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Medical Training Gets Put to the Test

Oceanus crewmembers trade the helm for the doctor bag

It was supposed to be a routine transit cruise from Woods Hole to meet a research expedition originating out of Fortaleza, Brazil. R/V Oceanus set out in fair weather, but in just a matter of hours Captain Larry Bearse and crew were caught by a rapidly developing winter storm. With winds whipping up to 30 knots, the ship began to pitch and roll.

The relief mess attendant, Kathleen Uto, was working with steward Chris Moody in the storeroom, carrying sacks of flour, when the ship lurched abruptly. Uto was catapulted through a watertight door opening, crashing headfirst into a steel bulkhead. Moody picked himself up off the storeroom floor, found Uto in a heap in the passageway, and called the bridge for help.

Blood pulsed from Uto's scalp as First Mate Courtenay Barber and Captain Bearse arrived. They tried to stem the flow of blood and assess her vital signs before moving her to a berth closer to the ship's center of gravity, where motion would be less. Ship's Mate Diego Mello, on the bridge of the ship, called for medical assistance on the satellite phone before trading places with Bearse. Barber and Mello are trained to provide medical care for everything from heart attacks to broken bones when a shipmate is injured at sea, but it's a skill they would rather not have to use. For two days in January 2003, Mello and Barber put those medical skills to work.

House Calls at Sea
For crews on all WHOI-operated vessels, the incident aboard Oceanus offered a fresh reminder of the importance of medical training. All crewmembers on WHOI-operated ships must complete courses in basic first aid, said Mike Brennan, Marine Personnel Coordinator. Ten crewmembers also have completed "medical personal in charge" (MEDPIC) courses offered by the Maritime Institute of Technology and Graduate Studies, a continuing education center based in Maryland. Every cruise carries at least one certified MEDPIC.

These shipboard medics do not take the place of licensed medical professionals. They are instructed in basic diagnostic procedures, CPR, medical reporting procedures, and the use of automated external defibrillators and various medications. But their main job is to be the eyes, ears, and hands of a land-based doctor at Medical Advisory Systems (MAS), a 24-hour medical center patched in by satellite phone.

WHOI ships are also equipped with medical supplies recommended by MAS. The supplies are organized and numbered so that a shore-based doctor can call up a computer profile and know exactly what tools and medicines are available to the MEDPIC. (These procedures are mandated by the federal agencies that control the vessels in the U.S. academic research fleet.)

Stitches on a Roller Coaster
This medical response system was tested when Uto got injured. Barber and Mello applied compresses to her head, but every time they seemed to stop the bleeding, blood would flow again. Between the rolling ship and Uto's thick, dark hair, it was difficult to assess what was wrong. The MAS support team was concerned about possible unseen trauma, such as a cracked skull, internal hemorrhaging, or a blood clot in the brain. Applying stitches was out of the question. "Envision attempting this on a roller coaster in motion," Bearse said, "and I think you get the idea."

Bearse diverted the ship toward Saint Georges, Bermuda, to set up a medical evacuation. But the nearest land was 30 hours away and the storm was continuing to intensify. In the best weather, Oceanus can cruise at 14 knots. Making a steady 12 knots, the ship was knocked about by Force 10 winds (over 55 knots) and seas of 20 to 40 feet. The ship repeatedly rolled 25 to 40 degrees, sometimes 55 degrees.

The ship's crew of twelve was suddenly down to eight. With Uto injured and Barber, Mello, and a rotating shift of helpers tending to their injured shipmate, "sleep and rest became a rare commodity," Bearse said. "Sacrifices had to be made, watches and duties juggled. But it was never necessary to give orders. The entire crew excelled."

Through the pitching and rolling and sleep deprivation, Barber and Mello had to keep Uto sitting up to prevent excessive bleeding. They braced her, and themselves, from sliding off the settee by sandwiching themselves around her for support.

Ship Shape Again
When Oceanus finally approached Saint Georges a day later, no weather-worthy helicopters or rescue vehicles were available. (Since the U.S. Navy pulled out of Bermuda, the island has been short of search-and-rescue capability.) A pilot boat ushered the ship into the harbor for a rare night docking.

Doctors met the ship at the dock and rushed Uto to the hospital, where she received many layers of stitches and spent the night. Uto was subsequently flown back to the United States for further treatment and recovery, and Oceanus departed for Brazil, short one crewmember. Uto has since recovered from her injuries and is living in Charleston, SC.

"The medical training I received was absolutely critical," Barber said. "I had a degree of confidence, and skill that I would not otherwise have." But he added a note of caution. "Good medical training is an ongoing process," Barber said. "Unlike EMTs ashore who practice their skills daily, we have long dry spells and, quite frankly, become rusty. Because we practice our craft so infrequently, it is important to attend refresher courses and continue our education."

"Someone once said that going to sea involves long periods of boredom punctuated by moments of terror," Barber said. He now cherishes the boredom a bit more, but he is equipped for the terror.

Originally published: November 1, 2003