Recommendations to USCG from NTSB about medical training

The US National Transportation Safety Board (NTSB) has recommended to US Coast Guard that crews with emergency medical training should always be present on board rescue boats. The recommendation came after the death of a fisherman in 2015. In this instance the USCG was responding to a stricken ship rather than any medical emergency, and so, as per the regulations, no fully trained medical emergency member was considered necessary.

The NTSB said that the USCG should ensure that at least one crewmember on board each type of response boat is present who is adequately trained in the types of medical emergencies expected in a marine environment and qualified in the use of all first-aid and/or trauma equipment carried on board. It also recommended that the USCG develop a standard for the contents of first-aid and trauma kits for each type of Coast Guard response vessel.

Fishing vessel Orin C sank on December 3rd 2015 in about 300ft of water, about 13nm east of Cape Ann, Massachusetts. It had been disabled by an engine failure before being taken in tow by “Good Samaritan” fishing vessel Foxy Lady. While under tow, Orin C sustained damage from a large wave. A USCG motor lifeboat was dispatched to assist and took the Orin C in tow as the waves grew to eight to 10 feet and winds exceeded 30 knots. Dewatering efforts could not keep pace and Orin C had to be abandoned. Orin C’s three crewmembers entered the water.

Although two swam safely to the USCG lifeboat. Captain David Sutherland, 47, made three distinct swimming strokes before losing consciousness. A motor lifeboat crewmember entered the water with a lifeline, swimming to the captain. Both were pulled back to the motor lifeboat, but by this time Sutherland had no pulse. The lifeboat crew immediately began CPR, but no automated external defibrillator was available. Attempts to lower a rescue swimmer with an automated external defibrillator and emergency medical technician kit from a USCG helicopter were unsuccessful. It was determined there was too much risk to continue those attempts due to the sea conditions.

CPR continued for more than an hour until a Coast Guard flight surgeon recommended ceasing resuscitation efforts. It transpired that the captain had an enlarged heart with severe thickening of the left ventricle and some thickening of the right ventricle, as well as slight to moderate coronary artery disease. Both placed him at increased risk for an acute cardiac event such as a heart attack, arrhythmia, or sudden cardiac death. The strain of the prolonged exposure to the cold, wet environment; the shock of entering the water and the physical exertion of swimming, along with stress of losing his vessel, increased the likelihood that the captain suffered an acute event, said the NTSB, which added that it was unlikely that use of an automated external defibrillator would have saved Sutherland’s life.

Although the lifeboat had advanced emergency first-aid kit including an oxygen tank and associated equipment such as tubing and masks, none of the crew on board had the training to use much of the equipment in the kit.

USCG officials referred to the Coast Guard Emergency Medical Services Manual, which states that boat crews are supplemented with personnel with a higher level of medical training when responding to designated medical emergencies. At the time the motor lifeboat was dispatched to aid the Orin C, the mission was to assist a stricken fishing vessel; there were no reports of injuries or specific medical requests.