Emergency operations and First aid on board

An emergency on board can occur at any time and in any situation. Effective action is only possible if pre-planned and practical procedures have been developed and are frequently exercised.

Organizational structure

When cargo is being transferred, the ship and shore become a combined operational unit and it is during this operation that the greatest overall risk arises. In this respect, the cargo connection is probably the most vulnerable area.

The objective of an emergency plan to cover cargo transfer operations should be to make maximum use of the resources of the ship, the terminal and local authority services. The plan should be directed at achieving the following aims:

• Rescuing and treating casualties;
• Safeguarding others;
• Minimising damage to property and the environment;
• Bringing the incident under control.

Alarms

Each gas ship and terminal should have fire-fighting plans and muster lists prominently displayed. These should be carefully read and understood by all personnel. As a general guide, when a liquid gas fire occurs, the correct procedure to adopt is as follows:

• Raise the alarm;
• Assess the fire’s source and extent, and if personnel are at risk;
• Implement the emergency plan;
• Stop the spread of the fire by isolating the source of fuel;
• Cool surfaces under radiation or flame impingement with water;
• Extinguish the fire with appropriate equipment or, if this is not possible or desirable, control the spread of the fire as above.

Raising the alarm and initial action

Fundamental to emergency procedures is how to report and how the alarm should be given to all concerned. These procedures should be developed independently for the terminal, the ship and the ship/shore system. Procedures should warn that a seemingly minor incident may quickly escalate to one of a more serious nature. Much is gained by immediately reporting any abnormal occurrence, thereby permitting early consideration of whether a general alarm is desirable.

In the case of incidents on a ship or on a jetty while a ship is alongside, the manpower and facilities immediately available on the ship will generally make it appropriate that the ship takes first autonomous action by initiating cargo transfer ESD by the agreed safe means, alerting the terminal to provide assistance as quickly as possible and immediately putting into action the ship’s own emergency procedure.

Emergency Procedures

Effective emergency response requires an emergency organisation round which detailed procedures may be developed. The international character of ocean shipping and its universally similar command structures lend themselves to the development of a standard approach in ship’s emergency planning. For gas carriers this broad uniformity can be extended further to the development of incident planning.

Such standartisation is of advantage since ship’s personnel generally do not continuously serve on the same ship. It is also of advantage in the handling of incidents in port in that terminal emergency planning can be more effective if there is knowledge of the procedures a ship is likely to follow. Outlined below is a suggested emergency organisational structure for gas carriers in port, which has received wide acceptance.

As shown, the basic structure consists of four elements:

1. Emergency Command Centre. In port the Emergency Command Centre should be established in the Cargo Control Room. It should be manned by the senior officer in control of the emergency, supported by another officer and a crewmember acting as a messenger. Communication should be maintained with the three other elements (see below) and with the terminal emergency control room by portable radio or telephone.
2. Emergency Party. The Emergency Party is a pre-designated group. It is the first team sent to the scene and reports to the Emergency Command Centre on the extent of the incident. The Party recommends the action to be taken and the assistance required. The Party is under the control of a senior officer and comprises officers and other suitable personnel trained to deal with rescue or fire-fighting.
3. Back-up Emergency Party. The Back-up Emergency Party stands by to assist the Emergency Party at the direction of the Emergency Command Centre. The Back-up Party should be led by an officer and comprises selected personnel.
4. Engineers Group. Some engineering personnel may form part of either emergency party. However, the Engineers Group is normally under the leadership of the chief engineer and has prime responsibility for dealing with an emergency in the main machinery spaces. Additionally, the Group provides emergency engineering assistance as directed by the Emergency Command Centre.

Incident plans

In developing plans for dealing with incidents, the following scenarios should be considered:

• Checks for missing or trapped personnel;
• Collision;
• Grounding;
• Water leakage into a hold or interbarrier space;
• Cargo containment leakage;
• Cargo connection rupture, pipeline fracture or cargo spillage;
• Lifting of a cargo system relief valve;
• Fire in non-cargo areas;
• Fire following leakage of cargo;
• Fire in a compressor or motor room.

Emergency shut-down (ESD) – ship/shore link

In any serious incident associated with cargo transfer, on shore or on ship, it is essential to shutdown cargo flow by stopping pumps and to close ESD valves. All gas carriers and all large terminals have a system for the rapid emergency shutdown of cargo transfer.

Where gas carriers and terminals are dedicated to each other, as in most LNG projects, terminal and ship ESD systems are linked during cargo transfer and act in combination. In general trading of other liquefied gases, the ship and shore ESD systems are not always linked and consideration must be given to avoiding escalation of an incident by creating disruptive surge pressures at the ship/shore cargo connection by the over-rapid closure of ESD valves against cargo flow. It is preferable that in loading a ship, the terminal ESD is actuated and completes its shutdown before the ship’s ESD valves close. Similarly, it is preferable during a ship discharge that the ship completes its ESD before the terminal’s ESD valves close.

It is a growing practice for loading terminals to present the ship with a pendant by means of which the ship may actuate the terminal’s ESD. Similarly, some receiving terminals encourage discharging ships to provide the jetty with a pendant by means of which the ship’s ESD may be actuated from the shore. In any case it is desirable that the maximum cargo flow rate be limited to that which will not cause excessive surge pressure should ESD valves downstream of the cargo connection be closed, at their known rate of closure, against the cargo flow. While the above procedures and pendant-controls may be suitable in some circumstances, they cannot always be relied upon, especially in an emergency when personnel may activate the system incorrectly.

To overcome this difficulty, it is recommended that ship and shore systems be fitted with a linked system. This must be engineered to ensure the appropriate procedure is followed, no matter which party initiates the shut-down.

First-Aid Treatment

In general

What is health? In short, it is when the physical is in balance with the non-physical, and the harmonisation here has a natural function. The result is good health. To maintain this, knowledge about harmonisation is the vital factor in health. Health is different for each one of us based on individual tendencies and external/internal influences that mark (or chooses to mark) our life.

All crewmembers that sign on a vessel should have been through a medical check in order to have a regular status of his/her health condition. Life at sea is a special place to work, it is important that the general health condition at all times is good. What can be done to maintain a good general health condition on board? The answer is built into the safety and protection of personnel on board.

You can also take care of one another in a good manor by being aware of the risks that may have direct and external effect on health, regarding the special cargoes carried onboard your vessel.

The body

The doctrine of how the body is built is called anatomy. The doctrine of the body’s function is called physiology. This will be roughly illustrated to achieve a synopsis of how the “machine” functions.

The cell

This is the smallest, independent unit of the body and the basis for all living organisms. All the processes in the body are caused by the chemical reactions that take place in the cells. Cells in different tissue and organisms co-operate in their duties. The cell has a water content of approximately 70 % in addition to proteins, carbohydrates, fat and inorganic material. All the cells have the same basic structure and a number of mutually basic qualities. Simultaneously each part of the cell has its function. We all utilise nutrients both to achieve energy and as “building stones”.

In new cell components, glucose (grape sugar) is the most important energy source. It is important to have nutrient rich and varying diet.

Tissue

Cells that look alike remain lying to form tissue. All surfaces of the body are covered with epithelial tissue (type of tissue that mainly covers all surfaces, the cavity and channels of the body). Connective tissue and support tissue forms the tissue network in the body and keeps tissue and organs together. There is an innumerable of tissues, for example osseous tissue, muscular tissue and nerve tissue. The cell co-operation is controlled by chemical signals. These signals consist of two types:

• nerve signals;
• hormone signals.

These two systems co-operate for an appropriate reaction. This is fully necessary for Questions and answers to Crew Evaluation System Test about Personal Survival and Survival Craftour survival. The hormone system controls the activity of many internal organs; the nerve system controls muscles and glands. Several organ systems co-operate to keep the composition of tissue fluid constant. The blood renews this tissue fluid. The blood must circulate the whole time. The duty of the lymph artery is to drain excess tissue fluid.

The respiratory organs

These absorb oxygen and partly carbon dioxide. Respiration is an exchange of gases between the blood arteries and the air in the lungs. The blood absorbs oxygen into the body’s cells and partly the excess carbon dioxide that arises. The respiratory organs consist of the bronchia and the lungs. Gas exchange between blood and air takes place in the lungs.

The skin

The skin forms an essential boundary to the surroundings, and is the body’s largest “breathing organ”. The skin consists of different tissue with different qualities and covers the body surface, like an almost impenetrable protective film. The skin is an important sensory organ with large adaptability.

The immune system

This system protects the body and consists of several parts. There is no possibility of living a normal life without this defence, as its duty is to render harmless infective agents or other strange material. In addition to combating infection from outside, this defence system also fights against any internal cell changes.

Thought, Action, Result, Feeling

Positive thoughts and attitudes together with a healthy diet form the basis for good health. We can do a lot ourselves by choosing the right things, as we are free to choose.

We now take a look at your work place, onboard a vessel, and the influence this has on your health. We will also discuss what external influences can be found in the atmosphere and the injuries/incidents that may occur on board.

Onboard different types of vessels carrying different types of cargo, danger to health from external influences are considered regarding the vessel’s protective equipment and routines. This protective equipment is placed practically and can be utilised, as necessary.

Familiarise yourself with the equipment onboard your vessel and use it!

With a sudden injury or illness on board, medical advice and guidance can be gathered from Radio Medico – the radio medical service for vessels at sea. It is important to have all the important information when help is needed for a serious condition onboard, such as:

• Age.
• Sex.
• Weight.
• Duration of the illness.
• Extent of the injury.
• Symptoms.
• Patient’s comments (complaints).
• Clinical findings (sign of a specific illness).
• How the injury happened.
• Character of the pain (grumbling, stabbing, squeezing).
• Whereabouts of the pain.
• Face colour, limpness, drowsiness, temperature, pulse, breathing trouble, nausea, blood, mucus, urination, etc.

All of the above is important. There is a “hospital” onboard containing ordered equipment for treatment and medication. The ship medical directions regarding the ship’s hospital deal with the maintenance, supply, inspection, etc. It is important to know how to protect oneself against harmful skin contact, skin absorption and respiratory absorption of dangerous gases in the atmosphere surrounding us, such as entering tanks and closed spaces.

Help given in the first minutes of an emergency situation is crucial. All must endeavour to have respectable first aid skills.

First aid

First aid is used with sudden unconsciousness, stopped breathing and lack of air. (Call for help, but do not abandon the patient, immediately start helping).

Air: Try to free the airflow, lie the patient on a flat surface, bend the head backwards, remove any dentures, vomit, etc.

Breathing: If the patient is not breathing, start resuscitation with 3-5 breaths/insufflations. Use the “Pocket Mask” as an option. Hold the head curved backward, check the pulse on the neck. If pulse is felt, continue with 12 respiration’s per minute.

Circulation: With deadly paleness and no pulse, give 2-3 powerful knocks over the heart. If this has no effect, start external heart compression once per second.

ABC

The method stands for air, breathing, and circulation. The priority of first-aid training and practice is of great importance. The better you are at first aid in an emergency; the chance of a good outcome is greater.

Heart problems

Heart problems can be suspected if sudden, strong pain behind the breastbone is experienced. For cardiac arrest, use the ABC.

Shock injuries

Description of shock is acute circular failure. This may be caused:

• by reduced blood volume from bleeding;
• shock by drop of blood pressure;
• or reduced pump functions from a cardiac infarction.

If a big incident occurs, shock must be calculated. The symptoms are:

• fast pulse;
• coldness;
• pain and difficulty in breathing.

Supply oxygen, warm blankets and fluids.

Head injuries

All knocks against the head must be taken seriously. The symptoms are headache, nausea and dizziness. Flat bed rest for 2-3 days. Limited fluid intake and be sure to supervise.

Poisoning and etch injuries

Refer to the IMO’s book “Medical First Aid and Guide for use in accidents involving dangerous goods”. This refers to the data sheets on the different cargo onboard. (This is illustrated later on in this part). Poisoning and etch injuries appear in connection with cargo contact, as air absorption, swallowing or skin absorption (skin contact).

The symptoms are:

• pink coloured skin;
• smell of almonds on the breath;
• headache;
• dizziness;
• nausea and vomiting.

Remember that in connection with cargo contact, the emergency squad should efficiently use protective equipment, gloves etc. Supply oxygen and follow the instructions on the data sheet for the cargo in question.

Fire injuries

In fire injuries, ensure a stabile lateral position for the patient, if possible. Supply oxygen and fluid. With fire injuries, quick help is double the help. Quickly cool for at least 20 minutes. Estimate the extent of the injury. The patient mustn’t freeze. Provide warm blankets and abundant fluid. The patient should rest, be under supervision, and have their pulse checked. Check the medical box for proper use of medication and bandages.

Frost injuries

Localised frost injuries on the skin’s top layer begins with a prickling feeling, then ascends to white spots on the skin. Careless handling of pipeline and cranes onboard vessels, which carry strongly cooled gases, can lead to localised frost injuries.

Important: Frozen hands and feet must not be warmed up actively with warm water.

Cover frozen skin parts with a soft woollen garment. Do not massage or rub. It helps a lot to warm up frozen skin with warm skin

Bone, joint & soft part injuries

A lot of injuries are sprains, fracture and soft part injuries. Use the ICE method, as the proper first aid, in such injuries. ICE means ice, compression and bandage, and elevation.

I – stands for ice. Ice the injury in order to lower the injured spot’s temperature. By doing so, the bleeding is reduced in the underlying tissue. Swelling and pain will also be reduced.

C – stands for compression bandage or compression. If cooling the injury is not sufficient, compression around the injured spot is recommended in order to counter the pressure from haemorrhage and reduce swelling and pain. Confer with the patient regarding the tightness of the bandage.

E – stands for elevation and rest. To decrease the blood pressure and reduce the seepage of blood on and around the injured place, raise an injured arm or foot to approximately heart height and rest for 1-2 days.

Intake of poison materials

Poisonous materials can be taken in by:

• inhaling (gas, dust);
• skin penetration;
• skin absorption (gas and liquid);
• swallowing (gas and fluid).

If any of this occurs, different reactions will occur depending on the kind of material, how much, etc. Refer to the material’s data sheet regarding treatment. Blood is most important, since it is the higher brain centre that is first affected from lack of oxygen.

A poisonous material emerges quickly to the brain cells and deprives them of oxygen. This may cause unconsciousness, at worst death. By inhaling small concentrations, we are exposed to localised effects (nasal, throat, and lung) or poisonous gas absorption into the blood.

Through skin penetration, gases and fluids are quickly absorbed into the blood and the effects depend on the characteristic of the material, the velocity of the penetration and poisonous elements. If material is swallowed, this is easily absorbed by the mucous membrane in the mouth.

The eyes

The eyes are very exposed to any spill or contact to cargo. There is normally irritation, burns and tears from harmful exposure. It is of utmost importance with a very fast first aid and abundant rinsing with water. With all injuries and illness it is of the utmost importance to administer first aid and contact competent medical help if any doubt of the outcome exists. Enclosed is a data sheet for Propane, which illustrates the layout and the content of information. There are such sheets for all types of dangerous cargo, which are made readily available and visible onboard.

The data sheets tell us about the cargo’s character, the emergency procedure for a cargo fire or cargo spill. There is also information about:

• health hazards;
• fire;
• explosion;
• chemical data;
• reaction data;
• physical data;
• and the condition of the material in freight.

Information regarding the quality of material is required with the freight of the material.