Personal Watercraft Safety doesn't stop at just having the right equipment and riding within your skill level. There may be times you are called upon to deal with injuries or accidents that occur despite your best efforts.
PWC Safety Initiative is proud to introduce our first guest blogger,
Brad King, NREMT-P, FP-C, a Flight Paramedic and founder of Lake Erie Jet Riders.
Brad's passion for emergency medicine and watercraft have provided him with an encyclopedic knowledge of first response best practices, and we are excited and humbled to have him share his knowledge for the betterment of the PWC community.
Enjoy and Ride Safe!
~Tamarin
My name is Brad King, and I’m the founder of Lake Erie Jet Riders, a PWC group based out of Erie, Pennsylvania. I have been involved in the PWC community for about 13 years now, owning, riding, buying, selling, building, and restoring everything from vintage stand ups to full-sized supercharged cruisers. My full-time job however has me spending time in the sky rather than the water. I work as a rotor wing Flight Paramedic and am lucky enough to be based out of my city of residence, Erie, PA along the shores of the Great Lakes. Along with my career comes a respect and understanding for trauma and critical care medicine. That being said, I am a huge advocate for safety and readiness when it comes to my favorite hobby, riding personal watercraft.
Regardless of how safe you or your group may ride, accidents do and will happen. According to U.S. Coast Guard statistics, there were 46 deaths and 624 total reported injuries in 2017 on personal watercraft alone. The top contributing factors in these deaths and injuries were operator inattention and improper lookout, operator inexperience, alcohol use, and excessive speed. What’s so great about this initiative is the focus to spread word and information about these factors. There is no reason that as a community we can’t get these numbers down. Injury prevention is the first step. Safe riding education and training for new riders is huge. Secondly, and the main reason that I’m writing this article, is caring for those that are injured. As we touched on earlier, accidents will continue to happen regardless of experience and training, so having a basic understanding of how to care for an injured operator is vital.
Availability of Resources
What some people fail to realize when it comes to the marine and boating world are the limitations involved with emergency services. While some areas may have resources, equipment and protocols in place for the rescue of injured boaters, many areas do not. I encourage you to look into what resources are available in your local area or the area that you’re traveling to so that you know what to expect in the event of an emergency. If said area does not have readily available marine emergency services, the time it may take emergency responders to arrive at your location may be fairly significant or may be impossible. In addition, many lakes and rivers in the U.S. are serviced by volunteer departments whose members would be responding from home in the event of an accident, thus adding to the time in which those services arrive. In the event of an on-water emergency, you or the people that you’re with ARE the first responders.
Basic First Aid and CPR
Having a general understanding of basic first aid is a skill that everyone should have. While this article isn’t intended to be a full how-to, there are many sources available to learn First Aid. This can be as simple as browsing the internet or watching a few videos on YouTube to familiarize yourself with basic equipment and treatments. Many local EMS or Fire Departments also offer low cost or free First Aid and CPR courses. Putting in the time and effort to learn may be the difference between life or death for a friend or loved one, and the importance is so often overlooked. We need to drop the “won’t happen to me” mentality and begin to look out for each other. Group leaders, I’m talking to you! All group leaders and organizers should have a basic knowledge of First Aid, be CPR Certified, and know of any major medical conditions or allergies within the riders of the group.
On Board First Aid Kits
While we all know that space is limited on a PWC, having a first aid kit that corresponds with your level of medical training is essential equipment. Especially for group rides and group leaders. Most commercially available first aid kits DO NOT include items for actual medical emergencies. What they DO provide are typically luxury items, or the items that consumers typically think of when they think “first aid kit”. When it comes down to it, if Neosporin or alcohol prep pads can solve your problem, you’re not experiencing a true medical emergency. We’re here today to talk about what will actually save a life.
After listing these items, I will explain why I chose them individually. Some of the equipment included in these kits should contain but not be limited to:
- Bleeding control items such as gauze pads, gauze rolls for packing puncture wounds, quick clot gauze, and a commercial style tourniquet.
- Pocket mask or barrier for rescue breathing, Nasopharyngeal or oropharyngeal airways if trained
- Triangle style bandages for basic temporary splinting or slinging
- Sterile water or Saline for flushing eyes and/or washing out lacerating injuries (infection prevention)
- Adjustable cervical collar
- Riders with anaphylactic type reactions to Bees, Shellfish, Nuts, etc. should have their Epi Pen and Benedryl, as well as an albuterol inhaler if prescribed. Diabetics should have a glucometer and some form of glucose or sugar available to them for cases of hypoglycemia.
- Quality medical tape, trauma shears, hemostats, and personal protective equipment
Why are these items so important??
Bleeding Control- STOP THE BLEED! – Trauma is likely one of the major contributing factors to death on the water. As we know, with trauma comes bleeding. Think of all the sharp items that can be found on the water. Hooks, spears, propeller/impeller blades, anchors, low hanging branches, mangled metal while diving shipwrecks, submerged items etc. A large laceration CAN be life threatening if bleeding isn’t controlled, especially if arterial in nature. TAKE A “STOP THE BLEED” COURSE! Learn how to properly and effectively use direct pressure, elevation, packing gauze, quick clot, and commercial style tourniquets to get bleeding to stop. This can be the difference between life and death for a shark attack victim, someone with an arterial bleed, or for someone on blood thinners.
Rescue breathing/CPR- The first step in understanding rescue breathing and assisted breathing equipment is to take a First Aid/CPR course. Once you’re certified, add a pocket mask or rescue breathing barrier to your first aid kit and learn how to use it effectively. Creating an adequate seal onto a patient’s face, manipulating the head to ensure passage of air to the lungs and not to the stomach, and creating chest rise with each breath is an artform in itself, and does require practice and technique. Breathing for a patient that becomes apneic or has a near drowning episode can be the difference between that individual surviving or not. If trained to the level of utilizing oropharyngeal or nasopharyngeal airways, add these to your kit as well. Having these items available will only make your efforts more effective. Remember, CPR cannot be performed in the water. Patients affected by cardiac arrest and requiring CPR must be placed on a hard, flat surface. If an AED does become available, dry the patient and the surface before administering any electrical therapy. It’s very important to become familiar with treating near-drowning victims due to the nature of this sport, and knowing CPR is the first step in understanding this. Persons with cardiac histories (Myocardial Infarction, Congenital disease, Bypass surgery, or implanted pacemaker/defibrillators) should disclose this information to group leaders prior to departure on any trip or ride.
Splinting- The importance of splinting is often over-looked. While fractures not involving long-bones are rarely fatal, Long bone fractures (humerus or femur), compound fractures (fractures that penetrate the skin), and pelvic fractures can be life threatening and must be appropriately cared for. After controlling bleeding, these injuries should be splinted to prevent further tissue damage to the areas around the bone. As you can imagine, broken bones can be sharp. Continued rubbing of sharp bone against tissue causes continued bleeding and impedes clotting, causes additional injury, increases the risk of infection (in open injuries), and is very painful. In addition, victims can lose a life-threatening amount of blood into the tissues around these long bones in closed fractures, and blood may never even become visibly present. It’s understandable that a commercial splint is likely not going to fit into a PWC first aid kit. Fortunately, there are many items that can be used to splint an injury. Use an emergency oar, a fishing rod, or even a stick or branch to splint the injury. Just remember to cover open injuries with something clean such as gauze prior to placing a foreign object over it to prevent infection. The splint can be secured using triangular bandages, medical tape, paracord or gauze. Pelvic fractures are common in the recreational community as well due to the nature of the sport. Machines with handlebars create a perfect environment for an injury such as a pelvic fracture to occur. When the body is forced forward in a crash, and the pelvis/hips strike the handlebars or other bunt object, these internal injuries are possible. Patients with pelvic fractures will likely be in severe pain in the pelvic, hip, or lower back areas and are very sensitive to any movement. Bruising may also be present over the hip bones, and in severe cases, the pelvis may actually feel unstable to the trained individual. There are many major blood vessels that run along and in proximity to the pelvis, and there is a lot of space in the pelvic region for a victim to bleed internally into. Once again, visible blood may never become present, and these injuries can easily become fatal. For patients with suspected pelvic fractures, stabilizing the pelvis can save their life. To stabilize a pelvis, place an object such as a towel, blanket, or even a life jacket under the victim’s knees, and shimmy it back and forth up to the level of the pelvis. Tie the towel or blanket very tightly, or if using a life jacket, cinch the straps down as tight as possible. This may be painful for the victim at first, but in cases of true pelvic injury the pain is usually greatly reduced once a binder is in place. Placing a pelvic binder will not only stabilize the fractured pelvis to prevent further damage and injury, but will also potentially slow any internal bleeding that may be present.
Infection prevention- Infection. Yes, infection can be lethal. Sepsis post-injury is a major contributing factor in trauma related deaths. As you can imagine, penetration with an object that contains significant amounts of bacteria, rust, and foreign debris is not good for the body. Carrying a bottle of sterile water or saline to flush out an injury right away may prevent that individual from becoming septic during recovery. One of the most effective ways to prevent infection is nothing other than thoroughly flushing an injury as soon as possible, covering with sterile gauze, and keeping the injury clean until true medical treatment can occur.
Head, Neck and spinal injuries- No surprise here. Head and neck injuries on PWC’s are very, very common. While treatment of head, neck, and spinal injuries is very limited outside of a trauma center, stabilization can help. Anyone complaining of neck or back pain after a traumatic event should be kept on a flat surface, and as still as possible until the arrival of emergency responders. This is especially important in cases where the victim has tingling, loss of sensory function, decreased movement, or complete paralysis of the extremities associated with their injury. These symptoms suggest possible spinal cord injury. A cervical collar, if available, should be placed on these victims by trained personnel. If nobody is trained in spinal care, place these victims on a flat, hard surface and advise them not to move their neck or back. Symptoms of head injury include but are not limited to loss of consciousness, confusion, repetitive questioning, nausea or vomiting after striking head, difficulty speaking or slurring of speech, vision changes, and unequal pupils. While there isn’t much that can be done for these injuries while out on the water, quick transport to a trauma center is vital.
Anaphylaxis, hypoglycemia, and Asthma- Allergies. Another potential life threat. Knowledge of the allergies of riders in your group is essential information. It’s also very important for those affected by potential anaphylactic reactions to carry an epi-pen with them in their first aid kit. If Epinephrine is not available, Benedryl, while not near as effective as Epi in anaphylaxis, is available over the counter and should be kept in every first aid kit for these situations. Riders affected by Asthma should carry their Albuterol Inhaler. Keep in mind that Epinephrine and Albuterol are only available to persons that have a prescription for these medications and know how to use them. Diabetic persons should carry a glucometer with them and have someone in the group that knows how to use their equipment for cases of hypoglycemia in which they may not be able to use it on their own. Hypoglycemic diabetics may become incapacitated, may appear confused, or may become completely unresponsive. As with patients with allergies, diabetics should carry glucose tabs or oral glucose gel tubes with them. Anaphylactic shock, Asthma exacerbation, and hypoglycemia are also real-life threats that should be taken very seriously.
Communication
The last link in this chain of events when caring for the sick and injured is your means of communication. While most people rely on their cell phone to communicate, remember that not all areas have cellular service. Operators and especially leaders of the groups should always carry a VHF marine radio, satellite messenger, satellite phone, or a combination of these items. Personally, I carry my cell phone, VHF radio, and a Garmin InReach satellite GPS messenger at all times while on my PWC. Even in areas that I know have cell service. Satellite messengers or satellite phones give you the ability to not only send your exact coordinates to emergency responders, but also allow for 2-way communication from basically anywhere on earth that you can see the sky. This communication allows emergency responders to ready themselves for your specific rescue, and also ensure that all required equipment for your rescue or treatment are brought to the scene. In an emergency situation, having this available to you is vitally important.
If you’ve made it this far, I greatly appreciate your time and I hope that this article sheds some light on the importance of understanding some basic first aid.
Disclaimer – This article is for informational purposes only and is not a substitute for formal training or certification. Never perform medical tasks outside of your scope of practice or comfort zone. Some treatments may require authorization or orders from a physician while operating under a licensed EMS service. Know your local laws and protocols pertaining to medical care by bystanders. The author of this article cannot be held liable for any treatments performed or direction given to the audience. As stated, this article is for informational purposes only, not instructional. There is no substitute for formal training. Get out, get trained, get informed, and make a difference; because some day, you may be the difference between life and death for someone.
Brad King, NREMT-P, FP-C, Flight Paramedic
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