Volunteering with the RNLI

Devon GP Dr Jane Aitken and her husband, former GP Dr Peter Aitken, volunteer as lifeboat medical advisers with the RNLI in Exmouth.

Drs Peter and Jane Aitken: 'Working with RNLI is close knit and supportive experience'
Drs Peter and Jane Aitken: 'Working with RNLI is close knit and supportive experience'

How did you become involved with the RNLI?

JA: Our boat was wintering in the lifeboat mechanic's boatyard in Exmouth and adjacent to the outgoing lifeboat medical adviser's (LMA) boat. They discovered we were doctors and asked if we would be interested in taking on the LMA role.

We did a bit of homework on what was involved and met the crew. We took our time getting to know the station before accepting.

PA: I was a GP, but I am now a consultant in liaison psychiatry. I grew up with dinghies and boats in the west of Scotland and have always had a healthy respect for the sea.

What does the LMA role involve?

PA: There is an occupational health function, with crew medicals very much part of the LMA role. All crew are trained in the RNLI world-renowned 'Big Sick, Little Sick'

pre-hospital care system (see box). The LMA helps with refresher exercises at the station and on the water between training courses.

Some LMAs go to sea, for which they require to be crew competent and have had the right training.

JA: As I'm still the GP I do all the medicals. The surgery I work in is supportive and lets me use the facilities there. Crew members turn up early in the morning before my surgeries. Each medical takes about 20-25 minutes.

How much time does it involve?

PA: The amount we give is down to us. The LMA role, at a minimum, takes the time required to do the medicals for around 30 people every five years, annually for older crew, and attend a monthly meeting with the lifeboat station management team.

We find it's more rewarding to involve ourselves across the full range of station activities, with training launches once a week, fundraising and social events, and crew and community support after particularly challenging 'shouts'.

We carry a pager between us, so we can hear when the boats are being called out, and if we're nearby and free, we can make the 'shout'.

Our whole family is involved. Our children are welcome on the station and they help out at the fundraising events and learn about looking after the boats and all the kit.

Did you have to undertake extra training?

JA: To keep us safe at sea, we have both been trained in marine safety and survival and basic boat handling. These courses allow you to become crew competent. It helps you understand what the crew face and how challenging it is to save lives at sea.

To support the Big Sick, Little Sick system we have training in the system and how to create scenarios to test crew competence.

This is one of the most interesting parts of the role for me. The system ensures people are competent at dealing with quite complex triage situations. It makes you think about things in a totally different way - you have to look at things as if you weren't medically trained. The crew undertake the training every three years with refreshers in between.

Have you been involved in any dramatic rescues?

PA: Much of saving lives at sea thankfully involves finding the vessel in difficulty and rescuing a well person. On one occasion we were called because the coastguard reported someone about to jump from nearby cliffs. Amazingly they hit the only soft earth on the cliff face and were thrown into the sea, then thrown clear of the rocks by the first wave to hit them.

Once our inshore lifeboat crew had checked them for injury and classed them as 'little sick' I was able to conduct a fuller assessment of their mental health and make arrangements for their care once we were back at shore.

What is it you like about volunteering with the RNLI?

PA: It's a great culture. The courage and trust among the crew and their supporters means it's a close knit and supportive social experience.

The work is approached professionally and the training and supervision are second to none. It is easy to feel pride in the service and for the medical role there is the freedom from financial bureaucracy.

JA: You learn so much. The volunteers come from all walks of life and are people I would never have met otherwise. There's a family feel. You really become part of the community.

Would you recommend this role to other GPs?

PA: Absolutely. The LMA role is a privilege. It is well supported with good induction and online support. Training opportunities are fantastic.

The LMA population has an older demographic. The coast needs more LMAs who can go to sea and learn first hand what it means to crew and save lives at sea in all conditions, so younger LMAs would really help.

JA: What has been a male culture has many women in crew and support roles - the RNLI has around 400 female crew members. Women LMAs are bringing a new perspective to the work.

Big Sick, Little Sick

Paul Savage, the RNLI's clinical lead, developed the 'Big Sick, Little Sick' course to simplify the approach to casualty care.

The course takes a symptom-based approach. Crew members are trained to assess a patient and gather physiological markers to identify if someone is 'big sick' (a time-critical, life-threatening illness or injury), or 'little sick' (injury or condition is not immediately life-threatening). This helps crews make accurate evacuation decisions.

The crews have waterproof check-cards with algorithms to help them assess and treat a casualty, without the need for retaining significant theory knowledge.

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