper available)
  • Drugs: Antibiotics for 48 hours, limited vasopressors
  • Diagnostics: No imaging, no blood tests
  • Weather: Moderate swell
  • Transit: 36 hours to nearest surgical port

ORS Score

Level 3–4. Surgical pathology suspected, no surgical capability onboard.

Bridge Phrase

“Captain, this crew member has a serious infection that likely requires surgery. We cannot perform surgery onboard. I recommend immediate course change toward the nearest port with surgical capability.”

Documentation

“Suspected intra-abdominal sepsis, likely appendicitis or perforation. No surgical or ICU capability available. Empiric antibiotics commenced. Master informed and diversion recommended.”

Learning Points

  • Sepsis management with limited drugs
  • Surgical pathology at sea
  • Documentation of capability gap

Initial Call

Day 4 of a gastro outbreak. 3-year-old passenger. Parents report 12 episodes of vomiting and 8 episodes of diarrhea in 24 hours. Not drinking. Listless.

First 5 Minutes

  • Weight estimated at 14kg
  • Signs of moderate-severe dehydration: sunken eyes, dry mucous membranes, reduced skin turgor, capillary refill 3 seconds

First 30 Minutes

  • Attempt oral rehydration — child vomits
  • IV access attempted — difficult in dehydrated child
  • Consider IO access protocol
  • IV 0.9% NaCl 20ml/kg bolus = 280ml over 20 minutes

Osolika Endurance Audit

  • Oxygen: Not currently needed
  • Staff: Adequate
  • Drugs: IV fluids limited (4L 0.9% NaCl total). Pediatric doses need careful calculation. No pediatric ICU.
  • Weather: Calm
  • Transit: 12 hours to port

ORS Score

Level 2–3. Currently managing, but rapid deterioration possible.

Bridge Phrase

“Captain, we have a seriously unwell child on board. We are treating with IV fluids but our pediatric resources are limited. I recommend we notify port health and arrange pediatric assessment on arrival.”

Documentation

“Pediatric dehydration secondary to AGE outbreak. IV rehydration commenced. Limited pediatric IV fluid supply. Port health notified. Pediatric assessment requested at next port.”

Learning Points

  • Pediatric fluid calculation at sea
  • Escalation thresholds
  • Outbreak documentation

Initial Call

Day 3 after departure from Dakar. 28-year-old deck crew. Fever 40.1°C, headache, myalgia, rigors. Was ashore in Dakar for 8 hours.

First 5 Minutes

  • ABCDE assessment
  • HR 110, BP 105/68, RR 22, SpO2 97%, GCS 15
  • Petechial rash noted on trunk
  • No neck stiffness

First 30 Minutes

  • Malaria rapid diagnostic test (if available in medical chest)
  • Blood film — cannot perform onboard
  • Empiric antimalarial treatment considered
  • Differential: malaria, dengue, typhoid, meningococcal disease
  • Isolation as precaution

Osolika Endurance Audit

  • Oxygen: Adequate
  • Staff: Adequate
  • Drugs: Limited antimalarials, may have artemether-lumefantrine
  • Diagnostics: Malaria RDT only
  • Weather: Calm
  • Transit: 4 days to next port

ORS Score

Level 3. Cannot confirm diagnosis. Empiric treatment without confirmation carries risk.

Bridge Phrase

“Captain, we have a crew member with a serious tropical fever that we cannot fully diagnose onboard. Malaria is a strong possibility. I recommend we explore options to reduce time to the next port with laboratory facilities.”

Documentation

“Febrile illness post-tropical port exposure. Malaria suspected. RDT performed. Empiric antimalarial commenced. Isolation precautions initiated. Unable to perform confirmatory blood film. Master informed.”

Learning Points

  • Tropical fever differentials at sea
  • Empiric treatment decisions
  • Isolation protocols

Initial Call

2100 — Security reports a passenger behaving erratically on Deck 12 balcony area. Shouting, threatening to harm himself. Intoxicated.

First 5 Minutes

  • Scene safety assessment
  • Security present
  • Approach from inside cabin, not balcony
  • De-escalation attempted
  • Patient is distressed, agitated, but responds to verbal contact

First 30 Minutes

  • Patient guided away from balcony area to medical centre
  • Verbal de-escalation continues
  • Consider oral sedation if cooperative (lorazepam 1–2mg PO)
  • If escalating: IM haloperidol 5mg + lorazepam 2mg IM
  • 1:1 observation initiated

Osolika Endurance Audit

  • Oxygen: N/A
  • Staff: Security available for physical safety
  • Drugs: Sedation available for 48 hours
  • Diagnostics: Clinical observation only
  • Weather: Calm
  • Transit: 2 days to next port

ORS Score

Level 2. Currently managed, but risk of re-escalation.

Bridge Phrase

“Captain, we have a passenger with a psychiatric emergency who presented a risk to himself. He is now in the medical centre under observation and sedation. I recommend security maintain proximity and we assess fitness to disembark at the next port.”

Documentation

“Psychiatric emergency. Patient presented with suicidal ideation and agitation while intoxicated. De-escalated and transferred to medical centre. Sedation administered. 1:1 observation initiated. Risk assessment ongoing.”

Learning Points

  • Scene safety at sea, balcony risk
  • Documentation for P&I
  • Duty of care vs. autonomy

Initial Call

Expedition landing. Zodiac tender crush injury. 45-year-old passenger. Left leg caught between tender and landing platform. Suspected open fracture tibia/fibula.

First 5 Minutes

  • ABCDE assessment with C-spine caution
  • Massive hemorrhage from open wound — direct pressure and tourniquet applied
  • HR 130, BP 90/60, RR 24, SpO2 96%
  • GCS 15 but distressed

First 30 Minutes

  • IV access x2
  • Fluid resuscitation 1L bolus
  • Wound packed and splinted
  • IV morphine 5mg for pain
  • Tetanus status unknown
  • IV antibiotics for open fracture (cefazolin if available)
  • Prepare for medical evacuation

Osolika Endurance Audit

  • Oxygen: 4 D-cylinders available
  • Staff: 1 doctor, 1 nurse, expedition leader assisting
  • Drugs: Analgesics adequate, antibiotics limited, no blood products
  • Diagnostics: Clinical only
  • Weather: Deteriorating, 3–4m swell expected
  • Evacuation: Helicopter requested but weather may prevent

ORS Score

Level 3–4. Hemorrhage control achieved but definitive surgical care needed.

Bridge Phrase

“Captain, we have a serious trauma with an open fracture and significant blood loss. This patient needs surgical care urgently. I recommend we request helicopter evacuation immediately before weather deteriorates further.”

Documentation

“Open fracture left tibia/fibula sustained during tender operation. Hemorrhage control achieved. Fluid resuscitation commenced. Helicopter evacuation requested. Weather window may close.”

Learning Points

  • Trauma management in expedition settings
  • Tourniquet use
  • Weather-dependent evacuation

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