It is a stormy night and a fishing boat starts taking on water. The boat is violently rolling and its mechanic is seriously injured while trying to stem the flow when his arm smashes against the engine block. He has a compound fracture.
The boat is going to sink so the skipper makes a Mayday call. The Royal National Lifeboat Institution's (RNLI) local station team goes into action.
You are the lifeboat medical adviser and sound asleep when the phone rings at 1am. The coxswain has just reached the boathouse and needs your advice on the best way to handle the injured fisherman.
You stay in touch with the lifeboat by telephone and VHF radio throughout the rescue, continuing to advise the team.
Giving their time freely
The RNLI is a charity and most members of its lifeboat station teams are volunteers. This includes its doctors: lifeboat medical advisers (LMAs) are typically GPs giving their time to their community. There are also GPs who volunteer as lifeboat crew.
Dr Colin Wilson is divisional medical adviser for the RNLI in Scotland. Using Oban Lifeboat Station as an example, he says: 'Most of the calls for the LMA are about transporting sick people from the islands, sick people at sea and divers with decompression sickness'.
The type and incidence of disasters at sea varies with the area and its topography, so LMAs' and other volunteers' roles will be rather different at, for example, Weymouth on the south coast compared with Oban, he explains.
Dr Wilson reckons only 20 per cent of calls at Oban will require input from the LMA. 'The commitment isn't huge for LMAs in terms of emergencies, though they will be doing other things for the RNLI in their spare time.'
Cornwall GP Dr Dale Staff, LMA for the Looe Lifeboat, describes what he does in addition to emergency medical support: 'I give weekly refresher first aid training, annual medicals for the crew to ensure they're fit and advise on boathouse safety'.
The RNLI has 250 lifeboat stations around the UK and Ireland and most of its 300 LMAs are GPs. Some LMAs are lifeboat crew as well, though this is generally a separate role.
Also a crew member, Dr Staff says he only answers his pager outside working hours. 'I can't walk out mid-surgery to a shout (rescue call), although I will help as an LMA.'
'I grew up in Looe, and core to the community is its seafaring heritage. What better way to give something back than get involved with the lifeboat?'
He recalls that in Looe last December, a woman injured herself slipping on ice, and there was no easy way of getting an ambulance to her because of the bad weather. The lifeboat station got a stretcher to her and carried her up a steep road to a resident's home to warm up.
The search and rescue helicopter was despatched to pick her up and, when it arrived, Dr Staff accompanied the patient to hospital. 'Just because she wasn't at sea doesn't mean we couldn't get involved,' he says.
Although doctors volunteering as crew are often British Association for Immediate Care (BASICS) members, this is not compulsory as crew volunteers do the RNLI Search and Rescue first aid course. This uses a symptoms-based approach to ensure that non-medical volunteers can provide a high level of care to a wide range of casualties during rescues.
As with any voluntary job, the more volunteers can bring to the organisation the more use will be made of them, says Dr Wilson. 'All the doctors in Oban are BASICS trained so they can be more use to the lifeboat.'
However, he says doctors may have other skills and cites GP Dr Alex Rowe, a volunteer with the Torbay Lifeboat (see case study), who had A&E experience before becoming a GP. 'He worked in casualty at a hospital before so has extensive experience in stabilising and treating patients on the scene.'
- If you are interested in volunteering, visit www.rnli.org.uk
'I have raced in the Fastnet and am a sailing fanatic', Dr Rowe says. In a potential crew member, the RNLI wants someone with extensive waterborne experience and someone who will fit in a team environment.
Dr Rowe met these requirements.
He refused the post of LMA when it came up. Doctors and paramedics on board are a bonus but not a requirement as they cannot put their full medical skills to use on a boat rolling on heavy seas. Search and rescue medicine is about rapid assessment and extraction to healthcare facilties on shore.
Dr Rowe was given an RNLI bravery award for a rescue mission when the cargo ship Ice Prince sank in 2008. The ship was in six-metre-high seas and the lifeboat coxswain decided to pull the lifeboat alongside the stern, take off one member of the distressed vessel's crew, back off and then do it again.
As a much smaller vessel, the lifeboat was moving up and down more quickly than the ship, making this a dangerous manoeuvre. But the Torbay Lifeboat saved all the Ice Prince's crew this way.
'I went below with them on the way back to shore and gave them medical checks,' Dr Rowe says. 'It's a wonder no one was seriously injured in all that. I expected to do far more than what, thankfully, happened.'