Management of a polytrauma in the maritime environment
Abstract
Background: A polytraumatised person is a severely injured patient with an association of several injuries
including at least one life-threatening. In an isolated and hostile environment like the maritime
environment, the principles of early care and fast evacuation of a polytraumatised person are sometimes
difficult to apply.
Clinical case: We report the story of a patient with a bilateral fracture of the lower extremities following an
accident on board a Moldavian tugboat off the coasts of Djibouti. He received a medical treatment thanks
to the intervention of a French military frigate after receiving a message of assistance by very high frequency,
and then a helicopter evacuation to the Medicine and Surgery “Bouffard” Hospital. The pre-hospital
care of a polytraumatised patients with limb injuries and the specificities of an intervention in a maritime
environment are described. The maritime international conventions relating to rescue at sea as well as
the specificities of the management of an injured person on a ship sailing under the Moldavian flag are
explained. Emphasis is placed on the importance of watchkeeping at sea and the presence on board of
trained first-aid personnel. Finally, a point is made on the French organisation of health support for ships,
through the Maritime Medical Consultation Centre and the Regional Operational Centres for Surveillance
and Rescue.
Conclusions: This case illustrates that the solidarity of the seafarers allows a seriously wounded person to
maintain, despite a degraded and isolated situation, the chances of successful management and preserve
the functional prognosis.
Keywords: polytraumamaritime conventionsSearch and Rescue
References
- Kroupa J. Definition of « polytrauma » and « polytraumatism »]. Acta Chir Orthop Traumatol Cech. 1990; 57(4): 347–360.
- Stahel P, Heyde C, Ertel W. Current Concepts of Polytrauma Management. Eur J Trauma. 2005; 31(3): 200–211.
- Maritime Transportation Research Board, Commission on Sociotechnical Systems, National Research Council. 1979.
- Napoleone P. Accidents on board merchant ships. Suggestions based on Centro Internazionale Radio Medico (CIRM) experience. Int Marit Health. 2016; 67(1): 21–23.
- Department of Economic Development. Medical care onboard ship and ashore. Maritime Labour Notice.
- Admiralty and Maritime Law Guide, International Conventions. Convention for the Unification of Certain Rules of Law with respect to Collisions between Vessels. 1910.
- International conference on safety of life at sea. Text of the convention for the safety of life at sea. London, 1914.
- Armateurs de France. La convention de Montego Bay en 50 leçons.
- International Convention on Maritime Search and Rescue (SAR). avr 27. 1979.
- International Maritime Organization. Medical Assistance at Sea. MSC/Circ. 960 juin, 2000.
- International Maritime Organization. Adoption of amendments to the international aeronautical and maritime search and rescue (IAMSAR) manual. MSC.1/Circ. 1289 déc, 2008.
- Maritime code of the Republic of Moldova. sept 30. 1999.
- Lee C, Porter KM. Prehospital management of lower limb fractures. Emerg Med J. 2005; 22(9): 660–663.
- Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004(1): CD003764.
