Guest blog - Dr. John Martin

This month, we’re delighted to introduce Dr John Martin as our guest blogger. John’s specialty is neurology, but with a keen interest in sailing amongst other sports, he’s able to apply his specific knowledge to our salt-watery, pre-hospital environment very effectively! Over to Dr John…

In the Beginning

In 1995, I was asked by a local GP for an opinion on types of cervical collars for rugby players. Within a corneal reflex of time thereafter I found myself appointed as medical officer to the team. 


Next came a call to be pitchside with the national team, an association with Resuscitation and Emergency Management Onfield (REMO), providing training courses for the English FA, running immediate care courses for the University of Wales Institute Cardiff (UWIC) in Cardiff (across all sports) and for the medical teams of the professional and semi-professional teams in south Wales. It’s important to note that pre-hospital immediate care presents challenges that elevate pre-hospital care to a speciality of its own. 


I have just completed the Safety at Sea course with South West Maritime Academy and returned from my annual sail off the West Coast of Scotland.  I already have experience of stabilising a casualty whilst awaiting ambulance transfer, which is a matter of minutes usually. But it’s a bit of a different time scale at sea! I am very much looking forward to being on board and being part of the medical team.

What I have learnt over the years

It is said that the best battle plans go completely out of the window when the first bullet is fired and certainly I have seen the medical equivalent. 

Another area, apart from the pre-injury team organisation, is the necessity to ensure that the care and equipment are updated as the recognised standards change. In the training scenarios it is also good to remember that it might be the lead doctor that gets the injury!


Of course, all casualty treatment starts with ABC which is fine for an ‘in-house’ cardiac arrest. But let’s start with ‘S’ for Safety First. 

We need to consider whether the engineer has collapsed due to a build up of noxious gases that could harm us. Or is there a risk of other dangers such as falling debris, floor instability or electrical hazards? Then perhaps we also include haemorrhage control of any obvious heavy external haemorrhage and need to apply a clean dressing and pressure. 


There may be internal haemorrhage from an object that has penetrated (such as a piece of railing etc). Ensure that the piece is somehow secured so it cannot penetrate further (I’d suggest a gate clamp or whatever you have to hand) Don’t ever try to remove a penetrating object!

We would always assume that the unconscious trauma victim has a fractured cervical spine injury until proven otherwise. So now let’s add ‘with cervical spine immobilisation’ to our A for Airway. 


My immediate consideration, that parallels the mantra, is the fact that the unconscious patient is just about to vomit. If the airway is clear, move swiftly onto B for Breathing. If not, it’s worth remembering that any manoeuvres in the mouth may induce vomiting so be prepared on every level! Open the mouth and use a pen-torch to look inside. 


The pen-torch has a larger diameter than the suction tubing, so if the patient clenches their teeth during an epileptic seizure they won’t be biting the end off the suction tube (or your finger if you’ve left it in the wrong place!). Remember to only suck under direct vision and only to suck on the way out. This is also a chance to view the posterior pharyngeal wall (back of the throat). If it is swollen or bruised it may represent a high cervical injury such as an odontoid peg fracture. 


If there are dentures and or other prosthetics visible and they are firmly in place, leave them there. A naso-pharyngeal airway (NPA) is better tolerated than an oropharyngeal airway (OPA) and less likely to initiate a gag reflex (remember that risk of vomiting!). 


The consideration of a skull base fracture is a relative and not an absolute contra-indication. If the patient tolerates an oro-pharyngeal airway readily, then either they are in a deep coma or the airway is too small. If there is now manual in-line spinal immobilisation, how are we to manage vomiting? Suction may be possible, but are we prepared to do either a 4, 3, or 2 man log roll to avoid aspiration of gastric contents? Even a one man roll may be necessary. It’s not ideal but may be the only option to avoid aspiration in a confined space.


These scenarios must be rehearsed. 


Prompt spinal immobilisation will enable the spinal board to be fully tilted by one person kneeling at the side and rotating the board away from them should vomiting occur.  Training sessions that focus on the immediate management of the unconscious patient in a variety of awkward positions, will focus on a team approach as members are designated specific roles. 


This begins with time dedicated to familiarity with all equipment, where to find these pieces in the kit bag and how to assemble them. For instance, flat packed cervical collars can be a source of confusion to the novice.  The well-established spinal board can be used as a ‘sledge’ to slide the patient into a more accessible area. 


Remember to secure the chest straps first, followed by the pelvis, so that if vomiting starts early, the heaviest part is secure and the head can simply be held while the board is rotated. Position your tallest responder opposite the smallest and tallest next to smallest. It sounds complicated, but basically the tallest are diagonally opposite. 


The team should train in terms of recognising the optimum way to lift a spine board from the round and how to allocate members based on individual height. The patient should be removed from the spinal board as soon as practical (after ABCDE) and managed in a vacuum extraction immobilisation bag. This will not only prevent pressure sores but will also prevent hypothermia whilst awaiting transfer to definitive care.


So where are we now?

The airway is clear and we apply oxygen (but check if it is a safe environment to put on 100% oxygen?), preferably with the use of an oxygen saturation monitor (SpO2). Aim for lower than optimal saturation if the patient has COPD (where 88-92% is considered appropriate in a patient with COPD). Ensure a trauma mask has its rebreathing bag filled before application.


Moving down. Check the trachea is central. But here we have to check the collar again. Even relatively light pressure on the jugular veins can elevate the intracranial pressure - which is a bad thing. Certainly I have treated patients in whom the medical attendants have applied a collar that is a bit on the small side, with the collar subsequently acting as a ‘neck warmer’ rather than an immobiliser. The consequence is raised intracranial pressure. The mistake can arise when sizing a collar, as the collar immobilises the neck by anchoring on the chin superiorly (at the top) and the trapezius muscle inferiorly (at the bottom). So the collar size is measured accordingly. One common mistake is a measurement taken on from the angle of the mandible. The collar won’t fit and subsequently a collar that is much too small is applied in error simply because it was easier and looks effective. 

Moving on to the chest and full exposure. 


Look, feel, listen seems straightforward enough. However make sure you also look at the abdomen. If there is paradoxical breathing (on inspiration the abdomen goes out rather than in and the chest doesn’t expand), there may be a lower cervical spinal fracture. In this scenario, the patient has paralysis of every muscle below the fracture (including the intercostal muscles) except the innervation to the diaphragm, via the phrenic nerve, which originates above the fracture level (the cervical vertebrae numbers 3, 4 and 5). If there is a fracture above that level the patient will not be breathing at all. 


There will be signs of neurogenic shock. This can be seen on occasions when the sympathetic nerve fibres below the fracture are not working and the parasympathetic fibres are unopposed. This means the patient will be very warm below the level of the fracture but also the skin will be very dry. There will be a level of temperature contrast which can be felt on the chest wall. Below the level of fracture the skin will be hot and dry and above the level the skin will be much cooler and very sweaty (clammy). Sometimes an actual line of sweat can be seen circling the chest. There will be associated low blood pressure and bradycardia (slow heart rate). 


The patient is unconscious so you will not be able to discern spinal shock easily. Sucking penetrating wounds need a three-sided adhesive dressing and thoracic decompression (tube) may be required if a tension pneumothorax is suspected when you assess for hyper-resonance on percussion, diminished air entry and a possible deviated trachea. The chest examination is not over until the back is examined (looking for step fractures, penetrating wounds, etc) and this is where, when immobilising the patient initially on the spinal board, we leapt a step out of sequence and examined the back as we log rolled onto the spinal board. 


Then it’s back to the start and if there are no changes (A, B) we get onto C - circulation. 


If possible we would use a wide bore cannula, ideally more than one. There is significant emphasis on intraosseous delivery (drilling into the bone) rather than intravenous for initial fluid therapy and indeed there are some areas of the world where it is the first line of fluid replacement. Warm fluids are best and we ensure urinary output is measured (via a catheter) to assess organ perfusion - how well the blood, with its oxygen and glucose, is circulating to the organs. 


Splinting long bone fractures is part of haemorrhage control. There are lots of different splinting devices to re-align fractures and here again, familiarity from training sessions pays dividends. Practice makes perfect!


Fire is a serious ship hazard and as such burns victims may certainly need significant fluid volume replacement before the helicopter arrives. Tourniquets can be life savers but must be frequently revisited to ensure one problem has not been changed for another. Scalp lacerations are common and can be extensive with significant haemorrhage. But pressure bandages can be difficult to keep in place on heads. I’ve found that large sutures tied tightly are the best primary management to stop haemorrhage even over depressed fracture. If bone is missing, then put saline soaked gauze over the wound and suture around the skin edges if there is a partial avulsion (torn off skin) of the scalp.


When you are handing over to either another crew member or a medical professional, such as a helicopter crew, there are a number of acronyms that are useful and rather universal to aid completeness.


SBARD

Situation

Background

Assessment

Recommendations

Decisions


In other words you have assessed and treated the patient and are now conferring regarding the decisions made, ready for the next line of care.


SAMPLE

Signs and Symptoms

Allergies

Medications

Past Medical History

Last Eaten


Useful for a medical (rather than trauma) handover to cover other aspects that may be pertinent.


RSVP

Reason (Injury is usually the reason and this is basically the nature of it)

Story (History so far)

Vitals (BP etc)

Plans (extrication)


MIST

Mechanism

Injuries

Symptoms and Signs

Treatment(s)


Similar to SBARD. This is my personal preference really.


Note from the Red Square Medical team - we love this one too, and normally add AT at the beginning to make it ATMIST. So starting with the patients AGE and gender, then the TIME of the incident. 


We hope you’ve enjoyed this insight into John’s advice for treating onboard and what we’ve taken from it is the need for familiarity with kit, with the crew onboard, and to carry out regular drills to make sure everyone knows their role and how to work together in the best interest of the patient. 

The Recovery Position - an STCW refresh

by Rachel Smith • 18 December 2024
Welcome to our December blog, which is all about the recovery position and how to manage an unconscious casualty who is breathing normally. Unconsciousness is a medical emergency as the person is very vulnerable and may not be able to manage their own airway effectively. We also need to think about the cause of unconsciousness. Is it a simple fainting episode due to illness? Is it a massive hemorrhage causing hypovolemic shock? Or is it due to some kind of external factor or injury? This blog looks at how to manage an unconscious casualty. So, if we have a casualty who is unconscious, but who is breathing normally for themselves, and we’re not suspecting a serious injury, the recovery position is the best position to use while monitoring them. The recovery position keeps their airway open and makes sure that vomit or liquid won’t cause them to choke.

Revisiting our guest blogs

by Rachel Smith • 11 December 2024
All the guest blogs! When we started adding blogs to our website back in early 2021, we did a little feature on each of our instructors of the time. They’re quite a fascinating bunch and the series proved quite popular amongst our followers. In addition to our amazing instructors, we work with some utterly incredible human beings all over the world, and the idea of sharing their stories grew and developed into what eventually became a monthly guest blog. It’s been interesting to find out more about how medical care at sea or in remote locations features in their work, and to discover a few fun facts along the way. This month, we thought that it might be a fun idea to give you a chance to go back into the archives and review all the guest blogs over the last few years! Maybe even let us know which your favourite one is?

Cayman Maritime Report 2023

by Rachel Smith • 27 November 2024
We’ve taken a look at the 2023 Casualty Summary Report from the Maritime Authority of the Cayman Islands (MACI) to see what kind of incidents and trends their data shows us, even with relatively small data sets, and how this may be able to transfer to our own risk assessments and actual practice. You can find the report here: Cayman Maritime Report 2023 The first thing we noted was the authors note that the data is split out into incidents. This means that one incident may include a number of events. So a collision and any resulting injury is one incident, but is reported as two events, or more, if more than one person is injured. It made us wonder whether this method of reporting by an authority represents how incidents are reported onboard and whether it should be a consideration? Of course, for any set of statistics presented at the moment, we also have to consider the COVID-19 pandemic and the impact this has on trends including that period. While essential shipping continued, the cruise and superyacht sectors reduced activity and staffing, often to a skeleton crew while anchored somewhere. So this will be reflected in the historic data sets that we analyse from 2019 to 2021 and may not accurately reflect increases and decreases during and since then. In some situations, we may need to look further back for accurate data. We also need to consider whether increases in incidents and events is also down to increased reporting - suggesting an improvement in the awareness of reporting requirements and greater engagement from the industry and individual sectors - this can only be a good development. Since 2020, the type of injury has been recorded in 8 different categories, with hand and foot injuries topping the leaderboard, closely followed by head, body, and back injuries. So if you were looking to run drills, or practise medical skills, these would be the key areas to cover. Only one death was an occupational accident, and is being investigated here: MAIB Investigations (search for case #9229607). It relates to a fall down a ventilation shaft on a bulk carrier in a Greek shipyard. The full report was still pending at the time of writing. Merchant ships are heavily regulated by a number of authorities, and the requirements for personal protective equipment and safe systems of work are enforced and applied to reduce accidents and incidents onboard. This has led to a lower reporting of incidents than in the commercial yacht sector. Could there be room for improvement here in this area? We certainly think so. Many of the hand and foot injuries reported can be career ending or life changing, but are preventable. Follow up has shown that there is a link here with injuries being sustained when inappropriate or no PPE was used. The supply and use of appropriate PPE is mandatory on vessels subject to the MLC and it’s worth remembering that some PPE can be produced in styles and designs compatible with the aesthetics of a yacht if required! On a much wider scale, a lack of transparency and standardisation globally can affect the collection of data and the issue of under reporting. While the MACI figures may be accurate, we need other accurate figures to compare them to, in order to build a bigger picture across the world as we have in aviation. From December 2024, the Maritime Labour Convention (MLC) will be enforcing an amendment so that seafarer deaths will be recorded and reported annually. The MACI and Cayman Islands Shipping Registry produces a number of safety flyers that are publicly available HERE that may be useful. In summary, analysing data can sometimes result in more questions than answers. But even this can lead to interesting and important developments that result in improved safety and reduced incidents and accidents onboard. Key points to take from this report are: Use the correct PPE for the task. Employ approved systems of work and risk assessments for the task. Reporting is key for safety in the future of our industry. Enjoy a night ashore, but don’t over do the cocktails! As always, if you’d like any input on medical training onboard or ashore, or drills that you can run yourselves, please just get in touch. References: https://www.lloydslist.com/LL1145359/Increase-in-incidents-of-deaths-at-sea

James Griffiths - Guest Blog

by Rachel Smith • 6 November 2024
Welcome to our latest guest blog where we’ve been chatting to James Griffiths, General Manager of Ocean Operations for Scenic Group and finding out more about what happens behind the scenes in order to keep a fleet of luxury expedition ships running. Here’s what James told us… As General Manager of Ocean Operations, I’m responsible for the operations of our fleet which includes four ships in service with around 850 colleagues. I currently live in Mumbles, near Swansea in the UK, but due to the nature of my work I spend a significant amount of time living in Croatia. Prior to this role, I spent many years working at sea and worked up through the ranks to Captain and over the last 15 years, my main focus has been on polar expedition travel. I hold a master mariner certificate of competency in addition to a degree in engineering and a post graduate diploma in law. Part of my job is to work with our medical service provider (Red Square Medical) to ensure that our ships are offering medical services that are appropriate for their deployment, and this can often be to some of the most extreme and remote locations around the world. It’s extremely varied, though during the COVID-19 pandemic, I came ashore when our operations paused for a significant period of time. I was fortunate enough to be given the opportunity to lead the restart of our Ocean Operations, which included setting up everything from a company to manage the ships, to selecting our crewing, medical, helicopter and submarine partners and providers, amongst many other things. Our areas of operation, and the nature of our cruises (expedition), plus having aircraft and submersibles onboard some, do mean additional elements involved in the management of these ships. You could say that this current position is more of a happy coincidence than one that I actually planned for! In some ways this is a great positive - I do think it’s possible to plan a little too much and then be disappointed if things don’t go quite the way you had imagined. But there’s no danger of that here!

Paramedic on tour - Simon Lawton heads to Mexico

by Rachel Smith • 3 October 2024
Back in February 2022, we brought you one of our very first guest blogs from Simon Lawton, a Paramedic who has swapped out his ambulance for a Superyacht! You can read the original blog here: https://www.redsquaremedical.com/superyacht-paramedic-a-guest-blog-from-simon-lawton Over the last 2+ years, we’ve followed Simon’s career, and some of you may even recognise him as he does put a Red Square Medical instructor hat on from time to time. But, as for all healthcare professionals, Simon has to keep his skills up to date. So, we asked him to tell us a bit more about how he juggles this along with a rota onboard. Here’s what he told us… I’m originally from Stoke-on-Trent in the UK and trained as a HCPC registered Paramedic. I’ve spent almost 5 years working at sea now, with almost continuous employment on three different vessels, after leaving the ambulance service in 2019. My first role was as a Paramedic/Deck hand on Superyachts, and I now work as a Medical Officer on a maritime vessel. Even before I applied to become a Paramedic, I intended to complete my studies to help find employment in a remote or offshore environment. I had always been attracted to the idea of being able to travel the world while earning a salary. Working at sea has meant that I have travelled extensively, earnt a higher salary, and have a better work/rest balance than would be possible in a role on land. Note: At the time of writing, a qualified Paramedic’s starting pay in the UK was £28,407 and Simon’s old rota was 2 days, 2 nights (all 12 hours) and 4 days off with very inflexible annual leave. This year I decided to carry out some continual professional development (CPD) at a hospital in Mexico, to keep my skills up to date. I was interested in travelling to find out more about how healthcare services are provided outside the UK and Europe. The CPD activity in Mexico allowed me to do exactly that, while caring for and treating a wide variety of patients who had either self-presented in the emergency department, or been conveyed to hospital by ambulance.

Inequalities in CPR on Women

by Rachel Smith • 25 September 2024
Welcome to our September blog, and as we all start (in the UK at least!) to think about adding a few layers for warmth, we’d like to talk about getting naked! Well, to be more specific, getting bra’s off. Fact: Women are dying because bystanders are less likely to carry out CPR on women than men. Research shows that women are 27% less likely to receive CPR than men and if a defibrillator is used, their chance of survival is affected by bra’s being left on. Most of us have never had the chance to train using a female manikin. The #BraOffDefibOn campaign aims to address the inequality in CPR for women and we’re supporting it.

Dr. Will Duffin - Joint Medical Director WEM

by Rachel Smith • 4 September 2024
In August, we brought you a Guest Blog from Mark Hannaford, the founder of World Extreme Medicine. This month, it’s the turn of another of the key WEM faculty members… introducing Dr Will Duffin. Hello everyone, I’m Dr Will Duffin and I’m a GP in Devon in the UK. I’m the Joint Medical Director of World Extreme Medicine (WEM) and the Lead Medic for the US CBS TV show ‘Survivor’ - for Seasons 43, 44, 46 and 48, which is also through WEM. Extreme Medicine is healthcare that is delivered across the full spectrum of remote, austere and challenging environments. This includes high mountains, deep oceans, jungles, deserts, polar, low earth orbit and refugee camps… the list is endless. Being a part of the wider Extreme Medicine community through WEM has been a portal into new worlds of possibility and opportunity in my medical career as an NHS GP. It’s a huge privilege to treat patients in a remote setting. You get to do proper ‘hands on’ medicine that truly tests your clinical skills, risk management and decision making. Even basic techniques and principles done well can transform patient outcomes. That’s the big reward. I graduated from Bristol Medical School in 2008 and completed my GP Training in Cornwall, UK in 2016. In between, I spent 18 months in Australia to gain as much emergency department experience as I could, whilst doing Wilderness Medicine Courses. I landed my first expedition gig 12 years ago when I was post-FY2 (Foundation Years follow on after qualifying as a doctor). I covered a Kilimanjaro Trek after another doctor dropped out at the last minute. Once I had this under my belt, I was able to leverage this experience to get the next trip. So, I soon found myself providing regular medical cover for various commercial and charity sector expeditions. These expeditions have taken me all over the world: Kilimanjaro, the Peruvian Andes, the Himalayas, Northern China, Eastern Europe, Myanmar and Madagascar. One highlight was working as the private doctor for a Luxury Trans-Siberian Train! Though I became frustrated having to constantly wrangle annual leave to go away, so I made the switch to being a freelance (locum) GP, which has given me the flexibility I need. I joined WEM in 2018 after responding to a Facebook Ad for the ‘Survivor’ job. I was invited to a selection weekend in the Peak District, which is when I first met Mark Hannaford WEM founder and CEO and Dr Joe Rowles, WEM’s other Medical Director, and it all went on from there. Early on, I was given the opportunity to lead on the content for the annual World Extreme Medicine Conference and our various podcasts and webinars. Through doing this, I have met a colourful cast of characters; other extreme medics who are as audacious as they are inspirational! We have a lot of fun at the conference every year, learning from one another. https://worldextrememedicine.com/registration/wem-conference-2024 (Note from the RSM team – the conference is highly recommended and well worth a visit!)

Mark Hannaford - Founder and CEO of World Extreme Medicine

by Rachel Smith • 5 August 2024
Last year, the Red Square Medical team descended on the World Extreme Medicine (WEM) conference for the very first time. We’d been aware of this unique organisation for many years, but just not had the chance to get involved. Liz was involved in a panel discussion and spoke at the conference, and we came away literally buzzing with enthusiasm - our first impressions were that WEM is a place with no ego’s, where everyone wants to learn, and is willing to share. We met some of the most fascinating people ever and can’t wait to go back this year. But what about the person who started it all… We spoke to Mark Hannaford, founder of World Extreme Medicine and its far reaching impact. Here’s what he had to say. I’ve been involved in expeditions, working in low resource environments and extreme medicine for the past three decades! My family was made up of generations of seafarers from Cornwall although I was brought up variously in Devon, Antigua in the Caribbean and the Middle East; reflecting my father’s job as a Master Mariner. My father was at one time the youngest captain aboard the UK’s largest registered vessel, and my grandfather was Harbour Master for Malta and the first in that role in Plymouth at the start of Queen Elizabeth’s reign. I wear a number of hats but primarily I am the founder and CEO of World Extreme Medicine, and the annual WEM Conference. I also founded the MSc in Extreme Medicine at the University of Exeter and Graduate Certificate program at Bouvré College of Health Sciences, Northeastern University, Boston.

Women's Health

by Rachel Smith • 3 July 2024
Women’s health is a huge topic, while it’s true that in the maritime sector women make up just 2% of seafarers at sea, up to 34% of the shore based staff are female. Looking at the bigger picture, women’s health directly affects just under half of our population globally, and indirectly (whether you like it or not!) the other half, we thought it was worth a blog about some of the issues, and the taboo’s, that could be affecting our maritime workforce and the women in our lives. It's common knowledge that women experience huge hormonal changes at puberty and menopause, both of which can have significant physical and mental health impacts. In the UK, there is a growing discussion and openness about peri-menopause (the years before periods stop altogether) and how for some women, this has devastating effects across all aspects of their lives, including work. Of course men experience changes at puberty, but their later life changes are less significant and generally don’t affect their ability to work. In December 2023 the World Health Organisation (WHO) issued a statement to advise that every year, at least 40 million women are likely to experience a long term health problem caused by childbirth. So there’s a good chance that we all know one or more women affected, or if you are female… this could be you. As part of a special series on maternal health, the study showed a high burden of postnatal conditions that persist in the months and years after giving birth. These issues include more than a third of women experiencing pain during intercourse, urinary incontinence (8-31%), anal incontinence (19%), anxiety (9-24%), depression (11-17%), perineal pain (11%), a fear of childbirth (6-15%) and secondary infertility (11%). All in all it doesn’t paint a great picture of life after childbirth for some women. If any of your workers experience these issues, either on or off shore, it could have a significant impact on areas of their working life and it’s something they may be reluctant to open up about. Even before childbirth, we may take it for granted that contraception is available, certainly in the developed world. But in developing countries where sexual violence is not uncommon, contraception is considered lifesaving due to the high level of unsafe abortions carried out. Around 13 million women (and girls) under 20 give birth annually and complications in the pregnancy and birth is a leading cause of death. Consequently abortion is an option, but this carries its own huge risks.

Guest Blog - Wendy Sullivan

by Rachel Smith • 25 June 2024
We just love speaking to and finding out more about the people who inspire us and we guarantee that this month’s blog will not disappoint! We first got in touch with Wendy Sullivan via LinkedIn and thought she seemed like a pretty awesome human. Wendy and her company, Maritime Medical Solutions in Australia, certainly share the same outlook as Red Square Medical. Fast forward a couple of years and we’re now collaborating on a project in Australia and the Pacific Islands. What we’ve learnt along the way is simply fascinating and Wendy has kindly agreed to share her story with us… Here is Wendy’s Guest Blog: I was born in Canada, grew up in Africa and now call Australia my home. I feel lucky to live in paradise where the weather allows us to be on the water year-round. I had to work hard to gain my Australian citizenship and I credit my work in the marine industry with giving me a pathway to stay in Australia permanently. It took years of hard work and uncertainty to gain my residency and is still one of the achievements I am most proud of. I started sailing in Canada and since emigrating to Australia gained my professional and commercial qualifications as a vessel master, marine engine driver, trainer and assessor. I also have a Diploma of Paramedical Science, ship masters medical qualifications, business administration and development and there is still so much more to come.
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